Hazardous Substances Emergency Events Surveillance (HSEES) protocol
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Hazardous Substances Emergency Events Surveillance (HSEES) protocol

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      This document is provided by the Agency for Toxic Substances and Disease Registry (ATSDR) ONLY as an historical reference for the public health community. It is no longer being maintained and the data it contains may no longer be current and/or accurate.

      The purpose of the protocol is to provide an overview of the functioning of the Hazardous Substances Emergency Events Surveillance (HSEES) system and the responsibilities of participating states and the Agency for Toxic Substances and Disease Registry (ATSDR). More detailed technical information can be found in the HSEES Training Manual (Appendix A), the HSEES Quick Reference Guide, the HSEES User Guide, Release Notes, and on the HSEES secure website.

      In an attempt to describe the morbidity and mortality experienced by employees, first responders, and the general public that result from hazardous substances emergencies, a surveillance system has been developed that is currently implemented in 15 states: Alabama, Colorado, Iowa, Louisiana, Minnesota, Mississippi, Missouri, New Jersey, New York, North Carolina, Oregon, Texas, Utah, Washington, and Wisconsin.

      The need for a state-based surveillance system for acute releases of hazardous substances was first suggested in a 1988 study on the sensitivity of three existing databases: the National Response Center (NRC), the Department of Transportation's (DOT) Hazardous Materials Information System (HMIS), and the Acute Hazardous Events Data Base (1). The study reported the shortcomings of any single national reporting source when trying to assess both the number and effects of hazardous substances emergencies. Of the 587 events reported to these three national databases during the study period, only eight (1%) appeared in all three systems.

      The purpose of these databases was not to assess adverse health outcomes that result from hazardous substances emergencies, but rather to serve as a mechanism of enforcement or notifying other agencies (e.g., environmental, enforcement, commercial clean-up, insurance). The raw numbers collected by these databases do not describe the many variables that are associated with the morbidity and mortality resulting from these emergencies, nor do they stratify by populations (i.e., employees, responders, general population) affected. In addition, these databases are limited because of the number of events missed by failure of reporting as well as by the selective reporting of substances.

      Barriers that have prevented establishing a surveillance system to assess the morbidity and mortality associated with hazardous substances emergencies include: 1) no legal mandate requiring these data to be reported, 2) no standard definition of an acute release of a hazardous substance, 3) no standard definition as to when an acute release of a hazardous substance begins and when one ends, 4) defining the geographic area of concern, and 5) identifying the exposed population.

      Data that are collected by federal (e.g., USEPA, DOT), state (e.g., departments of natural resources) and local agencies focus on the release of hazardous substances into, and the effects of these releases, on the environment as end-points. These data are not adequate to fully investigate the many risk factors associated with the morbidity and mortality resulting from the release of those hazardous substances.

      Therefore, a surveillance system which focused on the public health, and not the environmental impact, of hazardous substances emergencies was established in 1989 by ATSDR. Five state health departments participated in the 1990–1992 pilot phase of the HSEES system.

      By 1995, 14 state health departments were participating in the surveillance system, and by 2001, the number of participating states increased to 16. Currently, there are 15 participating state health departments.

      Consistent with ATSDR's mission to “serve the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and disease related to toxic substances,” ATSDR continues to make funds available for state health departments to participate in surveillance activities associated with hazardous substances emergencies.

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