Sandstorms, Oil Well Fires, Burning Trash--- Will that sand/smoke hurt me?

Sandstorms, Oil Well Fires, Burning Trash--- Will that sand/smoke hurt me?

Coleen Baird, MD, MPH

UNCLAS

Aug 2009

Medical Requirements and Chemical Exposures

Slide 2

Requires:Pre- and post- deployment health survey forms Identification, assessment, and documentation Immediate chain of command notification Risk communication Data available for epidemiologic evaluationsDocumentation of area-specific exposure and

monitoring summaries to be posted and accessible

JCS MEMO, MCM 0006-02 Feb 2002Updated Procedures for Deployment Health Surveillance

/MCHB-TS-MEM) 410-436-1010 / [email protected] Aug2006UNCLAS


Slide 3

How are (chemical) OEH exposure Risk levels determined?


Slide 4

HazardSeverity

Qualitative Interpretation of Health Impacts Associated with Hazard

Severity Level

CATASTROPHIC Increasing deaths and casualties....

CRITICAL Few, if any, deaths but significant numbers of disabling/incapacitating casualties….

MARGINAL Many may have noticeable but not disabling health effects… certain complex skills may be degraded….

NEGLIGIBLE Few noticeable health effects during mission ; potential increased risk of post-conflict health effects….

NO HAZARD No health effects (short or long term/ delayed) are anticipated….


Slide 5

Military Risk Matrix per FM 100-14 (FM 5-19); FM 3-100.12

HAZARD PROBABILITY

Frequent (A) Likely (B) Occasional (C) Seldom (D) Unlikely (E) HAZARD SEVERITY

Catastrophic (I) Extremely High Extremely High High High Moderate

Critical (II) Extremely High High High Moderate Low

Marginal (III) High Moderate Moderate Low Low

Negligible (IV) Moderate Low Low Low Low

RISK ESTIMATE


Slide 6

(COCOM) Country # of ORMS Low Risk Moderate Risk High Risk

CENTCOM

Afghanistan 60 50

8 - Ambient Air - PM10 ;

2 - Treated Water Quality

Djibouti, Egypt; Kenya, Ethiopia;Kyrgyzstan; Saudia Arabia; Uzbekistan; United Arab Emerits; Yemen 31 24

2 - Ambient Air Based on PM10 ;


Iraq195 125

57 - PM10 & metals 9 - Treated Water Quality 2 - Raw Water Quality 2 - PM10 & Lead

Kuwait 37 20 16 - Ambient Air Based on PM10 1 - Treated Water Quality

Qatar 11 9 2 - Ambient Air Based on PM10

EUCOM

Bosnia, Georgia, Kosovo (Serbia); Morocco 5 4 1 - Raw Water Quality

SOUTHCOM

Antigua; Belize; Dominican Republic; Columbia; Grenada; Guatemala; Haiti; Honduras; Netherlands Antilles;Nicaragua; Panama 17 12

1 - Water Quality;1 - Bottled Water 2 - Ambient Air Based on PM10

NORTHCOM - JTF KATRINA

USA 136 133

2 - Ambient Air Based on PM10


TOTALS

Total ORMs:

492

Total Low Risk:

378

Total Moderate Risk:

92 - Ambient Air 19 -Water Quality (e.g., turbidity)

Total High Risk:

2 - Ambient Air 1 – Water Quality

Army OEH Operational Risk Management (ORM) Assessments CY 2005


Slide 7

Common OEH Hazards

• Particular Matter (PM10 and increasingly PM 2.5)– Most common and significant deployment OEH hazards

– Real-time health complaints

– DNBI rates do not appear to be significantly impacted

– Potential for long-term effects being investigated

• Potable water quality– 3 types potable water

– TB MED 577 standards often only hazards found

– No real impact on DNBI rates or long-term health


Slide 8

What is an OEH “incident”?

Presents a Moderate or higher level of operational risk

Presents a perceived or actual significant health risk to troops

Identified as a likely or known source of medically-related health outcomes

NOTE: “Incidents” may be over before actual sampling is conducted or results are obtained


Slide 9

Example Exposure Incidents of Interest Fire Incident, Iraq Summer 2004

Exposure Group A

▪ Military troop responders

▪ Critical >250 persons - mostly active duty

▪ Several reported acute effects during course of ~ 3 week response

Exposure Group B

▪ Troops located a camp @ 5K away

▪ Exposures considered negligible


Slide 10

Example Exposure Incidents of Interest

• Highly industrialized area

• Routinely elevated PM10 levels (Moderate Risk)– Daily PM monitoring

– Other sporadic short-term industrial chemical releases:

• Sulfur dioxide, 2004

• Ammonia, 2006

– Standard SF600 has been generated and updated • For all troops medical records deployed to this site

• Indicates no long term effects anticipated……..

Ash Shuaiba Port/SPOD/E


Slide 11


• 2 Soldiers of EOD unit were exposed to Sarin (GB)

• Signs: pin point pupils, blurred vision, nausea

• Dx: Stable, no antidote administered

• RBC indicated mild-moderate exposure

• Non-symptomatic

• Returned to light duty in 3 days

• Other soldiers released with no signs/ symptoms

• No long-term effects

Sarin Incident, May 2004


Slide 12


• Lead in air exposures exceed ‘no hazard’ criteria

• Blood lead screening of returning troops per DoD Policy• No levels of concern noted

• No additional follow up required

• Current (2005-2006) air monitoring • Lower lead levels

• PM10 Moderate Risk

Camp War Eagle (Camp Hope) , Iraq 2004 – present


Slide 13


• Collateral damage resulted in chemical release – 11 soldiers washed down, placed on oxygen, and observed

– Equates to Critical severity/High risk

• No specific follow up

• Long-term effects not anticipated

Bagdad Industrial Complex Chlorine Release, Iraq 2005


Slide 14


• Prominent base with airfield

• Notable dust/PM10 hazards – – Smoke from open trash-burning pits – Includes dioxins at Negligible risk– Routine health complaints – Several SF 600s developed (AF, Army)

Balad (and Camp Anaconda) , Iraq 2004 – present


Slide 15

Where does OEH related data go?

USACHPPM is designated DoD data repository for OEH data

Currently not capturing all DoD data

Moving towards DOEHRS - users can input and access info

Medical information (associated with OEH exposures) is not required to be reported with OEH data


Slide 16

So, if you as a health care provider had a soldier report with complaints

of an chemical (e.g. chromium?) exposure during deployment …

What would you do?

Where would you go for information?

What specific information/tools would you want?


• Deployment Exposures Website


Slide 18

CHPPM POC INFORMATION

UNCLAS/MCHB-TS-MEM) 410-436-1010 / [email protected] May 2006

Environmental Medicine ProgramUS Army Ctr for Health Promotion and Preventive Medicine (USACHPPM)Bldg E1570 Stark Rd Aberdeen Proving Ground-Edgewood Area (APG-EA), MD 21010-5403FAX 410-436-4117

Coleen B. Weese, MD, MPH (Program Manager)[email protected] ; [email protected]

Veronique Hauschild, MPH [email protected] ; [email protected]

Sandstorms, Oil Well Fires, Burning Trash--- Will that sand/smoke hurt me?

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