Transcript Chemical Terrorism: Public Health Response

Incident Response:
Occupational and Environmental Health
Working Together for All Hazards Readiness
San Joaquin County
August 20, 2008
Division of Environmental and Occupational Disease Control
California Department of Public Health
Celia Golden, MD, MPH
[email protected]
Slides created by Rupali Das, MD, MPH
Division of Environmental and Occupational
Disease Control (DEODC)
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Environmental Health Investigation
Occupational Health
Environmental Health Laboratory
Childhood Lead Poisoning Prevention
What DEODC Provides
 Technical advice and expertise in:
 Assessing chemical exposure
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Exposure levels and anticipated risks
Health investigation and Illness tracking
Laboratory monitoring
Methods to minimize human health effects
 Risk communication and education
 Community
 Workers
 24-hour on call duty officer
 1-800-971-9631 (contact through CDPH duty officer)
Occupational Health Branch
Promoting Healthy Workplaces
 Provides guidance in protecting workers who
respond to biologic and chemical incidents
 Tracks conditions such as work-related asthma
to direct prevention efforts at high-risk jobs
 Investigates selected work-related illness
incidents
 Promotes alternatives that are safe for human
and environmental health
Environmental Health Investigations Branch
Protecting the Health of Californians
 Assesses the association between health
and the environment
 Collaborates with communities to address
environmental health concerns
 Collaborates with other agencies, states
to share preparedness knowledge
 Interstate Chemical Terrorism Workgroup
The Role of Public Health
following a chemical incident
 Identify the agent or cause based on
 Clinical presentation
 Lab analysis of
 environmental samples or
 biological specimens
 Determine temporal and geographical
distribution of exposure
 Determine relative (high/low) exposures
The Role of Public Health
following a chemical incident (cont.)
 Predict expected health outcomes
 Based on agent, exposure dose
 Provide advice for treatment and
evaluation, immediate and long-term
 Provide epidemiologic follow-up to
document long-term effects
 Prevent further adverse effects
Population Injured in
Chemical Incidents
General
Public
Students
First
Responder
Vol.
firefighter
Police
Prof.
firefighter
Workers
Based on 4,425 victims reported to ATSDR’s HSEES, 1999-2000
EMT
Workers Inadequately Prepared
 Firefighters feel
prepared but may not
be aware of chronic
health effects
 Patrol officers feel least
prepared even though
they may be first to
arrive the scene of an
incident
Response Workers are Varied
 Law enforcement
 EMT, fire fighters
 Health care providers
 Public health agencies
 Cleanup, remediation,
construction
…and so are Hazards
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Chemical
Thermal
Infectious
Mechanical
Ergonomic
Mental stress
Chemicals Detected at WTC Site
Sampled 9/13/01—1/11/02
% above OSHA Standard
Acid gases
1.6
Asbestos
12.6/0*
Carbon monoxide
0.02
Metals
5.1
Noise
35.6
Respirable silica
6.9
Total dust
2.8
Polynuclear aromatic
7.3
hydrocarbons
Other substances detected: benzene,
dioxin, Freon, mercury
Photo: The New Yorker, May 20, 2002
*Final analysis used TEM
http://www.osha.gov/nyc-disaster/summary.html
Injury Pattern Among Rescue
Workers at WTC Site
% NYFD workers
24 hrs.
11 mos.
N= 240
N= 10,116
Respiratory†
25.7
18.5
Trauma
38.1
Eye
10.4
Systemic
31.3
Psychological 3.3
12.6
† During first 2 weeks at WTC site, 19% of firefighters reported not using a
respirator; 50% reported using a respirator but only rarely.
MMWR September 11, 2002; 51:1-20.
Long-term Effects of WTC incident
 NYFD 1-year follow-up
 Decreased lung function equal to 12 years of
aging-related decline
 Increased symptoms of cough, wheeze,
airway reactivity in response workers,
residents
 2-fold increase in infants small-forgestational- age
 Depression, PTSD
Sulfuric Acid Release
 Tank car valve
rupture during illegal
unloading
 8 tons “oleum”*
released over 4 hours
 15-mile long plume
 Affected community-population 110,000
*Oleum= sulfur trioxide (SO3) or
(concentrated sulfuric acid H2SO4)
Sulfuric Acid Release
Health Outcomes
 22,000 total visits to clinics
and emergency rooms
 5000 visits on first day
 95% “worried well”
 <5% seen by physician
 90% respiratory
 10% GI
 <1% eye
Richmond CA, 1991
Metam Sodium Spill
Sacramento River, July 1991
Liquid metam + water  MITC in air, water
Emergency Room Visits
Days 1-4
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Cal/EPA data, 1991
Nausea
Headache
Eye irritation
Throat irritation
Dizziness
Vomiting
Shortness of breath
Chest tightness
Abdominal pain
Cough
Diarrhea
51%
44%
40%
26%
23%
22%
21%
16%
14%
10%
10%
Persistent Health Effects
 9 months after the
spill, of 197 residents
 10 had worsening of
pre-existing asthma
 20 had new onset
asthma
 Reactive Airways
Dysfunction Syndrome
Cone J et al. Chest. 1994; 106:500-508.
Optimizing Public Health Response
to Chemical Incidents: Workers
 Anticipate work-specific hazards and
potential emergency response actions
 Establish worker health and safety
protocols
 Illness and Injury Prevention Programs*
 Train workers through exercises
 Establish communication
*Title 8 Sec 3203
Optimizing Public Health Response
to Chemical Incidents: Community
 Establish criteria for determining illness
 Anticipate large numbers of “worried well”
 Collect biologic and environmental
samples early in the incident
 Recognize potential for prolonged effects
 Encourage community and personal
emergency preparedness plans
Public Health Response Tools
 California Poison Control System
 Rapid Response Registry
 Survey Modules
Illness after eating watermelon
Public Health Response
 Aldicarb highly toxic, unregistered pesticide
 Poison Control Centers helped to notify
physicians through Emergency Departments
 Watermelons embargoed statewide,
destroyed
 1000 probable pesticide illness reports
 In 8 other states, 2 Canadian provinces
 Integrated food surveillance program now
operational
Goldman. Pesticide food poisoning from contaminated watermelons in California, 1985.
ARCHIVES OF ENVIRONMENTAL HEALTH, July-August, 1990
Public Health Response Tools
California Poison Control System
 Calls routed to 4 hotlines
 UC Davis Medical Center
(Sacramento)
 San Francisco General Hospital
(San Francisco)
 Children's Hospital Central CA
(Fresno/Madera)
 UC San Diego Medical Center
(San Diego)
http://www.calpoison.org/
1-800-222-1222
How can Poison Control Centers
Serve Public Health Today?
 Provide individual
treatment advice
 Tracking illness patterns
to identify surreptitious
incidents before they
become large scale
emergencies
Alert Clinician Network
 Guidelines for staff to identify a
potentially serious public health incident
from thousands of calls
 Suspicious cases tagged
 Low– no action
 High– notification of CDPH, follow-up
Alert Clinician Network
Types of Cases
 Food contamination, deliberate/accidental
 Contaminated lot of commercial product
applied to skin or sprayed in air
 Adverse reaction to new product
 Environmental contamination of building,
public area, transportation system
Public Health Response Tools
Rapid Response Registry
 Tool to track individuals
during incidents
 Developed during Katrina
response by ATSDR
 2-page survey form
 Will be accessible on
CAHAN during incident
Public Health Response Tools
Survey Modules
 Tools for health effects follow-up studies
 Environmental exposure module
 Occupational module
 Lab specimen information
 Data collection
 Local
 Data entry, analysis
 State/Local
Conclusion
 Workers likely to be involved in every incident:
varied hazards, injuries
 Employers are required to consider potential
hazards & prevention methods
 Public health agencies investigate causes of
illness, provide treatment & follow-up advice
 Cooperation essential
 inter-agency, inter-jurisdictional
 Tools for occupational and environmental
evaluation are available
Tools for Worker Health & Safety
 Guide to Developing your Workplace Injury
and Illness Prevention Program
 http://www.dir.ca.gov/dosh/dosh_publications/iipp.html
 OSHA avian flu guidelines
 http://www.osha.gov/OshDoc/data_AvianFlu/avian_flu_guidan
ce_english.pdf
 Incident response worker health and safety
 http://www.osha.gov/SLTC/emergencypreparedness/nrp_work
_sh_annex.html
 Hazwoper regulations
 www.dir.ca.gov/Title8/5192.html
Worker Protection for Avian Flu
Cal/OSHA Interim Guidelines
 Minimum recommendations for workers
who may be exposed to birds with
zoonotic avian influenza
 Varies by activity and exposure risk
 Respiratory, Eye, Hand protection
 Disposable coveralls
 Boots
http://www.dir.ca.gov/dosh/doshreg/AIPPE_matrix_DoshReg.pdf