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 ung Dise a se in Co a l Mine Wo rke rs in the 21 st Ce ntury Bla c k L Ro be r t Co he n, MD, F CCP Global Cut the Dust Confe r e nc e Ho no r ar y Pr o fe sso r Unive r sity Goal Coast, Que e nsland, F e b 2020 o 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 o 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 .

40 35 25+ 20-24 15-19 30 10-14 0-9 25 Percentage 20 15 10 5 0 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Year Pr e vale nc e Coal Wor ke r s’ Pne umoc oniosis among c oal mine r s, by unde r gr ound 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

12 * NI OSH re turne d to “Ho t Spo ts” to 10 All USA 8 Percentage Utah surve y wo rking US mine rs 2006-07 Illinois 6 Alabama Virginia 4 Kentucky West Va 2 0 % of participating miners with Black Lung 0% 4.5 - 20.0% 22.2 - 40.0% 41.7 - 60% 61.5 - 80% * preliminary

Pe rc e nt of mine rs with Coal Worke rs’ Pne umoc oniosis (CWP) by te nure in mining, 1970-2006 35 Tenure in Mining 30 0-9 years 10-14 years 25 15-19 years 20-24 years Percentage 25+ years 20 15 10 5 0 1970-1974 1975-1979 1980-1984 1985-1989 1990-1994 1995-1999 2000-2004 2005-2006* 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

40 35 25+ 20-24 30 15-19 10-14 0-9 25 Percentage 20 15 10 5 0 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Year Pr e vale nc e of CWP, by mining te nur e , in Unite d State s fr om 1974 to 2012

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 . Pr e vale nc e of pr ogr e ssive massive fibr osis (PMF ) among wor king unde r gr ound c oal mine r s with at le ast 25 ye ar s of unde r gr ound mining te nur e in KY, VA, and WV

 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 o 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 o 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 e 1. Ve nn F igur dia g ra m o f the o 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. NCBL RDC Annua l Co nfe re nc e , Sa lt L a ke City Se pte mb e r 27, 2017

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

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 o 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

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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