Gulf Oil Spill 2010: Deep Water Horizon Oil Spill Human Health Interim Clinical Guidance
What Health Care Providers Should Know about Potential Health Hazards from the Deepwater Horizon Oil Spill
- The Gulf Coast Oil Spill has the potential to affect human health. Signs and symptoms are possible depending on the substance exposed to, the exposure dose, and route of exposure. Although a variety of hydrocarbon products produced from petroleum have specific toxic effects, the toxicity of crude light petroleum itself to humans is relatively low. (Stellman 2007) This may be due, in part, to the lower concentrations of individual fractions in crude oil as compared to the higher concentrations expected in refined products.
- Crude oil is a mixture of more than 1000 compounds (mostly hydrocarbons). The hydrocarbons in crude oil are mostly alkanes, cycloalkanes and various aromatic hydrocarbons while the other organic compounds contain nitrogen, oxygen and sulfur, and trace amounts of metals such as iron, nickel, copper and vanadium. The exact molecular composition varies widely. The specific type of oil spilled in the Gulf Coast is known as a light, crude oil which has low viscosity and is composed mostly of light hydrocarbon fractions which are volatile and may increase the risk for aspiration into the lungs if ingested.
- However, these light hydrocarbon fractions, such as benzene, xylene, toluene, and ethyl benzene generally evaporate into the air in the first 24-48 hours of a spill into the open ocean water (usually before reaching the shore). The medium and heavy parts (consistency much like motor oil) are what cleanup operations on the land and near shore areas focused on. This is also called “weathered” crude oil or “mousse.” Other potential exposures related to the clean up response may include airborne particulates from “oil burns” and/or contact with chemical dispersants used to help with bioremediation (cleanup).
- Because of the weathering process, inhalation hazards from the lighter, toxic volatile components of crude oil, such as benzene, are greatly reduced. The “weathered” crude substance, remaining after evaporation and biological degradation, is still of concern as a potential dermatitis hazard. Potential remaining higher molecular weight fractions may cause irritation by dissolving the natural protective oils on the surface of the skin. In addition, known polycyclic aromatic hydrocarbon skin carcinogens may remain in the “oil soup” or “mousse oil” after the weathering process. However, the risk of “weathered” crude as a skin cancer-causing agent is not known due to variability of compounds in the “weathered” oil mixture.
- Limited studies from previous oil spill disasters showed that common reported acute symptoms were due to irritant effects on mucus membranes, upper airway, and the skin. (NIOSH 1991). This is consistent with what is being reported for this spill as described under “Health Surveillance” later in this document.
- Symptoms related to mental or behavioral health such as anxiety, stress and depression have been frequently seen in previous oil spill disasters (Aguilera 2010). Thus, these conditions should be considered during the evaluation of patients throughout this oil spill. Please see the resource section for more information.
What the Provider Should Consider When Delivering Patient Care:
- Patients with respiratory, dermal, or other signs and symptoms should be treated and managed according to standard clinical protocols guided by the presentation of the patient.
- Clinical evaluation should include taking an exposure history (http://www.atsdr.cdc.gov/csem/exphistory/ehcover_page.html) and consideration of environmental etiologies in the differential diagnosis.
- The chemical makeup of “weathered” crude oil does not require laboratory testing for specific chemicals to guide the delivery of routine clinical care, therefore it is not recommended at this time. http://www.cdc.gov/niosh/hhe/reports/pdfs/1989-0200-2111.pdf
- Counsel/Advise patients to
- Limit exposures to potential air contamination, especially those with chronic respiratory conditions (e.g., asthma or COPD) by
- Staying indoors in an air-conditioned room
- Setting the air conditioner to the “recirculation” mode, if possible
- Return for additional medical evaluation if symptoms such as shortness of breath, nausea or other medical issues persist
- Avoid contact with water or sediments that may potentially be contaminated. If exposure has occurred, immediately wash with soap and water (do not use gasoline, solvents, or industrial cleaners). Baby oil or tanning lotion may be used to remove oily, tar-like residues.
- Advise patients to avoid direct exposure to oil or sludge as much as possible, especially pediatric patients, their parents and pregnant women. Children should be restricted from playing in or around contaminated areas, and they should not be involved in cleanup efforts.
- Report health effects potentially related to the oil spill to your local or regional Poison Control Center. For more information regarding your local or regional Poison Center call 1-800-222-1222 or online at: http://www.aapcc.org/dnn/About/FindLocalPoisonCenters/tabid/130/Default.aspx
- Patients may experience stress and related behavioral symptoms during and after environmental disasters, both natural and human-caused. Patients are at risk of physical and emotional responses to stress from what mental health professionals refer to as a traumatic incident. These stress responses are normal reactions to traumatic events. The term traumatic is used because of an unexpected and troubling change in the natural order of things, such as the untimely death or injury of oil-covered wildlife and longer-term impacts on the environment and affected communities such as fishing and tourism.
- It is important that patients continue to monitor their health and well-being during the disaster and even months after the response has ended. Any patient who is having difficulty functioning or who appears to be unduly depressed or distressed should be encouraged to see a mental health professional for evaluation.
- Recommendations to help manage stress during and after a disaster can be found on the Substance Abuse and Mental Health Services Administration’s (SAMSHA) website at http://samhsa.gov/Disaster/, on the CDC website at http://emergency.cdc.gov/masscasualties/copingpro.asp and http://emergency.cdc.gov/mentalhealth/, and on the NIOSH website at http://www.cdc.gov/niosh/topics/oilspillresponse/traumatic.html.
What Physicians Should Know about Current Environmental and Health Surveillance Findings
Health Effects Surveillance:
- CDC surveillance efforts have detected some complaints of throat irritation, eye irritation, nausea, headache and cough: these nonspecific symptoms could be attributable to a number of conditions.
- For CDC Surveillance Updates, go to http://emergency.cdc.gov/gulfoilspill2010/2010gulfoilspill/health_surveillance.asp
Environmental testing :
- EPA environmental testing efforts continue with updates available at www.epa.gov/bpspill/
- Coastal Air:
- EPA has observed low levels of odor-causing pollutants associated with oil along the shore in the Gulf region. The volatile organic compounds probably creating the odors may include low levels of benzene, toluene, ethylbenzene, xylene and naphthalene. Most exposures to these chemicals occur by inhalation; their odor generally provides adequate warning of acutely hazardous concentrations. The odors reported in some communities along the affected coast are similar to common odors of a gas station.
- These gas station-like odors can persist for days and can vary according to the wind or weather conditions. Some of these chemicals may cause headache, eye, nose and throat irritation, or nausea.
- The chemicals producing odors from the spill may have the potential to exacerbate or aggravate respiratory conditions such as asthma and COPD.
- EPA is also conducting additional air monitoring for ozone and airborne particulate matter. The air monitoring conducted through June 21 has found levels of ozone and particulates ranging from "good" to "unhealthy for sensitive groups" levels on EPA's Air Quality Index. http://airnow.gov/
- Coastal Water:
- Water samples collected along the Gulf coast in June 2010 found chrysene (an oil-related compound) exceeding chronic health-based drinking water guidance values. This level of chrysene may cause risk to aquatic life, but does not represent a human health hazard from dermal absorption that may occur from swimming in affected waters.
- Drinking Water:
- The oil spill is not expected to affect drinking water or domestic wells. The closest drinking water intake in use in Southeastern Louisiana on the Mississippi River is 49 miles upstream from the mouth of the river. The oil is not expect to migrate that far upstream at this time.
- Coastal Sediment:
- Sediment samples collected June 13, 2010 along the Gulf coast did not reveal elevated levels for chemicals that are usually found in oil.
EPA continues to collect air, water and sediment samples for oil-spill related chemical analysis.
For EPA updates including real-time air monitoring, visit www.epa.gov/bpspill/
What Health Care Providers Should Know About the Federal Efforts to Support Health and Medical Needs for Residents and Responders Impacted by the BP Deepwater Horizon Oil Spill
- CDC in coordination with state and local health departments is conducting surveillance across the 5 Gulf States for health effects related to the oil spill using established national surveillance systems, including the National Poison Data System (NPDS) and BioSense to track related health effects.
- At the request of CDC, local and regional Poison Control Centers including those in Alabama, Florida, Louisiana and Mississippi are specifically tracking health effects related to the oil spill. This information is then used at the local, state and federal level for public health surveillance. Therefore, it is important to call the poison control center with any suspected exposure resulting in adverse health effects. Updated surveillance reports are available on the CDC's website at http://emergency.cdc.gov/gulfoilspill2010/2010gulfoilspill/health_surveillance.asp
- The Department of Health and Human Services (HHS) has activated the National Disaster Medical System as a precaution should Gulf States need additional medical support as a result of the oil spill. They will be assisting with triage services for responders and community members who are concerned about health effects of the oil spill.
- The Environmental Protection Agency (EPA) is monitoring air, water, sediment and waste such as oily debris, tar balls, weathered oil or “mousse oil” along the Gulf Coast and providing recommendations for the public to take based upon the results of environmental monitoring. EPA is sampling for vapors that may evaporate from the water/oil mixture in the Gulf, as well as for particulate matter that may be present in the smoke from controlled burns when those occur. Information on EPA's environmental monitoring program and monitoring results are available on EPA's webpage at http://www.epa.gov/bpspill/.
- The Food and Drug Administration (FDA) is working with the National Oceanic and Atmospheric Administration (NOAA) National Marine Fisheries Service, the Environmental Protection Agency (EPA), other Federal agencies, and several state authorities in the regions affected by the recent oil spill. FDA continues to closely monitor this developing situation and its potential impact on the safety of seafood harvested from the area.
- Federal and state officials are monitoring the waters from which seafood is harvested and will act to close areas contaminated by the oil spill to fishing and shellfish harvesting. NOAA has the authority to close Federal waters to commercial fishing and states have the authority to close waters within their jurisdiction.
- NOAA has already closed a large area of the Gulf of Mexico to commercial fishing and some state mollusk and shellfish beds have been closed in anticipation of the oil nearing the shoreline. Closely monitoring and, if warranted, closing harvest waters which could be exposed to the oil spill should prevent unsafe seafood from reaching the market. If, despite these steps, adulterated seafood is found on the market, both the FDA and the states have the authority to seize such product and remove it from the food supply.
- FDA has implemented a surveillance sampling program of seafood products at Gulf Coast area primary processing plants. FDA is currently targeting oysters, crabs and shrimp, which could retain contaminants longer than finfish. This sampling will provide verification that seafood being harvested is safe to eat.
- Fish and shellfish harvested from areas unaffected by the closures are considered safe to eat.
- The Substance Abuse and Mental Health Services Administration (SAMHSA) is currently in contact with disaster behavioral health personnel in each of the impacted states offering technical assistance as they assess the mental and behavioral health needs of the area’s populations. SAMHSA response activities include conducting needs assessments, communicating with leadership, providing assistance and serving as a liaison with external constituents. SAMHSA is prepared to work with States and communities as they provide programs, services, and consultation to mitigate the behavioral health impact and restore the Gulf Coast.
- Workers and volunteers may experience stress and fatigue when they respond to environmental disasters, both natural and human-caused. Deepwater Horizon responders are at risk of feeling uncomfortable levels of stress from what mental health professionals refer to as a traumatic incident. The term traumatic is used because of an unexpected and troubling change in the natural order of things, such as the untimely death or injury of oil-covered wildlife and the impact on fishing communities and the environment. It is important that responders monitor their health and well-being during their response activity period, and even months after their response work has ended.
- Specific recommendations to help manage responder stress and fatigue during and after a response (in addition to tips for parents, teachers, and response workers) can be found on the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Website at http://samhsa.gov/Disaster/ and the NIOSH website at http://www.cdc.gov/niosh/topics/oilspillresponse/traumatic.html
- CDC's National Institute for Occupational Safety and Health (NIOSH) is monitoring the accidents, illnesses, and injuries experienced by workers involved in the cleanup effort. Oil spill response workers may be exposed to many different chemical, physical, and biological hazards depending on the type and stage of response, and the workers’ specific tasks. NIOSH is working to provide recommendations to workers about chemical exposures, physical hazards and biological hazards they may encounter. NIOSH is drawing on experience gained in 1989, when it conducted a health hazard evaluation during the cleanup of more than 10 million gallons of oil spilled in Prince William Sound, Alaska .
- NIOSH is working closely with other agencies such as NIH’s National Institute of Environmental Health Sciences (NIEHS), which has developed an awareness-level health and safety resource for personnel participating in an oil spill response and cleanup.
Oil Spill Surveillance and Public Health Recommendations
- CDC/ATSDR http://emergency.cdc.gov/gulfoilspill2010
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 24 Hours/Every Day in English and Spanish; e-mail email@example.com
- Joint Information Center (JIC) is a coordination center for federal, state and local responding agencies. 985-902-5231 or http://www.deepwaterhorizonresponse.com/go/site/2931/
- Environmental Protection Agency (EPA) surveillance and updated public health recommendations: http://www.epa.gov/bpspill/
- Deepwater Horizon Medical Support Line: 1-888-623-0287 (for public use if someone feels ill from oil spill exposure or has health-related oil spill questions).
- National Library of Medicine (NLM): http://sis.nlm.nih.gov/dimrc/oilspills.html
- Occupational Safety and Health Administration (OSHA)
- National Institute for Occupational Safety and Health (NIOSH)
- National Institute of Environmental Health Sciences (NIEHS)
- American Academy of Pediatrics (AAP) http://www.aap.org/disasters/oil-spill.cfm
- Pediatric Environmental Health Specialty Units (PEHSU) http://www.pehsu.net/facts.html
- Association of Occupational and Environmental Clinics (AOEC) http://www.aoec.org/
- American College of Occupational and Environmental Medicine (ACOEM) http://www.acoem.org/
- American College of Medical Toxicology (ACMT) http://www.acmt.net/
- American Academy of Clinical Toxicology (AACT) http://www.clintox.org
- Substance Abuse and Mental Health Services Administration (SAMHSA) http://www.samhsa.gov/Disaster
- National Institute for Occupational Safety and Health (NIOSH) Traumatic Incident Stress: Information for Deepwater Horizon Response Workers and Volunteers (http://www.cdc.gov/niosh/topics/oilspillresponse/traumatic.html)
Stellman, Steven and Guidotti, Tee “Polycyclic Aromatic Hydrocarbons and Petroleum Industry” In Environmental and occupational medicine. Rom, W. N., Markowitz, S. (2007). Philadelphia, PA: Lippincott Williams & Wilkins, pages 1240-1248.
NIOSH Health Hazard Evaluation Report on the Exxon/Valdez Alaska Oil Spill
NIOSH Report HETA 89-200 & 89-273-2111 (1991)
Aguilera F, Mendez J, Pasaro E, Laffon B. Review on the effects of exposure to spilled oils on human health. J Appl Toxicology 2010; 30: 291-301
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