Discussion

The Convention on the Transboundary Effects of Industrial Accidents, signed in 1992 which went into force in April 2000, is a United Nations Economic Commission for Europe convention focusing on the protection of both people and the environment against industrial accidents. ¹⁰

The Convention encourages international cooperation between countries in industrial disaster risk mitigation, prevention, and response by encouraging transboundary research collaborations and information sharing between states and regional organizations.

Industrial disasters with potential transboundary effects require that responsible states inform neighboring countries and regions. It is also important that before an event, regional partners ensure they have compatible emergency operations plans and a robust interoperability setup, should they need to surge and respond when local resources are overwhelmed. ^{Reference Stewart-Evans, Hall and Czerczak11} The Industrial Accident Notification System and the Assistance and Cooperation Programme were created to facilitate these processes. ¹²

The health aftermath of radiation industrial disasters such as Chernobyl and the Fukushima nuclear disaster remains controversial. ^{Reference Rowlatt13} A 2014 report by the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) and the World Health Organization projected no increase in miscarriages, stillbirths, or physical and mental disorders in babies born after the Fukushima accident. ^{Reference Mohan14,Reference Stafford15} Although people in the incident’s worst affected areas have a slightly higher risk of developing certain cancers such as leukemia, solid cancers, thyroid cancer, and breast cancer, the predicted risks for those in surrounding areas remain low, and no observable increases in cancer above natural variation in baseline rates are anticipated. ^{Reference Brumfiel16} However, data from atomic bomb survivors and Chernobyl demonstrated a peak incidence of thyroid cancer at 25 y, with significant increase above baseline up to 60 y out. ^{Reference Cardis and Hatch17} As the Fukushima accident occurred in 2011, we cannot rely on data from it as being conclusive of the totality of effect.

In addition, the Chernobyl data demonstrated similar elevations of thyroid cancer, as well as other cancers; however, due to the loss of follow-up on upward of 800,000 liquidators (those brought in from around the Soviet Union tasked with the clean-up of the site over 3 y), definitive analysis of the stochastic effects of the Chernobyl disaster is impossible. ^{Reference Cardis and Hatch17} Review of historic radiation disasters have also shown a large socio-economic and psychosocial impact of the fear of radiation.

From a chemical exposure perspective, the acute toxicity of direct chemical exposure such as the Bhopal gas tragedy in 1984 can be devastating, but the longer-term burden of disease to certain toxic industrial chemicals remains uncertain (but likely underestimated) as they may not have been measured or measurement may be difficult due to episodic exposure, unique chemistry, or low concentrations. There may also be absent or incomplete chemical monitoring data or other confounding factors might be present. ^{Reference Prüss-Ustün, Vickers and Haefliger18,19}

The psychological impact of industrial and technological disasters, such as post-traumatic stress disorder (PTSD), guilt by association, and anger toward individuals held accountable can be profound and longstanding. ^{Reference Hodgkinson20} Peri-traumatic dissociation and distress, acute stress, and depression are all related to the development of PTSD after an industrial disaster. ^{Reference Birmes, Daubisse and Brunet21} In addition to PTSD, survivors of an industrial or technological disaster may also experience the compounded trauma of job loss, social stigmatization, as well as anxiety associated with the prolonged physical health effects from chemical or toxic exposures such as cancer, fertility issues, and heritability effects. ^{Reference Sumner22}

Densely populated communities are frequently affected by industrial and technological disasters, often causing significant downstream effects on the local economy, ecology, and property, all of which may contribute to a public health crisis. While industrial disasters can be catastrophic, even the threat of such a disaster, such as the Three Mile Island nuclear reactor accident, can be enormously impactful on a community. ²³ Due to the complex nature of industrial and technical disasters, the synergy between public health preparedness and emergency management is vital to community resilience within the all-hazards approach to disaster preparedness. ^{Reference Rose, Murthy and Brooks24,Reference Khan, O’Sullivan and Brown25} Preventative measures, early recognition, and adequate response are keys to mitigation and preparedness. As well, access to care, on-site specialized medical care, transportation of affected individuals to appropriate treatment facilities, and early rehabilitation are essential to optimize public health outcomes in the response and recovery phases of the disaster cycle. ^{Reference Kaliaperumal and Kole26}

Though the data offer little insight regarding mortality/morbidity and other risk reduction measures in industrial disasters, many pre-hospital systems around the world have taken the incentive to better prepare their first responders. In Australia, for example, where a large mining, oil, and gas industry exists, “industrial paramedics” often have additional qualifications such as Major Incident Medical Management and Support Course and Basic Offshore Safety Induction and Emergency Training, as well as site and industry-specific training such as confined space rescue, self-contained breathing apparatus training in chemical exposures as well as vertical rescue qualifications. ²⁷ Other short courses include safe access and egress training and scene management training of a major incident. ²⁸ Other more extensive industrial disaster-specific medical courses also do exist but remain a relatively niche branch of disaster medicine. ²⁹ Furthermore, injury-specific resources such as the Advanced Burns Life Support course, the American Burn Association’s Disaster Response guidelines, and the World Health Organisation’s Emergency Medical Teams Technical Working Group on Burns have widespread global support and expert consensus of their utility in improving mortality and morbidity outcomes in mass casualty burns disasters. ^{30–Reference Yasti, Akgün and Akin33}

Training and education aside, the Occupational Safety and Health Administration (OSHA) under the jurisdiction of the United States Department of Labor, sets robust emergency preparedness and response guidelines for the industrial sector which are considered gold standard around the world. ³⁴

While research around occupational morbidity and mortality in the industrial sector does exist around the world and continuously informs changes in safety policies and protocols, they are predominantly focused on causal factors of single accident events, rather than mass casualty events. ^{Reference Faturos, Bodor and Proe35,Reference Prudêncio, Marques and Aguiar36} As expected, data collection in all disasters (whether it be natural or man-made) remains a difficult proposition but proposals and suggestions for interdisciplinary collaboration on critical data collection do exist, although adoption remains uncertain. ^{Reference Ge, Zobel and Murray-Tuite37,38} The international, Inter-Agency Coordination Group for industrial and chemical accidents have also published recommendations and framework for industrial and chemical accidents prevention, preparedness, and response, recognizing the need for a global strategy against such events. ³⁹

Most recently, a “Chain of Survival in Industrial Emergencies and Disasters” (early prevention, early recognition, early response system, early advanced care, and early rehabilitation) was proposed as a concept to reduce and mitigate risks of disasters but research specifically on industrial disasters related mortality and morbidity remains an area which needs further exploration. ^{Reference Kaliaperumal and Kole40}

Prompt response to industrial disasters is crucial in reducing human health and environmental fallout, but can pose significant challenges when first responder safety is at risk. Chemical spills, infrastructure collapse, and explosions all pose unique dangers necessitating specialized skills, knowledge, and equipment to operate within those warm zones. Effective training of local first responders, emergency medical services (EMS), hospital personnel, and community volunteers is key to mitigating the adverse impacts of an industrial disaster. In addition, the lingering effects of industrial disasters, such as the health impacts of contamination and exposures, require a multidisciplinary approach of academic institutions, government officials, and community partners to better prevent future disasters and address their long-term ramifications.Reference Symanski, An Han and Han ⁴¹

The frequency of industrial disasters has been down-trending since 2004, and pre-20th century, compensation for workers injured or killed while at work was comparatively cheap. Today, however, the financial cost of an injured worker includes medical bills, compensation, and productivity losses, and are much more significant, with the National Safety Council (NSC) estimating an average cost of $44,000.00 USD per injury requiring medical care and $1,300,000.00 USD per death. ⁴² While these figures may not be directly applicable to disasters outside of the United States, it does provide some context for the economic impact of industrial accidents and the importance of preventing them. The Convention on the Transboundary Effects of Industrial Accidents, as mentioned earlier, is 1 example of an international agreement aimed at preventing industrial accidents and mitigating their impact.

As a result of this upward shift in cost, along with other factors such as company reputation, and more robust industrial safety regulatory requirements, it became an industrial priority to invest in safety programs and equipment, with many industries pivoting from a previously reactive to a much more proactive approach today. ⁴³

While accidental events are largely preventable, intentional attacks on critical infrastructures such as the 2019 drone attacks on oil facilities in Saudi Arabia, the 2021 cyberattack on the Colonial pipelines in Texas, and the ongoing wartime shelling around the Zaporizhzhia nuclear plant in Ukraine are all cause for concern.Reference Tin, Kallenborn and Hart ⁴⁴

Counter-Terrorism Medicine studies and analyzes the health-care impacts of intentional attacks and is an emerging subspecialty field of Disaster Medicine gaining traction as conflicts and threats escalate around the globe. ^{Reference Tin45,Reference Tin, Margus and Ciottone46} The compounding complexities of intentional attacks on critical infrastructure necessitates early multi-agency conversations around health system risk vulnerability analysis and mitigation and preparedness strategies in case of catastrophic events. ^{Reference Symanski, An Han and Han41,Reference Tin, Hart and Ciottone47}