WWII Most costly ever in terms of lives lost and material destruction.
· • Mt. Vesuvius (Italy): 10,000- 25,000 lives lost • Mt. Pelee (Martinique): ~28,000 lives...
43
www.pehsu.net/nationalclassroom.html Webinars Series of scientific webinars that provide a forum for discourse on scientific issues. Live and On-Demand Case Conferences Journal Clubs Grand Rounds CE Available Online Courses Interactive and Self-Paced Evidence-based online courses on a variety of children's environmental health topics. CE Available Resource Catalog Fact sheets, journal publications, reports, and other resources for parents, community members, patients and healthcare professionals Topics included: Air Quality, Pesticides, Natural Disasters, BPA, Mold, Lead, Mercury
Transcript of · • Mt. Vesuvius (Italy): 10,000- 25,000 lives lost • Mt. Pelee (Martinique): ~28,000 lives...
www.pehsu.net/nationalclassroom.html
Webinars
Series of scientific webinars that provide a forum for discourse on scientific
issues.
Live and On-Demand
Case Conferences Journal ClubsGrand Rounds
CE Available
Online Courses
Interactive and Self-Paced
Evidence-based online courses on a variety of
children's environmental health topics.
CE Available
Resource Catalog
Fact sheets, journal publications, reports, and
other resources for parents, community members,
patients and healthcare professionals
Topics included: Air Quality, Pesticides, Natural
Disasters, BPA, Mold, Lead, Mercury
Health Impacts of Volcanic Emergencies
Presenters
Ziad Kazzi, MDAssociate Professor, Emergency Medicine and Medical ToxicologyEmory UniversityPEHSU Region 4
John Balmes, MDCore Consultant in Occupational and Environmental MedicineProfessor of Medicine, University of California San FranciscoProfessor of Environmental Health Sciences, School of Public HealthUniversity of California, BerkeleyPEHSU Region 9
PEHSU Region 9
Panelists
Robert J. Geller, MDProfessor of Pediatrics Emory UniversityMedical Director GA Poison CenterPEHSU Region 4
Fuyuen Y. Yip, PhD, MPHSection Chief (acting), Environmental Health Tracking SectionLead Poisoning Prevention and Environmental Health Tracking BranchNational Center for Environmental Health | Centers for Disease Control and Prevention
Kanta Sircar, MPH, PhD, PMPCDR, US Public Health ServiceEpidemiologist, Asthma and Community HealthDivision of Environmental Health Science and PracticeNational Center for Environmental Health | Centers for Disease Control and Prevention
Disclaimer & Acknowledgement
This material was supported by the American College of Medical Toxicology (ACMT) and funded (in part) by the cooperative agreement FAIN: U61TS000238-04 from the Agency for Toxic Substances and Disease Registry (ATSDR).
Acknowledgement: The U.S. Environmental Protection Agency (EPA) supports the PEHSU by providing partial funding to ATSDR under Inter-Agency Agreement number DW-75-95877701-4. Neither EPA nor ATSDR endorse the purchase of any commercial products or services mentioned in PEHSU publications
Objectives
After attending this webinar, participants will be able to:• List health hazards of volcanic emergencies• Discuss toxicological hazards of volcanic
emergencies• Discuss personal protective measures• Discuss patient assessment and
management of related toxicological health complaints
Volcanoes
Historically, 600 active volcanoes worldwide and 50 eruptions per year
~500 Million people live in areas of volcanic activity
Volcanic eruptions can have potentially devastating consequences in both human and economic losses
Presenter
Presentation Notes
Source: Baxter Volcanoes can be erupt explosively like the ones in the ring of fire and release a large amount of ash. Others release more lava and copious gas with less ash. Other volcanos are mixed and can have both explosive potential and effusion of lava and gas.
Decade Volcanoes – USGS - 1998
Ring of Fire
Presenter
Presentation Notes
Decade volcanoes are volcanoes designated by the International Association of Volcanology and Chemistry of the Earth's Interior (IAVCEI) for study due to their high geological activity and proximity to large population centers. The goals of this program are to increase awareness of the dangers of volcanic eruptions and to reduce the severity of natural disasters. http://vulcan.wr.usgs.gov/Imgs/Gif/DecadeVolcanoes/Maps/map_decade_volcanoes.gif Mount Vesuvis in Italy threatens 800 thousand people living in its proximity
Health Hazards from Volcanic Eruptions
Pyroclastic Flows Lahars Blast injuries from lava bombs Laze Tephra fallout Toxic gases Toxic compounds Earthquakes, tsunamis, and lightning
Pyroclastic Flows
Occur during explosive eruptions Hot gases and rock debris are thrown from the
volcano• Flows move between 50-150 km/h, hugging the
ground• Initial temperatures estimated to be between 600-
900 C, but usually cool rapidly
Flows represent a massive amount of momentum• Can flatten trees and buildings
Pyroclastic Flows
Flows can extend many kilometers away from the volcano• Even at the periphery, temperatures may be hot
enough to cause severe burns
Mt. St. Helen’s eruption in May 18, 1980• Trees were flattened up to 27 km from the crater• Three loggers suffered 2nd and 3rd degree burns
affecting 33% to 47% surface area, 19 km away the crater
Presenter
Presentation Notes
Pic is from Mt. Pinatubo
Pyroclastic Flows
Historically destructive:• Mt. Vesuvius (Italy): 10,000- 25,000 lives lost• Mt. Pelee (Martinique): ~28,000 lives lost
Evacuation is the key measure to reduce mortality in a pyroclastic event
Some benefit may be gained by remaining indoors
Lahars
Lahars are similar to mudflows• High temperatures can melt glaciers and snow• Any large water source can become a lahar
Consist of moving water and volcanic debris• Can be watery, or as dense as wet concrete• Deposited material can alter the course and
level of nearby rivers and lakes, leading to flooding
Volcanic debris can be mobile for years afterward
November 13, 1985 – Armero Nevado del Ruiz erupted causing massive
lahars 48 km downstream in the town of Armero, Colombia
20,000 of the 29,000 inhabitants died in the flooding
Worst natural disaster in Colombian history• Deadliest known lahar
Lahars
Lahars
Armero Town - Source Wikipedia
Presenter
Presentation Notes
Armero was located in the center of this photograph, taken late November 1985.
November 13, 1985
Presenter
Presentation Notes
The lahars, formed of water, ice, pumice, and other rocks,[35] mixed with clay as they travelled down the volcano's flanks.[36] They ran down the volcano's sides at an average speed of 60 km per hour, eroding soil, dislodging rock, and destroying vegetation. After descending thousands of meters down the side of the volcano, the lahars were directed into all of the six river valleys leading from the volcano. While in the river valleys, the lahars grew to almost 4 times their original volume. In the Gualí River, a lahar reached a maximum width of 50 meters (200 ft).[35] One of the lahars virtually erased the town of Armero in Tolima, which lay in the Lagunilla River valley. Only one quarter of its 28,700 inhabitants survived
Laze
Laze plumes forming from Pāhoehoe lava flowing into the Pacific Ocean, HawaiiBy I, Brocken Inaglory, CC BY-SA 3.0,
https://commons.wikimedia.org/w/index.php?curid=2426614
Presenter
Presentation Notes
Laze (a portmanteau of lava and haze) refers to acid rains and air pollution arising from steam explosions and large plume clouds containing extremely acidic condensate (mainly hydrochloric acid) that occur when molten lava flows enter cold oceans
Tephra
Presenter
Presentation Notes
Tephra is a general term describing ejected material from volcanoes Tephra fragments are classified by size: Ash – particles smaller than 2 mm (0.08 inches) in diameter Lapilli or volcanic cinders – between 2 and 64 mm (0.08 and 2.5 inches) in diameter Volcanic bombs or volcanic blocks – larger than 64 mm (2.5 inches) in diameter Ash is a common form of tephra. Represents fragments smaller than 2mm in diameter Gases and other volatile compounds are absorbed into ash Transported compounds are often washed into watercourses or onto crops
Blast Injuries
Explosive eruptions can produce concussive forces and launch large projectiles significant distances.• Projectiles may damage,
windows, roofs and people
Small explosive eruptions often occur without warning • Represent a danger to
volcano tourists and vulcanologists
Fusiform lava bomb. Capelinhos Vulcano, Faial Island, Azores. Source: Wikicommons
Blast Injuries
Mt. Etna, Sicily - 1979 Produced 1 m wide
projectiles that traveled up to 300 meters from the southeast crater
0.5 meter projectiles were thrown up to 500 meters
One small explosive eruption killed 9 tourists inside the crater
Lava bomb and crater, Papua New Guinea Source: Wikicommons
Tephra Fallout: Respiratory
Mount St Helens eruptions, May 18 to June 12, 1980. An overview of the acute health
impact. Baxter PJ et al. JAMA. (1981)
Presenter
Presentation Notes
ED Visits Surveillance - Mount St Helen 1980
Particle Size Influences Bioavailability
Tephra Fallout: Respiratory
Particles smaller than 10 microns in diameter considered respirable
Acute respiratory symptoms commonly reported by people during and after ash falls• Nasal Irritation and discharge• Throat irritation• Exacerbation of pre-existing respiratory conditions• Airway irritation of people with asthma or bronchitis
Short term effects of ash are generally not considered harmful for people without pre-existing respiratory illness
Tephra Fallout: Respiratory
Prevention• Avoid unnecessary exposure • Stay indoors• Keep all outside doors and windows closed• Set HVAC systems to minimize outdoor air intake• Use HVAC filters optimized for trapping small
particles (eg MIRV 11 or higher)
Tephra Fallout: Respiratory
Prevention-adults• Adults should wear an
appropriate dust mask when outdoors• N95 mask • Size appropriate for face• Eye protection also?
• People with lung diseases should remain inside
www.ivhhn.org
Source GNS Science
Tephra Fallout: Respiratory
Prevention-children• N95 masks sized for
children <3yr not available
• Child N95 masks may not be readily available
• Adult sizes too large for most children
Children without masks may be best served by staying indoors www.amazon.com
Tephra Fallout: Respiratory
Silica Inhalation• Some volcanoes disperse large amounts of free
crystalline silica in respirable sizes• No documented cases of silicosis from volcanic ash
Long term effects of ash inhalation are unknown• Chronic exposure to ash may result in adverse
health effects
Tephra Fallout: Ocular
Volcanic ash is abrasive and can irritate the eyes• Particularly people wearing contact lenses
Acute conjunctivitis and corneal abrasions are among the more common serious ocular complaints
No chronic effects have been noted
Tephra Fallout: Roof Collapse
The weight of volcanic ash on roofs can lead to the collapse of weaker buildings and directly injure inhabitants.
Damage to Clark Air Force Base airplane hangers collapsed under the weight of wet volcanic ash from the eruption of Mount Pinatubo in 1991. Source: Public domain
Presenter
Presentation Notes
Mount Pinatubo Eruption 1991: Although major loss of life from pyroclastic flows was avoided by a successful and timely evacuation of about 60,000 people living within 30 km of the volcano, as of July 17, 1991, the official numbers of casualties were 320 dead and 279 injured, and most of these casualties were believed to have been due to the collapse of roofs under the weight of wet ash on June 15
Tephra Fallout: Water
Hydrogen Chloride Hydrogen Fluoride
Acidic rain Acidic water in rivers Potential hazard: High
fluoride content in drinking water
Hekla Eruption Iceland 1980High F content in Water from 1970
Source wikicommons
Presenter
Presentation Notes
In Iceland 1970 Fluoride content in some of the rivers was 9 ppm > 4 ppm EPA MCL
Volcanic Gases and Toxicological Hazards
Sulfur Dioxide Hydrogen Sulfide
Volcanic Smog (vog) produced from SO2 gasSource USGIS
Presenter
Presentation Notes
Sulfur dioxide is a colorless gas with a pungent odor that irritates skin and the tissues and mucous membranes of the eyes, nose, and throat. SO2 emissions can cause acid rain and air pollution downwind of a volcano—at Kīlauea volcano in Hawaii, high concentrations of sulfur dioxide produce volcanic smog (VOG) causing persistent health problems for downwind populations. During very large eruptions, SO2 can be injected to altitudes of greater than 10km into the stratosphere. Here, SO2is converted to sulfate aerosols which reflect sunlight and therefore have a cooling effect on the Earth's climate. They also have a role in ozone depletion, as many of the reactions that destroy ozone occur on the surface of such aerosols.
Volcanic Gases and Toxicological Hazards
Sulfur Dioxide Degassing of volcanoes Denser than air Colorless gas with a
characteristic and irritating smell
Irritant gas Health effects are
secondary to respiratory and mucus membrane irritation
By N T Stobbs, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=4094275
Nelson's Column during the Great Smog of 1952
Gong H, et al. Chest. 2001;119:402-8.
Gong H, et al. Chest. 2001;119:402-8.
Volcanic Gases and Toxicological Hazards
Hydrogen Sulfide Hazardous near vents in volcanoes Dense, Irritant, Toxic
• Smells like “Rotten Eggs” at low concentrations• Poor warning properties
Cellular asphyxiant
Presenter
Presentation Notes
An H2S concentration of 150 ppm was found close to a fumarole despite a strong wind. This gas causes rapid loss of consciousness and death at 500-1000 ppm, a concentration that cannot be detected by smell, and fatal levels could arise if the plume is not dispersed (as in the storm) or if emissions increase. Two geologists have lost consciousness in the crater area on Vulcano. H2S poisoning is a well-known hazard in volcanic and geothermal areas; deaths have occurred in still weather on Kusatsu-Shirane volcano, Japan
Volcanic Gases and Toxicological Hazards
Hydrogen Sulfide With high-level exposure, neurological sequelae
have the greatest impact Acute respiratory effects can also occur Chronic low-level exposure may actually be
protective re: asthma risk
Environ Res 2013;122:81-7
Volcanic Gases and Toxicological Hazards
Carbon Dioxide• Dense, Toxic, Asphyxiant
Carbon Monoxide Helium, Radon
Lake Nyos Disaster Public Domain
Presenter
Presentation Notes
On 20 February 1979 149 people died of gas poisoning in Pekisaran village on the plateau near the Sinila crater
CDC Experience and Resources
Summary Points
Volcanic eruptions produce various complex hazards some of which are not familiar to the public or responders/emergency managers/public health professionals/health care providers
Toxicological effects are primarily from the irritant effect of chemicals
Public and clinician education are of important to mitigate the health impacts
Main Source
Volcanoes (Chapter 9) by Peter J. Baxter. The Public Health Consequences of Disasters by Noji, Eric K. Published by Oxford University Press, USA 1st (first) edition (1997) Hardcover
• Nicholas Byron Pitts, MD• Carl Baum, MD• Mark Miller, MD• Edwin M Kilbourne, MD
Resources
The Centers fo Disease Control and Prevention https://www.cdc.gov/disasters/volcanoes/index.html
The Environmental Protection Agency https://www.epa.gov/natural-disasters/volcanoes
Hawaii Department of Public Health http://health.hawaii.gov
The International Volcanic Health Hazard Network www.ivhhn.org
GNS Science https://www.gns.cri.nz
www.pehsu.net/nationalclassroom.html
Webinars
Series of scientific webinars that provide a forum for discourse on scientific
issues.
Live and On-Demand
Case Conferences Journal ClubsGrand Rounds
CE Available
Online Courses
Interactive and Self-Paced
Evidence-based online courses on a variety of
children's environmental health topics.
CE Available
Resource Catalog
Fact sheets, journal publications, reports, and
other resources for parents, community members,
patients and healthcare professionals
Topics included: Air Quality, Pesticides, Natural
Disasters, BPA, Mold, Lead, Mercury
