Acute Hazardous Substance Releases Resulting in Adverse Health Consequences in Children: Hazardous Substances Emergency Events Surveillance System, 1996-2003
Wattingey, Wendy A., Kaye, Wendy E., Orr, Maureen F., Journal of Environmental Health
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 factor and the second entry as the secondary factor. Starting in 2002, the primary factor was restricted to the following categories: equipment failure, human error, intentional or illegal act, bad weather, natural disaster, and other.
Victims were defined as people who suffered at least one adverse health effect or died as a consequence of the event. State coordinators try to gather information on each victim with respect to category (general public, student, employee, firefighter, EMS personnel, hospital personnel, police officer, or other responder); age; gender; type of injury sustained; and injury severity. To describe the type of injury or injuries sustained, state coordinators could identify as many as seven of the following injuries: trauma; respiratory irritation; eye irritation; gastrointestinal problems; heat stress; burns (chemical, thermal, or both); skin irritation; dizziness or other central nervous system symptom; headache; shortness of breath from unknown cause; and heart problems.
From the eligible 1996-2003 events with a release, the events involving at least one victim younger than 17 years of age were selected for the analysis. The first full year during which HSEES collected data on factors contributing to the release was 1996; 2003 is the latest year for which data are available at the time of the analysis. Contributing factors include improper mixing, equipment failure, operator error, improper filling, maintenance, system/process upset, system startup or shutdown, factors beyond human control, power failure, unauthorized dumping, deliberate damage, other, and unknown. Events involving only a threatened release were excluded from the analysis.
For our analysis, child victims were defined as victims younger than 17 years of age. In 2002 and 2003, age categories (in lieu of exact age) were added to the system, with victims categorized as less than 12 months, between 1 and 4 years, or between 5 and 14 years also defined as children. Victims with unknown age or age category who were reported as students in events occurring in elementary and secondary schools were also included. Victims for whom exact age was not known but who were categorized as between 15 and 19 years of age were not included.
The distribution of victims by sex, category (general public, student, or employee), and injury severity was examined for two age categories: 0-4 years and 5-17 years. Injury severity was categorized from least severe to most severe as follows: 1) treated outside of a hospital, including victims given first aid on the scene or seen by a private physician within 24 hours; 2) transported to the hospital-not admitted; 3) transported to the hospital-admitted; and 4) died. The percentage of victims reported to have experienced each of the 10 possible injury types also was examined by age group.
The frequency of industry codes was examined. Industry categories associated with at least 10 events involving one or more child victim and industry categories related to at least 50 victims overall were selected for further review. Within these selected industry categories, the number of events, the number of child victims, the number of events involving a severe injury (a child dying or being admitted to a hospital), and the number of severely injured children were identified. Similarly, the numbers of events, child victims, events involving a severe injury, and severely injured children were identified for chemical categories. For events that reported more than one chemical assigned to the same category, the category was counted once. An event that involved the release of multiple chemicals from different categories was assigned the category "multiple substances." Distributions of the more commonly released chemicals and chemical categories were also examined within industry types.
Factors contributing to the events (Table 1) were combined for analysis. Distribution of primary-factor categories, defined as operator/human error, equipment failure, intentional or illegal act, and all other categories, was examined overall and for selected industry categories (those associated with at least 10 events involving a child victim or at least 50 child victims).
During the seven-year period from 1996 through 2003, 56,819 events with actual releases were reported to the HSEES program by the 17 participating states. Of this total, 4,518 events (8.0 percent) involved one or more victims. For the 4,518 events, a total of 15,515 victims were reported, and the number of victims reported as less than 17 years old was 1,859. An additional 228 victims who were of unknown age but were students in an elementary or secondary school where an event occurred were included in the study. Thus, the total number of child victims is 2,087 from 297 events; 154 events had only one child victim each, 66 events had two to four child victims each, 32 events had 5 to 10 child victims each, and 45 events had more than 10 child victims each, with the highest number being 191.
The distribution of selected characteristics, injury severity, and type of injury or injuries is described in Table 2 by age group. Injured children were predominantly students (5-17 years of age) who were either given first aid on the scene or seen by a private physician (44 percent), or observed or treated at a hospital but not admitted (52 percent). A larger percentage of children zero to four years of age were observed or treated at a hospital but not admitted (74 percent). Overall, the most frequently reported injury sustained was respiratory irritation.
The two most frequent industry categories among events involving one or more child victims were "elementary and secondary schools" (71, or 24 percent) and "private households" (59, or 20 percent) (Table 3). "Elementary and secondary schools" also had the largest total number of child victims (813) because most of these events involved several victims. Of the 17 assigned chemical categories, oxy-organics, influenced primarily by carbon monoxide, was the category most frequently associated with events resulting in child victims and events involving severe child injury, and had the second largest number of child victims (Table 4). The large number of child victims in "multiple categories" is due in part to the release of both pyridine and ammonia in an event that occurred at a drug manufacturer.
A total of 443 chemicals were reported for the 297 events. For most events (89 percent) only one chemical was reported. Occurrence of the more commonly released chemicals and chemical categories by description of industry location was examined (data not shown). The five most frequently reported chemicals were carbon monoxide; ammonia; chlorine; o-chlorobenzylidene malononitrile (tear gas) and 2-chloroacetophenone (mace), or pepper spray; and hydrochloric acid. Carbon monoxide releases resulting in a child victim or victims occurred in a variety of indoor settings, including retail facilities; residences; hotels, motels, and lodges; and entertainment or recreation centers. Two of the carbon monoxide releases each resulted in a child dying, and four resulted in at least one child being admitted to a hospital. Most of the ammonia releases that resulted in a child being injured were associated with agriculture industries such as crop production, wholesale trade of farm equipment and supplies, and manufacturing of agricultural chemicals. Chlorine releases occurred predominantly in recreational centers, specifically pool areas. O-chlorobenzylidene malononitrile (tear gas) and 2-chloroacetophenone (mace), or pepper spray, were released more often in schools (12 events) and retail stores (four events). Hydrochloric acid and sulfuric acid were also associated with releases in schools that resulted in child victims. Although two mercury releases that caused acute childhood injury happened in schools, five such releases occurred in private households. Pesticides (11 events) and mixtures (six events) as chemical categories were often the cause of childhood injury in the home. Pyridine was associated with the three drug-manufacturing events.
Factors contributing to the releases were reported for 268 (91 percent) of the events (Table 5). Human error was reported as the primary factor for 130 (44 percent) of the events. Intentional or illegal acts contributed to a greater proportion of school events (27 percent) and non-industry-related events (38 percent) than of events in other categories. Equipment failure contributed to a greater proportion of events associated with drug manufacturing, entertainment and recreational services, and hotels and motels.
Public safety concerns for children primarily focus on the prevention of injuries due to leading causes such as motor vehicle crashes, bicycling accidents, falls, and medication poisoning (Agran et al., 2006). Although relatively few children are affected by chemical releases, it is of considerable public health importance to better understand the nature of such risks and to prevent causes and injuries. Children exposed to toxic substances may not only suffer immediate injury, but also develop adverse health effects later in life, and the effects may be irreversible (Schaefer, 1994). Efforts to broaden health care for children have done little to deal with environmental issues that can be a particular health threat to children because of their small size and ongoing organ development (Bearer, 1995). During the eight-year period used in this analysis, 2,087 of the victims captured in HSEES were less than 17 years of age. This report delineates locations, chemicals, and factors that contributed to acute hazardous substance releases resulting in childhood injury. This information can help guide the considerations necessary to protect children from short-term hazardous chemical exposure.
Children injured from exposure to acute hazardous substance releases were predominantly at school, at home, or at an entertainment or recreational center when the event took place. The greatest number of events and the greatest number of children injured occurred at schools. Unfortunately, mismanagement and improper storage of chemicals pose both immediate and long-term threats to students, teachers, and school employees. It is estimated that a minimum of 33,450 middle and high schools across the country have unnecessary or mismanaged chemicals, potentially affecting 21 million children nationwide. Widely publicized incidents involving mercury spills resulting in school closures and costly cleanups help illustrate the problem (Berkowitz et al., 2002). In response to this problem, the U.S. Environmental Protection Agency is leading the School Chemical Cleanout Campaign, designed to remove unnecessary dangerous chemicals from schools and build a system within schools for proper chemical management (U.S. EPA, 2006). A few dangerous school events involved the use of hydrochloric acid in the making of "chemical bombs" by pranksters (CDC, 2003).
Pesticides were the category of substance most frequently released in home events. A report on pesticide poisonings in the United States showed that 57 percent of all cases involved children under six years of age (Klein-Schwartz & Smith, 1997). Children are at higher risk than adults of neurological and respiratory damage from exposure to pesticides because of behavioral patterns that increase the likelihood of exposure and "biological factors such as the immature blood-brain barrier, large skin-surface/body mass ratio, and increased sensitivity of cholinergic receptors to pesticides" (Sanborn, Cole, Abelsohn, & Weir, 2002). The potential hazards of chemicals found in common household products are presented in an earlier report on HSEES home events (Ruckart et al., 2004).
Accidental carbon monoxide poisonings are a serious public health concern. The U.S. Consumer Product Safety Commission reported an estimated 3,948 nonfatal and 28 fatal unintentional non-fire-related carbon monoxide exposures in U.S. children during 2001-2003. The majority (64.3 percent) of nonfatal carbon monoxide exposures were reported to have occurred in homes, and 21.4 percent occurred in public facilities and public areas (CDC, 2005a). Carbon monoxide releases were responsible for about 10 percent of HSEES events involving child victims, with only 28 percent of these events occurring in private residences. The Centers for Disease Control and Prevention provides a checklist for prevention of carbon monoxide poisoning and guidelines on the Internet at http://www.cdc.gov/co/default.htm.
Chlorine is a highly reactive substance that is widely used in the manufacturing industry as a bleaching agent for paper and cloth and as an intermediate in the production of many organic products such as rubber, cleaning agents, and pharmaceuticals. Chlorine poses a significant threat of injury to employees, particularly in the manufacturing industry (Horton, Berkowitz, & Kaye, 2002). In the analysis presented here, chlorine was identified as one of the top harmful chemicals to children, and the events were most likely to occur at public swimming pools. Although human error contributed to most releases involving child victims, equipment failure was primarily responsible for acute chlorine releases.
Ammonia is used in many industries--for instance as a refrigerant in wholesale food processing, as a fertilizer for farm crops, and as a component of many household and industrial cleaners. Large quantities of ammonia are commonly held in outdoor storage tanks on farms and manufacturing facilities. Damaged or malfunctioning valves or gaskets on storage containers contributed to the vast majority of HSEES ammonia releases, exposing children in nearby areas. A few ammonia-related events linked to farms and one home event involved the illicit production of methamphetamine. Anhydrous ammonia is an ingredient commonly used to produce methamphetamine, and the theft of anhydrous ammonia for this purpose from outdoor storage tanks on farmland has increased with the growing methamphetamine epidemic (CDC, 2005c; U.S. EPA, 2000). Also, makeshift methamphetamine laboratories are often set up in private residences, an estimated 20 percent of which have children present (CDC, 2005c; Horton, Berkowitz, & Kaye, 2003).
Pharmaceutical drug manufacturing was associated with the greatest number of victims per event: 397 victims in three events. The three events occurred at one facility, where gasket leaks and pressure imbalances caused the release of pyridine and ammonia into the air. During each event, the resulting plumes drifted downwind to a nearby school, causing harm to 100 or more children. Children who experienced adverse health effects were treated on the scene, and symptoms consisted mostly of gastrointestinal problems (e.g., nausea), headaches, dizziness, and respiratory irritation. These symptoms are consistent with what would be expected from exposures to pyridine and ammonia; however, the partial influence of mass hysteria cannot be ruled out (Small, Feinberg, Steinberg, & Collins, 1994). In recent years, school siting has gained recognition as an environmental public health concern. For example, healthy-school advocates stress that schools not be located too close to existing or former industrial sites, transportation corridors, and other sources of toxic exposures (Rhode Island Legal Services, 2006).
In recent years, HSEES prevention programs have worked toward the development of intervention strategies to reduce the occurrence of events and subsequent injuries. Using state-specific HSEES data, each state develops activities intended to provide industry, responders, and the general public with information about ways to help prevent acute chemical releases or reduce harm if a release does occur. Prevention activities in the Midwestern agricultural states target theft from ammonia fertilizer tanks as a chemical safety alert. Recommendations are being communicated to farmers and industry personnel to help deter theft of anhydrous ammonia and prevent accidental releases. The recommendations include storing tanks in well-lit areas, using valve locks or fencing, and using a marking agent in the stored substance to help detect leaks (CDC, 2005c; U.S. EPA, 2000). In Wisconsin, activity to help prevent the release of chlorine in public swimming pool areas was conducted. This activity consisted of a telephone outreach to 132 swimming pool operators describing the adverse impact of such events, contributing factors, and recommendations for safe handling. Mercury is a common target for prevention because mercury-containing instruments are prevalent in homes and schools. Fact sheets that describe the potential adverse health effects of mercury exposure and high cleanup costs, and provide suggestions for handling of mercury spills are distributed to school administrators, chemistry teachers, and the general public. In addition, successful community programs have been conducted to collect and properly dispose of mercury thermometers. Guidelines issued by the New York State Health Department present teachers and administrators with a few simple steps that can markedly reduce the health risk and expense of mercury exposures. The guidelines include immediately calling authorities, isolating exposed persons outside in the open air, restricting contaminated areas, and removing contaminated shoes and clothing. School officials are told to never vacuum, mop, or sweep up mercury because doing so spreads toxic vapors (New York State Health Department, n.d.). Legislation banning the purchase or use of elemental mercury in primary and secondary schools in New York became effective September 4, 2004.
The usefulness of HSEES for capturing information about the public health consequences of acute hazardous chemical releases is evident from the numerous publications and prevention activities that the program supports (ATSDR, 2002). As with any surveillance system, however, some limitations should be considered when the overall data are interpreted. The reporting of events within states participating in HSEES is not mandatory Thus, state health departments are funded to build capacity with mandated or other appropriate notification agencies or resources within their state that collect reports of hazardous substance releases. Although some notification resources are consistent among states, such as monthly reports from the Department of Transportation's Hazardous Materials Incident Reporting System and the identification of events from the news media, states have to a varying degree established reporting capacity by networking with police and fire departments, emergency medical services, medical facilities, poison control centers, and prominent industries within their state. The definition of an eligible event as prescribed in the HSEES protocol is an uncontrolled or illegal release or threatened release of one or more hazardous substances in quantity sufficient to require removal, cleanup, or neutralization according to federal, state, or local law. Although a standard definition is provided to all states, state and local laws vary with respect to minimum substance reporting requirements and cleanup requirements. Therefore, the completeness of reporting and the definition of eligible events vary among states according to their reporting resources, interpretation of "cleanup" in the case definition, state and local laws, and capacity to follow up on events. In the HSEES data reported here, most hazardous-chemical releases that occurred in homes were reported by a single state that networked with hospital emergency departments and captured all events resulting in injury regardless of the quantity released. Another limitation is that HSEES state coordinators are instructed to include all injuries related to the event, whether those injuries are believed to be related to an actual chemical exposure or not. Thus, six of the nine fatalities reported in this analysis involved vehicular accidents that were likely due to trauma from the collision and not to the hazardous substance released. Last, HSEES lacks personal identifying information and resources to conduct follow-up and determine the long-term effects of acute exposure to hazardous chemicals.
Chemical releases that result in injury to children occur in various settings, mostly schools, homes, and recreational areas. Chemical accidents cannot be prevented entirely, but efforts can be made to provide safer environments for children to live, learn, and play in. Surveillance of acute hazardous chemical releases leads to an understanding of the contributing causes. Several accidental releases from chemical facilities resulted in harm to a large number of school children nearby and should serve as a warning about the siting of schools in proximity to such risks. Further recommendations to help deter specific releases and reduce the risk of injury are presented in detail in earlier HSEES reports (Berkowitz et al., 2002; CDC, 2005b, 2005c; Horton et al., 2004, 2005). These publications are available on the HSEES Internet site: http://www.atsdr.cdc.gov/HS/HSEES/Publications.html. Wide dissemination of safety recommendations and education programs is required to protect children from needless environmental dangers.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Agency for Toxic Substances and Disease Registry.
Corresponding Author: Wendy A. Wattigney, Mathematical Statistician, Agency for Toxic Substances and Disease Registry, Division of Health Studies, Epidemiology and Surveillance Branch, 2400 Century Parkway, Atlanta, GA 30345. E-mail: firstname.lastname@example.org.
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Wendy A. Wattigney, M.Stat.
Wendy E. Kaye, Ph.D.
Maureen F. Orr, M.S.
TABLE 1 Factors Reported as Contributing to Events, HSEES, 1996-2003 1996-2001 2002-2003 Improper mixing Improper mixing Equipment failure Equipment failure* Operator error Human error* Improper filling or loading Improper filling, loading, or packaging Maintenance Maintenance System/process upset System/process upset System start up and shutdown System start up and shutdown Factors beyond human control Dropped (now in bad weather conditions/natural disaster) Earthquake Dropped (now in bad weather conditions/natural disaster) Bad weather conditions Bad weather conditions/natural disaster* Power failure/electrical problem Power failure/electrical problem Fire Fire Explosion Explosion Unauthorized/improper dumping Unauthorized/improper dumping Deliberate damage/illegal act Intentional or illegal act* Other Other* Motor vehicle accident/rollover Vehicular or vessel collision Vehicular or vessel derailment/ rollover/capsizing Overspray/misapplication Illicit drug production related Load shift Forklift puncture * Designated as primary-factor categories starting in 2002. Equipment failure, human error and other are also listed as secondary-factor categories. TABLE 2 Distribution of Selected Characteristics, Injury Severity, and Type of Injury by Age Group Age of Victim 0-4 years 5-17 years Total number of children 104 1,983 Number (% of Age Group) Sex of victim Male 43 (41.3) 744 (37.5) Female 47 (45.2) 856 (43.2) Unknown 14 (13.5) 383 (19.3) Victim category General public 87 (83.7) 564 (28.4) Student 17 (16.3) 1,356 (68.4) Employee -- 63 (3.2) Severity of injury Nonhospital 15 (13.6) 875 (44.1) Hospital-released 76 (73.8) 1,030 (52.0 Hospital-admitted 10 (9.7) 72 (3.6) Died 3 (2.9) 6 (0.3) Number (% of Injury Type) Injury type Respiratory irritation 53 (51.0) 1,025 (51.7) Eye irritation 25 (24.0) 425 (21.4) Gastrointestinal problems 20 (19.2) 583 (29.4) Burns 16 (15.4) 24 (1.2) Dizziness/central nervous system 11 (10.6) 386 (19.5) Skin irritation 11 (10.6) 256 (12.9) Trauma 10 (9.6) 56 (2.8) Headache 8 (7.7) 396 (20.0) Shortness of breath 2 (1.9) 160 (8.1) Heart problems 0 25 (1.3) TABLE 3 Number of Events Involving Child Victims and Number of Child Victims, by Industry Category (a) -- HSEES, 1996-2003 Total Number of Events with Total Number Industry Number [greater than or equal to]1 of Child Description of Events Severe (b) Injury Victims Elementary and 71 6 813 secondary schools Private households 59 14 74 Miscellaneous 20 8 203 entertainment and recreational service Unable to classify 16 3 41 Trucking services 10 5 17 Drug manufacturing 3 0 397 Army 1 0 115 Hotels and motels 7 1 54 All others (c) 110 19 373 Total 297 56 2,087 Minimum Maximum Median Number of Number of Number of Number of Child Victims Child Child Child Industry with Severe Victims Victims Victims Description Injury per Event per Event per Event Elementary and 18 1 89 6 secondary schools Private households 15 1 5 1 Miscellaneous 22 1 63 entertainment and recreational service Unable to classify 3 1 13 1 Trucking services 5 1 4 1 Drug manufacturing 0 93 191 113 Army 0 115 115 115 Hotels and motels 3 1 17 7 All others (c) 25 1 49 2 Total 91 (a) Industry categories include industries associated with at least 10 events involving a child victim and industries involving at least 50 child victims. (b) Events associated with a child dying or being admitted to a hospital. (c) "All others" includes 63 industry codes overall: 36 associated with 1 event, 18 with 2 events, 4 with 3 events, and 5 with 4 to 8 events. For events with severe injury, "all others" includes 16 industry codes: 8 associated with 1 event, 4 with 3 events, and 3 with 3 events. TABLE 4 Number of Events Involving Child Victims and Number of Child Victims, by Chemical Category -- HSEES, 1996-2003 Total Number of Total Number Events with Number Chemical Category of [greater than or equal to]1 of Child (Frequent Chemical) Events Severe* Injury Victims Oxy-organics 37 8 362 (carbon monoxide) Acids (hydrochloric 30 5 129 acid and sulfuric acid) Mixture 29 7 86 Other inorganic 29 8 151 (mercury) Multiple categories 28 7 461 Pesticides (malathion) 27 6 117 Chlorine 23 4 117 Other (pepper spray) 20 3 174 Ammonia 20 3 61 Volatile organic 19 3 283 compounds (pyridine) Hetero-organics 12 0 71 (o-chlorobenzylidene malononitrile) Bases (sodium 11 0 52 hydroxide) Indeterminate 5 1 15 Formulation 2 0 3 Hydrocarbons 2 0 2 Polymers 2 1 2 Paints and dyes 1 0 1 Total 297 56 2,087 Chemical Category Number of Child Victims (Frequent Chemical) with Severe Injury Oxy-organics 31 (carbon monoxide) Acids (hydrochloric 6 acid and sulfuric acid) Mixture 10 Other inorganic 9 (mercury) Multiple categories 9 Pesticides (malathion) 8 Chlorine 6 Other (pepper spray) 4 Ammonia 3 Volatile organic 3 compounds (pyridine) Hetero-organics 0 (o-chlorobenzylidene malononitrile) Bases (sodium 0 hydroxide) Indeterminate 1 Formulation 0 Hydrocarbons 0 Polymers 1 Paints and dyes 0 Total 91 * Events associated with a child dying or being admitted to a hospital. TABLE 5 Frequency* of Factors That Contributed to Releases, by Industry Category, HSEES, 1996-2003 Factor Industry Equipment Illegal All Other Description Human Error Failure Act Factors Schools (n = 71) 30 (42%) 8 (11%) 19 (27%) 9 (13%) Private households 47 (80%) 1 (2%) 8 (14%) 1 (2%) (n = 59) Miscellaneous 5 (25%) 11 (55%) 2 (10%) 2 (10%) entertainment and recreational services (n = 20) Unable to classify 4 (25%) -- 6 (38%) 5 (31%) (n = 16) Trucking services 7 (70%) 1 (10%) -- -- (n = 10) Drug manufacturing -- 2 (67%) -- 1 (33%) (n = 3) Army (n = 1) 1 (100%) -- -- -- Hotels and motels 3 (43%) 3 (43%) -- 1 (14%) (n = 7) All events 130 (44%) 60 (20%) 51 (17%) 30 (10%) (n = 297) All events with 24 (43%) 12 (21%) 9 (16%) 3 (5%) severe injury (n = 56) Industry Description Unknown Schools (n = 71) 5 (7%) Private households 2 (4%) (n = 59) Miscellaneous -- entertainment and recreational services (n = 20) Unable to classify 1 (6%) (n = 16) Trucking services 2 (20%) (n = 10) Drug manufacturing -- (n = 3) Army (n = 1) -- Hotels and motels -- (n = 7) All events 26 (9%) (n = 297) All events with 8 (14%) severe injury (n = 56) * Number (percentage of events), for each industry, to which a given factor contributed.…
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Publication information: Article title: Acute Hazardous Substance Releases Resulting in Adverse Health Consequences in Children: Hazardous Substances Emergency Events Surveillance System, 1996-2003. Contributors: Wattingey, Wendy A. - Author, Kaye, Wendy E. - Author, Orr, Maureen F. - Author. Journal title: Journal of Environmental Health. Volume: 70. Issue: 4 Publication date: November 2007. Page number: 17+. © 1999 National Environmental Health Association. COPYRIGHT 2007 Gale Group.
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