Overview

On Friday, February 3, 2023, at 8:54 pm EST, a Norfolk Southern train derailed in East Palestine, Ohio, spilling large amounts of hazardous material into the area. The US Environmental Protection Agency reported that five of the 11 breached cars transporting hazardous materials contained vinyl chloride monomer, a highly volatile colorless compound produced for commercial use. The derailment site in East Palestine is located approximately 800 yards from the Ohio-Pennsylvania border.

Read Our Article in the May Issue of JPHMP

First responders mitigated attendant fires, but authorities expressed concern that the rising temperature in one of the tank cars might lead to a Boiling Liquid Expanding Vapor Explosion, or BLEVE. Despite conflicting perspectives, Norfolk Southern and Incident Command performed a vent and burn procedure to alleviate the pressure, which resulted in a massive plume comprising phosgene gas and hydrogen chloride.

Due to overlapping geographic jurisdictions and the involvement of multiple state and federal agencies, evacuation and notification orders were inconsistent across Ohio and Pennsylvania. Furthermore, the Center for Toxicology and Environmental Health, a contractor hired by Norfolk Southern, reported equivocal results about air quality. Some findings downplayed the extent of harms to humans while others offered direct evidence to the contrary.

Since the Norfolk Southern train derailment was regarded as an environmental incident rather than a public health emergency, authority for response efforts was led by the United States Environmental Protection Agency (EPA) with little input from local and state health agencies. Nevertheless, the train derailment and subsequent vent and burn procedure generated fears about public health and safety among residents who lived near the crash site. Below, we highlight actions taken by the Pennsylvania Department of Health to address public health concerns related to the Norfolk Southern train derailment.

• Communication with Healthcare Providers. Representatives from the Pennsylvania Department of Health conducted three webinars for healthcare providers to address growing concerns among patients regarding a variety of symptoms of unknown origin. Public health officials worked through the larger healthcare systems with a specific focus on primary care and the federally qualified health center that served the county.
• Circulation of the Assessment of Chemical Exposure (ACE) Survey. Pennsylvania officials worked with a response team from the Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry to develop an ACE survey specific to their location. One survey was distributed to Pennsylvania residents while the other focused on Pennsylvania first responders. Surveys were conducted in multiple ways including door-to-door canvasing, newsletters, door hangers, and a QR code.
• Coordination with Unified Command. The transition of Incident Command to Unified Command was handled by state and federal agencies under the authority of the EPA. Since the Pennsylvania Department of Health was considered a cooperating agency rather than a member of Unified Command, communication was moderated by a federal EPA representative through a Public Health Advisory Unit. This group met as often as three times per week at the beginning of the response, but the frequency of meetings decreased as the incident progressed.
• Establishment of a Health Resource Center. The Pennsylvania Department of Health opened a Health Resource Center adjacent to the site of the train derailment for clinical consultation. The Center was staffed by clinicians, Department of Health professionals, and behavioral health specialists, including members of the faith community through a local chaplaincy program. Representatives from the Pennsylvania Department of Environmental Protection and Pennsylvania Department of Agriculture were also available to field individual requests for water and soil testing.

Case Study Goals

Our new case study in the Journal of Public Health Management and Practice describes consequences of decision-making and implications for public health practice. Additionally, it poses discussion questions to prompt readers to consider issues raised by this disaster and potential disasters in the future. We encourage readers to pay attention to the formal and informal relationships between local, state, and federal authorities and to consider how these agencies addressed of failed to address health-related concerns.

For more information, read “When disasters cross state borders: Pennsylvania’s public health response to the Norfolk Southern train derailment in East Palestine, Ohio” in the May issue of the Journal of Public Health Management and Practice.

Related Resources

• Jaffe S. Hazardous train spills prompt calls for tougher safety rules. Lancet. 2023;401:1143-1144. National Transportation Safety Board. Norfolk Southern Railway derailment and hazardous materials release. RRD3MROO5 https://www.ntsb.gov/investigations/Documents/East%20Palestine%20Ohio%20Board%20Meeting%20Summary%20with%20Amendments.pdf Posted June 25, 2024. Accessed March 27, 2025.
• Schooling CM, Jones HE, McDermott S. East Palestine, Ohio, railroad derailment—Lessons learned, actions to take. American Journal of Public Health. 2023;113(8):841-842.

Matthew Fifolt, PhD, is an Associate Professor in the Department of Health Policy and Organization in the School of Public Health at the University of Alabama at Birmingham. His research focuses on program and quality improvement in evidence-based public health practice through high-quality program evaluation and assessment.

Andrew Pickett, MS, is the Director of the Bureau of Emergency Preparedness and Response for the Pennsylvania Department of Health. His areas of expertise include public safety, emergency management, and Geographic Information Systems.