Pilot of alternate data collection and distribution strategies for the National Toxic Substance Incidents Program to attain national coverage

Project Name: Pilot of alternate data collection and distribution strategies for the National Toxic Substance Incidents Program to attain national coverage

Project Status: Proposed

Point of Contact: Maureen Orr

Center: NCEH/ATSDR

Keywords: Electronic Reporting, Algorithms, Prevention Strategies, Strategic Surveillance

Project Description: In 1989, after the Bhopal, India tragedy where thousands of people were killed in an industrial accident involving methyl isocyanate, the Agency for Toxic Substances and Disease Registry (ATSDR) completed a study of existing U.S. chemical incident and public health impact data. The agency wanted to be able to measure the distribution and impact of chemical incidents in the U.S. so that similar tragedies could be averted here. However, there is no single complete source of this data. Since 1991, ATSDR has able to collect this data and conduct outreach and preparedness activities through cooperative agreements with state health departments or by providing state assignees to the state health departments to actively collect the data. This program, currently called the National Toxic Substance Incidents program, is a 3 part program to decrease the morbidity and mortality from acute chemical incidents.

Despite ATSDR’s best efforts, thousands of incidents and injuries occur annually. Over 20 years after Bhopal there are still catastrophic incidents occurring. For example, on April 17, 2013, in West, Texas a fertilizer plant explosion involving ammonium nitrate killed 15 people and injured hundreds more. A nursing home, apartment complex, schools and scores of private homes near the plant were destroyed. Congressional testimony following the incident revealed that 1) regulations on the safe storage of ammonium nitrate fertilizer are inadequate and 2) emergency preparedness was lacking.

Impact: On August 1, 2013 the President issued Executive Order -- Improving Chemical Facility Safety and Security. Part of the executive order that is particularly relevant to this proposal is Section. 5. Enhanced Information Collection and Sharing. On August 24, 2013, a Dallas Morning News investigative study finds U.S. chemical safety databases are wrong about 90 percent of time. They conclude the best data are in the National Toxic Substance Incidents Program but it needs to be expanded. Chemical incident and public health impact data are vital to other federal agencies, researchers, planners and policy makers who are trying to prevent chemical exposures and for situational awareness and preparedness..

Methodology: To collect reliable data on a larger number of incidents and injuries updated methods need to be explored. As budgets have declined and state health departments have many other competing priorities, the number of participating NTSIP states has dwindled from a high of 16 to a current low of 5. Several ideas that need to be vetted are 1) running additional algorithms on existing federal databases in the Department of Transportation’s HazMat Intelligence Portal (HIP) to establish better estimates of incidents and injuries, including the exploration of other electronic databases or refinement of the current case definition to a more narrow one that would allow for more concise data collection, 2) In 2012, 25 counties out of 2, 327 accounted for approximately (25%) of the estimated NTSIP national incidents. This points to the need to strategize the most efficient places to have surveillance personnel in place to actively collect data, including in local, state, regional or national offices for representativeness, 3) strategizing the best way to share data and lessons learned to get the most national impact from the data.

Scalability: Depending on funding and data availability this may be scaled by restricting either the case definition or by using all passive methods or employing active methods as well.

Measure of success

1. A reliable scalable model that can start to be implemented immediately.
2. Data from the improved surveillance will increase
   1. the number and types of publications using the data,
   2. references in legislation and impacts of legislation in reduction in incidents and injuries, and
   3. citations in training and guidance materials by other federal agencies
   4. ultimately improvements in preparedness and reductions in incidents and injuries.

For more information about this project, please contact the CHIIC at chiic@cdc.gov or Brian Lee at brian.lee@cdc.hhs.gov.