Maureen F. Orr

ELEVATED BIRTH DEFECTS IN RACIAL OR ETHNIC MINORITY CHILDREN OF WOMEN LIVING NEAR HAZARDOUS WASTE SITES

This case-control study evaluated the relationship between birth defects in racial or ethnic minority children born during 1983-1988 and the potential exposure of their mothers to contaminants at hazardous waste sites in California. Four categories of race or ethnicity were used: black/African American, Hispanic/Latino, American Indian/Alaska Native, and Asian/Pacific Islander. Case subjects were 13,938 minority infants with major structural birth defects (identified by the California Birth Defects Monitoring Program) whose mothers resided in selected counties at the time of delivery. The control group was composed of 14,463 minority infants without birth defects who were randomly selected from the same birth cohort as the case subjects. The potential for exposure was determined by whether the mother resided at the time of delivery in the same census tract as a hazardous waste site that was on the U.S. Environmental Protection Agencys National Priorities List (NPL). Racial/ethnic minority infants whose mothers had been potentially exposed to hazardous waste were at slightly increased risk for birth defects (odds ratio [OR] = 1.12, 95% confidence interval [CI] = 0.98-1.27) than were racial/ethnic minority infants whose mothers had not been potentially exposed. The greatest association was between potential exposure and neural tube defects (OR = 1.54, 95% CI = 0.93-2.55), particularly anencephaly (OR = 1.85, 95% CI = 0.91-3.75). The strongest association between birth defects and potential exposure was among American Indians/Alaska Natives (OR = 1.19, 95% CI = 0.62-2.27). Despite the limitations of this study, the consistency of these findings with previous studies suggests an association between environmental risk factors and birth defects. This is particularly relevant to minority populations. We recommend further investigation of birth defects among minority communities, particularly among American Indians/Alaska Natives. Special attention should also be paid to those defects and contaminants that consistently are associated with exposure to hazardous waste.

Acute public health consequences associated with hazardous substances released during transit, 1993-2000.

Massive quantities of hazardous substances are transported each day throughout the United States. While most arrive safely at their destination, uncontrolled releases of substances in transit do occur and have the potential of causing acute public health consequences for those individuals at or near the release. Data from 16 state health departments participating in the Agency for Toxic Substances and Disease Registrys (ATSDR) Hazardous Substances Emergency Events Surveillance (HSEES) system were analyzed to determine the public health consequences that occurred from actual releases in transit. Of the 9392 transportation events analyzed, 9.1% resulted in 2008 victims, including 115 deaths. The population groups injured most often were employees and the general public. The most common injury sustained was respiratory irritation. Evacuations were ordered in 5.5% of events effecting at least 63,686 people. Human error and equipment failure were the most common factors leading to events. These findings underscore the importance of job safety training, community planning, and effective emergency response to prevent adverse public health consequences from occurring or lessen their effect on the public.

Secondary Contamination of Medical Personnel, Equipment, and Facilities Resulting From Hazardous Materials Events, 2003–2006

BACKGROUND When not managed properly, a hazardous material event can quickly extend beyond the boundaries of the initial release, creating the potential for secondary contamination of medical personnel, equipment, and facilities. Secondary contamination generally occurs when primary victims are not decontaminated or are inadequately decontaminated before receiving medical attention. This article examines the secondary contamination events reported to the Agency for Toxic Substances and Disease Registry (ATSDR) and offers suggestions for preventing such events. METHODS Data from the ATSDR Hazardous Substances Emergency Events Surveillance system were used to conduct a retrospective analysis of hazardous material events occurring in 17 states during 2003 through 2006 involving secondary contamination of medical personnel, equipment, and facilities. RESULTS Fifteen (0.05%) Hazardous Substances Emergency Events Surveillance events were identified in which secondary contamination occurred. At least 17 medical personnel were injured as a result of secondary contamination while they were treating contaminated victims. Of the medical personnel injured, 12 were emergency medical technicians and 5 were hospital personnel. Respiratory irritation was the most common injury sustained. CONCLUSIONS Adequate preplanning and drills, proper decontamination procedures, good field-to-hospital communication, appropriate use of personal protective equipment, and effective training can help prevent injuries of medical personnel and contamination of transport vehicles and medical facilities.

Public health risks of railroad hazardous substance emergency events.

The number of railroad events reported to the Agency for Toxic Substances and Disease Registry’s Hazardous Substances Emergency Events Surveillance system increased from 84 in 1993 to 177 in 1998. Comparisons of data on railroad and non-railroad events were made. The results overall indicated a greater potential impact of railroad events on public health. A median number of 2039 persons were living within a 1-mile radius of railroad events versus 982 for non-railroad events. The percentage of events during times when people are more likely to be home was also greater for railroad events. Railroad event victims were more likely to need hospital treatment than non-railroad event victims, which suggested the need for better community planning, reevaluation of current federal regulations and priorities for railroad hazardous material transport, and enhanced railroad industry commitment to safety.

Frequency and Type of Injuries in Responders of Hazardous Substances Emergency Events, 1996 to 1998

This analysis describes the frequency and type of injuries among responders to hazardous materials releases. Data were analyzed from states that participated in the Hazardous Substances Emergency Events Surveillance system maintained by the Agency for Toxic Substances and Disease Registry from 1996 through 1998. A total of 348 responders were injured in 126 (0.7%) of 16,986 reported events. Firefighters and police officers were most often injured. Respiratory irritation and nausea were the most commonly reported injuries, and no injuries resulted in death. Almost half of the responder victims wore firefighter turn-out gear, and about a third had received hazardous materials training. Chemicals frequently released during these events were in the category “other substances not otherwise specified” and “acids.” Training, education, planning, and coordination are needed to effectively respond to hazardous substances emergency events.

Hazardous substances events associated with the manufacturing of chemicals and allied products.

This report describes events involving the acute release of hazardous substances reported to the Hazardous Substances Emergency Events Surveillance (HSEES) system for 1993-2000. HSEES, maintained by the Agency for Toxic Substances and Disease Registry (ATSDR), collects data on the industries/services associated with events. This analysis focuses on fixed-facility events that occurred during the manufacturing of chemicals and allied products (i.e. categorized according to the 1990 Industrial Classification System (ICS) of the US Bureau of the Census). This is the most frequently reported industry category in the surveillance system, with over 12000 events (28% of all events and 35% of fixed-facility events). Further classification found that the majority (71%) of these events involved the manufacturing of industrial and miscellaneous chemicals (ICS code 192), and 21% plastics, synthetics, and resins (ICS code 180). A total of 2676 persons reported injuries in 307 fixed-facility events. Most of the injured persons were employees (42%), followed by the general public (38%), students (15%), and responders (5%). Thirty-five percent of all injured persons and 46% of all injured employees had respiratory symptoms. Releases frequently occurred in processing vessels, and the majority was due to equipment failure. A review of the data indicates that manufacturers of chemicals and allied products could help reduce morbidity and mortality by taking preventive actions such as performing regular maintenance of processing equipment, regular training of employees and encouraging them to wear respiratory protection, and educating the public on what to do in the event of a release from these facilities.

Hazardous substances emergency events in the agriculture industry and related services in four mid-western states.

Learning ObjectivesRecognize the seasonality and farming-related factors connected with uncontrolled release of hazardous substances in the agricultural setting.Recall the commonest agricultural threats and their clinical sequelae.Describe what protective measures presently are in common use, and those that could limit the injurious effects of exposure to hazardous agricultural substances. Analysis of Hazardous Substances Emergency Events Surveillance data reported from 14 participating states between 1993 and 1998 found that acute releases are seasonal. This seasonality was more prevalent in four Midwestern states during April–June and coincided with their planting season, suggesting an association of these releases with the agricultural industry. A more detailed analysis of events related to this industry in these states found that ammonia was the chemical most frequently released, and ammonia related events resulted in a significantly higher number of evacuations than all other events (OR = 10.7, [5.25–22.28]). A logistic regression model to identify risk factors for an event with victims found an increased risk for: (1) events with ammonia during April–June (adjusted OR = 3.57, [2.09–6.09]); (2) events in fixed-facilities during April–June (aOR = 3.74, [2.01–6.95]); and (3) events with multiple substances (aOR = 2.33, [1.05–5.17]). The most common causes for the events were equipment failure and operator error. Resulting injuries were mainly respiratory, ocular and traumatic, and included six deaths. Employing more stringent safety measures and educating employees and the public about the health hazards involved with agricultural chemicals may reduce injuries and help contain costs associated with the releases.

Challenges During a Chlorine Gas Emergency Response.

OBJECTIVE A chlorine gas release occurred at a poultry processing plant as a result of an accidental mixing of sodium hypochlorite and an acidic antimicrobial treatment. We evaluated the public health and emergency medical services response and developed and disseminated public health recommendations to limit the impact of future incidents. METHODS We conducted key informant interviews with the state health department; local fire, emergency medical services, and police departments; county emergency management; and representatives from area hospitals to understand the response mechanisms employed for this incident. RESULTS After being exposed to an estimated 40-pound chlorine gas release, 170 workers were triaged on the scene and sent to 5 area hospitals. Each hospital redistributed staff or called in extra staff (eg, physicians, nurses, and respiratory therapists) in response to the event. Interviews with hospital staff emphasized the need for improved communication with responders at the scene of a chemical incident. CONCLUSIONS While responding, hospitals handled the patient surge without outside assistance because of effective planning, training, and drilling. The investigation highlighted that greater interagency communication can play an important role in ensuring that chemical incident patients are managed and treated in a timely manner. (Disaster Med Public Health Preparedness. 2016;10:553-556).

State Programs to Reduce Uncontrolled Ammonia Releases and Associated Injury Using the Hazardous Substances Emergency Events Surveillance System

Objective: To describe how the Hazardous Substances Emergency Events Surveillance (HSEES) program identifies leading causes of uncontrolled ammonia releases and targets activities aimed at reducing the frequency of these incidents. Methods: Ammonia incidents reported to HSEES nationally were examined. HSEES programs in state health departments conducted and evaluated data-driven prevention outreach. Results: The primary targeted ammonia incidents in the three HSEES states that are presented include food manufacturing, agriculture, and events related to the production of illicit methamphetamine. Key to these prevention activities was using state-specific HSEES data to identify problems and evaluate the prevention activity, and developing partnerships with other stakeholders. Conclusion: HSEES data is used to identify determinants of chemical incidents and their outcomes and to help guide strategies to reduce such occurrences. Surveillance of chemical incidents elucidates the causes and consequences of these events and helps identify problems and measure the effectiveness of prevention programs.

Threat of Secondary Chemical Contamination of Emergency Departments and Personnel: An Uncommon but Recurrent Problem.

OBJECTIVE To analyze acute hazardous substance release surveillance data for events involving secondary contamination of hospital emergency departments (EDs). Secondary contamination of EDs may occur when a patient exposed to a hazardous chemical is not decontaminated before arrival at the ED and when ED staff are not wearing appropriate personal protective equipment. This can result in adverse health outcomes among department personnel, other patients, and visitors. Even events without actual secondary contamination risk can be real in their consequences and require the decontamination of the ED or its occupants, evacuation, or temporary shutdown of the ED. METHODS Events involving secondary contamination were identified by using the Hazardous Substances Emergency Events Surveillance system and the National Toxic Substance Incidents Program from 2007 to 2013. RESULTS Five incidents involving the threat of secondary contamination (0.02% of all events reported to the surveillance systems [n=33,001]) were detected and are described. Four incidents involved suspected secondary contamination in which the facility was evacuated or shut down. CONCLUSIONS These results suggest that although rare, incidents involving secondary contamination continue to present a hazard for emergency departments. Suggested best practices to avoid secondary contamination have been described. Hospitals should be made aware of the risks associated with secondary contamination and the need to proactively train and equip staff to perform decontamination.