Kingston TVA Coal Ash Spill David Kirschke, MD Deputy State Epidemiologist Tennessee Department of Health Regional Epidemiology Meeting 3/30/09

Slough Off Emory River

Outline Tennessee Department of Health role Environmental investigation Water, air, soil, fish Exposure routes Health survey Surveillance Recommendations

Tennessee Department of Environment and Conservation Situation December 22 a retaining wall failed at the TVA Kingston Fossil Plant >5.4 million cubic yards of coal ash spilled from an on-site holding pond to cover >300 acres No immediate injuries Physical and natural environment has been dramatically impacted “Citizens’ lives have been disrupted, water quality has been impaired, and aquatic habitat has been destroyed.” Tennessee Department of Environment and Conservation

Tennessee Department of Health (TDH) Working with other federal/state/local agencies: Environmental sampling plan Environmental testing at state laboratory Interpreting environmental test results for potential impact on human health Providing public health recommendations Surveillance at hospital emergency departments for associated illnesses Neighborhood health survey with CDC

Fly Ash Material Safety Data Sheet Contains silica and trace metals “Short term exposure presents little to no hazard” Eye / respiratory irritation Chronic exposure – silicosis Depends on duration and level of exposure Chronic exposure – heavy metals No current evidence for chronic exposure

Tennessee Department of Environment and Conservation Sampling Plan Comprehensive sampling plan to address surface water, ground water, drinking water, soil and air monitoring to better inform communities and citizens while ensuring full, complete clean up Ongoing water quality monitoring and assessment within the major waterways impacted by the ash slide – Emory River, Clinch River and Tennessee River Tennessee Department of Environment and Conservation

Tennessee Department of Environment and Conservation Air Monitoring Oversight of TVA will be accomplished in several ways: Splitting samples collected by TVA to independently analyze their makeup Quality assurance of the TVA operated monitors by TDEC staff Installing co-located TDEC air monitor at a TVA monitoring site TDEC already operates a continuous air monitoring site in Harriman (approximately 2.5 miles from the ash spill) More than 2,600 mobile air monitoring samples have been collected All sample results have been within the National Ambient Air Quality Standards for Particulate Matter - except one Tennessee Department of Environment and Conservation

Particulate Matter (PM) Studies have linked particle pollution exposure to: increased respiratory symptoms, such as irritation of the airways, coughing, or difficulty breathing, for example; decreased lung function; aggravated asthma; development of chronic bronchitis; irregular heartbeat; nonfatal heart attacks; and premature death in people with heart or lung disease. People with heart or lung diseases, children and older adults are the most likely to be affected However, even if you are healthy, you may experience temporary symptoms from exposure to elevated levels of particle pollution EPA

Tennessee Wildlife Resources Agency (TWRA) Potential impacts to aquatic habitats will be tracked  Monitoring of rivers and the collection of fish Exceedences of Tennessee’s clean water goals have been noted Parameters of concern include arsenic, lead, thallium, and mercury  Fish tissue samples will be tracked for the metals associated with the ash Tennessee Wildlife Resources Agency (TWRA)

Tennessee Wildlife Resources Agency (TWRA) Fish TWRA advises until further notice that fishing and boating should be avoided in the lower section of the Emory River Existing advisories for Watts Bar, which would include the lower Emory River: Fish consumption advisory against eating striped bass and a precautionary advisory for catfish and sauger. A precautionary advisory means that children, pregnant women, and nursing mothers should not consume the fish species named. All other persons should limit consumption of the named species to one meal per month. Tennessee Wildlife Resources Agency (TWRA)

Heavy Metal Exposure Routes: ingestion, inhalation Factors: Toxicity Amount Duration Frequency Skin contact not an exposure route unless ingested

Public Health Recommendations Avoid contact Especially important for children Wash hands / clothes Don’t drink untested well water Heed fish advisories Follow air pollution recommendations if issued

Human Laboratory Screening Not Recommended Because tests of environmental samples have not shown levels of substances in ranges that would adversely affect human health, the Department of Health is not currently recommending human testing for any particular substance. Residents / providers may contact the Tennessee Poison Control Center (800-222-1222) for advice

Screening Pitfalls Quality control What to do with results? Some labs unreliable Skin/specimen contamination What to do with results? In absence of known exposure, results likely reflect past/ongoing unrelated exposures Occupational Environmental Dietary / smoking

Recommended Laboratory Testing If known or suspected toxic exposure to particular substance If illness presentation consistent with toxic exposure Tennessee Poison Control (800-222-1222) ATSDR toxicologist

Health Survey 5 teams of 2 person X 1 week Visited 324 residences 170 (52%) households interviewed 368 persons Average household 2.6 persons Age distribution <18 (24%), 18-64 (59%), ≥65 (17%)

Preliminary Results: Exposure 47% said fly ash in yard 4% said involved in cleaning it up 13% said skin contact 33% said ash on clothes 1% ate fish since spill 8% said pet tracked in ash

Preliminary Results: Behaviors 83% aware of public health messages Only 66% of people with ash on hands said they washed afterwards Persons drinking bottled water more than doubled (9 to 25%) 4 persons reported drinking well water before and only 1 afterwards 18% said they spend no time outdoors currently compared to 5% before

Preliminary Results: Health 12% with asthma 6% with COPD 5% with history of MI 7% with angina or coronary artery disease 45% with history of smoking 18% current smokers

Preliminary Results: Health Most had no change in health status 27% said cough is worse 14% said wheezing / SOB worse 25% said headache worse Some persons had complaints that may warrant increased attention to mental health issues 25% said difficulty sleeping 46% worried or anxious

Surveillance No diseases reported to health department associated with incident Syndromic surveillance at 5 area hospitals No spikes attributable to incident 19 children seen in ED at children’s hospital investigated; none appeared associated; no admissions Active surveillance at one local hospital Several visits with respiratory complaints investigated but none determined to be related to incident

Toxicology Consultation Tennessee Poison Control Center 800-222-1222 Pediatric toxicologist Robert Geller, MD; 404-616-6652 ATSDR toxicologist 770-488-7100 Tennessee Department of Health To notify of reportable illnesses: 800-404-3006

Deputy State Epidemiologist Tennessee Department of Health Thank You David Kirschke, MD Deputy State Epidemiologist Tennessee Department of Health