A historical overview of the Red Hill Bulk Fuel Storage Facility and its location above Oahu’s aquifer outlining its underground construction, fuel release timeline, and the later environmental and health consequences brought to light in recent years by the residents of Oʻahu.
An essential introduction to the work and mission of the Red Hill Registry, outlining its goals, functions, key contributors, community engagement efforts, scientific collaboration, and data security standards.
An educational resource for healthcare professionals seeking to address and understand their patients’ health in the context of jet fuel exposure despite the uncertainty of long-term health outcomes.
ACE 1 is the initial community health survey (January-February 2022) conducted by ATSDR where 2,289 people participated in a self-administered survey or interview. The findings of ACE 1 revealed 87% of participants reported health concerns or symptoms. Of those, 75% had symptoms that lasted a month or more, 37% sought medical care, and 17 people were hospitalized overnight. Participants of ACE 1 reported symptoms in various body systems.
The follow-up survey was conducted by ATSDR in August – September 2022; 986 people participated, of which 61% were returning participants of the initial survey, ACE 1. In ACE 2, 80% of responders reported ongoing health symptoms, 65% were confident their symptoms were related to fuel exposure, 55% reported worse physical health, and 50% reported worse mental health after the incident compared to before exposure. New and worsening symptoms were similar to those reported in the ACE 1 study.
The ACE 3 study, published in late 2025, is a review of 653 medical records between November 2021– February 2022 by ATSDR. This review of records showed up to 1 in 3 persons had new or persistent health issues, and 31% of adults as well as 19% of children who participated in the survey developed new conditions (acute) that persisted as long-lasting (chronic) health conditions, after the fuel exposure. Up to 1 in 4 persons had pre-existing conditions that became worse, and 24% of adults as well as 28% of children had pre-existing health conditions that were present before the fuel spill that became worse after the exposure. Also, 58 people were identified to be pregnant, and of those, 46 had enough medical records available for the researchers to review and analyze.
On March 19, 2026, the National Academies of Sciences, Engineering, and Medicine released a report titled “Clinical Follow-up and Care for Those Impacted by the JP-5 Releases at Red Hill.” Their findings confirm that there is not enough data to fully understand how jet fuel affects the human body, highlighting the need for continued research and long-term health tracking. Due to the fact that limited biological and environmental samples were collected during the 2021 fuel spill, there are still important gaps in understanding health effects. Therefore, ongoing research depends on health reports, medical records, and participation in health registries by individuals who were exposed.
Appendix F outlines clear, practical guidance for caring for people exposed to the 2021 Red Hill jet fuel contamination. It highlights the importance of documenting exposure details, history, and symptoms since no specific tests exist, and encourages evidence-based care, especially for children, pregnant patients, and other vulnerable groups. The guidance also standardizes medical records and links clinicians with toxicology experts to help track ongoing health concerns in the community.
