Best Brains Exchange Report – Integrating Environmental Health Research into Chemical Emergency/Disaster Management

The Science, Knowledge Translation & Ethics Branch, Canadian Institutes of Health Research
in collaboration with
The Chemical Emergency Preparedness and Response Unit and Science Policy Directorate, Health Canada, and The US National Institute of Environmental Health Sciences

CIHR Boardroom
160 Elgin Street
Ottawa, Ontario
Friday, February 19, 2016

Table of contents

  1. Executive Summary
  2. Best Brains Exchange Overview
    1. Best Brains Exchange Program Overview
    2. Policy Background
    3. Policy Context
    4. Best Brains Exchange Objectives
    5. Meeting Participants
    6. Format of the Best Brains Exchange
  3. Summary of the Best Brains Exchange Meeting
    1. Welcoming Remarks by Dr. Danika Goosney, Director General, Science, Knowledge Translation & Ethics, CIHR, and Tim Singer, Director, Environmental Health Science and Research Bureau, Health Canada
    2. Roundtable of Introductions & Review of Objectives facilitated by Prof. David Russell, Head of Centre for Radiation, Chemicals and Environmental Hazards – Wales, & Head of the WHO Collaborating Centre for Chemical Incidents, Centre for Radiation, Chemicals and Environmental Hazards
    3. Presentations     
      1. Scene Setting Presentation: The Public Health Implications of Chemical Incidents: Research and Development Requirements by Prof. David Russell
      2. Presentation #2: NIH Disaster Research Response (DR2) Program: Improving Timely Environmental Health Research by Dr. Aubrey Miller, Captain, Department of Health and Human Services, US Public Health Service, & Senior Medical Advisor to the Director, National Institute of Environmental Health Sciences
      3. Presentation #3: Chemical Disaster Research by RADM Scott Deitchman, Chief Medical Officer, National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry, US Centers for Disease Control and Prevention
      4. Presentation #4: The 2013 Lac-Mégantic Tragedy: The Public Health Response Then and Now by Dr. Mélissa Généreux, Public Health and Preventative Medicine Specialist, & Director, Public Health Estrie Region (QC), & Chief, Clinical Department of Public Health, Université de Sherbrooke Hospital, & Assistant Professor, Faculty of Medicine and Health Sciences, Université de Sherbrooke
    4. Discussions
      1. Panel Discussion: Considerations for integrating environmental health research into chemical emergency/disaster response facilitated by Dr. Tom Kosatsky, Scientific Director, National Collaborating Centre for Environmental Health, & Medical Director, Environmental Health Services, British Columbia Centre for Disease Control, and Dr. Ray Copes, Chief, Environmental and Occupational Health, Public Health Ontario
      2. Plenary Discussion A: Integrating environmental health research into chemical emergency/disaster response in Canada facilitated by Prof. David Russell, and Commentary by Dr. Tom Kosatsky & Dr. Ray Copes
      3. Plenary Discussion B: Next Steps facilitated by Prof. David Russell & Tim Singer.
    5. Closing Remarks by Prof. David Russell & Tim Singer

1. Executive Summary

On February 19, 2016 Health Canada and the Canadian Institutes of Health Research hosted a Best Brains Exchange (BBE) meeting which brought federal, provincial and territorial (F/P/T) decision-makers together with leading researchers and experts working in the field of chemical emergency/disaster management and environmental health to discuss the integration of environmental health research into chemical emergency/disaster management in Canada.  Currently, there is a need for federal, provincial and local policies in Canada that are specifically designed to support or coordinate research pertaining to the public and environmental health effects of chemical emergencies/disasters. The BBE meeting provided the opportunity for participants to share key information, generate dialogue and provide a platform where next steps could be identified to move this policy issue forward.

The BBE meeting objectives were to:

  1. Gain an understanding of the drivers, components, successes and challenges of the United States (US) National Institutes of Health (NIH) Disaster Research Response (DR2) Program;
  2. Discuss which components of the DR2 Program could be applicable in the Canadian F/P/T context;
  3. Identify capacity for and barriers to conducting environmental health research during and after the response to a chemical emergency/disaster in Canada; and,
  4. Consider the evidence, lessons learned and best practices from the DR2 Program to begin to lay the foundation of a Canadian framework to incorporate environmental health research into emergency management policies, plans and guidelines.

Throughout the morning session experts summarized research evidence and experiences from past chemical emergencies/disasters and response and recovery efforts.  This included a comprehensive overview of the DR2 Program. The afternoon session was dedicated to discussions regarding the development of a framework to guide the integration of health research into chemical emergency/disaster management. After considering various aspects of the DR2 Program, several gaps in chemical emergency/disaster response preparedness and recovery frameworks in Canada were identified, including:

  1. Community preparedness
  2. Community surveillance
  3. Community information sharing/knowledge dissemination
  4. Human resources for response and recovery
    1. Identification of key actors/stakeholders
    2. Training opportunities
  5. Federal, provincial and territorial strategies and guidelines, for:       
    1. Integration of public health into EOC planning framework
    2. Risk mitigation
    3. Chemical exposure
    4. Scientific research procedures & protocol
  6. Financing of research as a part of chemical emergency/disaster response and recovery
  7. Data management
    1. Repository of reliable data
    2. Systematic evaluations of past chemical emergencies/disasters
    3. Data management procedures for utilizing questionable data
    4. Data management procedures for accessing data, including privacy and security issues
    5. Compilation of chemical storage sites, transportation routes, and information on the chemicals
    6. Means to assure rapid information access
    7. Rapid ethical review (pre-established templates)

Health Canada was identified as the agency best suited to take the next steps in moving the policy issue forward.

2. Best Brains Exchange Overview

a. Best Brains Exchange Program Overview

The CIHR's mandate includes the creation of new scientific knowledge and enabling its translation into improved health, health services and products, and a strengthened Canadian health care system. The Best Brains Exchange Program (BBE) is one of many platforms that CIHR has to achieve its mandate to facilitate the movement of research into action. The BBE program is a one-day, in-camera meeting for researchers and federal, provincial and territorial partners. With a focus on Ministry/Health Portfolio-identified policy issues, researchers are invited to BBEs to hear and share high-quality, timely and accessible research evidence that is of immediate interest and use to policy makers. The BBE follows a deliberative dialogue model where a solution to a policy issue is not the intended immediate outcome, but rather next steps and recommendations are considered with the intention to move a policy issue forward.

b. Policy Background

Typically, policy and plans related to emergency management are designed to mobilize response assistance in a timely manner following an emergency/disaster. In Canada, there is a current need to assess whether undertaking a research study is actually appropriate for the incident in question, to which a protocol for a rapid determination might prove helpful. A framework to rapidly organize and integrate environmental health research efforts during chemical emergencies/disasters is also currently lacking, and as a result, very little data regarding the public and environmental health impacts of chemical emergencies/disasters is being captured. In the absence of data from chemical emergencies/disasters, opportunities to improve health outcomes following these incidents are lost, and response efforts may be hindered or their deployment delayed.

c. Policy Context

Under the Department of Health Act (1996), Section 4 (2) and the Emergency Management Act (2007), Section 6 (1), the Health Portfolio (HP) is charged with developing, testing and maintaining mandate-specific emergency management and response plans to protect the health and safety of Canadians in the event of national public health threats or events such as major disease outbreaks, natural disasters or significant chemical, biological, radio-nuclear or explosive (CBRNE) events. Within the Healthy Environments and Consumer Safety Branch at Health Canada, the Chemical Emergency Preparedness and Response Unit (CEPRU) is mandated to enhance chemical emergency preparedness and response capacity across the Health Portfolio and to coordinate related activities nationally and internationally.

While the federal government typically provides a leadership role in Canada for emergency management, there are currently no federal, provincial, regional or local policies in Canada addressing support for, or coordination of, research pertaining to the public and environmental health effects of chemical emergencies/disasters. In the US, the NIEHS Disaster Research Response (DR2) framework has been developed to guide the integration of health research into chemical emergency/disaster management. Designing and aligning a similar Canadian framework in cooperation with the US would ensure that mutual response to a chemical emergency/disaster that impacts both countries would be better coordinated, enable sharing of evidence to improve short- and long-term health outcomes and facilitate mutual aid.

d. Best Brains Exchange Objectives

The BBE allowed participants to:

  1. Gain an understanding of the drivers, components, successes and challenges of the US DR2 Program;
  2. Discuss which components of the DR2 Program could be applicable in the Canadian F/P/T context;
  3. Identify capacity for and barriers to conducting environmental health research during and after the response to a chemical emergency/disaster in Canada; and,
  4. Consider the evidence, lessons learned and best practices from the DR2 Program to begin to lay the foundation of a Canadian framework to incorporate environmental health research into emergency management policies, plans and guidelines.

e. Meeting Participants

The BBE was organized by Health Canada and CIHR to engage international, F/P/T policy makers, public health and environmental health researchers, emergency management practitioners and other key stakeholders.

f. Format of the Best Brains Exchange

The BBE was organized in a format that encouraged active participation during presentations and discussions. Half of the day was dedicated to presentations that highlighted the role of public health and environmental health research in chemical incidents, and explored response policies and interventions from around the globe, with special attention to the DR2 Program. The afternoon session was dedicated to plenary discussions that focused on future research and development requirements, and recommendations to integrate environmental and public health research into chemical/disaster responses in Canada.

3. Summary of the Best Brains Exchange Meeting

a. Welcoming Remarks
By Dr. Danika Goosney, Director General, Science, Knowledge Translation & Ethics, CIHR, and Tim Singer, Director, Environmental Health Science and Research Bureau, Radiation Health Sciences Directorate, Health Environment and Consumer Safety Branch, Health Canada

On behalf of CIHR, Dr. Goosney welcomed participants to the BBE. Participants were provided an overview of the BBE program and its objectives, and were reminded that the desired outcome of a BBE is not an immediate solution to policy issues; rather, it is intended to bring policy issues forward and identify next steps. Mr. Tim Singer was introduced and was invited to say a few words on behalf of Health Canada.

Mr. Singer welcomed and thanked participants for their involvement in the BBE, and gave a brief overview of the role that Health Canada plays in preparedness and response to chemical emergencies/disasters under CEPRU's mandate. In addition, Mr. Singer discussed the support functions that may be provided by Health Canada's research, risk assessment/management and policy units in the event of an emergency.

Following Mr. Singer's welcome address, Dr. Goosney introduced the facilitator for the day, Professor David Russell, Head of the Centre for Radiation, Chemicals and Environmental Hazards – Public Health England, and Head of the WHO Collaborating Centre for Chemical Incidents, Centre for Radiation, Chemicals and Environmental Hazards.

b. Roundtable of Introductions & Review of Objectives
Facilitated by Prof. David Russell, Head of Centre for Radiation, Chemicals and Environmental Hazards – Public Health England, & Head of the WHO Collaborating Centre for Chemical Incidents, Centre for Radiation, Chemicals and Environmental Hazards

Following a quick tour de table during which participants introduced themselves and their respective organizations, Prof. Russell gave a brief overview of the day's activities. Prof. Russell encouraged discussions that would achieve the BBE objectives (please see section 2d. Best Brains Exchange Objectives).  Participants were also reminded that they were free to communicate the information shared at the BBE beyond the meeting; however, no attributions were to be made.

c. Presentations

i. Scene Setting Presentation: The Public Health Implications of Chemical Incidents: Research and Development Requirements
By Prof. David Russell

Developed society is increasingly reliant on chemicals. On one hand, many chemicals have contributed positively to public health; on the other hand, many chemicals that are routinely utilized are recognized as being toxic to human health and/or the environment. Therefore, use and societal gain has to be balanced against the risks posed by synthesis, storage, transportation and disposal of these chemicals.  While regulatory frameworks are in place to manage the risks presented by many individual chemicals and mixtures, for many others toxicological data are lacking or limited. The huge number of chemicals recognized, together with the potential for widespread environmental dispersion and contamination, inevitably means that the number of potential scenarios is almost infinite and thus a flexible approach to planning, preparedness and response is required. Research plays an important role in filling knowledge gaps and improving preparedness and protecting human health.

Prof. Russell highlighted several chemical emergencies/disasters that have occurred worldwide. Evidence from these incidents suggests that a safe, efficient and effective response to chemical emergencies/disasters includes components that address both acute and chronic effects of exposure. The Bhopal incident, for example, was the results of a series of human errors that resulted in the release of large quantities of methyl isocyanate (MIC), resulting in fatalities and casualties with acute health effects and chronic sequelae.  Similar to many other chemical emergencies/disasters, this incident highlighted how the often disproportionately large and rapid affect of chemical incidents places severe constraints on the timeframe to mount an adequate response and that these challenges must be considered in chemical incident preparedness and management. There is no single response or recovery model for all incidents.

The typically short latency between an incident and impact requires a rapid response. Consequently, planning and preparedness based upon risk assessment, prioritization and mitigation is required prior to such incidents and events in order to facilitate rapid, efficient and effective response, thereby mitigating the potential public health impact, whether toxicological or psychological.  Prof. Russell suggested that risk mitigation exercises could help to inform chemical incident preparedness by:

  • Increase community awareness and knowledge as part of a risk (as opposed to a crisis) - communication strategy. Provide education to the community so that individuals can assess their own personal level of risk, assess their own exposure, and be better prepared for chemical incidents.
  • Improve land use planning by moving hazardous sites away from communities.
  • Inform and develop surveillance programs that are mature, sufficiently sensitive, and able to assess the public health impact of potential chemical incidents.
  • Establish and test emergency plans at national, regional and local levels.
  • Identify appropriate human resources for emergency response (by far and away the most important resource). Bring together and train experts and stakeholders so they have the capacity to deal with an incident that is acute or may be prolonged.
  • Establish appropriate detection and alert systems to detect and respond to incidents rapidly.
  • Increase research and development so as to increase our knowledge of the released chemicals in an incident, in order to better response to that incident.

ii. Presentation #2: NIH Disaster Research Response (DR2) Program: Improving Timely Environmental Health Research
By Dr. Aubrey Miller, Captain, Department of Health and Human Services, US Public Health Service, & Senior Medical Advisor to the Director, National Institute of Environmental Health Sciences

The urgent nature of chemical incidents creates a difficult environment within which to effectuate a collaborative, thoughtful and strategic response, both with respect to containing the impacts of the event, and identifying and addressing any adverse outcomes in both the  immediate and long-term (formative and strategic science).

As a result, many chemical emergency response initiatives and research projects are currently based on little or unreliable data. Dr. Miller suggested that efforts must be taken prior to incident occurrence to ensure that appropriate acute response resources or networks are established, the focal areas of research determined and that all relevant stakeholders be pre-identified in a consortium (or network). In the Canadian context, such networks may differ somewhat from the US, and might include federal, provincial and territorial stakeholders and researchers, as well as local stakeholders, including public health officials and representatives of potentially vulnerable populations (whether as a result of location or other factors, including socio-economic status).

A pre-determined framework to conduct research during a chemical incident and an ethical review process to accompany this framework (such as the DR2, refer to presentation slide deck) may help integrate human health research into the emergency response and longer-term follow-up. If these systems are in place in advance of the acute response, there may be more opportunities to collect high-quality data during chemical incidents, which will inform the development of an appropriate response(s), evaluate the efficacy of such responses, and plan for longitudinal research. For example, the NIH has developed a new DR2 program to provide tools specifically designed to enhance collaborations between the emergency response and environmental health research communities. These include:

  • A repository of accessible data collection tools and a pre-approved Institutional Review Board (IRB) protocol to facilitate faster development and field implementation of research.
  • A website to host the repository of tools and other information to assist those involved in rapid data collection in response to disasters.
  • New environmental health networks where key stakeholders are brought together to contribute their wide range of expertise and skills (e.g. exposure assessment, toxicology, environmental and public health, etc.) and prepare to mount rapid responses when incidents occur.
  • Training and education for research responders through information, training materials, and exercises.

Information sharing also needs to be addressed at the community level. The general public should be provided with appropriate, accurate information pertaining to chemical incidents; however, this information should be tailored to the needs and circumstances of the community target audience and their particular risks and vulnerabilities. It is important to recognize that the mode of communication and the type of information being communicated needs to be carefully planned and evaluated; public consumption and understanding of data should be tested to ensure that correct knowledge is being disseminated and that appropriate actions are being taken in response to an incident.

A brief discussion period followed each of Prof. Russell’s and Dr. Miller’s presentations. Several themes emerged in these discussions:

  • Acceptable levels of chemical exposure: In the context of disaster, what does this mean? And, for whom? These determinations are especially challenging when there is limited toxicological data regarding the chemical(s) in question. Where data on the impact of longer term exposures are adequate, there may be much greater uncertainty in the emergency/acute context with respect to both the magnitude of potential exposures and the likely risks associated with such exposures. Bringing this information to the community is challenging, and what does this mean? And, for whom?
  • Rapid Research Ethics Board (REB)/Ethical Advisory Board (EAB) approval: Not only do REB/EABs need to be established prior to chemical incidents, they need to be rapidly available throughout the incident response. Researchers must maintain contact with REB/EABs, and collaborate between various REB/EABs to ensure that all ethical considerations are acknowledged throughout the incident response. An ongoing dialogue will help researchers to continuously think ahead with respect to future needs.
  • Compensation policies for victims of chemical incidents: Should compensation be a part of chemical emergency/disaster response and preparedness planning? Suggestion was made that a pool of funding be established for compensation, should this be deemed a necessary part of chemical emergency/disaster response and recovery. Some issues that will also need to be addressed include establishment of clear eligibility criteria for individuals who are affected by chemical emergencies/disasters and provision of confidentiality for those who have been exposed to chemicals and are seeking compensation. Additionally, appropriate medical referrals for those found to have physical and mental health issues needs to be considered early in the planning process. 
  • Determining what and who to study and which events warrant short- and/or longer-term effects evaluation: In chemical incidents there is a need to make tools available to rapidly determine who will do what. Where will data go? Who will be able to access the data? What kinds of studies are necessary? Which stakeholders/researchers should be involved? Focus on which target population? Where is funding coming from to support research? How research is organized and managed will change according to the people/organizations that are quickest to respond. Research needs to be tailored to the response, and depending on the response, research may not focus on the incident, but instead on measuring the response itself. Additionally, appropriate medical referrals for those found to have physical and mental health issues needs to be considered early in the planning process. 

iii. Presentation #3 : Chemical Disaster Research
By RADM Scott Deitchman, Chief Medical Officer, National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry, US Centers for Disease Control and Prevention

Chemical incident research must be multidisciplinary because all levels of the response are multidisciplinary. The burden of research cannot rest with one sole agency/organization. All relevant stakeholders have the responsibility to draw on science to help understand how exposures in chemical incidents result in mortality and morbidity, and how society interprets and prioritizes this information. These data inform all aspects of chemical incident response, including ethical considerations at the study onset and whether this becomes a part of the response.

A partnership and/or network of all stakeholders must be established from the onset of emergency planning; these partnerships provide the opportunity for all health and non-health partners to collaborate in operational and research design. This group of partners/stakeholders must be inclusive, broad and far-reaching and include many participants so that guidelines, policies or protocols are not seen as impositions to those who are not involved. Responsibility must be assigned so that partners/stakeholders can rapidly convene in the event of a chemical incident and implement both an appropriate response and research program in a timely fashion. A key objective of a partnership/network of all stakeholders should be to generate research questions that would guide research activities and help ensure a more rapid, effective and efficient incident response.

Research strategies need to be negotiated in advance with all essential (health and non-health) stakeholders, and must be transferrable across federal, provincial, territorial and other relevant jurisdictions (local and regional). Dr. Deitchman suggested that a pre-existing strategy holds the potential to facilitate timely research and generate data that informs effective and efficient response interventions.

Dr. Deitchman highlighted the need for key stakeholders to clearly define and agree upon exposure impact thresholds and toxicological guidelines. These data are useless if exposure impact thresholds and guidelines are not identified, the direction of the exposure level is not clear, future risks for the population are not described, and clinical implications are not understood.
Dr. Deitchman also highlighted the frequent call for biological monitoring during chemical exposure incidents.  Citing a previously established criterion for biological monitoring, he suggested that research conducted during emergency responses should but here too similar criteria and these criteria should be incorporated in pre-event planning.

There are several gaps in the evaluation of communication methods and strategies in chemical incidents and response efforts. Evaluations of public communication should measure the effectiveness of the various modes of communication employed to disseminate information, how scientific knowledge is translated and communicated to the public, what kinds of information should be communicated to various community target groups, and how incident response is understood by the public – including those who have low levels of scientific literacy.

A discussion period following Dr. Deitchman’s presentation ensued. Themes captured included:

  • Identification of research questions: What questions need answering in order to bring about effective integration of health outcomes information in a response?
  • Establishing cross-jurisdiction integration of response strategy(ies) (including research): At what level should a strategy(ies) be drafted and implemented, and is this strategy(ies) adaptable to different jurisdictions? There is no one model that fits all chemical incidents.
  • Information Management: There is no single database in Canada that captures all aspects and experiences of chemical incident response that is accessible to all stakeholders involved.
  • Systematic evaluation of past chemical incidents: Most databases that contain data related to chemical incidents do not provide information about the efficacy of responses. Stakeholders must have access to historical data to systematically review chemical incidents and capture lessons learned, identify successes, challenges, key gaps, and identify what information researchers/responders need in the event of these incidents.
  • Creation of a task force/network of chemical incident specialists, federal, provincial, and territorial decision-makers, community stakeholders, researchers, and others, possibly in a virtual or in-person format.
  • Communication/Information Sharing (Public): Scientific evidence from chemical incidents and response need to be made accessible to the public and presented in a way that is reassuring and educational. The benefits of this transparency are anticipated to be enhanced credibility of emergency responders/public health official and improved public perception of the effectiveness/utility of research in chemical incidents.
  • Evaluation of Communication Strategies: Minimal research has been published on the effectiveness of the various modes of communication and messaging employed in chemical incident responses, and the extent to which messages influence public knowledge, perceptions and behaviors during a chemical emergency/disaster and response. This research gap should be addressed in future incident response(s).
  • Information Sharing (Responders): Response management must be informed by accurate information for appropriate decision-making. To date, it has been difficult to obtain accurate information from the incident onset. In order to accurately assess hazardous agents and design and implement appropriate response(s), reliable data must be collected and made available through a network of partners at all levels, including federal, provincial and territorial decision-makers, regional response teams, the military and health services, etc.
  • Infrastructure and Funding Support: Operational, logistical and financial elements of research need to be explored beyond the acute response. There is a need to create a parallel focus on long-term response, going beyond the response, its effects, aspects of recovery, etc.

iv. Presentation #4 : The 2013 Lac-Mégantic Tragedy: The Public Health Response Then and Now
By Dr. Mélissa Généreux, Public Health and Preventative Medicine Specialist, & Director, Public Health Estrie Region (QC), & Chief, Clinical Department of Public Health, Université de Sherbrooke Hospital, & Assistant Professor, Faculty of Medicine and Health Sciences, Université de Sherbrooke

Limitations on access to information created a hierarchy of responders. Initially, decision making by public health responders was limited because other stakeholders with authority (e.g.,Sûreté du Québec) were more powerful. These stakeholders made decisions regarding response efforts and activities, including activities such as evacuation and reintegration orders that might have an impact on public health. In the Lac-Mégantic incident the main issue was that the earliest reintegration activities were initiated by law enforcement, without the involvement of the public health department. Public health officials conducted risk assessments with the limited data available, and erred on the side of caution to protect human health, which was especially important for vulnerable populations who were disproportionately affected by this chemical emergency/disaster.

Multiple factors (e.g., nature and magnitude of the event, level of uncertainty in risk assessment, media attention, etc.) were found to increase perceived health risks on the part of citizens of Lac-Mégantic. The affected and general public expressed understandable suspicion of institutions and questioned their ability to protect the public. This mistrust persists today and is reflected in public behaviors (e.g., some members of the community do not drink tap water despite being advised by public health officials that the water is safe). These experiences demonstrate how response efforts must include:

  • Research to evaluate the effectiveness of various modes of communication and messaging for public consumption.
  • Greater collaboration between all stakeholders involved in response and recovery efforts (including information sharing, knowledge translation and dissemination).

Research has been conducted on the short-term and longer-term health effects of the Lac-Mégantic incident. The data collected as part of an epidemiological investigation found cases of mortality (within the initial impact and explosion zone) but fewer cases of morbidity (than might otherwise have been expected for a more extensive explosion. However, longer term studies might reveal higher morbidity (individuals who might have be impacted were dealing with the loss of loved ones and other more pressing needs than their own injuries at the time). This is an especially important consideration for chemical incident response, demonstrating the need for research that goes beyond the chemical incident and its response. These data need to be captured so that physicians and experts in the field can be adequately trained in chemical incident response and recovery.

d. Discussions

i. Panel Discussion: Considerations for integrating environmental health research into chemical emergency/disaster response
Facilitated by Dr. Tom Kosatsky, Scientific Director, National Collaborating Centre for Environmental Health, & Medical Director, Environmental Health Services, British Columbia Centre for Disease Control, and Dr. Ray Copes, Chief, Environmental and Occupational Health, Public Health Ontario

Dr. Kosatsky and Dr. Copes listed the top considerations derived from the day's presentations.

Dr. Kosatsky emphasized how research must be a part of chemical emergency/disaster responses. Investigations would be more efficient if people believed that research will help chemical incident responses. Research may be quickly initiated if there is community buy-in and a pre-established network of trained partners with specific expertise in chemical incident response. Buy-in and reassurance for research may be instilled through appropriate communications strategies. Additionally, a pre-determined set of questions, funding that is quickly deployed and readily available, and validated research tools would facilitate a more rapid initiation of research activities.

Dr. Copes noted that chemical incidents are most commonly transportation-related. Risk assessments of these pathways could help to predict where and when these events might occur. Appropriate tools should be developed to perform risk assessments prior to, during, and post-incident. This is especially important post-incident where research is the weakest. These tools would provide information on the level of exposure, guide risk assessment, avoid confusion and reduce the level of uncertainty in risk estimates during an incident.

There is insufficient information-sharing during chemical incident responses. A platform or repository where data regarding chemical incidents could be logged and shared in a systematic manner would enable stakeholders to share experiences and collectively and systematically think through and learn from past chemical emergencies/disasters. One particular area of concern identified in the discussion is the (often) limited toxicological data available regarding the chemicals involved in these incidents, particularly with respect to long term health consequences from acute exposures. Dr. Copes suggested that a policy be established for companies to share information on the chemicals they transport or store.

Participants were invited to join in an open discussion to elaborate on the points raised by Dr. Kosatsky and Dr. Copes, and provide insights or recommendations specific to the plenary discussion points.

ii. Plenary Discussion A: Integrating environmental health research into chemical emergency/disaster response in Canada
Facilitated by Prof. David Russell, and Commentary by Dr. Tom Kosatsky & Dr. Ray Copes

Dr. Kosatsky and Dr. Copes introduced the discussion topics:

  • Should environmental health research be integrated into chemical emergency/disaster response in Canada?
    • If so, what are the essential components of an updated Canadian emergency management framework?
  • Does Canada have the capacity (resources and processes) to conduct environmental health research during chemical emergency/disaster response?
  • What changes (e.g., political, organizational, cultural, etc.) to the current Canadian emergency management framework to better integrate environmental health research into chemical emergency/disaster responses are needed?

Key themes that emerged in discussing the above-mentioned questions included:

  • Community
    • Preparedness
      • Elaborate, implement and evaluate tabletop emergency exercises in close collaboration with researchers.
      • Increase community awareness and knowledge of chemical storage, transportation routes and other community-specific factors influencing the potential risk of a chemical incident. Enabling communities to perform their own personal risk assessment pre-incident, and understand the potential environmental and public health risks, balanced with the risk of terrorism.
      • Educate community members on emergency response measures and tools. Giving communities the knowledge to be able to assess their own personal level of exposure, and identify tools that can be used to respond and recover from environmental or public health affects.
      • Conduct research on how communities prepare, mobilize and assist in incidents.
      • Create chemical emergency/disaster management tools that can be leveraged by diverse communities.
      • Increase collaboration with the emergency management community to integrate the research function into the response process (i.e. Incident Command Structure and/or Incident Management Structure)
    • Surveillance
      • Identify timely monitoring systems that aim to protect from threats and ongoing surveillance of population health.
      • Conduct an environmental scan and risk assessment of possible sites for chemical emergencies/disasters, put in place contingency plans, and share information with the public.
      • Develop surveillance programs that are mature, sufficiently sensitive, and able to analyze data and assess environmental and public health impacts of potential chemical incidents.
      • Establish appropriate detection and alert systems to detect and respond to incidents and enable rapid communication with communities.
      • Conduct community mapping in areas where chemical emergencies/disasters may occur (e.g., communities indicated in risk assessments) to raise awareness of the needs of community residents.
    • Information Sharing/Knowledge Dissemination
      • Make the scientific evidence from chemical incidents and the responses accessible to affected communities in a way that is reassuring and educational. The benefits of this transparency are anticipated to include enhanced credibility of emergency managers and researchers and improved public perception of effectiveness and utility of research.
      • Address the research gap on the effect of modes of communication and messaging in chemical incident response, and the extent to which messages influence public knowledge, perceptions and behaviours during a chemical emergency/disaster and response.
  • Human Resources (Response and Recovery)
    • Establish a platform/task force where key stakeholders are identified and brought together to contribute a wide range of expertise and skills necessary in incident response and recovery. Clearly identify the terms of reference. Ensure that participants feel included and become prepared for rapid response when incidents occur – this can include the coordination of training and education for research responders.
    • Provide the task force with training in chemical emergency/disaster response and recovery, and the research needs in such events (including but not limited to data collection methods, data storage and interpretation, and knowledge translation), giving the task force the capacity to deal with an incident that is acute or may be prolonged, and to support local or regional health authorities.
  • Research Protocol to be Adopted
    • Ethical Considerations
      • Establish good ethical research practice guidelines.
      • Identify key individuals who can participate on a National Research Ethics Board/Ethical Advisory Board that reviews research specific to chemical incidents. This designated Research Ethics Board/Ethical Advisory Committee should be recognized and its decisions respected across Canada.
      • Ensure Research Ethics Boards/Ethical Advisory Boards work together in chemical emergencies/disasters to conduct a thorough yet rapid review process.
    • Research Questions
      • Identify research questions based on gaps and questions that need to be addressed in order to bring about effective integration in a response.
    • Research Tools
      • Establish and make available for reference/used during a chemical incident a repository of research approaches, methods and tools (e.g., surveys/ questionnaires, laboratory support and tools, etc.)
      • Explore how existing research tools (Canadian, US, European) can be adapted for use in a Canadian context.
  • Federal, Provincial and Territorial Strategies & Guidelines
    • Draft and implement a chemical emergency/disaster risk mitigation strategy.  For example, land use planning and zoning bylaws should be established that limit the development of any hazardous sites near residential areas, and move any existing sites, if possible.
    • Each province should assess key risks in terms of chemical incidents, assessing what needs to be done to mitigate the risks and whether it has the resources to do so. If not, the provinces could consider the possibility of accessing resources in neighboring provinces or exploring whether there is scope for a national resource to supplement their resources.
    • Establish and implement a cross-sectoral (federal, provincial, and territorial) chemical response and recovery strategy (ies) that may be adapted and utilized in any incident. Clarify who will govern the strategy.
    • Consider the creation of a compendium of exposure assessment guidelines and benchmarks for exposure level to various chemicals to determine range of needs for intervention/response, including biomarkers and toxicology studies. Determine what level of risks warrant a longitudinal study.
    • Develop compensation guidelines for victims of chemical incidents.
    • Establish scientific research guidelines to allow funding agencies (federal, provincial or territorial) to rapidly assess the scientific and methodological soundness of chemical emergency/disaster research.
  • Financing
    • Consider a central funding source specifically for chemical emergencies/disasters that would support a more rapid initiation of incident response and recovery, and be made available quickly.
    • Identify funds for chemical emergencies/disasters. May require changes at the policy level.
  • Data Management
    • Connect and make available reliable data to a network of partners at all levels, including federal, provincial and territorial decision-makers, regional response teams, military, health resources, etc.
    • Systematically evaluate past chemical incidents. Most databases that contain data related to chemical incidents do not provide information about the efficacy of responses. Periodic reviews of chemical incidents should be done to identify successes, challenges, key gaps, and identify what information researchers/responders need in the event of chemical incidents. Historical research will help to understand the phenomenon.
    • Compile a list of chemical storage facilities and transportation routes using existing information from Environment Canada or Transport Canada. The better our knowledge of the chemicals, storage and transportation, the better we will be able to prepare, respond or recover from an incident.

iii. Plenary Discussion B : Next Steps
Facilitated by Prof. David Russell & Tim Singer, Director, Environmental Health Science and Research Bureau, Health Canada

Prof. Russell and Mr. Singer facilitated the panel discussion which focused on next steps in developing a Canadian environmental health research response framework.

Discussions specifically aimed to answer the following questions:

  • How do we move forward in developing the components of a Canadian environmental health research response?
  • Who should be accountable/responsible for the following?
    • Leadership
    • Coordination
    • Support

Overall, meeting participants agreed that support is needed from the Government of Canada. At this time, Health Canada was identified as the best-suited agency to move this issue forward, possibly adopting a secretariat function. Key stakeholders from across Canada (including those who were not involved in the BBE), and in particular those who have been directly involved in the management of diverse chemical emergencies/disasters should be identified so that a resource or network can be established to facilitate interaction and guide research into environmental emergency response and recovery. An interdisciplinary approach of this nature would systematize what has been done in the past and create a new dynamic for stakeholders to work together and determine what can be done together in the future. Knowledge sharing would be the key objective. 

Moving forward, in addition to forming a resource or network for key stakeholder integration, it was suggested that other action items could include conducting an exercise/workshop similar to the process adopted by the DR2 to involve the emergency management community and create awareness and momentum for integrating research into response.  Another activity proposed was to conduct an environmental scan of studies to identify resources, opportunities and challenges related to enviro health research and chemical emergency/disasters.

Marc Lafontaine was designated as the key point of contact for meeting participants who wish to provide additional feedback and comments on a way forward. A questionnaire will be circulated to all BBE participants following the meeting.

e. Closing Remarks
By Prof. David Russell & Tim Singer

Prof. Russell and Mr. Singer thanked meeting participants for a very fruitful day of presentations and discussions. The Best Brains Exchange meeting was closed at 16:00.

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