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Medically-Based Enterprise Risk Management

Epidemiology and Health Hazard Evaluation

Congressionally Mandated Epidemiological Study to Determine if Work Related Illnesses Are Being Caused by Government Agency Buildings

Challenge:

For many years, some employees at the Fort Meade, Maryland complex of the National Security Agency (NSA or Agency) have reported discomfort and symptoms, which have been difficult to correlate with specific illnesses and specific building elements. Some employees continue to feel unwell at work, notwithstanding extensive efforts to investigate the etiology of these symptoms and to ameliorate any identified potential contributors. This lack of resolution, plus the vital national mission served by NSA, led to a Congressional mandate that directed the Secretary of Defense to undertake an epidemiological study and health hazard evaluation of the NSA buildings at Fort Meade (the Study). The purpose of the Congressional mandate was to determine whether building conditions at the Fort Meade NSA Campus were causing illnesses.

Solution:

Because of our strong scientific and health-based approach, we were awarded a contract to evaluate the agency's facilities. Our study design designated "study areas," representative of the working environments under investigation. Sampling of the indoor air, ducts, supply sources and returns was conducted; secure, confidential questionnaires were electronically administered to the individuals to assess aspects of the working environment, personnel issues and personal issues. A Health Hazard Evaluation included physician and nurse interviews with a self-selected group of workers, for whom strict privacy and confidentiality was maintained.

In analyzing our findings in the Study, we reviewed an extensive amount of scientific and medical literature, millions of data points, tens of thousands of environmental samples, and thousands of statistical analyses. Our exhaustive evaluation of study areas and cross-comparison of sampling and questionnaire/interview results revealed multiple factors affecting workers and worker performance, including absenteeism and presenteeism. The key findings of the Study were:

  • Nothing was identified in the air of these buildings during the study period that was making people sick.
  • A variety of factors such as dry air, cleanliness, underlying individual susceptibilities, and job stress contributed to symptoms.
  • Symptoms were correlated more closely with micro-environments within buildings than with either buildings themselves or campus wide.
  • When viewed in comparison to the 100 non-complaint buildings in the EPA BASE Study data, we did not see evidence of any increased risk to health in the Study buildings.
  • Sinusitis, allergies and asthma were the most common underlying clinical disorders reported by constituents. Those with all three of these medical conditions experienced more symptoms of all kinds, including those symptoms that are unrelated to allergies or the respiratory system.
  • Occupants' involvement in decisions affecting their work environment were lacking as they had no local control of ventilation, temperature or humidity.

Town hall meetings were held at the facilities during which our physician explained the findings of our study and recommendations to the agency, easing concerns of many of the employees.

Reflection:

Our independent, health-based approach to this problem was viewed by employees of this agency as an objective and factual analysis of their environment and health. The ability to independently but cooperatively investigate the agency's facilities was of primary importance in the success of this project.

Hazardous Waste Treatment Facility and Medical Monitoring

Challenge:

A hazardous waste treatment facility was about to go online in a Midwest city. Despite EPA approval, the community had staged massive protests which included celebrities chaining themselves to a fence surrounding the facility. A particularly vexing issue for the community was that the facility was poorly located, and its stack was at the same level as an elementary school, albeit one-half mile away.

Solution:

In town meetings, we explained the risk assessments which had been performed and detailed the expected emissions from the stack. Then, working with the state Department of Public Health, we devised a medical monitoring program that included blood lead levels for the children. In addition, based on our conservative models of the stack emissions, we proposed changes to the location and height of the stack to avoid exposures to the elementary school children.

Reflection:

Addressing the very real health concerns of the residents for their children and for themselves, we were able to reassure them that emissions would be carefully controlled, redirected and monitored to eliminate unsafe exposures. We were also able to reassure them that the medical monitoring would produce objective health evaluations of the children and would immediately uncover any unexpected or untoward exposure event.

Other Case Studies