Abstract The goals of this study were to field test and compare three methods for assessing carbon monoxide (CO) exposures to wildland firefighters, and to acquire additional exposure data to indicate activities and conditions under which this population may be exposed to hazardous CO levels. The three monitoring methods were: 1) passive colorimetric diffusion tubes; 2) electronic datalogging monitors; and 3) end-exhaled air (breath) monitoring. Full-shift time-weighted average CO exposures, determined using passive diffusion monitors, were low for all employees monitored, with a mean of 8.2 ppm (n = 51). These monitors were found to be an easy means for collecting a large number of full-shift CO measurements. The job tasks on these shifts included line construction, backfiring, line holding, and mop-up. Efforts to collect detailed individual activity information by having firefighters make entries in logbooks were largely unsuccessful. Real-time CO exposures for 12 individuals were monitored using electronic dataloggers. Two firefighters (17%) had 1-minute exposures of, respectively, 339 and 212 ppm, which exceeded the Occupational Safety and Health Administration ceiling limit of 200 ppm. One firefighter had a 45-minute CO exposure at approximately 150 ppm while performing a mop-up activity. Full-shift TWAs measured with the dataloggers agreed fairly well with those determined using the passive dosimeters. One firefighter had a postshift level of CO in end-exhaled air that exceeded a recently proposed Biological Exposure Index of 20 ppm. There was a small but statistically significant increase in CO in end-exhaled air across the shift (mean change was 2.2 ppm). Change in CO concentration in end-exhaled air across the shift did not correlate well with average airborne exposure. Further CO exposure monitoring of wildland firefighters is needed to associate the higher CO levels with specific activities and conditions. The electronic data-logging monitors are ideal for that purpose, but better methods for recording individual activities should be developed.
1. The "lead standards" established by OSHA for general industry in 1978 and the construction industry in 1993 require employers and clinicians to follow very specific guidelines for protecting lead exposed workers. Depending on the level of exposure, medical surveillance may be legally required. 2. Lead affects multiple body systems and can cause permanent damage. Low level exposures that in the past were thought safe are now considered hazardous as new information emerges about the toxicity of lead. 3. Lead poisoning, if undetected, often results in misdiagnosis and costly care. Adults are exposed to lead in many different workplace settings. All clinicians caring for lead exposed workers need to be informed about the health effects of lead, employer and physician responsibilities, and worker rights. 4. Occupational and environmental health nurses can help identify workers at risk and prevent lead poisoning by education and early intervention through collaboration with the workers, the employer, the company physician, and other health and safety professionals.
In January 2017, two local health departments notified the California Department of Public Health (CDPH) of three cases of coccidioidomycosis among workers constructing a solar power installation (solar farm) in southeastern Monterey County. Coccidioidomycosis, or Valley fever, is an infection caused by inhalation of the soil-dwelling fungus Coccidioides, which is endemic in the southwestern United States, including California. After a 1-3 week incubation period, coccidioidomycosis most often causes influenza-like symptoms or pneumonia, but rarely can lead to severe disseminated disease or death (1). Persons living, working, or traveling in areas where Coccidioides is endemic can inhale fungal spores; workers who are performing soil-disturbing activities are particularly at risk. CDPH previously investigated one outbreak among solar farm construction workers that started in 2011 and made recommendations for reducing risk for infection, including worker education, dust suppression, and use of personal protective equipment (2,3). For the current outbreak, the CDPH, in collaboration with Monterey County and San Luis Obispo County public health departments, conducted an investigation that identified nine laboratory-confirmed cases of coccidioidomycosis among 2,410 solar farm employees and calculated a worksite-specific incidence rate that was substantially higher than background county rates, suggesting that illness was work-related. The investigation assessed risk factors for potential occupational exposures to identify methods to prevent further workplace illness.
Lead is a potent poison that affects multiple body systems. It is well documented that children under age 6 years and the fetus are especially vulnerable to neurologic damage affecting learning and behavior with potential for life-long impact. In 1991, the Centers for Disease Control and Prevention (CDC) lowered the blood lead level (BLL) of concern for children from 25 to 10 micrograms per deciliter (μg/dL) (CDC 1991).1 Efforts to reduce lead in the environment, primarily by eliminating lead from gasoline and paint, have resulted in lowering the overall geometric mean BLL for the general population in the United States from approximately 13 micrograms per deciliter (μg/dL) in the late 1970’s to <2 μg/dL by 1999 (NCHS 1984; CDC 2001).2,3 Although the average BLL has markedly declined, National Health and Nutrition Examination Survey (NHANES) 1999– 2000 data indicate that 2.2% of U.S. children aged 1 to 5 years had BLLs ≥10 μg/dL (CDC 2003).4 Recent research suggests that levels once thought safe are considered hazardous as new information emerges about lead’s harmful effects at BLLs less than 10 μg/dL.5,6 Despite success in reducing the number of children with elevated BLLs, some remain at high risk for lead exposure, including those living in homes containing lead-contaminated dust. Invisible toxins may be carried home to household members by inadequately protected workers on their clothes, shoes, or bodies, called “take-home exposure.” Documented cases of take-home exposure include lead, beryllium, asbestos, pesticides, and other toxic materials.7 In this case series, we describe take-home lead exposure incidents in California from 1992 to 2002. Lead is used in more than 100 industries. Lead dust carried from work settles on surfaces in the vehicle and home where it can be ingested or inhaled by young children with normal mouthing behavior and by household members handling workers’ clothing. Children of lead-exposed workers have disproportionately high BLLs when compared to other children.8-10 One study estimated that 48,000 families have children under age 6 living with household members occupationally exposed to lead.11 Reports of take-home lead exposure include work in mining,8,12 automotive radiator repair,13 battery reclamation,14 construction,9 and antique furniture refinishing.15
On July 20, 2023 a letter was sent to the Director of the Centers for Disease Control and Prevention requesting the agency's Healthcare Infection Control Practice Advisory Committee seek input from more stakeholders and the public, recognize the importance of infectious disease transmission by inhalation of human-generated aerosols, and ensure the application of interventions from all levels of the control hierarchy.
On August 24, 2014, at 3:20 a.m., a magnitude 6.0 earthquake struck California, with its epicenter in Napa County (1). The earthquake was the largest to affect the San Francisco Bay area in 25 years and caused significant damage in Napa and Solano counties, including widespread power outages, five residential fires, and damage to roadways, waterlines, and 1,600 buildings (2). Two deaths resulted (2). On August 25, Napa County Public Health asked the California Department of Public Health (CDPH) for assistance in assessing postdisaster health effects, including earthquake-related injuries and effects on mental health. On September 23, Solano County Public Health requested similar assistance. A household-level Community Assessment for Public Health Emergency Response (CASPER) was conducted for these counties in two cities (Napa, 3 weeks after the earthquake, and Vallejo, 6 weeks after the earthquake). Among households reporting injuries, a substantial proportion (48% in Napa and 37% in western Vallejo) reported that the injuries occurred during the cleanup period, suggesting that increased messaging on safety precautions after a disaster might be needed. One fifth of respondents overall (27% in Napa and 9% in western Vallejo) reported one or more traumatic psychological exposures in their households. These findings were used by Napa County Mental Health to guide immediate-term mental health resource allocations and to conduct public training sessions and education campaigns to support persons with mental health risks following the earthquake. In addition, to promote community resilience and future earthquake preparedness, Napa County Public Health subsequently conducted community events on the earthquake anniversary and provided outreach workers with psychological first aid training.
The California Department of Health Services' Occupational Health Branch and others have identified the construction industry as being at high risk for injuries, illnesses, and fatalities. Effective tailgate trainings (brief job site safety meetings) can be a powerful tool to promote hazard awareness and safe work practices. The authors found that many contractors and supervisors conducted ineffective tailgate trainings. They developed the BuildSafe California Project to assist contractors to have more effective programs by holding 25 training-of-trainers sessions reaching 1,525 participants. The needs assessment, intervention, and evaluation results from the first 18 trainings are presented. Eighty-six percent of the participants found the program “very helpful.” Participants used the materials and made improvements in the quality and frequency of trainings. Supervisors must be skilled at conducting tailgate trainings as part of their responsibilities. There is a serious need to provide more culturally appropriate safety training in a workforce increasingly made up of Latino workers.
The authors discuss the multitude of contaminants to which wildland firefighters are exposed, including carbon monoxide, sulfur dioxide, particulate and silica, polyaromatic hydrocarbons, aldehydes, and benzene. They examine the respiratory effects of these contaminants and then present their recommendations for an occupational health program for wildland firefighters.
Field surveys were conducted of 67 dry cleaning establishments to assess working conditions and potential for exposure to perchloroethylene, a solvent of choice in this industry. Evaluation of ventilation controls showed that 28% of cleaning machines (transfer type) did not have functioning local exhaust systems, and an additional 32% had inadequately maintained systems providing less than the recommended face velocity at the door opening. Personal sampling was performed in 20 firms to relate operator exposure levels to the process used and degree of local exhaust ventilation. Utilization of the dry-to-dry (closed system) process resulted in a lower mean TWA exposure, 28.3 ppm, as compared to 86.6 ppm for transfer operations. Five-minute peak samples taken during clothing transfer demonstrated significant exposure levels ranging from 11.3 to 533.8 ppm. A lower mean peak exposure (25.3 ppm) was found for firms with local exhaust ventilation at the recommended rate than for facilities with poorly or unventilated cleaning machines (159.7 ppm). The study points out the manner in which available control measures can be used optimally to reduce employee exposure. Increased involvement of trade associations and local health authorities is also recommended to promote the safe use of perchloroethylene in the dry cleaning industry.
