ADVANCEMENT OF THE PRACTICE
ability to conduct follow-up impact and well- ness assessments of an a ected community, which can help public health authorities stay engaged with the a ected community and guide additional public health needs. The ACE and Epi CASE Toolkits are avail- able to all public health agencies. Many inves- tigations have used the methodology, which has proven to be an intuitive set of tools that provide data for timely public health action. The ACE team can provide technical assis- tance over the phone (404-567-3256) and via e-mail (ATSDRACE@cdc.gov), as well as deploy on-site when needed. Limitations ACE investigations are designed as rapid public health responses intended to facili- tate rapid needs assessments that capture the experiences of participating respondents and rapidly guide public health action. ACE investigations are not rigorous epidemiologi- cal investigations and their results are not generalizable. ACE investigation teams often work with other government agencies that provide vital response capacity (e.g., envi- ronmental testing) and regulatory authority. ATSDR is not a regulatory agency, however, and ACE investigation recommendations are not enforceable. Conclusion Acute chemical releases in the U.S. fre- quently result in exposure to the public and first responders, with the potential to cause both short- and long-term physi- cal and mental health issues. Such health e ects raise a need for a rapid epidemio- logical assessment of a ected, or potentially a ected, populations. Many investigations have used the ACE Toolkit and methodol- ogy, and public health authorities continue to request them for critical investigations. The dedication of the ACE team to con- tinuous improvements of the ACE and Epi CASE Toolkits has made ACE investigations a critical support tool for communities experiencing chemical incidents and other large-scale environmental emergencies. ACE investigations can now more rapidly collect data from more people in more var- ied situations to guide response and recov- ery e orts. A ected communities can also be revisited by investigators to ensure that their needs have been met.
FIGURE 2
Map of Investigations Conducted Through the Assessment of Chemical Exposures (ACE) Program, 2010–2023
ACE Investigation 2015/ 20 16 Deployed : Two investigations after reports of rash associated with lead contamination of a municipal water supply
ACE Investigation 2019 Deployed : Investigated health impacts of ammonia released during transport
ACE Investigation 2021/ 20 22 Deployed : Two investigations assessingthe health effects after an industrial chemical fire ACE Investigation 2010 Deployed : Investigated health impacts of chlorine gas exposure in a metal recycling plant ACE Investigation 2011 Deployed : Investigated health impacts after a chlorine release at a poultry processing facility
ACE Investigation 2023 Deployed : Investigated health effects associated with chemicals released after a train derailment
ACE Investigation 2012 Deployed : Investigated health effects of a vinyl chloride release after a train derailment
ACE Investigation 2014 Deployed : Investigated health effects of a chemical spill that contaminat ed the publi c water supply
ACE Investigation 2010 Deployed : Investigated health effects of an ammonia release at a refrigeration facility
ACE Investigation 2022/ 20 23 Deployed : Three investigations completed to assessthe health effects of jet fuel contamination of a municipal water supply
ACE Investigation 2019 Deployed : Investigated health impacts after a gas pipeline explosion
ACE Investigation 2015 Deployed : Investigated health effects of methyl bromide released at a resort
Puerto Rico and U . S . Virgin Islands
Corresponding Author: Stacey Konkle, Epide- miologist, Agency for Toxic Substances and Disease Registry, Atlanta, GA. Email: qdv8@cdc.gov. References Agency for Toxic Substances and Disease Registry. (2020). Epi CASE Toolkit . https:// www.atsdr.cdc.gov/epitoolkit/index.html Agency for Toxic Substances and Disease Registry. (2022). Assessment of Chemical Exposures (ACE) Program . https://www. atsdr.cdc.gov/ace/index.html Agency for Toxic Substances and Disease Registry. (2023). About GRASP . https:// www.atsdr.cdc.gov/placeandhealth/about_ grasp.html Bui, D.P., Kukielka, E.A., Blau, E.F., Tomp- kins, L.K., Bing, K.L., Edge, C., Hardin, R., Miller, D., House, J., Boehmer, T., Winquist, A., Orr, M., Funk, R., & Thoroughman, D. (2022). The occupational health e ects of responding to a natural gas pipeline explo- sion among emergency first responders— Lincoln County, Kentucky, 2019. Disaster Medicine and Public Health Preparedness , 16 (5), 1997–2004. https://doi.org/10.1017/ dmp.2021.266
Center for Domestic Preparedness. (2023). Disaster Related Exposure Assessment and Monitoring . Federal Emergency Manage- ment Agency. https://cdp.dhs.gov/training/ course/MGT%20908 Duncan, M.A. (2014). Assessment of chemi- cal exposures: Epidemiologic investiga- tions after large-scale chemical releases. Journal of Environmental Health , 77 (2), 36–38. Duncan, M.A., & Orr, M.F. (2016). Toolkit for epidemiologic response to an acute chemical release. Disaster Medicine and Public Health Preparedness , 10 (4), 631–632. https://doi.org/10.1017/dmp.2015.187 Kulkarni, P.A., Duncan, M.A., Watters, M.T., Graziano, L.T., Vaouli, E., Cseh, L.F., Risher, J.F., Orr, M.F., Hunte-Ceasar, T.C., & Ellis, E.M. (2015). Severe illness from methyl bromide exposure at a condominium resort—U.S. Virgin Islands, March 2015. Morbidity and Mortality Weekly Report , 64 (28), 763–766. https://doi.org/10.15585/ mmwr.mm6428a4 Miko, S., Poniatowski, A.R., Troeschel, A.N., Felton, D.J., Banerji, S., Bolduc, M.L.F., Bronstein, A.C., Cavanaugh, A.M., Edge, C., Gates, A.L., Jarvis, M., Mintz, N.A.,
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Volume 86 • Number 4
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