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Division of Health Studies
Epidemiology and Surveillance Branch

Hazardous Substances Emergency Events Surveillance (HSEES)

Biennial Report

1999-2000

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Note: While the original publication dates on some of ATSDR's documents may not appear to be current, the information in the documents is valid and may provide relevant information.

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, NE
Atlanta, Georgia
30333

Agency for Toxic Substances and Disease Registry
Julie L. Gerberding, MD, MPH, Administrator
Henry Falk, MD, MPH, Assistant Administrator
Robert F. Spengler, ScD, Associate Administrator for Science


Division of Health Studies
G. David Williamson, PhD, Director
Sharon S. Campolucci, MSN, Deputy Director
Tom Wilson, Editor

Epidemiology and Surveillance Branch
Hazardous Substances Emergency Events Surveillance Staff
Wendy E. Kaye, PhD, Chief
Zahava Berkowitz, MSc
Maureen Orr, MS
Casetta R. Simmons
Perri Zeitz, MPH
Kevin Horton, MSPH
Deana Manassaram, MPH
Lori Hutwagner, 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 1a-Number of events meeting the surveillance definition, by state and type of event, Hazardous Substances Emergency Events Surveillance, 1999


 

  • Table 1b-Number of events meeting the surveillance definition, by state and type of event, Hazardous Substances Emergency Events Surveillance, 2000


 

  • Table 2-Distribution of the number of substances released, by type of event, Hazardous Substances Emergency Events Surveillance, 1999-2000


 

  • Table 3-Distribution of the number of substances released, by substance category and type of event, Hazardous Substances Emergency Events Surveillance, 1999-2000


 

  • Table 4-Distribution of the number of victims, by type of event, Hazardous Substances Emergency Events Surveillance, 1999-2000


 

  • Table 5-Number of substances released in all events and events with victims, by substance category, Hazardous Substances Emergency Events Surveillance, 1999-2000


 

  • Table 6-Distribution of type of injury, by type of event, Hazardous Substances Emergency Events Surveillance, 1999-2000


 

  • Table 7-Profiles of events with =50 victims, Hazardous Substances Emergency Events Surveillance, 1999-2000


 

  • Table 8-Cumulative data for all states, Hazardous Substances Emergency Events Surveillance, 1993-2000


 


LIST OF FIGURES

  • Figure 1-Areas of fixed facilities involved in events, Hazardous Substances Emergency Events Surveillance, 1999-2000


 

  • Figure 2-Distribution of transportation-related events, by type of transport, Hazardous Substances Emergency Events Surveillance, 1999-2000


 

  • Figure 3-Factors reported as contributing to the occurrence of fixed-facility events, Hazardous Substances Emergency Events Surveillance, 1999-2000


 

  • Figure 4-Distribution of victims, by population group and type of event, Hazardous Substances Emergency Events Surveillance, 1999-2000


 

  • Figure 5a-Distribution of responder victims for fixed-facility events, by population group, Hazardous Substances Emergency Events Surveillance, 1999-2000


 

  • Figure 5b-Distribution of responder victims for transportation-related events, by population group, Hazardous Substances Emergency Events Surveillance, 1999-2000


 

  • Figure 6-Distribution of type of injury for all events, Hazardous Substances Emergency Events Surveillance, 1999-2000


 

  • Figure 7-Injury outcome, Hazardous Substances Emergency Events Surveillance, 1999-2000


 

  • Figure 8-Distribution of victims, Hazardous Substances Emergency Events Surveillance, 1993-2000


 

  • Figure 9-Cumulative data for all participating states, Hazardous Substances Emergency Events Surveillance, 1993-2000


 


LIST OF APPENDICES

  • Appendix A-The 100 Most Frequently Released Substances, Hazardous Substances Emergency Events Surveillance, 1999-2000


 

  • Appendix B-Profiles of events with fatalities in fixed facilities, Hazardous Substances Emergency Events Surveillance, 1999-2000


 

  • Appendix C-Profiles of events with fatalities in transportation events, Hazardous Substances Emergency Events Surveillance, 1999-2000


 

  • Appendix D-Hazardous Substances Emergency Events Surveillance-Related Publications


 


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 associated with the release of hazardous substances. This report summarizes the characteristics of events reported to the 13 state health departments participating in 1999 and the 15 state health departments participating in 2000. Information on acute hazardous substances emergency events was collected, including the substance(s) released, number of victims, number and types of injuries, and number of evacuations. The data obtained were computerized using an ATSDR-provided Web-based data entry system.

A total of 13,808 events was reported. In 13,215 (95.7%) of the events, only a single substance was released. The most commonly reported categories of substances were inorganic substances (excluding acids, bases, ammonia, and chlorine); volatile organic compounds (VOCs); mixtures involving more than one category; acids; ammonia; and pesticides. During this reporting period, 1,256 events (9.1% of all reported events) resulted in a total of 4,425 victims. The most frequently reported injuries sustained by victims were respiratory irritation, headache, eye irritation, dizziness or other central nervous system (CNS) symptoms, and gastrointestinal problems. A total of 74 persons died as a result of all events, and 622 (4.5%) events required evacuations.

The findings regarding the distribution of the numbers of events with victims and evacuations, and the numbers and types of injuries reported have, overall, been consistent since HSEES inception. The distribution of transportation events has increased over the last couple years, in part, because of the use of new notification sources for transportation events.

INTRODUCTION

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 associated with the release of hazardous substances. The decision to initiate a surveillance system of this type was made on the basis of a study published in 1989 on the reporting of hazardous substances releases to three national databases: the National Response Center Database, the Hazardous Materials Information System (HMIS), and the Acute Hazardous Events Database (1). A review of these databases indicated limitations. Many events were missed because of incomplete reporting (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 associated with the release of hazardous substances. The surveillance system has four goals:

  • To describe the distribution and characteristics of hazardous substances emergencies.
  • To describe the morbidity and mortality experienced by employees, responders, and the general public as a result of hazardous substances releases.
  • To identify risk factors associated with the morbidity and mortality.
  • To identify strategies that might reduce future morbidity and mortality resulting from the release of hazardous substances.

This biennial report summarizes the characteristics of hazardous substances releases and the associated public health consequences of events reported to the surveillance system during 1999-2000.

METHODS

In 1999, 13 state health departments (Alabama, Colorado, Iowa, Minnesota, Mississippi, Missouri, New York, North Carolina, Oregon, Rhode Island, Texas, Washington, and Wisconsin) collected data for HSEES. In 2000, two additional state health departments (New Jersey and Utah) collected data for HSEES. For each event, information was collected about the event, substance(s) released, victims, injuries, and evacuations.

Various data sources were used to obtain information about these events. These sources included, but were not limited to, records and oral reports of state environmental protection agencies, police and fire departments, the U.S. Department of Transportation, the National Response Center, and hospitals. Census data were used to estimate the number of residents living in the vicinity of the events. All data were computerized using a Web-based data entry system provided by ATSDR.

Hazardous substances emergency events are defined by HSEES as uncontrolled or illegal releases or threatened releases of hazardous substances. Events involving petroleum and no other hazardous substances are not included. Events are included if (1) the amount of substance that was 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 (2) there was only a threatened release of a substance, but the threat led to an action (for example, evacuation) that could have affected the health of employees, emergency responders, or the general public. Victims are defined as persons who suffered at least one adverse health effect or died as a consequence of the event. Victims who receive more than one type of injury are counted once in each applicable injury type. Events are defined as transportation-related if they occurred during surface, air, pipeline, or water transport of hazardous substances. All other events are considered fixed-facility events.

For the data analyses in this report, the substances released were categorized into 11 groups. The category "mixtures" consists of mixtures of substances from different categories, and the category "other inorganic substances" comprises all inorganic substances, except for acids, bases, ammonia, and chlorine. "Other" refers to substances that could not be categorized.

RESULTS

A total of 13,808 hazardous substances emergency events was reported for 1999-2000 to the HSEES system; 182 (1.3%) of these events were threatened releases. In 1999, 74.0% of the events occurred at fixed facilities (Table 1a), and in 2000, 72.9% were at fixed facilities (Table 1b). This distribution is heavily influenced by Texas, which had 37% of all events and had a larger than typical percentage of fixed-facility events. Thus, the distribution of fixed-facility events excluding Texas events indicated 64.4% for 1999 and 66.4% for 2000. These percentages are slightly less than those found in previous years for fixed-facility events.

For each fixed-facility event, one or two choices can be selected for type of area. Of all 11,030 fixed-facility area choices, 2,301 (20.9%) were classified as ancillary processing equipment, 2,199 (19.9%) as a process vessel (a reaction chamber in which chemicals are processed), 1,645 (14.9%) as storage areas above and below ground, and 1,386 (12.6%) as piping (Figure 1). Of the 3,675 transportation-related events, 3,142 (85.4%) occurred during ground transport (for example, truck, van, or tractor), and 277 (7.5%) involved transport by rail (Figure 2). Fewer events involved water, air, pipeline, or unknown transportation modes.

The primary factors contributing to the 10,133 fixed-facility events were also reported (Figure 3). Equipment failure was the primary contributing factor in 4,511 (44.5%) events, followed by 2,140 events involving operator error (21.1%), 942 involving "other" uncategorized factors (9.3%), and 412 involving system process upset (4.1%).

Ninety-six percent of all events involved the release of only one substance. Two substances were released in approximately 2% of the events, and 2% involved the release of more than two substances (Table 2).

There were 15,316 substances either released or threatened to be released during the 13,808 events. Two types of releases could be reported for each chemical (e.g., spill and air). Spills were reported in 8,275 (54.0%) of the releases, followed by 6,393 air releases (41.7%), 1,047 fires (6.8%), 361 threatened releases (2.4%), and 181 explosions (1.2%).

HSEES events were more likely when there was more industrial, commercial, or agricultural activity, e.g., in the 6 hours before noon (35.0%) and the 6 hours after and including noon (29.3%), compared with the 6 hours before midnight (14.2%) and the 6 hours after and including midnight (16.2%) (5.3% did not have a specified time). Additionally, 16%-17% of events occurred on each weekday as compared with 8%-9% on a weekend day. April through September, the peak agricultural season, had 56% of the events, and the other 6 months of the year had 44%.

SUBSTANCES

The 15,316 substances released were grouped into 11 categories. The number of substances released was greater than the number of events because more than one substance could be released per event. The categories of substances most commonly released in fixed-facility events (Table 3) were other inorganic substances (26.9%), volatile organic compounds (VOCs) (21.3%), mixtures (11.7%), acids (7.0%), and ammonia (6.7%). In transportation-related events, VOCs (15.9%), acids (14.3%), other inorganic substances (11.9%), pesticides (7.5%), and bases (7.3%) were most frequently released. The 100 substances most frequently reported for 1999-2000 are listed in Appendix A. Ammonia, sulfur dioxide, and sulfuric acid were the top released substances.

Table 1a-Number of events meeting the surveillance definition, by state and type of event, Hazardous Substances Emergency Events Surveillance, 1999.
 

State reporting event

Type of event

Total no. of events

Fixed facility

Transportation

No. of events

%

No. of events

%

Alabama

104

61.5

65

38.5

169

Colorado

148

59.2

102

40.8

250

Iowa

196

68.1

92

31.9

288

Minnesota

287

82.5

61

17.5

348

Mississippi

100

45.3

121

54.8

221

Missouri

166

57.0

125

43.0

291

New York

514

85.8

85

14.2

599

North Carolina

108

34.0

210

66.0

318

Oregon

80

76.2

25

23.8

105

Rhode Island

40

80.0

10

20.0

50

Texas

2,336

86.8

355

13.2

2,691

Washington

317

74.9

106

25.1

423

Wisconsin

238

46.9

269

53.1

507

Total

4,634

74.0

1,626

26.0

6,260


 

Table 1b-Number of events meeting the surveillance definition, by state and type of event, Hazardous Substances Emergency Events Surveillance, 2000.
 

State reporting event

Type of event

Total no. of events

Fixed facility

Transportation

No. of events

%

No. of events

%

Alabama

115

67.6

55

32.4

170

Colorado

99

47.1

111

52.9

210

Iowa

204

70.3

86

29.7

290

Minnesota

346

82.6

73

17.4

419

Mississippi

90

43.5

117

56.5

207

Missouri

199

55.1

162

44.9

361

New Jersey

457

90.1

50

9.9

507

New York

897

84.3

167

15.7

1,064

North Carolina

87

28.9

214

71.1

301

Oregon

178

65.9

92

34.1

270

Rhode Island

32

74.4

11

25.6

43

Texas

2,137

86.0

349

14.0

2,486

Utah

140

46.2

163

53.8

303

Washington

319

72.7

120

27.3

439

Wisconsin

199

41.6

279

58.4

478

Total

5,499

72.9

2,049

27.1

7,548

Figure 1-Areas of fixed facilities involved in events, Hazardous Substances Emergency Events Surveillance, 1999-2000.

*These areas were not available for the entire time period. Indoor @ res=an area inside a place where someone is residing. Indoor nonres=inside at a place that is not a residence (e.g., farm, industry, commercial business, and school). Outside nonind=outside at a place that is nonindustrial, or nonfarming (e.g., driveways, yards, roofs at residences, and schools). Outside ind=outside at an industry or farming area.

Figure 2-Distribution of transportation-related events, by type of transport, Hazardous Substances Emergency Events Surveillance, 1999-2000.*

*Four events had a combination of transportation types: one event, ground and rail; one event, water and rail; and two events, pipeline and water.

Figure 3-Factors reported as contributing to the occurrence of fixed-facility events, Hazardous Substances Emergency Events Surveillance, 1999-2000.


 

Table 2 -Distribution of the number of substances released, by type of event, Hazardous Substances Emergency Events Surveillance, 1999-2000.
 

No. of substances released

Type of event


All events

Fixed facility

Transportation

No. of events

(%)

No. of substances

No. of events

(%)

No. of substances

No. of events

(%)

No. of substances

  1

9,715

95.9

9,715

3,500

95.2

3,500

13,215

95.7

13,215

  2

216

2.1

432

121

3.3

242

337

2.4

674

  3

105

1.0

315

27

0.7

81

132

1.0

396

  4

44

0.4

176

11

0.3

44

55

0.4

220

≥5

53

0.5

722

16

0.4

89

69

0.5

811

Total

10,133

100.0

11,360

3,675

100.0

3,956

13,808

100.0

15,316

Table 3-Distribution of the number of substances released, by substance category and type of event, Hazardous Substances Emergency Events Surveillance, 1999-2000.
 

Substance  Category 

Type of event

All events

Fixed facility

Transportation

No. of substances

(%)

No. of substances

(%)

No. of substances

(%)

Acids

800

7.0

567

14.3

1,367

8.9

Ammonia

757

6.7

80

2.0

837

5.5

Bases

268

2.4

288

7.3

556

3.6

Chlorine

182

1.6

7

0.2

189

1.2

Other inorganics*

3,055

26.9

472

11.9

3,527

23.0

Paints and dyes

219

1.9

208

5.3

427

2.8

Pesticides

349

3.1

297

7.5

646

4.2

PCBs

163

1.4

12

0.3

175

1.1

VOCs

2,423

21.3

629

15.9

3,052

19.9

Mixtures†

1,332

11.7

170

4.3

1,502

9.8

Other‡

1,813

16.0

1,225

31.0

3,038

19.8

Total§

11,361

100.0

3,955

100.0

15,316

100.1

PCBs=Polychlorinated biphenyls.
VOCs=Volatile organic compounds.
*All inorganic substances except for acids, bases, ammonia, and chlorine.
†Mixtures of substances from different categories.
‡Not classified.
§Total may not equal 100% due to rounding.

VICTIMS

A total of 4,425 victims were involved in 1,256 events (9.1% of all events) (Table 4). Of the 1,256 events with victims, 744 (59.2)% events involved only one victim, and 919 (73.2)% events involved either one or two victims. Of the 4,425 total victims, 3,787 (85.6%) were injured in fixed-facility events.

The substances released most often were not necessarily the most likely to result in victims (Table 5). For example, other inorganic substances were released 3,527 times; however, only 340 (9.6%) of these events resulted in injury. Conversely, chlorine was released in only 189 events, but 62 (32.8%) of these events resulted in injury, which indicates chlorine's greater potential for immediate harm.

Employees (2,365 or 53.4%) were the population groups most often injured, followed by the general public (919 or 20.7%), students (662 or 15.0%), and responders (460 or 10.4%) (Figure 4). The population group was unknown for 19 victims (0.43%). There were 366 emergency response personnel injured in fixed-facility events. Of those, 144 (39.3%) were police, 86 (23.5%) were professional firefighters, and 83 (22.7%) volunteer firefighters (Figure 5a). There were 94 emergency-responder victims injured in transportation-related events. Of these, 50 (53.1%) were police officers, 22 (23.4%) were professional firefighters, and 12 (12.8%) were emergency medical technicians (EMTs) (Figure 5b).

The types of injuries sustained by victims are shown in Table 6 and Figure 6. Victims sustained a total of 6,970 injuries. Some victims had more than one injury. The most commonly reported injuries in fixed-facility events were respiratory irritation (32%), headache (13%), dizziness or other central nervous system (CNS) symptoms (11%), eye irritation (11%), and gastrointestinal problems (11%). In transportation-related events, trauma (30%), respiratory irritation (21%), headache (9%), and eye irritation (6%) were reported most frequently. Trauma was reported more frequently in transportation-related events (30%) than in fixed-facility events (3%). The trauma might have been caused by the sequence of events (for example, a motor vehicle accident) leading to the release of a hazardous substance, and not necessarily by exposure to the hazardous substance itself.

The sex of 79% of the victims was known; of these, 54% were male. The mean age of the 63% of victims with a specified age was 40 years (range: 0-77 years). For the 37% of injured persons for whom specific age was unknown, 70% were adults (first responders or employees), 3% were children (students), and 27% could have been adults or children (general public or unknown victim category). Most (49%) victims were transported to a hospital and treated on an outpatient basis, and 1.6% died (Figure 7). Appendix B details the fixed-facility events in which deaths occurred, and Appendix C details the transportation events in which deaths occurred.

Among victims, 34% of employees, 20% of emergency responders, and 99% of students had not worn any form of personal protective equipment. For injured employees reported as wearing personal protective equipment, a combination of gloves, eye protection, and a hard hat were worn (14%). Fourteen percent wore other type of protective equipment, 4% wore firefighter turnout gear, and 2% wore level "D" protection, as defined by the Occupational Safety and Health Administration (OSHA). Of the known personal protective equipment worn, the most frequently worn by emergency responders was firefighter turnout gear (5%) and OSHA level "A" protection (2%).

Level "A" protection is worn when the highest level of respiratory, skin, and eye protection is needed. It includes supplied-air respirator, approved by the Mine Safety and Health Administration (MSHA), U.S. Department of Labor, and the National Institute for Occupational Safety and Health (NIOSH); pressure-demand, self-contained breathing apparatus; fully encapsulating chemical-resistant suit; coveralls; long cotton underwear; chemical-resistant gloves (inner); boots, chemical-resistant, steel toe and shank; hard hat; disposable gloves and boot covers; cooling unit; and two-way radio communications. Level "D" is worn as a work uniform and is not recommended for sites with respiratory or skin hazards. Level "D" includes coveralls, gloves, boots/shoes (leather or chemical-resistant, steel toe and shank), safety glasses or chemical splash goggles, and hard hat. Level "D" provides no protection against chemical hazards. Firefighter turnout gear is protective clothing normally worn by firefighters during structural fire-fighting operations, and is similar to level "D" protection.

Table 7 lists all of the events in which 50 or more people were injured. There were eight such events during the 2-year period.

EVACUATIONS

Evacuations were ordered in 1,182 events, and the evacuation status of 64 events was unknown. Of known evacuations, 71% were of a building or the affected part of a building, 14% were of a defined circular radius surrounding an event, 6% were of a downwind/downstream area, 5% were reported as having a circular and downwind/downstream area, and 3% had no criteria. The median number of persons evacuated was 20. In 93 events, in-place sheltering was ordered by an official, and instructions regarding precautions to take during in-place sheltering were provided by an official in 18 of these events.

CONTINGENCY PLANS

A contingency plan was followed in 95% of events. The types of contingency or preparedness plans used during an event varied, with 72% involving the use of a company's operating procedures. Twenty-one percent of events were reported as using a (HAZMAT)/Response team's standard operating procedures, and 6% of events were reported as using an incident-specific ad hoc plan.

 

Table 4-Distribution of the number of victims, by type of event, Hazardous Substances Emergency Events Surveillance, 1999-2000.
 

No. of victims

Type of event


All events

Fixed facility

Transportation

No. of events

(%)

No. of substances

No. of events

(%)

No. of substances

No. of events

(%)

No. of substances

  1

526

55.4

526

218

71.0

218

744

59.2

744

  2

136

14.3

272

49

16.0

98

175

14.7

370

  3

79

8.3

237

2

3.9

36

91

7.2

273

  4

54

5.7

216

5

1.6

20

59

4.7

236

  5

33

3.5

165

9

2.9

45

42

3.3

210

≥6

121

12.8

2,371

14

4.6

221

135

10.7

2,592

Total

949

100.0

3,787

307

100.0

638

1,256

100.0

4,425

 

Table 5-Number of substances released in all events and events with victims, by substance category, Hazardous Substances Emergency Events Surveillance, 1999-2000.

  Substance Category

Total releases

Releases with victims

No.

 

 

Percentage of total releases

No.

Percentage of all releases with victims

Percentage of releases in substance category

Acids

1,367

(8.9)

238

(13.3)

17.4

Ammonia

837

(5.5)

169

(9.4)

20.2

Bases

556

(3.6)

63

(3.5)

11.3

Chlorine

189

(1.2)

62

(3.5)

32.8

Other inorganics*

3,527

(23.0)

340

(19.0)

9.6

Paints and dyes

427

(2.8)

27

(1.5)

6.3

Pesticides

646

(4.2)

107

(6.0)

16.6

Polychlorinated biphenyls

175

(1.1)

1

(0.1)

0.6

VOCs

3,052

(19.9)

302

(16.9)

9.9

Mixtures†

1,502

(9.8)

135

(7.5)

9.0

Other‡

3,038

(19.8)

348

(19.4)

11.5

Total

15,316

(100.0)

1,792

(100.0)

(100.0)

VOCs=Volatile organic compounds.
*All inorganic substances except for acids, bases, ammonia, and chlorine.
†Mixtures of substances from different categories.
‡Not classified.


Figure 4-Distribution of victims, by population group* and type of event, Hazardous Substances Emergency Events Surveillance, 1999-2000.

*Population group was unknown for 19 persons injured in fixed-facility events.


Figure 5a-Distribution of responders injured in fixed-facility events,* by population group, Hazardous Substances Emergency Events Surveillance, 1999-2000.

*A total of 366 responders were injured during fixed-facility events.


Figure 5b-Distribution of responder victims for transportation-related events,* by population group, Hazardous Substances Emergency Events Surveillance, 1999-2000.

*A total of 94 responders were injured during transportation-related events.

Table 6-Distribution of type of injury, by type of event,* Hazardous Substances Emergency Events Surveillance, 1999-2000.
 

Type of injury 

Type of event

All events

Fixed facility

Transportation

No. of injuries

(%)

No. of injuries

(%)

No. of injuries

(%)

Chemical burns

207

3.4

33

4.0

240

3.4

Heart problems

99

1.6

3

0.4

102

1.5

Dizziness/CNS†

699

11.4

42

5.1

741

10.6

Eye irritation

691

11.2

50

6.1

741

10.6

Headache

776

12.6

75

9.2

851

12.2

Heat stress

40

0.6

19

2.3

59

0.8

Gastrointestinal problems

644

10.5

41

5.0

685

9.8

Respiratory system

1,978

32.1

175

21.4

2,153

30.9

Shortness of breath

198

3.2

37

4.5

235

3.4

Skin irritation

187

3.0

37

4.5

224

3.2

Thermal burns

119

1.9

21

2.6

140

2.0

Trauma

168

2.7

242

29.7

410

5.9

Other

328

5.3

21

2.6

349

5.0

Vomiting

20

0.3

20

2.5

40

0.6

Total

6,154

100.0

816

100.0

6,970

100.0

*The number of injuries is greater than the number of victims because a victim could have had more than one injury.
†Central nervous system symptoms.


Figure 6-Distribution of type of injury for all events, Hazardous Substances Emergency Events Surveillance, 1999-2000.

*A total of 6,970 injuries was reported. The number of injuries was greater than the number of victims because some victims had more than one injury.
**Central nervous system symptoms.

Table 7-Profiles of events with =50 victims, Hazardous Substances Emergency Events Surveillance, 1999-2000.
 

Victim Type

No. of Victims

Treatment(s)

Chemical(s)

Injuries(s)

Employees,
Responders

54
4

Treated on scene

Benzene

Respiratory problems, dizziness or other CNS

General public,
Students

1
63

Treated at hospital

Carbon monoxide

Gastrointestinal problems, carbon monoxide poisoning, dizziness or other CNS

General public,
EMTs,
Volunteer firefighters,
Professional firefighters 

44
8
3
10

Treated at hospital, treated on scene

Ammonia

Respiratory problems,eye irritation, thermal burns, gastrointestinal problems, dizziness or other CNS, headache, heart problems

Employees,
General public

86
4

Treated at hospital, treated on scene, death

12 substances

Trauma; respiratory, skin, and eye irritation; thermal burns; gastrointestinal problems; dizziness or other CNS; headache; heart problems; shortness of breath; coughing blood; alkylemia; ringing in ears; posttraumatic syndrome

Students,
General public

98
9

Treated on scene, adverse health effects within 24 hours

Pyridine

Respiratory, skin, and eye irritation; headache; gastrointestinal problems; dizziness or other CNS; shortness of breath

Students,
General public

118
10

Treated on scene, adverse health effects within 24 hours

Pyridine

Respiratory and eye irritation, Headache, Gastrointestinal problems, Shortness of breath, Dizziness or other CNS

Employees

141

Treated on scene, treated at hospital

Dichlorobenzene

Respiratory problems, Dizziness or other CNS

Students,
General public

191
68

Treated on scene, treated at hospital, adverse health effects within 24 hours

Pyridine

Respiratory, skin, and eye irritation, Gastrointestinal problems, Dizziness or other CNS, Headache, Metallic taste, Fatigue, Malaise

Figure 7-Injury outcome, Hazardous Substances Emergency Events Surveillance, 1999-2000.

*Within 24 hours.

MANUFACTURING OF CHEMICALS AND ALLIED PRODUCTS

HSEES industry codes are based on the 1990 Industrial Classification System of the Bureau of the Census, U.S. Department of Commerce. Additional analyses of events involving industries in the category Manufacturing of Chemicals and Allied Products (codes 180-Plastics, synthetics, and resins, 181-Drugs, 182-Soaps and cosmetics, 190-Paints, varnishes, and related products, 191-Agricultural chemicals, and 192-Industrial and miscellaneous chemicals) were conducted to determine the public health consequences of these events.

The Manufacturing of Chemicals and Allied Products category was the second most frequently reported industry category in the surveillance system during 1999-2000. A total of 3,414 hazardous substances events (25% of all events and 33% of fixed-facility events) was reported to have occurred in this industry. Further classification by industry code found that 64% of these events occurred at manufacturers of industrial and miscellaneous chemicals, 28% in plastics, synthetics, and resins, 4% in agricultural chemicals, 2% in drugs, 2% in cosmetics, and approximately 1% in paints, varnishes, and related products manufacturing. Of the known primary contributing factors, 54% of the events occurred as a result of equipment failure and 11% were due to operator error. The category of substances most frequently released were VOCs (33%), other inorganic substances (22%), and mixtures (19%). Seventy-four percent of the releases were air emissions, 23% were spills, and the remainder involved mostly fire and explosions.

Events involving the Manufacturing of Chemicals and Allied Products category accounted for the most (22%, n=981) injured persons of any industry category in the surveillance system during 1999-2000. Forty-one percent of injured persons were students, 40% employees, 15% were the general public, and the remainder were first responders. Seventy-one percent (n=644) of the victims were treated at the scene, 14% (n=130) were transported and treated in the hospital, and 3% (n=27) were admitted to the hospital. Events in the category Manufacturing of Chemicals and Allied Products resulted in 10 deaths (13% of all deaths), of which nine were employees, and one was a first responder.

Twenty-five percent of events occurred within a quarter mile of a residential area. Evacuations were ordered in 105 (3%) of the events. The number of persons evacuated was available for 90% of events with known evacuation orders. Ordered evacuations resulted in the evacuation of a range of 0 to 4,493 persons, with a median of 20 persons. The length of the evacuation period, available for 84% of the events with known evacuation orders, ranged from 1 to 1,800 hours, with a median of 3 hours.

One particular drug manufacturing facility accounted for three of the events for which evacuations were ordered. Two of these events resulted in the evacuation of more than 4,400 persons on each occasion for periods of 3 to 4 hours. These three events resulted in 494 injured persons, 407 of whom were students at a neighboring high school. These figures illustrate the potential public health threat and financial costs associated with releases of hazardous substances in the manufacturing of chemicals and allied products industry.

USE OF HSEES DATA

During 1999-2000, ATSDR continued to respond to requests for HSEES information from local, state, and federal agencies and organizations. In addition, ATSDR continued to receive requests from researchers for copies of the HSEES protocol, data collection form, data, and publications. HSEES data have been used to produce the publications listed in Appendix D.

The HSEES Internet Web site page is available at http://www.atsdr.cdc.gov/HS/HSEES/. At this site, HSEES annual reports and other information can be downloaded to a user's personal computer. Internet linkages to other relevant Web sites will be available on the HSEES Web site in the future.

Current activities include collaboration with the Federal Emergency Management Agency and other agencies and organizations involved with response to chemical terrorism, emergency response, hazardous substances releases, and public health. Eight years of HSEES data are now available for trend analysis, and several publications are under way. Participating states have developed their own cumulative data reports and prevention plans.

In December 1999, a new Internet-based data-entry system became available for use by participating states. This system has improved data management and synchronization and has resulted in more rapid reporting, which could lead to broader uses of the data.

SUMMARY OF RESULTS, 1993-2000

The number of events, substances released, events with victims, and deaths for the years 1993 through 2000 are shown in Table 8. During this period, most events involved a single substance at fixed facilities. However, the number of transportation events is increasing, partially the result of using the U.S. Department of Transportation's Hazardous Materials Information System as a primary notification source for transportation events. The total number of events and the number of substances released during 1999-2000 continued the upward trend. This is partially explained by the addition of two new states in 2000; however, the number of events in states that have been in the system since 1993 grows every year.

Respiratory symptoms have consistently been most frequently reported. The number of deaths associated with events continues to suggest the need to evaluate not only the danger posed by exposure to hazardous substances, but also the circumstances surrounding the occurrence of events. Employees continue to be the most commonly reported victims of emergency events (Figure 8). Cumulative data on the number of events, substances, victims, and events involving victims are displayed in Figure 9.

HSEES data regarding risk factors related to the occurrence of emergency events and the associated morbidity and mortality have multiple uses. The states and ATSDR use the results of data analysis for prevention activities aimed at several different target groups, including school personnel, industry and labor groups, first responders, hospital personnel, and producers or users of potentially dangerous substances.

Table 8-Cumulative data for all states, Hazardous Substances Emergency Events Surveillance, 1993-2000.*
 

Year

No. of states

Type of event

No. of substances released

No. of deaths

No. of victims

Events with victims

No. -- (%)†

 

Fixed facility

Transportation

Total

1993

11

3,199

634

3,833

4,361

16

2,230

464

(12)

 

1994

12

3,321

912

4,233

5,073

21

2,181

414

(10)

 

1995

14

4,273

1,037

5,310

6,027

14

1,688

402

(8)

 

1996

14

4,327

1,159

5,486

5,862

33

1,622

390

(7)

 

1997

13

4,385

1,128

5,513

6,089

28

1,896

372

(7)

 

1998

13

4,729

1,252

5,981

6,486

36

1,533

405

(7)

 

1999

13

4,634

1,626

6,260

6,974

30

1,912

504

(8)

 

2000

15

5,499

2,049

7,548

8,384

44

2,513

752

(10)

 

Total

 

34,367

9,797

44,164

49,256

222

15,575

3,703

(8)

 


*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.


Figure 8-Distribution of victims, Hazardous Substances Emergency Events Surveillance, 1993-2000†

*The student category was not available before 1995.
†The numbers of unknown victims were as follows: 14 for 1993, six for 1994, three for 1996, 14 for 1997, eight for 1998, one for 1999, and 17 for 2000.


Figure 9-Cumulative data for all participating states, Hazardous Substance Emergency Events Surveillance, 1993-2000.

REFERENCE

1. Binder S. Death, injuries, and evacuations from acute hazardous materials releases. Am J Public Health 1989;79:1042-4.

APPENDICES

Appendix A-The 100 Most Frequently Released Substances, Hazardous Substances Emergency Events Surveillance, 1999-2000
 

 

Number

Standardized Substance Name

Frequency

1.

Ammonia

801

2.

Sulfur Dioxide

560

3.

Sulfuric Acid

422

4.

Hydrochloric Acid

330

5.

Paint or Coating NOS*

323

6.

Sodium Hydroxide

302

7.

Mercury

267

8.

Carbon Monoxide

259

9.

Nitric Oxide

253

10.

Ethylene Glycol

244

11.

Chlorodifluoromethane

192

12.

Butadiene

187

13.

Benzene

187

14.

Chlorine

183

15.

Oxides of Nitrogen NOS

179

16.

Polychlorinated Biphenyls

174

17.

Corrosive NOS

153

18.

Nitrogen Dioxide

127

19.

Solvent NOS

124

20.

Phosphoric Acid

123

21.

Hydrogen Sulfide

121

22.

Mix: Hydrogen Sulfide/Sulfur Dioxide

120

23.

Potassium Hydroxide

114

24.

Adhesive NOS

110

25.

Sodium Hypochlorite

110

26.

Mix: Nitric Oxide/Nitrogen Dioxide

105

27.

Acid NOS

96

28.

Resin Solution

92

29.

Ethanol

86

30.

Ethylene

82

31.

Pesticide NOS

82

32.

Xylene

82

33.

Toluene

79

34.

Methanol

77

35.

Flammable Liquid NOS

76

36.

Acetone

75

37.

Methylene Chloride

72

38.

Isopropanol

69

39.

Hydrogen Peroxide

68

40.

Nitric Acid

67

41.

Mix: Benzene/Butadiene

65

42.

Ink NOS

59

43.

Propylene

57

44.

Acetic Acid

56

45.

Ethyl Ether

54

46.

Formaldehyde

50

47.

Freon NOS

50

48.

Diesel Fuel

49

49.

Nitrogen Fertilizer

47

50.

Methyl Ethyl Ketone

46

51.

Tetrachloroethylene

46

52.

Brake or Hydraulic Fluid NOS

44

53.

Hypochlorite NOS

40

54.

Asbestos

39

55.

Resin NOS

38

56.

Base NOS

37

57.

Ethylene Oxide

37

58.

Hydraulic Oil

36

59.

Urea Ammonium Nitrate

36

60.

EPA F039: Multi-code Treatment, Storage, or Disposal Leachate

35

61.

Hydrofluoric Acid

35

62.

Malathion

35

63.

Sulfur

35

64.

Battery Acid NOS

33

65.

Fertilizer NOS

32

66.

Mix: Dimethyl Disulfide/Dimethyl Sulfide/Hydrogen Sulfide/Methyl Mercaptan

32

67.

Pendimethalin

31

68.

Vinyl Chloride

31

69.

Acrolein

30

70.

Ammonium Nitrate

30

71.

Calcium Hypochlorite

30

72.

Isopropylamine Glyphosate

30

73.

Mix: Nitric Oxide/Sulfur Dioxide

30

74.

Trifluralin

29

75.

VOCs NOS

29

76.

Ephedrine

28

77.

Methamphetamine Chemical NOS

28

78.

O-Chlorobenzylidene Malononitrile

28

79.

Styrene

28

80.

Chlorpyrifos

27

81.

Mix: Nitric Oxide/Nitrogen Dioxide/Sulfur Dioxide

27

82.

Phosphorus

27

83.

Ether NOS

25

84.

Iodine

25

85.

Methyl Mercaptan

25

86.

Urea

25

87.

Naphtha

24

88.

Carbon Dioxide

23

89.

Alcohol NOS

23

90.

Chloroform

23

91.

Transformer Oil NOS

23

92.

Xylene NOS

22

93.

Black Liquor†

22

94.

Nitrous Oxide

22

95.

Phenol

22

96.

Propylene Glycol

22

97.

Ammonium Hydroxide

21

98.

Calcium Oxide

21

99.

Carbon Black

21

100.

Diazinon

21

Total

 

9,169

VOCs--Volatile organic compounds.
NOS--Not otherwise specified.
*Unable to assign a standardized name for 128 substance.
†This is a substance used in pulp processing; it is not for consumption.

Appendix B-- Profiles of Events With Fatalities in Fixed Facilities, Hazardous Substances Emergency Events Surveillance, 1999-2000.
 

Industry/Location

Type of release

Chemicals (quantities)

Factors

Victim Category

Sex*

Injury

PPE*

Specialty plastic

Explosion

Tetrafluoroethylene

Human error

Employee

2 F
1 M

Thermal burns

Unknown

Industrial chemical mfg.*

Fire

Sulfur dioxide (1,000 lb)

Other

Employee

M

Respiratory irritation

Eye protection, hard had, steel-toed shoe

Private residence

Spill + Air emission

Oxidizer (liter)
Vinegar (liter)
Sodium hydroxide 
Sodium hypochlorite
Sodium silicate (liter)

Improper mixing

Employee

F

Respiratory irritation

None

Tire mfg.

Spill + Fire

Drain cleaner (liter)

Unknown

Employee

M

Trauma

None

Illegal drug lab

Fire + Explosion

Carbon black
Ethanol
Hexane

Illegal activity

General public

M

Respiratory irritation

None

Fireworks

Fire + Explosion

Black powder

Unknown

Employee

F

Trauma, thermal burns

None

Private residence/Business Fireworks

Explosion

Black powder
Pyrotechnic chemicals

Unknown

General public

M

Trauma, thermal burns

Unknown

Fireworks

Spill + Air emission

Black powder
Pyrotechnic chemicals

Human error

Employee

F

Trauma

None

Special chemical mfg.

Spill + Air emission

Sodium hydrosulfide

Human error

Employee

M

Asphyxia

Eye protection,
hard hat

Powder and magnesium mfg.

Explosion

Magnesium
Teflon
Viton

Other

Employee

M

Trauma,
chemical and
thermal burns

None

Dairy farm/Agriculture

Air emission

Ammonia
Carbon dioxide
Hydrogen sulfide
Methane

Human error

Employee

M
M

Other, respiratory irritation

None

Fireworks disposal

Explosion

Black powder
Sodium chlorate
Potassium perchlorate (100lb)

Human error

Employee

M

Thermal burns

None

Restaurant

Air emission

Ammonium
Calcium hypochlorite

Equipment failure

Employee

M

Respiratory irritation,
other

None

Private residence

Fire

Acid
Base
Solvent
Cyanide

Unknown

Employee

M

Trauma

None

Hospital

Air emission

Nitrogen

Equipment failure

Employee

M

Asphyxia

Unknown

Private residence

Air emission

Hydrochloric acid (2kg)

Human error

General public

M

Respiratory
and eye
irritation,
chemical
burns

Unknown

Organic chemicals mfg.

Fire

Di-tert-butyl peroxide (138 gal)

Human error

Employee

M

Thermal burns

Gloves
hard hat, eye protection

Polyethylene mfg.

Explosion + Spill +
Air emission + Fire

12 different chemicals
(22.5)

Improper mixing

Employee

M

Trauma,
chemical and 
thermal burns

Eye
protection,
hard hat,
steel toed shoe.

Private property/
Illegal drug

Fire

Acetone

Human error

General public

M
F

Thermal burns

None

Single family residence

Air emission

Carbon monoxide

Unknown

General public

1 M
2 F

Suffocation

None

Mfg. thermal controls

Spill

Mixture

Unknown

Employee

M

Chemical
and thermal
burns

Unknown

Boy Scout camp

Air emission

Carbon monoxide

Unknown

Employee

M

Suffocation

None

*Personal protective equipment.


Appendix C-- Profiles of Events With Fatalities in Transportation Events, Hazardous Substances Emergency Events Surveillance, 1999-2000.
 

Industry/Location

Type of release

Chemicals (quantities)

Victim Category

Sex*

Injury

PPE*

Truck transportation

Spill

Sulfur (900 gal)

Employee

M

Trauma

None

Transportations

Spill

Acrylic acid polymer

Employee

2 M

Trauma

Unknown

Aerial pesticide
applicators

Spill + Air
emission

Imazapyr
Triclopyr(13 lb)

Employee

2 M

Trauma

Unknown

Motor freight
transportation

Spill + fire

2-(2-Aminoethyoxyl)-
ethanol (8 ton)
Diesel fuel
Chlorimuron-ethyl
Metribuzine (10 tons)

Employee

M

Trauma

None

Grain elevator

Spill

Imazethapyr

Employee

M

Trauma

None

Motor freight
transportation

Spill

Sulfur (3,200 gal)

General public

M

Trauma

None

Motor freight
transportation

Spill + Fire

Fire fighting foam
(28 tons)
Household cleaners
(28 tons) 
Diesel fuel

Employee

2 M

Trauma

None

Motor freight
transportation

Air emission

Nitrogen (50 lb)

Employee

M

Trauma

None

Truck transportation

Spill

Potassium chloride
Diesel fuel

Employee

M

Trauma

None

Illegal meth drug lab

Explosion

Ammonia (20 lb)

General public

M

Trauma,
chemical burns,
respiratory

None

Truck transportation

Spill

Sodium hydroxide
(6 gal)

Employee

M

Trauma

None

Multi-vehicle
accident

Spill + Fire

Hydrochloric acid
(8 gal)
Gasoline

General public

2 F
8 M

Trauma,
asphyxia,
respiratory,
thermal
burns

None

Truck

Spill + Fire

Dichlobenil (20 tons)

General public

F

Trauma

None

Truck

Spill

Hydramethylnon
(360 lb)

Employee

M

Trauma

None

Private vehicles

Spill

Sulfuric acid (gal)
Methanol
Formaldehyde

General
public

M

Trauma,
heart
problems

None

Environmental
transport

Spill

Diesel fule
Sodium hypochlorite
(35 gal)

Employee

M

Trauma

Unknown

Truck

Spill

Diesel fuel (200 gal)
Vitamins

Employee

M

Trauma

None

Aerial spraying

Spill + Fire

Diesel fuel
Sulfur oil

Employee

M

Trauma

Unknown

Truck

Spill

Calcium carbonate
(200 lb)

General public

Unk

Trauma

Unknown

Private
contractor

Spill +
Threat

Diesel fuel (150 gal)
Ethyl lactate
(4,370 gal)

Employee

M

Trauma

None

Truck

Spill

Diesel fuel (75 gal)
Hydrochloric acid
(10 gal)

General 
public

M

Trauma

None

Motor freight
carrier

Spill

Sodium hypochlorite
(2,000 gal)

Employee

M

Trauma

None

Pool chemical
supply

Spill

Hydrochloric acid
(150 gal)

General public

M

Trauma

None

Crop duster

Spill

Atrazine
2,4-D
Metasulfuron-methyl
(20 gal)

Employee

M

Trauma

Eye
protection,
hard hat

Crop duster

Spill + Air 
emission

Malathion (100 gal)

Employee

M

Trauma

Hard hat

Motor freight 
carrier

Spill

Sodium hypochlorite
(150 gal)

Employee

M

Trauma

None

Motor freight
carrier

Threat

Helium (9,600 gal)

Employee

F
M

Trauma

None

Truck

Spill

Phosphoric acid

Employee

M

Trauma

None

Private citizen

Fire

Radioactive material
Plutonium

General public

F

Heart problems

None

Chemical transport

Air
emission

Carbon dioxide
(1 ton)

Employee

M

Trauma

None

Truck

Threat

Black liquor
(6,500 lb)

General public

M

Trauma

None

Manufacturing
adhesive and
resins

Spill

Phenon (ton)

Employee

M

Respiratory
irritation

None

*PPE = Personal protective equipment; mfg. = manufacturing; M = male; F = female.

Appendix D-Hazardous Substances Emergency Events Surveillance-Related Publications

Agency for Toxic Substances and Disease Registry. Hazardous Substances Emergency Events Surveillance annual report, 1993. Atlanta: US Department of Health and Human Services; 1994.

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.

Agency for Toxic Substances and Disease Registry. Hazardous Substances Emergency Events Surveillance annual report, 1994. Atlanta: US Department of Health and Human Services; 1995.

Agency for Toxic Substances and Disease Registry. Hazardous Substances Emergency Events Surveillance System: information for local emergency planning committees and first responders. Atlanta: US Department of Health and Human Services; 1995.

Agency for Toxic Substances and Disease Registry. Hazardous Substances Emergency Events Surveillance annual report, 1995. Atlanta: US Department of Health and Human Services; 1996.

Agency for Toxic Substances and Disease Registry. Hazardous Substances Emergency Events Surveillance annual report, 1996. Atlanta: US Department of Health and Human Services; 1997.

Agency for Toxic Substances and Disease Registry. Hazardous Substances Emergency Events Surveillance annual report, 1997. Atlanta: US Department of Health and Human Services; 1998.

Agency for Toxic Substances and Disease Registry. Hazardous Substances Emergency Events Surveillance annual report, 1998. Atlanta: US Department of Health and Human Services; 1999.

Agency for Toxic Substances and Disease Registry. Hazardous Substances Emergency Events Surveillance five-year cumulative report 1993-1997. Atlanta: US Department of Health and Human Services; 2001.

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

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.

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.

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.

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.

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, Kaye WE, Zeitz P, Powers ME, Rosenthal L. Letter to editor: Public health risks of railroad hazardous substance emergency events. J Occup Environ Med 2001;43:738-40.

Orr MF, Haugh GS, Kaye WE. Hazardous Substances Emergency Events Surveillance, 1993 to 1997. Chemical Health and Safety. Jan/Feb 2001:35-41.

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

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

Weisskopf MG, Drew JM, Hanrahan LP, Anderson HA. Hazardous ammonia releases in Wisconsin: trends and risk factors for evacuation and injury. Wisconsin Medical Journal. November 2000:30-46.

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

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.

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.

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.

Other HSEES documents available:

1995 Annual Report [HTML] [PDF]
1996 Annual Report [HTML] [PDF]
1997 Annual Report [HTML] [PDF]
1998 Annual Report [HTML] [PDF]
1999-2000 Biennial Report [PDF]
2001 Annual Report [HTML] [PDF]

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This page last updated on June 1, 2004

Casetta Simmons / CSimmons@cdc.gov


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