Forensic issues arising in the assessment of chlorine-related deaths in a domestic setting.

A retrospective review of autopsy files at the Forensic Science South Australia, Australia, was undertaken over a 20-year period from January 2000 to December 2019 for all cases where chlorine had caused or contributed to death. Two cases were identified out of a total of 25,121 autopsies (0.008%): a 53-year-old man who committed suicide in a cellar with granulated chlorine, and a 49-year-old woman with asthma who died of acute bronchospasm due to exposure to chlorine gas while mixing swimming pool chemicals in her kitchen. Chlorine-related deaths are uncommon in domestic situations. However, the absence of biomarkers and non-specific findings at autopsy complicate the diagnosis, particularly as environmental levels are not stable. While accidents with cleaning agents or swimming pool reagents are the most common event in the literature in domestic settings (exclusive of industrial or transportation accidents), suicide may also very rarely occur. Individuals with asthma and chronic respiratory diseases are at higher risk of an adverse outcome upon exposure to chlorine gas, with inattention to proper storage conditions and handling protocols being additional risk factors.

Should cities invest in sheltering-in-place measures against chlorine truck attacks by terrorists?

After an intentional release of chlorine in an office district, public responses such as sheltering-in-place could save many lives if rapid enough. However, previous work does not estimate how fast and effective such responses would be for several possible investments in attack detection, public alert, and building ventilation, nor whether such measures would be cost effective. We estimate public response times with investment options in place, and resulting changes in fatalities as well as system costs, including false alarm costs, and cost effectiveness in terms of cost per net death avoided. The measures do have life-saving potential, especially if all response times are at or near the lower limits of the ranges assumed in this article. However, due to uncertainties, it is not clear that responses would be rapid enough to save many people. In some cases total fatalities would increase, since sheltering after chlorine vapor has already entered buildings can increase occupants' chlorine exposure. None of the options considered have median cost per statistical life saved meeting a cost-effectiveness threshold of $6.5 million across all of the chlorine exposure dose-response and ingress-delay models considered here, even if there were one attack per year in the area covered by the system. Given these and other issues discussed in this article, at this point investments to improve sheltering-in-place capability appear not to be robust strategies for reducing fatalities from chlorine attack in an office district.

Rapid assessment of exposure to chlorine released from a train derailment and resulting health impact.

OBJECTIVES: After a train derailment released approximately 60 tons of chlorine from a ruptured tanker car, a multiagency team performed a rapid assessment of the health impact to determine morbidity caused by the chlorine and evaluate the effect of this mass-casualty event on health-care facilities. METHODS: A case was defined as death or illness related to chlorine exposure. Investigators gathered information on exposure, treatment received, and outcome through patient questionnaires and medical record review. An exposure severity rating was assigned to each patient based on description of exposure, distance from derailment, and duration of exposure. A case involving death or hospitalization > or = 3 nights was classified as a severe medical outcome. Logistic regression was used to examine factors associated with severe medical outcomes. RESULTS: Nine people died, 72 were hospitalized in nine hospitals, and 525 were examined as outpatients. Fifty-one people (8%) had a severe medical outcome. Of 263 emergency department visits within 24 hours of the incident, 146 (56%) were in Augusta, Georgia; at least 95 patients arrived at facilities in privately owned vehicles. Patients with moderate-to-extreme exposure were more likely to experience a severe medical outcome (relative risk: 15.2; 95% confidence interval 4.8, 47.8) than those with a lower rating. CONCLUSIONS: The rapid investigation revealed significant morbidity and mortality associated with an accidental release of chlorine gas. Key findings that should be addressed during facility, community, state, and regional mass-casualty planning include self-transport of symptomatic people for medical care and impact on health-care facilities over a wide geographic area.

Survey of construction workers repeatedly exposed to chlorine over a three to six month period in a pulpmill: II. Follow up of affected workers by questionnaire, spirometry, and assessment of bronchial responsiveness 18 to 24 months after exposure ended.

OBJECTIVE: The aim was to determine the prevalence of persistent respiratory symptoms and bronchial hyper-responsiveness due to reactive airways dysfunction syndrome in a population of construction workers at moderate to high risk of developing the syndrome, at an interval of 18 to 24 months after multiple exposures to chlorine gas during renovations to a pulp and paper mill. DESIGN AND PARTICIPANTS: 71 of 289 exposed workers (25%) were identified on the basis of an exposure and the onset of respiratory symptoms shortly after this event (moderate to high risk). A standardised respiratory questionnaire was first presented, followed by spirometry and a methacholine inhalation test on those whose questionnaire suggested the persistence of respiratory symptoms. RESULTS: 64 of 71 (90%) subjects completed the respiratory questionnaire at the time of the follow up. The questionnaire suggested a persistence of respiratory symptoms in 58 of the 64 workers (91%). Of the 58 subjects, 51 underwent spirometry and assessment of bronchial responsiveness. All of them used bronchodilators as required (not regularly) and four required inhaled anti-inflammatory preparations. Sixteen had bronchial obstruction (forced expiratory volume in one second) (FEV1 < 80% predicted) and 29 showed significant bronchial hyper-responsiveness. CONCLUSION: Of the subjects (n = 71) who were at moderate to high risk of developing reactive airways dysfunction syndrome after being exposed to chlorine and were seen 18 to 24 months after exposure ended, 58 (82%) still had respiratory symptoms, 16 (23%) had evidence of bronchial obstruction, and 29 (41%) had bronchial hyper-responsiveness.