1. 2009 Bunker Hill Superfund Site Coeur d’Alene Basin Blood Lead Levels Idaho Department of Health and Welfare Idaho Department of Environmental Quality Panhandle Health District United States Environmental Protection Agency February 17, 2010

2. Public health service offered by the State Not a study or experiment Box since 1974/1985 Basin since 1996 Lead Health Intervention Program (LHIP) Annual Blood Lead Surveys

3. No cash incentive for participants that live:  within the Box and are between 6 months and 9 years of age, or $40.00 cash incentive for participants that live:  within the Coeur d’Alene River Basin and are between 6 months and 6 years of age 2.5 times more participants in 2009 than in previous years ($20 cash incentive) Prior to blood draws, the parent/legal guardian or adult participant must sign a Consent Form and complete the appropriate Questionnaire Panhandle Health District LHIP Procedures

4. Screening blood test is done by skin puncture (capillary or fingerstick - FS) Results of capillary test are provided to the participant or parent immediately after analysis Panhandle Health District LHIP Procedures

5. Health Effects

6. Decreasing “elevated” blood lead levels 60 40 30 25 10? N Engl J Med 2003;348: p1517-26.

7. Neurotoxic Effects Neurobehavioral effects in early development persist into adolescence and young adulthood Neurocognative effects associated blood lead levels of 5-10 μg/dl A decline of 6.2 IQ points results from a blood lead change from 1 to 10 μg/dl (pooled results from 7 studies)

8. Cardiovascular Effects Increase in blood pressure (hypertension)

9. Other Organ System Effects Renal effects Immune system effects Bone and teeth effects Heme-synthesis effects Reproductive and developmental effects Adrenal effects Liver Effects Gastrointestinal Effects Metabolism Effects Genotoxic Effects Carcinogenic Effects

10. At Risk Populations Children Pregnant women Adults with cumulative exposure Genetically pre-disposed Individuals

11. “There is no level of Pb exposure that has yet been identified, with confidence, as clearly not being associated with possible risk of deleterious health effects.”

12. Box History

13. Bunker Hill Box Average Blood Lead: 1974-2002 * * * U.S. Average * “Elevated” blood lead level

14. Bunker Hill Box Superfund Site Remedial Action Objective l 95% of all children in each community with blood lead levels <10 µg/dl l No children (i.e. 15 µg/dl

15. Percent of Box Children with Blood Lead Levels > 10 μg/dl, by City, 1988-2002

16. Box Lead Health Intervention Summary Statistics 1988-1994 Number ofMean Number of children Percent children blood Pb with blood Pb (  g/dl) of children Year in survey(  g/dl)>25>15 >10 > 10  g/dl 1988* 230 9.9 73510546% 1989* 27511.4 87115456% 1990362 8.9 24113437% 1991365 6.3 217 56 15% 1992415 7.4 33111027% 1993445 5.6 110 6615% 1994416 6.2 115 7117% *does not include Pinehurst

17. Box Lead Health Intervention Summary Statistics 1995-2002 Number ofMean Number of children Percent children blood Pb with blood Pb (µg/dl) of children Year in survey(µg/dl) >25>15 >10 > 10 µg/dl 1995405 6.0 220 6215% 1996397 5.8 213 4912% 1997337 5.4 0 6 3611% 1998 375 4.8 0 5 31 8% 1999370 4.7 0 3 23 6% 2000320 4.3 0 5 17 5% 2001 322 3.2 0 4 10 3% 2002368 3.1 0 3 7 2%

18. 2009 Blood Lead Summary Statistics – Box (age 0-9) Total Number of Children (N) 18 Minimum (μg/dl) 1.3 Maximum (μg/dl) 10.0 Average (μg/dl) 3.2 Standard Deviation 2.1 Geometric Mean (μg/dl) 2.8 Geometric Standard Deviation 1.6 Percentage Total Number of Children (N) 18 Number of Children > 10 μg/dl 1 6% Number of Children > 15 μg/dl 0 0% Number of Children > 20 μg/dl 0 0%

19. Basin History

20. Blood Lead Levels by Area, 1974 0 20 40 60 80 100 I. Smelterville II. Kellogg III. Pinehurst IV. Osburn V. Mullan VI. Spirit Lake VII. Pine Creek % of children > 40 μg/dl

22. 2009 Blood Lead Summary Statistics – Basin (age 0-6) Total Number of Children (N) 175 Minimum (μg/dl) 1.4 Maximum (μg/dl) 10.0 Average (μg/dl) 3.1 Standard Deviation 1.8 Geometric Mean (μg/dl) 2.7 Geometric Standard Deviation 1.6 Percentage Total Number of Children (N) 175 Number of Children > 10 μg/dl 3 1.7% Number of Children > 15 μg/dl 0 0% Number of Children > 20 μg/dl 0 0%

23. Year199619971998199920002001 N581370162101*117 N ≥ 10 μ g/dl 82926147 % ≥ 10 μ g/dl 14%15%13%16%14%6% N ≥ 15 μ g/dl 3141242 % ≥ 15 μ g/dl 5%8%6%7%4%2% N ≥ 20 μ g/dl 002410 % ≥ 20 μ g/dl 0% 3%2%1%0% Basin Blood Lead Summary by Year, 1996 - 2001 (age 0-6 only) *1 child from 2000 was removed from the summary because the associated address was outside the Basin boundaries.

24. Year20022003200420052006200720082009 N1037580*81697173175 N ≥ 10 μ g/dl 43211013 % ≥ 10 μ g/dl 4% 2.5%1% 0%1.4%1.7% N ≥ 15 μ g/dl 02100000 % ≥ 15 μ g/dl 0%3%1%0% N ≥ 20 μ g/dl 00000000 % ≥ 20 μ g/dl 0% Basin Blood Lead Summary by Year, 2002 - 2009 (age 0-6 only) *2 children from 2004 were removed from the summary the associated addresses were outside the Basin boundaries.

25. Year199619971998199920002001 N581370162101*117 Min ( μ g/dl) 1.02.0 1.0 1.4 Max ( μ g/dl) 18.019.021.029.027.016.0 Ave ( μ g/dl) 5.26.06.36.45.84.5 GeoMean ( μ g/dl) 4.24.95.45.24.83.7 Basin Blood Lead Summary by Year, 1996 - 2001 (age 0-6 only) *1 child from 2000 was removed from the summary because the associated address was outside the Basin boundaries.

26. Year20022003200420052006200720082009 N1037580*81697173175 Min ( μ g/dl) 1.41.01.4 Max ( μ g/dl) 13.017.116.712.010.09.014.010.0 Ave ( μ g/dl) 3.74.13.92.92.82.92.43.1 GeoMean ( μ g/dl) 3.23.4 2.32.42.62.12.7 Basin Blood Lead Summary by Year, 2002 - 2009 (age 0-6 only) *2 children from 2004 were removed from the summary the associated addresses were outside the Basin boundaries.

27. AreaBurke (Ninemile) KingstonLower Basin MullanOsburn N223420849 Min ( μ g/dl) 1.4 1.61.4 Max ( μ g/dl) 8.010.0 4.08.0 Ave ( μ g/dl) 3.63.12.62.83.2 GeoMean ( μ g/dl) 3.12.62.32.72.8 2009 Basin Blood Lead Summary Statistics by Area

28. AreaSide Gulches SilvertonWallace N2598 Min ( μ g/dl) 1.4 Max ( μ g/dl) 5.35.15.6 Ave ( μ g/dl) 3.02.73.0 GeoMean ( μ g/dl) 2.82.62.7 2009 Basin Blood Lead Summary Statistics by Area

29. Age123456 N342524372728 Min ( μ g/dl) 1.4 Max ( μ g/dl) 10.07.07.68.07.210.0 Ave ( μ g/dl) 3.43.0 2.9 GeoMean ( μ g/dl) 2.92.82.72.62.82.6 2009 Basin Blood Lead Summary Statistics by Age (years)

30. ConsentedRefused Mullan 98%2% Wallace & Burke/Ninemile 98%2% Silverton 96%4% Osburn 98%2% Side Gulches 96%4% Pine Creek 96%4% Kingston 94%6% Lower Basin 78%22% Total 95%5% Consents and refusals received from 2004 through August 2009. Percentage of Parcels that have Consented and Refused Sampling

31. Lead Exposure Pathways

33. Soil and Dust Lead to Blood Pathways REMEDIATIONREMEDIATION Neighborhood Soil House Dust Blood Community Soil Yard Soil 30% 40%20% 60% 20%

34. Sources of Lead in Dusts l Dust lead concentrations and consequent lead loadings are strongly related to outdoor soil concentrations with some contribution from both exterior and interior paint to mat dust lead loading. l This leads to an overall conclusion that soil probably contributes from 60% - 80% of the lead to house dust.

35. Box Soil and House Dust History

38. Basin House Dust Exposure Monitoring

40. Notes: Vacuum samples were not collected in 1997, 2000, or 2001. 2002 had too little data to display. In 2005, only one vacuum sample was collected from the Lower Basin. When the number of samples is 2 or less, the results are not shown in order to maintain confidentiality.

41. NAS Investigation Health Related Conclusions

42. NAS Conclusions l “The committee found that scientific and technical practices used by EPA for decision making regarding human health risks in the Coeur d’Alene River Basin Superfund site are generally sound. The exceptions are minor. l However, for EPA’s decision making regarding environmental protection, the committee has substantial concerns, particularly regarding the effectiveness and long-term protection of the selected remedy.”

43. NAS Conclusions l Furthermore, the potential long-term effectiveness of the proposed remedial actions is severely limited by frequent flooding events and their potential to recontaminate remediated areas with contaminated sediments.”

44. NAS Conclusions l “Barring recontamination of remediated properties, it seems probable that the proposed remedies will reduce targeted human health risks. l However, long-term support of institutional control programs should be provided to maintain the integrity of remedies intended to protect human health and guard against health risks from contamination.”

45. Supporting ICP in the Box and Basin Developing Repositories Infrastructure Revitalization Remedy Protection and Flooding Flooding Assessments Institutional Controls and Infrastructure Revitalization Programs (ICP) (IRP)

46. Specific NAS Health Conclusions l There are elevated exposures in the Basin that are a threat to Human Health l Arsenic risks would be better characterized with biological indicators, EPA should continue to support national research on biomarkers of arsenic exposure

47. Specific NAS Health Conclusions l The analysis of exposures due to waste and lead paint was more than normally accomplished at a site. Mining waste is the most significant source, lead paint is indicated for some children l Long-term support of ICP should be provided, and evaluation of the efficacy of yard remediation should be supported by ongoing environmental and blood lead monitoring efforts

48. Specific NAS Health Conclusions l Universal blood lead screening is indicated due to the high environmental lead levels in the Basin l Subsistence exposures are ill- advised in the contaminated areas of the Basin

49. Specific NAS Health Conclusions l Health intervention efforts to address chronic stress associated with living in or near a Superfund Site should be addressed l Risk Assessments and effectiveness evaluations should address the 1-4 year- old age group. Combining these results with 5-9 year olds is misleading and understates risk among the target group

51. Notes: Mat samples were not collected in 1997 and 1999 through 2003. When the number of samples is 2 or less, the results are not shown in order to maintain confidentiality.

52. Box Vacuum Bag Lead Concentrations- 1990, 1994

53. Box Vacuum Bag Lead Concentrations- 1998, 2002

54. Basin Dust Mat Lead Concentrations- 1996, 2004, 2009

55. Basin Vacuum Bag Lead Concentrations- 1996, 2004, 2009