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PubMed1995

ATSDR's information databases to support human health risk assessment of hazardous substances. Agency for Toxic Substances and Disease Registry.

The American public, like persons in many other nations, is concerned about the potential adverse impacts of uncontrolled hazardous wastes. The concerns are often predicated on the fear that adverse health effects will occur because of releases of hazardous substances into community environments. To respond to these concerns, government agencies and private sector organizations must rely on credible, accessible, up-to-date information databases. These databases should be relevant to the needs of the people who respond to uncontrolled releases of hazardous substances. Of particular importance are databases that profile the toxicity of hazardous substances and other information useful to physicians and other health care providers. This paper describes how the federal Agency for Toxic Substances and Diseases Registry (ATSDR) has developed several toxicologic and human health information databases under mandates in the Superfund statute for responding to the public's concerns about hazardous substances.

Databases, Factual↗
PubMed1994

Surveillance for emergency events involving hazardous substances--United States, 1990-1992.

PROBLEM/CONDITION: A review of existing reporting systems indicated that not enough information was being collected to determine the public health consequences of emergency events involving hazardous substances. REPORTING PERIOD COVERED: January 1990 through December 1992. DESCRIPTION OF SYSTEM: State health departments in selected states collect and each quarter transmit information about the events, substances released, and the public health consequences of hazardous substance releases (i.e., morbidity, mortality, and evacuations) to the Agency for Toxic Substances and Disease Registry (ATSDR). Five state health departments (Colorado, Iowa, Michigan, New Hampshire, and Wisconsin) began data collection on January 1, 1990. On January 1, 1992, the reporting state health departments included those from Colorado, Iowa, New Hampshire, New York, North Carolina, Oregon, Rhode Island, Washington, and Wisconsin. RESULTS AND INTERPRETATION: During 1990-1992, 3,125 events were reported from participating states to ATSDR's Hazardous Substances Emergency Events Surveillance (HSEES) system. Of these events, 2,391 (77%) were fixed-facility events (i.e., occurred at stationary facilities), and 723 (23%) were transportation related. In 88% of events, a single chemical was released. The most frequently released hazardous substances were volatile organic compounds (18% of the total 4,034 substances released), herbicides (15%), acids (14%), and ammonias (11%). In 467 events (15% of all events), 1,446 persons were injured; 11 persons died as a result of these injuries. Respiratory irritation (37%) and eye irritation (23%) were the most frequently reported health effects. A total of 457 (15%) events resulted in evacuations; of these, 400 (88%) were ordered by an official (e.g., a police officer or firefighter).(ABSTRACT TRUNCATED AT 250 WORDS)

Emergencies↗
PubMed2005

Public health consequences from hazardous substances acutely released during rail transit--South Carolina, 2005; selected States, 1999-2004.

On January 6, 2005, two freight trains collided in Graniteville, South Carolina (approximately 10 miles northeast of Augusta, Georgia), releasing an estimated 11,500 gallons of chlorine gas, which caused nine deaths and sent at least 529 persons seeking medical treatment for possible chlorine exposure. The incident prompted the Agency for Toxic Substances and Disease Registry (ATSDR) to review data from its Hazardous Substances Emergency Events Surveillance (HSEES) system and update an analysis of 1993-1998 railroad events. The HSEES system is used to collect and analyze data concerning the public health consequences (e.g., morbidity, mortality, and evacuations) associated with hazardous-substance--release events that occur in facilities or during transportation. This report describes the event in South Carolina, which is not part of the HSEES system, and two others from HSEES, and summarizes all rail events reported to HSEES from 16 state health departments during 1999-2004. Local government agencies, employers, and first responders can help reduce morbidity and mortality from transit-associated hazardous-substance releases by examining historical spill data for planning purposes, developing emergency response plans, undergoing proper hazardous materials (HazMat) training, and reviewing epidemiologic investigation data.

Accidents↗
PubMedDate not supplied

Hazardous substances releases causing fatalities and/or people transported to hospitals: rural/agricultural vs. other areas.

INTRODUCTION: Mass-casualty and hospital preparedness has been analyzed widely. However, information regarding the types of areas where these events occur is limited. Therefore, the characteristics of acute hazardous substances releases resulting in death/multiple-victim events occuring in rural/agricultural areas and in all other areas were studied and compared. METHODS: Data reported to the Hazardous Substances Emergency Events Surveillance (HSEES) system from 16 state health departments during 1993-2000 were used to examine factors associated with events with death/multiple victims involving acute release of hazardous substances. A death/multiple-victim event is defined as any event resulting in a death and/or at least five people being transported to a hospital. RESULTS: Of a total of 43,133 events, 6661 occurred in rural/agricultural areas. Of these, 107 were death/multiple-victim events with 632 victims, of whom 91 died and 77 were hospitalized. All other areas had 472 death/multiple-victim events with 7981 victims, of whom 116 died and 413 were hospitalized. Death/multiple-victim events in rural/agricultural areas were more likely to be associated with transportation (Proportional Ratio (PR) = 4.1, 95% CI = 3.1-5.4) and fires and/or explosions (PR = 1.4, 95% CI = 0.95-2.0) than were death/multiple-victim events in all other areas. Among transportation-related events in rural/agricultural areas, 19 were associated with air transport--mainly crop dusters--and resulted in 18 deaths. Responders were three times more likely to be injured in rural/agricultural areas. Of responders, volunteer firefighters constituted 52% compared with 6.7% in all other areas. The most frequently released chemicals in rural/agricultural areas were ammonia, chlorine, and pesticides. In all other areas, ammonia, chlorine, hydrochloric acid, carbon monoxide, and 0-chlorobenzylidene malononitrile, a tearing agent often associated with an illegal or unauthorized act, were released most frequently. CONCLUSIONS: Findings from this analysis suggest that remedial actions should address safety measures in both transportation and fixed facilities containing acute hazardous substances. These include regular maintenance of equipment, education of workers about the substances used in their facility, rigorous training and licensing of drivers and crop duster operators, and education and training of employees and first responders in the use of protective equipment. These activities may reduce the number of events, casualties, and costs associated with hazardous substance events.

Agriculture↗
PubMed1994

Hazardous substance releases at the community level: a practical approach to analyzing potential health threats.

1. When a hazardous substance release occurs in a community, public health nurses must consider whether community members have been exposed, and whether that exposure is sufficient to impact public health. 2. An exposure pathway is the process by which an individual is exposed to contaminants that originate from some source of contamination. The exposure pathway method is effective in determining whether community members are exposed to hazardous substances in their community. 3. After determining a completed exposure pathway, a toxicological analysis estimates the dose of hazardous substances community members may have received and whether that dose may increase risks for an adverse health effect. 4. The Agency for Toxic Substances and Disease Registry (ATSDR) provides information to health care professionals that can assist them in conducting exposure and toxicological analyses.

Data Interpretation, Statistical↗
PubMed2004

Risk factors for acute chemical releases with public health consequences: Hazardous Substances Emergency Events Surveillance in the U.S., 1996-2001.

BACKGROUND: Releases of hazardous materials can cause substantial morbidity and mortality. To reduce and prevent the public health consequences (victims or evacuations) from uncontrolled or illegally released hazardous substances, a more comprehensive analysis is needed to determine risk factors for hazardous materials incidents. METHODS: Hazardous Substances Emergency Events Surveillance (HSEES) data from 1996 through 2001 were analyzed using bivariate and multiple logistic regression. Fixed-facility and transportation-related events were analyzed separately. RESULTS: For fixed-facility events, 2,327 (8%) resulted in at least one victim and 2,844 (10%) involved ordered evacuations. For transportation-related events, 759 (8%) resulted in at least one victim, and 405 (4%) caused evacuation orders. Fire and/or explosion were the strongest risk factors for events involving either victims or evacuations. Stratified analysis of fixed-facility events involving victims showed a strong association for acid releases in the agriculture, forestry, and fisheries industry. Chlorine releases in fixed-facility events resulted in victims and evacuations in more industry categories than any other substance. CONCLUSIONS: Outreach efforts should focus on preventing and preparing for fires and explosions, acid releases in the agricultural industry, and chlorine releases in fixed facilities.

Disasters↗
PubMedDate not supplied

Biomedical testing of the kidney for persons exposed to hazardous substances in the environment.

To identify kidney injury and dysfunction among persons exposed to hazardous substances in the environment, a battery of biomarker tests has been identified for systematic public health use. The standardized use of tests for conducting field epidemiology studies was reviewed in a 1995 joint American-European workshop, and recommended tests were selected by the Agency for Toxic Substances and Disease Registry (ATSDR) and the Centers for Disease Control and Prevention (CDC). These tests would be useful in conducting public health activities but are not recommended in a manner that would suggest changes in routine clinical practice. The tests selected include serum creatinine, urine analysis, urinary albumin, retinol-binding protein, N-acetyl-beta-D-glucosaminidase (NAG), alanine aminopeptidase (AAP), and osmolality. Urinary creatinine was also included to adjust for urine concentration. The tests were chosen for use not only in epidemiologic field studies but also clinically oriented population screening and case studies of persons exposed to hazardous substances at waste sites. Studies using the battery may address the relationship between kidney damage and dysfunction and exposures to hazardous substances, especially in susceptible populations including children. Also, longitudinal studies should be conducted to evaluate the long-term health implications of abnormal tests and to measure the tests' predictive value for renal injury. These studies could evaluate the continuum of renal dysfunction as expressed by persistent decrements in glomerular filtration to the development of end-stage renal disease.

Biomarkers↗
PubMed2005

Releases from improper chemical mixing, Hazardous Substances Emergency Events Surveillance system, 1996-2001.

OBJECTIVE: To examine the public health consequences of acute hazardous substance releases resulting from the improper mixing of chemicals. METHODS: Data from the Agency for Toxic Substances and Disease Registry's Hazardous Substances Emergency Events Surveillance system for 1996-2001 events were analyzed. RESULTS: "Private households" was the most frequent industry classification among improper mixing events, and chlorine was associated with a greater prevalence of improper mixing events. Releases from improper mixing were considerably more likely to involve fire, explosion, and fire-explosion combined; were markedly more likely to result in personal injury (48% for improper mixing events vs. 7% other events); and had a significantly greater percentage of victims with traumatic injury (PR = 3.07, 95% CI = 2.55-3.71). CONCLUSIONS: Improper chemical mixing can cause dangerous, harmful reactions and are preventable. Consumers should be educated to avoid mixing noncompatible products.

Adolescent↗
PubMed2004

Lessons learned from hazardous chemical incidents--Louisiana Hazardous Substances Emergency Events Surveillance (HSEES) system.

Since 2001, the Louisiana Department of Health and Hospitals (LDHH) has participated in the Hazardous Substances Emergency Events Surveillance (HSEES) system. In 2001, there were 815 events qualified for HSEES surveillance. Data for each event was gathered and analyzed. During these hazardous substances events, there were 1164 chemicals released resulting in injuries to 63 people, most with respiratory system irritation. Even though more people were injured in fixed-facility events, injuries were more likely to result from transportation-related events. The quantity and frequency of hazardous substance releases do not always positively correlate with the number of injuries sustained during those releases. A higher percentage of "Rail" transport events was observed in Louisiana when compared with other HSEES states. By collecting and analyzing more data and disseminating results to the public, it is expected that further adverse public health consequences from hazardous releases/spills in Louisiana can be reduced and/or minimized.

Accidents, Occupational↗
PubMed2003

Hazardous substances events associated with the manufacturing of chemicals and allied products.

This report describes events involving the acute release of hazardous substances reported to the Hazardous Substances Emergency Events Surveillance (HSEES) system for 1993-2000. HSEES, maintained by the Agency for Toxic Substances and Disease Registry (ATSDR), collects data on the industries/services associated with events. This analysis focuses on fixed-facility events that occurred during the manufacturing of chemicals and allied products (i.e. categorized according to the 1990 Industrial Classification System (ICS) of the US Bureau of the Census). This is the most frequently reported industry category in the surveillance system, with over 12000 events (28% of all events and 35% of fixed-facility events). Further classification found that the majority (71%) of these events involved the manufacturing of industrial and miscellaneous chemicals (ICS code 192), and 21% plastics, synthetics, and resins (ICS code 180). A total of 2676 persons reported injuries in 307 fixed-facility events. Most of the injured persons were employees (42%), followed by the general public (38%), students (15%), and responders (5%). Thirty-five percent of all injured persons and 46% of all injured employees had respiratory symptoms. Releases frequently occurred in processing vessels, and the majority was due to equipment failure. A review of the data indicates that manufacturers of chemicals and allied products could help reduce morbidity and mortality by taking preventive actions such as performing regular maintenance of processing equipment, regular training of employees and encouraging them to wear respiratory protection, and educating the public on what to do in the event of a release from these facilities.

Accidents↗
PubMed2001

Public health risks of railroad hazardous substance emergency events.

The number of railroad events reported to the Agency for Toxic Substances and Disease Registry's Hazardous Substances Emergency Events Surveillance system increased from 84 in 1993 to 177 in 1998. Comparisons of data on railroad and non-railroad events were made. The results overall indicated a greater potential impact of railroad events on public health. A median number of 2039 persons were living within a 1-mile radius of railroad events versus 982 for non-railroad events. The percentage of events during times when people are more likely to be home was also greater for railroad events. Railroad event victims were more likely to need hospital treatment than non-railroad event victims, which suggested the need for better community planning, reevaluation of current federal regulations and priorities for railroad hazardous material transport, and enhanced railroad industry commitment to safety.

Accidents↗
PubMed2005

Hazardous substances in separately collected grey- and blackwater from ordinary Swedish households.

The objective of this paper is to present the mass flows of a number of selected hazardous substances in raw, separate grey- and blackwater from ordinary Swedish households. The Vibyasen housing area was selected for the investigation since its wastewater system has separate flows for grey- and blackwater. Due to the high analytical costs, a limited number of hazardous substances had to be selected and the number of samples restricted. The greywater flow was manually measured and the samples were collected at set time intervals. The blackwater samples were randomly collected from a blackwater tank. A total of 105 selected hazardous substances were measured in both fractions. Of the 24 elements (Ca, Fe, K, Mg, Na, S, Al, Ag, As, Ba, Bi, Cd, Co, Cr, Cu, Hg, Mn, Ni, Pb, Pt, Sb, Sn, Te, Zn) measured in both fractions, 22 were detected in the greywater and 23 in the blackwater. 81 organic substances were selected and measured in both fractions (nonylphenol- and octylphenol ethoxylates, brominated flame-retardants, organotin compounds, PAH, PCB, phthalates, monocyclic aromatics, and triclosan). 46 organic substances were found in greywater and 26 in blackwater. PCB was the only group found in neither grey- nor blackwater. The greywater flow fluctuated, with a specific average flow of 66 L per person and day. The composition of blackwater also fluctuated, with shifting proportions of urine, faeces, and flush water. The specific average blackwater flow was 28.5 L per person and day. The mixture of substances in separate wastewater fractions from Swedish households was too complex to exactly distinguish their specific sources.

Hazardous Substances↗
PubMed1992

[Assessment of occupational exposures to industrial hazardous substances. V. A proposed method for evaluating employee's exposure averages (8-h TWAs) using a single day measurement].

Daily exposure averages (8-h TWAs) to hazardous substances may vary considerably day to day, even though a worker is engaged in the same job. Previously we proposed a method to evaluate a long-term exposure condition with interday fluctuation using some exposure measurements. As it is assumed that 8-h TWAs are log-normally distributed, geometric standard deviation (sigma g) representing true interday fluctuation of 8-h TWAs should be estimated. If a single day's 8-h TWA of a worker is measured, sigma g of his own distribution of 8-h TWAs cannot be estimated. Therefore, to evaluate a long-term condition using a single day's 8-h TWA, representative sigma g in all industrial workplaces must be determined beforehand. To investigate sigma g observed in many industrial workplaces, two days' 8-h TWAs of each worker were measured in a week on 260 workers exposed to 19 hazardous substances. Sg2 (geometric standard deviation estimated by two samples) ranged from 1.00 to 8.22 with a median of 1.47 and a 90% upper limit of 2.47. Transforming Sg2 into sigma g, median and 90% upper limit of sigma g were 1.75 and 2.47, respectively. According to a classification scheme in the proposed method, exposure levels (I to III) were calculated using sigma g of 1.75 and 2.47. A long-term exposure condition to hazardous substances can be evaluated by comparing a single day's 8-h TWA with the exposure levels.

Environmental Monitoring↗
PubMed1992

COSHH (Control of Substances Hazardous to Health) in the NHS--beyond awareness: the practical assessment of risk.

This paper describes one approach to practical COSHH assessment developed for the (Scottish) Health Service. For completeness, the COSHH Regulations and corresponding Approved Code of Practice are reviewed from the point of view of undertaking a practical assessment of risk in hospitals. An assessment pro-forma developed for a Scottish Health Board is outlined. A hospital COSHH case study is briefly described. The training of health service COSHH assessors is considered. Finally, the need for a management approach to health and safety based on development and implementation of a suitable safety management system is proposed.

Forms and Records Control↗
PubMed1992

COSHH (Control of Substances Hazardous to Health)--the priorities for the NHS.

Managing COSHH is like managing anything else: define the issues; evaluate the priorities; select management options; implement them and monitor the outcome. In COSHH terms this means inventories, assessments, control measures and auditing. But much of the identification and assessment work should be centralised--after all, the hazards and risks arising from Glutaraldehyde usage or painting with eggshell paints is virtually identical not just across a hospital, but across a District and Region. That is why the Hospital Helpline was established, and has been such a success--a core of COSHH assessments made available to all, so that efforts can be focused on what COSHH is about, after all they are the Control not the Assessment Regulations.

Hazardous Substances↗