Although sudden, unintentional exposures to hazardous chemicals most commonly are associated with manufacturing and transportation, and adversely affect employees (Horton, Berkowitz, & Kaye, 2004), children are sometimes injured when such disasters strike. Because their organs are at various stages of growth, children may be more susceptible than adults to the harmful effects of chemical toxins. Pediatric considerations regarding the treatment of exposures to specific chemical agents have been outlined for the emergency medical care community (Centers for Disease Control and Prevention [CDC], 2004; Kales & Christiani, 2004; Lynch & Thomas, 2004). In addition, surveillance of chemical exposures and resulting injuries can help guide public health efforts to protect children from chemical exposures. Active sentinel surveillance can provide assessment of the occurrence of acute chemical exposures and surrounding circumstances. For that reason, we examined the Hazardous Substances Emergency Events Surveillance (HSEES) system data to identify frequent locations, released substances, and factors contributing to short-term chemical exposures associated with adverse health consequences experienced by children.
The HSEES system was established by the Agency for Toxic Substances and Disease Registry (ATSDR) in 1990 to focus on the public health consequences rather than the environmental effect of acute hazardous substance releases. A need for this focus had been identified because previously established federal databases were used for enforcement and as channels of communication to other agencies (e.g., environmental, enforcement, commercial cleanup, insurance), not for assessment of adverse health outcomes (Binder, 1989). In the HSEES system, state health departments actively collect information from multiple sources about eligible events and enter the data into a standardized ATSDR-provided Web-based system. The information in the HSEES database describes the distribution and characteristics of acute hazardous substance releases and the associated morbidity and mortality experienced by employees, responders, and the general public.
A substance is considered hazardous if it might reasonably be expected to cause an adverse human health effect. HSEES events include uncontrolled or illegal releases of hazardous substances that according to federal, state, or local law need to be cleaned up or neutralized (ATSDR, 2004). Information about threatened releases that result in public health actions such as evacuation is also included in the system. In accordance with legislative mandate, however, events involving only petroleum are not eligible for HSEES (CERCLA, 1980).
Earlier reports on HSEES data described exposures in specified settings or types of hazardous release that in part affected children (Berkowitz, Haugh, Orr, & Kaye, 2002; CDC, 2003; CDC, 2005b; CDC 2005c; Ernst, Wattigney, & Kaye, 2005; Horton, Berkowitz, & Kaye, 2003; Horton, Berkowitz, & Kaye, 2005; Ruckart, Orr, & Kaye, 2004). The focus of this report, however, is a comprehensive description of 1996-2003 HSEES events associated with acute health consequences experienced by children. The main objective is to identify the more frequent locations, released substances, and factors contributing to events and thus to guide strategies to reduce the number of such events and associated childhood exposures and injury.
HSEES collects data on the characteristics and public health consequences of acute hazardous substance releases. State programs are funded for a five-year period or periods through a competitive program announcement, and awards are made according to the availability of funding and the outcome of an objective review. HSEES data from the 17 states that participated in 1996-2003 form the basis for the identification of events for the analysis presented here. For the entire period, 13 state health departments (Alabama, Colorado, Iowa, Minnesota, Mississippi, Missouri, New York, North Carolina, Oregon, Rhode Island, Texas, Washington, and Wisconsin) contributed data. Four additional state health departments contributed for various periods: Louisiana during 2001-2003, New Hampshire during 1996, and New Jersey and Utah during 2000-2003.
States establish various reporting sources by negotiating formal or informal agreements with state and local agencies that are normally notified when hazardous substance emergencies have occurred. These agencies include, but are not limited to, police and fire departments, environmental agencies, and various offices of emergency government. The media also serves as a resource for identifying events. For each event, information is collected about industry description, substance or substances released, victims, injuries, and evacuations.
Eligible events involve the acute release or threatened release of a substance that is considered hazardous because of the propensity of the substance to cause physical harm. For each HSEES event, industry codes were assigned according to the U.S. Census Bureau 1990 Classified Index of Industries and Occupations (Bureau of the Census, 1992). The industry classification system developed for the 1990 census consisted of 243 broad categories, and trained coders assigned the most appropriate category Events not associated with an industry were assigned a code to indicate a non-industry-related event.
The HSEES system captures all chemicals either released or threatened to be released for each event. Individual chemicals are assigned standard chemical names and one of 16 substance categories: acids; ammonia; bases; chlorine; formulations; hetero-organics; hydrocarbons; other inorganics; oxy-organics; paints and dyes; pesticides and agricultural; polychlorinated biphenyls; polymers; volatile organic compounds; "mixtures," compound substances consisting of substances from different categories (mixed before the event); and "other" (not fitting any of the other categories). Several chemicals qualify for more than one chemical classification. Relevance is assigned in a hierarchical manner, as follows: 1) if immediately hazardous, 2) by intended usage, 3) from most-to-less-precise chemical structure, 4) by formulations, and 5) other. Exceptions are pharmaceutical or biological and radioactive compounds that are always classified as other.
Factors contributing to the release were added to the system beginning in 1996, and categories have been updated periodically. A list of contributing factors is presented in Table 1. For each event, two factors could be selected, with the first entry designated as the primary …