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)