Health Effects Related To Fracturing Operations for Oil and Natural Gas

Toxic substances are present at every level of the fracturing process. Many of the chemicals used are proven toxins. These include benzene, ethylbenzene, toluene, xylene, naphthalene, polycyclic aromatic hydrocarbons, methanol, formaldehyde, ethylene glycol, glycol ethers, hydrochloric acid, sodium hydroxide, and others, which are hazardous if inhaled, ingested, or contacted by the skin. Some are considered caustic, carcinogenic, mutagenic, and/or teratogenic.

Of the hundreds of fracturing chemicals tested by the Endocrine Disruption Exchange, 93% of them affect health and 43% are endocrine disruptors. Endocrine disruptors are chemicals that, when absorbed into the body, mimic or block hormones and disrupt the body’s normal function. They have been linked to infertility, ADHD, autism, diabetes, thyroid disorders. There is even a link between some cancers and fetal exposure to endocrine disruptors. More information can be found here: http://endocrinedisruption.org/chemicals-in-natural-gas-operations/introduction

In addition to the chemicals used in fracturing, the waste water that is a byproduct of the drilling process picks up salts, naturally occurring radioactive material, barium, magnesium and various other volatile organic compounds, which are also carcinogenic. It has been concluded that the waste water contains radioactivity and other toxic materials at levels that are frequently higher than the level that federal regulators say is safe for waste water treatment plants to handle, and higher than many drinking water standards.

In states where fracturing for oil and natural gas has already occurred there have been many reports of serious health issues impacting the local residents. Studies are showing that residents living within 1-10 miles from horizontal fracturing sites may be affected by several aspects of the fracturing operations, of utmost concern are the impacts from air and water pollution.

Health impacts from fracturing related air and water contamination are dependent on many factors such as the resident’s age, sex, pregnancy status, and preexisting medical conditions. Also those factors associated with the site and operations itself such as the types of chemicals used, depth and length of drilling, various technology and processes used on the frack fields, truck traffic patterns, flaring patterns, wind patterns, local topography, geology and hydrology, and noise and light levels. Readers should be aware that researchers are finding that health impacts from fracturing operations fall disproportionately on sensitive populations, (children, elderly, pregnant women).

We recommend that residents within 10 miles of a proposed horizontal fracturing operation take notice of the permitting of the operation at the Illinois Dept. of Natural Resources. We recommend that you research the proposed fracturing operations, and if the operations are allowed to proceed then take notice of when work is started at the site. The more information that you collect and document about fracturing operations in your area the better you will be able to respond if there is a problem for you or your family, livestock, domesticated animals, and property.

The 2 predominant sources of toxic exposure that might cause fracturing related illnesses are air pollution and water contamination. Air pollution is often the first toxic exposure to occur near a fracturing site and will be covered in more detail on this page. Air pollution can start very soon after fracturing operations commence. The health effects of water contamination due to fracturing operations are sometimes subtle, often delayed and have been seen even years after a fracturing operation have been completed.

Sources of Oil and Gas Air Pollution

Much of the following information was summarized from an EARTHWORKS report on sources of oil and gas air pollution from fracturing operations. More information can be seen here: www.earthworksaction.org/issues/detail/sources_of_oil_and_gas_air_pollution#.UfbG66wjPni

Fracturing operations release significant air pollution including diesel exhaust, and fumes from flaring and open pits. This air pollution has been found in other states to contain many volatile organic compounds such as BTEX, (benzene, toluene, ethylbenzene, and xylene), and other air pollutants such as nitrogen oxides, carbon monoxide, sulfur dioxide, hydrogen sulfide, silica sand, and particulate matter. Sometimes the emissions are carried high into the sky by the wind until they are deposited to the ground, often miles away. Sometimes they are blown straight toward nearby homes.

The wide variety of air contaminants emitted from oil and natural gas fracturing operations are released from a number of sources: construction activity, engines, flaring, fugitive emissions, open pits, condensate tanks, dehydrators, vehicles and venting.

Construction activity
Construction accompanies every phase of the fracturing operations for oil and natural gas. Each phase requires disturbing the soil to some degree which generates particulate matter and stirs up dust, which in turn reacts with other chemicals and gases to form ground-level ozone, or smog.

Engines
Trucks, rigs and equipment found at fracturing operations typically run off of diesel-powered or gasoline engines. The engines can produce emissions that can impact people living downwind. Polycyclic aromatic hydrocarbons (PAHs) are found in exhaust from gasoline and diesel engines. A long list of other air pollutants, including nitrogen oxides, carbon monoxide, BTEX, formaldehyde and metals are also found in diesel exhaust.

Flaring
Flaring is the practice of burning gas that is deemed uneconomical to collect and sell. Flaring is also used to burn excess gases that present safety problems. It is common to flare natural gas that contains hydrogen sulfide (sour gas), in order to convert the highly toxic hydrogen sulfide gas into less toxic compounds. Inefficient flaring often results in hydrogen sulfide emissions if hydrogen sulfide is present in large enough amounts in the natural gas. Flares emit many other air pollutants, depending on the chemical composition of the gas being burned and the efficiency of the flare. In California, researchers found that the following air pollutants may be released from natural gas flares: benzene, formaldehyde, polycyclic aromatic hydrocarbons (PAHs, including naphthalene), acetaldehyde, acrolein, propylene, toluene, xylenes, ethyl benzene and hexane. (Researchers in Canada have measured more than 60 air pollutants downwind of natural gas flares, their list can be found at: http://wassmer.org/Adrian/W15958Leahey2001.pdf.)

Fugitive Emissions
Fugitive emissions are unintentional leaks of gases. This may occur from breaks or small cracks in seals, tubing, valves or pipelines, as well when lids or caps on equipment or tanks have not been properly closed or tightened. When natural gas escapes via fugitive emissions, methane as well as volatile organic compounds (VOCs) and any other contaminants in the gas (hydrogen sulfide) are released to the atmosphere.

A team of high-tech Environmental Protection Agency investigators used an infrared camera to record fugitive emissions off of fracturing operations, which are normally invisible to the naked eye. See the gases escape at this link:
https://www.youtube.com/watch?v=uH4Rx4zIUBM&list=UUe-EKlp_5biyXHHQ-IEUTpA
Without an infrared camera to detect the plumes of the volatile chemicals escaping from the tanks and infrastructure, it would be difficult to suspect that the tanks could pose a public health problem.

Pits
Open earthen pits are often used to store or evaporate produced waste water from the oil and natural gas wells and waste water from natural gas dehydration or oil/gas separation units. Additionally, prior to disposing drilling wastes (muds and cements) and fracturing flowback waste fluids, they are often stored in earthen or metal pits that are open to the air. There are hundreds of different chemicals that may be used during drilling and fracturing, including acids, biocides, surfactants, solvents, lubricants and others.
Chemical compounds that are naturally present in natural gas, or chemicals that have been injected into the well during drilling or fracturing operations, will be present in the water or wastes that are held in pits. Some of the lighter or more volatile chemicals and compounds, such as benzene, toluene, hydrogen sulfide, etc., will escape from the produced water pits into the atmosphere. These chemicals may then be transported through the air, to nearby residences. The odors associated with the natural gases or chemicals will vary, depending on the concentrations, volumes, and combinations of chemicals released.

Condensate tanks
Some natural gas wells produce a semi-liquid condensate along with the gas. Condensates are hydrocarbons that are in a gaseous state within the reservoir but become liquid during the production process. Condensates are composed of hydrocarbons as well as aromatic hydrocarbons such as benzene, toluene, xylenes and ethylbenzene (BTEX). Condensates may give off a characteristic hydrocarbon or petroleum-type smell. BTEX gives off a sweet, aromatic odor. Most people can smell benzene when it reaches levels of approximately 1.5 – 5 parts of benzene per million parts of air (ppm). The Occupational Safety and Health Administration (OSHA) has set maximum exposure levels for workers at 1 ppm (over an 8-hour period) and 5 ppm (over a 15-minute period). At levels above150 ppm some people may begin to experience serious and irreversible health effects. The vapors of benzene, toluene and xylenes are heavier than air and may accumulate in low-lying areas.

Dehydrators
Around natural gas wells there are found glycol dehydrators to remove water from the gas, the dehydrator may release aromatic organic chemicals to the atmosphere. If the natural gas undergoing dehydration contains benzene, toluene, or other volatile organic compounds, significant quantities of these compounds can be released when the glycol solution undergoes regeneration.

Vehicles
The biggest pollutant from motor vehicle traffic at oil and gas operations is dust.
Burning fuel to power trucks also emits nitrogen oxide, carbon monoxide, and sulfur dioxide, as well as particulate matter. These compounds combine with VOCs to form ground-level ozone (smog).

Venting
Venting is the release of gas to the atmosphere. Venting occurs at a number of points in the oil and gas development process (well completion; well maintenance; pipeline maintenance; tank maintenance; etc.). During oil and gas development, huge quantities of gas may be vented to the atmosphere. For example, during well completion, after a well is drilled and stimulated or fractured, the wellbore and surrounding formation must be cleaned out. The solids and fluids from the well go into pits, while the gases are allowed to escape into the atmosphere, or they are burned off (flared). It has been estimated that a single well Wyoming’s Jonah field will emit 115 tons of VOCs, and 4 tons of hazardous air pollutants such as benzene, toluene, ethylbenzene, xylene and hexanes. If the gas is flared, rather than vented, the emissions of VOCs and HAPs are reduced to 29 and 1 ton, respectively; but flaring of completion gases also results in the release of more than a ton of nitrogen oxides, and almost half a ton of carbon monoxide per well.

Methane
The primary component of natural gas is methane, which is odorless when it comes directly out of the gas well. At gas processing facilities, chemical odorants such as mercaptans are added to methane, so that consumers are able to smell it in the event of a gas leak. In addition to methane, natural gas typically contains other hydrocarbons such as ethane, propane, butane, and pentanes. Raw natural gas may also contain water vapor, hydrogen sulfide (H2S), carbon dioxide, helium, nitrogen, and other compounds.
Almost all references to the odor of raw or wellhead natural gas state that it, like methane, is odorless. But, in some cases, there may be a slight hydrocarbon odor associated with venting of natural gas. If the concentration of H2S in the gas is high enough, there may also be a “rotten egg” odor associated with the gas.

To give you an idea of the extent of air pollution near fracturing operations, we have included a comprehensive report released by Earthworks in 2013 on fracturing related air pollution in the Eagle Ford Shale region of Texas, “Reckless Endangerment in the Eagle Ford Shale: Government fails, public health suffers and industry profits from the shale oil boom.

Fracturing related air pollution is such a risk that in 2012 researchers were able to quantify the risk as it related to distance from a well site. They found that residents living ≤ ½ mile from wells are at greater risk for health effects from natural gas development than are residents living >½ mile from wells. Exposures to air pollutants during well completion activities were found to present the greatest risk for health effects. The risk for residents was driven primarily by exposure to trimethylbenzenes, xylenes, and aliphatic hydrocarbons. Cumulative cancer risks were 10 in a million and 6 in a million for residents living ≤ ½ mile and >½ mile from wells, respectively, with benzene as the major contributor to the risk. More information can be found here:
Human health risk assessment of air emissions from development of unconventional natural gas resources.

Water Contamination

Groundwater and even surface water contamination can occur from leaking storage containers, abandoned wells and failed casings of the oil or natural gas well itself.
As mentioned above the health effects of water contamination caused from fracturing operations are often subtle and delayed, and are somewhat dependent on those chemicals that are used in the fracturing operations located in your area.

In 2013 researchers in Garfield County, CO after collecting and analyzing water samples from areas near gas fracturing operations found elevated levels of endocrine-disrupting chemical activity in surface and ground water. These chemicals have been linked to infertility, birth defects, and cancer. More information can be found here: http://press.endocrine.org/doi/abs/10.1210/en.2013-1697?sid=2dea62d6-f51d-4277-8fc7-07b49313cc77&

We do recommend that you test your water both before drilling commences and regularly after drilling operations start, and of course if contamination is suspected or sensed directly.

Additional aspects of fracturing operations that might impact your health

–Handling, trucking and disposal of radioactive waste water and sludge
–Accidents involving transportation of radioactive/chemical waste
–High levels of radon in natural gas coming up from the well by itself and/or mixed with oil
–Respirable crystalline silica exposure, (a known carcinogen), (see Workers’ Health Issues)
–Oil, gas, waste water or chemical spills causing air pollution and water contamination
–Noise and light pollution – There have been many reports by residents living near fracturing operations of serious physical symptoms due to excessive noise and light from frack fields that often operate 24/7. Symptoms such as an increase in anxiety, stress, symptoms of mental illness, and sleep disturbances. These symptoms will not be covered in detail on this page but should be brought to the attention of your medical provider.

A Brief List of Physical Symptoms Commonly Reported Near Fracturing Operations

If you or your family experiences any new onset medical symptoms that occur after the start of fracturing operations then please seek medical care and carefully document your symptoms and medical care from that point forward.

Occasionally residents living around fracturing operations will experience an increase in the frequency or severity of already occurring physical symptoms as the first indication of toxicity from air or water contamination due to fracturing operations. If you notice your respiratory, cardiovascular, dermatological, gastrointestinal or neurological symptoms worsening after a fracturing operation commences in your area then please consult your medical provider immediately.

A complete list of all of the possible fracturing related physical symptoms is impossible to compile. The short list of symptoms below is not exhaustive, and there are many other symptoms that should raise concern. It has been reported that people with medical problems related to fracturing operations often present with their own unique constellation of symptoms, so every case can vary greatly. Please seek medical care for any symptom that is causing you or your family problems, and mention your exposure to fracturing operations to your medical provider at the time of the visit.

Bad Smells or Tastes
Often residents around fracturing operations complain of a bad smell, a petroleum or chemical smell, or a “bad egg” smell to their air or water. Frequently they will complain of a recurrent metallic or noxious taste in their mouth. But these symptoms are not experienced in all cases, in other cases patients have reported that their air or water was odorless.

Other fracturing related symptoms may include:

–Skin and/or eye irritation, new onset skin rashes

–Respiratory irritation, shortness of breath, wheezing, coughing, sinus congestion, recurrent sinus infections, persistent nasal congestion, nose bleeds

–Difficulty swallowing, throat pain, nausea, vomiting, gastrointestinal pain

–Chest pain, heart palpitations, fatigue

–Neurological symptoms such as dizziness, headaches, numbness, weakness and tingling.

If you or any member of your family experiences any of the symptoms listed above, or any new onset of symptoms, or worsening symptoms after fracturing operations commence in your area then please seek medical attention. If your symptoms warrant urgent attention then please contact your local emergency services.

If you are pregnant, plan on becoming pregnant, or have given birth recently you should know that researchers have been reporting a relationship between proximity to fracturing operations and evidence of diminished fetal and infant well being. If you live or work within 10 miles from a fracturing operation it is recommended that you contact your medical provider and discuss your proximity to a fracturing operation with them as soon as possible.

If your livestock or domesticated animals start suffering from unexplained medical problems after fracturing operations start in your area, then please seek veterinarian care for them. And then discuss their symptoms and diagnosis es with your medical doctor as well. As the canaries in the coal mines of yesteryear operated as an early warning system for the miners, your animals might be the first to exhibit symptoms of fracturing related toxic exposure and can alert you and your family that there might be a risk for you as well.

An excellent, well-documented resource on the health hazards of fracturing operations,
was recently released by The Concerned Health Professionals of New York, is the 70 page “COMPENDIUM OF SCIENTIFIC, MEDICAL, AND MEDIA FINDINGS DEMONSTRATING RISKS AND HARMS OF FRACKING” and can be found at; http://concernedhealthny.org/wp-content/uploads/2014/07/CHPNY-Fracking-Compendium.pdf.

Sometimes it is helpful to read about other people who have been affected by fracturing related illnesses to determine if you might have similar symptoms, the “List of the Harmed”, compiled by the Pennsylvania Alliance For Clean Water And Air is an ever-growing, list of 6085+ individuals and families that have been reported to be harmed by fracturing operations in the US. You can read their stories, written in their own words, here: http://pennsylvaniaallianceforcleanwaterandair.wordpress.com/the-list/

OTHER HELPFUL RESOURCES FOR INVESTIGATING THE HEALTH IMPACTS FROM FRACKING OPERATIONS FOR OIL AND NATURAL GAS
(Your medical provider may want to access these websites and reports,
please share this list with them.)

1) “Most Toxic Ingredients Used In Coal, Oil and Gas Production

2) “Top 20 Health Concerns Related to Fracking

3) “Drilling for Certainty: The Latest in Fracking Health Studies

4) The Medical Toolkit – Online Continuing Medical Education developed by The Southwest Pennsylvania Environmental Health Project (EHP) – A nonprofit environmental health organization created to assist and support Washington County, PA residents who believe their health has been impacted by natural gas drilling activities.

5) Physicians Scientists & Engineers for Healthy Energy – 10 Module Continuing Medical Education Course on potential acute and chronic medical effects, injuries, and disabilities associated with high-volume hydraulic fracturing of shale.

6) Collaborative on Health and the Environment :: Fracking: Implications for Human and Environmental Health

7) Impacts of Fracking – Partnerships for Environmental Public Health (PEPH)

8) Maternal and Infant Health – Center for Environmental Health, 6-part webinar series on fracking impacts on maternal health: Webinar Series: Fracking, Natural Gas, and Maternal Health

Including:
–“Unconventional Natural Gas Extraction and Special Vulnerabilities for Children”, webinar hosted by the Center for Environmental Health on April 21, 2014

–“Susceptibility During Pregnancy: What You Need to Know”, Alliance of Nurses for Healthy Environments, webinar hosted by the Center for Environmental Health on May 5, 2014

–“Natural Gas Development, Public Health, and Protecting the Most Vulnerable Populations”, The Endocrine Disruption Exchange, webinar hosted by the Center for Environmental Health on April 21, 2014.

9) Natural Gas Operations from a Public Health Perspective – The Endocrine Disruption Exchange

10) Health Effects Spreadsheet and Summary – The Endocrine Disruption Exchange – Health effects of chemicals in natural gas operations

Workers’ Health Issues
Fracturing for oil and natural gas is 8 times more dangerous than almost all other jobs in America. The number of workers employed by the U.S. oil and gas extraction industry last year was 435,000, the number of deaths in the industry last year was 138, an increase of more than 100% since 2009 . www.npr.org/2013/12/27/250807226/on-the-job-deaths-spiking-as-oil-drilling-quickly-expands

The greatest risks for workers on or near fracturing operations:
Trucking Accidents:
 The no# 1 risk for death is truck accidents because of the heavy traffic around the fracturing sites and the long shifts that oil and gas field workers are routinely pressured into working by their employers; these shifts can last typically last up to 20 hours. The legal limit of work shifts for most commercial truckers is 14 hours. Of the 2,200 oil and gas industry trucks inspected from 2009 to February 2012 by state police in Pennsylvania, the epicenter of the fracking boom, 40% were in such poor condition they had to be taken off the road.
Respiratory Exposure to Silica Sand:
Out of 11% of fracturing sites that were inspected by National Institute for Occupational Safety and Health (NIOSH) recently, where they collected air samples to evaluate worker exposure to crystalline silica, which is present in the “frac sand”, used in the oil and natural gas extraction process, and which causes silicosis, an incurable lung disease – 100% were found to have exposure to respirable crystalline silica that exceeded occupational health limits.
Frac sand is 100% crystalline silica and up to 4 million pounds of frac sand are used to fracture a single well. Why is silica a concern for workers during fracturing?
Fracturing sand contains up to 99% silica. Breathing silica can cause silicosis. Silicosis is a lung disease where lung tissue around trapped silica particles reacts causing inflammation and scarring and reducing the lungs’ ability to take in oxygen. Workers who breathe silica day after day are at greater risk of developing silicosis. Silica can also cause lung cancer and has been linked to other diseases, such as tuberculosis, chronic obstructive pulmonary disease, kidney, and autoimmune disease.
Recent NIOSH field studies identified overexposure to airborne silica as a health hazard to fracturing site workers.
Large quantities of silica sand are used during fracturing. Sand is delivered via truck and then loaded into sand movers, where it is subsequently transferred via conveyer belt and blended with other fracturing fluids prior to high pressure injection into the drilling hole. Transporting, moving, and refilling silica sand into and through sand movers, along transfer belts, and into blender hoppers can release dusts containing silica into the air. Workers can be exposed if they breathe the dust into their lungs.
NIOSH identified seven primary sources of silica dust exposure during fracturing operations:
• Dust ejected from thief hatches (access ports) on top of the sand movers during refilling operations while the machines are running (hot loading).
• Dust ejected and pulsed through open side fill ports on the sand movers during refilling operations
• Dust generated by on-site vehicle traffic.
• Dust released from the transfer belt under the sand movers.
• Dust created as sand drops into, or is agitated in, the blender hopper and on transfer belts.
• Dust released from operations of transfer belts between the sand mover and the blender; and
• Dust released from the top of the end of the sand transfer belt (dragon’s tail) on sand movers.
Employers must provide respiratory protection to protect workers:
Employers must provide workers with respirators if the silica sand exposure is significant. Whenever respirators are used, the employer must have a respiratory protection program that meets the requirements of OSHA’s Respiratory Protection Standard (29 CFR 1910.134). This program must include proper respirator selection, fit testing, medical evaluations, and training.
• If respirators are provided, use at least a NIOSH – approved N95 respirator. If the silica level is more than 10 times the PEL, a half-face respirator is not protective and a respirator that offers a greater level of protection (a full-facepiece respirator, which will protect workers at silica levels up to 50 times the PEL) must be used. Full-face powered air-purifying respirators (PAPR) provide more protection than half-face air-purifying respirators. In general, workers find PAPRs to be more comfortable.
For more information on respiratory protection see OSHA’s
Safety and Health Topics page and https://www.osha.gov/SLTC/etools/respiratory/index.html
What additional health and safety hazards exist during fracturing?
In addition to silica hazards, workers may be exposed to other work site health hazards that can include exposure to diesel particulate and exhaust gases from equipment, high or low temperature extremes, high noise levels, and overexertion leading to sprains and strains. In addition, fatigue may be a concern due to long working hours.
Fracturing sites also have safety hazards similar to those at other oil and gas drilling sites, including:
Being struck by moving equipment, including motor vehicle accidents (primarily when traveling to and between well sites), tools, and falling objects.
Poor lighting.
Being caught in pinch points (such as hammer union wings and hammers, pump iron, and racks).
Falling from heights.
Being struck by high-pressure lines or unexpected release of pressure (for example, mismatched or worn hammer unions, line failure).
Fires or explosions from flowback fluids containing ignitable materials (methane, butane, propane, ethane) and other flammable materials stored or used at the well site.
Working in confined spaces with possibly dangerous chemicals, radioactivity or excessive noise levels, such as sand storage trailers, frac tanks, and sand movers – where it is often necessary to take protective precautions for the skin, eyes, ears and respiratory systems, by wearing and using protective clothing, respirators, eye wear, hearing protection, hazmat protective gear and radioactive monitors.
For More Information On Workers Health Issues from the Occupational Safety and Health Administration, OSHA: www.osha.gov/dts/hazardalerts/hydraulic_frac_hazard_alert.html
Contact OSHA:
Contact your nearest OSHA office, visit www.osha.gov,
Call OSHA at 1-800-321-OSHA (6742), TTY 1-877-889-5627.
Contact NIOSH:
For more information about occupational safety and health topics,
visit www.cdc.gov/niosh
Call 1-800-CDC-INFO (1-800-232-4636), TTY 1-888-232-6348,
Email: cdcinfo@cdc.gov

How To Find A Qualified Health Professional With Training in Environmental Or Occupational Medicine
If you or your family are exposed to air pollution, water contamination or other hazards associated with fracturing operations, you might need to access medical professionals who have training in environmental medicine. For fracturing related illnesses it often takes a variety of experts to figure out what a person has been exposed to and what medical care is necessary. Experts may include physicians, toxicologists and environmental scientists.
The links below are to medical organizations whose accredited physicians specialize in environmental medicine.
We have refrained from referring readers to any one particular physician, but rather we prefer to direct inquires to the websites of professional groups where they can search for physicians in their regions with specialty training.
The American Academy of Environmental Medicine, (AAEM)
www.aaemonline.org
6505 E. Central Avenue, #296
Wichita, KS 67206
Phone: (316) 684-5500
Fax: (888) 411.1206
Email: administrator@aaemonline.org

AAEM is an international association of physicians and other professionals interested in the clinical aspects of humans and their environment.

The Academy is interested in expanding the knowledge of interactions between human individuals and their environment, as these may be demonstrated to be reflected in their total health. The AAEM provides research and education in the recognition, treatment and prevention of illnesses induced by exposures to biological and chemical agents encountered in air, food and water.
For AAEM Accredited Physicians, please access their referral page here: http://www.aaemonline.org/referral.php

The American College of Occupational and Environmental Medicine, (ACOEM)
www.acoem.org
25 Northwest Point Blvd.
Suite 700
Elk Grove Village, Illinois, 60007-1030
Telephone: 847/818-1800, Fax: 847/818-9266
From their website:
The American College of Occupational and Environmental Medicine (ACOEM) represents more than 4,500 physicians and other health care professionals specializing in the field of occupational and environmental medicine (OEM).
Founded in 1916, ACOEM is the nation’s largest medical society dedicated to promoting the health of workers through preventive medicine, clinical care, research, and education. A dynamic group of physicians encompassing specialists in a variety of medical practices is united via the College to develop positions and policies on vital issues relevant to the practice of preventive medicine both within and outside of the workplace.
For ACOEM Accredited Physicians please access their referral page here: http://www.acoem.org/DoctorFinderSearch.aspx

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