Mcga-shs Capt Guide Chap2

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Toxichazards

ofchemicalsinclud

ingpoisoning

Note

Toxic ha za rds

Inha led po isons

Sw al low ed poisons

Skin con ta ct

Eye conta ct

General notes

Notes o n specific toxicsubstances

CHAPTER 2

45

Note

More detai led informat ion on the t reatment o f the ef fec ts

of specific chemicals is given in the International Maritime

Organizations Medical First Aid Guide for use in Accidents

involving Da ng erous Go od s (MFAG) 1994 which your ship

may be carrying.

Toxic hazards

Ships carry a numb er of substances other tha n cargo w hich

are pot ent ially toxic. For insta nce, medicines are not g enera lly

poisonous but can become so if taken in a manner not

prescribed , such as in an overdo se . Then t here a re substanceslike clean ers, deg reasers and d isinfectants w hich can give

rise to toxic hazards on the ir own o r through misuse, e.g.

emptying a bucket of blea ching solution into a la vatory bow l

containing a proprietary caustic cleaner may result in the

release of poisonous gas in a confined space. Notes on

various specific toxic substances are g iven at the end of this

section. Manufacturers data sheets also contain specific

medical a dvice.

Toxic substa nces can harm the body in three w ays.

1. They ma y cause local burns or irritat ion if the y come into

contact w ith skin or eyes.

2. They may be a bsorbed into the b ody an d cause internal

da mag e or systemic poisoning.

3. They ma y cause an allergic reaction w hich could be life

threatening.

Toxic substa nces can enter t he b ody t hrough

The lung s e.g. fu mes or to xic ga ses.

The mout h e.g. b y sw allow ing

The skin a nd eyes.

The commonest route for a to xin to ent er the body onb oa rd

a ship is by breat hing it in. The toxin may be in the form o f a

vapo ur, ga s, mist, spray, dust or fume.

Poisons are less commonly swallow ed, usually by a ccident

during routine d uties, but sometimes deliberately.

The effe cts of to xins are often sudden an d dram atic, but

ma y be subtle, gra dua l and cumulat ive. The lat ter is especially

true of inhaled t oxins or those absorbed th rough th e skin.

Suspect that every chemical is toxic until you know

otherwise. Remember that toxins are poisonous to the

rescuer a s w ell a s the pa tie nt . TAKE ALL POSSIBLE

PRECAU TIONS TO PRO TECTYOURSELF.

Prompt, safety conscious treat ment can a void many of the

complications of poisoning.

Inhaled Poisons

(See Chapter 1 fo r rescue from an enclosed space.)

Many chemicals produce fumes wh ich can irrita te th e lungs

an d cause diff iculty in brea thing e.g . chlorine. This w ill alert

you to their presence.


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46 THE SHIP CAP TAINS MED ICAL GUID E

Other ga ses have no odo ur . This group includes carbon monoxide, carbon d ioxide, hydrog en

and some refrigerant g ases.

Gases such as carbon dioxide and carbon mo noxide may a lso be poisonous, particularly in a

confined space, because they replace oxygen in the air and t herefore in the blood .

The ma in sympto ms of exposure are :

difficulty in breathing ;

nausea, hea da che, dizziness;

confusion o r even un consciousness in severe ca ses.

Rememb er that precautions aga inst fire and explosion ma y be necessary for some g ases.

Treatment

Remove the casualty at once into t he fresh air. Loosen t ight clothing and ensure a clear

airwa y. Give oxygen if a vailable.

Start art ificial respiration by the mout h to nose or mouth m ethod if breathing is ab sent.

The use of a Laerda l Pocket Ma sk (mouth to m ask) is recommended for resuscita t ion in th e

case of poisoning by solvents, hydrog en cyanide (prussic acid) or petroleum prod ucts to

avoid poisoning t he rescuer. Use oxygen if a vailable.

Start chest compressions if the hea rt ha s stopped .

In cases of hydrogen cyanide poisoning w here breat hing a nd pulse are present, break an

ampo ule of amyl nitrite into a clea n hand kerchief or cloth a nd hold und er the pat ient s

nose so that he inhales the vapour.

SEEK RADIO MEDICAL ADVICEas specific treat ment ma y be required.

Keep the pat ient at rest in bed for at least 24 hours or until he has recovered.

Comp lication s of inhaled poisons

Severe difficulty in breat hing w ith frothy sputum (pulmona ry oedema ).

Pneumonia a nd bronchitis.

DO NOT GIVE MORPHINE TO A CASUALTY WHO HAS BEEN GASSED, as this will affect their

abil ity to breathe.

Swallowed PoisonsAstringents

Many substances will cause chemical burns to the mouth, gullet and stomach if swallowed.

These include bleaches an d o ther cleaners an d d isinfectants, a cids an d a lkalis and corrosives as

w ell as pet rochemicals.

The ma in symptoms are blistering of the mo uth, lips and tong ue an d pa in in the chest a nd

stomach. The pa tients breath o ften smells of th e a stringen t.

DO NOT MAKE THE CASUA LTY VOMIT. If the pat ient is conscious and in pa in then he may

respond t o a g lass of milk. Do no t g ive painkillers by mouth . Use suppositories or a pa inkilling

injection if you ha ve an y.

Other substa nces can cause acute a bdo minal pain a nd vomiting. These include arsenic, lead,

fung i, berries and partly decomposed food. Treat the pa tient by making them a s comforta ble aspossible, but do not ma ke them vomit .

Drugs and Alcohol

Drugs may cause harmf ul effects if taken fo r recreation al purposes or as an o verdose. An overdose

may be taken a ccidentally or as an a ttempt at deliberate self ha rm. Common overdoses include

Sleepin g Tablet s. These include Dia zepa m (valium), Tema zepa m a nd Nitraz epa m. They cau se

drow siness an d uncon sciousness if ta ken in excess. This may last fo r 24 hours. The b reat hing

may slow dow n a nd b ecome shallow. In severe cases it ma y stop. A similar picture may be seen

w ith some a ntidepressant s, such as Amitriptyline, or w ith a lcohol.


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Cha pt er 2 TOXIC HAZARDS OF CHEMICALS INCLUDING POISONING 47

Simple pa inkillers such a s paracetamola ndaspirinare oft en ta ken as overdoses.

Paracetamolmay cause a bdom inal pain a nd vomiting init ially. Large r overdoses can cause

severe liver da mag e several da ys lat er. (Liver da mag e is rare below 20 tablets)

Aspirincauses vomiting, abdominal pain, ringing in the ears, rapid breathing and semi-

consciousness in high doses.

Treatment

Try to discover exactly w ha t w as ta ken (ask the pa tient , look for empt y packets/bot tles etc.) but

do not wa s te t ime doing so in an emergency.

If the casua lty is conscious, give one sa chet (50g) of ora l activat ed cha rcoal in 250 mls of f luid,

if available. Encourage fluids in conscious cases of aspirin overdose. SEEK RADIO MEDICAL

ADVICE.

If the pa tient is unconscious, then put h im in the recovery (unconscious) position a nd Give art ificial respiration if brea thing has stopped.

Perform chest compressions if the heart has stopped.

DO NOTgive anything by mo uth.

SEEK URGENT RADIO MEDICAL ADVICE.

Skin Contact

Toxic substan ces can a ffe ct the skin in tw o w ays:

1. direct conta ct may cause redness and irrita t ion. In severe cases, burns to the skin can o ccur.

2. Absorption through the inta ct skin producing genera l symptoms such as nausea, vomiting,

drow siness, w ea kness an d rarely unconsciousness.

Treatment

The conta minate d clothing a nd shoes should be remo ved immediately.

Wash off th e chemical w ith copious amount s of wa ter for at lea st 10 minutes. Continue fo r

a f urthe r 10 minute s if th ere is an y evidence of chem icals still on t he skin.

If a burn has occurred, see ma nag ement o f burns.

Eye Contact

Man y substa nces, in part icular ma ny chemical liquid s or fume s of chem icals, w ill produ ce

redness and irritat ion if the eyes are a ccidenta lly splashed o r exposed t o th e fume s. Treatme nt

should be immedia te.

Wash the substance out of the eye w ith copious amo unts of cold fresh w at er as quickly as

possible, keeping the e yelids wide open. This must be done thoroug hly for ten minute s. If the re

is any doubt whether the chemical has been completely removed, repeat the eye wash for a

further 10 minutes. If severe pain is experienced, physical restraint to the patient may be

necessary in order to be certain of effective treatment. Read about identifying and treating

d amage t o t he ey e .

For pain, give tw o pa racetam ol tab lets by mouth every four hours until the pa in subsides. Ifthe re is very severe pa in use Morphine.

General notes

If you are dea ling w ith a suicide at tempt, it is your duty to do everything you can t o save his life

and to guard a ga inst fur ther at tempts . The pat ient should not b e lef t without a n at tend ant .

You should save any rema ins of poison tha t you ma y find in a g lass, cup, bott le or packag e.

Also collect in a bow l anything t hat is vomited a nd seal in a b ott le. These may help in identifying

the toxic substa nce and deciding further treat ment a fter the pat ient has been seen by a doctor

or taken ashore.


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48 THE SHIP CAP TAINS MED ICAL GUID E

Notes on specific toxic substancesFor treat ment see unde r inhaled poisons, swallow ed poisons etc. ab ove.

Disinfectant poisoning

Many types of disinfectants such as carbolic acid, cresol and bleaching solutions are toxic.

Carbolic acid (phenol) and cresols cause a severe rash on contact w ith the skin in dilute

solutions. Strong concentrated solutions w ill result in pa inless wh ite burns of the skin. If they

are swallowed, burns of the mouth will occur, and the casualty may have severe vomiting,

follow ed b y collapse a nd u nconsciousness. Convulsions can occur (see Epilept ic fits).

Bleaching solut ions (e.g . lavat ory clea ners, etc.) are usua lly solutions of sodium hypochlorite

in wa ter. These cause irritat ion of the skin a nd a re poisonous if swa llow ed. The pa tient ma y

complain of burning in the mout h and stoma ch and feel gen erally unw ell.

On contact with acids, these substances release fumes which are irritat ing to the lungscausing a cough, a feeling of breathlessness and burning in the mouth. However, these

substan ces are no t severely toxic an d the sympto ms usua lly subside rapidly.

Solvents, petroleum products and fuel oils

These substan ces usually cau se sympto ms aft er the fum es have be en a cciden ta lly inha led. The

symptom s are dro w siness, dizziness, na usea a nd occasiona lly vomiting . If severe exposure

occurs, the pa tient ma y become unconscious. If they are swa llow ed, the y usually produce the

same symptoms, but nausea a nd vomiting are w orse.

Cyanide

Hydroge n cyanide (prussic acid) gas is used in fumiga ting ships. Both th e solid cyanide a nd t he

ga s are extremely poisonous, and symptoms a nd signs may develop very rapidly. They a re

corrosive either in contact w ith the skin or after b eing swa llow ed, causing external burns, burns

in the mouth a nd intense pain in the ab dome n. There w ill be shortness of brea th, anxiety and

rapid loss of consciousness. Convulsions can o ccur. Deat h ma y result w ithin a fe w m inutes.

Carbon dioxide (carbonic acid gas)

Suffocation by th is odo urless ga s may occur w hile dealing w ith a fire in a hold. The g as is also

produced if grain in the hold ferments, and it may be generated by refrigerated cargoes of

certain food s; it is also used a s a refrigerant . The g as is heavier than a ir and collects in the low er

parts of holds and compartments. When exposed to it , a man has giddiness, difficulty in

breat hing an d hea da che. Late r he may fall dow n and lose consciousness.

Carbon monoxide

This odourless gas is also produced in hold fires, as a product o f a n explosion, in the w aste g ases

of petrol and oil driven engines, and w hen refrigerate d mea t cargoe s decompose. It is light er

tha n a ir and very poisonous. In heavy concentrat ion it is inflamma ble. A patient suffering from

the e ffects of this ga s feels giddy, ofte n w ith muscular w eakness. Difficulty in breat hing rapidly

develops and unconsciousness may come on quickly. In severe cases the lips may be bright red,

and the skin of t he fa ce and bo dy has a pink colour. Hyperbaric oxygen th erapy may be helpful

SEEK ADVICE consider urgen t evacuat ion.

Refrigerant gases

Ammonia vapour. Breathing ammonia vapour will cause intense irritat ion, varying from a

catching o f the breath w ith smar t ing and wa ter ing o f the eyes in low concentrat ions, up to

intense irritat ion and corrosion of the whole air passages, gasping for breath, collapse and

dea th in the case of highly concentrat ed vapo ur.

Carbon dioxid eis also present in a ddit ion to amm onia. If a person be comes faint or loses

consciousness in a refrigerating pla nt w here there is no evidence of escaping amm onia, he is

probab ly suffering from t he effects of this gas.

Methy l chlor ideis a colourless gas, smelling like eth er. It ma y cause drow siness, menta l

confusion, coma, nausea, vomiting, convulsions and death. It is also dangerous in low


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Cha pt er 2 TOXIC HAZARDS OF CHEMICALS INCLUDING POISONING 49

concentration ow ing to its explosive na ture. On no account, should any naked light b e exposed

in the presence of the va pour; electric motors should be stopped to a void risk of sparking. A

hea vy duty electric torch, sw itched on bef ore approa ching the escape, is the only saf e light to

use.

Trichlorethylene usually called trilene or trike is a volatile ana esthetic ga s wh ich causes

drow siness, menta l confusion, na usea, vomiting a nd coma . It can also result in dea th. It is used

medically as an a nae sthetic because it acts quickly. In the impure fo rm it is used a s a d ry cleaning

ag ent. Some peo ple are a ddicted to sniffing it . Exposure ma y cause palpitat ions, especially on

excitat ion. Those exposed to it should be kept in a ca lm environment for a t least 6 hours.

Freonis an o dourless and harmless ga s except in a concentration high e noug h to d eprive a

man of sufficient oxygen. The signs of o xygen de ficiency are men ta l confusion, f aintness,

stagg ering g ait , collapse and unconsciousness.

Poisonous gases from refrigerated cargoes

Certa in refrigera ted carg oes including fruit , vege tab les and cheese, generate carbon dioxide

during normal storag e. With any fa ilure of refrigerating pla nt , foo d cargoe s (especially mea t)

may g enerat e poisonous and inflamma ble ga ses. This can be pa rticularly da ngerous if the cargo

space is flooded. Carbon monoxide, ammonia, hydrogen sulphide and hydrogen may be

gene rated in ad dit ion to carbon dioxide. In any grea t concentration these ga ses are extremely

poisonous a nd some a re explosive. All precautions ag ainst fire and explosion m ust be ta ken in

addit ion to those ag ainst suf focat ion and poisoning.


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