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HomeMy WebLinkAboutCOM 0725.005 2010-2012 P/CDW'JC(L • • camtl. .72±) Later Symptoms of Lead Poisoning ■ Memory Problems Nausea - P. Kidney Problems Weight Loss Constipation i Weak Wrists or Ankles Does lead affect everyone equally? Lead does not affect everyone equally. Individuals at highest risk for lead poisoning are those exposed to lead through occupational means or hobbies, fetuses, and children up to six years of age, considered the at-risk age group for lead poisoning. Young children, infants, and fetuses absorb more lead than adults. A small amount of lead that may have little effect on an adult can have a large effect on a child who is still growing and developing. If a child is overexposed to lead it can cause disastrous consequences including the possibility of irreversible brain and nervous system damage. Even children who appear healthy can have lead poisoning. If you think your child or other family members may be at risk, contact your physician or local health department for testing. Pregnant women should be especially cautious of lead exposure. The presence of lead dust can cause difficulties during pregnancy. Lead enters the bloodstream and can pass the placental barrier from the mother to the unborn child. The fetus can be poisoned before birth. http://www.kdheks.gov/ablesdaghtml C t5C?'iti. 1 c _S. Fief. Ref. Date N 9 2012 How does lead affect human health? Lead particles can be ingested or inhaled posing serious threats to human health. In adults, the primary cause of lead poisoning is due to inhalation of lead dust. Lead enters the bloodstream and is distributed throughout the body. If not detected early enough, both children and adults are at risk. Symptoms of lead poisoning vary depending on the blood lead level. Low levels of exposure to lead can cause memory and concentration problems, muscle and joint pain, and can affect nervous system function. High levels of lead exposure have been associated with nerve disorders, digestive problems and in extreme cases, death. However, it is important to remember that many individuals show no outward signs of lead poisoning. An individual may have an elevated blood lead level even if they appear healthy and show no signs of lead poisoning. What are some symptoms of lead poisoning? Early Symptoms of Lead Poisoning Fatigue Headaches Irritability Metallic Taste ► Uneasy Stomach Poor Appetite Weight Loss Reproductive Problems THE BRIMSTONE. BATTLES: liousloe Chronicle S I octal Be I on lloustonChronicle.corn Chronicle Yews The Brimstone Battles Discussion Forum • Poison in Paradise Residents says operators of geothermal power plant are committing sulfuric sacrilege in goddess' garden PUNA DISTRICT, Hawaii—This is the • • realm ofPele, fitful goddess ofHawaii's volcanoes. y ;. • 'i' 'e.r 4, . Those who have lived on the Big Island Pa ' r '""" ' w � for some time cannot help but feel the '' .1•presence of the impulsive deity, who, �� r�r , '`µ; k. 3fc, , „ v:: Even by his standards, however, the official reception in Hawaii was chilly. It seemed that the only ones who wanted him here were the people ofLeilani Estates, a rustic subdivision just south of the geothermal plant. Most government and business leaders were less than convivial; PGV was a pet project, blessed by luminaries such as U.S. Sen. Daniel Inouye, and Legator was in a position to spoil it. At one point, there was talk of undersea cables that would carry 500 megawatts of electricity to tourist-saturated Oahu and Maui. Inouye even sought federal fiends for the project, but it went nowhere. By the time Legator entered the picture in 1996, some of the Leilani Estates residents already had organized into a group called Puna Malama Pono (rough translation:Protect the Goodness of Puna). They had complained for years about lethargy, dizziness, insomnia, vomiting, diarrhea the very symptoms that are associated with chronic hydrogen sulfide exposures in the medical literature and that Legator himself had observed near a synthetic-rubber plant in the West Texas city of Odessa. " '* ' ytrptt?rn Survey t'pna Legator is among a handful ofresearchers intrigued with the effects ofminiscule-and purportedly safe--levels of hydrogen sulfide on the human body over a period of months or years. "It's so ubiquitous, and we've had so much misleading information out there about y survive it,"he said. 7f you surviv l " - ; (an exposure), nothing's going to happen to you-that's the he Researcher Marvin Legator explains a health dotrli<rarrtOry ld today. survey of residents near the Puna Geothermal "All the Venture during the Big Island Science re to agene>es still hold to that same crap. Conference at the University of Hawaii The whole house ofcards collapses on them when you start talking about chronic, low-level exposures, because that's where the problems are." For Legator, Hawaii represented an unusual investigative opportunity:Here was an isolated population exposed over a period ofyears to generally small but quantifiable amounts of hydrogen sulfide from a known source. In a 1981 report, three scientists at Lawrence Livermore National Laboratory in California concluded that "atmospheric releases of hydrogen sulfide constitute the most significant energy ���public health issue of nergy production, and that carcinogenic and neurotoxic compounds such as benzene, arsenic, mercury and radon also could be released at levels ofconcern Two of Legator's research associates went on a scouting expedition to the Puna District in March 1996, conducting interviews with 69 people. Legator made his first visit at the beginning of this year and announced his preliminary findings-symptoms consistent with hydrogen sulfide exposure-at a Jan. 9 news conference at the University of Hawaii at Hllo. Legator thought he had made it clear that more work needed to be done. He realized that something chron.com/content/.../hawaii.html (] 2/3 was seriously amiss, however, when he read an article in the Jan. 12 edition of the Hawaii Tribune_ Herald. The headline was, "Official Health Survey Bogus."The story quoted Bruce Anderson, deputy director of the state Department of Health in Honolulu, as saying that the results of any survey Legator conducted would be inherently biased because the subjects were rabidly anti-geothermal and had years to bone up on the effects of hydrogen sulfide. The attacks didn't stop there. On March 26, a PGV official appealed to William Cunningham, chancellor of the University ofTexas System in Austin. 'PGV is surprised and disappointed that the University of Texas would knowingly allow its fine name to be attached to a health survey of the type produced by Dr. Legator,"wrote Jack Dean, the venture's vice president and general manager. Dean did not respond to Chronicle interview requests. Legator sail that he felt no pressure from either the university or the National Institute for Environmental Health Sciences—which funds research centers at UTMB and 25 other universities—to discontinue his work in Hawaii. Still, he was so put off by the experience that he asked the Coilegium Racr>aini, an international association of public-health researchers, to consider forming a defense committee for scientists browbeaten by industry. Legator and his associates have not finished their analysis of the complete Puma District survey, given to 97 people who live near PGV and 58 members ofa control group in Hilo, 20 miles away. Nonetheless, Legator said that many members of the "exposed"group appear to have been impaired by hydrogen sulfide. 'The vast majority—almost 90 percent—are showing neurotoxic effects,"he said. In an interview, Anderson said that Legator "essentially recruited individuals with known prejudices against geo-thermal power development in Hawaii Obviously, if you ask people who are upset about a development activity if they feel they've been affected, they're going to tell you they have. "If there's a health problem down there, we're going to take action to address that concern," Anderson said. "If it means shutting down(PGV), so be it. But if(Legator) is alarming people needlessly, that's not a good situation either." The saga in the Puna District began in December 1975, when the first well was drilled for the state- run Hawaii Geothermal Project, an experimental, three-megawatt power plant near Leilani Estates that went on line in 1981. Almost from the start, residents complained about the rotten-egg stench, a sure sign that hydrogen sulfide was present. However, when the state Health Department compared the one-year prevalence of illness in Leihni chron.com/content/.../hawaii.htmt 3/8 Estates with that in Hawaiian Beach Estates, a subdivision farther from the plant, it found no compelling differences-although it said that more of the Leil'ani Estates residents seemed to suffer from colds. The experimental plant was closed in December 1989. But geothermal was far from dead on the Big Island. Plans were made to drill into the Fast Rift Zone of the active Kilauea volcano. Transmission lines would slice through the towering Ohia trees of the Wao Kele 0 Puna(Green Forest of Puna), the last major rain forest in the United States. Native Hawaiians and sympathetic environmentalists were enraged by what they considered to be the supreme act of sacrilege, a defilement of Pele herself "If no other place in the world is like this, it has to stay like this," said Palikapu Dedman, president of the Pele Defense Fund, • .. which organized large protests against the undersea-cables4 project. ��� 1 The 50-year-old Dedman is a fisherman and coffee grower who `�',`* d'�' '^ , • ' \ ‘`, takes his religious beliefs seriously. He likens geothermal drilling in sacred areas to the sacking ofa Christian church "Our religion is something you can see and feel,"Dedman said as he crouched on the edge of the Kilauea crater, in what is now Hawaii Volcanoes National Park. Steam wafted from cracks in the earth around him-proof he said, that the volcano is a living The first PGV well was drilled in late 1990, with the blessing of Defense Fund, lls geo hermalele Inouye, the seasoned Democratic senator and World War II drilling a sacrilege. hero. Inouye had made no secret ofhis fondness for geothermal energy. He extolled it on the floor of the Senate on June 27, 1990, noting that Hawaii depended on 130,000 barrels of imported oil per day and needed a cleaner, more reliable source of energy as insurance. In a letter to the Geothermal Resources Council dated Oct 7, 1991, Inouye declined an invitation to be the keynote speaker at the group's annual meeting but promised his continued support. "Geothermal is the most technically and economically feasible and environmentally safe energy source Hawaii has at its disposal,"the senator wrote. He tailed to mention that a thundering well blowout at PGV had sent a plume of hydrogen sulfide into the Puna District foul-months earlier. Wilson Goddard, a consulting engineer from Lucerne, Calif, who has conducted periodic analyses of PGV since 1988, said that there is nothing inherently sinister about geothermal chron.com/content/.../hawaii.html ;/8 If it's done right and in the right location, it can be benign,"Goddard said. "Geothermal in Hawaii is a very powerful resource, with a very high percentage of hydrogen sulfide. The history of that(PGV) development, unfortunately, has not been good." PGV is jointly owned by Ormat Energy Systems, an Israeli company with an office in Sparks, Nev., and Baltimore Gas & Electric. The plant, whose output has risen from 25 to 30 megawatts, collects about 800,000 pounds of geothermal fluid (in essence, water heated by molten rock)per hour from two wells. The fluid is separated into steam, which is sent to a turbine to produce electricity, and brine, which is injected as waste into three other wells. Hydrogen sulfide levels in excess of 800 parts per million haw been measured in the vapor from one of the wells. Among the Leilani Estates residents who blame PGV for their poor health, few have suffered as much as the Harrisons, who moved here in 1986 from Southern California. Both Dru, 46, and Kate, 36, say that they are lethargic and have had cysts removed from their nasal passages. Like several other women in the neighborhood, Kate has had double menstrual cycles and sore, fibrous breasts. Dru often has bhurred vision. •,' 5 .+\,"..! • , - • �' ;'. 1 The three Harrison children-Brieanna, 11; i ; r ..i ',i` 7 "-"" Tyler, 8; and Kaili, 6-have experienced high,ttii r,a5•,-..,v>., i,e fevers, abdominal pain and other baffling /-rv$ ,, �,tt.�.i=- f M. f conditions. One morning not long ago, Kaili, -,r,-... , °� e F who was born a month before the June 1991 ‘.�tr ~. well blowout, got out of bed and collapsed in a c:� I. ,� .... ,s, heap. . .r. , . v 1 . ' '. ' :1" "She said, 'It feels like my legs aren't there, Brieanna Harrison holds up her school journal account Dad,"Dru Harrison said. He had to carry her of her various ailments.With her,from left,are brother Tyler,sister Kaili and mother Kate. for the better part of two days as she slowly regained her ability to walk. The family doctor attributed her temporary paralysis to viral cramping. "Just to go through this over and over again with your children-you feel so powerless,"said Kate Harrison. Aurora Martinovich, 35, and her 11-year-old daughter Waiala live within 2,000 feet of the PGV fence in a neighborhood called Lanipuna Gardens. Another erstwhile Californian, Martinovich frets about emissions from the plant and has become one of its most vociferous critics. 'The state has invested so much money in seducing developers out here,"she said. 'They're prostituting Hawaii to the highest bidder." Martinovich and the other Puna Malama Pono members have been mocked as counterculture ne'er- do-wells who oppose all economic development. chron.com/content/.../hawaii.html 5/3 To be sure, they are an idiosyncratic lot, a blend of dark-skinned natives and pale refugees from the mainland. Marijuana plants occasionally can be spotted amid the region's terns and papaya trees. Pahoa, the district's dominant town, is a colorful, slightly run-down hamlet evocative of the late 1960s. `"' '- �.' 5•�'e+ -F-�'`' �•„tom "It's arrogance, a lot of it,"Leilani Estates resident Geoff ` "s�'"� I e r � t. Last said of the geothermal boosters. "The lowlifes in ►' ��. _ g. r 7- e '' Puna can't tell them what to do." "` ` ' •.�"� *+qtr 'They're trying to label this community a bunch of .� ; "`""t -z radicals,"said an indignant Chantele Singleton, the .- ;' ;.."„'7 -- ,+� 7'' z,;2.. r,.4 a ,'ter. 7.::.1.4.1r. _ UZMB outreach coordinator assisting Legator with hs w,., ., 1.„ 4. .i�c, �,, 61 symptom survey. Aurora Martinovich keeps an eye on the Puna Geothermal Venture from the fenceline.Among Legator was encouraged to come to Hawaii by a PGV's most vocal critics,Martinovich believes colleague, Dr. Janette Sherman An internist in the plant is emitting unhealthful levels of Alexandria, Va, who for years saw patients in the hydrogen sulfide. islands, Sherman conducted a health survey of 71 people for a lawsuit hied against PGV by some of the Leianii Estates residents. She noted in a 1993 report that many of the subjects complained of recurring ailments such as shortness ofbreath, swollen glands, nausea, vomiting and diarrhea. Perhaps more significantly, 83 percent reported neuropsychiatric problems-depression, anxiety, sleeplessness-that had long been linked to hydrogen sulfide exposure. "This represents an epidemic!” Sherman wrote. "If this incidence were reported for a communicable disease, a state of emergency would be declared." Legator submitted a study proposal-"Assisting a Community Exposed to Emissions from a Geothermal Plant"-to the environmental health sciences institute's Galveston center in March 1995 and was awarded a $5,000 grant two months later. . At a scientific cont rence at the University of Hawaii-Hilo in April, he explained the rationale 1. ., •. behind his symptom survey: 'It's nothing very r N much more than a physician taking a medical lg „ �"° history so he knows where to go. It's a ,rt' r��r . .-:� , t :f t, , springboard for a more focused study." : ,, .7.„4. - 'X.« Some attribute the Puna District illnesses to the 1' i' }U' ' ,� , ° ''„`;;: island's naturally occurring volcanic gases. Graffiti painted on Pahoa-Pohoiki Road next to the Puna "Emissions from the volcano make every other Geothermal Venture symbolizes the feelings of many of anthropogenic source pale by comparison," the plant's neighbors.Residents of the Leilani Estates subdivision blame their illnesses on hydrogen sulfide Anderson said. releases from the facility. chron.com/content/.../hawaii.html 6/8 riuu�wnt.nronicie.com- I he 8nmstone... Legator, however, noted that these gases consist primarily of sulfur dioxide, which alTects the body differently than hydrogen sulfide. The former tends to cause respiratory distress; the latter disrupts the central nervous system. A 1996 report by U.S. Environmental Protection Agency suggested that PGV was a significant source of hydrogen sulfide. The agency published a list of 19 releases from the wells and the plant between February 1991 and May 1993; among these was a monstrous blowout ofwell KS-8 that began on June 12, 1991, and lasted 31 hours. Goddard, the consultant, conchxied that the blowout was PGVs doing, not an unavoidable act of nature, and well KS-8 was plugged. During a 30-minute cleanout ofwell KS-9 on Feb. 8, 1993, hydrogen sulfide levels again soared, sickening two plant workers and five police officers off site. In its report, the EPA criticized PGV's air monitoring and emergency planning and the state Health Department's supervision of these activities. It noted that the EPA's San Francisco office had lodged a complaint against PGV for failing to report the 1991 and 1993 releases to the National Response Center, and that state and local officials had not received timely information about these incidents. In an interview at his office in Hilo, Hawaii County Civil Defense Administrator Harry Kim expressed regret and revulsion over what he characterized as a government debacle. "When I leave this job, the lowest low will be our failure to protect the people with regard to geothermal,"Kim said. The 1991 blowout "should not have happened, would not have happened if government had followed up on its responsibilities,"Kim said. 'This was a life-threatening situation, not an inconvenience." Asked his opinion ofLegator's health survey, he said: 'The credibility of county government and state government on this issue is zero. That's why the University ofTexas is here." Things have been somewhat quieter at PGV the past few years. There have been no blowouts, although the plant's neighbors say that they still smell pungent odors—mainly at night—and worry about continuous, low-level hydrogen sulfide emissions. 'It's just there all the time,"said Barbara Dettweiler, who lives with her husband, Al, about a half-mile away. It literally dries up your throat and chokes you." Adrian Barber was working in his Spartan office,just beyond the PGV fence, during the 1993 well- cleanout. He experienced what oil field workers call a "knockdown" from the hydrogen sulfide. 'There was no warning,"said Barber, a British-born former rock 'n' roll record producer. "All of a sudden, the whole works turned verticaL It disoriented me; I'm crawling across this vertical surface to get to the door. I was vomiting. 'There was ringing in my ears." chron.com/content/.../hawaii.html 7/8 Barber, president of Puna Malama Pono, is acerbic and fiercely protective of his adopted home. "We are the poorest island, and this is the poorest corner of that island,"he said. Beneath the ground, however, lie pockets of 600-degree water with the potential to produce colossal amounts of energy. Although the Puna District has not become the "industrial hell"Barber and his neighbors fearfully envisioned when the first PGV well was drilled seven years ago, they have not let down their guard. Some believe that if PGV sut rs no more major mishaps, if Puna Malama Pono can be held at bay, the proposed 500-megawatt leviathan might be revived by the developers. "They've got enough heat in this volcano to make many powerful men rich beyond their wildest dreams,"Barber said. Back to top chron.com/content/.../hawaii.html 3/8 ELEMENT III PART II STATE OF HAWAII GEOTHERMAL ACTION PLAN MICROMETEOROLOGICAL AEROMETRIC AND HEALTH EFFECTS ANALYSIS CONTRIBUTION TO THE INDEPENDENT AIR AND NOISE MONITORING PROGRAM REVIEW CONCERNING THE JUNE '12, 13 AND 14, 1991 UNCONTROLLED VENTING OF THE PUNA GEOTHERMAL VENTURES KS8 GEOTHERMAL WELL SUBMITTED TO: Honorable Lorraine R. Inouye, Mayor County of Hawaii 25 Au Pu Ni Street Hilo, Hawaii, 96720 John C. Lewin, M.D., Director of Health Bruce S. Anderson, Ph.D., Deputy Director State of Hawaii Department of Health 1250 Punchbowl St., #325 Honolulu, Hawaii 96813 PREPARED BY: GODDARD & GODDARD ENGINEERING - ENVIRONMENTAL STUDIES - 6870 Frontage Road Lucerne, CA 95458 (707) 274-2171 Voice/FAX DATE: July 22, 1991 ) / . NSP No. 0008.02-N Attachment 119 Page 10of1.1 Amended: August 25; 1999 Steam Cendensdtt Fluorides (Total) Benzene Ammonium (Total) Mercury (Total)" pH Arsenio Total Dissolved Solids Lead Total Suspended Solids Cadmium ryllium Bicarbonate and Carbonate BAebestos Chlorides Sulfates Vinyl Chloride ride Radon Nitrates Boron (Total) Radionuclides (gross Alpha and Hydrogen Sulfide Beta) atELIL Benzene Fluorides (Total) Ammonium (Total) Mercury (Total) Arsenio Total Dissolved Solids Lead Cadmium Total Suspended Solids Bicarbonate and Carbonate �� Chlorides Vinyl Chloride Chlorides Radon Nitrates Boron (Total) Radionuclides (gross Alpha and Hydrogen Sulfide Beta) Noncond.ensible Oases Carbon Dioxide Benzene Arsenio ' Hydrogen Sulfide A sen o Ammonia Beryllium Mercury Vapor Radon Non-Methane Radionuclides (gross Alpha and Non-Methane Hydrocarbons Beta) Vinyl Chloride + The sampling and testing �� resource� during abated wel�eanout and upon tasting experiencing the first steam release, and at operations. During normal operation of each well. the sampling and testing of the resource shall be the testing of the noncondensibls genes. it the performed on an annual basis. During hydrogen sulfide concentrations deviates more than +10 percent after real well for test measurement. the permitiee shall repeat the sampling testing steam condensate, brine and noncondensible gases within the ne (6)m months. The permitter shall be required to perform a retest only once performing resource test. •-1.- 'O t'z" Z. v u-rvu,I y' -" . .'- ..,.. . -- • , c'�" • L=L- PDX GODDARD & GODDARD ENGINEERING - ENVIRONMENTAL STUDIES Pegs 30 TABLE 4-1 HEALTH EFFECTS OF AIR POLLUTANTS FROM GEOTHERMAL DEVELOPMENT Ammonia (NH,). Odor threshold: 5.2 ppm (Amoore at aL., 1983). Eye irritation: 5 ppm (NIOSH, 1974), 72 ppm (Industrial Bio Test Labs, 1973). Inhalation irritation: 20 ppm (EPA, 1977). Nasal irritation: 32 ppm; chest irritation: 134 ppm (Industrial Bio Test Labs, 1973). Increased morbidity and mortality: 70-105 ppm (Bittersohl, 1971). Pulmonary edema: 1 ,700-4,500 damage a in/sensitive e plants: 3 12 ppm for 4 hours health effects (EPA, 1977). 9 (Benedict aI at, 1955). Ammonium Bisulfide (NH4HS). Penetrates the skin more rapidly than hydrogen sulfide. Since it is an inherently unstable solid, it readily dissociates back to hydro- gen sulfide and ammonia gases. Ammonium Sulfate (NH4)2SO4. Toxic to plants (Malloch as aL,, 1979; Sharp, 1976). Arsenic (As). All forms of arsenic are toxic at various levels; some are potentially carcinogenic (Lee and Fraumeni, 1969; Tseng gt ajJ., 1968; Lander, 1975; NIOSH, 1975). Arsenic compounds are known to be corrosive to skin and are identified as a carcinogen. Brief contact has no effect, but prolonged contact can cause skin irritation, with mucous membranes the more sensitive to irritation (CAL/OSHA, 1983). Fluids containing arsenic levels of 5 mg/I (ppm) are considered toxic by the State of California (Department of Health Services, 1984). Odor threshold: 0.50 ppm (Amoore gt at, 1983). The fatal dose is 70-180 mg/m3. Boron(B). Data related to humans are limited. Several forms of boron are irritants to skin and mucous membranes. Ingestion of 15-20 gm of borax caused acute e poisoning. Boron particulate fallout damages plants (Malloch g1 AL, 1979; Sharp, 1976). Exact levels are not given but, for comparison, irrigation water with 10- 100 ppm boron content is toxic to plants (Eaton, 1935). Carbon Dioxide (CO2). 2% in air can stimulate human respiration. Not considered hazardous when adequate oxygen present (Gennis, 1978). Odor threshold: 74,000 ppm (Amoore at et., 1983). Chlorides. Not expected to produce adverse health effects (OXY, 1981 ). Ethane (CH CH3). A simple asphyxiant.r threshold: 20?000 ppm (Amoore well-ventilated� 8 envi- ronments (Germ's, 1978). Odor (H2). A simple asphyxiant. No hazard known in well-ventilated environ- ments (Germ's, 1978). Hydrogen Sulfide (H2S). Odor threshold: 0.0081 (Amoore gt al, 1983). Increased neurasthenic effects (fatigue, dizziness, nausea) with long term exposure: above 0.1 ppm. Eye irritation threshold: 10 ppm. Inhalation irritation threshold: 50-100 ppm. Sense of smell stops: 150 ppm. Fatal: 700 ppm. Damage to plants: more than 0.30 ppm (Thompson, 1976); 40 ppm for five hours (McCallan gI DI, 1936). 4 GODDARD & GODDARD ENGINEERING - ENVIRONMENTAL STUDIES Page 31 - TABLE 4-1 (Continued) HEALTH EFFECTS OF AIR POLLUTANTS FROM GEOTHERMAL DEVELOPMENT Mercury (Hg). The human lung absorbs 75-85% at concentrations of 50-350 mg/m , almost completely at lower concentrations (Kudsk, 1966). Inhalation produces many adverse effects. Mercury may also be absorbed through the skin or by ingestion. Elimination is slow, resulting in long-term effects which are only partially reversible. Children appear to be especially susceptible (Britt gt g1,., 1976). Methylmercury (CH Hg + ), the most toxic form, may cause growth deformities (Walton gj et, 1978T. Inhalation of 100 Ng/m3 can cause chronic mercury poison- ing, of 1 ,200-8,500 Ng/m3 can cause acute poisoning. Occupational exposure to 10-30 pg/m3 of elemental mercury may cause slight anemia, hypothyroidism and increased excitability. Prolonged exposure may cause neurologic disorders (Walton gl at, 1978). Mercury is toxic to plants at levels in the parts per billion range over several days (Jacobson It at, 1970). Over 10 ppm dry weight in plant tissue is toxic. Methane (CH4). Odorless. Not known to induce ill effects even at high concentra- tions in ambient air. Nitrogen (N2). No known hazard from its increased presence in ambient air. Radon-222 (222Rn). Adverse health effects, including lung cancer, may result from inhalation of Radon-222 and its short-lived, alpha-particle emitting daughters (BEIR, 1972). There is at present no known level of exposure to radiation below which no biological damage occurs (Kestin gi al,., 1980). Sulfur Dioxide (SO2). Annual concentrations of 0.05 ppm (130 Ng/m3) led to in- creased frequency of respiratory illness. The threshold for increased chronic bronchitis in adults and increased acute lower respiratory disease in children is 95- 200 pg/m3 (EPA, 1974; 1975). Hospital admissions with respiratory illness in- creased when 24 hour sulfur dioxide concentrations were 0.12-0.19 ppm (Finklea, 1973). Odor threshold: 1 .1 ppm (Amoore gt at, 1983). Irritation threshold: more than 3 ppm (Case gI AL, 1977). 1-10 ppm (2,600-26,000 Ng/m3) increased airway • resistance in humans and other animals. More than 400 ppm caused death. 0.3 ppm for 8 hours is toxic to plants (Gauch It at, 1954). Sulfates. Taste/odor threshold: 700 Ng/m3. Irritation Threshold: 350-2,000 pg/m3. 10-3,000 Ng/m3 can cause illness (Case el at, 1977; Layton gt 1981 ). Brief exposure to 700-5,000 Ng/m3 sulfuric acid mist (H2SO4) resulted in increased airway resistance. Suspended Particulate Matter. The health effects of suspended particulate matter depend on the particle size and chemical composition. "No effects" threshold: 100 pg/m3 (Case el al„ 1977). Morbidity threshold: 300-375 Ng/m3 (DHEW, 1970). Mortality threshold: 200-750 ,ug/m3. Particles larger than 0.5-2 pm diameter are usually trapped in the upper respiratory system and cleared in a few minutes. Smaller particles may remain in the body for months or years (Case ti al., 1977). r) GODDARD & GODDARD ENGINEERING - ENVIRONMENTAL STUDIES Page 1 GEOTHERMAL ACTION PLAN ELEMENT III PART II MICROMETEOROLOGICAL AEROMETRIC AND HEALTH EFFECTS ANALYSIS CONTRIBUTION TO THE INDEPENDENT AIR AND NOISE MONITORING PROGRAM REVIEW CONCERNING THE JUNE 12, 13 AND 14, 1991 UNCONTROLLED VENTING OF THE PUNA GEOTHERMAL VENTURES KS8 GEOTHERMAL WELL ES 1 .0 EXECUTIVE SUMMARY DI_ FINDINGS AND RECOMMENDATIONS A micrometeorological aerometric analysis has been conducted on the uncontrolled Puna Geothermal Ventures (PGV) injection well uncontrolled venting starting at 2319 hrs on June 12, 1991 and ending at 1200 hrs on June 14, 1991 . The purpose of this study is to provide independent verification of monitoring and spot measurements of ambient concentrations of hydrogen sulfide (H2S) as well as provide estimates of plume concentration and plume transport paths in areas where documented health effects occurred. ES 2.0 SUMMARY OF FINDINGS o Independent estimates of hydrogen sulfide (H2S) ambient concentrations were shown to be in substantial agreement with local monitoring station and mobile spot measurements throughout the venting period. o Local H2S concentrations were elevated above health significance levels and correlated with health complaints. o Regional H2S transport of the KS8 venting plume cloud was documented by visual sighting, by regional and local wind assessments, and by the chronol- ogy and position of health complaints beyond 10 miles (16 km). o Estimates of the emissions of other air toxics and estimates of the impacts are shown to be of significant health concern. o The permittee is in apparent violation of permit requirements for H2S emis- sion limits, for H2S air quality impacts, for exceeding noise limits in duration and in magnitude, has not utilized the Best Available Control Technologies and has not utilized equipment described in the Authority to Construct. pir° GODDARD & GODDARD ENGINEERING - ENVIRONMENTAL STUDIES Page 3 1 .0 INTRODUCTION A micrometeorological aerometric analysis has been conducted on the Puna Geo- thermal Ventures (PGV) injection well uncontrolled venting starting at 2319 hrs on June 12, 1991 and ending at 1200 hrs on June 14, 1991 . The purpose of this study is to provide independent verification of monitoring and spot measurements of ambient concentrations of hydrogen sulfide (H2S) and other air toxics as well as provide estimates of plume concentration and plume transport paths in areas where documented health effects occurred. The uncontrolled venting incident at the KS8 well released an estimated 200,000 lb/hr (95,300 kg/hr) of steam and brine containing 180 lb/hr (81 .7 kg/hr) of H2S in a complex plume cloud which was estimated to have emissions extending from ground level to a height of 65 ft (19.8 m). An estimate of the emissions of air toxics is contained in Table 1-1 . The estimates in Table 1-1 are based upon wells KS-3 and KS-1A recent well chemistry and on Table 4-4 of the March 1989 PGV Authority to Construct. • GODDARD & GODDARD ENGINEERING - ENVIRONMENTAL STUDIES Page 40 • TABLE 4-4 KS8 WELL VENTING COMMUNITY HEALTH COMPLAINTS Name Distance Direction Health Complaint miles Numbers Puu Honuaula • 3.6 East 4 Lanipuna 3 South 12 Pohoiki Bay Estates, Leilani 1 Southwest 37 Opihikao Homesteads 1 Southwest 12 Puna Palisades 5 South 3 Kehena 4 South 4 Kalapana Seaview Estates 10 Southwest 9 Black Sands Subdivision 6 Southwest 8 Upper Kaimu Homesteads 7 Southwest 1 Kamaili Homesteads 4 South 4 Kaohe 5 South 3 Ainaioa, Orchidland 9 Northwest 2 Hawaii Acres 8 Northwest 2 Hawaiian Paradise Park 9 Northwest 4 Hawaiian Beaches, Hawaiian Shores 5 Northwest 2 Pahoa, Nanawale 4 Northwest 9 Kapoho 4 Northeast 7 Total Health Complaints 123 Source: Appendix B ., Big Island Rain Forest Action Group Colleen Mandals, Pahoa Natural Foods Kapoho Community Association GODDARD & GODDARD ENGINEERING - ENVIRONMENTAL STUDIES, 1991 GODDARD & GODDARD ENGINEERING Environmental Studies John Waihee, Governor John C. Lewin, M.D., Director Bruce S. Anderson, Ph.D., Deputy Director J. Mark Ingoglia, MPH, Manager HE&ERP Department of Health State of Hawaii Harry Kim, Civil Defense Administrator County of Hawaii December 11, 1991 Dear Gentlemen: I have become aware of some inaccuracies that may have been stated yesterday to the Governor con- cerning my review and acceptance of the Geothermal Management Plan and the just released PGV Emergency Response Plan. Speaking as one of the independent reviewers of the June 12, 13 and 14, 1991 PGV KS-8 well blow-out • event, we were asked to review narrowly defined aspects of the "event" and our narrowly defined findings and recommendations, when implemented, should not be interpreted as giving the PGV project our full approval. I personally still have many reservations concerning the safety of the project. I have included a copy of a letter to Murray Towill describing my concern regarding the Geothermal Management Plan. Major deficiencies of the Plan include inadequate response to the need for complete geochemical data on the PGV wells. Another serious deficiency is the nearly complete exclusion of community members from the various Task Force planning and management activities. The communi- ty members are those for which the plan is being developed and their input is necessary and proper. I have not seen or reviewed the Final PGV Emergency Response Plan. I have FAXed a copy of my draft major review findings on the hazards analysis review to Dr. Lewin for his information. There are potential significant impacts of some analyzed emergency upset conditions which would require warn- ing and possible evacuation out to 6 km (4 mi) and impacts in excess of 25 km (16 mi). I will FAX copies of my full draft review to Dr. Lewin and staff and to Administrator Kim when it is completed. I look forward to completing my review. I would not normally discuss draft findings in this manner but felt obliged to demonstrate the severity of my concerns and again reiterate that I have not reviewed the Final ERP. Sincerely, Wilson B. Goddard, Ph.D. Principal 6870 Frontage Rd., Lucerne, CA 95458-8504 (707)274-2171 TABLE 3 Hawaii County Civil Defense Agency Declared Emergencies At Puna Geothermal Venture* June 1991-August 1999 1. KS-8 Blowout June 12, 1991 2. Flow Test Problem August 12, 1992 3. H2S Alert August 17, 1992 4. H2S Emissions August 18, 1992 5. Caustic Soda Emissions August 15, 1992 6. H2S Leak October 22, 1992 7. KS-8 Shut-In November 2, 1992 8. KS-9 Cleanout Problem February 8, 1993 9. KS-9& KS-10 leaks September 28, 1993 10. H2S Leak May 14, 1993 11. H2S Release November 9, 1993 12. H2S Leak October 3, 1996 13. H2S Leak October 4, 1996 14. H2S Leak June 16, 1997 15. H2S Leak June 17, 1997 16. H2S Leak October 31, 1997 17. H2S Leak April 26, 1999 18. H2S Leak August 30, 1999 * This is only a list of events determined to be emergencies by the Civil Defense Agency. It is not a complete list of incidents at the facility. 144 7:1 71 .o to w o0 = o � o � oo .., o `" „ . . . 00 . 0 . 0. _t b0 0 b0 Z A A _, . ° .. . 0. .. ..- 0 — u, , C) .471 0 0 0 = o. 0, W W W) 00 t4 M 1 O4 E"- 2 2 E" E-� 3 L-, E-+ -� '�, -s o � � 00000oo00 •a—',•a-' 000000 .°; 0 '40 N Cl) 0 0 o.� o. o. 0. Z .F - ZZZZZ .a .- p ° Q. 5, • w w • 6. 0 • 0 O . C O N N N O °- ° O N '0 M N O 0 �0 enn N ,r cen `. `m E-- — N r-+ .-. N ' ,O M 'O \0 M '0 '0 '0 �0 ,o 0 '0 'O � 0 N m 7 II O O O O ch N_d O 1 N O 0d N 0 O N - N d 0 0\ O O N 0 VD 0 W O N '7tM O ,Y v1 00 vf O &f ,_.O Q ,-.4 y N d ■0 00 00 N 00 ti''O N 00 0 - vi O M" 'O 7r N 4 rn at at . Pin W o WWWW W W i U N 0 -1. E-4 A N 75 a 1., c, ;, w a i i a 00 " 04) O 3 30 3 c >~ o w c, 0 0 0 0 0 'a q 4-0 4-0 0 c -`d 03 �:+ ((.15) -° 0 x _0 = l_ 0 0 0 0 E+ EyE� H o � � � C>7C>7 2 � C�7L7R RC7 w .., N M d• , ,--. - � c� cc "' '0 0 . . i . �i •-+ N O .,-, E0 0 O Owayio •.. � N • ,-, M Zr- 00ctCA ,-., ,--1 a) 0 0 a1C/1C7 nC4 v1v4 OvaOOv� r� r� v� v� Zc7c7t� c7Zxaaxx cc/pcip c3 L) cl N ci ci ,-, .-, .•, .--, M 'o O ,--, .--I N d- v1 O O O . ,r-, .•, N M M oN III �0 �O '0 '0 N N 00 00 00 00 00 00 CA 01 G1 CA CA 01 Q1 Q1 Q'. Cn Cn U N 01 Cr CA C'. C'. C'. Cr Cn CT CA CA 01 0\ 01 01 0\ 01 O\ Q\ CA 01 01 0\ C) ,; ,/+ ,-, .- ,, ,, ,, ,, .-, ,, ,, -, .- , -1 r-, .-. .-, .-r . . . . . . . , i `r \•• William G. Davis Harry Kim ;I 6:40 �- Administrator ElJMayor •\ . i Bruce Butts Assistant Administrator ainutfu of 74ncutcii CIVIL DEFENSE AGENCY 920 Ululani Street • Hilo,Hawai'i 96720 (808)935-0031 • Fax(SOS)935-6460 TO: Harry Kim, Mayor FROM: William G. Davis, Admimstrar t tfrK"^ DATE: February 28, 2001 SUBJECT: Puna Geothermal Venture (PGV) Incident Monday, February 26, 2001 At approximately, 8:45 p.m., I received a call from police dispatch informing me that Aurora Martinovich needed to talk to me as soon_ as possible, on PGV Hydrogen Sulfide (H2S) odor and readings at her home. I immediately called Aurora. She indicated that there was a very strong odor and that she was getting readings on her meter of 40+per billion. I informed her that I had not been contacted by PGV, but would get back to her as soon as I get in touch with PGV and-find out what's going on. - • At approximately, 9:15 p.m., I finally made contact with PGV and inquired what was happening at their plant. I was informed they had an H2S release, however things were under control. They had isolated the leak. I asked why I was not contacted. They replied they were just about to do so. I asked what are the readings? They asked if.they could call me back as soon as they got an accurate reading. I then contacted Aurora to inform her of my findings and that PGV had isolated the leak and secured the situation. She indicated her readings were slightly higher. Told her I would get back to her with additional information. At approximately 10:00 p.m., I again tried to get PGV, since I had not heard from them. When I finally got through, asked why I had not received a call back. I was informed they were just planning to call me. They indicated, again, the leak was secured and everything was under control and readings at the time were approximately 23 parts per billion. I asked them how this could be since their neighbor was getting a reading of 40+per billion. Their reply, "These readings are only preliminary."I asked them if they could give me more information on the leak. I was informed they would be writing a report. I would get a copy of the report. They assured me that the plant was secured. CD - ..aaau Harry Kim, Mayor Page 2 February 28, 2001 At approximately 10:30 p.m., I called Aurora back, to let her know the leak was secured and the reading were 23 parts per billion. She indicated at that time her readings had come down drastically and were almost in the normal range. I asked her to please let me know if she should notice an increase in her readings. Harry, would appreciate meeting with you to go over this, in more detail. Needless to say this was a learning experience. � Civil Defense Agency Lorraine Inouye County of Hawaii • 920 Ululani St. • Hllo,Hawaii %720 • (808)935-0031 • Fax(808)935.6460 Senator Inouye, I thank you for this time to address some issues that pertain to Hawaii and , especially , the Puna district. Senator, as we know, the volcanic eruption of 1990 covered thousands of acres of land in the Kalapana, Kaimu, Kapaauhu, and Wahaula areas of Puna. Along with the land, the miles of roads , utilities, homes, foliage , and all the use of those lands--be it for purposes of recreation, business or lifestyle. Senator , without the federal help through FEMA, the impact of the losses would have been so much greater, for local resources were so few. For this , we thank the federal programs . At this time, the county government of Hawaii has submitted , through the civil defense system, an application for FEMA assistance for an innovative project request to provide the residents of this land a place to play , sit, fish , and gather. Your office has been submitted a copy of the proposal that is unique and, as I understand it , a first time in concept for federal funding. We need this project for the people and I know the importance of your help in the chances for any success for this project. Senator, I ask for your personal attention and help on this proposal. There is an issue that has impacted people on this island and state , perhaps even more devasting than the losses of the volcanic eruption. Through all of the human drama and physical losses because of the activities of Kilauea, it never caused the kind of hostility , polarization, prejudices and distrust towards people and government as the issue of geothermal in Puna. The time is too short now to elaborate fully on all of the major areas of this geothermal issue . I would like to focus on what I consider to be some of the areas that have caused the situation to develop into almost a war-like atmosphere between the pro- and anti-geothermal factions . y ' ) J Page 2 Government Role Perhaps the greatest source of frustration with so many people is with government and its process in handling the development of geothermal from the onset. The master plan of the development of a 500 mega-watt power source in the Puna area that included research holes (SOH) , HGPA, cross-island and inter-island cables for power transmission, and finally , power production, reflected in the eyes of many--government planning without input by those that will be affected most and, perhaps , a perception of not even caring. It is difficult to understand , Senator, that the planners of this massive project (mainly funded by the federal government and supported by you) would remotely conclude that this project would not have major impacts on all that touches the land and the sea. The frustration, Senator, is that it took legal action from citizens against government to force that an EIS be done to measure , not if there will be any impacts , but rather what the impacts will be. The frustration, Senator, is that people had hoped that government would be the source of wanting this study and pushing for this study to ensure the project ' s soundness and safety through a careful and thorough process . The HGPA project reflected the same kind of dilemma of citizens against government. Again, court action had to be taken against government to focus attention on the health effects of the unabated H2S being emitted from the HGPA project. Senator, we committed wrong and caused hardship and suffering to people because of these wrongs . It was hoped by the affected residents that government would be the ally , but instead government had to be taken to court by citizens because we did not respond or , perhaps , as perceived- -did not care. _ The situation at the present geothermal plant reflects the same as that of the EIS issue and HGPA project. It is citizens taking government to court because of the frustration that concerns of their health, their land , and all that it touches , are not being adequately addressed. Senator , it is not unknown that some of my views are not shared by others in government. It is also not unknown that my professional views are being dismissed by some as one being anti-geothermal . I swear to you as I have sworn to all others the basis for my position are as follows : Page 3 :) Through the process, government has determined where geothermal will be developed, how it will be developed, and when it will be developed. Government has also determined that the hazards and the risk associated with its development have been satisfactorily addressed and planned for. Notwithstanding the other concerns expressed by some, my concerns are primarily directed towards those related to health and safety. It is known that should any of the very worse-case scenarios, as presented by the industry, were to occur the consequences may be far reaching and devastating to people ' s daily lives. It is this knowledge that demands that I continue to pursue and maintain the position that the hazards have not been adequately identified, and the risk of these hazards have not been examined. This position is not based on pro- or anti-geothermal , but on our responsibilities and understanding of what is expected and required of the Civil Defense Agency. Senator, the process that geothermal development has taken has also frustrated the geothermal supporters , and developers as well , because of the numerous delays that have caused so many hardships on their part and by the residents ' criticisms of this operation. I feel we have a war here that has taken away what the focus should (. be on. The war has made the focus to be on the people , and not the issues , concerning geothermal . Name calling of haole hippies , pakalolo growers , professional demonstrators , Hawaiian activists , welfare bums , vs. money people, government bureaucrats , and big business widens the war to the point that many remain silent for fear of being associated with one side or the other . Senator , I believe the federal , state, and county governments have wronged in the process and I believe it is the responsibility of the same to correct these wrongs . I know not where else to ask for help in preventing further escalation of this distrust of government and escalation of the war between the pro- and anti-geothermal segments of our community. I ask for your help. Harry Kim April 17 , 1992 l Health Effects from Chronic Low-Level Exposure to Hydrogen Sulfide MARVIN S. LEGATOR DEBRA L. MORRIS The University of Texas Medical Branch DONNA L. PHILIPS at Galveston The University of Texas Medical Branch Department of Preventive Medicine at Galveston and Community Health Department of Preventive Medicine Division of Environmental Toxicology and Community Health Galveston,Texas Division of Environmental Toxicology CHANTELE R. SINGLETON Galveston,Texas School of Allied Health Sciences Department of Clinical Laboratory Sciences The University of Texas Medical Branch at Galveston Galveston,Texas ABSTRACT.The acute toxic effects of hydrogen sulfide have been known for decades. How- ever,studies investigating the adverse health effects from chronic,low-level exposure to this chemical are limited. In this study, the authors compared symptoms of adverse health effects, reported by residents of two communities exposed mainly to chronic, low-levels of industrial sources of hydrogen sulfide, to health effects reported by residents in three refer- ence communities in which there were no known industrial sources of hydrogen sulfide. Trained interviewers used a specially created, menu-driven computer questionnaire to con- duct a multi-symptom health survey.The data-collection process and questions were essen- tially the same in the reference and exposed communities. The two exposed communities responded very similarly to questions about the major categories. When the authors com- pared responses of the exposed communities with those of the reference communities, 9 of the 12 symptom categories had iterated odds ratios greater than 3.0.The symptoms related to the central nervous system had the highest iterated odds ratio(i.e., 12.7;95%confidence interval= 7.59, 22.09), followed by the respiratory category (odds ratio= 11.92; 95% con- fidence interval=6.03, 21.72), and the blood category(odds ratio= 8.07;95% confidence interval=3.64,21.18).Within the broader health categories,individual symptoms were also elevated significantly.This study,like all community-based studies,had several inherent lim- itations. Limitations, and the procedures the authors used to minimize their effects on the study outcomes,are discussed.The results of this study emphasize the need for further stud- ies on the adverse health effects related to long-term,chronic exposure to hydrogen sulfide. KPH words chronic exposure, hydrogen sulfide, industrial 'sources, low level> HYDROGEN SULFIDE iH2S) is a highly toxic gas that not measured routinely,' but available information indi- cx curs naturally in thi' environment (e.g., in volcanic sates levels in the low parts per billion (ppb) range,'•z gases, marshes, swamps, sulfur springs, decaying mat- Levels of H2S in industrial settings can be in the range ter) and is a byproduct of many industrial processes, of 0.5-10 parts per million (ppm).' Spills, leaks, mal- such as paper manufac turfing.Ambient levels of H2S are fun(lions, or the accumulation of H2S in enclosed March/April 2001 (Vol.56(No. 2)1 123 1 workplaces or low-lying areas can result in much high- Materials and Method er levels that can be highly toxic and quickly lethal. Exposure to H2S is one of the leading causes of sudden We used a multi-symptom health survey, with multi- death in the workplace) In the United States, investiga- tors attributed at least 5,563 exposures and 29 deaths to symptoms in communities exposed to low levels of H2S this chemical between 1983 and 1992.4 In 1977, the to self-reported symptoms in reference communities National Institute for Occupational Safety and Health with no known exposure to H2S. The same question- (NIOSH) estimated that approximately 125,000 em- Haire and the same data-collection and data-evaluation ployees in 73 industries were potentially exposed to techniques were used for all communities. H2S in the United States.' Atmospheric release of H2S represents the most significant public health concern of Communities exposed to H2S the growing geothermal energy industry.' Odessa, Texas. Odessa is a community of approx- Many occupational and community studies, as well imately 96,000 persons, located in the heart of the as studies of laboratory animals, have documented the Permian Basin in West Texas. Beginning in about 1967, adverse health effects of acute exposure to relatively certain areas of this community were exposed to H2S high levels of H2S.2-'-"The mechanism of action of H2S produced as a result of microbial action in solar ponds involves interaction with a number of enzymes and of industrial wastewater containing sulfate ions. Air other macromolecules, including hemoglobin and myo- modeling, performed in conjunction with a lawsuit globin. A critical target enzyme of H2S is cytochrome based on citizen complaints, indicated that, in 1992, oxidase. Most organ systems are susceptible to the the levels of H2S 1.6 km (1 mi) from the ponds were(a) effects of H2S; therefore, this toxic gas has often been 500-750 pg/m' (335-503 ppb), for a maximum 8-hr regarded as a broad-spectrum toxicant. Organs and tis- measurement; (b) 150-300 Ng/m3 (101-201 ppb), for a sues most susceptible to H2S toxicity, however, are those maximum 24-hr measurement; and (c) .3-40 pg/m' with exposed mucus membranes and those with high (7-27 ppb), for an annual average dim Tarr, personal oxygen demands. Neurotoxicity of the central nervous communication). The ponds in this community were system (CNS) and pulmonary edema are well-docu- closed and reconstructed between 1995 and 1996. mented consequences of acute H2S poisoning.'" Car- Puna, Hawaii. Puna is a district located on the island diovascular toxicity and gastrointestinal disturbances of Hawaii, which is situated on the Kilauea East Rift are also associated with exposure to this chemical.'•" Zone. This area is volcanically active and is a site for Although many individuals are exposed regularly to geothermal energy production. Since 1976, geothermal relatively low levels of H2S through their jobs, or wells in the Puna area have been drilled for the purpose because they live in communities near industrial emis- of generating electrical power. The Puna Geothermal lions of H2S, studies investigating the adverse health Venture (PGV) currently generates up to 25% of the effects of chronic, low-level exposures to this corn- electricity on the island of Hawaii.1'There are several pound are limited. in one study, former workers and cit- fixed, elevated air monitors currently operating in the izens who lived downwind from the processing of Puna area. Complete data from the fixed monitors, crude oil had neurophysiological abnormalities. Resi- however, are not easily accessible, thus making it dents who lived near the plant were exposed to H2S at difficult for investigators to establish a clear and precise 10 ppb—with periodic peaks to 100 ppb. In a study of documentation of the recorded levels of H2S exposure sewer workers, evidence indicated that low-level expo- in this community. Available monitoring data from the sure to H2S may be associated with reduced lung func- 1990s indicate numerous H2S hourly averages doc- tion.' Residents in an area of Finland located near paper umented in the low-ppb range in the area near the PGV mills reported an excess of adverse health symptoms plant. Measurements of monitors run by the Hawaii (e.g., respiratory, eye, nasal symptoms) in comparison Department of Health in the area during this same time with a reference community, 2 although results in period also revealed levels in the low-ppb range in children did not reach statistical significance.'" H2S 1996-1997, although most hourly measurements were accounted for two-thirds of the total released sulfur less than 1 ppb or were not detectable.'8 As part of an compounds monitored in the reported studies.'' Recent investigation of the H2S exposures in the area surround- evaluations of hospital discharge records in Rotorua, ing PGV in 1997, the Agency for Toxic Substances Dis- New Zealand,which is situated near a geothermal field, ease Registry'" (ATSDR) was provided with 29 incident showed an elevated prevalence of diseases of the ner- reports that spanned the time period from lune 1996 to vous system and eye. The results of several additional July 1997. In these reports, the peak concentration community and occupational studies indicate a consid- detected was 301.7 ppb.18 Periodic releases of H2S in erable variety of adverse health effects from low-level, the range of 200-500 ppb have also been reported chronic exposure to H2S.17 during other years. In this study, we compared symptoms of adverse health effects, reported by residents of two communities Reference communities exposed mainly to chronic, low levels of industrial sources of H2S, to the health effects reported by resi- Hilo, Hawaii. Hilo is a community located approx- dents in three reference communities in which there imately 33.8 km (20 mi) to the northwest of the PGV were no known industrial sources of H2S. plant. Hilo is exposed to natural volcanic emissions that 124 Archives of Environmental Health r are similar to those of Puna, but there are no geo- tionnaire that was extensive and very structured. The thermal power plants or known sour(es of industrial questionnaire covered a broad spectrum of symptoms FI)S in the Hilo area. Therefore, we would expect that within 12 different categories of physical health or exposure to H;5 in this community would be much less function. The questionnaire also included detailed in- severe than exposure, in Puna or Odessa. formation on demographics, life style, reproductive Midlothian, Texas. Midlothian is a community of history, cancer history, and other medical information. approximately 5,100 people, located approximately 48 In ,ill 12 categories, reported symptoms had to originate km (.40 min south of the Dallas-Fort Worth metropolitan or worsen after the person moved into the community, area in Texas. The to. al economy is made up of both and symptoms had to occur with sufficient frequency to agricultural and industrial enterprises. industries in the constitute a significant health problem. For certain area include three cement companies and a secondary svrlptonts, a predetermined number of occurrences steel mill. There are no known industrial sources of H)S were necessary (e.g., persistent bronchitis 12 or more in the area. episodes per year), persistent cough (daily), and Waxahachie, Texas. Waxahac hie, a c ommunity of frequent headache 31 or more per week)). Copies of the about 19,000 people, is located 45 kin i28 mi) south of complete questionnaire are available from the authors f)allay, Texas. The local economy is mainly agricultural upon request. and small business or industrial enterprises. There are "rained interviewers administered the questionnaire no known industrial 'ources of H,S in the Waxahachie duiing face to-tace interview sessions. Interviewers en- area. tered data directly into laptop computers, and the data Selection of subjects. Selection of subjects in the were later downloaded to a central computer for storage communities potentially exposed to H1S was conducted and analysis. We used coded identification numbers for as follows. In Odessa, a random selection was made eat h subject to protect the confidentiality of the partici- from a list of plaintiff. (about 600) compiled by a legal pants of the study. firm involved in a community investigation. Participants The carefully constructed and refined structure of the it Odessa had to has., lived in the community for 5 or questionnaire used for this study diminished the poten- more y, and only those who lived within 1.6 km (1 mil tial for error Several internal checks served as indicators cat the H.S source were selected We recruited of data quality and, at several places in the question- panic ipants in Puna by phone; we used the local phone Haire, respondents had to meet certain criteria before book to identity persoins who lived within 8 km (5 mil the interviewer could proceed from that point with of the PGV source. Eligible participants had to have questioning. In general, information had to be entered lived in the community for at least I v. Flyers, which in 'he correct format for all activated data fields before were posted in Puna at various places in the the program would advance to the next field.The study community, also informed persons about the health coordinator also personally checked responses from survey.The nature of the study, or the fact that the study eac h interview to be sure that they were completed, involved industrial exposures, was not revealed or that respondents met any specific criteria required for discussed with potential participants. The one excep- certain areas of questioning, and that information was tun to this was that several flyers, posted at only one entered correctly in the proper format. li i(ation. encouraged persons to participate in the study Interviewer selection and training. The interviewers "if they believed PGV was making them sick."This error for the 5 community surveys were previously trained was made by one of 'he individuals in the community graduate students and staff from the University of Texas who helped with the study.These flyers were discovered Medical Branch, and community residents who were and were removed by the study coordinator after being rec rutted and specially trained to assist with the study. posted less than 1 full day. fho study c oordinator personally trained each inter- Volunteer participant, in the reference communities viewer in the precise methods that had been developed had to have lived in their community for at least 5 y,and for the proper use of the computer program. The coor- they had to live within, 8 km(5 mil of a specific zip code dinator also supervised mock interviews between inter- selected as a point tit reference. Participants in Mid- viewers for training purposes, and the coordinator loothian and Waxach.te hie were selected by random observed each interviewer as he or she conducted the phone calls within a certain geographic area. Partici- actual interviews.The study coordinator was accessible pants in Hilo were also recruited by this method, as at all times during interview sessions to address any well as by posted flyers that were similar to those used questions or potential problems. in Puna. Statistical analyses. Preliminary analysis included a All participants signed a consent form evidencing 3 x 2 chi-square cross-comparison of the three refer- their agreement to participate in the study. The exposed ence communities, as well as a 2 x 2 chi-square cross- group included 126 participants from the Odessa corn- comparison of the two potentially exposed communi- munity and 97 participants from the Puna community tie'. We conducted these comparisons to determine if (n = 223). The reference group included 58 participants there were any significant differences between the two from Midlothian, 54 participants from Waxahachie, and exposed communities and the three reference commu- 58 participants from t-lilo (n= 170. nit,es that would prevent them from being combined Survey instrument and data collection. The survey into the larger exposed and reference groups. Preva- instrument was a spev sally created, menu-driven ques- hence rates for total symptoms within each of the 12 March/April 2001 (Vol.56(No.2)J 125 Table 1.--Comparison of Symptom Categories in the Reference and Exposed Groups Reference population Exposed population Midlothian, Waxahachie, Hilo, Odessa, Puna, Texas Texas Hawaii Reference Texas Hawaii Exposed• (n= 58) (n= 54) (n=58) groups(n= 170) (n= 1261 (n=971 groups in= 170) Symptom/category n % n % n % X2(df=2) n % n % Xz(df= 1 Central nervous system 25 43 19 35 14 24 01 112 89 82 85 0.45 Ear/nose/throat 31 53 26 48 24 41 0 43 110 87 84 87 0.96 i Respiratory*t 19 42 5 12 8 14 <.01 58 66 54 70 0.68 Muscle/bone 17 29 25 46 16 28 0 07 79 63 58 60 0.76 Skin 15 26 10 19 13 22 0.65 58 46 36 58 011 Immune 15 26 11 20 11 19 0.64 79 63 55 57 0 44 Cardiovascular 23 40 27 50 20 34 0 24 78 62 53 55 0 34 Digestive 10 17 8 15 8 14 0.87 55 44 40 41 0 82 Teeth/gums 6 10 1 2 8 14 0.07 55 44 31 32 010 Urinary 10 17 9 17 4 7 0.19 37 29 27 28 0 92 Blood 3 5 3 6 1 2 0.53 37 29 24 25 0.54 Endocrine# 10 17 11 20 1 2 0.01 29 23 15 15 0 22 *Reference group comparison,excluding Midlothian;x2 p value is.64. tWe excluded smokers from this category because confounding was possible. tControl comparison,excluding Hilo;X`p value is.86. health categories covered in the questionnaire, as well between each of the three reference communities as prevalence rates for individual symptoms within cer- (Table 1). Symptoms in the two exposed populations tain categories, were tabulated for the combined refer- were also compared, and they were not significantly ence group(n= 170)and the combined exposed group different in any category. The three reference popula- (n = 223). For certain categories, comparisons of the tions were different(p< .05)in only two categories: res- two exposed groups were made individually with the piratory and endocrine. The Midlothian population combined reference group. For all comparisons of the reported a high number of respiratory symptoms (Table study and reference groups, we used Fisher's exact test 1).This was an expected finding because the population to establish p values. Odds ratios (ORs) and their 95% was near several cement kilns, thus resulting in expo- confidence intervals (Cps) were also estimated. sure to emissions containing potential respiratory irri- Given the potential for a strong confounding effect of tants."'When we excluded Midlothian from the control smoking on respiratory problems, smokers were re- comparison for the respiratory category, the chi-square moved from all analyses of respiratory symptoms. Also, p value for respiratory symptoms between the remain- as noted below, and in lieu of the findings reported in ing two reference communities was .64. Similarly, and Table 1, Midlothian was removed from the reference as noted in Table 1, the Hilo population had only 1 sub- group for analyses of respiratory symptoms, and Hilo ject who reported endocrine symptoms. When we was removed from the reference group for analysis of removed Hilo from the reference group comparisons for endocrine-system-related symptoms. endocrine symptoms, the chi-square p value between Results the remaining two reference groups became .86. In light of these differences, we excluded Midlothian from Demographic characteristics of the samples drawn the respiratory category and excluded Hilo from the from the 5 exposed and reference populations are list- analysis of endocrine symptoms. For all other symptom ed in Table 2.The percentages of subjects in each of the categories, the three reference groups were not signifi- categories are similar for the exposed and reference candy different from each other and, therefore, were groups, except with respect to ethnicity and age. The combined for analysis. Odessa population was primarily African-American and The numbers of symptoms reported and correspond- Hispanic, whereas Puna and the three combined refer- ing percentages in each of the 12 symptom categories ence communities were 76% and 84% white and non- for the two combined exposed groups and for the three Hispanic, respectively. The mean age of the Waxa- combined reference groups are shown in Table 3. Fish- hachie group (63.7 y)was higher than that of any other er's exact p values, odds ratios, and 95% confidence group, but the overall mean for the reference popula- intervals are also listed. As noted in the table, the tion was 56.2 y, which was only slightly higher than the reported numbers of symptoms in the exposed group mean of 50 y for the exposed population. were significantly higher than in the reference group tp To determine if the reference groups could be corn- < .001)for every symptom category, with the exception hined in the analyses of individual symptoms, chi- of the endocrine categeory. When we compared the square p values were calculated for a cross-comparison exposed communities individually to the combined ref- 126 Archives of Environmental Health N. I...., .... .. In 126, .n - 91, In- . . 11 ,:,- ,,,, ... ... ("h.lr.trtnrlctu n „ ,, 1%. n 4.. rr Ace n•, %lean 1 ; •,,,.: Range ,. .,, In.',,1 to ,1. r., ,,S 1,17 17 , .,• ... '15+ Si) 41' 1 ' 12 nt -o .,, -. .._ Male 41, , , „ _ .. 1e11,11t. ,,,, ... . ,,;Vh,ln-AI„r,.l-),.,,,n„ I , 71 7h 7r. 14 ,, ''.' ..- Uru.in-Amern an ti' 69 .I 0 ni ■ . I1sp4111u 3; 25' . , ' )tier .5 .. . in , e. ; 35 55 ', '1 - 0-29 11 28' 4' 4t . ,' _„ ... 101 tc, I- .. .,. ... Smokers? ,.. ... — 'Age Was undvd11.I411-, » 4 ...,.,, I ti.r. ' . • - tSlnnktng irltct.'.,..... . ,,,-.,',,1,4•1,•';',..' ,nwT,1,1,1, ,n. ) •,,r,•r,n r.r, •■• 14.,11,.x., r .1'... , ....,....,,..,, ...,w.............. Table 3.—Self-Reputk.■ y...pr..... ' - Iutai crt,a,..A. I'una!llrl,..... .,t.r41r43,11.1itAl vr.harhu.'t4,In System cattw;onc.'s n 00 ., I,.,.,r...I nu ,,;,,,_ r I .- _... ....... Central nervous wstem 194 87 38 44 12 ' 7 59,22 09 < 001 fan,brise/throat 194 147 81 48 7 14 4 i', 12.42 < .001 Respirator)' 112 68 11 15 11 '12 6.01,25 72 <.001 ,`lust le/hone 1 37 4,1 58 34 3 06 1 99,4 77 <.001 Skin 114 51 38 22 3.6 2.2”, 5 82 < 001 Immune 114 60 i;' 22 5.55 3 16,8 74 < 001 (a,duwau Oat 111 59 70 41 2. )3 1 3 t, 4 12 < .001 I)i„estive 95 4 3 26 15 4 I)5 2.44,696 < 001 Teeth/gums 86 t9 15 9 6 t1 3 46, 12 32 <.001 l lr nary 63 28 21 14 2 18 144,4 42 < 001 Blood 611 27 4 8.57 3 64,21 18 < 001 t ix lot r,net 44 21) 2, 19 I ')6 0 58. 1 98 88 Notes OR =exkk ratio and(51 =t iintident t interval 'In the respiratory comlwnson,Midlothian was excluded from the reference group,data from smokers were excluded from the respiratory (olnpanson.and smoking information was uI,asailable for 2 partu'pants in Midlothian and tier 2 panic(pants In Waxahachie. tin the endrrx one comparison, lido was exe:oiled from the reeve nce group erence communities, ,trnilar different es were reported, 22.09), the respiratory category(OR= 11.92; 95%CI = with the endocrine category being the only category 6 03, 25.72), and the blood category (OR = 8.07; 95% shat was not statistically different. Nine of the 12 symp- CI = 3.64, 21.18). In Figures 1-3, a breakdown of these torn t ategories resulted in odds ratios that exceeded three categories is presented. 3.0. Symptom categories with the highest odds ratios The percentages for the individual symptoms within were the CNS category (OR = 12.7; '35% CI = 7.59, the CNS category are shown in Figure 1. Statistical anal- Marchotpril 2001 [Vol.56(No.2)1 127 Fatigue Restlessness ,„ , Depression ST memory loss _m-muml_ Balance m Difficulty sleeping „ Anxiety „„ Numbness 0 Total Ref I II Puna Lethargy 0 Odessa Headaches LT memorj loss I I Dizziness ��� Tremors Change in senses 0 10 20 30 40 50 60 70 Percentage with symptoms Fig.1.Comparison of percentage of central nervous system symptoms among the combined reference populations and the hydrogen-sulfide- exposed Puna and Odessa populations.ST=short-term,and LT=long-term. Coughing up blood i Wheezing Shortness of breath Cl Total Ref Persistent cough ! Puna ■ i i Odessa Bronchitis Pneumonia Lung disease 0 10 20 30 40 50 Percentage with symptoms Fig.2.Comparison of percentage of respiratory symptoms among the combined reference populations and the hydrogen-sulfide-exposed Puna and Odessa populations. 128 Archives of Environmental Health m_. •rsy �x Lam! t�sr iivi JLP2 t . r rf—+. 0;miiir e.m •rvrelcie 1 i---1 , Clotting disorder Bruises easily Abnormal blood count 11111111116111111111.1 —: , 0 Total Ref • Puna ,111 Odessa Spleen problems Anemia 0 5 10 15 20 Percentage with symptoms Fig.3.Comparison of percentage of blood-related symptoms among the combined reference populations and the hydrogen-sulfide-exposed Puna and Odessa populations. ysrs of the data revealed that when we compared the ratios for the two exposed communities were not sig- Odessa and Puna communities, they were significantly nificantly different from each other for any of the indi- dilferent (p< .05) in r, of 14 individual categories (i.e., vidual categories. long-term memory loss, lethargy, anxiety, balance, de- pression, and fatigues. The two exposed communities Discussion were compared separately to the combined reference communities. For the exposed population in Odessa, In this multi-symptom health survey, we identified a the odds ratio for each of the individual symptoms was variety of adverse health symptoms that appear to be elevated significantly over the symptoms reported by associated with chronic exposure to low levels of HtS. In the combined reference populations (p < .05)—except this study, self-reported, adverse effects in every catego- for depression. For the exposed population in Puna, the ry analyzed, except the endocrine system, are docu- odds ratios for all individual symptoms were signifi- mented.Within the broader health categories, a number c antl‘ elevated over the combined reference popula- of specific symptoms were reported, with signif- t ons(p< .01). It should be noted that neuropsycholog- icantly higher frequencies in the two exposed groups ii al evaluations were also conducted on the participants than in the reference communities. Although some dif- from Puna. These objective measurements supported ferences were noted between the two exposed popula- and confirmed the CNS findings of this health-symptom Lions,the findings in these two independent groups were survey.`" generally very similar. Additional strengths of this study Individual respiratory symptoms are compared and include the consistency of the interviewing process and summarized in Figure 2. For both exposed populations, the use of identical questionnaires for all subjects in our the same four respiratory symptoms (i.e.. bronchitis, study. there were also several objective neuropsycho- persistent cough, shortness of breath, and wheezing) logical tests and measurements that were performed on were significantly different from the (ombined refer- subjects in the exposed Puna and the reference Hilo ence populations tp< .001). In a comparison of the two communities.'0 The results of these tests support findings exposed communities, the odds ratios were not signifi- within the important CNS symptom category. cantle different for any of the individual categories. There were also limitations in our study. Surveys of fhr comparisons of individual symptoms in the sell-reported symptoms may be susceptible to response blood category are shown in Figure 3. In both exposed enhancement bias (i.e., an increase in reported symp- communities, the same two symptoms ti.e., anemia and toms resulting from the fact that respondents are aware bruises easily) were significantly different from the ref- of,and sensitized to, the fact that they are exposed). Our erence group (p e 05t. All other individual blood study was vulnerable in this area given the rather intense symptoms were not significantly different. The odds political controversy that characterized the history of 129 March/April 2001 (Vol. 56(No.2)1 . H25 exposure in the Puna community. In Odessa, the us to know what the "true" exposure was for each indi- community was involved in a lawsuit related to HIS vidual, or even for groups of individuals, who lived in exposure, and this involvement may have contributed to a certain area. a potential response bias for this group. However, the Despite the listed limitations, the two potentially results of a recent study indicate that plaintiffs in a legal exposed communities were very similar in terms of case may be no more likely to "enhance" answers than adverse health symptoms reported within each broad the general population.21 Also, the survey results for category. They were also very similar in the subcate- Puna and Odessa were very similar, even for symptoms gories of respiratory and blood symptoms. Some differ- that the community respondents would likely have not ences were noted in individual symptoms in the CNS expected to be related to H2S exposure. category, but the exact reason for this difference is A standard problem in studies that use subjective unclear. Perhaps the difference may result, in part, from questionnaires is the potential for recall bias. In our the stressful atmosphere in Puna that is related to the study, we used a detailed questionnaire with internal intense political dissension about geothermal develop- checks to help control for this bias. It is impossible, ment in that area. however,with only subjective data, to completely avoid On the basis of information contained in the avail- this problem, but we minimized the effect by using able literature about acute toxic effects of H2S exposure, identical questionnaires for all of the subjects in all increased health effects in the exposed populations groups. There is also the potential for interviewers to (e.g., CNS, respiratory, and ear, nose, and throat symp- introduce systematic errors in the data if there is a spe- toms) could be anticipated."-".22 Other categorical cial way they ask certain questions, encourage certain symptoms in the exposed groups are less commonly responses, or if there are differences in the ways they associated with H2S exposure. Information exists, how- interpret and transcribe answers. The design and ever, that supports some of our unique findings. For methodology of this survey minimized the potential for example,changes in enzymes involved in heme metab- this type of error or bias in at least two important ways. olism have occurred in individuals exposed to H2S.2'.24 First, the use of computerized, menu-driven question- Alterations in iron metabolism have also been noted.25 naires, which allowed for direct input of data into the There is also evidence from studies in rats that HIS computers, enhanced the accuracy and consistency of interferes with bacterial inactivation in the Iung.2'Stud- the interviews. Second, the extensive training of the ies in humans have also indicated that, as levels of sul- interviewers included supervised mock interviews, and fur compounds's decrease, the incidence of respiratory the study coordinator also carefully supervised the actu- infections in individuals also decreases.'' al subject interviews. This study, like all community-based observations, There were several possible confounders that could requires extension and confirmation. However, our affect the findings of our study. Differences were results, providing evidence of the elevated prevalence observed in age, smoking behavior, and ethnicity of adverse health symptoms in communities potentially between the exposed and reference groups. As noted in exposed to low levels of H2S, emphasize the need for Table 1, Puna (a 76% white, non-Hispanic community) further studies on the effects of this toxin. and Odessa (primarily an African-American and His- Given that we still do not know whether adverse panic community) differed significantly in terms of their effects are associated with low-level exposure to indus- ethnicity. However,there were no statistically significant trial chemicals in residential settings, studies such as differences in the responses of the subjects in these two this multi-symptom, community-health survey should communities in the broader symptom categories. It prove valuable. However, community-based epidemio- appears, therefore, that any potential ethnic effects were logical studies, even conducted under the best of cir- not sufficiently great to influence the major findings of cumstances, do have important limitations, as discussed this investigation. With respect to age, the mean age for above. Despite these limitations, we anticipate that the reference group(56.2 y)was slightly higher than that studies such as this one will play an ever-increasing role of the exposed group (50 y). Given that older individu- in identifying potential health problems related to als might have a higher number of adverse health symp- chronic exposures to toxic substances. A committee of toms, we would expect that any age effect in this study the National Academy of Science recognized the limi- would have resulted in an underestimate of the true dif- tations of traditional environmental epidemiological ferences between the exposed and reference groups.As studies, but it asserted that a community symptom sur- noted previously, to minimize the possible confounding vey, coupled with pertinent knowledge gained from effects of smoking in this study, we removed smokers laboratory studies, could lead to "causal inference" from the analyses of all respiratory symptoms. about the effect of potentially toxic chemicals on A final limiting factor that should be noted is often human populations.28 The findings in our study, taken present in environmental studies of this type. In the together with previously reported data concerning Puna community, only a portion of the monitoring data adverse responses to H2S, strongly mandate the need for from the fixed, elevated monitors was available for this continued research on the possible detrimental effects investigation, thus making exposure difficult to ana- of chronic exposure to this toxic agent. This is of decid- lyze. Concurrent exposures to other chemicals, in ed public health significance, given the relatively large addition to H2S, in the Odessa community also cloud- segment of the population that is regularly exposed to ed the exposure picture. Hence, it was impossible for low levels of H2S. i 30 Archives of Environmental Health sr • i Parttr-Pelhnen K,tvlarttila 0,Vilkka V,et al.The South Karelia air pollution study•effects of low-level exposure to malodorous sul- This protect was partially supported by a grant from the National fur r impounds on symptoms, Arch Environ Health 1995: institute of Environmental Health Sc ienc e(NIEHSi,grant number PH) 51 113-20 1 SO6676. Partial support was also provided In Larry Wright ot 14 Mantilla 0, laakkola 11K,Vilkka V,et al The South Karelia air poi- tii,thoif and Jacks,Austin, IX lotion study the effects ot malodorous sulfur compounds from Submitted for publicahc n Iuly 14. 2(10(1;rev used, accepted for pub- pulp mulls on respiratory and other symptoms in children Envi- bo noon December 4. 200i ron fees 1494. 66 152 59 Requests lot reprints slit Add he sent to Dr Marvin S Legator, Dwi• 15 M.irttila 0,laakkola IIK, Partti-Pk•illinen K,et at South Karelia air ion of Environmental Toxn ology,Department of Preventive Medicine pollution study daily symptom intensity in relation to exposure and (onimunity I health, I he University of Texas Medical Branch at levels of malodorous sulfur compounds from pulp mills Environ i,alveslon. 700 Iladxrstur• Drive, 2 1112 Ewing 11,111, Galveston,TX Rays 1995 71 122-27 '755'.-1 1 10 16 R rtes MN, Nicholas C.Graham B.et al Cancer incidence,mor- brifite and geothermal air pollution in Rotorua.New Zealand.Int Epidem 1998, 2' 10 14 17 Mehlman MA. Dangerous and cancer-causing properties of References p io due is and chemicals in the oil refining and petrochemical industry VII Adverse health effects and toxic manifestations 1 1.S Environmental P"otee tion Agent y(EPA, I Iealth assessment c dosed M exposure to hydrogen sulfide I Oc cup Med Toxicol document for hydrogen sulfide Environmental Criteria and 1942, 1:143-58. Assessment t ftice, C)ffix a of Health and Environmental Assess- 18 Aseetc y tux lost( Substances and Disease Registry (ATSDR) nrent, Office of Rese in Is and Development Research Triangle t kealth consultation.Puna Geothermal Venture,Pahoa(Puna Dis- Prrk, N( EPA, 1992, EPA/600/8-8tJ(,26F tux 0.Hawaii County,Hawaii Atlanta,GA ATSDR, 1997,Cerchs Agency for Toxic Sub<ranees and Disease Registry(ATSDR) Tox- No 110984469536 Website www afsdr.cdc.gov/HAC/PHA/ uoklgical Profile to Hydrogen Sultde Atlanta, GA ATSDR, puna.pgvhtml I'199. 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CRC Cni Rev Toxicol inorganic sulphides.('pin Sci 1983,64.187-91 1984, I t 25-9- 14 Jaopin.rn I'Tenhunen R Hydrogen sulfide poisoning:blood cul- 1 C;lass DC A review of the health effects of hydrogen sulfide phick•concentration and changes in haem metabolism Br I Ind exposure Uccup Flyp; 1990,34.313-27 Med 19911,47 183-85 9 Reiftenstein RI, Hulbert WC, Roth SH Toxicology of hydrogen 25 Klinglx'rg I. Bevis A. (Alison C-G,et at Disturbed iron metabo- sulfide Ann Rev Phannnc of Toxicol 1992 32:109-34 ism among workers exposed to organic sulfides in a pulp plant. IO Guidon! TL, (kcupat•oral exposure to hydrogen sultide in the Sr and I Work Inviron Health 1988: 14:17-20 sour gas industry stin.e unresolved issues lift.\rch Oct up Envi- 26 Rogers RI. Fern J. Effect of hydrogen sulfide on bacterial macti- run Health 1994,66 '5(-60. vanon rn the rat lung Arch Environ Health 1981: 16:261-64 I I Kilburn KH,Warshaw Rif Hydrogen sulfide and reduc cd-sulfur 27 laakkola UK,Prrtti-Pelbnen K,Mantilla 0,et at The South Karelia gases adversely after t n etirophyswlogical functions. Toxrcol Ind air pollution study changes in respiratory health in relation to Health 1195. 11 185 '17 emission lobar tion of malodorous sulfur compounds Irom pulp 12 laakkola IIK.Vilkka V, st.rtilla O.et al.The youth Karelia air p o1- mills Arch Environ Health 1999, 54:254-63. lution study' the etiex is of malodorous suitor compounds trom 28 National Research Council.Environmental Epidemiology. Public pulp mills on respiratory and other symptoms.Am Rev Respir Dis Health and Hazardous Wastes.Washington,DC. National Acad- 1990: 142 1144-50 emv t'ress 1991. March/April 2001 (Vol.S6(No.2)1 131