through internal professional communica- tion channels. First responders who completed the first responders health survey and respondents who completed the general health survey (e.g., before the first responders health sur- vey was available) and self-identified as first responders were grouped together. Frequen- cies were calculated for reported demographic characteristics, use of personal protective equipment (PPE), contact with material, smelling an odor, symptoms, and healthcare use for first responders. No inferential statis- tical tests for first responders were performed because of small sample size. This activity was reviewed by the Centers for Disease Control and Prevention (CDC) and was conducted consistent with applica- ble federal law and CDC policy.
FIGURE 1
Kernel Density Map of General Health Survey Respondents Reporting a New or Worsening Symptom Within the 2 Weeks Prior to Survey Completion, Winnebago County, Illinois, July 2021
Results
Syndromic Surveillance ESSENCE syndromic surveillance data identified 15% more ED visits than baseline on the day of the incident in the county, and the number declined within the week. Mapping the area around the facility, the team identified 6 ZIP Code areas down- wind of the facility with the largest num- ber of ED visits. Among residents in those 6 ZIP Code areas, ESSENCE data showed alerts and warnings for specific chief com- plaints compared with the previous 90-day baseline. Chief complaints for respira- tory symptoms increased on June 14, and chief complaints for asthma increased on June 17. Chief complaints for disaster- related mental health increased on June 15, and chief complaints related to self-harm increased on multiple days. Continued trends in ESSENCE 1 month after the inci- dent were not identified. The ESSENCE query conducted by the Wisconsin Department of Health Services resulted in 17 unique results for individuals visiting the ED from June 15–24; further, 6 of the results had a direct reference to the chemical fire for the chief complaint. None of the individuals was admitted for a higher level of care. General Health Survey From an initial 2,053 responses, 2 dupli- cate entries, 17 responses with residential
Note. Data include survey respondents of the general health survey and exclude first responders. CDC/ATSDR = Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry.
First Responders Health Survey Although the general health survey was avail- able to the general public, a separate health survey was later developed specifically for first responders that had nearly identical questions. Because it was suspected that first responders did not want to be identified on the general health survey because of fear of professional consequences, the first respond- ers survey did not require them to enter identifying information to complete it. Local police and fire chiefs shared the survey link
sion was applied to assess the association of contact with material or smelling an odor with the outcome of symptom status (symp- tomatic versus asymptomatic) among resi- dents from the general public. Four sepa- rate models were developed with symptom status as the dependent variable and con- tact with smoke, contact with dust, contact with debris, or smelling an odor as the main exposure variable—and were adjusted for age, gender, race, ethnicity, and residential distance from the facility.
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March 2023 • Journal of Environmental Health
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