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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 RegistryUse 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.
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.
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:
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.
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.
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%.
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 |
*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.
*Four events had a combination of transportation types: one event, ground and rail; one event, water and rail; and two events, pipeline and water.
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.
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 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.
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.
*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.
*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 |
*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.
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.
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.
1. Binder S. Death, injuries, and evacuations from acute hazardous materials releases. Am J Public Health 1989;79:1042-4.
Appendix A.-The 100 Most Frequently Released Substances, Hazardous Substances Emergency Events Surveillance, 1999-2000
| Number | Standardized Substance Name | Frequency |
| 1. | Ammonia | 801 |
| 2. | Sulfor 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. | Chlorodifluoromehane | 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 | Respirtory 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, chemcial and thermal burns |
None |
| Dairy farm/Agriculture | Air emission | Ammonia Cabon 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,(br>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 transportion | Spill | Sulfur (900 gal) | Employee | M | Trauma | None |
| Transportations | Spill | Acrylic acid polymer | Employee | 2 M | Trauma | Unknosn |
| Aerial pesticide applicators |
Spill + Air emission |
Imazapyr Triclopyr(13 lb) |
Employee | 2 M | Trauma | Unknown |
| Motor frieight transportation |
Spill + fire | 2-(2-Aminoethyoxyl)- ethanol (8 ton) Diesel fuel Chlorimuron-ethyl Metribuzine (10 tons) |
Employee | M | Trauma | None |
| Grain elevtor | 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 transportion |
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-vechicle 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 fute 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.
This page last updated on December 6, 2002
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