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. Tennessee Department of Environment and Conservation
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. Tennessee Department of Environment and Conservation
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. Tennessee Department of Environment and Conservation
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. Tennessee Wildlife Resources Agency (TWRA)
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 ( ) for advice

18. Screening Pitfalls Quality control What to do with results?
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 ( )
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%), (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
Pediatric toxicologist
Robert Geller, MD;
ATSDR toxicologist
Tennessee Department of Health
To notify of reportable illnesses:

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