Deepwater Horizon oil-spill responders already are reporting chronic health problems that may be associated with toxicant-induced loss of tolerance (TILT) disease, said Claudia Miller, a professor at the University of Texas Health Science Center in San Antonio. The multisystem symptomatic disease causes fatigue, sleep problems, headaches, digestive difficulties, and problems with memory and concentration.

First responders later can develop new intolerances to everyday exposures, such as feeling dizzy or nauseated around engine exhaust, cleaning chemicals and fragrances, or ill after eating certain foods or drinking one can of beer, Miller said.

"The hallmark for the TILT phenomena is that [first responders] are showing new intolerances toward food, medications, caffeine and most commonly everyday chemical exposures that weren't a problem for them before," she said.

TILT is a new theory of disease, and scientists now are able to link multisystem symptoms after chemical exposure to the post — World War II chemical age that introduced into the environment synthetic organic chemicals derived from oil, plastic, coal and gas, among others, Miller said. As a result, TILT is almost always caused by exposure to petrochemicals and Gulf Coast clean-up crews were at risk, she said.

Flu-like symptoms after exposure are common. But Miller said in as little as two weeks after exposure new symptoms arise, triggered in response to everyday exposures or by repeating the initial exposure.

"Stage 1 of TILT is having flu-like symptoms," she said. "Stage 2 is when lots of different exposures trigger symptoms and perpetuate illness."

Symptoms can involve every organ system, and oil spill responders reported difficulty breathing, headaches, fatigue, sleep difficulties, confusion, memory and concentration problems, irritability and mood changes. Also reported were new intolerances, including feeling ill after exposure to diesel- or gas- engine exhaust, fragrances, or cleaning products.

"We think these new intolerances people develop — very pronounced — having major symptoms like difficulty concentrating, mood, fatigue and affecting other organ systems — that those changes are the hallmark symptoms … of TILT," Miller said.

Fire leadership needs to ensure firefighters protect themselves from exposure, including wearing SCBA and hazmat gear. Miller said incident commanders running hazmat scenes should monitor those exposed to chemicals, who tend to become symptomatic on scene and immediately should be relieved. If they are not getting better overnight or over a few days, it signifies that a chronic problem may be setting in.

Miller offers the QEESI test to help first responders determine whether they are susceptible to TILT. She also recommends chiefs download Chemical Exposures: Low Levels and High Stakes. Both are available free of charge.

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