Hazards and Injuries in Hazards and Injuries in the Chemistry Labthe Chemistry Lab

An Overview for EMS ProvidersAn Overview for EMS Providers

Bobbie Alexander EMTBobbie Alexander EMT--PPPresented by Scott C. Presented by Scott C. SavettSavett, Ph.D., EMT, Ph.D., EMT

Hazards and Injuries in the Hazards and Injuries in the ChemChem LabLab

We don’t usually view college campuses We don’t usually view college campuses as a place where we would encounter as a place where we would encounter Hazmat emergencies; however, Chemistry Hazmat emergencies; however, Chemistry Labs present a unique challenge to EMS Labs present a unique challenge to EMS providers confronted with injuries providers confronted with injuries sustained from chemical substances.sustained from chemical substances.

Hazard AwarenessHazard Awareness

Identification of Hazardous Identification of Hazardous MaterialsMaterials

Identification of Hazardous Identification of Hazardous MaterialsMaterials

Hazard Label CodingHazard Label CodingBlue Blue –– HealthHealthRed Red –– FlammabilityFlammabilityYellow Yellow -- ReactivityReactivityWhite White –– Specific HazardSpecific Hazard00--4 Severity Scale4 Severity Scale

4 Severe4 Severe3 Serious3 Serious2 Moderate2 Moderate1 Slight1 Slight0 Minimal0 Minimal

Identification of Hazardous Identification of Hazardous MaterialsMaterials

Identification of Hazardous Identification of Hazardous MaterialsMaterials

Know where Material Know where Material Safety Data Sheets Safety Data Sheets (MSDS) are located and (MSDS) are located and how they are organized. how they are organized. Sections 3 and 4 of an Sections 3 and 4 of an MSDS presents an MSDS presents an emergency overview, emergency overview, potential health effects, potential health effects, and first aid treatment and first aid treatment specific to the chemical.specific to the chemical.

Types of Hazards Present in the Types of Hazards Present in the ChemChem LabLab

Physical HazardsPhysical HazardsPressure and Vacuum ApparatusPressure and Vacuum ApparatusSteamSteamCompressed GasesCompressed GasesCryogenic (Liquid) GasesCryogenic (Liquid) GasesRadioactive MaterialsRadioactive MaterialsChemical SubstancesChemical Substances

Acids, BasesAcids, BasesOrganic SolventsOrganic SolventsOxidizing AgentsOxidizing AgentsReducing AgentsReducing Agents

Physical HazardsPhysical Hazards

Physical HazardsPhysical HazardsBroken glassware poses Broken glassware poses a laceration potential, but a laceration potential, but may also contaminate may also contaminate wounds with residual wounds with residual chemical substances.chemical substances.All wounds sustained All wounds sustained from lab glassware from lab glassware should be thoroughly should be thoroughly irrigated with water prior irrigated with water prior to bandaging.to bandaging.

Physical HazardsPhysical Hazards

Pressure and Pressure and Vacuum ApparatusVacuum Apparatuspose the danger of pose the danger of explosion or explosion or implosion with high implosion with high velocity fragments of velocity fragments of glass or metal.glass or metal.

Physical Hazards Physical Hazards Steam BurnsSteam Burns

Compressed GasesCompressed Gases

Flammables Flammables (Propane, (Propane, Acetylene, Hydrogen)Acetylene, Hydrogen)

Simple Simple asphyxiantsasphyxiants(N2, He, Argon)(N2, He, Argon)

Chemical Chemical asphyxiantsasphyxiants(CO, Cyanide, H2S, (CO, Cyanide, H2S, Phosgene)Phosgene)

Irritants/Corrosives Irritants/Corrosives (Chlorine, (Chlorine, HClHCl, Ammonia), Ammonia)

Inhaled SubstancesInhaled Substances

Symptoms will depend on specific Symptoms will depend on specific substance substance –– common ones include:common ones include:CO: weakness, fatigue, nausea, fluCO: weakness, fatigue, nausea, flu--like like symptomssymptomsLightheadedness, Lightheadedness, dyspneadyspnea, coughing, coughingBurning, throat and eye irritationBurning, throat and eye irritationBronchoconstrictionBronchoconstrictionPulmonary EdemaPulmonary Edema

Treatment for Inhalation ExposureTreatment for Inhalation Exposure

Do not become a victim yourself.Do not become a victim yourself.Patient should be moved to a fresh air Patient should be moved to a fresh air environment.environment.Oxygen provided by Oxygen provided by nonrebreathernonrebreather maskmaskMonitor vital signs, breath sounds, and pulse Monitor vital signs, breath sounds, and pulse oximetryoximetry. . (Be aware that pulse (Be aware that pulse oximetryoximetry is not reliable is not reliable in cases of CO toxicity)in cases of CO toxicity)Be alert for signs of pulmonary edema and Be alert for signs of pulmonary edema and systemic toxicitysystemic toxicityDetermine the identity of the substance the Determine the identity of the substance the patient was exposed to, and obtain a copy of the patient was exposed to, and obtain a copy of the MSDS to be transported with the patient.MSDS to be transported with the patient.

Cryogenic (Liquid) GasesCryogenic (Liquid) GasesArAr, He, N2, O2, He, N2, O2Stored at temperatures Stored at temperatures minus 240 F or lowerminus 240 F or lowerContact with cryogenic Contact with cryogenic liquids to the eyes or skin liquids to the eyes or skin can cause serious can cause serious frostbite injuries. Flesh or frostbite injuries. Flesh or tissues that come in tissues that come in contact with a contact with a cryogenically cooled cryogenically cooled material (even nonmaterial (even non--metallic materials) can metallic materials) can stick to that material, and stick to that material, and may tear on attempted may tear on attempted removal.removal.

Cryogenic (Liquid) GasesCryogenic (Liquid) Gases

Cryogenic LiquidsCryogenic Liquids require require handling with specialized handling with specialized personal protective personal protective equipment. equipment. Insulated gloves made to Insulated gloves made to withstand extremely low withstand extremely low temperatures should be temperatures should be worn worn –– they should fit they should fit loosely so they can be loosely so they can be easily thrown off if a easily thrown off if a splash occurs inside the splash occurs inside the glove.glove.

Cryogenic (Liquid) GasesCryogenic (Liquid) GasesIf exposure to a cryogenic liquid occurs, warm If exposure to a cryogenic liquid occurs, warm water should be run over the affected area. water should be run over the affected area. Thawed frostbitten skin will be very painful, red Thawed frostbitten skin will be very painful, red and swollen with a burning sensation. Bandage and swollen with a burning sensation. Bandage with bulky dressings, and seek advanced with bulky dressings, and seek advanced medical care.medical care.LiquifiedLiquified gases undergo a 700 x expansion from gases undergo a 700 x expansion from a liquid state to a gaseous state, and present an a liquid state to a gaseous state, and present an asphyxiation danger in enclosed spaces due to asphyxiation danger in enclosed spaces due to displacement of oxygen. One liter (quart) of displacement of oxygen. One liter (quart) of liquid Nitrogen can expand to almost 25 cubic liquid Nitrogen can expand to almost 25 cubic feet of gas. This can rapidly fill a small space, feet of gas. This can rapidly fill a small space, creating an oxygen deficient atmosphere.creating an oxygen deficient atmosphere.

Eye InjuriesEye Injuries

Eye InjuriesEye Injuries

““Eye Injuries in the workplace remain all Eye Injuries in the workplace remain all too common, afflicting more than 700,000 too common, afflicting more than 700,000 Americans each year. Yet, Prevent Americans each year. Yet, Prevent Blindness America says 90% of these Blindness America says 90% of these injuries can be avoided with a simple and injuries can be avoided with a simple and obvious expedient: safety eyewear.”obvious expedient: safety eyewear.”Excerpted from Occupational Hazards Excerpted from Occupational Hazards Magazine / February 2005Magazine / February 2005

Eye Injury from AlkaliEye Injury from Alkali

Eye InjuriesEye InjuriesCorneal Opacity from an Corneal Opacity from an acid burn to the eyeacid burn to the eyeUse of Safety Glasses, Use of Safety Glasses, Chemical Goggles, or Chemical Goggles, or Face Shields effectively Face Shields effectively prevents such injuriesprevents such injuriesIt is imperative for EMS It is imperative for EMS responders to become responders to become familiar with the operation familiar with the operation of eye washes and safety of eye washes and safety showers used in their showers used in their school’s laboratoriesschool’s laboratories

Treatment of Eye InjuriesTreatment of Eye Injuries--ANSI ANSI Standard Standard -- 2004 Revision2004 Revision

The American National The American National Standards Institute Standards Institute (ANSI) standard for (ANSI) standard for eyewashes and safety eyewashes and safety showers (ANSI Z358.1) showers (ANSI Z358.1) requires that this safety requires that this safety equipment have equipment have unobstructed access and unobstructed access and be accessible within 10 be accessible within 10 seconds or less of the seconds or less of the hazard.hazard.

ANSI Standard ANSI Standard –– Eyewashes and Safety Showers Eyewashes and Safety Showers How does your facility measure up ? ? ?How does your facility measure up ? ? ?

To be sure plumbed units are always in proper To be sure plumbed units are always in proper operating condition, they should be activated on operating condition, they should be activated on a weekly basis.a weekly basis.Beyond confirming that the units work, there are Beyond confirming that the units work, there are several reasons for regular activation:several reasons for regular activation:

Sedimentation is cleared, which can clog the supply Sedimentation is cleared, which can clog the supply linelineFlushing stagnated water from plumbed fixtures Flushing stagnated water from plumbed fixtures reduces the chance of microbial hazardsreduces the chance of microbial hazardsEye injuries should be flushed with the cleanest water Eye injuries should be flushed with the cleanest water possible.possible.

Treatment of Eye InjuriesTreatment of Eye InjuriesActivate eye washActivate eye washWearing chemical resistant glovesWearing chemical resistant gloves, hold eyelids , hold eyelids of patient open, and flush eyes for at least 15 of patient open, and flush eyes for at least 15 minutesminutesIf the person is wearing contact lenses and the If the person is wearing contact lenses and the lenses did not flush out from the running water, lenses did not flush out from the running water, have the person remove them during the have the person remove them during the flushing process.flushing process.Cover both eyes with a clean dressing, and do Cover both eyes with a clean dressing, and do not allow the patient to touch or rub the eye.not allow the patient to touch or rub the eye.

Chemical Burn InjuriesChemical Burn Injuries

Clinical signs and symptoms vary depending on Clinical signs and symptoms vary depending on the route of exposure and the particular the route of exposure and the particular substances involved.substances involved.Factors determining injury severity are:Factors determining injury severity are:

Chemical substance, concentration, physical form, Chemical substance, concentration, physical form, temperature, and pHtemperature, and pHRoute of exposureRoute of exposureTime of exposureTime of exposureVolume of exposureVolume of exposureSurface area of the body exposedSurface area of the body exposed

Dermal ExposureDermal ExposureSymptoms are dependent upon the specific Symptoms are dependent upon the specific chemical agent. Most common symptoms are:chemical agent. Most common symptoms are:

Abdominal painAbdominal painDyspneaDyspneaSeizure activitySeizure activityDizzinessDizzinessHeadacheHeadacheIrritabilityIrritabilityPain, burning or itching at site of contactPain, burning or itching at site of contactRash, redness, burns, or blisteringRash, redness, burns, or blisteringUnconsciousnessUnconsciousness

DO NOTDO NOTDo not become contaminated yourself Do not become contaminated yourself –– latex latex gloves are a very poor barrier to many chemical gloves are a very poor barrier to many chemical agents, particularly organic solvents.agents, particularly organic solvents.Do not try to neutralize any chemical without Do not try to neutralize any chemical without consulting Poison Controlconsulting Poison ControlDo not disturb blisters or remove dead skin from Do not disturb blisters or remove dead skin from a chemical burna chemical burnDo not apply any household remedy such as Do not apply any household remedy such as ointment or salve to a chemical burn ointment or salve to a chemical burn (exception is (exception is Calcium Calcium GluconateGluconate gel for Hydrofluoric Acid burns)gel for Hydrofluoric Acid burns)

ManagementManagementScene safetyScene safetyPersonal Protective Equipment (PPE)Personal Protective Equipment (PPE)Removal of patient from contaminated Removal of patient from contaminated environmentenvironmentRemoval of contaminated clothing, shoes, and Removal of contaminated clothing, shoes, and jewelry from the patient. (Use chemical jewelry from the patient. (Use chemical protective gloves)protective gloves)Surface decontamination with large volumes of Surface decontamination with large volumes of water for at least 15 minuteswater for at least 15 minutesAirway, Airway, ventilatoryventilatory support, O2support, O2Monitor vital signs, pulse Monitor vital signs, pulse oximetryoximetry

Exposure to Acids and BasesExposure to Acids and BasesBoth acids and bases (Both acids and bases (alkaliesalkalies) can be defined ) can be defined as caustics, which can cause significant damage as caustics, which can cause significant damage on contact.on contact.Most acids produce a coagulation necrosis by Most acids produce a coagulation necrosis by denaturing proteins, forming a coagulum that denaturing proteins, forming a coagulum that limits the penetration of the acid.limits the penetration of the acid.Bases typically produce a more severe injury Bases typically produce a more severe injury known as liquefaction necrosis. This involves known as liquefaction necrosis. This involves denaturing of proteins as well as denaturing of proteins as well as saponificationsaponificationof fats, which does not limit penetrationof fats, which does not limit penetration

Common laboratory acids and basesCommon laboratory acids and bases

Acids Acids Acetic AcidAcetic AcidChromic Acid Chromic Acid (systemic toxin)(systemic toxin)

Hydrofluoric Acid Hydrofluoric Acid (systemic toxin)(systemic toxin)

Nitric Acid Nitric Acid (produces (produces characteristic yellow or orange characteristic yellow or orange discoloration to the skin)discoloration to the skin)

Sulfuric Acid Sulfuric Acid (dehydrates (dehydrates the skin leaving a black the skin leaving a black discoloration)discoloration)

Bases (Bases (AlkaliesAlkalies))AmmoniaAmmoniaAmmonium HydroxideAmmonium HydroxideCalcium HydroxideCalcium HydroxidePhenol Phenol (systemic toxin)(systemic toxin)

Potassium HydroxidePotassium HydroxideSodium HydroxideSodium Hydroxide

Exposure to Specific SubstancesExposure to Specific Substances

Nitric Acid is a very powerful oxidizing agent and Nitric Acid is a very powerful oxidizing agent and will react with cyanides, carbides, and metallic will react with cyanides, carbides, and metallic powders with explosive force. It will also react powders with explosive force. It will also react violently with organic compounds and may be violently with organic compounds and may be selfself--igniting. Nitric acid burns tend to be quite igniting. Nitric acid burns tend to be quite severesevereOrganophosphates, Organophosphates, CarbamatesCarbamates (These (These materials are commonly used to manufacture materials are commonly used to manufacture pesticides and similar classes of compounds are pesticides and similar classes of compounds are used to produce chemical warfare agents)used to produce chemical warfare agents)Hydrofluoric AcidHydrofluoric Acid

Nitric Acid BurnNitric Acid Burn

Organophosphates, Organophosphates, CarbamatesCarbamatesSystemic effects from Dermal / Inhalation ExposureSystemic effects from Dermal / Inhalation Exposure

Symptoms (Symptoms (SLUDGESLUDGE))SSalivationalivationLLacrimationacrimationUUrinationrinationDDefecationefecationGGastrointestinal Upsetastrointestinal UpsetEEmesismesis

ManagementManagementScene SafetyScene SafetyPPEPPERemove patient from substance and Remove patient from substance and decontaminate (safety shower), removing decontaminate (safety shower), removing contaminated clothing, shoes & jewelry. contaminated clothing, shoes & jewelry. Contaminated clothing must be bagged in plastic Contaminated clothing must be bagged in plastic bags for disposal.bags for disposal.O2 and respiratory supportO2 and respiratory supportOrganophosphate exposure is treated with Organophosphate exposure is treated with Atropine by ALS providers Atropine by ALS providers

Hydrofluoric Acid ExposureHydrofluoric Acid Exposure

What is Hydrofluoric Acid ?What is Hydrofluoric Acid ?

Hydrofluoric acid, a solution of Hydrogen Hydrofluoric acid, a solution of Hydrogen Fluoride gas in water, is an extremely Fluoride gas in water, is an extremely corrosive acid that is clear and colorless corrosive acid that is clear and colorless with a density similar to water. It has a with a density similar to water. It has a number of chemical, physical and number of chemical, physical and toxicological properties which make toxicological properties which make handling this material especially handling this material especially hazardoushazardous

Properties of Hydrofluoric AcidProperties of Hydrofluoric AcidDisagreeable, pungent odor at 0.04 Disagreeable, pungent odor at 0.04 ppmppmIrritation of eyes and throat at 3 Irritation of eyes and throat at 3 ppmppmDissolves glassDissolves glassAttacks glazes, enamels, pottery, concrete, Attacks glazes, enamels, pottery, concrete, rubber, leather, many metals and organic rubber, leather, many metals and organic compounds.compounds.Upon reaction with metals, hydrogen gas is Upon reaction with metals, hydrogen gas is formed.formed.It must be packaged, used and stored in It must be packaged, used and stored in polyethylene, polypropylene, or Teflon polyethylene, polypropylene, or Teflon containers.containers.

Types of Exposure to HFTypes of Exposure to HFLiquid Exposure (splashing or spills) Pulmonary Liquid Exposure (splashing or spills) Pulmonary effects can result even from splashes on the effects can result even from splashes on the skin.skin.Vapor Exposure can cause damage to the skin, Vapor Exposure can cause damage to the skin, eyes, and respiratory systems. HF causes eyes, and respiratory systems. HF causes severe, deeply penetrating burns to the skin, severe, deeply penetrating burns to the skin, eyes, and lungs. Although concentrated acid is eyes, and lungs. Although concentrated acid is readily perceived by a burning sensation, more readily perceived by a burning sensation, more dilute solutions are often imperceptible for many dilute solutions are often imperceptible for many hours. This potential time delay between hours. This potential time delay between exposure recognition and treatment can lead to exposure recognition and treatment can lead to insidious and difficult to treat burns.insidious and difficult to treat burns.

Health EffectsHealth EffectsThe initial extent of the burn depends on the concentration, The initial extent of the burn depends on the concentration, temperature, duration of contact, and quantity of the acidtemperature, duration of contact, and quantity of the acid..

HF is irritating to the skin, eyes, and mucous HF is irritating to the skin, eyes, and mucous membranes, and inhalation may cause respiratory membranes, and inhalation may cause respiratory irritation or hemorrhage.irritation or hemorrhage.Systemic effects can occur from all routes of exposure Systemic effects can occur from all routes of exposure and may include nausea, vomiting, gastric pain, or and may include nausea, vomiting, gastric pain, or cardiac arrhythmia.cardiac arrhythmia.Symptoms may be delayed for several days, especially Symptoms may be delayed for several days, especially in the case of exposure to dilute solutions (< 20%)in the case of exposure to dilute solutions (< 20%)The systemic effects of HF are due to increased fluoride The systemic effects of HF are due to increased fluoride concentrations in the body which can change the levels concentrations in the body which can change the levels of Ca, Mg, and K in the blood.of Ca, Mg, and K in the blood.HypocalcemiaHypocalcemia can cause can cause tetanytetany, decreased myocardial , decreased myocardial contractility, and possible cardiovascular collapse while contractility, and possible cardiovascular collapse while hyperkalemiahyperkalemia may cause V Fibmay cause V Fib

Toxicological PropertiesToxicological Properties

The toxic effects of HF are due primarily to The toxic effects of HF are due primarily to the fluoride ion, which is able to penetrate the fluoride ion, which is able to penetrate tissues and bind intracellular calcium and tissues and bind intracellular calcium and magnesium. This results in cell magnesium. This results in cell destruction and local bone destruction and local bone demineralization.demineralization.

Dermal ExposureDermal ExposureAcid concentrations of more than 50% cause Acid concentrations of more than 50% cause immediate severe, throbbing pain and a whitish immediate severe, throbbing pain and a whitish discoloration of the skin, which usually forms discoloration of the skin, which usually forms blisters.blisters.HF solutions from 20HF solutions from 20--50% may produce pain 50% may produce pain and swelling, which may be delayed up to 8 and swelling, which may be delayed up to 8 hours.hours.HF solutions < 20% cause almost no immediate HF solutions < 20% cause almost no immediate pain on contact but may cause delayed serious pain on contact but may cause delayed serious injury 12injury 12--24 hours later24 hours laterIf an individual is exposed to Hydrofluoric Acid, they must seek medical attention IMMEDIATELY, even if they do not feel pain.

Why is HF Different Than Other Acids ?Why is HF Different Than Other Acids ?

HF treatment for exposure is not limited to HF treatment for exposure is not limited to simply washing off the skinsimply washing off the skinHF is readily absorbed into the skin with HF is readily absorbed into the skin with deep tissue destructiondeep tissue destructionHF binds to the Calcium and Magnesium HF binds to the Calcium and Magnesium in the body to form insoluble salts.in the body to form insoluble salts.

Insoluble salts interfere with cellular Insoluble salts interfere with cellular metabolism causing cellular death and metabolism causing cellular death and necrosis.necrosis.

How Do We Protect Ourselves How Do We Protect Ourselves from HF Exposure ?from HF Exposure ?

PPE is not a substitute for safe work practices.PPE is not a substitute for safe work practices.HF must ALWAYS be used in a fume hood. Eye HF must ALWAYS be used in a fume hood. Eye protection with safety glasses or goggles and a protection with safety glasses or goggles and a face shield should be used.face shield should be used.22 mil gloves made of Neoprene, 22 mil gloves made of Neoprene, NitrileNitrile, or , or VitonVitonshould be worn.should be worn.Acid resistant apron strongly recommendedAcid resistant apron strongly recommendedWarning sign indicating the use of HF should be Warning sign indicating the use of HF should be posted.posted.

Safety Equipment Safety Equipment –– HF Exposure KitHF Exposure Kit

Before beginning work Before beginning work with HF, an exposure kit with HF, an exposure kit must be available and must be available and located near the lab area.located near the lab area.

Calcium Calcium GluconateGluconate GelGel2 pairs of protective gloves2 pairs of protective glovesHeavy duty polyethylene Heavy duty polyethylene bag or container to be used bag or container to be used for materials contaminated for materials contaminated with HFwith HFMSDSMSDS

PrehospitalPrehospital ManagementManagementPatients exposed only to HF gas or vapor do not Patients exposed only to HF gas or vapor do not pose substantial risks of secondary pose substantial risks of secondary contamination to the rescuer. However, patients contamination to the rescuer. However, patients whose clothing or skin is contaminated with HF whose clothing or skin is contaminated with HF liquid, solution or condensed vapor can liquid, solution or condensed vapor can secondarily contaminate response personnel by secondarily contaminate response personnel by direct contact.direct contact.Rapid decontamination is critical.Rapid decontamination is critical.Victims who are able can assist with their own Victims who are able can assist with their own decontamination. Quickly remove and double decontamination. Quickly remove and double bag contaminated clothing.bag contaminated clothing.

Treatment for Dermal Exposure to HFTreatment for Dermal Exposure to HF

Use gloves resistant to Use gloves resistant to HFHFFlush exposed area with Flush exposed area with large volumes of water large volumes of water while removing while removing contaminated clothingcontaminated clothingApply calcium Apply calcium gluconategluconategel (2.5%) topically to gel (2.5%) topically to affected areas affected areas –– when the when the gel dries to a film, rinse gel dries to a film, rinse off, and reapplyoff, and reapply

Management of Respiratory ExposureManagement of Respiratory Exposure

BLS treatment includes O2 via BLS treatment includes O2 via nonrebreathernonrebreather face mask and monitoring face mask and monitoring for for bronchoconstrictionbronchoconstriction & pulmonary & pulmonary edema.edema.Advanced airway management is essential Advanced airway management is essential as early as possible post exposure.as early as possible post exposure.

Information ResourcesInformation Resources

ATSDR ATSDR –– Agency for Toxic Substances Agency for Toxic Substances and Disease Registry provides extensive and Disease Registry provides extensive information on the Medical Management information on the Medical Management Guidelines (Guidelines (MMGsMMGs) for Acute Chemical ) for Acute Chemical Exposures Exposures www.atsdr.cdc.gov/mmg.htmlwww.atsdr.cdc.gov/mmg.html

Questions ? ? ?Questions ? ? ?