NTSIP Success Stories

NTSIP Builds Carbon Monoxide Awareness into Tennessee Community Assessment for Public Health Emergency Response (CASPER)

The TN NTSIP team developed an expanded question set to measure people’s knowledge of CO risk. It was published statewide for inclusion in future Community Assessments for Public Health Emergency Response (CASPERs). The 2012 CASPER survey conducted in Cheatham County revealed a disagreement between residents’ perceived risk for carbon monoxide poisoning and their estimated risk. A proxy measure for estimated risk was calculated based on number of gas burning appliances per number of CO detectors present in the residence. These data provided justification for continued inclusion of CO-related questions in CASPERs conducted statewide. In addition, data collected during the first year of CO poisoning surveillance by the NTSIP team supported enhanced CO investigation.

NTSIP Involvement
Our NTSIP Associate conducted a literature review for validated environmental knowledge survey questions. Balancing validity, desired measures, and allowed format, the NTSIP team developed a subset of questions. The questions measure: 1) the presence of gas appliances in a residence; 2) knowledge of high-risk poisoning scenarios; 3) detector type (battery-operated or electrical); 4) interval of battery change; and 5) frequency and location of CO detectors within a residence. The questions were programmed into Epi Info 7 (EI7). An EI7 dashboard was created for real-time analysis of entered data. These questions were used for a March 2014 CASPER in west TN.

Public Health Impact
Building CO into the CASPER survey allowed the NTSIP team to further investigate knowledge gaps. A better understanding of the behaviors that affect CO risk, such as bringing generators inside or inhabited building, not using a CO detector with alarm, not changing detector batteries, or improper placement of detectors, will allow NTSIP to design targeted education and prevention messages.

Cheatham County’s CASPER Exercise

What was the situation?
In May 2010, Tennessee experienced a 1,000-year flood that devastated the middle and western parts of the state. Many of the areas still have not fully recovered. A Community Assessment for Public Health Emergency Response uses valid statistical methods to gather information about health and basic needs, allowing public health and emergency managers to prioritize their response and distribution of resources accurately. In Cheatham County, the CASPER was organized to collect emergency response data for future events and to exercise rapid deployment of emergency personnel.

How was TN NTSIP involved?
A review of 2010-2011 NTSIP surveillance data showed disparate morbidity and mortality related to carbon monoxide incidents. One major source of carbon monoxide exposure is from indoor generator use during emergency situations. The NTSIP Coordinator liaised with the CASPER planners to develop carbon monoxide awareness and preparedness survey questions for inclusion in the CASPER questionnaire. The NTSIP Coordinator and NTSIP Public Health Associate participated in the CASPER training and exercise, going door-to-door collecting data, and disseminating the NTSIP carbon monoxide factsheet.

What actions were taken to respond to concerned citizens?
NTSIP staff was able to directly engage with the public and address their concerns about carbon monoxide exposure. The questions about carbon monoxide and the accompanying factsheet raised public awareness about carbon monoxide exposure and risk reduction strategies.

What was the final outcome and how did this affect public health?
Data collected are currently being analyzed by the CASPER team. This will provide NTSIP with baseline data on the self-reported knowledge about carbon monoxide exposure, especially in emergency situations. These data will guide and improve effectiveness of future NTSIP environmental education communications about carbon monoxide.

New Healthy Homes Website

What was the situation?
Americans spend about 90 percent of their time indoors. A healthy, safe, affordable and accessible home supports their basic needs and protects them from illness and injury. However, many homes have unhealthy conditions. Several health problems or injuries can come from home. Dust, mold, roaches, carbon monoxide, fires, smoke, mice and poisons are some of the things that can be unhealthy. Environmental hazards in the home harm millions of people every year. TDH received phone calls concerning residential/housing problems almost every day. 

How was TN NTSIP involved?
To disseminate this information, TDH prepared a Healthy Homes website (http://health.tn.gov/healthyhomes) to guide the people make their homes healthy. More than 20 pages of new information were added to the website. TDH also made a booklet “Guide to a Healthy Home” for the public that provides information about the ways to make a hazard-free home. NTSIP staff specifically contributed information about carbon monoxide, natural gas and pesticides on the information pages.

What actions were taken to respond to concerned citizens?
A healthy home is designed, built and maintained in support of good health. The Healthy Homes website addressed multiple diseases, conditions and injuries in the home. This website was an easily accessible resource to increase awareness and provide recommendations to promote a healthier environment in which to live. The “Guide to a Healthy Home” booklet is a quick reference guide for families and individuals.

What was the final outcome and how did this affect public health?
The Healthy Homes website helps the public understand how to maintain good health. This website is a comprehensive approach to preventing diseases and injuries that result from housing-related hazards and deficiencies. The website will help people make their environment-friendly and disease-free neighborhood.

Carbon Monoxide Poisoning made a Reportable Event

What was our action?
As a result of information presented by the Tennessee NTSIP, the Tennessee Department of Health (TDH) realized the gap in surveillance and burden of morbidity and mortality of carbon monoxide (CO) poisoning. They demonstrated the benefits of collecting surveillance data for preventing future illness and injury. Their comprehensive proposal captured the attention of state public health leaders.

On January 1, 2013, carbon monoxide poisoning became a reportable event of in Tennessee. CO poisoning became the second environmental condition to be made reportable, next to blood lead testing. Tennessee NTSIP is currently collecting and investigating CO poisoning events throughout the state.

How was TN NTSIP involved?
The NTSIP team compared TN Poison Center call data and media reports about mass exposures to 2010 to 2012 CO-related incidents NTSIP incidents. NTSIP staff marked the lack of complete and centralized data describing acute CO poisoning in the state. To address the issue, the NTSIP team created reporting methodology. They built a case reporting form and computer database to capture the surveillance data.

The NTSIP team delivered the new instructions to public health partners across 95 counties to doctors, hospitals, medical centers, clinics, first responders, fire departments, and other public health officials. Most importantly, the NTSIP team enhanced their rapport with the TN Poison Center to generate a CO reporting query. Health promotion materials were drafted for healthcare providers, the news media, and the general public. A factsheet was made to educate about CO poisoning prevention.

NTSIP staff delivered presentations about CO to the TN Commissioner of Health, TDH Leadership, and Regional Epidemiologists. NTSIP staff is currently improving the reporting protocol and developing a plan for scale-up of reporting to the Tennessee Regional Health Offices.

What was the public health impact?
CO poisoning surveillance provides action, intervention, and policy change to a preventable environmental exposure. In less than three months, Tennessee NTSIP investigated over 200 reported CO poisoning events. Working with the Surveillance System and Informatics Program within TDH, NTSIP developed an online data collection page in the NEDSS Base System.

The NTSIP team trained other public health workers and is raising awareness about CO poisoning illness and injury. Team members created educational materials for the general public and the news media. They built webpages for general information and reporting requirements. More prevention messages will be released throughout the year.

A yearend data analysis will better describe the magnitude of CO morbidity and mortality in Tennessee. It will identify vulnerable populations for targeted prevention outreach. Success with CO poisoning reporting in Tennessee will make it possible to track more environmentally related disease.

TDH Assists with Response to Ammonia from landfill

What was the situation?
In Camden, Benton County, Tennessee, a landfill that disposed of aluminum dross waste was releasing unpleasant odors. The culprit was ammonia gas blowing in the wind. Ammonia is very irritating to the nose and throat. Citizens complained for several months about ammonia exposure and its pungent odor. They were concerned about their health and the health of their families.

How was TN Health involved?
Tennessee’s National Toxic Substance Incidents Program (NTSIP) logged frequent calls from concerned citizens to the National Response Center (NRC). TDH accepted a community petition to the Agency for Toxic Subtances and Disease Registry (ATSDR) for an environmental public health investigation. TDH accepted their petition and will produce a Health Consultation report.

What actions were taken to respond to concerned citizens?
Landfills are regulated by the Tennessee Department of Environment and Conservation (TDEC). TDH informed them of the exposure concerns. TDEC shared all of their site-related data. Together TDH visited the site to learn firsthand about the conditions and odors. TDH met with local residents concerned about the health of their families and community. TDH analyzed lots of data about ammonia concentrations in outdoor air. TDH were able to determine that ammonia was not an urgent hazard. Though, TDH could not rule out a potential chronic exposure hazard. TDH recommended that TDEC perform additional environmental air sampling. TDH will assist them with interpreting the results. TDH will share our findings with the community. In the meantime, the landfill operators have started engineering controls to minimize the release of ammonia.