Fatal Work-Related Injuries: Southeastern United States, 2008-2011.

In 2008, the work-related injury fatality rate was 3.8 per 100,000 workers in the United States but was 5.2 per 100,000 workers for the southeast region. Work-related fatalities in the southeast were examined for the period 2008 to 2011. Median work-related injury fatality rates are reported for the southeast region, each of the 12 states, and the United States. The percentages of employees in high fatality industries and work-related fatalities by cause were calculated. Finally, the Occupational Safety and Health Administration's database was searched for fatality reports. States with the highest rates (per 100,000 workers) included Arkansas (7.2), Louisiana (6.8), and West Virginia (6.6). Arkansas, Louisiana, Mississippi, and West Virginia each had more than 20% of their employees in high fatality industries. Forty percent of work-related injury fatalities were from transportation incidents in the southeast and the United States. Future analyses should include work-related injury fatality rates by industry and compare rates with other U.S. regions.

Exposures and symptoms among workers after an offsite train derailment and vinyl chloride release.

OBJECTIVE: In 2012 in New Jersey, a train derailment resulted in the puncture of a tanker car carrying liquid vinyl chloride under pressure, and a resulting airborne vinyl chloride plume drifted onto the grounds of a nearby refinery. This report details the investigation of exposures and symptoms among refinery workers. DESIGN AND SETTING: The investigation team met with refinery workers to discuss their experience after the derailment and provided workers a self-administered survey to document symptoms and worker responses during the incident. Associations among categorical variables and experiencing symptoms were evaluated using Fisher's exact test. PARTICIPANTS: Twenty-six of 155 (17 percent) workers present at the refinery or driving on the access road the date the spill occurred completed the survey. MAIN OUTCOME MEASURE(S): Any self-reported symptom following exposure from the vinyl chloride release. RESULTS: Fifteen workers (58 percent) reported ≥1 symptom, most commonly headache (12, 46 percent). Three (12 percent) reported using respiratory protection. No differences in reporting symptoms were observed by location during the incident or by the building in which workers sheltered. Workers who moved from one shelter to another during the incident (ie, broke shelter) were more likely to report symptoms (Fisher's exact test, p=0.03); however, there are only limited data regarding vinyl chloride concentrations in shelters versus outside. CONCLUSIONS: Breaking shelter might result in greater exposures, and managers and health and safety officers of vulnerable facilities with limited physical access should consider developing robust shelter-in-place plans and alternate emergency egress plans. Workers should consider using respiratory protection if exiting a shelter is necessary during a chemical incident.

Assessment of emergency responders after a vinyl chloride release from a train derailment - New Jersey, 2012.

On November 30, 2012, at approximately 7:00 am, a freight train derailed near a small town in New Jersey. Four tank cars, including a breached tank car carrying vinyl chloride, landed in a tidal creek. Vinyl chloride, a colorless gas with a mild, sweet odor, is used in plastics manufacture. Acute exposure can cause respiratory irritation and headache, drowsiness, and dizziness; chronic occupational exposure can result in liver damage, accumulation of fat in the liver, and tumors (including angiosarcoma of the liver). Because health effects associated with acute exposures have not been well studied, the New Jersey Department of Health requested assistance from the Agency for Toxic Substances and Disease Registry (ATSDR) and CDC. On December 11, teams from these agencies deployed to assist the New Jersey Department of Health in conducting an assessment of exposures in the community as well as the occupational health and safety of emergency personnel who responded to the incident. This report describes the results of the investigation of emergency personnel. A survey of 93 emergency responders found that 26% of respondents experienced headache and upper respiratory symptoms during the response. A minority (22%) reported using respiratory protection during the incident. Twenty-one (23%) of 92 respondents sought medical evaluation. Based on these findings, CDC recommended that response agencies 1) implement the Emergency Responder Health Monitoring and Surveillance (ERHMS) system for ongoing health monitoring of the emergency responders involved in the train derailment response and 2) ensure that in future incidents, respiratory protection is used when exposure levels are unknown or above the established occupational exposure limits.

Injuries and illnesses among American Red Cross responders-United States, 2008-2012.

OBJECTIVE: Occupational injury and illness rates for volunteer responders have not been well documented. We analyzed data specific to volunteers from the American Red Cross (ARC). METHODS: Data collected by the ARC between 2008 and 2012 were analyzed to identify disaster factors associated with responder injuries and illnesses. We focused on disaster-relief operation (DRO) level (indicating operational costs, ranging from 3 [lower] to 5+ [higher]); disaster type; region; and year. We calculated injury and illness rates and estimated rate ratios (RR) with 95% CI, using negative binomial regression. Also, we analyzed a total of 113 disasters. RESULTS: Hurricanes had the highest rates of injuries (14/1000 responders) and illnesses (18/1000 responders). In the adjusted model for injuries, RRs were higher for DRO levels 4 (3.6 [CI, 2.0-6.7]) and 5+ (4.9 [CI, 2.2-11.0]) than for level 3. In the adjusted model for illnesses, RRs also were higher for DRO levels 4 (4.4 [CI, 2.6-7.3]) and 5+ (8.6 [CI, 4.1-17.7]) than for level 3. CONCLUSIONS: Higher DRO levels were a significant predictor of greater rates of occupational injuries and illnesses. Careful selection of responders, including volunteers, has been warranted for deployments to such disasters. (Disaster Med Public Health Preparedness. 2014;0:1-7).

Racial and ethnic disparities in current asthma and emergency department visits: findings from the National Health Interview Survey, 2001-2010.

OBJECTIVES: Racial/ethnic disparities in current asthma prevalence and medical care are a major public health concern. We examined the differences in asthma prevalence and morbidity among major racial/ethnic populations in the US. METHODS: We analyzed data from the 2001-2010 National Health Interview Survey for adults (≥18 years) and children and adolescents (<18 years). Outcome variables were current asthma prevalence, at least one attack in the past 12 months, and at least one asthma-related emergency department/urgent care center (ED/UCC) visit in the past 12 months. We used multivariate logistic regression to calculate the model-adjusted prevalence and risk ratios (ARR). RESULTS: In our study, 9.0% of the children and 7.2% of the adults had current asthma. Non-Hispanic black and Puerto Rican children were more likely to have current asthma (ARR 1.46, 1.66, respectively) and to visit the ED/UCC (ARR 1.61, 1.67, respectively) than non-Hispanic whites. American Indian/Alaskan Native children were more likely to have current asthma (ARR 1.76) than non-Hispanic whites. Mexican/Mexican American children and adults had lower prevalence of current asthma but higher ED/UCC use (adults only) than non-Hispanic whites. Among adults, Puerto Ricans and American Indian/Alaskan Natives were more likely to have current asthma (ARR 1.60, 1.39, respectively) than non-Hispanic whites, and all the studied racial/ethnic groups except Asians were more likely to have visited the ED/UCC than non-Hispanic whites. Adults and children who received emergency care for asthma in the past 12 months more frequently received multiple components of asthma management and control (e.g., taking long-term medication, having an asthma management plan) compared to those without emergency care. CONCLUSIONS: Racial/ethnic differences in current asthma prevalence, asthma attacks, and increased utilization of emergency room visits for asthma among minorities persist among children and adults. Appropriate and effective asthma management and education may lead to better asthma control and reduce emergency care utilization.