CBRNE

CHEMICAL, BIOLOGICAL, RADIOLOGICAL, NUCLEAR AND EXPLOSIVE

Health Effects of Air Contaminants for Second Responders

Health Evaluations of 9/11 Responders

Over 50% of Responders Experience Pulmonary, ENT and/or Mental Health Symptoms One Year Following NY Terrorist Attacks Preliminary Findings of Medical Health Screening Program for WTC-Site Responders Source: Mt. Sinai Medical Center Press Office (Jan. 27, 2003)

Immediate Action: Respiratory Protection for Second Responders

Identify any IDLH air contaminants Identify proper type of respirator needed Provide and require the use of respirators

Immediate Action: Air Monitoring

Occupational Health Environmental (Public) Health EPA, OSHA, NIOSH, ATSDR, USGS, local health departments, public interest groups, insurance companies

Air Contaminant Hazards at a Disaster Scene

The possible list of air contaminants at a disaster site involving the destruction of a major infrastructure is nearly endless Administrators should be prepared to treat the exposure of second responders and the general public to air contaminant hazards as a major concern

Recordkeeping of Exposures to Toxic Substances

Personal exposure data General environmental sampling Medical surveillance results Medical removal

Mold Exposures
Mold may be present at a WMD site if organic materials (upholstery, treated fiberglass, paper) have become wet. Air monitoring for mold identification is not likely Particulate respirators used in response to visible mold is appropriate

Sewer Gases
Rupture of underground discharge lines Hydrogen sulfide is principal concern Dangerous because of toxicity and olfactory fatigue May discharge through rupture or build up in confined spaces

Air Contaminant Focus: Silica, Asbestos, Lead

The destruction of conventional infrastructure will cause substantial exposures to these three air contaminants Preparing second responders to work safely around these materials under emergency conditions is the overall goal of this lesson

Silica: Key Concepts

1. Toxicity is well documented 2. Widespread worker overexposure during demolition of concrete structures 3. Exposures can be controlled

WTC Dust Cloud

Examples of Overexposure

Examples of Overexposures

Silica and Mortality

250 Worker deaths per year (Compare to 175 deaths/yr from trenching accidents) Silicosis Tuberculosis Heart Disease Causation of Lung Cancer is under investigation Suspect Hum. Carcinogen A2 (ACGIH)

Health Effects
..\silicia(NADC)-1.mpg ..\Respiratory Hazard (CSC).mpg

Second Responders Must Know:

Silicosis is not a Curable Disease Prevention through Safe Work Practice is critical

Engineering Controls for Silica

1. Wet Methods 2. Ventilated Tools

1. Wet Methods

Water suppression of dust Very effective method Requires Pre-planning so that a supply of water is available for use

Block Cutting--Dry

Wet Methods: Block Cutting

Wet Methods: Requires Pre-planning

Wet Methods: Joint Cutting

Wet Methods: Jack hammer, chipping hammer, etc.

2. Silica Dust Control by Ventilation

Portable tools with dust exhaust: Surface Grinders Disc Grinders (tuck pointing) Crack chaser Power chipping tools Retrofit Dust hoods

Tuckpointing

Control by Ventilation: Tuckpointing

 Control by Ventilation: Slab Cutting

Control by Ventilation: Hand tools

Lead in Demolition

..\001-after work(NADC)-1.MPG ..\002-greeting family(NADC)-1.MPG

Lead and Burned Debris

..\003-dog at vet(NADC)-1.MPG

Exposures of Second Responders to Lead

Critical factor is lead exposure during Trigger Tasks Respiratory Protection should be used initially, based on the Trigger Task Category

EXPOSURE ASSESSMENT
Construction Trigger Tasks
Level 1 (10 x the PEL) Manual demolition of structures, hand scraping, heat guns, shrouded power tools equipped with dust collection Respiratory Protection Half-mask, either cartridge or filtering face-piece Fit test using qualitative method

EXPOSURE ASSESSMENT
Construction Trigger Tasks
Level 2 (10X - 50X PEL): Power tool cleaning without dust collection systems, removal of enclosures, cleanup where dry expendable abrasives are used, lead containing mortar, rivet busting Respiratory Protection - Half-mask with cartridge - Fit test using quantitative method

EXPOSURE ASSESSMENT
Construction Trigger Tasks
Level 3 (>50 x the PEL): abrasive blasting, welding, torch cutting Respiratory Protection - Supplied air respirator, with tight fitting facepiece - Fit test using either qualitative or quantitative method - Fit test must be done in the negative pressure mode

General Respiratory Requirements for Lead

A respirator must be provided if a lead exposed employee requests it, regardless of the level of exposure. A PAPR must be provided whenever an employee requests one and it is protective against the level of exposure.

Organ Systems Damaged by Lead Poisoning

Brain Disorders

Hematological Problems
Kidney Problems

Nerve Disorders

Decreased Red Blood Cells

Reproductive Problems

Slower Reflexes

Lead in the Body

Body Burden of lead - the amount of lead stored in the body. Lead is a cumulative poison.

Effects of Lead on the Blood-Forming System

Lead impairs the formation hemoglobin molecules in red blood cells which carry oxygen to tissues of the body. ..\005-how does lead get into your body(NADC)1.MPG

Effects of Lead on the Kidneys

Interferes with filtering function of kidneys Chronic nephropathy (kidney disease)

Other Health Effects of Lead Exposure

Hypertension - long-term, high exposures Gastrointestinal pain (called lead colic) Reproductive system Males decreased sex drive, impotence, and sterility Females difficulty becoming pregnant; miscarriages

Health Effects of Lead Acute vs. Chronic

Acute (short-term) effect is a severe immediate reaction, usually after a single large exposure. Example: Blood lead elevation Chronic (long-term) effects have latency periods, which may take days, months, or years to show up. Example: Kidney disease

ASBESTOS OVERVIEW FOR SECOND RESPONDERS

Background Information
Categories of asbestos-containing building materials Surfacing Materials Thermal System Insulation Miscellaneous Friable: Crumbled, pulverized, or reduced to a powder, when dry, by hand pressure

Surfacing Material

Thermal System Insulation (TSI)

Miscellaneous: Transite

Miscellaneous: Vinyl Asbestos Floor Tile, Roofing Materials

Health Effects of Exposure to Asbestos

Asbestos exposure can cause: Asbestosis Mesothelioma Lung Cancer Other Illnesses/Cancers

Respiratory Protection
<10 X PEL Half mask HEPA (not disposables) <50 X PEL Full facepiece with HEPA filters <100 X PEL PAPR with HEPA, or Supplied air respirator (SAR) in continuous flow mode <1000 X PEL Full facepiece SAR with pressure/demand regulator >1000 X PEL Full facepiece SAR with pressure/demand regulator, with escape provisions (SCBA bottle)

Control Methods
General Engineering controls Vacuum cleaners with HEPA filters for cleanup Wetting agents during handling unless infeasible due to creation of other hazards Prompt cleanup of debris in leak-tight containers Local exhaust ventilation with HEPA filtration Isolation of processes producing asbestos dust (where feasible) in a regulated ventilated area

Prohibited Methods
High-speed abrasive saws that lack HEPA filtered exhaust Compressed air to remove asbestos Dry sweeping, shoveling. Employee rotation as a means of reducing employee exposure

Protective Clothing
Coveralls, head coverings, gloves, and foot coverings are required for : Any employee potentially exposed above the PELs Any employee performing work involving removal of > 25 linear or 10 square feet of TSI (thermal system insulation) or surfacing Asbestos. Laundry must be informed of contaminated clothing so as to prevent exposures > PELs

..\014-decontamination-no sound(NADC).mpg

Hygiene Facilities and Practices

Decontamination area must be established adjacent and connected to the regulated area Equipment room Shower area ( adjacent to the equipment room and the clean room, where feasible) Clean change room Lunch areas must be provided in which the airborne asbestos concentration is below the PELs