Practical Chemical Response Tools for Local Health Departments

1
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.
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Outline

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

3
Environmental assessment (responding to chm
exposures) is an important element of

• Essential Public Health Services
• State Health Plan and
• Preparedness Objectives

4
Essential Public Health Service No. 2

• Identify, investigate, control, and prevent
  health problems and environmental health hazards
  in the community.

5
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.

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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.

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PreparednessChemical vs. Biological Risk

• Per Gary Ackerman, Monterey Institute for
  International Studies, 2003
• gt1,000 biological threats vs. 328 chemical
  threats
• Subtracting hoaxes, 83 biological threats vs. 277
  chemical
• Actual use 164 chemical vs. 39 biological
• gt5 fatalities 0 biological vs. 12 chemical
• 953 total chemical fatalities vs. 8 biological

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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

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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.

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Exposure Investigation Fundamentals

• Identify, Evaluate and Control
• Exposure Pathway

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Exposure Pathway
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Assessment Resources Are Now Much More Accessible

• Information access through the Web
• Technological advances in equipment
• SLH partnership

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Information Resources

• Exposure Guidance
• Chemical Safety
• Outreach and Fact Sheets

14
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

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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

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Exposure Guideline Hierarchy

• Degree of risk tolerance
• AEGLs/IDLH
• PELs
• TLVs
• MRLs
• RBCs

Risk Tolerance Hazmat/Evacuation Occupational/C
ommercial Residential/Community
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Mercury for Example-
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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/

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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

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TOXNET

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

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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.

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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.

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Fact Sheets

• Carbon Monoxide
• http//dhfs.wisconsin.gov/eh/ChemFS/fs/CO.htm
• http//www.nlm.nih.gov/medlineplus/carbonmonoxidep
  oisoning.html
• Mercury
• http//dhfs.wisconsin.gov/eh/mercury/
• http//www.epa.state.oh.us/opp/mercury_pbt/mercur
  y.pdf
• OWBs
• http//dhfs.wisconsin.gov/eh/HlthHaz/pdf/watersto
  ves.pdf
• http//www.epa.gov/woodheaters/

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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
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Equipment Available

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

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Common Chemical Exposures

• Carbon Monoxide
• Mercury
• Particulate

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Carbon Monoxide

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

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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 somethings up

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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.

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• 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!

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

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

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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

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Whats 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

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Health Effects Observed
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What kind of event is a problem?

• Considering density of 13.6 gm/cc, it doesnt
  take a whole lot
• Dont use vacuums!!!
• Monona case
• Price Co. case
• Importance of monitoring
• Availability of analyzers

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Mercury Video

• Volatilization
• Location of Breathing Zone
• Effect of Disturbance

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Particulate

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

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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)
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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.

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Enforcement Authority

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

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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)

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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)

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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

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Thanks!

• Jim Morrison
• Chemical Preparedness Coordinator
• WI Division of Public Health
• One W. Wilson St.
• Madison, WI 53703
• 608-267-3227
• morrijm1_at_dhfs.state.wi.us