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The Agency for Toxic Substances and Disease Registry (ATSDR) is the lead public health agency responsible for implementing the health-related provisions of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). ATSDR is an Atlanta-based federal agency with more than 400 employees and a budget for 2004 of approximately $73 million. ATSDR assesses the presence and nature of health hazards at specific Superfund sites, helps to prevent or reduce further exposure and illnesses resulting from those hazards, and expands the knowledge base about the health effects of exposure to hazardous substances.

ATSDR works closely with state agencies to carry out its mission to serve the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and disease related to toxic substances. ATSDR provides funding and technical assistance to states and other partners through cooperative agreements and grants to identify and evaluate environmental health threats to communities. These resources enable state and local health departments and other grantees to further investigate environmental health concerns and to educate communities. In fiscal years 1999-2004, ATSDR awarded more than $306,000 in direct funds and services to North Dakota for financial support of specific environmental health activities. In addition to direct funds and services, ATSDR staff provides technical and administrative guidance for state-conducted site activities.

ATSDR Site-Specific Activities

Public Health Assessment-Related Activities

One of ATSDR's important mandates is to conduct public health assessments of all National Priorities List (NPL) sites and of other sites where a significant threat to public health might exist. A public health assessment is a written, comprehensive evaluation of available data and information about the release of hazardous substances into the environment in a specific geographic area. Such releases are assessed for current or future impact on public health. ATSDR, in collaboration with public health and environmental officials from North Dakota, has conducted two public health assessments in the state.

A health consultation is a written or oral response from ATSDR to a specific request for information about health risks related to a specific site, chemical release, or hazardous material. A health consultation is a more limited response than a public health assessment. Four health consultations have been developed at four sites in North Dakota, including the following recent examples.

Former Robinson Insulation Minot Plant—In September 2003, ATSDR released a health consultation for the former Robinson Insulation Plant in Minot. Until it closed in the early 1980s, the plant processed more than 16,000 tons of asbestos-contaminated vermiculite ore mined in Libby, Montana. ATSDR concluded that the site currently poses no health hazard to area residents. However, former facility employees were exposed to elevated levels of asbestos. Residents of employees' households also may have been exposed to asbestos fibers brought home on employees' clothing. As a result, employees and people who lived in their homes may be at increased risk for asbestos-related diseases.

This site is part of ATSDR's National Asbestos Exposure Review (NAER) being conducted with other federal, state, and local environmental and public health agencies. NAER is an examination of more than 200 U.S. sites that received asbestos-contaminated vermiculite ore mined in Libby from the early 1920s until 1990. ATSDR is working closely with the U.S. Environmental Protection Agency (EPA) and state health partners to determine whether a hazard to public health exists at any of the sites.

Standing Rock Indian Reservation—Two U.S. Bureau of Indian Affairs (BIA) schools and a BIA administration building on the Standing Rock Indian Reservation in Sioux County were remediated because of contamination by polychlorinated biphenyls (PCBs) in oils dripping from fluorescent light ballasts. After the buildings were remediated, tribal members, tribal government representatives, and BIA workers were concerned about the safety of school children, school staff, and BIA personnel who were to reoccupy the buildings. In 1998, ATSDR was asked to determine whether any remaining PCB or dioxin contamination was cause for concern.

ATSDR studied the sampling methods, locations, and results in the remediation reports on the BIA administration building, elementary school, and high school. PCBs were not found in the postremedial sampling. All of the PCB-containing lights in these buildings were replaced, leaving no possibility for future exposure.

Because of community concerns about dioxin contamination, walls, ceilings, and ceiling tiles were sampled. Any ceiling tiles that contained dioxins were replaced. Walls and ceilings had very small amounts of dioxins. Although these amounts were not enough to be of concern, the walls were washed as a precautionary measure. ATSDR determined that schoolchildren, school staff, and BIA personnel were not expected to experience any adverse health effects as a results of the PCB and possible dioxin contamination-no PCB remained and the small amounts of dioxins were not of concern and were likely washed away.

Health Education and Community Activities

As part of its ongoing outreach activities in affected communities, ATSDR takes proactive steps to involve communities in identifying their health concerns and developing actions to address them. Examples of this type of involvement in North Dakota follow.

In March 2001, physicians representing the North Dakota chapter of the American Academy of Pediatricians participated in the groundbreaking session of the National Workshop to Establish an Environmental Safety Net for Children. The workshop was a joint venture between ATSDR and the American Academy of Pediatrics Committee on Environmental Health.

Through a national cooperative agreement with the Migrant Clinicians Network, ATSDR provides assistance in the development, implementation, and evaluation of environmental health education programs for health care providers working with migrant and seasonal farm workers. The Migrant Clinicians Network, the second-largest clinical network in the nation, brings together clinicians from various professions under one umbrella to meet the needs of migrant and seasonal farm workers. The Dakota Association of Community Health Centers in Bismarck and the Pembina Clinic Association in Pembina are local members of the Migrant Clinicians Network.

The North Dakota Environmental Health Association, with more than 70 members from the private sector as well as city, county, state, and tribal organizations, benefits from an ATSDR national cooperative agreement with the National Environmental Health Association. The cooperative agreement provides for the evaluation, planning, design and implementation of an environmental health education program that responds to the significant threat of chemical terrorism. One of the agreement's goals is to conduct regional or national training and education workshops.

Resource Materials

ATSDR develops materials for public health professionals and medical care providers to use to assess the public health impacts of chemical exposures. These resources are available in print, on the ATSDR Web site, and on CD-ROM. For example, medical management guidelines are available for acute chemical exposures to more than 50 chemicals. These guidelines were designed to aid emergency department physicians and other emergency health care professionals, such as first responders, who manage acute exposures resulting from chemical incidents. ATSDR's toxicological profiles comprehensively describe health effects; pathways of human exposure; and the behavior of more than 250 hazardous substances in air, soil, and water at hazardous waste sites. The toxicological profiles primarily are used as a comprehensive resource by health professionals at all levels. These profiles have been sent to requesters, including representatives of federal, state, and local health and environmental departments; academic institutions; private industries; and nonprofit organizations in North Dakota. ATSDR also has developed extensive resources for community members.

May 2004