What Are the Potential Physical Health Effects From the Gulf Oil Spill?

An Expert Interview With Vikas Kapil, DO, MPH, From the US Centers for Disease Control and Prevention

Janet Kim, MPH

Disclosures

July 23, 2010

Medscape: Certain populations appear to be more sensitive to or at greater risk for adverse physical health effects. Pregnant women, infants and children, the elderly, and people with preexisting respiratory conditions or compromised immune systems have been identified as populations of concern. What might be the particular adverse health effects experienced by members of these special populations?

Dr. Kapil: The oil may contain some chemicals that could, under some conditions, cause harm to special populations, such as children, the elderly, and pregnant women or their babies. However, the CDC has reviewed and continues to review sampling data from the EPA and believes that the levels of these chemicals are well below the level that would generally cause harm to persons in these vulnerable groups. The effects that chemicals might have depend on many things: means of contact with the oil; duration and frequency of exposure; and the overall health of the person exposed.

People can be exposed to oil spill-related chemicals by inhalation from the air, by ingestion from water or food, or by skin contact. If possible, everyone should avoid the oil spill-affected areas. The EPA and CDC are working together to continue monitoring the levels of oil in the environment. If levels are more likely to become harmful, the public is informed. The EPA Website has the most current information on monitoring data along the Gulf Coast.

Swimming in water contaminated with oil will be unpleasant and should be avoided. The public needs to be alert to local beach closings and advisories. Visitors to the Gulf of Mexico should stay away from cleanup activities and follow the advice and warnings from state and local health departments.

For now, those in populations of concern should avoid touching any oil, as well as any oil-stained water and sand. They also need to stay clear of areas where cleanup activities are under way. If some of the oil gets on their skin, they should wash it off as soon as possible with soap and water. If they notice a rash or other skin abnormalities even after washing the area of skin that came in contact with the oil, they need to consult a healthcare professional.

The amount and extent of seafood consumption by people could also potentially pose a health concern. As a general precaution, fishing areas affected by the spill are closed to fishing and oyster collection, for both personal and commercial use. Any seafood available in stores comes from waters open for fishing. Seafood that is unsafe will not be allowed in stores.

The US Food and Drug Administration (FDA) and the National Oceanic and Atmospheric Administration National Marine Fisheries Service are monitoring the oil spill and will alert the public if any problem is found with seafood from fishing areas in this area of the country. If harmful levels of chemicals are found in Gulf-area seafood, the CDC will work quickly with other federal agencies, such as the FDA and state agencies, to make sure that the public is notified.

The FDA Website has some general guidelines about eating seafood during pregnancy in case your pregnant patients are interested in more information on this topic.

Contact with dispersants is unlikely for the general public because they are applied subsea or under controlled conditions offshore. The use of dispersants is carefully controlled and monitored because some of the chemicals in the dispersants can cause harm to people under some conditions. Pregnant women and children should avoid contact with dispersants. For most people, brief contact with a small amount of oil spill dispersants will not cause harm. However, contact of longer duration can cause a rash, dry skin, and/or eye irritation. In the unlikely event of breathing in or swallowing dispersants, other health effects -- such as nausea, vomiting, and throat and lung irritation -- are possible. Individuals concerned about oil spill dispersants should contact their local poison control center. The CDC Website also has more information on oil dispersants.

Medscape: How can healthcare providers adequately screen patients from various populations exposed to the Gulf of Mexico oil spill or a similar disaster? What other guidance would you recommend that providers offer or communicate to their patients?

Dr. Kapil: Because many environmental-associated diseases either manifest as common medical problems or have nonspecific symptoms, an exposure history is vital for correct diagnosis. By taking a thorough exposure history, clinicians and specialists in toxicology, neurology, emergency medicine, occupational medicine, and other specialties can play an important role in detecting, treating, and preventing disease due to a potential toxic exposure. More detailed information about taking an exposure history is available on the ATSDR Website.

Some people may have dermal reactions to crude oil. Depending on the amount and duration of exposure, skin contact with crude oil may be mildly to moderately irritating; in a sensitive individual, the skin effects may be more pronounced after a smaller or shorter exposure.

Prolonged skin contact with crude oil and petroleum products may cause skin erythema, edema, and burning. The skin effects can worsen by subsequent exposure to sunlight, because trace contaminants in the oil, such as PAHs, may be more damaging when exposed to light. Skin contact with these products can result in defatting of the skin, increasing the possibility of dermatitis and secondary skin infections.

For most people, an occasional brief contact with a small amount of oil, such as that found in a tar ball, will do no harm, but this type of exposure is not recommended. Individuals, however, may have idiosyncratic reactions to various chemicals, including the hydrocarbons found in crude oil and petroleum products. They may have an allergic reaction or develop dermatitis even from brief contact with oil.

In general, dermal contact with oil should be avoided. If contact occurs, washing the area with soap and water is the preferred method for cleaning the skin. Do not use solvents, gasoline, kerosene, diesel fuel, or similar products on the skin. These hydrocarbon-based products, when applied to the skin, may present a greater health hazard than the smeared tar ball itself.

Healthcare providers can obtain assistance with questions about the treatment and management of oil- or dispersant-exposed persons by calling their local poison control center.

If providers are managing the care of persons exposed to crude oil and/or oil dispersants, they can consider some general guidelines depending on the route of exposure.

If a patient presents with skin contamination, no major complications should be observed; the oil can be wiped off whenever convenient in the patient treatment process. Oil- and oxygen-enriched atmospheres are potentially explosive; oil-contaminated clothing removed from patients, and oily cloths or rags used to wipe off patients, represent a potential fire hazard due to the risk for spontaneous combustion.

If a patient presents with wound contamination, current occupational practices for external and superficial wound cleaning are being modified to include use of waterless hand cleaners, white petroleum, mineral oil, corn oil, or antibiotic ointments. These agents must also be removed as completely as possible from within the wound after efforts to remove the crude oil have been completed.

If a patient presents with ocular exposure, which can result in irritation and transient conjunctivitis, no serious injury should result if treatment is instituted rapidly. Immediate treatment should include flushing the eye with copious amounts of water for at least 15 minutes. If the person wears contact lenses, remove them prior to irrigation. Contaminated contact lenses need to be discarded.

If a patient presents with ingestional exposure to a small amount of crude oil, clinical signs of toxicity are generally limited to mild gastrointestinal disturbances. The main danger of swallowing crude oil is that it can cause a chemical pneumonia if ingested oil is vomited and subsequently aspirated into the lungs. To treat patients exposed via ingestion, do not induce vomiting because this may lead to aspiration of the crude oil into the lung. Healthcare providers can consult their local poison control center for consultation.

If a patient presents with inhalational exposure to fresh crude oil vapors, inhalation of associated volatile hydrocarbons can also result. Symptoms, including headache, dizziness, confusion, nausea, or vomiting, may occur from breathing vapors given off by crude oil. Inhalation of weathered crude oil vapors is of less concern because of the diminution of volatile hydrocarbon amounts. Relocate the patient to a clear area and provide supplemental oxygen if needed.

Guideline Highlights

  • Oil- and oxygen-enriched atmospheres are potentially explosive; oil-contaminated clothing removed from patients, and oily cloths or rags used to wipe off patients, represent a potential fire hazard due to the risk for spontaneous combustion.

  • Dermal contact with oil should be avoided. If contact occurs, however, wash the area with soap and water.

  • Immediate treatment of ocular exposure should include flushing the eye with copious amounts of water for at least 15 minutes. If the person wears contact lenses, these should be removed prior to irrigation. Contaminated contact lenses need to be discarded.

  • Patients exposed via ingestion should not be induced to vomit because this may lead to aspiration of the crude oil into the lung.

  • Oil spill workers may need to wear personal protective equipment on the basis of the particular cleanup duties that they perform. The NIOSH Website has more information about their particular ongoing efforts to protect the health and safety of response workers.

  • If any questions remain about the treatment and management of oil- or dispersant-exposed persons, call your local poison control center at 1-800-222-1222.

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