Starkey Citizens for a Clean & Healthy Environment
Soutwest Pennsylvania Environmental Health Project

Exposure assessment

A. Complete an EHP intake form and have an interview with our nurse practitioner
In order to provide the best possible service to you, we ask that you fill out an intake form and speak with our nurse practitioner. The interview can take place via Skype or Facetime through the internet, by phone or in person in our office. Our intake assessment process covers topics on personal health and wellbeing, NGD activities in your local area, water source concerns, and your home environment. With this information, we can attempt to get as complete a picture as possible of your specific situation regarding NGD and your health status.

B. Map emissions sources
We can map emissions sources within ½ mile of your home and identify which sources are to the north, south, east and west. EHP will provide the map, to be created with your input.

1. Learn to use the EHP Air Model in conjunction with your map
This air pollution model allows you to monitor the air flow around your home on a regular basis and can provide estimates of emissions you may be exposed to over the course of a week, month, or even year. Training would be provided by EHP. The model can show how the estimated emissions from sources close to your home will travel through the air either toward or away from the house, depending on weather factors. You can:
• Learn how weather, time of day, and topography impact your air quality. For example:

o Predominant air flow is from south to north, but changes seasonally and may vary daily o Emissions at night will have greater impact on nearby homes
o Valleys tend to collect air emissions
• Use a wind meter (anemometer) to determine real time wind direction. This will help you assess which emissions may be flowing toward your home. An anemometer is inexpensive and easily obtained.
• Keep a record of estimated impacts on the chart we provide.

C. Monitor Your Health, Air and Water
1. Health
Keeping track of your health symptoms is important:
• Keep a health diary - record any health symptoms, noting date, time of day, and weather if appropriate. See our suggestions at:
http://www.environmentalhealthproject.org/health/health-diary/
• Keep your primary care physician informed about your health.
2. Air
• Inside the home – The Dylos 1100 Air Quality Monitor measures particulate matter (PM) from sources such as diesel engines. This monitor can run indefinitely and will provide real time readings of PM in the home. Remember that dust, dirt, gas stoves and other indoor sources can affect your readings.
o The Dylos costs about $200 and can easily be ordered online atwww.dylosproducts.com . By phone, we can assist you in setting up your meter o As you see changes in PM levels, you can make the recommended changes in the airflow of your home
o EHP will discuss the results with you by phone or email
• Outside the home - There are certain stages during well development when you may want to set up an outside air badge, such as during fracking and flaring when emissions are high. The air badge we are currently testing can monitor emissions for up to 30 days. If you are interested in using an air badge, we would need to assess whether our badges test for the appropriate compounds for the particular stage of NGD. At present we are testing near compressor stations in Washington County. There would be costs involved in analyzing the results, as well as training in use of the badges. We are still in the process of refining this procedure.
o Our current badges test for benzene, toluene, ethylbenzene, chlorobenzene, xylenes, 1,2,4 trimethylbenzene, 1,2,3-trimethylbenzene, acrylonitrile, cyclohexane and 1,3,5 trimethylbenzene
o Based on the results further monitoring may be recommended for measuring amounts of particular chemicals found in the first round
o EHP would discuss results with you, and recommend next steps

3. Water • Handheld TDS/conductivity meter – this allows you to watch for changes in water quality that may signal well water contamination. EHP can provide you with a meter.
• pH strips – these can be used to identify changes in water quality. These should be readily available at most drug stores. If not, contact us.
• CattFish electronic water monitor (NOT YET AVAILABLE) – this device sits in the toilet water tank and electronically records water quality measurements of TDS and temperature.
o The CattFish will be available in limited quantities later this year
o If contamination occurs follow guidelines in EHP’s well water document, with assistance from EHP
• Further water testing
o EHP has testing guidelines in the Well Water Contamination document found on our website: http://www.environmentalhealthproject.org/health/water/
o Partnerships with other water testing groups can sometimes be arranged

D. Reduce your exposures
EHP has general recommendations for protecting your health. These recommendations can be found in the document previously provided, “How to Protect Your Home and Your Health.” After your conversation with our nurse practitioner, and as monitoring and/or exposures occur, we can assess your particular situation and may be able to offer more specific recommendations.

Nonetheless, we advise you to filter the air in your home, if air quality seems compromised. At the present time, we know of only one room filter that comes highly recommended by indoor air experts. This filter, the Austin Air HealthMate, is expensive but effective. We will soon be testing other, less expensive models.

Medical Concerns
Your health concerns are valid and you obviously know that this well pad and its associated activities carry health risks.

E. Exposures
Although the research is not plentiful there are studies of emissions from the activities associated with natural gas development. From these, we know that emissions produced during the drilling or development phase can be significant – more so, we think, than during well completion.
According to Theo Colborn’s recent article (2012), most chemical detections occurred during the first four months of well development. The highest percentage of detections occurred during the initial drilling phase, prior to hydraulic fracturing on the well pad.

Volatile organic compounds (VOCs) including certain alkanes, BTEX and methylene chloride have been consistently measured. In addition researchers have found methane, ethane, and propane. Well pad activity also produces carbonyls, such as crotonaldehyde and formaldehyde. These (among others) were found at low levels. In terms of PAHs (polycyclic aromatic hydrocarbons), naphthalene has been measured at well pads. Nitrogen oxide and carbon monoxide have also been detected near drilling installations as has particulate matter that can be carried into the deep lung. McKenzie and Witter have shown that during the flowback stage of well completion, there are, among other emissions, trimethylbenzes, xylenes, and aliphatic hydrocarbons.

The above is an incomplete list of possible exposures. We are working on several appendices to this document. Among them is a list of compounds, organized by classification, that will be more comprehensive. It is also something that you could bring to your health care provider when discussing your concerns.

F. Symptoms
Research specific to health and NGD is scant. What we do have, however, is the toxicological information for many compounds (mentioned above) and a small number of papers and reports discussing the health consequences reported by individuals living near NGD activities. Nevertheless, there are patterns forming from the research and from the stories that people tell about their own experiences.

It should be noted that people who live near a well pad often also live near other installations such as compressor stations or condensate tanks; and these can produce health effects of their own that may be hard to distinguish from the symptoms developed on account of drilling activity.

Some of the most prevalent symptoms reported across many settings are: increased fatigue; nasal, throat and sinus irritation; eyes burning; shortness of breath; joint pain; headaches; nausea; and sleep disturbance. Dermatologic symptoms have also been quite prevalent across studies and interviews.

Academic research by Elaine Hill from Cornell University (2012) suggests that lower birthweight and apgar scores may be correlated with living near NGD sites during pregnancy. Cancer risks have been calculated by Mckenzie et al in a Colorado study (2012).

A set of health problems that can often be overlooked includes anxiety, depression, and increased alcohol and drug use. Individuals in communities with considerable environmental stressors often suffer from levels of anxiety and depression that can affect their daily lives and the lives of those in their households. We have strong reason to believe that these mental health effects, to varying degrees, are present in many of those living in close proximity to drilling activity. If you have these concerns about yourself or your family members you should take them seriously and discuss them with your doctor or other trusted professional.

G. Recommendations for baseline medical tests EHP is hesitant to suggest blood or urine testing for specific chemicals before and after NGD activities both because we do not know what exactly people might be exposed to and because tests results may often be misleading. We don’t want to encourage people to go on to a wild goose chase and instead want to encourage people to do what they can to limit exposure in all ways possible. That said, just as in a work setting, if an individual knows that he or she may be exposed to a particular harmful chemical that has a meaningful blood or urine monitoring test available, such as lead or arsenic, it would not be unreasonable to have the appropriate test performed to evaluate the impact of an exposure.

It is advisable to establish baseline routine health measures before NGD begins or ramps up. Although you should discuss these with your provider, these would typically include a complete blood count with platelets, a chemical profile measuring kidney and liver function, blood sugar and often a single measure of thyroid function. A routine urinalysis would usually be included as well. We suggest you tell your doctor what types of chemicals have been found consistently with NGD activity so that he or she can think about how those might affect the body. As mentioned above, we will be able to provide more detailed information if you need it.

There are a lot of unknowns to grapple with. You should encourage your doctor to call our office to speak with our nurse practitioner or our occupational health physician if he/she has questions. And you should also feel free to call us to talk about your specific concerns. It’s best to keep a health diary in which you can note any changes in your environment and any changes in your health and the health of others in your household. This can help a healthcare provider to begin to put the pieces together.

If your own primary care provider is unresponsive to your concerns, you’ll just have to keep trying until you find one who is amenable to working through this with you. Don’t give up hope. We believe that more and more doctors and nurses will be interested in solving these mysteries as the months go on. EHP, in fact, has developed a “Medical Toolkit” to educate doctors about NGD exposures and their possible health consequences. In addition, we are developing a network of doctors who are specialists in medical areas relevant to our concerns (dermatologists, endocrinologists, gynecologists, etc.). Unfortunately this is a slow process, but we are confident that we will identify these specialists and they can be available to doctors whose training is not in those areas.

Starkey Citizens for a Clean & Healthy Environment - frackfreestarkey.com