Module 3: Health and Safety - Welcome to IAFFonline!

Module 3: Health and Safety 3-1

Student Text IAFF Training for Hazardous Materials: Technician©

Module 3:

Health and Safety

3-2 Module 3: Health and Safety

IAFF Training for Hazardous Materials: Technician© Student Text



Module 3: Health and Safety

Module Description

This module addresses health and safety issues by classes of chemicals, and toxic effects onspecific body systems. Medical surveillance and proactive health and safety planning are alsocovered.

Prerequisites

• Students should have completed a hazardous materials operations level training program.

• Students should be certified emergency medical technicians or paramedics.

• Students should have access to the equipment and materials common to a fire departmentEMS unit.



Objectives

Upon completion of this module, participants will be able to:

Instructor Preparation

Obtain and become familiar with the following regulations:NFPA 473NFPA 1500NFPA 1580CFR 1910.120CFR 1910.1200CFR 1910.20CFR 1910.3040CFR 54.390IAFF Wellness Initiative

Obtain a facility preplan for a site in the local area and become familiar with it.

Research the most prevalent health and safety hazards in the local area. (For example, pesticidesmay be a significant hazard in agricultural areas.)

Data on local fire fighter illnesses and injuries on duty may be beneficial.

ObjectivesNFPA

StandardsOSHA

Standards

• Describe the risk/benefit approach and how it applies to decision-making during emergency incidents.

• List the key elements of a proactive health strategy.

• List the key elements of proactive safety strategy.

• List basic health and safety principles.

• Define hazardous materials toxic effects terms.

• Discuss the elements of medical surveillance.

• Explain the basic toxic effects on the human body.

• Describe the toxic effects in specific organ systems.

• Discuss toxicity specific to the DOT classes of hazardous materials.

NFPA 15006-2.1.1

NFPA 15009-2.1NFPA 15009-2.1

NFPA 1582

NFPA 15008-1.3NFPA 4733-2.1 (d)NFPA 4733-2.1 (d)NFPA 4723-2.3.8

29 CFR 1910.120(q) (6) (iii) (E)

29CFR1910.1200(h) (3) (ii)29CFR1910.1200(h) (3) (ii)

29CFR1910.1200(h) (3) (ii)29CFR1910.1200(h) (3) (ii)29CFR1910.1200(h) (3) (ii)29CFR1910.1200(h) (3) (ii)29CFR1910.1200(h) (3) (ii)



Find out about departmental Employee Assistance Programs (EAPs), community clinics, city-sponsored organizations, or any other programs designed to help people maintain a healthylifestyle.

Plan on giving the Prerequisite Quiz at the beginning of this module. If any students fail toanswer at least half the questions correctly, they should be directed to read Training for Hazard-ous Materials Response: Your Rights and Responsibilities and Hazardous Materials Training forFirst Responders (Unit 3-Hazardous Materials). Both programs are available through the IAFF’sHazardous Materials Department.

This module requires that students be certified EMTs or paramedics. Consequently, much of theinformation reviews material in EMS training. If possible, find out how much experience andknowledge your students have to gauge the level of detail you need to teach.

Equipment and Supplies

• IAFF Fire Fighter Line of Duty Death and Injury Investigation• Transparencies and overhead transparency projector• Chalkboard or flip chart• Copies of the NIOSH Pocket Guide to Chemical Hazards• DOT placards for the nine hazardous materials classes• Copies of your department’s medical surveillance plan and related forms• Copies of a comprehensive site pre-plan• “Silly String” or other non-staining substance to spray on clothing• Air freshener• Materials for Application Exercise (at end of module before appendices)• VCR and videotapes:

• Team Member: Health and Safety (formerly Exposure and the Body’sResponse)

• Salem, NH Nitric Acid Spill• Team Member: Medical Surveillance• Wellness/Fitness Initiative

Approximate Length

This module requires six to eight hours to complete. Fewer hours may be needed if the class isexperienced and up-to-date on EMS.





Module 3Prerequisite Quiz

1. Medical surveillance for emergency responders is part of which federal regulation?A. NFPA 1500B. NFPA 473C. 29 CFR 1910.1200D. 29 CFR 1910.120

2. The primary route of chemical exposure for fire fighters is:A. InhalationB. Skin absorptionC. IngestionD. Injection/puncture

3. Secondary contamination refers to:A. Contamination from a second chemical during one incidentB. Contamination of the publicC. Contamination from someone who has already been contaminatedD. Contamination from more than one source

4. Which of the following statements is not true of the skin?A. Intact skin is usually a good barrier to chemicals.B. Skin can be both a route of entry and a target site for chemicals.C. Water-soluble substances are more easily absorbed by the skin.D. Areas of the body with more hair follicles allow greater chemical absorption.

5. Which of the following items will provide minimum shielding from gamma radiation?A. Several inches of leadB. Chemical protective gearC. Bunker gearD. Nothing can protect you from gamma radiation

6. Under federal regulations, medical surveillance is required for:A. All fire fightersB. Members of EMS and hazardous materials teamsC. Members of EMS teams onlyD. Members of hazardous materials teams only

7. Biological monitoring measures:A. The amount of absorbed radiationB. The amount of an agent in your bodyC. Chemical exposure over long periods of timeD. Baseline body chemistry



8. Simple asphyxiants displace oxygen in the air. Chemical asphyxiants:A. Absorb oxygen in the airB. Combine with oxygen molecules to create a chemical reactionC. Prevent the respiratory system from inhaling oxygenD. Prevent the body from using inhaled oxygen

9. Etiologic means that an agent is:A. AirborneB. BloodborneC. InfectiousD. Carcinogenic

10. Which of the following organs is considered the primary “transfer point” for chemicals inthe body?A. The heartB. The brainC. The gastrointestinal systemD. The lungs



IntroductionQuestions

1. What are two common examples of chemicalasphyxiants?

2. What are mutagens?

3. Which of the following is a standard, and which is aguideline?

Threshold Limit Value (TLV)Permissable Exposure Limit (PEL)Short Term Exposure Limit (STEL)Immediately Dangerous to Life or Health (IDLH)

4. OSHA/EPA requires employers to maintain medicalrecords on exposed workers for how many years?

Making a safe and effective emergency response at thetechnician level requires a complex approach that integratespersonnel, protective equipment and other resources. Themost important resources at the scene of any emergency,including one involving hazardous materials, are the firefighters and paramedics who will do the work.

An effective response begins long before the incident with aset of initiatives that helps guarantee the long term health ofteam members. Emergency response is characterized by ahigh stress environment where many unknowns are at work.Responders must be able to quickly size up the situationand implement protective measures. Being effective in thishigh pressure role means making sure you operate at peakeffectiveness. No one can operate at peak efficiency with-out good health.





Health and Safety

Emergency Respondersand Health

Good health is characterized by physical and mental well-being. It’s the absence of disease, injury and pain. Goodhealth allows us to perform at our highest level and to enjoywhat we do. Having good health is not a chance occur-rence. For most of us it means being aware of our bodiesand making wise decisions that take into account thestresses we are under in our work. Few professions aremore stressful than fire fighting and emergency response.As a result, good health is extremely important.

Emergency Respondersand Safety

It is widely recognized that fire fighting and emergencymedical response, including hazardous materials emergen-cies, is highly dangerous work. The rate of worker injury ishigh; about 25% are injured each year. Some of theseinjures are serious, resulting in disability retirement. Inaddition to these injuries, members are constantly exposedto hazardous materials and other emergency events thattake a toll on their long term health.

While you often operate in a chaotic environment, youmust always work safely. This includes making the sceneas secure as possible while reducing the opportunity forinjury to occur. Professional response personnel under-stand that many elements of emergency response can beidentified and planned for in advance.



Proactive HazardousMaterials EmergencyResponse

To the public, fire department actions at the scene of aburning gasoline tanker might seem confused and chaotic.Dozens of fire fighters moving quickly, thousands ofgallons of foam in all directions, hoselines scattered every-where—only a trained professional would look at the samescene and see a carefully planned event that includes acoordinated attack using well managed resources. Theywould see that the coordination involves downhill controlof the product and that there are sufficient resources onscene to allow for effective rehabilitation of crews workingin the Hot Zone. While it may be an emergency event inthe eyes of the public, professional responders have care-fully planned in advance the key elements of the responsethat will ensure the health and the safety of fire fighters andparamedics. It’s what is known as proactive planning.Proactive planning means identifying key needs and creat-ing a strategy to meet them before they arise. You may notknow exactly when the specific emergency will occur, butyou can identify in advance many of the things you willneed to respond effectively and safely. Chief among theseneeds is good personal health.

As an emergency responder you are constantly risking yourpersonal health and safety to complete objectives at anemergency incident. A key component of an effectivehealth and safety strategy is ensuring that these risks areappropriate. The only way to know if the risk is appropri-ate is to understand the benefit.

The Risk/Benefit Approach

All risks on an emergency scene are not equal. Some ofthem, like securing the scene or shutting down the fuel flowfrom a remote location, can be achieved with little personaldanger. Other actions, such as moving directly into the HotZone to stop a leak or attempt a rescue can put emergencyresponders at extremely high risk. If anything goes wrong,



or if there is a rapid change in conditions, responders canbe killed or injured.

Unfortunately, there are many instances where fire fightershave either died or been seriously injured taking risks thatwere not equal to the benefits that would likely result fromtheir actions. Often these events involve close-up firesuppression in areas where there was little if any life threatto the community. In many instances the only lives endan-gered in the event were those of response personnel. Thesaving of any amount of property is not worth the life of anemergency responder.

Accordingly, you need to always ask yourself: What riskam I taking, and what benefit can I expect to receive? Ifrisks outweigh benefits, you should reduce the risk. Gener-ally speaking, fire fighters should only be exposed to lowrisk to save property. They may be put at slightly higherrisk in marginal rescues where a professional evaluationconcludes that there is not a high probability that the victimwill survive. Responders should be put at high risk only ifthere is a clearly savable life.

A risk/benefit assessment means that members must care-fully evaluate an incident, including patient viability andadequacy of emergency resources to safely handle theevent. If proper resources are not present or if the rescue isextremely complicated with little chance for success,aggressive actions should be carefully scrutinized.

Activity





Hazardous Materialsand Their Effect on theHuman BodyThe next step in understanding and preventing hazardousmaterials exposure is to review a substance’s overall effecton the body and specific body systems. We can also learnabout toxic exposure by studying some of the hazardspresented by each of the nine classes of hazardous materi-als. This approach provides a broad picture of exposureconcerns and organ systems, then links these issues to DOThazardous materials classifications.

Categories of ToxicSubstances

Asphyxiants

Asphyxiants deprive the body of oxygen. The normalconcentration of oxygen in air is 20.9 %. Lower concentra-tions result in an oxygen-deficient atmosphere, especially ifoxygen content is less than 19.5 %.

There are two types of asphyxiants: simple and chemical.Simple asphyxiants simply displace oxygen in the environ-ment. Examples of common simple asphyxiants includecarbon dioxide, nitrogen, methane, propane, and argon.

Chemical asphyxiants prevent the body from using oxygen,even though it may be present. Carbon monoxide, hydro-gen sulfide, and hydrogen cyanide are examples.

Signs and symptoms of oxygen deficiency include progres-sive problems such as: restlessness, agitation, drowsiness,confusion, stupor, coma, and death. Some asphyxiants canalso create other hazards such as flammable atmospheresthat may initially be above the flammable range but becomeflammable during operations.



Confined spaces such as tanks, underground areas andenclosed rooms are especially hazardous. Without self-contained breathing apparatus, you can be quickly over-come in an oxygen-deficient atmosphere.

Equipment that measures the oxygen level is becomingincreasingly available to technicians. Always remember tomonitor in teams of two and be aware that a decreasingoxygen reading can mean the presence of a lethal gas withmultiple hazardous properties.

Corrosives

Corrosives are divided into two categories: acids and bases.A primary danger from corrosives is that they can causeirreversible tissue damage. Their effects depend on theconcentration of the material, that is, the amount of prod-uct in solution (for example, 40% hydrochloric acid, or80% sodium hydroxide) and the strength of the acid orbase. Hydrochloric acid, for instance, is a stronger acidthan acetic acid and is consequently more toxic.

The skin, eyes and mucous membranes of the upper respi-ratory system are all very sensitive to corrosives. Acidstend to cause irritation, pain, or a burning sensation uponcontact. Bases, or alkalis, can cause tissue destruction thatmay initially be painless. If inhaled, general signs ofrespiratory tract irritation may include coughing or diffi-culty breathing. Skin or eyes affected by acids or alkalisshould be decontaminated with large amounts of water assoon as possible. Structural fire fighter protective clothingwill provide limited protection against corrosive exposure.The effects of corrosives, however, will affect the thermalproperties of the garment.

Irritants

Irritants cause temporary, but occasionally severe, inflam-mation of the eyes, skin, or respiratory tract. There can bepermanent damage if exposure is repeated over time.Symptoms depend on the tissue that is affected. You maybe familiar with the itching, redness, and discomfort ofirritated skin and eyes. Coughing and difficulty breathingare symptoms of respiratory exposure to an irritant. Manysolvents, such as benzene, cause skin irritation. Other



irritants include ammonia, chlorine, and hydrogen chloride.Keep in mind that these substances have other toxic proper-ties as well.

Sensitizers

Sensitizers cause allergic reactions after repeated expo-sures. A reaction can appear several hours after exposure toa sensitizing agent. In case of skin exposure, a rash maynot appear until several hours after exposure. Reactionsvary depending on the route of exposure and an individual’ssusceptibility to a specific toxin. Allergic reactions tend tobecome worse with repeated exposures. Inhalation maycause an asthma-like reaction in the short term with longerterm exposures resulting in permanent lung disease.

Examples of sensitizing agents include: formaldehyde,mercury, and toluene diisocyanate (TDI).

Carcinogens

Carcinogens cause cancer. Some carcinogens have beendefinitely linked to cancer in humans. Others are known tocause cancer in laboratory animals and are suspected ofcausing cancer in humans. Studying the cancer-causingpotential of chemicals is difficult since the latency period(the time that it takes cancer to develop) can be up to 30years. The exact levels of exposure can be difficult todocument. Very little is known about the health effects ofexposure to multiple carcinogens. Fire fighters and emer-gency responders may be exposed to multiple carcinogensduring fire fighting or hazardous materials response.

Carcinogens may affect an organ or organs remote from theroute of entry. Some examples include benzene, which isassociated with leukemia; vinyl chloride, which is associ-ated with a specific type of liver cancer; and asbestos,which causes a specific type of lung cancer and increasesthe risk of all lung cancers among exposed individuals,particularly those who smoke. Other examples of cancercausing agents include coal tar and cigarette smoke.



Neurotoxins

Neurotoxic chemicals can cause both temporary or perma-nent damage to the central nervous system (the brain andspinal cord) or the peripheral nervous system (the nervesresponsible for sensation and movement in the arms, hands,legs, and feet). Exposures to neurotoxins during an emer-gency are likely to be short-term and high-level.

Many solvents are neurotoxic. Their effects include dizzi-ness, euphoria, and impaired judgment and reflex time.Pesticides are common neurotoxic chemicals that can havesystem-wide effects including loss of muscle control,wheezing, muscle tremors and gastrointestinal disorders.Some neurotoxins are also convulsants, which produceseizures. These include chlorinated hydrocarbon insecti-cides such as aldrin and dieldrin; halogen fumigants such asmethyl bromide and sulfuryl fluoride; organophosphatessuch as diazinon and dursban; and solvents such as phenol,ethylene oxide, and carbon disulfide.

Mutagens

Mutagens are toxic agents that cause genetic changes.These changes occur in the genetic material in eggs andsperm. As a result, the characteristics of future generationscan be altered after exposure to mutagens. For example,one of the hazards of radiation exposure can be geneticalterations. Such hazards were apparent after the nuclearreactor incident at Chernobyl where thousands of peoplewere exposed to significant amounts of radiation in thedays and weeks after the explosion.

Examples of mutagens include ethylene oxide, ionizingradiation, hydrogen peroxide, and benzene.

Teratogens

Teratogens are substances that cause malformations in anunborn child. Fetuses are particularly susceptible to haz-ardous materials exposure because their cells are develop-ing and reproducing at a very high rate. Examples ofteratogens include anesthetic gases, organic mercurycompounds, ionizing radiation and German measles.



Infectious Agents

Infectious agents gain access to the body primarily throughinhalation, ingestion, and absorption through the skin.Many infectious agents have a preferred route of entry.Infectious agents include viruses such as hepatitis A,hepatitis B, hepatitis C, human immunodeficiency virus(HIV), and the herpes virus. Avoiding exposures to bloodand body fluids by using body substance isolation (BSI)can help to protect you from exposure. Body substanceisolation can be defined as the use of personal protectiveequipment and procedures designed to protect emergencyresponders against exposure to infectious agents. EMTsand paramedics should be thoroughly familiar with theseprocedures.

Bacteria are also infectious organisms that can causedisease in humans. Different types of bacteria cause tuber-culosis, strep throat, and most wound infections. Tubercu-losis infections are increasing and should be of concern toresponders who have direct patient contact. Routine tuber-culosis screening can detect infection early, so the diseasecan be promptly treated. Your department and participatinghealth care facilities must have procedures for follow-up ifyou are in direct contact with a patient infected by tubercu-losis.

Other organisms include fungi (plant-like organisms thatcause disease, such as oral thrush and athlete’s foot),parasites (organisms that live on other organisms, such asthose that cause trichinosis and dysentery), and rickettsia(microorganisms transmitted by insects, such as the tickthat carries Lyme disease).

Activity





The Language ofHazardous MaterialsToxicity

There are a number of good reasons why you shouldunderstand toxic effects. Even though you may operatesafely and efficiently, there is an still an opportunity forexposure. You already know that routine structural firefighting results in exposures to toxic materials. If you arealso engaged in hazardous materials response at the Techni-cian level, your potential for exposure increases.

A high profile element of a safe response is the ability tothoroughly research a toxic material as part of incidentresponse. Research will help you better determine the toxicproperties of the material(s) involved in the incident.Knowing and understanding key terms and principles canhelp in your research.

Toxicological Terms

Toxicology: The study of poisons

Toxicity: The inherent capacity of an agent to produceinjury

Toxin or Toxicant: An agent or substance capable ofcausing harm

Exposure: The process in which a toxicant reaches asusceptible body tissue

Target organs: The organs that are selectively affected bya particular agent or substance



What Makes aSubstance Toxic?

For a substance to be considered toxic it must have certainproperties and be present under certain conditions. Theseproperties and conditions work in concert to create a nega-tive health effect. Toxic materials must:

• Have physical and chemical properties capable ofcausing harm. Many times, solid materials are lesstoxic than gases because their potential to spread easilyand cause harm is much less. Chlorine gas can diffuserapidly and is extremely toxic in even small amounts.

• Be present in sufficient amounts to do harm. That is,the dose must be large enough. Carbon dioxide in smallamounts is virtually undetectable. However, in largerquantities it can replace oxygen in the atmosphere andresult in asphyxiation.

• Be present for a sufficient amount of time. Somematerials pose little threat if the exposure time is small.However, remaining in the contaminated area forextended amounts of time can result in significantexposure. Prolonged exposure to such common hazard-ous materials as gasoline can result in chemical burnsand long-term health effects such as cancer.

• Have a route of entry into the body. Intact skin is agood barrier because it provides some protectionagainst exposure. Intact skin is not, however, a replace-ment for proper personal protective equipment. Somematerials such as solvents can be easily absorbedthrough the skin and damage target organs such as theliver.

• Reach a susceptible body organ or tissue. Manymaterials have an affinity for specific body organs.Tuberculosis, an increasingly common infectious agentspread through respiratory contact, lodges in the lungsand can result in serious disease if undetected.



Exposed, Contaminated,or Both?

Understanding the difference between exposure and con-tamination will help you avoid the negative effects of toxicmaterials.

Exposure

Although there is often overlap between exposure andcontamination, it is possible to distinguish between the two.If you enter a confined space where carbon monoxide ispresent, without sufficient respiratory protection, youbreathe these fumes into your lungs. You are exposed to thematerial and the toxic effects that it produces. If you remainin this atmosphere for a sufficient amount of time, you willbegin to suffer the negative effects of exposure to carbonmonoxide. If, however, you leave the area and return tofresh air, you are no longer in the presence of the gas andthe exposure stops. You have been exposed to the gas bybeing in the area and breathing it into your body.

Exposure occurs when a toxic substance or infectiousagent is taken into the body or is in direct contact withthe body.

Contamination

If, during the course of operations at a large flammableliquid spill, you saturate part of your clothing with theproduct, you are contaminated. This hazardous materialwill remain on your clothing and possibly on your skin untilyou take steps to leave the area and remove the contami-nant. You have been contaminated with the material andyou may be receiving an exposure if the material is on, or inthe body.

Contamination occurs when the material clings to orsaturates clothing, or parts of your body.

It is possible to be contaminated at an incident withoutbeing exposed if you are using the correct personal protec-tive equipment in the Hot Zone and you undergo thoroughdecontamination when you have completed your assign-ment.



Similarly, it is possible to be exposed to a hazardous mate-rial but not contaminated by it. One example would beconducting rescue operations in close proximity to a sealedsource emitting radioactive gamma rays. You are exposedto the powerful wave of energy from the source, but whenyou leave the area, you are not contaminated.

Understanding these principles helps you avoid the negativehealth effects of hazardous materials.

Determining Toxic Effects

If you have been exposed to a hazardous material, you needadditional information to determine its likely effects.

Potential toxic effects. You must know how the specificmaterial will harm the body once it enters. Later sectionsin this module discuss how some materials target differentbody systems and how some classes of hazardous materialsalso have specific health effects.

Amount present. Estimating or determining the amount oftoxic substance involved can provide important informationabout the severity of the effects.

Route and conditions of the exposure. Knowing how thematerial entered the body provides clues to the body tissuesit will affect, and to what degree.

Characteristics of the susceptible person. Some personsare more susceptible to exposure than others. Youngchildren and persons with pre-existing medical conditionscan be especially vulnerable. Knowing these individualcharacteristics can help you estimate the severity of theexposure event.



Concentration and Duration

Two of the most important factors determining chemicaltoxic effects are concentration of the substance and durationof the exposure.

The concentration of vapors and gases is measured in partsof vapor or gas per parts of air (by volume). The standardunits of measure are parts per million (ppm) and parts perbillion (ppb). For example, a carbon monoxide concentra-tion measured as 1,500 ppm contains 1,500 parts of carbonmonoxide for every 1,000,000 parts of air.

Concentrations of solids can be measured according to theweight per volume of air—milligram/cubic meter (mg/m3 ).Solids suspended in air can be dusts, mists and fumes.Though ammonia is primarily an irritant gas, at a highenough concentration (around 150,000 ppm) it becomes aflammable gas, creating a whole new set of hazards forhazardous materials technicians.

Duration refers to the length of contact with a substance.Duration is one factor affecting how much is absorbed.Longer and more frequent exposure periods usually resultin greater absorption.

The dose of the agent is how much of the agent reaches atarget organ. The higher the concentration and longer theduration of exposure, the higher the dose.

The severity of effects depends on the situation. For ex-ample, exposure even to low concentrations of most toxicproducts of combustion will produce severe health effects ifthe exposure occurs over a long enough duration. On theother hand, a very short duration exposure to high concen-trations of toluene can produce severe effects as well.



Acute and Chronic Exposures

The toxic effects of hazardous materials can result fromacute or chronic exposure.

Acute

Acute exposure occurs over a short period of time to arelatively high concentration of a substance. An acuteexposure may have effects that are both immediate andlong-term. For example, the immediate effects of acuteexposure to carbon monoxide include headache, weakness,dizziness, and loss of consciousness. Days or weeks after“recovery” from the initial exposure there may be delayedsymptoms of brain impairment such as confusion, lack ofcoordination and behavioral changes. Other effects fromacute exposure may not be detected until years later.

Chronic

Chronic exposures are long-term (over several days toweeks or longer) and involve repeated periods of contact atrelatively low concentrations.

Effects of Acute and Chronic Exposures

In many cases, the effects of acute exposure are verydifferent from the effects of chronic exposure. For ex-ample, the primary acute toxic effect of benzene exposureis central nervous system (CNS) depression, whereaschronic exposures to benzene can cause leukemia. Acuteexposure to carbon monoxide causes asphyxiation, whilechronic exposure can cause heart problems.

Measures of Toxicity

The toxicity of a substance is usually determined throughcell or animal testing. A frequently used measure is LD50.This is the lethal dose for 50% of the animals being testedunder specific conditions. Other measures include LD

100,

the lethal dose for 100% of the population studied, the LC50

and LC100

, the lethal concentrations of a substance thatwill kill 50% and 100% of the population, respectively.



These measures are often found in references and indicate arelative toxicity, that is, the toxicity of one substancecompared with another. A substance whose LD

50 is 0.5 mg

(of substance) per kilogram (of animal body weight) isconsidered much more toxic than one with an LD

50 of 2.0

mg/kg. The lower the LD or LC, the higher the toxicity.

There is almost no reliable information about the toxiceffects of combinations of chemicals. For this reason, takeevery precaution to avoid exposure.

Standards and GuidelinesRelated to Toxic Exposure

Threshold Limit Value (TLV), Permissible Exposure Limit(PEL), Short Term Exposure Limit (STEL), and the Imme-diately Dangerous to Life or Health (IDLH) level are keyterms describing standards and guidelines related to theexposure limits of hazards. Some of these levels are deter-mined by the relationship between the dose of the sub-stance and the resulting toxic effect. Most are based ontime-weighted averages unless otherwise noted.

TLV 8 hours/day up to NO Determined by 40 hours/week a professional

organization

PEL 8 hours/day up to YES Set by OSHA 40 hours/week

STEL 15 minutes YES Set by OSHA

IDLH 30 minutes NO Determined by NIOSH - for escape only

REL-TWA up to 10 hrs/day NO Determined by during 40 hrs/ NIOSH week

LIMIT EXPOSURE IS IT LAW? COMMENTSDURATION



Threshold Limit Value (TLV) is the average airborneconcentration of substances to which it is believed nearlyall adults may be repeatedly exposed in the working envi-ronment for an eight hour workday or a forty hour workweek, without adverse effects. However, maintaining levelsbelow these levels does not guarantee there will not be anyadverse effects. The Threshold Limit Value, Ceiling (TLV-C), or ceiling level, refers to the level that should never beexceeded, even for a moment. TLVS are reviewed andupdated annually.

Permissible Exposure Limit (PEL) is the average airborneconcentration of a potentially toxic substance to which anemployee may be exposed for an eight-hour period. Thisstandard is the legal limit of exposure allowed in a work-place according to a federal law, the Occupational Safetyand Health Act. Most of these limits were adopted fromexisting TLVs.

Short Term Exposure Limit (STEL) is a standard or legallimit, like the PEL. The maximum duration of exposure atthis level is usually 15 minutes with no more than fourexposures in an eight-hour day and one hour betweenexposures. At the STEL, it is believed that exposure willnot result in permanent damage. There is no margin oferror in the STEL, and individuals who are more suscep-tible may experience toxic effects at lower levels.

The Immediately Dangerous to Life or Health (IDLH)level is defined as “a condition that poses a threat of expo-sure to airborne contaminants when that exposure is likelyto cause death or immediate or delayed permanent adversehealth effects or prevent escape from such an environment.”Substances that are suspected to cause cancer generally donot have IDLH levels since there is a potential for develop-ing permanent health effects.

These standards (legal limits) and guidelines (recom-mended limits) should not be regarded as the divisionbetween “safe” and “dangerous” levels. These levels areonly defined for single levels. They do not account forexposure to multiple toxicants. Sometimes the combinedtoxic effects of substances is far greater than the individualproperties of the materials. As an example, smokers with ahistory of asbestos exposure are at much greater risk for



cancer than nonsmoking asbestos workers or smokers whoare not exposed to asbestos. Because they are routinelyexposed to asbestos during overhaul and other fire fightingduties, fire fighters should not smoke.

Activity

How Toxic MaterialsEnter the Body

There are four major routes of exposure: skin absorption,inhalation, swallowing (ingestion), and injection or punc-turing. The eyes can also be a route of toxic exposure.

Skin Absorption

Toxic substances can be absorbed through the skin, or mayenter the bloodstream through broken skin. The skin canact as a barrier to provide varying degrees of protection.The longer a material is in contact with the skin, the greaterthe amount absorbed. The higher the concentration of thechemical, the greater the amount absorbed. Skin tempera-ture and blood flow also affect the rate of absorption. Areaswith hair follicles allow for greater absorption. For ex-ample, the scrotum is 300 times more susceptible to absorp-tion than the foot. The type of chemical also affects expo-sure. For example, fat soluble chemicals, like solvents, aremore readily absorbed. The integrity of the skin can bedamaged by trauma, heat/cold, humidity and moisture, andprevious chemical exposures.

Inhalation

The lungs act as a transfer point in the human body.Chemicals and infectious agents can enter the body throughinhalation. The rate and depth of respiration affect theamount of the material absorbed. Faster and deeper respi-ration rates increase exposure. This route of exposure ismost common for fire fighters unless SCBA is used.



Ingestion

Toxic materials can be swallowed if contaminated hands orclothes come in contact with the mouth. Ingested materialscan affect other organs as well as the gastrointestinal sys-tem. To avoid exposure through ingestion, always completedecontamination before you eat or drink.

Injection and Puncturing

Injection or puncturing can be:

• Intradermal (into the skin)• Subcutaneous (under the skin)• Intravenous (into a vein)• Intramuscular (into a muscle)

Injections and punctures result from contact with physicalagents such as syringes, high pressure devices or sharpobjects (e.g., jagged pieces of glass or metal). Injuries frominjection and puncture can be more serious than surfacecontact because chemicals can penetrate deep into thetissues. Consequently, it may be difficult to determine theextent of the exposure. Injection also damages the integrityof the skin, allowing an opening for other chemicals.

The Eyes

Up to 90% of hazardous materials can be absorbed throughthe eyes. Only 10% of all eye injuries involve hazardouschemicals, however, with chemical burns causing the mostsevere injuries. Chemicals that are both water and fatsoluble penetrate the farthest and do the most damage.Most chemical injuries to the eye are caused by alkalisplashes. Common chemical injuries involving the eyeinclude: lye, quick lime, ammonia, sulfuric acid, and hydro-carbons.

Activity



Toxicity Specific toClasses of HazardousMaterialsDOT classes describe the most significant hazard associ-ated with a regulated substance. These materials may posemultiple hazards. For example, uranium hexafluoride,which has a primary hazard of radiation, is also corrosive.A knowledge of chemistry is extremely important in under-standing hazard classes.

Explosives and Blasting AgentsClass 1

Many of these agents contain nitrates, which cause dilationof blood vessels. Symptoms include headache, nausea,abdominal cramping, and reduced blood pressure. Severeexposures can cause heart irregularities and shortness ofbreath. If inhaled or absorbed, nitrates can cause eye andskin irritation as well as reducing the capacity of red bloodcells to carry oxygen. Explosives with names containing“azo-” and “azid-” can emit toxic fumes of nitrogen oxideswhen they heat and decompose. These oxides can producesevere lung injury.

Poison Gases and PoisonClass 2, Division 2.3Class 6, Division 6.1

Poison Gas, Class 2, Division 2.3 materials are extremelytoxic and a small amount of vapor or gas is dangerous tolife. Cyanogen gas, phosgene gas, and organic phosphatesmixed with compressed gas are included in this category.The primary route of exposure is inhalation. Even brief orlow-level exposure requires immediate attention in a hospi-tal.

Materials classified as Poisons, Division 6.1 are consideredsomewhat less dangerous than those classified as poisongas because they exist in either a solid or liquid state.



Solids and liquids are not inhaled as readily as gases, butthey still pose a significant hazard. Arsenic compoundsfound in liquid or solid state, such as arsenic iodide, or evenpure arsenic in its solid form, are classified as poisons. Yetarsine gas results from the combination of these materials.These substances can be absorbed through inhalation,ingestion, or skin absorption and may be highly toxic.Immediate medical attention is required for exposure.Some of these compounds may cause cancer. Other ex-amples of poisons are carbon tetrachloride and hydrocyanicacid.

During a fire, many materials in the poison class can pro-duce gases that would be classified as poison gases.

Flammable GasesClass 2 Division 2.1

Many of these gases displace oxygen and can cause as-phyxiation in confined spaces. Acetylene is a simpleasphyxiant as well as a narcotic in high concentrations.Another gas, ethylene oxide, produces cancer and birthdefects in lab animals and may be a reproductive hazard inhumans as well. Ethylene oxide, like many flammablegases, is a strong irritant to skin, eyes, and mucous mem-branes.

Non-Flammable Gases and OxygenClass 2 Division 2.2

This class includes oxygen, carbon dioxide, ammonia, andinert gases. Oxygen-enriched environments are not toxic tohumans, but the danger of fire is very great. Carbon diox-ide and the inert gases are simple asphyxiants, rapidlycausing death because they displace oxygen in the atmo-sphere. Ammonia is extremely irritating and can burn evenat relatively low concentrations.

This class also includes the halogen acid gases, such ashydrogen fluoride, hydrogen chloride, and hydrogen bro-mide. All the halogens (chlorine, bromine, and fluorine)and their acids are highly irritating to the skin and mucousmembranes. Inhalation can cause pulmonary edema, whichimpairs breathing. Any material that reacts with water willreact with water found in body tissues.



Flammable/Combustible LiquidsClass 3

The majority of these materials are hydrocarbons andhydrocarbon derivatives. Hydrocarbons target severalorgans and can cause central nervous system depression,resulting in dizziness, lack of concentration, or sleepiness.The peripheral system may also be damaged, affecting boththe motor and the sensory nerves. Some hydrocarbons canalso cause dysrhythmias. High levels of inhalation expo-sure can result in irritation of the respiratory tract or pulmo-nary edema.

Halogenated hydrocarbons are toxic to the liver. Some maycause kidney damage as well. Benzene is a commonlyknown carcinogen. Chloroform and trichlorethylene areknown animal carcinogens and potential human carcino-gens. In addition to inhalation exposure to vapors, many ofthese agents are easily absorbed through the skin. In fact,skin exposure of one hydrocarbon may enhance absorptionof other hydrocarbons.

Flammable/Water-Reactive SolidsClass 4

Flammable solids include lithium compounds. Thesecompounds can cause irritation to the skin, eyes, andmucous membranes. Some may irritate the lungs if in-haled. Also in this class are some nitrogen compounds thatliberate oxides of nitrogen when they decompose in a fire.Several nitrogen compounds cause liver, kidney, cardiac, orcentral nervous system effects.

Oxidizers and Organic PeroxidesClass 5

Oxidizers include several families of agents such as organicperoxides. Organic peroxides can cause skin or mucousmembrane irritation, or pulmonary/laryngeal edema. Thehalogens are also members of the oxidizers class. They arehighly irritating to eyes and mucous membranes. In addi-tion, chlorine and fluorine are well known as powerfulcaustic irritants to tissue.



Other oxidizers include nitrate compounds, as previouslydiscussed. Ammonium compounds are also represented inthis class. They can liberate toxic fumes such as ammoniaand oxides of nitrogen when they decompose. In addition,some oxidizers, such as ammonium, are possibly carcino-genic.

Radioactive MaterialsClass 7

Radioactive materials will generally cause long-term orchronic problems rather than short-term effects. Acuteeffects from high exposures are very rare. Acute exposurescan result in neurologic problems, nausea, and vomiting,and skin and mucous membrane irritation. Chronic expo-sures are generally linked to increased rates of cancer andbirth defects.

CorrosivesClass 8

The corrosives hazard class includes acids and bases thatcan cause severe injury to skin and mucous membranes ondirect contact. Inhalation of corrosives may damage thelungs, and ingestion may cause severe injury to the gas-trointestinal tract.

Miscellaneous Hazardous MaterialsClass 9

Class 9 includes materials that are hazardous during trans-port, but are not included in another hazard class. Theseinclude anesthetic or noxious materials, as well as thosethat are subject to DOT requirements for hazardous sub-stances or hazardous wastes. Examples of Class 9 materi-als include PCBs and molten sulfur.

ORM-D Materials

An ORM-D material presents a limited hazard duringtransportation because of its form, quantity, and packaging.Small arms ammunition are examples of ORM-D materials.



Activity





Toxic Effects inSpecific OrganSystemsThis section briefly reviews some of the body’s major organsystems and how they can be affected by hazardous materi-als exposure. By understanding your body’s response, youcan take steps to protect yourself before, during, and afteran emergency incident. Remember that preventing expo-sure is the key.

Respiratory SystemMajor components of the respiratory system include thenose, pharynx, larynx, trachea and lungs.



The upper respiratory system includes the nose and physi-ological structures down the airway to the larynx. It pro-vides a means for drawing air down into the lungs andprovides some protection for the lower respiratory tract.The upper respiratory system is lined with mucous mem-branes, which can trap foreign matter and deliver it to thedigestive tract where it can be safely excreted. Toxic effectson the digestive system are discussed later.

The lower portion of the respiratory tract consists of thetrachea, bronchial “tree” and the lungs. The trachea extendsfrom the larynx to the middle of the chest. At that point, itdivides into the right and left bronchi. The bronchi are alsolined with mucous membranes that trap dirt and otherforeign matter. Each bronchus further leads into a grape-like cluster of tiny air sacs called alveoli. Each of thesealveoli is enveloped by a network of microscopic bloodvessels called capillaries. Oxygen enters the bloodstreamby diffusing, or crossing from these air sacs into the capil-laries.

The lung is both a route of entry and a target organ. Occa-sionally, a chemical that will eventually harm the lungsenters through the skin or the mouth. This is a systemiceffect, and is the case with the herbicide Paraquat, whichcan be absorbed through the skin but damages the lungs.More commonly, however, inhaled substances are respon-sible for direct respiratory system damage.

Factors affecting toxic response in the lung include:

• Rate and depth of respiration• Duration of the exposure• Nature and concentration of the exposure• Route of entry• Site of deposition

Individual characteristics also affect the body’s protectivemechanisms and predisposal to injury. Age, genetic back-ground, and other exposures such as smoking are examplesof such characteristic factors.

Two chemical properties determine how a substance affectsthe lungs: solubility and particle size.



Solubility refers to the ability of the substance to dissolvein water. Water soluble chemicals are often rapidly ab-sorbed within the lungs and carried to other parts of thebody before damaging lung tissue.

Particle size influences how far a substance penetrates therespiratory system. There are protective respiratory systemmechanisms to remove particle deposits from the body.Large particles are trapped in the mouth or nose and re-moved by nose blowing, sneezing, and swallowing.Smaller particles are removed by cilia in the trachea andbronchial tree. Cilia are hairlike projections from cells thatbeat in a coordinated wave. Cilia move foreign substancesup to the throat where they are removed. Most of thesmallest particles are removed through cells in the immunesystem and cilia motion. Protective mechanisms can beweakened by toxic exposure.

Individuals with chronic bronchitis can have narrowedrepiratory mucous layer passages. This increases thevelocity of particles moving through the airways, and moreparticles can be deposited. In addition, exposure to irritantscan cause bronchial constriction and also increase particledeposition.

Toxic Effects

The responses of the respiratory system to toxic agentsgenerally fall into one of the following general categories:

• Irritation: Airway constriction, abnormal fluid accu-mulation, infection and cell damage

• Sensitization: An allergic response that can restrictairways

• Production of fibrosis: Fibrotic tissue blocking airpassages

• Carcinogens: Cancer of the lung



Signs and Symptoms

Even though lungs may be damaged in many ways, thereare only a few signs and symptoms of injury, such asproductive (producing sputum and saliva) or dry cough, ordifficult or labored breathing (dyspnea). In some casesbreathing becomes more difficult when the person liesdown. Breathlessness may be accompanied by increasedrespiratory rate, posturing (such as hand and arm rigidity,or hand curling resulting from brain stem injury) andcyanosis (the slightly bluish color of skin due to a lack ofoxygen).

The Cardiovascular SystemThe cardiovascular system consists of the heart and asystem of blood vessels. This system circulates blood fromthe heart to the body and vice versa via its extensive net-work of blood vessels. The main function of the heart is topump oxygenated blood throughout the body. The heart isa muscle with its own electrical system. Electrical im-pulses cause the heart to contract, moving blood throughoutthe body.



The principal types of blood vessels are arteries, capillariesand veins. Arteries carry blood away from the heart toorgans and tissues while veins carry blood back to theheart. Capillaries are microscopic blood vessels with thinwalls through which oxygen, nutrients, and other materialsdiffuse. The collection of blood vessels that provides thebody’s limbs with oxygen and nutrients is known as theperipheral vascular system.

Toxic Effects

Toxic substances may affect the heart or peripheral vascularsystem. As with many other body systems, the severity ofthe effect is influenced by the concentration and duration ofexposure as well as pre-existing health conditions.

• Electrical conduction disturbances are abnormalcontractions of the heart muscle, such as potentiallylife-threatening ventricular tachycardia. Materials thatcan cause these effects include solvents, carbon disul-fide, Freon, and insufficient oxygen.

• Decrease in the contracting force of the heart muscleresults in an inadequate force to push the blood throughthe vessels. Ethanol, cobalt, and trichloroethane (TCA)can cause this effect.

• Enhanced arteriosclerosis or hardening of the arteriescan be caused by carbon monoxide and acrolein.

• Hypertension or high blood pressure can be due to avariety of causes. It can lead to strokes, heart diseaseand kidney failure. Exposure to lead and cadmium arelinked to hypertension.

• Hypotension or low blood pressure may be seen withtoxic exposures that result in dilation of the bloodvessels. If the body is unable to compensate for thisdilation, shock can result. Nitrates are known to causethese effects.



Signs and Symptoms

Signs and symptoms associated with cardiovascular expo-sure mimic those seen in medical emergencies involvingsolvent exposures. They include:

• Irregular or rapid pulse• Decreased tolerance for exercise or physical activity• Dizziness and fatigue• Swelling or edema in the ankles• Palpitations or the feeling of skipped heart beats• A feeling of indigestion• Pain in the chest, jaw, or left arm

Blood and BloodForming OrgansThis body system consists of the blood, bone marrow,spleen, and lymphatic tissue. As with other organ systems,the longer the duration of the exposure, the more severe thetoxic response.

Blood consists of red blood cells that transport oxygen andother nutrients to the body; white blood cells that assist thebody’s immune system; and platelets, which are cell frag-ments required for proper clotting. These are all suspendedin a pale yellow fluid called plasma.

Bone marrow is the spongy center of some bones includingthe sternum, ribs, hipbones and a few other bones such asthe vertebrae, clavicles, and cranial bones. Bone marrowforms all types of blood cells except some white bloodcells.

Toxic Effects

The blood system can be damaged by agents that affectbone marrow production, the components of the blood (redand white blood cells and platelets), or the oxygen carryingcapacity of red blood cells.



Toxic effects include:

• Bone marrow suppression: A decrease in the activityof the bone marrow that leads to decreased blood cellproduction. Examples include ionizing radiation andbenzene.

• Effects on platelet activity: Results in a change in theformation of blood clots. Examples: aspirin, whichinhibits clotting; benzene, which decreases the numberof platelets; and perchlorethane, which increases thenumber of platelets.

• An increase or decrease in the number of whiteblood cells: An increase occurs with leukemia, whichis a result of bone marrow cancer. Benzene and othersolvents may cause the white blood cell count to de-crease, as can chronic phosphorus exposure. A de-crease in white blood cell count impairs the body’sability to fight infection.

• Effects on the white blood cells responsible for theimmune response: Certain chemicals, such as toluenediisocyanate (TDI), trigger an allergic response that isregulated by specialized white blood cells.

• Destruction of red blood cells: When red blood cellsare destroyed, the oxygen-carrying capacity of theblood is decreased. Examples: arsine, trinitrotoluene(TNT), and naphthalene (the active ingredient in moth-balls).

• Effects on hemoglobin, the oxygen-carrying part ofred blood cells: Aniline, nitrobenzene, and dinitroben-zene alter the hemoglobin molecule so that it cannotform oxygen. Other chemicals, such as carbon monox-ide, do not alter the molecule but combine with it muchmore easily than oxygen so that the hemoglobin’sability to carry oxygen is severely reduced.



Signs and Symptoms

Signs and symptoms include:• Weakness• Fatigue• Unusually pale skin or mucous membranes• A resting heart rate of more than 100 beats per minute• Frequent bleeding from the gums or nose

Gastrointestinal System

The gastrointestinal system consists of the alimentary canaland three accessory organs: the salivary glands, the liverand the pancreas.



The alimentary canal or the digestive tract is a system oforgans that extend from the mouth to the anus. It consistsof the mouth, pharynx, esophagus, stomach, small intestine,and large intestine. The gastrointestinal tract digests andabsorbs food and can also absorb chemicals and otherhazardous materials that enter the mouth. Most orallyadministered chemicals can produce their effects on otherbody systems only after absorption has occurred from thegastrointestinal tract or, less frequently, from the mouth.The chemicals can also affect the GI system itself.

Most chemicals absorbed in the stomach and the smallintestine go to the liver first via the blood supply. The livermetabolizes chemicals and other toxic substances andchanges them into a form that can be excreted. Thisprocess is called biotransformation. Most biotransforma-tion occurs in the liver, where enzyme systems modify thetoxicant. The products of this process are less toxic thanthe original compound, but in some cases they are moretoxic.

Toxic Effects

Liver toxicity depends on the specific chemical agentinvolved in the exposure, the length of the exposure, andthe physical condition of the individual. Once again, pre-existing conditions such as liver problems (e.g. cirrhosis orhepatitis) increase susceptibility. A hepatoxin affects theliver’s ability to detoxify, or rid itself, of other substances.Diet, hormone activity, and alcohol consumption can alsoaffect biotransformation in the liver.

Examples of toxic effects of hepatoxins include:• Cell death or necrosis• Cirrhosis, which is a progressive fibrotic disease of the

liver• Malignant tumors



Urinary System

The kidneys and bladder are the primary organs of theurinary system. The kidneys act as filters to remove wastesfrom the blood. These wastes are excreted as urine. Fromthe kidneys, urine flows to the urinary bladder via ureters.The bladder collects and stores urine, which is eventuallydischarged from the body through the urethra. The kidneysmaintain a balance of water, salt, and pH in the body. Theyare the body’s primary means of excreting metabolic wastessuch as urea and uric acid, as well as certain toxic materi-als. Poorly or non-functioning kidneys may be unable toeliminate toxic substances from the body.

The kidney and bladder are susceptible to toxins for severalreasons. Blood flow to them is much higher than to mostother organs. As a result, large amounts of circulatingtoxins can reach the kidneys and the bladder fairly quickly.The kidneys have a high oxygen and nutrient requirementbecause of this heavy work load. They are affected by anyfactor (such as shock, hemorrhage, or dehydration) thatreduces blood flow. Systemic effects of toxins elsewhere inthe body can also indirectly affect kidney function.



Because they adjust the amount of water and other compo-nents in the blood and urine, the kidneys are capable ofincreasing the concentration of a toxic substance. In fact, anon-toxic concentration of a chemical in the blood cansuddenly become very toxic in the kidneys. The same istrue for the bladder, where the concentration and amount ofurine control the amount of toxin in contact with bladdertissue. Dehydration due to lack of fluid intake can causeurine to be more concentrated.

Toxic Effects


• Renal failure: Toxins that affect the kidneys areknown as nephrotoxins. If these substances, or theirmetabolites, cause direct damage to the kidneys, thekidneys’ ability to filter blood will be partially or totallydestroyed. This failure to function is known as renal(kidney) failure. Heavy metals such as mercury, cad-mium, arsenic, and lead can cause renal failure.

• Carcinogenesis: Many organic compounds such ascarbon tetrachloride, chloroform, and the herbicideParaquat are also examples of nephrotoxins that causecancer.

Signs and Symptoms

Signs and symptoms include:

• Change in the volume of urine unrelated to fluid intake,any difficulty or pain during urination, blood in theurine (usually difficult to see with the naked eye)

• Edema, or swelling in the feet or hands that is usuallyequal on both sides of the body

• Flank pain (in the back, just above the hips)



Reproductive SystemThe reproductive system in males includes testes, accessoryglands (prostate), penis, and conducting tubes that leadfrom the testes to the outside of the body. Specific hor-mones act on the testes, stimulating them to produce test-osterone and sperm. A number of toxicants have beenassociated with impairment of sperm and testosteroneproduction and may even lead to sterility.

In females, the principal reproductive organs consist of theovaries and the uterus. Hormone production such as estro-gen and the development and maturation of the ovum (egg)are key functions of the ovaries. These functions can beimpaired by exposure to hazardous materials. Exposing afertilized egg (either an embryo or a fetus) to a toxic sub-stance may be harmful.



Certain individuals may be more susceptible to reproduc-tive system toxicants because of their age, nutritionalstatus, or other exposures.

Toxic Effects


• Sperm production: A decrease in sperm productioncan reduce fertility or even cause sterility. Examples ofchemicals that reduce sperm production includedibromochloropropane (DBCP) and ethylene dibromide(EDB).

• Infertility: The result of effects on the production ofovum (egg) or the pathway of the ovum

• Impotence: Resulting from effects on the parasympa-thetic nervous system

• Hormonal changes: Hormones regulate the male andfemale reproductive cycles.

• Premature delivery or spontaneous abortion

• Congenital malformations of developing embryos

Examples of agents that have been associated with repro-ductive dysfunction in men are ionizing radiation, carbondisulfide, dibromochloropropane (DBCP), ethylene oxide,hexane, and lead.

Examples that have been associated with reproductivedysfunction in women include ionizing radiation, carbondisulfide, methyl mercury, and lead.



SkinThe skin has two layers: the outer layer (epidermis) and theinner layer (dermis). The skin preserves the body’s bal-anced environment in several ways. It protects the bodyfrom extremes in the environment. The extensive capillarynetwork and sweat glands are an important part of tempera-ture regulation. Other functions of the skin include theregulation of water balance and the excretion of some waterand waste products from the body. It also protects againstmechanical and some thermal injury, as well as serving as abarrier against many living organisms.

The skin is less able to protect against toxicants and chemi-cals. Even when intact, chemicals can travel through theepidermis or enter the body through the hair follicles. Ingeneral, fat soluble liquids and solids are more capable ofpenetrating the skin because of the fat content in underlyingtissue. The amount absorbed depends on the amount oftime in contact with the skin; the longer the contact, themore will be absorbed. Local skin factors such as tempera-ture and blood flow at the site will also influence the rate ofabsorption.

Intact skin is normally an excellent barrier to foreignsubstances; however, the skin can be damaged by trauma,heat, cold, humidity, and previous chemical exposures. If



exposure does occur, the amount of the chemical that isabsorbed depends on how much was applied, the concentra-tion, length of contact, and the exposed surface area.

The permeability of skin varies according to the bodyregion. Areas that are rich in hair follicles allow greaterabsorption. These include scalp, forehead, jaw area, under-arm and scrotum/perineal area. Moisture, particularlysweat, increases absorption; so may the presence of otherchemicals. Solvents, in particular, can increase permeabil-ity. The presence of surfactants, such as soaps and deter-gents, will increase the absorption of water soluble sub-stances. Also, any breaks in the skin caused by chapping,cuts or abrasions will enhance absorption.

Toxic Effects

There are five types of toxic skin reactions:

• Irritation: A substance acts on normal skin at the siteof contact and produces a local inflammatory response,known as dermatitis. This is different from an allergicreaction. Dermatitis can result from an acute exposureor repeated contact. Examples of substances causingirritation include trioxides, dichromates, and mostsolvents.

• Corrosion: The result of direct chemical action on skinthat results in its disintegration at the site of contact.Ulceration, tissue death, and subsequent scar formationcan occur. An example of a corrosive material is chro-mium.

• Photosensitization: Exposure to a chemical followedby exposure to sunlight, with resulting sunburning, skinthickening, or pigment changes. Examples includesoaps, detergents and medicines.

• Sensitization: An allergic reaction after prolonged orrepeated exposure. Potassium dichromate, turpentine,and formaldehyde can cause sensitization.

• Carcinogenesis: Cancer of the skin. Any type of skincell (in the dermis or epidermis) may be transformedfrom a normal cell to a cancerous one. Causes of skin



cancer include exposure to ultraviolet light, ionizingradiation, arsenic, and polycyclic aromatic hydrocar-bons (PAHs).

Signs and Symptoms

Signs and symptoms of toxic skin effects mainly appear onexposed areas of the skin and may include:

• Rash or redness• Localized swelling• Peeling• Skin thickening and the appearance of vesicles (blisters)• Itching or burning

The Nervous System

The nervous system allows the body to detect and respondto stimuli. The two principal divisions are the centralnervous system (CNS), consisting of the brain and spinalcord, and the peripheral nervous system (PNS), consistingof the nerves that link the CNS with the skin, other bodyorgans and muscles.

Toxic effects are partially controlled by predisposingfactors such as alcohol consumption, and health conditionsthat affect the nerves, such as diabetes. The primary con-cern is nerve cell injury because these cells have littlecapacity to regenerate. Though normal nerve functionsometimes returns, as other nerves begin to compensate forthe injury, recovery is slow.

Toxic Effects

Fat soluble chemicals are more likely to affect the nervoussystem. Many solvents and organic metals can easily reachbrain tissue after absorption. Tetraethyl lead is one ex-ample. But not all brain cells are affected in the same waysince certain areas receive different doses and some cellsare more sensitive to toxic exposure.



CNS toxicants may cause subtle effects such as personalitychanges, or dramatic ones, such as loss of balance. Testingcan be done to evaluate the seriousness of the effect. PNStoxicants can interfere with motor function (strength andmovement), sensory function (ability to sense touch, vibra-tion or pain), or both. Some of these effects are reversiblewhile others are not.

Like many other body systems, the partially developednervous system, as in the very young, is much more sensi-tive to toxins. Low level lead poisoning in children ischaracterized by central nervous system effects such ashyperactivity and learning disabilities.

In adults, effects on the PNS are seen first.

Signs and Symptoms

Signs and symptoms of toxic effects in the nervous systeminclude:• Personality changes• Loss of balance• Changes in motor function• Changes in sensory function

EyesThe eyes are affected by the same chemicals that affect theskin but they are more sensitive. Several types of com-pounds can burn the eyes by direct contact. Factors thatdetermine the extent of injury include concentration, pH,duration, eye defense mechanisms such as tearing andblinking, and of course, the specific chemical involved.

Toxic Effects

Acid burns such as sulfuric, hydrochloric, hydrofluoric, andtannic acids can cause scarring of the lids and conjunctiva,and can damage other structures of the eyes. Alkali burnsfrom ammonia, sodium hydroxide, and potassium hydrox-ide may initially appear to be mild, but can later result inulceration, perforation, or clouding of the cornea or lens.



Lacrimators such as chlorocetophen (tear gas) cause tearingat low concentrations. They are distinguished from othereye irritants such as hydrogen chloride by their ability tocause an instant reaction without damaging tissue. At veryhigh concentrations they can cause chemical burns anddestroy the cornea.

Some chemicals reach the eyes and cause damage by way ofthe blood system. The route of exposure could be inhala-tion, ingestion, or absorption instead of direct contact.Some examples include naphthalene, carbon disulfide, andmethanol.

Ears

Hearing loss can be due to a number of factors, such astrauma, recurrent infections, obstruction by a foreign body,antibiotics, some infections, other medical conditions, aswell as advancing age. The primary work-related agentresponsible for hearing loss is noise. The ear’s response tonoise depends on three factors: noise intensity, duration, andthe frequency or composition.

Toxic Effects

When a person is subjected to a loud noise in a certainfrequency range, hearing may be impaired, resulting indecreased ability to hear low volume noises. Such hearinglosses are usually temporary; however, higher intensitynoises of prolonged duration can permanently damagehearing.

There is some new evidence that fire fighter exposure tocarbon monoxide and hydrogen cyanide can also be respon-sible for hearing loss. It is essential that you protect allroutes of entry and use hearing protection routinely in loudenvironments. Of course, the first goal is to reduce oreliminate the source of the noise whenever possible.

Activity



Medical SurveillanceEmergency response work takes a direct toll on the healthof emergency responders. In 1997, 34 fire fighters diedfrom occupational diseases. Another 72 members wereforced to retire as the result of occupational disease. Infact, service separations related to injury and diseaserepresent nearly one in three retirements.

While we have always been aware of fire fighters who diefrom traumatic injuries at emergency scenes, it is onlyrelatively recently that we have become aware of thenumber who die as the result of occupational exposures tohazardous materials. This is because the negative healtheffects of these exposures can be very subtle and can takeyears, even decades to become apparent. Heart and lungdiseases and cancer are a few of the many health conditionsnow associated with fire fighting and hazardous materialsresponse.

Confronting this health reality means developing programsthat will protect you and your fellow fire fighters duringemergency response. These include the use of standardresponse procedures and personal protective equipmentincluding positive pressure self-contained breathing appara-tus. It also means going the extra step to carefully monitoryour health to detect any effects from hazardous materialsexposure.

It’s a Good Idea andIt’s also the Law

The Occupational Safety and Health Administration’s finalrule (29 CFR1910.120) regarding Hazardous Waste Opera-tions and Emergency Response specifies minimum require-ments in a number of areas of hazardous material emer-gency response. One area covers the provision of a medicalsurveillance program. Similarly, the Environmental Protec-tion Agency has established equal protection for all em-ployees not covered by OSHA. Hazardous materials teammembers have a right to medical surveillance. In addition,



the National Fire Protection Association has developed astandard for fire department occupational safety and healthprograms (NFPA 1500). This standard specifically ad-dresses the need for a comprehensive approach to the healthand safety of fire fighters and emergency medical careproviders.

A medical surveillance program can help to determine ifyou can safely perform job duties and use personal protec-tive equipment. It is also designed to detect early changesin body system functions that may have been caused byexposures. Early detection encourages early treatment sothat permanent damage does not occur. It is important toremember that medical surveillance programs do not takethe place of other health and safety strategies or your annualmedical exam with your private physician. All of theseprograms working together help to protect your health.

The Importance of MonitoringHealth Status

To effectively track the status of your health, you must havea baseline physical and assessment followed by routinelyscheduled evaluations. It is from these snapshots that keyinformation about health changes can be detected. Thesesnapshots are made up of information from a number ofdifferent sources. The sources, when taken together, give adetailed portrait of your personal health.

Sources of information include:• Questionnaire data• Physical examinations• Diagnostic medical testing• Biological monitoring

Questionnaire Data

Questionnaires provide important information regardingyour medical, occupational, family, and other personalbackground. A special emphasis is placed on currentsymptoms that might be related to hazardous materialsexposure.



A key component of the questionnaire is determining riskfactors. Risk factors are areas that might predispose you toa negative health effect. For example, someone withcardiac or respiratory disease history might not be able towear fully encapsulating chemical protective clothing orself-contained breathing apparatus in strenuous situations.Other risk factors include chronic obstructive pulmonarydisease (COPD), severe asthma, or previous heart attack.Also, a history of difficulty breathing, heat intolerance, orcurrent obesity may indicate potential problems usingpersonal protective equipment.

In addition to risk factors, questionnaires should alsoinclude an area devoted to occupational history. Thissection looks at current job duties, previous employmentand part-time work. This type of information, includingnon-occupational exposures, (perhaps from hobbies such ascar repair) can help to pinpoint areas of potential concern.Previous known exposures to asbestos and solvents such asbenzene are other examples.

Physical Examinations

There are a variety of medical examinations that may beappropriate during your participation in a comprehensivemedical surveillance program. Some of these examinationsare routine and others are specific to known or possibleexposures. Knowing the different types can help to ensurethat you participate successfully.

Pre-placement Exams

A pre-placement exam is given at the time of hiring orchange in job duties. It is an important opportunity to gainbaseline or initial data for use in future comparison. Itallows the physician to determine if you can safely wearprotective equipment while working in a hazardous envi-ronment. Pertinent history includes allergies, illnesses, riskfactors, dietary and exercise habits, as well as an occupa-tional history.



Minimal items included in the comprehensive physicalexamination include:• Physical evaluation• Body composition• Laboratory tests• Vision tests• Hearing evaluation• Spirometry• EKG• Cancer screening• Immunizations and infectious disease screening

These and other tests are described in detail in Appendix C.

Periodic Medical Examination

It is strongly recommended that hazardous materials techni-cians receive an annual medical review or interval examina-tion. This new medical data is compared to the baseline inorder to detect any changes in body systems. Thesechanges can be the basis for further testing or startingmedical treatment if necessary. Test results can also pro-vide evidence for changes in personal protective equipmentor work practices. These examinations can be performedmore frequently if necessary, based on special hazards,exposures, symptoms, or your age or health profile. Anyexposures during the interval since the last exam should becarefully reviewed.

You might also have a targeted examination focusing onorgans most likely affected by exposures. Other medicaltesting may be based on exposure information, medicalhistory and the results of the physical exam. For example,blood tests that reflect liver function may be performed if aresponder has been exposed to large amounts of petroleum-based solvents.

Acute Medical Care

There is always a chance that hazmat technicians willrequire medical attention as a result of operations at thescene of an emergency. Team members may becomeinjured or ill from exposures or heat stress. It is essentialthat provisions be made for emergency medical care at thesite. Because of the nature of the work, Advanced Life



Support should be available to treat and transport teammembers requiring attention.

As part of your pre-planning process, identify hospitals inyour area that are equipped to handle chemical and toxico-logical emergencies. These facilities may have speciallytrained providers and equipment that could make thedifference in an emergency.

Activity

Post-Exposure Monitoring

Post-exposure monitoring may be necessary even if mem-bers are not experiencing symptoms. Testing may also berequired even after medical treatment has been completed.In some cases, depending on the type of exposure, specifictests can be administered to quantify the exposure. Thesetests can serve as the basis for determining whether or notadditional medical treatment is necessary.

It is very important that all confirmed or suspected expo-sures be carefully documented in written form. Theserecords are very useful during the annual medical reviewand can also be used as claims evidence in applicableworkers compensation cases.

These evaluations are designed to assist in the early identi-fication of illness or injury that may be related to theadverse effect of a work site exposure or the workingenvironment. In addition, any employer having workerswith occupational exposures to infectious diseases isrequired to establish a written exposure control plan de-signed to eliminate or minimize exposures and to handlethem properly when they occur.

A typical follow-up procedure for a common exposure,asbestos, is detailed below:

• Upon confirmation of an exposure to asbestos, thefollowing baseline evaluations should be completed if



Years since first exposure Age 15 to 35 Age 35 to 45 Age 45+to hazardous materials

0 to 10 years Every 5 years Every 5 years Every 5 years

10+ years Every 5 years Every 2 years Every 1 year

documentation does not exist that these evaluationswere done within the previous 12 months or otheridentified schedule:• Basic physical evaluation and examination• Pulmonary function tests (FVC FEV1.0)• Chest X-ray, 14"x 17" post./ant.

• Members known to have been exposed are subject to thefollowing schedule for continued testing:

• In addition to the above evaluations, the OSHA Asbes-tos Standard Periodic Medical Questionnaire shall becompleted.

• This information shall be reviewed and evaluated by thephysician to ensure that appropriate medical follow-upis identified and communicated to personnel. Informa-tion concerning the occupational risks of exposure toasbestos should be provided to applicants during initialtraining and on a yearly basis to incumbents. Trainingand education should describe the nature of asbestos,proper respiratory protection and use of respirators, andprocedures for minimizing the risk of exposure toasbestos.

Exit Examination

This examination is performed when you leave your depart-ment or transfer to work that does not involve continuedexposure to hazardous materials. The purpose of an exitexam is to establish the state of a member’s health at theconclusion of a specific job assignment. The componentsof the exam are similar to those of the periodic exam.



Physician Qualifications

The physician conducting surveillance exams must be wellacquainted with the fire/rescue service and the specialneeds of hazardous materials emergency responders.Physicians trained in occupational medicine or toxicologyare ideally suited to conduct surveillance programs. It isessential that all physicians be familiar with OSHA/EPArequirements and NFPA standards as well as common workpractices. Physicians must also be aware of and followapplicable confidentiality and reporting requirements.

Record Keeping

Maintenance and access to your medical records must be inaccordance with OSHA regulations. The procedures setforth in NFPA 1500 should also be included in departmentpolicies. If you are exposed, OSHA regulations require thatyour medical records be maintained for 30 years after youleave employment.

The results of medical tests must be made available to youon request. The employer is only informed about limita-tions in your work duties, not specific information aboutmedical conditions. The cornerstone of a professional,successful medical surveillance program is confidentiality.Without the trust afforded by confidentiality, the programwill fail.

In addition, medical surveillance record keeping mustfollow these guidelines: The employer must retain yourname and social security number, the physician’s writtenopinion, any employee medical complaint related to expo-sures, and a copy of information provided to the examiningphysician by the employer regarding employee exposures.

Record keeping and reporting of occupational injuries andillnesses must be performed yearly. This function helpsreveal injury trends related to equipment and procedures.Finally, you must remember the importance of routinelydocumenting work-related exposures. You must retain yourown copy of these exposure records. Some local unionsand state associations also keep exposure records. This



documentation serves as the basis for needed changes andimprovements in emergency operations. Documentationalso plays a crucial role in diagnosis, treatment and cover-age for some medical conditions.

Annual Program Review

Just like any other program, the medical surveillancecomponent should undergo review to ensure that it iseffective. This review, which should occur annually at aminimum, can also help to identify injury trends and specialhealth effects. Review elements should include:

• Assessments of injuries and illnesses to determine thecause. This process allows you to modify health andsafety procedures when necessary.

• A review of medical testing for exposures and environ-mental monitoring to ensure that they are useful

• An examination of emergency response capabilities andtreatment procedures and an updated list of emergencycontacts and facilities. Through the on-going planningprocess, response capabilities should address newhazards and possible exposure.

• A careful analysis of group data to detect trends thatmay not be apparent through individual results. Fromthese findings, deficiencies in such areas as training orpersonal protective equipment can be corrected.

• A review of hazardous materials responses, medicalrecords, and exposure reports to ensure that team mem-bers are receiving proper follow-up care

• A review of confidentiality procedures and safeguardsto ensure that member privacy is protected. An audit ofreporting procedures can ensure that only informationon work status and restrictions is communicated tomanagement. This element builds trust in the medicalsurveillance system and will encourage members toparticipate fully and completely in the process.



Activity

A thorough medical surveillance program is a central partof an effective emergency response. It enhances planningand serves as a guide for improvements in training, equip-ment and procedures. Most importantly, it safeguards thehealth of responders by creating a system for consistent andthorough review of exposures and their effects.





Elements of aProactive HealthStrategyEvery emergency responder should achieve—and main-tain—extremely good health. Good health can help youenjoy a full life while offsetting the demands of emergencyresponse. Even routine emergency events (as well as howyou prepare for them) can be highly stressful. This stresscan result in disease processes that have both physical andmental dimensions.

Negative health effects such as serious accidents or healthproblems such as heart disease and cancer are essentiallyemergency incidents for our bodies. Our goal is to avoidthese emergencies whenever possible and to provide ad-equate resources to deal with them if they occur. We dothis in the same way we deal with any emergency—bypreplanning and providing adequate resources to overcomethe incident. As with emergency incidents, the more carewe give to preparation and planning for our health, themove effectively we can deal with a health event if it doesoccur.

The goal then, is to remain as healthy as possible through acomprehensive personal program that takes into accountour physical, emotional and medical needs. If you paydaily attention to these needs, you will reap significantbenefits—not only in emergency performance, but also inyour ability to enjoy life. The benefits of a sustainedcommitment to well-rounded personal health include:

• Less risk of death or injury or a disabling disease• Improved physical performance• Decreased levels of stress, tension and anxiety• Enhanced ability to rest and sleep• Better ability to bounce back from strenuous events

Some key components of a proactive health strategy are:medical review, fitness, diet, and stress management.



Medical Review

Emergency responders are exposed to a complex anddangerous work environment that includes exposure to awide range of toxins and infectious materials. The workenvironment also includes a high degree of on-going stressthat can cause a variety of diseases. Because of thesefactors, you must participate in a comprehensive annualmedical review program designed to detect and treat ad-verse medical conditions. Such a program is vital to ensur-ing good health. (Many of these components are alsoincluded in the Medical Surveillance section).

A comprehensive medical examination includes:

• Physical evaluation• Body composition• Laboratory tests• Vision tests• Hearing evaluation• Spirometry• EKG• Cancer screening• Immunizations and infectious disease screening

An annual medical review helps ensure that emergencyresponders are well informed about their physical health. Alife-long, consistent comparison of essential health data canhelp detect changes that require follow-up to eliminate thepossibility of disease. It is a critical element in a proactivehealth strategy.



Personal Fitness

Physical fitness is critical to your overall health and yourability to perform safely and effectively as an emergencyresponder. Higher levels of aerobic fitness, muscularendurance, and muscular strength are key assets in theemergency response profession. All members participatingin fitness programs should be medically cleared prior todoing so. This clearance can establish a health baseline andrule out any existing medical issues that might precludeparticipating in a fitness program.

Aerobic Capacity

Aerobic capacity is an integral part of a fitness program.Improved aerobic capacity leads to better cardiovascularfitness and keeps blood pressure, weight, and body chemis-try in the normal ranges. There is little debate that a highaerobic capacity is a prime goal for fire fighters and otheremergency responders.

Flexibility

Because emergency response work is physically demandingand often requires intense physical labor in restricted areas,the majority of injuries are sprains and strains. In addition,many fire fighters are forced into retirement each yearbecause of disabling back injuries. An important part ofinjury prevention is a flexibility program that creates fullrange of movement for joints and muscles.

Muscular Strength and Endurance

Muscular endurance is defined as the ability of a musclegroup to perform work over a period of time sufficient tocause muscle fatigue. Fire fighting and emergency re-sponse work frequently requires maximum exertion. Main-taining an appropriate level of muscular strength not onlyallows you to perform your work efficiently, it establishes areserve that can prevent sprains and strains. A routinestrength training component is a standard part of responderfitness.



Promoting Good HealthThrough Positive Behaviors

Wellness is critically linked to your personal behavior in anumber of key areas. The decisions you make and the waysin which you choose to manage stress are all linked to youroverall health. Behavioral health encompasses many areas,including:

Smoking: The use of tobacco in any form is associatedwith a wide range of negative health effects including heartdisease and cancer. Effective programs to stop the use oftobacco are essential.

Substance abuse: The abuse of alcohol is by far the largestconcern. An effective program to educate members andnew hires about the problems associated with alcohol anddrug abuse is an important part of health promotion. Inaddition, treatment at reasonable cost should be madeavailable for those who require it.

Stress management: To manage stress effectively youmust first be aware that you are subject to a variety ofstressors. Among these are typical job stress, criticalincident stress, stress from financial and legal concerns,family relations, and stress from issues such as infectiousdisease exposure. To manage stress, you need to recognizecommon reactions such as loss of appetite, trouble sleeping,and anger. Every responder needs to make full use ofprograms to combat stress. Such programs include profes-sional counseling, peer support, and education. The valueof regular exercise as a tool to relieve stress should also beemphasized.

Nutrition

Proper nutrition is a key part of proactive health mainte-nance. The basic fuel necessary to respond safely andeffectively to any emergency is found in our daily diet. Thehigher the quality of the fuel you consume, the more effec-tive and efficient we can be. High quality nutrition im-proves the quality of life and the performance of emergencyresponders. Some of the positive aspects of a good diet are



increased energy, shortened recovery time, and improvedresistance to diseases.

Two of the major risks of emergency response work—cancer and heart disease—can be lessened through goodnutrition. A diet low in total fats, saturated fats, cholesteroland salt, and high in fruits, vegetables, and fibers is anutritional game plan that may help offset these diseaseprocesses.

Following are some basic daily guidelines for a healthydiet:

• Carbohydrates: 50% to 70%

• Proteins: 15% to 30% (A typical serving of protein foran adult male would be the size of the palm of the handand about the thickness of the hand.)

• Fats: No more than 30%

• Eat five or more servings of fruits and vegetables

• Reduce the amount of cholesterol, salt, and fats, par-ticularly saturated fat

• Replace high fat meats with lean cuts

• Increase fiber intake

• Drink plenty of non-caffeinated and alcohol free bever-ages. Signs of dehydration include dark urine, a smallvolume of urine, and headaches. Remaining adequatelyhydrated is essential for emergency response personnel.





Health and SafetyResponse Principles

Always Have a Plan

In many cases, hazardous materials events involve patientswho are exposed or injured. Operating safely in such adynamic environment requires that you maintain yourcomposure and only take those actions that are reasonableand appropriate. One of the best ways to ensure that youoperate safely is to have a plan and follow it.

• Analyze the Problem. Using your size-up and hazard-ous materials skills, determine exactly what is occur-ring. Is the environment dynamic? Is there an imme-diate rescue problem? Do you have resources andequipment to rescue a viable patient? What are the fullrange of hazards present? What will happen if you takeno action at all?

• Plan the Response. Based on your analysis, decidewhich actions are appropriate. Ensure that the neces-sary resources are present or en route. Plan your stepscarefully, keeping safety as a top priority. Use the risk/benefit scenario to gauge your level of hazard andexposure.

• Implement Your Plan. Take the actions you havedetermined to be appropriate based on yourdepartment’s procedures. Operate as a team, and ensurethat you have back-up. Minimize exposure to thehazardous substance and keep your time and actions inthe Hot Zone to a minimum. If you are contaminated,ensure that you are properly decontaminated and as-sessed after you leave the Hot Zone.

• Evaluate Progress and Adjust as Necessary. Observeyour progress and remain aware of your effectivenessand the presence of new or additional hazards. Adjustyour plan if necessary to reflect changing conditions.Think ahead and always keep a margin of safety for youand your crew members.



Stay Alert to Changes

Planning is an essential component to a safe response. It isimportant to remember that these incidents are very dy-namic. Based on the type and amount of materials involvedand other factors such as the location, time of day, and theweather conditions, the incident can change rapidly. When-ever possible, create contingency plans during the planningprocess that take into account some of these dynamicvariables.

Often it will be very difficult to identify all the possibilities.Changes in wind direction and air temperature, settling ofcontents in a container, and changes in smoke color or fireintensity are just some of the indications that the incidentmay be escalating or creating new dangers for responders.In many cases, the longer you work at an incident the morelikely you are to be lulled into a false sense of safety. Thechallenge for professional responders is to stay alert atevery stage of the event, all the way through wrap-up andtermination.

Take Only AppropriateActions

Your priority list:

• Safety of emergency responders• Safety of civilians• Preservation of property• Preservation of the environment

The actions that we take at the scene of an emergencyshould be in line with our established health and safetypriorities. Our highest priority is to save a savable life. Inthis scenario, you could justifiably be placed at significantrisk. For those incidents where no life threat exists, youshould be placed at low or minimal risk.

Making sure that our actions are appropriate means estab-lishing a realistic plan based on what is occurring, what weexpect to achieve, and our available resources. In addition,you must be must be fully aware of :



• The materials involved• Weather conditions• Accessibility to the incident• Ignition sources• Containment systems (piping, dikes, tanks)• Damage to storage containers• Vulnerable populations

Making wise response decisions based on a realistic ap-praisal of what is happening— and what is likely to hap-pen— is the best way to ensure the safety of team mem-bers.

Take All Steps to ProtectAgainst Exposure

Enter the Hot Zone or contaminated area only if there issome clear benefit from doing so, such as lives that can besaved.

Before entering the Hot Zone, take the following precau-tions:• Review and plan control actions

• Work upwind and uphill and avoid contact with product

• Use remote shutdown sources, tools, and equipment tohelp reduce or avoid contamination

• Select and use the proper type and level of personalprotective equipment

Good decontamination procedures offer additional safe-guards that remove contaminants from PPE. The decon-tamination process should allow team members to exit theWarm Zone with the knowledge that all of the contaminantshave been removed.

Site security and clear designation of zones and work areascan lessen the opportunity for exposure by eliminating thelikelihood that contaminants will spread outside the WarmZone.



Pre- and post-entry assessments and the use of personalhygiene showers are an additional safeguard that helps teammembers leave the incident area free of contaminants.

Avoid SecondaryContamination

Each technician must work together to closely monitor theflow of potentially contaminated personnel, patients, toolsand equipment. The strict use of control zones and imple-mentation of safe work practices and decontaminationprocedures can reduce the opportunity for secondarycontamination.

Continuously monitoring members and equipment reducesthe chance of contaminants spreading outside the WarmZone. In addition, take all possible steps to ensure thatpatients are properly decontaminated prior to treatment andtransport. Often, simply removing the patient’s clothingcan remove up to 75% of the hazardous material. Takingthe time to remove contaminants ensures that EMS person-nel and hospital staff will not be unnecessarily exposed.One of your chief responsibilities is to strictly limit theopportunity for contamination outside of the incident area.

Keep Your Health and Safetya Top PriorityRemaining healthy and safe in the hazardous materialsemergency response setting means having a proactive plan.Much like emergency response preparation, it requireslearning in advance what the risks are and determining thespecial problems you may encounter.

Learn the personal health program components that make adifference. Medical reviews, exercise, diet, and rest createa healthy responder with a strong reserve capacity.

Taking a planning approach to incident safety helps youtake the “guess” out of the work and focus instead on thesafest, most efficient way to accomplish the tasks. A goodplan includes analyzing the hazard, having sufficient



resources, and creating a comprehensive site safety assess-ment.

Finally, examine the risks and the potential benefits andtake only those actions that are wise, prudent and safe.

Activity





Elements of aProactive SafetyStrategyThe safest possible emergency scene is one where carefulobservation and planning results in a strategy that takes intoaccount all of the known hazards. Unnecessary guessworkcan create an incident scene where responders take thewrong actions with catastrophic results. Having a proactivesafety strategy helps plan for the emergency in advance soyou have as much information as possible when you go towork.

Thorough Planning

Effective pre-planning is the keystone of a safe response.This is particularly true where hazardous materials emer-gencies are concerned. Thoroughly pre-plan high hazardoccupancies; those that frequently have problems, or areaswhere an event could be catastrophic should be thoroughlyplanned in advance. Gaining key information about theprocesses and products used at these facilities can makeinitial emergency actions more safe and effective. Goodplanning means that you will know essential informationsuch as building construction, in-place protection proce-dures, and professionals who can be contacted both on andoff site.

Many transportation corridors are sites of repeated hazard-ous materials incidents involving roll-overs and fires.These target transportation hazards can be pre-planned todetermine the safest and most effective way to handle aspill if it occurs. Be sure to identify critical items such aswater supply and storm drainage. In addition, you canidentify local and state resources who can respond duringan incident. Knowing these contacts in advance ensures asafer response.



Adequate Resources

While you can never know exactly when or where anincident will occur, you can identify the available resourcesin advance. In addition to traditional fire and rescue com-panies, specialized department resources such as technicalrescue and hazardous materials teams should be noted. Theavailability of mutual aid departments is also an importantresource. Often, these mutual aid sources can assist directlyin an emergency or provide standby service.

In hazardous materials emergency response, identifyingresources in advance is particularly crucial. Industryexperts, chemists, and spill control teams as well as localand state governmental agencies, can provide importanthelp while the emergency is under way. To make the mostof these resources, identify them in advance and build aworking relationship before an emergency occurs.

Other resources include federal assistance such as the:

• Coast Guard• Environmental Protection Agency• Occupational Health and Safety Administration

Effective, comprehensive development of resources beforethe incident means a safer coordinated response.

Hazard Analysis and Risk Assessment

Once target areas have been identified, you can determinethe likelihood that an event will occur at a particular occu-pancy. When visiting a petroleum tank farm, for example,you should learn every aspect about large storage tanks,large diameter pipeline delivery systems, and bulk deliveryby tanker trucks. This process allows you to determine notonly the full range of hazards, but also the emergencies thatare most likely to occur. Learn about what goes on at aparticular facility by reviewing information such as permitapplications, inspection reports, Material Safety DataSheets, and site drawings. By filling in these importantblanks ahead of time, you reduce the unknowns and create asafer emergency response when you arrive on the scene.



Site-Specific Safety and Health Plan

Before beginning operations at a hazardous materialsincident, develop a basic safety and health plan that takesinto account the special concerns and risks associated withthat incident. Doing this ensures that, at each incident, youtake the time to determine the incident characteristics thatpose the greatest risk. For example, have you taken thetime to evaluate the secondary hazards of all materialsinvolved? Have you clearly identified the hazards associ-ated with each of the tasks that may be performed? Ob-serving the incident scene from a safety plan point of viewwill help to ensure a low-risk response. Many of the itemsincluded in a safety and health plan review can be com-pleted during preplanning activities at target hazard loca-tions.

• Safety and health risk or hazard analysis for each sitetask and operation in the work plan. For example, if adrum filled with a flammable and toxic substance isuprighted and moved, are controls and tools in place tosafely move the container and avoid creating sparks?

• Adequacy of personal protective equipment. Re-search for chemical hazards to ensure that the protectiveclothing you choose meets the needs of the wearer andthe tasks that will be performed.

• Environmental and air monitoring. A primarycomponent of the safety plan is the reconnaissance andcharacterization effort. The use of appropriate instru-mentation can help determine exactly what hazards arepresent, and in what concentrations.

• Decontamination procedures. Review and verifyproper decontamination procedures during the researchprocess. These procedures outline the steps that mustbe taken to ensure that team members are free of allcontaminants when they exit the Hot Zone.

• Emergency action plan. Just because you have re-sponded to an emergency does not mean that an emer-gency can not occur once you have begun operating.Protective equipment failures and sudden product



releases can necessitate quick action on the part of theemergency response team. The plan must identify theselikely scenarios and how the team will respond if anemergency occurs. These items include emergency exitroutes, decontamination procedures, and the provisionof emergency care.

• Confined space operations. If the emergency eventinvolves confined spaces, then appropriate procedures,equipment, and personnel must be in place to ensure asafe entry, if one is deemed appropriate.

• Pre-entry briefing. Prior to any crew entering theWarm or Hot Zone, or performing tasks where personalprotective equipment is required, they should receive abriefing by an operations officer who defines the tasks,equipment required, special conditions or concerns, andrelevant emergency procedures.

The site safety plan should also include information on sitesecurity and control, general evacuation routes and proce-dures, personnel roles, lines of authority, and communica-tion. With this information, everyone knows who is incharge of the incident and exactly what to do if an emer-gency occurs during operations.



Application Exercises





Application Exercise

You will need:

• Five drums or other containers that could be used for hazardous materials

• Descriptions of five very short incident scenarios incorporating hazardous materialscommon in your local area• Do not specifically identify the hazardous materials in the scenarios• Use at least three hazard classes• Use different levels of toxicities for each chemical• Incorporate victims, vulnerable areas, etc.

• UN ID numbers for the hazardous materials used in your scenarios

• North American Emergency Response Guidebooks

• Additional reference books and other resource material normally used within the depart-ment

• Twenty-five copies of the questions on the following page

Preparation:

This exercise is intended to help students understand the effects of hazardous materials and takeappropriate actions to protect themselves. Set up the drums or containers at various placesaround the training facility. Tape one scenario and the related UN ID number to each container.(Make sure the containers are appropriate for the chemical.)

Divide the class into five groups. Give each group a North American Emergency ResponseGuidebook, and any other reference materials they would have access to in their department, andfive copies of the questions on the following page. Do not allow them to use their Student Texts.Assign one group to each container. Tell the groups to read the scenario, identify the chemicalusing the UN number and the Guidebook, and answer the questions on the following page. Afterabout 30 minutes, rotate groups to different containers. Continue the rotation until all groupshave had the opportunity to work through each scenario. Reconvene the class and discuss eachgroup’s responses to the questions.





Application Exercise

Read the scenario attached to the container and identify the chemical. Using any other resourcesto which you would normally have access, research the chemical and answer the followingquestions.

1. From what you know about the hazardous material and the situation, how would youassess the risks and benefits of taking offensive action in this scenario?

Material Involved Risk Benefit Assessment (Action taken)

2. What is the DOT hazard class for this material?

3. What are the health effects of this material, both acute and chronic?

4. Has the victim(s) been exposed, contaminated, or both?

5. What signs and symptoms should you look for in the victim(s)?

6. Which body system will suffer the most serious effects?

7. What action would you take if you were exposed to this material?





Action Statement





Action Statement

You have just completed the third module of the Hazardous Materials Technician course. Thetopics included:

• Assessment of the risks and benefits of taking action in a hazardous materials incident• Categories of hazardous materials and their health effects• Terms related to hazardous materials• Toxicities of specific classes of hazardous materials• Toxic effects in specific organ systems• Elements of a proactive health strategy• Health and safety response principles• Elements of a proactive safety strategy

Knowing how you respond to emergencies in your first due areas, would you change your actionsor habits based on the information covered in this module? Listed below are some suggestedactions. Some you may already do, and others may not fit your work environment. If there areactions you have not done in the past, do you think you will begin doing them as a result of thistraining?

As a result of this training, I will:

1. More carefully assess the risks and benefits of taking action in a hazardous materialsincident

2. Take greater measures to protect myself from the toxic effects of specific classes ofhazardous materials

3. During an incident, look for signs and symptoms in the public and fellow responders thatcould indicate possible exposures to hazardous materials

4. Discuss the specific elements of my medical surveillance plan with an occupationalhealth physician

5. Promote my own well-being through more exercise and healthier personal habits6. Conduct more and more thorough pre-incident plans7. (Create my own action statement)

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________





Appendix A

Activities





Risk/Benefit Activity 1

List the risks and benefits of the following situations. As a class, assess each situation anddetermine the action you would take.

Scenario

You arrive at the scene of anoverturned diesel truck. Thedriver is trapped and callingfor help.

You respond to the scene of afully involved corner grocerystore fire at 0200.

You are called to the scene ofan abandoned building whereyou discover several contain-ers and a leaking drumlabeled “muriatic acid”.

You respond to a tank carleaking ammonia in anisolated area around 1300hours. Approximately 10yards away ammonia read-ings are 100 ppm; approxi-mately 1,000 yards awayreadings are 0.

You respond to a tank carleaking chlorine gas behind amanufacturing plant onSunday. A calm wind isblowing toward a residentialarea 2,000 yards away.Chlorine readings are 500ppm in the area of the plant.

Risks of Offensive Action Benefits of Offensive Action





Categories of Toxic Substances Activity 2

For each of the categories below, have the students list at least one chemical example and threesigns or symptoms of exposure. This exercise can be conducted verbally or in writing.

Category Chemical Signs/Symptoms

Simple Asphyxiant

Chemical Asphyxiant

Corrosive (Acid)

Corrosive (Base)

Irritant

Sensitizer

Carcinogen

Neurotoxin

Mutagen

Teratogen

Infectious Agent





Definitions Activity 3

Read the definitions below, and ask the class to verbally respond with the appropriate term.

Definition Term

The study of poisons

The lethal dose for 50% of animals beingtested; a measure of toxicity

Refers to how long a substance remainsin contact with the body

High level, short-term exposure

Milligrams per cubic meter; a measurementof concentrations of solids

The average airborne concentration of apotentially toxic substance for which anemployee can be exposed for eight hours

Low level, long term exposure

Toxic level determined by NIOSH forescape only

An agent or substance capable ofcausing harm

The average airborne concentration of asubstance to which most adults areexposed during an eight-hour workday





Exposure Activity 4

Situation Product Released Route of Exposure Health Effects

Ruptured cylinder valve Chlorine vapor1001B chlorine

Broken fiberboard Granular dustcontainer, sodiumhydroxide spill

Overturned low-pressure Flammable liquidtransport container,gasoline

Broken one-liter Liquidcontainers, organophosphatepesticide

Complete the Routes of Exposure and Health Effects columns.





Chemical Explosion Case Study Activity 5

In May 1996, a large chemical manufacturing company in the northeast exploded, killing fivepeople. The company made pharmaceutical products and used a wide variety of hazardousmaterials. Two other fatal chemical explosions had occurred in the same area in the past. At thetime of the event, approximately 400,000 pounds of chemicals were stored in the complex.

On the night of the explosion, workers were mixing hazardous materials as part of a routinechemical process. As a result of a repair procedure, a small amount of water was added to themixture causing a flammable gas to slowly develop. While employees were operating in theimmediate area of the container, it vented a large amount of flammable gas and a deadly explo-sion occurred, killing the five workers and injuring several others. Some 75,000 square feet ofplant space was involved in fire or damaged by the blast. Included in the fire were a wide rangeof hazardous materials including aluminum powder, dipropylketone, lead, benzene, and methylchloride.

Fire fighters arrived and initiated a primarily defensive attack with truck companies entering thebuilding to conduct search and rescue operations. One severely burned employee was removedfrom the structure.

While fire fighters were wearing SFPC and SCBA, it is likely that some contamination or expo-sure occurred, particularly to truck company members who conducted the search.

Use the NIOSH Pocket Guide to determine possible routes of exposure, target organs, andmedical surveillance options.

1. What are the routes of exposure for lead?

What are the target organs for lead?

What first aid steps are appropriate for a lead exposure?

Is medical monitoring possible?

2. What are the routes of exposure for aluminum powder?

What are the target organs for aluminum powder?



What are the symptoms of exposure?

3. What are the routes of exposure for dipropylketone?

What are the target organs for dipropylketone?


4. What are the routes of exposure for benzene?

What are the target organs for benzene?

What first aid steps are appropriate for a benzene exposure?


5. What are the routes of exposure for methyl chloride?

What are the target organs for methyl chloride?

What first aid steps are appropriate for a methyl chloride exposure?




Mt. Helena, Arkansas Case Study Activity 6

Pesticide-fueled factory blaze spreads toxic fumes in Arkansas.

May 9, 1997West Helena, Arkansas (CNN)Three fire fighters died fighting a raging fire as a plume of black, “very toxic” smoke coveredthis small Mississippi River town, forcing hundreds of people to leave their homes and busi-nesses.

State police say 16 people were injured in the explosion that preceded the fire at the BPS Inc.chemical packaging plant.

Francis Huddleston of the Arkansas Office of Emergency Services said the blast released an“unknown quantity of toxic gas.” Another source at the OES described the fumes as “verytoxic.”

The fire fighters who were killed were outside the warehouse when the smoldering chemicaltriggered the blast, a fire official said.

“They suspect the cinder block wall and parts of the roof fell on them,” said Tim Snyder, theassistant fire chief in neighboring Helena.

Gov. Mike Huckabee praised their heroism. “These are the folks who got right in the middle andgo where angels fear to tread,” he said after going to the plant. Huckabee declared a state ofemergency, allowing the community to use state personnel to deal with the crisis.

The cause of the fire is believed to have been a smoldering bag of pesticide which caught fire andignited the explosion shortly after 1 p.m.

“We saw white smoke and heard an explosion...and then we saw a lot of fire,” said VickieBolden, who works at Helena Chemical, a short distance from BPS. “The flames were so high---150 feet---then the smoke turned black, and it was dark from then,” she said. “The fumes wouldburn your nose, it smelled bad, like ammonia, where it would take your breath”.

A source from the state Department of Pollution Control and Ecology said the primary chemicalinvolved was azinphosmethyl. Other pesticides were involved as well, and all are considereddangerous.

The city’s regional hospital, Helena Regional Medical Center, was evacuated because of thefumes. Some of the hospital’s 44 patients and 150 employees were taken to a local communitycollege. Other patients were taken to a hospital in Clarksdale, Mississippi, 30 minutes away.“It was like a thunderbolt that landed outside the building,” said hospital spokeswoman JanChambers. “It smells pitiful. It’s a strong odor. Very strong.”



The smoke could be seen billowing above the plant after the explosion from three miles, and wascarried by the wind across the river toward Mississippi. Areas up to a mile away were evacuated,including the southern part of Helena. A spokesperson for the Chamber of Commerce said aresidential subdivision near the plant was also evacuated.

Others in Helena and West Helena, with populations totaling about 18,000, were told to stayinside and shut their windows and doors. “We haven’t left our building,” said Nota Johnson ofthe Helena Chamber of Commerce.

The Lady Luck and casinos across the river in Lula, Mississippi considered closing, but gambledon staying open and won. Winds carried the worst of the fumes south of the casino complex.

Reuters contributed to this report.Edited from 1997 Cable News Network, Inc.

Questions

1. Using your resources, list the hazards and toxic effects of azinphosmethyl.

2. What is the acronym that describes the symptoms associated with this type of pesticide?

3. How do you treat exposure to this type of pesticide?



Henderson, Nevada Case Study Activity 7

In May of 1991, the National Institute for Occupational Safety and Health (NIOSH) received arequest for a health hazard evaluation (HHE) from the International Association of Fire Fighters(IAFF), on behalf of members in the Clark County, Nevada and Henderson, Nevada fire depart-ments. Fire fighters in these departments responded on May 6, 1991, to a chlorine leak at thePioneer Chlor Alkali plant located just outside the Henderson city limits. The IAFF reported thatseveral fire fighters who responded to this incident had developed respiratory symptoms that theyattributed to chlorine exposure.

Three weeks after the incident, NIOSH investigators held joint meetings with representativesfrom local fire departments. Information from these meetings, various records, and interviewswere used to reconstruct events and procedures followed during the incident response and toreview incident medical care and fire fighter symptoms. Six months following the May 6 chlo-rine leak, 150 medical questionnaires were sent by mail to the involved police and fire depart-ments for completion by workers potentially exposed during the incident.

According to available figures, approximately 200 fire fighters were involved in the response tothis emergency. Eleven fire fighters were hospitalized or held for observation, and several otherswere reportedly injured by exposure to the chlorine. Many of the fire fighters complained of skinirritation and respiratory difficulty, even though they were wearing self-contained breathingapparatus (SCBA) and structural fire fighter protective clothing. Although a Community Aware-ness and Emergency Response (CAER) plan had previously been devised by the chemical manu-facturers at the industrial complexes where the Pioneer plant is located and the local emergencyresponse units, this plan was reportedly not activated. Air monitoring performed by the ClarkCounty Health District (CCHD) indicated that chlorine concentrations during the incident rangedfrom less than 0.2 to 17 parts per million (ppm). Due to the weather conditions, the chlorineplume was unpredictable, and the command post was relocated on four occasions. Representa-tives from the responding agencies indicated that there were several instances of coordinationand communication difficulties. Reported concerns and problems encountered during the inci-dent response included delays in the response of the hazardous materials teams; deployment anduse of appropriate personal protective equipment; the lack of a common communications fre-quency for all participating agencies; and the need for appropriate decontamination procedures.

NIOSH received a total of 59 completed questionnaires: 42 from fire fighters and 17 fromindividuals other than fire fighters. Most fire fighters responding to the questionnaire reportedinhaling chlorine gas, even though most used SCBA during the incident. Symptoms includedcoughing, tightness in the chest, wheezing, tearing eyes, sore throat, and/or headache afterexposure to chlorine. Among the questionnaire respondents, symptom occurrence and severitywere greatest among those stationed at the leak site. The duration of symptoms also appeared toincrease with proximity to the chlorine leak. Symptom resolution was faster among respondentswho did not wear SCBA, which suggests that the intensity of exposure experienced, the personalperception of respirator need, and improper respirator use were related to symptom duration.



Questions

1. Was structural fire fighting clothing sufficient in this incident? If not, what type ofprotective equipment should have been worn?

2. What type of post-explosive monitoring should be done?

3. What long-term effects should be investigated as a result of this exposure during an exitexam?



Health Strategy Activity 8

Discuss the importance of each of the fitness data questions below.

In an average week during the past month, how often did you walk a mile or more at a timewithout stopping?

In an average week during the past month, how often did you engage in aerobic exercise for 20minutes or more without stopping?

In an average week during the past month, how often did you lift weights?

Compared with yourself 10 years ago, would you say that you are more active now, less activenow, or about the same?

Aerobic Capacity

• Test type treadmill, stair machine, exercise cycle, or step test?

• Capacity ml O2 per minute

• Capacity ml O2 /Kg body weight/minute

Flexibility

• Sit and reach measured in inches

Strength

• Hand dynamometer measured in kilograms

• Leg dynamometer measured in kilograms

• Arm dynamometer measured in kilograms

Endurance

• Push-ups # in 60 seconds

• Sit-ups # in 60 seconds





Four-Step Plan Activity 9

Scenario

Hazardous materials technicians respond to assist FRO units already on the scene of an emer-gency incident in an architectural firm located on the fifth floor of an eleven story office high-rise.

The first responding fire fighters responded to a fire alarm in the structure and were met by asecurity guard who indicated there was a strong odor on the fifth floor. The guard is familiarwith the firm and says there are four to six large ammonia cylinders used in a printing process.

He reports that there is no one in the firm but there may be cleaning crews on the tenth andeleventh floors.

Divide into four groups and spend three to five minutes listing key safety and health actions,including risk/benefit issues, in each of the four steps:

Analyze

Plan

Implement

Evaluate





Response Principles Case Study Activity 10

In May of 1995, a 36-inch pipeline carrying natural gas at a working pressure of 975 psi rupturedlate in the evening, raining large chunks of debris over a wide area. Located in relatively closeproximity to the pipeline were a number of apartment complexes, an interstate highway, and anasphalt manufacturing plant. Shortly after the rupture of the pipeline, the escaping gas ignited,creating a huge fireball that generated intense radiant heat for a significant distance in all direc-tions. This radiant energy almost immediately began to ignite occupied buildings in the gardenapartment complex. Shortly, eight apartment buildings were on fire.

Hazardous materials problems, primarily at the asphalt plant, included residual gas fires from thenearby pipeline, propane, acetylene, asphalt and a burning 20,000 gallon tank of #2 fuel oil. Inaddition, cooling water falling on white hot rocks created a constant projectile hazard as therocks shattered.

Health and safety response principles include the following steps:

• Always have a plan• Stay alert to changes• Only take appropriate actions• Take all steps to protect against exposure• Avoid secondary contamination• Keep your health and safety as a top priority

Divide into groups and write a list of objectives for each of the principles noted above. Allow tenminutes, then report back to the class.

Always have a plan:

Stay alert to changes:



Only take appropriate actions:

Take all steps to protect against exposure/ Avoid secondary contamination:

Keep your health and safety as a top priority:



Appendix B

Hazardous Toxicants,Their Health Effects,

and Medical Monitoring





Hazardous Substanceor Chemical Group

AromaticHydrocarbons:BenzeneEthyl benzeneTolueneXylene

Asbestos (orasbestiformparticles)

HalogenatedAliphaticHydrocarbons:

Carbon tetrachlorideChloroformEthyl chlorideEthylene dibromideEthylene dichlorideMethyl chlorideMethyl chloroformMethylene chlorideTetrachloroethane

(perchloroethylene)TrichloroethyleneVinyl chloride

Target Organs

BloodBone marrowCentral Nervous System (CNS)EyesRespiratory systemSkinLiverKidney

LungsGastrointestinal system

CNSKidneyLiverSkin

Potential Health Effects

All cause:CNS depression: decreased

alertness, headache, sleepi-ness, and loss of conscious-ness.

Defatting dermatitis.

Benzene suppresses thefunctioning of bone marrow(which makes white and redblood cells). Chronic exposurecan cause leukemia.

Note: Because other aromatichydrocarbons may be contami-nated with benzene, relatedhealth effects should beconsidered when exposure toany of these agents is suspected.

Chronic effects:Lung cancerMesotheliomaAsbestosisGastrointestinal malignancies

Asbestos exposure coupled withcigarette smoke has been shownto have a synergistic effect in thedevelopment of lung cancer.

All cause:CNS depression: decreased

alertness, headache, sleepi-ness, and loss of conscious-ness.

Kidney changes: decreased urineflow, swelling (especiallyaround eyes), and anemia.

Liver changes: fatigue, malaise,dark urine, liver enlargement,and jaundice.

Vinyl chloride is a knowncarcinogen; several others in thisgroup are potential carcinogens.

Medical Monitoring

Occupational/general medicalhistory emphasizing priorexposure to these or other toxicagents.

Medical examination with focuson liver, kidney, nervous system,and skin.

Laboratory testing:Complete blood count (CBC)Platelet count

Measurement of kidney andliver function.

History and physical examina-tion should focus on the lungsand gastrointestinal system.

Laboratory tests should includea stool test for occult bloodevaluation as a check forpossible hidden gastrointestinalmalignancy.

A high quality chest x-ray andpulmonary function test mayhelp to identify long-termchanges associated with asbestosdiseases; however, earlyidentification of low-doseexposure is unlikely.

Occupational/general medicalhistory emphasizing priorexposure to these or otheragents.

Medical examination with focuson liver, kidney, nervous system,and skin.

Laboratory testing for liver andkidney function; carboxyhemo-globin, where relevant.




Heavy Metals:

ArsenicBerylliumCadmiumLeadMercury

Herbicides:

Chlorophenoxycompounds:2,4-dichlorophenoxyacetic

acid (2,4-D)2,4,5-trichlorophenoxy-

acetic acid (2,4,5-T)Dioxin

OrganochlorineInsecticides:

Chlorinated ethanes:DDT

Cyclodienes:AldrinChlordaneDieldrinEndrin

Chlorocyclohexanes:Lindane

Target Organs

Multiple organs andsystems including:

BloodCardiopulmonaryGastrointestinalKidneyLiverLungCNSSkin

KidneyLiverCNSSkin

KidneyLiverCNS


All are toxic to the kidneys.

Each heavy metal has its owncharacteristic symptom cluster.For example, lead causesdecreased mental ability,weakness (especially hands),headache, abdominal cramps,diarrhea, and anemia. Lead canalso affect the blood-formingmechanism, kidneys, and theperipheral nervous system.

Long-term effects (in 10 to 30years) also vary. Lead toxicitycan cause permanent kidney andbrain damage; cadmium cancause kidney or lung disease.Chromium, beryllium, arsenic,and cadmium have beenimplicated as human carcino-gens.

Chlorophenoxy compounds cancause chloracne, weakness ornumbness of the arms and legs,and may result in long-termnerve damage.

Dioxin causes chloracne andmay aggravate pre-existing liverand kidney diseases.

All cause acute symptoms ofapprehension, irritability,dizziness, disturbed equilibrium,tremor, and convulsions.

Cyclodienes may causeconvulsions without any otherinitial symptoms.

Chlorocyclohexanes can causeanemia. Cyclodienes andchlorocyclohexanes cause livertoxicity and can cause perma-nent kidney damage.

Medical Monitoring

History-taking and physical exam:search for symptom clustersassociated with specific metalexposure, e.g. for lead, look forneurological deficit, anemia, andgastrointestinal symptoms.

Laboratory testing:Measurement of metallic content in

blood, urine, and tissues (e.g.,blood lead level; urine screen forarsenic, mercury, chromium, andcadmium).

CBCMeasurement of kidney function,

and liver function where relevant.

Chest x-ray or pulmonary functiontesting where relevant.

History and physical exam shouldfocus on the skin and nervoussystem.

Laboratory tests include:Measurement of liver and kidney

function, where relevant.Urinalysis.

History and physical exam shouldfocus on the nervous system.

Laboratory tests include:Measure of kidney and liver

function.CBC for exposure to

chlorocyclohexanes.




Organophosphate andCarbamate Insecti-cides:

Organophosphate:DiazinonDichlorovosDimethoateTrichlorfonMalathionMethyl parathionParathion

Carbamate:AldicarbBaygonZectran

PolychlorinatedBiphenyls (PCBs)

Target Organs

CNSLiverKidney

LiverCNS (speculative)Respiratory system

(speculative)Skin


All cause a chain of internalreactions leading to neuromus-cular blockage.Depending on the extent ofpoisoning, acute symptomsrange from headaches, fatigue,dizziness, increased salivationand crying, profuse sweating,nausea, vomiting, cramps, anddiarrhea to tightness in the chest,muscle twitching, and slowingof the heartbeat.Severe cases may result in rapidonset of unconsciousness andseizures. A delayed effect maybe weakness and numbness inthe feet and hands. Long-term,permanent nerve damage ispossible.

Various skin ailments, includingchloracne; may cause livertoxicity; carcinogenic toanimals.

Medical Monitoring

Physical exam should focus on thenervous system.

Laboratory tests should include:Red Blood Cell (RBC)

cholinesterase levels for recentexposure (plasma chloinesterasefor acute exposures).

Measurement of delayed neurotox-icity and other effects.

Physical exam should focus on theskin and liver.

Laboratory tests include:Serum PCB levels.Triglycerides and cholesterol.Measurement of liver function.

This table was adapted from DHHS, 1985, Occupational Safety and Health Guidance Manual for Hazardous Waste Site Activities.DHHS (NIOSH) Publication Number 85-115.





Appendix C

Physical Examination Overview





Physical Examination Overview

A comprehensive physical examination involves many areas of assessment. Below is a listingand description of specific components:

1. General Survey

Apparent state of health, signs of distress, skin color, stature, weight, posture, gait, dress, groom-ing, hygiene, odors, facial expressions, manner, mood, relationship to surroundings, speech andstate of awareness.

2. Vital Signs

The pulse (normal resting pulse is 60-100 beats per minute), respiratory rate (normal resting rateis 12-16 breaths per minute), and blood pressure (normal resting is 120/80). Cardiac or heartdisorders may be giving clues, such as irregular pulse or elevated blood pressure.

3. Skin

The color, vascularity (circulation), lesions, edema, moisture, temperature, texture, and mobilityare examined. Some diseased states have definite skin changes, i.e. liver disease. Also, infec-tious skin problems may be evident.

4. Head

The hair, scalp, skull, and face are examined for appearance. General protein production isinhibited in starvation (poor diet), which is reflected in reduced hair growth and dullness in hairappearance. Drugs can cause abnormal hair loss. Tumors can cause increased hair growth innormal sites.

The skull is assessed for size and shape. The shape is generally round with several prominencesover underlying bones. Previous fractures or hereditary traits may show up in the shape of theskull.

Obviously your facial appearance can change at a moment’s notice (i.e. where the doctor’s handis) but, in general, your face is observed for symmetry in size, position, and movement. Pulmo-nary disease may be detected through bluish lips. Edema may be evident in puffy eyelids.Prolonged illness may produce the appearance of sunken eyes, cheeks, and temple. Signs ofnerve damage may show up in each side of the face being different from the other.

5. Eyes

The visual acuity and fields of your actual vision, position of eyes, lacrimal apparatus (tearducts), conjunctiva and sclera, cornea, iris, pupils, extraocular movements and eye muscles are



examined. A fundoscopic exam (looking at blood vessels behind the eye’s surface) is performedwhere the doctor can look at the course of blood vessels as they emerge from the center of theeye. High blood pressure and diabetes may be evident when abnormal blood vessels are presentin the discs of the eyes.

6. Ears

Stretching across the back (inside) portion of the ear canal is the tympanic membrane (ear drum).This membrane separates the external ear from the inside ear or middle ear. The doctor willinsert a light source instrument into the external ear and assess the tympanic membrane for tearsor scars, wax build up in the canal, membrane inflammation, or discharge. A hearing check willbe conducted by a technician who assesses your ability to hear high and low sound frequencies.High frequency hearing loss may be the result of exposure to noise.

7. Nose and Sinuses

The external nose, inner-septum mucous and turbinates (thin plicated membranes on nasal wall)are examined.

8. Mouth and Pharynx

The lips, mucosae (mucous membranes), gums, dentition (teeth), tongue and pharynx are exam-ined. Any growth, oral lesions, or gum disease are noted, if present.

9. Neck

The trachea and thyroid are palpated and inspected for lymph nodes which will show a reactionto infection and other problems. The thyroid gland is situated in the front and on the sides of theneck and produces hormones vital to normal growth and metabolism (body’s chemical process touse food for energy). An enlarged thyroid gland may indicate excessive thyroid activity whichincreases metabolism.

10. Back

The spine and back muscles are palpated for tenderness. The CVA (costovertebral angle) orflank is checked for tenderness which could indicate kidney problems.

11. Thorax and Lungs

The thorax and lungs are inspected and listened to for evidence of asthma, chronic obstructivepulmonary disease (COPD), or other problems. Wheezing sounds are indicative of asthma;coarse breath sounds could be the result of a simple cold or early signs of heart failure.



12. Breasts and Axilla (Armpit)

In a woman, the breasts are examined with arms relaxed, then elevated and then again with handspressed against the hips. Inspection and palpation are used in the examination; no special equip-ment is necessary. The breasts are examined for symmetry of shape, color, size, and surfacecharacteristics. The axilla is likewise examined.

Male breast cancer accounts for approximately 1% of all breast cancers. Every male should begiven a thorough breast examination with an adaptation of the technique used for females. If youare male, your physician may or may not do a breast exam on you. If you have changes in yourbreast size or soreness, tell your doctor.

13. Heart

The heart is inspected and auscultated. It will be listened to in several areas, with the bell of thestethoscope. Your doctor will be listening for heart rate, regularity, presence or absence ofmurmurs, rales (funny sounds), or other unusual sounds. The jugular pulse and carotid pulses arechecked and compared.

14. Abdomen

The abdomen is inspected, percussed, and palpated. Tenderness, masses, organ enlargement, andprevious surgical scars are all evaluated.

15. Inguinal Area

The inguinal (groin) area will be palpated over the femoral vessels checking for various types ofhernias that may show up as bulges or impulses. An impulse may be felt when you turn yourhead and cough. Your doctors may also have you bear down as this elicits a more sustainedpressure.

16. Genitalia and Rectal Examination in Men

The penis, scrotal contents, anus, rectum, and prostate are examined checking for any unex-pected growth, nodes, hemorrhoids, or prostate enlargement. Cancerous growth may be presentand detected only by growth, as many are painless.

17. Legs

Vascularity (circulation), muscles evaluation and legs are palpated for edema. Edema mayindicate poor cardiac muscle or possibly an insufficient venous system which inhibits the bloodreturn.



18. Musculoskeletal

The range of spine motion, leg alignment, and feet are evaluated. If there is evidence of arthritisor scoliosis (spine curvature), an evaluation of each joint may be done.

19. Neurological Exam

The mental status, cranial nerves, motor system, sensory system, and reflexes are examined.Many parts of the neurological examination may be incorporated into other parts of the physicalexamination. You may expect to stick out your tongue, shrug your shoulder, demonstrate eye-hand coordination, walk on your toes, or walk the line. A more detailed exam will be done, ifthere is any question or abnormality.

20. Flexible Sigmoidoscopic Exam

In the proctoscopic examination, your doctor looks into the lower rectum and colon area with aflexible scope. This can detect ulcers, hemorrhoids, and silent cancer of the lower colon, whichis common in men and women over the age of 40. This examination is uncomfortable and nottoo popular, but is very effective in detecting cancer.



Laboratory and Other Medical Tests

In addition to the physical examination, various medical tests will be completed as describedbelow:

21. Audiometry

The hearing test (in a testing booth) will check for any abnormal hearing losses, such as high-endfrequency loss from nerve damage to the ear. In the testing booth, the hearing for each ear ismeasured from 125 to 8,000 Hz by air conduction (using earphones). Hearing loss is measuredin decibels. Test results are run through some formulas and plotted on a graph. The results areexplained by the doctor.

22. Urinalysis

A urinalysis is a common test that gives evidence of kidney and other internal abnormalities.Urinalysis is usually routine and done with all periodic health examinations. The first part is thespecific gravity, which is the ability of the kidneys to concentrate urine allowing the kidneys tohold water inside the body. The other part of the test is the microscopic examination of the urine,checking for white blood cells, which would be indicative of an infection in the urinary tractsystem, the bladder, or the kidneys. Under microscope, the urine is evaluated for crystals thatwould be indicative of gout or other abnormalities. The urinalysis can also show tumors orkidney stones.

23. Electrocardiogram

The electrocardiogram checks the electrical activity of the heart. Numerous leads are placed onyour body to measure the electrical activity from different planes. This test can show evidenceor suspicion of abnormalities in the coronary arteries, and hardening or thickening of the heartmuscle. In the treadmill stress test, a continuous electrocardiogram is taken. The treadmill stresstest may show abnormalities of the heart that a resting EKG might not show. In fact, the tread-mill stress test is normally done when the resting EKG test appears normal but you have beenexperiencing pain. With the EKG leads in place, you walk on a treadmill at a set speed andincline. Normally no EKG change is observed other than a heart rate increase. But if the extraphysical activity cuts down the amount of oxygen reaching the heart muscle, it may show up onthe EKG. If this occurs, the treadmill stress is stopped immediately and your heart will beevaluated for clogged arteries, etc. through additional specialized tests. These additional special-ized tests are not part of your routine medical exam at the Health Center but rather referred toyour primary care physician.



24. Radiology

A chest x-ray is taken annually if you smoke, otherwise, every three years unless other findingsare detected during the medical exam. In radiology, an x-ray beam passes through the heart andlungs from the posterior to the anterior part of the body (back to front); it also runs from side toside (left to right). The x-ray shows bony structures of the spine, and those bony structuressurrounding the heart, lungs, and rib cage. It can identify broken ribs and abnormalities of thetrachea and its branches. It shows a limited view of the lung tissue itself. Other abnormalitieslike tuberculosis, some tumors, and cancers will show up as white spots on a black view. Theheart also makes a shadow on the x-ray that can be measured. An enlargement of the heart maybe indicative of such things as congestive heart failure.

25. Pulmonary Function Test

The pulmonary function test measures the amount of air that goes through the mouth and tracheainto the lungs and is broken down into two functions. The first function is the flow test, whichmeasures the amount of air expelled from the lungs. This is referred to as forced expiratoryvolume. Forced expiratory volume is the amount of air that you can blow out as fast as possiblefrom your lungs. It measures the ability of someone to breathe. Decreased pulmonary functionmay be traced to cigarette smoking, asthma, or chronic bronchitis. The second function is thetest that measures the volume of air held in the lungs after expiration. The results can be indica-tive of emphysema, infection, or other exposures, such as chemicals.

Blood Tests

Blood tests can provide your doctor with a database for use in analyzing your health and toverify information found in your physical examination. In the comprehensive blood test, fourtubes of blood are needed. This is taken from a vein in your arm. The more common tests arelisted below.

26. Hemoglobin

The blood’s ability to carry oxygen is dependent on the amount and effectiveness of the hemo-globin. Exposure to toxic substances can alter the hemoglobin, as can iron deficiency and somestates such as sickle cell anemia.

27. Complete Blood Count (CBC)

The complete blood count is evaluated for several different things. The first is the white bloodcount (the number of white blood cells in the blood). The white corpuscles are basically thebody’s defense mechanism. They are divided into two main groups, the neutrophils and thelymphocytes. The neutrophils fight bacterial infections such as strep throat, pneumonia, bacterialmeningitis, and other common and serious infections. The lymphocyes are cells that fight suchthings as the flu and gastroenteritis. The CBC also measures the eosinophils which respond toallergies.



28. SGPT and SGOT

These two tests are part of the chemistry panel evaluated at each physical. These are enzymes(catalysts for biochemical reactions) that can screen for organ damage, such as liver inflamma-tion from hepatitis or toxic chemical exposures.

29. Uric Acid

This is the chemical responsible for gout (painful inflammation of the joints), which is a form ofarthritis. Uric acid levels in your body can vary depending on your diet. If your doctor feels theuric acid level is high, he may question you about the types of foods you eat.

30. Cholesterol

This is a solid alcohol called a steroid (steroid compounds also include hormones and vitamins),which is vital for proper brain and nervous system function. Elevated cholesterol levels arethought to be a high risk for heart attacks. Your doctor will evaluate your cholesterol levelagainst your diet and physical exam findings.

31. Triglycerides

Triglycerides are essentially blood fats that may contribute to cardiac disease. High triglyceridescan also be a sign of alcoholism and obesity.

All of these intensive, technological tests and doctor’s examination combine to provide a com-prehensive review of your mental and physical well being. Each component helps to confirmfindings found on either the physical exam or other medical tests. Additional tests are manytimes needed in order to further identify the severity of a disease process. These tests are recom-mended by the Health Center physician but referral is made back to your primary care physicianfor follow through.





Appendix D







The fire department physician must be chosen with care. The fire department is involved withthe health, wellness, fitness and safety of uniformed personnel from the beginning of their ca-reers (candidate evaluations), throughout their careers (annual health/fitness evaluations), duringinjury/illness (referrals, rehabilitation, counseling, and reevaluations), at retirement from activeduty (retirement evaluations), and, in many jurisdictions, during their retirement years.

Ideally, this professional should be board certified in occupational medicine, internal medicine,or family medicine. The fire department would also benefit from physicians specializing infields relevant to the fire service such as occupational toxicology, industrial hygiene, epidemiol-ogy, infectious disease, pulmonary care, cardiology, critical care, orthopedics, physiatry, burncare, and/or emergency medicine.

The ability to interact successfully with other professionals is essential since no single person canbe a specialist in all of the prescribed areas. The fire department physician must have a thoroughknowledge of job related activities, physical demands of the occupation and stresses associatedwith fire fighting. The individual must be able to conduct job analyses, remain current on medi-cal literature pertaining to fire service related issues, and conduct ongoing research related to firefighters’ health, safety, and fitness.

Additionally, the fire department physician must have knowledge of local, state, provincial, andfederal laws as well as the roles of labor and management relating to occupational medicine,health, and safety.

The fire department physician must be capable of intervening to prevent illnesses and injuries ofother fire fighters doing the same job as those currently being treated for occupational exposuresor physical injury, while maintaining personal credibility and patient confidentiality.





Appendix E

Salem, NH Nitric Acid Spill





Salem, New Hampshire Nitric Acid Spill

Quick action by workers for two companies and emergency response teams kept a chemical spillin Salem, N.H. from becoming a disaster.

Two chemists from Safety Kleen, a North Andover company that cleans up and removes hazard-ous materials, were removing a bottle of nitric acid from Dames and Moore, a Salem environ-mental consulting firm. The bottle disintegrated in the hands of one of the chemists, spillingabout a gallon of the corrosive liquid.

The chemists were wearing protective clothing, but a Dames and Moore engineer, Mark Kirouac,who was standing nearby, was not. The acid splashed on him, burning him severely.

Nitric acid is a corrosive liquid often used to strip metal. It burns the skin and can be deadly. Itsvapors can irritate the eyes, ears, throat, and lungs.

The Safety Kleen employees and Mr. Kirouac’s coworkers at Dames and Moore rushed him intoa nearby shower to wash the acid off. Mr. Kirouac sustained serious injuries requiring skin graftsurgery, but his doctor and fire officials credited the quick action of those around him withsparing him further injury.

Dames and Moore is located in a building at Five Industrial Way that houses two other busi-nesses, Nexus Systems and RAScom. Fire officials evacuated the building, fearing toxic fumesfrom the spilled acid.

A hazardous materials team formed of specially trained fire fighters from 14 communities set upa decontamination area and suited up with protective gear to go inside and locate the spill. Theyfound the acid, determined it was not reacting with anything, and allowed Safety Kleen workersin to remove it. The Southeastern New Hampshire Hazardous Materials Mutual Aid District wasformed last November to deal with just such an emergency.

The response of the hazardous materials team, Safety Kleen, and Dames and Moore workershelped get a dangerous situation under control quickly.

In rushing Mr. Kirouac into a shower, they may have saved his life. The hazardous materialsteam prevented anyone else from being seriously injured by the acid and prevented the contami-nation from spreading.

Their actions show the value of training and preparation in dealing with emergencies.





OCCUPATIONAL HEALTH SERVICES — NITRIC ACID - NITRIC ACID,TECHNICALMATERIAL SAFETY DATA SHEETNSN: 6810002229655Manufacturer’s CAGE: 0G9K0Part No. Indicator: APart Number/Trade Name: NITRIC ACID=========================================================================== General Information===========================================================================Item Name: NITRIC ACID,TECHNICALCompany’s Name: OCCUPATIONAL HEALTH SERVICES, INCCompany’s Street: 11 WEST 42ND, 12TH FLOORCompany’s City: NEW YORKCompany’s State: NYCompany’s Country: USCompany’s Zip Code: 10036Company’s Emerg Ph #: 212-789-3535/615-366-2000Company’s Info Ph #: 212-789-3535/800-445-MSDSRecord No. For Safety Entry: 004Tot Safety Entries This Stk#: 014Status: SEDate MSDS Prepared: 14JUL93Safety Data Review Date: 29AUG95Supply Item Manager: CXMSDS Serial Number: BXQDCSpecification Number: O-N-350CHazard Characteristic Code: D4Unit Of Issue: BTUnit Of Issue Container Qty: 500 MLSType Of Container: BOTTLENet Unit Weight: 500 MLS=========================================================================== Ingredients/Identity Information===========================================================================Proprietary: NOIngredient: NITRIC ACID (SARA 302/313) (CERCLA)Ingredient Sequence Number: 01Percent: 70NIOSH (RTECS) Number: QU5775000CAS Number: 7697-37-2OSHA PEL: 2 PPMACGIH TLV: 2 PPM/4 STEL; 9495Other Recommended Limit: NONE RECOMMENDED——————————————————-Proprietary: NOIngredient: WATERIngredient Sequence Number: 02Percent: 30NIOSH (RTECS) Number: ZC0110000CAS Number: 7732-18-5OSHA PEL: NOT ESTABLISHEDACGIH TLV: NOT ESTABLISHEDOther Recommended Limit: NONE RECOMMENDED



=========================================================================== Physical/Chemical Characteristics===========================================================================Appearance And Odor: COLORLESS TO PALE YELLOW LIQUID WITH A SUFFOCATINGODOR.Boiling Point: 181F,83CMelting Point: -44F,-42CVapor Pressure (MM Hg/70 F): 47.9 @20CVapor Density (Air=1): 3.2Specific Gravity: 1.5027 @25CSolubility In Water: VERY SOLUBLEpH: ACID=========================================================================== Fire and Explosion Hazard Data===========================================================================Extinguishing Media: WATER,DRY CHEMICAL OR SODA ASH. LG FIRES:FLOOS AREAW/WATER FROM A DISTANCE.Special Fire Fighting Proc: MOVE CNTNR FRM FIRE W/O RISK.APPLY COOL WATERTO CNTNR SIDES EXPO TO FLAME TIL WELL AFAT FIRE IS OUT.STAY AWAY FRM TKSENDS.MASSIVE FIRE IN CARGO AREA USE(SUPPUnusual Fire And Expl Hazrds: MAY IGN OTHER COMBUST MATLS(WOOD,PAPER,OIL,ETC).RXS VIOLENTLY W/H2O/FUEL.FLAMM,POISONOUS GAS MAY ACCUMU IN TKS/HOPPERCARS.RUNOFF TO SEWER CREATE FIRE/EXPLO HAZ=========================================================================== Reactivity Data===========================================================================Stability: YESCond To Avoid (Stability): RXS W/WATER EXOTHERMICALLY.Materials To Avoid: COMBUST MATLS,METALLIC POWDERS,HYDROGEN SULFIDE,CARBIDES,ALCOHOLS,CORR TO METALS,TURPENTINE,ORG ACIDS,READILY OXID MATLSHazardous Decomp Products: THERMAL DECOMPOSITION PRODUCTS MAY INCLUDETOXIC OXIDES OF NITROGEN.Hazardous Poly Occur: NOConditions To Avoid (Poly): NOT APPLICABLE=========================================================================== Health Hazard Data===========================================================================LD50-LC50 Mixture: UNKNOWNRoute Of Entry - Inhalation: YESRoute Of Entry - Skin: YESRoute Of Entry - Ingestion: YESHealth Haz Acute And Chronic: CORR INHAL/SKIN/EYE/INGEST.HIGHLY TOXIC BYINHAL.INHAL:100PPM IMMED DANGEROUS TO LIFE/HEALTH.SEV RESP IRRIT.PULMEDEMA,CYANOSIS,RAPID PULSE,TEETH EROSION.SKIN:SEV PAIN,BUNRS,EYLLOW STAINS,DERM.EYE:PAIN,LACRIMATIN,PHOTOPHOBIA,BUNRS,BLINDNESS,CONJ.INGEST:CORR OFMUC MEMB OF MOUTH/THROAT/EXOPHAGUS,PAIN,UNABLE TO (SUPPLEM)Carcinogenicity - NTP: NOCarcinogenicity - IARC: NOCarcinogenicity - OSHA: NOExplanation Carcinogenicity: PER MSDS:CARCINOGEN:NONE.Signs/Symptoms Of Overexp: INHAL:COUGH,CHOKE,YELLOWISH BURNS OF MUCMEMB.DIZZ,HEAD,NAU,WEAK,TIGHTNESS IN CHEST,DYSPNEA,FROTHY SPUTUM.SKIN:DERM,BURNS,YELLOW STAINS.EYE:PAIN,EYE DESTROYED,YELLOW EYE COLOR,CONJ,CORNEAVASCULARIZED/OPAQUE.INGEST:SHOCK,WEAK,RAPID PULSE,SHALLOW RESP,CLAMMY SKIN,



CIRCULARTORY COLLAPSE,ESOPHAGEAL/GASTRIC/PYLORIC STRICTURMed Cond Aggravated By Exp: PERSONS WITH IMPAIRED PULMONARY FUNCTION,PRE-EXISTING EYE & SKIN DISORDERS.Emergency/First Aid Proc: INHAL:REMOVE TO FRESH AIR IMMED.STOP BREATH GIVEART RESP.GIVE OXY IF AVAILABLE BY QUAL PERSON.SKIN:REMOE CONTAMINCLOTH/SHOE IMMED.WASH W/SOAP/MILD DETERGENT/LOTS OF WATER 15-20MINS.CHEMBURN COVER W/STERILE DRY DRESS.BANDAGE SECURELY.EYE:WASH IMMED W/LOTS OFWATER OPENING EYELIDS 15-20MINS.CONT W/NORMAL SALINE TIL PH NORMAL(3-60MINS).COVER W/STERILE BANDAGES.INGEST:NO GASTRIC LAVAGE/EMESIS.(SUP)=========================================================================== Precautions for Safe Handling and Use===========================================================================Steps If Matl Released/Spill: DIG HOLDING AREA(PIT/POND)TO CONTAIN.DIKESURFACE FLOW(SOIL BARRIER/SANDBAGS)ABSORB LIQ MASS W/FLY ASH/CEMENT POWDER.NEUTRALIZE.APPLY WATERSPRAY TO RED VAP.DIKE RUNOFF.DO NOT TOUCH SPILL.STOPLEAK W/O RISK.ISOLATE/DENY ENTRY.VENTI CLSD SPACE BEF ENTRNeutralizing Agent: SLAKED IME, SODIUM BICARBONATE OR CRUSHED LIMESTONE.Waste Disposal Method: SARA TPQ&RQ/CERCLA RQ:1000LBS.OSHA TQ:500LBS.SUBJTO REPORTING.OBSERVE ALL FED/STATE/LOC REGS WHEN DISPOSING THIS SUBSTANCE.DISPOSAL MUST BE IAW STD APPLICABLE TO GENERATORS OF HAZ WASTE.EPA HAZWASTE:D002.Precautions-Handling/Storing: OBSERVE ALL FED/STATE/LOC REGS WHEN STORINGMATL.PROT AGAINST PHYS DMG.SEPARTE FRM INCOMPA MATLS.PROVIDE GOOD VENTI.AVOID DIRECT SUNLIGHT.SEE NFPA 43AOther Precautions: NONE SPECIFIED BY MANUFACTURER.=========================================================================== Control Measures===========================================================================Respiratory Protection: SPEC RESP SELECTED MUST BE BASED ON CONTAMINLEVELS IN WORKPLACE,MUST NOT EXCEED WORKING LIMITS OF RESP,JOINTLY APPROVEDBY NIOSH/MSHA.ONLY NON-OXIDIZABLE SORBENTS ALOWED(NOT CHARCOAL).Ventilation: PROCESS ENCLOSURE RECOMMENDED TO MEET PUBLISHED EXPO LIMITS.Protective Gloves: APPROPRIATE PROT GLOVES.(PVC,NITRILE)Eye Protection: SPLASH-PROOF/DUST-RESIST SAF GOGG,FACSLDOther Protective Equipment: APPROP PROT IMPERV CLOTH/EQPMT TO PREVENT SKINCONTACT.EYEWASH FOUNTIAN,QUICK DRENCH SHOWER W/IN IMMED WORKAREA.Work Hygienic Practices: WASH HANDS AFTER HANDLING.Suppl. Safety & Health Data: FIREFIGHT:UNMANNED HOSE HOLDER/MONITOR NOZZ.IF IMPOSSIBLE W/D LET FIRE BURN.USE FLOOD AMTS OF H2O AS FOG.AVOID BREATHVAP.KEEP UPWIND.CONSIDER EVACU DOWNWIND IF LEAKING. HEAL HAZ:SWALLOW/TALK,THIRST,DIARR,VOMITUS W/BLOOD/MUCOSA,RENAL FAILURE,DEATH,CONV. 1STAID:DILUTEW/100X.IN ALL CASES GET MED ATTN IMMED.NO ANTIDOTE.=========================================================================== Transportation Data===========================================================================Trans Data Review Date: 95241DOT PSN Code: KFCDOT Proper Shipping Name: NITRIC ACIDDOT Class: 8DOT ID Number: UN2031DOT Pack Group: IDOT Label: CORROSIVEIMO PSN Code: KPFIMO Proper Shipping Name: NITRIC ACID



IMO Regulations Page Number: 8195IMO UN Number: 2031IMO UN Class: 8IMO Subsidiary Risk Label: -IATA PSN Code: RWFIATA UN ID Number: 2031IATA Proper Shipping Name: NITRIC ACIDIATA UN Class: 8IATA Label: CORROSIVEAFI PSN Code: RWFAFI Symbols: 0AFI Prop. Shipping Name: NITRIC ACID,AFI Class: 8AFI ID Number: UN2031AFI Pack Group: IIAFI Basic Pac Ref: 12-14Additional Trans Data: PER MSDS:DOT SHIPPING NAME:NITRIC ACID, UN2031,CORR MATL CLASS 8, PG I, LABEL:CORR.=========================================================================== Disposal Data====================================================================================================================================================== Label Data===========================================================================Label Required: YESTechnical Review Date: 29AUG95Label Status: FCommon Name: NITRIC ACIDSignal Word: WARNING!Acute Health Hazard-Moderate: XContact Hazard-Moderate: XFire Hazard-Slight: XReactivity Hazard-None: XSpecial Hazard Precautions: INHAL:SEV RESP IRRIT.PULM EDEMA,CYANOSIS,RAPIDPULSE,TEETH EROSION.SKIN:SEV PAIN,BUNRS,EYLLOW STAINS,DERM.EYE:PAIN,LACRIMATION,PHOTOPHOBIA,BUNRS,BLIND,CONJ.INGEST:HI TOXIC,MUC MEMB OF MOUTH/THROAT/EXOPHAGUS CORR,PAIN,UNABLE TO SWALLOW/TALK.1STAID:INHAL:MOVE TOFRESH AIR IMMED.STOP BREATH GIVE ART RESP.GIVE OXY IF AVAIL BY QUAL PERSON.SKIN:REMOVE CONTAMIN CLOTH/SHOE IMMED.WASH W/SOAP/MILD DETERG/LOTS OF WATER15-20MINS.CHEM BURN COVER W/STERILE DRY DRESS.BANDAGE SECURELY.EYE:WASHIMMED W/LOTS OF WATER OPEN EYE 15-20MINS.CONT W/NORMAL SALINE TIL PHNORMAL(3-60MINS).INGEST:NO GASTRIC LAV/EMESIS/DILUTE W/WATER/MILK.IN ALLCASES GET MED ATTN IMMEDProtect Eye: YProtect Skin: YProtect Respiratory: YLabel Name: OCCUPATIONAL HEALTH SERVICES, INCLabel Street: 11 WEST 42ND, 12TH FLOORLabel City: NEW YORKLabel State: NYLabel Zip Code: 10036Label Country: USLabel Emergency Number: 212-789-3535/615-366-2000



Appendix F

Products of Combustion





Products of Combustion

Date

6/13/98

6/22/98

6/24/98

6/24/98

6/25/98

6/26/98

6/29/98

6/30/98

Type ofStructure

Single familyhouse

Single familyhouse

Apartment

Single familyhouse

2-story vacanthouse

Mobile home

Single familyhouse

Commercialbuilding

Details

Fire originated in storage shed behind carport andextended to include the minivan parked in the carportas well as the kitchen/living area

Suspected arson fire. Fire began in two places on topof the roof and in the engine compartment of a car infront of the house. Minimal contents damage.

Fire originated in the kitchen and extended to theliving room. The entire apartment was approximately555 s.f. in size. Ventilation had begun prior to startingair monitoring.

Fire began in a single family garbage dumpster andextended to the house. Two bedrooms were gutted inthe fire.

No furniture in this house. The fire destroyed theentire second floor. Because there were no contents tosalvage, the fire was suppressed with significantamounts of foam and water.

Fire originated in living room.

Fire originated in living room of a small house,approximately 800 s.f.in size. Fire was mainlycontained in the living room.

Fire originated in the mansard in the roof and extendedto the attic. No fire involvement inside the structure,however, there was heavy smoke damage noted.

Gases present incone above pub-lished guidelines

CO, SO2

acetaldehyde, acrolein,benzene, formaldehyde,glutaraldehyde, PNAs

SO2, acetaldehyde,

formaldehyde

NO2, acetaldehyde,

formaldehyde

Acetaldehyde,formaldehyde,glutaraldehyde

Acetaldehyde

Acetaldehyde,formaldehyde,glutaraldehyde

Acetaldehyde,formaldehyde

CO, NO2, SO

2,

acetaldehyde, benzene,formaldehyde,glutaraldehyde



Products of Combustion (continued)

Date

7/5/98

7/7/98

7/25/98

7/27/98

7/31/98

8/2/98

8/7/98

8/8/98

8/21/98

Type ofStructure

2-story condo

2-storyapartment

Vacant house

Single familyhouse

Single familyhouse

Vacant house/commercialoffice

2-storyapartments

2nd floorapartment

Furniturewarehouse

Details

Apparent electrical fire concealed between walls. Noflames were visible but there were materials smolder-ing in between the walls of the condo unit.

Fire originated in a bedroom located on the secondfloor of an apartment. Room and contents completelyinvolved in the fire.

Small vacant house. Two out of three rooms total wereinvolved in the fire. Center room was area of fireorigin. Fire control was achieved just prior to airmonitoring.

Suspected arson fire. Fire originated in two places:kitchen and hallway. Ventilation of the area had begunprior to air monitoring.

Suspected arson fire. All four fire fighters stayed inone place due to unstable roof conditions.

Suspected arson. All four fire fighters removed airpacks and placed them on the floor due to heat stressissues.

Fire started in the attic by a lightening strike. Fire wassomewhat isolated in between the walls of twoapartments.

Fire originated in the couch. The couch was removedfrom the apartment during fire suppression. There wasno fire extension and no structural damage. Datacollected from this fire was eliminated from analysis.This fire did not represent typical overhaul activities.

Fire sprinklers suppressed the fire. The fire continuedto smolder in a 40 foot tower of stacked, cellophanecovered couches.


CO, acetaldehyde,formaldehyde,


Acetaldehyde

Acetaldehyde,formaldehyde,

Formaldehyde, PNAs

---

Formaldehyde

N/A

SO2, acetaldehyde,

formaldehyde



Products of Combustion (continued)

Date

8/23/98

8/24/98

8/26/98

8/26/98

8/31/98

9/19/98

9/20/98

9/22/98

Type ofStructure

Commercialbuilding

House

House

House

Commercialbuilding

House

Apartment

House

Details

Fire originated in attic from an apparent electric sourceon the roof. During monitoring, air monitoring teamnoted that a gas powered lamp inside the structure wascontributing to CO concentrations inside the structure.

Fire originated in the kitchen. Ventilation had begunbefore air monitoring. Overhaul activities werecompleted before air monitoring was complete.

Area of origin was in the living room. A vent hole wascut above the area of origin. Fire was confined to theliving room and attic. Suspected arson fire. Ventila-tion had started prior to air monitoring.

Fire originated in the bedroom by a 3 year old child.Fire extended to the hallway. Ventilation fans were upand running at the time of air monitoring team arrival.

Fire originated in the attic. The fire was still workingat the time of air monitoring team arrival. A vent holewas cut in the area of origin

Fire originated in the front of the house and extendedto another room. The entire front end of the house waswell involved in the fire. Horizontal ventilation wascompleted at the time of air monitoring team arrival.

Fire originated in attic. Fire vented through roof. Nointerior apartment fire damage. Fire fighters noted thatwhen the ventilation fans were redirected to exhaust--CO levels dropped and when they were readjusted topositive pressure CO levels increased.

Fire originated in bedroom. Room and contents fire.


SO2

acetaldehyde,formaldehyde,



Acetaldehyde,formaldehyde,PNAs



CO, acetaldehyde,formaldehyde




Date post:	12-Sep-2021
Category:	Documents
Upload:	others
View:	2 times
Download:	0 times

Module 3: Health and Safety - Welcome to IAFFonline!

Documents