1. Deepwater Horizon Disaster Response
Long Term Studies & Coast Guard Worker Roster
Dr. Erica G. Schwartz, MD, MPH

2. Disclosure Statement
I have no financial interests or other relationship with manufacturers of commercial products, suppliers of commercial services, or commercial supporters. Our presentation will not include any discussion of the unlabeled use of a product or a product under investigational use.

3. Outline Coast Guard responder population
Responder missions
Responder medical readiness
C.G. occupational surveillance
Medical surveillance of C.G. responders
Long term follow-up studies of responders
Coast Guard Responder Cohort
NIH GuLF Study

4. Coast Guard Response 34 response locations
~7,500 Coast Guard responders
~ 40 Coast Guard medical, safety and work-life specialists

5. Coast Guard Response Administrative Air – Overflight
Beach / Marsh Cleaning
Booming Operations
Controlled Burn Group
Distribution Center
Federal On-Scene Coordinator
Law Enforcement
Medical & Dental
Pollution Investigator
Rescue Swimmer
Safety
Shoreline Cleanup Assessment
Search & Rescue
Skimming Ops
SMART Group
Spill Clean Up & Decontamination
Staging
Subsea Containment Group
Work-Life
Wildlife Rehabilitation

6. Medical Readiness
All CG military members are required to have an annual Periodic Health Assessment (PHA)
Face to face visit with a medical provider to assess member’s health status and medical readiness

7. Occupational Surveillance
Occupational Medical Surveillance & Evaluation Program (OMSEP):
Identification of work related diseases or conditions
Use of baseline and periodic examinations
Use of quantitative work-site sampling

8. Occupational Surveillance
Resident inspectors
Pollution investigators
Marine safety (general)
Port safety (general)
Vessel inspectors
Marine investigators
Firefighters

9. Occupational Surveillance
Pesticides
Respiratory sensitizers
Solvents
Tuberculosis
Bloodborne Pathogens
Radiation
Asbestos
Benzene
Chromium
Hazardous Waste
Lead
Noise
Coast Guard Medical Surveillance Action Level: The medical surveillance action level (MSAL) is the level of worker exposure, determined by workplace sampling, at or above which occupational medical surveillance examinations will be performed. The Coast Guard MSAL will be 50% of the most stringent of the current OSHA permissible exposure limit (PEL), or the most current American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Value (TLV).
*Enrollment based upon the Medical Surveillance Action Level

10. Medical Surveillance
Coast Guard direct care + purchased care captured by CHCS, which feeds:
M2 database
ICD-9 codes
Query of diagnoses via ICD-9 codes
Electronic Health Records (EHRs)

11. Deepwater Horizon Inventory
All CG responders required to complete survey (“Inventory Tool”) upon demobilization
Demographics, period of deployment
Site, mission, self reported exposures, self reported injuries & symptoms, PPE use
Mobilization Readiness Tracking Tool (MRTT)
Provides denominator (approximate)
Some groups not covered (cutters, aviators, local shore units)
Enumerating total responder population by merging MRTT with other databases

12. Enumeration of Responder Cohort
Mobilization Readiness Tracking Tool (MRTT)
Provides denominator (approximate)
Some groups not covered (cutters, aviators, local shore units)
Enumerating total responder population by merging MRTT with other databases
National Pollution Funds Center (NPFC)

13. Follow-up of DWH responders
Follow-up by Coast Guard physicians for all “positive” responses in Inventory Tool
Epidemiology analysis of Inventory (existing survey) data
Surveillance based on inpatient/outpatient encounters (ICD-9 coding)
pre- and post-DWH rates for responder cohort
Comparison of responders to other CG members
Linkage with Electronic Health Record
For pre- and post-DWH health effects

14. Follow-up Study of Coast Guard DWH Responder Cohort
Rationale
Crude oil, burning oil, dispersants contain known and suspected toxins
Heat and stress may also have adverse long-term health effects
Clean-up workers’ exposures range from negligible to potentially significant
Little is known about health effects from oil spills on response workers, despite the frequency of these events worldwide
However, prediction of adverse health effects is not possible
because the long-term human health consequences of oil spills
are largely unknown

15. Follow-up Study of Coast Guard DWH Responder Cohort
Human studies of oil spill exposures
Very few, mainly in the wake of:
Exxon Valdez (1989), Braer (1993), Sea Empress (1996), Nakhodka (1997), Erika (1999), Prestige (2002), & Tasman Spirit (2003)
Crude methods of exposure assessment (exposed vs. non-exposed)
Predominantly cross-sectional
Provide some evidence of relationship between exposure to spilled oils and a range of acute adverse health effects, such as:
Respiratory, acute physical symptoms, neurologic, psychological, genotoxic, and endocrine effects in the exposed population
Long term effects?
Exposure to Corexit 9500 and 9527A?

16. Follow-up Study of Coast Guard DWH Responder Cohort
Overall objective:
Identify potential short- and long-term health effects from oil spill response work exposures
In a cohort of Coast Guard DWH responders
NIH RO-1 application
Collaborative effort:
Uniformed Services University
U.S. Coast Guard
Study Design: Prospective Cohort

17. Questions ?

18. Back-up Slides

19. Follow-up Study of Coast Guard DWH Responder Cohort
Specific Objectives
Identify health outcomes associated with the CG responders’ DWH response activities, including:
Respiratory, cardio-vascular, heat stress-related, hematologic, dermatologic, neurologic, immunologic, hepatic, renal, & mental health conditions
Identify health conditions newly diagnosed or that changed in severity since the oil spill by making pre- and post-spill comparisons
Further elucidate high interest associations identified in specific aims 1 & 2 by:
Focusing on an OMSEP subset
Accounting for genetic polymorphisms in genes related to the metabolism of benzene in a subset of highest exposed and group of controls
CYP2E1, GSTM1, GSTT1, EPHX, MPO, NQO1

20. Follow-up Study of Coast Guard DWH Responder Cohort
Key sources of data:
Exit survey (inventory) completed by responders
Self reported oil spill-related exposures & acute health effects
Personal monitoring data for subset of responders
Objective clinical data: EHRs, ICD-9 codes
Will enable validation of self reported health data, account for pre-existing health conditions, and allow for pre- and post-spill comparisons
Department of Defense Serum Repository

21. Follow-up Study of Coast Guard DWH Responder Cohort
Exposure Assessment
Exit survey (inventory):
Exposed missions vs. non-exposed missions
Comparisons of:
groups of missions
individual missions
individual exposures
geographic location of response
PPE use
Duration of response
Quantitative monitoring data + exit survey

22. Strengths & Limitations
Ability to compare objective health data, post-spill to pre-spill
Large population with exposure data already collected
Similar access to medical care
Limitations
Potential for few people with very high exposures
Buoy Tender cutters (booming and skimming operations)
Decontamination operations
Can only follow-up responders (under these mechanisms) while they remain in C.G.
Population may incur other responder exposures from other disaster responses