1. CDR Tarah S. Somers Commander US PHS Agency for Toxic Substances and Disease Registry May 2016 Environmental Health Nurse Agency for Toxic Substances and Disease Registry Division of Community Health Investigations The slides presented are those of the presenter and do not represent the Center for Disease Control and Prevention, the Agency for Toxic Substances and Disease Registry or the US Public Health Service.

2. Objectives Describe US PHS Describe ATSDR and the work we do in the Regional Offices –Site Work –Projects –Emergency Response Describe how ATSDR assesses sites and exposure pathways

3. U.S. Public Health Service Commissioned Corps "Protecting, promoting, and advancing the health and safety of the Nation".

4. WWII Recruiting poster for nurses

5. US PHS Commissioned Corps One of seven uniformed services Started in 1798 About 6,500 full-time, public health professionals –Physicians, Nurses, Environmental Health, Engineers, Veterinarians, Therapists, Scientists Officers are largely stationed within HHS agencies

7. Agency for Toxic Substance and Disease Registry (ATSDR) A federal public health agency Under the US Department of Health and Human Services Advisory  Not regulatory, not enforcement Assesses human health impacts from hazardous sites Recommends public health action to reduce or eliminate exposures to hazards to prevent adverse health outcomes  Uses the best available science

8. U.S. Department of Health and Human Services Organization Chart

9. What ATSDR Does Conduct Health Assessments for sites Publish Toxicological Profiles Conduct Exposure Investigations Maintain Registries Provide support to other agencies such as EPA and State Health Departments

10. ATSDR Regional Offices ATSDR has 10 Regional Offices Co-located with EPA regions Provide in person support /collaboration to EPA, states, tribes, state health departments and other partners Conduct site assessments and site support work Provide emergency response support Work on special projects (non site-specific) Attend public meetings

11. ATSDR Regional Work Site work –EPA NPL sites –Brownfield / Land Reuse sites –EPA Time Critical Removal sites –Petition sites Exposure Investigations Projects –Brownfield / Land Reuse issues –Children’s Health Projects –Urban gardening / SoilSHOP Emergency Response

12. Site Work Examples

13. Projects Examples

14. Brownfield/ Land Reuse Projects Direct involvement in brownfield sites including site visits ATSDR tools –PHAST tool –Land Reuse Site Tool

15. Children’s Health Projects Mercury spill prevention http://www.dontmesswithmercury.org http://www.dontmesswithmercury.org Safe Siting of Child Care Centers –ATSDR is working on a national project to help keep child care centers from being located on or adjacent to contaminated sites –ATSDR partner State of Connecticut created the SAFER program Published article in Environmental Health Reports in 2011

16. Urban Gardening - SoilSHOP Soil screening for lead Goal is to educate community members about safe urban gardening practices and preventing lead exposure Portland, ME Community members receive information at SoilSHOP

17. Hurricane Katrina, 2005 mold issues Mold growing inside homes after hurricane

18. Deployments for US PHS Officers in the US PHS are expected to deploy for responses Deployments are typically domestic and last several weeks

19. How Sites are Assessed Brief primer on how we look at environmental exposures Describe exposure and exposure pathway Example to illustrate exposure pathway

20. What is Exposure? Exposure means contact (inhalation, ingestion, dermal) with a contaminant Exposures can be short term (acute) or long term (chronic)

21. Exposure Pathway The route a substance takes from its source to its end point and how people can be exposed to it.

22. Exposure Pathway 1.Source of Contamination 2.Environmental Media / Transportation Mechanism 3.Point of Exposure 4.Route of Exposure 5.Receptor Population When all five parts are present, there is a completed exposure pathway.

23. Source of Contamination Place where contamination comes from - can be a natural source or from manmade activities Debris pile, Leeds Metal site, ME

24. Transport Mechanism How contaminant gets from source to where human exposure can occur

25. Point of Exposure Place where someone can come into contact with contaminants Example of a point of exposure could be where contact with water happens

26. Route of Exposure How contaminants enter a human Ingestion Inhalation Dermal contact Injection* * Rarely in environmental health would injection be an exposure route but in a clinical setting this could be a route or exposure

27. Receptor Population People who could come into contact with contaminant Examples of receptor populations could be people living near a the emissions stack on the left or in the home above with the stove

28. Sensitive Populations People who might be more sensitive or susceptible to exposure to hazardous substances because of factors such as age, occupation, gender, behaviors, or preexisting health conditions like asthma

29. Sensitive Population Examples children –smaller body size, still developing bodies, and different habits women of child bearing age subsistence living –fishing, hunting, gathering people in recreational activities –Swimming, fishing, trespassing elderly

30. Completed Exposure Pathway?  NO – if there is no completed exposure pathway then people will not be harmed by the contaminant  YES – if there is, was or might be in the future a completed exposure pathway then determine if the exposure is harmful to health

31. Factors to Consider to Determine the Harm from Exposures Type of contaminant Amount of contaminant Duration of exposure Frequency of exposure Understanding of the toxicology

32. Contact information Tarah S. Somers RN, MSN/MPH Commander, US Public Health Service ATSDR Region 1, New England Office 617-918-1493 work 703-505-7559 work cell tvs4@cdc.gov

33. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. For more information please contact Agency for Toxic Substances and Disease Registry 4770 Buford Hwy. NE, Chamblee, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.atsdr.cdc.gov Questions? Agency for Toxic Substances and Disease Registry Division of Community Health Investigations