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Deepwater Horizon Disaster Response. Long Term Studies & Coast Guard Worker Roster Dr. Erica G. Schwartz, MD, MPH. Disclosure Statement.

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deepwater horizon disaster response

Deepwater Horizon Disaster Response

Long Term Studies & Coast Guard Worker Roster

Dr. Erica G. Schwartz, MD, MPH

disclosure statement

Disclosure Statement

I have no financial interests or other relationship with manufacturers of commercial products, suppliers of commercial services, or commercial supporters. Our presentation will not include any discussion of the unlabeled use of a product or a product under investigational use.

outline
Outline
  • Coast Guard responder population
    • Responder missions
    • Responder medical readiness
    • C.G. occupational surveillance
    • Medical surveillance of C.G. responders
  • Long term follow-up studies of responders
    • Coast Guard Responder Cohort
    • NIH GuLF Study
coast guard response
Coast Guard Response
  • 34 response locations
  • ~7,500 Coast Guard responders
  • ~ 40 Coast Guard medical, safety and work-life specialists
coast guard response1
Coast Guard Response
  • Administrative
  • Air – Overflight
  • Beach / Marsh Cleaning
  • Booming Operations
  • Controlled Burn Group
  • Distribution Center
  • Federal On-Scene Coordinator
  • Law Enforcement
  • Medical & Dental
  • Pollution Investigator
  • Rescue Swimmer
  • Safety
  • Shoreline Cleanup Assessment
  • Search & Rescue
  • Skimming Ops
  • SMART Group
  • Spill Clean Up & Decontamination
  • Staging
  • Subsea Containment Group
  • Work-Life
  • Wildlife Rehabilitation
medical readiness
Medical Readiness
  • All CG military members are required to have an annual Periodic Health Assessment (PHA)
  • Face to face visit with a medical provider to assess member’s health status and medical readiness
occupational surveillance
Occupational Surveillance
  • Occupational Medical Surveillance & Evaluation Program (OMSEP):
    • Identification of work related diseases or conditions
    • Use of baseline and periodic examinations
    • Use of quantitative work-site sampling
occupational surveillance1
Occupational Surveillance
  • Resident inspectors
  • Pollution investigators
  • Marine safety (general)
  • Port safety (general)
  • Vessel inspectors
  • Marine investigators
  • Firefighters
occupational surveillance2
Occupational Surveillance
  • Asbestos
  • Benzene
  • Chromium
  • Hazardous Waste
  • Lead
  • Noise
  • Pesticides
  • Respiratory sensitizers
  • Solvents
  • Tuberculosis
  • Bloodborne Pathogens
  • Radiation

*Enrollment based upon the Medical Surveillance Action Level

medical surveillance
Medical Surveillance
  • Coast Guard direct care + purchased care captured by CHCS, which feeds:
    • M2 database
      • ICD-9 codes
      • Query of diagnoses via ICD-9 codes
  • Electronic Health Records (EHRs)
deepwater horizon inventory
Deepwater Horizon Inventory
  • All CG responders required to complete survey (“Inventory Tool”) upon demobilization
    • Demographics, period of deployment
    • Site, mission, self reported exposures, self reported injuries & symptoms, PPE use
  • Mobilization Readiness Tracking Tool (MRTT)
    • Provides denominator (approximate)
    • Some groups not covered (cutters, aviators, local shore units)
    • Enumerating total responder population by merging MRTT with other databases
enumeration of responder cohort
Enumeration of Responder Cohort
  • Mobilization Readiness Tracking Tool (MRTT)
    • Provides denominator (approximate)
    • Some groups not covered (cutters, aviators, local shore units)
    • Enumerating total responder population by merging MRTT with other databases
  • National Pollution Funds Center (NPFC)
follow up of dwh responders
Follow-up of DWH responders
  • Follow-up by Coast Guard physicians for all “positive” responses in Inventory Tool
  • Epidemiology analysis of Inventory (existing survey) data
  • Surveillance based on inpatient/outpatient encounters (ICD-9 coding)
    • pre- and post-DWH rates for responder cohort
    • Comparison of responders to other CG members
  • Linkage with Electronic Health Record
    • For pre- and post-DWH health effects
follow up study of coast guard dwh responder cohort
Follow-up Study of Coast Guard DWH Responder Cohort

Rationale

  • Crude oil, burning oil, dispersants contain known and suspected toxins
  • Heat and stress may also have adverse long-term health effects
  • Clean-up workers’ exposures range from negligible to potentially significant
  • Little is known about health effects from oil spills on response workers, despite the frequency of these events worldwide
follow up study of coast guard dwh responder cohort1
Follow-up Study of Coast Guard DWH Responder Cohort
  • Human studies of oil spill exposures
    • Very few, mainly in the wake of:
      • Exxon Valdez (1989), Braer (1993), Sea Empress (1996), Nakhodka (1997), Erika (1999), Prestige (2002), & Tasman Spirit (2003)
    • Crude methods of exposure assessment (exposed vs. non-exposed)
    • Predominantly cross-sectional
    • Provide some evidence of relationship between exposure to spilled oils and a range of acute adverse health effects, such as:
      • Respiratory, acute physical symptoms, neurologic, psychological, genotoxic, and endocrine effects in the exposed population
    • Long term effects?
    • Exposure to Corexit 9500 and 9527A?
follow up study of coast guard dwh responder cohort2
Follow-up Study of Coast Guard DWH Responder Cohort
  • Overall objective:
    • Identify potential short- and long-term health effects from oil spill response work exposures
    • In a cohort of Coast Guard DWH responders
  • NIH RO-1 application
    • Collaborative effort:
      • Uniformed Services University
      • U.S. Coast Guard
  • Study Design: Prospective Cohort
follow up study of coast guard dwh responder cohort3
Follow-up Study of Coast Guard DWH Responder Cohort
  • Specific Objectives
    • Identify health outcomes associated with the CG responders’ DWH response activities, including:
      • Respiratory, cardio-vascular, heat stress-related, hematologic, dermatologic, neurologic, immunologic, hepatic, renal, & mental health conditions
    • Identify health conditions newly diagnosed or that changed in severity since the oil spill by making pre- and post-spill comparisons
    • Further elucidate high interest associations identified in specific aims 1 & 2 by:
      • Focusing on an OMSEP subset
      • Accounting for genetic polymorphisms in genes related to the metabolism of benzene in a subset of highest exposed and group of controls
        • CYP2E1, GSTM1, GSTT1, EPHX, MPO, NQO1
follow up study of coast guard dwh responder cohort4
Follow-up Study of Coast Guard DWH Responder Cohort
  • Key sources of data:
    • Exit survey (inventory) completed by responders
      • Self reported oil spill-related exposures & acute health effects
    • Personal monitoring data for subset of responders
    • Objective clinical data: EHRs, ICD-9 codes
      • Will enable validation of self reported health data, account for pre-existing health conditions, and allow for pre- and post-spill comparisons
    • Department of Defense Serum Repository
follow up study of coast guard dwh responder cohort5
Follow-up Study of Coast Guard DWH Responder Cohort

Exposure Assessment

  • Exit survey (inventory):
    • Exposed missions vs. non-exposed missions
    • Comparisons of:
      • groups of missions
      • individual missions
      • individual exposures
      • geographic location of response
      • PPE use
      • Duration of response
  • Quantitative monitoring data + exit survey
strengths limitations
Strengths & Limitations

Strengths

  • Ability to compare objective health data, post-spill to pre-spill
  • Large population with exposure data already collected
  • Similar access to medical care

Limitations

  • Potential for few people with very high exposures
    • Buoy Tender cutters (booming and skimming operations)
    • Decontamination operations
  • Can only follow-up responders (under these mechanisms) while they remain in C.G.
  • Population may incur other responder exposures from other disaster responses