Welcome to the CLU-IN Internet Seminar

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Welcome to the CLU-IN Internet Seminar

OSC Readiness Presents...Increasing the Use of Poison Centers for Public Health Surveillance and Response: A CDC and ATSDR

PerspectiveSponsored by: EPA Office of Superfund Remediation and Technology

InnovationDelivered: August 23, 2012, 1:00 PM - 3:00 PM, EDT (17:00-19:00

GMT)

Instructors: Royal Law, CDC National Center for Environmental Health ([email protected])

Patrick Young, Agency for Toxic Substances Disease Registry (ATSDR) ([email protected])Moderator:

Jean Balent, U.S. EPA, Technology Innovation and Field Services Division ([email protected]) Visit the Clean Up Information Network online at www.cluin.org

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CAPT Patrick Young, M.S, RS US Public Health Service

ATSDR Region 6Dallas, TX

August 23, 2012 – EPA Webinar

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CDR Patrick Young is an employee of the Agency for Toxic Substances Disease Registry (ATSDR) working with the United States Environmental Protection Agency (U.S. EPA) in Region 6. This presentation has not been formally disseminated by the Agency for Toxic Substances and Disease Registry and should not be construed to represent any agency determination or policy. The information provided herein is the opinion of the author and does not represent the opinions or policy of the ATSDR or U.S. EPA.

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Department of Health and Human Services (DHHS)

Centers for Disease Control (CDC)

National Center for Environmental Health (NCEH)/Agency for Toxic Substances and

Disease Registry (ATSDR) 1980

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Assist in site specific investigations and follow up actions (EPA Superfund Sites, ATSDR Health Consultation & Petitioned Public Health Assessment)

Consult on environmental health issues Triage agency health

response Enhance state and

local health capacity

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1-800-222-1222

10 Centers in Region 66 Centers in Texas operate as

network.1 number to call. Also linked

directly to 911

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What is it all about?

Inclusion-Being invited to the dance!

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e-CFR Data is current as of June 7, 2012

TITLE 40--Protection of EnvironmentCHAPTER I--ENVIRONMENTAL PROTECTION AGENCYSUBCHAPTER J--SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMSPART 300--NATIONAL OIL AND HAZARDOUS SUBSTANCES POLLUTION CONTINGENCY PLAN

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?sid=45dd17cd4898fd9d679a689f18abbf7f&c=ecfr&tpl=/

ecfrbrowse/Title40/40cfrv28_02.tpl

Establishes the RRT/JRT

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RRT6 Members

Eagle Pass Disaster Drill September 21, 2006Bi-National HAZMAT

Exercise

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51015202530354045

# o

f C

alls

NTPC TPPC WTPC CTPC SETPC STPC

Center

Call Distribution by Center

Call Distribution by CenterNorth Texas PC 19Texas Panhandle PC 19West Texas PC 15Central Texas PC 42South East TPC 18South Texas PC 24Total 137

•All calls originated from Eagle Pass, TX•English and Spanish Callers

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1. Local responder/resident initial call to Poison Center: 7:50 A.M.

2. Poison Center notification to activate network: 7:52

3. Poison Center report to State and ATSDR: 8:004. Continue local calls to Poison Center Network:

8:00 – 9:005. Network communications: 9:00 – 10:006. Poison Center call to update EPA OSC: 10:00

0730 10300830 0930

Initial call

Network activatedPC notified Regional

ATSDR and State agencies

PC final update to EPA OSC

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PCC -Activation Protocol Region 6 Example

Industry HAZMAT

Event 1st

24/hrs

Industry

Notification NRC

State/Local Response

DEQ

EPA

R6

EPA or Coast Guard OSC

ATSDR R6

CDC EOC

Public

RRT

State

Health

NotificationU.S. Coast Guard &

EPA + Members

Activation

ATSDR – Agency for Toxic Substances and Disease Registry

NCEH – National Center for Environmental Health

CDC – Centers for Disease Control and Prevention

NRC – National Response Center – EPA/U.S. Coast Guard Headqrts

FOSC – Federal On-Scene Coordinator

RRT- Regional Response Team

DEQ – Department of Environmental Quality

R6 – Region 6

New Response Relationships

CDC/NCEH 24/7 Data Surveillance

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Outcome Measurements: Very first exercise involving the Texas Poison Center Network along US/Mexico Border. Involved all 6 Centers in Texas working together.•New connectivity between Environmental Regulatory Agencies (State DEQs and US EPA) and Poison Control Centers. Increased communication between EPA Federal On-Scene Coordinators (OSCs) to enhance sharing environmental sampling data in disasters. Request by RRT6 to develop interim guidance on activating PCC’s to support the RRT (16 Federal Agencies) Creation of the RRT6 Activation Guidance Document for Poison Control

Health Impacts: Access to free healthcare 24/7 through the 1-800-222-1222. Improved public health response through sharing of critical environmental data so PCC can faster assist technical medical response activities. HAZMAT incident - reduces hospital surge by treating patient at home if environmental data is available. Increased consultation with ATSDR Regional Office. Increased ability to address and treat occupational exposures. Improved data quality with state and national surveillance.

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CAPT Patrick YoungUS Public Health Service

ATSDR Regional Rep.Dallas, TX

[email protected]

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Use of the National Poison Data System (NPDS) for National Public

Health Chemical Exposure and Illness Surveillance

Royal Law, MPH

Health Studies BranchDivision of Environmental Hazards and Health Effects

National Center for Environmental Health Centers for Disease Control and Prevention (CDC)

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Poison Centers (PCs)

• National toll-free number available 24/7• Specialists in poison information (SPIs) include

trained toxicologists, nurses and pharmacists• Give information to public and clinicians • Provide exposure/case management• Collect and code call data using standard

protocols• Data entered into regional PC server as

caller provides it

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National Poison Data System (NPDS)• Web-based surveillance

system for calls to 57 Poison Centers

• Near real-time system, with calls uploaded every 24 minutes*

• Owned and operated by the American Association of Poison Control Centers

• CDC funds maintenance, system upgrades, and toxicosurveillance staff

*Bronstein A.C., Spyker D.A., Cantilena L.R., Green J.L., Rumack B.H., Giffin S.L. 2008 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 26th Annual Report. Clinical Toxicology 2009; 47:911-1084.

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NPDS Surveillance Goals

• Improve public health surveillance for chemical, poison and other hazardous exposures and associated illness

• Identify and characterize hazardous exposure events to enable a rapid and appropriate public health response

• Track potential cases and provide situational awareness

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NPDS Data Elements

• Caller zip code, state• Species• Age• Sex• Call date/time• PC managing call• Call type (exposure,

information)• Reason for call• Caller site

• Management • Treatment• Decontamination• Medical outcome

• Exposure substance and quantity

• Exposure route• Exposure site• Clinical effects

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NPDS Data Flow

General PublicHealth Professionals &

Hospitals

RegionalPoison Center

NPDS

Data Source

NPDS User

Key:

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NPDS Data Flow

General PublicHealth Professionals &

Hospitals

RegionalPoison Center

NPDS

Regional Poison Center

State and Local Health Departments

Data Source

NPDS User

Key:

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NPDS Data Flow

General PublicHealth Professionals &

Hospitals

RegionalPoison Center

NPDS

Regional Poison Center

State and Local Health Departments

AAPCC Toxicosurveillance

Team

CDC

Data Source

NPDS User

Key:

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NPDS Functionality

• Automated surveillance definitions• Anomalies in call volume • Anomalies in number of symptoms reported• Case definitions

• Email alerts

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Anomaly Characterization

• AAPCC and CDC staff evaluate anomalies for public health significance (PHS)

• Regional PCs contacted as required for additional information

• Confirmed public health issues communicated to state departments of health

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Use of NPDS for Public Health Emergencies

• Engage individual PCs• Assist with surge capacity and triage calls• Code calls appropriately

• Conduct national surveillance • Identify potential cases• Track temporal and spatial distribution• Characterize illness symptoms and

severity• Report potential cases to state HD

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Example Emergency Response: Deepwater Horizon Oil Spill

• 4/20/10 explosion occurred on Deepwater Horizon• CDC used NPDS to track reported exposures

• Track oil spill related calls• Track exposure to dispersants, seafood

contamination• Provided daily reports to CDC Emergency

Operations Center • State-specific data sent to the states daily

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Japan Earthquake and Radiological

Incident

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CDC Response

• Tracking reported ingestions of countermeasures and perceived risk from radiation

• Identifying health communication needs • Potassium Iodide (KI)• Other iodide-containing products• Radiation

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Characteristics of Confirmed Exposures

• Potassium Iodide – 24 exposures• No overdoses• Little to no adverse drug reactions

• Other Iodide products – 10 exposures• Kelp• Iodine-containing salt• ‘Rabano Yodado’

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Community of Practice: Poison Center and Public Health Collaborations for

Surveillance• The need for increased collaboration

between local, state and federal public officials and regional poison centers • Objective: bolster collaboration through sharing

best practices, information exchanging and networking across jurisdictions

• Webinars, in-person meetings and web-based forum

• Over 200 members

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phConnect.org

• A web-based Community of Practice forum enables posting of documents and exchange of information across jurisdictions

• Over 80 members are enrolled

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Thank you!

Royal Law [email protected]

770-488-3416

Josh [email protected]

770-488-3401

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