Hsu Edbert B, Grabowski Jurek G, Chotani Rashid A, Winslow Jason A, Alves Donald W, VanRooyen Michael J
Center for International Emergency, Disaster and Refugee Studies, Department of Emergency Medicine, The Johns Hopkins University Medical Institutions, Baltimore, Maryland 21201, USA.
Prehosp Disaster Med. 2002 Oct-Dec;17(4):196-201. doi: 10.1017/s1049023x00000492.
On 18 July 2001, a train hauling hazardous materials, including hydrochloric acid, hydrofluoric acid, and acetic acid, derailed in the city of Baltimore, Maryland, resulting in a fire that burned under a downtown street for five days. Firefighters were stymied in their efforts to extinguish the fire, and the city was subjected to thick smoke for several days.
To determine whether an urban chemical fire with a hazardous materials spill resulted in a detectable public health impact, and to demographically describe the at-risk population for potential smoke and chemical exposure.
The United States Centers for Disease Control and Prevention (CDC) was consulted about possible side effects from chemical exposure. Total numbers of emergency department (ED) patients and admissions from 15:00 hours (h), 15 July 2001 to 15:00 h, 21 July 2001 were collected from five local hospitals. Patient encounters citing specified chief complaints from 15:00 h, 15 July to 15:00 h, 18 July (pre-accident) were compared with the period from 15:00 h, July 18 to 15:00 h, 21 July (post-accident). Data were analyzed using Fisher's exact test. The United States Census Bureau's Topologically Integrated Geographic Encoding and Referencing (TIGER) digital database of geographic features and ArcView Geographic Information Systems (GIS) were used to create maps of Baltimore and to identify populations at-risk using attribute census data.
There were 62,808 people residing in the immediate, affected area. The mean of the values for age was 33.7 +/- 3.2 years (standard deviation; range = 16 yrs) with 49% (30,927) males and 51% (31,881) females. A total of 2,922 ED patient encounters were screened. Chief complaints included shortness of breath, pre-event = 109 vs. post-event = 148; chest complaints = 90 vs. 113; burns and/or skin irritation = 45 vs. 42; eye irritation 26 vs. 34; throat irritation = 33 vs. 27; and smoke exposure = 0 vs. 15. There was a statistically significant increase (p < 0.05) for shortness of breath and smoke exposure-related complaints. No statistically significant increase in numbers of admitted patients with these complaints was found.
In the setting of a large-scale urban chemical fire, local EDs can expect a significant increase in the number of patients presenting to EDs with shortness of breath and/or smoke inhalation. Most do not require in-patient hospitalization. Careful assessment of impact on local EDs should be considered in future city-accident planning. Some official warnings were widely misinterpreted or ignored. Public education on potential hazards and disaster preparedness targeted to populations at-risk should receive a high priority. Geographic information systems (GIS) may serve as useful tools for identifying demographics of populations at-risk for disaster planning and responses.
2001年7月18日，一列运载包括盐酸、氢氟酸和醋酸在内的危险物质的火车在马里兰州巴尔的摩市出轨，引发火灾，大火在市中心街道下燃烧了五天。消防员灭火行动受阻，该市数日浓烟弥漫。
确定一场伴有危险物质泄漏的城市化学火灾是否对公众健康产生了可检测到的影响，并从人口统计学角度描述可能受烟雾和化学物质暴露影响的高危人群。
就化学物质暴露可能产生的副作用咨询了美国疾病控制与预防中心（CDC）。收集了2001年7月15日15:00至2001年7月21日15:00期间，五家当地医院急诊科（ED）患者总数及住院人数。将2001年7月15日15:00至7月18日15:00（事故前）以特定主要症状就诊的患者情况与7月18日15:00至7月21日15:00（事故后）的情况进行比较。数据采用Fisher精确检验进行分析。利用美国人口普查局的地理特征拓扑集成地理编码与参照（TIGER）数字数据库以及ArcView地理信息系统（GIS）绘制巴尔的摩地图，并使用人口普查属性数据确定高危人群。
事故直接影响区域内有62,808人居住。年龄均值为33.7±3.2岁（标准差；范围 = 16岁），其中男性占49%（30,927人），女性占51%（31,881人）。共筛查了2922例急诊科患者就诊情况。主要症状包括呼吸急促，事故前 = 109例，事故后 = 148例；胸部不适 = 90例，事故后 = 113例；烧伤和/或皮肤刺激 = 45例，事故后 = 42例；眼部刺激 = 26例，事故后 = 34例；咽喉刺激 = 33例，事故后 = 27例；烟雾暴露 = 0例，事故后 = 15例。呼吸急促和与烟雾暴露相关的症状出现了统计学上的显著增加（p < 0.05）。这些症状的住院患者数量未发现统计学上的显著增加。
在大规模城市化学火灾的情况下，当地急诊科可能会迎来因呼吸急促和/或吸入烟雾前来就诊的患者数量显著增加。大多数患者无需住院治疗。在未来城市事故规划中应考虑仔细评估对当地急诊科的影响。一些官方警告被广泛误解或忽视。针对高危人群的潜在危害和灾难准备的公众教育应高度重视。地理信息系统（GIS）可作为识别灾难规划和应对高危人群人口统计学特征的有用工具。
