Improving Outreach and Surveillance Efforts Following a Large-Scale Carbon Monoxide Poisoning in Wisconsin.

OBJECTIVE: In December 2014, the largest carbon monoxide (CO) poisoning in Wisconsin's history occurred at an ice arena. Following this event, the Wisconsin Environmental Public Health Tracking (WI EPHT) Program sought to improve outreach and surveillance efforts. METHODS: WI EPHT designed and distributed educational materials on CO poisoning prevention and surveyed stakeholders to gauge the effectiveness of outreach efforts. To enhance surveillance, WI EPHT utilized data from the Wisconsin Poison Center (WPC) to generate real-time alerts of anomalous numbers of CO-related calls. RESULTS: WI EPHT found that 42% of stakeholders reviewed the outreach materials, and 1 ice arena had installed a CO detector as a result. CO alerts were developed using WPC data and are now routinely used in statewide public health surveillance. CONCLUSION: WI EPHT staff improved CO poisoning prevention outreach and saw a positive response among stakeholders. This work demonstrates ways that health agencies can improve outreach and surveillance for CO poisoning. Improvements in these areas can bolster public health response and may prevent CO-related illness and injury.

Taking Action With Data: Improving Environmental Public Health at the Community Level.

CONTEXT: The Wisconsin Environmental Public Health Tracking Program (Wisconsin Tracking) compiles and provides data on health endpoints and related environmental exposures as a resource to local health departments, tribes, academia, and other stakeholders. The goal of providing these data is that stakeholders use them to develop projects that improve environmental health in their communities-that is, moving from "data to action." OBJECTIVE: To encourage use of Wisconsin Tracking data, we developed a minigrants program and issued a funding opportunity to local health departments and tribes. The opportunity requested proposals for small projects using our data, with the goal of making public health improvements in those communities. Wisconsin Tracking evaluated the minigrants program after its completion. DESIGN/SETTING: Eight local health departments in Wisconsin were awarded up to $10 500 to develop and implement projects over a 9-month period. METHODS: Wisconsin Tracking created a funding opportunity announcement requiring utilization of our data to develop projects by local health departments in Wisconsin. We reviewed and scored applications, evaluating proposals on a range of criteria. During the 9-month project period, Wisconsin Tracking staff members provided a variety of technical assistance to grantees. An evaluation of the overall program followed. RESULTS: Funded communities used Wisconsin Tracking data to improve public health infrastructure, leverage partnerships, establish new initiatives, respond to emergencies, improve communication with stakeholders and residents, and make a variety of public health improvements in their communities. CONCLUSIONS: Efforts to increase use of our data catalyzed development of small-scale environmental health projects. This minigrants program was successful at building relationships between local health departments and Wisconsin Tracking, increasing awareness of Wisconsin Tracking data and resources, and contributing to numerous documented public health improvements throughout Wisconsin.

Exposure to Elevated Carbon Monoxide Levels at an Indoor Ice Arena--Wisconsin, 2014.

On December 13, 2014, the emergency management system in Lake Delton, Wisconsin, was notified when a male hockey player aged 20 years lost consciousness after participation in an indoor hockey tournament that included approximately 50 hockey players and 100 other attendees. Elevated levels of carbon monoxide (CO) (range = 45 ppm-165 ppm) were detected by the fire department inside the arena. The emergency management system encouraged all players and attendees to seek medical evaluation for possible CO poisoning. The Wisconsin Department of Health Services (WDHS) conducted an epidemiologic investigation to determine what caused the exposure and to recommend preventive strategies. Investigators abstracted medical records from area emergency departments (EDs) for patients who sought care for CO exposure during December 13-14, 2014, conducted a follow-up survey of ED patients approximately 2 months after the event, and conducted informant interviews. Ninety-two persons sought ED evaluation for possible CO exposure, all of whom were tested for CO poisoning. Seventy-four (80%) patients had blood carboxyhemoglobin (COHb) levels consistent with CO poisoning; 32 (43%) CO poisoning cases were among hockey players. On December 15, the CO emissions from the propane-fueled ice resurfacer were demonstrated to be 4.8% of total emissions when actively resurfacing and 2.3% when idling, both above the optimal range of 0.5%-1.0%. Incomplete fuel combustion by the ice resurfacer was the most likely source of elevated CO. CO poisonings in ice arenas can be prevented through regular maintenance of ice resurfacers, installation of CO detectors, and provision of adequate ventilation.

Using a partnership barometer to evaluate environmental public health tracking activities.

High-quality environmental health surveillance is challenged by a system in which environmental and health agencies often function with insufficient coordination to routinely address critical issues. The Environmental Public Health Tracking program is working to build a more cohesive system with the capacity for integrated data and information. This work requires a significant amount of effort dedicated to establishing strong partnerships between agencies. Such a task requires skills and activities that differ significantly from the more technical skills needed to physically link data and information from environmental and health resources. Although the work to link people is different from linking data, it is of primary importance because the development of strong partnerships almost invariably provides the necessary foundation for the future integration of data and expertise. As such, the development of partnerships between environmental and health agencies needs to be recognized as a priority product. One approach for moving partnerships into the fore is the creation of assessment tools, or "partnership barometers," that objectively quantify the collaborative process for monitoring progress between and within partners over time. Such measurement would provide a realistic indicator of progress toward tangible products but more importantly emphasizes the importance of building sustainable relationships.

Critical evaluation of historical occupational aerosol exposure records: applications to nickel and lead.

Published or unpublished data sets on individual occupational exposure situations are frequently combined and used for some wider purpose, either hazard evaluation or standards setting. This paper describes a model by which such individual data sets for occupational aerosol exposures might be evaluated in terms of their usefulness in this regard. For workplace aerosols, the model is centered around the particle size-selective framework for aerosol exposure assessment that has emerged in recent years as a rational basis for standards setting. In this paper, reported occupational exposures to airborne nickel and lead are used as examples. In a comprehensive review, 106 published peer-reviewed sources of potentially useful exposure data were found for nickel and 111 similar reports for lead. In addition, for lead 116 unpublished reports in the form of hazard evaluation reports from the US National Institute for Occupational Safety and Health were also examined. For both nickel and lead, a wide range of industry sectors was represented, and the data sets cover the period from 1930 to the present day. It was found that such published data sets are highly inconsistent in terms of the criteria by which the data were obtained, notably for the paucity of essential details of the methods that were used. In contrast, for the lead exposures, the unpublished government reports are more consistent, since they usually followed recognized exposure assessment standards. However, the latter may be misleading because they may have tended to represent high exposure situations. The evaluation model described in this paper provides not only a basis for the evaluation of historical exposure data but also guidelines for new exposure assessment to be carried out in the future. Meanwhile, although many of the historical exposure data sets were found to be generally quite weak in terms of their immediate usefulness, attention is drawn to some of their statistical properties that might allow their enhancement for the purposes of hazard evaluation and retrospective exposure assessment exercises.