Framework for Handling Asbestos After a Tidal Surge

* INTERNATIONAL PERSPECTIVES

Abstract The tidal surge associated with Tropical Cyclone Yasi-a Category 5 system-on February 3, 2011, culminated in asbestos-containing material (ACM) becoming comingled with soil, sand, vegetation, and other debris in the communities of Tully Heads and Hull Heads in Queensland, Australia. The situation was a major concern and the area was deemed by the Queensland Government a priority due to the potential public health risk. The immediate challenge was that no agreedupon operational framework existed between key response organizations for handling ACM after a tidal surge. This resulted in the development of strategies for addressing this situation during the response. An expansion of "declared disaster officers" under Queensland's Disaster Management Act 2003 was required to allow licensed asbestos contractors to enter and clean up public and private land at Tully Heads and Hull Heads. This declaration was the first time a group of people other than enforcement officers had been given such powers in Queensland. The situation was handled effectively; however, lessons have been learned and improvements can he made to enhance efficiency, planning, and reporting.

Introduction

The tidal surge associated with Tropical Cyclone Yasi culminated in asbestos-containing material (ACM) becoming comingled with soil, sand, vegetation, and other debris in the communities of Tully Heads and Hull Heads in Queensland, Australia. These are small communities on the northeast coast of Australia, approximately 160 km south of Cairns and 1,600 km north of Brisbane, the state capital of Queensland. The situation became a concern because improper handling and disposal of ACM could lead to future environmental and health issues (Luther, 2011). Further, no agreed-upon framework existed between key response agencies for handling ACM after a tidal surge, nor was there evidence of a similar situation occurring in recent Australian history.

To facilitate preparedness for disasters, this article discusses what occurred and provides a framework for handling asbestos, and possibly other public health risks, based on this experience. This article includes an overview of the cyclone, the definition of ACM, an outline of the public health risk of asbestos, discussion of the response, and a description of the processes used. The lessons learned are also discussed in order to provide an understanding of the challenges that may arise if a similar situation is experienced. Finally, an implementation strategy is provided along with a suggestion that this approach be applied as a generic framework for other public health risks.

At Tully Heads and Hull Heads, many of the houses alongside the road parallel and closest to the beach suffered major damage from the tidal surge, and some single-story houses washed away (see photo on page 2). The tidal surge penetration inland was approximately 500 m and reached around 1.5-2 m above the highest astronomical tide (James Cook University, 2011).

Prior to the cyclone, the largest hospital in the Cairns region, Cairns Base Hospital, was evacuated. An evacuation also occurred of low-lying areas between Cairns and Townsville (James Cook University, 2011). The cyclone impacted a region with a population of approximately 450,000 (Australian Bureau of Statistics, 2012). No deaths or serious injuries occurred as a result of the impact of the cyclone. The power supply to more than 220,000 homes and businesses was interrupted, with supplies restored to 200,000 homes and business within the first week and the remainder connected within 23 days (Queensland Reconstruction Authority, 2011).

Tully Heads and Hull Heads Demographics

According to the Australian Bureau of Statistics (2011) census data, the population of Tully Heads and Hull Heads was 438 with 245 males and 193 females. The median age was 55 years. The most common ancestries were English, 33%; Australian, 27%; Irish, 9%; Italian, 8%; and German, 6%. The majority of people were born in Australia (86%) and the most common overseas countries were England, New Zealand, Hungary, Italy, and Netherlands. At the time of census the most common religions were Catholic, 31%; no religion, 24%; Anglican, 22%; Uniting Church, 8%; and Presbyterian and Reformed, 6%. The families were 25% couples with children, 59% were couples without children, and 16% were one-parent families.

ACM

Asbestos is a generic name that refers to a group of six naturally occurring fibrous silicate minerals (actinolite, amosite, anthophylite, chrysotile, crocidolite, and tremolite) (Mahini, 2005). These fibrous minerals have properties that make asbestos cost-effective and versatile. They have high tensile strength, chemical and thermal stability, flexibility, and low electrical conductivity (Masayuki & Seiirchiro, 2006). ACM is made up of products or materials that contain asbestos in an inert bound matrix such as cement or resin (Department of Health, 2009). This material is included in building products such as profiled sheets used on roofs and walls and flat sheets in flashings, imitation brick cladding, roof shingles, plaster patching compounds, textured paint, and vinyl floor tiles (Occupational Health and Safety Unit, 2011). Although asbestos is now banned from use in Australia, it was a component of thousands of different products used in the community and industry from the 1940s until the late 1980s with some uses of asbestos products, mainly friction materials and gaskets, continuing until December 31, 2003 (Department of Justice and Attorney-General, 2009).

What Is the Public Health Risk?

Asbestos exposure has been shown to cause mesothelioma as well as lung cancer and nonmalignant pulmonary and pleural disorders (Kukkonen et al., 2011). Mesothelioma is caused by the inhalation of needle-like asbestos fibers deep into the lungs where they can damage cells (National Occupation Health and Safety Commission, 2005). The latency period between initial exposure and the onset of disease is 15 or more years, but varies with intensity of exposure (Antao, Pinheiro, & Wassell, 2009). Mesothelioma was once rare, but its incidence is increasing throughout the industrial world as a result of past exposures to asbestos. Australia has the highest incidence in the world (National Occupation Health and Safety Commission, 2005) along with Belgium and Great Britain (Bianchi & Bianchi, 2006).

Asbestos poses a risk to health whenever asbestos fibers become airborne and people are exposed to these fibers (Occupational Health and Safety Unit, 2011). Asbestos fibers are common in the general environment at low levels. According to Queensland Health (2010), low-level exposure to asbestos fibers is considered unlikely to result in the development of an asbestos-related disease, as fiber concentrations are likely to be insufficient to increase cumulative lifetime exposure. ACM when dry is considered friable and may become crumbled, pulverized, or reduced to powder by hand pressure. In this form ACM poses the greatest health risk (Department of Education, 2007). Although asbestos can have dangerous health effects, it is safe if handled correctly (Department of Justice and Attorney-General, 2011). The lack of immediate health effects has often meant that victims are unaware of the risks and subsequently exposure to the hazard can continue over a long period, causing serious health effects (Department of Justice and Attorney-General, 2009).

If left undisturbed, ACM poses a negligible health risk because the asbestos fibers are bound (Queensland Health, 2010). Air testing near the ground has shown the concentration of fibers is very low for undisturbed asbestos, very similar to it not being present (The Western Australian Advisory Committee on Hazardous Substances, 1990). All types of asbestos, if disturbed (i.e., through drilling and cutting) and inhaled at sufficient doses, can be harmful (Valic, 2002). The potential health impacts posed by different asbestos minerals and fiber dimensions should be treated as equivalent (Department of Health, 2009). The World Health Organization control limit for asbestos fibers in any localized atmosphere, measured and averaged over four hours, is 0.1 asbestos fibers per cubic centimeter of air (0.1 f/cm3). This is not deemed to be a safe level and any type of work activities involving asbestos should be designed to be as far below the control limit as possible (Health and Safety Executive, 2011).

ACM in a Disaster Response

One of the immediate problems after a disaster is the mixing of hazardous and nonhazardous wastes (Wisner & Adams, 2002). ACM is considered a hazardous waste and as such needs to be identified early during a disaster response and handled appropriately to prevent any risks to public health. This is particularly important to ensure subsequent disturbance and dissemination do not occur across the area and result in costly delays and extra investigative and remediation effort (Department of Health, 2009). Improper disposal of ACM may lead to future environmental health issues and highlights the need for an agreed-upon and coordinated approach when handling ACM after a disaster (Luther, 2011). Further, it is unlikely that the community, response volunteers, and workers will, in the first instance, be provided with appropriate personal protective equipment (PPE), thus increasing their risk of long-term health problems (Alexander & Liangmahe, 2008).

Response to Tropical Cyclone Yasi

The communities of Tully Heads and Hull Heads in the Cassowary Coast Regional Council (CCRC) area, Queensland, Australia, were heavily impacted by a tidal surge from Tropical Cyclone Yasi. Due to the age of some dwellings (pre-1990s), the tidal inundation resulted in ACM becoming comingled with other debris and impregnated in the soil across private and public land (see photo above). An initial environmental health rapid assessment of Tully Heads and Hull Heads was conducted on February 4, 2011, by teams of environmental health officers (EHOs) from Queensland Health in response to Tropical Cyclone Yasi.

The situation became a major concern and the area was deemed a priority due to the potential public health risk and growing media interest. The local communities used the media to get messages across to politicians and the general public about the issue and the need for rapid assistance. The issue was also escalated due to an upcoming state election.

The main public health concern was that if ACM was not cleaned up, or it was stored untreated, a further risk to public health may be presented through future daily activities such as lawn mowing and gardening. The immediate risk to public health associated with an appropriate cleanup was considered minimal; however, ACM is not biodegradable and if left unmanaged it presents an unknown public health risk in the future. Also, the full extent of the situation was unknown as the area was initially inaccessible for response agencies.

In response, key messages on the safe handling of ACM were communicated through newsletters, talk back radio, and information at community centers. A list of licensed contractors for asbestos removal and transport was made available, and residents, the state emergency service, and the army were also requested to notify CCRC of any suspected asbestos debris in the area and if possible to cordon off the area to restrict or prevent access.

The public was provided with access to asbestos kits containing gloves, masks, tape, plastic, and body suits at all community centers. Initially, it was business as usual for a disaster response:

* ACM on private property was the responsibility of the owner/occupier;

* owners/occupiers were requested to separate debris and place on the curbside and if possible double-wrap ACM in plastic; and

* CCRC collected ACM for disposal.

CCRC commenced remediating the public land at Tully Heads on February 10, 2011. This was being undertaken by a qualified asbestos removalist team. It quickly became evident that the contamination of the tidal surge areas of Tully Heads and Hull Heads was beyond the capacity of local resources. At the same time a significant amount of media and political interest was present about the need to remediate the area quickly to allow the community to go back to their homes. This included community meetings with Members of Parliament to rally support.

On February 11, 2011, the estimated cost for the ACM cleanup of residential properties was reported as far exceeding insurance payouts. Subsequently, prop- erty owners were going to find it difficult to cover the costs in ensuring the appropriate disposal of the hazardous waste and remediation of their property. Due to this issue and the growing concerns about the heavy amounts of ACM comingled with other debris, a decision was made by CCRC and Queensland Health that the cleanup of this area would need to be funded and undertaken by licensed asbestos contractors.

At the Local Disaster Management Group (LDMG) and District Disaster Management Group (DDMG) meeting on February 16, 2011, a decision was made that the Department of Public Works (QBuild) would lead the response in the Tully Heads and Hull Heads areas affected by the tidal surge. To guide this response an asbestos working group (AWG) was formed to coordinate and address all issues throughout Tully Heads and Hull Heads. The members of the AWG included Queensland Police (Chair); Queensland Health; QBuild; Department of Environmental and Resource Management; CCRC; Workplace Health and Safety; Department of Employment, Economic Development and Innovation; and the Department of Communities.

The AWG met for the first time on February 16, 2011, to formulate a strategy for commencing works. This included discussing the scope of work; possibilities for evacuating the area while heavy machinery was being used for the cleanup, transportation, and appropriate handling and disposal of ACM; provision of PPE to workers and residents; and appropriate communication to the residents. As a number of government agencies with a vested interest in asbestos-related issues were being represented, a course of action had to be determined and agreed upon (e.g., education rather than enforcement).

The need for the DDMG to extend the definition of "declared disaster officers" under Queensland's Disaster Management Act 2003 to clean up Tully Heads and Hull Heads was also discussed and later approved. These powers are generally provided for responders such as ambulance officers, fire officers, health officers, police officers, and other people who have the necessary expertise or experience to exercise the powers. Powers include the ability to control the movement of people, enter property, destroy or demolish property, etc. In this situation, expansion of the "declared disaster officers" was required to include licensed contractors so they could carry out the required tasks in the declared disaster area. This declaration was the first time a group of people had been given such powers in Queensland.

A key element of the AWG was to ensure effective communication with the residents and the general public. The AWG addressed a public meeting at Tully Heads on February 16, 2011. During the meeting residents were advised the group had been formed with a directive to ensure that their community was efficiently and safely cleaned as a matter of urgency. Residents were also advised that PPE and appropriate bagging materials in asbestos packs were available to all residents in the area to ensure exposure to asbestos fibers was minimized during cleanup operations (if they chose to stay in the area).

On February 18, 2011, the remediation of affected areas of public and private land commenced. As part of this an approved emergency disposal site at Hull Heads was opened. Teams of asbestos removal contractors were mobilized and they removed broken ACM from yards, streets, road verges, footpaths, and mangrove areas behind properties and the top layer (approximately 300 mm) of sand containing debris.

PPE was continually made available to all residents in the affected areas and QBuild was communicating with the community (via newsletters) about the works. Permission was granted for volunteers to assist on the condition that a licensed asbestos contractor was present. Also, Queensland Police Service and QBuild road blocks were put in place to ensure that only authorized residents and contractors were permitted access to the site during remediation.

One month after the cyclone crossed the coast, on March 7, 2011, the ACM cleanup in the areas of Tully Heads and Hull Heads was declared complete. Throughout the cleanup, newsletters were continually distributed to residents every few days about the status of the remediation and the precautions required ensuring the safe removal of ACM within their own yards.

It was estimated that within Tully Heads and Hull Heads, 50% of general waste piles contained ACM. Both communities were remediated with the top 300 mm of soil taken from affected areas with a total of 7,000 m3 of contaminated soil disposed of at the old Hull Heads landfill. This soil was capped by 800 mm of a clay-based material and 300 mm of mulch, then fenced and signed to prevent any future environmental health risks.

Legislative Powers

In Queensland, Australia, the Public Health Regulation 2005 provides the primary legislative guidance for handling asbestos. Homeowners and owner-builders must hold a certificate to remove more than 10 m2 of nonfriable (bonded) asbestos materials (Queensland Government, 2011). Removing more than 10 m2 of nonfriable asbestos materials must be undertaken by a licensed asbestos removalist (Queensland Government, 2011). This presented a challenge as most private properties had more than 10 m2 of nonfriable asbestos and occupiers did not hold an appropriate certificate.

The ambiguity of the legislation and its administration added complexity to the response. Administration is shared between local government, Queensland Health, and Workplace Health and Safety. Generally, enforcement on private property is undertaken by EHOs from Queensland Health, and Workplace Health and Safety regulate licensed asbestos contractors or removalists (e.g., workplaces and businesses). On Queensland governmentowned land, the Department of Public Works overseas asbestos management activities for the state.

Access to property was not a major issue during the response. Business-as-usual processes were followed during the response, which included seeking permission to enter. As it was a declared disaster area under the Disaster Management Act 2003, however, any place in the declared area could be accessed by authorized people.

Funding

The cleanup of Tully Heads and Hull Heads was funded through the Australian Government Natural Disaster Relief Recovery Arrangements (NDRRA). The arrangements are formed around three levels of government: local, state, and fed- eral (Department of Community Safety, 2012). The Queensland disaster management arrangements, however, include an additional state government tier between local and state governments known as disaster districts (Department of Community Safety, 2012). This model allows for an effective operational service delivery to support local communities in a large geographical and decentralized state.

Once a disaster is declared by the Premier of Queensland or relevant minister, grant schemes and other assistance programs are activated. For example, when local resources are overwhelmed in a disaster situation, assistance (including funding) is sought from the district. This process is replicated up through the system until support is received. The support and delivery of services are always focused on the local government.

In this situation, support was provided by the district and state to clean up Tully Heads and Hull Heads. The overall cost for the cleanup is unknown but the damage from Tropical Cyclone Yasi was estimated to cost U.S. $950 million (The Australian, 2011).

Framework for Handling Asbestos After a Disaster

During the response it became evident that no agreed-upon framework existed for the handling of ACM after a disaster. Using the steps undertaken during the response and through consultation with the Far North Queensland Public Health Disaster Management Working Group (working group), a framework for handling asbestos after a disaster has been developed (Figure 1). The working group is made up of environmental health and disaster management experts from across the region.

The purpose of the framework is to provide guidance on the steps to be undertaken. For this framework to be effective and applied locally it is vital for LDMGs to undertake stakeholder engagement and determine who performs the necessary steps (e.g., conducting field assessments, clarifying the priority definition, and who completes the remediation). It is recommended that an assessment of a community be completed within 48 hours to determine the priority of the required actions. Due to limitations in the rapid identification of ACM this would only include a visual inspection. Although this is not 100% accurate this method allows an investigator to establish a reasonable belief that ACM is or is not present. This approach is supported in Queensland by the Public Health Act 2005, which allows reasonable belief to be used as justification for a public health order (a direction for certain action to be undertaken).

The assessment of ACM involves answering three questions about the house/structure:

* Is it built before 1990?

* Does the material look like a material known to contain asbestos?

* Is the material installed in a location where ACMs were known to be used?

The underlying theme of any visual inspection would be to categorize any suspected material as ACM (Queensland Health, 2008). The subsequent actions required would be determined by priority:

* high-priority areas would be defined as areas where nonbonded and bonded ACM are comingled with other debris (e.g., tidal surge);

* medium-priority areas have bonded ACM debris that has not been comingled; and

* low-priority areas are where no ACM debris is present.

The immediate actions required for a high-priority area may include preventing entry into a community until the risk is removed or reduced. Meanwhile, for a medium-priority area this may result in a local government providing access to asbestos kits, information on cleanup requirements, and advice about storage of ACM waste for collection. For a low-priority area, no action is required.

A need exists for ongoing public awareness to be undertaken as a parallel activity. This would include the provision of advice around the handling and storage of ACM (e.g., keep wet and covered), and where residents could collect asbestos-handling kits. Advice would also be provided about the separation of ACM from other debris, labeling requirements, and the need to restrict access, particularly for children.

Implementation Strategy

To enhance preparedness for disasters, the following suggested actions have been provided for governments and key response organizations to effectively manage ACM. It is recommended these actions be complemented by the asbestos-handling framework in Figure 1.

1. Establish an agreed-upon framework for handling ACM after a disaster.

2. Develop an understanding of the communities that have buildings with suspected ACM. This information can then be used to determine the priority areas for assessment after a disaster. It is recommended that an asbestos map (similar to a flood map) of communities be created.

3. Conduct monitoring of airborne ACM (in areas where ACM is believed to be present) to measure the level of public health risk and allow appropriate actions to be taken (e.g., preventing people from entering a community unless they are wearing PPE).

4. Identify disposal sites for ACM and the processes that will be undertaken to transport the debris.

5. Develop fact sheets to ensure consistent and accurate messages are communicated to the public.

6. Determine who will conduct rapid assessments (within 48 hours) of communities after a disaster. It is also important to ensure these people have the appropriate skills and training. Also, formalize how this will be conducted (e.g., the tools that will be used, transportation to assessment sites, and reporting structure).

7. Maintain a store of asbestos cleanup packs that can be efficiently accessed and distributed throughout the community after a disaster.

8. Document the process in the appropriate disaster management plan.

Application of Framework to Other Public Health Risks

The asbestos-handling framework (Figure 1) and implementation strategy can be applied to any public health risk after a disaster. It provides a generic template for ensuring preplanning is conducted with all stakeholders, provides a mechanism for systematically identifying public health risks prior to a disaster, and allows interventions to be based on evidence. For example, point two from the implementation strategy could be expanded beyond identifying buildings with suspected ACM to gathering baseline public health data (e.g., drinking water system, location of chemical plants, type of sewage systems, etc). All of these are vital for identifying and measuring the impact of a disaster on public health. Such an approach would ensure a comprehensive framework is available to efficiently prepare for and respond to the public health risks associated with disasters.

Lessons Learned

* Most communities in Australia have some structures containing ACM and during cyclones, floods, fires and tidal surges, this material will be scattered and may pose a public health risk.

* The main objective during a disaster response must be to minimize the risk to all of the community while removing ACM and other hazardous material.

* During a disaster situation, simple plans produce less confusion.

* Community awareness of what is happening during a disaster response is vital.

* An agreed-upon framework needs to be in place between responding organizations for handling ACM prior to a disaster.

* A framework for handling ACM needs to be included in disaster management plans, which also requires a disposal site that will receive the material during the response.

* A comprehensive environmental health response framework is required to address all public health risks before and after a disaster.

Conclusion

The tidal surge associated with Tropical Cyclone Yasi facilitated the comingling of ACM with soil, sand, vegetation, and other debris in Tully Heads and Hull Heads thus providing a unique challenge to both the community and the response organizations managing the disaster cleanup. The main challenge was no agreed-upon framework existed between key response organizations for handling ACM after a tidal surge. This required the strategies for addressing this situation to be developed during the response. The response included the establishment of an asbestos working group, which developed and implemented a strategy for remediating these communities. This approach allowed the situation to be handled effectively. A number of improvements can be undertaken, however, to enhance efficiency. The most vital improvement is the development of an agreed-upon framework for handling ACM among response organizations, which will open communication lines, enhance preparedness, and more broadly improve responses to public health risks associated with future disasters.

Prepublished online September 2013, National Environmental Health Association.

Although most of the information presented in the Journal refers to situations within the United States, environmental health and protection know no boundaries. Thejoumal periodically runs International Perspectives to ensure that issues relevant to our international membership, representing over 30 countries worldwide, are addressed. Our goal is to raise diverse issues of interest to all our readers, irrespective of origin.

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Ben Ryan, MPH

Queensland Health

Ian Kuhl

Kuhl-Meadows

Rebecca Ware

Queensland Health

Corresponding Author: Ben Ryan, Environmental Health Officer, Queensland Health, William McCormack Place II Level 7, 5 Sheridan Street, Cairns QLD 4868, Australia. E-mail: [email protected].