Introduction

This section provides a resource listing for more information on

• Hazardous exposures from environmental and occupational sources,
• Potential adverse health effects, and
• The prevention, evaluation, treatment and management of exposed or potentially exposed patients.

It serves as an overview rather than an exhaustive list of publically available resources that may be of use to the primary health care provider in providing care to patients exposed or potentially exposed to hazardous substances from environmental and occupational sources.

Publically available clinical consultation and referral resources are available to assist primary health care providers in the detection, treatment, and prevention of disease(s) resulting from toxic exposure(s). Many federal agencies including

• The Agency for Toxic Substances and Disease Registry (ATSDR),
• The Centers for Disease Control and Prevention (CDC),
• The U.S. Environmental Protection Agency (EPA),
• The National Institute of Occupational Safety and Health (NIOSH), and
• The Occupational Safety and Health Administration (OSHA)

A variety of printed and online sources, including books, databases, journals, websites, and Information can also be obtained from sources such as U.S. Poison Control Centers, board certified specialists with expertise and experience in treating patients with exposures to toxic substances, government agencies, employers, health departments, manufacturers, and unions.

Agency for Toxic Substances and Disease Control (ATSDR)

Based in Atlanta, GA, ATSDR is a federal public health agency of the U.S. Department of Health and Human Services. It serves the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and diseases related to toxic substances.

• ATSDR http://www.atsdr.cdc.gov
  • For chemical, emergency situations
    • CDC Emergency Response: 770-488-7100 and request the ATSDR Duty Officer.
  • For chemical, non-emergency situations
    • CDC_INFO http://www.cdc.gov/cdc-info
    • 800-CDC-INFO (800-232-4636) TTY 888-232-6348 - 24 hours per day
    • E-mail: cdcinfo@cdc.gov

      Please note:

      ATSDR cannot respond to questions about individual medical cases, provide second medical opinions, or make specific recommendations regarding clinical treatment/therapy. Please see "Clinical Resources" for publically available clinical resource information.

  • ATSDR Toxicological Profiles. By Congressional mandate, ATSDR produces "toxicological profiles" for hazardous substances found at National Priorities List (NPL) sites. These hazardous substances are ranked based on frequency of occurrence at NPL sites, toxicity, and potential for human exposure. Toxicological profiles are developed from a priority list of 275 substances. ATSDR also prepares toxicological profiles for the Department of Defense (DOD) and the Department of Energy (DOE) on substances related to federal sites.

  • ATSDR Case Studies in Environmental Medicine (CSEM) are self-instructional, continuing-education primers designed to increase primary care providers' knowledge of hazardous substances and aid in the evaluation of patients potentially exposed to hazardous substances. Each CSEM comes with additional companion products such as Grand Rounds in Environmental Medicine and Patient Education and Care Instruction Sheets.

  • ATSDR ToxFAQs^TM are a series of summaries about hazardous substances developed by the ATSDR Division of Toxicology and Human Health Sciences. Information for this series is excerpted from the ATSDR Toxicological Profiles and Public Health Statements. Each fact sheet serves as a quick and easy to understand guide. Answers are provided to the most frequently asked questions (FAQs) about exposure to hazardous substances found around hazardous waste sites and the effects of exposure on human health.

Centers for Disease Control and Prevention (CDC)

CDC is the national public health institute of the United States. Its main goal is to protect public health and safety through the control and prevention of disease, injury, and disability. http://www.cdc.gov

• CDC works to protect public health and the safety of people by providing information to enhance health decisions, and promotes health through partnerships with state health departments and other organizations.
• The CDC focuses national attention on developing and applying disease prevention and control (especially infectious diseases), environmental health, occupational safety and health, health promotion, prevention and education activities designed to improve the health of the people of the United States.

The National Institute for Occupational Safety and Health (NIOSH)

NIOSH is the U.S. federal agency that conducts research and makes recommendations to prevent worker injury and illness. It is part of CDC and is not a regulatory agency.

• NIOSH produces new scientific knowledge and provides practical solutions vital to reducing risks of injury and death in traditional industries, such as agriculture, construction, and mining.
• NIOSH also supports research to predict, prevent, and address emerging problems that arise from dramatic changes in the 21st Century workplace and workforce.
• NIOSH partners with diverse stakeholders to study how worker injuries, illnesses, and deaths occur and can be prevented.

Occupational Safety and Health Administration (OSHA)

The OSHA is a federal agency of the U.S. Department of Labor. http://www.osha.gov Its mission is to "assure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance". Through the Occupational Safety and Health Act, OSHA issues workplace health and safety regulations.

These regulations include

• Limits on chemical exposure,
• Employee access to information,
• Requirements for the use of personal protective equipment, and
• Requirements for safety procedures.

U.S. Environmental Protection Agency (EPA)

The EPA is a federal agency created for the purpose of protecting human health and the environment by writing and enforcing regulations based on laws passed by Congress. http://www.epa.gov

• The agency conducts environmental assessment, research, and education.
• It has the responsibility of maintaining and enforcing national standards under a variety of environmental laws, in consultation with state, tribal, and local governments.
• It delegates some permitting, monitoring, and enforcement responsibility to U.S. states and the federal recognized tribes.

EPA works with industries and all levels of government in a wide variety of voluntary pollution prevention programs and energy conservation efforts.

Additional Sources of Information

NLM's Environmental Health and Toxicology website...a "one stop shop". http://hazmap.nlm.nih.gov/index.php

Collaborative on Health and the Environment (CHE). http://www.healthandenvironment.org/

Environmental Working Group. http://www.ewg.org/

Healthy Child, Healthy World. http://healthychild.org/

University of California-San Francisco's Program on Reproductive Health and the Environment's FASTEP Program: Toxic Matters. http://prhe.ucsf.edu/prhe/toxicmatters.html

Safety Data Sheets (SDS) (formally known as Material Safety Data Sheets (MSDS))

The objective of the Safety Data Sheets (SDS) (formally known as Material Safety Data Sheets (MSDS)) is to concisely educate workers about the hazards of materials they use so they can protect themselves and respond to emergency situations. The federally mandated OSHA Hazardous Communication Standard states that workers must have access to relevant SDSs and be educated on their contents and application in a format they can understand.

Some state and local "right-to-know laws" may be more comprehensive than the federal regulation.

The SDS (formally known as MSDS) is a component of the right-to-know law. Manufacturers and importers are required to provide an SDS for each hazardous chemical in a shipment. Users of the chemicals must keep copies of SDSs and make them available to workers, clinicians, and others.

SDSs contain information on the chemical properties of the substance, handling precautions, known health effects, and conditions that might worsen with exposure. The information on human health effects, however, can be vague and may have limited clinical value. The SDS may not provide information on the combined effects of multiple chemical exposures. Clinical decisions should not be based solely on information obtained from SDSs (sample MSDS; see Appendix II [PDF - 34 KB]). Search the Occupational Safety and Health Administration at https://www.osha.gov/Publications/OSHA3514.html for a more detailed description of the various required parts of the SDS (formally called MSDS).

To identify an SDS for a specific chemical, search "(name of chemical) Safety Data Sheet" using your Internet browser.

U.S. Poison Control Centers

The regional poison control centers can act as valuable resources in providing information about the toxicity and health effects of hazardous exposures involved in poisonings. The main emergency number across the country is 1-800-222-1222, although some states have other contact numbers, as well as a number for the hearing impaired. For more information, contact the American Association of Poison Control Centers at http://www.aapcc.org/.

Clinical Resources

Please refer to this alphabetized sample listing of publically available clinical resources for consultation on the prevention, treatment and management of patients exposed or potentially exposed to hazardous substances. This list does not imply endorsement by the Agency for Toxic Substances and Disease Registry or the U.S. Department of Health and Human Services.

• American Association of Poison Control Centers http://www.aapcc.org
  • Contact the American Association of Poison Control Centers for questions about poisons and poisonings.
  • The Web site provides information about poison centers and poison prevention. AAPC does not provide information about treatment or diagnosis of poisoning or research information for student papers.
  • American Association of Poison Control Centers (1-800-222-1222)
• American College of Medical Toxicology (ACMT) http://www.acmt.net
  • ACMT is a professional, nonprofit association of physicians with recognized expertise in medical toxicology.
  • The mission of the ACMT is to advance quality care of poisoned patients and public health through physicians who specialize in consultative, emergency, environmental, forensic, and occupational toxicology.
• American College of Occupational and Environmental Medicine (ACOEM) http://www.acoem.org
  • ACOEM is the nation's largest medical society dedicated to promoting the health of workers through preventive medicine, clinical care, research, and education.
  • Its members are a dynamic group of physicians encompassing specialists in a variety of medical practices united via the College to develop positions and policies on vital issues relevant to the practice of preventive medicine both within and outside the workplace.
• American College of Preventive Medicine (ACPM) http://www.acpm.org
  • ACPM is the national professional society for physicians committed to disease prevention and health promotion.
  • ACPM's 2,000 members are engaged in preventive medicine practice, teaching, and research.
• Association of Occupational and Environmental Clinics (AOEC) http://aoec.org
  • AOEC is a network of more than 60 clinics and more than 250 individuals committed to improving the practice of occupational and environmental medicine through information sharing and collaborative research.
• Pediatric Environmental Health Specialty Units (PEHSUs) http://www.pehsu.net
  • PEHSU form a respected network of experts in children's environmental health.

  • The PEHSU were created to ensure that children and communities have access to, usually at no cost, special medical knowledge and resources for children faced with a health risk due to a natural or human-made environmental hazard.

  • Located throughout the United States, Canada, and Mexico, PEHSU professionals provide quality medical consultation for health professionals, parents, caregivers, and patients. The PEHSUs are also dedicated to increasing environmental medicine knowledge among healthcare professionals around children's environmental health by providing consultation and training.

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