Kingston TVA Coal Ash Spill

1. Kingston TVA Coal Ash Spill David Kirschke, MD Deputy State Epidemiologist Tennessee Department of Health Regional Epidemiology Meeting 3/30/09

2. Slough Off Emory River

3. Outline • Tennessee Department of Health role • Environmental investigation • Water, air, soil, fish • Exposure routes • Health survey • Surveillance • Recommendations

4. Situation • December 22 a retaining wall failed at the TVA Kingston Fossil Plant • >5.4 million cubic yards of coal ash spilled from an on-site holding pond to cover >300 acres • No immediate injuries • Physical and natural environment has been dramatically impacted • “Citizens’ lives have been disrupted, water quality has been impaired, and aquatic habitat has been destroyed.” Tennessee Department of Environment and Conservation

7. Tennessee Department of Health (TDH) • Working with other federal/state/local agencies: • Environmental sampling plan • Environmental testing at state laboratory • Interpreting environmental test results for potential impact on human health • Providing public health recommendations • Surveillance at hospital emergency departments for associated illnesses • Neighborhood health survey with CDC

8. Fly Ash Material Safety Data Sheet • Contains silica and trace metals • “Short term exposure presents little to no hazard” • Eye / respiratory irritation • Chronic exposure – silicosis • Depends on duration and level of exposure • Chronic exposure – heavy metals • No current evidence for chronic exposure

9. Sampling Plan • Comprehensive sampling plan to address surface water, ground water, drinking water, soil and air monitoring to better inform communities and citizens while ensuring full, complete clean up • Ongoing water quality monitoring and assessment within the major waterways impacted by the ash slide – Emory River, Clinch River and Tennessee River Tennessee Department of Environment and Conservation

10. Air Monitoring • Oversight of TVA will be accomplished in several ways: • Splitting samples collected by TVA to independently analyze their makeup • Quality assurance of the TVA operated monitors by TDEC staff • Installing co-located TDEC air monitor at a TVA monitoring site • TDEC already operates a continuous air monitoring site in Harriman (approximately 2.5 miles from the ash spill) • More than 2,600 mobile air monitoring samples have been collected • All sample results have been within the National Ambient Air Quality Standards for Particulate Matter - except one Tennessee Department of Environment and Conservation

12. Particulate Matter (PM) • Studies have linked particle pollution exposure to: • increased respiratory symptoms, such as irritation of the airways, coughing, or difficulty breathing, for example; • decreased lung function; • aggravated asthma; • development of chronic bronchitis; • irregular heartbeat; • nonfatal heart attacks; and • premature death in people with heart or lung disease. • People with heart or lung diseases, children and older adults are the most likely to be affected • However, even if you are healthy, you may experience temporary symptoms from exposure to elevated levels of particle pollution EPA

13. Tennessee Wildlife Resources Agency (TWRA) • Potential impacts to aquatic habitats will be tracked  • Monitoring of rivers and the collection of fish • Exceedences of Tennessee’s clean water goals have been noted • Parameters of concern include arsenic, lead, thallium, and mercury  • Fish tissue samples will be tracked for the metals associated with the ash Tennessee Wildlife Resources Agency (TWRA)

14. Fish • TWRA advises until further notice that fishing and boating should be avoided in the lower section of the Emory River • Existing advisories for Watts Bar, which would include the lower Emory River: • Fish consumption advisory against eating striped bass and a precautionary advisory for catfish and sauger. • A precautionary advisory means that children, pregnant women, and nursing mothers should not consume the fish species named. All other persons should limit consumption of the named species to one meal per month. Tennessee Wildlife Resources Agency (TWRA)

15. Heavy Metal Exposure • Routes: ingestion, inhalation • Factors: • Toxicity • Amount • Duration • Frequency • Skin contact not an exposure route unless ingested

16. Public Health Recommendations • Avoid contact • Especially important for children • Wash hands / clothes • Don’t drink untested well water • Heed fish advisories • Follow air pollution recommendations if issued

17. Human Laboratory Screening Not Recommended • Because tests of environmental samples have not shown levels of substances in ranges that would adversely affect human health, the Department of Health is not currently recommending human testing for any particular substance. • Residents / providers may contact the Tennessee Poison Control Center (800-222-1222) for advice

18. Screening Pitfalls • Quality control • Some labs unreliable • Skin/specimen contamination • What to do with results? • In absence of known exposure, results likely reflect past/ongoing unrelated exposures • Occupational • Environmental • Dietary / smoking

19. Recommended Laboratory Testing • If known or suspected toxic exposure to particular substance • If illness presentation consistent with toxic exposure • Tennessee Poison Control (800-222-1222) • ATSDR toxicologist

20. Health Survey • 5 teams of 2 person X 1 week • Visited 324 residences • 170 (52%) households interviewed • 368 persons • Average household 2.6 persons • Age distribution • <18 (24%), 18-64 (59%), ≥65 (17%)

22. Preliminary Results: Exposure • 47% said fly ash in yard • 4% said involved in cleaning it up • 13% said skin contact • 33% said ash on clothes • 1% ate fish since spill • 8% said pet tracked in ash

23. Preliminary Results: Behaviors • 83% aware of public health messages • Only 66% of people with ash on hands said they washed afterwards • Persons drinking bottled water more than doubled (9 to 25%) • 4 persons reported drinking well water before and only 1 afterwards • 18% said they spend no time outdoors currently compared to 5% before

24. Preliminary Results: Health • 12% with asthma • 6% with COPD • 5% with history of MI • 7% with angina or coronary artery disease • 45% with history of smoking • 18% current smokers

25. Preliminary Results: Health • Most had no change in health status • 27% said cough is worse • 14% said wheezing / SOB worse • 25% said headache worse • Some persons had complaints that may warrant increased attention to mental health issues • 25% said difficulty sleeping • 46% worried or anxious

26. Surveillance • No diseases reported to health department associated with incident • Syndromic surveillance at 5 area hospitals • No spikes attributable to incident • 19 children seen in ED at children’s hospital investigated; none appeared associated; no admissions • Active surveillance at one local hospital • Several visits with respiratory complaints investigated but none determined to be related to incident

27. Toxicology Consultation • Tennessee Poison Control Center • 800-222-1222 • Pediatric toxicologist • Robert Geller, MD; 404-616-6652 • ATSDR toxicologist • 770-488-7100 • Tennessee Department of Health • To notify of reportable illnesses: 800-404-3006

28. Thank You David Kirschke, MD Deputy State Epidemiologist Tennessee Department of Health