Kelly Air Force Base and Public Health Activities 

Background
Community Involvement
Needs of Health-Care Providers
Outcomes
Impact
Reference

Background

Bexar County, Texas, is home to Kelly Air Force Base (AFB). Approximately 7 miles southwest of downtown San Antonio, Kelly AFB has been an aircraft repair, operations, maintenance, and logistics facility. The 700-acre base has operated continuously since 1916. Kelly AFB later became one of the Air Force's major logistical support centers, providing support to U.S. armed forces in Korea and Vietnam. During Desert Storm, the base was also a major military staging area.

In 1996, the Agency for Toxic Substances and Disease Registry (ATSDR) was petitioned by the late Senator Tejeda to investigate potential health effects in neighborhoods north and southeast of Kelly AFB. Community groups expressed concern about their health and about possible exposures to environmental contaminants. Residents have voiced concerns for the past 25 years--since federal and state regulatory agencies first adopted stronger antipollution regulations. These stronger regulations coincided with the first identification of areas of contamination inside the fence line at the base. In 1989, those problems surfaced outside the fence line in the first identifiable evidence that a plume of contamination (primarily composed of perchloroethene, trichloroethene, dichloroethene, and vinyl chloride) had extended beyond base boundaries. The Air Force hired a consultant, who, in conjunction with the San Antonio Metropolitan Health District, performed the first health assessment of this scope in San Antonio. The site highlights the need to educate health-care professionals about environmental hazards and the potential for human health impacts resulting from these hazards.

Community Involvement

The entire city of San Antonio is involved with the Kelly AFB story. The San Antonio Express-News, the local newspaper, ran a series of articles on the site cleanup issues and the extent of contamination surrounding the base (www.mysanantonio.com/expressnews/kelly). Environmental and neighborhood activists (the Community for Environmental Justice), residents, and state and federal governmental agencies (i.e., the Texas Natural Resource Conservation Commission, the Texas Department of Health, the U.S. Environmental Protection Agency, ATSDR, and the Department of Defense) are all involved in the cleanup and contamination issues at the base.

These and other concerns at Kelly AFB have been discussed at many community meetings. The Air Force convened a local Restoration Advisory Board to advise on community concerns and strategies to aid in the cleanup. Currently, a series of public education forums are being held to solicit input from residents on their concerns: health, cleanup options, property values, extent of contamination, and timelines being followed by regulatory agencies. Understandably, health has emerged as one of the residents' top concerns.

Needs of Health-Care Providers

Nursing, Health, and the Environment (1) reports that health-care providers are  increasingly being asked to respond to questions and address situations where environmental health impacts are an issue with the clients and population they serve.

The Nursing, Health, and the Environment (1) findings are mirrored in the Kelly AFB site. Among the community concerns cited were the need for understandable information on the Kelly AFB site and its potential impact on personal health. Residents also expressed concern about the lack of local health-care provider ability to address their environmental health problems.

Nurses are the largest component of the health profession; therefore, they play an important role in mitigating exposures and educating consumers about environmental hazards and health. Nurses are often approached with questions that patients do not want to ask their physicians.

Outcomes

According to Sam Sanchez (Environmental Health Administrator, San Antonio Metropolitan Health District), the district continues to take the lead role in bringing answers to the community. Specific education outreach activities aimed at nurses, physicians, and community residents continue. In 1998, the district collaborated with a nurse health educator from the ATSDR Division of Toxicology and Environmental Medicine to conduct several environmental health seminars.

In the community, public health action plans and community education activities are ongoing. The national nursing strategy effort continues, and physicians are networking and participating in further education on environmental health issues. Health department nurses, school nurses, nursing organizations, and faculty members of nursing schools are developing plans for implementing the knowledge and skills obtained in workshops into nursing opportunities. The importance of taking an exposure history continues to be stressed.

On October 27, 2000, the San Antonio Metropolitan Health District and ATSDR held a nurse education seminar for public health nurses who will be working on an environmental health screening project funded through ATSDR. Training on assessing environmental health issues and taking an exposure history is also being developed. Kelly AFB and the activities surrounding the cleanup and contamination issues highlight the fact that local public health departments must take the lead in tackling these issues. Local public health infrastructure is necessary; if such infrastructure is not established, it hampers effectiveness in activities. State and federal governments can help local governments develop the capacity to deal with these issues so that problems get resolved.

Impact

According to Mr. Sanchez, the Environmental Health Screening Project has the potential to significantly alter the delivery of health care services in a large portion of San Antonio. Awareness of the importance of training nurses in environmental health has been heightened.

Reference

1. Institute of Medicine. 1995. Nursing, health, and the environment. Washington (DC): National Academy of Sciences.

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To respond to the national nursing interest and motivation, the Agency for Toxic Substances and Disease Registry (ATSDR) is developing an environmental health nursing toolbox to facilitate implementation of environmental health principles in nursing curriculum and public health practice. The toolbox is being developed with a regional-specific approach to incorporate issues unique to each region of the country. Issues such as life span, growth and development, health behaviors, cultural practices, and exposure will be developed in case studies, advocacy and policy guidelines, visual aids, checklists, and resources based on environmental health science and nursing practice.

This project is being coordinated by the Association of Occupational and Environmental Clinics through a cooperative agreement with ATSDR. The toolbox will include nursing input and participation from all areas of practice. The tools are national in scope and will be adaptable for use with other disciplines working in environmental health.

Distance-Learning Mechanisms at Work

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