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Incident Response:Occupational and Environmental Health
Division of Environmental and Occupational Disease ControlCalifornia Department of Public Health
Celia Golden, MD, [email protected]
Slides created by Rupali Das, MD, MPH
Working Together for All Hazards Readiness
San Joaquin County
August 20, 2008
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Division of Environmental and Occupational Disease Control (DEODC)
Environmental Health Investigation Occupational Health Environmental Health Laboratory Childhood Lead Poisoning Prevention
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What DEODC Provides
Technical advice and expertise in: Assessing chemical exposure
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)
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Occupational Health BranchPromoting 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
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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
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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
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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
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Population Injured in Chemical Incidents
Based on 4,425 victims reported to ATSDR’s HSEES, 1999-2000
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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
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Response Workers are Varied
Law enforcement
EMT, fire fighters
Health care providers
Public health agencies
Cleanup, remediation, construction
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…and so are Hazards
Chemical Thermal Infectious Mechanical Ergonomic Mental stress
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Chemicals Detected at WTC SiteSampled 9/13/01—1/11/02
% above OSHA StandardAcid gases 1.6Asbestos 12.6/0*Carbon monoxide 0.02Metals 5.1Noise 35.6Respirable silica 6.9Total dust 2.8Polynuclear aromatic 7.3 hydrocarbons
Photo: The New Yorker, May 20, 2002
http://www.osha.gov/nyc-disaster/summary.html*Final analysis used TEM
Other substances detected: benzene, dioxin, Freon, mercury
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Injury Pattern Among Rescue Workers at WTC Site
% NYFD workers
24 hrs.N= 240
11 mos.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.
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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-for-gestational- age
Depression, PTSD
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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)
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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
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Metam Sodium Spill Sacramento River, July 1991
Liquid metam + water MITC in air, water
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Cal/EPA data, 1991
Emergency Room Visits
Days 1-4 Nausea 51% Headache 44% Eye irritation 40% Throat irritation 26% Dizziness 23% Vomiting 22% Shortness of breath 21% Chest tightness 16% Abdominal pain 14% Cough 10% Diarrhea 10%
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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.
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Optimizing Public Health Responseto 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
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Optimizing Public Health Responseto 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
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Public Health Response Tools
California Poison Control System Rapid Response Registry Survey Modules
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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
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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
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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
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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
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Alert Clinician NetworkTypes 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
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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
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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
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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
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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_guidance_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
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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