Introduction to Environmental Medicine

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Introduction to EnvironmentalMedicine
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African EnvironmentalistBaba Dioum

• For in the end we will conserve only what we
  love, We will only love what we understand, we
  will understand only what we are taught.

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Seminar Agenda

• Review Governmental Regulatory Agencies
• Review of OSHA Standards and Environmental Acts
  that protect the health of the public

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Who Are The Players?

• OSHA
• NIOSH
• CDC
• EPA

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RESOURCES Information Overload

• How can I possibly learn all this and try to keep
  up with clinical information???

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Answer

• A. You cant, but
• B. You dont have to!!, but
• C. You need to know the resources/agencies and
  where to find them.

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A look at the past...

• In 1970
• job-related accidents - 14,000 worker deaths
• nearly 2 and 1/2 million - disabled
• estimated new occupational diseases totaled
  300,000
• gt 90 million Americans working, but no uniform
  comprehensive provisions existed for their
  protection against wp safety health hazards

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OSHA

• To assure , as far as possible , every working
  man and woman in the Nation safe and healthful
  working conditions
• Chief regulatory agency for workplace health and
  safety.
• Established as part of the Dept. of Labor in 1970
  by the Occupational Safety and Health Act.
• Sets and enforces standards for general industry,
  maritime, construction and ag.

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OSHA cont.

• Standards are set as PELs, for airborne
  contaminants - allowable exposure levels for
  chronic toxins, or for chemicals causing acute
  effects.
• Levels are set for TWA, usually over 8 hours.
• STELS define 15 minute exposure limit
• Ceiling value limits sets an absolute limit to
  wp. exposure, they are NOT to be exceeded at any
  time for any duration

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OSHA cont.

• Action level - level is usually set at one-half
  of an 8-hr PEL and triggers certain requirements,
  especially medical surveillance.
• Action level recognizes that the PEL level will
  not protect 100 of workers.

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OSHA cont.

• Medical surveillance varies form standard to
  standard
• Blood tests for exposure to lead
• PFTs for cotton dust exposure

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OSHA Standards

• Prescriptive in nature and identifies specific
  remedies to prevent on-the-job injuries (machine
  guards)
• Categories include
• man lifts, vehicle mounted work platforms, means
  of egress, ppe, fire protection, materials
  handling and storage, welding, cutting,
  electrical

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OSHA cont.

• OSHA requires the recording and reporting of
  occupational illnesses/injuries
• Minor injuries and no loss of work time - not
  recorded
• OSHA LOG 200 forms, must be kept for 5 years
• all injuries requiring medical attention or
  result in lost work time
• all occupational illnesses

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OSHA cont.

• Inspections - conducts approx. 45-50 thousand per
  year
• Categories include
• eminent danger
• catastrophes or fatal accidents
• target industries
• employee complaints
• re-inspection

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NIOSH

• Sister agency established by the 1970 OSHAct
• Located within the Centers for Disease Control
  and Injury Prevention, Department of Health and
  Human Services
• NIOSH responsible for investigating health and
  safety hazards upon a valid request

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NIOSH cont.

• Recommends standards for prevention and control
  of health and safety hazards, ranging from
  chemicals to machinery
• Performs research and develops criteria documents
  that give RELs
• Provides educational courses and materials for
  IHs, nurses, physicians and toxicologists
  involved with protecting workers health
• Test and certifies respiratory protective
  equipment

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NIOSH cont.

• Registry of Toxic Effects of Chemcial Substances
  (RTECS)
• OSHAct requires NIOSH to publish annually a list
  of all know toxic substances and the
  concentrations at which such toxicity is know to
  occur
• information not reviewed, simply reported in the
  registry

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How does NIOSH differ from OSHA?

• Both created by the same act of congress, they
  are two distinct agencies with separate
  responsibilities
• OSHA is in the DOL
• NIOSH is in the DHHS

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How does NIOSH differ from OSHA?

• OSHA is responsible for creating and enforcing
  workplace safety and health regs, sets PELs
• NIOSH is the research arm, sets RELs

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OSHA Right to Know Standard

• Hazard Communication CFR 1910,1200
• requires employers to compile a complete list of
  materials used in their establishment
• includes the right of employee to obtain
  information about hazardous material in the wp
• through employer-provided training
• and through access to MSDS

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Hazard Communication CFR 1910,1200

• MSDS must be kept for each product on the
  chemical inventory
• MSDS files which are accessible to employees
• Appropriate warning labels on all containers of
  hazardous materials

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Hazard Communication CFR 1910,1200

• Training must include
• informing employees of the Haz Com Standard
• of operations where hazardous chemicals are
  present
• the location of chemical inventory and MSDSs
• employees must receive training
• toxic properties of materials they are exposed
• recognize the sxs of overexposure
• and protective measures

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29 CFR 1910.20

• Employees, employee reps, NIOSH and OSHA have the
  right to access medical and exposure records for
  toxic substances and harmful physical agents
• Access to medical records is specific to
  individuals, while employees can ask to see
  exposure records for those with similar jobs.

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Center for Disease Control and Injury Prevention

• Within the US Public Health Service
• Based in Atlanta
• Charged with protecting the publics health by
  providing direction in the prevention and control
  of communicable and other disease and responding
  to public health emergencies

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CDC ( P)

• Responsibilities evolve as the agency addresses
  contemporary threats to health, such as injury,
  environmental and occupational hazards,
  behavioral risks, and chronic disease

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EPA

• RCRA
• TSCA
• (CERCLA) Superfund
• SARA
• CAA
• CWA

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EPA Resource Conservation and Recovery Act
(RCRA)

• Enacted in 1976 to control solid waste disposal
  and to encourage recycling.
• Major emphasis is control of hazardous waste
  disposal
• System to identify waste and track their
  generation, transport, and ultimate disposal
• Cradle to grave coverage

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EPA Toxic Substance and Control Act

• TSCA enacted in 1976 - control exposure and use
  of raw industrial chemical
• Passed - ensure chemicals would be evaluated
  before use
• Exiting chemicals - ranked as to their hazard
  potential and subject to tox testing

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EPA Superfund

• 1990 Congress enacted the Comprehensive
  Environmental, Response, Compensation, and
  Liability Act (CERCLA or Superfund)
• Provides funding and enforcement authority for
  cleaning up hazardous waste sites and for
  responding to haz mat spills

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EPA Superfund Authorization-Reauthorization Act
(SARA)

• Extends CERCLA and in addition included a
  self-contained law - Title III - The Emergency
  Planning and Community Right-to-Know Act

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EPA SARA

• Has mandated Community Right to Know and
  Emergency Planning (SARA Title III)
• requires industries to report toxic emissions
• that are then recorded in a publicly accessible
  data base
• requires notification of local FD and other ER
  responders of the location of potentially
  hazardous materials

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EPA Clean Air Act (CCA)

• Enacted in 1970 and last amended in 1998
• Provides for the prevention and control of
  discharges into the air of substances which may
  harm public health or natural resources
• Includes regulation of air emissions from both
  stationary and mobile sources

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Clean Air Act (CAA)

• Act sets NAAQS to specify the level at which air
  pollutants can be tolerated
• CO
• SO2
• NO2
• ozone
• lead
• and particulate matter

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CAA

• Past in 1970
• Amended 1977, 1990, 1998
• Over past 25 years the overall outdoor US air
  quality has improved
• In the 1980s attention shifted to indoor air
  quality

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Air pollution health effects

• Primarily respiratory
• Lungs are not an effective barrier to inhaled
  toxic particles
• deposition of inhaled particles depend on
  breathing pattern
• and size of particle

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Clean Water Act

• Established permit system for discharging
  pollutants into surface waters

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Safe Drinking Water Act

• Protects drinking water in public systems and
  underground sources

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SUMMARY...

• EPA Tells what youre going to do before doing
  it
• OSHA Tells how youre going to do it
• CAA Dont put anything up the stack
• CWA Dont put anything out the pipe
• SDWA Dont put it in a hole in the ground
• RCRA Dont put it anywhere else
• HMTA Dont even carry it around

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Summary, cont.

• TSCA If its bad news, dont even make it in
  the first place
• CERCLA If it was put in the ground in the past,
  now dig it up

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Consumer Protection Safety Commission

• Is charged with assuring that there is no
  unreasonable risk in consumer products.

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FDA

• Primarily a regulatory agency
• drugs
• biologics
• medical devices
• cosmetics

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Who to ask??

• Plant safety engineer
• Plant industrial hygienist
• Occupational nurse
• Occupational physician
• Supervisor
• Agencies covered in this seminar

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Where to look??

• Labels
• MSDS
• Poison control
• Chemical and tox databases
• ATSDR, etc.