Top Five Industries Resulting in Injuries from Acute Chemical Incidents — Hazardous Substance Emergency Events Surveillance, Nine States, 1999–2008

Ayana R. Anderson, MPH

Jennifer Wu, MS

Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry, CDC

Abstract

Problem/Condition: Because industries using and/or producing chemicals are located in close proximity to populated areas, U.S. residents are at risk for unintentional chemical exposures.

Reporting Period: 1999–2008.

Description of System: The Hazardous Substances Emergency Events Surveillance (HSEES) system was operated by the Agency for Toxic Substances and Disease Registry during January 1991–September 2009 to collect data that would enable researchers to describe the public health consequences of chemical releases and to develop activities aimed at reducing the harm from such releases. This report summarizes data for the top five industries resulting in injuries from an acute chemical incident (lasting <72 hours) occurring in the nine states (Colorado, Iowa, Minnesota, New York, North Carolina, Oregon, Texas, Washington, and Wisconsin) that participated in HSEES during its last 10 full years of data collection (1999–2008).

Results: Five industries (truck transportation, educational services, chemical manufacturing, utilities, and food manufacturing) accounted for approximately one third of all incidents in which persons were injured as a result of unintentional release of chemicals; the same five industries were responsible for approximately one third of all persons injured as a result of such releases.

Interpretation: Acute chemical incidents in these five industries resulted in serious public health implications including the need for evacuations, morbidity, and mortality.

Public Health Implications: Targeting chemical incident prevention and preparedness activities towards these five industries provides an efficient use of resources for reducing chemical exposures. A variety of methods can be used to minimize chemical releases in industries. One example is the Occupational Safety and Health Administration's hierarchy of controls model, which focuses on controlling exposures to occupational hazards. The hierarchy includes elimination, substitution, engineering controls, administrative controls, and use of personal protective equipment.

Introduction

As the United States has become more industrialized and the use of chemicals has increased, the likelihood of unintentional releases of hazardous materials also has increased (1,2). Hazardous substance releases can occur anywhere, including in private homes, warehouses, and manufacturing facilities. Unintentional releases of hazardous substances can have serious consequences, including adverse health outcomes and in some cases death, need for decontamination, evacuations, environmental degradation, and financial losses. To prevent morbidity and mortality resulting from unintentional releases of chemicals, public health authorities must know where these incidents occur and where the potential exists to prevent harm.

The Hazardous Substances Emergency Events Surveillance (HSEES) system database provides information on the characteristics and spatial and temporal dimensions of hazardous chemical releases within the states that participated in the surveillance system. This report summarizes data for the top five industries resulting in injuries from acute chemical incidents occurring in selected states during 1999–2008 and is a part of a comprehensive surveillance summary (3). Public and environmental health and safety practitioners, worker representatives, emergency planners, preparedness coordinators, industry managers, emergency responders, and others who prepare for or respond to chemical incidents can use the findings in this report to prepare for and prevent chemical incidents and injuries.

Methods

This report is based on data reported to HSEES system by health departments in nine states (Colorado, Iowa, Minnesota, New York, North Carolina, Oregon, Texas, Washington, and Wisconsin) that participated in HSEES during its last 10 complete calendar years of data collection (1999–2008). Data from 2009 were not included because several states ended data collection mid-year. Case definitions, exclusion criteria, and 2006 changes in reporting guidelines used for this analysis are described (Box 1).

This analysis focuses on the top five industries with injured persons. HSEES defined an injured person as a person who experienced at least one documented acute (i.e., occurring in <24 hours) adverse health effect or who died as a consequence of the event. Injured persons must have had at least one injury type or symptom, and up to seven could be listed (4). The top five identified NAICS codes were sectors 311 (food manufacturing), 325 (chemical manufacturing), 484 (truck transportation), 611 (educational services), and 221 (utilities). Information about these sectors is summarized (Box 2).

States obtained data about hazardous substance releases from various sources including state and local environmental protection agencies, police and fire departments, poison control centers, hospitals, local media and federal databases (e.g., the Department of Transportation's Hazardous Material Incident Reporting Systems [HMIRS] and the U.S. Coast Guard's National Response Center [NRC]).

Descriptive analyses were performed by using SAS software (version 9.2) to describe the top industries with injured persons. Industries were identified using the Standardized Industrial Classification (SIC) for 1999-2001 data, and the 2002 North American Industry Classification System (NAICS) for 2002–2008 data. NAICS is the standard used by Federal statistical agencies to classify business establishments for the purpose of collecting, analyzing, and publishing statistical data related to the U.S. business economy (5). For this analysis, an excel file was used that indicated which SIC codes correspond to NAICS codes so that all were classified the same for consistency. The top five three-digit NAICS industries causing injury were identified, and additional analysis was performed on those incidents.

Results

During 1999-2008, of the 57,975 hazardous substance incidents that occurred, 4,621 (8%) incidents resulted in 15,506 persons being injured. Incidents at the following top five industries resulted in over one third (36%) of injured persons: chemical manufacturing (1,753 persons), educational services (1,562 persons), truck transportation (869 persons), food manufacturing (760 persons) and utilities (578 persons). These top five industries represented 30% of incidents with injured persons. These top five industries reported 478 evacuations in which 103,530 persons were evacuated. Educational services reported the highest number of evacuations and evacuees (144 and 56,269, respectively). Of the 156 incidents that reported shelter in place, the industry with the highest number of reported a shelter in place (26) was chemical manufacturing (Table 1).

In HSEES, up to two contributing causal factors can be reported. The number of persons injured associated with contributing factors reported by the top five industries are summarized (Table 2). Equipment failure was associated with the highest frequency of injured persons for chemical manufacturing (1,272) and food manufacturing (489). Chemical manufacturing also had a high number of injured persons associated with a system or process upset (any glitch in the system that upsets the process; the problem has to be specific to the facility) (386). Human error was associated with the highest frequency of injured persons for educational services (746), truck transportation (629) and utilities (250). For utilities, equipment failure was a close second (242). Educational services also had a high frequency of injured persons associated with intentional or illegal acts (447).

For incidents with only one chemical released, ammonia (141), chlorine (66), carbon monoxide (52), hydrochloric acid (52), and sulfuric acid (44) were the most commonly reported chemicals for the top five industries (Table 3). Ammonia was the most commonly released chemical in chemical manufacturing and food manufacturing. Chlorine was the most commonly reported chemical released in utilities, as was hydrochloric acid for truck transportation and sulfuric acid for educational services.

Employees represented 51% (2,824) of the injured persons and were the most commonly reported category for all but educational services (Table 4). Students were the most commonly reported category of injured persons for educational services (1,092), followed by employees (412). Students were also the second most commonly reported injured person category for chemical manufacturing (407). The second most commonly reported injured person category for food manufacturing (49), truck transportation (236), and utilities (181) was the general public.

The majority of the injured persons were either treated at the hospital and not admitted (48%) or treated on the scene (31%) (Table 5) Approximately 2% (122) of the injuries resulted in fatalities; the majority (90 [74%]) of the fatalities were reported in the truck transportation industry, which could have been the result of trauma from collisions or rollovers. The most frequently reported symptom overall for the top five industries was respiratory irritation (2,801 [35%]). This was also the most frequently reported symptom for chemical manufacturing (919 [39%]), educational services (763 [28%]), food manufacturing (574 [43%]), and utilities (295 [31%]) and was the second most frequently reported symptom for truck transportation. Nonchemical related traumas were the most frequently reported symptom for truck transportation (299 [33%]), again likely resulting from vehicle collisions or rollovers (Table 6).

Discussion

This analysis described the five industries with the highest frequencies of injured persons associated with acute chemical releases. The top five chemicals identified in this report as occurring most frequently in the top five industries were also the top five chemicals causing injury (6). Although chemical releases that occurred in chemical manufacturing resulted in the most injured persons, releases during truck transportation had the most incidents with injured persons and the most fatalities. Many of the injuries and fatalities that occurred during truck transportation were trauma related. Precautions can be taken to ensure safety if a release occurs. To protect the public health and environment, the shipper is responsible for all packaging, labeling, and marking of shipments (7). Labeling should be clear and legible for the transporters. Transporters should be aware of the potential dangers of the chemicals they are transporting and know whom to contact if a release occurs. The contributing factors that resulted in the most injured persons were equipment failure for chemical manufacturing and food manufacturing, and human error for educational services, truck transportation, and utilities. Various measures can be taken to prevent releases associated with equipment failure, including routine equipment inspections and maintenance (8-10). To ensure safety of the employees who work in manufacturing industries, the Occupational Safety and Health Administration (OSHA) requires appropriate chemical education and training. Also all employers with hazardous chemicals in their workplace must have labels and safety sheets for chemicals to which their workers might be exposed (11). For the transportation industry, the Pipeline and Hazardous Materials Safety Administration (PHMSA) has established policies and standards in addition to providing education to prevent hazardous chemical releases. PHMSA's goal is to prepare the public and first responders to reduce consequences if an incident occurs (12).

Because these five industries had a high frequency of students and general public injured, and evacuations, it is important for communities near these facilities to have a strong public health response infrastructure. It is important to include local emergency response, including first responders, hospitals, the manufacturing industry, labor representatives, educational facilities, political entities and the public, so they can develop a plan to respond to and prevent acute chemical releases (9,13). With educational services having a high frequency of injured persons associated with human error and intentional or illegal acts, proper chemical use and management (i.e. storing, inventory) is essential to protect the building's occupants (14). Proper training and supervision of students and instructors can mitigate school chemical releases (15). For releases caused by intentional or illegal acts, a focus on preventing students from illegally or intentionally releasing chemicals in education settings could mitigate adverse public health outcomes. Exploring the implementation of stricter enforcement might discourage students from experimenting with chemicals that can have serious financial and public health consequences. Also, proper storage of chemicals such as mercury can prevent children from unlawfully obtaining such chemicals and improperly releasing them into the environment. Another safety measure that could reduce injuries is the safe removable of unused, outdated, potentially dangerous chemicals from schools (16).

Ammonia was the overall most frequently reported chemical released and the most frequently released for chemical manufacturing and food manufacturing. Ammonia is used as a refrigerant in food manufacturing (17) and in many manufacturing processes. Exposure to ammonia can irritate skin, eyes, and the respiratory system and in extreme cases cause death (17). To mitigate morbidity and mortality associated with ammonia in food manufacturing, industries could use refrigerants gases that are not as flammable or toxic as ammonia, such as carbon dioxide (18,19). In additional, education initiatives can raise awareness about the dangers of ammonia, safer alternatives (where applicable) and proper management of ammonia. The Wisconsin HSEES Ammonia Awareness Day was designed to target workers in industries that used ammonia as refrigerant. Wisconsin used electronic mail and a Web page to disseminate information to raise awareness about ammonia (18).

Within the utilities industry, chlorine was the most frequently reported chemical released. The utilities industry includes water and sewage. Over 550 water treatment facilities have converted to safer alternatives to chlorine gas. Some safer alternatives to chlorine gas include liquid chlorine bleach (sodium hypochlorite) and ultraviolet light (20).

In addition, OSHA's Hierarchy of Controls model to control exposures to occupational hazards includes (in order of effectiveness) elimination, substitution, engineering control, administrative controls, and personal protective equipment (PPE) (21). Safer alternatives to some of the chemicals being used in industries exist (e.g., use of ultraviolet light instead of chlorine gas in water treatment facilities and carbon dioxide instead of ammonia in food manufacturing). However, elimination and/or substitution of chemicals can be difficult in implement in industries (21). When elimination o substitution is not an option, industries ensure that proper engineering controls are in place that will remove a hazard or implement a barrier to prevent chemical exposure. Although this option can have high initial costs, long-term operating costs can be lower (21). Administrative control and PPE are the least effective because they are not well controlled and require a substantial effort by the employees (22). These last two controls can be very costly in the long term (21). Other potential ways to protect surrounding populations and the general public and to decrease morbidity and mortality include maintaining a sufficient emergency mitigation systems and establishing adequate buffer zone distances to surrounding populations (22). Collaboration with industries, surrounding responders, hospitals, and community leaders to ensure that a well devised response plan is in place is important so that if a chemical release occurs, all parties involved are in accord.

Limitations

The findings in this report are subject to at least four limitations. First, despite the attempts to make the case definition the same among states, results are not comparable between states because reporting to HSEES was voluntary and data sources varied by state. Second, the results from these nine states might not be representative of the entire United States. Third, inconsistencies within and across states likely exist because reporting capacity (e.g., staffing) or local requirements varied. Specifically, certain states and localities had more stringent reporting regulations than the federal regulations or had more resources to conduct surveillance, possibly resulting in more reported incidents. These factors might have influenced the quality and number of reports or level of detail provided about the incidents. Finally, the changes in reporting guidelines in 2006 (e.g., the reporting requirement changed based on the amount of the release to >10 pounds or >1 gallon or any release amount for substances on the HSEES mandatory list) could have led to increased reporting of some types of incidents and decreased reporting of others. This also could have affected the reports of industries that had releases.

Conclusion

With thousands of chemicals being released annually and limited resources, it is important to target chemicals with the greatest public health implications. This analysis shows that five industries accounted for approximately one third of all incidents with injuries and 30% of injured persons. The top five chemicals in these five industries are also the top five chemicals causing injury in this time frame for all incidents, making them a good target for prevention efforts. Knowing where chemical releases occur and the magnitude of impact is important as it enables public health authorities to allocate and develop resources and prevention efforts efficiently by using the hierarchy of controls to select the best control methods for the situation and following guidelines and recommendations of OSHA and PHMSA.

References

1. Falk H. Industrial/chemical disasters: medical care, public health and epidemiology in the acute phase. In: Bourdeau P, Green G, eds. Methods for assessing and reducing injury from chemical accidents. John Wiley & Sons; 1989: 106-14.
2. Manassaram DM, Orr MF, Kaye WE. Hazardous substances events associated with the manufacturing of chemicals and allied products. J Hazard Mater 2003;104:123-35.
3. CDC. Hazardous Substances Emergency Events Surveillance, nine states, 1999-2008. MMWR Surveill Summ 2015;64(No. SS-2).
4. Agency for Toxic Substances and Disease Registry. Hazardous Substances Emergency Events Surveillance: biennial report 2007-2008. Atlanta, GA: US Department of Health and Human Resources, Agency for Toxic Substances and Disease Registry, CDC. Available at http://www.atsdr.cdc.gov/HS/HSEES/annual2008.html.
5. US Census Bureau. 2002 North American Industry Classification System (NAICS) Washington, DC: US Census Bureau; 2002. Available at http://www.census.gov/cgi-bin/sssd/naics/naicsrch?chart=2002.
6. Anderson A. Top five chemicals resulting in injuries from acute chemical incidents-Hazardous Substances Emergency Events Surveillance, nine states, 1999-2008. In: CDC. Hazardous Substances Emergency Events Surveillance, nine states, 1999-2008. MMWR Surveill Summ 2015;64(No. SS-2).
7. US Department of Transportation. Hazardous materials regulations. Washington, DC: US Department of Transportation Pipeline and Hazardous Materials Safety Administration; 2015. Available at http://www.phmsa.dot.gov/regulations.
8. Lees RE, Laundry BR. Increasing the understanding of industrial accidents: an analysis of potential major injury records. Can J Public Health 1989;80:423-6.
9. US Environmental Protection Agency. Why accidents occur: insights from the Accidental Release Information Program. Washington, DC: US Environmental Protection Agency; 1989. Available at http://nepis.epa.gov/Adobe/PDF/10003LZJ.PDF.
10. Uth HJ. Trends in major industrial accidents in Germany. J Loss Prev Process Ind 1999;12:69-73.
11. Occupational Safety and Administration. Chemical hazards and toxic substances. Washington, DC: US Department of Labor, Occupational Safety and Administration; 2014. Available at https://www.osha.gov/SLTC/hazardoustoxicsubstances/index.html.
12. Pipeline and Hazardous Materials Safety Administration. Mission and goals. Washington, DC: US Department of Transportation, Pipeline and Hazardous Materials Safety Administration; 2014. Available at http://www.phmsa.dot.gov/about/mission.
13. Broughton E. The Bhopal disaster and its aftermath: a review. Environ Health 2005;4:6.
14. Jones SE, Axelrad R, Wattigney WA. Healthy and safe school environment, Part II, Physical school environment: results from the School Health Policies and Programs Study 2006. J Sch Health 2007;77:544-56.
15. Orr M. School science class chemical incidents. Interstate Chemical Threats Workgroup [Webinar]. Atlanta, GA: US Department of Health and Human Services, Agency for Toxic Substances and Disease Registry; 2012. Available at http://ictw.net/members/wp-content/uploads/2011/07/Orr-ICTW-school-lab-powerpoint-final.pdf.
16. Wattigney WA, Rice N, Cooper DL, Drew JM, Orr MF. State programs to reduce uncontrolled ammonia releases and associated injury using the Hazardous Substances Emergency Events Surveillance System. J Occup Environ Med 2009;51:356-63.
17. Agency for Toxic Substances and Disease Registries. Toxicological profile for ammonia: health effects. Atlanta, GA: US Department of Health and Human Services, Agency for Toxic Substances and Disease Registries; 2004. Available at http://www.atsdr.cdc.gov/ToxProfiles/tp126-c3.pdf.
18. Mary Kay O'Connor, Process Safety Center. Challenges in implementing inherent safety principals in new and existing chemical processes. College Station, TX: Mary Kay O'Connor Process Safety Center; 2002. Available at http://psc.che.tamu.edu/wp-content/uploads/whitepaper_inherentsafety1.pdf.
19. Pearson, S. New, natural and alternative refrigerants. Washington, DC: Environmental Protection Agency; 2003. Available at http://www.epa.gov/greenchill/downloads/New_Natural_and_Alternative_Refrigerants.pdf.
20. Rushing R, Orum P. Leading water utilities secure their chemicals. Washington, DC: Center for American Progress; 2010. Available at https://www.americanprogress.org/issues/security/news/2010/03/02/7538/leading-water-utilities-secure-their-chemicals.
21. Occupational Safety Administration. Course 700: introduction to safety management. Washington, DC: US Department of Labor, Occupational Safety and Administration; 2014. Available http://www.oshatrain.org/courses/mods/700m5.html.
22. Orum P. Chemical security 101. Washington, DC: Center for American Progress; 2008. Available at https://www.americanprogress.org/issues/security/report/2008/11/19/5203/chemical-security-101.