As West Virginian residents begin to return to normalcy, after the last water ban was lifted following a chemical spill that threatened major water sources, the West Virginia Poison Center continues its efforts to address the health concerns of the community.
In a recent press conference, Governor Earl Ray Tomblin said, “We’ve been in this thing for 11 days. It’s a very complicated issue. I’m not a scientist, you know. I have to rely on the best information that I have.” Tomblin did not guarantee that the drinking water is safe but rather left it up to the individuals. “It’s your decision…if you do not feel comfortable drinking or cooking with this water then use bottled water.”
While the chemical spill itself created its own concerns and complications, investigation into the toxicity of the chemical itself created the most confusion. Few answers could be found on the chemical in question and its potential adverse effects in people.
Though the lack of definitive information on about 7,500 gallons of 4-methylcyclohexane methanol that leaked into the river may create its own limitations, Dr. Elizabeth Scharman, director of the West Virginia Poison Center, was confident that the available information, along with the expertise of a team of health care professionals and chemists, allowed for sufficient guidelines for the handling of immediate medical response to the chemical spill.
“When you don’t have specific information about a chemical’s toxicity, you can look at its structure and make some predictions about what could be expected.” said Scharman. “When you don’t have definitive information, you do what is best for public health and that is why the Governor put out a ‘do not use the water’ (except for flushing) order on the evening of January 9th.”
The West Virginia Poison Center collaborated with West Virginia’s state health department, the Centers for Disease Control (CDC), the Department of Environmental Protection (DEP), chemists, and others to ensure that the best interests for public health were being served. .
While the unique experience of facing an incident involving a large number of individuals exposed to a large quantity of an unknown compound entering the water system, created its own obstacles, Dr. Scharman and her team of Poison Specialists, like many health care professionals dealing with the chemical spill’s aftermath, were faced with the increased challenge of managing an influx of new cases, maintaining regular daily Poison Center call volume, and effectively determining if those experiencing symptoms were effected by the chemical spill or some other illness – a lofty task during the onset of flu season.
“What the Poison Specialists were doing was to take individual assessments to determine whether the caller or their family member were exposed to the water and if so how (e.g., drank it, bathed in it, brushed their teeth with it), and if they were having symptoms. If symptoms were not felt to be related to a pre-existing condition or other acute medical illness (in which case, a separate triage plan was followed), management recommendations and other information was provided specific to this water contamination incident. “Poison Centers are in an ideal position to play this role as they are staffed by health care professionals,” said Dr. Scharman.
A handful of callers were referred to an emergency department by the West Virginia Poison Center. The number referred were a very small percentage of the number of individuals who called the center. Dr. Scharman cautioned that, for those individuals who were admitted to a hospital with a concern for contaminated water exposure, the fact that they were admitted did not mean that their symptoms were determined to be related to the spill.
Dr. Scharman also stated that the substance itself, though somewhat illusive in toxicology reference sources, was not highly toxic.
“We were not expecting that we would have people with severe or harmful effects and this is consistent with the types of calls we evaluated,” she said.
The most common symptoms reported were nausea, diarrhea, or rashes.
Although the water ban has now been lifted, the West Virginia Poison Center continues to answer calls related to the chemical spill.
As a part of that brain trust, the West Virginia Poison Center was front and center when news of the chemical spill broke. Before calls came in regarding specific cases, the poison center had received a call from a reporter on the afternoon of January 9thasking about the chemical after individuals had called the media asking about smelling licorice in the air. While there hadn’t been any calls from the public at that time, the Poison Center began to research the chemical reported to have been involved in order to prepare itself should calls be received.
“That is part of what poison centers do. We do active surveillance in our communities in real time,” said Dr. Scharman.
When human exposure related calls began pouring in, 2,423 during the main phase of the incident, the poison center was ready.
Poison Specialist Jamie Cook, BSN, MSN, CSPI, who was answering the phones said, “I’ve been here for about three and a half years. This has definitely been the biggest [emergency situation]…We’ve really had to work together as a team. We’ve had to call in Poison Specialists, even those who were out for vacation.”
Cook said that perhaps one of the more challenging aspects of this particular situation was that the public had limited access to water which meant a decline in the ability to use soap and water for cleaning and the potential for some reported symptoms to be more a result of germs than the chemical spill as the duration of the “do not use” order became longer.
Despite the continued challenges of the chemical spill and the subsequent water ban, Cook is confident that the poison center played a crucial role in the health of the community and that the community is now more aware of the center’s role in their safety.
“I think there are people who were not aware that we were here or what we do, that are now,” she said.
As for the public, they’re strong she said, “West Virginians are very tough and very resilient and they’re always helping each other out.”