Pool Poison: Preventable Injuries in the Thousands

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With scorching temperatures right around the corner, many people will be readying their pools, which can be a surprisingly dangerous business. According to a recent study by the CDC, 4,900 people visited the emergency department for preventable pool chemical injuries in 2012. Commonly, the diagnosis of these injuries was poisoning, which would stem from things such as inhalation of vapors, fumes and gases. Fortunately, there were no deaths relating to pool chemicals at the time of the study.

EpiCenter allows public health departments to create and implement custom classifiers by building their own keyword lists. After reading the  CDC’s MMWR  regarding injuries related to pool chemicals, we built a custom classifier to detect exposure to pool chemicals using keywords like “chlorine poisoning” and “chlorine exposure.” We noticed that as of May 22nd, we have already begun to see a steady increase in the number of ED visits related to pool chemicals.

In 2013, 16 people were sent to the hospital after pool chemicals were incorrectly mixed at Mainland Regional High School in New Jersey.  The school’s superintendent said the chemical being used at the school was not supposed to contain chlorine, but was normally disinfected through a nonchlorine “shock treatment.” When the Atlantic County Office of Emergency Preparedness hazardous materials team tested the chemicals that caused the noxious fumes and required the evacuation of the building , however, they did find chlorine. At HMS, we were able to locate the visits associated with the incident in our system, which included complaints of chemical inhalation, chest pain, dizziness, and respiratory issues among 15-17 year-olds with home zip codes in the regions surrounding the school.

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Following the incident, New Jersey created a custom classifier to track chemical exposure-related ED visits and trigger notifications to be sent to public health officials in the event of another incident like the one at Mainland Regional High School. Since September of last year when the classifier was implemented, users have been alerted about a number of these sorts of events, and EpiCenter has aided public health officials in their process of triaging, investigating, and following up.

Chlorine is the product most commonly used to disinfect swimming pools, but many people don’t realize that chlorine exposure can be a serious health risk. The New York State Department of Health released facts about chlorine intended to educate the public about how chlorine poisoning affects the body. When chlorine enters the body as a result of breathing, swallowing, or skin contact, it reacts with water to produce acids. The acids are corrosive and damage cells in the body on contact. According to the CDC, some of the immediate signs and symptoms of chlorine exposure include:

• Blurred vision
• Burning pain, redness, and blisters on the skin if exposed to gas. Skin injuries similar to frostbite can occur if it is exposed to liquid chlorine
• Burning sensation in the nose, throat, and eyes
• Coughing
• Chest tightness
• Difficulty breathing or shortness of breath. These may appear immediately if high concentrations of chlorine gas are inhaled, or they may be delayed if low concentrations of chlorine gas are inhaled.
• Fluid in the lungs (pulmonary edema) that may be delayed for a few hours
• Nausea and vomiting
• Watery eyes
• Wheezing

For those working within the realm of public health, increasing public awareness around the dangers of chlorine can go a long way toward keeping a community safe. The CDC has recommendations on pool chemical safety available online. They also provide pool chemical safety handouts for download and distribution.