The price of industrial progress is the potential for exposure of an increasingly informed public to chemical hazards in the environment. Of particular concern are acute exposures to chemical incidents, where problematic health risk assessments have highlighted the lack of expertise and resources available to support public health professionals in Wales responsible for protecting the health of populations. A systematic literature review of chemical incident databases, public health surveillance systems and major chemical incidents worldwide was used to guide the development of the first active, multi-agency community-based public health surveillance system for acute chemical incidents to be undertaken in Europe. A total of 642 acute chemical incidents were reported in Wales from all sources over a three year period. Of the 270 incidents reported by the primary source, chemical spills were the most frequently reported type of incident (28%) and operational industrial sites the most common location (25%). Of the estimated 238,000 people exposed, 528 reported symptoms in a total of 57 incidents. A single chemical was implicated in 86% of the incidents. Shortfalls were identified in the current expertise and resources available to public health professionals in Wales, leading to the development of a public health management model for acute chemical incidents. Model development took place in the context of United Kingdom - wide initiatives and involved the conduct of structured interviews with 41 organisations with interests in the field. The model selected for Wales was implemented on 1 February 1997 and comprised three levels of operation: (a) accountability for the protection of public health vested in health authorities at the local level; (b) a subscription-based front-line advisory and support unit to those authorities; (c) and a centrally funded national co-ordinating centre to provide the necessary evidence-base through programmes of surveillance, training, and emergency planning.

The significant rise of both chronic diseases and disasters in the last 20 years and the healthcare outcomes of individuals with chronic diseases during and in the aftermath of disasters have raised concerns among public health practitioners, healthcare providers, the U.S government, and the general public. Researchers have indicated that during disasters, the health outcomes of individuals with chronic diseases are significantly unfavorable compared to the general public. However, there is inadequate information on the management of chronic diseases, quality of care, and resource identification and allocation by disaster responders. This qualitative, grounded theory study, explored how the study participants addressed chronic disease needs during and after disasters. A total of 15 adult disaster relief responders who had been involved in disaster planning, response, or care management of individuals with chronic diseases, were recruited through snowballing, public/bulleting postings, and social media. Using the ecological model of disaster management allowed the identification of individual and societal influences that hinder disaster preparedness and chronic disease management. Data collection consisted of semistructured in-depth open-ended interview questions, allowing participants to share their lived experiences. Data were analyzed through open, axial, and selective coding and managed using the Atlas ti8 software. The findings supported the ecological model of disaster management and strategies such as the use of special needs shelters during impending disasters. Such strategies could enhance disaster preparedness and planning efforts and potentially improve health outcomes during and after disasters.