Skip to main content

Medical Screening After a Coal Fly Ash Spill in Roane County, Tennessee

  • Gregory P. Nichols (a1), Donna L. Cragle (a1) and John G. Benitez (a2)

To assess the health of community residents following a coal fly ash spill at the Tennessee Valley Authority Kingston Fossil Plant in Harriman, Tennessee, on December 22, 2008.


A uniform health assessment was developed by epidemiologists at Oak Ridge Associated Universities and medical toxicologists at Vanderbilt University Medical Center. Residents who believed that their health may have been affected by the coal fly ash spill were invited to participate in the medical screening program.


Among the 214 individuals who participated in the screening program, the most commonly reported symptoms were related to upper airway irritation. No evidence of heavy metal toxicity was found.


This is the first report, to our knowledge, regarding the comprehensive health evaluation of a community after a coal fly ash spill. Because this evaluation was voluntary, the majority of residents screened represented those with a high percentage of symptoms and concerns about the potential for toxic exposure. Based on known toxicity of the constituents present in the coal fly ash, health complaints did not appear to be related to the fly ash. This screening model could be used to assess immediate or baseline toxicity concerns after other disasters. (Disaster Med Public Health Preparedness. 2014;0:1–8)

Corresponding author
Correspondence and reprint requests to Gregory P. Nichols, MPH, CPH, ORAU/Occupational Exposure and Worker Health Programs, PO Box 117/MS-23, Oak Ridge, TN 37831-0117 (e-mail:
Hide All
1.Agency for Toxic Substances and Disease Registry. Tennessee Valley Authority Kingston Fossil Plant coal ash release: public health assessment; September 7, 2010.
2. Ash slide at TVA Kingston Fossil Plant: metals and polynuclear aromatic hydrocarbons results; January 6-7, 2009. Tennessee Department of Environment and Conservation website. Accessed August 2013.
3.Agency for Toxic Substances and Disease Registry. US Department of Health and Human Services. Toxicological profile for selenium; September 2003.
4.Agency for Toxic Substances and Disease Registry. Toxicological profile for thallium. 1992. website.
5.Knudson, RJ, Lebowitz, MD, Holberg, CJ, Burrows, B. Changes in the normal maximal expiratory flow-volume curve with growth and aging. Am Rev Respir Dis. 1983; 127(6):725-734.
6.Hsu, KHK, Jenkins, DE, His, BP, et al. Ventilatory functions of normal children and young adults – Mexican-American, white, and black. I. spirometry. J Pediatr. 1979; 95(1):14-23.
7. SAS version 9.2 [computer program]. Cary, North Carolina: SAS Institute Inc., 2009.
8.Agency for Toxic Substances and Disease Registry. US Department of Health and Human Services. Toxicological profile for arsenic; August 2007.
9.Agency for Toxic Substances and Disease Registry. US Department of Health and Human Services. Public health statement for arsenic; August 2007.
10.Office of Dietary Supplements, National Institutes of Health. Dietary supplement fact sheet: selenium; July 2013. Accessed August 2013.
11.Brook, RD, Rajagopalan, S, Pope, CA, et al. Particulate matter air pollution and cardiovascular diseases: an update to the scientific statement from the American Heart Association. Circulation. 2010; 121:2331-2378.
12. Kingston ash slide: air quality information; December 5, 2013. Tennessee Valley Authority website. Accessed August 2013.
13.Tennessee Valley Authority. Kingston ash recovery project non-time-critical removal action embayment/dredge cell engineering evaluation/cost analysis (EE/CA); January 15, 2010.
14.AECOM. Root cause analysis of TVA Kingston dredge pond failure on December 22, 2008; June 25, 2009.
15.Andrews, SC, Robinson, AK, Rodriguez-Quinones, F. Bacterial iron homeostasis. FEMS Microbiol Rev. 2003; 27(2-3):215-237.
16.Smith, KR, Veranth, JM, Kodavanti, UP, Aust, AE, Pinkerton, KE. Acute pulmonary and systemic effects of inhaled coal fly ash in rats: comparison to ambient environmental particles. Toxicol Sci. 2006; 93(2):390-399.
17.Antonini, JM, Roberts, JR, Jernigan, MR, Yang, HM, Ma, JY, Clarke, RW. Residual oil fly ash increases the susceptibility to infection and severely damages the lungs after pulmonary challenge with a bacterial pathogen. Toxicol Sci. 2002; 70:110-119.
18.Gao, F, Barchowsky, A, Nemec, AA, Fabisiak, JP. Microbial stimulation by Mycoplasma fermentans synergistically amplifies IL-6 release by human lung fibroblasts in response to residual oil fly ash (ROFA) and nickel. Toxicol Sci. 2004; 81:467-479.
19.Costa, DL, Dreher, KL. Bioavailable transition metals in particulate matter mediate cardiopulmonary injury in healthy and compromised animal models. Environ Health Perspect. 1997; 105(suppl 5):1053-1060.
20.Baumgardner, DJ. Fungal infection after evacuation or natural disaster. Wilderness Environ Med. 1997; 8:177.
21.Schneider, E, Hajjeh, RA, Spiegel, RA, et al.A coccidioidomycosis outbreak following the Northridge, Calif, earthquake. JAMA. 1997; 277(11):904-908.
22.Zakai, NE, McClure, LA, Prineas, R, et al.Correlates of anemia in American blacks and whites: the REGARDS renal ancillary study. Am J Epidemiol. 2009; 169:355-364. Romana, DL, Olivares, M, Uauy, R, Araya, M. Risks and benefits of copper in light of new insights of copper homeostasis. J Trace Elem Med Biol. 2011; 25:3-13.
24.Buchwald, A. Serum copper elevation from estrogen effect, masquerading as fungicide toxicity. J Med Toxicol. 2008; 4:30-32.
25.Cockel, KA, Bertinato, J, L’Abbe, MR. Regulatory frameworks for copper considering chronic exposures of the population. Am J Clin Nutr.. 2008; 88(suppl 3):863S-866S.
26.Longnecker, MP, Taylor, PR, Levander, OA, et al.Selenium in diet, blood, and toenails in relation to human health in a seleniferous area. Am J Clin Nutr. 1991; 53:1288-1294.
27.Agency for Toxic Substances and Disease Registry. US Department of Health and Human Services. Coal fly ash landslide Forward Township, Allegheny County, Pennsylvania: health consultation; June 2006.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Disaster Medicine and Public Health Preparedness
  • ISSN: 1935-7893
  • EISSN: 1938-744X
  • URL: /core/journals/disaster-medicine-and-public-health-preparedness
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed