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Case study: Enschede fireworks disaster: lessons learned.

Kamp, I. van, Velden, P. van der, Yzermans, J. Case study: Enschede fireworks disaster: lessons learned. In: R. Duarte-Davidson, T.Gaulton, S. Wyke, S. Collins (Eds). Chemical health threats: assessing and alerting, chapter 3, Londen: Royal Society of Chemitry: 2019. p. 283-289.
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Background
Shortly after the fireworks disaster, in the afternoon of the 13th of May 2000, the Netherlands Institute for Public Health and the Environment (RIVM) measured concentrations of substances in the air and soil. Using health-based guidelines, it was concluded that negative health effects due to exposure were highly unlikely, except for short term irritation of the airways. Learning from the troublesome aftermath of the Bijlmermeer plane crash in 1992, the Dutch Government decided to start the following three activities immediately after the disaster: (1) provision of an Information and Advice Centre (2) psychosocial aftercare for residents and workers, (3) health monitoring by longitudinal surveys and use of electronic medical records of general practitioners from residents, rescue workers and a control group.

Method
Over a period of ten years the questionnaire surveys were carried out in four waves. Outcomes and lessons learned are summarized in this chapter.

Conclusions
The early measurement of concentrations of substances in the air and soil, as well as blood and urine tests to exclude exposure to toxic substances at levels with potential hazards to health were among the important activities that might have prevented unnecessary worry and speculation in the media after the Enschede firework disaster. Physical symptoms and diagnosis were strongly intertwined with psychological problems and disorders. Physical symptoms were often medically unexplained (e.g. tiredness and fatigue, pain in neck and shoulders). Most of these symptoms were presented to the general practitioner. Finally, help-seeking behaviour indicates that the mental health policy after the Enschede disaster facilitated recovery.