1 4Practical Chemical Response Tools for LPHD

Practical Chemical Response Tools for Local Health Departments: 

Practical Chemical Response Tools for Local Health Departments WPHA/WALHDAB Annual Public Health Conference May 23, 2007 Appleton, WI Jim Morrison, MS, CIH, CHMM WI DPH Chm. Preparedness Coord.

Outline: 

Outline Why respond to chemical exposures? Describe resources available to facilitate response Highlight commonly encountered chemical exposures

Environmental assessment (responding to chm exposures) is an important element of:: 

Environmental assessment (responding to chm exposures) is an important element of: Essential Public Health Services; State Health Plan; and Preparedness Objectives

Essential Public Health Service No. 2: 

Essential Public Health Service No. 2 “Identify, investigate, control, and prevent health problems and environmental health hazards in the community.”

2010 Implementation Plan EOH Objectives: 

2010 Implementation Plan EOH Objectives Chemical and Biologic Contaminants in the Home “By 2010, increase the capacity of local health departments to address environmental health issues in the home.” Environmental Health Indicators for Air, Land, and Water “By 2010, enhance the quality of life in Wisconsin through improvements in environmental health indicators for air, land, and water.”

Preparedness Objectives: 

Preparedness Objectives “Decrease the time needed to issue interim guidance on risk and protective actions by monitoring air, water, food, and soil quality, vector control, and environmental decontamination, in conjunction with response partners.” “Through partners increase the capability to monitor movement of releases and formulate public health response and interventions based on dispersion and characteristics over time.”

Preparedness:Chemical vs. Biological Risk: 

Preparedness: Chemical vs. Biological Risk Per Gary Ackerman, Monterey Institute for International Studies, 2003: >1,000 biological threats vs. 328 chemical threats Subtracting hoaxes, 83 biological threats vs. 277 chemical Actual use: 164 chemical vs. 39 biological >5 fatalities: 0 biological vs. 12 chemical 953 total chemical fatalities vs. 8 biological

HSEES Experience: 

HSEES Experience 2005: 346 Events, 39 victims, 2,143 Evacuees 1993-2005: 5,474 Events, 1,375 Victims, 45,245 Evacuees Ammonia, Corrosive NOS and Hydrochloric Acid most common

Practical Aspects of Preparedness: 

Practical Aspects of Preparedness While we ought to prepare for terrorist or catastrophic releases, we routinely respond to or are confronted with chemical exposure challenges requiring much of the same fundamental response principles.

Exposure Investigation Fundamentals: 

Exposure Investigation Fundamentals Identify, Evaluate and Control Exposure Pathway

Exposure Pathway: 

Exposure Pathway

Assessment Resources Are Now Much More Accessible: 

Assessment Resources Are Now Much More Accessible Information access through the Web Technological advances in equipment SLH partnership

Information Resources: 

Information Resources Exposure Guidance Chemical Safety Outreach and Fact Sheets

Exposure Guidance: 

Exposure Guidance Many sources of exposure guidance are available online Care needs to be exercised in selecting appropriate values Note that occupational exposure is different than community exposure

Why Is Community Exposure Different?: 

Why Is Community Exposure Different? Population is different: young and old, healthy and unhealthy Young have developing organ systems and have physical ratios that subject them to proportionately greater exposure Exposure can be continuous, 24 hours a day, 7 days a week Breathing zone locations vary Behaviors vary

Exposure Guideline “Hierarchy”: 

Exposure Guideline “Hierarchy” Degree of risk tolerance AEGL’s/IDLH PELs TLVs MRLs RBCs Risk Tolerance Hazmat/ Evacuation Occupational/ Commercial Residential/ Community

Mercury for Example-: 

Mercury for Example-

Chemical Safety Info.: 

Chemical Safety Info. WISER http://wiser.nlm.nih.gov/ Toxnet http://toxnet.nlm.nih.gov/ NA ERG http://hazmat.dot.gov/pubs/erg/gydebook.htm MSDS http://hazard.com/msds/

WISER: 

WISER National Library of Medicine system to assist first responders in hazardous material incidents. Wide range of information including substance identification support, physical characteristics, human health information, and containment and suppression advice. Web or PDA based

TOXNET: 

TOXNET Databases on toxicology, hazardous chemicals, environmental health, and toxic releases from the National Library of Medicine

NA ERG: 

NA ERG Guide for first responders to: (1) quickly identify the material(s) involved in the incident, and (2) protect themselves and the general public during the initial response phase of the incident.

Material Safety Data Sheets: 

Material Safety Data Sheets Chemical manufacturers and importers are required to evaluate the hazards of the chemicals they produce or import, and prepare labels and material safety data sheets (MSDSs) to convey the hazard information to their downstream customers. Care must be exercised. They vary in quality.

Fact Sheets: 

Fact Sheets Carbon Monoxide http://dhfs.wisconsin.gov/eh/ChemFS/fs/CO.htm http://www.nlm.nih.gov/medlineplus/carbonmonoxidepoisoning.html Mercury http://dhfs.wisconsin.gov/eh/mercury/ http://www.epa.state.oh.us/opp/mercury_pbt/mercury.pdf OWBs http://dhfs.wisconsin.gov/eh/HlthHaz/pdf/waterstoves.pdf http://www.epa.gov/woodheaters/

Equipment Available to Local/Tribal Health: Loan Program Overview: 

Equipment Available to Local/Tribal Health: Loan Program Overview Difficult to find time and money to acquire conventional sampling resources Advances in sampling tech lower faster smaller easier SLH has dedicated resources to maintain and make available desired equipment to public health agencies Star Trek Tricorder

Equipment Available: 

Equipment Available Mercury analyzers IAQ monitors Particle meters Photoionization detectors Multi-gas meter Organic vapor monitors SUMMA cans Other

Common Chemical Exposures: 

Common Chemical Exposures Carbon Monoxide Mercury Particulate

Carbon Monoxide: 

Carbon Monoxide 2001-2003: 480 deaths nationally, 15,200 treated annually in hospitals (CDC) December and January and biggest months

CO Discussion: 

CO Discussion Knobeloch WI Medical Journal Sept./Oct 1999 3 cases suspected as result of HVAC changes CO detector operation Effective in identifying pending problems? More than a few ppm means something’s up

Detector Response Time: 

Detector Response Time UL2034 Required Alarm Points*: • If the alarm is exposed to 400 ppm of CO, IT MUST ALARM BETWEEN 4 and 15 MINUTES • If the alarm is exposed to 150 ppm of CO, IT MUST ALARM BETWEEN 10 and 50 MINUTES. • If the alarm is exposed to 70 ppm of CO, IT MUST ALARM BETWEEN 60 and 240 MINUTES. The unit is designed not to alarm when exposed to a constant level of 30 ppm for 30 days.

Slide30: 

IMPORTANT! This CO Alarm measures exposure to CO over time. It alarms if CO levels are extremely high in a short period of time, or if CO levels reach a certain minimum over a long period of time. The CO Alarm generally sounds an alarm before the onset of symptoms in average, healthy adults. Just because you cannot see or smell CO, do not assume it is not present!

Backdrafting Potential: 

Backdrafting Potential Check atmospherically vented furnaces and water heaters for any signs of back-drafting Turn on dryer and all other exhaust fans in the home, turn on atmospheric water heater and hold hand by draft diverter Repeat test for other atmospheric combustion appliance(s) Purchase a good quality CO detector with a low level or peak level readout Source: WI Energy Conservation Corporation, Focus on Energy Pgm.

Backdrafting Water Heater: 

Backdrafting Water Heater Source: WI Energy Conservation Corporation, Focus on Energy Pgm.

Prevention: 

Prevention Be aware that attached garages are the primary cause of CO poisoning cases in homes Seal any air leaks between garage and house, including ductwork Do not leave car running in garage! Do not use un-vented space heaters in the garage or house Source: WI Energy Conservation Corporation, Focus on Energy Pgm.

Mercury: 

Mercury Why all the fuss over a tiny bit of material? What’s an appropriate target? What’s the data say? What’s a safe level for kids? What kind of things can cause this level?

Mercury Data Review: 

Mercury Data Review Occupational studies document subtle neurological effects at 25 ug/m3. MRL is based on these and adjusted for community setting resulting in 0.2 ug/m3 Fredikkson study shows developmental effects at 50 ug/m3 after short term exposure

What’s safe for kids though: 

What’s safe for kids though Several cases cited in ACGIH TLV and ATSDR Toxicological profile documentation involving health effects assoc. with household spills Bottom line- 1 ug/m3 is reasonable

Health Effects Observed: 

Health Effects Observed

What kind of event is a problem?: 

What kind of event is a problem? Considering density of 13.6 gm/cc, it doesn’t take a whole lot Don’t use vacuums!!! Monona case Price Co. case Importance of monitoring Availability of analyzers

Mercury Video: 

Mercury Video Volatilization Location of Breathing Zone Effect of Disturbance

Particulate: 

Particulate Change in PM2.5 standard Proliferation of OWBs Municipal Code Issues Legal Issues EPA OWB Initiative

PM2.5 Reduction: 

PM2.5 Reduction 24 hour standard reduced from 65 ug/m3 to 35 ug/m3 Sept. 2006 “Scientific studies have found an association between exposure to particulate matter and significant health problems, including: aggravated asthma; chronic bronchitis; reduced lung function; irregular heartbeat; heart attack; and premature death in people with heart or lung disease.” Source: Fact Sheet, Final Revisions to the National Ambient Air Quality Standards for Particle Pollution (Particulate Matter)

Code Issues: 

Code Issues § 180-14. Human health hazards and public nuisances enumerated. C. Air pollution. The escape of smoke, soot, cinders, noxious acids, fumes, gases, fly ash, industrial dust or any other atmospheric pollutants within the county that creates noncompliance with Chapter NR 445 of the Wisconsin Administrative Code.

Enforcement Authority: 

Enforcement Authority 254 is rather broad Overall- a duty to abate HHH State vs Local authority “Practical” Authority Private Nuisance Actions

Upcoming Training Opportunities: 

Upcoming Training Opportunities Human Health Hazard WRO- April 3rd SRO- April 11th NERO- April 12th NRO- March 29th SERO- April 25th Chemical Response NERO- May 16th WRO- June 27th NRO- July 11th SERO- TBA Vulnerability Assessment (TBA)

Chemical Response Training Agenda: 

Chemical Response Training Agenda Toxicology Review (20 min.) Basic Concepts, Organ Systems, Exposure Routes Hazard Identification (20 min.) Physical States, Toxic Agents, WMD, Resources, e.g. NA ERG, MSDS Use of Appropriate Exposure Guidance Values (20 min.) Importance of Proper Application, Exposure Guideline Hierarchy, Guidance Values, e.g. AEGLs, IDLH, PEL/TLV, MRLs, RBCs Break Chemical Investigation Fundamentals (20 min.) Evaluation Fundamentals, CEAT Manual, Exposure Pathways Site Safety and Personal Protective Equipment (20 min) Hazard Assessment, Physical Hazards, Respiratory Protection, Chemical Compatibility Hands-On Exercises (80 minutes) Mercury Analyzer (Mercury spill), Photoionization Detector (Stinky Business), Aerosol Monitor (OWB), Multi-Gas Monitor (Toxic Gas Release), IAQ Monitor (CO Event)

Chemical Exposure Assessment Manual: 

Chemical Exposure Assessment Manual Hyperlinked document Emergency contact numbers for local, state and federal agencies Exposure guidance values Sampling protocol for env. media and food Posted to the HAN

Thanks!: 

Thanks! Jim Morrison Chemical Preparedness Coordinator WI Division of Public Health One W. Wilson St. Madison, WI 53703 608-267-3227 morrijm1@dhfs.state.wi.us