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Annual Report 2003

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    Historical Document

    This document is provided by the Agency for Toxic Substances and Disease Registry (ATSDR) ONLY as an historical reference for the public health community. It is no longer being maintained and the data it contains may no longer be current and/or accurate.

    In 1980, Congress created the Agency for Toxic Substances and Disease Registry (ATSDR) to implement health-related sections of laws that protect the public from hazardous wastes and environmental spills of hazardous substances. The Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA), commonly known as the "Superfund" Act, designated ATSDR as the lead agency within the Public Health Service to help prevent or reduce further exposure to hazardous substances and the adverse health effects that result from such exposures, and also to expand the knowledge base about such effects.

    This publication reports the results and findings of a health study, registry, or other health-related activity supported by ATSDR in accordance with its legislative mandate described above.

    Comments regarding this report are welcome. Please send your comments to the following address:

    Agency for Toxic Substances and Disease Registry
    Attn: Director, Division of Health Studies (E-31)
    1600 Clifton Road, N.E.
    Atlanta, Georgia 30333

    Agency for Toxic Substances and Disease Registry
    Julie L. Gerberding, MD, MPH, Administrator
    Henry Falk, MD, MPH, Assistant Administrator

    Division of Health Studies
    G. David Williamson, PhD, Director
    Sharon Campolucci, MSN, Deputy Director
    Kim Blindauer, DVM, MPH, Assistant Director for Science

    Epidemiology and Surveillance Branch
    Wendy E. Kaye, PhD, Chief

    Hazardous Substances Emergency Events Surveillance Staff
    Zahava Berkowitz, MSc, MSPH
    Kevin Horton, MSPH
    Maureen Orr, MS
    Shannon Rossiter, MPH
    Perri Zeitz Ruckart, MPH
    Casetta R. Simmons
    Wendy Wattigney, MStat
    Charles Weir, MS

    Disclaimer

    Use of trade names and commercial sources is for identification only and does not imply endorsement by the Agency for Toxic Substances and Disease Registry or the U.S. Department of Health and Human Services.

    Contents

    List of Tables

    Table 1 – Number of events meeting the surveillance definition, by type of event- Hazardous Substances Emergency Events Surveillance, 2003

    Table 2 – Number of substances involved per event, by type of event-Hazardous Substances Emergency Events Surveillance, 2003

    Table 3 – Industries involved in hazardous substance events, by category-Hazardous Substances Emergency Events Surveillance, 2003

    Table 4 – Number of substances involved, by substance category and type of event- Hazardous Substances Emergency Events Surveillance, 2003

    Table 5 – Number of victims per event, by type of event-Hazardous Substances Emergency Events Surveillance, 2003

    Table 6 – Frequency of substance categories in all events and events with victims- Hazardous Substances Emergency Events Surveillance, 2003

    Table 7 – Frequencies of injuries/symptoms, by type of event-Hazardous Substances Emergency Events Surveillance, 2003

    Table 8 – Distribution of personnel who responded to the event-Hazardous substances Emergency Events Surveillance, 2003

    Table 9 – Cumulative data by year-Hazardous Substances Emergency Events Surveillance, 1993-2003

    Table 10 – Time period each state participated in Hazardous Substances Emergency Events Surveillance, 1993-2003

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List of Figures

Figure 1 – Areas of fixed facilities involved in events-Hazardous Substances Emergency Events Surveillance, 2003

Figure 2 – Distribution of transportation-related events, by type of transport-Hazardous Substances Emergency Events Surveillance, 2003

Figure 3a – Primary factors reported as contributing to events-Hazardous Substances Emergency Events Surveillance, 2003

Figure 3b – Secondary factors reported as contributing to events-Hazardous Substances Emergency Events Surveillance, 2003

Figure 4 – Number of victims, by population group and type of event-Hazardous Substances Emergency Events Surveillance, 2003

Figure 5 – Distribution of responders injured in fixed-facility events, by type of responder- Hazardous Substances Emergency Events Surveillance, 2003

Figure 6 – Injury disposition-Hazardous Substances Emergency Events Surveillance, 2003

Figure 7 – Number of victims, by category and year-Hazardous Substances Emergency Events Surveillance, 1993-2003
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List of Appendices

Appendix A – The 102 substances most frequently involved in events-Hazardous Substances Emergency Events Surveillance, 2003

Appendix B – Publications reference list

Chemical Fire Chemical Barrells

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Executive Summary

The Hazardous Substances Emergency Events Surveillance (HSEES) system, maintained by the Agency for Toxic Substances and Disease Registry (ATSDR), actively collects information to describe the public health consequences of acute releases of hazardous substances in 15 states. This report summarizes the characteristics of events reported to ATSDR by all participating state health departments in 2003. Information about acute events involving hazardous substances was collected, including the substance(s) released, number of victims, number and types of injuries, and number of evacuations. The data were computerized using an ATSDR-provided Web-based data entry system.

A total of 9,105 events were reported. In 8,060 (88.5%) events, only one substance was released. The most commonly reported categories of substances were other inorganic substances (excluding chemicals in the categories of acids, bases, ammonia, and chlorine), volatile organic compounds, and mixtures involving substances from different categories that were mixed or formed from a reaction before release. During this reporting period, 720 events (7.9% of all reported events) resulted in a total of 1,835 victims, of whom 51 (2.8%) died. The most frequently reported injuries were respiratory irritation, headaches, and gastrointestinal system problems. Evacuations were ordered for 531 (5.9%) events.

The findings regarding the percentage of events with victims and the distribution of the types of injuries reported have been consistent in recent years. Prevention outreach efforts continue to focus on chemicals that are likely to result in victims.

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Introduction

The Centers for Disease Control and Prevention defines surveillance as the

"ongoing, systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know. The final link of the surveillance chain is the application of these data to prevention and control. A surveillance system includes a functional capacity for data collection, analysis, and dissemination linked to public health programs" [1].

Since 1990, the Agency for Toxic Substances and Disease Registry (ATSDR) has maintained an active, state-based Hazardous Substances Emergency Events Surveillance (HSEES) system to describe the public health consequences of releases of hazardous substances. The decision to initiate a surveillance system of this type was based on a study published in 1989 about the reporting of hazardous substances releases to three national databases: the National Response Center Database, the Hazardous Material Information System (HMIS), and the Acute Hazardous Events Database [2].

A review of these databases indicated limitations. Many events were missed because of specific reporting requirements (for example, the HMIS did not record events involving intrastate carriers or fixed-facility events). Other important information was not recorded, such as the demographic characteristics of victims, the types of injuries sustained, and the number of persons evacuated. As a result of this review, ATSDR implemented the HSEES system to more fully describe the public health consequences of releases of hazardous substances.

HSEES has several goals:

    To describe the distribution and characteristics of acute hazardous substances releases;

    To describe morbidity and mortality among employees, responders, and the general public that resulted from hazardous substances releases; and to

    To develop strategies that might reduce future morbidity and mortality resulting from the release of hazardous substances.

For a surveillance system to be useful, it must not only be a repository for data, but the data must also be used to protect public health.

In the last few years, the last goal of the HSEES system has been emphasized; i.e., to develop strategies to reduce subsequent morbidity and mortality by having each participating state analyze its data and develop appropriate prevention outreach activities. These activities are intended to provide industry, responders, and the general public with information that can help prevent chemical releases and reduce morbidity and mortality if a release occurs.

This report provides an overview of HSEES for 2003 in all participating states, summarizes the characteristics of acute releases of hazardous substances and their associated public health consequences, and demonstrates how data from the system are translated into prevention activities to protect public health.

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Methods

In 2003, fifteen state health departments participated in HSEES: Alabama, Colorado, Iowa, Louisiana, Minnesota, Mississippi, Missouri, New Jersey, New York, North Carolina, Oregon, Texas, Utah, Washington, and Wisconsin.

Beginning in 2002, a newly updated data-collection form, approved by the Office of Management and Budget, went into effect. Information was collected about each event, including substance(s) released, victims, injuries (adverse health effects and symptoms), and evacuations.

Various data sources were used to obtain information about these events. These sources included records and oral reports of state environmental protection agencies, the U.S. Department of Transportation, the National Response Center, police and fire departments, and hospitals. Census data were used to estimate the number of residents in the vicinity of the events. All data were computerized using a Web-based data entry system provided by ATSDR.

HSEES defines hazardous substances emergency events as acute uncontrolled or illegal releases or threatened releases of hazardous substances. Events involving releases of only petroleum are excluded. Events are included if (a) the amount of substance released (or that might have been released) needed (or would have needed) to be removed, cleaned up, or neutralized according to federal, state, or local law or (b) the release of a substance was threatened, but the threat led to an action (for example, evacuation) that could have affected the health of employees, emergency responders, or members of the general public. HSEES defines victims as people who experience at least one documented adverse health effect within 24 hours after the event or who die as a consequence of the event. Victims who receive more than one type of injury or symptom are counted once in each applicable injury type or symptom. Events are defined as transportation-related if they occur (a) during surface, air, pipeline, or water transport of hazardous substances, or (b) before being unloaded from a vehicle or vessel. All other events are considered fixed-facility events.

For data analyses, the substances released were categorized into 16 groups. The category "mixture" comprises substances from different categories that were mixed or formed from a reaction before the event; the category "other inorganic substances" comprises all inorganic substances except acids, bases, ammonia, and chlorine; and the category "other" comprises substances that could not grouped into one of the other existing categories.

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Results

For 2003, a total of 9,105 acute hazardous substances events were reported to HSEES: 300 (3.3%) of these events were threatened releases. Fifty-six (0.6%) were events in which substances were both threatened to be released and actually released. A total of 6,782 (74.5%) events occurred in fixed facilities. Two states, Texas and New York, reported 42.6% of all releases event occurred could be selected. Of all 6,782 fixed-facility events, 5,855 (86.3%) reported one type of area and 916 (13.5%) reported a combination of two area types. Type of area was not reported for 11 (0.2%) events. Among events with one type of area reported, the main areas were classified as follows: 2,045 (34.9%) ancillary processing equipment, 712 (12.2%) process vessel (a reaction chamber in which chemicals are processed), and 576 (9.8%) piping (Figure 1). Of the events with two areas, 497 (54.2%) involved ancillary processing equipment in combination with other types of areas.

Table 1 - Number of events meeting the surveillance definition, by state and type of event



STATE REPORTING EVENT		 TYPE OF EVENT

TOTAL NO. OF EVENTS ( %)
FIXED FACILITY TRANSPORTATION
NO. OF EVENTS %* NO. OF EVENTS %*
Alabama 90 48.4 96 51.6 186 (2.0)
Colorado 55 29.3 133 70.7 188 (2.1)
Iowa 240 73.4 87 26.6 327 (3.6)
Louisiana 587 87.1 87 12.9 674 (7.4)
Minnesota 323 73.7 115 26.3 438 (4.8)
Mississippi 107 56.9 81 43.1 188 (2.1)
Missouri 225 52.3 205 47.7 430 (4.7)
New Jersey 508 72.5 193 27.5 701 (7.7)
New York 852 75.7 273 24.3 1,125 (12.4)
North Carolina 195 52.1 179 47.9 374 (4.1)
Oregon 189 73.8 67 26.2 256 (2.8)
Texas 2482 90.1 272 9.9 2,754 (30.2)
Utah 364 76.8 110 23.2 474 (5.2)
Washington 380 65.5 200 34.5 580 (6.4)
Wisconsin 185 45.1 225 54.9 410 (4.5)
Total 6,782 74.5 2,323 25.5 9,105 (100.0)

* Percentage = (number of events by type of event per state/total number of events in that state) x 100

Figure 1

Of the 2,323 transportation-related events, 2,010 (86.5%) occurred during ground transport (e.g., truck, van, or tractor) and 198 (8.5%) involved transport by rail (Figure 2). Fewer events involved water, air, and pipeline transportation modes. Most (82.2%) ground transportation events involved trucks. The largest proportions of transportation-related events occurred during unloading of a stationary vehicle or vessel (900 [38.8%]) and from a moving vehicle or vessel (737 [31.8%]). Of the 2,323 transportation-related events, 635 (27.4%) involved a release en route that was later discovered at a fixed facility. Factors contributing to the events consisted of primary and secondary entries. Primary factors were reported for 9,008 (98.9%) events (Figure 3a). Of the reported primary factors, most (58.7%) fixed-facility events involved equipment failure, and most (65.7%) transportation-related events involved human error.

Figure 2

 

Figure 3a

Secondary factors were reported for 6,091 (66.9%) events (Figure 3b). Of the reported secondary factors, most (20.2%) fixed-facility events involved system/process upset, and most (55.7%) transportation-related events involved improper filling, loading, or packing.

Figure 3b

More than 88% of all events involved the release of only one substance. Two substances were released in approximately 5% of the events, and approximately 7% involved the release of more than two substances (Table 2). Fixed-facility events were more likely than transportation events to have two or more substances released in an event (13.4% vs. 5.9%).

Table 2 - Number of substances involved per event, by type of event

NO. OF SUBSTANCES RELEASED TYPE OF EVENT ALL EVENTS
FIXED FACILITY TRANSPORTATION
NO. OF EVENTS (%) NO. OF SUB-
STANCES		 NO. OF EVENTS (%) NO. OF SUB-
STANCES		 NO. OF EVENTS (%) NO. OF SUB-
STANCES
1 5,873 86.6 5,783 2,187 94.1 2,187 8,060 88.5 8,060
2 353 5.2 706 90 3.9 180 443 4.9 886
3 144 2.1 432 28 1.2 84 172 1.9 516
4 261 3.9 1,044 13 0.6 52 274 3.0 1,096
≥ 5 151 2.2 1,416 5 0.2 44 156 1.7 1,460
Total 6,782 100.0 9,471 2,323 100.0 2,547 9,105 100.0 12,018

The number of events by month ranged from 613 (6.7%) in February to 915 (10.1%) in July, with the largest proportions occurring from June through August. The proportion of events ranged from 15.9% to 17.2% during weekdays, and from 8.7% to 9.5% during weekend days. Of all 8,908 (97.8%) events for which time of day or time category was reported, 34.9% occurred from 6:00 AM to 11:59 AM, 31.8% from 12:00 PM to 5:59 PM, 18.6% from 6:00 PM to 11:59 PM, and the remainder during the early hours of the day.

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Industries

The largest proportions of HSEES events were associated with the manufacturing (3,880 [42.6%]) and transportation (2,167 [23.8%]) industries (Table 3). Within manufacturing, chemical and allied products manufacturing (1,996 [51.4%]) and petroleum and coal manufacturing (1,251 [32.2%]) accounted for most of the events. The largest number of events with victims occurred from non-industrial illegal activity (illicit drug related) (125 [17.4%]). The total number of victims was greatest in the manufacturing industry (365 [19.9%]) followed by the number of victims in professional services (279 [15.2%]) and illegal activity (illicit drug related) (125 [11.7%]). The subcategory food and kindred products manufacturing accounted for 26.3% of all victims in the manufacturing industry. Although the manufacturing industry resulted in a large proportion of events with victims and a large number of victims, only 3.0% of all manufacturing events resulted in victims. Conversely, 35.5% of all events in the finance and real estate industry resulted in victims, but this industry represents a small proportion (1.5%) of events with victims.

Table 3 - Industries involved in hazardous substance events, by category

INDUSTRY CATEGORY TOTAL EVENTS EVENTS WITH VICTIMS % EVENTS
WITH VICTIMS		 TOTAL NO. OF VICTIMS (MAXIMUM)*
NO. % NO. %
Abandoned† 147 1.6 4 .06 2.7 6 (3)
Agriculture 185 2.0 30 4.2 16.2 148 (85)
Business and repair services 64 0.7 15 2.1 23.4 22 (5)
Communication 7 <0.1 1 0.1 14.3 1 (1)
Construction 107 1.2 20 2.8 18.7 38 (11)
Entertainment 38 0.4 9 1.3 23.7 25 (9)
Finance and Real estate 31 0.3 11 1.5 35.5 57 (16)
Illegal activity (illicit drug related) 515 5.7 125 17.4 24.2 215 (11)
Illegal activity (non-illicit drug related) 48 0.5 16 2.2 33.3 54 (15)
Manufacturing 3,880 42.6 118 16.4 3.0 365 (40)
Mining 252 2.8 2 0.3 0.8 2 (1)
Personal Services 255 2.8 60 8.3 23.5 148 (26)
Private vehicle or property 50 0.5 9 1.3 18.0 17 (5)
Professional services 222 2.4 77 10.7 34.7 279 (44)
Public administration 88 1.0 22 3.1 25.0 52 (20)
Retail trade 143 1.6 42 5.8 29.4 103 (18)
Transportation 2,167 23.8 94 13.1 4.3 176 (15)
Utilities 533 5.9 36 5.0 6.8 69 (6)
Wholesale trade 316 3.5 20 2.8 6.3 44 (10)
Unspecified and unknown 57 0.6 9 1.3 15.8 14 (3)
Total‡ 9,105 99.9 720 100.3 7.9 1,835


*Minimum number of victims per event=1.

† Includes chemical dumped on highway or other property and currently non-operating former business.

‡Percentages do not total 100% because of rounding.

 

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Substances

A total of 12,018 substances were released in all events, of which 1,125 (9.4%) substances were reported as threatened to be released. The substances most frequently released were ammonia, sulfur dioxide, carbon monoxide, and nitrogen oxide (NOX) (Appendix A). Substances were grouped into 16 categories. The substance categories most commonly released in fixed-facility events were other inorganic substances (2,407 [25.5%]), volatile organic compounds (1,666 [17.7%]), and mixtures (1465 [15.5%]) (Table 4). In transportation-related events, the most common substance categories released were volatile organic compounds (493 [19.5%]), acids (362 [14.3%]), and other (250 [9.9%]).

Two types of releases for each substance (e.g., spill and air) could be reported. Only one type of release was associated with the following: air release (5,527 [48.3%]), spill (4,352 [38.0%]), threatened release (1,133 [9.9%]), fire (357 [3.1%]), explosion (60 [0.5%]), and radiation (11 [0.1%]). Of events with two types of releases, the following combinations were reported: spill and air releases (370 [64.6%]), spill and fire (76 [13.3%]), fire and explosion (70 [12.2%]), spill and explosion (47 [8.2%]), and the remaining 10 (1.7%) involved other combinations of release types. The release type was missing for 5 substances.

Table 4 - Number of substances involved, by substance category and type of event

SUBSTANCE CATEGORY TYPE OF EVENT ALL EVENTS
FIXED FACILITY TRANSPORTATION
NO. OF SUBSTANCES (%) NO. OF SUBSTANCES (%) NO. OF SUBSTANCES (%)
Acids 660 7.0 362 14.3 1,022 8.5
Ammonia 519 5.5 72 2.8 591 4.9
Bases 265 2.8 231 9.1 496 4.1
Chlorine 202 2.1 33 1.3 235 2.0
Formulations 14 0.1 3 0.1 17 0.1
Hetero-organics 83 0.9 44 1.7 127 1.1
Hydrocarbons 108 1.1 53 2.1 161 1.3
Mixtures* 1,465 15.5 72 2.8 1,537 12.8
Other 593 6.3 250 9.9 843 7.0
Other inorganic substances 2,407 25.5 230 9.1 2,637 22.0
Oxy-organics 710 7.5 171 6.8 7.4
Paints and dyes 168 1.8 170 6.7 338 2.8
Pesticides 353 3.7 242 9.6 595 5.0
Polychlorinated biphenyls 80 0.8 3 0.1 83 0.7
Polymers 142 1.5 103 4.1 245 2.0
Volatile organic compounds 1,666 17.7 493 19.5 2,159 18.0
TotalΆ 9,435 99.8 2,532 100.0 11,967 99.7

* Substances from different categories that were mixed or formed from a reaction before the event.

† Not belonging to one of the existing categories.

‡ All inorganic substances except for acids, bases, ammonia, and chlorine.

ΆOf a total of 12,018 substances, 51 were excluded because they were not assigned a substance category: 36 occurred in fixed facilities and 15 during transportation. Percentages do not total 100% because of rounding.

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Victims

A total of 1,835 victims were involved in 720 events (7.9% of all events) (Table 5). Of the 720 events with victims, 456 (63.3%) events involved only one victim, and 123 (17.1%) involved two victims. Of all victims, 1,586 (86.4%) were injured in fixed–facility events. Fixed-facility events were more likely to have three or more victims per event (21.1%) than were transportation-related events (13.6%). Additionally, 347 persons in 115 events (1.3% of all events) were observed at a hospital or medical facility but did not have symptoms resulting from the event and, therefore, were not counted as victims.

Table 5 - Number of victims per event, by type of event

NO. OF VICTIMS TYPE OF EVENT ALL EVENTS
FIXED FACILITY TRANSPORTATION
NO. OF EVENTS (%) NO. OF VICTIMS NO. OF EVENTS (%) NO. OF VICTIMS NO. OF EVENTS (%) NO. OF VICTIMS
1 364   364 92 62.6 92

456

63.3

456
2 88   176 35 23.8 70

123

17.1

246
3 40   120 8 5.4 24

48

6.7

144
4 16   64 5 3.4 20

21

2.9

84
5 15   75 5 3.4 25

20

2.8

100
≥6 50   787 2 1.4 18

52

7.2

805
Total 573 100.0 1,586 147 100.0 249 720 100.1 1,835

To represent the magnitude of the effects of substances involved in injuries, the number of events in a specific substance category was compared with the number of events in the same category that resulted in victims.

In events that involved one or more substances from the same substance category, substances were counted once in that category. In events that involved two or more substances from different categories, substances were counted once in the multiple substance category. Substances released most often were not necessarily the most likely to result in victims (Table 6). For example, events categorized as other inorganic substances constituted 16.9% of all events; however, only 2.9% of these events resulted in injuries. Conversely, events involving chlorine and ammonia exclusively accounted for 2.3% and 5.1% of all events respectively, but 23.4% of the chlorine events and 15.9% of ammonia events resulted in injuries.

Table 6 - Frequency of substance categories in all events and events with victims*

SUBSTANCE CATEGORY NO. OF RELEASES (%) NO. OF RELEASES WITH VICTIMS (%) PERCENTAGE OF RELEASES WITH VICTIMS

Acids

665

7.3

95

13.3

14.3

Ammonia

466

5.1

74

10.4

15.9

Bases

369

4.1

28

3.9

7.6

Chlorine

205

2.3

48

6.7

23.4

Formulations

16

0.2

1

0.1

6.3

Hetero-organics

80

0.9

4

0.6

5.0

Hydrocarbons

94

1.0

6

0.8

6.4

Mixture†

 4,459

16.1

47

6.6

3.2

Multiple substance category

842

9.3

117

16.4

13.9

Other‡

 569

6.3

82

11.5

14.4

Other inorganic substances§

 1,533

16.9

44

6.2

2.9

Oxy-organics

550

6.1

59

8.3

10.7

Paints and dyes

289

3.2

13

1.8

4.5

Pesticides

407

4.5

31

4.3

7.6

Polychlorinated biphenyls

79

0.9

0

0.0

0.0

Polymers

193

2.1

11

1.5

5.7

Volatile organic compounds

1,256

13.8

54

7.6

4.3
Total 9,072 100.1 714 100.0 7.9

*Substances in events that involved multiple substances were counted only once in a substance category when all the substances were associated with the same category. If events involved multiple substances from different substance categories, they were counted only once in the multiple substance category.

†Substances from different categories that were mixed or formed from a reaction before the event.

‡Not classified.

§All inorganic substances except for acids, bases, ammonia, and chlorine.

ΆPercentages do not total 100% because of rounding. Of a total of 9,105 events, 33 were excluded because they were not assigned a substance category. Of the 33 events, 32 involved one substance each, and 1event involved two substances that could not be categorized. Six of the excluded events had victims.

Employees (943 [51.4%]) constituted the largest proportion of the population groups injured, followed by members of the general public (500 [27.2%]) (Figure 4). In fixed-facility events, 224 emergency response personnel were injured. Of those, 112 (50.0%) were police officers, 35 (15.6%) were volunteer firefighters, and 28 (12.6%) were career firefighters (Figure 5). Thirty-six responders were injured in transportation-related events. Of these, most (34 [94.4%]) were police officers, 1 (2.8%) was a firefighter of unknown type, and 1 (2.8%) was a responder of unknown type. Police officers were injured more frequently in transportation-related events (94.4%) than in fixed facility-events (50.0%).

Figure 4

Figure 5

Victims were reported to sustain a total of 2,964 injuries or symptoms (Table 7). Some victims had more than one injury or symptom. Of all reported injuries/symptoms, the most common injuries/symptoms in fixed-facility events were respiratory irritation (825 [31.1%]), headaches (381 [14.3%]), and gastrointestinal problems (354 [13.3%]). In transportation-related events, trauma (97 [31.5%]), respiratory irritation (78 [25.3%]), and eye irritation (28, 9.1%) were reported most frequently. Most (93.5%) of the trauma injuries in transportation-related events were not substance-related; these injuries resulted from a chain of events, such as a motor vehicle accident leading to the release of a hazardous substance, and not from exposure to the substance itself.

Table 7 - Frequencies of injuries/symptoms, by type of event*

TYPE OF INJURY TYPE OF EVENT ALL EVENTS
FIXED FACILITY TRANSPORTATION
NO. OF INJURIES (%) NO. OF INJURIES (%) NO. OF INJURIES (%)

Chemical burns

91

3.4

20

6.5

111

3.7

Dizziness/central nervous system symptoms

302

11.4

11

3.6

313

10.6

Eye irritation

268

10.1

28

9.1

296

10.0

Gastrointestinal system problems

354

13.3

15

4.9

369

12.4

Headache

381

14.3

27

8.8

408

13.8

Heart problems

10

0.4

1

0.3

11

0.4

Heat stress

11

0.4

0

0.0

11

0.4

Other

28

1.1

2

0.6

30

1.0

Respiratory irritation

825

31.1

78

25.3

903

30.5

Shortness of breath

47

1.8

7

2.3

54

1.8

Skin irritation

162

6.1

13

4.2

175

5.9

Thermal burns

76

2.9

9

2.9

85

2.9

Trauma†

101

3.8

97

31.5

198

6.7
Total 2,656 100.0 308 100.0 2,964 100.1


*The number of injuries is greater than the number of victims (1,835) because a victim could have had more than one injury.

† Of the 198 trauma injuries, 39 were chemical-related, 134 were not chemical-related, 7 were both chemical and non-chemical related, and the type of trauma was missing for 13 injuries.

‡ The injuries of one victim were not reported. Percentages do not total 100% because of rounding.

 

The median age of the 745 (40.6%) victims for whom exact age was reported was 35 years (range: 1-96 years). For the 1,359 (74.1%) injured persons for whom an age category was reported, 11 (0.8%) were <5 years of age, 131 (9.6%) were 5-14 years of age, 62 (4.6%) were 15-19 years of age, 861 (63.4%) were 20-44 years of age, 274 (20.2%) were 45-64 years of age, and 20 (1.5%) were >65 years of age. Of the 476 injured persons for whom age was not reported, 322 (67.6%) were presumably adults (because their population group was reported as responders or employees), and 154 (32.4%) could have been adults or children (because their population group was reported as members of the general public).

Sex was known for 1,447 (78.9%) of the victims; of these, 981 (67.8%) were males. Of all employees and responders for whom sex was reported, 75.4% were males.

Of the 1,835 victims, 991 (54.4%) were treated at a hospital without admission and 289 (15.9%) were treated at the scene. Fifty-one (2.8%) deaths were reported (Figure 6). Severity was unknown for 13 (0.7%) victims.

The status of personal protective equipment (PPE) use was reported for 822 (87.2%) employee-victims and for 234 (90.0%) responder-victims. Most of the employee-victims (91.0%) and 31.6% of the responder-victims had not worn any form of PPE. Employee-victims who wore PPE most often used eye protection (23 [31.1%]) and gloves (17 [23.0%]). Among injured emergency responders who wore PPE, 60 (25.6 %) wore firefighter turnout gear with respiratory protection, 60 (25.6%) wore gloves, and 21 (9.0%) wore firefighter turnout gear without respiratory protection.*

Only one event involved more than 50 injured people. Eighty-five employees were injured due to carbon monoxide exposure from three forklifts that were operating at an onion processing plant. The release was caused by human error. All of the victims reported headaches and gastrointestinal system problems, and 28 (32.9%) also reported dizziness/central nervous system symptoms and respiratory irritation. Seventy-two employee-victims were treated at a hospital and released, and 13 were admitted to a hospital. Ninety-two people were evacuated from the building for 20 hours, and access to the building was restricted. A fire department and certified HazMat team responded to this event.

Figure 6

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Nearby populations

The proximity of the event location in relation to selected populations was determined using geographic information systems (GIS) or health department records. Residences were within 1/4 mile of 6,155 (68.6%) events, schools within 1/4 mile of 1,007 (11.3%) events, hospitals within 1/4 mile of 119 (1.3%) events, nursing homes within 1/4 mile of 344 (3.9%) events, licensed daycares within 1/4 mile of 1,053 (11.8%) events, industries or other businesses within 1/4 mile of 8,138 (91.1%) events, and recreational areas within 1/4 mile of 910 (10.2%) events. Information for proximity of the event location in relation to selected populations was missing for 131-195 events.

The number of events at which persons were at risk of exposure was determined primarily using GIS. There were 6,082 (70.0%) events with persons living within 1/4 mile of the event; 7,050 (81.2%) events with persons living within 1/2 mile; and 7,866 (90.5%) events with persons living within 1 mile. Information on the number of people living within 1/4, 1/2, and 1 mile of the event was missing for 421, 420, and 411 events, respectively.

*Firefighter turnout gear is protective clothing usually warn by firefighters during structural firefighting operations and is similar to Level "D" protection. The Occupational Safety and Health Administration defines Level "D" protection as coveralls, boots/shoes (chemical-resistant leather, steel toe and shank), safety glasses or chemical splash goggles, and hard hats. Level "D" provides limited protection against chemical hazards.

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Evacuations

Evacuations were ordered in 531 (5.9%) of 9,009 events where evacuation status was reported. Of these evacuations, 72.1% were of buildings or affected parts of buildings; 14.7% were of defined circular areas surrounding the event locations; 5.5% were of areas downwind or downstream of the event; and the remainder were of circular and downwind or downstream areas, of no criteria, or not known. The number of people evacuated was known for 461 (86.8%) events and ranged from 1 to 3,300 people, with a median of 15 people. However, 3 ordered evacuations were reported as having no evacuees. The median length of evacuation was 2 hours (range: 12 minutes to 7 days). Evacuation length was missing for 31 (5.8%) events. Of all 9,105 events, 1,827 (20.0%) had access to the area restricted. Fifty-eight events had in-place sheltering ordered by an official.

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Decontamination

Of the 1,566 (85.3%) victims for whom decontamination status was known, 1,316 (84.0%) were not decontaminated, 128 (8.2%) were decontaminated

Smoke Stacks

at the scene, 85 (5.4%) were decontaminated at a medical facility, and 37 (2.4%) were decontaminated at both the scene and a medical facility.

Response

In events where uninjured persons were decontaminated, the median number of uninjured decontaminated individuals was 4 persons per event (range: 1?56 persons). Decontamination at a medical facility was done for 8 uninjured employees, 27 uninjured responders, 73 uninjured members of the general public, and 28 uninjured students. Decontamination at the scene was done for 157 uninjured employees, 815 uninjured responders, 77 uninjured members of the general public, and 4 uninjured students.

Of the 7,929 (87.1%) events with information on who responded to the event, 19.8% reported 2 or more categories of personnel who responded, 9.9% reported 3 or more categories, and 5.7% reported 4 or more categories.. The response team of the company where the release occurred (74.9%) responded most frequently to events, followed by fire departments (17.7%), law enforcement agencies (16.0%), and certified HazMat teams (11.5%) (Table 8).

Table 8 - Distribution of personnel who responded to the event

Responder category No. %*
Certified HazMat team 908 11.5
Department of works/ utilities/ transportation 75 0.9
Emergency medical technicians 464 5.9
Environmental agency 599 7.6
EPA† response team 19 0.2
Fire department 1,405 17.7
Health department/health agency 141 1.8
Hospital personnel 20 0.3
Law enforcement agency 1,272 16.0
Other 135 1.7
Response team of company where release occurred 5,940 74.9
Specialized multi-agency team 73 0.9
State, county, or local emergency managers/coordinators/planning

committees

92 1.2

*Percentages total greater than 100% because multiple responder categories could be reported per event.
†Environmental Protection Agency.

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Summary of Results, 1993–2003

During 1993-2003, the largest proportion of events occurred in fixed facilities (Table 9). However, the number of reported transportation-related events has increased in recent years. The increase is partially due to the 1999 addition of the U.S. Department of Transportation's Hazardous Materials Information System as a primary notification source for transportation events. In addition, the total number of events continued to increase. The increase in the number of events may have been due, at least in part, to the expansion of reporting sources.

Table 9  ─ Cumulative data by year—1993-2003*

YEAR NO. OF STATES TYPE OF EVENT NO. OF SUB-
STANCES RELEASED		 NO. OF DEATHS NO. OF VICTIMS EVENTS WITH VICTIMS

   #    (%)*

FIXED FACILITY TRANSPORTATION TOTAL
1993

11

3,199

2,230

16

634

4,361

3,833

464

12.1
1994

12

3,321

2,181

21

912

5,072

4,233

414

9.8
1995

14

4,273

1,688

14

1,037

6,027

5,310

402

7.6
1996

14

4,327

1,622

33

1,159

5,861

5,486

390

7.1
1997

13

4,385

1,896

28

1,128

6,089

5,513

372

6.7
1998

13

4,729

1,533

36

1,252

6,486

5,981

405

6.8
1999

13

4,634

1,912

30

1,626

6,974

6,260

504

8.0
2000

15

5,499

2,513

44

2,049

8,342

7,548

752

10.0
2001

16

6,736

2,168

22

2,242

11,764

8,978

710

7.9
2002

15

6,493

2,150

47

2,520

11,009

9,013‡

739

8.2
2003

15

6,782

1,835

51

2,323

12,018

9,105

720

7.9
TOTAL

54,378

16,882

71,260‡

84,003

21,728

342

5872

8.2

 

* Numbers in the table may differ from those reported in previous years because of adjustments in HSEES qualification requirements for events.

† Percentage of events with victims.

‡The total number of events does not include one event occurring in 2002 because the type of event was not known.

 

The number of substances released has also increased. The percentage of events with victims was highest in 1993 (12.1%) and lowest in 1997 (6.7%). With the exception of 2000, the average percentage of events with victims during 1999-2003 was 8.0%, which is similar to the percentage of events with victims during the total time period 1993-2003.

Respiratory irritation has consistently been the most frequently reported injury. Employees continue to be the most commonly reported victims of acute chemical releases. However, members of the general public constitute a large proportion of he victims as well (Figure 7). The number of injured responders has increased recently, and this increase likely results from police officers who are injured when responding to events involving the manufacture of methamphetamine.

The number of deaths associated with acute hazardous substances events has increased in recent years. Many of these deaths were attributed to nonchemical circumstances surrounding the events (e.g., a crash resulting from high-speed travel of a truck pulling an ammonia tank).

Figure 7

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Public Use Dataset

ATSDR has created a public-use HSEES dataset. This dataset will enable public health professionals and other interested parties to perform their own analyses. A data dictionary provides users with detailed instructions for working with the dataset. This dataset is available for download from the ATSDR Web site. The data contained in the file are related to events that occurred in the 17 participating HSEES states from 1996 to 2001 (Table 10). The public use dataset contains 39,764 records and 71 variables. More information about the public use dataset can be accessed at http://www.atsdr.cdc.gov/HS/HSEES.

Table 10 - Time period each state participated in Hazardous Substances Emergency Events Surveillance, 1993–2003

State Years Participated
Alabama 1993–2003
Colorado 1993–2003
Iowa 1993–2003
Louisiana 2001–2003
Minnesota 1995–2003
Mississippi 1995–2003
Missouri 1994–2003
New Hampshire 1993–1996
New Jersey 2000–2003
New York 1993–2003
North Carolina 1993–2003
Oregon 1993–2003
Rhode Island 1993–2003
Texas 1993–2003
Utah 2000–2003
Washington 1993–2003
Wisconsin 1993–2003
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Prevention Activities

During 2003, the state HSEES coordinators performed various prevention activities. These activities included:

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Uses of HSEES Data

During 2003, ATSDR continued to respond to requests for HSEES information from local, state, and federal agencies and organizations. HSEES data have been analyzed for articles published in peer-reviewed journals (Appendix B) and for presentations in international, national, and state conferences. In 2003, ATSDR presented HSEES data at several conferences, including the Medical and Biological Aspects of Chemical Weapons Stockpile Demilitarization symposium in Volgograd, Russia; the American Public Health Association (APHA) annual meeting in San Francisco; the American Occupational Health Conference (AOHC) in Atlanta; the ATSDR Partners Meeting in Atlanta; the Sixth National Environmental Public Health Conference in Atlanta, GA; and a Comprehensive HazMat Emergency Response Capability Assessment Program (CHERCap) meeting in Boston. The ATSDR HSEES Internet Web site page is available at http://www.atsdr.cdc.gov/HS/HSEES/. At this site, annual reports and other information can be downloaded. Internet links to other relevant Web sites and a public use dataset are also available.

Current HSEES-related activities include collaborations with other agencies and organizations that are involved with response to chemical terrorism, emergency response, hazardous substances, and public health (e.g., the U.S. Environmental Protection Agency). HSEES is also collaborating with international partners to pilot test the system in India and Poland. In India, HSEES is partnering with the National Institute of Occupational Health (NIOH) and in Poland, HSEES is partnering with the Nofer Institute for Occupational Health.

An important contribution of HSEES data is that it helps build capacity within each participating state health department to target prevention activities related to acute spills and their associated public health consequences. In 2003, target audiences included school personnel, first responders, industry, local health departments, occupational health and safety professionals, health care providers, and the general public. Activities are conducted by state HSEES coordinators, often in collaboration with other local and state agencies. The activities are evaluated to measure their effectiveness.

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References

1. Centers for Disease Control and Prevention. Comprehensive plan for epidemiologic surveillance. Atlanta: US Department of Health and Human Services; 1986.

2. Binder S. Death, injuries, and evacuations from acute hazardous materials releases. Am J Public Health 1989;70:1042-4.

Appendices

Appendix A

Substance

 No. Events
1 Ammonia 569
2 Sulfur dioxide 537
3 Carbon monoxide 452
4 Nitrogen oxide (NOX) 365
5 Hydrochloric acid 342
6 Sodium hydroxide 250
7 Sulfuric acid 238
8 Volatile organic compounds NOS* 229
9 Mercury 199
10 Nitric oxide 196
11 Methamphetamine chemicals NOS* 169
12 Paint NOS* 159
13 Oxides of nitrogen NOS* 154
14 Chlorine 130
15 Acetone 124
16 Benzene 118
17 Ethylene glycol 112
18 Solvent NOS* 101
19 Hydrogen sulfide 98
20 Methyl alcohol 91
21 Ethyl alcohol 85
22 Polychlorinated biphenyls 81
23 Resin NOS* 79
24 Corrosive NOS* 78
25 Toluene 78
26 Lithium 77
27 Acid NOS* 73
28 Flammable liquid NOS* 72
29 Adhesive NOS* 70
30 Phosphoric acid 70
31 Nitrogen dioxide 69
32 Mix: carbon monoxide/hydrogen sulfide/nitrogen oxide (NOX)/sulfur dioxide 68
33 Phosphorus 67
34 Xylene 67
35 Hydrogen peroxide 65
36 Iodine 65
37 Ethylene 63
38 Potassium hydroxide 63
39 Paint or coating NOS* 61
40 Mix: carbon monoxide/hydrogen sulfide/oxides of nitrogen NOS*/sulfur dioxide 61
41 Isopropyl alcohol 59
42 Nitrous oxide 58
43 Sodium hypochlorite 57
44 Vinyl chloride 57
45 Butadiene 54
46 Fluorocarbon 50
47 Ethyl ether 45
48 Freon 45
49 Alcohol NOS* 41
50 Pesticide NOS* 39
51 Mix: carbon monoxide/oxides of nitrogen NOS*/sulfur dioxide/volatile
organic compounds NOS*		 39
52 Propane 38
53 Mix: carbon monoxide/nitrogen oxide (NOX)/propylene 38
54 Asbestos 36
55 Diesel fuel 36
56 Hydraulic oil 32
57 Hydraulic fluid 31
58 Propylene 31
59 Ether NOS* 30
60 Methyl ethyl ketone 30
61 Antifreeze 29
62 Battery acid 29
63 Coleman fuel 29
64 Ink NOS* 29
65 Nitric acid 28
66 Ethylene oxide 27
67 Methylene chloride 27
68 Fertilizer NOS* 26
69 Mix: acetylene/carbon monoxide/hydrogen sulfide/of nitrogen NOS* 26
70 Mix: carbon monoxide/nitrogen oxide (NOX) 26
71 Mix: carbon monoxide/oxides of nitrogen NOS*/volatile organic compounds NOS* 25
72 Acetic acid 24
73 Ammonium nitrate 24
74 Mix: carbon monoxide/oxides of nitrogen NOS* 24
75 Ethylene dichloride 23
76 Heptane 23
77 Mix: carbon monoxide/nitrogen oxide (NOX)/volatile organic
compounds NOS*		 22
78 Mix: carbon monoxide/nitrogen oxide (NOX)/sulfur dioxide/volatile
organic compounds NOS*		 22
79 Chloroform 21
80 Calcium oxide 20
81 EPA f039: multi-code treatment, storage, or disposal leachate 20
82 Latex paint 20
83 Paint thinner NOS* 20
84 Mix: hydrogen sulfide/sulfur dioxide 20
85 Formaldehyde 19
86 Naphtha 19
87 Sodium hydroxide NOS* 19
88 Mix: carbon monoxide/ethylene/nitrogen oxide (NOX) 19
89 3M light water AFFF 18
90 Ammonium hydroxide NOS* 18
91 Cleaning agent NOS* 18
92 Ephedrine 18
93 Bleach 17
94 Corrosive liquid acidic inorganic NOS* 17
95 Nitrogen fertilizer 17
96 Sodium chloride 17
97 Sulfuric acid NOS* 17
98 Base NOS* 16
99 Caustic NOS* 16
100 Chlorpyrifos 16
101 Coal tar creosote 16
102 Tetrachlorcethylene 16

*NOS = not otherwise specified.

 

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Appendix B

Publications reference list

2005

Ernst KP, Wattigney WA, Kaye WE. Releases from improper chemical mixing, Hazardous Substances Emergency Events Surveillance system, 1996-2001. J Occup Environ Med 2005; 47:287-93.

Centers for Disease Control and Prevention (CDC). Public health consequences from hazardous substances acutely released during rail transit-South Carolina, 2005; selected states, 1999-2004. MMWR 2005;53:64-7.

2004

Berkowitz Z, Horton DK, Kaye WE. Hazardous substances releases causing fatalities and/or people transported to hospitals: rural/agricultural vs. other areas. Prehospital Disaster Med 2004;19(3):213-20.

Centers for Disease Control and Prevention (CDC). Brief report: exposure to tear gas from a theft-deterrent device on a safe-Wisconsin, December 2003. MMWR 2004;53:176-7.

Horton DK, Berkowitz Z, Kaye WE. Hydrofluoric acid releases in 17 states and the acute health effects associated, 1993-2001. J Occup Environ Med 2004;46:501-8.

Centers for Disease Control and Prevention (CDC). Brief report: Injuries associated with homemade fireworks-selected states, 1993-2004. MMWR. 2004;53(25):562-3.

Horton DK, Berkowitz Z, Kaye WE. Surveillance of hazardous materials events in 17 states, 1993-2001: a report from the Hazardous Substances Emergency Events Surveillance (HSEES) system. Am J Ind Med 2004;45:539-48.

Centers for Disease Control and Prevention (CDC). Carbon monoxide releases and poisonings attributed to underground utility cable fires-New York, January 2000-December 2003. MMWR 2004;53:920-2.

Ruckart PZ, Borders J, Villanacci J, Harris R, Samples-Ruiz M. The role of adverse weather conditions in acute releases of hazardous substances, Texas, 2000-2001. J Hazard Mater 2004;115:27-31.

Ruckart PZ, Wattigney W, Kaye WE. Risk factors for acute chemical releases with public health consequences: Hazardous Substances Emergency Events Surveillance in the U.S., 1996-2001. Environ Health 2004;3(1):10.

Ruckart PZ, Orr MF, Kaye WE. Hazardous chemical releases in the home. J Environ Health 2004;67(5):14-9.v

2003

Berkowitz Z, Barnhart HX, Kaye WE. Factors associated with severity of injury resulting from acute releases of hazardous substances in the manufacturing industry. J Occup Environ Med 2003;45:734-42.

Centers for Disease Control and Prevention (CDC). Homemade chemical bomb events and resulting injuries-selected states, January 1996-March 2003. MMWR 2003;52:662-4.

Horton DK, Berkowitz Z, Kaye WE. The acute consequences to children exposed to hazardous substances used in illicit methamphetamine production, 1996 to 2001. J Child Health 2003;1:99-108.

Horton DK, Berkowitz Z, Kaye WE. Secondary contamination of ED personnel from hazardous materials events, 1995-2001. Am J Emerg Med 2003;21:199-204.

Horton DK, Berkowitz Z, Haugh GS, Orr MF, Kaye WE. Acute public health consequences associated with hazardous substances released during transit, 1993-2000. J Hazard Mater 2003;B98:161-75.

Manassaram DM, Orr MF, Kaye WE. Hazardous substances events associated with the manufacturing of chemicals and allied products. J Hazard Mater 2003;104:123-35.

Manassaram DM, Orr MF, Kaye WE. Counterterrorism planning using the hazardous substances events surveillance system. Disaster Manag Response 2003;1:35-40.

Weisskopf MG, Drew JM, Hanrahan LP, Anderson HA, Haugh GS. Hazardous ammonia releases: public health consequences and risk factors for evacuation and injury, United States, 1993-1998. J Occup Environ Med 2003;45(2):197-204.

2002

Berkowitz Z, Haugh GS, Orr MF, Kaye WE. Releases of hazardous substances in schools: data from Hazardous Substances Emergency Events Surveillance system, 1993-1998. J Environ Health 2002;65:20-7.

Berkowitz Z, Orr MF, Kaye WE, Haugh GS. Adverse public health effects associated with releases of hazardous substances in the agricultural industry and related services in four mid-Western states. J Occup Environ Med 2002;44:714-23.v

Horton DK, Berkowitz Z, Kaye WE. The public health consequences from acute chlorine releases, 1993-2000. J Occup Environ Med 2002;44:906-13.

Zeitz P, Orr MF, Kaye WE. Public health consequences of mercury spills: Hazardous Substances Emergency Events Surveillance System: 1993-1998. Environ Health Perspect 2002;110:129-32.

2001

Burgess JL, Kovalchick DF, Harter L, Kyes KB, Lymp JF, Brodkin CA. Hazardous materials events: evaluation of transport to health care facility and evacuation decisions. Am J Emerg Med 2001;19:99-105.

Orr MF, Kaye WE, Zeitz P, Powers ME, Rosenthal L. Public health risks of railroad hazardous substance emergency events. J Occup Environ Med 2001;43:94-100.

Orr MF, Haugh GS, Kaye WE. Hazardous Substances Emergency Events Surveillance (HSEES), 1993 to 1997. Chemical Health and Safety 2001;35-41.

Welles WL, Wilburn RE. Hazardous Substances Emergency Events Surveillance (HSEES) in New York State, 1993 to 1997. Chemical Health and Safety 2001;42-52.

2000

Burgess JL, Kovalchick DF, Harter L, Kyes KB, Thompson JN. Hazardous materials events: an industrial comparison. J Occup Environ Med 2000;42:546-53.

Centers for Disease Control and Prevention (CDC). Public health consequences among first responders to emergency events associated with illicit methamphetamine laboratories-selected states, 1996-1999. MMWR 2000;49:1021-4.

Souther L, Small-Johnson J, Messing RB. A description of agricultural releases of anhydrous ammonia in Minnesota. Chemical Health and Safety 2000;16-22.

Weisskopf MG, Drew JM, Hanrahan LP, Anderson HA. Hazardous ammonia releases in Wisconsin: trends and risk factors for evacuation and injury. Wisc Med J 2000;30-46.

Zeitz P, Berkowitz Z, Orr MF, Haugh GS, Kaye WE. Frequency and type of injuries in responders of hazardous substances emergency events, 1996 to 1998. J Occup Environ Med 2000;42:1115-20.

1996

Hall HI, Dhara VR, Kaye WE, Price-Green PA. Public health consequences of hazardous substance releases. Toxicol Ind Health 1996;12:289-93.

Hall HI, Haugh GS, Price-Green PA, Dhara VR, Kaye WE. Risk factors for hazardous substance releases that result in injuries and evacuations: data from 9 states. Am J Public Health 1996;86:855-7.

Wendt RD, Hall HI, Price-Green PA, Dhara VR, Kaye WE. Evaluating the sensitivity of hazardous substances emergency events surveillance: a comparison of three surveillance systems. J Environ Health 1996;58:13-7.

1995

Agency for Toxic Substances and Disease Registry. ATSDR update: Hazardous Substances Emergency Events Surveillance (HSEES) system: 1993 data. Health and Environment Digest 1995;8:83-4.

Hall HI, Price-Green PA, Dhara VR, Kaye WE. Health effects related to releases of hazardous substances on the Superfund priority list. Chemosphere 1995;31:2455-61.

1994

Hall HI, Dhara VR, Price-Green PA, Kaye WE. Surveillance for emergency events involving hazardous substances-United States, 1990-1992. MMWR 1994;43(No. SS-2):1-6.

Hall HI, Dhara VR, Kaye WE, Price-Green PA. Surveillance of hazardous substance releases and related health effects. Arch Environ Health 1994;49:45-8.

Other HSEES documents available:

1995 Annual Report []
1996 Annual Report [HTML] []
1997 Annual Report [HTML] [ ]
1998 Annual Report [HTML] []
1999-2000 Biennial Report [HTML] []
2001 Annual Report [HTML] []
2002 Annual Report [ HTML] [ ]
2003 Annual Report [HTML] [ ]
2004 Annual Report [HTML] [ ]
1993 through 1997 Annual Report [HTML] []
1998 through 2001 Annual Report [HTML ] []

 

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