responding to a lead poisoning outbreak during construction and renovation at an indoor firing range...

Responding to a lead poisoning outbreak during construction and renovation at an

indoor firing range

Ryan Kellogg and Steve WhittakerLocal Hazardous Waste Management Program

Public Health – Seattle & King County

Outline

• Lead in firing ranges• The Incident• Lead’s health effects• Blood lead levels in perspective• Vulnerable populations• Public Health challenges• Looking forward

Source: www.buzzle.com/articles/lead-the-element.html

Lead in bullets

• Projectile:– Elemental lead

• Primer:– Lead styphnate – Lead peroxide– Lead nitrite

Source: http://science.howstuffworks.com/revolver2.htm

Lead on the range

Source: http://www.njnoordhoek.com/?p=735Source: http://snovalleystar.com/2013/03/06/police-gun-range-is-under-fire-for-age-and-residue

Combustion Abrasion Impact

Typical range

Initial reports

• WA Lead Registry gets two elevated BLL reports from gun range employees

• Employee interviews:– Demolition and

construction project– “Tons of sand with

lead” moved and sifted– Fiberglass insulation

removed

Used with permission, confidential informant

Registry refers to WA OSHA

• History of lead violations • Multiple contractors on-site• More help needed • WA OSHA opens inspections on 11/13/12• Air & wipe sampling → high lead levels on

surfaces and in breathing zones, lead passing through exhaust ducts

• Inadequate ventilation!

Blood Lead Levels (BLLs)

BLL (µg/dL) Gun Range Employees

Construction Workers

<10 6 4810 to 24 7 1225 to 39 9 540 to 49 2 450 to 59 2 2

60 to 159 0 3Unknown 16 43

Total 42 117

>5Spontaneous abortionDevelopmental delay Hypertension/kidney dysfxn

>10 Reduced birth weightNeurocognitive deficits

>20

HeadacheFatigue, Sleep disturbanceAnorexiaConstipationArthralgia, MyalgiaDecreased libido

>40Sperm abnormalitiesNephropathyPeripheral neuropathyAnemia, Colic, Gout

Public Health’s involvement

• WA OSHA makes a referral to PHSKC - concerned about lead exposures to the public

• Can PHSKC close the range until construction is completed?

Source: http://adweek.blogs.com/Adfreak/page/339/Source: www.reedsindoorrange.com

Source: http://lowcountrybikers.com/cristin-katie-visit-the-gun-range

Ladies Night!

Cluster and environmental evaluation

• Interviewed 100+ workers• Surface sampling (public areas) – 1,000s ug/ft2

• Contamination of multiple surfaces• High air lead levels – 100s ug/m3

• Contamination in vehicles, homes, hotel rooms• Elevated BLLs in a contractor’s children and

spouse

Public Health challenges

• Health Officers in WA (and most other states) have broad statutory authority to protect public health

• Lack of regulatory procedure or precedent to guide action, and compel:– cooperation of business owner – temporary closure to protect the public– collection of data to assess public exposure risk– sharing of industrial hygiene data collected by owner’s

consultants

Public Health challenges

• No regulatory limits to protect public from lead in air• Requires close consultation/concurrence with Federal

and State agencies• High political valance on federal lead regulation• Worker exposure limits based in 70’s science• No internal PH capacity to collect personal breathing

zone samples• Local permit requirements (where they exist) do not

stipulate lead exposure controls• Gun ranges are hazardous!

Looking forward

• Specify surface- and air- lead levels that ensure BLLs <5 mg/dl:– Integrated Exposure Uptake Biokinetic Model

(IEUBK) modeling to predict BLLs from inhalation and hand-to-mouth exposures

– Consider vulnerable population receptors (women of childbearing age / pregnant women / children)

• Increase awareness of lead hazards in the shooting public

Looking forward

• Promote “best practices” – shooter behavior:– No smoking, eating, or other hand-to-mouth

activities– Wash skin after shooting– Wear long sleeves and pants– Clean footwear when leaving the range– Wash range clothing separately

Looking forward

• Promote “best practices”– range operations:– Jacketed or lead-free ammunition– Lead-free primers in bullets– Replace sand berms with solid bullet traps (with

proper disposal of sand!)– Adequate ventilation, tested regularly– Clean range surfaces daily - with confirmation

sampling– Routine blood lead testing of employees,

regardless of air lead levels. Medical removal at 10 ug/dL

Public Health actions

• Educate range operators and shooters who consider lead exposure as “normal”

• Explore state and local options to address policy and procedural gaps– Incorporate health standards in existing permits (i.e., business licenses)

– State regulations to authorize local Health permits of businesses that cause potentially harmful conditions for customers

– Ground state and local policies in current evidence base on lead exposure risks

• Assure stable funding for lead registries

Acknowledgements• PHSKC:

– Stella Chao– Jeff Duchin– Carina Elsenboss– Hilary Karasz– Mike Kinzer– Ngozi Oleru– Will Perry– Sharon Schoenfeld-Cohen– Olivia Stapleman– Nicole Thomsen– Dennis Worsham

• Lead Registry:– Todd Schoonover

• DOH:– Rad Cunningham– Glen Patrick

• WA OSHA:– Gina Colby– Venetia Runnion– John Stebbins

• Ecology:– Trudy Harding– Dave Misko

• ATSDR:– Mary Jean Brown– Karen Larson

Adult blood lead levels in perspective

60

50

40

10

5

1.4

BLL (mg/dL)

OSHA’s medical removal

OSHA’s return to work

ABLES case definition for adults / CA medical management trigger

CA pregnancy guideline

Adult U.S. geometric mean

Temporary ventilation

Gun Range Incident Timeline

2012 Oct Nov Dec Jan Feb Mar 2013

Construction complete?

Construction starts

Apr

Sept-Oct 2012Ecology consulted on berm disposal

Oct-Nov 2012Poor ventilation

while open to publicRange EE BLLs:

48 and 40 µg/dl

Dec-Jan 2013PHSKC wipe samples

– public area –1000s ppmLead registry makes

referral to DOSHWipe sampling:100,000s ppm13 Range EE BLLs:15 to 58 ug/dl

10/12/12DOSH opens inspection

DOSH: Lead in air exhausts, on

surfaces, ↑PBZs

12 contractor & subcontractor BLLs:

16 - 153 ug/dl

11/30/12DOSH contacts PHSKC

PHSKC requests closure, then data before reopening

(denied)

Feb-Apr 2013Lawsuits!

03/06/13PHSKC demobilizes

Range EEs move sand berm, “mine”

for lead

Pressure washing / disposal on veg.

Range EEs remove fiberglass insulation

DOSH no longer requires PPE for

Range EEsMedia coverageFinal ventilation system installed

Construction contractors hired

Contamination of vehicles, tools,

homes, hotel rooms, family members

PHSKC initiates surge response

ATSDR ConsultedRange hires IH consultantPHSKC requires

signageTwo shooting bays

closed – poor ventilation

Men’s restroom closed. High lead on

floor

Lead abatement contractor hired – surfaces cleanedImprovements to

ventilationLadies Night

Exposure Assess.