Dust Manage me nt Syste m F ailur e s L e sso ns fro m the - - PowerPoint PPT Presentation

Dust Manage me nt Syste m F ailur e s

L e sso ns fro m the Austra lia a nd the US – Why we still ha ve Bla c k L ung Dise a se in Co a l Mine Wo rke rs in the 21st Ce ntury

Global Cut the Dust Confe r e nc e Goal Coast, Que e nsland, F e b 2020 Ro be r t Co he n, MD, F CCP

Ho no r ar y Pr

• fe sso r

Unive r sity

• f Que e nsland, SMI

Clinic a l Pro fe sso r - E OHS, Unive rsity o f I llino is Sc ho o l o f Pub lic He a lth Chic a g o , I llino is Pro fe sso r o f Me dic ine No rthwe ste rn Unive rsity F e inb e rg Sc ho o l o f Me dic ine Se nio r Co nsulta nt NI OSH Re spira to ry He a lth Divisio n

Disc lo sure o f F ina nc ia l Suppo rt

F

unde d b y the Alpha F

• unda tio n fo r the

I mpro ve me nt o f Mine Sa fe ty a nd He a lth, I nc .

F

unde d b y HHS/ HRSA/ ORHP/ BL CP & BL CE

Se nio r Co nsulta nt NI

OSH/ RHD

F

unde d b y USDOL / OWCP & MSHA

F

unde d b y Que e nsla nd Go ve rnme nt, Austra lia

Ob je c tive s

 De sc rib e the fa ilure s o f the pub lic he a lth syste ms in the

US a nd in Austra lia re sulting in re surg e nt b la c k lung

US – Suc c e ss – 1970-1990’ s US – F

a ilure s – 1990’ s to pre se nt

Austra lia n syste m

Prio r to 1984 1984-2015 2015 to pre se nt

F e de r al Coal Mine He alth and Safe ty Ac t of 1969

Co ng re ss ma nda te d tha t re spira b le c o a l mine dust e xpo sure s b e re duc e d to a le ve l “…whic h will pre ve nt ne w inc ide nc e s o f re spira to ry dise a se a nd the furthe r de ve lo pme nt o f suc h dise a se in a ny pe rso n.”

F e de r al Mine Safe ty and He alth Ac t of 1977

T he Se c re ta ry…sha ll…a ssure o n the b e st a va ila b le e vide nc e tha t no mine r will suffe r ma te ria l impa irme nt o f he a lth o r func tio na l c a pa c ity e ve n if suc h mine r ha s re g ula r e xpo sure to the ha za rds de a lt with b y suc h sta nda rd fo r the pe rio d o f his wo rking life .

Year 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Percentage 5 10 15 20 25 30 35 40

25+ 20-24 15-19 10-14 0-9

Pr e vale nc e Coal Wor ke r s’ Pne umoc oniosis among c oal mine r s, by unde r gr

• und mining te nur

e — Unite d State s

Bla c k L ung Re surg e nc e in the US

Do ub ling o f te nure -a djuste d CWP (ra dio lo g ic

pne umo c o nio sis) pre va le nc e fro m 1990 to 2008

I

nc re a sing CWP mo rta lity (Ye a rs o f po te ntia l life lo st)

Se ve re CWP c a se s a mo ng yo ung mine rs who wo rke d

e xc lusive ly unde r c urre nt dust e xpo sure limits

Ra pidly pro g re ssive CWP Re surg e nt PMF

Ra pidly Pro g re ssive CWP b y Co unty

0% 4.5 - 20.0% 22.2 - 40.0% 41.7 - 60% 61.5 - 80%

* Results from NIOSH Coal Workers’ Health Surveillance Program, 1996-2002 Not shown are counties with fewer than 5 miners evaluated

NI OSH re turne d to “Ho t Spo ts” to surve y wo rking US mine rs 2006-07

0% 4.5 - 20.0% 22.2 - 40.0% 41.7 - 60% 61.5 - 80% 2 4 6 8 10 12 Percentage % of participating miners with Black Lung All USA Utah Illinois Alabama Virginia Kentucky West Va

*

* preliminary

Pe rc e nt of mine rs with Coal Worke rs’ Pne umoc oniosis (CWP) by te nure in mining, 1970-2006

1970-1974 1975-1979 1980-1984 1985-1989 1990-1994 1995-1999 2000-2004 2005-2006* Percentage 5 10 15 20 25 30 35

0-9 years 10-14 years 15-19 years 20-24 years 25+ years Tenure in Mining

SOURCE: NIOSH Coal Workers’ X-ray Surveillance Program (CWXSP) as cited in NIOSH 2007 WoRLD Report, Figure 2-4.

Upper Big Branch Mine - April 5, 2010

Uppe r Big Bra nc h, April 5, 2010

 Fire and Explosion Killed 29 Miners  Analysis of the pattern of injuries from the Upper Big Branch Disaster showed 10 deaths from CO  The remainder primarily due to blast and thermal injuries  A systematic pathologic review suggests a continuing high proportion had pneumoconiosis 86%  Settlement of law suit resulting from the disaster resulted in the formation of the Alpha Foundation which is funding part of our work

Year 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Percentage 5 10 15 20 25 30 35 40

25+ 20-24 15-19 10-14 0-9

Pr e vale nc e of CWP, by mining te nur e , in Unite d State s fr

• m 1974 to 2012

Pr e vale nc e of pr

• gr

e ssive massive fibr

• sis (PMF

) among wor king unde r gr

• und c oal mine r

s with at le ast 25 ye ar s

• f unde r

gr

• und mining te nur

e in KY, VA, and WV

Bla c kle y DJ, Ha lldin CN, L a ne y AS.

Re sur ge nc e o f a de bilitating and e ntir e ly pr e ve ntable r e spir ato r y dise ase amo ng wo r king c o al mine r s.

Am J Re spir Crit Care Me d. 2014;190(6):708-709. do i:10.1164/ rc c m.20 1407-1286L E .

 1/ 1/ 15–8/ 17/ 16, a to ta l o f 60 pa tie nts with PMF  49 ha d the ir ra dio g ra ph ta ke n during 2016.  Surve illa nc e da ta ha ve indic a te d a re surg e nc e

• f PMF

in re c e nt ye a rs, b ut the c a se s de sc rib e d in this re po rt re pre se nt a la rg e c luste r no t disc o ve re d thro ug h ro utine surve illa nc e .

416 Ca se o f PMF fro m 3 Clinc s

Blackley et. al. JAMA 319:5 p. 500-501

Pro po rtio n o f PMF Cla ims in DOL BL BP – 1970-2016

PMF c a se s fo und in re tire d mine rs who ne ve r pa rtic ipa te d in NI OSH CWHSP. Why do n’ t mine rs pa rtic ipa te ?

 Ho le s in the so c ia l sa fe ty ne t:  1985 – 2005, e mplo yme nt in the Appa la c hia c o a l mining

industry de c line d b y 56% due to

 Co st o f c o a l re la tive to o il a nd na tura l g a s  I

nc re a se d me c ha niza tio n

 Shift to c o ntra c t la b o r

 F

e a r o f jo b lo ss

 F

e a r o f dise a se a nd a sso c ia te d disa b ility

 Mistrust o f g o ve rnme nt

Co a l Wo rke rs’ He a lth Surve illa nc e Pro g ra m a nd Bla c k L ung Be ne fits Pro g ra m

 CWHSP

 Ava ila b le to a ll ac tive mine rs, b ut pa rtic ipa tio n is vo lunta ry

 BL

BP

 F

• rme r Mine rs

 Da ta c o lle c te d b y the U.S. DOL

DCMWC in c la ims a djudic a tio n pro c e ss

 I

nc lude d a ll c la ims fro m 2000 to 2013

L inka g e Re sults

NCBL RDC Annua l Co nfe re nc e , Sa lt L a ke City Se pte mb e r 27, 2017

F igur e 1. Ve nn

dia g ra m o f the

• ve rla p b e twe e n

pa rtic ipa nts in the NI OSH Co a l Wo rke rs’ He a lth Surve illa nc e Pro g ra m (CWHSP) (N = 273,644) a nd the De pa rtme nt o f L a b o r’ s Bla c k L ung Be ne fits Pro g ra m (BL BP) (N = 37,548), 1970 – 2013.

Advanced Pneumoconiosis Why?

 Are dust c o ntro l pla ns a de q ua te ?  Do e nfo rc e me nt dust sa mple s indic a te the mine r’ s a c tua l e xpo sure s?

? ?

Advanced Pneumoconiosis - Why?

Silica dust is 20 times more toxic than coal Freshly fractured dusts are more toxic Silica from cutting roof?

Adva nc e d Pne umo c o nio sis - Why?

F

e we r mine rs b ut mo re c o a l

Mo re pro duc tive e q uipme nt Sma lle r pa rtic le s ?

L

• ng e r shifts a nd e xte nde d wo rk we e ks

I

nc re a se inha le d dust

Re duc e time b e twe e n shifts to c le a r dust fro m lung s

E

no ug h time fo r dust to c le a r fro m lung s?

2016 New MSHA Dust Rule

 Mine rs o fte n wo rke d lo ng e r tha n 8 ho ur shifts; o ld rule

sa mple d o nly 8 ho urs

Ne w rule re q uire s sa mpling fo r e ntire shift  Mine rs a re e xpo se d e ve ry wo rking shift; o nly 5 shifts a re

sa mple d; sa mple s a re “a ve ra g e d” to de te rmine e xpo sure

Ne w rule me a sure s e xpo sure e a c h shift

Cha ng e s with Ne w Rule

 Sa mple s c urre ntly ma y b e ta ke n a t re duc e d le ve ls o f

pro duc tio n

 Ne w rule re q uire s sa mpling a t a ve ra g e o f la st 30 pro duc tio n shifts

 Mine rs a re g e tting dise a se a t c urre nt sta nda rd

 Ne w rule ha s 1.5 mg / m3 PE

L

 Mine rs a re no t pro vide d suffic ie nt info rma tio n a b o ut the ir

he a lth a nd e xpo sure s

 Ne w rule a llo ws use o f CPDM a nd a dditio na l me dic a l mo nito ring

wo uld pro vide mine rs info rma tio n o n whic h to a c t

i

Ne w MSHA Silic a Rule ? ? ?

Rediscovery/Resurgence of Black Lung in Australia Myth that CWP was eliminated for 30 years Reports of many cases that were missed

Myth tha t Bla c k L ung Wa s E limina te d

 1998 Re vie w o f Co a l Wo rke rs’ He a lth Sc he me

c o nc lude d tha t pne umo c o nio sis wa s no t a pro b le m

 Cha ng e d surve illa nc e pro g ra m into fitne ss fo r wo rk

pro g ra m

 Anyo ne c o uld ta ke CXRs a nd no sta nda rds fo r who m o r

ho w the ima g e s we re c la ssifie d

 I

ma g e s se nt to the De pa rtme nt o f Na tura l Re so urc e s a nd Mining – b ut no t re vie we d

 No c e ntra l da ta c a pture o r pro c e ssing

Myth tha t Bla c k L ung Wa s E limina te d

 F

irst Bla c k L ung Ca se in Que e nsla nd dia g no se d Ma y 2015 a fte r 30 ye a rs o f no t o ne c a se !

 1984 – E

.M. Ra thus’ I nve stig a tio n into CWP in Que e nsla nd (ha d do ne prio r re po rt in 1970)

7907 CXRs re vie we d 499 Ab no rma l finding s 75 Ca se s do c ume nte d o f CWP No histo ry o f a ny fo llo w up

Re c o mme nda tio ns o f Ra thus Re po rt 1970

 No te d tha t me dic a l surve illa nc e wa s e sse ntia l to fe e d

b a c k o n e ffe c tive ne ss o f dust c o ntro ls

 Re c o mme nde d c o lla b o ra tio n b e twe e n physic ia ns,

industria l hyg ie nists, a nd mining e ng ine e rs

 Re c o mme nde d using UK

Sta nda rds fo r dust

 Re c o mme nde d e xte nsio n o f CMWHS to Silic a e xpo se d

wo rke rs in 1970

Re c o mme nda tio ns o f Ra thus Re po rt 1984

 Re c o mme nde d CXR e ve ry 5 ye a rs fo r e a rly de te c tio n (i.e . se c o nda ry

pre ve ntio n)

 Annua l CXR fo r mine rs with po sitive finding s  Re q uire CXR o n re tire me nt to no tify mine r a nd fo r pub lic he a lth a na lysis.  E

sta b lish me dic a l se rvic e to c a rry CMWHS to c o o rdina te e xa ms a nd e va lua te da ta

 F

• llo w up o n re tire d mine rs b y CXR o n ro utine b a sis

 Ce ntra lize d da ta c o lle c tio n  Initia te re se a rc h into he a lth pro b le ms o f c o a l mine rs

 Re c o mme nde d e xte nsio n o f CMWHS to Silic a e xpo se d wo rke rs in 1970

Ca se s o f CWP in Austra lia Re po rte d b y Co a l Se rvic e s, I nc .

Dust Manage me nt Syste m F ailur e s But wait… .

But the E mpe r

• r

has no c lo the s!!! T he r e is blac k lung in Austr alia!!

I ma g e s Bro ug ht to US fo r Re vie w

 UMWA Co nve ntio n with fra te rna l unio ns – CF

ME U Austra lia

 Se ve ra l mine rs ha d b e e n dia g no se d with o the r dise a se s

tha n b la c k lung – i.e . Sa rc o ido sis

 Re vie we d ima g e s whic h we re c o nsiste nt with CWP  Re vie w o f c he st ima g ing o f ra ndo m sa mple o f 300

mine rs fo und 18 ne w c a se s

Disc o ve ry o f Ca se s L e a d to Pa rlia me nta ry I nve stig a tio n

 Mine rs with Bla c k L

ung

 Unio n  I

ndustry

 Go ve rnme nt Re g ula to rs  T

ho ra c ic So c ie ty

 Ra dio lo g y So c ie ty  Co lle g e o f Oc c upa tio na l

Me dic ine

Austra lia n F e de ra l Go ve rnme nt

Que e nsla nd Pa rlia me nt I nve stig a tio n Re po rt I ssue d Ma y 2017

B-Re a ding Co urse s – Brisb a ne – No w 31 B-re a de rs in NSW, QL D, WA, Vic

DNRME HSU Go e s fro m 6 to 23 Wo rke rs

U Sha pe d Curve o f Co nc e rn in Pub lic He a lth

Ne w Yo rk City T B Ra te / 100,000 Po p 1969-1989 Pre va le nc e (%) o f PMF a mo ng Appa la c hia n Wo rking Mine rs >25 ye a rs te nure . 1974-2012

F r

• m: Co he n, RA e t. al. AJRCCM 2016, 194(6):773- 775

Ac kno wle dg e me nts - Co lla b o ra to rs

MinE R Ce nte r at UIC

K irste n Almb e rg , PhD L e o na rd Go , MD K a thle e n K e nne dy, PhD L e e F rie dma n, PhD

National Je wish He alth

Ce c ile Ro se , MD, MPH

Unive r sity of Ne w South Wale s

De b o ra h Ya te s, MD Guy Ma rks, MD T re vo r Wa ite , PhD

Unive r sity of Que e nsland

Da vid Cliff