Proceedings of a Workshop—in Brief

Public Health Research and Surveillance Priorities from the East Palestine Train Derailment

Proceedings of a Workshop—in Brief

On November 6–7, 2023, the National Academies of Sciences, Engineering, and Medicine hosted a 2-day virtual public workshop¹ on health research and surveillance priorities related to the East Palestine, Ohio, train derailment and hazardous material release that occurred on February 3, 2023.² The workshop was intended to explore potential human health impacts and lessons learned from the incident, focusing on research questions specific to affected communities in East Palestine and surrounding areas of Ohio and Pennsylvania. Kristen Malecki, a professor and the division director of Environmental and Occupational Health Sciences at the University of Illinois Chicago, opened the workshop emphasizing the development of a research agenda responsive to community questions and concerns across hazards, exposures, risks, and health impacts to inform strategies for protecting residents now and in the future.

Richard Woychik, the director of the National Institute of Environmental Health Sciences (NIEHS) and the National Toxicology Program, urged participants to actively discuss strategies such as characterizing exposures, determining appropriate health surveillance, examining acute and long-term health effects, and applying insights from prior transportation disasters to aid East Palestine. Discussions centered on perspectives on the impact of the incident, hazardous material exposures and risks, risk characterization and communication, and challenges in and strategies for addressing and monitoring long-term community health impacts. Dr. Woychik also urged for the development of very specific actions for all involved parties to take and address the challenges faced by the East Palestine community.

IMPACT OF THE EAST PALESTINE TRAIN DERAILMENT

This section covers the physical, emotional, and social impacts described by community members and local responders and providers after the derailment. It highlights the acute health symptoms, mental trauma, loss of trust, financial hardships, gaps in disaster preparedness, mental health care access, and uncertainties concerning long-term health risks reported in the community.

Community Member Perspectives

Panelists representing community perspectives described the physical, emotional, and social tolls that

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the derailment and response took on East Palestine residents in both the short and long term. Numerous acute symptoms such as rashes, headaches, and nausea were reported, which Christa Graves, a resident of Columbiana County, and Jess Conard, the Appalachia director of Beyond Plastics, associated with chemical exposures. Zsuzsa Gyenes, also a resident of Columbiana County, expressed concerns about potential long-term effects such as cancers, hormone disruption, and respiratory impacts as well as anxiety over health problems manifesting years later with limited testing and monitoring available. Gyenes expressed that the evacuation process was chaotic and poorly communicated, which led to prolonged displacement and financial strain for some families that are still unable to return home months later. Conard and Gyenes described additional mental health effects including trauma, a loss of trust, and feelings of abandonment by failing systems meant to protect them. Similarly, Conard also explained that anger and sadness emerged over divisions within the community and cited the bullying experienced by vocal residents. She also noted exhaustion and burnout from having to fight for answers and resources. However, perspectives differed on how widespread health issues are in the community. For example, Bill Sutherin, the director of the United Methodist Committee on Relief, stated that among people he spoke with, either downtown or in church settings, most have not reported problems related to the incident though he acknowledged that some community members have experienced anxiety related to the event.

In terms of information needs, Gyenes and Graves expressed frustration with the lack of transparency and access to data from officials. With no single clear source of information, many did their own extensive research to understand risks, reaching out to varied experts, agencies, and affected communities from prior disasters, according to Conard, Gyenes, and Graves. However, this often yielded contradictory information and no definitive answers, Gyenes said. Gyenes, Graves, and Conard further stated that distrust was highest toward Norfolk Southern, the Environmental Protection Agency (EPA), and local leaders accused of downplaying risks. Adding to Gyenes’s and Graves’s sentiments about information availability and quality, Sutherin said that the released monitoring data could have been better, with “more down-to-earth explanation as the months passed about the data instead of such a high technical point of view.” Conrad and Gyenes called for centralized resources, continued monitoring, and accountability for those deemed responsible.

Responder and Provider Perspectives

Panelists representing responders and providers involved with the incident shared their perspectives on patient impacts, training and education, ongoing research, and concerns about potential long-term health effects. Mental health professionals Kristen Barefield, a family therapist at Metta Wellness, and Marcy Patton, the executive director of the Columbiana County Mental Health and Recovery Services Board, reported that the derailment took a major emotional and psychological toll on many East Palestine residents, both immediately and in the long term. Barefield observed increased anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms in existing clients as well as in new clients coming for help after the event at her private practice office. Patton explained that the evacuation was extremely traumatic, with ongoing stress for those still displaced months later. Both noted gaps in mental health services and available research on the long-term psychological health impacts of similar environmental disasters.

According to Gretchen Nickell, the chief medical officer at the East Liverpool City Hospital and the medical director for the Columbiana County Health District, many patients reported acute physical symptoms such as rashes; irritation of the eyes, ears, nose, and throat; respiratory symptoms; and nausea, which improved when leaving the contaminated area, even temporarily. However, she said, gaps in research on the specific chemical exposures from the derailment make it impossible to definitively link symptoms to the event. Nickell said that long-term health screenings are available at the new clinic in East Palestine, but uncertainty remains concerning access to additional specialty care if health effects emerge over the long term.

Providers also acknowledged gaps in disaster preparedness and training. George Garrow, the chief

executive officer of Primary Health Network, and Barefield, said that clinicians lacked training on responding to environmental disasters and exposures. Garrow said that environmental exposures and toxicology are not well covered in standard medical education. Barefield and Patton also noted limits on the sorts of research on mental health impacts that was needed to properly inform the response. Garrow emphasized the need to continue learning to better monitor patient health in the long term in order to address the uncertainty that Nickell described.

While providers came together collaboratively to support the community in the immediate aftermath, Patton and Nickell shared concerns about the dearth of the sorts of training, research, and resources needed to adequately monitor potential long-term health effects. Continued education, surveillance, specialty care access, and mental health support will be crucial in caring for affected residents in the months and years ahead, Nickell said. The desire for long-term tracking of potential health effects was also emphasized by all panelists.

HAZARDS, EXPOSURES, AND RISKS

This section summarizes individual presentations and discussions that cover findings from environmental and health assessments conducted after the derailment by government agencies and academic researchers. Speakers highlighted air, water, and soil sampling results as well as reported acute health symptoms and discusses remaining uncertainties about long-term impacts.

Environmental Monitoring and Exposure Science

In presentations, speakers highlighted extensive environmental sampling conducted in East Palestine across air, water, and soil, while also acknowledging that key data gaps remain regarding long-term monitoring, health impacts, risk communication, and chemical mixture exposures that require further research and analysis.

Mark Durno, the response coordinator for EPA’s Region V, reported that extensive air monitoring and sampling was conducted after the East Palestine train derailment using stationary monitors, mobile labs, and volatile organic compound (VOC) analysis methods, with more than 115 million measurements collected. However, he acknowledged limitations in the ability of indoor screening techniques to detect certain chemicals such as butyl acrylate at low levels. Specifically, he said that a study found that the detectors could not reliably detect butyl acrylate below certain low concentration thresholds that are relevant for evaluating community health impacts. Adding to this, Albert Presto, a research professor in mechanical engineering at Carnegie Mellon University, discussed his team’s use of using advanced mobile sampling and proton transfer reaction–mass spectrometry (PTR-MS) instrumentation to map concentration gradients and identify potential exposure hotspots. But Presto cautioned that this provided only short-term data; continuous monitoring was required to identify long-term concentration trends. Both Durno and Presto cited gaps in rapidly communicating complex datasets to the public in readily understandable formats and contexts. Advanced technologies such as PTR-MS allow rapid, specific chemical measurements but require significant dedicated resources, Presto explained. Durno noted that EPA trace atmospheric gas analyzer units are often unavailable for emergencies and advocated integrating emerging technologies such as PTR-MS with conventional monitoring to take advantage of the strengths of both approaches.

Transitioning the discussion to indoor air monitoring, Durno detailed EPA’s vapor intrusion assessment process using the contaminant source pathway. He reported that hydrogen chloride and vinyl chloride sampling was done in around 100 East Palestine homes, with no detections. However, Presto cautioned that commercial canister tests often provide limited context on the origins of detected compounds. For example, photoionization detectors indicate general VOC levels but cannot pinpoint specific sources. Expanding on Durno’s and Presto’s remarks, Andrew Whelton, a professor of civil engineering and environmental and ecological engineering at Purdue University, said that in addition to regulatory sampling, his research team conducted field investigations to assess contamination distributions across sites, including homes, businesses, soil, and consumer products. He reported finding heavy, heterogeneous contamination

slugging through area creeks weeks after the derailment, which differed from some official water sampling results. He also said that 2-butoxyethanol was not screened for initially, and other VOCs were still present at concerning levels in buildings months after the derailment, indicating potential vapor intrusion risks from contaminated creek water flowing beside and underneath buildings that require further examination.

For future incidents, Presto and Durno suggested rapid deployment of advanced instrumentation and measuring as many compounds as possible at high time resolution. Durno emphasized collecting early samples to identify key contaminants and advised carrying out proper planning and quality assurance for defensible, meaningful data. Durno and Presto both encouraged quick multi-faceted air sampling and monitoring using conventional and emerging technologies, and they said there had been gaps in the effort to rapid communicating complex datasets to the public in readily understandable formats and contexts. Durno further highlighted the value of partnering EPA data with university and community efforts. Concluding the discussion, Whelton urged data transparency and collaboration so that affected residents can benefit from monitoring efforts.

Human Health Impacts

Panelists from government agencies, medical centers, and academic institutions presented findings from health surveys and exposure assessments conducted in the aftermath of the East Palestine train derailment, providing insights into acute symptoms while discussing uncertainties concerning potential long-term impacts.

Motria Caudill, the regional director of the Region V Office with the Agency for Toxic Substances and Disease Registry (ATSDR), said that ATSDR conducted community and first responder health surveys in March 2023, within weeks of the February derailment incident. According to Caudill, the community survey found symptoms like nose, throat, and eye irritation were most commonly reported, along with headaches and mental health effects. Caudill added that these acute symptoms were consistent with known irritant exposures and were expected to resolve after the incident. The first responder survey showed high rates of similar acute symptoms, she said, and found that as many as 70–90 percent of responders in commonly reported jobs were not wearing protective masks or respirators during initial incident response.

Adding to this, Nicholas Newman, the director of the Environmental Health and Lead Clinic at Cincinnati Children’s Hospital, said that poison control centers (PCCs) received more than 200 exposure-related calls regarding East Palestine, mostly about respiratory, neurological, and gastrointestinal symptoms. He advised regular check-ups to monitor potential long-term effects, eliminate ongoing exposures, and manage current symptoms. Realizing the need for more information, Newman assisted in developing chemical fact sheets for PCC staff. While they found them useful, he said, staff members saw a need for expanded clinical guidance with updated research on management decisions, diagnosis, and treatment recommendations for physicians dealing with potential exposures, particularly for children and pregnant women.

Erin Haynes, the chair of the Department of Epidemiology and Environmental Health at the University of Kentucky, presented preliminary data from a community health tracking survey that showed high rates of respiratory, neurological, dermal, and gastrointestinal symptoms as well as indicators of stress and PTSD attributed to the derailment. Haynes discussed efforts to assess chemical exposures through blood, urine, and wristband samples. She emphasized working closely with community members for meaningful participatory research.

Similarly, Lauryn Spearing, an assistant professor in civil, materials, and environmental engineering at the University of Illinois Chicago, shared findings from a community survey examining impacts and experiences after the East Palestine train derailment. Key findings included the evacuation or relocation of many residents, odors noticed in homes, and increased bottled water use due to drinking water concerns. Despite environmental sampling efforts, she said, most community respondents that received results found the results unclear or

untrustworthy. Residents felt that recovery resources and decision-making processes lacked transparency and equity. Many also reported not receiving clear guidance or information on long-term health consequences. Spearing highlighted the needs for improved communication, building trust in agencies, transparency, equitable resource allocation, and long-term monitoring to protect community health.

Regarding the acute health effects such as irritant symptoms and mental health impacts that were reported in community and first responder surveys, Caudill said that, based on current knowledge, these acute effects are expected to resolve over time. However, Caudill, Haynes, and Newman acknowledged substantial uncertainty regarding potential long-term health impacts that may emerge months or years later, requiring continued monitoring and research. To respond to community members’ interest in measuring biomarkers of exposure, Haynes highlighted her efforts to collect biological samples for analysis and engage members of the community in the development of data and report-back materials. Caudill said that ATSDR did not do any environmental sampling or biological sampling for exposure measures because there were no known reliable tests for the chemicals of concern. Given the uncertainties about future impacts, several panel members emphasized the need for continued health monitoring and research of exposed populations. Recommendations from Newman and Caudill to improve future response included enhancing coordination across health agencies and establishing standardized communication procedures in advance of disasters. Caudill further commented that ATSDR is working to streamline communications and engage PCCs earlier in a disaster response. Newman and Caudill also cited the need for concise clinical guidance documents and rapid distribution mechanisms to inform health care providers about chemicals and other exposures of concern related to the disaster.

Finally, Haynes and Newman emphasized that collaborating closely with community members and organizations can help build trust and help develop effective communication strategies and messages including when communicating complex technical results bearing on risks and recommendations for communities. Spearing also emphasized the importance of improving risk communication to both community members and providers in disaster response.

RISK CHARACTERIZATION AND COMMUNICATION

Panelists next discussed challenges in disaster risk characterization and risk communication, with various panel members highlighting needs for accessible toxicity data and meaningful community engagement from diverse perspectives. Keeve Nachman, an associate professor at the Johns Hopkins Bloomberg School of Public Health, explained the risk assessment paradigm that uses diverse evidence to translate exposures into characterized health risks.^3,4 These risks in turn guide risk management decisions and communication strategies to answer community questions about safety, Nachman said.

Building on this concept, Weihsueh Chiu, a professor of veterinary physiology and pharmacology at the School of Veterinary Medicine and Biomedical Sciences at Texas A&M University, spoke about translating East Palestine air monitoring measurements into exposure and risk estimates. He outlined the difficulties of clearly communicating the complex continuum of risk to the public when data contain gaps and uncertainties. Chiu also pointed out that transitioning from quantitative hazard quotients to plain language descriptions of safety involves dealing with some uncertainty, which will need to be communicated as well.

Furthering this discussion, Sue Fenton, the director of the Center for Human Health and the Environment at North Carolina State University, reviewed a scoping report⁵ from NIEHS summarizing the known hazards of East Palestine contaminants. She emphasized using

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curated authoritative toxicity data sources to ensure reliability. Fenton also noted that mixtures of chemicals pose challenges, as potential interactions are often unknown.

Antony Williams, a scientist at EPA’s Center of Computational Toxicology and Exposure, described advanced cheminformatics tools that make possible the rapid gathering of chemical hazard and safety data to inform emergency response and risk assessment. He said that existing publicly accessible applications like the CompTox Chemical Dashboard⁶ and the Cheminformatics Modules, including the Hazard Profile Module,⁷ allow for efficient mining of disparate data to characterize risks and potentially help to guide actions.

Wesley Vins, the health commissioner for Columbiana County, shared his firsthand experience communicating during the East Palestine disaster response. He highlighted difficulties managing information flow among government agencies at different levels, media partners, and concerned community members. Vins stressed the importance of coordinated messaging, given public expectations for transparency. Nachman echoed this, emphasizing the importance of transparently conveying uncertainties and involving stakeholders throughout the process.

The panelists addressed several important questions related to the East Palestine train derailment and its potential health impacts. Fenton and Chiu explained that dioxins are a complex mixture, making risk assessment challenging. There are limited authoritative sources that quantify risks from specific dioxins, Fenton said, and while there are clearly associated health outcomes, more research is needed to determine relative potency factors. Nachman acknowledged that as scientific understanding of chemicals’ propensity to elicit adverse health effects evolves, toxicological reference values should be lowered to reflect new sensitive endpoints when supported by evidence. He went on to highlight the importance of considering more than just the most sensitive endpoints associated with chemical exposures, especially in the case of chemical mixtures. He noted that the combined toxicity of multiple chemicals may elicit additional effects beyond the most sensitive ones associated with the individual chemical; constituents of the mixture. Fenton said that NIEHS’s scoping review of potentially hazardous contaminants considered how recent each review was, giving more weight to newer science.

Nachman introduced the critical issue of assessing health risks from cumulative exposures, particularly regarding how to evaluate the combined effects of chemical mixtures in disasters. He said that properly characterizing threats is challenging, given the significant data gaps. Adding context, Chiu and Nachman said that a typical approach today relies on component-based approaches (e.g., calculating the hazard index) that are summed quantitatively, although some whole mixtures, such as diesel particulates, are assessed jointly. Chu suggested that additional research is needed on in vitro methods that can better evaluate interactions and synergy. Nachman noted that assessments commonly assume additivity between chemicals—a limitation, given the uncertainties concerning the effects of the nature of chemical interactions when synergy and antagonism may also be possible. He emphasized the importance of considering exposure scope when managing mixture risks rather than focusing solely on quantifying uncertain interactions. Williams highlighted emerging computational mixture assessment methods, although chemical interaction data remain limited.

Some of the panelists agreed that substantial data gaps severely restrict precision in cumulative risk quantification. Nachman highlighted how assessments predominantly add up independent chemical risks, neglecting potential interactions among mixture components. Nachman and Williams mentioned the value of analyzing toxicity pathways across mixtures and predictive approaches to model interactions. But some of the discussants also called for more real-world mixture research to comprehensively evaluate disaster releases. For example, Chiu indicated that animal models could be used to test mixtures and that there is interest in using in vitro methods to examine synergy or antagonism of

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compounds in a more rapid manner. He added that there is future potential to take samples from a particular incident and rapidly test for a whole mixture screening of potential toxicity but acknowledged that the technology is not yet ready for field application. Regarding potential biomonitoring⁸ in exposed populations, Fenton and Chiu said that per- and polyfluoroalkyl substance (PFAS) markers from firefighting foam would be unique long-term indicators of exposure not otherwise present. While many chemicals dissipate, they agreed that PFASs and dioxins persist in the body to serve as biomarkers.

OPPORTUNITIES TO ASSESS AND ADDRESS LONGER-TERM COMMUNITY HEALTH IMPACTS

Speaker discussions throughout the workshop highlighted insights from previous disasters and health crises, focusing on the integration of research with practical action, vigilant monitoring for effects, the implementation of community-centered strategies, and the consideration of long-term health consequences to aid in the recovery of East Palestine.⁹

Research and Action Integration

Speakers discussed long-term health studies and community partnerships established after past disasters that have advanced scientific knowledge while providing the affected populations with essential health monitoring and resources. Melanie Pearson, an associate professor of environmental health at the Emory University Rollins School of Public Health, spoke about the Michigan Long-Term Polybrominated Biphenyl (PBB) Study and Registry¹⁰ as an example of how to monitor and address health concerns by partnering with the exposed community after contamination disasters. The PBB registry, which was established in the 1970s after widespread agricultural contamination in Michigan, has tracked health outcomes in exposed populations for more than 50 years. Pearson said that the long-term research has uncovered elevated risks of cancers and other diseases tied to PBB exposure as well as multi-generational health impacts. Importantly, she emphasized that collaborating with affected communities to understand concerns and integrate them into the science has been key to producing relevant findings, building trust in the research, and catalyzing public health action.

Building on this, Michele Marcus, a professor of epidemiology, environmental health, and pediatrics at the Emory University Rollins School of Public Health, said that conducting studies after disasters like the Michigan Long-Term PBB Study help communities heal by determining how to prevent and mitigate health impacts. Nachman agreed, explaining that research partnerships have advanced science and public health around specific disasters such as the Michigan PBB contamination. Linda Birnbaum, an adjunct professor in the Department of Environment Sciences and Engineering at the University of North Carolina’s Gillings School of Global Public Health, emphasized that disaster research should aim to improve the science base for protecting both physical and mental health during disasters and in their aftermath. She said that research is needed to better understand health impacts in the short and long term, to establish the safety of treatments, to characterize exposure risks, to assess the efficacy of decontamination efforts, and to identify vulnerable groups. Birnbaum added that studies should engage partners across academia, agencies, businesses, and communities while integrating with emergency response teams. She highlighted the Disaster Research Response (DR2)¹¹ Program’s repository of data-collection tools and pre-approved research protocols that can equip scientists to gather data more quickly when disasters occur.

Environmental and Health Monitoring

Several presenters emphasized that analytical methods to identify chemicals and quantify exposures used in combination with long-term biomonitoring can help reconstruct past exposures and their health impacts when real-time data are limited. Judy Westrick, the

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director of the Lumigen Instrument Center at Wayne State University, explained various analytical methods to identify chemicals over time after spills and track contamination. She said that targeted analysis can quantify known hazardous substances based on available methods. However, she added, untargeted screening can be valuable for discovering unknown contamination. For example, her team used untargeted gas chromatography–mass spectrometry to identify concerning compounds such as 2-ethylhexanol and hexanal. Westrick recommended integrated targeted and untargeted monitoring of environmental and biological samples to fully characterize exposures and metabolites. She said that new techniques like metabolomics and exposomics research can help link exposures to health risks and resilience. Marcus said that after the East Palestine derailment, independent chemical measurements provided key information when government assurances failed to satisfy community concerns. Chiu noted that analyzing the health risks of chemical mixtures like dioxins remains challenging due to the large number of potential compounds and limited authoritative sources quantifying their relative potencies. In ideal circumstances, biomarkers should be collected as the exposure event is happening, but most often samples are collected after an event has occurred according to Manish Arora, a professor and the vice chair of environmental medicine and public health at the Icahn School of Medicine, Mount Sinai. Because the half-life for many chemicals containing blood and urine is too short to capture a record of past exposures, Arora said that biomarkers in teeth, hair, and blood can reconstruct past exposures even when traditional measures return to baseline levels. He explained that biomarkers in shed baby teeth provide a precise record of fetal and early childhood exposures that can be mapped over time by sampling microscopic layers reflecting weekly exposures. Though more limited in timescale, hair biomarkers also enable mapping of prior exposures following disasters. Arora advocated combining emerging biomonitoring tools with traditional measures in exposed populations to fully characterize exposure scopes and histories.

In a related vein, Phillip Landrigan, the director of Global Public Health and the Common Good at Boston College and formerly the director of preventative medicine at the Icahn School of Medicine, Mount Sinai, described the importance of creating exposure registries of responders and community members, such as the World Trade Center Registry¹² and the Flint Registry,¹³ to create a foundation for relating exposures to health outcomes. For example, the World Trade Center Registry enabled documentation of exposure–response relationships between cumulative dust inhalation and severity of both pulmonary dysfunction and mental health problems in first responders. Mona Hanna-Attisha, the associate dean for public health at Michigan State University, added that establishing the Flint Registry following the Flint, Michigan, water crisis allowed exposure assessment and longitudinal tracking of health indicators and referrals to health services.

Community-Centric Approaches

Panelists shared lessons from past disasters that could shape community-engaged approaches to validate resident experiences, build trust, and increase research accessibility following the East Palestine incident. Jennifer Horney, a founding director of and professor in the epidemiology program at the University of Delaware, emphasized that disaster severity is in part a function of community structures and resources. Engaging affected populations in research often improves health outcomes while building community capacity, she said. Echoing this, Erika Kinkead, a certified school nurse, the New Brighton Area school district president, and a member of the Beaver County School Nurse Association, said that trust building requires validating resident experiences and concerns. Joan Casey, an assistant professor of environmental and occupational health sciences at the University of Washington, advocated for forming community partnerships to inform study design, data collection, analysis, and communication of findings in accessible ways as a way of increasing inclusion. However, she noted, academic timelines often lag behind community needs.

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Concerning roles for community representatives, Hanna-Attisha said that the Flint Registry staff were hired from affected communities to ensure responsive, trauma-informed research practices that mitigated harms. Marcus said that community members catalyzed action after the PBB contamination by demanding research and cleanups when institutions failed to protect public health. Supporting state and local health departments is a priority, but many are under-resourced, making it difficult to fully engage communities in crises, said Hanna-Attisha, Landrigan, and Patrick Breysse, a professor emeritus at the Johns Hopkins Bloomberg School of Public Health. Breysse also emphasized early community partnerships and trust as well as the prioritization of diverse local needs, transparent communication, timely data release, and interagency coordination. Because health departments have the primary responsibility for addressing these problems but are chronically underfunded, Breysse, Landrigan, and Burke further advocated for securing more resources to bolster state and local health department capacity to aid communities dealing with environmental incidents.

Long-Term Health Impacts and Interventions

Panelists described studying disease progression, mental health impacts, and multigenerational effects and improving provider education as being critical to addressing long-term physical and psychological consequences in affected communities. Juliane Beier, an assistant professor of medicine at the University of Pittsburgh, shared information about her studies of metabolic dysfunction associated steatotic liver disease (formerly known as nonalcoholic fatty liver disease) and how environmental exposures may interact with underlying risk factors to drive disease progression. She explained that examining mechanisms underlying progression stages and risk modifiers helps determine how chemical co-exposures combine with preexisting conditions and other stressors to negatively affect health over time. Her work focuses specifically on the impacts of exposures such as vinyl chloride, including the effects of exposure on inflammation, fibrosis, and cancer risk, when combined with such factors as obesity-associated metabolic dysfunction.

Hanna-Attisha emphasized that addressing trauma through mental health care is as vital as assessing toxic exposures, given population-level loss of trust. Marcus said that the possible presence of long-term effects make multigenerational tracking critical, because epigenetic changes and similar issues will emerge gradually. She called for improving physician education on addressing environmental exposures as a way to enhance patient care and community support. Landrigan suggested using both exposure rosters and clinical databases to relate responder exposures to long-term respiratory and other health effects that appear years later.

CONCLUDING DISCUSSIONS

In her closing remarks, Malecki described ongoing challenges in East Palestine that have been reported by community members, including persistent health issues, uncertainty regarding future health risks, trauma from the events that unfolded, and ongoing displacement coupled by longer-term feelings of hopelessness for those with unanswered questions and continued health concerns. She emphasized the need for research to monitor the longer-term health impacts and how this event and those that were discussed can support more robust research to advance disaster preparedness particularly for VOCs with short half-lives and unknown health risks. The community remains divided regarding the adverse impacts and ongoing issues adding to the psychosocial toll and pervasive mental health concerns. However, she noted that residents primarily desire that action be taken, rather than simply having additional recommendations shared with them.

The nature of the train derailment and proximity of East Palestine as a border city required a multi-state response. This led to a more complicated response effort requiring coordination across multiple jurisdictions and response agency authorities, Malecki said. The response required coordination of the Ohio and Pennsylvania Departments of Public Health who sought information from regional ATSDR and EPA locations. Ohio is part of Region V and Pennsylvania is part of Region III for both agencies. Early health data presented during the workshop showed adverse impacts across age groups

and that many clinical responders, including primary care and emergency department physicians, lacked the necessary environmental health training to address community concerns regarding exposures and related health impacts. While ATSDR and other agencies did provide information and fact sheets regarding exposures and risks from the derailment, poison control center responders indicated practitioners on the ground wanted more digestible clinical guidance based on community testimonies. Agencies did respond, but this information could have been available with increased research into the health impacts of acute exposures and understanding of the complex mixtures emanating from the train derailment and subsequent burning. Malecki emphasized resolving uncertainties, expanding data collection to advance research, listening to community concerns, and acting quickly to address these concerns and establish research to monitor long-term health impacts.

Additionally, several presenters and discussants underscored that continued collaborative efforts centered on integrating East Palestine community priorities will be essential to implementing meaningful solutions and rebuilding trust. Multiple moderators highlighted the urgency of coordinating research initiatives in order to maximize the efficient use of resources while maintaining strong communication channels with participating residents. Haynes prioritized environmental exposure assessment, biomarker development and collection, the need for long-term follow-up, and effective communication messages and strategies, and stressed the need for community coordination, ownership, and engagement throughout all of these activities to ensure that the data collection and report-back is meaningful to the community. Connecting to those priorities, Harold “Fritz” Nelson, the pastor of the First United Presbyterian Church of East Palestine, emphasized that science should be conducted carefully to validate community experiences and provide data to empower local advocacy around urgent needs. He also called for multidisciplinary and multi-institutional efforts that will enable coordination and trust-building across involved stakeholders, from government agencies to academic researchers to community groups. In line with strengthening collaboration, Whelton expressed hope that this event will spark actionable change centered on helping East Palestine while also addressing related problems on a national level. However, communication gaps remain an issue, according to Nachman, who spotlighted the information chaos and uncertainty concerning health impacts. He recommended updating evidence-based risk communication strategies to account for modern barriers related to information overload and social/political polarization. Nachman also suggested improving training on mixtures risk assessment specifically for public health professionals on the frontlines. Echoing concerns about the public health infrastructure, Roberta Lavin, a professor in and the deputy director of the Center for Health Equity and Preparedness at the University of New Mexico College of Nursing, acknowledged gaps in chemical exposure education for many health care providers. She called for addressing persistent divides separating experts and community members affected by environmental disasters.

Furthering the discussion, Marcus stressed the value of helping East Palestine residents regain control of their health, while noting the importance of identifying and eliminating any continuing exposures from the train derailment aftermath. Marcus also advocated for research that supports health care providers in protecting community health and preventing potential long-term consequences. Adding further context, Maureen Lichtveld, the dean of the University of Pittsburgh School of Public Health, advocated for a clear roadmap linking research to action, with the existing gaps made explicit. She noted the difference between funding streams for scientific studies versus funding for health services and called for transparency around this issue when communicating with the community. Lichtveld emphasized the need for additional provider training and for making a commitment to establish a disease/exposure registry. Finally, Thomas Burke, a professor emeritus at the Johns Hopkins Bloomberg School of Public Health, expressed concern about the lack of a playbook with established guidelines for disaster responses. He advocated a greater focus on clinical preparedness and medical infrastructure to adequately meet community needs in the wake of environmental crises. Burke pointed

to some progress made in Flint following the water contamination scandal as a model to apply to the East Palestine recovery efforts.

In closing the workshop, Aubrey Miller, the deputy director of scientific coordination at NIEHS, underscored the need for comprehensive health-informed disaster research and surveillance. He noted systemic challenges in connecting science, public health practice, and community needs in the wake of catastrophes like the East Palestine train derailment. While pockets of progress exist, he said, citing efforts following the Deepwater Horizon BP Gulf of Mexico Oil Spill,¹⁴ the prevailing narrative emerging from East Palestine and an increasingly frequent and severe pattern of incidents signals the urgency for change. Miller emphasized that the consequences of disasters like East Palestine persist long after the initial incident. While cleanup efforts may be swiftly completed, Miller concluded that trauma continues to linger within affected communities. He stressed that the full impacts extend beyond physical environmental damage, encompassing chronic mental and emotional burdens as well. What heals and sustains devastated populations over the long term, Miller emphasized, involves translating data into effective preparedness, responsive systems, and future looking recovery efforts that people can trust. He described vital synergies where research, clinical experience, and public health surveillance come together, not as isolated domains. He stressed the importance of considering mental health needs along with continuing environmental exposures and health risks disproportionately affecting vulnerable groups. Overall, Miller conveyed hope that by working together across sectors, initiatives could effectively inform practice and interventions over the long term in order to help the community heal.

Potential strategies for addressing and monitoring community health impacts offered by individual speakers can be found in the Box.

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DISCLAIMER This Proceedings of a Workshop—in Brief was prepared by Justin Snair, Matthew Masiello, and Scott Wollek as a factual summary of what occurred at the workshop. The statements made are those of the rapporteurs or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine. Artificial intelligence (AI) tools including Otter.ai, Petal AI, and Claude 2 were used in the initial drafting of this Proceedings of a Workshop—in Brief. All materials generated by AI tools were based on the public workshop and were fact-checked to ensure accuracy of the presented information.

* The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop—in Brief rests with the institution. The planning committee comprises Kristen Malecki (Chair), University of Chicago; Thomas Burke, Johns Hopkins Bloomberg School of Public Health; Carol Cunningham, Ohio Department of Public Safety; Kristen Dickerson, Ohio Department of Health; Erin Haynes, University of Kentucky; Darryl Hood, The Ohio State University; Alex Kemper, Nationwide Children’s Hospital; Erika Kinkead, New Brighton Area School District; Roberta Lavin, University of New Mexico; Maureen Lichtveld, University of Pittsburgh School of Public Health; Michele Marcus, Emory University; Julie Miller, Pennsylvania Department of Public Health; Keeve Nachman, Johns Hopkins Bloomberg School of Public Health; Harold “Fritz” Nelson, First United Presbyterian Church of East Palestine; Ivan Rusyn, Texas A&M University; and Andrew Whelton, Purdue University.

REVIEWERS To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by Patrick Breysee, Johns Hopkins University, and Erika Kinkead, New Brighton Areas School District. Leslie Sim, National Academies of Sciences, Engineering, and Medicine, served as the review coordinator.

SPONSORS This workshop was funded by the Centers for Disease Control and Prevention’s Agency for Toxic Substances and Disease Registry and the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Cancer Institute, National Institute of Environmental Health Sciences, National Institute of Mental Health, National Institute of Neurological Disease and Stroke, and National Institute on Aging under Contract #75N96023P00219.

STAFF Scott Wollek, Lisa Brown, Matthew Masiello, Shalini Singaravelu, Michael Berrios, Rayane Silva-Curran, and Elizabeth Boyle.

For additional information regarding the workshop, visit https://www.nationalacademies.org/our-work/public-health-research-and-surveillance-priorities-from-the-east-palestine-ohio-train-derailment-a-workshop.

SUGGESTED CITATION National Academies of Sciences, Engineering, and Medicine. 2024. Public health research and surveillance priorities from the East Palestine train derailment: Proceedings of a workshop—in brief. Washington, DC: The National Academies Press. https://doi.org/10.17226/27441.

Health and Medicine Division Copyright 2024 by the National Academy of Sciences. All rights reserved.