ADVANCEMENT OF THE PRACTICE
DIRECT FROM ATSDR
Assessment of Chemical Exposures (ACE) Program:
Toolkit Advances and Recent Investigations
Stacey Konkle, MPH, PhD
D. Kevin Horton, MSPH, DrPH
Maureen Orr, MS
made surveys targeted for populations of interest (e.g., adults, children, first respond- ers), household-level surveys, medical chart abstractions, and preapproved consent forms. The toolkit also includes a decision sup- port tool (Figure 1) designed to help health authorities determine whether a postdisaster registry is a valid public health action. In addition to the traditional door-to- door and phone interviews conducted dur- ing disaster responses, recent modifications to the ACE and Epi CASE Toolkits allow for the rapid distribution of online surveys. The ability to reach large numbers of people quickly with limited stang requirements, via online survey distribution and data col- lection, has increased the utility and reach of ACE investigations. Qualitative questionnaires have been added to ACE investigations and will be incorpo- rated into future toolkit enhancements. Qual- itative questionnaires help gather feedback on community concerns and broader eects on community resources that might not have initially been identified. A more comprehen- sive understanding of community percep- tions regarding the success of the response and any lingering concerns or needs can help authorities tailor future recommendations and appropriately allocate resources. The ACE team has worked with the National Institute for Occupational Safety and Health and Federal Emergency Management Agency to develop the Disaster Related Expo- sures Assessment and Monitoring (DREAM) course, which is oered through the Center for Domestic Preparedness and provides free, hands-on training for public health respond- ers on how to implement ACE and Epi CASE (Center for Domestic Preparedness, 2023).
Editor’s Note: As part of our continued e ort to highlight innovative approaches to improve the health and environment of communities, the Journal is pleased to publish regular columns from the Agency for Toxic Substances and Disease Registry (ATSDR) at the Centers for Disease Control and Prevention (CDC). ATSDR serves the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and diseases related to toxic substances. The purpose of this column is to inform readers of ATSDR’s activities and initiatives to better understand the relationship between exposure to hazardous substances in the environment, its impact on human health, and how to protect public health. The findings and conclusions of this column are those of the author(s) and do not necessarily reflect the views of CDC or ATSDR. Dr. Stacey Konkle is an epidemiologist for the Registries and Surveillance Section within the Oce of Innovation and Analytics at ATSDR. Dr. D. Kevin Horton is chief of the Registries and Surveillance Section. Maureen Orr is an epidemiologist and the Surveillance Team lead for the Registries and Surveillance Section.
I ntroduction In 2010, the Agency for Toxic Substances and Disease Registry (ATSDR) devel- oped the Assessment of Chemical Exposures (ACE) Toolkit to assist state and local health departments with performing epidemiologic assessments after acute chemical releases (Duncan, 2014). The ACE Toolkit has been enhanced and adapted over the years for use in various types of acute environmental inci- dents, including the ability to conduct rapid epidemiological assessments after radiologi- cal and nuclear incidents, explosions, natural disasters, and other environmental incidents (Duncan & Orr, 2016). The ACE Toolkit contains easily modifi- able surveys, corresponding consent forms,
training modules, and interoperable software tools that public health authorities can use to conduct rapid epidemiological assessments of exposed individuals (Agency for Toxic Sub- stances and Disease Registry [ATSDR], 2022). Toolkit Advances The ACE team at ATSDR strives to incorpo- rate innovative techniques and implement key takeaways from each investigation into its toolkits. The addition of the Epi CASE (Epidemiologic Contact Assessment Symp- tom Exposure) Toolkit allows for rapid per- son-level data collection (e.g., demographics, exposure data, clinical information) during an ongoing disaster investigation (ATSDR, 2020). The Epi CASE Toolkit contains ready-
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Volume 86 • Number 4
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