About the Program

About the ACE Program
Incident Investigations

When chemical releases happen suddenly, ATSDR can provide local authorities with valuable help through the ACE program.

In June 2011, after a chemical incident at a poultry processing facility, 600 workers were potentially exposed to chlorine, 170 of whom needed transportation to five area hospitals for medical evaluation. The state Department of Health asked ATSDR to assist in the investigation of the incident, including an evaluation of the emergency response. An ACE team was deployed in response. The team discovered that the state Department of Emergency Management was not required to notify the health department when the incident occurred. This resulted in missed opportunities for assistance, such as coordinating with local hospitals regarding where patients were transported for care or providing treatment protocols for chlorine gas.

After the ACE investigation identified the issue, the Department of Emergency Management modified their procedure for notification of the state health department to include any incident involving a biological, chemical, radiological, or nuclear substance. About two weeks after the procedures were modified, two different ammonia releases occurred in the same city as the previous release. Because of the new procedures, emergency management officials immediately notified the health department of the incidents, resulting in a more coordinated and effective response.

A large industrial fire billows smoke into the air near grazing cows.

When toxic substance spills or chemical emergencies happen, ATSDR helps state and local health departments by providing ACE resources to perform a rapid epidemiologic assessment.

Pre-Incident

DREAM training: https://cdp.dhs.gov/training/course/MGT 908

Assessment of Chemical Exposures Training: The Assessment of Chemical Exposures (ACE) training introduces how to perform an epidemiologic assessment after a chemical incident. It also describes the ACE Toolkit, which contains surveys, consent forms, databases, and training materials that are useful in responding to or preparing for a chemical release.

During Response
ACE Tool Kit

ACE provides training on how to perform an epidemiologic assessment after a chemical incident. The ACE Toolkit is a helpful resource to assist local authorities in responding to or preparing for a chemical release. The toolkit contains materials that can quickly be modified to meet the needs of a local team performing an epidemiologic assessment, including:

hazard symbols
  • Surveys
  • Consent forms
  • Medical chart abstraction form
  • Interviewer training manual
  • Epi Info™7 databases to enter and analyze the data

When an incident occurs ACE provides technical assistance by forming a multi-disciplinary, often multi-agency, team to assist the state and local health department. Team members may assist from ATSDR headquarters in Atlanta, Georgia or deploy to the scene.

Other support the ACE team can provide is:

  • GIS mapping and assistance with sample methodologies
  • Clinical testing, if appropriate
  • Liaising with other federal agencies
Post-Incident

Publications and Presentations – https://www.atsdr.cdc.gov/ntsip/publications.html

What happens during an ACE investigation?
ACE talks with incident responders and hospital staff that treated patients to understand
  • what happened,
  • who was exposed,
  • steps taken to protect public health, such as an evacuation or shelter-in-place order,
  • communication during the response, and
  • lessons learned during the response.
ACE also interviews people who may have been exposed to collect detailed information on
  • exposure history,
  • symptoms experienced,
  • who was exposed,
  • health services used,
  • needs resulting from the exposure,
  • medical history,
  • how people received information about the release, and
  • health impacts on pets.

ACE typically reviews hospital medical charts and veterinary chart abstractions to learn more details about health effects experienced as a result of the release. ACE may also assist in collecting and analyzing clinical samples if a laboratory test is available to determine exposure to the substance. If testing is done, results are sent to participants to share with their physicians.

Why perform an ACE investigation?
State and local health departments can use information obtained from rapid assessments to
  • assess impact of the release on individuals as well as the community,
  • direct the public health response,
  • target outreach to prevent similar incidents,
  • assess the need to modify emergency response procedures, and
  • identify a group of exposed people that may need to be followed-for long-term effects.

A body of data from multiple incidents can be used for education and training to prepare for future incidents.

What are some examples of ACE investigations?

The ACE team worked with the state or local health agency on the investigations and public health actions described below. Additionally, ATSDR has partnered with other public health and safety agencies, like the National Institute for Occupational Safety and Health (NIOSH) to work on chemical releases. The goals of each investigation were determined by the inviting agency. Each investigation involved multiple components, including interviewing responders and owners/managers of facilities, surveying exposed persons and staff at hospitals where patients were treated, and reviewing hospital charts for patients treated for chemical exposure.

View Past Investigation Examples

Page last reviewed: January 24, 2022