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Workers’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium June 20, 2011 National Institute for Occupational Safety and Health Office for Emergency Preparedness and Response Examining NIOSH’s Health Hazard Evaluation at the Deepwater Horizon Response

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Page 1: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Workers’ Health and Safety

CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO

Deepwater Horizon PanelUSPHS Scientific and Training Symposium

June 20, 2011

National Institute for Occupational Safety and Health

Office for Emergency Preparedness and Response

Examining NIOSH’s Health Hazard Evaluation at the Deepwater Horizon Response

Page 2: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Worker Risks & NIOSH Objectives Response

Objectives: To provide

opportunity for every response worker to be counted

To prevent illness and injury real-time during the event by reducing or eliminating exposures

Health & Safety Risks:

Injury and Illness Chemical

Exposures Heat Stress Work Stress Fatigue Mental Health

Page 3: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Federal Response Leadership

Key NIOSH Impact Activities• Technical Guidance and

Communication• Toxicity Testing• Health Surveillance• Rostering• Health Hazard Evaluations Worker repairing boom

(HHE participant)

Page 4: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Interim Guidance for Protecting Deepwater Horizon Response

Workers and Volunteers National Institute for Occupational Safety and Health, Centers for Disease

Control and Prevention, U.S. Department of Health and Human Services andOccupational Safety and Health Administration, U.S. Department of Labor

June 25, 2010

For more information on general disaster response, consult the NIOSH Emergency Response Topic Page at

http://www.cdc.gov/niosh/topics/emergency.html

Technical Guidance and Communication

NIOSH and OSHA Collaboration

• CDC provided health information to 14 million Gulf region residents• Posted 16 new interim guidance documents; • Posted 5 interim guidance documents with OSHA Co-branding• Cleared & released 60 unique documents & fact sheets • CDC Web pages received more than 225,000 page views

Page 5: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Toxicity TestingAcute animal testing (rats):

Dispersant (Nalco Corexit 9500A) Crude Oil from the source Dispersant/crude oil mixture

Inhalation studies Measuring Pulmonary, cardiovascular, and Central Nervous System outcomes

Dermal studies Assessing hypersensitivity and immune-mediated responses

Six Dispersant Abstracts: The Journal of the Federation Amer. Soc. For Experimental Biology - April 2011, Vol 25 (4)

Page 6: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Health Surveillance ResourcesPromoting Response “Safety

Culture”

• BP/UAC health data• Hospital Emergency Department

data• State surveillance data• Poison Control Centers, and

BioSense data• BP injury and illness data analysis• HHS/ASPR on Medic Log data• Roster worker questionnaire• HHE Health Symptom Surveys

Page 7: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

NIOSH Injury and Illness Report of BP Incident Data

Page 8: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Responder Rostering Roster ≠ Registry

• Rostered over 55,500 response workers• Staging areas and training sites• Paper-based and web-based• BP employees, contractors, federal, state

employees, & volunteers

Rostering Workers in LA

27092; 51%

19360; 36%

4253; 8%

1623; 3% 1233; 2%

Race/Ethnicityfrequency, percent

Non-Hispanic whiteNon-Hispanic blackHispanic or Latino/LatinaAsianOther

Page 9: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

NIOSH received a request from BP for a Health Hazard Evaluation of workers responding to Deepwater

Horizon Oil Spill

• Evaluate responder activities and controls

• Conduct health monitoring

Observational assessments of work activities

Health symptom surveys

• Conduct exposure assessment

Industrial hygiene monitoring

• Provide remediation recommendations

NIOSH’sHealth Hazard EvaluationProgram

Page 10: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

When an HHE Can Help

• New hazards, exposures, or processes

• Illnesses from an unknown cause• Exposure to unregulated agents• Adverse health effects at

exposures less than the standards

• Emergency Response SituationsBP Responders being hospitalized ….

BP Request received on May 28th, and

first NIOSH team was on the ground by June 2nd.

Page 11: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

9 HHE Reports ~ 20 Worksites Assessed Multiple Types of Workers

(n=3211)Off-Shore (41%)

– Dispersant vessels

– In-Situ Burn vessels

– Skimming vessels

– Booming– Shrimp

trawlers– Source Vessels

On-Shore (59%)– Wildlife– 67 sites of

Beach Clean-up– Decontaminati

on– Waste

Management– BP

Administration (work organization & resiliency)

Page 12: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

–Demographics –Work History–Employer–Days on oil spill, boat–Exposures to oil, dispersant, chemicals–Symptoms: Heat stress; by organ system; job stress– Skin contact with oil– Respirator use

Roster had initially included:

• Past Medical history,• Pharmaceutical use,• Smoking History,• Training

So these things were not asked.

At the sites, we surveyed

workers

Page 13: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Industrial Hygiene Sampling:

Measured 111 different chemical constituents 42 on personal breathing zone air

samples92 on general area air samples

2,577 total air samples were

collected

33% were personal breathing zone air

sample points

67% were general air sample points

Page 14: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Occupational Exposure Limits

• Levels below which most of the working population could be exposed on a regular basis with a low risk to health– Considers a critical health effect –the one

effect at the lowest level, acute or chronic– Determines an exposure-response relationship– Considers the Acceptability of Risk and the

Extent of Uncertainty– Based on expert opinion & science & politics

Page 15: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Evaluation of Dispersant Use

Applied from a boat

Applied from the air

Page 16: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Large containers of dispersant connected to

hoses

Dispersant Vessel: on this boat, scientists evaluated the efficacy of the dispersant

breaking up the oil

Page 17: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Corexit®

9500ADispersant applied to surface oil

Page 18: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Dispersant breaking up the Oil on the Surface of the Gulf

Page 19: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Note the PPE* useOf the Dispersant Applicator:Impermeable suit with hood, gloves, cartridgerespirator, goggles,steel-toed boots, life vest

PPE=personal protective equipment

Page 20: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Chemical dispersants being released near Houma, Louisiana in the Gulf of Mexico (USCG photo)

We evaluated aerial release of dispersant from a support aircraft

Page 21: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Dispersant monitoring 1 hour

after aerial sprayingNote the difference in personal protection

equipment : only wrist-length gloves

Page 22: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

• Symptom surveys given within 1 hour after

dispersant application• 4 hours later, each participant was interviewed

Health Surveys on The Dispersant Vessels

Results : workers monitored after aerial spraying reported more headaches, exhaustion, and skin symptoms compared to Dispersant ship; they wore less PPE, and were out in sun longer

Page 23: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Measurement Results on the Dispersant VesselsAll samples* were at non-detectable or low concentrations well below occupational exposure limits (OELs)

OELs= Occupational Environmental LimitsVOCs = volatile organic compoundsOEL: occupational exposure limits

*VOCs, 2-butoxyethanol, benzene, ethanol, ethyl benzene, naphthalene, toluene, CO, H2S, dipropylene glycols, mercury, total hydrocarbons

Page 24: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

A pair of shrimping trawlers towed 300 feet of boom trailing and capturing floating oil, until it was about 3 mm thick.

Evaluation of In-Situ Burns

Page 25: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

The oil would be litby an igniter

Page 26: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Note the burning oil plume of smoke and the proximity to the small boat

– the burn duration ranged 45 minutes to 6 hours

Page 27: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Health Survey at the In-Situ Burns

• 39/65 workers surveyed

• Most frequent symptoms: upper respiratory symptoms, headaches, fatigue, back pain, and feeling stressed, worried, and pressured.

Page 28: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Measurement Resultsat the In-Situ Burn

• Samples* were either non-detectable or well below OELs• Carbon monoxide peak exposure was above NIOSH REL ceiling limit; occurred when the gasoline powered engines idling.

OELs= Occupational Environmental LimitsOEL: occupational exposure limitsREL: recommended exposure limit

*VOCs, 2-butoxyethanol, benzene, ethanol, ethyl benzene, naphthalene, toluene, H2S, dipropylene

glycols, mercury, total hydrocarbons

Page 29: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Recommendations: In Situ Burns

• Vessels should stay much further away from the fire because of potential exposure to combustion products

• Workers should wear appropriate fire resistant PPE

• No need for continuous wearing of respirators…but… during emergency situations, (shifts in wind), use Escape Respirators

• Attend to idling of boats and potential CO exposure

Page 30: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Evaluation at the Spill Source

“The Source” above the leaking well on the ocean floor, at the Time of the NIOSH HHE

DDII:The relief well

Discoverer Enterprise:

Vessel capturing leaking oil

Page 31: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Source Workers on VesselsRisk of exposure to

contaminants from oil:– Proximity to the source

of the oil– Enclosed spaces– Flares created possible

exposures to combustion by‐products. However, these were full time oil rig workers, and their exposure to oil was not novel…

Page 32: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Health Survey on the Source Vessels

• 62/178 completed the survey • Most frequent symptoms:

– Heat Stress symptoms– Nose or eye irritation– Headaches– Stress (worried, pressured,

stressed, short tempered) on the DDII

Page 33: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Measurement Results at the Source

• Low concentrations of VOCs were detected on both vessels. Most abundant were C10‐C16 aliphatic hydrocarbons.

• Samples* were all well below OELs

– On DD II: 69% (90/130) below detectable levels

– On D. Enterprise: 67% (94 of 140) below detectable levels *VOCs, propylene glycol ethers, sulfides, PAHs, CO,

H2S, toluene, naphthalene, limonene, ethyl benzene, 2 -butoxyethanol

Page 34: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Recommendations at the Source

• No need for routine respirator use, but make respirators immediately available for uncontrolled situations

• Attend to Heat Stress Management Plan

• Consider a special emphasis follow-up with regard to Employee Assistance Program service, due to stress reported on DDII

Page 35: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Evaluated Barge Vacuuming of Oil

• Lack of fall protection: workers bending at 8 ft ledge• Musculoskeletal risk: from continuous bending • Noise risk: from vacuum - lack of hearing protection

Page 36: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Most Frequent Symptoms: Scrapes and cuts; Itchy

skin or rash; Headache or feeling faint, dizzy, or fatigued; Hand, shoulder, or back pain

Evaluated Wildlife Cleaners

Recommendations: Follow heat stress management plans; Minimize skin & mucus membrane exposures; Follow ergonomic recommendations; Provide adequate staffing & work rotation schedules

Page 37: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Evaluated Shore Workers

Page 38: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Health Survey in On-Shore Workers*

• Evaluated 1,899 workers at 67 work sites.

• Most frequently reported symptoms

Upper and lower respiratory symptomsHeat stress symptomsSkin symptomsHand, shoulder, and back painPsychosocial and stress symptoms *Located in Louisiana, Alabama, Florida, and

Mississippi.

Page 39: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

IH Measurement Results for On-Shore Sites

• None of the individuals’ chemical exposures exceeded any OEL– Personal breathing zone sampling on 24

individuals– 154/261 (59%) samples: non-detectable– 25/107 (23%) detectable samples less

than minimum quantifiable concentration

• Workers around pressure washers likely to have exposures above NIOSH noise REL* * REL= recommended exposure limit

85 decibels, A-weighted, as an 8-hr Time-Weighted Average

Page 40: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

On-Shore Worker Recommendations

• Minimize contact with oil through work practices and PPE

• Follow heat stress management plan, including the role PPE may add to heat stress risk

• Improve design of tools for beach cleaning• Address hearing protection and

conservation• Maintain routine reporting of illnesses and

injuries• Employ pre-placement medical evaluations

of workers

Page 41: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

HHE Conclusions• Worker exposures to oil constituents

and dispersant chemicals well below OELs

• Concentration above OELs were known hazards (CO from idling boats, noise)

• Health surveys identified heat exposure as major worker exposure

• Targeted groups had explainable exposures and symptoms (wildlife handlers: cuts and scrapes; in-situ burns: upper respiratory; beach cleaners: back pain; source workers: stress and work pressure)

Page 42: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

How HHEs Resolve Problems

Multi-disciplinary Approach

Confirm

Anticipate

Evaluate

Risk Management

Decision-MakingFrameworkControl

Recognize

Health and Medicine:Physician, Nurse, Vet, PsychologistsControl Measures:EngineerField & Lab Methods Development:Lab Scientist

Exposure Assessment:Industrial Hygienist

Page 43: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Thank You

http://www.cdc.gov/niosh/topics/oilspillresponse/gulfspillhhe.html

The NIOSH Health Hazard Evaluation Interim Reports can be found at:

Acknowledgements:Members of the Hazard Evaluation and Technical Assistance Branch and other branches of NIOSH involved in the DWH response, especially:

•Allison Tepper, PhD

•Teresa Seitz, MPH, CIH•Bruce Bernard, MD•John Gibbins, DVM• Brad King, MPH, CIH•Nancy Burton, PhD, CIH•Chad Dowell, MS, CIH•Kenny Fent, PhD•Renee Funk, DVM, MPH•John Halpin, MD, MPH•Margaret Kitt, MD, MPH

Page 44: Workers ’ Health and Safety CAPT James Spahr, MPH, RS, DAAS Associate Director, NIOSH-OD-EPRO Deepwater Horizon Panel USPHS Scientific and Training Symposium

Questions?

[email protected]

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348

E-mail: [email protected] Web: http://www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

National Institute for Occupational Safety and Health

Emergency Preparedness and Response Office