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APPENDIX STATE AND LOCAL ENVIRONMENTAL AND OCCUPATIONAL HEALTH INFORMATION PROGRAMS A brief description of state and local programs for O-E information is given for New Jersey, Iowa, and San Francisco, California. New~lersey's Environmental and Occupational Health Information Program (EOHIP) The State of New Jersey ranks high in population density and chemical production. In recognition of the serious threats to its water and air resources from any possible indiscriminate use and disposal of hazardous substances, the EOHIP program was developed to educate the public about O-E health risks in the Office of Consumer Health EcJucation, Department of Environmental and Community Medicine, University of Medicine and Dentistry of New Jersey - Robert Wood Johnson Medical School. 27
The EOHIP is under the oversight of an Advisory Committee composed of leaders that represent private industry, state, local, and federal government; major health organizations; voluntary environmental groups; and labor. It has six primary approaches: · continuing education in O-E health for physicians; . resource Center for dissemination of O-E health information; · O-E health articles for distribution through major New~Jersey employers; . . . O-E health information services for focal governmental and voluntary environmental organizations; and O-E health information programs in New~Jersey schools; O-E health services to small industries. The goal of the EOHIP is to provide the public and professionals with current information about the prevention and control of O-E health risks from a reliable and accessible source. Both technical assistance and information are disseminated through responses to telephone and mad! inquiries. Printed information and INFOsheets - each authored by a prominent scientist - are available to address a various topics of concern. Each is written in a straightforward question and answer format. INFOline is an 800 telephone number available in New Jersey only that responds to questions for information about environmental or job-related health topics. It is not for specific medical problems. 28
UWorksafe Iowan Program The University of Iowa Institute of Agricultural Medicine and Occupational Health, through a W.K. Kellogg Foundation grant, has designed and implemented a state- wide occupational safety and health outreach program Worksafe Iowa. This program was developed to provide O-E medical information, education and consultation to agriculture, industry and health care providers in Iowa and the region. lt is built around an O-E medical resource center which includes-occupational medicine physicians, toxicologists, industrial hygienists, epidemiologists, environmental health specialists, and O-E health educators and information specialists. Specific components of the program include a consultation unit in occupational medicine and industrial hygiene, an O-E medical education unit, and the Worksafe Iowa Information Network (WIIN). Specific programs and staff expertise are available for the three target groups - agriculture, industry and health care providers - and all programs and staff overlap and interact. For health care providers two interrelated programs have been designed. The first is the Worksafe Iowa Occupational Medicine Associates Network which now consists of five community hospital-based occupational medicine clinics. This Network is expanding to 10-12 hospitals throughout the state in the summer of ~ 990. These clinics provide occupational medicine and education programs to their respective communities and affiliated smaller hospitals and clinics. Worksafe Iowa provides technical support to these hospitals in the areas of O-E medicine, industrial hygiene, and educational and information systems in exchange for an annual membership fee which covers less than half of the program costs (the remainder is covered by the Kellogg 29
grant). Each clinic is networked to the Center and each other via WIIN which operates a personal computer-based electronic bulletin board to facilitate information dissemination and in the future will provide an operational data-base for occupational illness and injury surveillance data. The second program for health care providers, which is not ye! implemented, is an 800 O-E information access number for all physicians in Iowa. This service will provide access by phone, or by computer through WIIN. It will provide access to the appropriate expert on the Worksafe Iowa staff, or transfer to the University Poison Control Center, the University Cancer Hotline, or for referral to the University of Iowa Hospitals and Clinics Occupational Medicine Clinic or other relevant specially clinics. Foflow- up will provide information by mail, facsimile or WIIN electronic bulletin board on a fee-for-service basis. Inquiries will be loggec' upon receipt into a data-base that will provide surveillance information for the several hospitals on the network, for the University of Iowa Hospitals and Clinics, for the Iowa Department of Public Health (that conducts occupational medicine surveillance on selected occupational illnesses and injuries), and for Worksafe Iowa. Both of these components of a primary health care provider O-E medical information program for education, consultation and surveillance are currently being implemented and evaluated as a state and regional model. 30
SAN FRANCISCO BAY AREA REGIONAL POSION CONTROL CENTER (SFBARPCC) AND ITS TOXIC INFORMATION CENTER (TIC) San Francisco's Toxic Information Center Operation The San Francisco Bay Area Regional Poison Control Center (SFBARPCC) is a 24 hour a day toll-free informational hotline serving the San Francisco Bay Area and the northern coast of California (population over 4 million). Certified as a Regional Poison Center by the State of California and the American Association of Poison Control Centers, the SFBARPCC provides immediate information and treatment advice to callers regarding the toxicity of drugs, poisons, and environmental chemicals. In-depth advice is provided to calling physicians and other health care professionals managing complicated poisonings or drug overdoses. The Poison Center also provides referrals to local, state and federal agencies when appropriate. Located adjacent to the Emergency Department at San Francisco General Hospital, the SFBARPCC began operating in 1979, and has grown steadily from a staff of 5 handling 12,000 calls to a staff of 10 managing over 70,000 calls per year, utilizing the most up-to-date 31
computerized information systems. The telephone hotline staff are all doctorate-level clinical pharmacists (PharmDs) with extensive experience in managing poisoning anc! drug overdose. They are assisted by a back-up pane' of 5 amending physicians, all board-certified in Medical Toxicology, with specialties including emergency medicine, internal medicine,-occupational medicine, and laboratory medicine. In addition, the Center maintains a list of volunteer experts in industrial hygiene, environmental health, botany, mycology, and medical subspecialties. The SFBARPCC is actively involved in the education of health professionals. Each year more than 50 pharmacy and medical students and residents rotate through an intensive 4-6 week training program. Postgraduate fellows in Clinical Toxicology receive comprehensive training towards board certification in Medical Toxicology. Each year the Center sponsors a 2-day continuing education symposium, amended by over 200 participants, providing lectures and discussion sessions on a variety of topics, including diagnosis and treatment of acute drug overdoses as well as occupational and environmental emergencies. The SFBARPCC staff is also in the final phase of completing a handbook for treatment of poisoning, to be privately in 1990. In 1983, under a contract with the California State Department of Health Services Community Toxicology Unit, the SFBARPCC created the Toxic Information Center (TIC) to serve the entire State of California with information about the toxic effects of environmental chemicals and hazardous materials. The TIC receives approximately 5,000 calls each year, on topics such as asbestos, solvents, pesticide use, house-ho hazardous waste, carcinogens, and is staffed by specially trained environmental toxicologists. The TIC assists in the management of over 100 acute hazardous materials 32
incidents each year, providing information to on-scene and hospital personnel about the acute toxic hazards of the materials involved, specific treatments including antidotes, and recommendations or protective gear and decontamination, as well as referral to appropriate local and state agencies. The TIC also provides information about the health effects of the involved chemicals to calling public and media. The TIC maintains an extensive reprint file and a large library of books, journals, and computerized information sources to provide the specialized information requested by calling health professionals, citizens, and government agencies. The TIC is physically located within the SFBARPCC hotline area, providing for direct referral of callers with acute toxic exposures to on-duty Poison Control Center staff, and allowing for after business hours coverage. The TIC also makes referrals to its affiliated telephone information service for occupational hazards, the Hazard Evaluation System and Information Service (HESIS), and to the Occupational and Environmental Health Clinic at San Francisco General Hospital. The TIC is actively involved in research related to environmental and occupational medicine, and has published studies supporting the use of poison control centers as sources for reporting of occupational illness. The TIC also contributes articles on common household and environmental poisons to the SFBARRPCC's bimonthly newsletter, Community Newswire. The TIC has developed special training programs in environmental toxicology and meclical management of hazardous materials emergencies. As a member of the State Emergency Medical Services Authority's Hazardous Materials Advisory Committee, its Medical Director has participated in the development of practical protocols for on-scene and hospital treatment of victims of acute hazardous materials exposure. These protocols are being 33
adopted statewide. In addition, the TIC has developed, in association with the EMS Authority and UC Davis Extension, a course on medical management of hazardous material emergency to train physicians, other health professionals, emergency and disaster planners, and firefighters to recognize and manage acute hazardous chemical exposure. The TIC has responded to emerging needs of California's health professionals and citizens, and now provides information regarding health effects and focal and state regulations regarding health effects and local and state regulations relating to household hazardous waste disposal, Proposition 65 chemicals, and air toxics emissions reported under the EPA Toxics Release Inventory. Recognizing the need for a reliable source of peer-reviewed, summarized information on acute and chronic toxic effects of environmental and occupational chemicals, the SFBARPCC and TIC are actively working with the American Association of Poison Control Centers. the Agency for Toxic Substances and Disease Registry, the National Academy of Sciences, and the Chemical Manufacturers Association. 34
Table A-1. A Hypothetical Cost Projection for An O-E Infonnation Center Expense TypeStartup YearSubsequent Years.Subsequent Years. PERSONNEL 1 MD toxicologist$ 90,000$ 95,000$ 100,000 MPH CIH Level60,00063,00066,000 . . specialist Health educator45,00047,00050,000 Administrative30,00031,00031,000 Telephone infonna-60,000(1.5 FTE)125,000 (3.0 FTE)220,000 (5.0 FEE) don Specialists EQUIPMENT: Computers60,00020,00010,000 Software and40,00020,0005,000 software development Piles and furniture5,00000 SUPPLIES: Books and journals5,0002,0001,000 Computer programs5,0001,0001,000 Online services30,00015,00015,000 and CD ROMs Miscellaneous30,00040,00050,000 TELEPHONES: Equipment10,00000 line charges10,00020,00040,000 $480,000$479,000 Source: The subcommittee projected these costs from the members' estimates of salaries, and costs of equipment, supplies, and telephones. $589,000 1Costs for personnel must be increased depending on the numbers of professionals on a 24 hour cycle. Also, in some locations the telephone information specialist might best include industrial . . hygienists. 35