1. Responding to a lead poisoning outbreak during construction and renovation at an indoor firing range Ryan Kellogg and Steve Whittaker Local Hazardous Waste Management Program Public Health – Seattle & King County

2. Outline Lead in firing ranges The Incident Lead’s health effects Blood lead levels in perspective Vulnerable populations Public Health challenges Looking forward Source: www.buzzle.com/articles/lead- the-element.html

3. Lead in bullets Projectile: – Elemental lead Primer: – Lead styphnate – Lead peroxide – Lead nitrite Source: http://science.howstuffworks.com/revolver2.htm

4. Lead on the range Source: http://www.njnoordhoek.com/?p=735 Source: http://snovalleystar.com/2013/03/06/police-gun-range-is- under-fire-for-age-and-residue Combustion Abrasion Impact

5. Typical range

6. Initial reports WA Lead Registry gets two elevated BLL reports from gun range employees Employee interviews: – Demolition and construction project – “Tons of sand with lead” moved and sifted – Fiberglass insulation removed Used with permission, confidential informant

7. Registry refers to WA OSHA History of lead violations Multiple contractors on-site More help needed WA OSHA opens inspections on 11/13/12 Air & wipe sampling → high lead levels on surfaces and in breathing zones, lead passing through exhaust ducts Inadequate ventilation!

8. Blood Lead Levels (BLLs) BLL (µg/dL) Gun Range Employees Construction Workers <10648 10 to 24712 25 to 3995 40 to 4924 50 to 5922 60 to 15903 Unknown1643 Total42117 >5 Spontaneous abortion Developmental delay Hypertension/kidney dysfxn >10 Reduced birth weight Neurocognitive deficits >20 Headache Fatigue, Sleep disturbance Anorexia Constipation Arthralgia, Myalgia Decreased libido >40 Sperm abnormalities Nephropathy Peripheral neuropathy Anemia, Colic, Gout

9. Public Health’s involvement WA OSHA makes a referral to PHSKC - concerned about lead exposures to the public Can PHSKC close the range until construction is completed?

10. Source: http://adweek.blogs.com/Adfreak/page/339/ Source: www.reedsindoorrange.com Source: http://lowcountrybikers.com/cristin-katie-visit-the-gun- range

11. Cluster and environmental evaluation Interviewed 100+ workers Surface sampling (public areas) – 1,000s ug/ft 2 Contamination of multiple surfaces High air lead levels – 100s ug/m 3 Contamination in vehicles, homes, hotel rooms Elevated BLLs in a contractor’s children and spouse

12. Public Health challenges Health Officers in WA (and most other states) have broad statutory authority to protect public health Lack of regulatory procedure or precedent to guide action, and compel: – cooperation of business owner – temporary closure to protect the public – collection of data to assess public exposure risk – sharing of industrial hygiene data collected by owner’s consultants

13. Public Health challenges No regulatory limits to protect public from lead in air Requires close consultation/concurrence with Federal and State agencies High political valance on federal lead regulation Worker exposure limits based in 70’s science No internal PH capacity to collect personal breathing zone samples Local permit requirements (where they exist) do not stipulate lead exposure controls Gun ranges are hazardous!

14. Looking forward Specify surface- and air- lead levels that ensure BLLs <5  g/dl: – Integrated Exposure Uptake Biokinetic Model (IEUBK) modeling to predict BLLs from inhalation and hand-to-mouth exposures – Consider vulnerable population receptors (women of childbearing age / pregnant women / children) Increase awareness of lead hazards in the shooting public

15. Looking forward Promote “best practices” – shooter behavior: – No smoking, eating, or other hand-to-mouth activities – Wash skin after shooting – Wear long sleeves and pants – Clean footwear when leaving the range – Wash range clothing separately

16. Looking forward Promote “best practices”– range operations: – Jacketed or lead-free ammunition – Lead-free primers in bullets – Replace sand berms with solid bullet traps (with proper disposal of sand!) – Adequate ventilation, tested regularly – Clean range surfaces daily - with confirmation sampling – Routine blood lead testing of employees, regardless of air lead levels. Medical removal at 10 ug/dL

17. Public Health actions Educate range operators and shooters who consider lead exposure as “normal” Explore state and local options to address policy and procedural gaps – Incorporate health standards in existing permits (i.e., business licenses) – State regulations to authorize local Health permits of businesses that cause potentially harmful conditions for customers – Ground state and local policies in current evidence base on lead exposure risks Assure stable funding for lead registries

18. Acknowledgements PHSKC: – Stella Chao – Jeff Duchin – Carina Elsenboss – Hilary Karasz – Mike Kinzer – Ngozi Oleru – Will Perry – Sharon Schoenfeld-Cohen – Olivia Stapleman – Nicole Thomsen – Dennis Worsham Lead Registry: – Todd Schoonover DOH: – Rad Cunningham – Glen Patrick WA OSHA: – Gina Colby – Venetia Runnion – John Stebbins Ecology: – Trudy Harding – Dave Misko ATSDR: – Mary Jean Brown – Karen Larson

19. Adult blood lead levels in perspective 60 50 40 10 5 1.4 BLL (  g/dL) OSHA’s medical removal OSHA’s return to work ABLES case definition for adults / CA medical management trigger CA pregnancy guideline Adult U.S. geometric mean

22. Temporary ventilation Gun Range Incident Timeline 2012 Oct Nov Dec Jan Feb Mar 2013 Construction complete? Construction starts Apr Sept-Oct 2012 Ecology consulted on berm disposal Sept-Oct 2012 Ecology consulted on berm disposal Oct-Nov 2012 Poor ventilation Poor ventilation while open to public Oct-Nov 2012 Poor ventilation Poor ventilation while open to public Range EE BLLs: 48 and 40 µg/dl Dec-Jan 2013 PHSKC wipe samples – public area – 1000s ppm Dec-Jan 2013 PHSKC wipe samples – public area – 1000s ppm Lead registry makes referral to DOSH Wipe sampling: 100,000s ppm 13 Range EE BLLs: 15 to 58 ug/dl 10/12/12 DOSH opens inspection 10/12/12 DOSH opens inspection DOSH: Lead in air exhausts, on surfaces, ↑PBZs 12 contractor & subcontractor BLLs: 16 - 153 ug/dl 11/30/12 DOSH contacts PHSKC 11/30/12 DOSH contacts PHSKC PHSKC requests closure, then data before reopening (denied) Feb-Apr 2013 Lawsuits! Feb-Apr 2013 Lawsuits! 03/06/13 PHSKC demobilizes 03/06/13 PHSKC demobilizes Range EEs move sand berm, “mine” for lead sand berm Range EEs move sand berm, “mine” for lead sand berm Pressure washing / disposal on veg. Range EEs remove fiberglass insulation DOSH no longer requires PPE for Range EEs Media coverage Final ventilation system installed Construction contractors hired Contamination of vehicles, tools, homes, hotel rooms, family members PHSKC initiates surge response ATSDR Consulted Range hires IH consultant PHSKC requires signage signage PHSKC requires signage signage Two shooting bays closed – poor ventilation Men’s restroom closed. High lead on floor Lead abatement contractor hired – surfaces cleaned Improvements to ventilation Ladies Night Exposure Assess.