Responding to a lead poisoning outbreak during construction and renovation at an indoor firing range...
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Transcript of Responding to a lead poisoning outbreak during construction and renovation at an indoor firing range...
Responding to a lead poisoning outbreak during construction and renovation at an
indoor firing range
Ryan Kellogg and Steve WhittakerLocal Hazardous Waste Management Program
Public Health – Seattle & King County
Outline
• Lead in firing ranges• The Incident• Lead’s health effects• Blood lead levels in perspective• Vulnerable populations• Public Health challenges• Looking forward
Source: www.buzzle.com/articles/lead-the-element.html
Lead in bullets
• Projectile:– Elemental lead
• Primer:– Lead styphnate – Lead peroxide– Lead nitrite
Source: http://science.howstuffworks.com/revolver2.htm
Lead on the range
Source: http://www.njnoordhoek.com/?p=735Source: http://snovalleystar.com/2013/03/06/police-gun-range-is-under-fire-for-age-and-residue
Combustion Abrasion Impact
Typical range
Initial reports
• WA Lead Registry gets two elevated BLL reports from gun range employees
• Employee interviews:– Demolition and
construction project– “Tons of sand with
lead” moved and sifted– Fiberglass insulation
removed
Used with permission, confidential informant
Registry refers to WA OSHA
• History of lead violations • Multiple contractors on-site• More help needed • WA OSHA opens inspections on 11/13/12• Air & wipe sampling → high lead levels on
surfaces and in breathing zones, lead passing through exhaust ducts
• Inadequate ventilation!
Blood Lead Levels (BLLs)
BLL (µg/dL) Gun Range Employees
Construction Workers
<10 6 4810 to 24 7 1225 to 39 9 540 to 49 2 450 to 59 2 2
60 to 159 0 3Unknown 16 43
Total 42 117
>5Spontaneous abortionDevelopmental delay Hypertension/kidney dysfxn
>10 Reduced birth weightNeurocognitive deficits
>20
HeadacheFatigue, Sleep disturbanceAnorexiaConstipationArthralgia, MyalgiaDecreased libido
>40Sperm abnormalitiesNephropathyPeripheral neuropathyAnemia, Colic, Gout
Public Health’s involvement
• WA OSHA makes a referral to PHSKC - concerned about lead exposures to the public
• Can PHSKC close the range until construction is completed?
Source: http://adweek.blogs.com/Adfreak/page/339/Source: www.reedsindoorrange.com
Source: http://lowcountrybikers.com/cristin-katie-visit-the-gun-range
Ladies Night!
Cluster and environmental evaluation
• Interviewed 100+ workers• Surface sampling (public areas) – 1,000s ug/ft2
• Contamination of multiple surfaces• High air lead levels – 100s ug/m3
• Contamination in vehicles, homes, hotel rooms• Elevated BLLs in a contractor’s children and
spouse
Public Health challenges
• Health Officers in WA (and most other states) have broad statutory authority to protect public health
• Lack of regulatory procedure or precedent to guide action, and compel:– cooperation of business owner – temporary closure to protect the public– collection of data to assess public exposure risk– sharing of industrial hygiene data collected by owner’s
consultants
Public Health challenges
• No regulatory limits to protect public from lead in air• Requires close consultation/concurrence with Federal
and State agencies• High political valance on federal lead regulation• Worker exposure limits based in 70’s science• No internal PH capacity to collect personal breathing
zone samples• Local permit requirements (where they exist) do not
stipulate lead exposure controls• Gun ranges are hazardous!
Looking forward
• Specify surface- and air- lead levels that ensure BLLs <5 mg/dl:– Integrated Exposure Uptake Biokinetic Model
(IEUBK) modeling to predict BLLs from inhalation and hand-to-mouth exposures
– Consider vulnerable population receptors (women of childbearing age / pregnant women / children)
• Increase awareness of lead hazards in the shooting public
Looking forward
• Promote “best practices” – shooter behavior:– No smoking, eating, or other hand-to-mouth
activities– Wash skin after shooting– Wear long sleeves and pants– Clean footwear when leaving the range– Wash range clothing separately
Looking forward
• Promote “best practices”– range operations:– Jacketed or lead-free ammunition– Lead-free primers in bullets– Replace sand berms with solid bullet traps (with
proper disposal of sand!)– Adequate ventilation, tested regularly– Clean range surfaces daily - with confirmation
sampling– Routine blood lead testing of employees,
regardless of air lead levels. Medical removal at 10 ug/dL
Public Health actions
• Educate range operators and shooters who consider lead exposure as “normal”
• Explore state and local options to address policy and procedural gaps– Incorporate health standards in existing permits (i.e., business licenses)
– State regulations to authorize local Health permits of businesses that cause potentially harmful conditions for customers
– Ground state and local policies in current evidence base on lead exposure risks
• Assure stable funding for lead registries
Acknowledgements• PHSKC:
– Stella Chao– Jeff Duchin– Carina Elsenboss– Hilary Karasz– Mike Kinzer– Ngozi Oleru– Will Perry– Sharon Schoenfeld-Cohen– Olivia Stapleman– Nicole Thomsen– Dennis Worsham
• Lead Registry:– Todd Schoonover
• DOH:– Rad Cunningham– Glen Patrick
• WA OSHA:– Gina Colby– Venetia Runnion– John Stebbins
• Ecology:– Trudy Harding– Dave Misko
• ATSDR:– Mary Jean Brown– Karen Larson
Adult blood lead levels in perspective
60
50
40
10
5
1.4
BLL (mg/dL)
OSHA’s medical removal
OSHA’s return to work
ABLES case definition for adults / CA medical management trigger
CA pregnancy guideline
Adult U.S. geometric mean
Temporary ventilation
Gun Range Incident Timeline
2012 Oct Nov Dec Jan Feb Mar 2013
Construction complete?
Construction starts
Apr
Sept-Oct 2012Ecology consulted on berm disposal
Oct-Nov 2012Poor ventilation
while open to publicRange EE BLLs:
48 and 40 µg/dl
Dec-Jan 2013PHSKC wipe samples
– public area –1000s ppmLead registry makes
referral to DOSHWipe sampling:100,000s ppm13 Range EE BLLs:15 to 58 ug/dl
10/12/12DOSH opens inspection
DOSH: Lead in air exhausts, on
surfaces, ↑PBZs
12 contractor & subcontractor BLLs:
16 - 153 ug/dl
11/30/12DOSH contacts PHSKC
PHSKC requests closure, then data before reopening
(denied)
Feb-Apr 2013Lawsuits!
03/06/13PHSKC demobilizes
Range EEs move sand berm, “mine”
for lead
Pressure washing / disposal on veg.
Range EEs remove fiberglass insulation
DOSH no longer requires PPE for
Range EEsMedia coverageFinal ventilation system installed
Construction contractors hired
Contamination of vehicles, tools,
homes, hotel rooms, family members
PHSKC initiates surge response
ATSDR ConsultedRange hires IH consultantPHSKC requires
signageTwo shooting bays
closed – poor ventilation
Men’s restroom closed. High lead on
floor
Lead abatement contractor hired – surfaces cleanedImprovements to
ventilationLadies Night
Exposure Assess.