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Managing Hazardous Materials Incidents

A Planning Guide for the Management of Contaminated Patients
U.S. Department Of Health And Human Services Public Health Service Agency for Toxic Substances and Disease Registry

Volume I Volume II Volume III
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1,1,1-Trichloroethane 1,3-Butadiene Acrolein Acrylonitrile Ammonia Aniline Arsenic Trioxide Arsine Benzene Blister Agents (H, HD, HT) Blister Agents (HL, L) Blister Agents (HN-1, HN-2, HN-3) Calcium-Sodium Hypochlorite Carbon Disulfide Chlordane Chlorine Crotonaldehyde Diborane Ethylene Dibromide Ethylene Glycol Ethylene Oxide Formaldehyde Gasoline Hydrogen Chloride Hydrogen Cyanide

Hydrogen Fluoride Hydrogen Peroxide Hydrogen Sulfide Malathion Mercury Methyl Bromide Methyl Isocyanate Methyl Mercaptan Methylene Chloride Nerve Agents Nitrogen Oxides Parathion Phenol Phosgene Oxime Phosgene Phosphine Selenium Hexafluoride Sodium Hydroxide Sulfur Dioxide Tetrachloroethylene Toluene Diisocyanate Toluene Trichloroethylene Unidentified Chemical Vinyl Chloride Xylene

MANAGING HAZARDOUS MATERIALS INCIDENTS A Three Volume Series
Agency for Toxic Substances and Disease Registry March 2001

Under the authority of the Superfund Amendments and Reauthorization Act of 1986 (SARA), the Agency for Toxic Substances and Disease Registry (ATSDR) works to prevent or mitigate adverse human health effects and diminished quality of life resulting from exposure to hazardous substances in the environment. In pursuit of this mission, Managing Hazardous Materials Incidents, Volume I , II, & III, and the training video have been developed to provide emergency medical services (EMS) personnel and hospital emergency departments (EDs) with the necessary guidance to plan for, and improve their ability to respond to, incidents that involve human exposure to hazardous materials. The guidelines inform emergency personnel how to appropriately decontaminate, treat, and recommend follow-up care to exposed persons, as well as take measures to protect themselves.

HIGHLIGHTS: ATSDR's Managing Hazardous Materials Incidents is a three volume
set (with video) comprised of recommendations for on-scene (prehospital), and hospital medical management of patients exposed during a hazardous materials incident. Volume I - Emergency Medical Services: A Planning Guide for the Management of Contaminated Patients and Volume II - Hospital Emergency Departments: A Planning Guide for the Management of Contaminated Patients are planning guides to assist first responders and hospital emergency department personnel in planning for incidents that involve hazardous materials. Volume III - Medical Management Guidelines for Acute Chemical Exposures is a guide for health care professionals who treat persons who have been exposed to hazardous materials. Community Challenge: Hazardous Materials Response and the Emergency Medical System - is a training video for Volumes I & II (50 minutes total; 25 minutes for each volume).
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MANAGING HAZARDOUS MATERIAL INCIDENTS A Three Volume Series The ATSDR Internet address is < http://www.atsdr.cdc.gov >

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INTENDED AUDIENCE: HAZMAT Teams, Emergency Medical Personnel, Hospital Emergency Department Personnel, DHHS, DOD, DOE, FBI, FEMA, U.S. Marine Corps Chemical and Biological Incident Response Force (CBIRF), U.S. Uniformed Services University, City and County Emergency Management Agencies, International/Foreign Agencies and Organizations.

For more information about the Managaing Hazardous Mateerial Incidents publications including the Medical Management Guidlines contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-57, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-6396359. The ATSDR Internet address is < http://www.atsdr.cdc.gov >.

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Managing Hazardous Materials Incidents

Volume I
(Revised)

Emergency Medical Services:
A Planning Guide for the Management of Contaminated Patients

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service Agency for Toxic Substances and Disease Registry

The Agency for Toxic Substances and Disease Registry (ATSDR) has produced a three-volume series entitled Managing Hazardous Material Incidents. The series is designed to help emergency response and health care professionals plan for and respond to hazardous material emergencies. Volume I Emergency Medical Services: A Planning Guide for the Management of Contaminated Patients Hospital Emergency Departments: A Planning Guide for the Management of Contaminated Patients Medical Management Guidelines for Acute Chemical Exposures

Volume II

Volume III

Volumes I and II are planning guides to assist first responders and hospital emergency department personnel in planning for incidents that involve hazardous materials. Volume III is a guide for health care professionals who treat persons who have been exposed to hazardous materials.

Agency for Toxic Substances and Disease Registry.........................................Jeffrey P. Koplan, Ph.D., M.P.H., Administrator Henry Falk, M.D., M.P.H., Assistant Administrator Division of Toxicology.........................................Christopher T. DeRosa, Ph.D., Director

Additional copies of this report are available from: Agency for Toxic Substance and Disease Registry (ATSDR) Division of Toxicology Information Center (E57) 1600 Clifton Road, N.E. Atlanta, Georgia 30333 (404) 639-6357 Internet address: www.atsdr.cdc.gov/prevent.html

2 Printed on recycled paper

DEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service Agency for Toxic Substances and Disease Registry (MS-E57) Atlanta, GA 30333 Official Business Penalty for Private Use $300

SPECIAL FOURTH-CLASS RATE POSTAGE & FEES PAID PHS/CDC Permit No. G-284

Volume I - Table of Contents

Page Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iii Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v I. Systems Approach to Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 The Role of EMS in a Systems Approach to Planning . . . . . . . . . . . . . . . . . . . . . . . . . 1 Prehospital Response Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 The Spectrum of Hazardous Materials Incidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SARA Title III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 The State Emergency Medical Services (EMS) Agency . . . . . . . . . . . . . . . . . . . . . . . . 4 Federal Emergency Response Activities Hazard Analysis Training ...................................6

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Selected Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 II. Emergency Medical Services Response to Hazardous Materials Incidents . . . . . . . . .13 Hazard Recognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Principles of Toxicology for Emergency Medical Service Personnel . . . . . . . . . . . . . 21 Personnel Protection and Safety Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Respiratory Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Site Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

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Decontamination of Emergency Medical Service Personnel . . . . . . . . . . . . . . . . . . . . 38 Communications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Selected Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 III. Response and Patient Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 En Route to a Hazardous Materials Scene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Assessment, Decontamination, and Initial Treatment of Patients . . . . . . . . . . . . . . . . 49 Considerations for Patient Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Patient Transport to the Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Critique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 60 Patient Management Under Mass Casualty Conditions Involving Hazardous Chemicals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60 Critical Incident Stress Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Selected Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Appendix A Appendix B Appendix C Hazardous Materials Classification Systems . . . . . . . . . . . . . . . . . . . . . . . . . A1 Types of Respiratory Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B1 Levels of Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C1

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Acknowledgments
This document was first published in 1992 and updated in 2000. ATSDR wishes to thank all those who participated in making this a useful guidance document, including:
2000 Revision of Volume I Emergency Medical Services: A Planning Guide for the Management of Contaminated Patients: 2000 Revision of Volume II Hospital Emergency Departments: A Planning Guide for the Management of Contaminated Patients:

Craig DeAtley, P.A.-C., C.C.T.

George C. Rodgers, Jr., M.D., Ph.D.

Associate Professor, Emergency Medicine Professor of Pediatrics and Pharmacology/Toxicology Disaster Medicine and Special Operations Section University of Louisville George Washington University School of Medicine Louisville, KY and Health Sciences Washington, D.C.

Peer Review Panel for revised (2000) Volumes I and II:1
Sella Burchette (U.S. Environmental Protection Agency) Keith Burkhart, M.D., F.A.C.E.P. (American College of Emergency Physicians) Andrea Carlson (Physicians for Social Responsibility) Linda Cochiarella, M.D. (American Medical Association) Paul Cousins (The National Association of Emergency Medical Technicians) Richard Duffy (International Association of Firefighters) Philip Edelmen, M.D. (Association of Occupational and Environmental Clinics) Robert McCunney, M.D. (American College of Occupational and Environmental Medicine) Kent Olson, M.D. (American Association of Poison Control Centers) Leslie Stein-Spencer, R.N. (Emergency Nurses Association) Milton Tenenbein, M.D. (American Academy of Pediatrics) John Turley (Emergency Management Institute)
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The above reviewers were recommended by the organizations listed but do not necessarily represent them.

This project was directed by Scott V. Wright, ATSDR. For the 2000 revision, Linda Stein of Eastern Research Group, Inc. (ERG) was the project manager, and Chris Reid of ERG was the editor (under ATSDR Contract No. 205-93-0641). The following panel of experts contributed to the original (1992) development of Volumes I and II: Phillip Currance, EMT-P; Ralph B. Monty Leonard, Ph.D., M.D., F.A.C.E.P.; Mary Beth Michos, R.N.; Eric Noji, M.D., M.P.H., F.A.C.E.P.; Martin J. O’Neill; Paul Seidlitz, R.N. The following experts served as peer reviewers for the original 1992 Volumes I and II: Ben Blankeshire, Kenneth Bouvier, MacNeil Cross, Robert Daughdril, Craig DeAtley, Eileen Faries, Steve Finefrock, John Friery, Niel Holtz, Winston E. Jones, William J. Keffer, Gus A. Koehler, Kenneth Kuntz, Paul Manascalo, Kent Olson, Chappell D. Pierce, Alonzo Smith, Clark Staten, Dave Tauber, Joe E. Taylor, Sandra L. Tirey, Wallace Weaver, Steve White

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Introduction
The presence of hazardous materials or toxic chemicals at an incident location or other emergency situation adds a new dimension of risk to those handling and treating casualties. The fundamental difference between a hazardous materials incident and other emergencies is the potential for acute risk from contamination to both patient and responder. In some cases, traditional practices must be altered to avoid compounding a critical situation. Emergency medical services (EMS) must protect their personnel on site and en route to the hospital, and other people within the hospital, while providing the best care for the chemically contaminated patient. This guide is intended to help emergency medical services plan for incidents that involve hazardous chemicals and improve their ability to respond to these incidents. To ensure appropriate and timely patient care, as well as optimal response protection, emergency personnel must understand decontamination procedures and personal protective equipment, neither of which are routinely covered in the course of their professional training. They should also be aware of community resources that could be called upon to assist with an emergency response. Current training curricula for emergency room physicians and nurses and emergency medical technicians (EMTs) often do not adequately prepare these professionals to manage the contaminated individual or to decontaminate patients exposed to toxic substances. Accurate, specific, and concise guidance is needed to describe appropriate procedures to be followed by emergency medical personnel to safely care for a patient(s), as well as to protect responders, equipment, hospital personnel, and others from risk of secondary exposure. In response to this need, the Agency for Toxic Substances and Disease Registry (ATSDR) contracted for the production of a three-volume series entitled Managing Hazardous Materials Incidents: I. Emergency Medical Services: A Planning Guide for the Management of Contaminated Patients; II. Hospital Emergency Departments: A Planning Guide for the Management of Contaminated Patients; and III. Medical Management Guidelines for Acute Chemical Exposures. The second document is designed for use by emergency department personnel to minimize their risks of exposure within the emergency department, and to provide for the safe and effective treatment of chemically contaminated patients. This volume, written for emergency response personnel, is designed to familiarize readers with the terminology, concepts, and key operational considerations that affect the proper management of incidents of chemical contamination. It is designed not only to present uniform guidance for the emergency care of chemically contaminated patients, but also to provide basic information necessary to comprehensive planning and implementation of EMS strategies. It is intended to illustrate the characteristics of hazardous materials (hazmat) incidents that compel emergency response personnel to modify their preparations and response procedures. Not all hospitals and community emergency response systems are prepared to respond to a hazardous chemical incident to the same degree. This document may be used to assess the capabilities of EMS with respect to potential community hazards and to develop response plans using national and community-specific resources. Employee safety and training are also key factors in effective management of medical emergencies. This document is intended to provide source material for developing local training and safety protocols.

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includes guidelines for EMS preparation and response to a potential hazardous materials incident. These materials should be carefully reviewed before preparing any strategic plans or conducting training exercises on this topic. It is not. and details various hazardous materials classification systems. chemical exposure. Government and private planning activities are outlined. This chapter discusses the need for hazard identification and risk analysis pertaining to hazardous materials located in a community or transported through it. outlines general principles for hazard recognition. all-encompassing. introduces guidelines for emergency preparedness and prehospital response planning. Other ATSDR documents specifically address WMD concerns. Recommended training for EMS personnel is also included. the hazard recognition section presents generalized guidance for determining whether a given situation constitutes a hazardous materials incident. vi vi . This guidance document is intended to improve the safety of responders as well as of patients. Systems Approach to Planning. including those established under Title III of the Superfund Amendments and Reauthorization Act (SARA). Section II. the Community Awareness Emergency Response (CAER) program. although some of the information presented is pertinent to these situations as well.Section I. Response and Patient Management. Section III. This section provides basic toxicological and chemical terminology that emergency personnel need to understand to effectively conduct patient assessments. and decontamination guidelines. It also presents an outline of personal protective equipment. this document generally does not cover issues associated with weapons of mass destruction (WMD). Supplemental material that is vital to successful response to hazardous materials contamination is cited within the document. Emergency Medical Services Response to Hazardous Materials Incidents. In addition. such as respiratory devices and protective clothing. however. clinical management. the National Response Team. Also. nor can it be regarded as a substitute for comprehensive instruction and training for hazardous materials incidents. This chapter also discusses patient assessment. and personal protective equipment. and the Chemical Emergency Preparedness Program (CEPP).

Local emergency planning committees are mandated under federal law to identify high-risk locations and ensure adequate response planning and training. and hospitals do not have a tested hazardous materials response plan in place that integrates all of the responding agencies and personnel. chemical incidents are capable of endangering the health of the individuals involved and the emergency personnel directed to assist them. PREHOSPITAL RESPONSE PLANNING To ensure an effective and safe response to a hazardous materials accident. incident command practices to follow. such as fire. police. and other response agencies must participate jointly in local meetings involving hazmat planning. l EMS agencies are a crucial link in the community response system for emergency preparedness planning. community hospitals. A common characteristic of the successful management of chemical incidents is adequate contingency planning. This requires an integrated emergency medical response. For effective coordination and communication. EMS personnel are often the first to arrive at an incident scene and must assess the nature and extent of the hazard as well as attend to the immediate needs of victims. including initial treatment of people who may have been chemically contaminated. or among public responders. EMS agencies must acknowledge their role and responsibility as a component of the communitywide emergency response system. People who have been seriously injured by a hazardous material have a greater chance of recovery without complications when appropriate emergency treatment is provided by trained prehospital Emergency Medical Service (EMS) personnel at the scene. private businesses. This agency plan should include important definitions. and understand what services are expected from each participant. many local governments. EMS and police departments. an EMS agency must develop a written response plan which becomes an integral part of the local community response plan. other health facilities. Systems Approach To Planning THE ROLE OF EMS IN A SYSTEMS APPROACH TO PLANNING The potential for hazardous materials incidents exists almost everywhere. However. have not been clearly identified and formalized. hospitals. Optimally. and when the patient is transported to a facility having the most appropriate personnel and technical resources to manage his or her care.Section I. Communication channels between the private and public sectors. incident management. and health departments and area hospitals. The medical community has not been firmly integrated into many response systems and may not be prepared to treat multiple casualties resulting from a serious hazardous materials incident. and the regional Poison Control Center. Administrators should familiarize themselves with the contingency plans of other participants. 1 . EMS staff should be represented on planning committees that develop and periodically review these contingency plans. While infrequent. This has resulted in several problems: l l Incidents have been poorly managed on site by first responders. EMS agencies. and protocol review. Planning requires the involvement of an array of community institutions. including fire.

excluding fuel spills. In turn. to the mass-casualty level. normal systems of transportation (ambulances) are inadequate or disrupted. .5 times as often in fixed locations as in transit. l Multi-casualty: This situation is usually limited to a single location: . . . The plan should be revised. or where there are low levels of hazmat skills and experience among EMTs. occur in the fixed locations where the chemicals are used or stored. May pose a problem in rural areas with small hospitals. equipment. safety practices. through the multi-casualty. Involves normal systems of transportation. Various types of disaster drills should be held each year to evaluate the effectiveness of the plan. such units may not be part of the local EMS system. and transportation guidelines. but the demand on all systems is much greater. Patients may be treated locally at different facilities that provide various levels of care. and further training offered.operational policies and procedures. statistics show that almost 75 percent of acute hazardous materials events. . THE SPECTRUM OF HAZARDOUS MATERIALS INCIDENTS Local and state EMS agencies should be able to participate in the response to a range of hazmat incidents from the individual level. or even outside of the area altogether. The plan should be developed in collaboration with other response agencies and hospitals. as well as of the training sessions. or at home. Involves several locations. May be an intentional criminal act with secondary harmful devices present. medical practices. Patients are usually treated at the same level facility as a single emergency response. and supply needs into state and local hazmat plans. and reviewed annually. l Mass-casualty: Disrupts a large segment of the community: . l Individual patient: A single individual is contaminated and must be transported to an emergency department: . Planning should integrate hospital(s) and EMS personnel. based on feedback from its use. the hospital must be familiar with these plans and know how to use them if it is involved in an incident that overwhelms its capabilities. In addition. Training sessions based on the plan should be given on a regular basis to all agency personnel. Involves long-range mutual aid. . events resulting in death and injury occur almost 1. Involves additional units to the normal responders (mutual aid). . in a public place. 2 2 . Can occur in the workplace. and these units may not know how the system works. The hospital(s) and emergency medical responders are key components of the local response system. While transportation incidents attract larger media attention.

environmental. requires that each state establish a State Emergency Response Commission (SERC). health. medical personnel. public health. occupational safety. The plan must include: l l l l l l Identification of facilities subject to planning provisions under Title III Identification of transportation routes for extremely hazardous substances Identification of risk-related facilities Methods and procedures for response Designated community and facility coordinators Procedures for public notification 3 . civil defense. and transportation. establishing procedures for handling public requests for information. The SERC is responsible for establishing local emergency planning districts (usually on a county level). The legislation also provides for public access to information on the presence and releases of specified hazardous chemicals in communities. media. transportation. industries. and exercising its plan.Hazardous material incidents range from small releases at a factory site to rapidly expanding events that may endanger a community. law enforcement. implementing. Contributions to hazardous materials planning come from a variety of sources. As part of the planning process. This preplanning often requires coordination among local. consisting of members with technical expertise in emergency response. military hospitals. state. at a minimum. firefighters. its successful management depends on preplanning. as well as those in the community who use and maintain stocks of potentially hazardous materials. media. and facility owners or operators subject to the emergency planning requirements. hospital. SARA TITLE III Title III of the 1986 Superfund Amendments and Reauthorization Act (SARA) provides for an infrastructure in states and local communities to plan for effective response to hazardous materials emergencies. each LEPC must evaluate available resources for developing. state EMS agencies. Regardless of the size or location of an incident. LEPCs were also charged with making information on hazardous chemicals available to the public. LEPCs were primarily responsible for preparing a comprehensive emergency response plan for their districts by October 1988. state and local planning committees established under Title III of the Superfund Amendments and Reauthorization Act (SARA). using information about the presence of potentially hazardous chemicals reported by businesses and other facilities under Title III. These include regulations from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). appointing and overseeing local emergency planning committees (LEPCs). Title III. the Health Department. and federal agencies. and federal agencies. first aid. representatives from the following groups: state and local officials. the regional Poison Control Center. SARA Title III requires that the local committees include. environmental and natural resources. and reviewing LEPC emergency plans. The Emergency Planning and Community Right-to-Know Act of 1986.

Other provisions of Title III provide further information on the presence. In April 1987. and Liability Act of 1980 (CERCLA) must be reported to the LEPC and SERC. and transportation operations. Exemptions under this provision apply only to vessels (ship/boat). These data further assist the LEPC in obtaining a comprehensive picture of chemical risk in the local district. and emissions of hazardous and toxic chemicals. Accidental releases of EHSs and other hazardous substances identified in the Comprehensive Environmental Response. and thus are an essential part of the planning process. Compensation. In addition. However. These facilities must also appoint a coordinator to work with the LEPC for specific inclusion of that facility in the local plan. Representative facilities covered under the planning provisions include not only major chemical manufacturing facilities but a wide variety of chemical users. EPA listed 406 Extremely Hazardous Substances (EHSs) and established a Threshold Planning Quantity (TPQ) for each. and for prevention and treatment measures during nonemergencies. EMS agencies should maintain an inventory of disaster medical supplies. The duties of these agencies vary from state to state. Title III contains a specific provision requiring facility owners or operators to disclose the chemical identity of substances for which companies have made trade secret claims. Title III provides for the submission of information on hazardous and toxic chemicals as presented above. EMS agencies should also develop and maintain communications protocols for onsite activities 4 4 . federal facilities. and nurses in obtaining further information for diagnostic and treatment recommendations during emergencies. and other service-related businesses. EPA was mandated by Congress to establish a list of chemicals to help focus local emergency planning activities. physicians. dry cleaners. THE STATE EMERGENCY MEDICAL SERVICES (EMS) AGENCY Planning for hazardous materials incidents should include the appropriate linkage to the state EMS agency. In addition. storage.l l l Methods for determining release occurrence and the area affected Description of emergency equipment and facilities. This body is often part of the SERC. such as farmers. This requirement ensures immediate notification of local response personnel. and those responsible for them Evacuation plans and training programs Under Title III s planning provisions. Emergency medical personnel can be better prepared to respond to incidents that involve contaminated victims by actively participating in the LEPC planning process. EMS agencies are usually responsible for medical management of civilians and injured first responders. The state agencies are responsible for overseeing a network of local EMS units. EMS agencies must develop medical mutual aid agreements between counties and establish procedures for distribution of casualties between hospitals. Any business or facility that contains one or more of these EHSs in an amount equal to or greater than its respective TPQ is required to notify the SERC and LEPC. Storage incidental to transportation is exempt provided that the EHSs are still moving under active shipping papers and have not reached the final consignee. Access to chemical identities assists health professionals.

Planning should address antidote utilization and the rapid acquisition of additional supplies and pharmaceuticals. the regional Poison Control Center can provide decontamination and medical management protocols via fax. Planning should also address how to handle children. Health Department(s). Mental Health: Identify mental health resources. and through the base hospital or via cellular telephone to EMTs in the field. Hyperbaric Chamber Facilities. Further. Suggested planning activities include: l Incident Management: Establish with fire and police departments a unified command approach to mitigating a hazmat or Weapons of Mass Destruction (WMD) incident. The Poison Center will often know which hospitals are best prepared to handle exposures to which substances. response personnel. supplies. EMS agencies must work with local and state officials in designating field casualty decontamination and collection points for a major disaster.(e. and Other Specialty Centers: Provisions should be made to alert and coordinate patient destination with various specialty care centers. Patient Destination: Hospital emergency departments are able to provide supportive care. such as critical incident stress debriefing teams. and the general public. Media Relations: Appoint an individual who will handle all media requests for information.. to assist with meeting the mental health needs of patients. Coordination with Burn Centers. if needed. between base hospitals and ambulances. Trauma Centers. One option is to contact the regional Poison Control Center or the base hospital. the elderly and the infirm. pregnant women. Medical Management Protocols: The literature on the clinical management of hazardous materials exposures is sometimes inconsistent in its recommendations. Provisions should be made in the plan for obtaining field and hospital medical management information from experienced physicians.g. The plan should include directions for obtaining this information. Triage: Outline triage procedures to be utilized in prioritizing decontamination and transport of multiple patients. it may be more appropriate to take the patient to a hospital that has expertise in handling certain kinds of poison exposures or injuries. however. and pharmaceuticals. Decontamination: Institute a regional standard for performing decontamination of ambulatory and nonambulatory patients. For example. or telephone to all receiving hospitals. In some cases. as well as large numbers of patients (mass decontamination). hazmat team(s). l l l l l l l l 5 . in coordination with the fire department. between receiving hospitals and the base hospital. between all hospitals and the regional Poison Control Center). Medical Management Guidelines for Acute Chemical Exposures. Documentation: Identify the required incident documentation that must be completed during and after the hazardous materials incident. and hospitals. e-mail. Volume III in this series. and in arranging for the acquisition and distribution of additional equipment. contains useful emergency care recommendations for prehospital and hospital personnel.

NRT-1 represents a concerted effort by federal agencies to consolidate their general hazardous materials planning guidance into an integrated federal document. EMS. U. Department of the Interior. Environmental Protection Agency (EPA). and a group of On-Scene Coordinators (OSCs) have been established. These multidisciplinary teams. consisting of police. are specially trained and equipped to respond to serious hazmat incidents as well as to NBC-related situations. Department of Agriculture. The Hazardous Materials Emergency Planning Guide. Help LEPCs and individual communities prepare a plan that is appropriate for their needs and consistent with their capabilities. a National Response Team (NRT) and a National Response Center. Department of Health and Human Services (Agency for Toxic Substances and Disease Registry [ATSDR]). Furnish criteria for risk and hazard assessments. Department of State. and maintaining community emergency plans. and to assist communities in determining whether a hazardous materials incident plan is needed in addition to the districtwide plan developed by the LEPC. provides guidance to help local communities prepare for potential hazardous materials incidents. testing. Department of Transportation. Department of Commerce (National Oceanic and Atmospheric Administration [NOAA]). with passage of the NunnLugar-Domenici Anti-Terrorism Bill in 1996. as well as by LEPCs formed in accordance with the Emergency Planning and Community Right-to-Know Act of 1986 (SARA Title III). Preplanning and coordination of services are equally critical at the national level. and was developed cooperatively by its federal member agencies. Biological. including the Department of Defense. The federal government established a National Contingency Plan (NCP) to promote coordination of resources and services of federal and state response systems. a network of Regional Response Teams (RRTs). Nuclear Regulatory Commission (NRC). and the Department of Energy (DOE). Department of Labor (Occupational Safety and Health Administration [OSHA]). To oversee this plan. In addition. the U. referred to as NRT-1. NRT-1 can be used by local communities developing their own plans. hazmat. Department of Justice. Department of the Treasury. Coast Guard. Federal Emergency Management Agency (FEMA). and hospital personnel. The objectives of the Hazardous Materials Emergency Planning Guide are to: l l l Focus communities on emergency preparedness and response. Provide communities with information that can be used to organize the emergency planning task.FEDERAL EMERGENCY RESPONSE ACTIVITIES Contingency planning is essential to the successful implementation of any system designed to manage chemically contaminated patients and to promptly contain the hazard itself.S. l l NRT-1 is published by the National Response Team. Public Health Service developed a series of strategically placed Metropolitan Medical Response Teams (NMRTs) to respond in the event of Nuclear. General Services Administration (GSA). Contingency plans require a coordinated community response that may also involve state and federal agencies. or Chemical (NBC) terrorism. Provide a method for revising. 6 6 .S.

CAER has outlined specific steps for industrial plants: l l l l l l l l l Review the plant s emergency plan Improve employee awareness and training Prepare a community relations plan Inventory the status of local emergency planning Develop a briefing paper Prepare a list of initial contacts Meet with initial contacts and identify key officials Establish a coordinating group Begin implementation steps On the federal level. and feet. arms. The NRT-1 document also recommends that contingency plans include standard operating procedures for entering and leaving sites.. Further. As previously mentioned. and other emergency services personnel to help them protect themselves and the public during the initial minutes immediately following a hazardous materials incident. The CAER program encourages local chemical manufacturing facilities to inform area residents. decontamination procedures. police. In some areas of the country. It also recommends that hospital. supplied-air respirator. the chemical industry has established physician networks to encourage better dialogue between company physicians and local health authorities.e. EPA and FEMA provide technical assistance and guidance to local and state planners through the SARA Title III program. the type of clothing that must be worn.NRT-1 states that an emergency plan must include response procedures of facilities and local emergency and medical personnel. recommended safety and health equipment. eyes. NRT-1 describes relevant publications that provide specific operational guidance to emergency responders. such as the DOT s North American Emergency Response Guidebook (NAERG). which provides guidance for firefighters. face. and the equipment needed to protect the head. and emergency response organizations about industry operations and to integrate their onsite emergency response plans with the planning efforts of the local community. or air-purifying respirator) that should be used. and personal safety precautions. SARA Title III requires medical. as well as a description of emergency equipment and facilities in the community. 7 . hospital. and health department personnel be included as members of an emergency planning team. see Section II). emergency medical service. The document suggests that emergency plans include a list of emergency response equipment appropriate to the various degrees of hazard based on EPA s four levels of protection (Levels A through D. ears. the document provides information on the Chemical Manufacturers Association s (CMA) Community Awareness Emergency Response (CAER) and Chemical Transportation Emergency Center (CHEMTREC) programs. and first aid personnel to be members of the local emergency planning committee. In addition. public officials. self-contained breathing apparatus. it recommends that the list include the type of respirator (i. accountability for personnel entering and leaving sites. hands.

During the process of identifying hazards. NRT-1 recommends that medical personnel be made aware of significant chemical hazards in the community to prepare for possible hazardous materials incidents. and location(s) of hazardous materials in the community. such as chlorine.In addition. This is a key step because it permits planners to describe and evaluate risks. 8 8 . This section focuses primarily on hazard identification. vulnerability analysis. and venting to the atmosphere. petroleum plants.. and hydrochloric and sulfuric acids. placing airport. and to allocate resources accordingly. such a facility can provide technical experts. the fire department). In requesting information directly from facilities. DOT.g. particularly if the committee includes industry representatives. and risk analysis. It is a three-step decisionmaking process comprised of hazard identification. Such materials should be given special attention (vulnerability analysis) by the LEPC in the planning process. It should be noted that several federal agencies (e. It is essential that these industries or businesses understand the role this information plays in ensuring a sound emergency response plan. such as explosions. Hazards should be identified at as many facilities in the community as possible. EMS personnel should consult with the LEPC or their agency head to review the hazard analysis information for their area. fires. For example. EPA) report that frequently encountered substances often pose the most prevalent dangers. The LEPCs may provide assistance here. or industrial representatives on the communitywide planning committee. and cleanup capabilities. the Disaster Committee. These include the obvious ones such as chemical plants. storage facilities. The assistance and cooperation of a facility that regularly deals with hazardous materials also presents the local planning unit with a wide array of services. It also states that emergency medical teams and hospital personnel must be trained in the proper methods for decontaminating and treating individuals exposed to hazardous chemicals. and warehouses. However. ammonia. as required under SARA Title III. spills. FEMA. In this context.. remember that the planning provisions under SARA Title III require certain facilities to provide the LEPC with any information on the facility that the committee needs to develop and implement its plan. and (2) the nature of the hazard that would accompany incidents. should facilitate their cooperation. HAZARD ANALYSIS Hazard analysis is a necessary component of comprehensive emergency planning for a community. or the LEPC. or transported through a community. the task of analyzing all relevant hazards may not prove cost effective for many communities. The planning committee should. facilities or transportation routes will be pinpointed that contain materials that are potentially dangerous to humans. training and safe handling instructions. assign priorities to the hazards found in its community and establish affordable limits for analysis. These materials include fuels and chemicals. As previously stated. The first task in conducting such an analysis is to complete an inventory of the hazardous materials present in the community and to determine the nature of the hazard. refineries. a hazard is any situation that is capable of causing injury or impairing an individual s health.g. Spill Prevention Control and Countermeasure (SPCC) plans. quantities. business. The identification of hazards also should provide information on: (1) the types. therefore. Hazard analysis is usually the task of an agency (e.

and trucking terminals.gov/pubs/FactSheets/toxnctfs. EPA published a supplement to NRT-1 in December 1987. The type of risk to the environment. 9 . This training provides an introduction to basic response principles: the importance of incident recognition.html). TRAINING Each member of an EMS agency (career. These two courses and other instructional programs. are recommended for all EMS personnel who will be responding to hazardous materials calls. Personnel at this level are also able to coordinate EMS activities at a hazardous materials incident and provide medical support for hazmat response personnel. hospitals and educational and governmental facilities should not be overlooked since they all contain a variety of chemicals. The National Fire Protection Association (NFPA) has published several standards for fire departments regarding hazardous materials response. such as an acute. Information that is necessary for risk analysis includes: l l l The type of risk to humans. from manufacturers to service-related businesses. The groups that are most at risk. whereas Level II EMS/HM responders are prepared to provide care to individuals who still may pose a risk of secondary contamination (i. or delayed reaction. such as the Domestic Preparedness: Weapons of Mass Destruction Training program. timely. In conjunction with FEMA and DOT.cdc. www.In identifying hazards. Level I EMS/HM-trained responders are prepared with the knowledge and skills to safely deliver emergency medical care in the Support (Cold) Zone. Risk analysis includes the probable damage that may occur if a chemical incident occurs. provides technical assistance to LEPCs in assessing the lethal hazards associated with potential airborne releases of extremely hazardous substances. www.NIH. railroad yards.e. which outlines desired levels of competence for EMS personnel responding to hazmat incidents. numerous sites on the Internet offer free access to educational materials pertaining to hazardous materials (e.. such as permanent damage or a recoverable condition. SARA Title III planning provisions address many of these potential transportation risk areas by requiring facility cooperation in plan preparation and by including specific risk areas as well as a wide range of chemical handlers. and cost-effective instruction.gov/hazdat. A growing number of commercially available audiovisual and computer-based training programs are becoming available which provide accurate. vessels in port. Standards for Professional Competence of Responders to Hazardous Materials Incidents. This document. In 1997 it released Standards for Professional Competence of EMS Responders to Hazardous Materials Incidents (NFPA 473).NLM. or combined service) is mandated to receive 8 hours of hazmat awareness training each year. should also be included in the overall hazards identification plan. Many documents can be of assistance in conducting a risk analysis. In addition. such was airports. All EMS agency administrators should familiarize themselves with this standard. working in the Contamination Reduction (Warm) Zone). assessment.ATSDR. as well as with NFPA 472. and taking defensive strategies until more qualified assistance arrives.g.. volunteer. Risk analysis in transportation settings is outlined in the DOT s Community Teamwork: Working Together To Promote Hazardous Materials Safety. Major transportation routes and transfer points. entitled Technical Guidance for Hazardous Analysis and often referred to as the Green Book. A Guide for Local Officials. chronic.html.

1983.S. National Emergency Training Center.S. Emmitsburg. A. MA: National Fire Protection Association. Auf der Heide. MD. Noll. (ed. 1983. 1995. Hazardous Materials Toxicology: Clinical Principles of Environmental Health. Incident Command System. TX: American College of Emergency Physicians. DC: Government Printing Office.). MA: National Fire Protection Association. U. U. NFPA 473. G.. SARA Title III Compliance Guidebook. National Fire Protection Association. Quincy. 1996 North American Emergency Response Guidebook. U. Department of Defense. National Fire Protection Association. Washington. MA: National Fire Protection Association. Recommended Practice for Responding to Hazardous Materials Incidents. 1992. 1992. M. Community Medical Disaster Planning and Evaluation Guide.gov/gydebook. 1985. DC: Government Printing Office. Baltimore. National Response Team.S. MD: HEMP Curriculum Guidelines.G. Stillwater. Edgewood. Guidelines for Public Sector Hazardous Materials Training. Washington. 1996.V. MA: National Fire Protection Association.G. Brunancini. Louis. OK: Oklahoma State University Press. 1992. [available in English. J. National Fire Protection Association. 1998. and J. NFPA 471. 2nd ed.dot. USAMRICD Chemical Casualty Division. Krieger. 1989. Quincy. Inc. Quincy. OK: Fire Protection Publications. Fire Command. U.R. DC: Government Printing Office. MD: Williams & Wilkins. Disaster Response: Principles of Preparation and Coordination. Standards for Professional Competence of Responders to Hazardous Materials Incidents.htm] 10 10 . Washington.B. Stillwater. 1997. Dallas. MO: Mosby. 1988. Hildebrand. A Guide for Local Officials. 1995. Department of Transportation. 1987. Yvonna. ISBN: 0-86587-749-1. Standards for Professional Competence of EMS Responders to Hazardous Materials Incidents. St. Community Teamwork: Working Together To Promote Hazardous Materials Safety. E.SELECTED BIBLIOGRAPHY Auf der Heide. Sullivan. Army. and G. Hazardous Materials Emergency Planning Guide. 3rd ed. Quincy. Spanish and French][http://hazmat. Medical Response to Chemical Warfare and Terrorism. Fire Protection Publications. 1998.S. NFPA 472. Department of Transportation. Government Institutes. E. Hazardous Materials: Managing the Incident.S.

Washington. DC: Government Printing Office.U.S.S.S. 1992. U. Technical Guidance for Hazardous Analysis: Emergency Planning for Extremely Hazardous Substances. EPA Standard Safety Operating Guidelines. Federal Emergency Management Agency. U. Washington. Environmental Protection Agency and U.S. Environmental Protection Agency. DC: Environmental Protection Agency. DC: Government Printing Office. Federal Emergency Management Agency. Washington. 1996. 11 . 1987. Guide for all Hazard Emergency Operations Planning.

12 12 .

Certain combinations of patient symptoms such as nausea. Identification numbers. such as slipping off a ladder. Oxy stands for oxidizer). There are three categories of packaging: stationary bulk storage containers at fixed facilities that come in a variety of sizes and shapes. such as rail and truck tank cars. construction sites). emergency response personnel may not be aware that the situation involves hazardous materials. rail tank cars. that these data sheets may have incomplete information and that the medical information provided is generally at a basic first aid level. emergency personnel should be alert to the obvious locations in their communities that use and/or store hazardous materials (e. Emergency Medical Services Response to Hazardous Materials Incidents HAZARD RECOGNITION When dispatched to the scene of an incident. The manual Recognizing and Identifying Hazardous Materials (produced by the National Fire Academy and the National Emergency Training Center) states that there are six primary clues that may signify the presence of hazardous materials. An injury at a hazardous materials incident need not invariably involve chemical exposure: it could have resulted from a physical accident. W indicates dangerous when wet. The shape and configuration of the container can often be a useful clue to the presence of hazardous materials. burning eyes or skin. but does not provide productspecific information. dizziness. Community preplanning should identify the specific sites that contain hazardous materials. farm and paint supply outlets. Department of Transportation (DOT) regulations delineate container specifications for the transport of hazardous materials. Each quadrant represents a different characteristic: the left. however. or cyanosis should also suggest to the dispatch staff the presence of hazardous materials.. white quadrant highlights special information (e. are required on all cargo tanks. red quarter pertains to flammability. Railcars may have the names of certain substances stenciled on the side of the car. yellow area is for reactivity. that vary in shape depending upon the cargo. bulk transport vehicles. Container Shape.. As a result. Markings/Colors. portable tanks. factories. drums. and should ask the dispatch personnel and victims about the nature of the event. and the bottom. the involvement of hazardous materials should be considered a possibility on every call.Section II. and other packages that carry hazardous materials. emergency medical services personnel should always be alert to the possibility that they may be dealing with a chemically contaminated individual. including identification (ID) numbers. located on both ends and both sides. the top. laboratories. In addition. Dispatch protocols should seek to obtain information about these clues and relay the information to field personnel as soon as possible. The Department of Labor s Material Safety Data Sheets (MSDSs) should also be available. l l 13 . blue section refers to health. and labeled fiberboard boxes. or cylinders for smaller quantities of hazardous materials. It should be kept in mind. The six principle clues to hazardous materials incidents are: l Occupancy and Location. But as a routine precaution. This system uses a diamond divided into four quadrants.g. especially for any particularly dangerous chemicals kept on site. Certain transportation vehicles must use DOT markings. A marking scheme designed by the National Fire Protection Association (NFPA 704M System) identifies hazard characteristics of materials at terminals and industrial sites.g. the right. These clues are included below to facilitate and expedite the prompt and correct identification of any hazardous materials at the scene of an incident.

and quantity. on the products themselves. with zero representing the minimum risk. In addition.A number from zero through four in each quadrant indicates the relative risk of the hazard. 14 . and placarding guide. and may indicate whether the material is waste or poison. American National Standard Institute (ANSI) Standards for Precautionary Labeling of Hazardous Industrial Chemicals. hazard class. if one detects an odor of hazardous materials. They should provide the shipping name. fire. The military also uses distinctly shaped markings and signs to designate certain hazards. however. Shipping papers should remain at the incident scene for use by all response personnel. Binoculars are helpful to ascertain visible information from a safe distance. The location where the shipping papers are stored can be problematical. dead animals or fish. carbon monoxide). however. and either hazard class wording or four-digit identification numbers. or taste at all (e. It is important that any and all available clues are used in substance identification. which must accompany all hazardous material shipments. l Placards/Labels. because the container or vehicle holding a hazardous material may be improperly labeled or recorded. Odor. Labels designate hazardous materials kept in smaller packages. These markings may be found on vehicles. This system does not indicate what the product is. or its exact location. These convey information through use of colors. or on shipping papers. the DOT s hazardous materials marking. Placards are used when hazardous materials are being stored in bulk (usually over 1. vapor clouds. Generally. can impair an individual s sense of smell (e. Caution must be exercised. United Nations Hazard Class Numbers. the quantity. Shipping Papers. labeling. especially obvious sources such as the information provided on a label or in shipping papers. Hazard Communication Standards. and others have no odor.g. ID number. l l Appendix A provides greater detail on NFPA s 704M system. or it may not have any exterior warning..001 lb).. color. Senses.g. it does not reveal the compound s reactivity with other chemicals. Shipping papers can clarify what is labeled as dangerous on placards. and the Department of Labor s MSDS. are now required to list a 24-hour emergency information telephone number. and skin or eye irritation can signal the presence of hazardous materials. symbols. such as in cargo tanks. Shipping papers. often they are found in close proximity to the hazardous material(s) or in other locations not easily accessible during an emergency. hydrogen sulfide). Some chemicals. although some chemicals have a detectable odor at levels below their toxic concentrations. it should be assumed that exposure has occurred and the individual is still in the danger area.

the increased risk of the documents being lost or damaged because of their small size and soft cover bindings. Note. and the Centers for Disease Control (CDC) can be contacted 24 hours a day to provide vital information on the medical management of hazardous materials exposure. Printed reference materials provide several advantages: they are readily available. Care should be exercised when selecting information sources. it is not. Disadvantages include the difficulty of determining the correct identity for an unknown chemical through descriptive text. They can help by describing the toxic effects of a chemical. and they are relatively inexpensive. The regional Poison Control Center. some medical management information may be based only on DOT or MSDS data. 15 . and advice on the adequacy of specific types of protective gear. and the potential for secondary contamination. early and accurate identification of the hazardous material(s) involved allows emergency personnel to initiate appropriate management steps at the scene. Exhibit II-2 provides a partial listing of the available computerized and online information sources. EMS personnel should have immediate access to and be proficient at using the DOT s North American Emergency Response Guidebook and other medically-oriented response documentation. that not all online databases are peer reviewed. Exhibit II-lA is a partial listing of the many information resources available by telephone. its relative potency. clinical management strategies. the logistics of keeping the materials current. they are not dependent on a power source or subject to malfunction. and many of these resources can provide guidance in the formation of an effective response plan. Many resources are available to provide information concerning response to and planning for hazardous materials incidents. Identifying the hazardous material and obtaining information on its physical characteristics and toxicity are vital steps to the responder s safety and effective management of the hazardous materials incident. however. Since each compound has its own unique set of physical and toxicological properties. and the problem that no single volume is capable of providing all the information that may be needed. There is also a vast array of telephone and computer-based information sources concerning hazardous materials. Exhibit II-1B is a list of suggested telephone numbers that should be filled in for your community. however.The aim of emergency personnel should be to make a chemical-specific identification while exercising caution to prevent exposure to any chemicals. They may also recommend decontamination procedures. Planning is an essential part of every response. they can be kept in the response vehicle. the Soldier and Biological Chemical Command (SBCCOM). a complete list of the materials available. A selected bibliography of written material is included at the end of each section of this guidebook.

MD. UT.m. Contact number for technical questions about railway transport of hazardous materials. IN. NV. PW) Region X (AK.gov/regional available for technical assistance. SC. WV) Region IV (AL. For emergencies. to 6:00 p. WY) Region IX (AZ. VT) Region II (NJ. MA. KS. RI. (EST). FM. including onsite assistance. PA. PR. HI. Agency for Toxic Substances and Disease Registry (ATSDR) 1-404-639-6360 24-hour emergency number for health-related support in hazardous materials emergencies. MN. OR. FL. GA. MP. TN) Region V (IL. WI) Region VI (AR. call CHEMTREC (1-800-424-9300). ME. MT. 1-617-918-1111 1-212-637-3000 1-215-814-2900. Emergency Response & Removal Branch: 1-800-564-7577 1-312-353-2000 1-214-665-2200 1-913-551-7003 1-303-312-6312 1-415-744-1500. KY. NH. ID. TX) Region VII (IA.m. CA. LA. Available 9:00 a. Also provides access to the Chlorine Emergency Response Plan (CHLOREP).Exhibit II-1A Telephone Information and Technical Support References Resource Chemical Transportation Emergency Center (CHEMTREC) Contact Services Provided 1-800-424-9300 24-hour emergency number connecting with manufacturers and/or shippers. list of extremely hazardous substances. MH. OK. decontamination considerations. Pacific Islands AS. SD. rescue gear. ND. MI. VI) Region III (DE. NY. etc. GU.epa. Advice provided on handling. DC. OH. MO. Provides information on SARA Title III. NM. MS. WA) website: Environmental response teams www. intra-regional only: 1-800-438-2474 1-404-562-9900. and planning guidelines. NE) Region VIII (CO. VA. NC. Bureau of Explosives 1-719-585-1881 Emergency Planning and Community 1-800-424-9346 Right-to-Know Act (EPCRA) and Resource Conservation and Recovery Act (RCRA) Information Hotline Environmental Protection Agency (EPA) Regional Offices Region I (CT. emergencies: 1-415-744-2000 1-206-553-1200 16 .

cleanup. serious injury. National Pesticide Telecommunications Network (NPTN) (Oregon State University) 1-800-858-7378 Provides information about pesticide-related website: topics. safety. including pesticide products.000. Provides an emergency response team to investigate incidents and to perform laboratory analysis. investigation of pesticide incidents. ace. 1-800-424-8802 A federal hotline for reporting oil and chemical spills where hazardous materials are responsible for death. emergency treatment.purdue. 24-hour consultation service for threats and releases pertaining to chemical and biological agents.edu/npirs pesticides. fungicides.S. National Response Center U. toxicology. insecticides. or continuing danger to life and property.Exhibit II-1A (continued) Resource National Animal Poison Control Center Contact 1-800-548-2423 1-888-426-4435 Services Provided 24-hour consultation services concerning animal poisonings or chemical contamination. Army Soldier and Biological Chemical Command (SBCCOM) 1-800-368-6498 17 . and state and federally registered chemicals. National Pesticides Information Retrieval System 1-765-494-6616 Contact information for help in searching (NPIRS) website: NPIRS database to get fact sheets on ceris. property damage in excess of $50. referrals for laboratory analyses.orst.edu/info/nptn recognition and management of pesticide poisoning. health and environmental effects. environmental chemistry. and disposal procedures.

Army Soldier and Biological Chemical Command 18 .Exhibit II-1B Local Telephone Information and Technical Support Resource Worksheet Resource Contact (fill in for future reference) Services Provided (fill in for future reference) EPA Regional or State Office Regional Poison Control Center State Emergency Response Commission State Health Department State Emergency Management Office Local Fire Department Local Hazardous Materials Response Team Community Police Department Local Emergency Planning Committee Local Health Department State Department of Natural Resources FEMA Regional Office State Agriculture Office State Lab Office State EMS Office Hyperbaric Medicine Chamber Burn Center CDC U.S.

htm Kevin Coburn Information Systems Manager U. Colorado 80111-4740 (800) 525-9083 website: www.epa.nlm. health hazards. D. reactivities.micromedex. compiled by the National Library of Medicine.dla. physicochemical properties.S. developed by the Coast Guard and comprised of reviews on fire hazards. N. and shipping information for over 1.H.gov/ceppo/cameo CIS.oxmol. Maryland 20894 (301) 496-6531 website: sis. HMIS Hazardous Material Information Systems contains information on hazardous materials.mil/hmis. Inc. Inc. Chemical identification database assists in determining substance(s) involved.E. Provides information on emergency medical treatment and recommendations for initial hazardous response.nih.htm HSDB Representative National Library of Medicine Specialized Information Systems 8600 Rockville Pike Bethesda. HSDB Hazardous Substances Data Bank.C. predicting downwind concentrations. Seattle. and identifying potential hazards.dlis.gov/sis1 Description Computer-aided management of emergency operations available to on-scene responder(s). Washington 98115 (206) 526-6317 website: www. such as spills. Maryland 21031 (800) 247-8737 website: www.Exhibit II-2 Computerized Data Sources for Information and Technical Support Data System CAMEO Contact CAMEO Database Manager National Oceanic and Atmospheric Administration (NOAA) Hazardous Materials Response Division 7600 Sand Point Way. fire-fighting recommendations. 19 .com/products/ pd-main. Syracuse Way Englewood. 20590-0001 website: www. c/o Oxford Molecular Group 11350 McCormick Road Executive Plaza.1 (Hazardous Materials Incident Report Form). CHRIS Chemical Hazard Response Information System. providing response recommendations. hazards. leaks. HAZARDTEXT Assists responders dealing with incidents involving hazardous materials. Suite 1100 Hunt Valley. Suite 300 6200 S.Room 8104 400 7th Street SW Washington. provides reviews on the toxicity.com/software/cis/ details/CHRIS.M. Transportation-related incidents may be reported on DOT form 5800.shtml Micromedex. 63 .000 chemicals. Department of Transportation D. and regulatory status of over 4.000 frequently used chemicals. use of protective clothing. and fires.

1st MEDICAL RESPONSE Micromedex. Syracuse Way Englewood.micromedex. Inc.htm Oxford Molecular Group. Inc.htm MEDITEXT Micromedex. the Registry of Toxic Effects of Chemical Substances.micromedex. A computerized system of three toxicologically oriented data banks operated by the National Library of Medicine the Hazardous Substances Data Bank. TOXNET provides information on the health effects of exposure to industrial and environmental substances. Suite 300 6200 S.oxmol. Hazardtext. CHRIS.com/products/ pd-main.shtml Micromedex. Syracuse Way Englewood. 11350 McCormick Rd. PROTOCOLS Suite 300 6200 S. TOMES TOXNET Toxicology Data Network (TOXNET) National Library of Medicine Specialized Information Services 8600 Rockville Pike Bethesda.com/software/cis/ details/OHMTADS. HSBD. and recommends procedures for handling cleanups. The Tomes Plus Information Systems is a series of comprehensive databases on a single CD-ROM disc. The Tomes Plus database contains Meditext. Colorado 80111 (800) 525-9083 website: www.htm Provides recommendations regarding the evaluation and treatment of exposure to industrial chemicals.com/products/ pd-main. Executive Plaza 3.Exhibit II-2 (continued) Data System Contact Description Helps develop training programs and establish protocols for first aid or initial workplace response to a medical emergency.nih. Suite 300 6200 S.gov/sis1 20 . OHMTADS Oil and Hazardous Materials/Technical Assistance Data Systems provides information on the effects of spilled chemical compounds and their hazardous characteristics and properties. Maryland 20894 (301) 496-6531 website: sis. and 1st Medical Response Protocols.nlm.com/products/ pd-main. Inc. It provides information regarding hazardous properties of chemicals and medical effects from exposure. Colorado 80111 (800) 525-9083 website: www. and the Chemical Carcinogenesis Research Information System. Maryland 21031 (800) 247-8737 website: www. OHMTADS. Inc. Suite 1100 Hunt Valley. assists in identifying unknown substances. Colorado 80111 (800) 525-9083 website: www.micromedex. Syracuse Way Englewood.

the less likely the chemical will produce an inhalable gas and vice versa. nitrogen) that displace oxygen in inspired air. for example. Inhalation of toxic agents generally results in a rapid and effective absorption of the compound into the bloodstream because of the large surface area of the lung tissue and number of blood vessels in the lungs. This is merely a sample list of toxic end points that might be encountered (Exhibit II-3). (2) the route of exposure. such as vomiting or diarrhea. Chronic health effects are long-term effects that may take years to manifest. for example. It is important for medical providers to recognize that exposure to chemical compounds can result not only in the development of a single systemic effect but also in the development of multiple systemic effects or a combination of systemic and local effects. (3) the nature and extent of exposure. such as cancer. Asphyxiants are chemicals that impede the body s ability to obtain or utilize oxygen. nose. pulmonary edema.g. typically the skin and the mucous membranes of the eyes. The lower the VP. are dependent on: (1) the toxicity of the chemical. produce a localized toxic effect in the respiratory tract.PRINCIPLES OF TOXICOLOGY FOR EMERGENCY MEDICAL SERVICE PERSONNEL Exposure to hazardous chemicals may produce a wide range of adverse health effects. Acute health effects are short-term effects that manifest within hours or days. respiratory. cardiac. To better understand potential health effects. and produce adverse effects such as neurological. are absorbed through the skin. is termed a local toxic effect. distributed to other parts of the body. solids and liquids can be inhaled as dusts or aerosols. emergency medical personnel should understand the basic principles and terminology of toxicology. However. or respiratory tract. Carbon monoxide and cyanide are examples of asphyxiants. neurotoxicity (nervous system damage). Inhalation results in the rapid introduction of toxic compounds into the respiratory system. Knowing a chemical s vapor pressure (VP) can be useful in determining the inhalation risk for a particular exposure. 21 . Water solubility is also an important contributor for symptom development. Chemical asphyxiants produce harm by preventing oxygen delivery or utilization for energy production by the body s cells. or other problems. sometimes for as long as 48 hours or more. a toxic chemical may be absorbed into the bloodstream and distributed to other parts of the body. Irritant agents that are water soluble usually cause early upper respiratory tract irritation. producing systemic effects. sometimes called toxic end points. such as age and the presence of chronic disease. while corrosive acids and bases can result in local damage to the skin.. Irritant gases such as chlorine and ammonia can. Routes and Extent of Exposure There are three main routes of chemical exposure: inhalation. causing delayed symptoms (12 to 24 hours) which include trouble breathing. Many pesticides. resulting in coughing and throat irritation. Toxicology is the science that deals with poisons and their effect on living organisms. and nephrotoxicity (kidney damage). Partially water-soluble chemicals penetrate into the lower respiratory system. Examples of these adverse effects. The likelihood of an adverse health effect occurring. Most of the compounds that are commonly inhaled are gases or vapors of volatile liquids. include carcinogenicity (development of cancer). hepatotoxicity (liver damage). argon. and ingestion. A chemical injury at the site of contact. Some of these effects may be delayed. propane. and coughing up blood. Toxic chemicals often produce injuries at the site which they come into contact with the body. and (4) factors that affect the susceptibility of the exposed person. mouth. dermal contact (with skin or mucous membranes). Simple asphyxiants are inert gases (e. Health effects can also be acute or chronic. In addition. and the severity of the effect.

In addition. Compounds may also be introduced into the body through injection. 22 . and swallowing of saliva and mucus that contains contaminants may also result in exposure by this route.Exhibit II-3 Examples of Adverse Health Effects from Exposure to Toxic Chemicals Toxic End Point Target Organ Systems Example of Causative Agent Benzene Health Effect Acute Health Effect Chronic Carcinogenicity All Dermatitis Headache Dizziness Sleepiness Vomiting Abdominal pain Dizziness Nausea Vomiting Abdominal pain Vomiting Diarrhea Chest pain Acute myelogenous leukemia Hepatotoxicity Liver 1. and some areas of the body (e. Absorption is increased by damage to the skin and by warm weather. incidental hand-to-mouth contact. although some chemicals are readily taken in through the skin. However. 1-1 trichloroethane Liver necrosis Fatty liver Neurotoxicity Nervous system Lead Wrist drop IQ deficits Encephalopathy Kidney damage Anemia Nephrotoxicity Kidney Cadmium Dermal contact does not typically result in as rapid absorption as inhalation. the hands). 1. Many organic compounds are lipid (fat) soluble and can therefore be rapidly absorbed through the skin and mucus membranes..g. which may themselves be chemically contaminated. although this is a relatively uncommon scenario in spills or discharges of hazardous materials. Explosions may result in injection injuries and lead to imbedded foreign bodies.g. emergency medical personnel in both hospital and prehospital settings treat chemical exposures in patients who have ingested toxic substances as a result of accidental poisonings or suicide attempts. the groin) absorb chemicals faster than others (e. Ingestion is a less common route of exposure for emergency response personnel at hazardous materials incidents.. smoking.

allowing more effective surface area for absorption in dermal exposures. termed the dose-response relationship.g. It is important to recognize that children may be more susceptible to many toxic exposures. Injuries that disrupt the skin may lead to absorption of chemicals that would not normally penetrate the skin. is a key concept in toxicology. children have a larger skin area relative to their weight than do adults. This principle. However. presence of open wounds or breaks in the skin.. Dose-Response Relationship The effect produced by a toxic compound is primarily a function of the dose. the concentrations increase as you get closer to the ground. such as area of skin surface exposed. This occurs for a number of reasons. because we usually only monitor the concentration of the toxic substance in the environment (e. Many factors affect the normal doseresponse relationship and they should be considered when attempting to extrapolate toxicity data to a specific situation (Exhibit II-4). This relationship is important for emergency response personnel to understand because the adverse effects produced by a toxic compound are often related to the dose of that compound received by a patient. children are more likely to ingest toxic chemicals because of increased hand-to-mouth behavior. It is also probable that the child s lung is a more effective absorbent surface than that of the adult. the actual dose of the compound received by the patient is seldom known. including pica. as well as a greater respiratory volume (liters/min/kg of body weight). and the rate and depth of respirations. even when they all are exposed to the same scenario. parts per million (ppm) of a compound in air). and renal system increases his or her susceptibility to injury as a result of exposure to chemicals. A child s skin is more easily penetrated by chemicals.The route by which personnel are exposed to a compound plays a role in determining the total amount of the compound taken up by the body because a compound may be absorbed by one route more readily than by another. allowing for a more rapid and effective dermal absorption. Factors specific to the exposed individual. All of these factors may lead to an increased dose relative to size in children as compared to adults. the route of exposure may affect the nature of the symptoms that develop. children have a larger lung surface area relative to their weight than adults. 23 . First. are important in estimating the dose of the compound received by the patient. A complex relationship exists between the total amount of the compound absorbed by the body (dose) and the concentration of that compound in the environment. Second. The amount of the compound absorbed by the body also depends on the duration of exposure and the concentration of the compound to which one is exposed. Third. In addition. A child s immature central nervous system. Finally. children are shorter than adults and since most toxic gases are heavier than air. Children are also likely to receive a higher dose relative to body weight than an adult. liver.

duration Heredity. One dose-response term that is commonly used is the lethal dose 50 (LD50). pregnancy Media (air. age. sex. solid. temperature.). which are usually experimental animals. concentration. liquid. a factor that influences the dose of the compound in the body. Toxicity information is often expressed as the dose of a compound that causes an effect in a percentage of the exposed subjects.). and fire Factors related to exposure Factors related to the exposed person Factors related to environment Typically. nutrition. carriers Dose. which is the concentration of a material in air that on the basis of respiratory exposure in laboratory tests is expected to kill 50 percent of a group of test animals when administered as a single exposure (usually 1 hour). hormones. health status. etc. the severity of the toxic response increases. preexisting diseases. etc. exposure to 200 ppm tetrachloroethylene can result in a loss of motor coordination in some individuals.Exhibit II-4 Classification of Factors Influencing Toxicity Type Factors related to the chemical Examples Composition (salt. 24 .). additional chemicals present. immunology. and the reported acute LD50 values of these compounds when they are administered by ingestion to rats. presence of impurities. A similar term is the lethal concentration 50 (LC50). physical characteristics (size. These dose-response terms are often found in the Material Safety Data Sheets (MSDSs) and other sources of health information. a solvent that is commonly used for dry-cleaning fabrics. may experience relatively mild symptoms. humidity. However. route of exposure (inhalation. Exhibit II-6 lists a number of chemicals that may be encountered in dealing with hazardous materials incidents. freebase. etc. physical properties (volatility. As shown in Exhibit II-5. air pressure. breakdown products. ingestion. the severity of the toxic effect also depends on the duration of exposure. and exposure to 1.500 ppm tetrachloroethylene for 30 minutes may result in loss of consciousness (Exhibit II-5). This is the dose that is lethal to 50 percent of an animal population from exposure by a specific route (except inhalation) when given all in one dose. such as headache and drowsiness. soil.). as the dose increases. etc. Humans exposed to 100 ppm of tetrachloroethylene. water. solubility. dermal).

uncoordination Dizziness. emergency medical personnel should remember that the LD50 and LC50 values are only useful for comparing the relative toxicity of compounds. infants may not be able to excrete chemicals from the body as efficiently as adults because their kidneys and liver are not fully developed.4 to 10 mg/kg of sodium cyanide is required to produce the same effect. This same age dependence may exist in humans. damage to these organs may be more extensive and can be permanent. it is difficult to compare the effects seen in experimental animal studies to the effects expected in humans exposed to hazardous materials in the field. as may values determined in animals with an underlying disease. however. Therefore. Also. adverse or chronic effects. Furthermore.Exhibit II-5 Dose-Response Relationship for Humans Inhaling Tetrachloroethylene Vapors Levels in Air 50 ppm 100 ppm 200 ppm 600 ppm 1. Values determined in young animals may be quite different.000 ppm 7 hours 2 hours 10 minutes 1-2 minutes Duration of Exposure Effects on Nervous System Odor threshold Headache. The immaturity of metabolizing enzymes in the liver may lead to either increased or decreased toxicity in infants relative to adults. intolerable eye and respiratory tract irritation Coma 1. LC50 and LD50 values are also usually determined in healthy adult animals. Which may occur is difficult to predict for many chemicals. They also do not reflect possible additive effects from the mixture of chemicals sometimes found with exposure to hazardous materials.000 to 3. 25 . particularly the brain. LD50 values typically come from experimental animal studies. The LD50 values that appear on an MSDS or in the literature must be used with caution by emergency medical personnel.800 mg/kg tetrachloroethylene is lethal to 50 percent of rats that received the compound orally. only 6. It is known that many chemicals are more toxic (lower LD50 or LC50 values) in young or newborn animals than in adults. This may lead to longer and greater exposure to the chemical than would occur in an adult with the same relative exposure.500 ppm 30 minutes From Exhibit II-6 it can be seen that a dose of 3. drowsiness Dizziness. Because of the anatomical and physiological differences between animals and humans. Because several organs. Therefore. are still developing in young children. loss of inhibitions Marked dizziness. These values are an index of only one type of response and give no indication of the ability of the compound to cause nonlethal. compounds with low LD50 values are more acutely toxic than substances with higher LD50 values.

smoking. Thus. Among the key questions to consider are: l l What is the route of exposure and how can further exposure be minimized? Do the acute symptoms give clues as to the potential exposure and chronic health effects? 26 .4-10 50-230 83-560 88-91 2. personal habits (e. EMS personnel need a strong knowledge of toxicology principles to assess the degree of hazard in a hazmat incident.. exposure to concentrations of toxic compounds that would not be expected to result in the development of a toxic response in most individuals may cause an effect in susceptible individuals. Some carcinogens (cancer-causing chemicals) may produce a response (tumors) at any dose level. The presence of preexisting medical conditions (e. chronic obstructive pulmonary disease (COPD). Not all chemicals. literature values for levels which are not likely to produce an effect do not guarantee that an effect will not occur. however. and medications may also increase an individual s sensitivity to toxic chemicals. Therefore.g.Exhibit II-6 Acute LD50 Values for Representative Chemicals When Administered Orally to Rats Chemical Acute Oral LD50 (mg/kg)1 6.000 3. Some individuals. for example.600-7.. are more likely to experience adverse health effects after exposure to a toxic chemical because of a reduced ability to metabolize that compound.800 Sodium cyanide Pentachlorophenol Chlordane Lindane Toluene Tetrachloroethylene 1 Milligrams of the compound administered per kilogram body weight of the experimental animal. diet). Factors such as age. renal disease) can also increase one s susceptibility to toxic chemicals.000-3. diabetes. Respiratory distress in patients or workers with asthma may be triggered by exposure to toxic chemicals at lower levels than might be expected to produce the same effect in individuals without respiratory disease. Responses to toxic chemicals may differ among individuals because of the physiological variability that is present in the human population. and any exposure to these compounds may be associated with some risk of developing cancer. have a threshold level.g. previous exposure to toxic chemicals.

Examples of these are listed in Exhibit II-7A. a child or an adult with preexisting health problems? Can an exposure dose be estimated and will this help to estimate short. Emergency Response Planning Guidelines (ERPGs). The values listed in Exhibit II-7A were established to provide worker protection in occupational settings. only the OSHA values are regulatory limits.l Is this individual at increased risk because of greater susceptibility: for example. Short-term Public Emergency Guidance Levels (SPEGLs). TLV. Furthermore. under development by the EPA). Emergency medical personnel responsible for the management of chemically contaminated patients should be familiar with all of these exposure limits because they will be encountered in various documents dealing with patient care or the selection of PPE. Emergency medical personnel responsible for managing chemically contaminated patients are encouraged to obtain further training in their recognition and treatment. and Acute Exposure Guidelines (AEGLs. these occupational exposure limits are only useful if trained personnel with special detection equipment are available for measuring the levels of toxic chemicals at the spill site. Some of these conditions are individual susceptibility or aggravation of a preexisting condition. The ACGIH values are for guidance only and have certain caveats that may or may not affect the usefulness of the values. or ceiling concentration limits to which the worker can be exposed without adverse effects. it is difficult to interpret how these values should be used by emergency medical personnel dealing with a hazardous materials incident. These values are designed for a healthy adult working population and have limited utility when applied to some of the at risk groups previously mentioned. special exposure limits have been established. PEL. At best. This brief discussion highlights some fundamental concepts of toxicology. Because the settings in which these values are appropriate are quite different than an uncontrolled spill site. Of the occupational exposure limit values shown in Exhibit II-7A. A list of general toxicology references is provided at the end of this section that will allow emergency medical personnel to undertake a more in-depth examination of the principles of toxicology. 27 . IDLH. ceiling values. and REL values can be used as benchmarks for determining relative toxicity. Additional expertise can be obtained by taking classes offered by the ACGIH or at many colleges and universities. and perhaps to assist in selecting appropriate levels of personal protective equipment (PPE).and long-term health effects? l Exposure Limits The various occupational exposure limits found in the literature or in an MSDS are based primarily on time-weighted average limits. Because of the limitations of PELs and TLVs. have been designed to assist emergency response personnel in making decisions regarding nonworkplace exposure (Exhibit II-7B).

Exhibit II-7A Occupational Exposure Limits Value Threshold Limit Value (ACGIH)1 Abbreviation TLV Definition Refers to airborne concentrations of substances and represents conditions under which it is believed that nearly all workers may be repeatedly exposed day after day without adverse effect.or 10-hour work day. or to materially reduce work efficiency. Threshold Limit Value: Ceiling (ACGIH)1 Permissible Exposure Limit (OSHA)2 Immediately Dangerous to Life and Health (OSHA)2 TLV-C PEL IDLH Recommended Exposure Limit (NIOSH)3 REL 1 2 American Conference of Governmental Industrial Hygienists Occupational Safety and Health Administration 3 National Institute for Occupational Safety and Health 28 . expressed as a ceiling limit or time-weighted average for an 8. A maximum airborne concentration from which one could escape within 30 minutes without any escape-impairing symptoms or any irreversible health effects. The concentration that should not be exceeded during any part of the working exposure. or (3) narcosis of a sufficient degree to increase the likelihood of accidental injury. Threshold Limit Value: Time-Weighted Average (ACGIH)1 TLV-TWA Threshold Limit Value: Short-Term Exposure Limit (ACGIH)1 TLV-STEL The concentration to which workers can be exposed continuously for a short period of time without suffering from (1) irritation. Same as TLV-TWA. Highest allowable airborne concentration that is not expected to injure a worker. to impair self-rescue. to which nearly all workers may be repeatedly exposed. (2) chronic or irreversible tissue damage. and provided that the daily TLV-TWA is not exceeded. day after day. The time-weighted average concentration for a normal 8-hour work day and a 40-hour work week. without adverse effect.

or (3) life-threatening effects or death (AEGL-3). 16. including susceptible or sensitive individuals but not those who are hypersusceptible or hypersensitive.g. long-lasting effects or impaired ability to escape (AEGL-2). Synonymous with the NAS4 term.. 1. and 1. Developed for four exposure periods: 30 minutes. (2) irreversible or other serious. 4 . 4. 8. 2. Community Emergency Exposure Levels (CEELs). single. and 8 hours. Represents the airborne concentration of a substance at or above which it is predicted that the general population (as defined above) could experience (1) notable discomfort (AEGL-1). or (3) experiencing or developing life-threatening health effects (ERPG-3). Proposed short-term threshold or ceiling exposure value intended for the protection of the general public. An acceptable concentration for unpredicted. 24 hours).Exhibit II-7B General Population Exposure Limits Value Abbreviation Definition Maximum airborne concentration below which it is believed that nearly all individuals could be exposed for up to 1 hour without (1) experiencing other than mild transient adverse health effects or perceiving a clearly defined objectionable odor (ERPG-1). May be developed for different exposure periods (e. short-term exposure of the general public in emergency situations. (2) experiencing or developing irreversible or other serious health effects or symptoms that could impair an individual s ability to take protective action (ERPG-2). Emergency Response Planning Guidelines (AIHA)1 ERPG Short-term Public Emergency Guidance Level (NRC)2 SPEGL Acute Exposure Guidelines (EPA NAC/AEGL)3 AEGL 1 2 American Industrial Hygiene Association National Research Council 3 EPA National Advisory Committee/AEGL Committee 4 National Academy of Sciences 29 .

and EMS personnel. such as firefighters. and stored. and biological hazards that may be encountered at a hazardous materials incident. Excessive protection can be as hazardous as underprotection. Federal Regulations Pertaining to Use of Personal Protective Equipment (PPE) The term personal protective equipment (PPE) is used in this document to refer to both clothing and equipment. they should make arrangements with the local fire department or hazmat team to be ready. personnel should not be expected to use PPE without adequate training. Considerations in determining what an EMS s capabilities should be include the number of incidents occurring locally (several per week versus only a few per year).120)) as it applies to emergency medical personnel states: Training shall be based on the duties and functions to be performed by each responder of an emergency response organization. According to state and federal regulations. To 30 . No single combination of protective equipment and clothing is capable of protecting against all hazards. Thus. specifically respiratory equipment. however. tested. such as heat stress. may not be able to expend the funds and time necessary to provide the highest level of PPE protection for their employees. In the majority of cases. each agency must develop a health and safety program and provide for emergency response. and should be avoided. and communication. For any given situation. Many EMS agencies. and risks posed from terrorism. police officers. In cases where EMS personnel have no PPE. physical. physical and psychological stress. and impaired vision. if the situation warrants. These standards also are intended to provide particular protection for those who respond to hazardous materials incidents. PPE should be used in conjunction with other protective methods. equipment must be maintained according to OSHA specifications. Levels of Protection). given their workload and fiscal constraints. 1989. and must maintain that proficiency. mobility. The use of PPE can itself create significant worker hazards.PERSONNEL PROTECTION AND SAFETY PRINCIPLES This section provides emergency medical services personnel with information on protective equipment and safety principles. Staff must be trained initially in the proficient use of personal protective equipment (PPE). 29 CFR (1910. for example. OSHA standards mandate specific training requirements (8 hours of initial training or sufficient experience to demonstrate competency) for personnel engaged in emergency response to hazardous substances incidents at the First Responder Operations Level. EMS staff will not experience incidents involving chemically contaminated patients frequently enough to keep them optimally trained or their equipment properly maintained. In general. be prepared to work in Level C attire (see below. EMS personnel should. In addition. Training is essential before any individual attempts to use PPE. OSHA s final rule (March 6. especially those who are to be transported to a hospital. In addition. The purpose of PPE is to shield or isolate individuals from the chemical. proximity to industries or transportation routes that have the potential for a hazardous materials incident (see Section I SARA Title III). the greater the level of PPE protection. at a minimum. respirators and their cartridges have to be properly fitted. equipment and clothing should be selected that provide an adequate level of protection. The two basic objectives of any PPE program are to protect the wearer from safety and health hazards and to prevent injury to the wearer from incorrect use and/or malfunction of the PPE. to completely decontaminate patients. the greater are the associated risks.

Appendix C outlines the protective equipment recommended for each level of protection. and mucous membrane protection is needed. suit breach. skin. In addition. insufficient air supply. air-purifying. Exhibit II-8 illustrates these four levels of protection. criteria for using air-purifying respirators are met. chemical-resistant suit. hard hat. including limited visibility. (4) selection. an emergency distress signal should be identified in the briefing before individuals enter the work area. and self-contained breathing apparatus (SCBA). and the effects of heat and cold. eye. or fully. The actions of all personnel wearing PPE should be closely observed by the Safety Officer and others during each work period. dehydration. Levels of Protection EPA has designated four levels of protection to assist in determining which combinations of respiratory protection and protective clothing should be employed: Level A protection should be worn when the highest level of respiratory. Proper donning and doffing procedures must be followed. claustrophobia. disposable chemical-resistant coveralls. Level B protection should be selected when the highest level of respiratory protection is needed. It provides no respiratory protection and minimal skin protection. reduced dexterity. Medical surveillance evaluations should be conducted on all personnel both before and immediately after their use of PPE. concentration is measured. It consists of a fully-encapsulated. and skin and eye exposures are unlikely. restricted movement. It differs from Level A only in that it provides splash protection through use of chemical-resistant clothing (overalls and long-sleeved jacket. and decontamination of PPE. This involves a full facepiece. For more information on this subject. chemical-resistant boots with steel toe and shank. all personnel should be examined to ascertain marked changes in health. non-vapor-tight suit and SCBA). (3) environmental surveillance. 31 . (2) medical monitoring. Only individuals who are physically fit and have met the OSHA/NIOSH/NFPA training requirements should be wearing PPE during an incident. canister-equipped respirator and chemicalresistant clothing. but a lesser degree of skin and eye protection is required. Level D is primarily a work uniform. and (5) training. It provides the same degree of skin protection as Level B. two-piece chemical splash suit. Appropriate medical care should be initiated when illness or injury is discovered. chemical-resistant inner/outer gloves. but a lower level of respiratory protection. and it should not be worn on any site where respiratory or skin hazards exist.accomplish these goals. vapor-tight.encapsulated. Following the completion of technical decontamination. a comprehensive PPE program should include: (1) hazard identification. coveralls. with assistance from other onsite personnel. maintenance. use. Level C protection should be selected when the type of airborne substance(s) is known. Personnel not meeting prescribed inclusion criteria set by the hazmat team or by the EMS Medical Director should be reassigned to an area not requiring the use of PPE. PPE Complications Personnel wearing PPE are likely to encounter a number of potential problems.

Level A Level B Level C Level D 32 .

and are subsequently absorbed or ingested. Chemical Protective Clothing (CPC) Protective clothing is designed to prevent direct contact of a chemical contaminant with the skin or body of the user. since no one material presently provides protection against all known chemicals. and the specific task assigned to the user. Essential to any protective ensemble are chemical resistant boots with steel toe and shank. Wearing multiple layers of gloves impairs dexterity and makes performing basic aspects of patient assessment (e. Improperly used equipment can expose the wearer to danger. no one single material that will afford protection against all substances. There is. Routes of Entry PPE is designed to provide emergency medical personnel with protection from hazardous materials that can affect the body by one of three primary routes of entry: inhalation. As a result. thus limiting the transfer of heat from the body through natural evaporation. This can occur unwittingly when an individual wipes his mouth with his hand or sleeve. and a known length of exposure to a hazardous material.Exhibit II-8 Levels of Protection Factors to be considered in selecting the proper level of protection include the potential routes of entry for the chemical(s). however. Mucous membranes in the mouth. protection. but only if it is properly fitted and worn correctly. CPC is designed to afford the wearer a known degree of protection from a known type.g. and direct contact. Cooling vests are sometimes used in warm weather situations to keep the body temperature normal. become trapped or lodged in the mucus. throat. the degree of contact. Chemical resistant inner and outer layered gloves must also be worn. nose. Ingestion usually is the result of a health care provider transferring hazardous materials from his hand or clothing to his mouth. taking a pulse) difficult without constant practice. Activities can also be undertaken to determine which level of protection should be chosen. ingestion. or smokes tobacco. a known concentration. Many hazardous materials adhere to and assimilate with the moist environment provided by these membranes. The EPA and NIOSH recommend that initial entry into unknown environments or into a confined space that has not been chemically characterized be conducted wearing at least Level B. and respiratory system may be affected by more than one of these routes of entry. Respirators are designed to protect the wearer from contamination by inhalation but they must be worn properly and fit-tested frequently to ensure continued protection. Compatibility charts should be consulted to determine the appropriate type of boot and gloves to use. Research is now underway to develop lightweight suits that are breathable but still protective against a wide range of chemicals. Direct contact refers to chemical contact with the skin or eye. if not Level A.. multilayered garments may be employed in specific situations despite their negative impact on dexterity and agility. Inhalation occurs when emergency personnel breathe in chemical fumes or vapors. drinks. Skin is protected by garments. and full-face respirators protect against ingestion and direct eye contact. inner ear. This is a particularly important factor in hot environments or for strenuous tasks since such garments can increase the likelihood of heat-related injuries. 33 . checking breathing. but with mixed results. Another factor to keep in mind when selecting CPC is that most protective clothing is designed to be impermeable to moisture. eats.

Penetration occurs when there is an opening or a puncture in the protective material. Furthermore. These openings can include unsealed seams. the nature of the protective barrier in the CPC. and boot covers. equipment must be inspected and checked for serviceability on a routine basis. NIOSH has established comprehensive requirements for the certification of respiratory protection equipment. Atmospheresupplying respirators include self-contained breathing apparatus (SCBA) and supplied-air respirators (SAR). permeation. earplugs. There are two basic types of respirators: air-purifying and atmosphere-supplying. Selection of the appropriate CPC will depend on the specific chemical(s) involved. and on the specific tasks to be performed. 34 . Degradation can also result in an increased permeation rate through the garment. and zippers. Personnel must be fit-tested for use of all respirators. Emergency medical personnel must evaluate the properties of the chemical versus the properties of the protective material. In addition. buttonholes. and penetration. OSHA has set mandatory legal minimum requirements (29 CFR (1910. manufacturers suggest the types of hazards against which their respirators can offer protection. Protective clothing is available in a wide assortment of forms.134)) for respiratory protection. Often such openings are the result of faulty manufacture or problems with the inherent design of the suit. RESPIRATORY PROTECTION Substantial information is available for the correct selection. training. Permeation is the process by which chemical compounds cross the protective barrier of CPC because of passive diffusion. and the concentration of the chemical on the surface of the protective material. Anyone attempting to wear any type of respirator must be trained and drilled in its proper use. The correct respirator must be employed for the specific hazard in question. hard hats. Even a small space between the respirator and you could permit exposure to a hazardous substance(s) by allowing in contaminated air. Most CPC manufacturers provide charts on the breakthrough time the time it takes for a chemical to permeate the material of a protective suit for a wide range of chemical compounds.The effectiveness of CPC can be reduced by three actions: degradation. and use of respirators. Chemical degradation occurs when the characteristics of the material in use are altered through contact with chemical substances or aging. ranging from fully-encapsulated body suits to gloves. The rate at which a compound permeates CPC is dependent on factors such as the chemical properties of the compound. offering a range of protection against a number of chemicals. Material Safety Data Sheets (if available) often specify the type of respirator that will protect users from risks. Examples of degradation include cracking and brittleness. In addition. and other changes in the structural characteristics of the garment. CPC comes in a variety of materials.

The most commonly used APR depends on cartridges (Exhibit II-9) or canisters to purify the air by chemical reaction. The use of half-mask APRs is not generally recommended by most emergency response organizations. APRs should not be used when substances with poor warning properties are known to be involved or. when environmental levels of a substance exceed the filtration capacity of the canisters. disposables. filtration. However. Three basic types of APRs are used by emergency personnel: chemical cartridges or canisters. After use. manufacturers have color-coded the cartridges and canisters to indicate the chemical or class of chemicals for which the device is effective. Cartridges and canisters are designed for specific materials at specific concentrations. such as asbestos. These respirators are typically half-masks that cover the face from nose to chin. the entire respirator is usually discarded. adsorption. cartridges and canisters should be considered contaminated and disposed of accordingly. although some are approved for use with other contaminants. However. then the cartridge or canister must be immediately replaced. Filters may also be used in combination with cartridges and canisters to provide an individual with increased protection from particulates. In addition. Exhibit II-9 Chemical Cartridge Air-Purifying Respirator 35 . The major advantage of the APR system is the increased mobility it affords the wearer.5 percent) since it depends on ambient air to function. but do not provide eye protection. or absorption. Disposable APRs are usually designed for use with particulates.Air-Purifying Respirators (APRs) An air-purifying respirator purifies ambient air by passing it through a filtering element before inhalation. NIOSH recommends that use of a cartridge not exceed one work shift. a respirator can only be used where there is sufficient oxygen (19. Once used. if breakthrough of the contaminant occurs first. and powered air-purifiers. To aid the user. if the agent is unknown. This type of APR depends on a filter to trap particulates.

Exhibit II-10 Self-Contained Breathing Apparatus and Supplied-Air Respirators 36 . According to OSHA guidelines. Atmosphere-Supplying Respirators Atmosphere-supplying respirators consist of two basic types: the self-contained breathing apparatus (SCBA). which depends on an air supply provided through a line linked to a distant air source. men with beards can wear the hooded system but not the full facemask. Some individuals find the hooded system to be more comfortable and less claustrophobic than the mask.Powered Air-Purifying Respirators (PAPRs) have the advantage of creating an improved facemask seal. Air being blown into the mask can also have a cooling affect. and the supplied-air respirator (SAR). thus reducing the risk of inhalation injury. PAPRs come with either full facemasks or pullover hoods. which contains its own air supply. Exhibit II-10 illustrates an example of each.

and can be used for only the period of time allowed by air in the tank.120(q)(iv)) in incidents where personnel are exposed to hazardous materials.and negativepressure models. closed-circuit. there is always the potential danger that contaminants may enter the facemask if it is not properly sealed. This includes delineating work zones. only positive-pressure SARs are recommended for use at hazardous materials incidents. However. property. In addition. SARs are less bulky than the SCBAs. Open-circuit SCBAs. In this system. Closed-circuit SCBAs. and public access from all directions must be restricted promptly. rules regarding access to the site must be implemented. recycle exhaled gases and contain a small cylinder of oxygen to supplement the exhaled air of the wearer. The most common SCBA is the open-circuit. however. and the environment. for use in case of an emergency. An Incident Commander (IC) is responsible for control of the scene and for keeping contaminants on site. There are three varieties of SCBAs: open-circuit. An Incident Command System (ICS) coordinates management of facilities. a worker must retrace his steps to stay connected to the SAR.Self-Contained Breathing Apparatus (SCBA) A self-contained breathing apparatus respirator is composed of a facepiece connected by a hose to a compressed air source. SARs also require the air source to be in close proximity (within 300 feet) to the work area. also known as rebreathers. personnel. One major advantage the SAR has over the SCBA device is that it allows an individual to work for a longer period. and escape. By necessity. usually in the form of a small. personnel using an SAR must carry an immediately operable emergency escape supply of air. and communications during a hazardous materials incident. and therefore cannot leave the contaminated work area by a different exit. who exhales into the atmosphere. The use of a negative-pressure SCBA is prohibited by OSHA under 29 CFR (1910. SARs are available in both positive. One disadvantage of SCBAs is that they are bulky and heavy. establishing levels of protection. equipment. SITE CONTROL Hazardous materials incidents often attract large numbers of people and equipment. This complicates the task of minimizing risks to humans. and implementing decontamination activities. provide clean air from a cylinder to the wearer. most often used in emergency response. When wearing a negative-pressure-type apparatus. a higher air pressure is maintained inside the facepiece than outside. air is supplied to the wearer from a cylinder and enters the facepiece under positive pressure. To enhance control at the site of a chemical incident. In addition. Supplied-Air Respirators (SARs) Supplied-air respirators differ from SCBAs in that the air is supplied through a line that is connected to a source away from the contaminated area. This affords the SCBA wearer the highest level of protection against airborne contaminants since any leakage in the facepiece may force the contaminant out. Inactive individuals and equipment should be kept at a safe distance from the area of possible contamination. Escape SCBAs provide air for a limited amount of time and should only be used for emergency escapes from a dangerous situation. In contrast to the negative-pressure units. compressed air cylinder. 37 . positive-pressure type.

g. Equipment that may eventually be needed should be kept in staging areas beyond the crowd control line.. in the process. and the hospital where the patient is taken. or degradation to. Protects other patients already receiving care at the hospital. Protects the community by preventing transportation of hazardous materials from the hospital to other sites in the community by secondary contamination. their protective clothing and equipment. meaning it is free of all hazardous materials contamination. and EPA recommend dividing the incident area into three zones. OSHA. and delineating a contamination reduction corridor. contaminate themselves.. Work Zones NIOSH. bullhorns) may be restricted depending on the hazards involved. The respective radius of the Contamination Reduction (Warm) Zone is determined by the length of the decontamination corridor. Access to the different zones should be tightly controlled and limited to as few people as possible. Communication between work areas should be face-to-face whenever possible. The command post and staging areas for necessary support equipment should be located in the Support Area. establishing access control points. transport. Exhibit II-11 illustrates the recommended zones. Use of radios or other electronic devices (e. Protects workers by reducing the contamination and resultant permeation of. Decontamination is of the utmost importance because it: l Protects all hospital personnel by sharply limiting the transfer of hazardous materials from the contaminated area into clean zones. Personnel in charge of each sector should be easily recognized (e.g.In addition. All access to the incident site must be approved by the Incident Commander and the press personnel who enter the site must be escorted by a Public Information Officer. upwind and uphill of the Exclusion Zone. media access should be limited to an area established as the Public Information Sector by a designated Public Information Officer. The Exclusion (Hot) Zone should encompass all known or suspected hazardous materials contamination. Many incidents have occurred involving seemingly successful rescue. with a command vest). l l l 38 . which contains all of the needed decontamination stations. USCG. The Support (Cold) Zone should be clean. including discarded protective clothing and respiratory equipment. and treatment of chemically contaminated individuals by unsuspecting emergency personnel who. the equipment. DECONTAMINATION OF EMERGENCY MEDICAL SERVICE PERSONNEL Decontamination is the process of removing or neutralizing harmful materials that have gathered on personnel and/or equipment during the response to a chemical incident.

Exhibit II-11 NIOSH/OSHA/USCG/EPA Recommended Zones 39 .

and on the type of CPC being worn.. However. scraping. if contamination is unavoidable. gloves) and systematically removing these garments in a manner that precludes contact with the contaminants. suits. and by chemical methods where the contaminant is degraded. such as dilution. It should be stressed that to carry out proper decontamination. Physical decontamination of protective clothing and equipment (known as technical decontamination) can be achieved by several different means. There is an increasing trend toward using disposable clothing (e. and vacuuming. Patient decontamination is addressed in Section III.This section only addresses the steps necessary for dealing with worker decontamination. solidified. Avoiding contact is the easiest method of decontamination that is. boots. personnel must have received at least the same degree of training as required for workers who respond to hazardous materials incidents. Thoroughly researching the chemicals involved and their properties. not to get the material on the worker or his protective equipment in the first place. Segregation and proper placement of the outer gear in a polyethylene bag or steel drum will be necessary until thorough decontamination is completed. the residues of the decontamination process must be treated as hazardous wastes. In addition. is necessary to make these kinds of decisions. Reusable suits will require thorough cleaning and testing after each use. or disinfected through some type of chemical process. The decontamination stations and process should be confined to the Contamination Reduction Zone (see Exhibit II-11). brushing. a nine-station decontamination process need not be set up if only a bootwash station would suffice. The appropriate decontamination procedure will depend on the contaminant and its physical properties. Care must be taken at all times to ensure that the decontamination methods being used do not introduce fresh hazards into the situation. The used items of clothing are then thrown away in a sealed container. With extremely hazardous materials. 40 . neutralized. For example. it may be necessary to dispose of the contaminated items altogether. The design of the decontamination process should take into account the degree of hazard and should be appropriate for the situation. Steps for personnel decontamination are outlined in Exhibit II-12. and the technical decontamination process is discussed below. These all include the systematic removal of contaminants by physical methods. In addition to understanding the technical decontamination steps to be used for CPC and equipment. or consultation with an expert. EMS responders must be familiar with the emergency procedures to be followed if a responder wearing PPE becomes ill or is injured and needs to be quickly decontaminated prior to normal removal of his suit. then proper decontamination and/or disposal of the worker s outer gear will be necessary.g. Response and Patient Management.

Exhibit II-12 Nine-Step Personnel Decontamination Plan 41 .

turning them inside out as they are removed. PA systems. Double-bag all clothing and label bags appropriately. or designated hand signals may be useful alternatives. the Health Department. one person should be assigned to manage communications. 4. and CHEMTREC. Other networks that may have to be activated include one linking EMTs to the hospital emergency department or medical control and one dedicated for use by the teams in the Exclusion and Contamination Reduction Zones. remove undergarments and place them in a plastic bag. COMMUNICATIONS Effective communications are essential to maintaining incident control. Place the masks in plastic bag and hand the bag over the clean line for placement in second bag held by another staff member. Remove mask.Technical Decontamination Process for EMS Personnel Personnel should remove protective clothing in the following sequence. then line of sight must be maintained at all times for personnel in those Zones. Handbook of Common Poisonings in Children. Secure the dirty area until the level of contamination is established and the area is properly cleaned. Remove other boot/shoe cover and put that foot over the clean line. turning it inside out and folding it downward. 1988. Remove outer gloves. Remove inner gloves and discard them in a drum inside the dirty area. Remove suit. 9. 5. 3. 42 . 2. The last person removing his/her mask may want to wash all masks with soapy water before removing his/her suit and gloves. 1994. If a sufficient number of radios are not available or cannot be used in the Exclusion Zone. 6. Send bag for decontamination. Cincinnati. Remove tape (if used) securing gloves and boots to suit. Elk Grove Village. such as the regional Poison Control Center. Personnel should shower and redress in normal working attire and then report for medical surveillance. IL. 1. Avoid shaking. 8. Use of whiteboards. Guidelines for the Selection of Chemical Protective Clothing. Another network should link the onsite command post to support groups. American Academy of Pediatrics. SELECTED BIBLIOGRAPHY American Conference of Governmental Industrial Hygienists. Remove boot/shoe cover from one foot and step over the clean line. Personnel should then move to a shower area. OH. These include a dedicated radio frequency and a sufficient number of radios for distribution to all participating agencies. 3rd ed. When an Incident Command System is activated. 7.

G. NJ: Prentice Hall. Boston. Emergency Management of Hazardous Materials Incidents. 1993. Hazardous Materials Exposure-Emergency Response and Patient Care. New York. 1991. 1994. M.F. 1994. Bronstein. Chemicals. 1999. CT: Appleton and Lange. NY: John Wiley and Sons.C. Bronstein. MO: Mosby.D. Porter. NY: Van Nostrand Reinhold. MD: National Audio-Visual Center.G. 1999. Heckelman and J. 1996. Hazardous Materials for EMS. P..D. 2nd ed. 4th ed. Emmitsburg. and J. P. Kinneary. and S. St. Recognizing and Identifying Hazardous Materials. Barceloux. MO: Mosby. 5th ed. Clayton. NJ: Brady. Callan. C. National Emergency Training Center. R. New York. 1987. Books on Demand.C.).A. Levine.C. Guidelines for Public Sector Hazardous Materials Training. Chemical Manufacturers Association (CMA) and the Association of American Railroads.O. Amdur. NY: Elsevier. J. and D. K. 1996. 1993. A Textbook of Modern Toxicology. Quincy. 1995. E. (ed..Borak. M. Forsberg. Lu. DC: CMA. Stamford. Abbott. Ellenhorn. Protecting Personnel at Hazardous Waste Sites. Washington. 6th ed. Clayton. E. and R. Louis. Terms for Personal Protective Equipment. and A. A.W. 1985.E. Emergency Care for Hazardous Materials Exposure. Englewood Cliffs. and P. Currance. MA: National Fire Protection Association. A. Budavari. and W. 2nd ed..P. Stamford.J. Weapons of Mass Destruction Emergency Care. 1997. M. Target Organs. Goldfrank s Toxicological Emergencies.S. and P. L. S.Z. S. DeLorenzo. 12th ed. A.E. and Risk Assessment. 2nd ed. McGraw-Hill Health Professions Division. National Fire Academy and National Emergency Training Center.L. CT: Appleton and Lange. Goldfrank.). and W. 1996. Medical Toxicology: Diagnosis and Treatment of Human Poisoning. Klaassen. Basic Toxicology: Fundamentals. 43 . 1998. Louis. and Biologicals.R. Principles and Methods of Toxicology. 2nd ed. MA: Butterworth Publishers. J.L. 2nd ed. Casarett and Doull s Toxicology: The Basic Science of Poisons. 3th ed. Capitol Heights. Taylor & Francis. Inc. Levi. F. Currance. 2nd ed.New York.). 1998. 1997. Martin (eds. Chapman & Hall. 1994. The Merck Index: An Encyclopedia of Drugs. and F. MD: HMEP Curriculum Guidelines. Bowen. Hodgson. Hayes. Patty s Industrial Hygiene and Toxicology. Mansdorf. Quick Selection Guide to Chemical Protective Clothing. St. Doull (eds. Smith.

U. Ulin. 1999. 3rd ed. Sax.R. USAMRICD Chemical Casualty Division. 1993. 1989. (ed. and J. Region VII. Hazardous Materials Handbook for Emergency Responders. U. Miramar. Guidelines for the Selection of Chemical Protective Clothing.R. National Fire Protection Association. 1997.I.G.. 3rd ed. U. 1992. Chemical Hazards of the Workplace. Recommended Practice for Responding to Hazardous Materials Incidents. K. Handbook of Medical Toxicology. 1993. J. Hazardous Materials Response Handbook. Noll. 1992. W. MD: Williams & Wilkins. HAZTOX EMS Response For Hazardous Materials Incidents.S. A. 2nd ed. NY: Van Nostrand Reinhold. Hazardous Materials Guide for First Responders. NFPA 471. Varla. MA: National Fire Protection Association. (ed. Ulin. Hazardous Materials: Managing the Incident.National Fire Protection Association.L. 2nd ed. Stillwater. MD: Bradford. Stutz. FL: GDS Communications.D.S. and D. G. 8th ed.S. MA: National Fire Protection Association. 1992.). Quincy. 1992. 1999. Edgewood. New York. New York. Sullivan. J. Jr. 1998. 1995. 1987. Fire Administration. and S.H.). 1993. Olson. DC: Environmental Protection Agency. Baltimore. Proctor. OK: Fire Protection Publications. and S. NY: Van Nostrand Reinhold. G. Quincy. Rom. 44 . Brown. and G. P. Weitzman.B. 1989.. P. N. Environmental and Occupational Medicine. Viccellio. R. J. 2nd ed. Boston.G. MA: Little. Poisoning and Drug Overdose.. New York.S. Environmental Protection Agency. Costas. DC: Government Printing Office. Jackson. Washington. Hazardous Materials Toxicology: Clinical Principles of Environmental Health. N. OH: American Conference of Governmental Industrial Hygienists. Chemical Response Planning and Operations.. J. MA: National Fire Protection Association. Federal Emergency Management Agency and U.O. Krieger. Hildebrand. Boston: Little Brown.J.S. Quincy. Army. Handbook for Prehospital Care. Stutz. Standards for Professional Competence of EMS Responders to Hazardous Materials Incidents. U. 3rd ed. R. and M. CT: Appleton and Lange. Fishman. NY: Van Nostrand Reinhold. Dangerous Properties of Industrial Materials.S.P. Stamford. M. Medical Response to Chemical Warfare and Terrorism.R. NFPA 473. Beltsville. 1996. Schwope. Hughes. (ed. 1992. Washington. 2nd ed. Tokle. Department of Defense.). Yvonna. Cincinnati. MD. 3rd ed.

or radioactive materials. eye irritation) or the address might suggest that the call may involve a chemical release. EMS personnel should know their responsibilities and how to perform them. EN ROUTE TO A HAZARDOUS MATERIALS SCENE First responders must be alert for hazardous materials when responding to every call. and (3) patient transport to the hospital. yet the appropriate signage is often missing. sensory signals. Therefore. particularly the sense of smell. must be determined immediately before first responders enter a chemically contaminated area. Steps in the protocol must be practiced before a hazardous materials emergency occurs. or in urban areas places such as courtyards or near tall buildings. For example.Section III. or lack thereof. and treatment of affected persons. however. often indicate the presence of hazardous materials. If a vehicle has a diamond-shaped placard or an orange-numbered panel on the side or rear. may contain vapor clouds protected from dispersal by the wind. as in the case of noxious fumes. or death. Accidents involving railroad tank cars or tanker trucks. Their presence depends on the chemical(s) involved and on the surrounding conditions. are not always reliable indicators. the cargo should be assumed to be hazardous. the responder should pay attention to clues that suggest the possibility of hazardous materials. and nasal or eye irritation. gasoline. The dispatcher may provide information such as unusual signs and symptoms (e. (2) guidelines for assessment. not all hazardous materials transport vehicles are clearly marked. responders are advised to move a safe distance away until they ascertain its source. The nature of an incident is also key to identifying the possibility of hazardous materials. first responders should use caution when attempting rescues at any incident scene. Unfortunately. The senses are among the best tools for detecting chemicals. Response and Patient Management An EMS protocol for responding to potential hazardous materials incidents should consider: (1) activities to undertake en route and upon arrival at the scene. In other situations. pungent odor. Emergency responders should pay attention to factors such as wind direction and topography when approaching a suspected hazardous materials incident and advance upwind and upgrade of suspected chemical emissions. Should an odor be detected. and all required equipment should be readily accessible and ready to use. The hazard. illness. or corrosive liquid spills. billowing smoke or clouds of vapor could indicate the presence of a dangerous substance(s). or incidents at fixed locations where chemicals are used or stored. as with odorless but poisonous and/or flammable vapors and liquids. Many delivery trucks regularly carry hazardous materials that could be released in a collision. The presence of hazardous materials may be obvious. color.. Failure to do so could result in injury.g. the hazardous nature of the chemical(s) may not be immediately apparent. decontamination. They also need to consider that low-lying areas such as streambeds and gulleys. 45 . Despite their value. While in transit to an incident scene. such as smell.

the Incident Commander (IC) will identify the best approach route. If an Incident Command System (ICS) has been implemented. (5) the need for decontamination. dermal contact. if one has been established. If a hazardous substance has been identified. and property from exposure to contaminants or other dangers such as fire or explosion.. MSDSs. Communications with other agencies or services should also be initiated while en route to the event site. (4) required PPE. including: (1) the nature of possible injuries. (3) risk of secondary contamination.g. preplans should be reviewed to assist with locating proper vehicle staging locations. in addition to the designated resource center (see Section I Hazard Recognition). liquid. (6) decontamination procedures. (2) potential routes of exposure. regional Poison Control Center. database networks. Communications between onsite response personnel and receiving facilities should be kept open to relay as much advance information as possible. the possible dangers involved. telephone hotlines. gas) Routes of exposure (inhalation. and (7) the appropriate safe distance from the hazard to protect EMS personnel. 46 . A checklist to help determine initial actions should be developed and made available to all EMS personnel. websites. If available. and patient treatment centers. Chemical-specific information can help identify possible health hazards. etc. It should include: l l l l l l l l l l Type and nature of incident Caller s telephone number Knowledge of whether a chemical(s) may be involved Chemical and trade name(s) of substance(s) involved Number and ages of victims Signs and symptoms being experienced by the patients Nature of injuries State of the material (solid. if appropriate. and with the hazmat response team.Responders should attempt to gather as much information as possible while traveling to an incident. responders should locate specific information on the chemical(s) by consulting reference guidebooks. This information may also be available from a command post. Communications should also be established with local fire and police departments. and the DOT s North American Emergency Response Guidebook. and the estimated number of injuries. emergency responders should relay their observations to a predesignated resource center (e. the public. ATSDR) for information regarding definitive care procedures. evacuation routes.) Length of exposure Using as much information as can be gleaned en route.

. containers. and by reporting anything suspicious. use of a PA system to give instructions). Exhibit III-1 illustrates a typical decision tree for making choices about risk and response. or hazardous materials response team personnel. Unless otherwise directed.g. Onsite assistance should include police. The top priority for first responders is scene isolation. or people to the command post. often these types of decisions are. a rescuer entering a contaminated area also risks exposure and the potential to become another victim. the fire-rescue squad. and pointing away from any incident where hazardous materials are suspected. Rescue should only be attempted by trained and equipped EMS. First responders should immediately establish an Exclusion (Hot) Zone. police officers. l l l l l l The first units to arrive at a large industrial or storage facility. it should only be attempted without undue risk to the responder(s). In such cases. often disregarding the possibility of danger to themselves. if necessary. Keep others away! Keep unnecessary equipment from becoming contaminated by giving exact information on safe routes of arrival and vehicle staging locations. a judgment call. and puddles. The Exclusion Zone should encompass all contaminated 47 . transportation accident. including smoke. and the local industry response team(s). While training and experience are valuable in these situations. Do not attempt to recover shipping papers or manifests unless adequately protected.ARRIVAL AT THE SCENE Many first responders (e. General guidelines for responders include: l Do not drive or walk through any spilled or released materials. or a mass gathering location should anticipate a rush by evacuating victims.. fire department. taking care not to become exposed during the process (see Exhibit II-11). A first-in responder should also confirm that local authorities have been notified and are aware that hazardous materials might be involved. Avoid exposure while approaching a scene. Even though rescue of an injured patient is important. fire. EMS personnel) are accustomed to immediately attending an injured victim. the hazmat response team(s). upgrade. Do not attempt rescue unless trained and equipped with appropriate PPE for the situation. Safe distances for specific chemicals may be determined from the DOT s North American Emergency Response Guidebook. an initial assessment of the nature and extent of the incident should be conducted and additional support requested. Proper steps must be taken to keep responders from becoming contaminated or otherwise harmed (e. responders should park at a safe distance that is upwind. or by consulting CHEMTREC or other written or electronic references. vapors. Report all suspicious packages. with the presence of secondary devices intended to injure emergency personnel. Upon arrival at a scene. Responders must also remain alert to the possibility that the incident is the result of an intentional criminal act. and health departments.g. Do not approach anyone coming from contaminated areas. Avoid unnecessary contamination of equipment. at best.

Exhibit III-1 Sample EMS Decision Tree for Chemical Incidents Chemical Accident/ Injury Event YES Contaminants Potentially Life Threatening or Unknown YES Self.. rinse patient from head to toe with water). rinse patient from head to toe with water)1 Simultaneously perform gross decontamination (e.IV..or buddy-rescue OR Fire dept. avoid causing the patient to sweat. remove/ bag clothing. medications) NO Place patient in Contamination Reduction (Warm) Zone Perform secondary decontamination (wash and rinse until patient is as clean as possible (ACAP 2 ) Ensure that transport crew(s) and vehicle(s) are adequately protected to avoid secondary contamination Lifesaving Procedures Required? Further medical attention or surveillance required NO YES Notify and transport to appropriate medical facility NO Notify incident command and get further instructions 1 2 No patient should be transported without a minimum of gross decontamination performed.g. continue needed medical care (e. Contamination reduced to a level that is no longer a threat to patient or responder (once achieved.g.1 initiate stabilization of ABCs Patient(s) moved to safe area out of the hazardous environment and evaluated by emergency personnel wearing appropriate PPE Environmental or patient conditions prevent furthur decontamination YES Cover or wrap patient to prevent spread of contamination. or hazmat rescue NO Perform gross decontamination (remove/bag clothing. O 2 . 48 . move patient to the Support [Cold] Zone).

AND INITIAL TREATMENT OF PATIENTS The primary goals for emergency personnel in a hazardous materials incident include cessation of patient exposure. bullhorn. Rehabilitation Officer. fire. siren PA system) can be effective for directing ambulatory patients on what to do and where to go. Communications). containment of the hazard to prevent further contamination. this may be the primary responsibility of the Incident Commander (IC) or of responders other than EMS. requiring assessment and possible decontamination. The IC should coordinate patient evacuation and emergency care activities. Anyone leaving the Exclusion Zone should be considered contaminated.g. or Public Information Officer. as well as the mobility restrictions inherent in PPE. DECONTAMINATION. ASSESSMENT. until the risk is known. If the victim is removed from the possibility of additional exposure or other dangers and is no longer considered contaminated. termination of exposure is best accomplished by removing the patient from the incident area and then decontaminating the patient. Depending upon available personnel. or explosion. The essential requirements for any decontamination task are: l l l l l A safe area to keep a patient while undergoing decontamination A method for washing contaminants off a patient A means of containing the rinsate Adequate protection for personnel treating the patient Disposable or cleanable medical equipment to treat the patient 49 . The potential for injury to the patient or to response personnel prohibits any treatment other than basic life support inside the Exclusion Zone. including a Contamination Reduction (Warm) Zone and a Support (Cold) Zone. should be delineated at the first available opportunity. EMS Section Officer (e. EMS responders who are not properly trained and equipped should stay out of the Exclusion and Contamination Reduction Zones. and no unauthorized personnel should be allowed to enter that Zone..areas. this does not provide maximum skin or respiratory protection. and patient treatment all without jeopardizing their own safety. the level of required PPE for emergency personnel can be downgraded to a level that will better facilitate patient care. A public address system (e. While it is recommended that all EMS personnel be trained and equipped to work (at a minimum) in Level C PPE protective attire (see Section II). In addition to providing patient care in the Support Zone. Do not remove nonambulatory patients from the Exclusion Zone unless properly trained personnel with the appropriate PPE are available and a decontamination corridor has been established.. Entry into a Hot or Warm Zone requires a determination that the level of PPE being worn affords adequate protection. Triage. removal of the patient from danger. qualified EMS personnel may be asked to assume any of the following roles: Safety Officer. Treatment. Additional zones. Transportation. outweigh the benefits of time saved by patient care in the Hot Zone. While not all chemicals pose a hazard for secondary contamination. The dangers of hazardous substances.g. patient stabilization. EMS personnel also frequently provide medical surveillance for the hazmat team.

Any obvious contamination should be brushed or wiped off. care should be exercised not to recontaminate them. Priority should be given to the fundamentals of emergency treatment airway. sealed. Once life-threatening matters have been addressed. mucous membranes. Care should be taken to protect any open wounds from contamination by covering them with a waterrepellent dressing (e. with initial attention paid to contaminated eyes and open wounds. rescue personnel can direct their attention to more thorough decontamination and secondary patient assessment.Gross Patient Decontamination Primary assessment can be undertaken while simultaneously performing gross decontamination in the outer edge of the Exclusion Zone or in the Contamination Reduction Zone. gross decontamination should be performed simultaneously with initial patient stabilization. and labeled. supplies. or eyes. it may be necessary to flush exposed skin and eyes with water or normal saline for a minimum of 15 minutes. and circulation (ABCs). Exhibit III-2 outlines the minimum equipment that is required for patient decontamination by emergency response personnel. a longer rinsing period and a greater volume of water is required. Appropriate personal protective equipment and clothing must be worn until the threat of secondary exposure no longer exists. 50 . such as strong alkaline substances. The sooner the patient is decontaminated. a more deliberate decontamination process known as secondary or definitive decontamination should be initiated on each patient before transfer into the Support Zone. These lists are not comprehensive. If there is a risk of secondary contamination. Detection monitors (to indicate how clean an area is) have limited value and are not generally available to most fire departments or EMS agencies. This can be aided by covering the wounds with a waterproof dressing.. All removed items should be doubled-bagged in plastic bags. Determining the adequacy of decontamination can be very difficult. This consists of cutting away or otherwise removing all potentially contaminated clothing. followed by a 1-minute-long rinsing from head to toe with tepid water. If the suspected chemical is water-reactive. When a patient cannot be definitively decontaminated. Therefore.g. the sooner he or she can be transferred to the Support Zone for further evaluation and treatment. then he or she should be loosely wrapped in a cocoon-like fashion with a blanket or sheet prior to transfer to the Support Zone. For some chemicals. breathing. This process includes washing the individual. in an organized and thorough manner. usually with soap and water. and are provided to guide departments in developing their own equipment lists based on community needs and requirements. With few exceptions. intact skin is more resistant to hazardous materials than injured flesh. Chux). Initiating this step implies that contamination has been reduced to a level that is no longer a threat to the patient or to the responder. secondary decontamination should begin at the head and proceed downward. Once wounds have been cleaned. including jewelry and watches. water. Throughout these procedures. weather). If conditions permit (appropriate personnel. every effort should be made by emergency personnel to avoid contact with any potentially hazardous substance(s). however. and is often based on a best clinical judgment rather than on objective data. Secondary or Definitive Decontamination Effective decontamination consists of making the patient As Clean As Possible (ACAP).

. men and women should be provided separate treatment areas. In such cases. and vigorous scrubbing should seldom be used because they cause vasodilation. Responders should try to contain all run-off from decontamination procedures for proper disposal. In addition. PPE used by decontamination personnel should be no less than one level below that used for entry into the hazardous environment. The backboard and collar 51 . . and increased entry of toxicants through the skin. buttocks. axilla.Exhibit III-2 Suggested Decontamination Equipment The equipment and supplies listed are the minimum necessary to undertake decontamination procedures. stiff brushes. it may be necessary to provide instructions in multiple languages. to assure that patients understand the problem and follow instructions. hair. Careful attention must be paid to cleaning the back. zip-front body suits or large water repellant blankets to minimize contamination to transport personnel and ambulances Tape (duct. and genitalia. preferably using a prerecorded message. Patient compliance with clothing removal and decontamination instructions will likely be influenced by their perception of the threat to their life and health. Hot water. abrasion. l l Towels and blankets Disposable clothes and shoes for ambulatory patients Large plastic bags for contaminated clothing with predetermined unique ID tags to go on the bag and patient wrist/neck Small plastic bags for patients valuables (clear freezer bags are preferable) Tags and waterproof pens to mark bags Clear. Positive-pressure self-contained breathing apparatus (SCBA) and fully-encapsulated suits may be necessary in extreme cases. The skin of young children is particularly sensitive and should be treated accordingly. soft bristle brushes or sponges. and a mild soap. l Containment equipment . Whenever possible. Decontamination of nonambulatory patients is more difficult and labor-intensive. 4-inch) Triage tags Pool or tank Tarps l 6-mil construction plastic l l l l l l l l Fiberglass backboards Supports for ambulatory patients Sawhorses to support backboards Water supply Scissors for clothing removal Mild detergent (dishwashing liquid) Five-gallon buckets Sponges and soft brushes l l l l l Washing should be done using warm water. Allowing ambulatory patients to decontaminate themselves under supervision may accelerate the process and reduce the need for response personnel. such as dishwashing liquid. as well as by the clarity and authoritative nature of the instructions given.

Mass Population Decontamination Certain hazmat incidents result in large numbers of patients being exposed (or believing they were exposed) to a chemical agent.. are highly poisonous. and then given definitive decontamination at the hospital or other heated location. such as carbon monoxide or arsine. Most toxic gases. Even many chemicals that have the potential for spreading contamination can be rendered less hazardous by clothing removal and simple dilution of contaminants with copious amounts of water. a plain 52 . patients should be given towels. but once the victim has been brought out of the exposure area and into the fresh air. PPE may be frightening to a young child. even though highly toxic. Constant reassurance and compassion will be especially important if a child is separated from his or her parent(s). If a patient is seriously ill. In this situation. carry no intrinsic risk for contamination to others. the amount of leftover gas in and around the patient is unlikely to poison others. Once through the decontamination steps. especially when the patient s clothes are removed.g. invasive procedures (e. and transport to the hospital. Large volumes of water from charged hose lines. intubation) should not be initiated in the Contamination Reduction Zone unless absolutely necessary. and specially-mounted nozzles or deluge guns on fire engines. Increased susceptibility to hypothermia is an important consideration in determining to what degree a child is decontaminated in the field as opposed to being grossly decontaminated. Some fire departments or hazmat teams use portable trailers and/or aerial ladder trucks with special spray systems containing both soap and water (or bleach and water) to provide gross and/or secondary decontamination for large-scale efforts. Many chemical substances. temporary clothing (e. All potentially contaminated patient clothing and belongings that have been removed and bagged should remain in the decontamination area. morbidity. while likely to be more compliant with instructions and self-sufficient during the decontamination process. Gaining quick control of the escaping crowd and initiating immediate decontamination procedures (if indicated) is essential to minimize secondary contamination. or to quickly expand the decontamination system to clean more patients simultaneously. either at the scene or at the hospital.g.along with any other medical equipment used to transport the patient must either be decontaminated or exchanged prior to the individual entering the Support Zone. Efforts at reuniting parent and child should be made as early as is safely possible. Whenever possible. While protective to the wearer. Pediatric Decontamination Considerations The complexity of managing a hazardous materials incident is increased when children are involved. They should not be transported with the patient in the ambulance unless approved by the Decontamination Officer or Safety Officer. ventilation support and the administration of medicines may be required while he or she is undergoing decontamination. can be used to quickly rinse large numbers of individuals.. wrapped in a blanket for transport. Older children. may nevertheless be more susceptible to mass hysteria if not properly informed and reassured. However. medical treatment. mortality and panic. responding personnel will find it necessary to implement proper triage to prioritize patients entry through the decontamination process. resulting in less cooperation and greater psychological trauma. children and parents (or other adults known to them) should remain together while undergoing decontamination.

. l l l Properly label the bags that contain clothing or other potentially contaminated articles Consult with proper officials (e. .. contain all runoff from decontamination procedures for proper disposal. .g. . Safety Officer. Ensure that all potentially contaminated patient clothing and belongings have been bagged and tagged: .Decontamination l l l Make sure all clothing is removed. water Decontaminate exposed wounds and eyes before intact skin areas Cover wounds with a waterproof dressing after decontamination Take care not to introduce contaminants into open wounds Remember the back. . or as far as the situation or their clinical condition allows. Isolate the patient from the environment by wrapping in blanket/sheet to prevent the spread of any remaining contaminants. Decontaminate systematically from the head down with water: . Water-wash contaminated area gently under a stream of water. Hazmat Officer) regarding disposition of bags containing patient valuables 53 . . . never hot. l Remove contaminants to the level that they are no longer a threat to the patient or response personnel. If possible. Brush or vacuum particulate matter off of skin. and scrub with a soft brush or surgical sponge along with soap Limit mechanical or chemical irritation of the skin by overzealous scrubbing or forceful water flow Use warm. under skin folds and genitalia Watch for any changes in the patient s condition .

CONSIDERATIONS FOR PATIENT TREATMENT In most aspects. If spinal immobilization appears necessary. proper triage procedures should be implemented using local emergency response plans (see Section I SARA Title III). wheelchairbound). Primary surveys should be accomplished simultaneously with decontamination. In multiple patient situations. caring for physically impaired patients (e. Mass decontamination planning should also address issues such as non-Englishspeaking patients. nonambulatory. a contaminated patient is like any other patient except that responders must protect themselves and others from dangers due to secondary contamination. if indicated. Bear in mind the chemical-specific information received from the designated poison control or medical control center. Response personnel must first address life-threatening issues and gross decontamination before taking supportive measures. and gloves). Delay prophylactic measures until the patient is decontaminated. l l l l l l 54 . Complete primary and secondary surveys as conditions allow. In treating patients. blind. and then directed to the Treatment Sector for evaluation.g. Perform invasive procedures only in uncontaminated areas. booties. and a blanket. Administer antidotes and dosages per local protocol. Reassess the patient frequently because many chemicals have latent physiological effects. Treat for spinal injury.. begin proper triage procedures. In multiple patient situations. and secondary surveys completed as conditions allow. it should be initiated as soon as feasible. and large numbers of worried but well victims. personnel should consider the chemical-specific information received from the Poison Control Center and other information resources.Tyvek suit with hood. Patient Treatment l l Assign highest priorities to ABCs and decontamination.

most cases can be handled with symptomatic care. Oxygen should be given using a bag valve mask with reservoir device (rebreather) or with a manually triggered oxygen-powered breathing device. Emergency personnel must have a thorough understanding and familiarity with authorized antidotes since they can have significant side effects. Oxygen bottles and regulators should be encapsulated in plastic to facilitate decontamination. Caution must also be exercised when dealing with patients who are vomiting. and every effort should be made to avoid mixing contaminated air with the oxygen. Exhibit III-3 Antidotes and Select Pharmacologic Treatment Agents Antidote Atropine1 Pralidoxime chloride (2-PAM Chloride)1 Cyanide antidote kit Methylene blue 1% Activated charcoal Calcium gluconate (Gel and IV) Oxygen Toxicant Organophosphate pesticides and nerve agents Organophosphate pesticides and nerve agents Cyanide Methemoglobinema Certain ingested substances Hydrofluoric acid and fluoride toxicity Carbon monoxide 1 Can be found combined in auto-injection kit known as Mark I. should be performed only in fully decontaminated areas and where conditions permit because they may create a direct route for introducing hazardous material(s) into the patient. off-gassing of a product or absorption through the skin or mucous membranes can occur from the emesis in some cases. While some contaminated patients may require treatment with antidotes. Medication dosing for children must be carefully checked because they are most often administered on a mg/kg basis. antidote availability. Antidote administration should be based on patient condition. such as intravenous injections or intubation. and therapeutic and toxic levels can be very close. 55 .The patient should undergo frequent reassessments because many hazardous materials have latent physiological effects. prophylactic invasive procedures. Unless required by life-threatening conditions. and proximity to the hospital. Exhibit III-3 lists frequently used antidotes and selected other pharmacologic treatment agents.

Unnecessary equipment should be stored in a safe location or removed. should be recorded before leaving the scene. Control and proper disposal of the run-off is necessary to avoid injury to the patient and prehospital caregiver(s). If secondary decontamination cannot be performed prior to transport. Consideration should also be given to chemicals that present the added danger of accelerated skin absorption due to heat. as appropriate. Exposed surfaces that the patient is likely to contact should be protected by disposable sheeting. and any other data available. open windows) that weather conditions permit to the patient s and driver s compartments.. Verbal reassurances and other forms of psychological support will also be important to minimize further fear and anxiety. Oxygen should be administered by rebreather mask for any victim with respiratory problems unless contraindicated (e. Seizures may occur and should be treated according to local protocol. undergone gross decontamination.g. In the case of acid and alkaline burns to the eyes. regardless of the presence or absence of odors. During transport.. If a wooden backboard is used.. at a minimum. Personnel should also be alert for any signs of respiratory distress. 56 . and further contact with contaminants should be avoided. and irrigation should be continued en route to the hospital. Eyes that have been exposed should be irrigated with available saline or water. Contact the receiving hospital and provide an update on treatment provided or required and any other pertinent clinical information. they should be continuously irrigated en route to the hospital. responders should attempt to prevent the spread of contamination by wrapping the patient loosely but completely in a large blanket or sheet.e. ambulance personnel should use appropriate respiratory protection. it should be wrapped in a disposable cover or it may have to be discarded. The patient should be as clean as reasonably possible before transport. end-stage chronic obstructive pulmonary disease (COPD)). Items should be added or deleted based on local needs and experience. The name(s) of the involved chemicals.g.PATIENT TRANSPORT TO THE HOSPITAL When transporting a contaminated patient (i. Facilities receiving a potential hazardous materials patient will need as much information as possible. The use of both chemically resistant backboards and disposable sheeting are highly recommended. as soon as possible. Exhibit III-4 outlines suggested equipment for the care and transport of contaminated patients. if identified. No patient should be transported who has not. special care should be exercised to prevent contamination of the vehicle and subsequent patients. Protective clothing should be worn by response personnel. Various types and degrees of burns may be seen and should be treated per local burn protocol or Burn Center instructions. or gastrointestinal complaints. only gross decontamination performed) by ambulance. Provide the maximum fresh air ventilation (e. Instructions for the procedure to enter the hospital with a contaminated patient should also be requested. cardiovascular collapse. Body bags are not recommended for encapsulating patients for physiological and mental health reasons. Patients experiencing pain as a result of their injuries should be treated per medical control or agency protocol. equipment that does come in contact with the patient should be segregated for decontamination or disposal.

. . mist and fumes. . NOTE: The protective equipment listed is to be used for patient care situations after initial decontamination. selection of protective equipment must be done by a qualified individual. Must not be used without prior training and fit testing. Cover floor of ambulance Cover squad seat Cover litter l Disposable sheet(s) l Plastic trash bags to contain contaminated medical supply waste. This may include positive-pressure SCBA and fully encapsulated suits. CPC disposable suits with built-in hoods and booty/boot covers Positive-pressure SCBA2 Full-facemask respirator with an orange. highly toxic dust. Under no circumstances should this equipment be relied upon for entry into hazardous environments. stability is important. Consequently. .and purple-type cartridge (acid gas.Exhibit III-4 Supplies Needed to Prepare the Ambulance for Care of a Patient Contaminated with Hazardous Materials l Sufficient 6-mil construction plastic1 cut to size to: . Protective equipment for entry must be appropriate to and compatible with the products involved. . if necessary . . 1 2 Wet plastic is slippery. 57 . organic vapor. HEPA cartridge)2 Polyvinyl chloride (PVC) or duct tape for taping closures Two-piece rainwear Rubber boots with steel toes Nitrile gloves with 14-inch cuffs Duct tape to seal suit seams. Many factors must be taken into consideration when determining the appropriate level of protection. and radionuclides-rated. . gloves and the victim s clothes. . It is meant to be used when complete decontamination of the patients cannot be guaranteed or when assisting with decontamination procedures (in extreme cases positive-pressure SCBA and encapsulated suites may be required for decontamination procedures). It is not meant to be used in rescue operations of victims found in a hazardous area. and vomitus l Personal Protection: .

To protect hospital staff and other patients. thereby limiting exposure to hospital facilities. Inquiries should be made at the hospital to determine where the ambulance can be safely decontaminated.A radio report checklist should be developed and made available for all vehicles and telephone or radio communication centers. then the vehicle s interior will also be clean. if the patient is clean.g. the victim should not be brought into the emergency department before ambulance personnel receive permission from the hospital staff.. The method of decontamination should be based on the chemical(s) involved and the extent of patient decontamination prior to transport. the use of disposable equipment is recommended. Upon release of the patient to the hospital. 58 . The ambulance should not go back into service until it is determined to be safe by an appropriately trained individual (e. This information will aid in initiating appropriate actions: l l l l l l l l Type and nature of incident Number and ages of patients Signs and symptoms being experienced by the patients Nature of injuries Name of chemical(s) involved. This again emphasizes the benefits of thorough patient decontamination prior to transport. any nondisposable equipment that is believed to be contaminated should be double-bagged. and whether equipment is available for this purpose. including the MSDSs Extent of patient decontamination in the field Estimated time of arrival The ambulance should park in an area away from the emergency room or go directly to a predesignated decontamination location. a hazmat team coordinator). including trade names Information available at the site concerning the chemical(s). In most cases soap and water are adequate for vehicle decontamination. Whenever possible. Contaminated articles should be kept sealed until the Incident Commander or his designee gives further instructions.

Decontaminate exposed emergency personnel. After unloading the patient. Continue to irrigate eyes as needed with normal saline or water. Before leaving the scene. Have open bag ready in case of vomiting and carefully isolate vomitus since off-gassing can occur. write down the name of the involved chemical(s) and any other available data. Obtain instructions on approaching and entering the hospital. provide protection to the vehicle. MSDS. Contact the receiving hospital ASAP. Park the ambulance in a location away from the emergency department or go directly to a predesignated decontamination area. Provide fresh air ventilation to the patient s and the driver s compartments. l l l l l l l l l l l l 59 . administer oxygen by mask for any patient with respiratory problems (except as contraindicated). identify the chemical. Be alert for any respiratory distress. provide information on the patient and treatment rendered. Do not bring patients into the emergency department before receiving permission from the hospital staff. and any other pertinent information. wear protective clothing as appropriate. check with the hospital to determine where the ambulance can be safely decontaminated. its toxicology. Avoid contact with contaminants.Transport to the Hospital l l Get patient as clean as possible prior to transport. and the availability of equipment for this purpose. Provide other patient care according to condition and local protocol.

Acute stress reactions recognized during and after the incident should be immediately addressed by qualified peer debriefers or other mental health professionals. stress debriefing sessions should be held shortly after the incident. The purpose of this review is to examine which activities succeeded and which did not. especially if it occurs along with another disaster such as an earthquake. injured or not. If necessary.. the down draft from the helicopter can affect vapor or fume dispersion at the scene. CRITIQUE As soon as possible following a hazardous materials incident. with decontamination performed at the same time. Furthermore. Especially in cases involving more severe injuries.term psychological consequences in response personnel. PATIENT MANAGEMENT UNDER MASS CASUALTY CONDITIONS INVOLVING HAZARDOUS CHEMICALS Basic medical procedures in a large-scale hazardous materials incident are not substantially different from life-saving measures in other mass casualty disasters. flight program policies specifically preclude the use of helicopters for these types of incidents.g. A major chemical incident may overwhelm any one hospital. and as a result the flight crew risks becoming seriously ill in transit. There are. CRITICAL INCIDENT STRESS MANAGEMENT Situations involving large numbers of ill or injured individuals. and a better transport system for taking stabilized victims out of the area. In many areas.Air Transportation of Chemically Exposed Patients The role of aeromedical support for hazmat incidents is limited because of the potential danger in transporting patients by helicopter from a hazardous materials site. the patient. several important differences in disasters involving hazardous materials. however. combined with gas inhalation). Training in the appropriate procedures to be followed is essential for potential responders to a hazardous materials incident involving mass casualties. are sources of critical incident stress. and risks of harm to the responder(s). It may also be necessary to establish casualty collection points to provide stabilizing care in the field prior to transport. decontamination is often incomplete before removal. Primary attention should focus on the ABC fundamentals of emergency care. and training given on new policies and procedures. 60 . Triage may also be complicated for chemical exposures associated with the delayed onset of signs and symptoms. crushing injuries or spinal trauma. Identified weaknesses or omissions in the response plan should be corrected. The flight path to the site may also require their traveling through an unsafe area. and to evaluate the overall coordination effort with an aim toward making necessary improvements. all participating units should send knowledgeable representatives to meet and review the measures that were taken by each unit or agency. The results of the discussion should be shared with all agency personnel. This would require increased numbers of personnel. perhaps more sophisticated medical equipment. must be decontaminated before being transported to the emergency department to protect EMS and emergency department staff. To minimize the occurrence of acute or long. A hazmat disaster may require setting up mass screening and decontamination centers. Such an event would drastically increase the number of casualties and the complexity of the medical care that must be provided (e.

Currance. J. DC: Government Printing Office. Chicago. 1996. 1998. 61 . GA: US-DHHS. Federal Emergency Management Agency.F. U.S. J. Washington. Fire Administration. MO: Mosby.). Guidance for Developing State and Local Radiological Emergency Response Plans and Preparedness for Transportation Accidents. 1980.S. 1996. Kelen. Federal Emergency Management Agency and U. Atlanta.K. Reigart. Saunders Co. Prepared by the Office of Emergency Management. Department of Transportation.S. Manual of Toxicologic Emergencies. IL: Year Book. Lancaster. DC: Government Printing Office.L. Department of Health and Human Services. DC: Federal Emergency Management Agency. and G.dot. 3rd ed.C. and J. Hazardous Materials Emergencies: The Professional Response Team.gov/gydebook. Agency for Toxic Substances and Disease Registry (ATSDR). Hazardous Materials Guide for First Responders. P. 1998.S. Haddad.S. [available in English. Washington. PA: W. U.htm] U. Annals of Emergency Medicine.B. III. Emergency Department Radiation Accident Protocol.M. Vol. U. 1994. 1995. Hazardous Materials Management System: A Guide for Local Emergency Managers. and French][http://hazmat. Ricks.S. DC: Federal Emergency Management Agency. Clinical Management of Poisoning and Drug Overdose. Roberts. and A. Environmental Protection Agency. JR (eds. E. Louis. Leonard. Noji. 5th ed. National Pesticide Telecommunications & Network (NPTN). September. U. Federal Emergency Management Agency. 3rd ed. Spanish. Philadelphia. 1989. 1981.R. R.S. St.D. Washington. Bronstein. Recognition and Management of Pesticide Poisonings. L. U. Washington. 1985.R.SELECTED BIBLIOGRAPHY Cashman. and J. Emergency Care for Hazardous Materials Exposure.B. Managing Hazardous Materials Incidents: Medical Management Guidelines for Acute Chemical Exposures. 2nd ed. 1999. PA: Technomic Publishing Co. R. 1996 North American Emergency Response Guidebook. Winchester. and R.

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. . . . . . . . . . . . DOT Chart 11 . . 704M System . . . . . . . . .A9 A1 . . . . . . . . . . . . . Material Safety Data Sheet . . . . . . . . . . . . . . . . . . . . . . . Department of Labor. .S. . . . . . .A5 U. . . . . .A3 Department of Transportation. . . . . .Appendix A HAZARDOUS MATERIALS CLASSIFICATION SYSTEMS National Fire Protection Association. . . . . . . . . . . . . . . . . . . . . .

A2 .

coat. pants. with each quadrant representing a different characteristic. Flammability (Red) Susceptibility to burning is the basis for assigning risk levels within this category. Only hazards arising out of an inherent property of the material are considered. which may vary from a few seconds up to an hour. are based upon protective equipment normally used by firefighters. gloves. arms. Risk level 4: Very flammable gases or very volatile flammable liquids. Water may be ineffective because of the low flash point. Risk level 3: Materials extremely hazardous to health. ranging from four (highest risk) to zero (minimum risk). 704M SYSTEM The marking system designed by the National Fire Protection Association identifies hazard characteristics of materials at terminal and industrial sites. with bands around the legs. It may be desirable to wear self-contained breathing apparatus. but areas may be entered with extreme care. Full protective clothing including self-contained breathing apparatus. Risk level 4: Materials too dangerous to human health to expose firefighters. Risk level 3: Materials that can be ignited under almost all normal temperature conditions. and waist should be provided. Health (Blue) Health hazards in firefighting generally result from a single exposure. A few whiffs of the vapor could cause death or the vapor or liquid could be fatal on penetrating the firefighter s normal full protective clothing. The normal full protective clothing and breathing apparatus available to the average fire department will not provide adequate protection against inhalation or skin contact with these materials. but areas may be entered freely with full facemask self-contained breathing apparatus that also provides eye protection. It should be noted. and boots. that the physical exertion demanded in firefighting or other emergency conditions tends to intensify the effects of any exposure. Risk level 0: Materials which on exposure under fire conditions would offer no hazard beyond that of ordinary combustible materials. The method of attacking the fire is influenced by the material s susceptibility factor. The risk level ratings. Risk level 1: Materials only slightly hazardous to health. A3 . It uses a diamond divided into four quadrants. No skin surface should be exposed. as explained below. Risk level 2: Materials hazardous to health. however. Shut off flow and keep cooling water streams on exposed tanks or containers.NATIONAL FIRE PROTECTION ASSOCIATION.

Caution must be used in approaching the fire and applying water. water fog gently applied to the surface will cause a frothing that will extinguish the fire. or that can undergo violent chemical change at elevated temperatures and pressures. Special Information (White) The quadrant includes information on specific characteristics of the material (e. Risk level 2: Materials that (in themselves) are normally unstable and readily undergo violent chemical change. Firefighting should be done from an explosive-resistant location. tendency to oxidize). Fire exposure is one of the factors considered. along with conditions of shock and pressure. Includes materials that are sensitive to mechanical or localized thermal shock. Risk level 0: Materials that (in themselves) are normally stable even under fire exposure conditions and that are not reactive with water. Includes materials that can undergo chemical change with rapid release of energy at normal temperatures and pressures. Risk level 3: Materials that (in themselves) are capable of detonation or of explosive decomposition or reaction that require a strong initiating source that must be heated under confinement before initiation. Normal firefighting procedures may be used.g. reactivity with water. If a chemical with this hazard rating is in an advanced or massive fire. Includes materials that are sensitive to thermal or mechanical shock at elevated temperatures and pressures. Water spray may be used to extinguish the fire because the material can be cooled below its flash point. Risk level 0: Materials that will not burn. Also includes those materials that may react violently with water or that may form potentially explosive mixtures with water. A4 . Risk level 4: Materials that (in themselves) are readily capable of detonation or of explosive decomposition or reaction at normal temperatures and pressures.. However. the area should be evacuated. Reactivity/Stability (Yellow) The assignment of degrees in the reactivity category is based upon the susceptibility of materials to release energy either by themselves or in combination with water. Water may cause frothing if it gets below the surface of the liquid and turns to steam. Risk level 1: Materials that (in themselves) are normally stable but that may become unstable at elevated temperatures and pressures or that may react with water with some release of energy. firefighting should be done from a safe distance or from a protected location. or that react explosively with water without requiring heat or confinement.Risk level 2: Materials that must be moderately heated before ignition will occur. but do not detonate. Risk level 1: Materials that must be preheated before ignition will occur. In advanced or massive fires. but not violently.

A5 .

A6 .

A7 .

A8

MATERIAL SAFETY DATA SHEETS
The Material Safety Data Sheet (MSDS) has become a major source of chemical information. It is the key document used to provide hazard information to employees and can become an invaluable tool for emergency response personnel when used in a chemical emergency. The Occupational Safety and Health Administration s (OSHA) Hazard Communication Standard (29 CFR 1910.1200) requires all manufacturers of pure chemicals and/or mixtures to evaluate their products and relate, via MSDSs, any hazards that may be encountered while handling these materials. This standard is intended for all workplaces, manufacturing and nonmanufacturing alike. The Environmental Protection Agency s (EPA) Emergency Response and Community Right-to-Know Act of 1986 ensures the availability of MSDSs to emergency response personnel, such as fire departments, first aid crews, and hospital emergency room staff. The MSDS contains a wealth of information that may be understood with a minimum of training. Below is a brief explanation of the format and information found in a properly prepared MSDS.

Section 1
This section identifies the material by product or trade name and chemical name. It is the product or trade name that is usually found on the container labels, although the chemical name is also required by some states. Section I also contains the manufacturer s name, address, and telephone number.

Section 2
Section 2 provides physical data about the product that can be utilized for proper identification. Included are specifics such as color, odor, specific gravity (weight), vapor pressure, and boiling point.

Section 3
This section lists the chemical ingredients of the material, if they are known or suspected to be hazardous. Hazardous materials that are not carcinogens must be reported if they represent 1 percent or more of the product. Carcinogens must be reported and identified as such if their levels are 0.1 percent or higher. Also included in Section 3 are Threshold Limit Values (TLVs) and the OSHA Permissible Exposure Limit (PEL).

Section 4
Section 4 includes fire and explosion hazard data. This information is especially useful when devising both in-house and community contingency plans. Plant first responders, local fire departments, and hazmat teams need unlimited access to this information.

Section 5
Section 5 contains health hazard data. It describes any acute (short-term exposure) and/or chronic (long-term exposure) effects on the body. These include routes of exposure (inhalation, dermal contact, ingestion) and the bodily organs affected, as well as the signs and symptoms of overexposure. First

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aid procedures are also be found in this section. (NOTE: First aid measures recommended in MSDSs are not always correct and should be confirmed.)

Section 6
This section contains information on the reactivity of the product. It lists other chemicals that, when mixed with the product, will result in a chemical reaction. If a product is water reactive, it will be noted. Also included in Section 6 is information on hazardous decomposition products, such as carbon monoxide and other hazardous gases, that are formed and emitted during chemical reactions or fires. It is imperative that this section be carefully noted by both in-house and local firefighters.

Section 7
Section 7 lists the procedures that should be used if the product spills or leaks, including waste disposal methods.

Section 8
Section 8 contains information regarding the proper personal protective equipment (PPE) necessary to handle the product in a manner that will minimize exposure. Ventilation practices are also listed in this section.

Summary
A Material Safety Data Sheet can aid in making the right decisions on health and safety issues in a plant or in a community. It must be noted, however, that it is but one of many references that should be used to make final determinations. MSDSs are offered by manufacturers for identification and verification and are not the last word on safety and health practices.

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Appendix B

TYPES OF RESPIRATORY PROTECTION

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Appendix B Types of Respiratory Protection
Type of Respirator Air Purifying
Air-Purifying Respirator (including powered sea level) [PAPRs]) Enhanced mobility Cannot be used in IDLH or oxygen-deficient atmospheres (less than 19.5 percent oxygen at air-purifying respirators Limited duration of protection; may be hard to gauge safe operating time in field conditions Only protects against specific chemicals, and up to specific concentrations Use requires monitoring of contaminant and oxygen levels Can only be used: (1) against gas and vapor contaminants with adequate warning properties; or (2) for specific gases or vapors provided that the service is known and a safety factor is applied, or if the unit has an ESLI (end-of-service-life-indicator)

Advantages

Disadvantages

Lighter in weight than an SCBA; generally weighs 2 pounds or less (except for PAPRs)

Atmosphere-Supplying
Self-Contained Breathing Apparatus (SCBA) Provides the highest available level of protection against airborne contaminants and oxygen deficiency Provides the highest available level of protection under strenuous work conditions Bulky, heavy (up to 35 pounds) Finite air supply limits work duration May impair movement in confined spaces

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Appendix B (continued)

Type of Respirator

Advantages

Disadvantages
Not approved for use in IDLH or oxygendeficient atmospheres (less 19.5 percent oxygen at sea level) unless equipped with an emergency egress unit, such as an escape-only SCBA, that can provide immediate emergency respiratory protection in case of air line failure Impairs mobility Mine Safety and Health Administration/ NIOSH certification limits hose length to 300 feet As the length of the hose is increased, the minimum approved airflow may not be delivered at the faceplate Air line is vulnerable to damage, chemical contamination, and degradation. Decontamination of hoses may be difficult Worker must retrace steps to leave work area Requires supervision/monitoring of the air supply line

Positive Pressure Supplied- Enables longer work periods than an SCBA Air Respirator (SAR)
(also called air line respirator) Less bulky and heavy than an SCBA; SAR equipment weigh less than 5 pounds (or around 15 pounds, if escape SCBA protection is included) Protects against most airborne contaminants

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Appendix C

LEVELS OF PROTECTION

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Appendix C Levels of Protection1
Level of Protection Equipment
A

Protection Provided

Should be used when:
The chemical substance has been identified and requires the highest level of protection for skin, eyes, and the respiratory systems based on: -measured (or potential for) high concentration of atmospheric vapors, gases, or particulates; or -site operations and work functions involving a high potential for splash, immersion, or exposure to unexpected vapors, gases, or particulates of materials that are harmful to skin or capable of being absorbed through the intact skin Substances with a high degree of hazard to the skin are known or suspected to be present, and skin contact is possible Operations must be conducted in confined, poorly ventilated areas until the absence of conditions requiring Level A protection is determined

Limiting Criteria
Fully-encapsulated suit; material must be compatible with the substances involved

Recommended: The highest available Pressure-demand, full level of respiratory, facepiece SCBA or pressure- skin, and eye protection demand, supplied-air respirator with escape SCBA Fully-encapsulated, chemicalresistant suit Inner chemical-resistant gloves Chemical-resistant safety boots/shoes Two-way radio communication

Optional: Cooling unit Coveralls Long cotton underwear Hard hat Disposable gloves and boot covers

1

Reprinted from NIOSH/OSHA/USCG/EPA, 1985. Occupational Safety and Health Guidance Manual for Hazardous Waste Site Activities. Washington, DC: Department of Health and Human Services.

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Appendix C Levels of Protection (continued)
Level of Protection Equipment
B Recommended: Pressure-demand, full-facepiece SCBA or pressure-demand, suppliedair respirator with escape SCBA

Protection Provided

Should be used when:

Limiting Criteria

The type and atmospheric concentration of substances have been identified and require a high level of respiratory protection, but less skin It is the minimum level protection. This involves: Chemical-resistant clothing recommended for initial (overalls and long sleeved site entries until the -atmosphere with IDLH jacket; hooded, one- or hazards have been concentrations of specific two-piece chemical splash further identified substances that do not suit; disposable chemicalrepresent a severe skin resistant one-piece suit) hazard; or Inner and outer chemicalresistant gloves Chemical-resistant safety boots/shoes Hard hat Two-way radio communications -atmosphere containing less than 19.5 percent oxygen Presence of incompletely identified vapors or gases is indicated by direct-reading organic vapor detection instrument, but vapors and gases are not suspected of containing high levels of chemicals harmful to skin or capable of being absorbed through intact skin

The same level of respiratory protection, but less skin protection than Level A

Use only when the vapor or gases present are not suspected of containing high concentrations of chemicals that are harmful to skin or capable of being absorbed through intact skin Use only when it is highly unlikely that the work being done will generate either high concentrations of vapors, gases, or particulates or splashes of material that will affect exposed skin

Optional: Coveralls Disposable boot covers Face shield Long cotton underwear

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5 percent oxygen C5 . immersion. one. air-purifying.Appendix C Levels of Protection (continued) Level of Protection C Equipment Protection Provided Should be used when: Limiting Criteria Recommended: Full-facepiece. or the potential for unexpected inhalation of or contact with hazardous levels of any chemicals This level should not be worn in the Exclusion Zone The atmosphere must contain at least 19. minimal skin protection The atmosphere contains no known hazard Work functions preclude splashes. splashes immersion. disposable chemical-resistant one-piece suit) Hard hat Optional: Gloves Escape mask Face shield The atmosphere contains no known hazard Work functions preclude. or the potential for unexpected inhalation of or contact with hazardous levels of any chemicals This level should not be worn in the Exclusion Zone The atmosphere must contain at least 19. minimal skin protection Chemical-resistant clothing (overalls and long sleeved jacket: hooded.5 percent oxygen D Recommended: Coveralls Safety boots/shoes Safety glasses or chemical splash goggles Hard hat Optional: Gloves Escape mask Face Shield No respiratory protection.or twopiece chemical splash suit. No respiratory canister-equipped respirator protection.

E. GA 30333 C6 .Comments The Agency for Toxic Substances and Disease Registry would greatly appreciate your comments and suggestions for improving future editions of this guidance document. Comments may be addressed to: Scott V. N. Wright Emergency Response and Scientific Assessment Branch (MS E57) Agency for Toxic Substances and Disease Registry (ATSDR) 1600 Clifton Road. Atlanta.

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S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Agency for Toxic Substances and Disease Registry .Managing Hazardous Materials Incidents Volume II (Revised) Hospital Emergency Departments: A Planning Guide for the Management of Contaminated Patients U.

.H..............H..P....P... Ph. M...D.The Agency for Toxic Substances and Disease Registry (ATSDR) has produced a three-volume series entitled Managing Hazardous Material Incidents. Georgia 30333 (404) 639-6357 Internet address: www.... Volume I Emergency Medical Services: A Planning Guide for the Management of Contaminated Patients Hospital Emergency Departments: A Planning Guide for the Management of Contaminated Patients Medical Management Guidelines for Acute Chemical Exposures Volume II Volume III Volumes I and II are planning guides to assist first responders and hospital emergency department personnel in planning for incidents that involve hazardous materials........... Assistant Administrator Division of Toxicology.... Administrator Henry Falk.. N. The series is designed to help emergency response and health care professionals plan for and respond to hazardous material emergencies.... Ph..D........Christopher T..atsdr... M..... Agency for Toxic Substances and Disease Registry.... M....Jeffrey P....... Koplan.... Volume III is a guide for health care professionals who treat persons who have been exposed to hazardous materials.......html 2 Printed on recycled paper ...E.. DeRosa.gov/prevent.D. Atlanta. Director Additional copies of this report are available from: Agency for Toxic Substance and Disease Registry (ATSDR) Division of Toxicology Information Center (E57) 1600 Clifton Road.....cdc.

.

GA 30333 Official Business Penalty for Private Use $300 SPECIAL FOURTH-CLASS RATE POSTAGE & FEES PAID PHS/CDC Permit No. G-284 .DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service Agency for Toxic Substances and Disease Registry (MS-E57) Atlanta.

. . . . 39 i . . . . . . . . . .7 Selected Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Communications . . . . . . . . . . . . . .Table of Contents Page Acknowledgments . .11 Principles of Toxicology for Emergency Department Personnel . .iii Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . Emergency Department Response to Hazardous Materials Incidents . . . . .v I. . . . . . . . . . . . . . . . . 32 Emergency Department Personnel Decontamination . . . . . . . . .3 SARA Title III . . . . . . . . . . . . . . . . . . . . .3 The State Emergency Medical Services (EMS) Agency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Systems Approach to Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Personnel Protection and Safety Principles . . . . . . . . . . . . . . . . . . . 36 Selected Bibliography . . . . . . . . . . . 25 Respiratory Protection . .5 Hazard Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 The Spectrum of Hazardous Materials Incidents . . . . . . . . .9 II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 The Role of the Hospital in a Systems Approach to Planning . . . . . . . . . . . . . . . . . . . . . .4 Federal Emergency Response Activities . .11 Hazard Recognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Volume II . . . . . . . . . . . . .

. . . . 48 Selected Bibliography . . . . . A1 Types of Respiratory Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48 Patient Management Under Mass Casualty Conditions Involving Hazardous Chemicals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Appendix A Appendix B Appendix C Hazardous Materials Classification Systems .48 Critique . . . . . . . . . . . . . . . . . . . . . . .Table of Contents (Continued) III. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Emergency Department Preparation . . . . . . . . . . . . . . . . . . . . . . . . .Volume II . . . . . . . . . . . . . . . . . . . . . . . . C1 ii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B1 Levels of Protection . . . . 48 Critical Incident Stress Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Community Education and Briefing . . . . . . . . . . . . . . . 45 Considerations for Patient Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . Patient Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Patient Arrival . . 45 Patient Decontamination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . .

D. (American Association of Poison Control Centers) Leslie Stein-Spencer. ATSDR.P.H.A.T. (American Academy of Pediatrics) John Turley (Emergency Management Institute) 1 The above reviewers were recommended by the organizations listed but do not necessarily represent them.C. Paul Seidlitz. Joe E.. Eileen Faries. M. M. George C.N. F.P. Taylor.P. MacNeil Cross.E. (Emergency Nurses Association) Milton Tenenbein...D. M. Ph. (American College of Emergency Physicians) Andrea Carlson (Physicians for Social Responsibility) Linda Cochiarella. R. 205-93-0641).E. Dave Tauber. Robert Daughdril. M. and Chris Reid of ERG was the editor (under ATSDR Contract No.D. Associate Professor. Emergency Medicine Professor of Pediatrics and Pharmacology/Toxicology Disaster Medicine and Special Operations Section University of Louisville George Washington University School of Medicine Louisville.E. Eric Noji. EMT-P. Steve Finefrock. Paul Manascalo. Kenneth Bouvier.-C. Monty Leonard. Kenneth Kuntz.A. The following panel of experts contributed to the original (1992) development of Volumes I and II: Phillip Currance.Acknowledgments This document was first published in 1992 and updated in 2000. O’Neill. William J. M..N. R. D. Winston E. M.D.. (American Medical Association) Paul Cousins (The National Association of Emergency Medical Technicians) Richard Duffy (International Association of Firefighters) Philip Edelmen. F. Clark Staten. KY and Health Sciences Washington. Jones.. Alonzo Smith. The following experts served as peer reviewers for the original 1992 Volumes I and II: Ben Blankeshire.S. (American College of Occupational and Environmental Medicine) Kent Olson. Environmental Protection Agency) Keith Burkhart. Niel Holtz.N.C. Wallace Weaver. Pierce.C. M. Tirey. Kent Olson.A. including: 2000 Revision of Volume I Emergency Medical Services: A Planning Guide for the Management of Contaminated Patients: 2000 Revision of Volume II Hospital Emergency Departments: A Planning Guide for the Management of Contaminated Patients: Craig DeAtley.D. Ralph B. For the 2000 revision. Rodgers. R.P... M.. (Association of Occupational and Environmental Clinics) Robert McCunney. F. M. ATSDR wishes to thank all those who participated in making this a useful guidance document. Mary Beth Michos.D. (ERG) was the project manager. This project was directed by Scott V. Keffer. Wright. Peer Review Panel for revised (2000) Volumes I and II:1 Sella Burchette (U. C. Sandra L.D. Steve White iii .. Linda Stein of Eastern Research Group..D. John Friery.A.C. Martin J.C. Jr. Craig DeAtley.D. Gus A. P.D.D. M. Koehler. Chappell D. Ph. Inc.

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illustrates the characteristics of hazardous materials incidents that compel modifications to traditional emergency response procedures. and key operational considerations that affect the management of incidents of chemical contamination. and concise guidance is needed to describe appropriate procedures to be followed by emergency medical personnel to safely care for a patient. In some cases. v . hospital personnel. terminology. This guide is intended to help hospital emergency departments plan for incidents that involve hazardous materials and to improve their ability to respond to these incidents. and others from risk of secondary exposure. They should also be aware of community resources that could be called upon to assist with an emergency response. Hospital Emergency Departments: A Planning Guide for the Management of Contaminated Patients. while providing the best care for the chemically contaminated patient. Hospital emergency departments must protect their personnel and other people within the hospital. the Agency for Toxic Substances and Disease Registry (ATSDR) contracted for the production of a three-volume series entitled Managing Hazardous Materials Incidents: I. It presents uniform guidance for the emergency care of chemically contaminated patients. emergency personnel must understand decontamination procedures and personal protective equipment. as well as optimal worker protection. as well as to protect equipment. Current training curricula for emergency room physicians and nurses and emergency medical technicians (EMTs) often do not adequately prepare these professionals to manage the contaminated individual or to decontaminate patients exposed to toxic substances.Introduction The presence of hazardous materials or toxic chemicals at an incident location or other emergency situation adds a new dimension of risk to those handling and treating casualties. patients. To ensure appropriate and timely patient care. The first document is designed for use by emergency medical technicians and other prehospital care providers to minimize their risks of exposure during the prehospital period and to provide for the safe and effective treatment of chemically contaminated patients. The fundamental difference between a hazardous materials incident and other emergencies is the potential for acute risk from contamination to both patient and responder. written for emergency department personnel. II. and presents effective preparatory response actions. This volume. traditional practices must be altered to avoid compounding a critical situation. neither of which are routinely covered in the course of their professional training. Emergency Medical Services: A Planning Guide for the Management of Contaminated Patients. provides basic information critical to advance planning and implementation of emergency medical strategies. In response to this need. Medical Management Guidelines for Acute Chemical Exposures. Accurate. specific. is designed to familiarize readers with the concepts. and III.

It also provides an overview of personal protective equipment. These materials should be carefully reviewed before preparing any strategic plans or conducting training exercises on this topic. Section I. although some of the information presented is pertinent to these situations as well. This chapter also discusses patient assessment and decontamination guidelines. however. nor can it be regarded as a substitute for comprehensive instruction and training for hazardous materials incidents. the National Response Team. all-encompassing.Not all hospital and community emergency response systems are prepared to respond to a hazardous chemical incident to the same degree. the hazard recognition section presents general guidance for determining whether a given situation constitutes a hazardous materials incident and details various hazardous materials classification systems. and the Chemical Stockpile Emergency Preparedness Program (CSEPP). introduces the guidelines for emergency preparedness and hazardous materials and waste programs of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Section III. Patient Management. This guidance document is intended to improve the safety of responders as well as of patients. such as respiratory devices and protective clothing. this document generally does not cover issues associated with weapons of mass destruction (WMD). the Community Awareness Emergency Response (CAER) program. Emergency Department Response to Hazardous Materials Incidents. Employee safety and training are also key factors in the effective management of medical emergencies. This section also provides basic toxicological and chemical terminology that emergency personnel need to understand to effectively conduct patient assessments. This document also is intended to provide source material for developing local training and safety protocols. chemical exposure. Systems Approach to Planning. Also. This document may be used to assess a hospital s capabilities with respect to potential community hazards and to develop response plans using national and community-specific resources. vi . In addition. includes guidelines for emergency department preparation and response to a potential hazardous materials incident. It is not. and personal protective equipment. outlines general principles for hazard recognition. Section II. including those established under Title III of the Superfund Amendments and Reauthorization Act (SARA). This chapter discusses the need for hazard identification and risk analysis pertaining to hazardous materials located in a community or transported through it. Other ATSDR documents specifically address WMD concerns. Supplemental material that is vital to successful response to hazardous materials contamination is cited within the document. Government and private planning activities are also outlined.

People who have been seriously injured by a hazardous material have a greater chance of recovery without complications when appropriate emergency treatment is provided by trained EMS personnel at the scene. and health departments. While infrequent. However. and when the patient is transported to a facility having the most appropriate personnel and technical resources to manage his or her care. Emergency Medical Services (EMS). Communication channels between the private and public sectors. and community hospitals. private businesses. have not been clearly identified and formalized. many local governments. Coordination and communication between hospitals and other elements of an Emergency Medical Services system can best be achieved by hospital staff. but as repositories of hazardous materials themselves. l Hospitals are a crucial link in the community response system for emergency preparedness planning. Local emergency planning committees are mandated under federal law to identify high-risk locations and to ensure adequate response planning and training. In fact. emergency department personnel must be knowledgeable about where to send patients for further specialized care. they are potential sites of hazardous materials incidents. Optimally. 1 . or among public responders. Planning requires the involvement of an array of community institutions. The medical community has not been firmly integrated into many response systems and may not be prepared to treat multiple casualties resulting from a serious hazardous materials incident. This requires an integrated emergency medical response. Not every hospital in an area needs to have an emergency department capable of handling hazardous materials patients. including fire and police departments. many communities have centralized such services into one major area hospital or trauma center. and understand what services are expected from hospitals. Not only are hospitals asked to treat patients who have been chemically contaminated at remote sites. In addition. chemical incidents are capable of endangering the health of the individuals involved and the emergency personnel directed to assist them. Hospital administrators need to familiarize themselves with the contingency plans of other participants. all hospitals should be capable of performing decontamination and basic care since some patients may come in on their own and not through EMS systems. such as fire. Systems Approach To Planning THE ROLE OF THE HOSPITAL IN A SYSTEMS APPROACH TO PLANNING The potential for hazardous materials incidents exists almost everywhere. and hospitals do not have a tested hazardous materials response plan in place that integrates all of the responding agencies and personnel. However.Section I. fully participating at local meetings for hazardous materials (hazmat) planning and protocol review. Hospitals must acknowledge their role as a component of the communitywide emergency response system. including physicians. A common characteristic of the successful management of chemical incidents is adequate contingency planning. hospital staff should be represented on planning committees that develop and periodically review these contingency plans. This has resulted in several problems: l l Incidents have been poorly managed onsite by first responders. police.

as well as those in the community who use and maintain stocks of potentially hazardous materials. l Mass-casualty: Disrupts a large segment of the community: . and federal agencies. l Multi-casualty: This situation is usually limited to a single location: . equipment. events resulting in death and injury occur almost 1. and industries.THE SPECTRUM OF HAZARDOUS MATERIALS INCIDENTS EMS agencies and hospitals should be able to participate in the response to a range of hazmat incidents from the individual level. or where there are low levels of hazmat skills and experience among EMTs. occur in the fixed locations where the materials are used or stored.5 times as often in fixed locations as in transit. Involves several locations. the hospital must be familiar with these plans and know how to use them if it is involved in a incident that overwhelms its capabilities. This preplanning often requires coordination between local. . . Involves normal systems of transportation. excluding fuel spills. its successful management depends on preplanning. While transportation incidents attract larger media attention. or even outside of the area altogether. statistics show that almost 75 percent of all acute hazardous materials events. state. to the mass-casualty level. Can occur in the workplace. and these units may not know how the system works. but the demand on all systems is much greater. . Involves additional units to the normal responders (mutual aid). In turn. or at home. l Individual patient: A single individual is contaminated and must be transported to an emergency department: . Involves long-range mutual aid. In addition. Regardless of the size or location of an incident. Patients may be treated locally at different facilities that provide various levels of care. May pose a problem in rural areas with small hospitals. normal systems of transportation (ambulances) are inadequate or disrupted. . Planning should integrate hospital personnel. The hospital and emergency medical responders are key components of the local response system. Contributions to hazardous materials planning come from a variety of sources: regulations from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). and federal agencies. Hazardous materials incidents range from small releases at a factory site to rapidly expanding events that may endanger a community. Patients are usually treated at the same level facility as a single emergency response. and supply needs into state and local hazmat plans. . 2 2 . state EMS agencies. such units may not be part of the local EMS system. state and local planning committees established under Title III of the Superfund Amendments and Reauthorization Act (SARA). through the multi-casualty. in a public place.

each LEPC must evaluate available resources for developing. LEPCs were also charged with making information on hazardous chemicals available to the public. The SERC is responsible for establishing local emergency planning districts (usually on a county level). requires that each state establish a State Emergency Response Commission (SERC). using information about the presence of potentially hazardous chemicals reported by businesses and other facilities under Title III. consisting of members with technical expertise in emergency response. Title III. first aid. media. The legislation also provides for public access to information on the presence and releases of specified hazardous chemicals in communities. appointing and overseeing local emergency planning committees (LEPCs). and facility owners or operators subject to the emergency planning requirements. SARA TITLE III Title III of the 1986 Superfund Amendments and Reauthorization Act (SARA) provides for an infrastructure in states and local communities to plan for effective response to hazardous materials emergencies. The Emergency Planning and Community Right-to-Know Act of 1986. These standards allow hospitals more leeway in how specific goals are achieved. firefighters. LEPCs were primarily responsible for preparing a comprehensive emergency response plan for their districts by October 1988. transportation. environmental. civil defense. occupational safety. current JCAHO guidance takes the form of standards to be met. environmental and natural resources. and transportation. establishing procedures for handling public requests for information. As part of the planning process. A comprehensive accreditation survey takes place once every three years. While the JCAHO has in the past provided very specific guidelines relating to emergency department resources. and emergency preparedness. media. public health. handling of hazardous materials. SARA Title III requires that the local committees include. and exercising its plan. and reviewing LEPC emergency plans. The JCAHO establishes standards that must be met before a hospital can receive accreditation. law enforcement. with intermittent evaluation(s) if a specific area of weakness is identified at the time of full review. representatives from the following groups: state and local officials. at a minimum.JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS (JCAHO) In drawing up contingency plans. implementing. The plan must include: l l l l Identification of facilities subject to planning provisions under Title III Identification of transportation routes for extremely hazardous substances Identification of risk-related facilities Methods and procedures for response 3 . hospital. hospital administrators have guidance available from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). health.

Title III contains a specific provision requiring facility owners or operators to disclose the chemical identity of substances for which companies have made trade secret claims. Any business or facility that contains one or more of these EHSs in an amount equal to or greater than its respective TPQ is required to notify the SERC and LEPC. Access to chemical identities assists health professionals. and transportation operations. Title III provides for the submission of information on hazardous and toxic chemicals as presented above. and Liability Act of 1980 (CERCLA) must be reported to the LEPC and SERC. Representative facilities covered under the planning provisions include not only major chemical manufacturing facilities but a wide variety of chemical users. Storage incidental to transportation is exempt provided that the EHSs are still moving under active shipping papers and have not reached the final consignee. and nurses in obtaining further information for diagnostic and treatment recommendations during emergencies. and other service-related businesses. This requirement ensures immediate notification of local response personnel. However. Compensation. physicians. EPA was mandated by Congress to establish a list of chemicals to help focus local emergency planning activities. THE STATE EMERGENCY MEDICAL SERVICES (EMS) AGENCY Planning for hazardous materials incidents should include the appropriate linkage to the state EMS agency. EMS agencies usually are responsible for medical management and medical control of injured civilians and first responders. The duties of these agencies vary from state to state. and thus are an essential part of the planning process. These facilities must also appoint a coordinator to work with the LEPC for specific inclusion of that facility in the local plan. EPA listed 406 Extremely Hazardous Substances (EHSs) and established a Threshold Planning Quantity (TPQ) for each. These state agencies are responsible for overseeing a network of local EMS units. EMS agencies must develop medical mutual aid agreements between counties and establish procedures for distribution 4 4 . Exemptions under this provision apply only to vessels (ship/boat). such as farmers. Other provisions of Title III provide additional information on the presence.l l l l l Designated community and facility coordinators Procedures for public notification Methods for determining release occurrence and the area affected Description of emergency equipment and facilities and those responsible for them Evacuation plans and training programs Under Title III s planning provisions. and for prevention and treatment measures during nonemergencies. and emissions of hazardous and toxic chemicals. storage. In addition. Accidental releases of EHSs and other hazardous materials identified in the Comprehensive Environmental Response. This body is often part of the SERC. federal facilities. These data further assist the LEPC in obtaining a comprehensive picture of chemical risk in the local district. Hospitals can be better prepared to respond to incidents that involve contaminated patients by actively participating in the LEPC planning process. dry cleaners. In April 1987.

Decontamination and Medical Management Protocols: The literature on the clinical management of hazardous materials exposures is sometimes inconsistent in its recommendations. Volume III in this series. it may be more appropriate to take the patient to a hospital that has expertise in handling certain kinds of poison exposures. One option is to go through the regional Poison Control Center or through the base hospital. Medical Management Guidelines for Acute Chemical Exposures. l l l FEDERAL EMERGENCY RESPONSE ACTIVITIES Contingency planning is essential to the successful implementation of any system designed to manage chemically contaminated patients and to promptly contain the hazard itself. a National Response Team (NRT) and a National Response Center.of casualties among hospitals. between base hospitals and ambulances.g. 5 . Trauma Centers. The Poison Center will often know which hospitals are best prepared to handle exposures to which substances. however. Coordination with Burn Centers. supplies and pharmaceuticals. To oversee this plan. Further. Contingency plans require a coordinated community response that may also involve state and federal agencies. who is a medical toxicologist with training and experience in hazardous materials.. provides extensive information on many commonly encountered chemicals. and through the base hospital or via cellular telephone to EMTs in the field. including its own medical director. Patient Destination: Hospital emergency departments are able to provide supportive care. The plan should include directions for obtaining this information. EMS agencies should maintain an inventory of disaster medical supplies. and in arranging for the acquisition of additional equipment. and Other Specialty Centers: Provisions should be made to alert and coordinate patient destination with various specialty care centers. Hyperbaric Chamber Facilities. In addition. In some cases. State planning activities include: l Medical Direction: The local EMS agency or base hospital should be contacted for information on how medical control is provided for the EMS system. and a group of On-Scene Coordinators (OSCs) have been established. a network of Regional Response Teams (RRTs). The federal government established a National Contingency Plan (NCP) to promote coordination of the resources and services of federal and state response systems. EMS agencies must work with local and state officials in designating field casualty decontamination and collection points for a major disaster. between all hospitals and the regional Poison Control Center). Preplanning and coordination of services are equally critical at the national level. The Poison Center also has rapid access to experts. the regional Poison Control Center can provide decontamination and medical management protocols via fax or telephone to all receiving hospitals. between receiving hospitals and the base hospital. EMS agencies should also develop and maintain communications protocols for onsite activities (e. For example. Provisions should be made in the plan for obtaining field and hospital medical management information from experienced physicians.

hospital.The Hazardous Materials Emergency Planning Guide. public officials. NRT-1 represents a concerted effort by federal agencies to consolidate their general hazardous materials planning guidance into an integrated federal document. Department of State. The objectives of the Hazardous Materials Emergency Planning Guide are to: l l Focus communities on emergency preparedness and response. police. SARA Title III requires medical. Environmental Protection Agency (EPA). including the Department of Defense. Provide communities with information that can be used to organize the emergency planning task. as well as a description of emergency equipment and facilities in the community. emergency medical service. In addition. Nuclear Regulatory Commission (NRC). Department of the Interior. Department of the Treasury. The CAER program encourages local chemical manufacturing facilities to inform area residents. and to assist communities in determining whether a hazardous materials incident plan is needed. which provides guidance for firefighters. provides guidance to help local communities prepare for potential hazardous materials incidents. and emergency response organizations about industry operations and to integrate their onsite emergency response plans with the planning efforts 6 6 . General Services Administration (GSA). As previously mentioned. NRT-1 states that an emergency plan must include response procedures for facilities and local emergency and medical personnel. in addition to the districtwide plan developed by the LEPC. as well as by LEPCs formed in accordance with the Emergency Planning and Community Right-to-Know Act of 1986 (SARA Title III). and health department personnel be included as members of an emergency planning team.S. such as the DOT s North American Emergency Response Guidebook (NAERG). testing. Coast Guard. It also recommends that hospital. and first aid personnel to be members of the local emergency planning committee. Provide a method for revising. l l l NRT-1 is published by the National Response Team. and other emergency services personnel to help them protect themselves and the public during the initial minutes immediately following a hazardous materials incident. and maintaining community emergency plans. Department of Transportation. Department of Labor (Occupational Safety and Health Administration [OSHA]). Department of Health and Human Services (Agency for Toxic Substances and Disease Registry [ATSDR]). U. NRT-1 describes relevant publications that provide specific operational guidance to emergency responders. Department of Commerce (National Oceanic and Atmospheric Administration [NOAA]). NRT-1 can be used by local communities developing their own plans. Furnish criteria for risk and hazard assessments. and was developed cooperatively by its federal member agencies. Help LEPCs and individual communities prepare a plan that is appropriate for their needs and consistent with their capabilities. Federal Emergency Management Agency (FEMA). the document provides information on the Chemical Manufacturers Association s (CMA) Community Awareness Emergency Response (CAER) and Chemical Transportation Emergency Center (CHEMTREC) programs. and the Department of Energy (DOE). Department of Justice. referred to as NRT-1. Department of Agriculture.

This is a key step because it permits planners to describe and evaluate risks and to allocate resources accordingly. eyes. decontamination procedures. However. accountability for personnel entering and leaving sites.e. the type of clothing that must be worn. It is a three-step decisionmaking process comprised of hazard identification. CAER has outlined specific steps for industrial plants: l l l l l l l l l Review the plant s emergency plan Improve employee awareness and training Prepare a community relations plan Inventory the status of local emergency planning Develop a briefing paper Prepare a list of initial contacts Meet with initial contacts and identify key officials Establish a coordinating group Begin implementation steps On the federal level. and the equipment needed to protect the head. and personal safety precautions. NRT-1 recommends that medical personnel be made aware of significant chemical hazards in the community to prepare for possible hazardous materials incidents. see Section II). Further. arms. The document suggests that emergency plans include a list of emergency response equipment appropriate to the various degrees of hazard based on EPA s four levels of protection (Levels A through D. HAZARD ANALYSIS Hazard analysis is a necessary component of comprehensive emergency planning for a community. EPA and FEMA provide technical assistance and guidance to local and state planners through the SARA Title III program. face. the 7 . The first task in conducting such an analysis is to complete an inventory of the hazardous materials present in the community and to determine the nature of the hazard. supplied-air respirator. It also states that emergency medical teams and hospital personnel must be trained in the proper methods for decontaminating and treating individuals exposed to hazardous chemicals. vulnerability analysis. hands. self-contained breathing apparatus.of the local community. the chemical industry has established physician networks to encourage better dialogue between company physicians and local health authorities. In some areas of the country.. The NRT-1 document also recommends that contingency plans include standard operating procedures for entering and leaving sites. recommended safety and health equipment. In addition. This section focuses primarily on hazard identification. and feet. ears. and risk analysis. it recommends that the list include the type of respirator (i. or air-purifying respirator) that should be used.

such as airports. spills. vessels in port. such as explosions. As previously stated.. These include the obvious ones such as chemical plants. such as chlorine. as required under SARA Title III. railroad yards. Such materials should be given special attention by the LEPC in the planning process. Risk analysis includes the probable damage that may occur if a chemical incident occurs. and venting to the atmosphere. hospitals and educational and governmental facilities should not be overlooked since they all contain a variety of chemicals. should also be included in the overall hazards identification plan. from manufacturers to service-related businesses. fires. For example. and hydrochloric and sulfuric acids. In this context. such a facility can provide technical experts. SARA Title III planning provisions address many of these potential transportation risk areas by requiring facility cooperation in plan preparation and by including specific risk areas as well as a wide range of chemical handlers. These materials include fuels and chemicals. In identifying hazards. Information that is necessary for risk analysis includes: l l l The type of risk to humans. It should be noted that several federal agencies (e. petroleum plants. EPA) report that frequently encountered substances often pose the most prevalent dangers. training and safe handling instructions. Major transportation routes and transfer points. or transported through a community. In requesting information directly from facilities. quantities. should facilitate their cooperation. refineries. placing business or industrial representatives on the communitywide planning committee. The assistance and cooperation of a facility that regularly deals with hazardous materials also presents the local planning unit with a wide array of services. The identification of hazards also should provide information on: (1) the types. DOT. or delayed reaction The groups that are most at risk The type of risk to the environment. and warehouses. such as an acute. FEMA. Hazards should be identified at as many facilities in the community as possible. The LEPCs may provide assistance here. a hazard is any situation that is capable of causing injury or impairing an individual s health. storage facilities. remember that the planning provisions under SARA Title III require certain facilities to provide the LEPC with any information on the facility that the committee needs to develop and implement its plan. and locations of hazardous materials in the community.task of analyzing all relevant hazards may not prove cost effective for many communities. and trucking terminals. During the process of identifying hazards. facilities or transportation routes will be pinpointed that contain materials that are potentially dangerous to humans. and cleanup capabilities. such as permanent damage or a recoverable condition 8 8 .g. The planning committee should. therefore. Spill Prevention Control and Countermeasure (SPCC) plans. assign priorities to the hazards found in its community and establish affordable limits for analysis. It is essential that these industries or businesses understand the role this information plays in ensuring a sound emergency response plan. particularly if the committee includes industry representatives. chronic. ammonia. and (2) the nature of the hazard that would accompany incidents.

E. Emmitsburg. 9 . Incident Command System.dot. 1983. Quincy.S. 1983. U. Community Teamwork: Working Together To Promote Hazardous Materials Safety. Fire Protection Publications. Louis. M. National Emergency Training Center. National Fire Protection Association. and J. SELECTED BIBLIOGRAPHY Auf der Heide. MA: National Fire Protection Association. G. ed. Washington. OK: Oklahoma State University Press. NFPA 472.G. Government Institutes. [available in English. 1992. ISBN: 0-86587-749-1. Hazardous Materials Emergency Planning Guide. Washington. Spanish and French][http://hazmat. Yvonna. DC: Government Printing Office. Department of Transportation. provides technical assistance to LEPCs in assessing the lethal hazards associated with potential airborne releases of extremely hazardous substances. Quincy. Stillwater. SARA Title III Compliance Guidebook. 1996. EPA published a supplement to NRT-1 in December 1987. Inc. Standards for Professional Competence of Responders to Hazardous Materials Incidents. Risk analysis in transportation settings is outlined in the DOT s Community Teamwork: Working Together To Promote Hazardous Materials Safety.. DC: Government Printing Office. 1992. Disaster Response: Principles of Preparation and Coordination. National Fire Protection Association.S.S. 1988. 2nd.htm] U. EPA Standard Safety Operating Guidelines. Washington. A Guide for Local Officials. 1992. This document. NFPA 473.gov/gydebook. North American Emergency Response Guidebook. MA: National Fire Protection Association. In conjunction with FEMA and DOT. 1997. National Response Team. Stillwater. Recommended Practice for Responding to Hazardous Materials Incidents. DC: Government Printing Office. MO: Mosby. National Fire Protection Association. Hildebrand. 1995. Standards for Professional Competence of EMS Responders to Hazardous Materials Incidents. MD: HEMP Curriculum Guidelines. entitled Technical Guidance for Hazardous Analysis and often referred to as the Green Book. Department of Transportation. U. 1987. Washington. Quincy.Many documents can be of assistance in conducting a risk analysis. Environmental Protection Agency. NFPA 471. 1989. MA: National Fire Protection Association. A Guide for Local Officials. 1998. Noll.G.S. DC: Government Printing Office. OK: Fire Protection Publications. Hazardous Materials: Managing the Incident. Guidelines for Public Sector Hazardous Materials Training. St.

S. Washington. U.S. 1987.S. Washington. Pocket Guide to Chemical Hazards. Washington. Federal Emergency Management Agency. 1996.S. 1985.S. U. 1997. DC: Government Printing Office. Federal Emergency Management Agency. Federal Emergency Management Agency. National Institute for Occupational Safety and Health and U. Occupational Safety and Health Administration. Guide for all Hazard Emergency Operations Planning. DC: Government Printing Office. Environmental Protection Agency and U. DC: Government Printing Office. FEMA-10. Federal Emergency Management Agency. DC: Government Printing Office. DC: Environmental Protection Agency. 10 10 . Guide for Development of State and Local Emergency Operations Plan. U.U. Technical Guidance for Hazardous Analysis: Emergency Planning for Extremely Hazardous Substances. 1981. Washington.S. Planning Guide and Checklist for Hazardous Materials. Washington. U.S.

that vary in shape depending upon the cargo. or cylinders for smaller quantities of hazardous materials. the involvement of hazardous materials should be considered a possibility in such situations. such as slipping off a ladder. emergency response personnel may not be aware that the situation involves hazardous materials. patient symptoms reported from the field such as nausea. There are three categories of packaging: stationary bulk storage containers at fixed facilities that come in a variety of sizes and shapes. and labeled fiberboard boxes. Community preplanning should identify the specific sites that contain hazardous materials. construction sites).Section II. dizziness.g. farm and paint supply outlets. bulk transport vehicles. factories. itching and burning eyes or skin. laboratories. drums. l 11 . and they should ask incident victims and prehospital personnel about the nature of the event. Patients may also originate from situations occurring within the hospital. that these data sheets may have incomplete information and that the medical information provided is generally at a basic first aid level. These clues are included below to facilitate and expedite the prompt and correct identification of any hazardous materials at the scene of an incident. The manual Recognizing and Identifying Hazardous Materials (produced by the National Fire Academy and the National Emergency Training Center) states that there are six primary clues that may signify the presence of hazardous materials. It should be kept in mind. They could then request field personnel to examine the site for these six clues: l Occupancy and Location. or cyanosis could suggest to hospital staff the presence of hazardous materials. As a result. Department of Transportation (DOT) regulations delineate container specifications for the transport of hazardous materials. such as rail and truck tank cars. But as a routine precaution. emergency personnel should be alert to the obvious locations in their communities that use and/or store hazardous materials (e. Emergency Department Response to Hazardous Materials Incidents HAZARD RECOGNITION When dispatched to the scene of an incident. An injury at a hazardous materials incident need not invariably involve chemical exposure: it could have resulted from a physical accident. Container Shape. For example. The shape and configuration of the container can often be a useful clue to the presence of hazardous materials. In addition. Emergency departments should also be prepared for exposed patients who arrive unannounced in privately-owned vehicles. especially for any particularly dangerous chemicals kept on site. however. The Department of Labor s Material Safety Data Sheets (MSDSs) should also be available. emergency department personnel should always be alert to the possibility that they may be dealing with a chemically contaminated individual. Hospital emergency department personnel who are familiar with these clues will find their communication with field personnel enhanced..

Each quadrant represents a different characteristic: the left. such as in cargo tanks. United Nations Hazard Class Numbers. l l l 12 . Senses. hazard class. are required on all cargo tanks. if one detects an odor of hazardous materials. and others have no odor. Certain transportation vehicles must use DOT markings. Placards are used when hazardous materials are being stored in bulk (usually over 1. hydrogen sulfide). A marking scheme designed by the National Fire Protection Association (NFPA 704M System) identifies hazard characteristics of materials at terminals and industrial sites. Shipping papers should remain at the incident scene for use by all response personnel. the quantity.001 lb). but does not provide product-specific information. Labels designate hazardous materials kept in smaller packages. the right. They should provide the shipping name. Shipping papers. or it may not have any exterior warning. dead animals or fish. rail tank cars. This system uses a diamond divided into four quadrants. Odor. Railcars may have the names of certain substances stenciled on the side of the car. Shipping papers can clarify what is labeled as dangerous on placards. The location where the shipping papers are stored can be problematical. including identification (ID) numbers. and quantity. because the container or vehicle holding a hazardous material may be improperly labeled or recorded.. Oxy stands for oxidizer). symbols. vapor clouds. ID number. and the bottom. These convey information through use of colors.g. on the products themselves. are now required to list a 24-hour emergency information telephone number. A number from zero through four in each quadrant indicates the relative risk of the hazard. however. In addition. and other packages that carry hazardous materials.g. American National Standard Institute (ANSI) Standards for Precautionary Labeling of Hazardous Industrial Chemicals.. and either hazard class wording or four-digit identification numbers. portable tanks. color or taste at all (e.l Markings/Colors. it does not reveal the compound s reactivity with other chemicals. and skin or eye irritation can signal the presence of hazardous materials. Caution must be exercised. or on shipping papers. carbon monoxide).. Placards/Labels. however. Shipping Papers. red quarter pertains to flammability. The military also uses distinctly shaped markings and signs to designate certain hazards. Some chemicals. although some chemicals have a detectable odor at levels below their toxic concentrations. Identification numbers. yellow area is for reactivity. This system does not indicate what the product is. W indicates dangerous when wet. or its exact location. can impair an individual s sense of smell (e. Hazard Communication Standards. Generally. located on both ends and both sides. and may indicate whether the material is waste or poison. with zero representing the minimum risk. blue section refers to health. it should be assumed that exposure has occurred and the individual is still in the danger area.g. Binoculars are helpful to ascertain visible information from a safe distance. fire. the top. which must accompany all hazardous material shipments. These markings may be found on vehicles. often they are found in close proximity to the hazardous material(s) or in other locations not easily accessible during an emergency. white quadrant highlights special information (e.

needs to be interpreted with respect to the specific release scenario. however. and placarding guide. especially obvious sources such as the information provided on a label or in shipping papers. All such information. and the potential for secondary contamination. Identifying the hazardous material and obtaining information on its physical characteristics and toxicity are vital steps to the effective management of a hazardous materials incident.Appendix A provides greater detail on the NFPA s 704M system. There is also a vast array of telephone and computer-based information sources concerning hazardous materials. Disadvantages include the difficulty of determining the correct identity for an unknown chemical through descriptive text. Exhibit II-1B is a list of suggested telephone numbers that should be filled in for your community. and they are relatively inexpensive. labeling. Note. Since each compound has its own unique set of physical and toxicological properties. the DOT s hazardous materials marking. however. they can be kept in the response vehicle. Printed reference materials provide several advantages: they are readily available. its relative potency. and the Department of Labor s MSDS. a complete list of the materials available. early and accurate identification of the hazardous material(s) involved allows emergency personnel to initiate appropriate management steps. They may also recommend decontamination procedures. that not all online databases are peer reviewed. Exhibit II-1A is a partial listing of the many information resources available by telephone. Care and planning should be used when selecting information sources. and advice on the adequacy of specific types of protective gear. Exhibit II-2 provides a partial listing of computerized and online information sources. A selected bibliography of written material is included at the end of each section of this guidebook. Planning is an essential part of every response. the logistics of keeping the materials current. The aim of the health provider should be to make a chemical-specific identification while exercising caution to prevent exposure to any chemicals. It is important that any and all available clues are used in substance identification. They can help by describing the toxic effects of a chemical. however. 13 . they are not dependent on a power source or subject to malfunction. for example. it is not. which is a ready source of information 24 hours a day. Many resources are available to provide information concerning response to and planning for hazardous materials incidents. including the regional Poison Control Center. some medical management information may be based only on DOT or MSDS data. clinical management strategies. and many of these resources can provide guidance in the formation of an effective response plan. and the problem that no single volume is capable of providing all the information that may be needed.

intra-regional only: 1-800-438-2474 1-404-562-9900. emergencies: 1-415-744-2000 1-206-553-1200 14 . NY. OH. to 6:00 p. OR. NH. CA. 1-617-918-1111 1-212-637-3000 1-215-814-2900. NM. DC. HI. UT. ME. TN) Region V (IL. OK.Exhibit II-1A Telephone Information and Technical Support References Resource Chemical Transportation Emergency Center (CHEMTREC) Contact Services Provided 1-800-424-9300 24-hour emergency number connecting with manufacturers and/or shippers.m. MP. KS. PR. For emergencies. rescue gear. Agency for Toxic Substances and Disease Registry (ATSDR) 1-404-639-6360 24-hour emergency number for healthrelated support in hazardous materials emergencies. FM. VT) Region II (NJ. NC. VA.m. Advice provided on handling. WA) website: Environmental response teams www. KY. etc. MI. ND.gov/regional available for technical assistance. MD. (EST). NV. ID. Contact number for technical questions about railway transport of hazardous materials. PA. Emergency Response & Removal Branch: 1-800-564-7577 1-312-353-2000 1-214-665-2200 1-913-551-7003 1-303-312-6312 1-415-744-1500. WY) Region IX (AZ. including onsite assistance. RI. MT. Provides information on SARA Title III. WV) Region IV (AL. list of extremely hazardous substances. LA. PW) Region X (AK. MS. MO. NE) Region VIII (CO. decontamination considerations. IN. SD. MA. GA. VI) Region III (DE. Available 9:00 a. MN. SC. call CHEMTREC (1-800-424-9300). MH. Bureau of Explosives 1-719-585-1881 Emergency Planning and Community 1-800-424-9346 Right-to-Know Act (EPCRA) and Resource Conservation and Recovery Act (RCRA) Information Hotline Environmental Protection Agency (EPA) Regional Offices Region I (CT.epa. TX) Region VII (IA. and planning guidelines. WI) Region VI (AR. Pacific Islands AS. FL. GU. Also provides access to the Chlorine Emergency Response Plan (CHLOREP).

safety. insecticides. A federal hotline for reporting oil and chemical spills where hazardous materials are responsible for death. referrals for laboratory analyses. cleanup. investigation of pesticide incidents. emergency treatment. toxicology. serious injury.Exhibit II-1A (continued) Resource National Animal Poison Control Center Contact 1-800-548-2423 1-888-426-4435 Services Provided 24-hour consultation services concerning animal poisonings or chemical contami nation. environmental chemistry. 24-hour consultation service for threats and releases pertaining to chemical and biological agents. fungicides. including pesticide products. Provides information about pesticide-Network related topics. property damage in excess of $50. and disposal procedures. health and environmental effects. or continuing danger to life and property. recognition and management of pesticide poisoning. Contact information for help in searching NPIRS database to get fact sheets on pesticides.purdue.edu/info/nptn National Response Center 1-800-424-8802 U.orst. and state and federally registered chemicals. Provides an emergency response team to investigate incidents and to perform laboratory analysis.000.edu/npirs National Pesticide Telecommunications (NPTN) (Oregon State University) 1-800-858-7378 website: ace.S. - National Pesticides Information Retrieval System (NPIRS) 1-765-494-6616 website: ceris. Army Soldier and Biological Chemical Command (SBCCOM) 1-800-368-6498 15 .

Army Soldier and Biological Chemical Command 16 .Exhibit II-1B Local Telephone Information and Technical Support Resource Worksheet Resource Contact (fill in for future reference) Services Provided (fill in for future reference) EPA Regional or State Office Regional Poison Control Center State Emergency Response Commission State Health Department State Emergency Management Office Local Fire Department Local Hazardous Materials Response Team Community Police Department Local Emergency Planning Committee Local Health Department State Department of Natural Resources FEMA Regional Office State Agriculture Office State Lab Office State EMS Office Hyperbaric Medicine Chamber Burn Center CDC U.S.

leaks.nlm. 20590-0001 website: www. Colorado 80111-4740 (800) 525-9083 website: www. use of protective clothing. 17 .htm HSDB Representative National Library of Medicine Specialized Information Systems 8600 Rockville Pike Bethesda. Inc.000 frequently used chemicals. developed by the Coast Guard and comprised of reviews on fire hazards. and fires. Chemical identification database assists in Hazardous Materials Response Division determining substance(s) involved.Exhibit II-2 Computerized Data Sources for Information and Technical Support Data System CAMEO Contact CAMEO Database Manager 7600 Sand Point Way. provides reviews on the toxicity. 63 .oxmol.mil/hmis.shtml Micromedex.com/software/cis/ details/CHRIS.nih. compiled by the National Library of Medicine. Suite 300 6200 S.gov/sis1 HAZARDTEXT Assists responders dealing with incidents involving hazardous materials. N. Provides information on emergency medical treatment and recommendations for initial hazardous response. physicochemical properties. and and regulatory status of over 4. and identifying potential hazards.1 (Hazardous Materials Incident Report Form).Room 8104 400 7th Street SW Washington. HSDB Hazardous Substances Data Bank. hazards. Chemical Hazard Response Information System. such as spills. and shipping information for over 1.000 chemicals.dla.dlis. Department of Transportation D. providing response recommendations.H.htm Kevin Coburn Information Systems Manager U. health hazards. Inc. Seattle.M. Transportation-related incidents may be reported on DOT form 5800. D. fire-fighting recommendations.micromedex. Washington 98115 (206) 526-6317 website: www. Maryland 21031 (800) 247-8737 website: www. HMIS Hazardous Material Information Systems contains information on hazardous materials. c/o Oxford Molecular Group 11350 McCormick Road Executive Plaza. Maryland 20894 (301) 496-6531 website: sis.com/products/ pd-main.E.C. predicting downwind concentrations.epa. reactivities.S. Syracuse Way Englewood. CHRIS CIS.gov/ceppo/cameo Description Computer-aided management of National Oceanic and Atmospheric Administration (NOAA) operations available to on-scene responder(s). Suite 1100 Hunt Valley.

micromedex. TOMES TOXNET Toxicology Data Network (TOXNET) National Library of Medicine Specialized Information Services 8600 Rockville Pike Bethesda. and the Chemical Carcinogenesis Research Information System. the Registry of Toxic Effects of Chemical Substances. Colorado 80111 (800) 525-9083 website: www. Inc. and recommends procedures for handling cleanups.htm MEDITEXT Micromedex. CHRIS. 1st MEDICAL RESPONSE Micromedex. It provides information regarding hazardous properties of chemicals and medical effects from exposure.oxmol.shtml Micromedex. Syracuse Way Englewood. Maryland 20894 (301) 496-6531 website: sis.htm Provides recommendations regarding the evaluation and treatment of exposure to industrial chemicals.micromedex. Syracuse Way Englewood. Colorado 80111 (800) 525-9083 website: www.gov/sis1 18 . Suite 1100 Hunt Valley. Maryland 21031 (800) 247-8737 website: www. TOXNET provides information on the health effects of exposure to industrial and environmental substances. Inc.com/products/ pd-main. Suite 300 6200 S. Inc. Colorado 80111 (800) 525-9083 website: www.micromedex.nlm.nih. Hazardtext. 11350 McCormick Rd. HSBD. The Tomes Plus database contains Meditext.com/products/ pd-main. The Tomes Plus Information Systems is a series of comprehensive databases on a single CD-ROM disc. and 1st Medical Response Protocols. Executive Plaza 3. PROTOCOLS Suite 300 6200 S. Syracuse Way Englewood.Exhibit II-2 (continued) Data System Contact Description Helps develop training programs and establish protocols for first aid or initial workplace response to a medical emergency. Inc.com/products/ pd-main. Suite 300 6200 S. A computerized system of three toxicologically oriented data banks operated by the National Library of Medicine the Hazardous Substances Data Bank.htm Oxford Molecular Group. OHMTADS Oil and Hazardous Materials/Technical Assistance Data Systems provides information on the effects of spilled chemical compounds and their hazardous characteristics and properties. OHMTADS. assists in identifying unknown substances.com/software/cis/ details/OHMTADS.

or respiratory tract. sometimes called toxic end points.PRINCIPLES OF TOXICOLOGY FOR EMERGENCY DEPARTMENT PERSONNEL Exposure to hazardous chemicals may produce a wide range of adverse health effects. nose. such as age and the presence of certain chronic diseases. Irritant gases such as chlorine and ammonia can. Toxic chemicals often produce injuries at the site which they come into contact with the body. (2) the route of exposure. Examples of these adverse effects. are dependent on: (1) the toxicity of the chemical. (3) the nature and extent of exposure. a toxic chemical may be absorbed into the bloodstream and distributed to other parts of the body. This is merely a sample list of toxic end points that might be encountered (Exhibit II-3). emergency department personnel should understand the basic principles and terminology of toxicology. Many Exhibit II-3 Examples of Adverse Health Effects from Exposure to Toxic Chemicals Toxic End Point Target Organ Systems Example of Causative Agent Benzene Health Effect Acute Health Effect Chronic Carcinogenicity Multiple sites Dermatitis Acute myelogenous Chest tightness leukemia Dizziness Headache Liver necrosis Abdominal pain Fatty liver Dizziness Rash Wrist drop Vomiting IQ deficits Abdominal pain Encephalopathy Kidney damage Diarrhea Anemia Chest pain Hepatotoxicity Liver Carbon tetrachloride Vomiting Neurotoxicity Nervous system Lead Nausea Nephrotoxicity Kidney Cadmium Vomiting 19 . Toxicology is the study of the nature. typically the skin and the mucous membranes of the eyes. and (4) factors that affect the susceptibility of the exposed person. and nephrotoxicity (kidney damage). The likelihood of an adverse health effect occurring. neurotoxicity (nervous system damage). A chemical injury at the site of contact. while corrosive acids and bases can result in local damage to the skin. include carcinogenicity (development of cancer). To better understand potential health effects. hepatotoxicity (liver damage). and the severity of the effect. mouth. In addition. for example. is termed a local toxic effect. produce a localized toxic effect in the respiratory tract. and detection of poisons in living organisms. effects. producing systemic effects.

However. dermal contact (with skin or mucous membranes). Dermal contact does not typically result in as rapid absorption as inhalation. Health effects can also be acute or chronic. Partially water-soluble chemicals penetrate into the lower respiratory system causing delayed symptoms (12 to 24 h) which include trouble breathing.. and swallowing of saliva and mucus that contains contaminants may also result in exposure by this route. The amount of the compound absorbed by the body also depends on the duration of exposure and the concentration of the compound to which one is exposed. incidental hand-to-mouth contact. Acute health effects are short-term effects that manifest within hours or days. pulmonary. Routes and Extent of Exposure There are three main routes of chemical exposure: inhalation. Water solubility is also an important contributor for symptom development. for example. the less likely the chemical will produce an inhalable gas and vice versa.pesticides. Some materials that come in contact with the eyes can also be absorbed. Some of these effects may be delayed. although some chemicals are readily taken in through the skin. smoking. In addition. emergency medical personnel in both hospital or prehospital settings treat chemical exposures in patients who have ingested toxic substances as a result of accidental poisonings or suicide attempts. although this is an unlikely route of exposure in spills or discharges of hazardous materials. 20 . pulmonary edema. Carbon monoxide and cyanide are examples of asphyxiants. Ingestion is a less common route of exposure for emergency response personnel at hazardous materials incidents. argon. distributed to other sites in the body. However. It is important for medical providers to recognize that exposure to chemical compounds can result not only in the development of a single systemic effect but also in the development of multiple systemic effects or a combination of systemic and local effects. and produce adverse effects such as seizures or cardiac. propane. which may themselves be chemically contaminated. Simple asphyxiants are inert gases (e. Explosions may result in injection injuries and lead to imbedded foreign bodies. nitrogen) that displace oxygen in inspired air. Most of the compounds that are commonly inhaled are gases or vapors of volatile liquids. and coughing up blood. In addition. and ingestion. and potentially into the bloodstream. resulting in coughing and throat irritation. Many organic compounds are lipid (fat) soluble and can therefore be rapidly absorbed through dermal exposure. Chemical asphyxiants produce harm by preventing oxygen delivery or utilization for energy production by the body s cells. Compounds may also be introduced into the body through injection. Irritant agents that are water soluble usually cause early upper respiratory tract irritation. Knowing a chemical s vapor pressure (VP) can be useful in determining the inhalation risk for a particular exposure. the route of exposure may affect the nature of the symptoms that develop. solids and liquids can be inhaled as dusts or aerosols.g. or other problems. Asphyxiants are chemicals that impede the body s ability to obtain or utilize oxygen. Inhalation results in the introduction of toxic compounds into the respiratory system. Chronic health effects are long-term effects that may take years to manifest. sometimes for as long as 48 or more hours. such as vomiting or diarrhea. The route by which personnel are exposed to a compound plays a role in determining the total amount of the substance taken up by the body because a compound may be absorbed by one route more readily than by another. such as cancer. Inhalation of toxic agents generally results in a rapid and effective absorption of the compound into the bloodstream because of the large surface area of the lung tissue and number of blood vessels in the lungs. The lower the VP. are absorbed through the skin.

This principle. as well as a greater respiratory volume (liters/min/kg of body weight). Humans exposed to 100 ppm of tetrachloroethylene. are important in estimating the dose of the compound received by the patient. children are shorter than adults and since most toxic gases are heavier than air. 21 . In addition. Factors specific to the exposed patient.. However. and renal system also increase their susceptibility to injury as a result of exposure to chemicals. the severity of the toxic response increases. However. A complex relationship exists between the total amount of the compound absorbed by the body (dose) and the concentration of that compound in the environment. A child s skin is also more easily penetrated by chemicals. First. As shown in Exhibit II-5. a solvent that is commonly used for dry-cleaning fabrics. termed the dose-response relationship. such as headache and drowsiness. exposure to 200 ppm tetrachloroethylene can result in a loss of motor coordination in some individuals. parts per million (ppm) of a compound in air). children have a larger lung surface area relative to their weight than adults.It is important to recognize that children may be more susceptible to many toxic exposures. such as area of skin surface exposed. the concentrations increase as you get closer to the ground. Many factors affect the normal dose-response relationship and they should be considered when attempting to extrapolate toxicity data to a specific situation (Exhibit II-4). This occurs for a number of reasons. Finally. liver. the severity of the toxic effect also depends on the duration of exposure. presence of open wounds or breaks in the skin. It is probable that the child s lung is a more effective absorbent surface than that of the adult. This relationship is important for emergency medical personnel to understand because the adverse effects produced by a toxic compound are usually related to the dose of that compound received by a patient.500 ppm for 30 minutes may result in a loss of consciousness (Exhibit II-5). even when they all are exposed to the same scenario. Children s immature central nervous system. in part because they are likely to receive a higher dose relative to body weight than an adult. the actual dose of the compound received by the patient is seldom known. including pica. Children also have a larger skin area relative to their weight than do adults. All of these factors may lead to an increased dose relative to size in children as compared to adults. as the dose increases. may experience relatively mild symptoms. allowing more effective surface area for absorption in dermal exposures. a factor that influences the dose of the compound in the body.g. children are more likely to ingest toxic chemicals because of increased hand-to-mouth behavior. Dose-Response Relationship The effect produced by a toxic compound is primarily a function of the dose of the compound. is a key concept in toxicology. allowing for more rapid and effective dermal absorption. and exposure to 1. Typically. because we usually only monitor the concentration of the toxic substance in the environment (e. and the rate and depth of respirations.

physical characteristics (size. breakdown products. intolerable eye and respiratory tract irritation Coma 1. freebase. physical properties (volatility.). health status. ingestion. concentration. drowsiness Dizziness. etc. hormones. solubility.). immunology. route of exposure (inhalation.500 ppm 30 minutes 22 . etc. etc. carriers Dose.000 ppm 7 hours 2 hours 10 minutes 1-2 minutes Duration of Exposure Effects on Nervous System Odor threshold Headache. additional chemicals present.). uncoordination Dizziness. soil. nutrition. solid. duration Heredity. pregnancy Media (air. water. liquid. loss of inhibitions Marked dizziness.Exhibit II-4 Classification of Factors Influencing Toxicity Type Factors related to the chemical Examples Composition (salt.). age. and fire Factors related to exposure Factors related to the exposed person Factors related to environment Exhibit II-5 Dose-Response Relationship for Humans Inhaling Tetrachloroethylene Vapors Levels in Air 50 ppm 100 ppm 200 ppm 600 ppm 1. dermal). preexisting diseases. temperature. air pressure. etc. humidity. presence of impurities. sex.

Exhibit II-6 lists a number of chemicals that may be encountered in dealing with hazardous materials incidents. as may values determined in animals with an underlying disease.Toxicity information is often expressed as the dose of a compound that causes an effect in a percentage of the exposed subjects. compounds with low LD50 values are more acutely toxic than substances with higher LD50 values. They also do not reflect possible additive effects from the mixture of chemicals sometimes found with exposure to hazardous materials. only 6. it is difficult to compare the effects seen in experimental animal studies to the effects expected in humans exposed to hazardous materials in the field. This same age dependence may exist in humans. emergency medical personnel should remember that the LD50 and LC50 values are only useful for comparing the relative approximate toxicity of compounds. however. A similar term is the lethal concentration 50 (LC50). LD50 values typically come from experimental animal studies. Also. LC50 and LD50 values are also usually determined in healthy adult animals. This is the dose that is lethal to 50 percent of an animal population from exposure by a specific route (except inhalation) when given all in one dose. It is known that many chemicals are more toxic (lower LD50 or LC50 values) in young or newborn animals than in adults.800 mg/kg tetrachloroethylene is lethal to 50 percent of rats that received the compound orally. From Exhibit II-6 it can be seen that a dose of 3. and the reported acute LD50 values of these compounds when they are administered by ingestion to rats.4 to 10 mg/kg of sodium cyanide is required to produce the same effect. Because of the anatomical and physiological differences between animals and humans. Therefore. Which may occur is difficult to predict for many chemicals. particularly the brain. These dose-response terms are often found in the Material Safety Data Sheets (MSDSs) and other sources of health information. Furthermore. Therefore. damage to these organs may be more extensive and can be permanent. which are usually experimental animals. The immaturity of metabolizing enzymes in the liver may lead to either increased or decreased toxicity in infants relative to adults. infants may not be able to excrete chemicals from the body as efficiently as adults because their kidneys and liver are not fully developed. One dose-response term that is commonly used is the lethal dose 50 (LD50). Values determined in young animals may be quite different.000 to 3. These values are an index of only one type of response and give no indication of the ability of the compound to cause nonlethal. The LD50 values that appear in an MSDS or in the literature must be used with caution by emergency medical personnel. 23 . are still developing in young children. adverse or chronic effects. This may lead to longer and greater exposure to the chemical than would occur in an adult with the same relative exposure. which is the concentration of a material in air that on the basis of respiratory exposure in laboratory tests is expected to kill 50 percent of a group of test animals when administered as a single exposure (usually 1 hour). Because several organs.

smoking. or ceiling concentration limits to which the worker can be exposed without adverse effects. and medications may also increase an individual s sensitivity to toxic chemicals. The presence of preexisting medical conditions (e. hepatic.. however. Not all chemicals. for example. ceiling values. Examples of these limits are listed in Exhibit II-7A.4-10 50-230 83-560 88-91 2.600-7. Thus. previous exposure to toxic chemicals. diabetes) can also increase one s susceptibility to toxic chemicals. and any exposure to these compounds may be associated with some risk of developing cancer. diet). 24 . Therefore. pulmonary. are more likely to experience adverse health effects after exposure to a toxic chemical because of a reduced ability to metabolize that compound. literature values for levels that are not likely to produce an effect do not guarantee that an effect will not occur. Respiratory distress in people with asthma may be triggered by exposure to toxic chemicals at lower concentrations than might be expected to produce the same effect in individuals without respiratory disease.g.800 Sodium cyanide Pentachlorophenol Chlordane Lindane Toluene Tetrachloroethylene 1 Milligrams of the compound administered per kilogram body weight of the experimental animal. Some individuals.000-3.Exhibit II-6 Acute LD50 Values for Representative Chemicals When Administered Orally to Rats Chemical Acute Oral LD50 (mg/kg)1 6.. personal habits (e. exposure to concentrations of toxic compounds that would not be expected to result in the development of a toxic response in most people may cause an effect in susceptible individuals. Responses to toxic chemicals may differ among individuals because of the physiological variability that is present in the human population. Some carcinogens (cancer-causing chemicals) may produce a response (tumors) at any dose level.g.000 3. Exposure Limits The various occupational exposure limits found in the literature or on an MSDS are based primarily on time-weighted average limits. Factors such as age. or renal disease. have a threshold level.

These values are designed for a healthy adult working population and have limited utility when applied to some of the at risk groups mentioned previously. Emergency Response Planning Guidelines (ERPGs). Emergency medical personnel responsible for the management of chemically contaminated patients should be familiar with all of these exposure limits because they will be encountered in various documents dealing with patient care or the selection of PPE. including those who are transported to a hospital before they are decontaminated. At best. these hospitals should make arrangements with the local fire department or hazmat team to be ready. A list of general toxicology references is provided at the end of this section that will allow emergency medical personnel to undertake a more in-depth examination of the principles of toxicology. it is difficult to interpret how these values should be used by emergency medical personnel when dealing with a hazardous materials incident. PERSONNEL PROTECTION AND SAFETY PRINCIPLES This section provides information on personal protective equipment (PPE) and safety principles to emergency medical personnel who. Staff must be initially trained in the proficient use of PPE. IDLH. In the majority of cases. This brief discussion highlights some fundamental concepts of toxicology. to decontaminate patients. and perhaps to assist in selecting appropriate levels of personal protective equipment (PPE).The values listed in Exhibit II-7A were established to provide worker protection in occupational settings. According to state and federal regulations. In these cases. tested. special exposure limits have been established. and respirators and their cartridges have to be properly fitted. hospital staff will not experience incidents involving chemically contaminated patients frequently enough to keep them optimally trained or their equipment properly maintained. because of their proximity to a chemical industrial area or transport corridor. Of the occupational exposure limit values shown in Exhibit II-7A. Furthermore. the ACGIH limits have certain caveats that may or may not affect the usefulness of the values. these occupational exposure limits are only useful if trained personnel and appropriate instrumentation are available for measuring the levels of toxic chemicals in the air at the spill site. Because the settings in which these values are appropriate are quite different than an uncontrolled spill site. only the OSHA values are regulatory limits. given their workload mix and fiscal constraints. may be required to treat chemically contaminated patients. In addition. PEL. and Acute Exposure Guidelines (AEGLs. and REL values can be used as benchmarks for determining relative toxicity. Emergency medical personnel responsible for managing chemically contaminated patients are encouraged to obtain further training in their recognition and treatment. The ACGIH values are for guidance only and are not regulatory limits. TLV. may not be able to expend the funds and time necessary to accomplish this task. Considerations in determining what a hospital s capabilities should be include the number of incidents occurring locally (several per week versus only a few per year) and proximity to industries or transportation routes that have the potential for a hazardous materials incident (see Section I SARA Title III). and must maintain that proficiency. Some of these conditions are individual susceptibility or aggravation of a preexisting condition. equipment must be maintained according to OSHA specifications. Because of the limitations of PELs and TLVs. 25 . Many hospitals. if the situation warrants. Short-term Public Emergency Guidance Levels (SPEGLs). specifically respiratory equipment. and stored. under development by the EPA) have been designed to assist emergency personnel in making decisions regarding nonworkplace exposures (Exhibit II-7B).

Exhibit II-7A Occupational Exposure Limits Value Threshold Limit Value (ACGIH)1 Abbreviation TLV Definition Refers to airborne concentrations of substances and represents conditions under which it is believed that nearly all workers may be repeatedly exposed day after day without adverse effect. Threshold Limit Value: Time-Weighted Average (ACGIH)1 TLV-TWA Threshold Limit Value: Short-Term Exposure Limit (ACGIH)1 TLV-STEL Threshold Limit Value: Ceiling (ACGIH)1 Permissible Exposure Limit (OSHA)2 Immediately Dangerous to Life and Health (OSHA)2 TLV-C PEL IDLH Recommended Exposure Limit (NIOSH)3 REL 1 2 American Conference of Governmental Industrial Hygienists Occupational Safety and Health Administration 3 National Institute for Occupational Safety and Health 26 . day after day. or (3) narcosis of a sufficient degree to increase the likelihood of accidental injury. Same as TLV-TWA. The time-weighted average concentration for a normal 8-hour work day and a 40-hour work week. expressed as a ceiling limit or time-weighted average for an 8. or to materially reduce work efficiency. to impair self-rescue. (2) chronic or irreversible tissue damage.or 10-hour work day. A maximum airborne concentration from which one could escape within 30 minutes without any escape-impairing symptoms or any irreversible health effects. Highest allowable airborne concentration that is not expected to injure a worker. The concentration to which workers can be exposed continuously for a short period of time without suffering from (1) irritation. and provided that the daily TLV-TWA is not exceeded. without adverse effect. to which nearly all workers may be repeatedly exposed. The concentration that should not be exceeded during any part of the working exposure.

long-lasting effects or impaired ability to escape (AEGL-2).. Proposed short-term threshold or ceiling exposure value intended for the protection of the general public.Exhibit II-7B General Population Exposure Limits Value Emergency Response Planning Guidelines (AIHA)1 Abbreviation ERPG Definition Maximum airborne concentration below which it is believed that nearly all individuals could be exposed for up to 1 hour without (1) experiencing other than mild transient adverse health effects or perceiving a clearly defined objectionable odor (ERPG-1). An acceptable concentration for unpredicted. or (3) experiencing or developing life-threatening health effects (ERPG-3).g. 8. Represents the airborne concentration of a substance at or above which it is predicted that the general population (as defined above) could experience (1) notable discomfort (AEGL-1). and 1. short-term exposure of the general public in emergency situations. 16. (2) irreversible or other serious. and 8 hours. (2) experiencing or developing irreversible or other serious health effects or symptoms that could impair an individual s ability to take protective action (ERPG-2). 4 . 1. including susceptible or sensitive individuals but not those who are hypersusceptible or hypersensitive. single. Community Emergency Exposure Levels (CEELs). 4. Developed for four exposure periods: 30 minutes. 2. Short-term Public Emergency Guidance Level (NRC)2 SPEGL Acute Exposure Guidelines (EPA NAC/AEGL)3 AEGL 1 2 American Industrial Hygiene Association National Research Council 3 EPA National Advisory Committee/AEGL Committee 4 National Academy of Sciences 27 . May be developed for different exposure periods (e. Synonymous with the NAS4 term. or (3) life-threatening effects or death (AEGL-3). 24 hours).

PPE should be used in conjunction with other protective methods. To accomplish these goals. The actions of all personnel wearing PPE should also be closely observed by the safety officer and others during each work period. a comprehensive PPE program should include: (1) hazard identification. The use of PPE can itself create significant worker hazards. In general. and communication. the greater are the associated risks. and should be avoided. Medical surveillance evaluations should be conducted on all individuals both before and immediately after their use of PPE. restricted movement. with assistance from other onsite personnel. police officers. Thus. each employer must develop health and safety programs and provide for emergency response. use. Proper donning and doffing procedures must be followed. including limited visibility. physical. dehydration. and impaired vision. 28 . insufficient air supply. In addition. such as heat stress. No single combination of protective equipment and clothing is capable of protecting against all hazards. equipment and clothing should be selected that provide an adequate level of protection. Only individuals who are physically fit and have met the OSHA/NIOSH/NFPA training requirements should be wearing PPE during an incident. 1989. such as firefighters. 29 CFR (1910. OSHA standards mandate specific training requirements (8 hours of initial training or sufficient experience to demonstrate competency) for personnel engaged in emergency response to hazardous substances incidents at the First Responder Operations Level. Excessive protection can be as hazardous as under-protection. and EMS personnel. and (5) training. In addition. suit breach. and decontamination of PPE. Responders in PPE can also be frightening to pediatric patients. claustrophobia. maintenance. The purpose of PPE is to shield or isolate individuals from the chemical. OSHA s final rule (March 6.120)) as it applies to emergency medical personnel states: Training shall be based on the duties and functions to be performed by each responder of an emergency response organization. In addition. The two basic objectives of any PPE program should be to protect the wearer from safety and health hazards and to prevent injury to the wearer from incorrect use and/or malfunction of the PPE. reduced dexterity. physical and psychological stress.Federal Regulations Pertaining to Use of Personal Protective Equipment (PPE) The term personal protective equipment (PPE) is used in this document to refer to both clothing and equipment. Training is essential before any individual attempts to use PPE. (3) environmental surveillance. personnel should not be expected to use PPE without adequate training. These standards also are intended to provide additional protection for those who respond to hazardous materials incidents. PPE Complications Personnel wearing PPE are likely to encounter a number of potential problems. an emergency distress signal should be identified in the briefing before individuals enter the work area. (2) medical monitoring. the greater the level of PPE protection. and the effects of heat and cold. (4) selection. For any given situation. and biological hazards that may be encountered at a hazardous materials incident. mobility.

Respirators are designed to protect the wearer from contamination by inhalation but they must be worn properly and fit-tested frequently to ensure continued protection. and it should not be worn on any site where respiratory or skin hazards exist. Appendix C outlines the protective equipment recommended for each level of protection. the degree of contact. Level D is primarily a work uniform. and respiratory system may be affected by more than one of these routes of entry. and are subsequently absorbed or ingested. criteria for using air-purifying respirators are met. Direct contact refers to chemical contact with the skin or eye. Level C protection should be selected when the type of airborne substances is known. nose. and direct contact. or smokes a cigarette. This involves a full facepiece.Levels of Protection EPA has designated four levels of protection to assist in determining which combinations of respiratory protection and protective clothing should be employed: Level A protection should be worn when the highest level of respiratory. but a lower level of respiratory protection. For more information on this subject. coveralls. It provides no respiratory protection and minimal skin protection. eats. protection. ingestion. It provides the same level of skin protection as Level B. vapor-tight. throat. and mucous membrane protection is needed. skin. air-purifying. Activities can also be undertaken to determine which level of protection should be chosen. concentration is measured. Mucous membranes in the mouth. and self-contained breathing apparatus (SCBA). Skin is protected by garments. if not Level A. Exhibit II-8 illustrates these four levels of protection. eye. Many hazardous materials adhere to and assimilate with the moist environment provided by these membranes. canister-equipped respirator and chemical-resistant clothing. hard hat. nonvapor-tight suit and SCBA). twopiece chemical splash suit. and skin and eye exposures are unlikely. and full-face respirators protect against ingestion and direct eye contact. disposable chemical-resistant coveralls. Factors to be considered in selecting the proper level of protection include the potential routes of entry for the chemical(s). chemical-resistant inner/outer gloves. It differs from Level A only in that it provides splash protection through use of chemical-resistant clothing (overalls and long-sleeved jacket. 29 . Ingestion usually is the result of a health care provider transferring hazardous materials from his hand or clothing to his mouth. chemical-resistant boots with steel toe and shank. Inhalation occurs when emergency personnel breathe in chemical fumes or vapors. chemical-resistant suit. or fully-encapsulated. Level B protection should be selected when the highest level of respiratory protection is needed but a lesser degree of skin and eye protection is required. Routes of Entry PPE is designed to provide emergency medical personnel with protection from hazardous materials that can affect the body by one of three primary routes of entry: inhalation. drinks. It consists of a fully-encapsulated. inner ear. and the specific task assigned to the user. become trapped or lodged in the mucus. The EPA and NIOSH recommend that initial entry into unknown environments or into a confined space that has not been chemically characterized be conducted wearing at least Level B. This can occur unwittingly when an individual wipes his mouth with his hand or sleeve.

Exhibit II-8 Levels of Protection Level A Level B Level C Level D 30 .

31 . ranging from fully-encapsulated body suits to gloves. Often such openings are the result of faulty manufacture or problems with the inherent design of the suit. a known concentration. Protective clothing is available in a wide assortment of forms. Permeation is the process by which chemical compounds cross the protective barrier of CPC because of passive diffusion. The rate at which a compound permeates CPC is dependent on factors such as the chemical properties of the compound. Selection of the appropriate CPC will depend on the specific chemical(s) involved. Penetration occurs when there is an opening or a puncture in the protective material. since no one material presently provides protection against all known chemicals. Emergency medical personnel must evaluate the properties of the chemical versus the properties of the protective material. taking a pulse) difficult without constant practice. There is. thus limiting the transfer of heat from the body through natural evaporation. multilayered garments may be employed in specific situations despite their negative impact on dexterity and agility. Improperly used equipment can expose the wearer to danger. As a result. Research is now underway to find lightweight suits that are breathable but still protective against a wide range of chemicals. however. Most CPC manufacturers provide charts on the breakthrough time the time it takes for a chemical to permeate the material of a protective suit for a wide range of chemical compounds. Compatibility charts should be consulted to determine the appropriate type of boot and gloves to use. and zippers.g. Degradation can also result in an increased permeation rate through the garment. and the concentration of the chemical on the surface of the protective material. CPC is designed to afford the wearer a known degree of protection from a known type. Cooling vests are sometimes used in warm weather situations to keep the body temperature normal..Chemical Protective Clothing (CPC) Protective clothing is designed to prevent direct contact of a chemical contaminant with the skin or body of the user. CPC comes in a variety of materials. and other changes in the structural characteristics of the garment. but only if it is properly fitted and worn correctly. checking breathing. and boot covers. permeation. Chemical resistant inner and outer layered gloves must also be worn. hard hats. no single material that will afford protection against all substances. These openings can include unsealed seams. and on the specific tasks to be performed. Another factor to keep in mind when selecting CPC is that most protective clothing is designed to be impermeable to moisture. Essential to any protective ensemble are chemical resistant boots with steel toe and shank. buttonholes. The effectiveness of CPC can be reduced by three actions: degradation. Examples of degradation include cracking and brittleness. This is a particularly important factor in hot environments or for strenuous tasks since such garments can increase the likelihood of heat-related injuries. Chemical degradation occurs when the characteristics of the material in use are altered through contact with chemical substances or aging. offering a range of protection against a number of chemicals. and penetration. earplugs. Wearing multiple layers of gloves impairs dexterity and makes performing basic aspects of patient assessment (e. but with mixed results. and a known length of exposure to a hazardous material. the nature of the protective barrier in the CPC.

manufacturers have color-coded the cartridges and canisters to indicate the chemical or class of chemicals for which the device is effective. However.5 percent) since it depends on ambient air to function. In addition. The major advantage of the APR system is the increased mobility it affords the wearer. but do not provide eye protection. The use of half-mask APRs is not generally recommended by emergency response organizations. In addition. although some are approved for use with other contaminants. if breakthrough of the contaminant occurs first. a respirator can only be used where there is sufficient oxygen (19. NIOSH has established comprehensive requirements for the certification of respiratory protection equipment. Once used. disposables. There are two basic types of respirators: air-purifying and atmosphere-supplying. such as asbestos. OSHA has set mandatory legal minimum requirements (29 CFR (1910. The correct respirator must be employed for the specific hazard in question. After use. when environmental levels of a substance exceed the filtration capacity of the canisters. Personnel must be fit-tested for use of all respirators. and use of respirators. However. Anyone attempting to wear any type of respirator must be trained and drilled in its proper use. Cartridges and canisters are designed for specific materials at specific concentrations. This type of APR depends on a filter to trap particulates. To aid the user. Material Safety Data Sheets (if available) often specify the type of respirator that will protect users from risks. or absorption. if the agent is unknown. manufacturers suggest the types of hazards against which their respirators can offer protection. Three basic types of APRs are used by emergency personnel: chemical cartridges or canisters. 32 . APRs should not be used when substances with poor warning properties are known to be involved or. The most commonly used APR depends on cartridges (Exhibit II-9) or canisters to purify the air by chemical reaction. NIOSH recommends that use of a cartridge not exceed one work shift. filtration. the entire respirator is usually discarded. then the cartridge or canister must be immediately replaced. and powered air-purifiers. Even a small space between the respirator and you could permit exposure to a hazardous substance(s) by allowing in contaminated air. Air-Purifying Respirators (APRs) An air-purifying respirator purifies ambient air by passing it through a filtering element before inhalation. Disposable APRs are usually designed for use with particulates. Furthermore.134)) for respiratory protection. These respirators are typically half-masks that cover the face from nose to chin. training. adsorption.RESPIRATORY PROTECTION Substantial information is available for the correct selection. Filters may also be used in combination with cartridges and canisters to provide an individual with increased protection from particulates. In addition. Atmospheresupplying respirators include self-contained breathing apparatus (SCBA) and supplied-air respirators (SAR). cartridges and canisters should be considered contaminated and disposed of accordingly. equipment must be inspected and checked for serviceability on a routine basis.

Exhibit II-9 Chemical Cartridge Air-Purifying Respirator Powered Air-Purifying Respirators (PAPRs) have the advantage of creating an improved facemask seal. One disadvantage of all SCBAs is that they are bulky and heavy. which contains its own air supply. who exhales into the atmosphere. and the supplied-air respirator (SAR). Closed-circuit SCBAs. Air being blown into the mask can also have a cooling affect. Exhibit II-10 illustrates an example of each. This affords the SCBA wearer the highest level of protection against airborne contaminants since any leakage may 33 . PAPRs come with either full facemasks or pullover hoods. In this system. most often used in emergency response. closed-circuit. Self-Contained Breathing Apparatus (SCBA) A self-contained breathing apparatus respirator is composed of a facepiece connected by a hose to a compressed air source. also known as rebreathers. According to OSHA guidelines. There are three varieties of SCBAs: open-circuit. The most common SCBA is the open-circuit. positive-pressure type. a higher air pressure is maintained inside the facepiece than outside. air is supplied to the wearer from a cylinder and enters the facepiece under positive pressure. In contrast to negativepressure units. provide clean air from a cylinder to the wearer. Atmosphere-Supplying Respirators Atmosphere-supplying respirators consist of two basic types: the self-contained breathing apparatus (SCBA). and can be used for only the period of time allowed by air in the tank. and escape. men with beards can wear the hooded system but not the full facemask. Open-circuit SCBAs. thus reducing the risk of inhalation injury. Escape SCBAs provide air for a limited amount of time and should only be used for emergency escapes from a dangerous situation. which depends on an air supply provided through a line linked to a distant air source. Some individuals find the hooded system to be more comfortable and less claustrophobic than the mask. recycle exhaled gases and contain a small cylinder of oxygen to supplement the exhaled air of the wearer.

One major advantage the SAR has over the SCBA device is that it allows an individual to work for a longer period. only positive-pressure SARs are recommended for use at hazardous materials incidents. a worker must retrace his steps to stay connected to the SAR. however.120(q)(iv)) in incidents where personnel are exposed to hazardous materials. and therefore cannot leave the contaminated work area by a different exit. SARs are less bulky than SCBAs. SARs also require the air source to be in close proximity to the work area. for use in case of an emergency.Exhibit II-10 Self-Contained Breathing Apparatus and Supplied-Air Respirators force the contaminant out. In addition. However. usually in the form of a small. The use of a negative-pressure SCBA is prohibited by OSHA under 29 CFR (1910. When wearing a negative-pressure-type apparatus. personnel using an SAR must carry an immediately operable emergency escape supply of air. By necessity. In addition. there is always the potential danger that contaminants may enter the facemask if it is not properly sealed. Supplied-Air Respirators (SARs) Supplied-air respirators differ from SCBAs in that the air is supplied through a line that is connected to a source away from the contaminated area. 34 . SARs are available in both positive.and negativepressure models. compressed air cylinder.

or degradation to. and the technical decontamination process is discussed below. Care must be taken at all times to ensure that the decontamination methods being used do not introduce fresh hazards into the situation. Protects the community by preventing transportation of hazardous materials from the hospital to other sites in the community by secondary contamination. a nine-station decontamination process need not be set up if only a bootwash station would suffice. is necessary to make these kinds of decisions. Many incidents have occurred involving seemingly successful rescue. and the facilities to which they bring the victim.EMERGENCY DEPARTMENT PERSONNEL DECONTAMINATION Decontamination is the process of removing or neutralizing harmful materials that have gathered on personnel and/or equipment during the response to a chemical incident. The design of the decontamination process should take into account the degree of hazard and should be appropriate for the situation. These all include the systematic removal of contaminants by washing. However. personnel must have received at least the same degree of training as required for workers who respond to hazardous materials incidents. l l l This section only addresses the steps necessary for dealing with worker decontamination. The appropriate decontamination procedure will depend on the contaminant and its physical properties. if contamination is unavoidable. usually with soap and water. It should be stressed that to carry out proper decontamination. contaminate themselves. The decontamination stations and process should be confined to the Contamination Reduction Zone (see Exhibit II-11). Protects workers by reducing the contamination and resultant permeation of. the residues of the decontamination process must be treated as hazardous wastes. In rare cases. Avoiding contact is the easiest method of decontamination that is. and then rinsing. Physical decontamination of protective clothing and equipment can be achieved by several different means. their protective clothing and equipment. then proper decontamination or disposal of the worker s outer gear will be necessary. 35 . Steps for personnel decontamination are outlined in Exhibit II-12. With extremely hazardous materials. or consultation with an expert. Thoroughly researching the chemicals involved and their properties. the equipment. and treatment of chemically contaminated individuals by unsuspecting emergency personnel who. Patient decontamination will be addressed in Section III. Segregation and proper disposal of the outer gear in a polyethylene bag or steel drum will be necessary until thorough decontamination is completed. it may be necessary to dispose of equipment as well. In addition. Protects other patients already receiving care at the hospital. boots. Decontamination is of the utmost importance because it: l Protects all hospital personnel by sharply limiting the transfer of hazardous materials from the contaminated area into clean zones. gloves) and systematically removing these garments in a manner that precludes contact with the contaminant. in the process. There is a trend toward using disposable clothing (e. transport. Patient Management. not to get the material on the worker or his protective equipment in the first place.g. suits.. the use of solvents may be necessary. For example.

Double-bag all clothing and label bags appropriately. Other networks that may have to be activated include one linking the hospital emergency department to EMTs and one dedicated for use by the teams in the Exclusion and Contamination Reduction Zones. Secure the dirty area until the level of contamination is established and the area is properly cleaned. remove undergarments and place them in a plastic bag. 5. Remove suit. The last person removing his/her mask may want to wash all masks with soapy water before removing his/her suit and gloves. Remove other boot/shoe cover and put that foot over the clean line.Technical Decontamination Process for Hospital Personnel Personnel should remove protective clothing in the following sequence. Remove tape (if used) securing gloves and boots to suit. Remove mask. When an Incident Command System is activated. 9. Remove inner gloves and discard them in a drum inside the dirty area. Avoid shaking. 8. Send bag for decontamination. Personnel should then move to a shower area. 1. turning them inside out as they are removed. COMMUNICATIONS Effective communications are essential to maintaining incident control. one person is often assigned to manage communications. Personnel should shower and redress in normal working attire and then report for medical surveillance. 7. Remove boot/shoe cover from one foot and step over the clean line. Remove outer gloves. Place the masks in plastic bag and hand the bag over the clean line for placement in second bag held by another staff member. 3. These include a dedicated radio frequency and a sufficient number of radios for distribution to all participating agencies. 36 . 2. such as the Poison Control Center and the Health Department. turning it inside out and folding it downward. 4. Another network should link the onsite command post to support groups. 6.

Exhibit II-11 NIOSH/OSHA/USCG/EPA Recommended Zones 37 .

Exhibit II-12 Nine-Step Personnel Decontamination Plan 38 .

and Biologicals.). Currance. Stamford. P. Clayton. St. (ed. NY: Van Nostrand Reinhold.. Smith. G. and W. Bowen. Hayes. 1988. Washington. NJ: Brady. 1997.). 1994. P. Levine.W. Chapman & Hall.C. 1994. W. 1993.E.E. Heckelman.O. 1999. Casarett and Doull s Toxicology: The Basic Science of Poisons. J.R. Borak. Handbook of Common Poisonings in Children.M.G.J. MO: Mosby. Patty s Industrial Hygiene and Toxicology. Barceloux. New York. Bronstein.L. Currance.G. and S. MA: National Fire Protection Association. and A. 1998. A. 2nd ed. 1996. Terms for Personal Protective Equipment. L. Goldfrank s Toxicological Emergencies. 2nd ed. Kinneary. Callan. Amdur. New York. Mansdorf. Emergency Care for Hazardous Materials Exposure. 1995. Guidelines for the Selection of Chemical Protective Clothing. Bronstein. Abbott. Hodgson. OH. 2nd ed. MO: Mosby. IL. Ellenhorn. 5th ed. Schuman. 1987. Books on Demand.Z. E.P. 3rd ed.C. Medical Toxicology: Diagnosis and Treatment of Human Poisoning. MA: Butterworth Publishers. Klaassen. Thomas. 1997. S. Cincinnati. Doull (eds. M. E. and J. Toxicology of the Eye. 6th ed. 1993. A Textbook of Modern Toxicology.L. 12th ed. and J. M. 1994. and D. Principles and Methods of Toxicology. Elk Grove Village. Boston.. 1994. NY: John Wiley and Sons. and F. Louis. 1991. 2nd ed. The Merck Index: An Encyclopedia of Drugs. Goldfrank. Springfield. Hazardous Materials for EMS. Martin (eds. Protecting Personnel at Hazardous Waste Sites. Englewood Cliffs. J. Emergency Management of Hazardous Materials Incidents. C. K. American Academy of Pediatrics. 4th ed. CT: Appleton and Lange.SELECTED BIBLIOGRAPHY American Conference of Governmental Industrial Hygienists. Chemicals. and J. McGraw-Hill Health Professions Division. 1996. 1993. Quincy. S.D. NY: Elsevier. Levi. Grant. IL: Charles C. and P. Stamford. A. 2nd ed. A. St. 4th ed. Louis. DC: CMA.D. and W. M. New York. Quick Selection Guide to Chemical Protective Clothing.). 39 . Chemical Manufacturers Association (CMA) and the Association of American Railroads.. and P. 2nd ed. Hazardous Materials Exposure-Emergency Response and Patient Care. Clayton.F. Budavari. CT: Appleton and Lange. Forsberg.

2nd ed.). 1993. Dangerous Properties of Industrial Materials. Washington.S. and G. Schwope. 1992. Washington. Proctor. Rom. MA: Little. MD. 8th ed. Edgewood.R. Fishman. FL: GDS Communications. R.Lu.D. 1992. NY: Van Nostrand Reinhold. U. Hazardous Materials Toxicology: Clinical Principles of Environmental Health. 2nd ed.P. J. N. USAMRICD Chemical Casualty Division. Emmitsburg. Quincy.O.). Franz (eds. Krieger. Army. Department of Defense.S. OH: American Conference of Governmental Industrial Hygienists.L. Inc. Jr.C. 1996. and Risk Assessment.I. Environmental Protection Agency. (ed. MD: National Audio-Visual Center.S. National Fire Academy and National Emergency Training Center. Costas. A.R. Region VII.. MD: HMEP Curriculum Guidelines. Baltimore. 1989. Hazardous Materials Guide for First Responders. DC: Environmental Protection Agency. DC: Government Printing Office. Guidelines for Public Sector Hazardous Materials Training. HAZTOX EMS Response For Hazardous Materials Incidents. Taylor & Francis.R.S. 1992. Target Organs. Weitzman. Medical Response to Chemical Warfare and Terrorism. Department of the Army. National Emergency Training Center. 3rd ed. Medical Aspects of Chemical and Biological Warfare. J. 40 . Environmental and Occupational Medicine. P. G. 3rd ed. 1999. Cincinnati. New York. Ulin. 1993. F. and D. Federal Emergency Management Agency and U. 1987. 1997. J. 3rd ed. U. Hazardous Materials Response Handbook. Chemical Response Planning and Operations.. Sax. DC: Borden Institute. Sullivan. U. NY: Van Nostrand Reinhold. Washington. MA: National Fire Protection Association.S.B. Stutz. 1985. Guidelines for the Selection of Chemical Protective Clothing. 1998. Chemical Hazards of the Workplace. Sidell. 1989. Miramar. Brown.R. and D. Fire Administration.J. 2nd ed. Boston. N. and M. Tokle. U. and S. Jackson. New York. Capitol Heights.S.H.. 1998. MD: Williams & Wilkins. Hughes. Recognizing and Identifying Hazardous Materials. F. U. W. Basic Toxicology: Fundamentals.

C.. the call should be verified before a hazardous materials response plan is initiated. and some of the same principles apply. including correct spelling Extent of patient decontamination in the field Estimated time of arrival After the above information is received.Section III. regional Poison Control Center. Ricks.B. prepared for the Federal Emergency Management Agency. Information that will aid in initiating appropriate actions includes: l l l l l l l l Type and nature of incident Caller s telephone number Number and ages of patients Signs and symptoms being experienced by the patients Nature of injuries Name of chemical(s) involved. Steps in the protocol must be practiced before a hazardous materials emergency occurs. Leonard and R. Further information on radiation response procedures is contained in Hospital Emergency Department Management of Radiation Accidents by R. Emergency department personnel should know their responsibilities and how to perform them. Ambulance personnel should be notified of any special approach or entrance to the emergency department and also advised 41 . ATSDR) should be contacted for information regarding definitive care procedures. radioactive exposure). and all required equipment should be immediately accessible. a predesignated resource center (e.g. When a hospital receives a call that a patient exposed to hazardous materials is being transported to its facility. Ricks. Many of these principles are outlined in the article Emergency Department Radiation Accident Protocol by R. Communications should be kept open with onsite response personnel to obtain as much advance information as possible. However. a planned course of action should be implemented.C. published in the September 1980 issue of Annals of Emergency Medicine. A checklist should be developed and made available for all telephone or radio communication centers. If incident notification comes through other than usual emergency communication channels. This should include the need for decontamination and what methods should be used.. Patient Management Growing concern about the proper treatment of chemically contaminated patients has outpaced adequate guidance on the subject. definitive work has been done on cases that bear similar characteristics (e.g. Individuals receiving a potential hazardous materials call should obtain as much information as possible.

preparation of a decontamination area. Emergency Department Mobilization The person receiving a call of an incoming victim(s) should notify the Nursing Supervisor or other designated individual. equipment needs. EMERGENCY DEPARTMENT PREPARATION Every member of the emergency department should be familiar with the hospital s hazardous materials response plan and be required to participate in scheduled drills. Preplanning with the fire department and/or hazmat team should determine the location. Often patients contaminated by hazardous materials are brought into the emergency department unannounced or not through regular EMS channels. Preparation for arrival of a contaminated patient should include notification of all services involved. who will in turn notify the appropriate personnel according to the hospital s response plan. This could be an ambulatory patient or an individual transported by private vehicle. A written copy of the plan should also be kept in a central location in the emergency department for quick reference. to prevent unauthorized entry. where arriving patients can be screened for adequate decontamination before entering. Ideally. Therefore. these individuals should be isolated from other patients and assessed and decontaminated as soon as possible. The ventilation system should either be separate from the rest of the hospital or turned off to prevent the spread of airborne contaminants through heating and air conditioning ducts to other 42 42 .not to bring the patient into the emergency department until he or she has been assessed by appropriate emergency department staff. A reception station should be set up just outside the emergency department entrance. the route from the emergency entrance to the Decontamination Area may also become contaminated and all persons along that route should be removed by security personnel prior to the arrival of the contaminated patient. The hospital operator should be instructed to notify security and maintenance. to control the entry of contaminated patients into the department. Security personnel should be stationed at the main entrance to the emergency department. and to direct the vehicle(s) transporting the patient(s) to the appropriate area. The ideal response to this situation is to call the fire department or a hazmat team that is properly trained and equipped to come to the hospital and set up a decontamination area outside the ambulance entrance. and logistics for decontamination outside of the hospital during all weather conditions. close to the Decontamination Area. A decontamination area should be large enough to facilitate decontamination of more than one patient and to accommodate the many personnel involved in patient treatment and contamination reduction. and suiting up of the decontamination team. Decontamination Area Preparation Any victim of a hazardous materials incident must be considered to be contaminated until demonstrated otherwise. Care should be exercised in walking on plastic sheeting because it can become very slippery when wet. this area should be protected with a barrier of plastic or paper sheeting taped securely to the floor. In any event. and the nurse on duty should contact the predesignated resource center.

and plastic garbage bags in a predesignated area outside the back door to the emergency department. Under most circumstances. To prevent unnecessary contamination. the best place to evaluate and initially treat contaminated patients is outside. and plain latex gloves will adequately protect hospital staff if they have to assist the patient in removing soaked clothing. especially if air-purifying respirators are used. If it is anticipated that your facility is likely to receive heavily contaminated patients who have not received prior decontamination. A clean member of the staff should stand on the clean side of the entrance to hand in supplies and receive medical specimens. soap. light switches. disposable chemical protective clothing and unmilled nitrile gloves offer additional protection. or performing eye irrigation. such as pesticides. a wading pool. If the ventilation system is shut off during the handling of a contaminated victim in an enclosed area. Personnel should not enter the area unless properly protected. OSHA regulations on atmospheric monitoring (29 CFR (1910. and no personnel or equipment should leave the area until properly decontaminated. However. A partial tent or curtain can provide for patient privacy. cabinet handles. where ambient ventilation will keep airborne cross-exposure low. With large amounts of concentrated corrosives or very oily materials. all nonessential and nondisposable equipment should be removed from the decontamination area. place it in a double bag. The patient may be able to remove his or her own contaminated clothing. and do his or her own soap and water decontamination. Weather permitting. ordinary hospital gowns.120)(q)(3)(iv)) should be followed. without prior training. The essential requirements for any decontamination task are: l l l l l A safe area to keep a patient while undergoing decontamination A method for washing contaminants off a patient A means of containing the rinsate Adequate protection for personnel treating the patient Disposable or cleanable medical equipment to treat the patient 43 . An outside or portable decontamination system is a viable substitute and would aid in preventing contamination of the emergency department and other patients. The floor covering should be securely taped to prevent slippage.parts of the facility. To address this. washing exposed skin and hair. Door knobs. and the entrance to the room marked with a wide strip of colored tape to indicate a contaminated area. the emergency department staff could be endangered. no person should wear and use specialized PPE. A practical alternative for facilities with limited resources is to have a warm shower nozzle. Some hospitals have radiation decontamination facilities that can be used with minor changes. then it may be advisable to purchase appropriate protective gear and to fit and train emergency department staff in its use. plastic goggles. and the floors should be covered with plastic or paper sheeting. especially respiratory protective gear. and other surfaces that have contact with hands should be taped.

Decontamination Team Preparation A decontamination team should be predesignated and trained in appropriate personal protection equipment and procedures. the regional Poison Control Center). as appropriate (see Section II). neoprene or disposable nitrile gloves. 44 44 . . should be changed whenever torn. .. and placed on the back of the protective suit. Multiple layers of surgical gloves.g. or a predesignated resource center (e. websites. telephone hotlines. Appropriate dress for the decontamination team should include: l l l A scrub suit. Nursing Supervisor Occupational Health and Safety Officer Security Maintenance Recorder . This may be determined by consulting reference guidebooks. Disposable chemical protective clothing with built-in hood and booties. database networks. will assist team members in communicating. The team should consist of: l l l l Emergency department physicians Emergency department nurses and aides A trauma surgeon. and with hood taped at the neck. Respiratory protection. Protective eyewear. Polyvinyl chloride (PVC) gloves taped to sleeves. The decontamination team should be equipped with personal protective clothing (as discussed in Section II) for whatever level is deemed appropriate for the substance(s) involved. l l l l A 2-inch-wide piece of masking tape with the team member s name written on it. . if injuries are present Support personnel . Plastic shoe covers. with the bottom layer taped.

If a patient s clothing was not removed at the incident site. breathing. Contaminated clothing should be double-bagged in plastic bags. In other words. emergency department personnel can then direct their attention to thorough decontamination and secondary patient assessment. contamination reduction should simultaneously be performed. transfer the patient. it may be necessary to flush exposed skin and eyes with water or normal saline for an extended period of time. Once wounds have been cleaned. if necessary. With a few exceptions.PATIENT ARRIVAL The emergency physician-in-charge or an emergency department nurse should meet the ambulance upon arrival and assess the condition of the patient(s) as well as the degree of contamination. contain the contamination present. and triage procedures should be initiated at this point. care should be exercised so that they are not recontaminated. For some chemicals. decontamination should be performed before patient transport. PATIENT DECONTAMINATION The basic purpose of decontamination is to reduce external contamination. This can be aided by covering the wounds with a waterproof dressing. and brushing or wiping off any contamination. intact skin is more resistant to hazardous materials than injured flesh. During initial patient assessment and stabilization. decontamination should begin at the head of the patient and proceed downward with initial attention paid to contaminated eyes and open wounds. The recorder should note on a diagram of the body the areas found by the physician to be contaminated. Once life-threatening matters have been addressed. in cases of carbon monoxide exposure). It is important to remember that appropriate personal protective clothing must be worn until personnel are no longer in danger. sealed. including jewelry and watches. and prevent the further spread of potentially dangerous substances. remove what you can and contain what you can t. Therefore. however. Identification of the hazardous materials involved can be simultaneously performed by other personnel. and labeled. This will reduce further exposure to the patient and lessen the extent of contamination introduced into the emergency department. such as strongly alkaline substances. 45 . This consists of cutting away or otherwise removing all suspected contaminated clothing. Ideally. it should be removed outside the ambulance but before entry into the emergency department. This means that the contamination has been reduced to a level that is no longer a threat to the patient or to the responder. Effective decontamination consists of making the patient As Clean As Possible (ACAP). Care should be taken to protect any open wounds from contamination. or eyes. The decontamination team should bring the prepared stretcher to the ambulance. Emergency department personnel should make every effort to avoid contact with any potentially hazardous substance(s). field decontamination facilities are limited and emergency department personnel should consider that all hazardous materials patients need decontamination unless information has been received indicating that it is not necessary (e. Priority should be given to the fundamentals of emergency treatment airway. and circulation simultaneous with contamination reduction.. Personnel should keep in mind that the actual contamination may be (or become) a life-threatening condition. and take him or her directly to the Decontamination Area along the predesignated route. mucous membranes.g.

which results in increased permeability. personnel should consider the chemical-specific information received from the hazardous materials response resources. including the hair. Hot water. patient stabilization. The sooner a patient becomes decontaminated the sooner he or she can be treated as a normal patient and protective measures reduced or downgraded. These areas allow for rapid absorption of hazardous materials. The skin of young children is particularly sensitive and should be treated accordingly. care must be taken to avoid hypothermia. Contaminated nares and ear canals should also be gently irrigated. with frequent suction to prevent any material being forced deeper into those cavities. In treating patients. Contaminated areas should be gently washed under a spray of warm (never hot) tap water.External decontamination should be performed using the least aggressive methods. Mechanical or chemical irritation to the skin should be limited to prevent damage to the epidermal layer. This increases the chances for absorption of hazardous materials through the skin. Gentle irrigation of the eyes should be performed with the stream of normal saline diverted away from the medial canthus so that it does not force material into the lacrimal duct. If a parent is available and can accompany the child through decontamination. All run-off from decontamination procedures should be collected for proper disposal. If not. Deep debridement and excision should be performed only when particles or pieces of material have been embedded in the tissues. proper triage procedures should be implemented. Patients should be frequently reassessed and monitored because many hazardous materials have latent physiological effects. young children are particularly sensitive to cold stress. using a sponge and a mild soap. or vigorous scrubbing should seldom be used because they cause vasodilation and abrasion. 46 46 . such as IVs or intubation. and patient treatment all without jeopardizing their own safety. Symptoms and signs being experienced by patients should be treated as appropriate and when conditions allow. a nurse should be assigned to stay with the child. Decontamination of eyes should also take high priority. this may be desirable. CONSIDERATIONS FOR PATIENT TREATMENT The primary goals for emergency department personnel in handling a contaminated individual include cessation of patient exposure. If decontamination is performed outside. Invasive procedures. Recommendations from the designated Poison Control Center and orders from the attending physician should be carefully followed. Wounds should be irrigated with copious amounts of normal saline. The first priority in the decontamination process should be treatment of contaminated open wounds. Decontamination of young children poses particular problems because they are usually frightened and may not understand what is happening. Washing with soap and tepid water. Termination of exposure can best be accomplished by removing the patient from the incident area and by removing contaminants from the patient. is usually all that is needed to remove contamination. In multiple patient situations. should be used only for life-threatening conditions until decontamination is performed. stiff brushes.

Using resources outlined elsewhere in this section. gas) Length of exposure Route(s) of exposure Possible adverse health effects Recommended treatment or antidote therapy PPE required Decontamination procedures The importance of getting a rapid but comprehensive overview on an unknown substance cannot be overemphasized. The attending staff must remember that since exposure to some substances can result in serious delayed effects. After the patient is transferred to the clean area. personnel should identify and obtain detailed information involving treatment. and the like. Based on past hazmat incidents. and in Section II under Hazard Recognition. 47 . and possible adverse health effects of the specific chemical(s) involved. Level A protection should be worn because it provides additional skin protection. sustained observation and monitoring may be required. If the patient is not ambulatory. place a clean piece of plastic on the floor for the patient and staff to use when exiting the clean area. liquid.Information on Materials Involved Identification of the material(s) involved in a hazardous materials incident should be determined as early in the process as possible. NIOSH and EPA recommend that Level B protection is the minimum level to be worn when entering an area containing unknown substances. However. the physician can perform a physical examination and initiate routine patient management. corrosion. a clean stretcher or wheelchair should be brought to the doorway by an individual who has not been exposed. depending on his or her clinical condition. Removal of Patient from Decontamination Room After the patient has been decontaminated. Needed information includes: l l l l l l l l Chemical name of substance(s) involved Form of the material (solid. if the substance in question is suspected to involve the skin as a route of exposure or is otherwise noted to be dangerous by absorption. The patient can be discharged home or admitted to the hospital. decontamination procedures.

are sources of critical incident stress. 48 48 . with decontamination performed at the same time. and risks of harm to the responder(s). such as the regional Poison Control Center. whether received by phone or by onsite media representatives. Hospitals need to preplan what steps to take if they are unable to handle the number of hazmat patients. A plan must be in place to deal with information requests. It is essential that all information be delivered by a knowledgeable person and be coordinated with the agency handling the event in the field. In the absence of such coordination. and to evaluate the overall coordination effort with an aim toward making necessary improvements. The purpose of this review is to examine which activities succeeded and which did not. the emergency department will be used as a source of information by the community and the media. all participating units should send knowledgeable representatives to review the measures that were taken by each unit or agency. Primary attention should focus on the ABC fundamentals of emergency care. Above all. A chemical disaster may overwhelm any one hospital. CRITICAL INCIDENT STRESS MANAGEMENT Situations involving large numbers of ill or injured individuals. Acute stress reactions recognized during the incident should be immediately addressed by qualified peer debriefers or other qualified mental health professionals. stress debriefing sessions should be held shortly after the incident is terminated. To minimize the occurrence of acute or long-term psychological consequences in response personnel. misleading or inaccurate information may be released which may worsen public reaction to an incident. The emergency department may opt to defer all information requests to other involved agencies. it is essential that patient confidentiality be respected. PATIENT MANAGEMENT UNDER MASS CASUALTY CONDITIONS INVOLVING HAZARDOUS CHEMICALS Basic medical procedures in a large-scale hazardous materials incident are not substantially different from life-saving measures in other mass casualty disasters. particularly if it occurs along with another disaster such as an earthquake.COMMUNITY EDUCATION AND BRIEFING During a hazardous materials incident. CRITIQUE As soon as possible following a hazardous materials incident.

U. Standards for Professional Competence of Responders to Hazardous Materials Incidents. G. Hospital Emergency Department Management of Radiation Accidents. Hildebrand. 2nd ed.R. Cashman. JR (eds. Lancaster. Goldfrank s Toxicological Emergencies.). Ellenhorn s Medical Toxicology. Manual of Toxicologic Emergencies. 1998. Oak Ridge. Stamford. Ricks. 1997. P. 49 .C. Louis. and D.S. and J.J. Currance. Kelen. Chicago. MA: National Fire Protection Association. IFSTA. National Fire Protection Association. F. September. MD: Williams & Wilkins. and J. 1998. 1997. Elk Grove. J. L. 1995. Inc. NFPA 473. 1998. Noll. 4th ed. Stutz. Hazardous Materials Emergencies: The Professional Response Team. Environmental Protection Agency.R. and G. 2nd ed. Medical Aspects of Chemical and Biological Warfare.). 1994.M. Bronstein.B. Quincy. 1994. Recognition and Management of Pesticide Poisonings. Recommended Practice for Responding to Hazardous Materials Incidents. IL: Year Book. DC: Borden Institute.R. National Fire Protection Association. 3rd ed. Managing the Incident. 2nd ed..D. Yvorra. L. and R. D. Saunders Co. National Fire Protection Association. Annals of Emergency Medicine. 1995. Standards for Professional Competence of EMS Responders to Hazardous Materials Incidents. Emergency Care for Hazardous Materials Exposure. U. Reigart. 3rd ed. Franz (eds.R. Quincy. Department of the Army. IL: American Academy of Pediatrics. M. NFPA 471. Haddad. 1980. Ellenhorn. Noji. 1997. 6th ed. Sidell.B. Emergency Department Radiation Accident Protocol. R.L. MD: BRADCOMM. PA: Technomic Publishing Co. Baltimore. Clinical Management of Poisoning and Drug Overdose. and A. NFPA 472. Hazardous Materials. Leonard. PA: W. Ricks. Ulin.S. M.R. St. 5th ed. TN: Oak Ridge Associated Universities. Goldfrank. E. 1992.C. CT: Appleton and Lange.R. J. MA: National Fire Protection Association. MO: Mosby. 1984. Handbook of Common Poisonings in Children. MA: National Fire Protection Association. and J. Winchester. 1989. National Pesticide Telecommunications & Network (NPTN).S. 1992. R.SELECTED BIBLIOGRAPHY American Academy of Pediatrics. Greenbelt.G. Philadelphia. 3rd ed.K. R.F. Hazardous Materials Injuries: A Handbook for Pre-Hospital Care. Roberts. Quincy. and S. 1997. Washington.

Hazardous Materials Management System: A Guide for Local Emergency Managers. GA: US-DHHS.Sullivan. 1981. DC: Federal Emergency Management Agency. U. 1996.S. DC: Government Printing Office. Federal Emergency Management Agency and U. Department of Health and Human Services. Atlanta. Federal Emergency Management Agency. Hospital Emergency Department Management of Radiation Accidents. [available in English. Federal Emergency Management Agency. III. DC: Federal Emergency Management Agency. 50 50 . U. Vol. 1996.S.S. and G. DC: Government Printing Office.gov/gydebook. Prepared by the Multnomah County [OR] Office of Emergency Management. Hazardous Materials Toxicology: Clinical Principles of Environmental Health. Washington. Managing Hazardous Materials Incidents: Medical Management Guidelines for Acute Chemical Exposures.S. U.S.S. Washington. Federal Emergency Management Agency. Fire Administration.dot. Spanish and French][http:// hazmat. Kriege. Washington.B. MD: Williams & Wilkins. 1985.R.htm] U. Hazardous Materials Guide for First Responders. 1992. 1996 North American Emergency Response Guidebook. U. Washington. J. Department of Transportation. Agency for Toxic Substances and Disease Registry (ATSDR). DC: Federal Emergency Management Agency. U.S. Guidance for Developing State and Local Radiological Emergency Response Plans and Preparedness for Transportation Accidents. 1984. Washington. 1999. Baltimore.

A5 U. . . . .Appendix A HAZARDOUS MATERIALS CLASSIFICATION SYSTEMS National Fire Protection Association. Department of Labor. . . . .A9 A1 . . . . . . . . . . . . . .S. . . . . . . DOT Chart 11 . 704M System . . . . . . . . . . . . . . . . . . . . . . . Sample Material Safety Data Sheet (MSDS) . . . . . . . . . . . . . . . . . . . . .A3 Department of Transportation. . . . . .

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arms. as explained below. pants. Shut off flow and keep cooling water streams on exposed tanks or containers. Health (Blue) Health hazards in firefighting generally result from a single exposure. The risk level ratings. Flammability (Red) Susceptibility to burning is the basis for assigning risk levels within this category. The normal full protective clothing and breathing apparatus available to the average fire department will not provide adequate protection against inhalation or skin contact with these materials. but areas may be entered freely with full facemask self-contained breathing apparatus that also provides eye protection. that the physical exertion demanded in firefighting or other emergency conditions tends to intensify the effects of any exposure. A3 . Risk level 3: Materials that can be ignited under almost all normal temperature conditions. A few whiffs of the vapor could cause death or the vapor or liquid could be fatal on penetrating the firefighter s normal full protective clothing. are based upon protective equipment normally used by firefighters.NATIONAL FIRE PROTECTION ASSOCIATION. It may be desirable to wear self-contained breathing apparatus. Only hazards arising out of an inherent property of the material are considered. coat. with bands around the legs. Risk level 0: Materials which on exposure under fire conditions would offer no hazard beyond that of ordinary combustible materials. Water may be ineffective because of the low flash point. Risk level 1: Materials only slightly hazardous to health. It uses a diamond divided into four quadrants. with each quadrant representing a different characteristic. Risk level 4: Very flammable gases or very volatile flammable liquids. ranging from four (highest risk) to zero (minimum risk). It should be noted. but areas may be entered with extreme care. and boots. 704M SYSTEM The marking system designed by the National Fire Protection Association identifies hazard characteristics of materials at terminal and industrial sites. Risk level 3: Materials extremely hazardous to health. which may vary from a few seconds up to an hour. however. No skin surface should be exposed. The method of attacking the fire is influenced by the material s susceptibility factor. Full protective clothing including self-contained breathing apparatus. gloves. Risk level 2: Materials hazardous to health. Risk level 4: Materials too dangerous to human health to expose firefighters. and waist should be provided.

along with conditions of shock and pressure. but do not detonate. Special Information (White) The quadrant includes information on specific characteristics of the material (e. If a chemical with this hazard rating is in an advanced or massive fire. Risk level 4: Materials that (in themselves) are readily capable of detonation or of explosive decomposition or reaction at normal temperatures and pressures. but not violently. Risk level 3: Materials that (in themselves) are capable of detonation or of explosive decomposition or reaction that require a strong initiating source that must be heated under confinement before initiation. Caution must be used in approaching the fire and applying water. Includes materials that are sensitive to mechanical or localized thermal shock. Includes materials that can undergo chemical change with rapid release of energy at normal temperatures and pressures. Water may cause frothing if it gets below the surface of the liquid and turns to steam. or that can undergo violent chemical change at elevated temperatures and pressures. reactivity with water. A4 . Includes materials that are sensitive to thermal or mechanical shock at elevated temperatures and pressures. water fog gently applied to the surface will cause a frothing that will extinguish the fire. In advanced or massive fires. Normal firefighting procedures may be used..g. Fire exposure is one of the factors considered. Also includes those materials that may react violently with water or that may form potentially explosive mixtures with water. Water spray may be used to extinguish the fire because the material can be cooled below its flash point. Risk level 2: Materials that (in themselves) are normally unstable and readily undergo violent chemical change. the area should be evacuated.Risk level 2: Materials that must be moderately heated before ignition will occur. or that react explosively with water without requiring heat or confinement. Reactivity/Stability (Yellow) The assignment of degrees in the reactivity category is based upon the susceptibility of materials to release energy either by themselves or in combination with water. tendency to oxidize). Firefighting should be done from an explosive-resistant location. Risk level 0: Materials that will not burn. Risk level 0: Materials that (in themselves) are normally stable even under fire exposure conditions and that are not reactive with water. firefighting should be done from a safe distance or from a protected location. However. Risk level 1: Materials that must be preheated before ignition will occur. Risk level 1: Materials that (in themselves) are normally stable but that may become unstable at elevated temperatures and pressures or that may react with water with some release of energy.

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1200) requires all manufacturers of pure chemicals and/or mixtures to evaluate their products and relate. and boiling point. The Environmental Protection Agency s (EPA) Emergency Response and Community Right-to-Know Act of 1986 ensures the availability of MSDSs to emergency response personnel. any hazards that may be encountered while handling these materials. Carcinogens must be reported and identified as such if their levels are 0. if they are known or suspected to be hazardous. Included are specifics such as color. It is the key document used to provide hazard information to employees and can become an invaluable tool for emergency response personnel when used in a chemical emergency. Section 1 This section identifies the material by product or trade name and chemical name. manufacturing and nonmanufacturing alike. vapor pressure. Hazardous materials that are not carcinogens must be reported if they represent 1 percent or more of the product. odor. and telephone number. via MSDSs. Section 3 This section lists the chemical ingredients of the material. local fire departments. such as fire departments. although the chemical name is also required by some states. This standard is intended for all workplaces.1 percent or higher.MATERIAL SAFETY DATA SHEETS The Material Safety Data Sheet (MSDS) has become a major source of chemical information. Section I also contains the manufacturer s name. Below is a brief explanation of the format and information found in a properly prepared MSDS. Also included in Section 3 are Threshold Limit Values (TLVs) and the OSHA Permissible Exposure Limit (PEL). and hazmat teams need unlimited access to this information. This information is especially useful when devising both in-house and community contingency plans. and hospital emergency room staff. first aid crews. It is the product or trade name that is usually found on the container labels. A9 . The Occupational Safety and Health Administration s (OSHA) Hazard Communication Standard (29 CFR 1910. specific gravity (weight). Plant first responders. Section 2 Section 2 provides physical data about the product that can be utilized for proper identification. Section 4 Section 4 includes fire and explosion hazard data. address. The MSDS contains a wealth of information that may be understood with a minimum of training.

dermal contact. ingestion) and the bodily organs affected. Also included in Section 6 is information on hazardous decomposition products. will result in a chemical reaction. that it is but one of many references that should be used to make final determinations. including waste disposal methods. These include routes of exposure (inhalation. A10 .) Section 6 This section contains information on the reactivity of the product. It is imperative that this section be carefully noted by both in-house and local firefighters. Ventilation practices are also listed in this section. such as carbon monoxide and other hazardous gases. MSDSs are offered by manufacturers for identification and verification and are not the last word on safety and health practices. If a product is water reactive. as well as the signs and symptoms of overexposure. when mixed with the product. however. Section 8 Section 8 contains information regarding the proper personal protective equipment (PPE) necessary to handle the product in a manner that will minimize exposure.Section 5 Section 5 contains health hazard data. It lists other chemicals that. Section 7 Section 7 lists the procedures that should be used if the product spills or leaks. It must be noted. (NOTE: First aid measures recommended in MSDSs are not always correct and should be confirmed. It describes any acute (short-term exposure) and/or chronic (long-term exposure) effects on the body. it will be noted. First aid procedures are also be found in this section. that are formed and emitted during chemical reactions or fires. Summary A Material Safety Data Sheet can aid in making the right decisions on health and safety issues in a plant or in a community.

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Appendix B TYPES OF RESPIRATORY PROTECTION B1 .

B2 .

Appendix B Types of Respiratory Protection Type of Respirator Air Purifying Air-Purifying Respirator (including powered sea level) [PAPRs]) Enhanced mobility Cannot be used in IDLH or oxygen-deficient atmospheres (less than 19. heavy (up to 35 pounds) Finite air supply limits work duration May impair movement in confined spaces B3 . or if the unit has an ESLI (end-of-service-life-indicator) Advantages Disadvantages Lighter in weight than an SCBA. may be hard to gauge safe operating time in field conditions Only protects against specific chemicals. and up to specific concentrations Use requires monitoring of contaminant and oxygen levels Can only be used: (1) against gas and vapor contaminants with adequate warning properties.5 percent oxygen at air-purifying respirators Limited duration of protection. or (2) for specific gases or vapors provided that the service is known and a safety factor is applied. generally weighs 2 pounds or less (except for PAPRs) Atmosphere-Supplying Self-Contained Breathing Apparatus (SCBA) Provides the highest available level of protection against airborne contaminants and oxygen deficiency Provides the highest available level of protection under strenuous work conditions Bulky.

Enables longer work periods than an SCBA Air Respirator (SAR) (also called air line respirator) Less bulky and heavy than an SCBA. such as an escape-only SCBA.Appendix B (continued) Type of Respirator Advantages Disadvantages Not approved for use in IDLH or oxygendeficient atmospheres (less 19. Decontamination of hoses may be difficult Worker must retrace steps to leave work area Requires supervision/monitoring of the air supply line Positive Pressure Supplied. chemical contamination. that can provide immediate emergency respiratory protection in case of air line failure Impairs mobility Mine Safety and Health Administration/ NIOSH certification limits hose length to 300 feet As the length of the hose is increased. if escape SCBA protection is included) Protects against most airborne contaminants B4 .5 percent oxygen at sea level) unless equipped with an emergency egress unit. SAR equipment weigh less than 5 pounds (or around 15 pounds. and degradation. the minimum approved airflow may not be delivered at the faceplate Air line is vulnerable to damage.

Appendix C LEVELS OF PROTECTION C1 .

C2 .

Appendix C Levels of Protection1 Level of Protection Equipment A Protection Provided Should be used when: The chemical substance has been identified and requires the highest level of protection for skin. gases. full level of respiratory. or -site operations and work functions involving a high potential for splash. gases. or particulates. Occupational Safety and Health Guidance Manual for Hazardous Waste Site Activities. Washington. poorly ventilated areas until the absence of conditions requiring Level A protection is determined Limiting Criteria Fully-encapsulated suit. or exposure to unexpected vapors. and skin contact is possible Operations must be conducted in confined. or particulates of materials that are harmful to skin or capable of being absorbed through the intact skin Substances with a high degree of hazard to the skin are known or suspected to be present. material must be compatible with the substances involved Recommended: The highest available Pressure-demand. C3 . D. chemicalresistant suit Inner chemical-resistant gloves Chemical-resistant safety boots/shoes Two-way radio communication Optional: Cooling unit Coveralls Long cotton underwear Hard hat Disposable gloves and boot covers 1 Reprinted from NIOSH/OSHA/USCG/EPA 1985. supplied-air respirator with escape SCBA Fully-encapsulated. facepiece SCBA or pressure. immersion. and the respiratory systems based on: -measured (or potential for) high concentration of atmospheric vapors. and eye protection demand.skin.: Department of Health and Human Services.C. eyes.

or Inner and outer chemicalresistant gloves Chemical-resistant safety boots/shoes Hard hat Two-way radio communications -atmosphere containing less than 19. hooded. disposable chemicalrepresent a severe skin resistant one-piece suit) hazard. This involves: Chemical-resistant clothing recommended for initial (overalls and long sleeved site entries until the -atmosphere with IDLH jacket. suppliedair respirator with escape SCBA Protection Provided Should be used when: Limiting Criteria The type and atmospheric concentration of substances have been identified and require a high level of respiratory protection. but vapors and gases are not suspected of containing high levels of chemicals harmful to skin or capable of being absorbed through intact skin The same level of respiratory protection. full-facepiece SCBA or pressure-demand. one. gases.5 percent oxygen Presence of incompletely identified vapors or gases is indicated by direct-reading organic vapor detection instrument. but less skin protection than Level A Use only when the vapor or gases present are not suspected of containing high concentrations of chemicals that are harmful to skin or capable of being absorbed through intact skin Use only when it is highly unlikely that the work being done will generate either high concentrations of vapors. or particulates or splashes of material that will affect exposed skin Optional: Coveralls Disposable boot covers Face shield Long cotton underwear C4 .or hazards have been concentrations of specific two-piece chemical splash further identified substances that do not suit. but less skin It is the minimum level protection.Appendix C (continued) Levels of Protection Level of Protection Equipment B Recommended: Pressure-demand.

or the potential for unexpected inhalation of or contact with hazardous levels of any chemicals This level should not be worn in the Exclusion Zone The atmosphere must contain at least 19. minimal skin protection The atmosphere contains no known hazard Work functions preclude splashes. disposable chemical-resistant one-piece suit) Hard hat Optional: Gloves Escape mask Face shield The atmosphere contains no known hazard Work functions preclude. immersion.5 percent oxygen D Recommended: Coveralls Safety boots/shoes Safety glasses or chemical splash goggles Hard hat Optional: Gloves Escape mask Face Shield No respiratory protection.or twopiece chemical splash suit. one.Appendix C (continued) Levels of Protection Level of Protection C Equipment Protection Provided Should be used when: Limiting Criteria Recommended: Full-facepiece. No respiratory canister-equipped respirator protection. or the potential for unexpected inhalation of or contact with hazardous levels of any chemicals This level should not be worn in the Exclusion Zone The atmosphere must contain at least 19.5 percent oxygen C5 . air-purifying. splashes immersion. minimal skin protection Chemical-resistant clothing (overalls and long sleeved jacket: hooded.

N.Comments The Agency for Toxic Substances and Disease Registry would greatly appreciate your comments and suggestions for improving future editions of this guidance document. GA 30333 C6 . Comments may be addressed to: Scott V. Atlanta.E. Wright Emergency Response and Scientific Assessment Branch (MS E57) Agency for Toxic Substances and Disease Registry (ATSDR) 1600 Clifton Road.

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Agency for Toxic Substances and Disease Registry .Managing Hazardous Materials Incidents Volume III (Revised) Medical Management Guidelines for Acute Chemical Exposures U.S.

the Agency for Toxic Substances and Disease Registry (ATSDR) has made diligent effort to ensure the accuracy and currency of the ‘information presented but makes no claim that the document comprehensively addresses all possible situations related to this topic. This document is intended as an additional resource for physicians and other health professionals in assessing the condition and managing the treatment of patients potentially exposed to hazardous substances. In this document. however. a substitute for the professional judgment of a health care provider and must be interpreted in light of specific information regarding the patient available to such a professional and in conjunction with other sources of authority. Agency for Toxic Substances and Disease Registry 2000 ATSDR .The state of knowledge regarding the treatment of patients potentially exposed to hazardous substances in the environment is constantly evolving and is often uncertain. It is not.

1. L) 1. HT) Blister Agent (HN1.3-Butadiene Chlordane Chlorine Ethylene Glycol Ethylene Oxide Formaldehyde Gasoline Hydrogen Chloride Hydrogen Cyanide Hydrogen Fluoride Hydrogen Peroxide Hydrogen Sulfide Mercury Methyl Bromide Methylene Chloride Nerve Agent (GA. HD. HN2. GD. HN3) Blister Agent (HL.CONTENTS Acronyms and Abbreviations Preface Acknowledgments Introduction Chemical Protocols Acrylonitrile Ammonia Aniline Arsenic Trioxide Arsine Benzene Blister Agent (H.1-Trichloroethane Trichloroethylene Vinyl Chloride Xylene ATSDR Page iii v vii 1 i . VX) Nitrogen Oxides Parathion Phenol Phosgene Phosgene Oxime Phosphine Sodium Hydroxide Sulfur Dioxide Tetrachloroethylene Toluene Toluene Diisocyanate 1. GB.

Unidentified Chemical Appendix I Appendix II Appendix III Appendix IV Glossary Regional Poison Control Centers A-1 Association of Occupational and Environmental Clinics State Health Departments Consultation Resources A-11 A-20 A-27 G-1 ii ATSDR .

3-demercaptosuccinic acid deoxyribonucleic acid Department of Transportation electrocardiogram emergency department electroencephalogram emergency medical services Emergency Medical Services Authority Environmental Protection Agency Emergency Response Planning Guideline Fahrenheit gram gamma aminobutyric acid General Accounting Office gastrointestinal glucose-6-phosphate dehydrogenase hazardous material hydrochloric acid hypochlorous acid Hazardous Substances Data Bank ATSDR iii .Acronyms Acronyms and Abbreviations AAPCC ABG ABS ACGIH AIHA ALS AOEC ARDS ATSDR BAL BUN C CDC CAS CBC CERCLA CNS CPC CPK DC DHHS dL DMSA DNA DOT ECG ED EEG EMS EMSA EPA ERPG F g GABA GAO GI G6PD HAZMAT HCl HClO HSDB American Association of Poison Control Centers arterial blood gases acrylonitrile/butadiene/styrene American Conference of Governmental Industrial Hygienists American Industrial Hygiene Association advanced life support Association of Occupational and Environmental Clinics acute respiratory distress syndrome Agency for Toxic Substances and Disease Registry British anti-Lewisite (dimercaprol) blood urea nitrogen Celsius Centers for Disease Control and Prevention Chemical Abstract Service complete blood count Comprehensive Environmental Response. and Liability Act central nervous system chemical protective clothing creatine phosphokinase direct current Department of Health and Human Services deciliter 2. Compensation.

Acronyms IARC IDLH IRIS i.v. kg L m mEq mg mL mm Hg m3 MSDS MSHA MTBE MW NAC NFPA NIOSH NO NPIRS NTP OSHA PAM PEG PEL PhAC Po2 ppm PVC RADS RBC SARA SCBA STEL TBA TOCP TSCA TWA TERIS UN UV WHO International Agency for Research on Cancer immediately dangerous to life and health Integrated Risk Information System intravenous kilogram liter meter milliequivalent milligram milliliter millimeters of mercury cubic meters Material Safety Data Sheet Mine Safety and Health Administration methyl-t-butyl ether molecular weight N-acetylcysteine National Fire Protection Association National Institute for Occupational Safety and Health nitric oxide National Pesticides Information Retrieval System National Toxicology Program Occupational Safety and Health Administration pralidoxime chloride polyethylene glycol permissible exposure limit S-phenyl-N-acetyl cysteine partial pressure of oxygen parts per million polyvinyl chloride reactive airways dysfunction syndrome red blood cel1 Superfund Amendments and Reauthorization Act self-contained breathing apparatus short-term exposure limit t-butyl alcohol tri-o-cresyl phosphate Toxic Substances Control Act time-weighted average Teratogen Information Service United Nations ultraviolet World Health Organization iv ATSDR .

and patient disposition.S. potential effects. ATSDR provides educational and referral resources to health care providers who are responsible for chemically exposed patients. Emergency Department Management: Contains specific medical procedures to treat the exposed patient. ATSDR was created by the U. and Liability Act of 1980 (CERCLA).S. will also find the information useful. Congress through the Comprehensive Environmental Response. such as first responders. Department of Health and Human Services (DHHS). In pursuit of this mission. Health Effects: Contains organ systems affected by acute exposure. Other rescue personnel. decontamination. Organized by Decontamination Area and Critical Care Area. and effects of chronic exposure. and public health officials. physical properties. potential sequelae. routes of exposure. Each chemical protocol is divided into five sections. but because of the focus of the protocols. and exposure standards. (1) Description: Contains synonyms. Prehospital Management: Contains personal protection. support. The Guidelines contain 40 chemical-specific protocols that provide recommendations for the on-scene (prehospital) and hospital (ED) medical management of patients exposed during a hazardous materials (HAZMAT) incident. Compensation. potential for secondary contamination. The Medical Management Guidelines for Acute Chemical Exposures (Guidelines) is designed to assist emergency department physicians.Preface Preface The Agency for Toxic Substances and Disease Registry (ATSDR) is an agency of the Public Health Service in the U. appearance. triage. and follow-up instructions for the victims of a HAZMAT incident. Decontamination Zone. Patient Information Sheet: Contains information on exposure. and Support Zone. The mission of ATSDR is to prevent or mitigate adverse human health effects and diminished quality of life resulting form exposure to hazardous substances in the environment. these professions are encouraged to rely on other sources and training in their primary field for more definitive and complete guidance. (2) (3) (4) (5) ATSDR v . sources/uses. Organized by Hot Zone. The Agency’s responsibilities were markedly increased through the Superfund Amendments and Reauthorization Act of 1986 (SARA). and transportation. emergency medical technicians. It is the third volume in a 3-volume series provided by ATSDR.

and government consultants are listed. Association of Occupational and Environmental Health Clinics. The Introduction also describes the use. In addition. vi ATSDR . consult Volumes I and II. rationale. and private. State Health Officials. It is written in the format of an individual protocol. and limitations of the data contained in each section of a chemical protocol. The Prehospital Management and Emergency Department Management sections of the Introduction begin with the recommendations form the Unidentified Chemical protocol. The reader is urged to complete the Introduction before attempting to use the individual protocols. the Guidelines contains a glossary of chemical and medical terminology. respectively. Emergency Medical Services: A Planning Guide for the Management of Contaminated Patients.Preface The Introduction to this volume provides important background information and a brief overview of the activities at a HAZMAT incident. For more information on managing HAZMAT activities. The recommendations are followed by the rationale for the procedures suggested. university. and Hospital Emergency Department: A Planning Guide for the Management of Contaminated Patients. Appendices I through IV contain resources for the emergency department physician seeking consultation in treating chemically exposed patients: AAPCC-Certified Regional Poison Control Centers.

PhD. FACP. MPH. FACP. FACEP. David C. MPH. MD. MD.. Lisa Ingerman. MD. Frederick M. Ph. FACEP.. MD. Olson. Alan Hall. For the 2000 version. and Susan Little. and A. and Virginia Sublet. MD. ABMT.. MD. Fernando Llados.D. ABMT. ABMT. Tominack. ABMT. ATSDR.D. Robert Geller. MD. Wright.Acknowledgments Acknowledgments This document was first published in 1992 and updated in 2000.. The major contributors to the original (1992) Medical Management Guidelines for Acute Chemical Exposures were Jonathan Borak. ATSDR 1 . Olson. The following experts served as peer reviewers for the original 1992 document and the 2000 update: Eddy Bresnitz. Ph.. MD. 205-1999-00024). This project was directed by Scott V. Kent R. Logan. Linda Rae Murray. of SRC were contributing scientists (under ATSDR contract No. Jr. Burkle. MPH.D. William Lixey. MS. MD. FACEP.D. MD. and Rebecca L. Rosa MacDonald. Lewis Goldfrank. ABMT. of Syracuse Research Corporation (SRC) was the project manager. MD. Kent R. Ph. Ph. ATSDR wishes to thank all those who participated in making this a useful guidance document.

2 ATSDR .

The Introduction is key to the appropriate use of the protocols. Even trained and experienced responders are urged to read it before using the individual protocols in an emergency situation. describes the use and limitations of the information presented. The Prehospital and Emergency Department sections incorporate the Unidentified Chemical protocol as an example. which is in the same format as the individual protocols.Introduction Introduction This Introduction. ATSDR 1 .

2 ATSDR .S. Department of Health and Human Services.Introduction Use of trade names is for identification only and does not imply endorsement by the Public Health Service or the U.

Substances that present the most serious risks of secondary contamination include the following: C C C highly toxic liquids and solids or finely divided solids (e. carbon monoxide).g. harmful viruses or bacteria) Secondary Contamination Every effort must be made to decontaminate contaminated victims before they are transported to a medical care facility.. arsine.g. propylene glycol.. carbon monoxide. skin. this eliminates both the potential for rescuer contamination and further exposure to the victim. organophosphate pesticides) radioactive liquids and dusts certain biologic agents (e. The potential for secondary contamination has implications for decontamination and triage of victims and for the protection of rescue and health care personnel. or hair of victims in sufficient quantities to threaten other personnel.g.Introduction General Information Section Chemical Name (Chemical Formula) CAS Number. UN Number Common synonyms C C C Potential for secondary contamination Common form and important characteristics such as odor and flammability Routes of exposure and potential for absorption Primary contamination refers to direct contact of the victim with the hazardous material. Secondary contamination refers to the transfer of material from the victim to personnel or equipment.g.. Examples of substances with little or no risk of secondary contamination include the following: C C C gases (e. amine) vapors (unless they condense to a liquid state on clothing or skin) substances with no serious toxicity or skin absorption (e. motor oil) Note that although several of the substances listed above are highly toxic (e. Immediate victim decontamination is recommended for materials that pose risks of secondary contamination. they do not pose ATSDR • General Information 3 .g.. A substance poses a risk of secondary contamination if it is both toxic and likely to be carried on the clothing..

and ingestion-are described. Methods of shipment or storage and the physical hazards associated with the chemical are also described.Introduction risks of secondary contamination because these chemicals will not contaminate the victim. Liquids and solids may also be inhaled when they are finely divided mists. Less soluble gases and vapors and smaller particles can be inhaled more deeply into the respiratory tract. Corrosive agents cause direct damage to tissues by various Routes of Exposure Inhalation Skin/Eye Contact 4 General Information • ATSDR . or gases. or dusts. Ingested materials may react with stomach acid to produce noxious gases. Description This section summarizes the color. and symptoms to be expected at specific exposure levels. warning properties. and the duration of con tact. Previously published documents on hazardous materials have recommended zipping patients into body bags to minimize the transfer of chemical from patient to rescuer. This technique is not completely effective for preventing rescuer exposure. which can pose risks to both the victim and rescuers. Skin and eye contact can occur by exposure to solids. whereas less soluble materials may produce delayed symptoms in the lower airways. Usually. the concentration of the material. odor. The most likely routes of exposure--inhalation. For each route of exposure. therefore. direct contact with the skin or eyes. Secondary contamination also may be a risk in cases of ingestion. or gas) of the chemical at room temperature. they cannot secondarily contaminate rescuers. When available. and physical state (solid. Body bags are not recommended as an alternative to thorough decontamination. aerosols. the risk of injury depends on the toxicity of the chemical involved. Inhaled substances may be absorbed into systemic circulation. Vomitus may off-gas the hazardous material or a reaction product. causing toxicity to various organ systems. information is provided on odor threshold. highly water-soluble materials rapidly produce symptoms of upperairway irritation. Inhalation is the most common route of exposure to gases and vapors. fumes. and it may pose a significant risk of increased dermal absorption to victims. Highly watersoluble gases and vapors and larger mist or dust particles (greater than 10 microns in diameter) generally are deposited in the upper airways. liquids. liquid. Toxic vomitus should be quickly isolated in closed containers.

or removal of moisture (desiccant effect).Introduction mechanisms including low or high pH.g. chemical reaction with surface tissue. Ingestion Ingestion is not a common route of exposure in most hazardous materials (HAZMAT) incidents. Absorption. Some chemicals absorbed through the skin and eyes can produce systemic toxicity. a healthy. and stomach. In most cases. If instantaneous monitoring is not feasible.g. although it is common in suicide attempts. This section describes the chemical’s most common uses and the methods of production. throat. Government agencies and professional organizations have established standards and guidelines for hazardous chemical exposures. cut. chemical bum. removal of normal skin fats (defatting). The OSHA ceiling is an instantaneous concentration that must not be exceeded any time. The standards and guidelines address both acute and chronic exposures. creating products that are toxic to the patient. The Occupational Safety and Health Administration (OSHA) permissible exposure limit (PEL) is a regulatory limit established to avoid adverse health effects from exposure. especially after vomiting. Ingested chemicals may react with stomach acid.. the ceiling is normally assessed as a 15minute TWA concentration. Ingested chemicals may also be aspirated into the lungs. is more likely to occur when the normal skin barrier is disrupted (e. esophagus. Sources/Uses Standards and Guidelines The OSHA short-term exposure limit (STEL) is a 15-minute (unless otherwise noted) TWA concentration that should not be ATSDR • General Information 5 . hydrogen cyanide from ingested cyanide salts).. working adult can be exposed to a chemical at the PEL for an g-hour workday and a 40-hour workweek and suffer no adverse health effects. The OSHA “skin” designation indicates the likelihood of dermal absorption. Ingestion of corrosive agents can cause severe burns to the mouth. PELs are timeweighted-average (TWA) air concentrations.. and therefore toxicity. If the measured air concentration at a HAZMAT incident is less than the PEL and the exposure is shortterm. the health care provider (e. organophosphate and organochlorine pesticides).g. causing chemical pneumonitis. or abrasion) or when the chemical is highly fat-soluble (e. and potentially. persons at the scene are probably not at serious risk.

g.. The table in the Properties section includes only ERPG-2-the exposure level that could impair a person’s ability to take protective action. The NIOSH immediately dangerous to life or health (IDLH) level represents the maximum chemical concentration from which one could escape within 30 minutes without a respirator and without experiencing any escape-impairing (e. The National Institute for Occupational Safety and Health (NIOSH) recommends workplace exposure guidelines. ERPG levels are defined as follows: ERPG-1 is the maximum airborne concentration below which it is believed that nearly all persons could be exposed for up to 1 hour without experiencing symptoms other than mild transient adverse health effects or perceiving a clearly defined objectionable odor. severe eye irritation) or irreversible health effects. ERPG-2 is the maximum airborne concentration below which it is believed that nearly all persons could be exposed for up to 1 hour without experiencing or developing irreversible or other serious health effects or symptoms that could impair their abilities to take protective action. even if the 8-hour TWA concentration is below the PEL. Unlike occupational expo sure standards..Introduction exceeded at any time. and life-threatening) and apply to practically all persons. including children and the elderly. ERPG-3 is the maximum airborne concentration below which it is believed that nearly all individuals could be exposed for up to 1 hour without experiencing or developing life-threatening health effects. ability impairment. When available. ERPG levels are applicable to the general public. The three ERPG levels vary with the health effects expected with exposure (transient symptoms. Warning properties: Odor and irritation are the primary determinants of exposure awareness. Physical Properties Description: Physical state and useful characteristics of the chemical at room temperature are presented. an objective description of odor (e. The American Industrial Hygiene Association (AIHA) Emergency Response Planning Guidelines (ERPG) state concentrations at which one might reasonably anticipate observing adverse effects from exposure to specific substances.g. garlic-like) and the lowest air 6 General Information • ATSDR .

However. or does not cause irritation. A boiling point at or below room temperature means that the chemical is in the gaseous state at room temperature. Specific gravity is the ratio of the density of a liquid to the density of a reference material (usually water). The higher the vapor pressure. A specific gravity less than 1 indicates that the substance will float on water. a chemical is considered to have inadequate warning properties if it has no detectable odor at toxic air concentrations. Molecular weight (MW) is the sum of the weights of the atoms in a molecule.4 L/mole (1 mole of gas occupies 22.16. Molecular weight is provided in daltons. For chemicals with an odor threshold below the toxic air concentration. A gas density greater than 1 indicates that the vapor or gas is heavier than air.e. Freezing point is the temperature at which a chemical’s solid phase is in equilibrium with the liquid phase. A gas heavier than air may collect in ATSDR • General Information 7 . a specific gravity greater than 1 indicates that the substance will sink in water. A vapor pressure greater than 760 mm Hg at room temperature indicates that the chemical exists as a gas. Freezing point and melting point are equal in numeric value. has an odor that is not reliably detected because of olfactory fatigue. Vapor pressure is the pressure (expressed in millimeters of mercury [mm Hg] of a vapor in equilibrium with its liquid or solid form at a given temperature. “melting point” refers to the temperature at which a solid forms a liquid. Boiling point of a liquid is the temperature at which its vapor pressure is equal to the atmospheric pressure. odor threshold) is provided. The term”freezing point” refers to the temperature at which a liquid forms a solid.Introduction concentration that can be detected (i. Gas density is the ratio of the density (weight per volume) of a substance (at a given temperature) to the density of air (at that temperature).4 L at standard temperature and pressure). a unit that is based on the mass of oxygen. the greater the amount of chemical existing in the vapor phase. Molecular weight can be used to convert measurements of air concentrations of chemicals from parts per million (ppm) to milligrams per cubic meter (mg/m3) using the following equation: mg/m3 = (ppm x M W) / 22.. odor may provide an adequate warning of dangerous exposure conditions.

Flammable range (lower explosive limit to upper explosive limit) is expressed as the percentage of gas or vapor dispersed in air that will bum when an ignition source is present. Water solubility is measured in weight of substance per volume of water (e..nor flame-resistant and may melt if a fire occurs. The flammable range may indicate the need for special protective clothing. and nonflammable chemicals have flashpoints above 200 °F. is included in this section. A substance that is water soluble is likely to be removed from the skin and hair with a plain water wash.Introduction low-lying areas where it can displace air. The temperature.g. Most chemical-resistant protective clothing is neither heat. and the potential for a vapor or gas to travel to an ignition source and flash back may affect rescue activities. combustible chemicals have flashpoints between 100 °F and 200°F. Water solubility may indicate the effectiveness of water in decontamination. Water solubility indicates the degree to which a substance dissolves in water at a specific temperature. creating an oxygendeficient atmosphere. Incompatibilities HAZMAT incidents commonly involve more than one chemical. primarily from the NIOSH Pocket Guide to Chemical Hazards. Flammability is the ease with which a material will ignite. the flammable range. Incompatibility and reactivity information. Flammable chemicals have flash points below l00 °F. Substances that are poorly water soluble may require the use of soap. 8 General Information • ATSDR . g/100 ml or %).

the mechanism of action is discussed. Although HAZMAT incident exposures are likely to be short. premature ventricular contractions. Hypotension may also occur because of volume depletion from excessive vomiting. Even mildly toxic substances. diarrhea. Most HAZMAT incidents involve acute exposures that last only minutes. Cardiovascular Many chemicals have direct depressant or stimulatory effects on cardiac function.g. chlorinated hydrocarbons.. however. aromatic hydrocarbons) may lower the myocardial threshold to the dysrhythmogenic effects of catecholamines.g. Acute Exposure When suspected or known. risks of adverse health effects still exist. and the duration of exposure. a victim may be susceptible to ventricular dysrhythmias (e. can be hazardous if the exposure is prolonged or the concentration is high. its concentration. Highly toxic chemicals may pose a risk of illness even if the exposure duration is brief or the concentration of the substance is low. For several hours after solvent exposure.. Certain solvents (e.Introduction Health Effects Section C C Common symptoms Systemic effects and mechanism of action Health risk depends on the intrinsic toxic potential of the chemical. The organ system or metabolic process mentioned first in each chemical protocol is the most severely affected. ventricular tachycardia. freons. or severe chemical bums. Hypotension and dysrhythmias may be aggravated by hypoxia from respiratory depression or pulmonary aspiration of gastric contents. Organ systems or metabolic processes that are adversely affected by the chemical are discussed in the following sections. ATSDR • Health Effects 9 . but the chemical concentration may be extremely high. those not affected by the chemical are not addressed. Acute exposure is defined as chemical exposure of less than 14 days duration. or ventricular fibrillation) especially from administered sympathomimetic drugs such as bronchodilators or dopamine or the increased quantity of endogenous epinephrine produced during intense physical activity. The onset of health effects caused by acute exposure can be immediate or delayed.

vomiting. burns from mineral acids) usually are immediately obvious. Electrolyte Some chemicals can produce effects on serum electrolytes (e. Electrolyte imbalance can cause muscle weakness and cardiac dysrhythmias. benzene). chemicals can also produce systemic effects. with bleeding.g. abdominal pain. bone marrow suppression. Headache. Disruption of the normal protective barrier allows easier entry of chemicals into systemic circulation. The skin generally provides a relatively impermeable protective barrier. sodium) and total anion gap. CNS stimulants (e..g. if absorbed. methemoglobinemia. and anemia) can be detected by blood tests or simply by the color or appearance of the blood Gastrointestinal Hematologic 10 Health Effects • ATSDR . alkaline corrosives.. anxiety.Introduction CNS Central nervous system (CNS) depressants (e. hemolysis.g. hydrofluoric acid) cause a progressive penetrating injury that may not be apparent for hours. Physical injury such as thermal bums or traumatic events may also result in loss of the skin’s barrier effect. or destroying cells. Systemic illness can also occur without skin damage because many fat-soluble chemicals (e.g. a few chemicals (e. potassium. calcium. and stomach. Excessive muscular activity associated with seizures can cause hyperthermia. or stricture formation as potential sequelae.. arsine. scarring. and diarrhea are common symptoms after chemical exposure and may be due to direct gastrointestinal irritation or to systemic effects.. and seizures. Nausea. Some chemical depressants have early stimulatory effects. perforation. organophosphate insecticides) can cause agitation. delirium. confusion. throat. Many chemicals disrupt the skin’s integrity by removing fats. Dermal Dermal contact with chemicals can produce local injury. dizziness.g. Most hematologic changes (e. Components of the blood and blood-forming organs can be damaged by many chemicals (e. Severe depression of the brain stem can cause respiratory arrest and cardiovascular collapse.. stupor. producing chemical burns.g. producing euphoria and giddiness similar to ethanol. esophagus..g. hydrocarbon solvents) cause a generalized decrease in brain activity. some organophosphate insecticides) rapidly penetrate intact skin. However.g. or coma may result. Local injuries (e.. Ingestion of some chemicals can also cause severe corrosive injury to the mouth. lethargy..

Toxic hepatitis may progress to liver failure and death.. laboratory tests will show abnormal liver function (e. Some chemicals injure the kidneys directly. Most patients who have eye injuries involving the conjunctival or cornea1 surfaces experience pain and irritation. Effects are pronounced in the largest muscle groups such as those in the lower limbs. death may rapidly ensue from upper airway obstruction. and stridor may develop. Musculoskeletal damage due to chemical exposure is unusual. Most serious ocular injuries result from direct eye contact with corrosive liquids or solids. In addition. which typically does not manifest for 2 to 3 days after exposure. corneal damage causes intense pain and the sensation of a foreign body in the eye. Some effects are arthritis and hardening. or cancer of the bone. elevated bilirubin or aminotransferase levels or increased prothrombin time). High concentrations of or prolonged exposures to gases or vapors may also injure the eye. At that time. wheezing. Immunologic effects may include induced sensitivity and allergy. or oxalic acid. Chest radiography may indicate pulmonary edema when damaged lung cells allow fluid to leak into the alveoli (referred to as noncardiogenic pulmonary edema because the fluid Renal Respiratory ATSDR • Health Effects 11 . ammonia.. lactic.g. Metabolic acidosis is the most common adverse metabolic effect that occurs after chemical exposure. Immunologic Metabolic Musculoskeletal Ocular Peripheral Neurologic Peripheral nervous system effects can include changes in sensation. Inhalation of a chemical irritant (e. any poisoning causing massive muscle destruction can lead to kidney injury from excessive myoglobin in the kidney tubules. and upper respiratory tract. Painful coughing. Severe eye exposure carries a risk of blindness or other visual impairment and demands immediate evaluation by an ophthalmologist. destruction. excessive lacrimation. Acidosis results from an accumulation of acid anions such as formic. massive alveolar destruction. reduced reflexes.g. If the exposure is massive. Generally. and impaired motor function.Introduction Hepatic Some chemical exposures result in acute injury to the liver. or asphyxiation. throat. and possibly crusting and swelling of the eyelids. chlorine) usually causes rapid onset of burning and irritation of the nose.

may aspirate gastric contents into the lungs. Hydrocarbons irritate the lung tissue and interfere with surface tension in the alveoli. Most information about chronic toxicity is from epidemiologic studies and case reports of workplace exposures. The unconscious or convulsing patient may vomit and then. Pulmonary aspiration can sometimes be prevented by inserting a cuffed endotracheal tube into the patient’s airway or by placing the patient in a head-down. because of depressed airway protective reflexes. stridor. painful cough. to guide the clinician who must address these patient concerns. such as ammonia. typically over a long period of time. disrupting gas exchange. However. cause rapid onset of symptoms (burning nose and throat. low-level exposures. Repeated. reproductive effects. reproductive. Potential Sequelae Known or suspected sequelae and the prognosis for recovery after an acute exposure are described in this section. The onset and location of respiratory symptoms is partially related to the water solubility of the inhaled chemical. No data exist on these outcomes from acute exposure to most chemicals. Injury to the respiratory tract also can occur after ingestion of a chemical substance. Because HAZMAT incidents are unlikely to involve repeated or long-term exposures. However.Introduction accumulation is not caused by left ventricular failure. chronic health effects are outlined only briefly. left-side position and using suction immediately if vomiting occurs. 12 Health Effects • ATSDR Chronic Exposure . Pulmonary aspiration of an ingested hydrocarbon can cause severe pneumonitis. or impaired fetal development. we have included carcinogenic. It is not known whether the data from chronic exposures are applicable to victims who are acutely exposed in a HAZMAT incident. Some major concerns of patients who have experienced an acute chemical exposure are the risks of cancer. which occurs in cardiogenic pulmonary edema). Highly watersoluble gases. Signs and symptoms expected at various stages of recovery and the potential for permanent deficits are presented. wheezing) as the gases dissolve in the mucous membranes of the upper respiratory tract. less soluble gases such as phosgene are breathed deeply into the lower airways and typically cause only mild or no early symptoms. and developmental effects that have resulted from chronic exposure to the chemical. may produce health effects that differ in type or degree from effects of acute exposure. noncardiogenic pulmonary edema may develop after 12 to 36 hours.

Most clinicians are not adequately prepared to help the patient make this decision. 2. DES. The information included was based on the following hierarchy: DHHS is offered if available. DDT. regional reproductive risk/teratogen information centers. Denver. a proprietary database of Micromedex. Inc. ethylene oxide. An additional source of information was Reproductive and Developmental Toxicants. tobacco smoke.4. ATSDR • Health Effects 13 . PCBs. the Teratogen Information System (TERIS). lead. mercury. gossypol. carbon monoxide. TCDD. GAOLPEMD-92-3) that lists 30 chemicals of concern because of widely acknowledged reproductive and developmental consequences.S. For more information. Reproductive and Developmental Effects Information about reproductive and developmental effects was obtained primarily from three data files that are included in TOMES Plus. carbon disulfide. Dabney. toluene. the International Association for Research on Cancer (IARC). EGEE. hexachlorobenzene. vinyl chloride. or the MotherRisk Program. lithium. PhD. written by Thomas H. chloroprene. Failure of these organizations to evaluate a chemical does not necessarily mean that the chemical does not cause cancer. see Appendices I and III. These organizations develop ratings of chemicals that indicate the cancer-producing ability of the chemicals. The topic of reproductive hazards is controversial and emotionally charged.Introduction Carcinogenicity The cancer information included in this section is derived from assessments made by the Department of Health and Human Services (DHHS). Potentially high risk to the fetus may warrant considering termination of the pregnancy. cadmium. CO. Shepard. EGME. MD. edited by Betty J. ethylene dibromide. developed by the University of Washington. vitamin A. nicotine. The 30 chemicals are alcohol.. and warfarin. a 1991 report published by the U. These data files are Reprotext.5-T. arsenic. chlordecone. and Shepard’s Catalog of Teratogenic Agents. DBCP. then EPA. or the Environmental Protection Agency (EPA). General Accounting Office (GAO Report no. PBBs. Expert assistance may be available from regional poison control centers. then IARC.

Introduction 14 Health Effects • ATSDR .

it is assumed to pose an immediate health risk. Goals of the EMS HAZMAT Responder C Protect yourself. The Support Zone (or Cold Zone) is the outermost ring where no exposure or risk is expected. Approach the Scene cautiously. medical personnel. particularly those activities that relate to Emergency Medical Services (EMS) personnel. Transport victims to an appropriate medical facility as quickly as possible. its health effects. Provide basic and advanced life support (ALS). C C C C C C ATSDR • Prehospital Management 15 . Maintain a safe distance and inspect the scene from a nearby elevated area such as a hill. Respect the established exclusion zones and resist the temptation to rush in to attempt a rescue. Determine the potential for secondary contamination. and other support persons and equipment operate in the Support Zone.Introduction Prehospital Management Section The Prehospital Management section describes the activities that typically occur in the three concentric areas surrounding a HAZMAT incident (Figures 1 and 2). ambulance. the National Fire Protection Association (NFPA) hazard labeling system. Be familiar with the Department of Transportation (DOT) placard system. and medical treatment. or hospital if decontamination is not completed at the scene. The incident commander. report to the incident commander. Material Safety Data Sheets (MSDS). arriving upwind. If a command post has been established. ‘The user of the protocols should be aware that large data gaps exist in the scientific literature. The Hot Zone (or Exclusion Area) is the area surrounding the chemical release. Understand the risk to yourself and to others in the Support Zone. Consult the appropriate protocol and local sources to obtain information about the chemical. The Decontamination Zone (or Warm Zone) is the area surrounding the Hot Zone where primary contamination is not expected but where personnel must use protective clothing and equipment to avoid chemical exposure from contaminated victims. The information provided in the chemical protocols is an attempt to offer an accurate and practical approach to the management of hazardous materials emergencies. Identify the chemical. Perform appropriate and thorough decontamination. and shipping papers.

KR. 1990. Organization of a HAZMAT incident area Adapted from Olson. Norwalk. 16 Prehospital Management • ATSDR . Poisoning and drug overdose. CT: Appleton and Lange. ed.Introduction Figure 1.

Detail of decontamination zone Adapted from Hazardous material medical management protocols. Sacramento. 2nd edition. CA: Emergency Medical Services Authority. 1991.Introduction Figure 2. ATSDR • Prehospital Management 17 .

Introduction 18 Prehospital Management • ATSDR .

g. worst-case possibilities concerning toxicity must be assumed.g. The plain g&ace provides details or an explanation. victims whose skin. The Hot Zone includes the area immediately around the chemical spill where persons may be in danger from chemical exposure or physical hazards (e. only limited medical care can be provided in the Hot Zone.Introduction Prehospital Management Section C C C Potential for secondary contamination Health effects expected from an acute exposure Patient care (supportive care. If the proper equipment Is not available. the key factors in determining the potential for secondary contamination are the route and extent of exposure. Victims exposed only to gas or vapor are not likely to carry significant amounts of chemical beyond the Hot Zone and are not likely to endanger personnel outside the Hot Zone. The bold text below is from the Unidentified Chemical protocol. Hot Zone Rescuers should be trained and appropriately attired before entering the Hot Zone.. fire or explosion).. The potential for severe local effects ( e. assistance should be obtained from a local or regional HAZMAT team or other properly equipped response organization. Although some of these persons may be trained as paramedics. In the prehospital setting. Advanced medical care is provided in the Decontamination Zone and Support Zone. or if rescuers have not been trained in its use. Victims who have ingested a toxic chemical may expose others through toxic vomitus or by vapor off-gassing from toxic vomitus. Only persons who have specialized HAZMAT training should enter the Hot Zone. irritation and burning) and severe systemic ATSDR • Prehospital Management 19 . Rescuer Protection When a chemical is unidentified. However. antidotes) Secondary contamination is discussed on page 3 of the Introduction. hair. or clothing is grossly contaminated with solid or liquid chemical (including condensed vapor) may contaminate personnel by direct contact or by offgassing vapor. It is presented as an example of the information presented in each section.

selfcontained breathing apparatus (SCBA) should be used in all response situations. The self-contained breathing apparatus (SCBA) is often used in HAZMAT incident response to prevent inhalation of hazardous chemicals because it is self-contained. SCBA consists of a facepiece that seals. The respiratory-tract and skin protection (e. and a hose that runs from the air tank to the facepiece. Trained responders should select protective equipment and clothing based on the general regulations in 29 CFR 1910.120 (OSHA Hazardous waste operations and emergency response).g. a tank of compressed air carried on the back. The supplied-air respirator consists of a mask or facepiece connected to an air hose supplied by a compressor at a distant site. Respiratory Protection: Pressure-demand. although air is always flowing into the facepiece (pressure). The protocols contain chemical-specific recommendations for rescuer protection. short-term exposures such as those expected at a HAZMAT incident. the supplied-air respirator should not be used at a HAZMAT incident.g. The specific type of SCBA recommended in the Guidelines is “pressure demand”. The Rescuer Protection section begins with a summary of the health hazards that are pertinent for one-time. the supplied-air respirator is not practical for operations during an emergency. the flow increases in response to inhalation (demand). Two basic types of respiratory protection are available: atmosphere-supplying and air-purifying respirators. Skin Protection: Chemical-protective clothing should be worn when local and systemic effects are unknown. Atmospheresupplying respirators provide compressed air at greater than atmospheric pressure to a face mask that is worn by the rescuer and may be supplied-air or self-contained. portable. respirators and chemical-protective clothing) recommendations are based on these health hazards. organ damage) should be assumed when specific rescuer-protection equipment is selected.. 20 Prehospital Management • ATSDR .Introduction effects (e. Although commonly used at hazardous waste clean-up sites. that is. and familiar.. Because the air hose may be degraded by chemicals or heat and the hose may become tangled.

g. CPC that fails can subject the wearer to significant exposure and adverse health effects. The cartridge filters the air before it is inhaled. they offer no protection from the inhalation of chemical vapors or gases and are not recommended in the Guidelines. The NFPA has established performance standards for two types of chemical-protective garments: a vapor-protective suit and a liquid-splash-protective suit. and valve/closure construction suitability.. Permeation involves chemical movement through the suit material but not necessarily destruction of it. Conditions that preclude the use of an air-purifying respirator include C C C C C oxygen-deficient atmosphere (19. overall durability. Chemical-protective clothing (CPC) is not subject to performance standards set by a government agency. Air-purifying respirators can use the same type of facepiece as an air-supplied respirator. and permeation are important factors to consider in selecting CPC. Regardless of the type of respiratory protection used. penetration. they are connected to a charcoal or other filter-containing cartridge. However. they simply filter the ambient air and are seldom used at HAZMAT incidents. all respirators should be approved by NIOSH and the Mine Safety and Health Administration(MSHA).5% O2) unidentified contaminant unknown concentration of contaminant concentration of contaminant above NIOSH IDLH high relative humidity Most HAZMAT incidents involve at least one of these conditions. even exhaled air is trapped inside until pressure activates ATSDR • Prehospital Management 21 . Penetration is movement of a chemical through an opening in the material or article of clothing (e.Introduction Air-purifying respirators do not supply air to the user. causing exposure.NIOSH and MSHA designate performance characteristics of respirators. Chemical-specific resistance to degradation. Dust or surgical masks are also air-purifying-they filter and prevent the inhalation of large particles. The vapor protective suit is completely encapsulating. once the user is attired. through punctures or zippers). The standards provide methods for testing material and suits to assure chemical resistance. therefore. Instead of an air-supply hose. Degradation involves the chemical breakdown of the suit material itself. air-purifying respirators are rarely appropriate for emergency response.

Specialized personal protective gear should be used only by those with prior training and fitting. EPA has established a 4-stage classification system to address the levels of protection afforded by respiratory and chemicalprotective clothing combinations commonly used by HAZMAT responders. therefore. Level C includes a nonencapsulating chemical-resistant suit (equivalent to an NFPA splash-protective suit) and an air-purifying respirator. The EPA classification does not address use of the common firefighting ensemble .. The NFPA performance standards do not address respiratory protection.g. are called levels A through D. The certification accompanying protective clothing that meets NFPA guidelines specifies the chemicals and conditions under which the clothing was tested. however. Additional protective equipment may be required when risks of fire or explosion exist. Level B includes a nonencapsulating chemical-resistant suit (equivalent to an NFPA splash-protective suit) and an SCBA.Introduction one-way release valves. Level D consists of work clothes that do not provide any specific respiratory or skin protection. in descending order of protection. the equivalent NFPA suit is specified below. The choice of specific chemicalresistant materials (e. The four classes. or butyl rubber) is beyond the scope of this document and is generally the responsibility of an expert on the HAZMAT team. 22 Prehospital Management • ATSDR . Saranex. Turnouts are not designed to protect against chemical exposure and should not be worn when hazardous chemical exposure is possible.SCBA with “turnouts” or “bunker” gear. The EPA definitions do not address NFPA clothing. no assumptions can be made regarding respiratory protection based on the NFPA suit designation. Suits meeting the NFPA guidelines can be used to provide protection according to the EPA classifications described below. Tyvek. Level A includes a fully encapsulating chemical-resistant suit (equivalent to an NFPA vapor-protective suit) and a pressure-demand SCBA.

maintain cervical immobilization manually and apply a cervical collar and a backboard when feasible. lead them out of the Hot Zone to the Decontamination Zone. decreasing the availability of evaporative cooling. The goal in the Hot Zone is to quickly remove the victim from continued exposure and risk. cooling systems may actually be harmful. ABC Reminders Quickly ensure a patent airway. cooling systems may encourage rescuers to work longer and build up a dangerously high core body temperature. litters. brushing off gross contaminants. Rescuers can often perform only simple maneuvers such as ensuring a patent airway. or if necessary. The Decontamination Zone is a corridor between the Hot Zone and the Support Zone. carefully carry or drag victims to safety. Only minimal patient care can be performed in the Hot Zone while wearing Level A or Level B protective gear. All others require decontamination (see Basic Decontamination. as appropriate. If trauma is suspected. applying a cervical collar. page 25).Introduction Although CPC provides protection against adverse health effects due to chemical exposure. they serve only to reduce peripheral body temperature and not core body temperature. Ambulatory victims may need to be guided to the Decontamination Zone. body heat builds quickly because of the heavy workload and CPC prevents heat dissipation. carefully dragged or carried to safety. Because core body temperature does not decrease. however. By cooling the skin and making the user feel more comfortable. in the safest and quickest way possible. and applying direct pressure to stop arterial bleeding. Several cooling systems are available for use under CPC. The Decontamination Zone may be set up in any convenient location that is safely beyond the Hot Zone. Decontamination Zone Victims exposed only to gas or vapor who have no skin or eye irritation may be transferred immediately to the Support Zone. Nonambulatory victims can be removed on backboards. or gurneys. CPC prevents both the inward and. if these are not available. Victims who are unable to walk may be removed on backboards or gurneys. but ATSDR • Prehospital Management 23 . During an incident. it contributes to heat stress. Victims should be removed from the Hot Zone to the Decontamination or Support Zone. Victim Removal If victims can walk. outward movement of moisture.

only personnel with prior fitting and training should be permitted to don protective gear. and circulatory support for patients in the Decontamination Zone. the level of clothing is the same as that worn in the Hot Zone. personnel in the Decontamination Zone should wear the same protective equipment used in the Hot Zone (see Rescuer Protection. Stabilize the cervical spine with a collar and a backboard if trauma Is suspected. Victims exposed only to gases or vapor who do not have skin or eye irritation generally do not need decontamination. To provide airway. Assist ventilation with a bag valve-mask device If necessary. the chemical is not highly volatile or the decontamination area is set up outside with good natural ventilation). Depending on the concentration of the chemical and its potential for secondary contamination. the rescuer may have to establish an artificial airway. If the risk of inhaling off-gassing vapors is also low (i. Generally. Administer supplemental oxygen as required. A lower level of protective clothing can be used when the risk of secondary contamination is low. 24 Prehospital Management • ATSDR . Air contaminants must be identified and measured to assure safety before a lesser level of respiratory protection is used. administer supplemental oxygen or nebulized bronchodilators. Because personnel in the Decontamination Zone normally require protective gear.. a nonencapsulating suit (NFPA splash protective suit) can be used if an encapsulating suit (NFPA vapor-protective suit) is required in the Hot Zone. For example. breathing. Victims who have been decontaminated or who do not require de contamination should be transferred immediately to the Support Zone.g. Decontamination is not required for all victims. Rescuer Protection If the chemical or concentration is unidentified. If possible. Direct pressure should be applied to control heavy bleeding.. ABC Reminders Quickly ensure a patent airway. and assist ventilation. page 19). victims with serious trauma or medical complications (e.e. only trained HAZMAT-team members should be present. the Decontamination Zone should be established outdoors (preferably upwind and uphill from the Hot Zone) where natural ventilation will allow dispersion of vapor off-gassing from contaminated victims.Introduction separate from the Support Zone. Personnel in the Decontamination Zone normally require protective gear. it may be acceptable to use a lower level of respiratory protection.

Electronic equipment. liberating toxic gases or creating explosions. whereas clothing or shoes may require disposal. use mild soap on the skin and hair. continue irrigation while transferring the victim to the Support Zone. Remove contact lenses if present and easily removable without additional trauma to the eye. and hair in the Decontamination Zone. such as cardiac monitors. the ATSDR/CDC Emergency Response 24hour Hotline ([404] 639-0615) or the EPA Environmental Response Team. Cautions about water reactivity (e. Edison. Rescuers wearing respirators and heavy gloves will find it difficult to provide advanced medical care such as inserting an intravenous line or performing endotracheal intubation. Consult a HAZMAT specialist affiliated with the local fire department. this care is not administered until the victim is transferred to the Support Zone.g. If a corrosive material is suspected or if pain or injury is evident. statement in the DOT Emergency Response Guidebook or in an MSDS) generally do not apply to flushing eyes. Leather items can be especially difficult to decontaminate and may need to be incinerated. Flush exposed or irritated eyes with plain water or saline for at least 5 minutes. Consider bagging the victim’s jewelry and other valuables separately from clothing for easier retrieval later. generally are not taken into the Decontamination Zone because the equipment may not be safe to operate and may be difficult to decontaminate.Introduction seizures) may have to wait for advanced medical care until gross contamination is removed. Nonporous materials such as metal jewelry may be easy to decontaminate by washing. In fact. therefore. Basic Decontamination Victims who are able and cooperative may assist with their own decontamination.. New Jersey ([732] 321-6740) for advice on the disposition of contaminated equipment and clothing. skin. There is little risk of creating a serious reaction hazard by adding large amounts of water to the small amount of residual chemical on the victim’s body. Flush exposed or irritated skin and hair with water for 3 to 5 minutes. the naturally occurring moisture on the skin is already reacting with ATSDR • Prehospital Management 25 . Remove and double-bag contaminated clothing and personal belongings. For oily or otherwise adherent chemicals. Many chemicals react violently with water.

which may inflict injury. Removal of oily or insoluble materials from the skin and hair requires washing with soap. Solids should be gently brushed from hair.or dish-washing soap will be satisfactory. Ten to 15 minutes may be required for concentrated or strongly alkaline materials. Any liquid hand. Unless a corrosive chemical has been ingested. Avoid forceful removal. See Ingestion Exposure. Bleach. protect the victim’s eyes. Victims who are conscious and able to swallow should be given 4 to 8 ounces of water. hair. Irrigation and transfer to the Support Zone should not be delayed because of difficulty in removing contact lenses. and mouth. The risk of pulmonary aspiration is also increased when vomiting occurs. or other solutions used for equipment decontamination should not be used for washing skin. do not induce emesis.Introduction the chemical. Activated charcoal adsorbs many chemicals and is relatively easy to administer. neutralizing agents should not be used for decontamination because the heat from neutralization may cause added injury. vinegar. page 26 Prehospital Management • ATSDR . The length of time recommended for flushing exposed skin or eyes will vary with the chemical and the circumstances of exposure. Obtain medical care immediately. Eye decontamination after exposure should be continued while the patient is transferred to the Support Zone and even during transport to a medical facility. nose. Vomiting may increase damage to the esophagus and stomach if irritating or corrosive chemicals have been ingested. Generally. hastening removal from the skin is preferable to leaving the chemical to further injure the victim. and clothing. a slurry of 50 to 60 grams of activated charcoal should be given to an adult patient who is awake and has a gag reflex. Vomiting is relatively ineffective in emptying the stomach after a chemical ingestion and may be harmful to the victim. Charcoal may obscure the view when endoscopy is performed (at the hospital) to determine the extent of injury. In cases of ingestion. Likewise. vomiting should not be induced. abrasive brushing may enhance skin injury and penetration. Use only soft-bristled brushes. Dilution with large volumes of water is preferred for decontamination. An attempt should be made to remove contact lenses. skin. Most chemicals that cause only mild skin or eye irritation can be removed by flushing for 3 to 5 minutes. or eyes. During brushing.

An exception involves victims exposed to a potent and adherent chemical (e. In such cases. in which case the Support Zone team should wear disposable aprons or gowns and latex gloves. Victims should be moved from the Decontamination Zone to the Support Zone as soon as possible. Initially. More sophisticated medical management can begin in the Support Zone where rescuer movement is less encumbered and more equipment and personnel are available. Victims who have undergone decontamination or have been exposed only to gas or vapor and who have no evidence of skin or eye irritation generally pose no serious risks of secondary contamination. others may require transport on a gurney. maintain cervical immobilization manually and apply a cervical collar and a backboard when feasible. Personnel in the Support Zone do not require special protective clothing if victims have been decontaminated properly. Ambulatory patients can walk.g. administer 4 ATSDR • Prehospital Management 27 Additional Decontamination . If trauma is suspected. Continue irrigating exposed skin and eyes. Intravenous lines should be inserted as soon as possible. halogenated or aromatic hydrocarbons) to produce dysrhythmogenic effects. breathing. ABC Reminders Quickly ensure a patent airway. Ensure a palpable pulse. primary contamination is not a serious problem in this area. Because the Support Zone is set up away from the dangers of physical hazards or chemical exposures.. administer supplemental oxygen as required. do not induce emesis. and circulatory support for the patient. for further decontamination. Establish intravenous access if necessary. as appropriate. an organophosphate pesticide). Ensure adequate respiration. In cases of ingestion.g. Support Zone personnel require no specialized protective gear.. this care is centered on airway. If the patient is conscious and able to swallow.Introduction 40. Attach a cardiac monitor. A cardiac monitor should be attached because of the potential for some chemicals (e. Support Zone Be certain that victims have been decontaminated properly. Transfer to Support Zone discussion of gastrointestinal-tract As soon as basic decontamination is complete. move the victim to the Support Zone.

appropriate treatment must be instituted in the Support Zone.Introduction to 8 ounces of water if it has not been given previously. The additional decontamination recommendations do not imply that the victim poses a risk of secondary contamination. 28 Prehospital Management • ATSDR . Patients who are comatose. a slurry of activated charcoal should be administered as soon as possible to prevent gastrointestinal absorption. Advanced Treatment Intubate the trachea in cases of respiratory compromise.g. irrigation should be completed before the monitor is attached. perform cricothyroidotomy if equipped and trained to do so. rinse the mouth and throat by administering 6 to 8 ounces of water. Gastrointestinal decontamination procedures should be carried out only if the patient is alert and has a gag reflex. Ingestion exposure is an uncommon occurrence in a HAZMAT incident. Exposure to a concentrated or strongly alkaline material may require continued irrigation of eyes and skin during transport and in the hospital. If a cardiac monitor is required. If the chemical is corrosive or has not been identified. The water will also dilute the hazardous material in the stomach. hypotensive. If ingestion has occurred and initial gastrointestinal decontamination has not been carried out in the Decontamination Zone. For most chemicals. or have seizures or cardiac dysrhythmias should be treated according to ALS protocols.. Use these and all catecholamines with caution because of the enhanced risk of cardiac dysrhythmias after exposure to certain chemicals. the protocols do not recommend emesis and in some cases (e. Many chemicals are effectively adsorbed on the surface of charcoal. When the patient’s condition precludes endotracheal intubation. emesis is contraindicated. Obtain medical care immediately. When indicated in the protocol. exposure to corrosives or hydrocarbons). Eye irrigation is easily and conveniently accomplished using saline or water and intravenous tubing attached to a nasal canula placed over the bridge of the nose with the prongs pointed down toward the eyes. Some victims may require continued irrigation of irritated skin and eyes. Treat patients who have bronchospasm with aerosolized bronchodilators.

Contact the regional poison control center (see Appendix 1) or the hospital base station for advice specific to the incident. The base station and receiving medical facility should be apprised of the patients’ status. When bronchodilators are needed. Toxic vomitus can contaminate personnel and equipment by direct contact or by offgassing volatile chemicals. such as metaproterenol (Alupent or Metaprel) or albuterol (Proventil or Ventolin). more advanced medical care can be readily administered. Special procedures for patient care en route can be discussed.g. Notifying the medical facility of your arrival time ensures appropriate emergency department preparation. Before transporting patients who have ingested hazardous materials. prepare the ambulance by lining a basin or bucket with open plastic bags to catch and isolate toxic vomitus. sodium azide can produce hydrazoic acid gas). However. Some chemicals are converted to poisonous gases by the action of stomach acids (e. Evaluate the patient for possible opioid overdose or hypoglycemia and administer naloxone (Narcan) and dextrose according to standard ALS protocols. cyanide salts create hydrogen cyanide gas. If a chemical has been ingested. these medications increase heart rate and may provoke cardiac dysrhythmias in victims who have been exposed to certain chlorinated or aromatic hydrocarbons. and estimated time of arrival at the medical facility. can be administered by metereddose inhaler. by hand-held nebulizer. treatment given. Consider the possibility that coma or seizures may be the result of trauma (e. Have ready several towels and open plastic bags to quickly clean up and isolate vomitus. especially if transport time will be lengthy. or preferably. Bronchodilators.. prepare the ambulance in case the victim vomits toxic material. Transport to Medical Facility Report to the base station and the receiving medical facility the condition of the patient. Administer specific antidotes as described in the chemical-specific protocols if within the prehospital scope of practice.g. ATSDR • Prehospital Management 29 .Introduction In the Support Zone.. the lowest effective dose should be given and cardiac rhythm should be monitored. head injury) rather than of chemical poisoning.

Use of the body bag technique is not effective and puts the victim at risk of substantial skin injury and absorption. Consult with the base station physician or regional poison control center for further advice regarding triage of multiple victims. Multi-Casualty Triage All exposed patients should be transported to a medical facility for evaluation. Most supplies recommended in the Guidelines are standard equipment or are easily obtained from grocery or drug stores.Introduction Ambulances that transport HAZMAT victims require only standard equipment. and telephone numbers are recorded. If patients have been decontaminated effectively. Asymptomatic patients who have not had direct chemical exposure can be discharged from the scene after their names. but at a minimum include the following: C disposable gloves C splash goggles C waterproof disposable shoe covers C disposable gowns to cover EMS personnel clothing and to be used by stripped and decontaminated patients C large supply of oxygen C plastic garbage bags C large wash basin or bucket (lined with plastic to isolate toxic vomitus) C liquid soap C saline and intravenous tubing for eye irrigation C disposable towels to soak up toxic vomitus Only decontaminated patients or patients not requiring decontamination should be transported. Those discharged should be advised to seek medical care promptly if symptoms develop. no danger of secondary contamination exists. The Multi-Casualty Triage section in each protocol makes general recommendations for transport 30 Prehospital Management • ATSDR . Some earlier HAZMAT protocols called for zipping patients into “body bags” without proper decontamination. Triage is a complex process that identifies victims who have the most serious injuries and who can benefit most from rapid treatment and transport. addresses. The specific equipment most likely to be used in HAZMAT response will vary with the training and policies of individual emergency medical services agencies.

Introduction priorities based only on the chemical. ATSDR • Prehospital Management 31 . however. the base station physician or regional poison control center (see Appendix I) should give advice for specific situations.

Provide supportive and antidotal emergency care (resources for toxicity information include the Guidelines and a regional poison control center [Appendix I]). practical approach to the management and treatment of HAZMAT victims. The protocols are not a substitute for the professional judgment of a health care provider and must be interpreted in light of specific information regarding the patient and in conjunction with other sources of authority. decontaminate patients. are based on the consensus of a panel of experts. the user of the protocols should be aware that large data gaps exist in the scientific literature and knowledge regarding the treatment of patients exposed to hazardous substances is constantly evolving. Obtain appropriate laboratory tests. hospital admission. However. Arrange for observation. 32 Emergency Department Management • ATSDR . and follow-up care as needed.Introduction Emergency Department Management Section The Guidelines. Goals of the Hospital Provider in HAZMAT Incidents: C C C C C Determine the potential for secondary contamination. which represent a state-of-the-art. If necessary.

Introduction ATSDR • Emergency Department Management 33 .

hair. However. Basic decontamination is safely and practically performed outside in a naturally ventilated area adjacent to the ambulance entrance. (Several companies make disposable or reusable decontamination 34 Emergency Department Management • ATSDR . a contaminated victim might be brought directly to the emergency department by a coworker. antidotes) Secondary contamination is discussed on page 3 of the introduction. Victims who were exposed only to gas or vapor or who were decontaminated at the scene are not likely to pose a risk of secondary contamination to hospital personnel. lack of ventilation may compound the risk to emergency department personnel attending the victim. Basic decontamination should be carried out at the scene of the incident before the victim is transports.Introduction Emergency Department Management Section C C C Potential for secondary contamination Health effects expected from an acute exposure Patient care (supportive care. Decontamination Area Previously decontaminated patients and patients exposed only to gas or vapor who have no evidence of skin or eye irritation may be transferred immediately to the Critical Care Area. However. Toxic vomitus can also expose hospital personnel directly or through off-gassing vapor. Contaminated victims received in indoor facilities create potentially serious risks of secondary contamination to hospital personnel. victims whose skin. Very few hospitals have the financial resources to properly construct a separate decontamination room with appropriate ventilation. Many hospital protocols suggest shutting off the ventilation system to protect the hospital from cross-contamination. or clothing is grossly contaminated with solid or liquid chemical (including condensed vapor) may endanger health care personnel by direct contact or by off-gassing vapor. Hospitals should plan for the arrival of contaminated victims. For example. this does not always occur. especially if materials are volatile. Other patients will require decontamination as described below. however. Suggested equipment and supplies for an outdoor hospital Decontamination Area include the following: C Gurney with plastic tub or run-off collector.

of butyl rubber) in different sizes Rubber aprons Mild soap and shampoo Soft-bristled brushes Splash-protective goggles or other protective eye wear Wading pool for decontamination of ambulatory patients Plastic garbage bags Oxygen tanks with delivery supplies Disposable towels and gauze Surgical scrubs for decontaminated patients Extra blankets and sheets for patient privacy and warmth Portable privacy barriers (do not totally enclose decontamination area or natural ventilation will be lost) ABC Reminders Evaluate and support airway. Simultaneous treatment and decontamination of patients should be carried out whenever possible. and circulation. use these and all catecholamines wlth caution because of the potential enhanced risk of cardiac dysrhythmias. breathing. breathing. Treat patients who have bronchospasm with aerosolized bronchodilators.g. basic airway. However. and circulation must be addressed in victims who have life-threatening symptoms.Introduction C C C C C C C C C C C C C C tables or foldable rubber tubs that can be placed on top of a gurney. hypotensive. Persons soaked with flammable materials cannot be treated with DC countershock until decontamination has been carried out because of risk of fire and explosion. decontamination is performed before treatment is started.g. Generally. ATSDR • Emergency Department Management 35 . Patients who are comatose. If the patient’s condition precludes Intubation. Intubate the trachea in cases of respiratory compromise. patients should not be touched until staff is appropriately gloved and gowned.) A warm-water source with a hose and soft-stream shower head Disposable chemical-resistant jumpsuits (e... of Tyvek or Saranex) Chemical-resistant gloves (e. Patients heavily contaminated with highly toxic organophosphate insecticides pose great risks of secondary contamination to health care personnel. or have seizures or ventricular dysrhythmias should be treated in the conventional manner. surgically create an airway.

the naturally occurring moisture on the skin will react with the chemical. An attempt should be made to remove contact lenses. Remove contact lenses if present and easily removable without additional trauma to the eye. Chemicals that cause only mild skin or eye irritation can be flushed for 3 to 5 minutes. Remove and double-bag contaminated clothing and personal belongings. Concentrated or strongly alkaline materials may require 10 to 15 minutes. The length of time for flushing exposed skin or eyes with water will vary with the chemical and the circumstances of exposure. Difficulty in removing contact lenses should not delay irrigation or transfer to the Critical Care Area. whereas clothing or shoes may require disposal. Flush exposed or irritated eyes with plain water or saline for at least 5 minutes.g. Cautions about water reactivity (e. During brushing. use mild soap on the skin and hair. hastening removal of the chemical from the skin is preferable to leaving it to potentially cause further injury. Nonporous materials such as metal jewelry may be easy to decontaminate by washing. skin. In fact. continue irrigation while transferring the patient to the Critical Care Area.Introduction Basic Decontamination Patients who are able and cooperative may assist with their own decontamination. the statements in the DOT Emergency Response Guidebook or in an MSDS) generally do not apply when decontaminating victims with water. For easier retrieval. Avoid forceful removal that may inflict injury. Flush exposed or irritated skin and hair with plain water for 3 to 5 minutes.. If a corrosive material is suspected or if pain or injury is evident. Solid contaminants should be gently brushed from hair. Rinse thoroughly with water. 36 Emergency Department Management • ATSDR . consider bagging the victim’s jewelry and other valuables separately from clothing. Adding large amounts of water to the small amount of residual chemical on the victim’s body poses little risk of creating a serious reaction hazard. liberating toxic gases or creating explosions. protect the victim’s eyes. Eye decontamination may be continued while the patient is transferred to the Critical Care Area. and clothing. Some chemicals react violently with water. For oily or otherwise adherent chemicals. Leather items can be especially difficult to decontaminate and may need to be incinerated.

If a corrosive chemical has been ingested. latex gloves. For most chemical ingestions. However. Vomiting is relatively ineffective in emptying the stomach after a chemical ingestion and may be harmful to the victim. or radioactive dust). potent chemicals. hair.Introduction Removal of oily or insoluble materials from the skin and hair requires washing with soap or shampoo. do not administer activated charcoal because it may obscure the view when endoscopy is performed. such as covering floors and walls with plastic or shutting off the ventilation system. water-resistant gowns or aprons.) ED personnel in the Critical Care Area generally do not need specialized protective gear. prepare to isolate toxic vomitus quickly (see Ingestion Exposure. if risk of residual skin contamination exists (e. if the patient has ingested a chemical. Any liquid hand. page 40). See Critical Care Area below for further discussion of gastrointestinal decontamination. or solutions used for decontaminating equipment should not be used for washing skin. page 33. such as some organophosphate pesticides. or eyes. Activated charcoal adsorbs many chemicals and is relatively easy to administer. However. and eye-splash protection ate ATSDR • Emergency Department Management 37 . Be certain that appropriate decontamination has been carried out. Vomiting may increase the risk of pulmonary aspiration or damage to the esophagus and stomach if irritating or corrosive chemicals have been ingested. do not induce emesis..or dishwashing soap is satisfactory. Critical Care Area If appropriate decontamination efforts have been completed before entry to the Critical Care Area. Use only soft-bristled brushes. (See Decontamination Area. Emesis is not generally recommended in the protocols. vinegar. In cases of ingestion. Administer 4 to 8 ounces of water to dilute stomach contents if the patient is conscious and able to swallow. abrasive brushing may enhance skin injury and penetration. Bleach. Neutralizing agents should not be used because the heat of the neutralization may cause added injury. are not needed. Immediately transfer the patient to the Critical Care Area. Flooding volumes of water are preferable. a slurry of 50 to 60 grams of activated charcoal should be administered to an adult patient who is awake and has a gag reflex.g. special precautions.

diazepam. administer naloxone (Narcan) and dextrose according to usual protocols. Hypotension may be complicated by hypothermia or hyperthermia. rather than from hazardous material exposure. Hyperthermia may result from certain systemic poisons (e.Introduction necessary. Watch for signs of laryngeal edema and respiratory system compromise. The fluid should be titrated to maintain acceptable urine output and blood pressure. or phenobarbital). Hypothermia should be considered if the victim was stripped and decontaminated with cold water or in a cold ambient setting. smoke inhalation can cause airway injury because of heat and irritant chemicals and coma from asphyxiants such as carbon monoxide and cyanide. or cyanosis.g. hypotensive. Place an intravenous line in all patients who are unconscious. Care must be taken not to overhydrate the patient. Patients exposed to substances that may cause cardiac sensitization or intravascular hemolysis may also require intravenous access. Patients who are comatose. Establish intravenous access in seriously ill patients. hypoventilation. ABC Reminders Evaluate and support airway. Treat patients who have hypotension using rapid infusions of normal saline (250 mL to 1 L in adults). Continuously monitor cardiac rhythm. or have seizures or ventricular dysrhythmias should be treated in the conventional manner. An initial bolus of an appropriate intravenous solution should be given. Use dopamine or other inotropic drugs for persistent hypotension. hypotensive. and circulation as in ABC Reminders. Consider the possibility of exposure to multiple chemicals as well as multiple-system injuries. dinitrophenol).g. such as progressive hoarseness. 38 Emergency Department Management • ATSDR . page 34. strider. Many chemicals can cause progressive airway injury or systemic illness with delayed onset.. For example. Consider the possibility that coma or seizures may be from a head injury or from alcohol or other drug intoxication. or may become so. phenytoin. Consider possible opioid overdose and evaluate for hypoglycemia. breathing. Emergency medical care providers usually carry these protective items for universal infection control or communicable disease control. obtunded.. Treat patients who have seizures with conventional anticonvulsants (e.

The time period for developing pulmonary edema varies with the chemical and is noted in each individual protocol. ATSDR • Emergency Department Management 39 . delivered by mechanical ventilation and positive end-expiratory pressure. In these situations.g. phosgene and some nitrogen oxides) produce slow onset of airway irritation and respiratory distress. if needed.. Treat patients who have bronchospasm with aerosolized bronchodilators. poorly soluble irritants (e. In patients who have altered hemoglobins. Corticosteroids and antibiotics have been commonly recommended for treatment of chemical pneumonitis. it is unreliable or falsely normal in patients who have dyshemoglobinemias (e. or diuretics. Bronchodilators may provoke ventricular dysrhythmias in some patients who have been exposed to aromatic or halogenated hydrocarbons. Watch for signs of respiratory distress and intubate if necessary. methemoglobinemia or carboxyhemoglobinemia) because it measures only oxygen dissolved in the blood and not the status of tissue oxygenation. Although pulse oximetry is a convenient way to continuously monitor oxygenation in patients. afterload reduction..g. ammonia or hydrogen chloride) rapidly produce respiratory effects. are standard treatments for chemically induced (noncardiogenic) pulmonary edema.g. use these and all catechola mines with caution because of the potential or possible enhanced risk of cardiac dysrhythmias.Introduction Inhalation Exposure Administer supplemental oxygen by mask to patients who have respiratory complaints. Poorly soluble agents are commonly associated with delayed (12 to 72 hours) onset pulmonary edema. but their effectiveness has not been substantiated. treat as thermal burns. not left ventricular failure as is cardiogenic pulmonary edema. Skin Exposure If chemical burns are present. morphine. Supplementary oxygen. a CoOximeter should be used to measure specific levels of hemoglobins unable to transport oxygen. the pulse oximeter does not reflect the impaired oxygen carrying or delivery capacity of the red cells.. Chemically induced pulmonary edema is due to leaky pulmonary alveoli. Patients who have chemically induced pulmonary edema do not benefit from digoxin. Soluble irritants (e.

and under the fingernails and toenails. A Morgan Lenscan also be placed to provide continuous.Introduction The extent and depth of injury in a chemical burn is often not immediately apparent. Special decontaminating agents are recommended for only a few chemicals (see specific protocols). and a magnifier or slit lamp. cloudy or bloody material in the anterior chamber. and that the pH of the conjunctival fluid is normal. a UV light source. If serious injury is evident (e. Patients who have been exposed to highly corrosive. For small corneal defects. Eye Exposure Ensure that adequate eye irrigation has been completed. Loss of circulating fluid may occur. that no visible residual material is in the conjunctival sac. which fluoresces under UV light. care givers should wear gowns and gloves to protect themselves. Examine the eyes for corneal damage using a magnifying device or a slit lamp and fluorescein stain.. In addition. nostrils. The disrupted corneal surface allows accumulation of the fluorescein. or persistent chemicals may require additional or continuous decontamination. 40 Emergency Department Management • ATSDR . analgesic medication.g. hair. and an eye patch. Do not use neutralizing or other decontaminating solutions. hence the severity of the bum is frequently underestimated. buttocks. Immediately consult an ophthalmologist for patients who have corneal injuries. or obvious perforation of the globe). groin. ears.. an ophthalmologist should be consulted immediately. organophosphate pesticides or radioactive dust). Ensure that contact lenses have been removed. thorough eye decontamination. Irrigation is easily continued in a hospital setting using intravenous tubing to provide a steady. If the material is highly contaminating (e. dermal absorption of a corrosive chemical may contribute to systemic toxicity. low-pressure stream of water or saline. extensive corneal fluorescein accumulation. oily.g. Use liquid soap for cleansing the skin and hair. Residues may remain in the armpits. use ophthalmic antibiotic ointment or drops. penetrating. A corneal burn or abrasion can easily be seen with the aid of fluorescein stain. Test visual acuity.

and liver-function tests.Introduction Ingestion Exposure Do not Induce emesis. Additional. ATSDR • Emergency Department Management 41 .g. specific recommendations are listed in the laboratory tests section to aid both diagnosis and treatment. do not give a slurry of activated charcoal. to isolate toxic vomitus or gastric washings. care must be taken when placing the gastric tube because blind gastric-tube placement may further injure the chemically damaged esophagus or stomach. therefore. This can be done by attaching the lavage tube to isolated wall suction or other closed container. If the patient is alert and charcoal has not been given previously. ingested cyanide salts are converted to highly toxic hydrogen cyanide gas in the stomach. Staff must take measures. administer 4 to 8 ounces of water. All patients should have CBC. glucose. Activated charcoal is capable of adsorbing most chemicals and should be given as early as possible. Ingested chemicals and products formed by their reaction with stomach acid may be hazardous to ED personnel through direct contact with vomitus or by inhalation of the gases liberated from the vomitus. Charcoal may need to be removed by gastric washing before endoscopy can be performed. However. Consider endoscopy to evaluate the extent of gastrointestinaltract injury. Corrosive liquids should be removed from the stomach as early as possible. administer a slurry of activated charcoal. For example. and electrolyte determinations. renalfunction tests. If a large dose has been ingested and the patient’s condition is evaluated within 30 minutes after ingestion. Chest radiography and pulse oximetry (or ABG measurements) are recommended for severe inhalation exposure. Even chemicals that have relatively poor adsorption to charcoal (e. glucose. Laboratory Tests Routine laboratory studies for all exposed patients include CBC. Additional studies for patients exposed to an unidentified chemical Include ECG monitoring. cyanide and alcohols) are still bound to some extent. consider gastric lavage. If a corrosive material is suspected.. and electrolyte determinations. The individual guidelines provide information on the use of specific antidotes. Antidotes and Other Treatments Treatment consists of supportive measures.

Introduction Laboratory test results are often within normal range immediately after an exposure but may become abnormal after a delay of several hours or even days. Tests to measure a specific chemical contaminant in biologic samples are rarely available on an emergency basis. unreliable. This sheet should be reviewed with the patient before discharge. the intrinsic toxicity of the chemical. Disposition and Followup Consider hospitalizing patients who have a suspected serious exposure and persistent or progressive symptoms. However. methemoglobinemia or carboxyhemoglobinemia). the patient should be observed for an extended period or admitted to the hospital. A regional poison control center (Appendix I) can assist with the selection and interpretation of specialized laboratory tests. The turnaround time may be several hours to days. If the chemical agent is known to produce delayedonset illness or is unidentified. these tests rarely are clinically useful. A signed copy should be 42 Emergency Department Management • ATSDR . For example.. depending on the specific chemical exposure. Patient disposition should be determined based on the symptoms. chest radiography may not show signs of pulmonary edema for 12 to 24 hours and signs of liver injury may not appear for 2 to 3 days following exposure. the asymptomatic patient should be admitted for observation. and course of illness.g. hence. and no signs of toxicity after 6 to 8 hours of observation may be discharged with instructions to seek medical care promptly if symptoms develop. Patient Release Asymptomatic patients who have minimal exposure. the results of these tests may aid in confirming or documenting exposure. Delayed Effects When the chemical has not been identified. The usual duration of observation in an emergency department is 6 to 8 hours. Pulse oximetry and routine arterial blood gas determination of Po2 tests may provide falsely normal. Some patients may be safely discharged from the emergency department while others will require prolonged observation or intensive care. Each protocol includes a detailed Patient Information Sheet with a list of possible delayed symptoms. normal initial examinations. or misleading results in patients with abnormal hemoglobin states (e.

you may be legally required to file a report. and a copy sent home with the patient. Other persons may still be at risk in the setting where this incident occurred. Patients who have corneal injuries should be reexamined within 24 hours. New Jersey ([732] 321-6740) may be able to assist in determining procedures for the cleaning of hospital facilities and equipment. Some articles will require disposal at a hazardous waste site or by incineration. See Appendices III and IV for a list of agencies that may be of assistance. Most items can be reused after washing. Reporting If a work-related incident has occurred. Edison. ATSDR • Emergency Department Management 43 . Appendix II contains the telephone numbers and addresses of members of the Association of Occupational and Environmental Clinics (AOEC). These clinics employ specialists in the diagnosis and treatment of chemically exposed patients. some contaminated articles cannot be rendered safe for reuse (e. They may provide consultation and follow-up advice. Followup Provide the patient with follow-up instructions to return to the emergency department or a private physician to reevaluate initial findings. However. inform patients that they may request an evaluation of their workplace from OSHA or NIOSH. Appendix III contains the telephone numbers of state health departments. If the incident occurred in the workplace.g. discussing it with company personnel may prevent future incidents. If a public health risk exists.. In addition to filing a report. contact your state or local health department. leather goods.Introduction included in the medical chart. notify your state or local health department or other responsible public agency. that are contaminated with methyl bromide or organophosphate pesticides). Consult a HAZMAT specialist affiliated with the local fire department or the ATSDR/CDC Emergency Response 24-hour Hotline ([404] 6390615) for advice on the disposition of contaminated personal effects. such as shoes. When appropriate. state health departments or the EPA’s Environmental Response Team. Do not release clothing or personal items to the patient before a determination of residual contamination is made.

Appendix IV contains the numbers of the NIOSH office that may be of assistance.Introduction You may also advise your patients to call the regional OSHA office to report a suspected violation of safe work practices. 44 Emergency Department Management • ATSDR .

Introduction ATSDR • Emergency Department Management 45 .

The follow-up instructions on the back of the Patient Information Sheet are statements that the clinician can check off if they apply to the patient. 46 Patient Information Sheet • ATSDR . medications. directions for obtaining follow-up appointments. The instructions include a list of signs and symptoms specific to each chemical (and directions to the patient to seek medical care if they occur). and restrictions on activities. alcohol and cigarette smoke. Space is provided for the clinician to write other instructions. It is written in an easy to understand question and answer format and addresses the questions most often asked. It is intended to be given to the patient.Introduction Patient Information Sheet The Patient Information Sheet provides information and follow-up instructions for persons who have been exposed to the chemical.

Introduction ATSDR • Patient Information Sheet 47 .

Appendix I Appendix I AAPCC-Certified Regional Poison Control Centers ATSDR A-1 .

Appendix I A-2 ATSDR .

Medical Center 200 West Arbor Drive San Diego CA 92103 Emergency: (800) 876-4766 California Poison Control System-San Francisco San Francisco General Hospital 1001 Potrero Avenue. Markham Little Rock AR 77205 Emergency: (800) 376-4766 TDD/TTY (800) 641-3805 CALIFORNIA California Poison Control SystemFresno/Madera Valley Children’s Hospital 9300 Valley Children’s Place Madera CA 93638 Emergency: (800) 876-4766 (CA only) California Poison Control System-Sacramento UC Davis Medical Center 2315 Stockton Boulevard Sacramento CA 95817 Emergency: (800) 876-4766 (CA only) California Poison Control System-Dan Diego UC San Diego. The Regional Poison Control Centers can act as a valuable resource in providing information about the toxicity and health effects of hazardous exposures involved in poisonings.Appendix I AAPCC-Certified Regional Poison Control Centers Poison Control Centers were established around 1953 to help physicians deal with poisoning of adults and children in the United States. Room 1E86 San Francisco CA 94110 Emergency: (800) 876-4766 (CA only) COLORADO Rocky Mountain Poison and Drug Center 9902 E.O. McDowell–Ancillary 1 Phoenix AZ 85006 Emergency:(800) 362-0101 (AZ only) (602) 253-3334 ARKANSAS Arkansas Poison and Drug Information Center College of Pharmacy University of Arkansas for Medical Sciences Mail Slot 552 4301 W. the American Association of Poison Control Centers (AAPCC) was established as the professional organization for Poison Control Centers. In 1983. ALABAMA Alabama Poison Center 2503 Phoenix Drive Tuscaloosa AL35405 Emergency: (800) 462-0800 (AL only) (205)345-0600 Children’s Hospital of Alabama Poison Control Center 1600 7th Avenue South Birmingham AL 35233 Emergency: (800) 292-6678 (AL only) (205) 933-4050 ALASKA Anchorage Poison Control Center 3200 Providence Drive P. Box 196604 Anchorage AK 99519 Emergency: (800) 478-3193 (907) 261-3193 ARIZONA Arizona Poison and Drug Information Center Arizona Health Sciences Center Room 1156 1501 North Campbell Avenue Tuscon AZ 85724 Emergency: (800) 362-0101 (AZ only) (602) 626-6016 Samaritan Regional Poison Center Good Samaritan Regional Medical Center 1111 E. Ninth Avenue Denver CO 80220 Emergency: (800) 332-3073 (CO only/outside metro area) (303) 739-1123 (Denver metro) ATSDR A-3 .

SE. Ninth Avenue Denver CO 80220 Emergency: (800) 860-0620 (ID only) ILLINOIS Illinois Poison Center 222 S.O. Room B-400 .Appendix I CONNECTICUT Connecticut Poison Control Center University of Connecticut Health Center 263 Farmington Avenue Farmington CT 06030 Emergency: (800) 343-2722 (CT only) (860) 679-3456 DELAWARE The Poison Control Center 3535 Market Street. Box 016960 (R-131) Miami FL 33101 Emergency: (800) 282-3171 (FL only) (305) 585-5253 FLORIDA (continued) Florida Poison Information Center-Tampa Tampa General Hospital P. Suite 985 Philadelphia PA 19104 Emergency: (800) 772-7112 (215) 386-2100 DISTRICT OF COLUMBIA National Capitol Poison Control Center 3201 New Mexico Avenue. P. NW Suite 310 Washington DC 20016 Emergency: (202) 625-3333 TDD/TTY: (202) 362-8563 (TTY) FLORIDA Florida Poison Information Center-Jacksonville 655 West Eighth Street Jacksonville FL 32209 Emergency: (800) 282-3171 (FL only) (904) 549-4480 Florida Poison Information Center-Miami University of Miami Department of Pediatrics P.O. Box 1289 Tampa FL 33601 Emergency: (800) 282-3171 (FL only) (813) 253-4444 GEORGIA Georgia Poison Center Hughes Spalding Children’s Hospital Grady Health System 80 Butler Street. Riverside Plaza. Box 26066 A-4 ATSDR Atlanta GA 30335 Emergency: (404) 606-9000 TDD/TTY: (404) 606-9287 (TDD) HAWAII Hawaii Poison Center 1319 Punahou Street Honolulu HI 96826 Emergency: (808) 941-4411 IDAHO Rocky Mountain Poison and Drug Center 8802 E.CC101 GH The University of Iowa Hospitals and Clinics 200 Hawkins Drive Iowa City IA 52242 Emergency: (800) 272-6477 (IA only) KANSAS Mid-American Poison Control Center University of Kansas Medical Center 3901 Rainbow Blvd. Suite 1900 Chicago IL 60606 Emergency: (800) 942-5969 (IL only) INDIANA Indiana Poison Center Methodist Hospital I-65 at 21st Street Indianapolis IN 46206 Emergency: (800) 382-9097 (IN only) (317) 929-2323 TDD/TTY: (317) 929-2336 (TTY) IOWA Iowa Poison Center St..O. Luke’s Regional Medical Center 2720 Stone Park Boulevard Sioux City IA 51104 Emergency: (800) 352-2222 (712) 277-2222 IOWA (continued) Poison Control Center Department of Pharmaceutical Care.

State Street Jackson MS 39216 Emergency: (601) 354-7660 MISSOURI Regional Poison Center Cardinal Glennon Children’s Hospital 1465 S. Suite 616 Detroit MI 48201 Emergency: (800) 764-7661 (MI only) (313) 745-5711 TTD/TTY: (800) 356-3232 (TTY) Spectrum Health Regional Poison Center 1840 Wealthy S. Paul MN 55108 Emergency: (888) 779-7921 MISSISSIPPI Mississippi Regional Poison Control Center University of Mississippi Medical Center 2500 N. Louis MO 63104 Emergency: (800) 366-8888 (314) 772-5200 MONTANA ATSDR A-5 . Grand Blvd. PH230 Baltimore MD 21201 Emergency: (800) 492-2414 (MD only) (410) 528-7701 TDD/TTY: (410) 706-1858 National Capitol Poison Control Center 3201 New Mexico Avenue. NW Suite 310 Washington DC 20016 Emergency: (202) 625-3333 TDD/TTY: (202) 362-8563 (TTY) MASSACHUSETTS Regional Center for Poison Control and Prevention Services for Massachusetts and Rhode Island 300 Longwood Avenue Boston MA 02115 Emergency: (800) 682-9211 (MA and RI only) (617)232-2120 MICHIGAN Regional Poison Control Center Chidren’s Hospital of Michigan 4160 John R Harper Professional Office Bldg.E.Appendix I Kansas City KS 66160 Emergency: (800) 332-6633 (913) 588-6633 TDD/TTY: (913) 588-6639 (TDD) KENTUCKY Louisville Kentucky Regional Poison Center Medical Towers South. Suite 572 234 East Gray Street Louisville KY 40202 Emergency: (502) 589-8222 LOUISIANA Louisiana Drug and Poison Information Center Unitversity of Louisiana at Monroe College of Pharmacy Sugar Hall Monroe. LA 71209 Emergency: (800) 256-9822 (LA only) MAINE Maine Poison Control Center Maine Medical Center 22 Bramhall Street Portland ME 04102 Emergency: (800) 442-6305 (ME only) (207) 871-2950 MARYLAND Maryland Poison Center University of MD at Baltimore School of Pharmacy 20 North Pine Stree. St. Grand Rapids MI 49506 Emergency: (800) 764-7661 (MI only) TTD/TTY: (800) 356-3232 (TTY) MINNESOTA Hennepin Regional Poison Center Hennepin County Medical Center 701 Park Avenue Minneapolis MN 55415 Emergency: (800) POISON1 (MN and SD only) (612) 347-3141 TDD/TTY: (612) 904-4691 (TTY) PROSAR International Poison Control Center 1295 Bandana Boulevard Suite 335 St.

Ninth Avenue Denver CO 80220 Emergency: (800) 446-6179 (NV only) NEW HAMPSHIRE New Hampshire Poison Information Center Dartmouth-Hitchcock Medical Center One Medical Center Drive Lebanon NH 03756 Emergency: (800) 562-8236 (NH only) (603) 650-8000 NEW JERSEY New Jersey Poison Information and Education System 201 Lyons Avenue Newark NJ 07112 Emergency: (800) POISON-1 (NJ only) NEW MEXICO New Mexico Poison and Drug Information Center Health Science Center Library Room 125 University of New Mexico Albuquerque NM 87131 Emergency: (800) 432-6866 (NM only) (505) 272-2222 NEW YORK A-6 ATSDR Central New York Poison Center 750 East Adams Street Syracuse NY 13210 Emergency: (800) 252-5655 (NY only) (315) 476-4766 Finger Lakes Regional Poison and Drug Information Center University of Rochester Medical Center 601 Elmwood Avenue P. (212) VEN-ENOS TDD/TTY: (212) 689-9014 (TDD) Western New York Regional Poison Control Center Children’s Hospital of Buffalo 219 Bryant Street Buffalo NY 14222 Emergency: (800) 888-7655 (NY western regions only) (716)-878-7654 .O. Box 321 Rochester NY 14642 Emergency: (800) 333-0542 (NY only) (716) 275-3232 TDD/TTY: (716) 273-3854 (TTY) NEW YORK (continued) Hudson Valley Regional Poison Center Phelps Memorial Hospital Center 701 North Broadway Sleepy Hollow NY 10591 Emergency: (800) 336-6997 (NY only) (914) 366-3030 Long Island Regional Poison Control Center Winthrop University Hospital 259 First Street Mineola NY 11501 Emergency: (516) 542-2323 (516) 663-2650 TTD/TTY: (516) 924-8811 (TDD Suffolk) (516) 747-3323 (TDD Nassau) New York City Poison Control Center NYC Department of Health 455 First Avenue Room 123. Box 81 New York NY 10016 Emergency: (800) 210-3985 (212) 340-4494. (212) POI-SONS.Appendix I Rocky Mountain Poison and Drug Center 8802 E. Ninth Avenue Denver CO 80220 Emergency: (800) 525-5042 (MT only) NEBRASKA The Poison Center Children’s Hospital 8301 Dodge Street Omaha NE 68114 Emergency: (800) 955-9119 (NE and WY only) (402) 354-5555 NEVADA Oregon Poison Center Oregon Health Sciences University 3181 SW Sam Jackson Park Road Portland OR 97201 Emergency: (503) 494-8968 NEVADA (continued) Rocky Mountain Poison and Drug Center 8802 E.

SD only) (701) 234-5575 OHIO Central Ohio Poison Center 700 Children’s Drive. Room 3512 Oklahoma City OK 73104 Emergency: (800) 764-7661 (OK only) (405) 271-5454 OREGON Oregon Poison Center Oregon Health Sciences University 3181 SW Sam Jackson Park Road Portland OR 97201 Emergency: (800) 452-7165 (OR only) (503)494-8968 PENNSYLVANIA Central Pennsylvania Poison Center Penn State Geisinger Health System The Milton S. OH only) TDD/TTY: (614) 228-2272 Cincinnati Drug and Poison Information Center Regional Poison Control System 2368 Victory Parkway. Suite B Charlotte NC 28208 Emergency: (800) 848-6946 (NC only) (704) 355-4000 NORTH DAKOTA North Dakota Poison Information Center Meritcare Medical Center 720 4th Street North Fargo ND 58122 Emergency: (800) 732-2200 (ND. Suite 985 Philadelphia PA 19104 Emergency: (800) 772-7112 (215) 386-2100 RHODE ISLAND Regional Center for Poison Control and Prevention Services for Massachusetts and Rhode Island 300 Longwood Avenue Boston MA 02115 Emergency: (617) 232-2120 SOUTH CAROLINA Palmetto Poison Center College of Pharmacy University of South Carolina Columbia SC 29208 Emergency: (800) 922-1117 (SC only) (803) 777-1117 SOUTH DAKOTA Hennepin Regional Poison Center Hennepin County Medical Center 701 Park Avenue Minneapolis MN 55415 Emergency: (800) POISON1 (MN and SD only) (612) 347-3141 TDD/TTY: (612) 904-4691 (TTY) ATSDR A-7 . Hershey Medical Center MC HO453 PO Box 850 500 University Drive Hershey PA 17033 Emergency: (800) 521-6110 TDD/TTY: (717) 531-8335 Pittsburgh Poison Center Children’s Hospital of Pittsburgh 3705 Fifth Avenue Pittsburgh PA 15213 Emergency: (412) 681-6669 The Poison Control Center 3535 Market Street. Room L032 Columbus OH 43205 Emergency: (800) 682-7625 (OH only) (800) 762-0727 (Dayton. 13th Street.Appendix I NORTH CAROLINA Carolinas Poison Center Carolinas Medical Center 5000 Airport Center Parkway. MN. Suite 300 Cincinnati OH 45206 Emergency: (800) 872-5111 (OH only) (513) 558-5111 Greater Cleveland Poison Control Center 11100 Euclid Avenue Cleveland OH 44106 Emergency: (888) 231-4455 (216) 231-4455 OKLAHOMA Oklahoma Poison Control Center Children’s Hospital of Oklahoma 940 N.E.

Room 146 Department of Surgery 7703 Floyd Curl Drive San Antonio TX 78284 Emergency: (800) 764-7661 (TX only) Southeast Texas Poison Center The University of Texas Medical Branch 3.O. Suite 230 Salt Lake City UT 84108 Emergency: (800) 456-7707 (UT only) (801) 581-2151 VERMONT Vermont Poison Center Fletcher Allen Health Care 111 Colchester Avenue Burlington VT 05401 Emergency: (877) 658-3456 (toll free) VIRGINIA Blue Ridge Poison Center University of Virginia Health System PO Box 800774 Charlottesville VA 22908 Emergency: (800) 451-1428 (VA only) National Capitol Poison Control Center 3201 New Mexico Avenue. Coulter Armarillo TX 79106 Emergency: (800) 764-7661 (TX only) West Texas Regional Poison Center Thomason Hospital 4815 Alameda Aveue El Paso TX 79905 Emergency: (800) 764-7661 (TX only) UTAH Utah Poison Control Center 410 Chipeta Way.Appendix I TENNESSEE Middle Tennessee Poison Center The Center for Clinical Toxicology 501 Oxford House 1161 21st Avenue South Nashville TN 37232 Emergency: (800) 288-9999 (TN only) (615) 936-2034 (Greater Nashville) TDD/TTY: (615) 936-2047 (TDD) Southern Poison Center 875 Monroe Avenue Suite 104 Memphis TN 35163 Emergency: (800) 288-9999 (TN only) (901) 528-6048 TEXAS Central Texas Poison Center Scott and White Memorial Hospital 2401 South 31st Street Temple TX 76508 Emergency: (800) POISON-1 (TX only) (254) 724-7401 North Texas Poison Center Texas Poison Center Network Parkland Health and Hospital System 5201 Harry Hines Blvd. NW Suite 310 Washington DC 20016 Emergency: (202) 625-3333 TDD/TTY: (202) 362-8563 (TTY) Virginia Poison Center Medical College of Virginia Hospitals Virginia Commonwealth University PO Box 980552 Richmond VA 23298 Emergency: (800) 552-6337 A-8 ATSDR . P. Box 35926 Dallas TX 75235 Emergency: (800) POISON-1 (TX only) South Texas Poison Center The University of Texas Health Science CenterSan Antonio Forensic Science Building.112 Trauma Building Galveston TX 77555 Emergency: (800) 764-7661 (TX only) (409) 765-1420 TEXAS (continued) Texas Panhandle Poison Center 1501 S.

Appendix I

WASHINGTON Washington Poison Center 155 NE 100th Street, Suite 400 Seattle WA 98125 Emergency: (800) 732-6985 (WA only) (206) 526-2121 TDD/TTY: (206) 517-2394 (TDD) (800) 572-0638 (TDD WA only) WEST VIRGINIA West Virginia Poison Center 3110 MacCorkle Ave., S.E. Charleston WV 25304 Emergency: (800) 642-3625 (WV only) WISCONSIN Children’s Hospital of Wisconsin Poison Center PO Box 1997 Milwaukee WI 53201 Emergency: (800) 815-8855 (WI only) (608) 262-3702 WYOMING The Poison Center Children’s Hospital 8301 Dodge Street Omaha NE 68114 Emergency: (800) 955-9119 (NE and WY only) (402) 354-5555 ANIMAL POISON CENTER ASPCA National Animal Poison Control Center 1717 South Philo Road Suite 36 Urbana IL 61802 Emergency: (888) 426-4435 (900) 680-0000

ATSDR

A-9

Appendix I

A-10

ATSDR

Appendix II

Appendix II

Association of Occupational and Environmental Clinics

ATSDR

A-11

Appendix II

A-12

ATSDR

Appendix II

Association of Occupational and Environmental Clinics (AOEC)
Professionals in the AOEC act as consultants for treatment of persons exposed to hazardous substances. ALABAMA University of Alabama at Birmingham 930 20th Street South Birmingham, AL 35205 (205) 975-2767; FAX (205) 975-4377 Timothy J. Key, MD, MPH ARIZONA Samaritan Occupational and Environmental Toxicology Clinic Department of Medical Toxicology 925 E. McDowell Rd., Second Floor Phoenix AZ 85006 (602) 239-6690; FAX (602) 239-4138 Kevin Wallace, MD CALIFORNIA Occupational & Environmental Medicine Clinic University of California at San Francisco/SFGH Building 30, 5th floor, 1001 Potrero Avenue SanFrancisco CA 94110 (415) 206-4320; FAX (415) 206-8949 Patricia Quinlan, MPH, CH Alt. Contact: Denise Souza, RN, MSN, OHNP, COHN-S UCSF Occupational Health Services University of California at San Francisco 2380 Sutter Street, 3rd Floor San Francisco, CA 94115 (415) 885-7580; FAX (415) 771-4472 Robert Harrison, MD, MPH Alt. Contact: Leslie Israel, DO, MPH Occupational & Environmental Health Clinic Employee Health Services University of California, Davis Medical Center Primary Care Building, Suite A 2221 Stockton Blvd. Sacramento CA 95817 (916) 734-8393; FAX (916) 734-7510 Appointments: (916) 734-8393 Stephen McCurdy, MD, MPH Occupational & Health Environmental Clinic University of California at Irvine Center for Occupational and Environmental Health 19722 MacArthur Blvd. Irvine CA 92715 (949)-824-8641; FAX (949) 824-2345 Dean Baker, MD, MPH COLORADO Division of Environmental & Occupational Health Sciences National Jewish Medical Research Center Center 1400 Jackson Street Denver CO 80206 (303) 398-l520; FAX (303) 398-l452 Appointments (303) 398-1733 Peggy Mroz, MSPH Alt. Contact: Cecile Rose, MD, MPH Toxicology Associates 2555 S. Downing Street #260 Denver CO 80210 (303) 765-3800; FAX (303) 765-3804 Scott Phillips, MD, FACP CONNECTICUT Yale Occupational & Environmental Medicine Program 135 College Street, 3rd Floor New Haven, CT 06510 (203) 785-7267; FAX (203) 785-7391 Mark R. Cullen, MD Alt. Contact: Peter M. Rabinowitz, MD, MPH University of Connecticut Occupational and Environmental Medicine Program 263 Farmington Avenue Farmington, CT 06030 (860) 679-2893; FAX (860) 679-4587 Eileen Storey, MD, MPH

CALIFORNIA (continued)
ATSDR A-13

Appendix II

CONNECTICUT (continued) Northwest Connecticut Occupational Medical Center 333 Kennedy Drive, Suite 202 Torrington CT 06790 (860) 482-4552; FAX (860) 489-4647 Gregory E. McCarthy, MD DISTRICT OF COLUMBIA Division of Occupational and Environmental Medicine School of Medicine, George Washington University 2300 K Street, NW Washington, DC 20037 (202) 994-1734; FAX (202) 994-0011 Tee L. Guidotti, MD, MPH Alt. Contact: Katherine Hunting, PhD, MPH Section of Occupational & Environmental Medicine Washington Hospital Center 110 Irving St., NW Washington, DC 20010-2975 (202) 877-5466; FAX (202) 877-4136 Laura Welch, MD GEORGIA Environmental and Occupational Medicine Consultative Clinic The Emory Clinic 1525 Clifton Road, NE, Rm 404 Atlanta, GA 30322 (404) 778-5978; FAX (404) 727-8744 Howard Frumkin, MD, Dr. PH ILLINOIS Occupational Medicine Clinic Cook County Hospital 1900 W. Polk, Rm 500 Chicago IL 60612 (312) 633-5310; FAX (312) 633-6442 Rachel Rubin, MD, MPH Alt. Contact :Ann Naughton, RN, MPH, COHN University of Illinois Occupational Medicine Program 914 S. Wood, M/C 684 Chicago IL 60612 (312) 996-7420; FAX (312) 413-8485 Linda Forst, MD, MPH

IOWA University of Iowa, Occupational Medicine Clinic Department of Internal Medicine, College of Medicine 200 Hawkins Drive, C33-GH Iowa City, IA 52242 (319) 356-4419; FAX (319) 356-7147 Gary Hunninghake, MD KENTUCKY University of Kentucky Occupational Medicine Program 2400 Greatstone Point Lexington, KY 40504 (606) 257-5150; FAX (606) 257-8982 Terrence Collins, MD, MPH LOUISIANA Ochsner Center for Occupational Health 1514 Jefferson Highway New Orleans, LA 70121 (504) 842-3955; FAX (504) 842-3977 Gregg A. Bendrick, MD, MPH Alt. Contact: Lori Brown Tulane Centers for Occupational Health 1415 Tulane Avenue, Box HC31 New Orleans LA 70112 (540) 736-5333; FAX (504) 736-4835 Douglas A. Swift, MD, MPH MARYLAND Johns Hopkins University Center for Occupational and Environmental Health 5501 Hopkins Bayview Circle Baltimore, MD 21224 (410) 550-2322; FAX (410) 550-3355 Edward J. Bernacki, MD, MPH Occupational Health Project University of Maryland School of Medicine 405 Redwood Street Baltimore, MD 21201 (410) 706-7464; FAX (410) 706-4078 Janie Gordon, ScM

A-14

ATSDR

Appendix II

MASSACHUSETTS Caritas Good Samaritan Occupational Health Services Merchants Building 75 Stockwell Dr. Avon MA 02322 (508) 427-3900; FAX (508) 427-3905 Robert Naparstek, MD Center for Occupational and Environmental Medicine Massachusetts Respiratory Hospital 2001 Washington Street South Braintree, MA 02184 (781) 848-2600; FAX (718) 849-3290 Dianne Plantamura, MSW, Coordinator Alt. Contact: David Christiani, MD, MPH, MS Occupational Health Program Department of Family and Community Medicine University of Massachusetts 55 Lake Avenue North Worcester, MA 10655 (508) 856-2818; FAX (508) 856-l 680 Tom Hicks, MD, MPH Occupational and Environmental Health Center Cambridge Hospital 1493 Cambridge Street Cambridge, MA 02139 (617) 665-1580; FAX (617) 665-1671 Rose Goldman, MD, MPH Occupational & Environmental Health Center Children’s Hospital 300 Longwood Ave Boston MA 02115 (617) 355-8177; FAX (617) 738-0032 Michael Shannon, MD, MPH Alt. Contact: Alan Woolf, MD, MPH MICHIGAN Michigan State University Department of Medicine 117 Est Fee East Lansing, MI 48824 (517) 353-1846; FAX (517) 432-3606 Appointments: (517) 353-4941 Kenneth Rosenman, MD

Health Wayne State/Department of Family Medicine 4201 Street Antoine, Suite 4J Detroit, Ml 48201 (313) 577-l 420; FAX (313) 577-3070 Appointments/Clinic: (313) 745-4093 Maryjean Schenk, MD, MPH Occupational Health Program School of Public Health, University of Michigan 1420 Washington Heights Ann Arbor, Ml 48109 (734) 764-2594; FAX (734) 763-8095 David Garabrant, MD, MPH Alt. Contact: Alfred Franzblau, MD Center for Occupational and Environmental Medicine 22255 Greenfield Rd., Suite 440 Southfield, MI 48075 (248) 559-6663; FAX (248) 559-8254 Laura Harbut, EMT, MBA Occupational Health Service St. Lawrence Hospital Work and Health Institute 1210 W. Saginaw Lansing, MI 48915 (517) 377-0309; FAX (517) 377-0310 R. Michael Kelly, MD, MPH MINNESOTA HealthPartners-Regions Hospital Occupational & Environmental Medicine 640 Jackson St. St. Paul, MN 55101-2595 (651) 221-3771; FAX (651) 221-8848 Paula Geiger Alt. Contact: William H. Lohman, MD Columbia Park Medical Group Occupational Medicine Department 6401 University Ave., NE #200 Minneapolis MN 55432 (612) 572-5710; FAX (612) 571-3008 Donald Johnson, MD Alt. Contact: Dorothy Quick

MICHIGAN (continued) Division of Occupational and Environmental
ATSDR A-15

Appendix II

NEW JERSEY Environmental and Occupational Health Clinical Center Environmental and Occupational Health Sciences Institute UMDNJ-Robert Wood Johnson Medical School 170 Frelinghuysen Rd. Piscataway, NJ 08854 (732) 445-0123; FAX (732) 445-0127 Howard Kipen, MD, MPH Alt. Contact: Gail Buckler, RN, MPH, COHN-S NEW MEXICO Presbyterian Occupational Medicine Clinic 5901 Harper, NE PO Box 26666 Albuquerque NM 87125 (505) 823-8450; FAX (505) 823-8484 William I. Christensen, MD, MPH Occupational and Environmental Medicine Clinic 2400 Tucker NE, Rm 177 Albuquerque NM 87131 (505) 272-2900; FAX (505) 272-4494 Karen B. Mulloy, DO, MSCH NEW YORK Eastern NY Occupational & Environmental Health Center 155 Washington Avenue Albany NY 12210 (518) 436-5511; FAX (518) 436-9110 Anne Tencza, BS, RN, COHN-S Alt. Contact: Eckardt Johanning, MD Mount Sinai -Irving J. Selikoff Center for Occupational and Environmental Medicine P.O. Box 1058 Gustave Levy Place New York, NY 10029 (212) 241-0176; FAX (212) 996-0407 Appointments: (212) 987-6043 Stephen Mooser, MPH Alt. Contact: Stephen Levin, MD

NEW YORK (continued) Center for Occupational & Environmental Medicine School of Medicine Health Sciences Center, Level 3-086 University at Stony Brook Stony Brook, NY 11794 (516) 444-2196; FAX (516) 444-7525 Wajdy Hailoo, MD, Msc, DIH Central NY Health Clinical Center 6712 Brooklawn Parkway Suite 204 Syracuse, NY 13211 (315) 432-8899; FAX (315) 431-9528 Michael B. Lax, MD, MPH New York University/Bellevue Hospital Occupational and Environmental Medicine Clinic Bellevue Hospital, Room CD 349 462 1st Avenue New York, NY 10016 (212) 562-4572; FAX (212) 562-4574 George Friedman-Jimenez, MD Finger Lakes Occupational Health Services 980 Westfall Road, Suite 210 Rochester NY 14618 (716) 256-0843; FAX (716) 256-2271 Deanna Woodhams, MA NORTH CAROLINA Division of Occupational and Environmental Medicine Duke University Medical Center Box 3834 Durham, NC 27710 (919) 286-3232; FAX (919) 286-1021 Dennis J. Darcey, MD, MSPH Alt. Contact: Gary Greenberg, MD, MPH

OHIO Community Health Partners Occupational
A-16 ATSDR

Health Center The Lorain Clinic for Occupational Medicine &

Appendix II

Rehabilitation 1800 Livingston Ave Lorain OH 44052 (440) 233-1068; FAX (440) 246-4560 Kathleen Fagan, MD, MPH Alt. Contact: Ann Wise, MD Center for Occupational Health Holmes Hospital-Tate Wing University of Cincinnati College of Medicine Eden and Bethesda Avenue Cincinnati, OH 45267 (513) 584-1234; FAX (513) 584-1010 James Donovan, MD, MS Alt. Contact: Susan Pinney, MD OKLAHOMA University Occupational Health Services Division of Occupational and Environmental Medicine Oklahoma Memorial Hospital 900 NE 10th Street, #2400 Oklahoma City, OK 73104 (405) 271-6177; FAX (405) 271-4125 David Paul, MD, MPH OREGON Occupational Health Program Oregon Health Sciences University (OHSU) 3181 SW Sam Jackson Park Rd. Mail Code OP-20C Portland OR 97201 (503) 494-1027; FAX (503) 494-4457 Nina Wolf, RN, BSN, COHN-S PENNSYLVANIA Occupational and Environmental Medicine Program University of Pittsburgh 3708 Fifth Avenue, Suite 401, Medical Arts Bldg. Pittsburgh, PA 15261 (412) 647-5360; FAX (412) 647-1140 Joseph J. Schwerha, MD, MPH

PENNSYLVANIA (continued) University of Pennsylvania School of Medicine Occupational Medicine-Silverstein Pavilion 3400 Spruce Street Philadelphia, PA 19104 (215) 349-5708; FAX (215) 662-3953 Appointments: (215) 662-2354 Edward A. Emmett, MD Center for Occupational and Environmental Health Abington Memorial Hospital 2510 Maryland Road, Suite 101 Willow Grove, PA 19090 (215) 481-5909; FAX (215) 481-5920 Lora S. Regan, MD, MPH TENNESSEE Occupational and Environmental Medicine Clinic Meharry Medical College 1005 D.B. Todd Boulevard Nashville TN 37208 (615) 327-6736; FAX (615) 327-6717 Otis Cosby, MD, MPH Alt. Contact: Herman Ellis, MD, MPH TEXAS Texas Institute of Occupational Safety & Health 11937 U.S. Highway 271 Tyler, TX 75708 (903) 877-5900; FAX (903) 877-7982 Jeffrey Levin, MD, MPH University of Texas Health Services 7000 Fannin, Suite 1620 Houston TX 77030 (713) 500-3267; FAX (713) 500-3263 Thomas Mackey, RNC, PhD

UTAH Rocky Mountain Center for Occupational and Environmental Health 75 South 2000 East University of Utah

Salt Lake City, UT 84112 (801) 581-3841; FAX (801) 581-7224 Appointments: (801) 581-5056 Anthony Suruda, MD, MPH Alt. Contact: Royce Moser, MD, MPH
ATSDR A-17

Appendix II

VIRGINIA Carillon Occupational Medicine Falin Center 903 S. Jefferson Street Roanoke, VA 24016 (540) 985-9820; FAX (540) 985-8118 Elaine Gill Alt. Contact: Hetzal Hartley, MD, MPH WASHINGTON Occupational and Environmental Medicine Program University of Washington Harborview Medical Center 325 9th Avenue, #359739 Seattle, WA 98104 (206) 731-3005; FAX (206) 731-8247 Drew Brodkin, MD, MPH Alt. Contact: Scott Barnhart, MD, MPH WEST VIRGINIA Division of Occupational & Environmental Health Department of Family and Community Medicine Marshall University School of Medicine 1600 Medical Center Huntington, WV 25755 (304) 691-1178; FAX (304) 691-1153 Chris McGuffin, MSCH, MSOSH Alt. Contact: James Becker, MD WEST VIRGINIA (continued) Institute of Occupational & Environmental Health West Virginia University School of Medicine 3801 Robert F. Byrd health Science Center South Morgantown WV 26506 (304) 293-3693; FAX (304) 293-2629 Alan Ducatman, MD, Msc CANADIAN CLINICS ALBERTA Occupational Medicine Consultation Clinic University of Alberta 13-103 Clinical Science Bldg. Edmonton Alberta, CD T6G 2G3 (780) 492-6291; FAX (780) 492-0364 Jim Cheng, MD MANITOBA MFL Occupational Health Centre, Inc. 102-275 Broadway
A-18 ATSDR

Winnipeg, Manitoba, CD R3C 4M6 (204) 949-0811; FAX (204) 956-0848 Shiela Braidek ONTARIO Occupational Health Clinics for Ontario Workers 15 Gervais Drive, Suite 308 Toronto ON, Canada M3C 1Y8 (416) 449-0009; FAX (416) 449-7772 Andrew King, Executive Director Occupational Health Clinics for Ontario Workers 848 Main Street East Hamilton ON, Canada L8M 1L9 (905) 549-2552; FAX (905) 549-7993 Chuck Emberson, Executive Director Occupational Health Clinics for Ontario Workers 1780 Regent Street South Times Square Mall Sudbury ON, Canada P3C 3Z8 (705) 523-2330; FAX (705) 522-8957 Donna Campbell, Executive Director ONTARIO (continued) Occupational Health Clinics for Ontario Workers 547 Victoria Ave. Windsor ON, Canada N9A 4N1 (519) 973-4800; FAX (519) 973-1906 Jim Brophy, Executive Director Occupational Health Clinics for Ontario Workers 171 Kendall St. Point Edward ON, Canada N7V 4G6 (519) 337-4627; Jim Brophy, Executive Director PEDIATRIC ENVIRONMENTAL HEALTH SPECIALITY UNITS CALIFORNIA The University California-San Francisco/ University of California-Irvine Pediatric Environmental Health Speciality Unit Contact: (415) 206-4320* Contact for both sites-San Francisco and Irvine GEORGIA The Southeast Pediatric Environmental Health Speciality Unit Emory University Atlanta GA (877) 33PEHSU (877-337-3478)

Appendix II

ILLINOIS Pediatric Environmental Health Center Cook County Hospital Chicago IL (312) 633-5310 MASSACHUSETTS Pediatric Environmental Health Center at Children’s Hospital Occupational and Environmental Health Center at Cambridge Hospital Boston MA (888) CHILD14 (888-244-5314)

NEW YORK Mt. Sinai Pediatric Environmental Health Unit Mt. Sinai-Irving J Selikoff Center for Occupational and Environmental Medicine New York NY (212) 241-6173 WASHINGTON Children’s Environmental Health Center University of Washington Occupational and Environmental Medicine Program Seattle WA (877) KID-CHEM (877-543-2463) ALBERTA Pediatric Environmental Health Clinic Misericordia Child Health Centr Edmonton AB (780) 930-5794

ATSDR

A-19

Appendix III

Appendix III

State Health Departments

A-20

ATSDR

Appendix III

ATSDR

A-21

Suite 4400 Washington. Adams Street. Jefferson Street Springfield. 12th Street Des Moines. NW. GA 30303 (404) 657-2700 Guam Department of Public Health and Social Services PO Box 2816 Agana. DC 20002 (202) 442-5999 Florida Department of Health 2585 Merchants Row Blvd. 312 E. IA 50319 (515) 281-5605 Kansas Department of Health and Environment 900 SW Jackson. FL 32399 (850) 245-4321 Georgia Department of Human Resources 2 Peachtree Street NW. Suite 140 Tallahassee.. AR 72205-3867 (501) 661-2417 California Department of Health Services 714 P Street Sacramento. AZ 85007 (602) 542-1025 Arkansas Department of Health 4815 W. Room 407 Phoenix. DE 19903 (302) 739-4700 A-22 ATSDR District of Columbia Department of Health 825 North Capitol St.Appendix III State Health Departments Alabama Department of Public Health The RSA Tower. AL 36130 (334) 206-5200 Alaska Department of Health and Social Services Alaska Office Building PO Box 110610 Juneau. GU 96910 011-671-7357102 Hawaii Department of Health 1250 Punchbowl Street PO Box 3378 Honolulu. IN 46204 (317) 233-7400 Iowa Department of Public Health Lucas State Office Bldg. 6th Floor Topeka. HI 96813 (808) 586-4410 Idaho Department of Health and Welfare 450 W. Box 83720 Boise. CO 80246 (303) 692-2011 Connecticut Department of Public Health 410 Capitol Avenue Hartford. PO Box 637 Dover. CA 95814 (916) 657-1431 Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver.. ID 83720 (208) 334-5945 Illinois Department of Public Health 535 W. CT 06134 (860) 509-7101 Delaware Division of Public Health Jesse Cooper Bldg. KS 66612 (785) 296-1086 . AK 99811-0610 (907) 465-3090 American Samoa Department of Health Government of American Samoa LBJ Tropical Medical Center Pago Pago AS 96799 011-684-6334606 Arizona Department of Health Services 1740 W. Markham Street Little Rock. Suite 15-470 Atlanta. Suite 1552 201 Monroe Street Montgomery. State Street. IL 62761 (217) 782-4977 Indiana Department 2 North Meridan Indianapolis.

MN 55101 (651) 251-5813 Mississippi State Department of Health PO Box 1700 2423 N. NV 89701 (775) 684-4200 New Hampshire Department of Health and Human Services 6 Hazen Drive Concord. Preston Street. Box PS 70. Box 409. CK Saipan MP 96950 (670) 234-8950 Nebraska Department of Regulation and Licensure PO Box 95007 Lincoln. MT 59604 (406) 444-5622 North Mariana Islands Department of Public Health P. Martin Luther King. State Street Jackson. MS 39215 (601) 960-7634 Missouri Department of Health 920 Wildwood Drive Jefferson City. Main Street Frankfort. Ml 48909 (517) 335-8024 Micronesia Government of the Federal States of Micronesia P. ATSDR A-23 . Jr. Room 805 Trenton.Appendix III Kentucky Department for Health Services 275 E. Room 201 Carson City. ME 04333 (207) 287-8016 Maryland Department of Health and Mental Hygiene 201 W. 2nd Floor Boston. 14th Floor Empire State Plaza Albany. LA 70821 (225) 342-8093 Maine Bureau of Health Department of Human Services State House Station #11 Augusta. Blvd PO Box 30195 Lansing. NJ 08625 (609) 292-7837 New Mexico Health 1190 St. Suite 500 Baltimore. KY 40621 (502) 564-3970 Louisiana Department of Health and Hospitals PO Box 3214 Baton Rouge. MO 65102 (573) 751-6002 Montana Department of Health and Human Services 111 North Sanders.O. NH 03301 (603) 271-8560 New Jersey Department of Health and Senior Services PO Box 360. NY 12237 (518) 474-2011 North Carolina Department of Environment.O. 3rd Floor Helena. King Street. NM 87502 (505) 827-2613 New York Department of Health Corning Tower Building. Suite 400 St. Paul. MA 02108 (617) 624-5200 Michigan Department of Community Health 3423 N. MD 21201 (410) 767-6505 Massachusetts Department of Public Health 250 Washington Street. Francis Drive Santa Fe. NE 68509 (402) 471-8566 Nevada State Health Division Nevada Department of Human Resources 505 E. Palikir Stn Pohnpei FM 96941 011-691-3202619 Minnesota Department of Health 85 East 7th Place.

RI 02908 (401) 222-2231 South Carolina Department of Health and Environmental Control 2600 Bull Street Columbia. Mail Stop 7890 Olympia. PA 17108 (717) 787-6436 Puerto Rico Department of Health PO Box 70184 San Juan. Thomas. SC 29201 (803) 898-3300 South Dakota State Department of Health 600 East Capitol c/o 500 East Capitol Pierre. ND 58505-0200 (701) 328-2372 Ohio Department of Health 246 N.. WV 25305 (304) 558-2971 A-24 ATSDR . High Street PO Box 118 Columbus. Bldg. SD 57501 (605) 773-3361 Tennessee Department of Health 3rd Floor. UT 84114 (801) 538-6111 Vermont Department of Health PO Box 70 Burlington. PR 00936 (787) 274-7600 Rhode Island Department of Health 3 Capitol Hill Providence. 3. WA 98504-7890 (360) 236-4015 West Virginia Department of Health and Human Services 1900 Kanawha Blvd. OR 97232 (503) 731-4000 Pennsylvania Department of Health PO Box 90. Room 518 Charleston. TX 78756 (512) 458-7376 Utah Department of Health 288 North 1460 West PO Box 142802 Salt Lake City. VT 05402 (802) 863-7280 Virgin Islands Social and Health Services 48 Sugar Estate St. Boulevard Avenue Bismark. Harrisburg. Room 802. VA 23219 (804) 786-3561 Washington State Department of Health 1112SE Quince Street. OH 43266-0588 (614) 466-2253 Oklahoma State Department of Health 1000 NE 10th Street Oklahoma City. #21 Portland.Appendix III Health and Natural Resources Division of Health Services 101 Blair Drive Adams Building Raleigh. TN 37247-0101 (615) 741-3111 Texas Department of Health 1100 W. 425 5th Avenue N Nashville. VI 00802 (340) 774-0117 Virginia Department of Health 1500 East Main Street PO Box 2448 Richmond. OK 73117 (405) 271-4200 Oregon Department of Human Services 800 NE Oregon Street. 49th Street Austin. NC 27626 (919) 733-4392 North Dakota Department of Health 600 E. Cordell Hull Bldg.

Appendix III Wisconsin Division of Health PO Box 309 Madison. WI 53701-0309 (608) 266-1511 Wyoming Department of Health 117 Hathaway Bldg. Cheyenne. WY 82002 (307) 777-7656 ATSDR A-25 .

Appendix IV Appendix IV Consultation Resources A-26 ATSDR .

Appendix IV ATSDR A-27 .

Department of Pathology Brigham and Women’s Hospital 75 Francis Street Boston. Membership is open to any person who shares the goals of the Association.D. Park Drive PO Box 8820 Harrisburg PA 17105-8820 (717) 558-7846 Association of Occupational and Environmental Clinics Katherine Kirkland. and consultation. Teratogen Exposure Registry and Surveillance (TERAS) Frederick Bieber. Arlington Heights Road Arlington Heights. clinical evaluations.Appendix IV Consultation Resources American College of Occupational and Environmental Medicine 114 N. Executive Director 1010 Vermont Avenue Suite 513 Washington. Executive Director 777 E. DC 20005 (202) 347-4976 The Association of Occupational and Environmental Clinics (AOEC) is a network of clinics affiliated with medical schools throughout the U. University programs in occupational health. A lending library of training materials is maintained for use by members. Ph. IL 60004 (847) 818-1800 American Board of Medical Toxicology Heather Miller. In addition. some hospitals have occupational or environmental health clinics that accept referrals.S. industrial hygiene. A-28 ATSDR . Clinicians can contact the AOEC office for referrals. Member clinics provide professional training. or toxicology Schools of public health or schools of medicine at universities function as resources to local communities. exposure and risk assessment. MA 02115 (617) 732-6507 TERAS is a network of geneticists and pathologists studying human embryos and fetuses exposed to teratogens. community education about toxic substances. TERAS maintains information networks for consultation and evaluations.

or chemicals in the work environment will harm the developing fetus or breast-fed baby.. Director Hospital for Sick Children 555 University Avenue Toronto. Genetic counseling is available from the Hospital for Sick Children’s Genetic Department. The team of physicians and information specialists give advice on whether medications.D.Appendix IV MotherRisk Program Gideon Koren. ATSDR A-29 . or radiation during pregnancy or breast feeding. X-rays. Ontario M5G lX8 (416) 813-6780 The MotherRisk Program will counsel callers about t he safety of an exposure to drugs. M. chemicals.

htm Integrated Risk Information System (IRIS) Hazardous chemicals information.edu/info/nptn/ National Pesticide Information Retrieval System (NPIRS) Help number for searching NPIRS database to get fact sheets on pesticides. insecticides. actions being taken (800) 775-5037 http://www.orst.Appendix IV State/Federal/National Resources Chemical Emergencies National Response Center (800) 424-8802 http://nrc.gov/iris/ IRIS User Support (513) 569-7254 Lung Disease Lungline/National Jewish Hospital Information on lung disease from chemical exposure (800) 222-5864 http://www.NationalJewish.edu/npirs/ npirs. Funded by EPA/USDA.epa.epa.growinglifestyle.uscg.htm Superfund Order and Information Line Provides information about Superfund Records of Decision-hazardous waste sites to be cleaned up. list of more than 400 acutely toxic chemicals (800) 535-0202 http://www.mil/index.htm Hazardous Waste Emergency Planning and Community RightTo-Know Hotline (EPA) Developing chemical contingency plans.osha. fungicides.epa.niosh/ homepage.purdue.cdc.html Medical Section/Diagnosis and Treatment (513) 841-4388 Industrial Hygiene (513) 841-4374 OSHA (Occupational Safety and Health Administration) Regulations for toxic and hazardous substances in the workplace For emergencies: (800) 321-6742 For other inquires: (202) 693-1999 http://www. including health effects (513) 569-7254 http://www.org Lead National Center for Environmental Health and Injury Control (CDC) Lead poisoning prevention (404) 488-4880 http://www.gov Pesticides National Pesticide Hotline (800) 858-7378 http://www.org/ Occupational Health NIOSH Information and publications on health effects of occupational exposures (800) 356-4674 http://www. gathering site-specific information. state and federally registered chemicals. managed by Purdue University (765) 494-6616 http://ceris.html National Pesticide Telecommunications Network (800) 858-7378 http://ace.nmchc.gov.html A-30 ATSDR .cdc.gov/superfund/sites/ phonefax/index.com/article/ 73p5/a1656.gov/epaoswer/hotline/in dex.gov Child and Maternal Health Clearinghouse Publications on lead poisoning (888) 434-4MCH http://www.

epa.co m/chemtrec.nih.cdc.html EPA Radon Information Center (800) 438-4318 http://www.html Toxic Chemical Release Inventory System (EPA) Information about which chemicals are used.nlm.Appendix IV Radon Radon Hotline (800) SOS-RADON http://www.gov.gov/ TechResources/tirc/hmepg.gov CHEMTREC (Chemical Manufacturers Association) Nonemergency health and safety information on chemicals (800) 282-8200 http://memberexchange.gov/ Toxic Substances Control Act (TSCA) Hotline/Public Information Office (EPA) Answers questions and gives general technical assistance on TSCA.gov/iaq/radon/ index.ornl.html Toxic Substances Toxicology Information Response Center (Oak Ridge) General toxics information.gov/iaq/iaqinfo.html Agency for Toxic Substances and Disease Registry (ATSDR) Emergency Response Section.safewater ATSDR A-31 . searches on chemicals (865) 576-1746 http://www. released by companies (800) 535-0202 http://toxnet.epa.epa.epa. stored.nsf Water EPA Safe Drinking Water Hotline (800) 426-4791 www. Guidance on TSCA regulations (202) 554-1404 Http://es. (404) 639-0615 (24 hours) (404) 639-6360 (24 hours) (404) 639-6363 (fax) http://www.cmahq. Rapid assistance provided about health issues from chemical exposures.atsdr.gov/oeca/ccsmd/ tsca.

Appendix IV A-32 ATSDR .

1.Glossary Chemical Glossary Chemical Formula Structural Formula Chemical Name AsH3 As2O3 CHCl2NO CHN CH2Cl2 CH2O CH3Br C2Cl4 C2HCl3 C2H3Cl C2H3Cl3 C2H4O C2H6O2 C3H3N C4H6 C6H6 C6H6O C6H7N C7H8 C8H10 C9H6N2O2 C10H6Cl8 C10H14NO5PS COCl2 Cl2 HCI HF Hg H2O2 H2S NH3 NOx PH3 NaOH SO2 AsH3 As2O3 ClC[NOH]Cl HCN CH2Cl2 HCHO CH3Br Cl2CCCl2 CICHCCl2 CH2CHCl CH3CCl3 [CH2]2O HO[CH2]2OH CH2CHCN CH2[CH]2CH2 C6H6 C6H5-OH C6H5NH2 C6H5-CH3 CH3-C6H4-CH3 CH3C6H3[NCO]2 C10H6Cl8 [C2H5O]2P[S]OC6H4NO2 COCl2 Cl2 HCI HF Hg H2O2 H2S NH3 NOx PH3 NaOH O2S Arsine Arsenic trioxide Phosgene oxime Hydrogen cyanide Methylene chloride Formaldehyde Methyl bromide Tetrachloroethylene Trichloroethylene Vinyl chloride 1.3-Butadiene Benzene Phenol Aniline Toluene Xylene Toluene diisocyanate Chlordane Parathion Phosgene Chlorine Hydrogen chloride Hydrogen fluoride Mercury Hydrogen peroxide Hydrogen sulfide Ammonia Nitrogen oxides Phosphine Sodium hydroxide Sulfur dioxide ATSDR G-1 .1-Trichloroethane Ethylene oxide Ethylene glycol Acrylonitrile 1.

Glossary G-2 ATSDR .

HD. HN3) Dihydrogen dioxide See Hydrogen peroxide Dihydrogen sulfide See Hydrogen sulfide Diisocyanatotoluene See Toluene diisocyanate Dimethylbenzene See Xylene Dimethylene oxide See Ethylene oxide Dinitrogen tetroxide See Nitrogen oxides DNTP See Parathion ATSDR G-3 . HT) Bis(2-chloroethyl) sulfide See Blister agent (H. HN2. HT) Dichloromethane See Methylene chloride 2. HN3) Dichloroformoxime See Phosgene oxime. HN2.2'-Dichloro-N-methyldiethylamine See Blister agent (HN1. HN2. HD. HT) Di-2-chloroethyl sulfide See Blister agent (H. HD. HN3) CD-68 See Chlordane Chlordan See Chlordane Chlordane Chlorine Chlor-Kil See Chlordane Chlormethine See Blister agent (HN1.N-bis(2-chloroethyl)ethanamine See Blister agent (HN1.1. HN2. HN3) Chloroethene See 1. HT) Bis(2-chloroethyl)ethylamine See Blister agent (HN1.2'-Dichlorotriethylamine See Blister agent (HN1. HD.3-Butadiene C-100 See Chlordane Carbolic acid See Phenol Carbon oxychloride See Phosgene Carbonic acid dichloride See Phosgene Carbonic dichloride See Phosgene Carbonyl chloride See Phosgene Caustic soda See Sodium hydroxide Caryolysin See Blister agent (HN1.3-Butadiene Bivinyl See 1. L) Bromoethane See Methyl bromide 1. HT) Blister Agent (HN1. HD. HN3) Coal tar naptha See Benzene CX See Phosgene oxime Cyanocthylene See Acrylonitrile Cyclohexatriene See Benzene Danthion See Parathion 2. HN2. HN3) Bis(2-chloroethyl)methylamine See Blister agent (HN1. HN2. HN3) Blister Agent (HL. HN2. Arsine) Acetylene trichloride See Trichloroethylene Acrylonitrile Alkron See Parathion Alleron See Parathion Aminobenzene See Aniline Aminophen See Aniline Ammonia Ammonia gas See Ammonia Ammonia solution See Ammonia Ammonium hydroxide See Ammonia Amprolenne See Methylene oxide AN See Acrylonitrile Anammonide See Hydrogen cyanide Anhydrous ammonia See Ammonia Aniline Aqueous ammonia See Ammonia Arsenic hydride See Arsine Arsenic trihydride See Arsine Arsenic trioxide Arseniuretted hydrogen See Arsine Arsenous acid See Arsenic trioxide Arsenous oxide See Arsenic trioxide Arsenous hydride See Arsine Arsine Arylamine See Aniline Benzene Benzenamine See Aniline Benzenol See Phenol Benzol See Benzene Bis(beta-chloroethyl) sulfide See Blister agent (H. HN3) Dichloren See Blister agent (HN1. Subjects of chemical protocols are in boldface italics (e. HN3) 1-Chloro-2(beta-chloroethylthio)ethane See Blister agent (H. HT) 2-Chloro-N-(2-chloroethyl)-N-ethylethanamine See Blister agent (HN1..1-Trichloroethane Chloroethylene See vinyl chloride Chloroformyl chloride See Phosgene Chlorohydric acid See Hydrogen chloride 2-Chloro-N.g. HN3) Blister Agent (H. HN2.Glossary Chemical Index Listed below are names of chemical protocols and their synonyms. HD.2'-Dichloroethyl sulfide See Blister agent (H. 2. HN2. HN2.

HN2. HT) L See Blister agent (HL. HN3) Hydrochloric acid See Hydrogen chloride Hydrocyanic acid See Hydrogen cyanide Hydrofluoric acid See Hydrogen fluoride Hydrofluride See Hydrogen fluoride Hydrogen arsenide See Arsine Hydrogen chloride Hydrogen cyanide Hydrogen dioxide See Hydrogen peroxide Hydrogen fluoride Hydrogen peroxide Hydrogen phosphide See Phosphine Hydrogen sulfide Hydroperoxide See Hydrogen peroxide Hydroxybenzene See Phenol Iprit See Blister agent (H. HD. GB. VX) Nitric oxide See Nitrogen oxides Nitrogen dioxide See Nitrogen oxides Nitrogen monoxide See Nitrogen oxides Nitrogen peroxide See Nitrogen oxides Nitrogen tetroxide See Nitrogen oxides G-4 ATSDR . HN3) HN3 See Blister agent (HN1. HN2. HN3) Ethylbis(2-chloroethyl)amine See Blister agent (HN1. HN3) HN2 See Blister agent (HN1.2-Ethanediol See Ethylene glycol Ethyl-S See Blister agent (HN1.Glossary DPP See Parathion E-605 See Parathion Epoxyethane See Ethylene oxide 1. L) Lewisite See Blister agent (HL. GD. HN2. HD. HN2. L) Mustine See Blister agent (HN1. L) HN1 See Blister agent (HN1. L) Liquid ammonia See Ammonia Lye See Sodium hydroxide MBA See Blister agent (HN1. HN3) Nerve agent (GA. HN3) Mechlorethamine See Blister agent (HN1. HN2. HT) Mustard-Lewisite See Blister agent (HL. HD.1-Trichloroethane Methyl toluene See Xylene Methylene bichloride See Methylene chloride Methylene chloride Methylene dichloride See Methylene chloride Methylene oxide See Formaldehyde Mixed xylenes See Xylene Molecular chlorine See Chlorine Monobromomethane See Methyl bromide Monohydride See Hydrogen fluoride Monohydroxybenzene See Phenol Mononitrogen monoxide See Nitrogen oxides Monophenol See Phenol Motor fuel See Gasoline Muriatric acid See Hydrogen chloride Mustard gas See Blister agent (H. HN3) Mercury Methanal See Formaldehyde Methane dichloride See Methylene chloride Methyl aldehyde See Formaldehyde Methyl benzene See Toluene Methyl benzol See Toluene Methyl bromide Methylchloroform See 1. HN2. HT) Iscobrome See Methyl bromide Kampstoff “Lost” See Blister agent (H. HN2.1. HN3) Ethyl parathion See Parathion Ethylene glycol Ethylene oxide Ethylene tetrachloride See Tetrachloroethylene Ethylene trichloride See Trichloroethylene Ethinyl trichloride See Trichloroethylene Etilon See Parathion ETO See Ethylene oxide Fluoric acid See Hydrogen fluoride Fluorine monohydride See Hydrogen fluoride Formaldehyde Formalin See Formaldehyde Formic aldehyde See Formaldehyde Formonitrile See Hydrogen cyanide Gasoline Gas See Gasoline HL See Blister agent (HL. HN2.

2"-Trichlorotriethylamine See Blister agent (HN1.Glossary NTO See Nitrogen oxides Nitrogen fumes See Nitrogen oxides Nitrous fumes See Nitrogen oxides Nitrogen oxides Octachlor See Chlordane Oxirane See Ethylene oxide Oxacyclopropane See Ethylene oxide Oxomethane See Formaldehyde Paraform See Formaldehyde Parathion Perc See Tetrachloroethylene Perchloroethylene See Tetrachloroethylene Peroxide See Hydrogen peroxide Petrol See Gasoline Phenic acid See Phenol Phenol Phenyl alcohol See Phenol Phenyl hydroxide See Phenol Phenylic acid See Phenol Phenylic alcohol See Phenol Peroxide See Hydrogen peroxide Phenyl hydride See Benzene Phenylamine See Aniline Phenylmethane See Toluene Phosgene Phosgene oxime Phosphine Phosphorus hydride See Phosphine Phosphorus trihydride See Phosphine Phosphoretted hydrogen See Phosphine Propenenitrile See Acrylonitrile Prussic acid See Hydrogen cyanide Pyrrolyene See 1. L) Sulfurous anhydride See Sulfur dioxide Sulfurous oxide See Sulfur dioxide TCE See Trichloroethylene TDI See Toluene diisocyanate Tabun See Nerve agent (GA. HT) Stathion See Parathion Stink damp See Hydrogen sulfide Sulfur dioxide Sulfur hydride See Hydrogen sulfide Sulfur mustard agent H See Blister agent (H. VX) Senfgas See Blister agent (H. GD. HD. HT) Yperite See Blister agent (H. HD. HD. HT) Sulfur mustard agent HD See Blister agent (H. HT) Sulfur mustard agent HT See Blister agent (H.1-Trichloroethane Trichloroethene See Trichloroethylene Trichloroethylene 2.3-Butadiene Quick silver See Mercury Sarin See Nerve agent (GA. GD. VX) White arsenic See Arsenic trioxide Xylene Xylol See Xylene Yellow cross liquid See Blister agent (H. GB. HT) Sewer gas See Hydrogen sulfide Soda lye See Sodium hydroxide Sodium hydrate See Sodium hydroxide Sodium hydroxide Soman See Nerve agent (GA.1. HN3) VCN See Actylonittile Velsicol 1068 See Chlordane Vinyl ethylene See 1.3-Butadiene Vinyl chloride Vinyl cyanide See Acrylonitrile VX See Nerve agent (GA. HD. HN3) Tris(2-chloroethyl)amine See Blister agent (HN1. HD. HN2. GB. HT) Sulphos See Parathion Sulfuretted hydrogen See Hydrogen sulfide Sulfur mustard/lewisite See Blister agent (HL. VX) Spirits of salt See Hydrogen chloride S-yperite See Blister agent (H. HT) ATSDR G-5 . HN2.2'. HT) Sulfur mustards See Blister agent (H. VX) Termicide C-100 See Chlordane Tetrachloroethylene Thiophos See Parathion Toluene Toluene diisocyanate Toluol See Toluene Tolylene diisocyanate See Toluene diisocyanate Topichlor See Chlotdane Toxichlor See Chlordane Tri See Trichloroethylene 1. GD. HD. HD. GD. GB. GB. HD.

Glossary G-6 ATSDR .

Glossary Absorption. Alkali. usually indicative of transient dysfunction or disease. or other material to limit the spread of contamination. The tendency of certain receptors to become less responsive or cease to respond to repeated or continued stimuli. blood. Alveoli (singular alveolus). Antidote. the amount of hemoglobin. Respirators or filtration devices that remove particulate matter. Lack of oxygen in inspired air. Lack of appetite. An agent that neutralizes a poison or counteracts its effects. or other substance. Anorexia. The incorporation of liquids or gases into the body. Air-supplied respirators. Anhydrous. The fluid-filled front portion of the eye between the cornea and the lens. facepiece-mounted cartridges with no eye protection. Any condition in which the number of red blood cells. Anterior chamber of the eye. and the volume of packed red blood cells per 100 milliliters of blood are less than normal. Alveolar ducts. Containing no water. Microscopic air sacs in which gas exchange between the blood and the lungs occurs. liquid. Adsorption. sawdust. Albuminuria. A device that provides the user with compressed air for breathing. Absorption is also the process by which liquid hazardous materials are soaked up by sand. ATSDR G-7 . Anisocytosis. Any parts of the respiratory tract through which air passes during breathing. gases. Sometimes called bronchioles. These devices range from full-facepiece. A single encounter to toxic concentrations of a hazardous material or multiple encounters over a short period of time (usually 24 hours). Anemia. A basic substance (pH greater than 7) that has the capacity to neutralize an acid and form a salt. Anuria. Absence of urine production. or vapors from the atmosphere. The smallest of the lungs’ airways that connect terminal bronchioles and alveolar sacs. Considerable variation in the size of blood cells. Anoxia. Airways. dual-cartridge respirators with eye protection to halfmask. Adaptation. Acute effect. The property of a substance to attract and hold to its surface a gas. or tissues. The presence of protein (primarily albumin) in the urine. Acute exposure. A pathologic process caused by a single substantial exposure. Air purification devices. aversion to food.

Bronchorrhea. A tendency or predisposition to allergic reactions. Bronchiole. The lowest temperature at which a gas or vapor-air mixture will ignite from its own heat source or a contacted heated surface without a spark or flame.e. as determined from the proportions in which they are present in a given element. Blepharospasm. Slow heart rate. Cessation of breathing. Large divisions of the trachea that convey air to and from the lungs. usually food or vomitus. Boiling point. allergy. especially affecting gait and speech. Atomic weight. A red pigment that results from normal and abnormal destruction of red blood cells. The average weight (or mass) of all the isotopes of an element. Atopy. Axonal.000). Asphyxia. usually associated with a persistent cough and sputum production. Increased bronchial secretions. A small-diameter airway branching from a bronchus. which is the official international standard. A condition characterized by a decrease in the amount of hemoglobin in the blood due to incomplete or defective development of red blood cells. or other stimuli. Atelectasis. Inflammation of the mucous membrane of the bronchial tubes. A chronic condition in which constriction (spasm) of the bronchial tubes occurs in response to irritation. Incoordination of voluntary movement.. Involuntary spasmodic blinking or closing of the eyelids due to severe irritation.Glossary Aplastic anemia. usually under 60 beats per minute. The temperature at which the vapor pressure of a liquid equals the atmospheric pressure and the liquid becomes vapor. large number of fibrils enveloped by a segmented myelin sheath. Apnea. measured in daltons. Asthma. Autoignition temperature. dendrites). compared with the mass of the 12 isotope of carbon (taken as precisely 12. Pertaining to an axon. into the bronchi. Bilirubin. Inflammation of the lungs due to inhalation of foreign material. Bronchitis. A condition in which the exchange of oxygen and carbon dioxide in the lungs is absent or impaired. The part of a nerve cell that conducts nervous impulses away from the nerve cell body to the remainder of the cell (i. usually accompanied by defective regeneration of white blood cells and platelets. Ataxia. Axon. Bradycardia. G-8 ATSDR . Lung collapse. Aspiration pneumonia. Bronchi (singular bronchus).

Formerly referred to as cardiac arrhythmia. or destroys living tissue. Clothing specifically designed to protect the skin and eyes from direct chemical contact. includes the cerebral hemispheres (cerebral cortex and basal ganglia). The large brain mass located at the posterior base of the brain. Cardiac dysrhythmia. A pathologic process caused by repeated exposures over a period of long duration. or sequence of the heart beat. Cerebrum. Chemical-protective clothing.Glossary Bronchospasm. ATSDR G-9 . Loss of transparency (clouding) of the lens of the eye. Contraction of the smooth muscle of the bronchi. corrodes. Abnormality in the rate. Causing cancer. Compressed gas. The collection of atomic symbols and numbers that indicates the chemical composition of a pure substance. Cerebellum. use of chemicals to remove scars or pigmentation defects. Coma. Cerebellar abnormalities.g. typically associated with wheezing. bums. Caustic. Any liquid that has a flash point at or above 100 EF (37. Gas whose volume has been reduced by pressure. The largest portion of the brain. State of profound unconsciousness from which the patient cannot be aroused. Chemical skin peeling. Substance that strongly irritates. Cerebral infarctions. Bullae. epinephrine [adrenaline] or dopamine) to increase heart rate and blood pressure. This narrowing increases the resistance of air flow into the lungs and may cause a shortness of breath. Chemical formula. causing narrowing of the bronchi. regularity. Chronic effect. Any irregularity in the cerebellum of the brain.7 EC) and below 200 EF (93. responsible for balance and coordination of movement. Chronic exposure. Large fluid-filled blisters.3 EC). Repeated encounters with a hazardous substance over a period of long duration. Chemexfoliation. Cataract. Substances of a specific chemical nature (pyrocatechols with an alkylamine side chain). or medicines with the same general chemical structure and effect. Congenital anomalies. respectively). Carcinogenic. Birth defects. Cognitive function. Catecholamines.. The ability to think. Death of tissue in the cerebrum due to lack of blood flow to the area. Combustible liquid. Catecholamines of biochemical interest am those produced by the nervous system (e. Descriptions of chemical-protective apparel include nonencapsulating and encapsulating (referred to as liquid-splash protective clothing and vapor-protective clothing.

a molecular breakdown of material because of chemical contact. G-10 ATSDR . and a rapid succession of confused and unconnected ideas. Conjunctivitis. Ability to destroy the texture or substance of a tissue. Decontamination Zone. Cornea1 opacification. Degradation. The area surrounding a chemical hazard incident (between the Hot Zone and the Support Zone) in which contaminants are removed from exposed victims. A condition of extreme mental (and sometimes motor) excitement marked by defective perception. and loss of tensile strength will also reveal degradation. That area in a hospital designated for the treatment of severely ill patients. shrinking. Inflammation of the conjunctiva. and tearing of the eye. Shrinkage or wasting of muscles due to loss of nerve supply. can result in redness. generally includes the Hot Zone. irritation. Dermal. Contact dermatitis (allergic). Testing clothing material for weight changes. Dermatitis. Delirium. Removal (destruction) of the myelin sheath that surrounds and protects nerves. Demyelination. degradation is evidenced by visible signs such as charring.Glossary Conjunctiva (plural conjuctivae). Relating to the skin. The process of decomposition.e. Areas at a hazardous materials incident whose boundaries are based on safety and the degree of hazard. Cornea. Clouding of the cornea. A delayed-onset skin reaction caused by skin contact with a chemical to which the individual has been previously sensitized. Control zones. Skin inflammation. Contact dermatitis (irritant). Denervation atrophy.. Corrosive. often with illusions and hallucinations. Bluish discoloration of the skin and mucous membranes due to deficient oxygenation of the blood. impaired memory. or dissolving. usually evident when reduced hemoglobin (i. hemoglobin unable to carry oxygen) exceeds 5%. Dementia. The delicate mucous membrane that covers the exposed surface of the eyeball and lines the eyelids. To remove natural oils from the skin. Decontamination. Cyanosis. Transparent membrane that covers the colored part of the eye. When applied to protective clothing. The process of removing hazardous materials from exposed persons and equipment at a hazardous materials incident. and Support Zone. Inflammatory skin reaction caused by a skin irritant. thickness changes. A general deterioration of mental abilities. Decontamination Zone. Defat. Critical Care Area.

The portion of the digestive canal extending from the throat to the stomach. or plant or animal life. Edema. the developing conceptus up to 8 weeks after fertilization of the egg. Dyspnea. water. Excessive perspiration. Emergency. The dermis has a rich supply of blood vessels. Embolization. widespread reddening of the skin. Diaphoresis. usually identified as swelling. Environmental hazard. difficult or labored breathing. Esophagus. Dysuria. Ability to harm the embryo. The outermost layer of the skin. Esophageal strictures. Removal of moisture. Accumulation of fluid in body cells or tissues. Desiccant effect. Embryo. nerves. Erythroderma. Emesis. Diplopia. Embryotoxicity. A condition capable of posing an unreasonable risk to air. The use of water to lower the concentration or amount of a contaminant. Desiccation. Narrowing of the esophagus that causes difficulty in swallowing. Erythema. Epidermis. Painful or difficult urination. Any disease of the brain. Obstruction of a blood vessel by a transported clot or other mass.Glossary Dermis. Dilution. often due to scar formation following extensive bums. Vomiting. The layer of the skin just below the epidermis or outer layer. Encephalopathy. and skin structures. ATSDR G-11 . Drying of the skin caused by removal of soluble oils. See also fetus. Shortness of breath. Redness of the skin. A sudden and unexpected event requiring immediate remedial action. Also referred to as the gullet. Difficulty in swallowing. Double vision. Intense. In humans. Dysphagia. or soil quality. drying. Dyscrasia. Blood disorder.

Fetotoxic. G-12 ATSDR . can expand and contract greatly in response to changes in temperature and pressure. Exfoliative dermatitis. the mixture is too rich to bum. A physical state of matter that has low density and viscosity. See also embryo. Exothermic reaction. Gas. Constant or intermittent contact with a patient after diagnosis or therapy. Gangrene. the temperature at which a solid substance begins to melt as it is slowly heated. the mixture is too lean to bum. Death of tissue due to lack of blood supply. The range of gas or vapor concentration (percentage by volume in air) that will bum or explode if an ignition source is present. chemical reaction). Temperature at which crystals start to form as a liquid is slowly cooled. Flash point. typically occurs via the vapor of a highly volatile liquid or by a flammable gas escaping from a cylinder. Explosives. Muscle twitching. Freezing point.. alternatively. Limiting concentrations are commonly called the lower explosive limit and upper explosive limit. Accumulation of excessive fluoride in the body. The movement of a flame to a fuel source. Flammable. condensation of vapors. An intense and exaggerated feeling of well-being. Slow or unable to bum. The minimum temperature at which a liquid produces enough vapor to ignite. Fluorosis. Fume.g. Compounds that are unstable and break down with the sudden release of large amounts of energy. Explosivity.Glossary Euphoria. readily and uniformly distributes itself throughout any container. Fine particles (typically of a metal oxide) dispersed in air that may be formed in various ways (e. Flammable (explosive) range. Having the ability to harm the fetus. the conceptus from 8 weeks after fertilization until birth. The ability of a substance to ignite and bum. above the upper explosive limit. Fasciculation. characterized by increased bone density and mineral deposits in tendons. The characteristic of undergoing very rapid decomposition (or combustion) to release large amounts of energy. and muscles. Followup. A skin condition that involves scaling or shedding of the superficial cells of the epidermis. In humans. Fetus. Chemical reactions that produce heat. Flame-resistant. ligaments. Flashback. Below the lower explosive limit.

A condition in which an abnormally large amount of bilirubin is found in the blood. Hemodialysis. A condition in which an abnormally low concentration of calcium ions is present in the blood. Jaundice becomes apparent when the level of bilirubin is double the normal level. pain. if not properly controlled. pose a risk to people. ATSDR G-13 . A condition in which the deep tendon reflexes are exaggerated. Removal of soluble substances from the blood by their diffusion through a semipermeable membrane. Hazard. Hypersensitization. Any anemia resulting from destruction of red blood cells. The uncontrolled release or potential release of a hazardous material from its container into the environment. Condition in which the urine contains an abnormal amount of hemoglobin. Destruction or dissolution of red blood cells in such a manner that hemoglobin is liberated into the medium in which the cells are suspended. Condition in which the urine contains an abnormal amount of blood or red blood cells. Hyperbilirubinemia. Hazardous materials incident. The area immediately surrounding a chemical hazard incident. High blood pressure. Hypocalcemia. Hazardous materials. Increased sensitivity to touch. or the environment. induced by initial exposure with subsequent exposures eliciting a greater than expected immunologic response. Hemolysis. Enlargement of the liver. A disease of the eye characterized by abnormal and damaging high pressure inside the eye. A tuft formed of capillary loops that filter blood in the kidney. A circumstance or condition that can cause harm. in which contamination or other danger exists. Hyperesthesia. Hyperreflexia. Glomerulus (plural glomeruli). Increased sensitivity of the immune system. The spitting of blood derived from hemorrhage in the lungs or bronchial tubes. Substances that. property. Hepatic. Hemolytic anemia. Hemoglobinuria. Hematuria.Glossary Glaucoma. Pertaining to the liver. Hemoptysis. Hypertension. or other sensory stimuli. Hepatomegaly. Hot Zone. such as a spill. usually due to a blockage of the channel that normally allows the outflow of fluid from the eye. Hyperpigmentation. An excess of pigment in a tissue or part of the body.

Interstitial pneumonitis. Characteristic (e. Trembling of the extremities during movement. Low arterial blood pressure. Ischemia. short of anoxia. allocating resources.. Hypoxemia. A condition in which there is a loss of muscle tone. Inflammation of the alveolar walls and the spaces between them. Death of cells as a result of decreased blood flow to affected tissues. odor. making appropriate assignments. G-14 ATSDR . bilirubin) in the circulating blood. The minimum temperature required to ignite gas or vapor without a spark or flame being present. Ischemic necrosis. Jaundice. An agent that has the ability to kill insects. Hypoxia. managing information. Hypotension. Hypophosphatemia.. That atmospheric concentration of a chemical that poses an immediate danger to the life or health of a person who is exposed but from which that person could escape without any escape-impairing symptoms or irreversible health effects.g. Ignition (autoignition) temperature. Insecticide. irritation) of a substance that is not sufficient to cause a person to notice exposure. Condition in which below-normal levels of oxygen are present in the air. Inadequate warning property. short of anoxia. The person responsible for establishing and managing the overall operational plan at a hazardous material incident. Obstruction of blood flow (usually by arterial narrowing) that causes lack of oxygen and other bloodborne nutrients. Yellowing of the skin and whites of the eyes due to an accumulation of bile pigments (e. Condition in which an abnormally low concentration of phosphate is found in the blood. may cause convulsions and concurrent hypocalcemia. A condition in which inadequate oxygen is present in arterial blood. Inflammation of the colored part of the eye (iris). A companion measurement to the permissible exposure limit (PEL). IDLH concentrations represent levels at which respiratory protection is required. Hypotonia. Iritis. blood.Glossary Hypokalemia. IDLH is expressed in parts per million (ppm) or mg/m3. The incident commander is responsible for developing an effective organizational structure. and continually attempting to mitigate the incident. Hypomagnesemia. A condition in which the plasma concentration of magnesium ions is abnormally low. Incident commander. or body tissues. Intention tremor. Immediately dangerous to life and health (IDLH). A condition in which an abnormally low concentration of potassium ions is present in the blood.g.

Myalgia. Monocytic leukemia.v. ATSDR G-15 . Dilation of the pupil. mononuclear white blood cells in tissues.g. organs. Laryngospasm. Condition in which methemoglobin is present in the urine. Mitigation. Miosis. Methemoglobin. Lacrimation. and about emergency response plans. Mydriasis. A form of bone marrow cancer characterized by an increase in the number of large. A state of extreme tiredness or fatigue. Secretion of tears. Swelling of the voice box due to fluid accumulation. Condition in which methemoglobin is present in the circulating blood. Actions taken to prevent or reduce the severity of harm. Myocardial ischemia. Able to mix (but not chemically combine) in any ratio without separating into two phases (e. Liquid droplets dispersed in air. and the circulating blood. Inflammation of the mucous membrane of the larynx. Inflammation of the cornea. Methemoglobinemia.Glossary Keratitis. Severe muscle pain. which prevents the release of oxygen to the tissues. Documents prepared by the chemical industry to transmit information about the physical properties and health effects of chemicals. Molecular weight. Contraction of the pupil to a pinpoint. water and alcohol). A form of bone marrow cancer characterized by the presence of large numbers of granular white blood cells in tissues. due to cancer of the bone marrow cells that form leukocytes. Progressive proliferation of abnormal leukocytes found in blood and blood-forming tissues and organs. Material safety data sheet (MSDS). measured in daltons. Lethargy. organs. White cell normally present in circulating blood. Leukemia. and the circulating blood. especially in excess. Leukocyte. Insufficient oxygen supply to meet the metabolic demands of heart muscles. The sum of the atomic weights (q.) of the atoms in a molecule. Myelocytic leukemia. Laryngitis. Spasmodic closure of the vocal apparatus. Miscible. Methemoglobin contains oxygen that is firmly bound to the Fe+3 ion.. A transformation product of hemoglobin in which normal Fe+2 is oxidized to Fe+3. Laryngeal edema. Mist. Methemoglobinuria.

Presence of myoglobin in urine. in contemporary usage. Ocular. Involuntary spasm or twitching of a muscle or group of muscles. Nystagmus. not due to heart failure. Tetanic spasm in which the spine and extremities are bent up and forward so that a reclining body rests on the head and the heels. Optic neuritis. Peripheral neuropathy. Nephrotoxic. Pertaining to the eye. Inflammation of the optic nerve. The lowest concentration of a vapor or gas that can be detected by smell. Capable of damaging the kidney. Condition in which abnormally small amounts of urine are produced. Giving off a vapor or gas. resembles blood hemoglobin in function. Odor threshold. Temporary loss of the sense of smell due to repeated or continued stimulation. pigmented protein of muscle. Involuntary rapid movements of the eyeballs. Abnormal hardening or increase in density of the bone. either rhythmical or jerky. A disorder of the nervous system. Necrosis. Passage of a substance through unbroken skin. or tingling. The oxygen-transporting. Myoclonus. Neuropathy. Oliguria. Death of one or more cells or a portion of a tissue or organ.Glossary Myocarditis. An abnormal sensation such as burning. Paresthesias. Osteosclerosis. Opisthotonos. The passage of chemicals. Relating to the nasal cavity and that part of the throat that lies above the level of the soft palate. Inflammation of the muscles of the heart. A disorder of the peripheral nerves. Percutaneous absorption. on a molecular level. Myoglobin. Optic atrophy. Olfactory fatigue. Off-gassing. through intact material such as protective G-16 ATSDR . An accumulation of an excessive amount of fluid in the lungs as a result of leakage from pulmonary capillaries. a disease involving the cranial or spinal nerves. Noncardiogenic pulmonary edema. prickling. Permeation. Myoglobinuria. Shrinkage or wasting of the optic nerve that may lead to partial vision loss or blindness. Nasopharynx.

Posthypoxic encephalopathy. Pupil. The circular opening in the center of the iris through which light rays enter the eye. Retrobulbar neuritis. Routes of exposure. Pertaining to itching. A condition in which an abnormal amount of protein is present in the urine.g.. HAZMAT team). Respiratory depression. Psychosis. Reactivity. Pulmonary edema. Photophobia. Response personnel. inhalation. An organization prepared to provide assistance in an emergency (e. 40 hours per week without adverse health effects. A discharge from the nasal mucous membrane. Pruritic. The ability of a substance to chemically interact with other substances. The maximum time-weighted average concentration mandated by the Occupational Safety and Health Administration (OSHA) to which workers may be repeatedly exposed for 8 hours per day. especially of the eyes. Abnormal sensitiveness to light. Permissible exposure limit (PEL). ingestion). Slowing or cessation of breathing due to suppression of the function of the respiratory center in the brain. The state (solid. Rescuer protection equipment.g. The manner in which a chemical contaminant enters the body (e. The presence of irregularly shaped red blood cells in the peripheral blood. Inflammation of the lungs. Physical state. A mental disorder characterized by derangement of personality and loss of touch with reality. Accumulation of extravascular fluid in the lungs that impairs gas exchange. Response organization. Gear necessary to prevent injury to workers responding to chemical incidents.. Inflammation of the mucous membranes of the nasal passages. Rhinorrhea. fire department). Pneumonitis. liquid.Glossary clothing. ATSDR G-17 . See also albuminuria.. Rhinitis. usually due to either increased intravascular pressure or increased permeability of the pulmonary capillaries. Inflammation of the portion of the optic nerve behind the eyeball. or gas) of a chemical under specific conditions of temperature and pressure.g. Condition in which the brain has been damaged as a result of insufficient oxygen. Proteinuria. Staff attached to a response organization (e. Poikilocytosis.

Tachypnea. Sensory neuropathy. The process by which necrotic cells separate from the tissues to which they have been attached. An agent that reduces surface tension (e. Support Zone. Blood vessel clotting. Soluble. That concentration of a substance in air that is measured by collecting it on a substrate at a known rate for a given period of time. Sequela (plural sequelae). Sloughing. Solvent. The ratio of the mass of a unit volume of a substance to the mass of the same volume of a standard substance (usually water) at a standard temperature. Rapid breathing. temperature) to the brain. Tetany. Protective equipment consisting of an enclosed facepiece and an independent. usually liquid. A condition marked by involuntary muscle contractions or spasms.. white supporting tunic of the eyeball. individual supply (tank) of air. high-pitched respiratory sound often heard in acute respiratory obstruction. Rapid heartbeat (typically greater than 100 beats per minute). G-18 ATSDR . Secondary contamination. The tough. Transfer of a harmful substance from one body (primary body) to another (secondary body). used for breathing in atmospheres containing toxic substances or underwater. detergents. Teratogenic. Thrombosis. touch. Damage to the nerves that carry information about sensation (e. Status epilepticus. A homogeneous mixture of two or more substances. Thrombocytopenia. A condition in which there is an abnormally small number of platelets in the blood.g. Solution. thus potentially permitting adverse effects to the secondary body. Tachycardia. That area beyond the Decontamination Zone that surrounds a chemical hazard incident in which medical care can be freely administered to stabilize a victim. Self-contained breathing apparatus (SCBA). Having the ability to cause congenital anomalies.g. Capable of being dissolved.Glossary Sclera. Solubility. A condition that follows as a consequence of injury or disease. The ability of one material to dissolve in or blend uniformly with another. Severe seizures in which recovery does not occur between major episodes. Stridor. Time-weighted average (TWA) air concentration. wetting agents. dispersing agents). pain.. A substance that dissolves another substance. Specific gravity. Surfactant. A harsh.

Water-reactive material. A substance that readily reacts with water or decomposes in the presence of water. ATSDR G-19 . Ventricular fibrillation. Vesicant. usually a sign of spasm or narrowing of the airways. Inflammation of the membrane lining the trachea. Toxic potential. Tracheitis. Toxic. tremulous movement of the ventricle that replaces normal contractions of the heart muscle. Tubular necrosis. Death of the cells lining the kidney tubules. A measure of the tendency of a liquid to become a gas at a given temperature. Vapor pressure. Vapor density. Vesiculation. Breathing noisily and with difficulty. The weight of a given volume of vapor or gas compared to the weight of an equal volume of dry air. Vasodilation. results in little or no blood being pumped from the heart Vertigo. Lockjaw. typically with substantial energy release. An agent that produces blisters. due to kidney dysfunction. Rapid. Wheezing. Vascular. Urticaria.Glossary Tinnitus. Vapor. Increased diameter of the blood vessels. Uremia. Sensation of spinning or revolving. especially by chemical means. Condition in which an abnormally high level of urea or other nitrogenous waste is found in the blood. Pertaining to blood vessels. The presence or formation of blisters. Ringing in the ears. The inherent ability of a substance to cause harm. Trismus. Having the ability to harm the body. both measured at the same temperature and pressure. Hives. The gaseous form of a substance that is normally a solid or liquid at room temperature and pressure.

Glossary G-20 ATSDR .

Glossary ATSDR G-21 .

New York The Pediatric Environmental Health Unit was established in 1998 as a regional center for pediatric environmental health. The Director of the Center is Michael Shannon. and resource specialists. Mt. Staffed by pediatricians. Sinai Medical Center. Five units are fully operational. (This is being done through unit-sponsored special education opportunities such as grand rounds and seminar series. The Center at Children’s Hospital offers multidisciplinary evaluation and management of children with known or suspected exposure to environmental toxins. SinaiIrving J. MPH. The clinical services provided by the Unit are available on-site at the Mt. Sinai-Irving J. MD. The Pediatric Environmental Health Center can be contacted by phoning 888-Child14. and communities. publishes articles advancing the field of pediatric environmental medicine. (2) improve access to expertise in pediatric environmental medicine. MPH. the National Center for Environmental Health. and the American College of Preventive Medicine. Mt. outdoor pollutants. MD. by holding conferences such as “Environmental Influences on Children: Brain. Harvard Medical School. The key focus areas of the units are medical education and training. The major purposes of the Unit are to • provide clinical services to children with diseases of toxic environmental origin and to children who have sustained toxic exposures in their environment. with support from ATSDR and AOEC. with support from ATSDR. Selikoff Center for Occupational and Environmental Medicine New York. indoor air pollutants. ScD. and conducts educational activities for medical students. MSc is the Principal Investigator at the Mt. the center staff developed a teaching tool entitled the “Pediatric Environmental Health History.” This tool is available in a CD-ROM format. The Program is designed to (1) reduce environmental health threats to children. Howard Hu. is affiliated with the Center. and by training health fellows under the supervision of faculty of the Departments of Pediatrics and Community and Preventive Medicine. Sinai PEHSU. Sinai School of Medicine. MPH. .” by publishing articles. nurses. MD. medical toxicologists. and other health care providers. and clinical specialty referral for children who may have been exposed to hazardous substances in the environment. Harvard School of Public Health. MPH. other health care providers. the Center provides medical management for illnesses or intoxications resulting from heavy metals. a total of nine units are scheduled to be in operation in the United States. Sinai Hospital. Development. The Center is a joint program of the Children’s Hospital in Boston. Mt. It is a multi-disciplinary program of research. • • serve as a regional source of referral and consultation in environmental pediatrics increase pediatricians’ knowledge of environmental threats to children’s health. By the end of 2000. and Behavior. and the Occupational and Environmental Medicine Program. and Rose Goldman. and (3) strengthen public health prevention capacity.In 1998. the Occupational and Environmental Health Program at Cambridge Hospital. education. MD. residents. serve as Co-Directors. The Center also provides consultative services by telephone. the Agency for Toxic Substances and Disease Registry (ATSDR) joined with the Association of Occupational and Environmental Clinics (AOEC) to develop the Pediatric Environmental Health Specialty Unit (PEHSU) Program as a national resource for pediatricians. clinical service. Alan Woolf. Massachusetts The Pediatric Environmental Health Center was established in 1998 as a regional center for pediatric environmental health. Mt.) Philip Landrigan MD. Pediatric Environmental Health Center Children’s Hospital Boston. clinical consultation. Selikoff Center for Environmental and Occupational Medicine. and community partnership. Recently. and adolescent occupational exposures.

pediatrics. Sinai Unit can be contacted by phoning 212241-6173. Robert Geller. The Center exists to • evaluate. The Center is also developing interactive.edu/sph/glakes/kids. create an infrastructure for delivering pediatric environmental health care. and federal environmental and public health agencies. are Co-Investigators. The Center offers a monthly lecture series at Cook County Hospital as well as continuing educational programs and workshops throughout Region V. . The Center has a multi-disciplinary staff with experts in environmental medicine. communities.The Mt. with support from ATSDR.uic.edu. DrPH is the Principal Investigator for the Southeast PEHSU. and Gerald Teague. local. and prevent children’s environmentassociated illnesses. treat. the U. state. • • • expand the knowledge of children’s • Howard Frumkin. The Center for Children’s Environmental Health Cook County Hospital Chicago. Janice Nodvin is the Project Administrator. The Southeast Pediatric Environmental Health Specialty Unit Emory University Atlanta. Leslie Rubin. The objectives of the Unit are to • develop a variety of educational materials on children’s environmental health. web-based case presentations that can be accessed through the Center’s website at www. Environmental Protection Agency (EPA). provide clinical consultation to agencies and health care providers in the region. referral of those needing treatment. and provide clinical pediatric environmental health services. including maintaining a database of conditions linked to environmental hazards and consulting with government agencies to formulate solutions. The Center is part of the Health Hazard Evaluation (HHE) Program which investigates health hazards in communities through environmental monitoring. Illinois The Center for Children’s Environmental Health was established in 1999 as a regional center for pediatric environmental health. The Center works closely with the Illinois Poison Control Center. MD. Environmental Protection Agency (EPA). and establishment of a network of expert clinicians.S. and a variety of Emory University-affiliated clinical facilities. and AOEC. children. and industrial hygiene. including evaluation of children. with support from ATSDR. and health care providers throughout the Southeast (Region IV) regarding environmental hazards and the most effective ways to protect children’s health.S.uic. epidemiology. MD. the U. and adolescents. The Unit links Emory University’s Department of Environmental and Occupational Health. the Georgia Poison Center. and AOEC. MD. and prevent environmental illnesses in infants. The future website address is www. including Children’s Health Care of Atlanta and the Hughes Spalding Children’s Hospital. Rollins School of Public Health. Georgia The Southeast Pediatric Environmental Health Unit was established in Fall 1999 as a regional center for pediatric environmental health. treat. School of Medicine. and local health care institutions. and clinical evaluations. clinical toxicology. environmental health problems through research. and the Department of Pediatrics. • promote children’s environmental health in communities. The Center’s faculty includes clinical and public health scientists who conduct research on the most effective ways to diagnose. • train pediatricians and other health care professionals in pediatric environmental health issues. the Marcus Institute. The Southeast Unit can be contacted by phoning 87733PEHSU (877-337-3478). MD. The Center is affiliated with the Great Lakes Center for Occupational and Environmental Safety and Health at the University of Illinois and Chicago’s Toxikon Consortium. • provide information and carry out health education activities for families. The Center is a joint program of the Division of Occupational and Environmental Medicine and the Department of Pediatrics at Cook County Hospital.

parents of children in Head Start Programs. MD. educators.S. and drinking water quality.edu/ oemp/pehsu/index. FAAP. Pediatric Environmental Health Specialty Unit Harborview Medical Center Seattle. physicians. to provide clinical and diagnostic services either on site or through the Department of Pediatrics. is the Co-Director.S. MD. The topics of greatest concern reported were air • • . Providers are specifically trained in both pediatrics and environmental medicine. allergens. University of California . • • to conduct educational activities.San Francisco (UCSF)/University of California Irvine (UCI) Pediatric Environmental Health Specialty Unit The University of California Pediatric Environmental Health Unit was established in the winter of 2000 as a regional center for pediatric environmental health. The objectives for the UC-PEHSU are • to provide consultative services to health professionals. visit the PEHSU website at http://depts. MD. and families. • clinical services on a case-by-case basis to see children and their families. California Poison Center and the Departments of Pediatrics at UCSF and UCI. ACMT. Andrew Brodkin. The Associate Directors are Jay Mayefsky. MPH.html.washington. governmental agencies and the California Poison Control System through an effective network of pediatrics specialists in collaboration with the Occupational and Environmental Medicine Program at both sites. pollution. Clinic visits are available at Children’s Hospital and Regional Medical Center. FACMT. MPH. the U. Much of the training curriculum is based on results from an environmental health survey completed by school nurses. To learn more about training opportunities. and AOEC. The Director of the Harborview PEHSU is C. and to coordinate program evaluation activities for the PEHSU. The PEHSU staff provide • clinical consultations with experts at the Washington Poison Center for those concerned about childhood environmental exposures. The Center for Children’s Environmental Health can be contacted by phoning 312-633-5310. The PEHSU’s goal is to provide expertise on childhood environmental health risk to health care providers. The Harborview PEHSU can be contacted by phoning 877-KID-CHEM (west of the Mississippi River) and 206-526-2121. with support from ATSDR. MD. As a joint collaborative project providing services in both the northern (UCSF) and southern (UCI) areas of the state. and others. ParentTeacher Association (PTA) leaders. MPH. and the Association of Occupational and Environmental Clinics (AOEC). communities. Washington The Harborview Pediatric Environmental Health Specialty Unit (PEHSU) was established in 1998 and currently serves as a regional center for pediatric environmental health. and Carl Baum. Robertson. William O. with support from the Agency for Toxic Substances and Disease Registry (ATSDR). Environmental Protection Agency (EPA). Environmental Protection Agency (EPA). together with the Washington Poison Control Center and Children’s Hospital and Regional Medical Center. MD. Callers’ concerns have included the consumption of well water contaminated with pesticides and solvent exposures from painting a child’s bedroom. This PEHSU was created by the University of Washington’s Occupational and Environmental Medicine Program. training for health care providers as well as the public on childhood environmental health issues. The Poison Center experts address some 2. the unit links the Occupational and Environmental Medicine Programs at the respective campuses with the UCSF-Mount Zion Hospital and UCSF-San Francisco General Hospital.000 such inquiries every month. food-related hazards. the U.The Center’s Director is Daniel Hryhorczuk.

• improve the recognition.cdc. Levin can be reached directly at (903) 877-5900 or emailed at jeffrey. is the principal investigator and Dean Baker. at 404-639-6351.Irvine PEHSU can be reached at 415-206-4320 (for both sites). MD. • reduce the environmental health disparities among children in EPA/ATSDR Region 3. ATSDR.D. MD. MPH. and AOEC. and concerned parents. • develop new knowledge about communications between clinicians. George Washington University Medical Center Washington. and Larry K. and patients about environmental health issues. Lowry can be Additional information on the PEHSU Program can be obtained by calling Katherine Kirkland. Jeffrey Levin. • conduct educational activities that will assist both health professionals and communities in addressing environmental risks to children. Texas The Southwest Center for Pediatric Health began operation on September 1. and management of environmental health problems in children. Both Dr. parents. Jerome Paulson.cdu. MPH.S. Levin and Dr. faxed to (202) 994-4861. The unit is a project of the George Washington University Medical Center (GWUMC) and the Children’s National Medical Center.lowry@uthct. The specific aims for the SW-CPEH are to • develop materials and present training to health professionals and public health officials on environmental health issues and their impact on children’s health. MSN. and Benjamin Gitterman. Executive Director. Lowry can be faxed at (903) 877-7060. C-NP.levin@uthct. MD. The goals of the George Washington University PEHSU are to • increase the cooperation and exchange of information between pediatricians and occupational and environmental health professionals. Dr. and AOEC. In addition.that’s (888) 422-8737 or website at www. Southwest Center for Pediatric Environmental Health University of Texas Health Center Tyler. MPH. the U.. the Southwest Center has assembled a team that includes the Texas Poison Center Network and its North Texas Poison Center. PhD. Paulson at (202) 9949914. serve as co-principal investigators.atsdr.John Balmes.S. Project Officer. the U. • • The toll-free number for the Southwest Center for Pediatric Environmental Health is (888) 901-5665. It was established with support from ATSDR. MD. DDS. public health agencies. they have assembled a team which includes the Howard University College of Nursing and faculty from the University of Maryland School of Medicine and the Medical College of Pennsylvania. . answer requests for information regarding pediatric environmental health and risk communication from health care professionals. Environmental Protection Agency (EPA). M. at 202-347-4976 or Christine Rosheim. For more information about ATSDR contact ATSDR’s toll-free information line at (888) 42-ATSDR. Dr. AOEC. M. will serve as coprincipal investigators. The George Washington University specialty unit will be starting on October 1. Questions concerning the PEHSU can be directed to Dr. evaluation. 2000. MPH is the co-prinicipal investigator. or e-mailed at hcsjap@gwumc. John Balbus.edu. RN. Mary Koebler.cdu. and includes collaboration between the GWUMC Division of Occupational Medicine and Toxicology and the Department of Pediatrics.. COHN-S serves as the UCI liaison for the project components. DC.gov. The University of California . COHN-S is the project coordinator. 2000. In addition.San Francisco/ University of California . MPH. reached at (903) 877-5919 or e-mailed at larry.. MSPH. Environmental Protection Agency (EPA). It was established with support from ATSDR. Lowry. the New Mexico Poison and Drug Information Center and the Program of Occupational and Environmental Health at the University of New Mexico.D. Denise Souza. and is a collaboration between UTHCT’s Occupational Medicine Program and the Departments of Pediatrics and Allergy. provide clinical consultation services for patients and their health care providers.

Clifton Road Mailstop E-29 Atlanta.1 You may visit our web site < http://www. Public Health Service Agency for Toxic Substances and Disease Registry .atsdr. DEPARTMENT OF HEALTH AND HUMAN SERVICES. U. such as during an emergency re. ment. If needed. What is a ToxFAQs™ sheet? 1 1 1 1 1 1 1 1 1 1 What is [substance X] ? What happens to [substance X] when it enters the environment ? How may I be exposed to [substance X] ? How can [substance X] affect my health ? How likely is [substance X] to cause cancer ? How can [substance X] affect children ? How can families reduce their exposure to [substance X] ? Is there a medical test to show whether I have been exposed to [substance X] ? Has the federal government made recommnendations to protect human health ? Where can I get further information on [substance X] ? The ToxFAQs™ are useful whenever a quick review or background is needed about Where can I get further information? that substance. the Public Health State.cdc. a at 404-498-0093.OVERVIEW Division of Toxicology ToxFAQs™ ToxFAQs™ April 2003 The ToxFAQs™ sheets are a series of two page summaries about hazardous substances and their health effects. is also available for each substance from 1 You may write to ATSDR Division of Toxicology.gov>. or fax the Division of Toxicology sponse or at community meetings. GA 30333. 1600 ATSDR. 1-888-4228737 or 404-498-0160.S. The ToxFAQs™ are written in an easy to read terms in a question and answer format and address issues of important interest. The complete list of questions is shown at the right. slightly larger version. such as how can it affect your health or can it cause cancer. What is a ToxFAQs™ sheet? Each ToxFAQs™ sheet is a two page summary of information about the health effects possible from exposure to one of a variety of individual hazardous (chemical) substances.1 You may call during normal business hours. They provide answers to the most frequently asked questions (FAQs) about health effects possible from exposure.

Hydrogen Fluoride. DEPARTMENT OF HEALTH AND HUMAN SERVICES.1-Dichloroethene 1.2-Dichloroethane 1. Public Health Service Agency for Toxic Substances and Disease Registry .HN-2.3'-Dichlorobenzidine 1.and 2.2-Diphenylhydrazine Di-n-octylphthalate (DNOP) Disulfoton Endosulfan Endrin Ethion Ethylbenzene Ethylene Oxide Ethylene Glycol Fluorides. U.2-Dibromoethane 1. Acetone Acrolein Acrylonitrile Aldrin/Dieldrin Aluminum Americium Ammonia Aniline Antimony Arsenic Arsenic Trioxide Arsine Asbestos Atrazine Barium Benzene Benzidine 2.3-Benzofuran Beryllium Bis(2-chloroethyl)ether Bis(chloromethyl)ether Blister Agents: Lewisite(L) Mustard-Lewisite Mixture(HL) Blister Agents: HN-1..6-Dinitrotoluene 1. Automotive Heptachlor and Heptachlor Epoxide Hexachlorobenzene Hexachlorobutadiene Continued on page 2 . You may click on any specific name below to go directly to that substance's ToxFAQs™ sheet. DDE.4-Dichlorobenzene 3.S.3-Dichloropropene Dichlorvos Di(2-ethylhexyl)phthalate (DEHP) Diethyl Phthalate Diisopropylmethylphosphonate (DIMP) Di-n-butylphthalate 1.2-Dichloropropane 1. DDD Diazinon Diborane Dibromochloropropane 1.ToxFAQs™ Substance List Division of Toxicology ToxFAQs™ April 2003 This is a complete hyperlinked list of the 182 ToxFAQs™ information sheets available on this CD-ROM.2-Dichloroethene 1.HN-3 (Nitrogen Mustards) Blister Agents: Sulfur Mustard Agents H/HD.4. HT Boron Bromodichloromethane Bromoform Bromomethane 1. Used Creosote Cresols Crotonaldehyde Cyanide DDT.3-Dinitrobenzene Dinitrocresols Dinitrophenols 2. and Fluorine Formaldehyde Fuel Oils (Kerosene) Gasoline..1-Dichloroethane 1.3-Butadiene 2-Butanone 2-Butoxyethanol Cadmium Calcium Hypochlorite/ Sodium Hypochlorite Carbon Disulfide Carbon Tetrachloride Cesium Chlordane Chlorfenvinphos Chlorinated Dibenzo-p-Dioxins (CDDs) Chlorine Chlorine Dioxide Chlorobenzene Chlorodibenzofurans (CDFs) Chloroethane Chloroform Chloromethane Chlorophenols Chlorpyrifos Chromium Cobalt Copper Crankcase Oil.

2. Atlanta. and treat illnesses resulting from exposure to hazardous substances.atsdr.2. GA 30333.5-Trinitrobenzene 2. Their specialists can recognize. Division of Toxicology.2-Tetrachloroethane Tetrachloroethylene (PERC) Tetryl Thallium Thorium Tin Titanium Tetrachloride Toluene Toluene Diisocyanate Total Petroleum Hydrocarbons (TPH) Toxaphene 1.2-Trichloroethane Trichloroethylene (TCE) 1.3-Trichloropropane 1.gov/toxfaq. 1600 Clifton Road NE.GB.3.1.1.continued from page 1. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.6-Trinitrotoluene (TNT) Uranium Vanadium Vinyl Acetate Vinyl Chloride Xylene Zinc ToxFAQs™ Hexachlorocyclohexane (HCH or Lindane) Hexachlorocyclopentadiene Hexachloroethane Hexamethylene Diisocyanate(HDI) Hexane 2-Hexanone HMX (Octogen) Hydraulic Fluids Hydrazines Hydrogen Chloride Hydrogen Peroxide Hydrogen Sulfide Iodine Ionizing Radiation Isophorone Jet Fuels JP-4 and JP-7 Jet Fuels JP-5 and JP-8 Kerosene (Fuel Oils) Lead Malathion Manganese Mercury Methoxychlor Methyl Isocyanate Methyl Mercaptan Methyl Parathion Methyl t-Butyl Ether (MTBE) 4..html >.html Mirex and Chlordecone Mustard Gas N-Nitrosodimethylamine N-Nitrosodiphenylamine N-Nitrosodi-n-propylamine Naphthalene Nerve Agents (GA. FAX: 404-498-0093. ATSDR can tell you where to find occupational and environmental health clinics.GD.4'-Methylenebis(2-chloroaniline) (MBOCA) Methylene Chloride Methylenedianiline Where can I get more information? For more information.4.1-Trichloroethane 1. Mailstop E-29.gov/toxfaq. Substance List The ToxFAQs™ Internet address is http://www.. The ToxFAQs™ Internet address is < http://www. Federal Recycling Program Printed on Recycled Paper .atsdr. Phone: 1-888-422-8737.cdc.cdc.1. contact the Agency for Toxic Substances and Disease Registry.Page 2 .VX) Nickel Nitrobenzene Nitrogen Oxides Nitrophenols Otto Fuel II Pentachlorophenol Phenol Phosgene Phosgene Oxime Phosphine Phosphorus. White Plutonium Polybrominated Biphenyls (PBBs) Polychlorinated Biphenyls (PCBs) Polycyclic Aromatic Hydrocarbons (PAHs) Propylene Glycol Pyrethrins/Pyrethroids Pyridine Radium Radon RDX (Cyclonite) Selenium Selenium Hexafluoride Silver Sodium Hydroxide Stoddard Solvent Strontium Styrene Sulfur Dioxide Sulfur Trioxide Sulfuric Acid Synthetic Vitreous Fibers 1. evaluate.

416 National Priorities List sites identified by the Environmental Protection Agency. call the ATSDR Information Center at 1-888-422-8737. personal traits and habits. What happens to acetone when it enters the environment? G A large percentage (97%) of the acetone released during its manufacture or use goes into the air. For more information. G It’s broken down by microorganisms in soil and water. G Acetone doesn’t bind to soil or build up in animals. or coming in contact with products or soil that contain acetone. What is acetone? (Pronounced ²s“¹-t½n”) Acetone is a manufactured chemical that is also found naturally in the environment. tobacco smoke. drugs. G Drinking water or eating food containing acetone. about one-half of the total amount breaks down from sunlight or other chemicals every 22 days. Very high exposure may cause you to lose consciousness. Acetone is used to make plastic. DEPARTMENT OF HEALTH AND HUMAN SERVICES. and whether other chemicals are present. volcanic gases. and other chemicals. This chemical has been found in at least 572 of 1. It is also used to dissolve other substances. drinking water. How can acetone affect my health? If you are exposed to acetone. but the time required for this to happen varies. it goes into your blood which then carries it to all the organs in your body. SUMMARY: Exposure to acetone results mostly from breathing air. is flammable. G It can move into groundwater from spills or landfills. G Acetone is broken down in water and soil. and dissolves in water. It evaporates easily. and make you dizzy. It is also called dimethyl ketone.S. G Breathing higher levels of contaminated air in the workplace or from using products that contain acetone (for example. G It moves from the atmosphere into the water and soil by rain and snow. G In air. and beta-ketopropane. It is a colorless liquid with a distinct smell and taste. fibers. Exposure to moderateto-high amounts of acetone can irritate your eyes and respiratory system. and as a product of the breakdown of body fat. The effects of exposure to any hazardous substance depend on the dose. G Smoking or breathing secondhand smoke.ACETONE CAS # 67-64-1 Agency for Toxic Substances and Disease Registry ToxFAQs September 1995 This fact sheet answers the most frequently asked health questions (FAQs) about acetone. It occurs naturally in plants. Industrial processes contribute more acetone to the environment than natural processes. nail polish. Breathing moderate. and landfill sites. the liver breaks it down to chemicals that are not harmful and uses these chemicals to make energy for normal body functions. It also moves quickly from soil and water back to air. G For children. It’s important you understand this information because this substance may harm you. G Touching products containing acetone. This fact sheet is one in a series of summaries about hazardous substances and their health effects. the duration. how you are exposed. How might I be exposed to acetone? G Breathing low background levels in the environment. eating soil at landfills or hazardous waste sites that contain acetone.to-high levels U. If it is a small amount. Public Health Service Agency for Toxic Substances and Disease Registry . forest fires. and paint). 2-propanone. trees. It is present in vehicle exhaust. household chemicals.

The test can tell you how much acetone you were exposed to. vomiting. ToxFAQs Internet address via WWW is http://www. confusion. and nerve damage.atsdr. The National Institute for Occupational Safety and Health (NIOSH) recommends an exposure limit of 250 ppm in workplace air for up to a 10-hour workday over a 40-hour workweek. Glossary Carcinogenicity: Ability to cause cancer.atsdr. 1994. Mailstop E-29. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. Division of Toxicology.Page 2 ACETONE CAS # 67-64-1 ToxFAQs Internet address via WWW is http://www. nausea. effects on blood. but your doctor can take blood or urine samples and send them to a testing laboratory.html ATSDR can tell you where to find occupational and environmental health clinics. Kidney.S. liver. throat. Swallowing very high levels of acetone can result in unconsciousness and damage to the skin in your mouth. GA 30333.000 ppm) for an 8-hour workday over a 40-hour week to protect workers. contact the Agency for Toxic Substances and Disease Registry. Federal Recycling Program Printed on Recycled Paper . The test must be performed within 2-3 days after exposure because acetone leaves your body within a few days. Is there a medical test to show whether I’ve been exposed to acetone? Methods are available to measure the amount of acetone in your breath. Atlanta. Public Health Service. and the Environmental Protection Agency (EPA) have not classified acetone for carcinogenicity. the International Agency for Research on Cancer.cdc. Atlanta. The Occupational Safety and Health Administration (OSHA) has set a maximum concentration limit in workplace air of 1. How likely is acetone to cause cancer? The Department of Health and Human Services. and shortening of the menstrual cycle in women. These tests are not routinely performed at your doctor's office. Long-term: Lasting one year or longer. headaches. Their specialists can recognize. increased birth defects. blood. It is not known if people would have these same effects. Health effects from long-term exposures are known mostly from animal studies. Acetone does not cause skin cancer in animals when applied to the skin. Phone:1-888-422-8737. and eye irritation. unconsciousness and possibly coma. increased pulse rate. although the amount that References Agency for Toxic Substances and Disease Registry (ATSDR). Skin contact can result in irritation and damage to your skin. Has the federal government made recommendations to protect human health? The EPA requires that spills of 5. and treat illnesses resulting from exposure to hazardous substances. and lowered ability to reproduce (males only) occurred in animals exposed long-term. and urine. lung. The smell and respiratory irritation or burning eyes that occur from moderate levels are excellent warning signs that can help you avoid breathing damaging levels of acetone.000 pounds or more of acetone be reported. Ingesting: Taking food or drink into your body.gov/toxfaq. GA: U.html of acetone for short periods of time. FAX: 404-498-0093. 1600 Clifton Road NE. light-headedness. Where can I get more information? For more information. The tests can't tell you if you will experience any health effects from the exposure. Department of Health and Human Services.000 parts of acetone per million parts of air (1. Evaporate: To change into a vapor or a gas.gov/toxfaq. Studies of workers exposed to it found no significant risk of death from cancer. can cause nose.cdc. We don't know if breathing or swallowing acetone for long periods will cause cancer. evaluate. however. Toxicological profile for acetone. people have naturally in their bodies varies with each person.

177 National Priorities List sites identified by the Environmental Protection Agency (EPA). such as fried foods and roasted coffee. It is also used to make other chemicals. This chemical has been found in at least 7 of the 1. The effects of exposure to any hazardous substance depend on the dose. or living near. The information we have indicates that breathing large amounts damages the lungs and could cause death. acrolein can be broken down to other chemicals by reactions with water or bacteria. Animal studies show that breathing acrolein causes irritation to the nasal cavity. This fact sheet is one in a series of summaries about hazardous substances and their health effects. q Acrolein does not build up in the food chain. weeds. q Working in. Public Health Service Agency for Toxic Substances and Disease Registry . other plants. It dissolves in water very easily and quickly changes to a vapor when heated. How can acrolein affect my health? There is very little information about how exposure to acrolein affects people's health. tobacco. q Eating foods. It’s important you understand this information because this substance may harm you. bacteria. q Drinking water containing small amounts of acrolein. gasoline. Cigarette smoke and automobile exhaust contain acrolein.ACROLEIN CAS # 107-02-8 Agency for Toxic Substances and Disease Registry ToxFAQs July 1999 This fact sheet answers the most frequently asked health questions (FAQs) about acrolein. q Smoking tobacco or breathing air containing tobacco smoke or automobile exhaust. call the ATSDR Information Center at 1-888-422-8737. It also burns easily. For more information. What happens to acrolein when it enters the environment? q Acrolein may be found in soil. or air. q Acrolein evaporates rapidly from soil and water. industries where it is manufactured or used to make other chemicals. q It breaks down fairly rapidly in the air (about half will disappear within 1 day) by reacting with other chemicals and sunlight. and damage to U. and oil are burned. What is acrolein? (Pronounced ²k“r…-lºn) Acrolein is a clear or yellow liquid with a disagreeable odor. DEPARTMENT OF HEALTH AND HUMAN SERVICES. q Once dissolved in water. the duration. How might I be exposed to acrolein? q Breathing contaminated air near hazardous waste sites that contain acrolein. Acrolein causes burning of the nose and throat and can damage the lungs. HIGHLIGHTS: Exposure to acrolein occurs mostly from breathing it in the air.S. Acrolein is used as a pesticide to control algae. water. Small amounts of acrolein can be formed and can enter the air when trees. and whether other chemicals are present. and mollusks. personal traits and habits. that may contain small amounts of acrolein. how you are exposed. lowered breathing rate. Breathing lower amounts may cause eye watering and burning of the nose and throat and a decreased breathing rate.

Any release to the environment of more than 1 pound of acrolein Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). Federal Recycling Program Printed on Recycled Paper .1 ppm acrolein averaged over a 10-hour period or a 40-hour workweek.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize. Laws today protect the welfare of research animals and scientists must follow strict guidelines. GA 30333.html the lining of the lungs.gov/toxfaq. 1600 Clifton Road NE. evaluate. The International Agency for Research on Cancer (IARC) has determined that acrolein is not classifiable as to human carcinogenicity. however. Toxicological profile for acrolein.cdc. Atlanta.32 ppm) to prevent possible health effects from drinking water or eating fish contaminated with acrolein. ppm: Parts per million.gov/toxfaq. Atlanta.S.atsdr. Department of Health and Human Services.cdc. Has the federal government made recommendations to protect human health? The EPA recommends that levels in lakes and streams should be limited to 0. CAS: Chemical Abstracts Service. contact the Agency for Toxic Substances and Disease Registry. We do not know if acrolein causes reproductive effects or birth defects in people or animals. 40-hour workweek. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. Where can I get more information? For more information. Glossary Carcinogenicity: Ability to cause cancer. must be reported to the EPA. Public Health Service. FAX: 404-498-0093. there are no specific medical tests available in a doctor's office to determine if you have been exposed to acrolein. Evaporate: To change into a vapor or a gas. Pesticide: A substance that kills pests. ToxFAQs Internet address via WWW is http://www.32 parts of acrolein per million parts of water (0. Division of Toxicology. Is there a medical test to show whether I’ve been exposed to acrolein? Methods have been developed to detect acrolein or breakdown products of acrolein in biological or environmental samples. GA: U.Page 2 ACROLEIN CAS # 107-02-8 ToxFAQs Internet address via WWW is http://www. The National Institute of Occupational Safety and Health (NIOSH) recommends that average workplace air should not exceed 0. The federal recommendations have been updated as of July 1999.1 ppm over an 8-hour workday. and treat illnesses resulting from exposure to hazardous substances. Phone: 1-888-422-8737. National Priorities List: A list of the nation’s worst hazardous waste sites. Mailstop E-29. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. How likely is acrolein to cause cancer? There are no definitive studies on the carcinogenic effects of acrolein in people or animals. The Occupational Safety and Health Administration (OSHA) has set a limit of 0. 1990.atsdr.

For more information. man-made chemical with a sharp. If spilled on the skin. Acrylonitrile primarily affects the nervous system and lungs. Public Health Service Agency for Toxic Substances and Disease Registry .or garlic-like odor. The effects of exposure to any hazardous substance depend on the dose. and acrylic fibers. liquid. and convulsions. q In air. call the ATSDR Information Center at 1-888-422-8737. It can be dissolved in water and evaporates quickly. DEPARTMENT OF HEALTH AND HUMAN SERVICES. weakness.177 National Priorities List sites identified by the Environmental Protection Agency (EPA). How might I be exposed to acrylonitrile? q Unless you live near a factory where acrylonitrile is made or near a hazardous waste site that contains acrylonitrile.S. and whether other chemicals are present. impaired judgment. q Acrylonitrile can enter groundwater by filtering through the soil. HIGHLIGHTS: Exposure to acrylonitrile occurs mostly from breathing it in the air. q Swallowing food and water that contains small amounts of acrylonitrile. q When it is released to soil. difficulty breathing. most of it is released to the air from facilities where it is produced and used. q Working in. q Breathing contaminated air near hazardous waste sites that contain acrylonitrile. These symptoms usually disappear when exposure is stopped. synthetic rubber. or air near industrial sites where it is made. onion. however. U. Acrylonitrile is used to make other chemicals such as plastics. some of it will be broken down by bacteria. all pesticide uses have stopped. acrylonitrile breaks down quickly (about half will disappear within 5 to 50 hours) by reacting with other chemicals and sunlight. A mixture of acrylonitrile and carbon tetrachloride was used as a pesticide in the past. but most of it will evaporate to the air or filter to groundwater. the duration. or at hazardous waste sites where it has been disposed of. What is acrylonitrile? (Pronounced …-kr¹l“½ nº-tr¹l) Acrylonitrile is a colorless. It’s important you understand this information because this substance may harm you. nausea. headache. q Because acrylonitrile evaporates easily. tightness in the chest. dizziness. industries where it is manufactured or used. q Acrylonitrile does not build up in the food chain. the skin will turn red and blisters may form. or living near. how you are exposed. What happens to acrylonitrile when it enters the environment? q Acrylonitrile may be found in the soil. personal traits and habits. This fact sheet is one in a series of summaries about hazardous substances and their health effects. How can acrylonitrile affect my health? Breathing high concentrations of acrylonitrile will cause nose and throat irritation. but it is not commonly found in groundwater. This chemical has been found in at least 3 of the 1.ACRYLONITRILE CAS # 107-13-1 Agency for Toxic Substances and Disease Registry ToxFAQs July 1999 This fact sheet answers the most frequently asked health questions (FAQs) about acrylonitrile. q It is broken down by bacteria in surface water. water. you are unlikely to be exposed to it. acrylonitrile will burn the skin and produce redness and blisters. If it is spilled on the skin.

Other tests can be used to measure the breakdown products (metabolites) of acrylonitrile in urine. Department of Health and Human Services. 1600 Clifton Road NE. evaluate. National Priorities List: A list of the nation’s worst hazardous waste sites.gov/toxfaq. Studies of people are inconclusive.058 ppb) to prevent possible health effects Where can I get more information? For more information. so it is not a definite indicator of acrylonitrile exposure.atsdr.html ATSDR can tell you where to find occupational and environmental health clinics. In a few cases. Has the federal government made recommendations to protect human health? The EPA recommends that levels in lakes and streams should be limited to 0. Atlanta. 1990. Their specialists can recognize. There is evidence that children are much more sensitive to acrylonitrile than adults. weakness. Pesticide: A substance that kills pests. Glossary CAS: Chemical Abstracts Service. Atlanta.atsdr. changes in the breathing rate. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). The National Institute of Occupational Safety and Health (NIOSH) recommends that average workplace air should not exceed 1 part per million (1 ppm) acrylonitrile averaged over a 10-hour period.058 parts of acrylonitrile per billion parts of water (0. These effects include irritation to the nasal cavity and lungs.html Animal studies show effects from breathing acrylonitrile.cdc. Mailstop E-29. Division of Toxicology. Decreased fertility and birth defects have been observed in some laboratory animals exposed to high concentrations of acrylonitrile in air or drinking water. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. The federal recommendations have been updated as of July 1999. GA 30333. One of the metabolites (cyanide) could come from other chemicals you might have been exposed to. while animal studies have shown cancers of the brain and mammary glands. ppm: Parts per million. and treat illnesses resulting from exposure to hazardous substances. and paralysis. Evaporate: To change into a vapor or a gas.S. from drinking water or eating fish contaminated with acrylonitrile. Federal Recycling Program Printed on Recycled Paper . contact the Agency for Toxic Substances and Disease Registry. children have died following exposure to acrylonitrile vapors that caused only minor nose and throat irritation in adults. and they are not routinely available in a doctor’s office. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. The results of these tests could also be affected by cigarette smoking. Any release to the environment greater than 100 pounds of acrylonitrile must be reported to the EPA. Laws today protect the welfare of research animals and scientists must follow strict guidelines. FAX: 404-498-0093. GA: U. ppb: Parts per billion. Toxicological profile for acrylonitrile. The Occupational Safety and Health Administration (OSHA) has set a limit of 2 ppm over an 8-hour workday.cdc. fluid accumulation in the lungs. ToxFAQs Internet address via WWW is http://www.gov/toxfaq. How likely is acrylonitrile to cause cancer? The Department of Health and Human Services (DHHS) has determined that acrylonitrile may reasonably be anticipated to cause cancer in people. Is there a medical test to show whether I’ve been exposed to acrylonitrile? There is a test that can detect acrylonitrile in blood. 40-hour workweek. Phone: 1-888-422-8737. Special equipment is needed for these tests. Public Health Service.Page 2 ACRYLONITRILE CAS # 107-13-1 ToxFAQs Internet address via WWW is http://www.

vomiting. Dieldrin has been found in at least 287 of the 1. Neither substance occurs naturally in the environment. or meats. ‘ Air. Public Health Service Agency for Toxic Substances and Disease Registry . Health effects may also occur after a longer period of exposure to smaller amounts because these chemicals build up in the body. For more information. We do not know whether aldrin or dieldrin affect the ability of people to fight disease. ‘ Plants take in and store aldrin and dieldrin from the soil.613 sites. How can aldrin and dieldrin affect my health? People who have intentionally or accidentally ingested large amounts of aldrin or dieldrin have suffered convulsions and some died. ‘ Aldrin rapidly changes to dieldrin in plants and animals. surface water. irritability. personal traits and habits. and uncontrolled muscle movements. ‘ Dieldrin in soil and water breaks down very slowly. ‘ Dieldrin is stored in the fat and leaves the body very slowly. EPA banned all uses of aldrin and dieldrin in 1974. Pure aldrin and dieldrin are white powders with a mild chemical odor. but at very low levels. dairy products. Aldrin has been found in at least 207 of the 1. U. or soil near waste sites may contain higher levels. Aldrin and dieldrin build up in the body after years of exposure and can affect the nervous system. how you are exposed. They are discussed together in this fact sheet because aldrin quickly breaks down to dieldrin in the body and in the environment. and whether other chemicals are present. What happens to aldrin and dieldrin when they enter the environment? ‘ Sunlight and bacteria change aldrin to dieldrin so that we mostly find dieldrin in the environment. fish. oral exposure to lower levels for a long period also affected the liver and decreased their ability to fight infections.S. Animals exposed to high amounts of aldrin or dieldrin also had nervous system effects. the duration. such as root crops. ‘ Eating food like fish or shellfish from lakes or streams contaminated with either chemical. Because of concerns about damage to the environment and potentially to human health. call the ATSDR Information Center at 1-888-422-8737. ‘ They bind tightly to soil and slowly evaporate to the air. The less pure commercial powders have a tan color. ‘ Living in homes that were once treated with aldrin or dieldrin to control termites. From the 1950s until 1970. How might I be exposed to aldrin or dieldrin? ‘ Dieldrin is everywhere in the environment. Some workers exposed to moderate levels in the air for a long time had headaches. Studies in animals have given conflicting results about whether aldrin and dieldrin affect reproduction in male animals and whether these chemicals may damage the sperm. dizziness.613 National Priorities List sites identified by the Environmental Protection Agency (EPA). aldrin and dieldrin were widely used pesticides for crops like corn and cotton. Workers removed from the source of exposure rapidly recovered from most of these effects. In 1987.ALDRIN and DIELDRIN CAS # 309-00-2 and 60-57-1 Division of Toxicology ToxFAQsTM September 2002 This fact sheet answers the most frequently asked health questions (FAQs) about aldrin and dieldrin. HIGHLIGHTS: Exposure to aldrin and dieldrin happens mostly from eating contaminated foods. or contaminated root crops. This fact sheet is one in a series of summaries about hazardous substances and their health effects. DEPARTMENT OF HEALTH AND HUMAN SERVICES. What are aldrin and dieldrin? Aldrin and dieldrin are insecticides with similar chemical structures. EPA banned all uses. It is important you understand this information because this substance may harm you. except to control termites. In animals. The effects of exposure to any hazardous substance depend on the dose. or seafood.

Has the federal government made recommendations to protect human health? The EPA limits the amount of aldrin and dieldrin that may be present in drinking water to 0. Atlanta. and treat illnesses resulting from exposure to hazardous substances. for protection against health effects other than cancer. exposure to these compounds will occur only from past usage. The EPA has determined that a concentration of aldrin and dieldrin of 0.0002 mg/L in drinking water limits the lifetime risk of developing cancer from exposure to each compound to 1 in 10. 40 hour week. Where can I get more information? For more information. urine.25 mg/m3 for both compounds for up to a 10-hour work day. we do not know whether children are more susceptible than adults to the effects of aldrin or dieldrin.gov/toxfaq. Their specialists can recognize. respectively.gov/toxfaq. The National Institute for Occupational Safety and Health (NIOSH) also recommends a limit of 0.atsdr. if any. 1600 Clifton Road NE. The allowable range is from 0 to 0. There are no known unique exposure pathways for children. Mailstop E-29. Department of Health and Human Services.html. as occurred in adults. ATSDR can tell you where to find occupational and environmental health clinics. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). the test has to be done shortly after you are exposed to aldrin. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. Since dieldrin can stay in the body for months. These tests are not routinely available at the doctor’s office because they require special equipment. Because aldrin changes to dieldrin fairly quickly in the body. therefore.25 mg/m3) in the workplace during an 8-hour shift. Dieldrin has been found in human breast milk. The tests cannot tell you whether harmful health effects will occur. We do not know whether aldrin or dieldrin cause birth defects in humans. and body tissues.S. The Occupational Safety and Health Administration (OSHA) sets a maximum average of 0. Children who swallowed amounts of aldrin or dieldrin much larger than those found in the environment suffered convulsions and some died. Public Health Service.25 milligrams of aldrin and dieldrin per cubic meter of air (0. Is there a medical test to show whether I’ve been exposed to aldrin and dieldrin? There are laboratory tests that can measure aldrin and dieldrin in your blood.002 milligrams per liter (mg/L) of water. depending on the type of food product. ‘ Because aldrin and dieldrin were applied to the basement of some homes for termite protection. GA: U.001 and 0. The EPA has determined that aldrin and dieldrin are probable human carcinogens.html We do not know whether aldrin or dieldrin affect reproduction in humans.000.1 ppm. pesticides have been used within the home. 2002. 40-hour week. However. The International Agency for Research on Cancer (IARC) has determined that aldrin and dieldrin are not classifiable as to human carcinogenicity. How likely are aldrin and dieldrin to cause cancer? There is no conclusive evidence that aldrin or dieldrin cause cancer in humans. measurements of dieldrin can be made much longer after exposure to either aldrin or dieldrin. it can be passed to suckling infants.cdc.atsdr. Toxicological Profile for Aldrin/Dieldrin (Update). evaluate. GA 30333.Page 2 ALDRIN and DIELDRIN CAS # 309-00-2 and 60-57-1 ToxFAQsTM Internet address is http://www. Atlanta. FAX: 404-498-0093. Pregnant animals that ingested aldrin or dieldrin had some babies with low birth weight and some with alterations in the skeleton. The Food and Drug Administration (FDA) regulates the residues of aldrin and dieldrin in raw foods. Aldrin and dieldrin have been shown to cause liver cancer in mice.cdc. ToxFAQs Internet address via WWW is http://www. Federal Recycling Program Printed on Recycled Paper . before buying a home families should investigate what. Division of Toxicology. How can aldrin and dieldrin affect children? Children can be exposed to aldrin and dieldrin in the same way as adults. Phone: 1-888-4228737. contact the Agency for Toxic Substances and Disease Registry. How can families reduce the risk of exposure to aldrin and dieldrin? ‘ Since aldrin and dieldrin are no longer produced or used.

Infants and adults who received large doses of aluminum as a treatment for another problem developed bone What happens to aluminum when it enters the environment? G It binds to particles in the air. This fact sheet is one in a series of summaries about hazardous substances and their health effects. G It is not known to bioconcentrate up the food chain. buffered aspirin. and water. It is always found combined with other elements such as oxygen. G Acid rain may dissolve aluminum from soil and rocks. Public Health Service Agency for Toxic Substances and Disease Registry . astringents. and fluorine. For more information. air. air. to produce glass. however. and in consumer products such as antacids. and building materials. Aluminum. or contact with skin is not thought to harm your health. G It can be taken up into some plants from soil. manufacturing plants. G Eating substances containing high levels of aluminum (such as antacids) especially when eating or drinking citrus products at the same time. Aluminum has been found in at least 427 of the 1.S. rubber. water. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Exposure to high levels of aluminum may result in respiratory problems. streams. and ceramics. and antiperspirants. It’s important you understand this information because this substance may harm you. or areas naturally high in aluminum. and whether other chemicals are present.ALUMINUM CAS # 7429-90-5 Agency for Toxic Substances and Disease Registry ToxFAQs June 1999 This fact sheet answers the most frequently asked health questions (FAQs) about aluminum. call the ATSDR Information Center at 1-888-422-8737. G Breathing higher levels of aluminum dust in workplace air. and rivers depending on the quality of the water. How can aluminum affect my health? Low-level exposure to aluminum from food. Some studies show that people with Alzheimer’s disease have more aluminum than usual in their brains. appliances. How might I be exposed to aluminum? G Eating small amounts of aluminum in food. It is often used in cooking utensils. The effects of exposure to any hazardous substance depend on the dose. containers. food additives.467 National Priorities List sites identified by the Environmental Protection Agency (EPA). G It can dissolve in lakes. What is aluminum? (Pronounced …-l›“m…-n…m) Aluminum occurs naturally and makes up about 8% of the surface of the earth. G Drinking water with high levels of aluminum near waste sites. Aluminum metal is silver-white and flexible. U. People who are exposed to high levels of aluminum in air may have respiratory problems including coughing and asthma from breathing dust. personal traits and habits. how you are exposed. It is also used in paints and fireworks. G Very little enters your body from aluminum cooking utensils. the duration. HIGHLIGHTS: Everyone is exposed to low levels of aluminum from food. is not a necessary substance for our bodies and too much may be harmful. We do not know whether aluminum causes the disease or whether the buildup of aluminum happens to people who already have the disease. silicon.

Where can I get more information? For more information. or what the long-term effects might be in adults exposed as children. and treat illnesses resulting from exposure to hazardous substances. aluminum foil.2 ppm) because of aesthetic effects. contact the Agency for Toxic Substances and Disease Registry. caps so children will not accidentally eat them. The Food and Drug Administration (FDA) has determined that aluminum cooking utensils. Make sure these products have child-proof Source of information Agency for Toxic Substances and Disease Registry (ATSDR). so parents may want to consult with their physician when choosing an infant formula. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. Aluminum has been shown to cause lower birthweights in some animals.2 parts of aluminum per million parts of water (0. which suggests that aluminum may cause skeletal problems. 1999. Their specialists can recognize. Since aluminum is so common and widespread in the environment. Exposure to the low levels of aluminum that are naturally present in food and water and the forms of aluminum present in dirt and aluminum cookware is generally not harmful. antiperspirants. How likely is aluminum to cause cancer? The Department of Health and Human Services. GA: U. Special regulations are set for aluminum phosphide because it is a pesticide. It is not known whether aluminum affects children differently than adults. but your doctor can take samples and send them to a testing laboratory. Department of Health and Human Services. Is there a medical test to show whether I’ve been exposed to aluminum? There are tests to measure aluminum in blood. Aluminum has not been shown to cause cancer in animals. Other health effects of aluminum on children have not been studied. Toxicological profile for aluminum.atsdr. GA 30333. and the EPA have not classified aluminum for carcinogenicity. Has the federal government made recommendations to protect human health? EPA requires that spills or accidental releases of 5.atsdr. How can families reduce the risk of exposure to aluminum? The most important way families can lower exposure to aluminum is to know about the sources of aluminum and lessen exposure to these sources. urine. EPA recommends that the concentration of aluminum in drinking water not exceed 0. Public Health Service. Tests can also detect aluminum in your hair and fingernails. 1600 Clifton Road NE.html ATSDR can tell you where to find occupational and environmental health clinics. Some sensitive people develop skin rashes from using aluminum chlorohydrate deodorants. Large amounts of aluminum have been shown to be harmful to unborn and developing animals because it can cause delays in skeletal and neurological development.Page 2 ALUMINUM CAS # 7429-90-5 ToxFAQs Internet address via WWW is http://www.S.cdc. families cannot avoid exposure to aluminum. Atlanta. the International Agency for Research on Cancer. Federal Recycling Program Printed on Recycled Paper . ToxFAQs Internet address via WWW is http://www. Mailstop E-29. Phone: 1-888-422-8737.gov/toxfaq. Atlanta.gov/toxfaq. How can aluminum affect children? Children with kidney problems who were given aluminum in their medical treatments developed bone diseases. Some soybased formulas may contain high levels of aluminum. Division of Toxicology. Not all of these tests are routinely performed at your doctor’s office. and other aluminum products are generally safe. FAX: 404-498-0093.html diseases. and feces.cdc. such as taste and odor problems. The amount in your urine can tell you whether you have been exposed to higher than normal levels of aluminum. evaluate. The best way to reduce exposure to aluminum is to avoid taking large quantities of soluble forms of aluminum such as aluminum-containing antacids and buffered aspirin. antacids.000 pounds or more of aluminum sulfate be reported.

585 National Priorities List (NPL) sites identified by the Environmental Protection Agency (EPA). and food. ‘ Fish may take up 241Am. this period of time is called the halflife. How can americium affect my health? The radiation from exposure to americium is the primary cause of adverse health effects from americium. This fact sheet is one in a series of summaries about hazardous substances and their health effects. The effects of exposure to any hazardous substance depend on the dose. In shellfish. ‘ 241Am released into water will stick to particles in the water or the sediment at the bottom. and food. water.S. 241 ‘ 241Am strongly sticks to soil particles and does not travel very far into the ground. Both isotopes give off alpha particles as they decay. the duration. Inside your body. DEPARTMENT OF HEALTH AND HUMAN SERVICES. There is no commercial use for 243Am. water. where it remains for a long time. Both americium isotopes decay into radioactive elements. It is important you understand this information because this substance may harm you. It takes about 432 years for half of 241Am to give off its radiation and about 7. ‘ People working at sites where nuclear waste is stored or at nuclear power plants may be exposed to higher levels of americium. HIGHLIGHTS: Very low levels of americium occur in air. personal traits and habits. people may be exposed to higher than normal levels of radiation. U. Americium has been found in at least 8 of the 1. but little builds up in the fleshy tissue. ‘ As a result of a nuclear accident. and increases as the dose increases. Nuclear explosions or degradation of plutonium generate Am. and whether other chemicals are present.AMERICIUM CAS #7440-35-9 Division of Toxicology ToxFAQsTM July 2001 This fact sheet answers the most frequently asked health questions (FAQs) about americium. Two important isotopes of americium are americium 241 (241Am) (read as americium two-forty-one) and 243Am. For more information. 241 ‘ The general population may be exposed to very small amounts of 241Am in air. soil. 241Am is attached to the shell and not to the parts you normally eat. soil. ‘ People producing or handling 241Am in smoke detectors or other devices may be exposed to higher levels of radiation. how you are exposed. Exposure to very large amounts of radioactive americium may result in increased cancer risk. Public Health Service Agency for Toxic Substances and Disease Registry . Both isotopes have the same chemical behavior in the environment and the same chemical effects on your body. What happens to americium when it enters the environment? ‘ 241Am released to the air (from nuclear weapon tests) will be associated with particles and will settle to the soil and water in rain or snow. How might I be exposed to americium? Americium is used in ionization smoke detectors. Americium has no naturally occurring or stable isotopes. 243Am is produced inside nuclear reactors from 241Am or from the decay of plutonium 241. americium is concentrated in your bones. ‘ Plants may take up small amounts of 241Am from the soil. What is americium? Americium is a man-made radioactive chemical.370 years for 243Am. The radiation given off by 241Am can change the genetic material of the bone cells and this could result in the formation of bone cancers. call the ATSDR Information Center at 1-888-422-8737. The chance of getting cancer is low at low doses. Small particles in air can travel far from the point of release. They may also be exposed to very low levels of radiation from smoke detectors.

html. nuclear reactor. and thyroid.html Laboratory animals exposed to very high levels of americium had damage to the lungs. Consequently. or teeth. so the samples must be sent to a special laboratory. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). Has the federal government made recommendations to protect human health? The Nuclear Regulatory Commission (NRC) has set limits of 0. there are no actual data showing that children are more sensitive than adults to americium. and treat illnesses resulting from exposure to hazardous substances. the same types of cancers as those observed in Japanese survivors of the atomic bombing incidents might be expected among individuals acutely exposed to high levels of radiation from a radioactive americium source.gov/toxfaq. feces. liver. tissue samples. urine. Atlanta. follow the advice of public health officials who will publish appropriate guidelines for reducing exposure. Atlanta. exposure as children would let the americium build up in bone to higher levels. evaluate.00002 microcuries per liter of water for releases to water by licensed facilities (microcurie is a radiation unit). Toxicological Profile for Americium (Draft for PublicComment). ATSDR can tell you where to find occupational and environmental health clinics. How likely is americium to cause cancer? No human studies specifically associate exposure to radioactive americium with an increased cancer risk. americium is accumulated in these organs for only a relatively short time. In the unlikely case that you are exposed to high levels of radioactive americium because of accidental release at a manufacturing facility. or plant that manufactures ionization smoke detectors.atsdr. Studies in animals have demonstrated that internal exposure to 241Am results in the development of cancer in the tissues that store this element. It is unlikely that you would be exposed to amounts of americium large enough to cause harmful effects in these organs. Division of Toxicology. Department of Health and Human Services. Is there a medical test to show whether I’ve been exposed to americium? If americium were to enter your body from americiumcontaminated air or food. Where can I get more information? For more information. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. radiation detectors could measure radiation from your blood.atsdr. However. ToxFAQs Internet address via WWW is http://www. Special radiation detectors could also be used to measure the radiation that leaves your whole body from americium that is inside your body.cdc. contact the Agency for Toxic Substances and Disease Registry. Because radioactive americium emits ionizing radiation. Federal Recycling Program Printed on Recycled Paper . at a nuclear plant.S. How can families reduce the risk of exposure to americium? Higher-than-normal levels of americium may be in soil near a nuclear waste site. Their specialists can recognize.00000002 microcuries per cubic meter of air for 241Am released to the air and 0. However. While this may occur. 1600 Clifton Road NE. This could cause bone cancer after many years. FAX: 404-498-0093.cdc. Mailstop E-29. How can americium affect children? Children can be affected by americium in the same ways as adults.gov/toxfaq. GA: U. GA 30333. 2001. prevent your children from eating dirt and make sure they wash their hands frequently. Phone: 1-888-4228737. or because a nuclear weapon has been damaged or detonated.Page 2 AMERICIUM CAS #7440-35-9 ToxFAQsTM Internet address is http://www. Radiation detectors are not normally available in your doctor’s office.

613 National Priorities List sites identified by the Environmental Protection Agency (EPA). ! Plants and bacteria rapidly take up ammonia from soil and water. pulp and paper production. Ammonia and ammonium can change back and forth in water. Liquid ammonia is found in many household cleaners. In U. tank trucks. This fact sheet is one in a series of summaries about hazardous substances and their health effects. ! Ammonia released to air is rapidly removed by rain or snow or by reactions with other chemicals. you can breathe ammonia released to the air. Most of the ammonia produced in chemical factories is used to make fertilizers. What is ammonia? Ammonia is a colorless gas with a very sharp odor. it is found throughout the environment in soil. storage facilities. It does not last very long in the environment. eyes. The amount of ammonia produced by humans every year is almost equal to that produced by nature. It is commonly sold in liquid form. refrigerants. It dissolves easily in water and evaporates quickly. the duration. soil. throat. ! Some ammonia in water and soil is changed to nitrate and nitrite by bacteria. Ammonia is essential for many biological processes. and lungs. The remaining is used in textiles. ! Ammonia does not build up in the food chain. and animal wastes. and rail cars. and water. Public Health Service Agency for Toxic Substances and Disease Registry . you will be exposed to ammonia released to the air and through contact with your skin. food and beverages. pipelines. ! Ammonia has a strong irritating odor that people can easily smell before it may cause harm.S. ! You may be exposed to ammonia from leaks and spills from production plants. It is made both by humans and by nature. air. Ammonia is produced naturally in soil by bacteria. ! If you apply ammonia fertilizers or live near farms where these fertilizers have been applied. It is important you understand this information because this substance may harm you. How might I be exposed to ammonia? ! Everybody is regularly exposed to low levels of ammonia in air. nose.AMMONIA CAS # 7664-41-7 Division of Toxicology ToxFAQsTM September 2002 This fact sheet answers the most frequently asked health questions (FAQs) about ammonia. an odorless liquid. call the ATSDR Information Center at 1-888-422-8737. but serves as a nutrient source for plants and bacteria. For more information. how you are exposed. It is also used in smelling salts. The effects of exposure to any hazardous substance depend on the dose. and lungs. DEPARTMENT OF HEALTH AND HUMAN SERVICES. plastics. ! If you use ammonia cleaning products at home. household cleaning products . ! Most of the ammonia in water changes to ammonium. and other products. personal traits and habits. decaying plants and animals. ! Ammonia is recycled naturally in the environment as part of the nitrogen cycle. Ammonia has been found in at least 134 of the 1. Exposure to high concentrations can cause serious burns. eyes. throat. food. explosives. Ammonia is irritating to the skin. HIGHLIGHTS: Ammonia is a gas that occurs naturally in the environment and is also manmade. and water. What happens to ammonia when it enters the environment? ! Because ammonia occurs naturally. How can ammonia affect my health? Exposure to high concentrations of ammonia in the air may cause severe burns to your skin. and whether other chemicals are present.

Atlanta. blindness. unpleasant smell and strong taste. We do not know if exposure to ammonia causes birth defects. ToxFAQs Internet address via WWW is http://www. ! Maintain adequate room ventilation when using cleaners containing ammonia and wear proper clothing and eye protection. ! Avoid entering fields when ammonia fertilizer is being applied. evaluate. Children can still be exposed the same way as adults to ammonia gas from spills or leaks from ammonia tanks or pipelines.S. Animal studies show effects similar to those observed in people. If you were exposed to harmful amounts of ammonia you would notice it immediately because of the strong. Where can I get more information? For more information.atsdr.cdc. Is there a medical test to show whether I’ve been exposed to ammonia? There are tests that can detect ammonia in blood and urine. such as soda bottles. lung damage. 1600 Clifton Road NE. Concentrated ammonia spilled on the skin will cause burns. Your skin. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. How can families reduce the risk of exposure to ammonia? ! Keep products containing ammonia out of the reach of children. We do not know if ammonia affects reproduction in humans.atsdr. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR).Page 2 AMMONIA CAS # 7664-41-7 ToxFAQsTM Internet address is http://www. Mailstop E-29. GA 30333. Toxicological Profile for Ammonia (Draft for Public Comment). Atlanta. eyes. the International Agency for Research on Cancer (IARC).html extreme cases. GA: U. Division of Toxicology. or if it can pass to the fetus across the placenta or to infants via breast milk.html. Has the federal government made recommendations to protect human health? The Occupational Safety and Health Administration (OSHA) has set a limit of 25 parts of ammonia per million parts of air (25 ppm) in the workplace during an 8-hour shift and a shortterm limit (15 minutes) of 35 ppm. ATSDR can tell you where to find occupational and environmental health clinics. Public Health Service. and throat would also be irritated. and stomach. and the EPA have not classified ammonia for carcinogenicity. nose.gov/toxfaq. The Department of Health and Human Services (DHHS). Breathing lower concentrations will cause coughing and nose and throat irritation. FAX: 404-498-0093.cdc. 2002. Their specialists can recognize. or death could occur.gov/toxfaq. Department of Health and Human Services. How likely is ammonia to cause cancer? We do not know whether ammonia can cause cancer in humans or in laboratory animals. throat. ! Prevent children from entering a room where ammonia is being used. you could suffer burns in your mouth. contact the Agency for Toxic Substances and Disease Registry. and treat illnesses resulting from exposure to hazardous substances. The effects of ammonia on children are likely to be the same as for adults. Children can also be exposed to dilute ammonia solutions from household cleaners containing ammonia. Phone: 1-888-4228737. If you swallow ammonia. especially on farms where it is used as a fertilizer. However. How can ammonia affect children? Children are less likely to be exposed to concentrated ammonia because most exposures of that kind occur in occupational settings. these tests cannot definitely determine if you have been exposed because ammonia is normally found in the body. Federal Recycling Program Printed on Recycled Paper . ! Never store cleaning solutions in containers that may be attractive to children.

It is important you understand this information because this substance may harm you. ‘ Aniline does not accumulate in the food chain. Most of the aniline in soil will be broken down by bacteria and other microorganisms. convulsions. Dizziness. The damaged hemoglobin can not carry oxygen. you may be exposed to aniline. varnishes. Acute exposure to high amounts of aniline may lead to coma and death. How can aniline affect my health? Aniline can be toxic if ingested. ‘ If you work in a place that makes products like dyes. Aniline has been found in at least 59 of the 1. agricultural chemicals. varnishes and explosives. so people who smoke or breath in second-hand smoke may also be exposed to aniline.585 National Priorities List sites identified by the Environmental Protection Agency (EPA). Aniline damages hemoglobin. coma. call the ATSDR Information Center at 1-888-422-8737. the duration.S. Aniline is slightly soluble in water and mixes readily with most organic solvents. herbicides. how you are exposed. For more information. ‘ Aniline in water can stick to sediment and particulate matter or evaporate to the air. synthetic dyes. What is aniline? Aniline is a clear to slightly yellow liquid with a characteristic odor. Methemoglobinemia is the most prominent symptom of aniline poisoning in humans. The effects of exposure to any hazardous substance depend on the dose. Public Health Service Agency for Toxic Substances and Disease Registry . and U. DEPARTMENT OF HEALTH AND HUMAN SERVICES. personal traits and habits. herbicides. but these amounts are usually very small. a protein that normally transports oxygen in the blood. Most of it will be broken down by bacteria and other microorganisms. It will be broken down within a few days. and whether other chemicals are present.ANILINE CAS #62-53-3 Division of Toxicology ToxFAQsTM April 2002 This fact sheet answers the most frequently asked health questions (FAQs) about aniline. Small amounts may evaporate into air or pass through the soil to groundwater. Significant exposure may occur only if you work with aniline. What happens to aniline when it enters the environment? ‘ Aniline in air will be broken down rapidly by other chemicals and by sunlight. How might I be exposed to aniline? ‘ The general population may be exposed to aniline by eating food or drinking water containing aniline. This condition is known as methemoglobinemia and its severity depends on how much you are exposed to and for how long. ‘ Aniline will partially stick to the soil. stabilizers for the rubber industry. This may have mild to severe consequences depending on the duration and amount of exposure. inhaled. HIGHLIGHTS: Aniline is a manufactured chemical used by a number of industries. ‘ Aniline has also been detected in tobacco smoke. antioxidants. This fact sheet is one in a series of summaries about hazardous substances and their health effects. The main effect of aniline by any route of exposure is a blood disorder in which oxygen delivery to the tissues is impaired. Aniline is used to make a wide variety of products such as polyurethane foam. headaches. or by skin contact. and explosives. irregular heart beat. resulting in cyanosis (a purplish blue skin color) following acute high exposure to aniline. ‘ People living near uncontrolled hazardous waste sites may be exposed to higher than normal levels of aniline. It does not readily evaporate at room temperature.

The EPA has determined that aniline is a probable human carcinogen. Is there a medical test to show whether I’ve been exposed to aniline? Aniline can be measured in the urine. p-aminophenol. however. Rats that ate food contaminated with aniline for life developed cancer of the spleen. Phone: 1-888-422-8737.cdc.cdc.gov/toxfaq. Mailstop E-29.html ANILINE death may also occur. ToxFAQsTM Internet address is http://www.atsdr.html . Division of Toxicology. This test shows that you have been exposed to aniline but not to how much or how recently. Newborn infants are more susceptible than adults to development of methemoglobinemia caused by exposure to aniline. It is likely that the health effects seen in children exposed to aniline will be similar to the effects seen in adults. Long-term exposure to lower levels of aniline may cause symptoms similar to those experienced in acute high-level exposure. Federal Recycling Program Printed on Recycled Paper . These tests are not routinely done in a doctor’s office. Where can I get more information? For more information. How can aniline affect children? There are no studies on the health effects of children exposed to aniline. ‘ Children should avoid playing in soils near uncontrolled hazardous waste sites where aniline may have been discarded. How can families reduce the risk of exposure to aniline? ‘ Most families will not be exposed to significant levels of aniline. Direct contact with aniline can also produce skin and eye irritation. and treat illnesses resulting from exposure to hazardous substances. A breakdown product of aniline in the body. Methemoglobin can be measured in the blood. Their specialists can recognize. How likely is aniline to cause cancer? The available studies in humans are inadequate to determine whether exposure to aniline can increase the risk of developing cancer in people. Has the federal government made recommendations to protect human health? The Occupational Safety and Health Administration (OSHA) sets a limit of 5 parts of aniline per million parts of air (5 ppm) in workplace air in any 8-hour shift. Methemoglobin levels in blood can be used to determine the appropriate treatment that exposed individuals should receive. evaluate. The studies on developmental effects in animals are not conclusive. 1600 Clifton Road NE.atsdr. The International Agency for Research on Cancer (IARC) determined that aniline is not classifiable as to its carcinogenicity to humans. 40-hour workweek. Studies in animals have not demonstrated reproductive toxicity for aniline. this breakdown product is not specific for aniline exposure. also can be measured in the urine.Page 2 CAS #62-53-3 ToxFAQsTM Internet address is http://www. We do not know if exposure to aniline will result in birth defects or other developmental effects in people. ATSDR can tell you where to find occupational and environmental health clinics. but exposure to many other chemicals also increase methemoglobin levels in the blood. There is no reliable information on whether aniline has adverse reproductive effects in humans. FAX: 404-498-0093. contact the Agency for Toxic Substances and Disease Registry.gov/toxfaq. Atlanta. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. GA 30333.

This chemical has been found in at least 403 of 1. coal-fired plants. Breathing high levels for a long time can irritate your eyes and lungs and can cause heart and lung problems. vomiting. However. heart. the general population is exposed to low levels of it every day. call the ATSDR Information Center at 1-888-422-8737. manganese.416 National Priorities List sites identified by the Environmental Protection Agency. and refuse incinerators. Antimony ores are mined and then mixed with other metals to form antimony alloys or combined with oxygen to form antimony oxide. SUMMARY: Exposure to antimony occurs in the workplace or from skin contact with soil at hazardous waste sites. and whether other chemicals are present. This information is important because this substance may harm you. but when mixed into alloys. Little antimony is currently mined in the United States. Antimony oxide is added to textiles and plastics to prevent them from catching fire. G Workers in industries that process it or use antimony ore may be exposed to higher levels. the duration. water.ANTIMONY CAS # 7440-36-0 Agency for Toxic Substances and Disease Registry ToxFAQs September 1995 This fact sheet answers the most frequently asked health questions (FAQs) about antimony. How might I be exposed to antimony? G Because antimony is found naturally in the environment. it may be found in the air. and soil. G In the air. How can antimony affect my health? Exposure to antimony at high levels can result in a variety of adverse health effects. solder. and as enamels for plastics. such as smelters. Antimony isn't used alone because it breaks easily. Public Health Service Agency for Toxic Substances and Disease Registry . sheet and pipe metal. or aluminum. U. drinking water. personal traits and habits. and glass. G Most antimony ends up in soil. The effects of exposure to any hazardous substance depend on the dose. Animals that breathed high levels What happens to antimony when it enters the environment? G Antimony is released to the environment from natural sources and from industry. For more information. primarily in food. and can cause problems with the lungs. castings. G In polluted areas containing high levels of antimony. there are companies in the United States that produce antimony as a by-product of smelting lead and other metals. and stomach ulcers. and fireworks. It is also used in paints. In short-term studies. ceramics. Breathing high levels of antimony for a long time can irritate the eyes and lungs. DEPARTMENT OF HEALTH AND HUMAN SERVICES. G It may be found in air near industries that process or release it. G Antimony is found at low levels in some rivers. how you are exposed. It is brought into this country from other countries for processing. and pewter. diarrhea. animals that breathed very high levels of antimony died. and air. where it attaches strongly to particles that contain iron.S. bearings. antimony is attached to very small particles that may stay in the air for many days. lakes. metal. What is antimony? (Pronounced ²n“t…-m½”n¶) Antimony is a silvery-white metal that is found in the earth’s crust. This fact sheet is one in a series of summaries about hazardous substances and their health effects. and streams. it is used in lead storage batteries. and stomach. stomach pain.

It has been used as a medicine to treat people infected with parasites.html ATSDR can tell you where to find occupational and environmental health clinics. 1992. problems with fertility have been seen when rats breathed very high levels of antimony for a few months. We don't know what other effects may be caused by ingesting it. Is there a medical test to show whether I’ve been exposed to antimony? Tests are available to measure antimony levels in the body. and blood for several days after exposure. Milligram (mg): One thousandth of a gram. ToxFAQs Internet address via WWW is http://www. Division of Toxicology. The EPA requires that discharges or spills into the environment of 5. Phone: 1-888-422-8737. 1600 Clifton Road NE. and treat illnesses resulting from exposure to hazardous substances. these tests cannot tell you how much antimony you have been exposed to or whether you will experience any health effects.html had lung. contact the Agency for Toxic Substances and Disease Registry. hair loss. Antimony can have beneficial effects when used for medical reasons. Some References Agency for Toxic Substances and Disease Registry (ATSDR). In animal studies. GA 30333. Antimony can irritate the skin if it is left on it. tests are not usually performed in most doctors' offices and may require special equipment to conduct them. feces. evaluate. and kidney damage.atsdr.S. Federal Recycling Program Printed on Recycled Paper . Where can I get more information? For more information.Page 2 ANTIMONY CAS # 7440-36-0 ToxFAQs Internet address via WWW is http://www.cdc. Glossary Carcinogenicity: Ability to cause cancer.atsdr. CAS: Chemical Abstracts Service. Ingestion: Taking food or drink into your body.000 pounds or more of antimony be reported. 40-hour workweek. Toxicological profile for antimony. How likely is antimony to cause cancer? The Department of Health and Human Services.5 milligrams of antimony per cubic meter of air (0. Ingesting large doses of antimony can cause vomiting. the International Agency for Research on Cancer. Lung cancer has been observed in some studies of rats that breathed high levels of antimony. Atlanta.006 ppm). Antimony can be measured in the urine. However. animals that breathed very low levels of antimony had eye irritation. Has the federal government made recommendations to protect human health? The EPA allows 0. liver. Long-term: Lasting one year or more. and heart problems.006 parts of antimony per million parts of drinking water (0. Atlanta. We don't know whether antimony will cause cancer in people.cdc. Parasite: An organism living in or on another organism. In long-term studies. lung damage. The Occupational Safety and Health Administration (OSHA) has set an occupational exposure limit of 0. heart. Their specialists can recognize. Department of Health and Human Services. Long-term animal studies have reported liver damage and blood changes when animals ingested antimony.gov/toxfaq. No human studies are available. Problems with fertility were also noted.gov/toxfaq. FAX: 404-498-0093.5 mg/m3) for an 8-hour workday. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. Mailstop E-29. The American Conference of Governmental Industrial Hygienists (ACGIH) and the National Institute for Occupational Safety and Health (NIOSH) currently recommend the same guidelines for the workplace as OSHA. ppm: Parts per million. Short-term: Lasting 14 days or less. and the Environmental Protection Agency (EPA) have not classified antimony as to its human carcinogenicity. GA: U. Public Health Service.

how you are exposed. This fact sheet is one in a series of summaries about hazardous substances and their health effects. decreased production of red and white blood cells. HIGHLIGHTS: Exposure to higher than average levels of arsenic occurs mostly in the workplace. and a sensation of “pins and needles” in hands and feet. drinking water.S. [ Breathing contaminated workplace air. How can arsenic affect my health? Breathing high levels of inorganic arsenic can give you a sore throat or irritated lungs. Arsenic has been found at 1.ARSENIC CAS # 7440-38-2 Division of Toxicology ToxFAQsTM July 2001 This fact sheet answers the most frequently asked health questions (FAQs) about arsenic. How might I be exposed to arsenic? [ Eating food. chlorine. [ Arsenic in air will settle to the ground or is washed out of the air by rain. but the arsenic in fish is mostly in a form that is not harmful. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Organic arsenic compounds are used as pesticides. The effects of exposure to any hazardous substance depend on the dose. and sulfur to form inorganic arsenic compounds. Arsenic in animals and plants combines with carbon and hydrogen to form organic arsenic compounds. At high levels. or breathing air containing arsenic. Lower levels of arsenic can cause nausea and vomiting. damage to blood vessels. What is arsenic? Arsenic is a naturally occurring element widely distributed in the earth’s crust. Ingesting high levels of inorganic arsenic can result in death. arsenic is combined with oxygen. It’s important you understand this information because this substance may harm you. and whether other chemicals are present.014 of the 1. For more information. [ Many arsenic compounds can dissolve in water. What happens to arsenic when it enters the environment? [ Arsenic cannot be destroyed in the environment. near hazardous waste sites. [ Fish and shellfish can accumulate arsenic. It can only change its form. inorganic arsenic can cause death. primarily on cotton plants. or in areas with high natural levels. personal traits and habits. abnormal heart rhythm.598 National Priority List sites identified by the Environmental Protection Agency (EPA). Public Health Service Agency for Toxic Substances and Disease Registry . call the ATSDR Information Center at 1-888-422-8737. Exposure to lower levels for a long time can cause a discoloration of the skin and the appearance of small corns or warts. [ Living near uncontrolled hazardous waste sites containing arsenic. In the environment. Ingesting or breathing low levels of inorganic arsenic for a long time can cause a darkening of the skin and the U. [ Living in areas with unusually high natural levels of arsenic in rock. [ Breathing sawdust or burning smoke from wood treated with arsenic. the duration. Inorganic arsenic compounds are mainly used to preserve wood.

cdc. Where can I get more information? For more information.cdc. and torso. Department of Health and Human Services. Birth defects have been observed in animals exposed to inorganic arsenic.05 ppm (50 ppb). Mailstop E-29. It is likely that health effects seen in children exposed to high amounts of arsenic will be similar to the effects seen in adults. the current EPA arsenic drinking water standard remains at 0. in the interim. urine. Skin contact with inorganic arsenic may cause redness and swelling. gloves. kidney cancer. The World Health Organization (WHO). Exposure to high levels of some organic arsenic compounds may cause similar effects as inorganic arsenic. the Department of Health and Human Services (DHHS). has reverted to the previous standard for arsenic. evaluate.gov/toxfaq. FAX: 404-498-0093.atsdr. bladder cancer. published on January 22. and. Federal Recycling Program Printed on Recycled Paper . [ If you live in an area with high levels of arsenic in water or soil. Atlanta. and prostate cancer. Organic arsenic compounds are less toxic than inorganic arsenic compounds. and treat illnesses resulting from exposure to hazardous substances. in the Federal Register. and protective clothing to decrease exposure to sawdust. Has the federal government made recommendations to protect human health? EPA has set limits on the amount of arsenic that industrial sources can release to the environment and has restricted or canceled many uses of arsenic in pesticides. Public Health Service. Atlanta. contact the Agency for Toxic Substances and Disease Registry.Page 2 ARSENIC CAS # 7440-38-2 ToxFAQsTM Internet address is http://www. 2000. and the EPA have determined that inorganic arsenic is a human carcinogen. EPA has set a limit of 0. How can arsenic affect children? We do not know if exposure to arsenic will result in birth defects or other developmental effects in people. you should wear dust masks.html . You can also contact your community or state health or environmental quality department if you have any more questions or concerns. the EPA is currently reviewing the science and cost estimate supporting this rule.gov/toxfaq. 2001. Toxicological Profile for Arsenic.html appearance of small “corns” or “warts” on the palms. liver cancer. Tests on hair and fingernails can measure exposure to high levels or arsenic over the past 6-12 months.S. 1600 Clifton Road NE.01 ppm (10 ppb) reported in the ATSDR February 2001 Arsenic ToxFAQs was based on the EPA final rule for arsenic in drinking water. ToxFAQsTM Internet address is http://www. They cannot predict how the arsenic levels in your body will affect your health. skin cancer. How likely is arsenic to cause cancer? Several studies have shown that inorganic arsenic can increase the risk of lung cancer. Their specialists can recognize. However. Is there a medical test to show whether I’ve been exposed to arsenic? There are tests to measure the level of arsenic in blood. Division of Toxicology.atsdr. These tests can determine if you have been exposed to above-average levels of arsenic. Phone: 1-888-422-8737. GA: U. Thus. The urine test is the most reliable test for arsenic exposure within the last few days. The EPA arsenic drinking water standard of 0. hair. or fingernails. The Occupational Safety and Health Administration has set limits of 10 g arsenic per cubic meter of workplace air (10 g/m3) for 8 hour shifts and 40 hour work weeks. How can families reduce the risk of exposure to arsenic? [ If you use arsenic-treated wood in home projects.05 parts per million (ppm) for arsenic in drinking water. GA 30333. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). soles. ATSDR can tell you where to find occupational and environmental health clinics. you should use cleaner sources of water and limit contact with soil.

Breathing high levels of asbestos fibers for a long time may result in scar-like tissue in the lungs and in the pleural membrane (lining) that surrounds the lung. Asbestos minerals have separable long fibers that are strong and flexible enough to be spun and woven and are heat resistant. This substance has been found at 83 of the 1. People with asbestosis have difficulty breathing. Asbestos fibers are not able to move through soil. How might I be exposed to asbestos? We are all exposed to low levels of asbestos in the air we breathe. ceiling and floor tiles. brake. crocidolite. In general. This disease is called asbestosis and is usually found in workers exposed to asbestos. exposure may occur only when the asbestos-containing material is disturbed in some way to release particles and fibers into the air. People living near these industries may also be exposed to high levels of asbestos in air. and anthophyllite) that occur naturally in the environment. Some vermiculite or talc products products may contain asbestos.0001 fibers per milliliter of air and generally are highest in cities and industrial areas. often a cough. What happens to asbestos when it enters the environment? Asbestos fibers can enter the air or water from the breakdown of natural deposits and manufactured asbestos products. repair. and the fibrous varieties of tremolite. Asbestos fibers do not evaporate into air or dissolve in water. call the ATSDR Information Center at 1-888-422-8737. Asbestos fibers may be released into the air by the disturbance of asbestos-containing material during product use. DEPARTMENT OF HEALTH AND HUMAN SERVICES. chrysotile. Larger diameter fibers and particles tend to settle more quickly. heat-resistant fabrics. asbestos has been used for a wide range of manufactured goods. but not in the general public. gaskets. actinolite. Because of these characteristics.ASBESTOS CAS # 1332-21-4 Division of Toxicology ToxFAQsTM September 2001 This fact sheet answers the most frequently asked health questions (FAQs) about asbestos. Small diameter fibers and particles may remain suspended in the air for a long time and be carried long distances by wind or water before settling down. Asbestos fibers are generally not broken down to other compounds and will remain virtually unchanged over long periods.00001 to 0. individual susceptibility and personal habits. building or home maintenance. This fact sheet is one in a series of summaries about hazardous substances and their health effects. People working in industries that make or use asbestos products or who are involved in asbestos mining may be exposed to high levels of asbestos.585 National Priorities List sites identified by the Environmental Protection Agency (EPA). and transmission parts). packaging. For more information. These levels range from 0. and whether other chemicals are present. HIGHLIGHTS: Exposure to asbestos usually occurs by breathing contaminated air in workplaces that make or use asbestos. how you are exposed. friction products (automobile clutch. How can asbestos affect my health? Asbestos mainly affects the lungs and the membrane that surrounds the lungs. the duration. mostly in building materials (roofing shingles. It’s important you understand this information because this substance may harm you. Asbestos is also found in the air of buildings that are being torn down or renovated.S. U. Drinking water may contain asbestos from natural sources or from asbestos-containing cement pipes. and coatings. The effects of exposure to any hazardous substance depend on the dose. paper products. What is asbestos? Asbestos is the name given to a group of six different fibrous minerals (amosite. Asbestosis is a serious disease and can eventually lead to disability and death. and asbestos cement products). Asbestos exposure can cause serious lung problems and cancer. and remodeling. demolition work. Public Health Service Agency for Toxic Substances and Disease Registry . and in severe cases heart enlargement.

if you have been exposed to asbestos you should stop smoking. Department of Health and Human Services. the World Health Organization (WHO). evaluate. and diagnostic tests are needed to evaluate asbestos-related disease. in general. GA 30333. How can families reduce the risk of exposure to asbestos? Materials containing asbestos that are not disturbed or deteriorated do not.S. EPA has proposed a concentration limit of 7 million fibers per liter of drinking water for long fibers (lengths greater than or equal to 5 m). or lung washings of the general public. Federal Recycling Program Printed on Recycled Paper . esophagus. GA: U. Therefore.Page 2 ASBESTOS CAS # 1332-21-4 ToxFAQsTM Internet address is http://www. Cancer from asbestos does not develop immediately. uses established before this date are still allowed. 1600 Clifton Road NE. Public Health Service. Atlanta. It is known that breathing asbestos can increase the risk of cancer in people. pose a health risk and can be left alone. A thorough history. physical exam. contact the Agency for Toxic Substances and Disease Registry. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). Update. There are two types of cancer caused by exposure to asbestos: lung cancer and mesothelioma.000 fibers with lengths greater than or equal to 5 m per cubic meter of workplace air for 8-hour shifts and 40hour work weeks. Lung function tests and CAT scans also assist in the diagnosis of asbestos-related disease. intestines. EPA banned all new uses of asbestos. Chest x-rays are the best screening tool to identify lung changes resulting from asbestos exposure. Pleural plaques can occur in workers and sometimes in people living in areas with high environmental levels of asbestos. The Occupational Safety and Health Administration has set limits of 100. It is likely that health effects seen in children exposed to high levels of asbestos will be similar to the effects seen in adults. Their specialists can recognize. FAX: 404-498-0093. 2001. EPA established regulations that require school systems to inspect for damaged asbestos and to eliminate or reduce the exposure by removing the asbestos or by covering it up. ATSDR can tell you where to find occupational and environmental health clinics. and kidneys). mucus. EPA regulates the release of asbestos from factories and during building demolition or renovation to prevent asbestos from getting into the environment. pancreas. Toxicological Profile for Asbestos.cdc. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. suspect that you may be exposed to asbestos in your home. Higher than average levels of asbestos fibers in tissue can confirm exposure but not determine whether you will experience any health effects. Effects on breathing from pleural plaques alone are not usually serious. contact your state or local health department or the regional offices of EPA to find out how to test your home and how to locate a company that is trained to remove or contain the fibers.atsdr. This may be the most important action that you can take to improve your health and decrease your risk of cancer. How can asbestos affect children? We do not know if exposure to asbestos will result in birth defects or other developmental effects in people. Mesothelioma is a cancer of the thin lining surrounding the lung (pleural membrane) or abdominal cavity (the peritoneum). Early identification and treatment of any cancer can increase an individual’s quality of life and survival. but higher exposure can lead to a thickening of the pleural membrane that may restrict breathing. ToxFAQsTM Internet address is http://www.cdc.gov/toxfaq.html Breathing lower levels of asbestos may result in changes called plaques in the pleural membranes. and the EPA have determined that asbestos is a human carcinogen. and treat illnesses resulting from exposure to hazardous substances.html . How likely is asbestos to cause cancer? The Department of Health and Human Services (DHHS). Is there a medical test to show whether I’ve been exposed to asbestos? Low levels of asbestos fibers can be measured in urine. Division of Toxicology. Studies of workers also suggest that breathing asbestos can increase chances of getting cancer in other parts of the body (stomach. Mailstop E-29. but this is less certain. Cigarette smoke and asbestos together significantly increase your chances of getting lung cancer.gov/toxfaq. Birth defects have not been observed in animals exposed to asbestos. but shows up after a number of years. Has the federal government made recommendations to protect human health? In 1989. feces. If you Where can I get more information? For more information. Phone: 1-888-422-8737.atsdr. Atlanta.

primarily on farms. What is atrazine? Atrazine is an herbicide that does not occur naturally. Public Health Service Agency for Toxic Substances and Disease Registry . and heart damage has been observed in animals exposed to atrazine. Birth defects and liver. kidney. It is important you understand this information because this substance may harm you. bacteria. This chemical has been found in at least 20 of the 1. Atrazine may affect pregnant women by causing their babies to grow more slowly than normal. and heart damage has been seen in animals exposed to high levels of atrazine. only trained people are allowed to spray it. Atrazine is used to kill weeds. This fact sheet is one in a series of summaries about hazardous substances and their health effects. How likely is atrazine to cause cancer? Available information is inadequate to definitely state whether atrazine causes cancer in humans. kidney. ‘ If atrazine enters the air. ‘ It may also wash from soil into streams or groundwater where it will stay for a long time. or flammable and that will dissolve in water. Atrazine has also been shown to cause changes in blood hormone levels in animals that affected ovulation and the ability to reproduce. The effects of exposure to any hazardous substance depend on the dose. ‘ People may also be exposed to atrazine by digging in dirt that has atrazine in it. However. and people who work in factories that make atrazine may be exposed. ‘ Atrazine does not accumulate in living organisms such as algae. HIGHLIGHTS: The general population is probably not exposed to atrazine. There are limited U. What happens to atrazine when it enters the environment? ‘ Atrazine enters the environment primarily through spraying on farm crops. personal traits and habits. How might I be exposed to atrazine? ‘ Most people are not exposed to atrazine on a regular basis. Pure atrazine is an odorless.585 National Priorities List sites identified by the Environmental Protection Agency (EPA). but has also been used on highway and railroad rights-of-way. chemical sprayers. or it may adhere to particles such as dust which eventually settle out of the air. ‘ In soil. exposure to atrazine may occur at farms where it has been sprayed. DEPARTMENT OF HEALTH AND HUMAN SERVICES. because breakdown of the chemical is slow in water. we do not know if this would also occur in humans. it may be broken down by reactions with chemicals in the air. reactive. or fish. ‘ Individuals may also be exposed by drinking water from wells that are contaminated with the herbicide. and whether other chemicals are present.S. atrazine is taken up by the plants growing in the soil or is broken down over a period of days to months. ‘ Farm workers.ATRAZINE CAS #1912-24-9 Division of Toxicology ToxFAQsTM September 2001 This fact sheet answers the most frequently asked health questions (FAQs) about atrazine. clams. How can atrazine affect my health? Liver. For more information. These effects are not expected to occur in humans because of specific biological differences between humans and these types of animals. how you are exposed. call the ATSDR Information Center at 1-888-422-8737. white powder that is not very volatile. The EPA now restricts how atrazine can be used and applied. the duration.

Public Health Service. How can atrazine affect children? Little information is available regarding the effects of atrazine in children.2 mg/L) for lifetime exposure of adults. These tests are not usually available at your doctors office.atsdr. None of these tests. A few studies are available that suggest that atrazine could affect pregnant women by causing their babies to grow more slowly than normal or by causing them to give birth early. In pregnant animals.gov/toxfaq.Page 2 ATRAZINE CAS #1912-24-9 ToxFAQsTM Internet address is http://www. How can families reduce the risk of exposure to atrazine? The general population is not likely to be exposed to large amounts of atrazine.cdc. ToxFAQs Internet address via WWW is http://www. however. 2001.cdc. Is there a medical test to show whether I’ve been exposed to atrazine? Atrazine can be detected in your blood and some other body tissues within 24 to 48 hours after your last exposure. ATSDR can tell you where to find occupational and environmental health clinics. however. exposure to atrazine causes a decrease in fetal growth and birth defects.02-15 ppm). Children should avoid playing in soils near uncontrolled hazardous waste sites where atrazine may have been discarded. We do not know whether children differ from adults in their susceptibility to atrazine. GA: U. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. However. A Cancer Assessment Review Committee (CARC) sponsored by EPA has classified atrazine as not likely to be carcinogenic to humans. Toxicological Profile for Atrazine (Draft for Public Comment) Atlanta.html human and animal data that suggest that there may be a link between atrazine exposure and various types of cancer. may be exposed to greater amounts of atrazine. In areas of high atrazine use. Has the federal government made recommendations to protect human health? The EPA allows 0. contact the Agency for Toxic Substances and Disease Registry. and treat illnesses resulting from exposure to hazardous substances. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). The Occupational Safety and Health Administration (OSHA) has set a limit of 5 milligrams of atrazine per cubic meter of workplace air (5 mg/m3) for an 8-hour workday and 40-hour work week. Where can I get more information? For more information. Atlanta. It is likely that the health effects seen in children should be similar to the effects seen in adults.02-15 parts atrazine per million parts of food (0. Federal Recycling Program Printed on Recycled Paper . Division of Toxicology.gov/toxfaq.2 milligrams of atrazine per liter of drinking water (0. Atrazine may be washed from fields where it is sprayed into streams and rivers or may migrate into wells used for drinking and bathing. Therefore.S. The EPA has determined maximum levels allowed in foods of 0. The International Agency for Research on Cancer (IARC) has determined that atrazine is not classifiable as to its carcinogenicity to humans. staying away from fields that have been recently sprayed may reduce exposure.html. It is unclear whether or at what level of exposure this might occur in humans. Mailstop E-29. GA 30333. Phone: 1-888-4228737. individuals should avoid swimming in or drinking from contaminated water sources and may desire to have personal well water tested for the presence of atrazine. but your doctor can send the samples to a laboratory that can perform the tests. Department of Health and Human Services. the women in these studies were also exposed to other chemicals that may have caused or contributed to these effects. can predict whether you will experience any health effects.atsdr. Exposure to high levels of atrazine during pregnancy caused reduced survival of fetuses. evaluate. FAX: 404-498-0093. Their specialists can recognize. 1600 Clifton Road NE. Populations living in the areas where atrazine is used on crops.

kidneys.416 National Priorities List sites identified by the Environmental Protection Agency.S. and production of barium compounds. U. A barium compound (barium sulfate) is sometimes used by doctors to perform medical tests and to take x-rays of the stomach. personal traits and habits. What is barium? (Pronounced bâr“¶-…m) Barium is a silvery-white metal found in nature. Barium compounds are used by the oil and gas industries to make drilling muds. The effects of exposure to any hazardous substance depend on the dose. bricks. G Breathing higher levels in air while working in industries that make or use barium compounds. G Fish and aquatic organisms accumulate barium. They are also used to make paint. G Barium is found in most soils and foods at low levels. DEPARTMENT OF HEALTH AND HUMAN SERVICES. and eating food. Barium compounds that do not dissolve well in water are not generally harmful and are often used by doctors for medical purposes. This chemical has been found in at least 649 of 1. Drilling muds make it easier to drill through rock by keeping the drill bit lubricated. and rubber. refining. It occurs combined with other chemicals such as sulfur or carbon and oxygen. SUMMARY: Exposure to barium occurs mostly in the workplace or from drinking contaminated water. G Breathing air near barium mining or processing plants. G Drinking water containing high levels of barium from natural sources. and other organs. drinking water. What happens to barium when it enters the environment? G Barium gets into the air during the mining. Barium compounds can also be produced by industry. and whether other chemicals are present. liver. For more information. and from the burning of coal and oil. Ingesting high levels of barium compounds that dissolve well in water over the short term has resulted in G Difficulties in breathing G Increased blood pressure G Changes in heart rhythm G Stomach irritation. rivers. the duration. call the ATSDR Information Center at 1-888-422-8737.BARIUM CAS # 7440-39-3 Agency for Toxic Substances and Disease Registry ToxFAQs September 1995 This fact sheet answers the most frequently asked health questions (FAQs) about barium. Public Health Service Agency for Toxic Substances and Disease Registry . These combinations are called compounds. how you are exposed. and streams. glass. stomach. How might I be exposed to barium? G Breathing very low levels in air. tiles. Those barium compounds that dissolve well in water may cause harmful health effects in people. Ingesting high levels of barium can cause problems with the heart. This information is important because this substance may harm you. This fact sheet is one in a series of summaries about hazardous substances and their health effects. G Some barium compounds dissolve easily in water and are found in lakes. How can barium affect my health? The health effects of the different barium compounds depend on how well the compound dissolves in water.

and treat illnesses resulting from exposure to hazardous substances. and the American Conference of Governmental Industrial Hygienists (ACGIH) have set an occupational exposure limit of 0.html G Brain swelling G Muscle weakness G Damage to the liver.Page 2 BARIUM CAS # 7440-39-3 ToxFAQs Internet address via WWW is http://www.cdc. ToxFAQs Internet address via WWW is http://www. How likely is barium to cause cancer? The Department of Health and Human Services. Soluble: Dissolves well in liquid. Mailstop E-29. 40-hour workweek. Where can I get more information? For more information. GA: U. Milligram (mg): One thousandth of a gram. Animal studies have found increased blood pressure and changes in the heart from ingesting barium over a long time. Department of Health and Human Services. Short-term: Lasting 14 days or less. NIOSH currently recommends that a level of 50 mg/m3 be considered immediately dangerous to life and health.gov/toxfaq. contact the Agency for Toxic Substances and Disease Registry. The OSHA exposure limit for barium sulfate dust in air is 5 to 15 milligrams of barium per cubic meter of air (5– 15 mg/m3). Toxicological profile for barium.5 milligrams of soluble barium compounds per cubic meter of air (0. We don’t know the effects of barium from breathing it or from touching it.atsdr.gov/toxfaq. Carcinogenicity: Ability to cause cancer. 1992. Division of Toxicology.5 mg/m3) for an 8-hour workday. Barium has not been classified because there are no studies in people and the two available animal studies were inadequate to determine whether or not barium causes cancer. kidney.atsdr. evaluate. FAX: 404-498-0093. Atlanta. the International Agency for Research on Cancer. and the Environmental Protection Agency (EPA) have not classified barium as to its human carcinogenicity. Public Health Service. these tests are usually done only for cases of severe barium poisoning and for medical research. Due to the complexity of the tests. Long-term: Lasting one year or longer. 1600 Clifton Road NE.html ATSDR can tell you where to find occupational and environmental health clinics. GA 30333. References Has the federal government made recommendations to protect human health? EPA allows 2 parts of barium per million parts of drinking water (2 ppm). the National Institute for Occupational Safety and Health (NIOSH). urine. Federal Recycling Program Printed on Recycled Paper . and feces. Their specialists can recognize. The Occupational Safety and Health Administration (OSHA). EPA requires that discharges or spills into the Agency for Toxic Substances and Disease Registry (ATSDR). and spleen. Glossary Is there a medical test to show whether I’ve been exposed to barium? There is no routine medical test to show whether you have been exposed to barium. We don’t know the effects in people of ingesting low levels of barium over the long term. This is the exposure level of barium that is likely to cause permanent health problems or death. using very complex instruments. Phone: 1-888-422-8737. ppm: Parts per million.cdc. environment of 10 pounds or more of barium cyanide be reported.S. However. heart. Ingesting: Taking food or drink into your body. Atlanta. bones. doctors can measure barium in the blood. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

convulsions. detergents. It evaporates into the air very quickly and dissolves slightly in water. dizziness. Some industries use benzene to make other chemicals which are used to make plastics. This information is important because this substance may harm you. and can pass through the soil into underground water. gasoline. HIGHLIGHTS: Benzene is a widely used chemical formed from both natural processes and human activities.430 National Priorities List sites identified by the Environmental Protection Agency (EPA). Public Health Service Agency for Toxic Substances and Disease Registry . How might I be exposed to benzene? G Outdoor air contains low levels of benzene from tobacco smoke. G People working in industries that make or use benzene may be exposed to the highest levels of it. dizziness. U. personal traits and habits. Benzene is widely used in the United States. Benzene is also used to make some types of rubbers. and whether other chemicals are present. sleepiness. Eating or drinking foods containing high levels of benzene can cause vomiting. and cigarette smoke. long-term benzene exposure causes effects on the bone marrow and can cause anemia and leukemia. it ranks in the top 20 chemicals for production volume. and detergents. irritation of the stomach. drugs. automobile service stations.BENZENE CAS # 71-43-2 Agency for Toxic Substances and Disease Registry ToxFAQs September 1997 This fact sheet answers the most frequently asked health questions (FAQs) about benzene. rapid heart rate. tremors. G It breaks down more slowly in water and soil. DEPARTMENT OF HEALTH AND HUMAN SERVICES. G Benzene can pass into the air from water and soil. the duration. headaches. paints. G A major source of benzene exposures is tobacco smoke. call the ATSDR Information Center at 1-888-422-8737. G Benzene in the air can attach to rain or snow and be carried back down to the ground. For more information. exhaust from motor vehicles. G Leakage from underground storage tanks or from hazardous waste sites containing benzene can result in benzene contamination of well water. dyes. What is benzene? (Pronounced b n“z¶n”) Benzene is a colorless liquid with a sweet odor. What happens to benzene when it enters the environment? G Industrial processes are the main source of benzene in the environment. Natural sources of benzene include volcanoes and forest fires. and pesticides.S. confusion. furniture wax. rapid heart rate. dizziness. G Indoor air generally contains higher levels of benzene from products that contain it such as glues. G It reacts with other chemicals in the air and breaks down within a few days. and nylon and synthetic fibers. lubricants. Breathing benzene can cause drowsiness. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is highly flammable and is formed from both natural processes and human activities. Benzene has been found in at least 813 of the 1. and unconsciousness. How can benzene affect my health? Breathing very high levels of benzene can result in death. The effects of exposure to any hazardous substance depend on the dose. resins. how you are exposed. and industrial emissions. and unconsciousness. G Air around hazardous waste sites or gas stations will contain higher levels of benzene. Benzene is also a natural part of crude oil. G Benzene does not build up in plants or animals. and death. while high levels can cause drowsiness.

GA. delayed bone formation. Public Health Service in Atlanta. Is there a medical test to show whether I’ve been exposed to benzene? Several tests can show if you have been exposed to benzene. Long-term exposure to high levels of benzene in the air can cause leukemia. Phone: 1-888-422-8737.cdc. Certain metabolites can be measured in the urine. 1600 Clifton Road NE.S. Public Health Service. contact the Agency for Toxic Substances and Disease Registry. There is test for measuring benzene in the breath. since the metabolites may be present in urine from other sources.html ATSDR can tell you where to find occupational and environmental health clinics.gov/toxfaq. Glossary Anemia: A decreased ability of the blood to transport oxygen. Source of Information This ToxFAQs information is taken from the 1997 Toxicological Profile for Benzene (update) produced by the Agency for Toxic Substances and Disease Registry. Some women who breathed high levels of benzene for many months had irregular menstrual periods and a decrease in the size of their ovaries. Department of Health and Human Services. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. measurements are accurate only for recent exposures.005 mgL). evaluate. ToxFAQs Internet address via WWW is http://www. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. Where can I get more information? For more information.gov/toxfaq. The Occupational Safety and Health Administration (OSHA) has set a permissible exposure limit of 1 part of benzene per million parts of air (1 ppm) in the workplace during an 8-hour workday. benzene is converted to products called metabolites. Federal Recycling Program Printed on Recycled Paper . Has the federal government made recommendations to protect human health? The EPA has set the maximum permissible level of benzene in drinking water at 0. increasing the chance for infection. Benzene can also be measured in the blood. Benzene causes harmful effects on the bone marrow and can cause a decrease in red blood cells leading to anemia.cdc. this test must be done shortly after exposure and is not a reliable indicator of how much benzene you have been exposed to. It can also cause excessive bleeding and can affect the immune system.005 milligrams per liter (0. Animal studies have shown low birth weights. Division of Toxicology. cancer of the blood-forming organs. Milligram (mg): One thousandth of a gram. Metabolites: Breakdown products of chemicals.atsdr. 40-hour workweek. The EPA requires that spills or accidental releases into the environment of 10 pounds or more of benzene be reported to the EPA. It is not known whether benzene exposure affects the developing fetus in pregnant women or fertility in men. GA 30333. However. U. since benzene disappears rapidly from the blood. Their specialists can recognize. however. and bone marrow damage when pregnant animals breathed benzene. How likely is benzene to cause cancer? The Department of Health and Human Services (DHHS) has determined that benzene is a known human carcinogen. and treat illnesses resulting from exposure to hazardous substances. In the body. FAX: 404-498-0093. this test must be done shortly after exposure. Carcinogen: A substance with the ability to cause cancer. Atlanta. Pesticide: A substance that kills pests. Laws today protect the welfare of research animals and scientists must follow strict guidelines. Chromosomes: Parts of the cells responsible for the development of hereditary characteristics.Page 2 BENZENE CAS # 71-43-2 ToxFAQs Internet address via WWW is http://www. Mailstop E-29.atsdr. CAS: Chemical Abstracts Service.html The major effect of benzene from long-term (365 days or longer) exposure is on the blood.

‘ Only very small amounts of free benzidine will dissolve in water. This substance has been found in at least 28 of the 1. It is a crystalline solid that may be grayish-yellow. The effects of exposure to any hazardous substance depend on the dose. benzidine salts can dissolve more readily in water. benzidine is found in either its “free” state (as an organic base). For more information. or food. In the environment. The main type of cancer found in workers is cancer of the urinary bladder. Most people are not exposed to benzidine in the environment. paper. ‘ People living near uncontrolled hazardous waste sites may be exposed to benzidine. It is no longer produced or used commerically in the U. HIGHLIGHTS: Benzidine is a manufactured chemical that was used to produce dyes. soil. DEPARTMENT OF HEALTH AND HUMAN SERVICES. The benzidine in air will eventually settle over land and water. Public Health Service Agency for Toxic Substances and Disease Registry . the duration. call the ATSDR Information Center at 1-888-422-8737. white. Liver.585 National Priorities List sites identified by the Environmental Protection Agency (EPA). how you are exposed. and whether other chemicals are present. ‘ Benzidine is not likely to accumulate in the food chain. What is benzidine? Benzidine is a manufactured chemical that does not occur naturally. This fact sheet is one in a series of summaries about hazardous substances and their health effects. water.S. Benzidine was used to produce dyes for cloth. What happens to benzidine when it enters the environment? ‘ Benzidine in the air exists as a vapor or attached to very small particles.BENZIDINE CAS #92-87-5 Division of Toxicology ToxFAQsTM September 2001 This fact sheet answers the most frequently asked health questions (FAQs) about benzidine. kidney. immune. We do not know if these effects would also occur in humans. and neurological effects have been observed in laboratory animals given relatively high amounts of benzidine. Benzidine released into waterways will sink and become part of the bottom sludge. benzidine has not been definitely shown to cause major adverse health effects in humans. How likely is benzidine to cause cancer? It is known that long term occupational exposure to benzidine can increase the risk of developing cancer in people. or reddish-gray. and leather. If it comes in contact with your skin it may cause a skin allergy. or as a salt. U. ‘ Benzidine in soil is likely to be strongly attached to soil particles and will not easily pass into underground water. personal traits and habits.S. How can benzidine affect my health? Except for the cancer discussed next. It is important you understand this information because this substance may harm you. Occupational exposure has been associated with increased risk of urinary bladder cancer. How might I be exposed to benzidine? ‘ The general population is not likely to be exposed to benzidine through contaminated air.

atsdr. GA: U. Atlanta. but your doctor can send the samples to a laboratory that can perform the tests.html The Department of Health and Human Services (DHHS). and Direct Brown 95 cause cancer in animals. such as Direct Blue 6.html. and Direct Brown 95. and the EPA have determined that benzidine is a human carcinogen. contact the Agency for Toxic Substances and Disease Registry. None of these tests.gov/toxfaq. can predict whether you will experience any health effects. Benzidine and its breakdown products can also bind to proteins within your red blood cells. however. Where can I get more information? For more information. but only within about 2 weeks after your last exposure.gov/toxfaq. Direct Black 38. FAX: 404-498-0093. These tests are not usually available at your doctor’s office. and treat illnesses resulting from exposure to hazardous substances. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). Mailstop E-29. ToxFAQs Internet address via WWW is http://www. Federal Recycling Program Printed on Recycled Paper .S. the World Health Organization (WHO). We do not know if exposure to benzidine will result in birth defects or other developmental effects in people. have been shown to cause cancer in humans. Is there a medical test to show whether I’ve been exposed to benzidine? Benzidine and its breakdown products can be detected in your urine. Phone: 1-888-4228737. 1600 Clifton Road NE. Has the federal government made recommendations to protect human health? The EPA recommends that the amount of benzidine in drinking water be less than 1 part benzidine in a trillion parts of water (1 ppt).cdc. Direct Black 38. In addition dyes made from benzidine. Their specialists can recognize. Department of Health and Human Services. 2001.cdc. It is likely that health effects seen in children exposed to high levels of benzidine will be similar to the effects seen in adults. How can families reduce the risk of exposure to benzidine? ‘ Most families will not be exposed to benzidine.Page 2 BENZIDINE CAS #92-87-5 ToxFAQsTM Internet address is http://www. ‘ Children should avoid playing in soils near uncontrolled hazardous waste sites where benzidine may have been discarded. evaluate. ATSDR can tell you where to find occupational and environmental health clinics. GA 30333. Public Health Service. Toxicological Profile for Benzidine Atlanta. The Food and Drug Administration (FDA) allows a maximum of 1 part benzidine per billion parts of some color additives for food. and this can be detected for up to 4 months. Division of Toxicology. The DHHS has determined that Direct Blue 6 and Direct Black 38 cause cancer in animals and WHO determined that Direct Blue 6. How can benzidine affect children? There are no studies on health effects on children exposed to benzidine.atsdr. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

G Drinking contaminated water near manufacturing or hazardous waste sites.3-benzofuran in human breast milk. DEPARTMENT OF HEALTH AND HUMAN SERVICES.S.3-benzofuran in the coating or packaging gets into the food.3-Benzofuran is a colorless.416 National Priorities List sites identified by the Environmental Protection Agency. and soil during its manufacture. We do not know how often the resin is used or whether any 2. or storage at hazardous waste sites.3-benzofuran. G One study reported detecting 2. It may also be formed during other uses of coal or oil. how you are exposed. Animal studies have shown effects on the liver. and whether other chemicals are present. sweet-smelling. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. For more information.3-bµn-z½“fy‹r“ôn”) 2. oily liquid made by processing coal into coal oil.3-Benzofuran is not used for any commercial purposes.3-benzofuran. 2. The resin also provides water resistance and is used in coatings on paper products and fabrics. The resin has been approved for use in food packages and as a coating on citrus fruits.3-benzofuran is most likely to occur from breathing contaminated air at the workplace. U. G It does not readily dissolve in water.3-benzofuran? (Pronounced 2. G Drinking contaminated human breast milk. lungs. G Breathing contaminated air around manufacturing or hazardous waste sites.3-benzofuran or of the coumarone-indene resin. indicating that the mother had been exposed. and stomach from exposure to high levels of 2. This resin resists corrosion and is used to make paints and varnishes. but the part of the coal oil that contains 2. G Eating foods from packaging material that contain coumarone-indene resins. What happens to 2. waste sites.3-BENZOFURAN CAS # 271-89-6 Agency for Toxic Substances and Disease Registry ToxFAQs September 1995 This fact sheet answers the most frequently asked health questions (FAQs) about 2. kidneys. G Smoking cigarettes.3-Benzofuran is not expected to accumulate in fish or aquatic animals to any great extent.3-benzofuran when it enters the environment? G Very little is known about the stability or breakdown of 2. G 2. but not much is known about how much gets into the food. G Limited information indicates that it will move into soil and sediment from water. the duration. This chemical has been found in at least 11 of 1. How might I be exposed to 2.3-benzofuran? G Breathing contaminated air or touching the chemical in the workplace.3-benzofuran is made into a plastic called coumarone-indene resin. Public Health Service Agency for Toxic Substances and Disease Registry . call the ATSDR Information Center at 1-888-422-8737.3-Benzofuran may enter the air. but may enter the groundwater near manufacturing or hazardous waste sites. use. personal traits and habits. What is 2. water. It is used as an adhesive in food containers and some asphalt floor tiles. G 2. SUMMARY: Exposure to 2. but more information is needed.2. The effects of exposure to any hazardous substance depend on the dose.

3-benzofuran in the blood or in breast milk. Has the federal government made recommendations to protect human health? There are no standards or recommendations specific for 2.3-benzofuran as to its human carcinogenicity.3-benzofuran as to its human carcinogenicity. Public Health Service. and stomach damage. Division of Toxicology. FAX: 404-498-0093. lungs. The test can't tell whether you may develop any health problems from an exposure.atsdr. evaluate. this test requires special equipment and is not usually available in your doctor’s office. However. GA 30333. There are no studies that have looked at the effects in people from exposures to air. ppm: Parts per million. or through skin contact. How likely is 2.3-benzofuran to human health. the ability of animals to reproduce was not affected.3-benzofuran.gov/toxfaq. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. or food. water. Toxicological profile for 2. Mailstop E-29.3-benzofuran affect my health? Very little is known about the possible harmful effects of 2.cdc.3-benzofuran. There are some studies in animals from exposures in food or water. Those exposed over a long time to moderate levels had liver. In one study. FDA also allows the use of coumarone-resin as a component of adhesives used in food packaging and as a substance in plastics intended for repeated use in contact with food. kidney. Phone: 1-888-422-8737. lung. Their specialists can recognize.3-benzofuran's potential to cause cancer in people.html ATSDR can tell you where to find occupational and environmental health clinics. References Agency for Toxic Substances and Disease Registry (ATSDR). ToxFAQs Internet address via WWW is http://www.3-benzofuran for long periods of time. Where can I get more information? For more information. Federal Recycling Program Printed on Recycled Paper . Ingesting: Taking food or drink into your body. and treat illnesses resulting from exposure to hazardous substances. This test may only measure 2.cdc.gov/toxfaq.3-benzofuran to cause cancer? The Department of Health and Human Services has not classified 2. Rats and mice that ingested high levels of 2. It is not known how long 2. There are no studies on 2. Atlanta. The Food and Drug Administration (FDA) allows 200 parts of coumarone-indene resin per million parts of coating on the peels of citrus fruits (200 ppm). Is there a medical test to show whether I’ve been exposed to 2.atsdr. or stomach was seen in rats and mice that ingested 2. The International Agency for Research on Cancer and the Environmental Protection Agency (EPA) have also not classified 2. Department of Health and Human Services. 1992. contact the Agency for Toxic Substances and Disease Registry.3-BENZOFURAN CAS # 271-89-6 ToxFAQs Internet address via WWW is http://www. Short time: Lasting 14 days or less.html How can 2.Page 2 2. Atlanta. Glossary Carcinogenicity: Ability to cause cancer. Long time: Lasting one year or longer. GA: U.S.3-benzofuran? There is a test to measure 2.3-benzofuran from a recent exposure. liver. We do not know if people will experience health effects similar to those seen in animals.3-benzofuran remains in your body after you have been exposed.3-benzofuran over a short time had liver and kidney damage. 1600 Clifton Road NE. Cancer of the kidneys.

aircraft and space vehicle structures. and/or fatigue. machined. How can beryllium affect my health? Beryllium can be harmful if you breathe it.BERYLLIUM CAS #7440-41-7 Division of Toxicology ToxFAQsTM September 2002 This fact sheet answers the most frequently asked health questions (FAQs) about beryllium. alloys. for how long. About 1-15% of all people occupationally-exposed to beryllium in air become sensitive to beryllium and may develop chronic beryllium disease (CBD). Beryllium alloys are used in automobiles. or converted into metal. and whether other chemicals are present. and dental bridges. shortness of breath. These individuals may develop an inflammatory reaction in the respiratory system. What is beryllium? Beryllium is a hard. how you are exposed. sports equipment (golf clubs). and individual susceptibility. xray machines. of beryllium in air. coal. and water. but most stick to particles and settle to the bottom. DEPARTMENT OF HEALTH AND HUMAN SERVICES. ‘ People living near uncontrolled hazardous waste sites may be exposed to higher than normal levels of beryllium. It can also result in anorexia. Beryllium has been found in at least 535 of the 1. and from industrial waste. Beryllium oxide is used to make speciality ceramics for electrical and high-technology applications. The effects of exposure to any hazardous substance depend on the dose. Some exposed workers (1-15%) become sensitive to beryllium. and may also lead to right side heart What happens to beryllium when it enters the environment? ‘ Beryllium dust enters the air from burning coal and oil. an acute condition can result.613 National Priorities List sites identified by the Environmental Protection Agency (EPA). It is important you understand this information because this substance may harm you. and mirrors. CBD may be completely asymptomatic or begin with coughing. an irreversible and sometimes fatal scarring of the lungs. call the ATSDR Information Center at 1-888-422-8737. How might I be exposed to beryllium? ‘ The general population is normally exposed to low levels U. For more information. processed. Beryllium ore is mined. HIGHLIGHTS: People working or living near beryllium industries have the greatest potential for exposure to beryllium. This condition resembles pneumonia and is called acute beryllium disease Occupational and community air standards are effective in preventing acute lung damage. personal traits and habits. and the beryllium is purified for use in nuclear weapons and reactors. and can occur years after exposure to higher than normal levels of beryllium (greater than 0. People living near these industries may also be exposed to higher than normal levels of beryllium in air. computers. chest pain. and other chemicals may be exposed to high levels of beryllium. This condition is called chronic beryllium disease (CBD). weakness. soil. Some beryllium compounds will dissolve in water. and can cause difficulty in breathing. grayish metal naturally found in mineral rocks. the duration. ‘ Beryllium does not accumulate in the food chain. food. This disease can make you feel weak and tired. This beryllium dust will eventually settle over the land and water. ‘ It enters water from erosion of rocks and soil. The effects depend on how much you are exposed to. and volcanic dust. ‘ People working in industries where beryllium is mined.S. ‘ Most beryllium in soil does not dissolve in water and remains bound to soil. weight loss. Lung damage has been observed in people exposed to high levels of beryllium in the air. This fact sheet is one in a series of summaries about hazardous substances and their health effects. instruments. Public Health Service Agency for Toxic Substances and Disease Registry . If beryllium air levels are high enough (greater than 1000 ug/m3).2 ug/m3).

Has the federal government made recommendations to protect human health? The EPA restricts the amount of beryllium that industries may release into the air to 0.04 ug/m3 beryllium can result in a one in a thousand chance of developing cancer.0002 ug/m3). these tests do not show if you have become sensitized to beryllium. The EPA has determined that beryllium is a probable human carcinogen. 2002.gov/toxfaq. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). Toxicological Profile for Beryllium Atlanta. Depending on your exposure history. can help your doctor decide if you are sensitized to beryllium. The Occupational Safety and Health Administration (OSHA) sets a limit of 2 ug/m3 for an 8-hour work shift measured as a personal sample. ToxFAQs Internet address via WWW is http://www.atsdr. It is also useful for separating chronic beryllium disease from diagnoses that resemble it (for example. ‘ Children should avoid playing in soils near uncontrolled hazardous waste sites where beryllium may have been discarded. and test results. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. These tests are rarely done because they are not reliable measures of your exposure over time. or lungs. skin. This test is only done in a few specialized laboratories.cdc. Mailstop E-29. How can families reduce the risk of exposure to beryllium? ‘ Individuals working at facilities that use beryllium should make sure that contaminated clothing and objects are not brought home. Some people who are sensitized to beryllium may not have any symptoms. clinical findings. How can beryllium affect children? It is likely that the health effects seen in children exposed to beryllium will be similar to the effects seen in adults.cdc. Is there a medical test to show whether I’ve been exposed to beryllium? Beryllium can be measured in samples from your blood. GA: U.html. the beryllium lymphocyte proliferation test (BeLPT). sarcoidosis). ATSDR can tell you where to find occupational and environmental health clinics. Public Health Service. Atlanta. contact the Agency for Toxic Substances and Disease Registry.01 ug/m3. Division of Toxicology. averaged over a 30day period.S. Also. evaluate. urine. The Department of Health and Human Services (DHHS) and the International Agency for Research on Cancer (IARC) have determined that beryllium is a human carcinogen. The BeLPT is most often done for people who work with beryllium. Swallowing beryllium has not been reported to cause effects in humans because very little beryllium is absorbed from the stomach and intestines.html enlargement and heart disease in advanced cases. We do not know if exposure to beryllium will result in birth defects or other developmental effects in people. How likely is beryllium to cause cancer? Long term exposure to beryllium can increase the risk of developing lung cancer in people. Another test. Where can I get more information? For more information. EPA has estimated that lifetime exposure to 0.00003-0. Phone: 1-888-4228737. Their specialists can recognize.Page 2 BERYLLIUM CAS #7440-41-7 ToxFAQsTM Internet address is http://www. Beryllium contact with skin that has been scraped or cut may cause rashes or ulcers. your doctor may also recommend additional specialized testing. The general population is unlikely to develop chronic beryllium disease because ambient air levels of beryllium are normally very low (0.gov/toxfaq. We do not know whether children differ from adults in their susceptibility to beryllium. Ulcers have been seen in dogs ingesting beryllium in the diet. and treat illnesses resulting from exposure to hazardous substances. Federal Recycling Program Printed on Recycled Paper . FAX: 404-498-0093. The studies on developmental effects in animals are not conclusive. 1600 Clifton Road NE. GA 30333.atsdr. Department of Health and Human Services. but doctors familiar with the test can collect blood samples and send them for testing by overnight carrier.

eyes. In some cases. What is bis(2-chloroethyl) ether? (Pronounced b¹s“ 2 klôr“½ µth“…l ¶“th…r) Bis(2-chloroethyl) ether is a colorless. or as a chemical intermediate to make other chemicals. How can bis(2-chloroethyl) ether affect my health? Bis(2-chloroethyl) ether causes irritation to the skin. Bis(2-chloroethyl) ether has been found at 81 of the 1. and lungs. and a decrease in growth rate.BIS(2-CHLOROETHYL) ETHER CAS # 111-44-4 Agency for Toxic Substances and Disease Registry ToxFAQs July 1999 This fact sheet answers the most frequently asked health questions (FAQs) about bis(2-chloroethyl) ether. It does not occur naturally. eyes. and most of it is used to make pesticides. q You could be exposed if you drank water that was contaminated with bis(2-chloroethyl) ether. the duration. For more information. These effects include irritation to the skin. nose. cleaner. q Bis(2-chloroethyl) ether does not build up in the food chain.518 National Priorities List sites identified by the Environmental Protection Agency (EPA). throat.S. This fact sheet is one in a series of summaries about hazardous substances and their health effects. nonflammable liquid with a strong unpleasant odor. and lungs. It dissolves easily in water. What happens to bis(2-chloroethyl) ether when it enters the environment? q Bis(2-chloroethyl) ether released to air can be broken down by reactions with other chemicals and sunlight or can be removed by rain. some will filter through the soil to groundwater. Breathing low concentrations will cause coughing and nose and throat irritation. Animal studies show effects similar to those observed in people. and some will evaporate to the air. but some of it is used as a solvent and cleaner. component of paint and varnish. damage to the lungs can be severe enough to cause death. U. and lungs. and whether other chemicals are present. The effects of exposure to any hazardous substance depend on the dose. Bis(2-chloroethyl) ether is made in factories. and some of it will slowly evaporate to the air. nose. it can be broken down by bacteria. Animals that survived the exposures recovered fully in 4 to 8 days. throat. q In water. HIGHLIGHTS: Bis(2-chloroethyl) ether is mainly used as a chemical intermediate to make pesticides. rust inhibitor. q People who live near a waste site or industrial facility containing bis(2-chloroethyl) ether may be exposed to it in the air they breathe or by touching contaminated soil. DEPARTMENT OF HEALTH AND HUMAN SERVICES. lung damage. how you are exposed. How might I be exposed to bis(2-chloroethyl) ether? q You are most likely to be exposed to bis(2-chloroethyl) ether if you work in a factory where it is made or used. It is irritating to the skin. Some of it is used as a solvent. personal traits and habits. It’s important you understand this information because this substance may harm you. some will be broken down by bacteria. q When released to soil. call the ATSDR Information Center at 1-888-422-8737. Public Health Service Agency for Toxic Substances and Disease Registry .

contact the Agency for Toxic Substances and Disease Registry.03 parts per billion parts of water (0. The National Institute of Occupational Safety and Health (NIOSH) recommends that workplace air should not exceed 5 ppm bis(2-chloroethyl) ether averaged over a 10-hour workday or 40-hour workweek.cdc. and death. Federal Recycling Program Printed on Recycled Paper . The federal recommendations have been updated as of July 1999.html ATSDR can tell you where to find occupational and environmental health clinics. 40-hour workweek. CAS: Chemical Abstracts Service. How likely is bis(2-chloroethyl) ether to cause cancer? The ability of bis(2-chloroethyl) ether to cause cancer in humans has not been established. We do not know if bis(2-chloroethyl) ether causes reproductive effects or birth defects in people or animals. GA 30333. Agency for Toxic Substances and Disease Registry (ATSDR). Atlanta.atsdr. and treat illnesses resulting from exposure to hazardous substances.atsdr. National Priorities List: A list of the nation’s worst hazardous waste sites.html Some animal studies indicate that bis(2-chloroethyl) ether can affect the nervous system resulting in sluggish and slow movement. The Occupational Safety and Health Administration (OSHA) has set a limit of 15 parts per million (15 ppm) over an 8-hour workday.S. Where can I get more information? For more information. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. ppm: Parts per million. Evaporate: To change into a vapor or a gas. but these tests have not been developed for measuring bis(2-chloroethyl) ether in people. Atlanta. Department of Health and Human Services.cdc. Public Health Service. ppb: Parts per billion. FAX: 404-498-0093.gov/toxfaq. Toxicological profile for bis(2-chloroethyl) ether.Page 2 BIS(2-CHLOROETHYL) ETHER CAS # 111-44-4 ToxFAQs Internet address via WWW is http://www. Their recommended short-term exposure limit (up to 15 minutes) is 10 ppm averaged over an 8-hour period. Source of Information Has the federal government made recommendations to protect human health? The EPA recommends that levels in lakes and streams should be limited to 0. Phone: 1-888-422-8737. Is there a medical test to show whether I’ve been exposed to bis(2-chloroethyl) ether? There are tests that can detect bis(2-chloroethyl) ether in some animal tissues and in environmental samples. Mailstop E-29. Glossary Carcinogenicity: Ability to cause cancer. ToxFAQs Internet address via WWW is http://www. evaluate. The International Agency for Research on Cancer (IARC) has determined that bis(2-chloroethyl) ether is not classifiable as to its carcinogenicity in humans. unconsciousness. Any release to the environment greater than 10 pounds of bis(2-chloroethyl) ether must be reported to the EPA. 1600 Clifton Road NE. staggering. Pesticide: A substance that kills pests. There is some evidence that bis(2-chloroethyl) ether causes cancer in mice. 1989. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Their specialists can recognize. Division of Toxicology.gov/toxfaq. Laws today protect the welfare of research animals and scientists must follow strict guidelines. GA: U.03 ppb) to prevent possible health effects from drinking water or eating fish contaminated with bis(2-chloroethyl) ether.

U. Breathing low concentrations will cause coughing and nose and throat irritation. some will evaporate to the air but most of it will be broken down by reacting with soil moisture. or it can be removed by rain. In the past. Bis(chloromethyl) ether is highly irritating to the skin. This fact sheet is one in a series of summaries about hazardous substances and their health effects. it is broken down quickly to formaldehyde and hydrochloric acid. and textiles. so chances for exposure are very low. It does not occur naturally. throat. and lungs. What is bis(chloromethyl) ether? (Pronounced b¹s“ klôr“½ mµth“…l ¶“th…r) Bis(chloromethyl) ether is a clear liquid with a strong unpleasant odor. eyes. and whether other chemicals are present. For more information. and lungs and it is a carcinogen. eyes.S. an industrial facility that makes or uses chemicals that may contain bis(chloromethyl) ether as a contaminant. nose. but its use is now highly restricted. throat. it was used to make several types of polymers.BIS(CHLOROMETHYL) ETHER CAS # 542-88-1 Agency for Toxic Substances and Disease Registry ToxFAQs Jul. How might I be exposed to bis(chloromethyl) ether? q Because bis(chloromethyl) ether does not last long in the environment and because of its restricted use. DEPARTMENT OF HEALTH AND HUMAN SERVICES. the duration. q The most likely way to be exposed is by breathing it in the air if you work at.518 National Priorities List sites identified by the Environmental Protection Agency (EPA). What happens to bis(chloromethyl) ether when it enters the environment? q Bis(chloromethyl) ether released to air can be broken down by reactions with other chemicals and sunlight. In some cases.y 1999 This fact sheet answers the most frequently asked health questions (FAQs) about bis(chloromethyl) ether. but degrades rapidly and readily evaporates into air. Use of this chemical is highly restricted. Public Health Service Agency for Toxic Substances and Disease Registry . HIGHLIGHTS: Bis(chloromethyl) ether is only used in small amounts inside fully enclosed systems to make other chemicals. chloromethyl methyl ether. The small quantities that are produced are only used in enclosed systems to make other chemicals. Only small quantities of bis(chloromethyl) ether are produced in the United States. How can bis(chloromethyl) ether affect my health? Bis(chloromethyl) ether causes irritation to the skin. damage to the lungs can be severe enough to cause death. It’s important you understand this information because this substance may harm you. However. small quantities of bis(chloromethyl) ether may be formed as an impurity during the production of another chemical. you are not likely to be exposed to this chemical. The effects of exposure to any hazardous substance depend on the dose. personal traits and habits. q Bis(chloromethyl) ether does not build up in the food chain and does not last long in the environment. q When released to soil. how you are exposed. Bis(chloromethyl) ether has been found at 2 of the 1. resins. It dissolves easily in water. call the ATSDR Information Center at 1-888-422-8737. or live near. q In water.

1989. 1600 Clifton Road NE. bleeding. Tumor: An abnormal mass of tissue. Mailstop E-29. Polymer: Chemical compounds consisting of repeating structural units. How likely is bis(chloromethyl) ether to cause cancer? There is evidence that bis(chloromethyl) ether causes lung cancer and other tumors in people and animals. swelling. or other tests to identify damage to the respiratory tract. GA: U.html ATSDR can tell you where to find occupational and environmental health clinics.gov/toxfaq. CAS: Chemical Abstracts Service. and treat illnesses resulting from exposure to hazardous substances. these tests are not specific for this chemical and can only be used after damage has occurred. nose.cdc. Phone: 1-888-422-8737. Evaporate: To change into a vapor or a gas. Department of Health and Human Services. These effects include irritation to the skin.html Animal studies show effects similar to those observed in people. Public Health Service.atsdr. ppb: Parts per billion. We do not know if bis(chloromethyl) ether causes reproductive effects or birth defects in people or animals. Federal Recycling Program Printed on Recycled Paper . Atlanta.Page 2 BIS(CHLOROMETHYL) ETHER CAS # 542-88-1 ToxFAQs Internet address via WWW is http://www. Atlanta. The federal recommendations have been updated as of July 1999. The only available medical tests involve physical examination of the nose and throat. Toxicological profile for bis(chloromethyl) ether. and destruction of tissue. National Priorities List: A list of the nation’s worst hazardous waste sites.cdc. and lungs and lung damage (swelling and bleeding). GA 30333. evaluate. FAX: 404-498-0093. Application of the liquid to the skin of mice and rabbits has produced hair loss. there are no specific tests to determine if someone has been exposed to this chemical. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed.0000038 ppb) to prevent possible health effects from drink- Where can I get more information? For more information. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR).gov/toxfaq. contact the Agency for Toxic Substances and Disease Registry. ing water or eating fish contaminated with bis(chloromethyl) ether. Their specialists can recognize. Has the federal government made recommendations to protect human health? The EPA recommends that levels in lakes and streams should be limited to 0.S. The Occupational Safety and Health Administration (OSHA) has set a limit of 1 ppb as the highest acceptable level in workplace air.0000038 parts per billion parts of water (0. and strict controls have been established to minimize exposure to this chemical. The Department of Health and Human Services (DHHS) has determined that bis(chloromethyl) ether is a known human carcinogen. Glossary Carcinogen: A substance that can cause cancer.atsdr. Any release to the environment greater than 10 pounds of bis(chloromethyl) ether must be reported to the EPA. Laws today protect the welfare of research animals and scientists must follow strict guidelines. Division of Toxicology. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. chest X-rays. Is there a medical test to show whether I’ve been exposed to bis(chloromethyl) ether? Because bis(chloromethyl) ether is broken down rapidly in the body. However. ToxFAQs Internet address via WWW is http://www.

Mustard-Lewisite Mixture is a liquid with a garlic-like odor. It is important you understand this information because this substance may harm you. personal traits and habits. but small amounts may evaporate. Lewisite and Mustard-Lewisite.BLISTER AGENTS: LEWISITE (L) CAS #541-25-3 MUSTARD-LEWISITE MIXTURE (HL) CAS # NOT AVAILABLE Division of Toxicology ToxFAQsTM April 2002 This fact sheet answers the most frequently asked health questions (FAQs) about the blister agents. but small amounts may evaporate. What are Lewisite and Mustard-Lewisite? Lewisite is an oily. Mustard-Lewisite is a mixture of Lewisite and a sulfur mustard known as HD. Public Health Service Agency for Toxic Substances and Disease Registry . Exposure to high levels may be fatal. and whether other chemicals are present. This fact sheet is one in a series of summaries about hazardous substances and their health effects. For more information. People who breathe in vapors of Lewisite or Mustard-Lewisite may experience damage to the respiratory system. your airways will immediately become irritated. how you are exposed. Contact with the skin or eye can result in serious burns. Lewisite or Mustard-Lewisite also can cause damage to bone marrow and blood vessels. but such reports have not been confirmed. ‘ Lewisite and Mustard-Lewisite will be broken down in water quickly. How can Lewisite and Mustard-Lewisite affect my health? If you breathe Lewisite or Mustard-Lewisite vapors. ‘ Lewisite and Mustard-Lewisite do not accumulate in the food chain. ‘ Lewisite and Mustard-Lewisite are no longer produced in the United States. colorless liquid with an odor like geraniums. blister agents Lewisite and Mustard-Lewisite will be broken down by compounds that are found in the air. Lewisite might have been used as a chemical weapon by Japan against Chinese forces in the 1930s. How might I be exposed to Lewisite and Mustard-Lewisite? ‘ The general population will not be exposed to blister agents Lewisite or Mustard-Lewisite. ‘ Lewisite and Mustard-Lewisite will be broken down in moist soil quickly. call the ATSDR Information Center at 1-888-422-8737. U. HIGHLIGHTS: It is unlikely that the general population will be exposed to blister agents Lewisite or Mustard-Lewisite. You could experience burning pain in the nose and sinuses. but they may persist in air for a few days before being broken down. DEPARTMENT OF HEALTH AND HUMAN SERVICES. laryngitis. Blister agents Lewisite and MustardLewisite have not been found in any of the 1.S. The effects of exposure to any hazardous substance depend on the dose.585 National Priorities List sites identified by the Environmental Protection Agency (EPA). the duration. ‘ In air. as mandated by the Chemical Weapons Convention. What happens to Lewisite and Mustard-Lewisite when they enter the environment? ‘ Blister agents Lewisite and Mustard-Lewisite could enter the environment from an accidental release. ‘ People that are potentially exposed to Lewisite or Mustard-Lewisite are soldiers who might be exposed to chemical weapons or people who work at military sites where these compounds are stored. Any stored Lewisite in the United States must be destroyed before April 2007.

U. Mailstop E-29. Their specialists can recognize. or ingest. nausea. Where can I get more information? For more information. How can families reduce the risk of exposure to Lewisite and Mustard-Lewisite? It is unlikely that families will be exposed to Lewisite or Mustard-Lewisite. pass to your blood stream. which could result in low blood pressure and damage to the rest of your body. FAX: 404-498-0093. nausea. You could also experience airway tissue damage and accumulation of fluid in your lungs. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. We to not know whether the Mustard-Lewisite mixture might also be a human carcinogen. Phone: 1-888-422-8737. How likely are Lewisite and Mustard-Lewisite to cause cancer? The Department of Health and Human Services (DHHS). We do not know whether children differ from adults in their susceptibility to these blister agents. but children would probably be affected in the same ways as adults. touch.html cough. vomiting. you will suffer immediate pain and rapid swelling. and treat illnesses resulting from exposure to hazardous substances. Both the DHHS and IARC have classified the blister agent H/HD (the sulfur mustard used in the Mustard-Lewisite mixture) as a human carcinogen. and rash.003 milligrams of Lewisite and Mustard-Lewisite per cubic meter of air (0. How can Lewisite and Mustard-Lewisite affect children? There is no information on children exposed to Lewisite or Mustard-Lewisite. We do not know whether Lewisite or Mustard-Lewisite can cause developmental effects in humans.gov/toxfaq. Atlanta.cdc. The presence of arsenic in the urine could indicate if you have been exposed to one of these blister agents. it can cause bone marrow damage and fluid loss from your blood vessels.atsdr. the International Agency for Research on Cancer (IARC). GA 30333. and vomiting.003 mg/m3) has been established as a time-weighted average (TWA) for the workplace. followed by blistering that might be delayed for hours. as well as serious damage to the cornea and other parts of the eye. swelling. Contact of the skin with Lewisite or Mustard-Lewisite vapors or liquid will result in local pain.S.Page 2 BLISTER AGENTS: LEWISITE (L) CAS #541-25-3 MUSTARD-LEWISITE MIXTURE (HL) CAS # NOT AVAILABLE ToxFAQsTM Internet address is http://www. If Lewisite or Mustard-Lewisite vapors or liquid contact your eyes. will cause severe stomach pain. which could result in death. Is there a medical test to show whether I’ve been exposed to Lewisite and Mustard-Lewisite? There are no specific tests to indicate whether you have been exposed to Lewisite or Mustard-Lewisite. 1600 Clifton Road NE. Division of Toxicology. and the EPA have not classified Lewisite as to its carcinogenicity. If some of the Lewisite and Mustard-Lewisite that you breathe. ToxFAQsTM Internet address is http://www. contact the Agency for Toxic Substances and Disease Registry.atsdr. Federal Recycling Program Printed on Recycled Paper . We do not know if exposure to Lewisite or Mustard-Lewisite causes reproductive effects in humans.gov/toxfaq. shortness of breath.html . Has the federal government made recommendations to protect human health? An Airborne Exposure Limit (as recommended by the Surgeon General’s Working Group. ATSDR can tell you where to find occupational and environmental health clinics.cdc. Department of Health and Human Services) of 0. evaluate. and bloody stools. Ingestion of Lewisite or Mustard-Lewisite will burn your mouth and throat.

What are nitrogen mustards? Nitrogen mustards (HN-1. This fact sheet is one in a series of summaries about hazardous substances and their health effects. HN-2. Contact with the skin or eyes may cause burns. fishy or musty odor. and HN-3. oily liquids that evaporate very slowly. Nitrogen mustards HN-1. HN-2. HN-1 has been used to remove warts in the past. HN-3 (nitrogen mustards) CAS #538-07-8 (HN-1). how you are exposed. HN-2. ‘ Nitrogen mustards will be broken down in water quickly. HN-3) are colorless to yellow. HN-2. Exposure to high levels can cause death. DEPARTMENT OF HEALTH AND HUMAN SERVICES. HIGHLIGHTS: It is unlikely that the general public will be exposed to nitrogen mustards agents HN-1. HN-1 has a faint. CAS #51-75-2 (HN-2). It is important you understand this information because this substance may harm you. they may cause damage to bone marrow and the immune system. When nitrogen mustards are absorbed by the body. and only small amounts may evaporate. chemical warfare inventory. nitrogen mustards will be broken down by compounds that are found in the air. they were never stockpiled as part of the U. call the ATSDR Information Center at 1-888-422-8737.S. Although nitrogen mustards could be used in chemical warfare. ‘ Nitrogen mustards will be broken down in moist soil quickly. and HN-3 have not been identified in any of the 1.BLISTER AGENTS HN-1. For more information.585 National Priorities List sites identified by the Environmental Protection Agency (EPA). ‘ When released to air. personal traits and habits. and HN-3 could enter the environment from an accidental release. U. HN-3 may smell like butter almond. How might I be exposed to nitrogen mustards? ‘ The general population will not be exposed to nitrogen mustards. Exposure to vapors of nitrogen mustards can damage the respiratory airways. HN-2. there are presently no records of such use. and HN-2 has been used sparingly in chemotherapy. CAS #555-77-1 (HN-3) Division of Toxicology ToxFAQsTM April 2002 This fact sheet answers the most frequently asked health questions (FAQs) about nitrogen mustards. and HN-3 are not manufactured in significant commercial quantities in the United States. ‘ Nitrogen mustards do not accumulate in the food chain. Although several of the nitrogen mustards have medicinal uses and as chemical warfare agents. HN-2. but they may persist in air for a few days before being broken down.S. and only small amounts may evaporate. What happens to nitrogen mustards when they enter the environment? ‘ Nitrogen mustards HN-1. HN-2 has a soapy odor at low concentrations and a fruity odor at higher concentrations. Public Health Service Agency for Toxic Substances and Disease Registry . ‘ The nitrogen mustards HN-1. the duration. The effects of exposure to any hazardous substance depend on the dose. and whether other chemicals are present.

and treat illnesses resulting from exposure to hazardous substances. How likely are nitrogen mustards to cause cancer? The International Agency for Research on Cancer (IARC) has classified nitrogen mustard HN-2 as probably carcinogenic to humans. esophagus. There is some evidence that nitrogen mustard treatment in humans may result in decreased fertility.html . But we do not know whether children differ from adults in their susceptibility to nitrogen mustards.cdc. laryngitis. A few case reports have linked treatment with HN-2 in pregnant mothers to changes in the unborn child. they may cause damage to your immune system and bone marrow. and stomach. based on evidence that it causes leukemia in humans and cancers of the lung. cough. and shortness of breath. U.gov/toxfaq. Their specialists can recognize. you may experience eye inflammation. and large intestine in animals. you will likely experience such effects as nasal and sinus pain or discomfort. Nitrogen mustards have been shown to cause damage to the fetus in animals. Atlanta. Division of Toxicology. you will probably experience burning of the mouth. Phone: 1-888-422-8737. swelling. pain. Contact with high levels of nitrogen mustards can result in second. Department of Health and Human Services) of 0. liver.Page 2 BLISTER AGENTS HN-1. Is there a medical test to show whether I’ve been exposed to nitrogen mustards? There are no specific tests to indicate whether you have been exposed to nitrogen mustards. HN-2.S. Where can I get more information? For more information. Federal Recycling Program Printed on Recycled Paper .gov/toxfaq. pharyngitis.003 mg/m3) has been established as a timeweighted average (TWA) for the workplace. FAX: 404-498-0093. ATSDR can tell you where to find occupational and environmental health clinics. If nitrogen mustards touch the eye. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. Has the federal government made recommendations to protect human health? An Airborne Exposure Limit (as recommended by the Surgeon General’s Working Group.html How can nitrogen mustards affect my health? If you breathe nitrogen mustard vapors. How can nitrogen mustards affect children? Children exposed to nitrogen mustards would probably experience the same effects seen in exposed adults. If you swallow nitrogen mustards.003 milligrams of HN-1 per cubic meter of air (0. Skin contact with nitrogen mustard vapors or liquid. HN-3 (nitrogen mustards) CAS #538-07-8 (HN-1). ToxFAQsTM Internet address is http://www. contact the Agency for Toxic Substances and Disease Registry. 1600 Clifton Road NE. burns. evaluate. followed by blistering.atsdr. corneal damage. Exposure to high levels could cause death.cdc.CAS #555-77-1 (HN-3) ToxFAQsTM Internet address is http://www. Mailstop E-29. How can families reduce the risk of exposure to nitrogen mustards? Families are not likely to be exposed to nitrogen mustards.and third-degree burns. will likely cause initial swelling and rash. uterus. GA 30333.atsdr. and even blindness. When nitrogen mustards are absorbed by the body. CAS #51-75-2 (HN-2). Damage to cells lining your airways may begin within hours and get worse over the next several days.

and some might evaporate. This fact sheet is one in a series of summaries about hazardous substances and their health effects. The effects of exposure to any hazardous substance depend on the dose. Sulfur mustards were introduced as chemical warfare agents during World War I. but small amounts may evaporate. Exposure to sulfur mustards can burn the skin and eyes. but they may persist in air for a few days before being broken down. ‘ When released to air. stockpiles of chemical agents. ‘ Sulfur mustards are no longer produced in the United States. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Sulfur mustard agent H/HD has been identified at 3 of the 1. but are typically yellow to brown oily liquids with a slight garlic or mustard odor. Agent H contains about 20-30% impurities. HIGHLIGHTS: Exposure to sulfur mustard agents H/HD and HT can occur due to accidental release from a military storage facility. Higher levels may cause death. call the ATSDR Information Center at 1-888-422-8737. Destruction of U. They do not dissolve much in water. cause blisters.585 National Priorities List sites identified by the Environmental Protection Agency (EPA). ‘ Sulfur mustards will be broken down in water quickly. How might I be exposed to sulfur mustard agents H/HD and HT? ‘ The general population will not be exposed to sulfur mustard agents H/HD and HT unless an accidental release were to occur at military sites where they are stored. how you are exposed. What happens to sulfur mustards agents H/HD and HT when they enter the environment? ‘ Sulfur mustards agents H/HD and HT could enter the environment from an accidental release. and other solvents. and cause respiratory effects such as coughing and bronchitis.S. They are stable at ambient temperatures. the duration. but will be broken down gradually in moist soil. Sulfur mustards are chemical warfare agents that can cause skin burns and U. but dissolve easily in oils. More than a dozen countries have sulfur mustard agents in their chemical arsenals.S. personal traits and habits. How can sulfur mustard agents H/HD and HT affect my health? The primary routes of potential human exposure to sulfur mustards are inhalation and dermal contact. including sulfur mustards.BLISTER AGENTS SULFUR MUSTARD AGENT H/HD CAS #505-60-2 SULFUR MUSTARD AGENT HT CAS #6392-89-8 Division of Toxicology ToxFAQsTM April 2002 This fact sheet answers the most frequently asked health questions (FAQs) about sulfur mustard blister agents H/HD and HT. sulfur mustards will be broken down by substances that are found in the air. What are sulfur mustards agents H/HD and HT? Sulfur mustards H/HD and HT are manufactured compounds. ‘ People who might be exposed to chemical weapons or who work at military sites where these compounds are stored have the potential of being exposed to these chemicals. ‘ Sulfur mustards may remain in dry soil. was mandated by the Chemical Weapons Convention to take place before April 2007. fats. They are colorless when pure. and whether other chemicals are present. Public Health Service Agency for Toxic Substances and Disease Registry . For more information. The nearly pure substance is called HD. It is important you understand this information because this substance may harm you. ‘ Sulfur mustard agents H/HD and HT do not accumulate in the food chain. HT is a mixture of 60% HD and 40% of another substance called agent T.

Studies in humans indicate that long-term exposure to sulfur mustards may lead to cancer of the upper respiratory airways. Phone: 1-888-422-8737. or in tropical climates. ToxFAQsTM Internet address is http://www. Their specialists can recognize. If you are exposed to large amounts of sulfur mustards. and treat illnesses resulting from exposure to hazardous substances.003 milligrams of H/HD or HT per cubic meter of air (0. bronchitis. ATSDR can tell you where to find occupational and environmental health clinics. humid days. Atlanta. because of the smaller diameter of their airways. A breakdown product of sulfur mustards can be measured in urine. Sulfur mustards burn your skin and cause blisters within a few days of exposure.Page 2 BLISTER AGENTS SULFUR MUSTARD AGENT H/HD CAS #505-60-2 SULFUR MUSTARD AGENT HT CAS #6392-89-8 ToxFAQsTM Internet address is http://www.html blisters and damage to the respiratory airways. and long-term respiratory disease.gov/toxfaq. Sulfur mustards make your eyes burn.S. Is there a medical test to show whether I’ve been exposed to sulfur mustard agents H/HD and HT? There is no effective medical test to determine if you have been exposed to sulfur mustards. contact the Agency for Toxic Substances and Disease Registry. Department of Health and Human Services) of 0.003 mg/m3) has been established as a time-weighted average (TWA) for the workplace.atsdr. Mailstop E-29. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. If you breath sulfur mustards. it can cause coughing.cdc. evaluate.html . Children exposed to sulfur mustard agents H/HD or HT are likely to experience the same toxic effects experienced by exposed adults. In general. GA 30333. FAX: 404-498-0093. 1600 Clifton Road NE.cdc. Has the federal government made recommendations to protect human health? An Airborne Exposure Limit (as recommended by the Surgeon General’s Working Group. The International Agency for Research on Cancer (IARC) has classified agent H/HD as carcinogenic to humans. Division of Toxicology. you can eventually die from it. We do not know if these substances can cause birth defects or other developmental effects in humans. and cause you to blink a lot.atsdr. Sulfur mustards did not cause birth defects in rats that breathed it. Exposure is particularly harmful around sweaty parts of the body. We do not know if sulfur mustards can affect people’s ability to reproduce. but this chemical can also be found in people who have not been exposed to sulfur mustards. How likely are sulfur mustard agents H/HD and HT to cause cancer? The Department of Heath and Human Services (DHHS) has determined that blister agent H/HD is a known human carcinogen.gov/toxfaq. children may be more vulnerable to corrosive agents than adults Where can I get more information? For more information. It is also more harmful to the skin on hot. How can sulfur mustard agents H/HD and HT affect children? There are no studies of children exposed to sulfur mustard agents H/HD or HT. Sulfur mustards did not affect reproduction in rats that breathed it. U. your eyelids swell. Federal Recycling Program Printed on Recycled Paper . How can families reduce the risk of exposure to sulfur mustard agents H/HD and HT? It is unlikely that the general population will be exposed to sulfur mustard agents H/HD or HT.

This fact sheet is one in a series of summaries about hazardous substances and their health effects. How might I be exposed to boron? G In air. G Boron is also released from industries that use it. Reproductive effects. salts of borates. G Eating foods containing high levels. were seen in men exposed to boron over the long-term. Some pesticides used for cockroach control and some wood preservatives also contain borates. call the ATSDR Information Center at 1-888-422-8737. such as cosmetics and laundry products. throat. G Working in borax mining and refining plants and at sites where boric acid is manufactured. and eyes. What is boron? (Pronounced bôr“¼n”) Boron is a compound that occurs in nature. and What happens to boron when it enters the environment? G Boron is released to the environment from natural sources such as oceans. Public Health Service Agency for Toxic Substances and Disease Registry . Breathing moderate levels of boron irritates the nose. throat. or soil. liver. the duration. kidney. and whether other chemicals are present. cosmetics. and food at low levels. The effects of exposure to any hazardous substance depend on the dose. Breathing moderate levels of boron can result in irritation of the nose. Most of the studies are on short-term exposures. and boron oxide. and eyes. how you are exposed. and geothermal steam.BORON CAS # 7440-42-8 Agency for Toxic Substances and Disease Registry ToxFAQs September 1995 This fact sheet answers the most frequently asked health questions (FAQs) about boron. personal traits and habits. water. They are also used in fire retardants. and for high-energy fuel. This information is important because this substance may harm you. This chemical has been found in at least 142 of 1. G No information is available on how long boron remains in air. Borates are used mostly to produce glass. U.416 National Priorities List sites identified by the Environmental Protection Agency. G Drinking water that contains it from areas where boron is found naturally at high levels in the earth. How can boron affect my health? There is little information on the health effects of longterm exposure to boron. G Using consumer products that contain it. It is often found combined with other substances to form compounds called borates. leather tanning industries. such as low sperm count. DEPARTMENT OF HEALTH AND HUMAN SERVICES. photographic materials. G Boron accumulates in plants and is found in foods. SUMMARY: Exposure to boron occurs in the workplace or from using certain consumer products. Common borate compounds include boric acid. water. mainly fruits and vegetables. soaps and cleaners. Animal studies have shown effects on the lungs from breathing high levels of boron. For more information. intestines. G Boron does not appear to accumulate in fish or other organisms in water. Several companies in the United States produce most of the world's borates by processing boron compounds.S. volcanoes. Ingesting large amounts of boron over short periods of time can harm the stomach.

References Has the federal government made recommendations to protect human health? The EPA allows no more than 30 parts of boron per million parts of cottonseed oil (30 ppm) and 8 ppm of boron in or on citrus fruits. Birth defects were also seen in the offspring of female animals exposed during pregnancy.html ATSDR can tell you where to find occupational and environmental health clinics. Is there a medical test to show whether I’ve been exposed to boron? Tests are available to measure boron levels in blood and urine. The National Institute for Occupational Safety and Health (NIOSH) currently recommends an occupational exposure limit of 10 mg/m3 for boron oxide dust. The Occupational Safety and Health Administration (OSHA) has set an occupational exposure limit of 15 milligrams per cubic meter (15 mg/m3) for boron oxide dust in workplace air for an 8-hour workday. Public Health Service. Short-term: Lasting 14 days or less. Department of Health and Human Services. NIOSH also recommends that 25 ppm boron trifluoride be considered immediately dangerous to life and health. These tests must be done shortly after exposure. The EPA requires that discharges or spills into the environment of 100 pounds of more of boron trichloride and boron trifluoride be reported. Federal Recycling Program Printed on Recycled Paper .Page 2 BORON CAS # 7440-42-8 ToxFAQs Internet address via WWW is http://www. Their specialists can recognize. These tests are not usually performed in doctors' offices because special equipment is needed to conduct them.S.cdc. ppm: Parts per million. Glossary Carcinogenicity: Ability to cause cancer. ToxFAQs Internet address via WWW is http://www. How likely is boron to cause cancer? The Department of Health and Human Services. Agency for Toxic Substances and Disease Registry (ATSDR). evaluate. Where can I get more information? For more information. and the Environmental Protection Agency (EPA) have not classified boron as to its human carcinogenicity. Long-term: Lasting one year or longer. Animal studies of ingestion of boron found effects on the testes in male animals. Atlanta.html brain. Mailstop E-29. One animal study found no evidence of cancer after lifetime exposure to boric acid in food. GA: U. We don't know what the effects are in people from skin contact with boron. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. Division of Toxicology. The Food and Drug Administration (FDA) allows no more than 310 ppm of boron as a food additive. FAX: 404-498-0093. Phone: 1-888-422-8737. Ingesting: Taking food or drink into your body. 40-hour workweek.cdc.atsdr. contact the Agency for Toxic Substances and Disease Registry. and treat illnesses resulting from exposure to hazardous substances. the International Agency for Research on Cancer. Pesticides: Chemicals used to kill pests. because most excess boron leaves the body through the urine within a few days of exposure. This is the exposure level of a chemical that is likely to cause permanent health problems or death. It is not known whether boron levels measured in the body can be used to predict whether health problems will occur. 1600 Clifton Road NE. Atlanta. No human studies are available. GA 30333.atsdr. Animal studies have found skin irritation when boron was applied directly to the skin.gov/toxfaq.gov/toxfaq. Toxicological profile for boron. Milligram (mg): One thousandth of a gram. 1992.

How might I be exposed to bromodichloromethane? G The most likely way people are exposed to bromodichloromethane is by drinking chlorinated water. most bromodichloromethane is formed as a by-product when chlorine is added to drinking water to kill bacteria. However. What is bromodichloromethane? (Pronounced br½“m½ dº-klôr“½ mµth“³n”) Bromodichloromethane is a colorless. Only small quantities of bromodichloromethane are produced in the United States. nonflammable liquid.518 National Priorities List sites identified by the Environmental Protection Agency (EPA). most will evaporate to the air but some of it will be broken down by bacteria. G Bromodichloromethane does not build up in the food chain. it will evaporate to the air and/or be broken down slowly by bacteria. G People who live near a waste site containing bromodichloromethane could be exposed by drinking contaminated groundwater or breathing vapors released to the air. The effects of exposure to any hazardous substance depend on the dose. how you are exposed. G You may breathe vapors released from chlorinated water in a swimming pool or in the home (cooking.). The small quantities that are produced are used in laboratories or to make other chemicals. What happens to bromodichloromethane when it enters the environment? G Bromodichloromethane released to air is slowly broken down by reactions with other chemicals and sunlight or it can be removed by rain. G Some bromodichloromethane may filter into the groundwater. For more information. G Some bromodichloromethane may enter your body directly through your skin when bathing or swimming. Public Health Service Agency for Toxic Substances and Disease Registry . G When released to soil. bathing. G In water. Bromodichloromethane has been found at 5 of the 1. This fact sheet is one in a series of summaries about hazardous substances and their health effects. the duration. G People who work at or live near a laboratory or factory that makes or uses this chemical could be exposed by breathing bromodichloromethane in the air. washing dishes. It’s important you understand this information because this substance may harm you. etc. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Bromodichloromethane is not known to cause adverse health effects in people.S. Small amounts are formed naturally by algae in the oceans. call the ATSDR Information Center at 1-888-422-8737. but animal studies show that high concentrations can damage the liver and kidneys and affect the brain. Some of it will dissolve in water. and whether other chemicals are present. but it readily evaporates into air.BROMODICHLOROMETHANE CAS # 75-27-4 Agency for Toxic Substances and Disease Registry ToxFAQs July 1999 This fact sheet answers the most frequently asked health questions (FAQs) about bromodichloromethane. HIGHLIGHTS: Most bromodichloromethane is formed as a by-product when chlorine is added to water-supply systems. personal traits and habits. U.

ppm: Parts per million. Longer exposure to lower doses causes damage to the liver and kidneys. Glossary Carcinogen: A substance that can cause cancer. urine.000 pounds of bromodichloromethane must be reported to the EPA. The effects of high doses on the central nervous system include sleepiness and incoordination. CAS: Chemical Abstracts Service. ToxFAQs Internet address via WWW is http://www. National Priorities List: A list of the nation’s worst hazardous waste sites. Atlanta.S. contact the Agency for Toxic Substances and Disease Registry.1 parts per million (ppm) for the combination of bromodichloromethane and a group of similar compounds (called trihalomethanes) that occur in chlorinated water.gov/toxfaq. Atlanta.Page 2 BROMODICHLOROMETHANE CAS # 75-27-4 ToxFAQs Internet address via WWW is http://www. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Federal Recycling Program Printed on Recycled Paper . and intestinal cancer in rats and mice. Their specialists can recognize.cdc. The federal recommendations have been updated as of July 1999. Laws today protect the welfare of research animals and scientists must follow strict guidelines. evaluate.19 ppm to prevent possible health effects from drinking water or eating fish contaminated with this group of chemicals. Toxicological profile for bromodichloromethane. Has the federal government made recommendations to protect human health? The EPA has set a Maximum Contaminant Level (MCL) of 0. There is some evidence from animal studies that bromodichloromethane may cause birth defects at doses high enough to make the mother sick. Animal studies indicate that the liver. Department of Health and Human Services. GA 30333. but not enough information is available to use such tests to predict if any health effects might occur.html How can bromodichloromethane affect my health? No studies are available regarding health effects in people exposed to bromodichloromethane. Any release to the environment greater than 5. GA: U.html ATSDR can tell you where to find occupational and environmental health clinics. Division of Toxicology. kidney.atsdr. 1989. 1600 Clifton Road NE. Phone: 1-888-422-8737. Where can I get more information? For more information. How likely is bromodichloromethane to cause cancer? There is evidence that eating or drinking bromodichloromethane causes liver. The Department of Health and Human Services (DHHS) has determined that bromodichloromethane is reasonably anticipated to be a human carcinogen. It is not known if lower doses would cause birth defects. Public Health Service. FAX: 404-498-0093. Is there a medical test to show whether I’ve been exposed to bromodichloromethane? Methods are available to measure low levels of bromodichloromethane in human blood. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. and fat. Mailstop E-29.cdc. these tests are not usually done in the doctor's office. kidney. and treat illnesses resulting from exposure to hazardous substances. and central nervous system are affected by exposure to bromodichloromethane. Evaporate: To change into a vapor or a gas. Because special equipment is needed. breath.gov/toxfaq. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR).atsdr. The EPA recommends that levels of halomethanes in lakes and streams should be limited to 0.

or to make other chemicals. personal traits and habits. What happens to bromoform and chlorodibromomethane when they enter the environment? G When released to air. For more information.BROMOFORM and CHLORODIBROMOMETHANE CAS # 75-25-2 and 124-48-1 Agency for Toxic Substances and Disease Registry ToxFAQs July 1999 This fact sheet answers the most frequently asked health questions (FAQs) about bromoform and chlorodibromomethane. G Bromoform and chlorodibromomethane do not build up in the food chain. call the ATSDR Information Center at 1-888-422-8737. HIGHLIGHTS: Small amounts of bromoform and chlorodibromomethane are naturally produced by ocean plant life. How might I be exposed to bromoform and chlorodibromomethane? G The most likely way people are exposed to bromoform and chlorodibromomethane is by drinking chlorinated water. . It’s important you understand this information because this substance may harm you. This fact sheet is one in a series of summaries about hazardous substances and their health effects. how you are exposed. these chemicals will evaporate to the air and/or be broken down slowly by bacteria. and some may filter into the groundwater. Only small quantities of bromoform and chlorodibromomethane currently are produced in the United States. G You may breathe vapors released from chlorinated water in a swimming pool or in the home (cooking. some will be broken down by bacteria. G Exposure could occur by breathing bromoform and chlorodibromomethane in the air in or near a laboratory or factory that makes or uses this chemical. Small amounts are formed naturally by plants in the oceans. G People that live near a waste site containing bromoform or chlorodibromomethane could be exposed by drinking contaminated groundwater or breathing vapors released to the air. G When released to soil. What are bromoform and chlorodibromomethane? (Pronounced br½”m½ fôrm and klôr“½ dº br½”m½ mµth“³n”) Bromoform and chlorodibromomethane are colorless. etc. G Some bromoform and chlorodibromomethane may enter your body directly through your skin while bathing or swimming. but now they are used mainly as laboratory reagents. bathing. They are also formed as by-products when chlorine is added to water-supply systems. bromoform and chlorodibromomethane are slowly broken down by reactions with other chemicals and sunlight or can be removed by rain. The effects of exposure to any hazardous substance depend on the dose. Bromoform and chlorodibromomethane have been found at 14 of the 1. High levels of bromoform and chlorodibromomethane can damage the liver and kidneys and affect the brain. and whether other chemicals are present.177 National Priorities List sites identified by the Environmental Protection Agency (EPA). These chemicals were used in the past as solvents and flame retardants. They are somewhat soluble in water and readily evaporate into air.). nonflammable liquids with a sweet odor. washing dishes. the duration. G In water. however. most will evaporate to the air. Most of the bromoform and chlorodibromomethane that enters the environment is formed as by-products when chlorine is added to drinking water to kill bacteria. this is not likely for most people.

GA 30333. and treat illnesses resulting from exposure to hazardous substances. Several recorded cases of overdose indicate that high doses affect the central nervous system causing unconsciousness. We do not know if bromoform and chlorodibromomethane cause birth defects or infertility. and tremors. Any release to the environment greater than 100 pounds of bromoform or chlorodibromomethane must be reported to the EPA. Toxicological profile for bromoform and chlorodibromomethane. Atlanta. Laws today protect the welfare of research animals and scientists must follow strict guidelines. OSHA has set a workplace air concentration limit of 0. How likely are bromoform and chlorodibromomethane to cause cancer? There is evidence that ingestion of bromoform causes intestinal cancer in rats and ingestion of chlorodibromomethane causes liver cancer in mice.html How can bromoform and chlorodibromomethane affect my health? No studies are available about health effects in people exposed to chlorodibromomethane. breath.atsdr. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. The EPA recommends that levels of halomethanes in lakes and streams should be limited to 0. Mailstop E-29.Page 2 BROMOFORM AND CHLORODIBROMOMETHANE CAS # 75-25-2 AND 124-48-1 ToxFAQs Internet address via WWW is http://www.gov/toxfaq. constricted pupils. predict if any health effects might occur. and death. loss of reflexes. Is there a medical test to show whether I’ve been exposed to bromoform or chlorodibromomethane? Methods are available to measure low levels of bromoform and chlorodibromomethane in human blood. shallow breathing.5 ppm for bromoform over an 8-hour workday. these tests are not usually done in the doctors’ office. Bromoform was used as a sedative to treat children with whooping cough during the early 1900s. 1989. Atlanta. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. evaluate. Phone: 1-888-422-8737. and respiratory failure. 1600 Clifton Road NE. increased liver weight.atsdr.html ATSDR can tell you where to find occupational and environmental health clinics. Division of Toxicology. and fat. contact the Agency for Toxic Substances and Disease Registry. incoordination. the Occupational Safety and Health Administration (OSHA) has not set limits of exposure for workplace air.cdc. Animal studies indicate that the liver. and central nervous system are affected by exposure to bromoform and chlorodibromomethane.cdc. and liver and kidney damage. It is not known if they cause cancer in people. The federal recommendations have been updated as of July 1999. erratic heart rate. Longer-term exposure to lower doses causes drowsiness. kidney. FAX: 404-498-0093. The effects on the central nervous system appear quickly after exposure to high doses and include labored breathing. Federal Recycling Program Printed on Recycled Paper .S. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). but not enough information is available to use such tests to Where can I get more information? For more information. Because chlorodibromomethane has such a limited use in industry.1 parts per million (0. Their specialists can recognize. Department of Health and Human Services. Because special equipment is needed. GA: U. Milder cases resulted in rapid breathing. 40-hour workweek.19 ppm to prevent possible human health effects from drinking water or eating fish contaminated with this group of chemicals. Has the federal government made recommendations to protect human health? The EPA has set a Maximum Contaminant Level (MCL) of 0. ToxFAQs Internet address via WWW is http://www. Public Health Service. The International Agency for Research on Cancer (IARC) has determined that the human carcinogenicity of bromoform and chlorodibromomethane is not classifiable.1 ppm) for the combination of bromoform and chlorodibromomethane and a group of similar compounds (called trihalomethanes) that occur in chlorinated water.gov/toxfaq. sedation.

If you breathe large amounts. Exposure to high levels can affect your lungs and cause breathing difficulty.600 to 60. G Breathing air where it has been used as a pesticide. nerve damage. or food. call the ATSDR Information Center at 1-888-422-8737. It can also damage your kidneys and nervous system. G Usually not found in surface water. Exposure levels leading to death vary from 1. This information is important because this substance may harm you. For more information. It could cause muscle tremors. fluid may build up in your lungs and it may be hard to breathe. How might I be exposed to bromomethane? G Breathing very. It is usually not found in surface water.S.60060. how you are exposed. kidney damage. or food. personal traits and habits. This fact sheet is one in a series of summaries about hazardous substances and their health effects.000 ppm).416 National Priorities List sites identified by the Environmental Protection Agency.BROMOMETHANE CAS # 74-83-9 Agency for Toxic Substances and Disease Registry ToxFAQs September 1995 This fact sheet answers the most frequently asked health questions (FAQs) about bromomethane. G It breaks down slowly in air over several years. What is bromomethane? (Pronounced br½“m½”mµth“³n”) Bromomethane is a manufactured chemical. and wool. It also occurs naturally in small amounts in the ocean where it is formed. and even death. and can even cause death. It is also used to make other chemicals or as a solvent to get oil out of nuts. SUMMARY: Exposure to bromomethane occurs mostly from breathing contaminated air in the workplace or at waste sites. Public Health Service Agency for Toxic Substances and Disease Registry . the duration. seeds. depending on the length of the exposure. U. nonflammable gas with no distinct smell. Bromomethane is used to kill a variety of pests including rats. Other names for bromomethane are methyl bromide. mono-bromomethane. DEPARTMENT OF HEALTH AND HUMAN SERVICES. These What happens to bromomethane when it enters the environment? G It moves very quickly into the air when released to the environment or when present in soil or water. G It does not build up in plants or animals. soil. How can bromomethane affect my health? If you breathe bromomethane you may develop a headache and begin to feel weak and nauseated several hours later. Trade names include Embafume and Terabol.000 parts of bromomethane in 1 million parts of air (1. and whether other chemicals are present. soil. G It breaks down quickly in soil over a few days. G It breaks down in groundwater over a period of several months. and fungi. and methyl fume. It is a colorless. probably by algae and kelp. G Breathing workplace air where it is made or used. This chemical has been found in at least 74 of 1. G Small amounts can move from the soil into the groundwater. insects. The effects of exposure to any hazardous substance depend on the dose. G Breathing contaminated air with high levels near waste sites. very low background levels in the environment. seizures.

Swallowing bromomethane may cause stomach irritation. We do not know if it affects our ability to reproduce. GA 30333. Atlanta. Glossary Carcinogenicity: Ability to cause cancer. kidney. it can cause itching.cdc. Division of Toxicology. This test is only useful if done within 1-2 days following exposure and cannot predict if any health effects will occur. CAS: Chemical Abstracts Service. much higher than those to which you would normally be exposed to. These effects are caused by levels that are higher than levels you might normally encounter. except at high exposure levels. Their specialists can recognize. These tests are not routinely performed at doctors' offices. It can be measured in your blood or in the air you breathe out. The respiratory. Animal studies do not provide conclusive evidence. Public Health Service. but the level would be higher if you had been exposed to bromomethane. FAX: 404-498-0093. and recommends that exposure be reduced as low as possible. Where can I get more information? For more information. If bromomethane gets on your skin.atsdr. ToxFAQs Internet address via WWW is http://www. No cases of severe effects on the nervous system from long-term exposure to low levels have been noted in people. Bromide is normally present in your blood. How likely is bromomethane to cause cancer? The Environmental Protection Agency (EPA) has determined that bromomethane is not classifiable as to its human carcinogenicity. Is there a medical test to show whether I’ve been exposed to bromomethane? Several tests are available to tell if you have been exposed to bromomethane. This test is not very useful because most bromomethane doesn't stay in your body long. 1600 Clifton Road NE.gov/toxfaq. 1992. Federal Recycling Program Printed on Recycled Paper . Mailstop E-29.html levels are much.html ATSDR can tell you where to find occupational and environmental health clinics. Has the federal government made recommendations to protect human health? EPA requires that spills or accidental releases into the environment of 1. The Food and Drug Administration (FDA) set a limit of 125-400 parts of bromide per million parts of food (ppm) for food treated with bromomethane.000 pounds or more of bromomethane be reported.gov/toxfaq. Department of Health and Human Services. GA: U. contact the Agency for Toxic Substances and Disease Registry. and neurologic effects are of the greatest concern to people. evaluate. but your doctor can take blood or urine samples and send them to a testing laboratory. There are no studies available to indicate that bromomethane is carcinogenic to people.atsdr. and blisters. Studies in animals suggest that bromomethane does not cause birth defects and does not interfere with reproduction.cdc.Page 2 BROMOMETHANE CAS # 74-83-9 ToxFAQs Internet address via WWW is http://www. The Occupational Safety and Health Agency (OSHA) limits the average level of bromomethane in workplace air to 20 ppm for an 8-hour workday over a 40-hour week. Phone: 1-888-422-8737. Another test measures the main breakdown product of bromomethane (bromide) in your blood or urine. Toxicological profile for bromomethane. but studies in rabbits and monkeys have shown moderate to severe injury. redness. References Agency for Toxic Substances and Disease Registry (ATSDR). Atlanta.S. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. and treat illnesses resulting from exposure to hazardous substances. Long-term: Lasting one year or longer.

G It evaporates very quickly from water and soil. G Skin contact with gasoline. G Ingesting foods contained in plastic or rubber food containers.3-by›”t…-dº“¶n”) 1. transport. It is the 36th highest volume chemical produced in the United States. but adequate tests are not available to measure the amounts. Synthetic rubber is widely used for tires on cars and trucks. U. SUMMARY: Exposure to 1. but levels are low. in sunny weather. or disposal. use.3-butadiene when it enters the environment? G It quickly evaporates to the air as a gas from leaks during production.3-butadiene comes from studies where the exposure was from breathing contaminated air. G Breathing contaminated air from car and truck exhaust. G Breathing contaminated workplace air where it is manufactured or used. G 1.416 National Priorities List sites identified by the Environmental Protection Agency. What is 1.3-butadiene is used to make synthetic rubber. plastic. This information is important because this substance may harm you. how you are exposed. it is not expected to be found in water or soil. It is a colorless gas with a mild gasolinelike odor.S.3-butadiene? G Breathing urban and suburban air. 1. or wood fires. DEPARTMENT OF HEALTH AND HUMAN SERVICES. but these levels are generally very low except in polluted cities or near chemical. Effects on the nervous system and irritations of the eyes. How can 1. the duration. nose. waste incineration.3-Butadiene is a chemical made from the processing of petroleum.1. it takes a few days for about half of it to break down in the air. This fact sheet is one in a series of summaries about hazardous substances and their health effects.3-Butadiene may be broken down by microorganisms in the soil. G When not sunny. half of it breaks down in about 2 hours. G Since it evaporates so easily.3-butadiene? (Pronounced 1. Public Health Service Agency for Toxic Substances and Disease Registry . G Drinking contaminated water near production or waste sites. call the ATSDR Information Center at 1-888-422-8737. About 75% of the manufactured 1. This chemical has been found in at least 7 of 1. Small amounts are found in gasoline. personal traits and habits. and rubber facilities that use it. G Breathing cigarette smoke. but levels are generally very low or not present at all. The effects of exposure to any hazardous substance depend on the dose. How might I be exposed to 1.3-BUTADIENE CAS # 106-99-0 Agency for Toxic Substances and Disease Registry ToxFAQs September 1995 This fact sheet answers the most frequently asked health questions (FAQs) about 1. storage. G It breaks down quickly in air by sunlight. G It is not expected to accumulate in fish. and whether other chemicals are present. What happens to 1. For more information. and throat have been seen in people who breathed contaminated air.3-Butadiene is also used to make plastics including acrylics.3-butadiene occurs mainly from breathing contaminated air.3-butadiene affect my health? Most of the information on the health effects of 1.3-butadiene.

3-butadiene to cause cancer? The Department of Health and Human Services has determined that 1. There is no information on the effects of eating or drinking 1.atsdr. Skin contact with liquid 1. contact the Agency for Toxic Substances and Disease Registry. How likely is 1. Toxicological profile for 1. Atlanta. Mailstop E-29. fatigue. FAX: 404-498-0093. References Agency for Toxic Substances and Disease Registry (ATSDR).3butadiene. Animal studies show that breathing 1. We also do not know what levels in the air will cause these effects in people when breathed over many years. decreased blood pressure and pulse rate. Has the federal government made recommendations to protect human health? The Environmental Protection Agency (EPA) requires that discharges or spills into the environment of 1 pound or more of 1. blurred vision.3-butadiene? There is currently no reliable medical test to determine whether you have been exposed to 1. and damaged lungs. Other effects seen in animals that breathed low levels of 1. headache. scientists are working on methods to measure it in the blood.gov/toxfaq.3-butadiene for one year include kidney and liver disease. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.cdc. 1600 Clifton Road NE.html Breathing very high levels of 1. Phone: 1-888-422-8737. Where can I get more information? For more information. Glossary Carcinogen: A substance that can cause cancer.3-butadiene may reasonably be anticipated to be a carcinogen.3-butadiene during pregnancy can increase the number of birth defects. and throat.cdc.3-butadiene can cause irritation and frostbite.html ATSDR can tell you where to find occupational and environmental health clinics. The National Institute for Occupational Safety and Health (NIOSH) recommends that 1. Is there a medical test to show whether I’ve been exposed to 1.3-butadiene be reported. Department of Health and Human Services.gov/toxfaq.3-butadiene. Their specialists can recognize. ToxFAQs Internet address via WWW is http://www. Atlanta. There are no recorded cases of accidental exposures at high levels that caused death in humans. Studies on workers who had longer exposures with lower levels have shown an increase in heart and lung damage. However.3-butadiene per million parts of air (1. but this could occur.atsdr.000 parts of 1. Ingesting: Taking food or drink into your body. We don’t know for sure which chemical (or chemicals) caused the effects.3-butadiene. nausea.S. nose. Federal Recycling Program Printed on Recycled Paper . Breathing lower levels may cause irritation of the eyes. Public Health Service. Division of Toxicology.3-BUTADIENE CAS # 106-99-0 ToxFAQs Internet address via WWW is http://www. GA: U.3-butadiene.Page 2 1. and treat illnesses resulting from exposure to hazardous substances. and unconsciousness. Tumor: An abnormal mass of tissue. The Occupational Safety and Health Administration (OSHA) has set an occupational exposure limit of 1. Some of the animals died. This is based on animal studies that found increases in a variety of tumor types from exposure to 1.3-butadiene for a short time can cause central nervous system damage.000 ppm). but these workers were also exposed to other chemicals. Studies on workers are inconclusive because the workers were exposed to other chemicals in addition to 1.3-butadiene be kept to the lowest feasible concentration because of its potential to cause cancer.3-butadiene. evaluate. 1992. GA 30333. ppm: Parts per million.

This fact sheet is one in a series of summaries about hazardous substances and their health effects. G Breathing cigarette smoke. For more information. G It dissolves in water and is broken down more slowly to a simpler chemical form in about 2 weeks.S. It is also known as methyl ethyl ketone (MEK).416 National Priorities List sites identified by the Environmental Protection Agency. How might I be exposed to 2-butanone? G Breathing contaminated air from the production or use of paints. This information is important because this substance may harm you. and whether other chemicals are present. throat. G Breathing contaminated air near hazardous waste sites. use and transport. G It is not expected to concentrate in fish or increase in the tissues of animals further up the food chain. 2-Butanone occurs as a natural product. G It does not stick to soil and will travel through the soil to the groundwater. skin. Public Health Service Agency for Toxic Substances and Disease Registry . SUMMARY: Exposure to 2-butanone occurs in the workplace or from using consumer products containing it. It is a colorless liquid with a sharp. G Some of the 2-butanone in soil or water will evaporate into the air. It is made by some trees and found in some fruits and vegetables in small amounts. It is also released to the air from car and truck exhausts. call the ATSDR Information Center at 1-888-422-8737. No one has died from breathing 2-butanone alone. glues. G In air. How can 2-butanone affect my health? The known health effects to people from exposure to 2-butanone are irritation of the nose. 2-Butanone is produced in large quantities. It is also used in glues and as a cleaning agent. and throat were seen in people who breathed 2-butanone. it can increase the amount of damage that occurs. G Skin contact with the liquid during production or use. how you are exposed. G Sniffing glues. one-half of it will break down from sunlight in 1 day or less. and from hazardous waste sites. sweet odor. If 2-butanone is breathed along with other chemicals that damage health.2-BUTANONE CAS # 78-93-3 Agency for Toxic Substances and Disease Registry ToxFAQs September 1995 This fact sheet answers the most frequently asked health questions (FAQs) about 2-butanone. The effects of exposure to any hazardous substance depend on the dose. Mild irritations of the eyes. What happens to 2-butanone when it enters the environment? G 2-Butanone enters the air during production. G It does not deposit in the bottom of rivers or lakes. or cleaning agents containing it. U. and eyes. What is 2-butanone? (Pronounced 2-by›”t…-n½n) 2-Butanone is a manufactured chemical but it is also present in the environment from natural sources. G Drinking contaminated water from wells near manufacturing or hazardous waste sites. DEPARTMENT OF HEALTH AND HUMAN SERVICES. nose. coatings. the duration. personal traits and habits. Nearly half of its use is in paints and other coatings because it will quickly evaporate into the air and it dissolves many substances. This chemical has been found in at least 472 of 1.

Toxicological profile for 2-butanone. and urine. Atlanta.cdc. evaluate. contact the Agency for Toxic Substances and Disease Registry. loss of consciousness. but your References Agency for Toxic Substances and Disease Registry (ATSDR). Division of Toxicology. 1600 Clifton Road NE. Mailstop E-29. ToxFAQs Internet address via WWW is http://www. 1992.gov/toxfaq. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. GA 30333. There was no damage to the ability to reproduce. The Occupational Safety and Health Administration (OSHA) set an occupational exposure limit of 200 parts of 2-butanone per million parts of workplace air (200 ppm) for an 8-hour workday. GA: U.gov/toxfaq. Department of Health and Human Services. Short time: Lasting 14 days or less.S. The American Conference of Governmental Industrial Hygienists (ACGIH) and the National Institute for Occupational Safety and Health (NIOSH) have established the same guidelines as OSHA for the workplace. doctor can take blood or urine samples and send them to a testing laboratory. Where can I get more information? For more information. Public Health Service. These tests are not usually performed at your doctor's office. There are no long-term studies with animals either breathing or drinking 2-butanone. breath. Glossary Carcinogenicity: Ability to cause cancer. rats had nervous system effects including drooping eyelids and uncoordinated muscle movements. ppm: Parts per million. Two studies of workers exposed to 2-butanone and other chemicals did not find an increase in cancer. these effects included birth defects. FAX: 404-498-0093. 40-hour workweek.html Serious health effects in animals have been seen only at very high levels. Mild kidney damage was seen in animals that drank water with lower levels of 2-butanone for a short time. These tests are useful only to measure recent exposures because 2-butanone and its breakdown products leave the body rapidly. Is there a medical test to show whether I’ve been exposed to 2-butanone? Tests are available to measure 2-butanone or its breakdown products in blood. and treat illnesses resulting from exposure to hazardous substances. No animal studies are available that examine the potential for 2-butanone to cause cancer. Mice who breathed low levels for a short time showed temporary behavioral effects.atsdr. Atlanta. Has the federal government made recommendations to protect human health? The EPA requires that discharges or spills into the environment of 5. Long-term: Lasting one year or longer. How likely is 2-butanone to cause cancer? The Department of Health and Human Services has not classified 2-butanone as to its human carcinogenicity.atsdr. Phone: 1-888-422-8737. and death.Page 2 2-BUTANONE CAS # 78-93-3 ToxFAQs Internet address via WWW is http://www. When breathed. Evaporate: To change into a vapor or a gas. Their specialists can recognize. The International Agency for Research on Cancer and the Environmental Protection Agency (EPA) have also not classified 2-butanone as to its human carcinogenicity.000 pounds of more of 2-butanone be reported. Federal Recycling Program Printed on Recycled Paper .cdc.html ATSDR can tell you where to find occupational and environmental health clinics. When swallowed.

and herbicides. butoxyethyl acetate. Breathing in large amounts of 2-butoxyethanol or 2-butoxyethanol acetate may result in irritation of the nose and eyes. Public Health Service Agency for Toxic Substances and Disease Registry . It has many names including ethylene glycol monobutyl ether. G 2-Butoxyethanol and 2-butoxyethanol acetate do not build up in plants and animals. varnish removers. It is used as a solvent for lacquers. and vomiting. G Breathing air or having skin contact with household cleaners or other liquids that contain these compounds. This fact sheet is one in a series of summaries about hazardous substances and their health effects. 2-Butoxyethanol acetate is a colorless liquid with a fruity odor. What happens to 2-butoxyethanol and 2-butoxyethanol acetate when they enter the environment? G 2-Butoxyethanol and 2-butoxyethanol acetate may be released into the air when they are used as solvents and in household products. butyl glycol acetate. or snow. It is also used in liquid soaps. varnishes. the duration. ice. G In air. U. DEPARTMENT OF HEALTH AND HUMAN SERVICES. ethylene glycol n-butyl ether. ethylene glycol butyl ether acetate. Butyl Cellusolve. enamels. 2-butoxyethanol and 2-butoxyethanol acetate may be removed by rain. For more information. and dry-cleaning compounds.2-BUTOXYETHANOL and 2-BUTOXYETHANOL ACETATE CAS # 112-07-2 and 111-76-2 Agency for Toxic Substances and Disease Registry ToxFAQs August 1999 This fact sheet answers the most frequently asked health questions (FAQs) about 2-butoxyethanol and 2-butoxyethanol acetate. headache. 2-Butoxyethanol has been found in at least 20 of the 1. G 2-Butoxyethanol and 2-butoxyethanol acetate may break down in air into other compounds within a few days. G Drinking contaminated water. and latex paints and as an ingredient in paint thinners and strippers. personal traits and habits. butyl glycol. and butyl Oxitol. and acetic acid 2-butoxyethyl ester. What are 2-butoxyethanol and 2-butoxyethanol acetate? (Pronounced 2-by›“t¼k“s¶ µth“…-nôl” and 2-by›“t¼k“s¶ µth“…-nôl” ²s“¹-t³t”) 2-Butoxyethanol is a clear colorless liquid that smells like ether. How might I be exposed to 2-butoxyethanol and 2-butoxyethanol acetate? G Many people are exposed to small amounts of 2-butoxyethanol and 2-butoxyethanol acetate every day. and whether other chemicals are present. It’s important you understand this information because this substance may harm you. HIGHLIGHTS: Exposure to 2-butoxyethanol and 2-butoxyethanol acetate occurs mainly from breathing air or having skin contact with household products containing them. and epoxy resins. cosmetics. G Both compounds may pass into air from water and soil. ethylene glycol butyl ether. The effects of exposure to any hazardous substance depend on the dose. industrial and household cleaners. how you are exposed. call the ATSDR Information Center at 1-888-422-8737. It is also known as ethylene glycol monobutyl ether acetate. It is used as a solvent in spray lacquers. varnishes.430 National Priorities List sites identified by the Environmental Protection Agency.S. It is also used in some ink and spot remover compounds. enamels.

printing. and treat illnesses resulting from exposure to hazardous substances. Toxicological Profile for 2-butoxyethanol and 2-butoxyethanol acetate. Glossary Carcinogenicity: Ability to cause cancer.gov/toxfaq. Animal studies have shown hemolysis (destruction of red blood cells that results in the release of hemoglobin) from exposure to 2-butoxyethanol and 2-butoxyethanol acetate. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. GA: U. Division of Toxicology. No carcinogenicity studies on 2-butoxyethanol and 2-butoxyethanol acetate are available in people or animals. and blood in the urine. It is not known whether 2-butoxyethanol or 2-butoxyethanol acetate can affect reproduction or cause birth defects in people. acidic blood. low blood pressure. a metallic taste in their mouths. Laws today protect the welfare of research animals and scientists must follow strict guidelines. Certain blood tests can tell if your red blood cells are damaged.html ATSDR can tell you where to find occupational and environmental health clinics. Herbicides: Substances used to stop plant growth. the International Agency for Research on Cancer. CAS: Chemical Abstracts Service. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). How can 2-butoxyethanol and 2-butoxyethanol acetate affect my health? People exposed to high levels of 2-butoxyethanol for several hours reported irritation of the nose and eyes. 1998. 40-hour workweek. Their specialists can recognize. GA 30333. Department of Health and Human Services. High doses of 2-butoxyethanol can also cause reproductive problems and minor birth defects in animals. evaluate. G Living near a hazardous waste site where 2-butoxyethanol and 2-butoxyethanol acetate are disposed of. Federal Recycling Program Printed on Recycled Paper . You can also contact your community or state health or environmental quality department if you have any more questions or concerns. and Environmental Protection Agency have not classified 2-butoxyethanol and 2-butoxyethanol acetate as to their human carcinogenicity.cdc. Where can I get more information? For more information.Page 2 2-BUTOXYETHANOL and 2-BUTOXYETHANOL ACETATE CAS # 111-76-2 and 112-07-2 ToxFAQs Internet address via WWW is http://www. but this effect is not specific to 2-butoxyethanol. and automobile repair shops that use materials containing 2-butoxyethanol and 2-butoxyethanol acetate. How likely are 2-butoxyethanol and 2-butoxyethanol acetate to cause cancer? The Department of Health and Human Services. 1600 Clifton Road NE. Has the federal government made recommendations to protect human health? The Occupational Safety and Health Administration has set an exposure limit of 50 parts of 2-butoxyethanol per million parts of air (50 ppm) for an 8-hour workday.html G Working in occupations such as silk-screening.gov/toxfaq. and vomiting. headache. These tests need to be done within a day after exposure because 2-butoxyethanol and its breakdown products leave your body within 24-48 hours. contact the Agency for Toxic Substances and Disease Registry.atsdr. Atlanta. Solvents: Chemicals that can dissolve other substances. FAX: 404-498-0093. No harmful effects were seen on their lungs or hearts. Atlanta. furniture production and finishing. People who swallowed large amounts of cleaning agents containing 2-butoxyethanol have shown breathing problems.cdc. Phone: 1-888-422-8737. low levels of hemoglobin (the substance in the blood that carries oxygen to organs of the body).S. Mailstop E-29. Is there a medical test to show whether I’ve been exposed to 2-butoxyethanol and 2-butoxyethanol acetate? Breakdown products of 2-butoxyethanol can be measured in your blood and urine to see if you have been recently exposed to the chemical. ToxFAQs Internet address via WWW is http://www. These tests cannot tell how much you have been exposed to or whether health effects will occur.atsdr. Public Health Service. spray-painting operations.

S. HIGHLIGHTS: Exposure to cadmium happens mostly in the workplace where cadmium products are made. G It enters water and soil from waste disposal and spills or leaks at hazardous waste sites. and plastics. G Breathing cadmium in cigarette smoke (doubles the average daily intake). Cadmium damages the lungs. All soils and rocks. how you are exposed. G Breathing contaminated air near the burning of fossil fuels or municipal waste. including batteries. call the ATSDR Information Center at 1-888-422-8737. What happens to cadmium when it enters the environment? G Cadmium enters air from mining. and burning coal and household wastes. DEPARTMENT OF HEALTH AND HUMAN SERVICES. the duration. What is cadmium? (Pronounced k²d“m¶-…m) Cadmium is a natural element in the earth’s crust. or water leads to a buildup of cadmium in the kidneys and possible kidney disease. G Eating foods containing it. U. For more information. G Fish. and kidney meats). industry. contain some cadmium. It’s important you understand this information because this substance may harm you. G Cadmium stays in the body a very long time and can build up from many years of exposure to low levels. lead. and animals take up cadmium from the environment. chlorine (cadmium chloride). but can change forms. Long-term exposure to lower levels of cadmium in air. G It doesn’t break down in the environment. The general population is exposed from breathing cigarette smoke or eating cadmium contaminated foods. metal soldering or welding). including coal and mineral fertilizers. cadmium sulfide). Cadmium does not corrode easily and has many uses.467 National Priorities List sites identified by the Environmental Protection Agency (EPA). Eating food or drinking water with very high levels severely irritates the stomach. This fact sheet is one in a series of summaries about hazardous substances and their health effects. G Cadmium particles in air can travel long distances before falling to the ground or water. G Drinking contaminated water. leading to vomiting and diarrhea. How might I be exposed to cadmium? G Breathing contaminated workplace air (battery manufacturing. food. G It binds strongly to soil particles. pigments. liver. personal traits and habits. G Some cadmium dissolves in water. and copper. This substance has been found in at least 776 of the 1. and may irritate the digestive tract. plants.CADMIUM CAS # 7440-43-9 Agency for Toxic Substances and Disease Registry ToxFAQs June 1999 This fact sheet answers the most frequently asked health questions (FAQs) about cadmium. How can cadmium affect my health? Breathing high levels of cadmium severely damages the lungs and can cause death. low levels in all foods (highest in shellfish. The effects of exposure to any hazardous substance depend on the dose. or sulfur (cadmium sulfate. It is usually found as a mineral combined with other elements such as oxygen (cadmium oxide). metal coatings. can cause kidney disease. Public Health Service Agency for Toxic Substances and Disease Registry . Most cadmium used in the United States is extracted during the production of other metals like zinc. and whether other chemicals are present.

The Occupational Safety and Health Administration (OSHA) limits workplace air to 100 micrograms cadmium per cubic meter (100 µg/m3) as cadmium fumes and 200 µg cadmium/m3 as cadmium dust.html ATSDR can tell you where to find occupational and environmental health clinics.Page 2 CADMIUM CAS # 7740-43-9 ToxFAQs Internet address via WWW is http://www. hair. use all safety precautions to avoid carrying cadmium-containing dust home from work on your clothing. FAX: 404-498-0093. and urine levels show both recent and earlier exposure. 1600 Clifton Road NE. skin.atsdr. liver disease. Cadmium may also affect birth weight and the skeleton in developing animals. Their specialists can recognize.gov/toxfaq. If you work with cadmium. evaluate. and treat illnesses resulting from exposure to hazardous substances. or is high in fat. The babies of animals exposed to high levels of cadmium during pregnancy had changes in behavior and learning ability.S. hair.html Other long-term effects are lung damage and fragile bones. The reliability of tests for cadmium levels in hair or nails is unknown. Cadmium does not readily go from a pregnant woman's body into the developing child. Toxicological profile for cadmium. Has the federal government made recommendations to protect human health? The EPA has set a limit of 5 parts of cadmium per billion parts of drinking water (5 ppb). Division of Toxicology. Atlanta. Atlanta. We don’t know if humans get any of these diseases from eating or drinking cadmium. Is there a medical test to show whether I’ve been exposed to cadmium? Tests are available in some medical laboratories that measure cadmium in blood. EPA doesn't allow cadmium in pesticides. lung and intestinal damage). 1999. contact the Agency for Toxic Substances and Disease Registry. urine. ToxFAQs Internet address via WWW is http://www. or iron. How can families reduce the risk of exposure to cadmium? In the home. GA 30333. Blood levels show recent exposure to cadmium.cdc. Department of Health and Human Services. Phone: 1-888-422-8737.cdc. and nerve or brain damage. protein. Skin contact with cadmium is not known to cause health effects in humans or animals. or tools. A balanced diet can reduce the amount of cadmium taken into the body from food and drink. Where can I get more information? For more information. Mailstop E-29. It can also be found in breast milk. We don't know if cadmium causes birth defects in people.gov/toxfaq.atsdr. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. The Food and Drug Administration (FDA) limits the amount of cadmium in food colors to 15 parts per million (15 ppm). Federal Recycling Program Printed on Recycled Paper . How can cadmium affect children? The health effects in children are expected to be similar to those in adults (kidney. Animal studies also indicate that more cadmium is absorbed into the body if the diet is low in calcium. iron-poor blood. Public Health Service. Animals given cadmium in food or water had high blood pressure. GA: U. and keep nickel-cadmium batteries out of reach of young Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). or nails. but some portion can cross the placenta. children. A few studies show that younger animals absorb more cadmium and are more likely to lose bone and bone strength than adults. How likely is cadmium to cause cancer? The Department of Health and Human Services (DHHS) has determined that cadmium and cadmium compounds may reasonably be anticipated to be carcinogens. store substances that contain cadmium safely.

It also has a strong chlorine odor. personal traits and habits. and whether other chemicals are present. The effects of exposure to any hazardous substance depend on the dose. For more information.CALCIUM HYPOCHLORITE SODIUM HYPOCHLORITE CAS #7681-52-9 Division of Toxicology ToxFAQsTM April 2002 CAS #7778-54-3 This fact sheet answers the most frequently asked health questions (FAQs) about sodium and calcium hypochlorite. skin. Exposure to high levels can result in severe corrosive damage to the eyes. How might I be exposed to sodium and calcium hypochlorite? ‘ You can be exposed to low levels of sodium and calcium hypochlorite if you use disinfectants like household bleach. What happens to sodium and calcium hypochlorite when they enter the environment? ‘ When released to air. Neither compound occur naturally in the environment. ‘ Drinking water from public drinking water supplies where these chemicals were added to kill bacteria. If you ingest a small amount of household bleaches (3-6% U. They are components of commercial bleaches. DEPARTMENT OF HEALTH AND HUMAN SERVICES. call the ATSDR Information Center at 1-888-422-8737. ‘ In water and soil. calcium and hypochlorite ions (an ion How can sodium and calcium hypochlorite affect my health? The toxic effects of sodium and calcium hypochlorite are due primarily to the corrosive properties of hypochlorite. cleaning solutions. Sodium and calcium hypochlorite are used primarily as bleaching agents or disinfectants. is an electrically charged atom or molecule). sodium and calcium hypochlorite separate into sodium. ‘ Sodium and calcium hypochlorite do not accumulate in the food chain.585 National Priorities List sites identified by the Environmental Protection Agency (EPA). Sodium and calcium hypochlorite can cause irritation of the eyes. and disinfectants for drinking water and waste water purification systems and swimming pools. It is important you understand this information because this substance may harm you. ‘ Workers employed in occupations where these compounds are used to bleach paper and textiles may be subject to slightly higher levels of exposure. respiratory and gastrointestinal tract. Sodium hypochlorite solutions are clear. sodium and calcium hypochlorite are broken down by sunlight and compounds commonly found in the air. ‘ You can also be exposed by swimming in pools where these chemicals were added to kill bacteria. Although available. Calcium hypochlorite is a white solid that readily decomposes in water releasing oxygen and chlorine. greenish to yellow liquids with an odor of chlorine. These ions may react with other substances found in the water. the duration.S. Workers in occupations that use these chemicals have the highest risk of being exposed. skin. Sodium and calcium hypochlorite have been found 6 times each in the 1. how you are exposed. Public Health Service Agency for Toxic Substances and Disease Registry . What are sodium and calcium hypochlorite? Sodium hypochlorite is generally used dissolved in water at various concentrations. solid sodium hypochlorite is not commercially used. respiratory and gastrointestinal tissues and can be fatal. HIGHLIGHTS: The general public can be exposed to small amounts of sodium and calcium hypochlorite by using household products that contain these chemicals. This fact sheet is one in a series of summaries about hazardous substances and their health effects.

calcium or chlorine in the blood or urine are not generally useful. perforation. Some of these tests can be performed in a doctor’s office.atsdr. Atlanta. blood and urine analyses and other tests may show whether damage has occurred to the lungs and gastrointestinal tract.html hypochlorite) you may experience gastrointestinal irritation. out of the reach of children. ATSDR can tell you where to find occupational and environmental health clinics. contact the Agency for Toxic Substances and Disease Registry.cdc. esophagus and stomach with bleeding. How can sodium and calcium hypochlorite affect children? Children are probably affected by exposure to sodium and calcium hypochlorite in the same ways as adults. Division of Toxicology. as sodium hypochlorite or calcium hypochlorite. ToxFAQsTM Internet address is http://www. Contact of the eye with mild bleach solutions may cause mild and transitory irritation. and eventually death. FAX: 404-498-0093.036 pounds. If you ingest a more concentrated commercial bleach (10% or higher hypochlorite) or hypochlorite powder you may suffer severe corrosive injuries to the mouth.gov/toxfaq. evaluate. Phone: 1-888-422-8737. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. Their specialists can recognize.0. of chlorine per pound of dry food starch. If a severe exposure has occurred. GA 30333. ‘ Household products containing sodium or calcium hypochlorite should be stored in safe locations. How likely are sodium and calcium hypochlorite to cause cancer? The International Agency for Research on Cancer (IARC) has determined that hypochlorite salts are not classifiable as to their carcinogenicity to humans. If you inhale chlorine gas released from concentrated hypochlorite solutions you may experience nasal irritation.Page 2 SODIUM HYPOCHLORITE CALCIUM HYPOCHLORITE CAS #7681-52-9 CAS #7778-54-3 ToxFAQsTM Internet address is http://www. children may be more vulnerable to corrosive agents than adults because of the smaller diameter of their airways. We do not know whether children differ from adults in their susceptibility to sodium and calcium hypochlorite. and coughing. 1600 Clifton Road NE. In general. How can families reduce the risk of exposure to sodium and calcium hypochlorite? ‘ Most families will not be exposed to high levels of sodium or calcium hypochlorite. and treat illnesses resulting from exposure to hazardous substances. Long-term exposure to low levels of hypochlorite can cause dermal irritation. Mailstop E-29. We do not know if exposure to chlorine can result in reproductive effects. Some testing may require hospital facilities. throat.cdc.atsdr. sore throat. Is there a medical test to show whether I’ve been exposed to sodium and calcium hypochlorite? Specific tests for the presence of sodium. Contact of strong hypochlorite solutions with your skin may cause burning pain.0082 or 0. More concentrated solutions may cause severe eye injuries. inflammation. respectively.gov/toxfaq. We do not know if exposure to sodium and calcium hypochlorite can result in birth defects or other developmental effects. Permanent scars and narrowing of the esophagus may occur in survivors of severe intoxication. and blisters. Federal Recycling Program Printed on Recycled Paper . Where can I get more information? For more information.html . not to exceed 0. Has the federal government made recommendations to protect human health? The Food and Drug Administration (FDA) has set a limit for chlorine.

Public Health Service Agency for Toxic Substances and Disease Registry . water. q Carbon disulfide does not appear to be taken up in significant amounts by the organisms living in water. tiredness. carbon disulfide may be life-threatening because of its effects on the nervous system. People who U.CARBON DISULFIDE CAS # 75-15-0 Agency for Toxic Substances and Disease Registry ToxFAQs September 1997 This fact sheet answers the most frequently asked health questions (FAQs) about carbon disulfide. It easily explodes in air and also catches fire very easily. HIGHLIGHTS: Exposure to carbon disulfide can occur by breathing it in the air and by drinking water or eating foods that contain it. in volcanic eruptions or over marshes.S. personal traits and habits. The effects of exposure to any hazardous substance depend on the dose. drinking water. call the ATSDR Information Center at 1-888-422-8737. like that of rotting radishes. Breathing very high levels can be life threatening because of its effects on the nervous system. small amounts of carbon disulfide are found in gases released to the earth’s surface as. q Most carbon disulfide in the air and surface water is from manufacturing and processing activities. Carbon disulfide has been found in at least 210 of the 1. trouble sleeping. DEPARTMENT OF HEALTH AND HUMAN SERVICES. It’s important you understand this information because this substance may harm you. How can carbon disulfide affect my health? At very high levels. and it also moves through soils fairly quickly. and whether other chemicals are present. Carbon disulfide evaporates at room temperature. For more information. and the vapor is more than twice as heavy as air. Breathing low levels for long periods may result in headaches. q It is found naturally in coastal and ocean waters. In nature. the duration. This fact sheet is one in a series of summaries about hazardous substances and their health effects. and slight changes in the nerves. for example. q People may also be exposed through skin contact with soil. or eating foods that contain it. q Carbon disulfide does not stay dissolved in water very long. Commercial carbon disulfide is made by combining carbon and sulfur at very high temperatures. how you are exposed.430 National Priorities List sites identified by the Environmental Protection Agency (EPA). What happens to carbon disulfide when it enters the environment? q The amount of carbon disulfide released into the air through natural processes is difficult to judge because it is so small. q Carbon disulfide evaporates rapidly when released to the environment. What is carbon disulfide? (Pronounced kär“b…n dº-s¾l“fºd”) Pure carbon disulfide is a colorless liquid with a pleasant odor that is like the smell of chloroform. The impure carbon disulfide that is usually used in most industrial processes is a yellowish liquid with an unpleasant odor. or other substances that contain carbon disulfide. How might I be exposed to carbon disulfide? q The people most often exposed to carbon disulfide are workers in plants that use carbon disulfide in their manufacturing processes. q People may be exposed by breathing air.

cdc. 1600 Clifton Road NE. However.atsdr. the test is not specific for carbon disulfide exposure. Has the federal government made recommendations to protect human health? The EPA requires that spills or accidental releases into the environment of 100 pounds or more of carbon disulfide be reported to the EPA. Dissolve: To disappear gradually. the International Agency for Research on Cancer (IARC). and treat illnesses resulting from exposure to hazardous substances. evaluate. and heart.S. Their specialists can recognize. The Occupational Safety and Health Administration (OSHA) has set a limit of 20 parts of carbon disulfide per million parts of air (20 ppm) for an 8-hour workday for a 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) recommends that workroom air levels of carbon disulfide not exceed 1 ppm for a 10-hour workday. Atlanta. How likely is carbon disulfide to cause cancer? The Department of Health and Human Services (DHHS). contact the Agency for Toxic Substances and Disease Registry. Among workers who breathed lower levels. Glossary Carcinogenicity: Ability of a substance to cause cancer. 40hour workweek. Department of Health and Human Services. CAS: Chemical Abstracts Service. These tests aren’t available at most doctors’ offices. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. but can be done at special laboratories that have the right equipment. After pregnant rats breathed carbon disulfide in the air.gov/toxfaq.atsdr. Where can I get more information? For more information. U. ToxFAQs Internet address via WWW is http://www. Some workers who breathed high levels during working hours for at least 6 months had headaches. and the EPA have not classified carbon disulfide for carcinogenicity.html breathed carbon disulfide near an accident involving a railroad car showed changes in breathing and some chest pains. Division of Toxicology. Mailstop E-29. Phone:1888-422-8737.html ATSDR can tell you where to find occupational and environmental health clinics. Public Health Service. tiredness. some developed very slight changes in their nerves. GA. However. There are no definitive data in humans or animals that indicate a carcinogenic potential for carbon disulfide. FAX: 404-498-0093. A second test based on a specific breakdown substance is more sensitive and specific. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Studies in animals indicate that carbon disulfide can affect the normal functions of the brain. Is there a medical test to show whether I’ve been exposed to carbon disulfide? One chemical test using urine can be done to tell whether the levels of breakdown substances from carbon disulfide are higher than normal. Federal Recycling Program Printed on Recycled Paper . some of the newborn rats died or had birth defects.gov/toxfaq. and trouble sleeping.Page 2 CARBON DISULFIDE CAS # 75-15-0 ToxFAQs Internet address via WWW is http://www. GA 30333. Public Health Service in Atlanta. High concentrations of carbon disulfide have caused skin burns when the chemical accidentally touched people's skin. Laws today protect the welfare of research animals and scientists must follow strict guidelines.cdc. Source of Information This ToxFAQs information is taken from the 1996 Toxicological Profile for Carbon Disulfide produced by the Agency for Toxic Substances and Disease Registry. It also requires special equipment and cannot tell you exactly how much carbon disulfide you were exposed to or predict whether harmful effects will occur. Evaporate: To change into vapor or a gas. these workers may have been exposed to other chemicals besides carbon disulfide. liver.

This is most likely to occur around hazardous waste sites or in the workplace. call the ATSDR Information Center at 1-888-422-8737. or benziform. kidneys. For more information. and whether other chemicals are present. how you are exposed. It was used in the production of refrigeration fluid and propellants for aerosol cans. personal traits and habits. perchloromethane. drinking. tetrachloroethane. This information is important because this substance may harm you. G When it does break down. or breathing it. DEPARTMENT OF HEALTH AND HUMAN SERVICES. G Contact with or eating contaminated soil at waste sites. This chemical has been found in at least 326 of 1. G It is very stable in air (lifetime of 30-100 years). It's a clear liquid with a sweet smell that can be detected at low levels. In people. It's also called carbon chloride. Public Health Service Agency for Toxic Substances and Disease Registry . SUMMARY: Exposure to carbon tetrachloride results mostly from breathing air. G Breathing contaminated air and skin contact with water while showering or cooking with contaminated water. the duration. as a cleaning fluid and degreasing agent. These effects result from either eating. G It can be broken down or transformed in soil and water within several days. We do not know if it builds up in plants. Carbon tetrachloride is most often found as a colorless gas. The effects of exposure to any hazardous substance depend on the dose. these uses are now banned and it is only used in some industrial applications. in fire extinguishers. or coming in contact with soil that is contaminated with it. Halon 104. G Breathing workplace air when it is used. the rest evaporates or moves into the groundwater. drinking water. How might I be exposed to carbon tetrachloride? G Breathing contaminated air near manufacturing plants or waste sites. G Only a small amount sticks to soil particles. and possibly from exposure to the skin. and in spot removers. Freon 10. and central nervous system damage. G It evaporates very quickly from soil and surface water. The liver is especially sensitive to carbon tetrachloride because it swells and cells U. Tetraform. or Tetrasol. What is carbon tetrachloride? (Pronounced kär“b…n tµt“r… klôr“ºd”) Carbon tetrachloride is a manufactured compound that does not occur naturally. exposure to very high amounts of carbon tetrachloride can damage the liver. so most of it is in the air.S.CARBON TETRACHLORIDE CAS # 56-23-5 Agency for Toxic Substances and Disease Registry ToxFAQs September 1995 This fact sheet answers the most frequently asked health questions (FAQs) about carbon tetrachloride. as a pesticide. G Swimming or bathing in contaminated water.416 National Priorities List sites identified by the Environmental Protection Agency. How can carbon tetrachloride affect my health? High exposure to carbon tetrachloride can cause liver. What happens to carbon tetrachloride when it enters the environment? G It moves very quickly into the air upon release. it forms chemicals that can destroy ozone in the upper atmosphere. kidney. It's not flammable and doesn't dissolve in water very easily. methane tetrachloride. G Drinking contaminated water near manufacturing plants and waste sites. This fact sheet is one in a series of summaries about hazardous substances and their health effects. G It doesn't build up in animals. and nervous system. Because of its harmful effects. Trade names include Benzinoform.

How likely is carbon tetrachloride to cause cancer? The Department of Health and Human Services has determined that carbon tetrachloride may reasonably be anticipated to be a carcinogen. contact the Agency for Toxic Substances and Disease Registry. Kidneys are also damaged. Is there a medical test to show whether I’ve been exposed to carbon tetrachloride? Several sensitive and specific tests are available to measure the amount of carbon tetrachloride in your breath. Atlanta. urine. coma and even death can occur. These tests aren't routinely performed in doctors' offices. The EPA recommends that brain.atsdr. Where can I get more information? For more information. Agency for Toxic Substances and Disease Registry (ATSDR). Glossary Carcinogen: A substance that can cause cancer. including the of drinking water (0. People may feel intoxicated and experience drinking water exposures should not exceed 0. Case studies in environmental medicine. Atlanta. GA: U. causing a buildup of wastes in the blood.cdc. The tests must be done soon after exposure because it leaves your body quickly. but in severe years). 1994. sleepiness. dizziness. If exposure is low and then stops. the nervous system. Public Health Service. Ingesting: Taking food or drink into your body. The Occupational Safety and Health Administration (OSHA) set a maximum concentration limit in workplace air of 10 ppm for an 8-hour workday over a 40-hour workweek. 1600 Clifton Road NE. Has the federal government made recommendations to protect human health? The Environmental Protection Agency (EPA) has set a limit of 0. Federal Recycling Program Printed on Recycled Paper . Atlanta.gov/toxfaq. GA 30333. and body tissues.gov/toxfaq. Their specialists can recognize. The EPA has also set limits on how much carbon tetraThere have been no studies in people on carbon chloride can be released from an industrial plant into wastetetrachloride's effects on reproduction or development.Page 2 CARBON TETRACHLORIDE CAS # 56-23-5 ToxFAQs Internet address via WWW is http://www. FAX: 404-498-0093. blood. Department of Health and Human Services. Phone: 1-888-422-8737.005 ppm). You can also contact your community or state health or environmental quality department if you have any more questions or concerns. The tests can't tell you how much carbon tetrachloride you were exposed to or whether there will be any effects on your health.005 parts of carbon tetrachloride per million parts If exposure is very high.S. Division of Toxicology. cases. ToxFAQs Internet address via WWW is http://www. We also do not know if breathing or ingesting it will cause cancer in people. GA: U. the liver and kidneys can repair the damaged cells and function normally again. Public Health Service. References Agency for Toxic Substances and Disease Registry (ATSDR). Evaporate: To change into a vapor or a gas. but water and is preparing to set limits on how much can be studies in rats showed no adverse effects. but your doctor can tell you where to obtain such a test. Department of Health and Human Services.07 ppm for children for long periods of time (7 These effects may subside if exposure is stopped. is affected.html ATSDR can tell you where to find occupational and environmental health clinics.S. Animals that ingested carbon tetrachloride over a long time developed liver cancer. and nausea and vomiting. Toxicological profile for carbon tetrachloride. evaluate.html are damaged or destroyed.cdc. 1992. released into outside air. and treat illnesses resulting from exposure to hazardous substances. Carbon tetrachloride toxicity. adults and 0.atsdr. We do not know if breathing carbon tetrachloride causes cancer in animals. Mailstop E-29.3 ppm for headaches.

vomiting. It takes about 2 years for half of 134Cs to give off its radiation and about 30 years for 137Cs. most cesium compounds are very soluble. 134Cs and 137Cs. 133Cs (read as cesium one-thirty-three). For more information. HIGHLIGHTS: Exposure to stable or radioactive cesium occurs from ingesting contaminated food or drinking water or breathing contaminated air. Both isotopes decay into non-radioactive elements. vomiting. It is important you understand this information because this substance may harm you. High levels of radioactive cesium can cause nausea. or eating food containing cesium. ‘ Food and drinking water are the largest sources of exposure to cesium. Public Health Service Agency for Toxic Substances and Disease Registry . call the ATSDR Information Center at 1-888-422-8737. and even death. and whether other chemicals are present.585 National Priority List (NPL) sites identified by the Environmental Protection Agency (EPA). soil. Stable (non-radioactive) cesium has been found in at least 10 of the 1.CESIUM CAS #7440-46-2 Division of Toxicology ToxFAQsTM July 2001 This fact sheet answers the most frequently asked health questions (FAQs) about cesium. Nuclear explosions or the breakdown of uranium in fuel elements can produce two radioactive forms of cesium. 134 Cs and 137Cs generate beta particles as they decay. This may occur after nuclear accidents or detonation of atomic bombs. such as increased or decreased activity. ‘ Most cesium compounds dissolve in water. Naturally occurring cesium is not radioactive and is referred to as stable cesium. and even death in the case of very high exposures. bleeding. diarrhea. drinking water. ‘ Working in industries that process or use natural cesium or cesium compounds. bleeding. how you are exposed. The effects of exposure to any hazardous substance depend on the dose. Exposure to large amounts of radioactive cesium can damage cells in your body from the radiation You might also experience acute radiation syndrome which includes nausea. How might I be exposed to cesium? ‘ You can be exposed to low levels of stable or radioactive cesium by breathing air. U.S. coma. coma. ‘ In most soils. This fact sheet is one in a series of summaries about hazardous substances and their health effects. What happens to cesium when it enters the environment? ‘ Stable cesium in air can travel long distances before settling to the ground or water. How can cesium affect my health? It is highly unlikely that you would be exposed to high enough amounts of stable cesium to cause harmful health effects. ‘ Cesium binds strongly to most soils and does not travel far below the surface of the soil. Laboratory animals given very large amounts of cesium compounds showed changes in behavior. diarrhea. the duration.585 NPL sites identified by the EPA. DEPARTMENT OF HEALTH AND HUMAN SERVICES. ‘ Living near uncontrolled radioactive waste sites containing cesium. There is only one stable form of cesium naturally present in the environment. personal traits and habits. this period of time is called the half-life. and dust in low amounts. ‘ Radioactive decay is the only way of decreasing the amount of 134Cs and 137Cs in the environment. ‘ You can be exposed to radioactive cesium if you eat food that was grown in contaminated soil. Radioactive cesium has been found in at least 22 of the 1. What is cesium? Cesium is a naturally occurring element found combined with other elements in rocks.

Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). but will not predict whether harmful effects will occur. NRC also set a limit intake of 0. 1600 Clifton Road NE. Has the federal government made recommendations to protect human health? The EPA has established a maximum contaminant level of 4 millirem per year for beta particles and photon radioactivity for man-made radionuclides (including radioactive cesium The National Institute for Occupational Safety and Health (NIOSH) recommends a limit of 2 milligrams of cesium hydroxide per cubic meter of air (2 mg/m3) as an average for a 10-hour workday. In the unlikely case that you are exposed to high levels of radioactive cesium because of accidental release at a nuclear plant or a nuclear weapon has been detonated. Phone: 1-888-4228737. There are special laboratory tests to measure cesium in blood.1 mCi for 134Cs and 0. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. These tests are most useful for people exposed to high levels.06 µCi/ m3 for 137Cs. If a person has been exposed to radioactive cesium. special tests can be used to measure levels of radiation in blood. Infants born to atomic bomb survivors exposed to high doses of ionizing radiation while pregnant. carcinogenic effects similar to those observed in Japanese survivors of the atomic bombing incidents might be expected among individuals acutely exposed to very high levels of radiation from a radioactive cesium source. Because radioactive cesium emits ionizing radiation. Mailstop E-29. The Nuclear Regulatory Commission (NRC) has set occupational air limits of 0. feces.S. However. it is difficult to determine if a person has been exposed only to external radiation from radioactive cesium. we cannot avoid being exposed to it.gov/toxfaq.gov/toxfaq. GA: U. Rats exposed to high doses of radiation from 137Cs had increased risk of mammary tumors. How can cesium affect children? Children can be affected by cesium in the same ways as adults. Is there a medical test to show whether I’ve been exposed to cesium? Everyone has small amounts of cesium in their bodies. Where can I get more information? For more information. There are no human studies that specifically associate exposure to radioactive cesium with increased cancer risk. 40-hour workweek. FAX: 404-498-0093. or urine.html How likely is cesium to cause cancer? There are no studies regarding non radioactive cesium and cancer.04 µCi/m3 for 134Cs and 0.atsdr.cdc. ToxFAQs Internet address via WWW is http://www. Exposure to the radiation from radioactive cesium has caused birth defects in animals. GA 30333. Federal Recycling Program Printed on Recycled Paper .html. How can families reduce the risk of exposure to cesium? Since cesium is naturally found in the environment. ATSDR can tell you where to find occupational and environmental health clinics.cdc.atsdr. follow the advice of public health officials who will publish appropriate guidelines for reducing exposure.Page 2 CESIUM CAS #7440-46-2 ToxFAQsTM Internet address is http://www. Toxicological Profile for Cesium (Draft for Public Comment). urine.2 mCi for 137Cs for on-the-job exposure. Division of Toxicology. and treat illnesses resulting from exposure to hazardous substances. and tissues. Older rats seemed more resistant than younger ones. showed later signs of decreased mental abilities. Atlanta. However. these relatively low amounts do not warrant immediate steps to reduce exposure. Public Health Service. Their specialists can recognize. Atlanta. feces. evaluate. 2001. Department of Health and Human Services. contact the Agency for Toxic Substances and Disease Registry.

EPA banned all uses. Public Health Service Agency for Toxic Substances and Disease Registry . q By breathing air or by touching soil near waste sites or landfills. This information is important because this substance may harm you.S. How can chlordane affect my health? Chlordane affects the nervous system. such as root crops. What happens to chlordane when it enters the environment? q Chlordane entered the environment when it was used as a pesticide on crops. irritating smell. High levels of chlordane can cause damage to the nervous system or liver. stomach cramps. q Chlordane sticks strongly to soil particles at the surface and is not likely to enter groundwater. meats. birds. but is actually a mixture of pure chlordane mixed with many related chemicals. DEPARTMENT OF HEALTH AND HUMAN SERVICES. It doesn't occur naturally in the environment. q By breathing air or touching soil near homes treated for termites with chlordane. What is chlordane? (Pronounced klôr“d³n”) Chlordane is a manufactured chemical that was used as a pesticide in the United States from 1948 to 1988. fish. the digestive system. diarrhea. chlordane was used as a pesticide on crops like corn and citrus and on home lawns and gardens. In 1988. How might I be exposed to chlordane? q By eating crops grown in soil that contains chlordane. on lawns and gardens. irritability. Some of its trade names are Octachlor and Velsicol 1068. the Environmental Protection Agency (EPA) banned all uses of chlordane in 1983 except to control termites.416 National Priorities List sites identified by the Environmental Protection Agency. q It builds up in the tissues of fish. how you are exposed. This chemical has been found in at least 171 of 1. and whether other chemicals are present. the duration. vomiting. q Chlordane doesn’t dissolve easily in water. Technical chlordane is not a single chemical. and shellfish. personal traits and habits. Chlordane has a mild. q By eating fish or shellfish caught in water that is contaminated by chlordane. q Most chlordane leaves soil by evaporation to the air. and the liver in people and animals. U. Until 1983. and to control termites. This fact sheet is one in a series of summaries about hazardous substances and their health effects. q It can stay in the soil for over 20 years. and mammals. Large amounts of chlordane taken by mouth can cause convulsions and death in people.CHLORDANE CAS # 57-74-9 Agency for Toxic Substances and Disease Registry ToxFAQs September 1995 This fact sheet answers the most frequently asked health questions (FAQs) about chlordane. SUMMARY: Exposure to chlordane occurs mostly from eating contaminated foods. call the ATSDR Information Center at 1-888-422-8737. Headaches. For more information. q It breaks down very slowly. weakness. confusion. Because of concern about damage to the environment and harm to human health. It is a thick liquid whose color ranges from colorless to amber. and jaundice have occurred in people who breathed air containing high concentrations of chlordane or accidentally swallowed small amounts of chlordane. or from touching contaminated soil. The effects of exposure to any hazardous substance depend on the dose. vision problems.

fat. 1600 Clifton Road NE. 40-hour workweek. urine. GA: U. Department of Health and Human Services.cdc.html A man who had long-term skin contact with soil containing high levels of chlordane had convulsions. The Food and Drug Administration (FDA) limits the amount of chlordane and its breakdown products in most We do not know whether chlordane affects the ability of fruits and vegetables to less than 300 ppb and in animal fat people to have children or whether it causes birth defects.cdc. Milligram (mg): One thousandth of a gram. Their specialists can recognize. ToxFAQs Internet address via WWW is http://www. Animals given high levels of chlordane by mouth for short periods died or had convulsions. Phone: 1-888-422-8737. Toxicological profile for chlordane (update). Studies of workers who made or used avoided because this may be a significant route of exposure. References Has the federal government made recommendations to protect human health? In 1988. Ani. and treat illnesses resulting from exposure to hazardous substances. than 60 parts of chlordane per billion parts of drinking water (60 ppb) for longer than 1 day. the National Institute for Occupational Health and Safety (NIOSH). Long-term exposure caused harmful effects in the liver of test animals. Division of Toxicology.S. Is there a medical test to show whether I’ve been exposed to chlordane? Long-term: Lasting one year or longer. mals exposed before birth or while nursing developed behavThe Occupational Safety and Health Administration ioral effects later. EPA has set a limit in drinking water of 2 ppb. Federal Recycling Program Printed on Recycled Paper . evaluate. The EPA recommends that a child should not drink water with more Agency for Toxic Substances and Disease Registry (ATSDR).and fish to less than 100 ppb. and breast milk. Public Health Service. Carcinogenicity: Ability to cause cancer. and the American Conference of Governmental Industrial Hygienists (ACGIH) set a maximum level of 0. (OSHA). You can also contact your community or state health or environmental quality department if you have any more questions or concerns. These determined that chlordane is not classifiable as to its carcinoagencies have advised that eye and skin contact should be genicity to humans.Page 2 CHLORDANE CAS # 57-74-9 ToxFAQs Internet address via WWW is http://www. Mice fed low levels of chlordane in food developed liver canGlossary cer.5 How likely is chlordane to cause cancer? milligrams of chlordane per cubic meter (mg/m3) in workThe International Agency for Research on Cancer has place air for an 8-hour workday. amount of breakdown products measured in body fat or breast milk does not tell how much or how long ago you were exposed to chlordane or if harmful effects will occur.atsdr.atsdr. EPA requires spills or releases of chlordane into the environment of 1 pound or more to be reported to EPA. Atlanta. contact the Agency for Toxic Substances and Disease Registry. GA 30333. products in blood. chlordane do not show that exposure to chlordane is related to cancer. The ppb: Parts per billion. but the information is not sufficient to know for sure. Japanese workers who used chlordane over a long period of time had minor changes in liver function. Mailstop E-29.html ATSDR can tell you where to find occupational and environmental health clinics.gov/toxfaq. 1994. the EPA banned all uses of chlordane. feces. Atlanta.gov/toxfaq. FAX: 404-498-0093. Where can I get more information? For more information. Laboratory tests can measure chlordane and its breakdown Pesticide: A substance that kills pests.

q It may also be found in surface waters from rain. blurred vision. Sapercon®. or the U. Commercial preparations commonly sold in stores were usually 90% chlorfenvinphos. call the ATSDR Information Center at 1-888-422-8737.S. q It does not appear to accumulate in plants. how you are exposed. HIGHLIGHTS: Chlorfenvinphos is an insecticide which is no longer used in the United States. The effects of exposure to any hazardous substance depend on the dose. Steladone®. q Another way to be exposed is by using pharmaceutical products that contain lanolin. fish. and whether other chemicals are present.430 National Priorities List sites identified by the Environmental Protection Agency (EPA). For more information. you could be exposed to it. The chemical is manufactured and does not occur naturally in the environment. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Public Health Service Agency for Toxic Substances and Disease Registry .S. What is chlorfenvinphos? (Pronounced klôr fµn“ v¹n-f¼s”) Chlorfenvinphos is an insecticide that is a colorless liquid with a mild odor. q If you breathe air or touch soil near a hazardous waste site containing chlorfenvinphos. How can chlorfenvinphos affect my health? The major effect of chlorfenvinphos is on the nervous system. It was commonly used until 1991 when all products containing chlorfenvinphos as an active ingredient were canceled in the United States. or freshwater animals. It’s important you understand this information because this substance may harm you. How might I be exposed to chlorfenvinphos? q The most common way to be exposed is by eating imported agricultural products contaminated with it. and mice. Ingesting chlorfenvinphos results primarily on nervous system effects. and Supona®. a natural grease from sheep’s wool (chlorfenvinphos is often used to control flies in animal buildings and can contaminate sheep’s wool). personal traits and habits. Use of trade names is for identification only and does not imply endorsement by the Agency for Toxic Substances and Disease Registry. the Public Health Service. Chlorfenvinphos been found in at least 1 of the 1. q Chlorfenvinphos may move from soil to the air by evaporation. q If you work in the disposal of chlorfenvinphos or its wastes you are most likely to be exposed. fleas. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Most of the chlorfenvinphos used was in liquid form. Ingesting large doses may cause nausea and vomit- U. the duration. q It may leach into soil and underground water. and confusion. such as headaches.CHLORFENVINPHOS CAS # 470-90-6 Agency for Toxic Substances and Disease Registry ToxFAQs September 1997 This fact sheet answers the most frequently asked health questions (FAQs) about chlorfenfinphos. Dermaton®. It was sold under common trade names including Birlane®. Chlorfenvinphos was widely used to control household pests such as flies. Department of Health and Human Services. weakness. What happens to chlorfenvinphos when it enters the environment? q Chlorfenvinphos enters the environment from runoff after rainfall and leaching from hazardous waste sites.

Laws today protect the welfare of research animals and scientists must follow strict guidelines. Mailstop E-29. abdominal cramps. Where can I get more information? For more information. GA 30333. but can be done at special laboratories that have the right equipment. evaluate. body tissue. Has the federal government made recommendations to protect human health? The EPA requires that spills or accidental releases into the environment of 500 pounds or more of chlorfenvinphos be reported to the EPA. Long-term: 365 days or longer. Insecticide: A substance that kills insects.2 ppm). This test requires only a small amount of blood and can be done in your doctor’s office. Fertility: Ability to have children. ppm: Parts per million. GA.005 to 0. The Department of Health and Human Services (DHHS). How likely is chlorfenvinphos to cause cancer? It is not known whether chlorfenvinphos causes cancer in people.atsdr. difficulty in breathing. ToxFAQs Internet address via WWW is http://www. diarrhea. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Phone:1888-422-8737. and treat illnesses resulting from exposure to hazardous substances. Source of Information Is there a medical test to show whether I’ve been exposed to chlorfenvinphos? There is a general test that can be used to determine if you have been exposed to a group of insecticides. CAS: Chemical Abstracts Service. including chlorfenvinphos. FAX: 404-498-0093. There is no evidence that long-term exposure to small amounts of chlorfenvinphos causes any harmful health effects in people.Page 2 CHLORFENVINPHOS CAS # 470-90-6 ToxFAQs Internet address via WWW is http://www.005-0. and urine. These symptoms may start within 30-60 minutes and reach their maximum effect after 6-8 hours. Specific tests are available to identify chlorfenvinphos or its breakdown products in your blood.2 parts chlorfenvinphos per million parts of food (0. This test measures the activity of an enzyme called acetylcholinesterase in the blood.gov/toxfaq. contact the Agency for Toxic Substances and Disease Registry. and another study reported that chlorfenvinphos interfered with the development of rats when the pregnant animals were fed chlorfenvinphos. It does not specifically show exposure to chlorfenvinphos. One animal study reported decreased fertility in rats given chlorfenvinphos in their food.gov/toxfaq. Atlanta.html ATSDR can tell you where to find occupational and environmental health clinics. Lower doses may cause headaches. Glossary Carcinogenicity: Ability to cause cancer. weakness.html ing. Public Health Service. Division of Toxicology. Ingest: To eat or drink something. Department of Health and Human Services.S. and the EPA have not classified chlorfenvinphos for carcinogenicity. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. This ToxFAQs information is taken from the 1997 Toxicological Profile for Chlorfenvinphos produced by the Agency for Toxic Substances and Disease Registry. The Food and Drug Administration (FDA) has set tolerances for chlorfenvinphos for agricultural products ranging from 0. It is not known whether chlorfenvinphos can affect reproduction or cause birth defects in people. and inability to see clearly. confusion. and fainting. the International Agency for Research on Cancer (IARC). Their specialists can recognize. 1600 Clifton Road NE. Public Health Service in Atlanta. runny nose. Federal Recycling Program Printed on Recycled Paper . U.cdc. dizziness.cdc. These tests aren’t available at most doctors’ offices.atsdr.

8-TCDD include skin rashes. but most attach to soil and settle to the bottom sediment in water.3. It’s important you understand this information because this substance may harm you.7. q When released in waste waters. some evaporate to air. some CDDs are broken down by sunlight. the duration. q Living near an uncontrolled hazardous waste site containing CDDs or incinerators releasing CDDs. Other skin effects noted in people exposed to high doses of 2. resulting in measurable levels in animals.7.3.CHLORINATED DIBENZO-p-DIOXINS (CDDs) Agency for Toxic Substances and Disease Registry ToxFAQs February 1999 This fact sheet answers the most frequently asked health questions (FAQs) about chlorinated dibenzo-p-dioxins (CDDs).7. how you are exposed. HIGHLIGHTS: Exposure to chlorinated dibenzo-p-dioxins (CDDs) (75 chemicals) occurs mainly from eating food that contains the chemicals. CDDs are released into the air in emissions from municipal solid waste and industrial incinerators. DEPARTMENT OF HEALTH AND HUMAN SERVICES.S.3. In the pure form.7. CDDs are also formed during chlorination by waste and drinking water treatment plants. and whether other chemicals are present. For more information. Chloracne is a severe skin disease with acne-like lesions that occur mainly on the face and upper body.8-TCDD. This fact sheet is one in a series of summaries about hazardous substances and their health effects.7.8-tetrachlorodibenzo-p-dioxin or 2. One chemical in this group.8-TCDD is odorless and the odors of the other CDDs are not known.7.3.3. and fish. It causes effects on the skin and may cause cancer in people.8-TCDD.8-TCDD) may be formed during the chlorine bleaching process at pulp and paper mills. q CDD concentrations may build up in the food chain. 2. some CDDs may be transported long distances. The effects of exposure to any hazardous substance depend on the dose. q Skin contact with certain pesticides and herbicides. or operating incinerators. working at paper and pulp mills. even around the globe.467 National Priorities List sites identified by the Environmental Protection Agency (EPA).8-TCDD is chloracne. dis- U. dairy products. CDDs are crystals or colorless solids.3. They can occur as contaminants in the manufacture of certain organic chemicals. has been shown to be very toxic in animal studies. personal traits and habits. This chemical has been found in at least 91 of 1. makes up more than 90% of the intake of CDDs for the general population. How might I be exposed to CDDs? q Eating food. The most noted health effect in people exposed to large amounts of 2. 2. call the ATSDR Information Center at 1-888-422-8737. q Working in industries involved in producing certain pesticides containing CDDs as impurities. It is one of the most toxic of the CDDs and is the one most studied. One of these compounds is called 2.7. How can CDDs affect my health? What happens to CDDs when they enter the environment? q When released into the air. CDDs are not intentionally manufactured by industry except for research purposes. Public Health Service Agency for Toxic Substances and Disease Registry .3. CDDs enter the environment as mixtures containing a number of individual components. They (mainly 2. What are CDDs? CDDs are a family of 75 chemically related compounds commonly known as chlorinated dioxins. q Breathing low levels in air and drinking low levels in water. primarily meat.

Atlanta.8-TCDD may reasonably be anticipated to cause cancer.cdc. Atlanta.atsdr.3.3. Has the federal government made recommendations to protect human health? The EPA has set a limit of 0. Phone: 1-888-422-8737. but these tests are not routinely available.3. Federal Recycling Program Printed on Recycled Paper . blood. 1600 Clifton Road NE. or accidental releases of 1 pound or more of 2. liver damage. Department of Health and Human Services.7. Most people have low levels of CDDs in their body fat and blood.7.7.S. In certain animal species.8-TCDD greater than 50 parts per trillion (50 ppt).gov/toxfaq. FAX: 404-498-0093. Where can I get more information? For more information. spills.7.7.8-TCDD. contact the Agency for Toxic Substances and Disease Registry. and excessive body hair. such as weight loss. tests cannot be used to determine when exposure occurred. GA 30333.3.3. How likely are CDDs to cause cancer? Several studies suggest that exposure to 2.8-TCDD weakens the immune system and causes a decrease in the system’s ability to fight bacteria and viruses. Animal studies have also shown an increased risk of cancer from exposure to 2. ToxFAQs Internet address via WWW is http://www.00003 µg/L). GA: U.00003 micrograms of 2. Their specialists can recognize. Exposure to high concentrations of CDDs may induce longterm alterations in glucose metabolism and subtle changes in hormonal levels. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). q Discourage children from eating dirt or putting toys or other objects in their mouths. Is there a medical test to show whether I’ve been exposed to CDDs? Tests are available to measure CDD levels in body fat.3.atsdr.8-TCDD must be reported to EPA.8-TCDD is a human carcinogen.3. How can CDDs affect children? Very few studies have looked at the effects of CDDs on children. How can families reduce the risk of exposure to CDDs? q Children should avoid playing in soils near uncontrolled hazardous waste sites. this cannot be ruled out.html ATSDR can tell you where to find occupational and environmental health clinics. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.gov/toxfaq. exposure to 2.7. and treat illnesses resulting from exposure to hazardous substances. Some animal species exposed to CDDs during pregnancy had miscarriages and the offspring of animals exposed to 2.7.8-TCDD per liter of drinking water (0. Division of Toxicology.3. Discharges. The Food and Drug Administration (FDA) recommends against eating fish and shellfish with levels of 2. Mailstop E-29. 1998.7.7.cdc.8-TCDD is especially harmful and can cause death after a single exposure. q Everyone should wash hands frequently if playing or working near uncontrolled hazardous waste sites.3.3. kidney defects. In other animal studies.7. In many species of animals. Exposure to lower levels can cause a variety of effects in animals.3. and levels considerably above these levels indicate past exposure to above-normal levels of 2.7. restrict eating foods from the proximity of uncontrolled sites with known CDDs. Chloracne has been seen in children exposed to high levels of CDDs. and breast milk.8-TCDD during pregnancy often had severe birth defects including skeletal deformities.8-TCDD increases the risk of several types of cancer in people.8-TCDD has caused reproductive damage and birth defects. and weakened immune responses. 2. q For new mothers and young children. and disruption of the endocrine system.Page 2 CHLORINATED DIBENZO-p-DIOXINS (CDDs) ToxFAQs Internet address via WWW is http://www. The Department of Health and Human Services (DHHS) has determined that 2. 2.7. evaluate. The World Health Organization (WHO) has determined that 2.3. We don't know if CDDs affect the ability of people to have children or if it causes birth defects. Toxicological profile for chlorinated dibenzop-dioxins. Although CDDs stay in body fat for a long time. Changes in blood and urine that may indicate liver damage also are seen in people.html coloration. but given the effects observed in animal studies. Public Health Service.8-TCDD.

skin. chlorine will react with water to form hypochlorous acid and hydrochloric acid. Public Health Service Agency for Toxic Substances and Disease Registry . Chlorine is mainly used as a bleach in the manufacture of paper and cloth and to make a wide variety of products. ‘ Chlorine is slightly soluble in water. wheezing. The hypochlorous acid breaks down rapidly. U. This fact sheet is one in a series of summaries about hazardous substances and their health effects. blue coloring of the skin. Exposure to even higher levels can produce severe eye and skin burns. The hydrochloric acid also breaks down. chlorine is a yellow-green gas that is heavier than air and has a strong irritating odor. how you are exposed. rapid breathing. and eye and skin irritation. skin. ‘ Since chlorine is a gas it is rarely found in soil. the duration. What is chlorine? At room temperature. and could lead to pulmonary edema and even death in extreme cases. and death. ‘ Chlorine gas is used to synthesize other chemicals and to make bleaches and disinfectants. Chlorine gas can cause irritation of the eyes. These compounds can react with other substances found in soil. HIGHLIGHTS: People working in facilities that use chlorine to manufacture other chemicals have the highest risk of being exposed to chlorine. chlorine will react with moisture forming hypochlorous acid and hydrochloric acid. If released to soil. For more information. ‘ Chlorine does not accumulate in the food chain. accumulation of fluid in the lungs. Therefore workers employed in occupations where these products are made may inhale chlorine gas or get it on their skin. It reacts with water to form hypochlorous acid and hydrochloric acid. DEPARTMENT OF HEALTH AND HUMAN SERVICES. and whether other chemicals are present. How can chlorine affect my health? Chlorine gas is irritating and corrosive to the respiratory tract. its breakdown products will lower the pH of the water (makes it more acidic). Chlorine gas has been found in at least 60 of the 1. call the ATSDR Information Center at 1-888-422-8737. and respiratory tract. The effects depend on how much you are exposed to and for how long. Exposure to higher levels could cause burning of the eyes and skin. Exposure to high levels can result in corrosive damage to the eyes. and skin. and respiratory tissues.591 National Priorities List sites identified by the Environmental Protection Agency (EPA). narrowing of the bronchi. lung collapse. eyes. It can be converted to a liquid under pressure or cold temperatures.S. but may be exposed to products which are made from chlorine like sodium hypochlorite which is used as a disinfectant in public drinking water and swimming pools and as a common household bleach.CHLORINE CAS #7782-50-5 Division of Toxicology ToxFAQsTM April 2002 This fact sheet answers the most frequently asked health questions (FAQs) about chlorine. Exposure to low concentrations of chlorine gas (1 to 10 ppm) may cause sore throat. What happens to chlorine when it enters the environment? ‘ When released to air. personal traits and habits. How might I be exposed to chlorine? ‘ The general population is probably not exposed to chlorine gas. coughing. which are removed from the atmosphere by rainfall. and pain in the lung region. The effects of exposure to any hazardous substance depend on the dose. It is important you understand this information because this substance may harm you.

If you swallow a product that contains sodium hypochlorite. This condition is called reactive airways dysfunction syndrome (RADS). and the EPA have not classified chlorine as to its carcinogenicity.atsdr. Where can I get more information? For more information. ATSDR can tell you where to find occupational and environmental health clinics. How can families reduce the risk of exposure to chlorine? ‘ Most families will not be exposed to high levels of chlorine gas. corrosive chlorine gas could be produced in your stomach and cause serious corrosive injury. and a short-term exposure level (STEL) of 1 ppm of chlorine. out of the reach of children. Their specialists can recognize. How likely is chlorine to cause cancer? The Department of Health and Human Services (DHHS).html CAS #7782-50-5 Some people may develop an inflammatory reaction to chlorine.Page 2 CHLORINE ToxFAQsTM Internet address is http://www.5 ppm of chlorine for an 8-hour per day. a type of asthma caused by some irritating or corrosive substances. Division of Toxicology. FAX: 404-498-0093. ‘ Household products containing substances such as sodium hypochlorite (which may release chlorine gas) should be stored in safe locations. We do not know if exposure to chlorine can result in birth defects or other developmental effects.gov/toxfaq. If you were to come into skin contact with liquified chlorine. the International Agency for Research on Cancer (IARC). 40-hour work week.cdc. There is no additional information to determine whether exposure to chlorine might cause cancer. Some testing may require hospital facilities. Federal Recycling Program Printed on Recycled Paper . If a severe exposure has occurred. The American Conference of Governmental Industrial Hygienists (ACGIH) recommends a time-weighted average (TWA) threshold limit value (TLV) of 0. In general. GA 30333. children may be more vulnerable to corrosive agents than adults because of the smaller diameter of their airways. Mailstop E-29. Has the federal government made recommendations to protect human health? The EPA has set a limit for drinking water of 4 milligrams of chlorine per liter of water (4 mg/L) and also recommends that levels of chlorine in lakes and streams be limited to 10 mg/L to prevent possible human health effects from drinking water or eating fish contaminated with this chemical.cdc.gov/toxfaq. Some of these tests can be performed in a doctor’s office. blood and urine analyses and other tests may show whether damage has occurred to the lungs and gastrointestinal tract. ToxFAQsTM Internet address is http://www. evaluate.atsdr. you could experience frostbite. We do not know whether children differ from adults in their susceptibility to chlorine. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. and treat illnesses resulting from exposure to hazardous substances. Phone: 1-888-422-8737. Atlanta. 1600 Clifton Road NE. How can chlorine affect children? Children can be affected by exposure to chlorine in the same ways as adults. We do not know if exposure to chlorine can result in reproductive effects. The Occupational Safety and Health Administration (OSHA) set a ceiling limit of 1 part of chlorine per million parts of workplace air (1 ppm).html . contact the Agency for Toxic Substances and Disease Registry. Is there a medical test to show whether I’ve been exposed to chlorine? Specific tests for the presence of chlorine in the blood or urine are not generally useful.

CHLORINE DIOXIDE and CHLORITE CAS # 10049-04-4 and 7758-19-2 Division of Toxicology ToxFAQsTM September 2002 This fact sheet answers the most frequently asked health questions (FAQs) about chlorine dioxide and chlorite. call the ATSDR Information Center at 1-888-422-8737. It does not occur naturally in the environment. ! Neither chlorine dioxide nor chlorite ions build up in the food chain. Eating or drinking large amounts of chlorite salts may cause irritation in the mouth. There is no evidence that chlorine dioxide or chlorite affect reproduction in humans. How can chlorine dioxide and chlorite affect my health? Both chlorine dioxide and chlorite react quickly in water or moist body tissues. Chlorite ions in water combine with metal ions to form soluble salts. and lungs. HIGHLIGHTS: Chlorine dioxide is a gas that does not occur naturally in the environment. sunlight will rapidly break down chlorine dioxide into chlorine gas and oxygen. What happens to chlorine dioxide and chlorite when they enter the environment? ! Chlorine dioxide is a very reactive compound and will not exist in the environment for long periods of time. How might I be exposed to chlorine dioxide and chlorite? ! Chlorine dioxide is added to drinking water to protect people from harmful bacteria and other microorganisms. although reaction with soil and sediments may reduce the amount chlorite ions reaching groundwater. municipal water treatment facilities. Chlorine dioxide is used as a bleach at paper manufacturing plants. Public Health Service Agency for Toxic Substances and Disease Registry . and whether other chemicals are present. U. throat. ! Most people will be exposed to small amounts chlorine dioxide and chlorite ions by drinking water treated with chlorine dioxide. the duration. ! In air. DEPARTMENT OF HEALTH AND HUMAN SERVICES. It is used to disinfect drinking water and make it safe to drink. ! Chlorite ions in water may move into groundwater. This fact sheet is one in a series of summaries about hazardous substances and their health effects. ! Individuals who are employed at pulp and paper mills. For more information. About 5% of the water treatment facilities serving more than 100. What are chlorine dioxide and chlorite? Chlorine dioxide is a yellow to reddish-yellow manufactured gas. like sodium chlorite. It is important you understand this information because this substance may harm you. personal traits and habits. and lung irritation. ! In water. Chlorine dioxide and chlorite have not been found in any of the 1. The effects of exposure to any hazardous substance depend on the dose. chlorine dioxide was used to decontaminate a number of public buildings following the release of anthrax spores in the United States. esophagus. how you are exposed.S. When it reacts in water. throat. chlorine dioxide will quickly form chlorite ions. chlorine dioxide forms chlorite ion. Breathing air containing chlorine dioxide gas may cause nose. ! Chlorite ions do not exist in air. a compound which is also very reactive. and in public water treatment facilities to make water safe to drink. and other facilities that use chlorine dioxide as a disinfectant may have high exposures to chlorine dioxide and chlorite (ions or salts). or stomach.613 National Priorities List sites identified by the Environmental Protection Agency (EPA). Chlorite is formed when chlorine dioxide reacts with water. In 2001.000 people in the United States use chlorine dioxide to treat drinking water. High levels of chlorine dioxide can be irritating to the nose. eyes.

Atlanta. Federal Recycling Program Printed on Recycled Paper . the International Agency for Research on Cancer (IARC) and the EPA have determined that chlorine dioxide and sodium chlorite are not classifiable as to human carcinogenicity. evaluate. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). There are no reliable studies of effects of chlorine dioxide or chlorite in developing humans. However.gov/toxfaq. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.Page 2 CHLORINE DIOXIDE and CHLORITE CAS # 10049-04-4 and 7758-19-2 ToxFAQsTM Internet address is http://www. 1600 Clifton Road NE. Division of Toxicology. GA: U. Their specialists can recognize. Mailstop E-29. Is there a medical test to show whether I’ve been exposed to chlorine dioxide and chlorite? There are no routine medical tests available to measure chlorine dioxide or chlorite in the body.cdc. The Occupational Safety and Health Administration (OSHA) has set a limit of 0.8 mg/L for both the maximum residual disinfectant level for chlorine dioxide and the maximum contaminant level for chlorite in drinking water treated with chlorine dioxide as a disinfectant. Based on inadequate information in humans and in animals. How can families reduce the risk of exposure to chlorine dioxide and chlorite? ! Families that drink water treated with chlorine dioxide may reduce the risk of exposure to chlorine dioxide and chlorite by drinking bottled water that has not been treated with these chemicals. FAX: 404-498-0093.S.1 ppm) in the workplace during an 8-hour shift. Has the federal government made recommendations to protect human health? The EPA has set a maximum contaminant level of 1 milligram of chlorite per liter (1 mg/L) of drinking water. but the test cannot tell the extent of the exposure or whether harmful effects will occur. and feces. Department of Health and Human Services. Studies in rats have shown that exposure of pregnant animals to chlorine dioxide and chlorite or exposure of pups shortly after birth may cause delays in the development of the brain. 40-hour workweek. blood. The EPA also has set a goal of 0. and treat illnesses resulting from exposure to hazardous substances. How can chlorine dioxide and chlorite affect children? There are no unique exposure pathways for children to chlorine dioxide and chlorite. How likely are chlorine dioxide and chlorite to cause cancer? There are no studies on cancer in humans exposed to chlorine dioxide or chlorite. the exposure levels in these studies were much higher than what humans are usually exposed to in the drinking water. GA 30333.1 parts of chlorine dioxide per million parts of air (0.cdc.atsdr. Toxicological Profile for Chlorine Dioxide and Chlorite (Draft for Public Comment). Phone: 1-888-4228737. contact the Agency for Toxic Substances and Disease Registry.html. Atlanta.html Studies in animals exposed to high amounts of chlorine dioxide or chlorite have shown effects similar to those seen in exposed people.gov/toxfaq. Where can I get more information? For more information. There is a special test to measure chlorite in tissues. urine.atsdr. Public Health Service. ToxFAQs Internet address via WWW is http://www. 2002. Children exposed to large amounts of chlorine dioxide or chlorite would be expected to be affected in the same manner as adults. ATSDR can tell you where to find occupational and environmental health clinics.

numbness. such as phenol and DDT. q Chlorobenzene does not build up in the food chain. and vomiting. How can chlorobenzene affect my health? Workers exposed to high levels of chlorobenzene in the air complained of headaches. The effects of exposure to any hazardous substance depend on the dose. and central nervous system are affected by exposure to chlorobenzene. Now chlorobenzene is used as a solvent for some pesticide formulations. What happens to chlorobenzene when it enters the environment? q Chlorobenzene released to air is slowly broken down by reactions with other chemicals and sunlight or can be removed by rain. We cannot be certain that all of these effects were due to chlorobenzene exposure because the workers may have been exposed to other chemicals. q In water.177 National Priorities List sites identified by the Environmental Protection Agency (EPA). For more information. Chlorobenzene production in the United States has declined by more than 60% from its peak in 1960. It was used in the past to make other chemicals. It’s important you understand this information because this substance may harm you. the duration. breathing vapors released to the air. It does not occur naturally in the environment. Animal studies indicate that the liver. It has been found at 97 of the 1. and as a chemical intermediate to make several other chemicals. how you are exposed. call the ATSDR Information Center at 1-888-422-8737. almond-like odor. or getting contaminated soil on their skin. This fact sheet is one in a series of summaries about hazardous substances and their health effects. to degrease automobile parts. and whether other chemicals are present. it is broken down rapidly by bacteria.CHLOROBENZENE CAS # 108-90-7 Agency for Toxic Substances and Disease Registry ToxFAQs July 1999 This fact sheet answers the most frequently asked health questions (FAQs) about chlorobenzene. High levels of chlorobenzene can damage the liver and kidneys and affect the brain. personal traits and habits. nausea.S. How might I be exposed to chlorobenzene? q If you work where chlorobenzene is made or used you could be exposed by breathing air with chlorobenzene vapors or by spilling or splashing chlorobenzene on your skin. q When released to soil. sleepiness. chlorobenzene will rapidly evaporate to the air and/or be broken down by bacteria. and to make other chemicals. U. q People that live near a waste site containing chlorobenzene could be exposed by drinking contaminated groundwater. What is chlorobenzene? (Pronounced klôr”½-bµn“z¶n) Chlorobenzene is a colorless. HIGHLIGHTS: Chlorobenzene is used as a solvent for some pesticide formulations. flammable liquid with an aromatic. Some of it will dissolve in water. q You could be exposed by eating food contaminated with chlorobenzene but there is not enough information to determine how often this occurs. kidney. but it readily evaporates into air. Public Health Service Agency for Toxic Substances and Disease Registry . as a degreaser. DEPARTMENT OF HEALTH AND HUMAN SERVICES. but some will evaporate to the air and some may filter into the groundwater.

The EPA has determined that chlorobenzene is not classifiable as to human carcinogenicity based on inadequate evidence in both humans and animals.S. The EPA recommends that levels of chlorinated benzenes (a group of chemicals that includes chlorobenzene) in lakes and streams Agency for Toxic Substances and Disease Registry (ATSDR). Solvent: A substance that dissolves another substance. GA 30333. liver nodules which can lead to cancer were produced in male rats.atsdr.gov/toxfaq. but these tests cannot be used to predict whether harmful health effects will occur. and death.html ATSDR can tell you where to find occupational and environmental health clinics. 1600 Clifton Road NE. Where can I get more information? For more information. Source of Information Has the federal government made recommendations to protect human health? The EPA has set a Maximum Contaminant Level (MCL) of 0.1 parts per million (0. and body fat. The limited data available indicate that chlorobenzene does not cause birth defects or infertility. Any release to the environment greater than 100 pounds of chlorobenzene must be reported to the EPA. Department of Health and Human Services. Division of Toxicology.html Effects on the central nervous system from breathing chlorobenzene include unconsciousness.cdc. blood. 40-hour workweek.1 ppm) for chlorobenzene in drinking water. should be limited to 0.Page 2 CHLOROBENZENE CAS # 108-90-7 ToxFAQs Internet address via WWW is http://www. CAS: Chemical Abstracts Service. GA: U. How likely is chlorobenzene to cause cancer? It is not known whether chlorobenzene causes cancer in people. ppm: Parts per million. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. ToxFAQs Internet address via WWW is http://www. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. The federal recomendations have been updated as of July 1999. Tremor: Trembling or shaking caused by disease or stress. Federal Recycling Program Printed on Recycled Paper . Evaporate: To change into a vapor or a gas. Atlanta. Although chlorobenzene did not produce cancer in animal studies with rats and mice. The Occupational Safety and Health Administration (OSHA) has set a workplace air concentration limit of 75 ppm over an 8-hour workday. FAX: 404-498-0093. 1990. Glossary Carcinogenicity: Ability to cause cancer. National Priorities List: A list of the nation’s worst hazardous waste sites. evaluate. Their specialists can recognize.gov/toxfaq. Is there a medical test to show whether I’ve been exposed to chlorobenzene? Exposure to chlorobenzene can be determined by measuring it or its metabolites in urine. restlessness. Laws today protect the welfare of research animals and scientists must follow strict guidelines.atsdr. Mailstop E-29. These tests are not usually done in the doctors’ office because special equipment is needed. Public Health Service. tremors.488 ppm to prevent possible health effects from drinking water or eating fish contaminated with this group of chemicals.cdc. Phone: 1-888-422-8737. Longer exposure has caused liver and kidney damage. Toxicological profile for chlorobenzene. contact the Agency for Toxic Substances and Disease Registry. Concentrations in drinking water for short-term exposures (up to 10 days) should not exceed 2 ppm. Atlanta. and treat illnesses resulting from exposure to hazardous substances. exhaled air. Pesticide: A substance that kills pests.

Most CDFs are produced in small amounts as undesirable by-products of certain processes. and people that are exposed to CDFs in their food. This fact sheet is one in a series of summaries about hazardous substances and their health effects. dibenzofuran. G Breathing contaminated workplace air. Not all of the different types have been found in large enough quantities to study the physical properties. CDFs can also be released from incinerators.7. wood. are a family of chemicals that contain one to eight chlorine atoms attached to the carbon atoms of the parent chemical. results from eating contaminated food). call the ATSDR Information Center at 1-888-422-8737. G They attach to soil and sediment in lakes and rivers. and milk (90% of daily exposure.CHLORODIBENZOFURANS (CDFs) Agency for Toxic Substances and Disease Registry ToxFAQs September 1995 This fact sheet answers the most frequently asked health questions (FAQs) about chlorodibenzofurans (CDFs). of those that have been studied. G They are not likely to move into groundwater from soil. There are 135 different types of CDFs with varying harmful health and environmental effects. coffee filters. SUMMARY: Exposure to chlorodibenzofurans (CDFs) occurs mainly by eating certain contaminated foods. fish. G They can enter the environment from car exhausts or from burning coal. What are chlorodibenzofurans (CDFs)? (Pronounced klôr“½ dº bµn“-z½ fy‹r“ôn”) Chlorinated dibenzofurans. G Breathing air or drinking water that is contaminated. G They can be removed from the air in snow and rain. birds. G They also build up in other animals.3. how you are exposed. What happens to CDFs when they enter the environment? U. In people. and whether other chemicals are present. the duration. However. G Vaporized CDFs are broken down by other chemicals in the atmosphere. they are not deliberately produced by industry. The effects of exposure to any hazardous substance depend on the dose. or CDFs.8-positions of the dibenzofuran molecule are known to be especially harmful. such as manufacturing other chemicals or bleaching at paper and pulp mills. For more information. G CDFs exist in the air as solid particles and sometimes vapors. G Using products such as milk cartons. There is no known use for these chemicals. DEPARTMENT OF HEALTH AND HUMAN SERVICES. which is only a few picograms [pg]. This chemical has been found in at least 51 of 1. The compounds that contain chlorine atoms at the 2. such as meat. they do not dissolve in water easily and appear to be in the form of colorless solids. How might I be exposed to CDFs? G Eating contaminated foods.416 National Priorities List sites identified by the Environmental Protection Agency. and increased vulnerability to respiratory infection and nervous system effects. and tampons could result in very low exposures. Other than for research purposes. or oil for home heating.S. personal traits and habits. exposure to CDFs is most likely to cause skin and eye irritation. G They accumulate in fish to tens of thousands times higher levels than in the water or sediment. Public Health Service Agency for Toxic Substances and Disease Registry . or coming in contact with contaminated soil. and the production of electricity. This information is important because this substance may harm you.

1600 Clifton Road NE. body fat. Most of the information on the adverse health effects comes from studies in people who were accidentally exposed to food contaminated with CDFs. Is there a medical test to show whether I've been exposed to CDFs? There are tests available to measure CDFs in your blood. cancer did develop. There are no cancer studies in animals that ate or References Agency for Toxic Substances and Disease Registry (ATSDR).gov/toxfaq. ToxFAQs Internet address via WWW is http://www. Animals also had severe weight loss. Public Health Service. 1994. It is not definitely known if CDFs cause cancer in people.cdc. Division of Toxicology. and immune systems were seriously injured. Many of the same effects that occurred in people also occurred in laboratory animals that ate CDFs. Mailstop E-29. and in severe cases. effects on the nervous system. they did not cause cancer. including severe acne. more frequent lung infections. Nearly everyone in the United States and other industrialized countries has been exposed to low levels of CDFs because they are in the environment. and their stomachs. Children born to exposed mothers had skin irritation and more difficulty learning. One study found that when CDFs were applied to the skin of animals. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. or small amounts over several weeks or months. How likely are CDFs to cause cancer? The Department of Health and Human Services. Phone: 1-888-422-8737. Carcinogenicity: Ability to cause cancer. darkened skin color. CDFs caused skin and eye irritations. the International Agency for Research on Cancer.atsdr. and breast milk. FAX: 404-498-0093. The tests can tell you if you have been exposed. and swollen eyelids with discharge from the eyes. and treat illnesses resulting from exposure to hazardous substances. numbness. Atlanta.atsdr. and the Environmental Protection Agency (EPA) have not classified CDFs for carcinogenicity. The tests also cannot predict whether you will experience harmful health effects. breathed CDFs. and mild changes in the liver. Department of Health and Human Services. Picogram (pg): One trillionth of a gram. Federal Recycling Program Printed on Recycled Paper .html ATSDR can tell you where to find occupational and environmental health clinics. some animals died. contact the Agency for Toxic Substances and Disease Registry. Toxicological profile for chlorodibenzofurans. The amounts that these people were exposed to were much higher than are likely from environmental exposures or from a normal diet.html How can CDFs affect my health? Very little is known about the health effects in people or animals from breathing or touching CDFs.cdc. Glossary Anemia: A decreased ability of the blood to transport oxygen. which is known to initiate tumors.gov/toxfaq. Atlanta. kidneys. CDF poisoning also caused vomiting and diarrhea. but when they were applied with another compound called MNNG. evaluate. anemia. GA: U. livers. GA 30333. Some animals had birth defects and testicular damage.Page 2 CHLORODIBENZOFURANS (CDFs) ToxFAQs Internet address via WWW is http://www. A study in mice showed that skin exposure to low levels over several weeks produced effects similar to those from ingesting CDFs. but they can't tell you the exact amount of CDFs or for how long you were exposed. Their specialists can recognize. These effects in animals were seen when they were fed large amounts of CDFs over a short time.S. Where can I get more information? For more information. Has the federal government made recommendations to protect human health? There are no federal guidelines or recommendations for protecting human health or the environment from exposure to CDFs.

HIGHLIGHTS: Exposure to chloroethane can occur from breathing air or drinking water containing it. however.CHLOROETHANE CAS # 75-00-3 Agency for Toxic Substances and Disease Registry ToxFAQs June 1999 This fact sheet answers the most frequently asked health questions (FAQs) about chloroethane.467 National Priorities List sites identified by the Environmental Protection Agency (EPA). but strict new government regulations have reduced that use dramatically. chloroethane is slowly changed into a simpler form by reaction with water. People may be exposed through skin contact if it is used in a medical procedure. how you are exposed. The effects of exposure to any hazardous substance depend on the dose. the duration. call the ATSDR Information Center at 1-888-422-08737. dyes. Public Health Service Agency for Toxic Substances and Disease Registry . U. It can evaporate from landfills. It’s important you understand this information because this substance may harm you. personal traits and habits. For more information. and painters. mechanics. Small amounts can enter groundwater by filtering through the soil. It has a characteristically sharp smell. It can be released during its use as a solvent. and whether other chemicals are present.S. What happens to chloroethane when it enters the environment? G Most chloroethane exists as a gas in the atmosphere. Workers who may be exposed include doctors. causing lack of muscle control and unconsciousness. What is chloroethane? (Pronounced klôr“ ½ µth“ ³n”) Chloroethane is a colorless gas at room temperature and pressure. refrigerant. medicinal drugs. and as a solvent and refrigerant. Exposure to high levels of chloroethane can affect your nervous system. In groundwater. It is also used to numb the skin before medical procedures such as ear piercing and skin biopsies and as a treatment in sports injuries. and other commercial products. Chloroethane may be present in drinking water as a result of chlorination. Some types of bacteria in water may break it down to smaller compounds. This fact sheet is one in a series of summaries about hazardous substances and their health effects. plumbers. Chloroethane catches fire easily. It was used in leaded gasoline. It is a liquid when stored in pressurized containers. This substance has been found in at least 282 of the 1. DEPARTMENT OF HEALTH AND HUMAN SERVICES. and anesthetic. It is used in the production of cellulose. nurses. G G G G It breaks down fairly rapidly (about half disappears within 40 days) by reacting with other substances in the air. How might I be exposed to chloroethane? G G G G G G Chloroethane can be released to air from factories that manufacture or use it. the liquid evaporates quickly when exposed to room air.

Their specialists can recognize. Is there a medical test to show whether I’ve been exposed to chloroethane? There are complex analytical tests that chemists use to measure chloroethane in blood. The Occupational Safety and Health Administration (OSHA) regulates the amount of chloroethane in workplace air. contact the Agency for Toxic Substances and Disease Registry. The limit for an 8-hour workday.html ATSDR can tell you where to find occupational and environmental health clinics. Has the federal government made recommendations to protect human health? EPA requires industries to report accidental discharges or spills of 100 pounds or more of chloroethane to EPA. How can chloromethane affect children? We don't know whether chloroethane exposure can affect development in people. Atlanta. The American Conference of Governmental Industrial Hygienists (ACGIH) recommends a limit of 100 ppm chloroethane in workplace air. Where can I get more information? For more information.000 ppm).S. is 1. Phone: 1-888-422-8737. or urine. Department of Health and Human Services.000 parts per million (1. Open windows and doors when such products are used in the home. Federal Recycling Program Printed on Recycled Paper . GA 30333.html How can chloroethane affect my health? Brief exposure to high levels can produce temporary feelings of drunkenness. vomiting.cdc. Store products containing it safely and follow directions carefully. Some people had allergic reactions to it. it can cause lack of muscle coordination and unconsciousness. the babies of mice exposed to chloroethane during pregnancy had delayed development. frostbite can result. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). FAX: 404-498-0093. It is not known whether it causes cancer in humans. paints.gov/toxfaq. It is not known whether children differ from adults in their susceptibility to chloroethane. The International Agency for Research on Cancer (IARC) has concluded that chloroethane is not classifiable as to its carcinogenicity in humans. However. Public Health Service. Atlanta. Mailstop E-29. How likely is chloroethane to cause cancer? Laboratory tests in animals have shown that long-term exposure can cause cancer in mice. and other solvents. G G G Make sure containers are tightly covered.gov/toxfaq. Toxicological profile for chloroethane. At higher levels. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. ToxFAQs Internet address via WWW is http://www. GA: U. nausea. Limit the use of consumer products that contain it. no commonly used medical tests are available to determine whether or not a person has been exposed to chloroethane. How can families reduce the risk of exposure to chloroethane? G G G Avoid using products that contain chloroethane if you are pregnant. over a 40-hour workweek.atsdr.atsdr. evaluate. Division of Toxicology. Make your children aware of the harmful effects of sniffing glue. In animal studies. It can also cause stomach cramps. If it is applied for too long. milk. and others experienced mild pain after being sprayed for 10 seconds. Chloroethane is sometimes applied to the skin as a numbing agent before surgery.cdc. and treat illnesses resulting from exposure to hazardous substances. and eye irritation. 1600 Clifton Road NE. 1998.Page 2 CHLOROETHANE CAS # 75-00-3 ToxFAQs Internet address via WWW is http://www.

and whether other chemicals are present. How might I be exposed to chloroform? G Drinking water or beverages made using water containing chloroform. DEPARTMENT OF HEALTH AND HUMAN SERVICES. the duration. but it is a slow process. It can cause sores if large amounts touch your skin. For more information. This fact sheet is one in a series of summaries about hazardous substances and their health effects. How can chloroform affect my health? Breathing about 900 parts of chloroform per million parts air (900 ppm) for a short time can cause dizziness. nonirritating odor and a slightly sweet taste. U. What happens to chloroform when it enters the environment? G Chloroform evaporates easily into the air. HIGHLIGHTS: Exposure to chloroform can occur when breathing contaminated air or when drinking or touching the substance or water containing it. and headaches. G Chloroform doesn’t appear to build up in great amounts in plants and animals. but it isn’t used that way today. fatigue. fatigue. call the ATSDR Information Center at 1-888-422-8737.CHLOROFORM CAS # 67-66-3 Agency for Toxic Substances and Disease Registry ToxFAQs September 1997 This fact sheet answers the most frequently asked health questions (FAQs) about chloroform. which are both toxic. or drinking water containing high levels of chloroform for long periods of time may damage your liver and kidneys. In the past.S. G It doesn’t stick to soil very well and can travel through soil to groundwater. Public Health Service Agency for Toxic Substances and Disease Registry . Breathing chloroform or ingesting chloroform over long periods of time may damage your liver and kidneys. and headache. What is chloroform? (Pronounced klôr“…-fôrm”) Chloroform is a colorless liquid with a pleasant. Other names for chloroform are trichloromethane and methyl trichloride. Breathing air.430 National Priorities List sites identified by the Environmental Protection Agency (EPA). Today. G The breakdown products in air include phosgene and hydrogen chloride. G Breathing indoor or outdoor air containing it. eating food. It’s important you understand this information because this substance may harm you. G Skin contact with chloroform or water that contains it. Large amounts of chloroform can cause sores when chloroform touches your skin. G Chloroform dissolves easily in water and some of it may break down to other chemicals. especially in the workplace. Breathing chloroform can cause dizziness. such as in swimming pools. personal traits and habits. how you are exposed. It will burn only when it reaches very high temperatures. chloroform was used as an inhaled anesthetic during surgery. G Chloroform lasts a long time in groundwater. G Most of the chloroform in air breaks down eventually. G Eating food that contains it. The effects of exposure to any hazardous substance depend on the dose. This substance has been found in at least 717 of the 1. chloroform is used to make other chemicals and can also be formed in small amounts when chlorine is added to water.

a class of chemicals that includes chloroform.gov/toxfaq. The Occupational Safety and Health Administration (OSHA) has set the maximum allowable concentration of chloroform in workroom air during an 8-hour workday in a 40-hour workweek at 50 ppm. Has the federal government made recommendations to protect human health? The EPA drinking water limit for total trihalomethanes. Division of Toxicology. GA.atsdr. U. Animal studies have shown that miscarriages occurred in rats and mice that breathed air containing 30 to 300 ppm chloroform during pregnancy and also in rats that ate chloroform during pregnancy.html ATSDR can tell you where to find occupational and environmental health clinics. 1600 Clifton Road NE. Phone:1888-422-8737. urine. Department of Health and Human Services.atsdr.S. Although the amounts of chloroform in the air that you exhale and in blood.gov/toxfaq.html It isn’t known whether chloroform causes reproductive effects or birth defects in people. Ingesting: Taking food or drink into your body. and body tissues can be measured. Mailstop E-29. may help to determine if you have come into contact with Public Health Service in Atlanta. contact the Agency for Toxic Substances and Disease Registry. FAX: 404-498-0093.cdc. evaluate.cdc. Agency for Toxic Substances and Disease Registry. Microgram (µg): One millionth of a gram. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. How likely is chloroform to cause cancer? The Department of Health and Human Services (DHHS) has determined that chloroform may reasonably be anticipated to be a carcinogen.Page 2 CHLOROFORM CAS # 67-66-3 ToxFAQs Internet address via WWW is http://www. The EPA requires that spills or accidental releases of 10 pounds or more of chloroform into the environment be reported to the EPA. large amounts of chloroform. Source of Information there is no reliable test to determine how much chloroform you This ToxFAQs information is taken from the 1997 Toxicohave been exposed to or whether you will experience any logical Profile for Chloroform (update) produced by the harmful effects. Their specialists can recognize. research animals and scientists must follow strict guidelines. but these tests are useful for only Animal testing is sometimes necessary to find out how a short time after you are exposed. Glossary Carcinogenicity: A substance with the ability to cause cancer. Rats and mice that ate food or drank water with chloroform developed cancer of the liver and kidneys. Chloroform in your body might also indicate that you have come into contact with other toxic substances might harm people and how to treat people who have been exposed. CAS: Chemical Abstracts Service. and treat illnesses resulting from exposure to hazardous substances. Atlanta. is 100 micrograms per liter of water (100 µg/L). ppm: Parts per million. Is there a medical test to show whether I’ve been Miscarriage: Pregnancy loss. Abnormal sperm were found in mice that breathed air containing 400 ppm chloroform for a few days. exposed to chloroform? Where can I get more information? For more information. GA 30333. Federal Recycling Program Printed on Recycled Paper . Laws today protect the welfare of chemicals. ToxFAQs Internet address via WWW is http://www. Offspring of rats and mice that breathed chloroform during pregnancy had birth defects. Public The measurement of chloroform in body fluids and tissues Health Service.

personal traits and habits. colorless gas. and sediment. Chloromethane is an impurity in vinyl chloride. sweet odor that is noticeable only at levels that may be toxic. It could also affect your heart rate and blood pressure. These symptoms can last for several months or years. tremors. and it is extremely flammable. animals. and heart. Most of the chloromethane in soil will move to air. confusion. how you are exposed. and whether other chemicals are present. How can chloromethane affect my health? Breathing very high levels.467 National Priorities List sites identified by the Environmental Protection Agency (EPA). This substance has been found in at least 172 of the 1. charcoal. Public Health Service Agency for Toxic Substances and Disease Registry . nausea. but certain microorganisms can break it down more quickly. and plastics are burned. What is chloromethane? (Pronounced klôr” ½ mµth“ ³n) Chloromethane is also known as methyl chloride. exposure could occur from disposal of vinyl chloride waste. aerosol propellants.CHLOROMETHANE CAS # 74-87-3 Agency for Toxic Substances and Disease Registry ToxFAQs June 1999 This fact sheet answers the most frequently asked health questions (FAQs) about chloromethane. U. It is also given off when materials like grass. such as chemical reactions that occur in the oceans. It’s important you understand this information because this substance may harm you. blurred or double vision. kidneys. It breaks down slowly in water. How might I be exposed to chloromethane? K Some chloromethane is produced by industry. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Chloromethane breaks down very slowly in air. including convulsions and coma. and chlorinated swimming pools. fatigue. Lower exposures can also cause staggering. Other sources of exposure are cigarette smoke. DEPARTMENT OF HEALTH AND HUMAN SERVICES. surface water. soil. call the ATSDR Information Center at 1-888-422-8737. polystyrene insulation. even for a short time. or vomiting. groundwater. It does not concentrate in plants. For more information. can have serious effects on your nervous system. It is present at very low concentrations throughout the atmosphere. It is heavier than air. dizziness. It is a clear. HIGHLIGHTS: Exposure to high levels of chloromethane can cause serious problems to your nervous system. including convulsions and coma. K K K K What happens to chloromethane when it enters the environment? K K K K K K Chloromethane is found in air.S. The effects of exposure to any hazardous substance depend on the dose. It can also affect your liver. the duration. or fish. Exposure to chloromethane can harm your liver and kidneys. It has a faint. personality changes. K Most of the chloromethane that is released into the environment is from natural sources. It is present in lakes and streams and has been found in drinking water. wood.

may suggest to a doctor that a person has been exposed to chloromethane. In animal studies. Where can I get more information? For more information. contact the Agency for Toxic Substances and Disease Registry.S. and male and female rats did not. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. Symptoms resembling drunkenness and food poisoning. and treat illnesses resulting from exposure to hazardous substances. Mailstop E-29. Laws today protect the welfare of research animals and scientists must follow strict guidelines. ToxFAQs Internet address via WWW is http://www.Page 2 CHLOROMETHANE CAS # 74-87-3 ToxFAQs Internet address via WWW is http://www.cdc.atsdr. 1600 Clifton Road NE. or even sterile. Properly dispose of the older types of refrigerators that used chlormethane as a refrigerant. Their specialists can recognize. Animal studies show that female rats exposed to chloromethane during pregnancy had young that were smaller than normal.cdc. We do not know if chloromethane exposure will harm developing fetuses or young children. Females that became pregnant by these males lost their developing young. K K How likely is chloromethane to cause cancer? There is no evidence that chloromethane causes cancer in people. Division of Toxicology.gov/toxfaq. such as workplaces that use chloromethane. How can chloromethane affect children? There are no studies on the health effects on children from exposure to chloromethane. Source of Information How can families reduce the risk of exposure to chloromethane? K K K Keep children away from contaminated areas.html ATSDR can tell you where to find occupational and environmental health clinics. with underdeveloped bones. males that were exposed to chloromethane were less fertile. Check product labels for ingredients.atsdr.html Some animal studies showed that animals that breathed low levels of chloromethane experienced slower growth and had brain damage. or produced damaged sperm. Has the federal government made recommendations to protect human health? The Occupational Safety and Health Administration (OSHA) has set a permissible exposure limit for chloromethane of 100 parts per million (100 ppm) for an 8-hour workday in a 40-hour workweek. Have your drinking water tested if you are concerned about it. 1998. Public Health Service. Department of Health and Human Services. Toxicological profile for chloromethane. The EPA has determined that chloromethane is a possible human carcinogen. male mice that breathed contaminated air for 2 years developed tumors in their kidneys. GA 30333. evaluate. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Phone: 1-888-8737. Atlanta: U.gov/toxfaq. Atlanta. FAX: 404-498-0093. Is there a medical test to show whether I’ve been exposed to chloromethane? There are no known reliable medical tests to determine whether you have been exposed to chloromethane. along with a sweet odor of the breath. Federal Recycling Program Printed on Recycled Paper . Become familiar with safety practices if you work with or near chloromethane. K Teach children the dangers of breathing smoke from burning vinyl plastic or silicone rubber products (chloromethane is released). Agency for Toxic Substances and Disease Registry (ATSDR). In other animal studies. and possibly abnormal hearts (this effect remains uncertain). contact manufacturers for additional information if you need it. but female mice.

sunlight helps destroy these compounds and rain washes them out of the air. G Low levels of chlorophenols in water. G You can be exposed if you work with chlorophenols or use them as pesticides. G There are some chlorophenols in city air. call the ATSDR Information Center at 1-888-422-8737.CHLOROPHENOLS Agency for Toxic Substances and Disease Registry ToxFAQs June 1999 This fact sheet answers the most frequently asked health questions (FAQs) about chlorophenols. or sediment are broken down and removed from the environment in a few days to weeks by microorganisms. the duration. G In the air. In laboratory studies. For more information. G Most chlorophenols released to the environment go into water. Public Health Service Agency for Toxic Substances and Disease Registry . G Chlorophenols stick to soil and sediments at the bottom of lakes. They are also produced while bleaching wood pulp with chlorine to make paper. It’s important you understand this information because this substance may harm you. There are 5 basic types of chlorophenols and 19 different chlorophenols. They have a strong. and rivers. and whether other chemicals are present. This fact sheet is one in a series of summaries about hazardous substances and their health effects. What happens to chlorophenols when they enter the environment? G Chlorophenols can enter the environment when they are being made or used as pesticides. Phenol is an aromatic compound derived from benzene. These substances have been found in at least 166 of the 1. how you are exposed. DEPARTMENT OF HEALTH AND HUMAN SERVICES. The effects of exposure to any hazardous substance depend on the dose.467 National Priorities List sites identified by the Environmental Protection Agency (EPA). How can chlorophenols affect my health? Workers exposed to pesticides that contain chlorophenols have developed acne and mild injury to their livers. Most chlorophenols are solid at room temperature. Some chlorophenols are used as pesticides. Small amounts are produced when water is disinfected with chlorine. Small amounts can be tasted in water.S. Exposure to high levels can cause damage to the liver and immune system. What are chlorophenols? (Pronounced klôr“…-f¹-n¼lz“) Chlorophenols are a group of chemicals that are produced by adding chlorines to phenol. G You can be exposed if you make or use treated wood. They did not gain as much weight as animals not fed the compounds. G Small amounts of chlorophenols enter the air. HIGHLIGHTS: Chlorophenols are a group of compounds that are used in a number of industries and products. High levels of chlorophenols given to pregnant female U. soil. Others are used in antiseptics. streams. personal traits and habits. How might I be exposed to chlorophenols? G Most people are exposed to very low levels of chlorophenols in chlorinated drinking water. medicinal taste and smell. animals that received high levels of chlorophenols in food or water developed liver and immune system effects.

and caused low birth weights. 1999. spine. 1600 Clifton Road NE. For 2. How can chlorophenols affect children? Children can be exposed in the same ways as adults. Chlorophenols leave the body quickly. Atlanta. caused leukemia in rats and liver cancer in mice.S. GA 30333. 2.4.04 mg/L) of 2-chlorophenol for a lifetime exposure for an adult.04 milligrams per liter (0. Toxicological profile for chlorophenols. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). Always check labels on household products. The Department of Health and Human Services (DHHS) has determined that 2.gov/toxfaq. Department of Health and Human Services.cdc. FAX: 404-498-0093. however. Atlanta. such as soda bottles.atsdr. There are tests for certain compounds that are produced in your body when chlorophenols break down.6-trichlorophenol. or longer exposure for a child. ToxFAQs Internet address via WWW is http://www. How likely are chlorophenols to cause cancer? There is evidence to suggest that people exposed to chlorophenols for a long time may have slightly higher incidences of cancer.atsdr.4-dichlorophenol. exposure to other substances could also produce the same test results. original containers.cdc. There are no human studies on the effects of chlorophenols on developing fetuses. and store them safely in their Where can I get more information? For more information. and skull. How can families reduce the risk of exposure to chlorophenols? Parents should keep children away from areas where chlorophenols have been used as pesticides.6-trichlorophenol may reasonably be anticipated to be a carcinogen. contact the Agency for Toxic Substances and Disease Registry. The most common problems are delayed hardening of the bones of the breastbone. Never store chemicals in containers that children might find attractive to eat or drink from.05 mg/L for a 1-day. evaluate. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Chlorophenols have not been shown to cause birth defects in animals.03 mg/L for a 1-day. Has the federal government made recommendations to protect human health? EPA recommends that drinking water contain no more than 0. Phone: 1-888-422-8737. In animal studies. and treat illnesses resulting from exposure to hazardous substances. Mailstop E-29. the people studied were exposed to other chemicals as well.html rats in their drinking water reduced the number of babies they had. Their specialists can recognize. 10-day.4. Laws today protect the welfare of research animals and scientists must follow strict guidelines. Studies in rats showed that chlorophenols can pass through the placenta and produce toxic effects to the developing fetuses.html ATSDR can tell you where to find occupational and environmental health clinics. Federal Recycling Program Printed on Recycled Paper . 10-day. Division of Toxicology. Is there a medical test to show whether I’ve been exposed to chlorophenols? There is no test to show if you have been exposed to chlorophenols. and 0. However. or longer exposure for a child. However.Page 2 CHLOROPHENOLS ToxFAQs Internet address via WWW is http://www. one chlorophenol. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. Public Health Service. GA: U.gov/toxfaq. children may be more sensitive than adults to the effects of chlorophenol-based pesticides and herbicides. EPA recommends that drinking water contain no more than 0. so they are not likely to accumulate in the mother’s tissues or breast milk.

DEPARTMENT OF HEALTH AND HUMAN SERVICES. watering of the eyes (called lacrimation). runny nose. In the home. so it is usually mixed with oily liquids before it is applied to crops or animals. The effects of exposure to any hazardous substance depend on the dose. nau- U. This fact sheet is one in a series of summaries about hazardous substances and their health effects. blurred vision. fleas or cockroaches. spills. It’s important you understand this information because this substance may harm you. What is chlorpyrifos ? (Pronounced ôH F H]= B I) Chlorpyrifos is an insecticide that is a white crystal-like solid with a strong odor. ranging from headaches. How might I be exposed to chlorpyrifos? G Using it to control household pests such as termites. how you are exposed. How can chlorpyrifos affect my health? Breathing the air in an area in which chlorpyrifos has recently been sprayed may produce a variety of effects on the nervous system including headaches. houses and other buildings. lawns. depending on the amount and length of exposure.S. and termites. G Chlorpyrifos sticks tightly to soil particles. coma. G Putting food or other chlorpyrifos contaminated items in your mouth. G Touching soil or crops in a field where it was sprayed or touching freshly sprayed areas in a house. On the farm. G Breathing air outside of homes or other buildings where chlorpyrifos was applied to the ground around the foundation to control termites. and the disposal of chlorpyrifos waste. or other chemical processes. and death. bacteria. Public Health Service Agency for Toxic Substances and Disease Registry . Chlorpyrifos has been found in at least 7 of the 1. and whether other chemicals are present. the duration. and salivation to seizures. Chlorpyrifos has been widely used in homes and on farms. blurred vision. excessive salivation. confusion. dizziness.CHLORPYRIFOS CAS # 2921-88-2 Agency for Toxic Substances and Disease Registry ToxFAQs September 1997 This fact sheet answers the most frequently asked health questions (FAQs) about chlorpyrifos. G Breathing air in a field where chlorpyrifos was sprayed on to crops. HIGHLIGHTS: Chlorpyrifos is an insecticide which has been widely used in homes and on farms. it is also used in some pet flea and tick collars. fleas.430 National Priorities List sites identified by the Environmental Protection Agency (EPA). G It may also enter the environment through volatilization. muscle weakness or tremors. so it rarely enters local water systems. What happens to chlorpyrifos when it enters the environment? G Chlorpyrifos enters the environment through direct application to crops. It may also be applied to crops in a capsule form. Breathing or ingesting chlorpyrifos may result in a variety of nervous system effects. G It does not mix well with water. G Once in the environment. all the ATSDR Information Center at 1-888-422-8737. It does not mix well with water. it is used to control cockroaches. personal traits and habits. For more information. it is broken down by sunlight. it is used to control ticks on cattle and as a spray to control crop pests.

contact the Agency for Toxic Substances and Disease Registry. GA. Laws today protect the welfare of research animals and scientists must follow strict guidelines. Glossary Carcinogen: A substance with the ability to cause cancer. Public Health Service in Atlanta. There is no information at present to show that chlorpyrifos either effects the ability of humans to reproduce or causes human birth defects. or death. There is also a test which measures a metabolite. Has the federal government made recommendations to protect human health? The EPA requires that spills or accidental releases into the Where can I get more information? For more information. seizures. The EPA has not classified chlorpyrifos for carcinogenicity. including chlorpyrifos.html sea. The effect depends on the amount in the air and length of time exposed. putting objects of hands in with chlorpyrifos levels greater than 0.cdc. Public Health Service. loss of con0. Phone: 1-888-422-8737. may cause similar water (0.atsdr. The Food and Drug Administration (FDA) has set tolerExposure to high levels may cause severe sweating. Their specialists can recognize. of chlorpyrifos in the urine.Page 2 CHLORPYRIFOS CAS # 2921-88-2 ToxFAQs Internet address via WWW is http://www. Federal Recycling Program Printed on Recycled Paper .03 milligrams per liter of their mouth after touching chlorpyrifos.05 to 15 parts chlorpyrifos per million parts of food (0. ToxFAQs Internet address via WWW is http://www. in the case of children. severe muscle tremors. CAS: Chemical Abstracts Service. Animal studies have not shown that chlorpyrifos causes Insecticide: A substance that kills insects. cancer. The metabolite TCP can usually be found in the urine for several days after the exposure to chlorpyrifos occurred. Division of Toxicology. U.05– sciousness (coma). evaluate. Milligram (mg): One thousandth of a gram. How likely is chlorpyrifos to cause cancer? Ingest: To eat or drink something. and treat illnesses resulting from exposure to hazardous substances. 15 ppm). Department of Health and Human Services. It is not known whether chlorpyrifos can cause cancer in people. a pesticide. environment of 1 pound or more of chlorpyrifos be reported to the EPA. TCP: Metabolite of chlorpyrifos. loss of ances for chlorpyrifos for agricultural products ranging from bowel control. This test measures the activity of an enzyme called acetylcholinesterase in the blood. Is there a medical test to show whether I’ve been exposed to chlorpyrifos? There is a general test that can be used to determine if you have been exposed to a ceratin group of insecticides. Volatilization: The changing of a liquid into a vapor or a gas. Source of Information This ToxFAQs information is taken from the 1997 Toxicological Profile for Chlorpyrifos produced by the Agency for Toxic Substances and Disease Registry. Atlanta.html ATSDR can tell you where to find occupational and environmental health clinics. symptoms. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.cdc.S. GA 30333.atsdr.gov/toxfaq. Ingesting chlorpyrifos orally through contaminated food The EPA also recommends that children not drink water containers or.03 mg/L) for periods of 1–10 days. or breakdown product (known as TCP). 1600 Clifton Road NE. Mailstop E-29.gov/toxfaq. FAX: 404-498-0093. diarrhea. and sudden changes in heart rate. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. ppm: Parts per million (1 ppm is equal to 1 mg/L in water).

and chromium(VI).CHROMIUM CAS # 7440-47-3 Division of Toxicology ToxFAQsTM February 2001 This fact sheet answers the most frequently asked health questions (FAQs) about chromium. leather tanning. and in volcanic dust and gases. No taste or odor is associated with chromium compounds. soil. This fact sheet is one in a series of summaries about hazardous substances and their health effects. and even death. Chromium has been found at 1. Breathing high levels of chromium(VI) can cause irritation to the nose. and ulcers and holes in the nasal septum. the duration. dyes and pigments. How might I be exposed to chromium? [ Eating food containing chromium(III). HIGHLIGHTS: Exposure to chromium occurs from ingesting contaminated food or drinking water or breathing contaminated workplace air. call the ATSDR Information Center at 1-888-422-8737. and soil mostly in the chromium(III) and chromium(VI) forms. chromium compounds are present mostly as fine dust particles which eventually settle over land and water. personal traits and habits. Chromium is present in the environment in several different forms. [ Drinking contaminated well water. The metal chromium.036 of the 1. How can chromium affect my health? Chromium(III) is an essential nutrient that helps the body use sugar.S. protein. For more information. Chromium(VI) and chromium(III) are used for chrome plating. and fat. What is chromium? Chromium is a naturally occurring element found in rocks. [ Living near uncontrolled hazardous waste sites containing chromium or industries that use chromium. water. nosebleeds. animals. The most common forms are chromium(0). chromium(III). DEPARTMENT OF HEALTH AND HUMAN SERVICES. What happens to chromium when it enters the environment? [ Chromium enters the air. such as runny nose. and wood preserving. [ Chromium can strongly attach to soil and only a small U. The effects of exposure to any hazardous substance depend on the dose. [ In air. how you are exposed. It’s important you understand this information because this substance may harm you. Chromium(VI) at high levels can damage the nose and can cause cancer. [ Breathing contaminated workplace air or skin contact during use in the workplace. Ingesting large amounts of chromium(VI) can cause stomach upsets and ulcers. is used for making steel.591 National Priority List sites identified by the Environmental Protection Agency (EPA). Chromium(VI) and chromium(0) are generally produced by industrial processes. which is the chromium(0) form. and whether other chemicals are present. plants. Chromium(III) occurs naturally in the environment and is an essential nutrient. amount can dissolve in water and move deeper in the soil to underground water. Public Health Service Agency for Toxic Substances and Disease Registry . kidney and liver damage. convulsions. [ Fish do not accumulate much chromium in their bodies from water.

Their specialists can recognize. How likely is chromium to cause cancer? Several studies have shown that chromium(VI) compounds can increase the risk of lung cancer. Atlanta. Some people are extremely sensitive to chromium(VI) or chromium(III). and treat illnesses resulting from exposure to hazardous substances. [ Although chromium(III) is an essential nutrient.000 g/m3 for metallic chromium(0) and insoluble chromium compounds. 1600 Clifton Road NE. It is likely that health effects seen in children exposed to high amounts of chromium will be similar to the effects seen in adults. These tests cannot determine the exact levels of chromium that you may have been exposed to or predict how the levels in your tissues will affect your health. The EPA has determined that chromium(VI) in air is a human carcinogen.cdc. and 52 g/m3 for chromium(VI) compounds for 8-hour work shifts and 40-hour work weeks.html Skin contact with certain chromium(VI) compounds can cause skin ulcers.gov/toxfaq. you should avoid excessive use of dietary supplements containing chromium.html . How can families reduce the risk of exposure to chromium? [ Children should avoid playing in soils near uncontrolled hazardous waste sites where chromium may have been discarded.S. Mailstop E-29. Toxicological Profile for Chromium. The World Health Organization (WHO) has determined that chromium(VI) is a human carcinogen. Allergic reactions consisting of severe redness and swelling of the skin have been noted. How can chromium affect children? We do not know if exposure to chromium will result in birth defects or other developmental effects in people.gov/toxfaq. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. evaluate. urine. Phone: 1-888-422-8737. FAX: 404-498-0093. Birth defects have been observed in animals exposed to chromium(VI). These tests are most useful for people exposed to high levels. contact the Agency for Toxic Substances and Disease Registry. GA 30333. Federal Recycling Program Printed on Recycled Paper . Where can I get more information? For more information. The Occupational Safety and Health Administration (OSHA) has set limits of 500 g water soluble chromium(III) compounds per cubic meter of workplace air (500 g/m3). Has the federal government made recommendations to protect human health? EPA has set a limit of 100 g chromium(III) and chromium(VI) per liter of drinking water (100 g/L). Is there a medical test to show whether I’ve been exposed to chromium? Since chromium(III) is an essential element and naturally occurs in food. Division of Toxicology. GA: U. Department of Health and Human Services.Page 2 CHROMIUM CAS # 7440-47-3 ToxFAQsTM Internet address is http://www. Animal studies have also shown an increased risk of cancer. ATSDR can tell you where to find occupational and environmental health clinics. The Department of Health and Human Services (DHHS) has determined that certain chromium(VI) compounds are known to cause cancer in humans.atsdr. Public Health Service. Atlanta.cdc.atsdr. ToxFAQsTM Internet address is http://www. 1. there will always be some level of chromium in your body. and blood. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). 2000. There are tests to measure the level of chromium in hair.

and used as a drier for porcelein enamel and paints. eating food. and 57Co. At high levels. and food. how you are exposed. What is cobalt? Cobalt is a naturally occurring element found in rocks. or that produce cobalt alloys or use cobalt. At low levels. or nuclear waste storage sites may be exposed to 60Co or 58Co. The two most commercially important radioactive cobalt isotopes are 60Co (read as cobalt sixty). and whether other chemicals are present. magnets. Radioactive decay is the only way of decreasing the amount of radioactive cobalt in the environment. However. plants. Cobalt is beneficial for humans because it is part of vitamin B12. and food irradiation. It is important you understand this information because this substance may harm you. the duration. HIGHLIGHTS: The general population is exposed to low levels of cobalt in air. is used to produce alloys (mixtures of metals) used in the manufacture of aircraft engines. grinding and cutting tools. it is part of vitamin B12. artificial hip and knee joints. How might I be exposed to cobalt? ‘ You can be exposed to low levels of cobalt by breathing air. This fact sheet is one in a series of summaries about hazardous substances and their health effects. personal traits and habits. Public Health Service Agency for Toxic Substances and Disease Registry . mine.S. The effects of exposure to any hazardous substance depend on the dose. radiation therapy for treating cancer patients. For more information.COBALT CAS #7440-48-4 Division of Toxicology ToxFAQsTM September 2001 This fact sheet answers the most frequently asked health questions (FAQs) about cobalt. irradiation facilities. Exposure to high levels of cobalt can result in lung and heart effects and dermatitis. This chemical has been found in at least 11 of the 1. ‘ Working in industries that make or use cutting or grinding tools. Non radioactive cobalt. call the ATSDR Information Center at 1-888-422-8737. which is essential for good health. ‘ In the air it will be associated with particles which will settle to the ground within a few days. Cobalt compounds are also used to color glass. workers at nuclear facilities. ‘ Cobalt cannot be destroyed in the environment. It takes about 5. ‘ The general population is rarely exposed to radioactive cobalt unless a person is undergoing radiation therapy. Some cobalt compounds may dissolve in water. Cobalt has both beneficial and harmful effects on health. or process cobalt metal or ores. soil. 60Co is used as a source of gamma rays for sterilizing medical equipment and consumer products. referred to as stable cobalt. ceramics and paints. U. 57Co is used in medical and scientific research. DEPARTMENT OF HEALTH AND HUMAN SERVICES. It can only change its form or become attached or separated from particles. refine. or drinking water. ‘ Cobalt released into water or the soil will stick to particles. smelt. for manufacturing plastics. Food and drinking water are the largest sources of exposure to cobalt for the general population.7 years for half of 60Co to give off its radiation and about 272 days for 57Co. water. There are non radioactive and radioactive forms of cobalt. it may harm the lungs and heart. and animals. this period of time is called the half-life. water.585 National Priorities List sites identified by the Environmental Protection Agency (EPA). Liver and kidney effects have also been observed in animals exposed to high levels of cobalt. What happens to cobalt when it enters the environment? ‘ Cobalt enters the environment from natural sources and the burning of coal or oil or the production of cobalt alloys. How can cobalt affect my health? Cobalt has both beneficial and harmful effects on human health.

html. We do not know if exposure to cobalt will result in birth defects or other developmental effects in people. GA 30333.cdc. However.html Exposure to large amounts of radioactive cobalt or the radiation it emits can damage cells in your body from the radiation You might also experience acute radiation syndrome which includes nausea. these tests cannot predict whether you will experience any health effects.Page 2 COBALT CAS #7440-48-4 ToxFAQsTM Internet address is http://www. however. 2001. Based on the laboratory animal data. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). GA: U. vomiting. Public Health Service. Exposure to cobalt radiation can also result in developmental effects. Division of Toxicology. It is likely that the health effects seen in children should be similar to the effects seen in adults. urine. Phone: 1-888-4228737. Studies in animals suggest that children may absorb more cobalt than adults from foods and liquids containing cobalt. but your doctor can send the samples to a laboratory that can perform the tests. Department of Health and Human Services. How can families reduce the risk of exposure to cobalt? Children should avoid playing in soils near uncontrolled hazardous waste sites where cobalt may have been discarded.gov/toxfaq. the International Agency for Research on Cancer (IARC) has determined that cobalt and cobalt compounds are possibly carcinogenic to humans. special tests can be used to measure levels of radiative cobalt in blood. Toxicological Profile for Cobalt (Draft for Public Comment).1 milligrams of non radioactive cobalt per cubic meter of workplace air (0. diarrhea. Atlanta. in animals who breathed cobalt or when cobalt was placed directly into the muscle or under the skin. ATSDR can tell you where to find occupational and environmental health clinics.S. ToxFAQs Internet address via WWW is http://www. or the total amount in the body. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.atsdr. The Nuclear Regulatory Commission (NRC) has set annual occupational air limits of 200 ì Ci for 60Co and 3000 µCi for 57 Co. Federal Recycling Program Printed on Recycled Paper . and treat illnesses resulting from exposure to hazardous substances.atsdr. contact the Agency for Toxic Substances and Disease Registry. bleeding. Mailstop E-29. Where can I get more information? For more information. Cancer has been shown. How likely is cobalt to cause cancer? Non radioactive cobalt has not been found to cause cancer in humans or animals following exposure in food or water. Exposure to high levels of cobalt radiation can cause changes in the genetic materials within cells and may result in the development of some types of cancer. Is there a medical test to show whether I’ve been exposed to cobalt? There are reliable tests that can measure cobalt in the urine and blood within a couple of days of exposure. Birth defects have been observed in animals exposed to non radioactive cobalt. These tests are not available at your doctor’s office.gov/toxfaq. and even death. feces. 1600 Clifton Road NE.1 mg/m3) for an 8-hour workday and 40-hour work week. FAX: 404-498-0093. How can cobalt affect children? Little information is available regarding the effects of cobalt in children. evaluate. Has the federal government made recommendations to protect human health? The Occupational Safety and Health Administration (OSHA) has set a limit of 0. The amount of cobalt in your blood or urine can be used to estimate how much cobalt you were exposed to. We do not know whether children differ from adults in their susceptibility to cobalt. If a person has been exposed to radioactive cobalt. Atlanta.cdc. Their specialists can recognize. coma. it is difficult to determine if a person has been exposed only to external radiation from radioactive cobalt. However.

phosphate fertilizer production. The effects of exposure to any hazardous substance depend on the dose.g. and air. Most copper compounds are blue-green in color.S. personal traits and habits. how you are exposed. forest fires. Copper compounds are commonly used in agriculture to treat plant diseases like mildew. It also occurs naturally in plants and animals. and fabrics. vomiting. and natural sources (e. DEPARTMENT OF HEALTH AND HUMAN SERVICES. ! Copper does not typically enter groundwater. Low levels of copper are essential for maintaining good health. electrical wiring. ! Copper in soil strongly attaches to organic material and minerals. For more information. and whether other chemicals are present. Copper has been found in at least 884 of the 1. wood production. soil. but are also manufactured. stomach crumps. HIGHLIGHTS: Copper is a reddish metal that occurs naturally in the environment. for water treatment and. fungicides) to control plant diseases. drinking water. ! Copper that dissolves in water becomes rapidly bound to particles suspended in the water. and nausea. Public Health Service Agency for Toxic Substances and Disease Registry . Copper salts occur naturally. Metallic copper can be easily molded or shaped. This fact sheet is one in a series of summaries about hazardous substances and their health effects. The most common copper salt is copper sulfate.613 National Priorities List sites identified by the Environmental Protection Agency (EPA). or other copper-containing substances. Copper is also found as part of other compounds forming salts. combustion of fossil fuels and wastes. ! Copper carried by particles emitted from smelters and ore processing plants is carried back to the ground by gravity or in rain or snow. ! It can also enter the environment through domestic waste water. mouth and eyes. Metallic copper is also found in mixtures (called alloys) with other metals such as brass and bronze. as preservatives for wood. the duration. Copper also occurs naturally in plants and animals.COPPER CAS # 7440-50-8 Division of Toxicology ToxFAQsTM September 2002 This fact sheet answers the most frequently asked health questions (FAQs) about copper. volcanoes. and some water pipes. eating food.S. ! Some copper in the environment can be taken up by plants and animals.. How might I be exposed to copper? ! Breathing air. ! You may breathe copper-containing dust or have skin contact if you work in the industry of mining copper or What happens to copper when it enters the environment? ! Copper can enter the environment from the mining of copper and other metals and from factories that make or use metallic copper or copper compounds. U. leather. diarrhea. High levels can cause harmful effects such as irritation of the nose. It is important you understand this information because this substance may harm you. call the ATSDR Information Center at 1-888-422-8737. Metallic copper can be found in the U. ! Higher exposure may occur if your water is corrosive and you have copper plumbing and brass water fixtures. decaying vegetation. and by skin contact with soil.. water. and sea spray). penny. What is copper? Copper is a reddish metal that occurs naturally in rocks.g. ! You may be exposed to higher amounts of copper if you drink water or swim in lakes or reservoirs recently treated with copper to control algae or receive cooling water from a power plant that may have high amounts of dissolved copper. windblown dust from soils. water. ! Copper does not break down in the environment. ! Living near bronze and brass production facilities may expose you to higher copper levels in soil. ! Using some garden products (e.

and nails.S. hair. Has the federal government made recommendations to protect human health? The EPA has determined that drinking water should not contain more than 1.cdc. Department of Health and Human Services. you may carry Source of Information Agency for Toxic Substances and Disease Registry (ATSDR).cdc. or tools. and changing clothing before leaving work. dizziness. ToxFAQs Internet address via WWW is http://www. How can copper affect my health? Copper is essential for good health. ATSDR can tell you where to find occupational and environmental health clinics. and diarrhea. and your work clothes should be kept separate from other clothes and laundered separately. The Occupational Safety and Health Administration (OSHA) has set a limit of 0. Mailstop E-29. copper home on your skin. How can families reduce the risk of exposure to copper? ! The greatest potential source of copper exposure is through drinking water. urine. run the water for at least 15-30 seconds before using it. 890 µg/day for children aged 14-18 years. You may breathe high levels if you grind or weld copper metal. Drinking water with higher than normal levels of copper may cause vomiting. Is there a medical test to show whether I’ve been exposed to copper? Copper is normally found in all tissues of the body. How likely is copper to cause cancer? We do not know whether copper can cause cancer in humans. diarrhea. How can copper affect children? Exposure to high levels of copper will result in the same type of effects in children and adults.1 mg per cubic meter (0.1 mg/m3) of copper fumes (vapor generated from heating copper) and 1 mg/m3 of copper dusts (fine metallic copper particles) and mists (aerosol of soluble copper) in workroom air during an 8-hour work shift. Long-term exposure to copper dust can irritate your nose. Federal Recycling Program Printed on Recycled Paper . Studies in animals suggest that the young children may have more severe effects than adults.3 mg/L). and cause headaches. 700 µg/day for children aged 9-13 years. GA: U. Atlanta.gov/toxfaq. GA 30333. These tests cannot tell the extent of exposure or whether you will experience harmful effects. 1600 Clifton Road NE. mouth. blood. Public Health Service. especially in water that is first drawn in the morning after sitting in copper pipes and brass faucets overnight. High levels of copper in these samples can show that you have been exposed to higher than normal levels of copper. The Food and Nutrition Board of the Institute of Medicine recommends dietary allowances (RDAs) of 340 micrograms (340 µg) of copper per day for children aged 1-3 years. FAX: 404-498-0093. Studies in animals suggest that ingestion of high levels of copper may cause a decrease in fetal growth.Page 2 COPPER CAS # 7440-50-8 ToxFAQsTM Internet address is http://www. stomach cramps. nausea. clothes. Tests to measure copper levels in the body are not routinely available at the doctor’s office because they require special equipment. The EPA has determined that copper is not classifiable as to carcinogenicity. we do not know if this would also be true in humans. feces. You can avoid this by showering. Atlanta. 2002. Division of Toxicology. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. and eyes. 440 µg/day for children aged 4-8 years. ! To reduce exposure. There is a very small percentage of infants and children who are unusually sensitive to copper. evaluate. Phone: 1-888-4228737. 40-hour workweek.gov/toxfaq.3 milligrams of copper per liter of water (1.atsdr. ! If you are exposed to copper at work. Intentionally high intakes of copper can cause liver and kidney damage and even death.html. We do not know if copper can cause birth defects or other developmental effects in humans. Their specialists can recognize. contact the Agency for Toxic Substances and Disease Registry.html processing the ore. and 900 µg/day for adults. Where can I get more information? For more information. but high amounts can be harmful. Toxicological Profile for Copper (Draft for Public Comment). and nausea. and treat illnesses resulting from exposure to hazardous substances.atsdr.

call the ATSDR Information Center at 1-888-422-8737. The chemicals found in used mineral-based crankcase oil vary depending on the brand and type of oil. q Some hydrocarbons evaporate into the air very quickly. q Some metals in used mineral-based crankcase oil dissolve in water and move through the soil easily and may be found in surface water and groundwater. q Hydrocarbon components of the oil that enter surface water bind to small particles in the water and eventually settle to the bottom.S. and others evaporate more slowly. and various additives that improve the oil's performance. Exposure to this oil can occur when you change the oil of your car or another type of engine. whether gasoline or diesel fuel was used. how you are exposed. For more information. q Breathing a small amount of the chemicals from the oil in exhaust fumes or from burning the oil as heating fuel. This fact sheet is one in a series of summaries about hazardous substances and their health effects. antifreeze. Exposure to very high levels of used oil can cause skin rashes. Used oil has been found in at least 85 of the 1. and whether other chemicals are present. It is similar to unused oil except it contains additional chemicals from its use as an engine lubricant. q The hydrocarbon components of the oil generally stick to the soil surface. It’s important you understand this information because this substance may harm you. Used oil also contains chemicals formed when the oil is exposed to high temperatures and pressures inside an engine. The effects of exposure to any hazardous substance depend on the dose. It also contains some metals from engine parts and small amounts of gasoline. q Hydrocarbons from used mineral-based crankcase oil may build up in shellfish or other organisms. Used oil is not naturally found in the environment. q It may enter water or soil when disposed of improperly. headaches and tremors. What is used mineral-based crankcase oil? Used mineral-based crankcase oil is the brown-to-black. How can used mineral-based crankcase oil affect my health? The health effects of used mineral-based crankcase oil vary depending on the brand and type of oil used and the U.USED MINERAL-BASED CRANKCASE OIL CAS # 8002-05-9 Agency for Toxic Substances and Disease Registry ToxFAQs September 1997 This fact sheet answers the most frequently asked health questions (FAQs) about used mineral-based crankcase oil. What happens to used mineral-based crankcase oil when it enters the environment? q Used mineral-based crankcase oil enters the air through the exhaust system during engine use. oily liquid removed from the engine of a motor vehicle when the oil is changed. HIGHLIGHTS: Used mineral-based crankcase oil is also called used engine oil. and the amount of use between oil changes. which are distilled from crude oil. The chemicals in oil include hydrocarbons. personal traits and habits. q Touching contaminated soil or drinking contaminated water. How might I be exposed to used mineral-based crankcase oil? q When you change the engine oil in your car. the mechanical condition of the engine that the oil came from. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Public Health Service Agency for Toxic Substances and Disease Registry . and chemicals that come from gasoline when it burns inside the engine.416 National Priorities List sites identified by the Environmental Protection Agency (EPA). the duration.

Department of Health and Human Services. blood effects (anemia). Is there a medical test to show whether I’ve been exposed to used mineral-based crankcase oil? Used mineral-based crankcase oil is a mixture of a large number of chemicals. its recycling. Phone:1888-422-8737. These tests aren’t available at most doctors’ offices. and treat illnesses resulting from exposure to hazardous substances. Some PAHs have been identified as the cancer-causing agents. but can be done at special laboratories that have the right equipment. evaluate. GA. Some cows that ate used oil containing metals such as molybdenum and lead in contaminated pastures experienced anemia and tremors. 1600 Clifton Road NE.gov/toxfaq. However. Volunteers who breathed mists of used mineral-based crankcase oil for a few minutes had slightly irritated noses. Oils contain PAHs.atsdr. Source of Information This ToxFAQs information is taken from the 1997 Toxicological Profile for Used Mineral-based Crankcase Oil produced by the Agency for Toxic Substances and Disease Registry. Public Health Service in Atlanta. the International Agency for Research on Cancer (IARC). Mailstop E-29.S. Mechanics and other auto workers who are exposed to used mineral-based crankcase oil from a large number of cars have experienced skin rashes. How likely is used mineral-based crankcase oil to cause cancer? Long-term exposure (365 days or longer) of the skin to used mineral-based crankcase oil causes skin cancer in mice. Animals that ate large amounts of this oil developed diarrhea. Its composition depends on the brand of oil and the characteristics of the engine in which it was used. Has the federal government made recommendations to protect human health? The EPA and most states have developed regulations regarding disposal of used oil. the more likely for the oil to be carcinogenic. CAS: Chemical Abstracts Service. Federal Recycling Program Printed on Recycled Paper . Carcinogenicity: Ability to cause cancer. Animal tests have shown that the higher the PAH content in oil. Some of the cows died.cdc. and eyes.html characteristics of the engine it came from.cdc. We do not know if exposure to used mineral-based crankcase oil affects the reproductive ability of men or women or whether it causes birth defects. these workers are also exposed to other chemicals. However. Atlanta. Glossary Anemia: A decreased ability of the blood to transport oxygen. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. spraying used oil onto road surfaces for dust control. GA 30333.html ATSDR can tell you where to find occupational and environmental health clinics. there are methods for determining if you have been exposed to some of the chemicals in used oil. The Department of Health and Human Services (DHHS). You can also contact your community or state health or environmental quality department if you have any more questions or concerns. FAX: 404-498-0093. throats. Where can I get more information? For more information. or burning it as a fuel. which may have caused these health effects. PAHs: Polyaromatic hydrocarbons. Laws today protect the welfare of research animals and scientists must follow strict guidelines. Evaporate: To enter the air as a vapor.atsdr. a group of chemicals found in oil and other minerals. U. Thus. and the EPA have not classified used mineral-based crankcase oil with regard to its carcinogenicity in people. Their specialists can recognize. Public Health Service.Page 2 USED MINERAL-BASED CRANKCASE OIL CAS # 8002-05-9 ToxFAQs Internet address via WWW is http://www.gov/toxfaq. contact the Agency for Toxic Substances and Disease Registry. people who swallow used mineralbased crankcase oil may also have diarrhea. Division of Toxicology. and headaches and tremors. ToxFAQs Internet address via WWW is http://www.

What is creosote? Creosote is the name used for a variety of products: wood creosote. HIGHLIGHTS: Creosote is a mixture of many chemicals. and whether other chemicals are present. ‘ Working in the wood preservative. how you are exposed. Coal tar creosote is a thick. Wood creosote has been used as a disinfectant. and coal tar pitch volatiles. and also as animal and bird repellents. Coal tar and coal tar pitch are usually thick. U. coal tar creosote. The effects of exposure to any hazardous substance depend on the dose. bridges. coal tar pitch. with a smoky odor. Coal tar creosote is the most widely used wood preservative in the United States. or railroad tracks. and a cough treatment. coal. ‘ Drinking water contaminated by a hazardous waste site. ‘ Some components of coal tar creosote dissolve in water and may move through the soil to groundwater. and stomach pain. These products are mixtures of many chemicals created by burning of beech and other woods. and coking. Coal tar products are used in medicines to treat skin diseases such as psoriasis. and even death. coke-producing. personal traits and habits. which are sold as dietary supplements. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Eating food or drinking water with high levels of creosote may cause burning in the mouth and throat. Brief direct contact with large amounts of coal tar creosote may result in a rash or severe irritation of the skin. How might I be exposed to creosote? ‘ Using products that contain creosote to improve skin problems such as eczema or psoriasis. unconsciousness. chemical burns of the surfaces of the eyes. It is important you understand this information because this substance may harm you. or from the resin of the creosote bush. ‘ Once in groundwater. ‘ We do not know what happens to wood creosote when it enters the environment. convulsions and mental confusion. Long-term contact with creosote has been associated with increased risk of contracting cancer. coal tar pitch. black. For more information. or installing telephone poles. ‘ Coal tar creosote can build up in plants and animals. coal tar. Coal tar. and fungicides. aluminum smelting. Public Health Service Agency for Toxic Substances and Disease Registry . Creosote has been found in at least 46 of the 1. the duration. and stomach pains. ‘ Using creosote-treated wood in building fences. it may take years for it to break down. Longer direct skin contact with low levels of What happens to creosote when it enters the environment? ‘ Coal tar creosote is released to water and soil mainly as a result of its use in the wood preservation industry. but has since been replaced by better medicines. This fact sheet is one in a series of summaries about hazardous substances and their health effects.CREOSOTE CAS # 8021-39-4. ‘ Living in treated-wood houses that may result in air or skin contact with creosote. kidney or liver problems. 8001-58-9.S. How can creosote affect my health? Eating food or drinking water contaminated with high levels of creosotes may cause a burning in the mouth and throat. Wood creosote is a colorless to yellowish greasy liquid with a smoky odor and burned taste.613 National Priorities List sites identified by the Environmental Protection Agency (EPA). insecticides. animal dips. Taking large amounts of herbal remedies containing creosote bush leaves may cause damage to the liver or kidney. ‘ Components of creosote that do not dissolve in water will remain in place in a tar-like mass. a laxative. or dark-brown liquids or semi-solids. ‘ Eating herbal remedies containing the leaves from the creosote bush. or asphalt industries. call the ATSDR Information Center at 1-888-422-8737. 8007-45-2 Division of Toxicology ToxFAQsTM September 2002 This fact sheet answers the most frequently asked health questions (FAQs) about creosote. and coal tar pitch volatiles are used for roofing. oily liquid typically amber to black in color.

has resulted in skin cancer and cancer of the scrotum. ‘ Instruct children not to come in contact with creosotetreated wood when playing on or near railroad tracks. Longer exposure to creosote vapors can cause irritation of the respiratory tract. 8001-58-9. evaluate. 2002. Federal Recycling Program Printed on Recycled Paper . damage to the cornea. Where can I get more information? For more information. Some components of creosote mixtures can be measured in body tissues. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. skin. they may be found in breast milk and could pass to nursing infants. How can families reduce the risk of exposure to creosote? ‘ If you live in a residential area that used to have a wood preservation facility or gas manufacturing plant nearby. wear long-sleeved shirts and long pants when working or playing outside and avoid using water contaminated with creosote. ATSDR can tell you where to find occupational and environmental health clinics. 8007-45-2 ToxFAQsTM Internet address is http://www. GA 30333. phenols) of coal tar creosote may be stored in body fat. tools.html creosote mixtures or their vapors can result in increased light sensitivity. or on bridges or piers. ‘ If you are exposed to creosote in the workplace. 1600 Clifton Road NE. Animal studies have also shown skin cancer from skin exposure to coal tar products. ToxFAQs Internet address via WWW is http://www. Their specialists can recognize. The EPA has determined that coal tar creosote is a probable human carcinogen. Department of Health and Human Services.atsdr. but we do not know whether the same effects would occur in humans. hair. Phone: 1-888-4228737.gov/toxfaq. or other objects from the workplace (shower before going home). in ditches close to utility poles. and treat illnesses resulting from exposure to hazardous substances. 40-hour workweek. Children who played on soil contaminated with creosote had more skin rashes than children who played in uncontaminated areas. Mailstop E-29. Cancer of the scrotum in chimney sweeps has been associated with long-term skin exposure to soot and coal tar creosotes.atsdr. Some animal studies indicate that creosotes may cross the placenta and reach the fetus. and skin damage.Page 2 CREOSOTE CAS # 8021-39-4.S. ‘ Avoid using herbal remedies containing the leaves of the creosote bush and seek alternatives to skin remedies containing creosote. Because chemical components (PAHs. Studies in animals have shown birth defects in the young of mothers exposed to high levels of creosote during pregnancy. Has the federal government made recommendations to protect human health? The Occupational Safety and Health Administration (OSHA) has set an exposure limit of 0. We do not know whether children differ from adults in their susceptibility to health effects from creosote.gov/toxfaq. FAX: 404-498-0093. Atlanta. Toxicological Profile for Creosote (Update). cresol. How can creosote affect children? There is no unique exposure pathway of children to creosote. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). The tests are not routinely available at the doctor’s office because they require special equipment. Is there a medical test to show whether I’ve been exposed to creosote? There is no medical test to determine if you have been exposed to creosote. urine. GA: U. Atlanta. in old barns or other farm structures. These tests cannot tell whether harmful health effects will occur. contact the Agency for Toxic Substances and Disease Registry.cdc. especially direct contact with the skin during wood treatment or manufacture of coal tar creosote-treated products. Division of Toxicology. or blood after exposure to creosote. Children exposed to creosote will probably experience the same health effects seen in adults exposed to creosote.html. Public Health Service.2 mg/m3) in workplace air during an 8-hour day. How likely is creosote to cause cancer? Long-term exposure to low levels of creosote. The International Agency for Research on Cancer (IARC) has determined that coal tar is carcinogenic to humans and that creosote is probably carcinogenic to humans.cdc.2 milligrams of coal tar pitch volatiles per cubic meter of air (0. make sure you do not carry the chemical home in your clothing.

or cigarette smoke. and whether other chemicals are present. The effects of exposure to any hazardous substance depend on the dose. When cresols are breathed. Cresols. manufacturing use. but they can be removed by bacteria. G Drinking contaminated water near manufacturing sites. coal tar. personal traits and habits. or landfills. and para-cresol (p-cresol). how you are exposed. Small organisms in soil and water produce cresols when they break down materials in the environment. when breathed at very high levels. These forms occur separately or as a mixture. and in brown mixtures such as creosote and cresylic acids. G Breathing workplace air or skin contact in the workplace. meta-cresol (m-cresol). G In soil. This information is important because this substance may harm you. These chemicals have been found in at least 314 of 1. What are cresols? (Pronounced kr¶“-s½lz”) Cresols are a widely occurring natural and manufactured group of chemicals.CRESOLS CAS # 1319-77-3 Agency for Toxic Substances and Disease Registry ToxFAQs September 1995 This fact sheet answers the most frequently asked health questions (FAQs) about cresols. or applied to the skin at very high levels. For more information. the duration. coal or wood combustion. crude oil. G Cresols appear everywhere in our environment. they can be very harmful. cheese. which are wood preservatives. Cresols are found in many foods and in wood and tobacco smoke. G Cresols do not appear to accumulate in fish or meat. but usually at low levels. tomatoes. There are three forms of cresols that are only slightly different in their chemical structure: ortho-cresol (o-cresol). DEPARTMENT OF HEALTH AND HUMAN SERVICES. What happens to cresols when they enter the environment? G Cresols enter the environment from natural sources. In their pure form. and to make certain chemicals that kill insect pests. G Eating foods. half the total amount of cresols will break down in about a week. SUMMARY: Exposure to cresols occurs mainly from breathing air containing car exhaust. and smoking cigarettes. ingested. How can cresols affect my health? Most exposures to cresols are at very low levels that are not harmful. waste sites. and bacon. G In air. as disinfectants and deodorizers. but generally the levels are not harmful. oil refineries. cresols quickly break down into other chemicals.S. car exhaust. breathing air from homes heated with coal or wood.416 National Priorities List sites identified by the Environmental Protection Agency. combustion. Public Health Service Agency for Toxic Substances and Disease Registry . including ketchup. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Cresols smell like medicine. may cause irritation of the nose and throat. G Cresols may last longer in deep groundwater or water that does not have bacteria. G Cresols do not evaporate quickly from water. butter. because they quickly break down. They are used to dissolve other chemicals. and waste sites. How might I be exposed to cresols? G Breathing contaminated air from car exhaust. they are colorless solids and may be liquids if they are mixtures. call the ATSDR Information Center at 1-888-422-8737. Effects observed in people include irritation and burning of U.

& m-cresol.gov/toxfaq.atsdr. for example.atsdr. Short-term and long-term studies with animals have shown similar effects from exposure to cresols. Ingesting: Taking food or drink into your body. Skin contact with high levels of cresols can burn the skin and damage the kidneys. Has the federal government made recommendations to protect human health? The EPA requires that discharges or accidental spills of 1.html skin. and lungs. Animal studies show that cresols may increase the ability of some carcinogenic chemicals to cause tumors. OSHA advises avoiding eye and skin contact because this may be a route of significant exposure. Where can I get more information? For more information. GA 30333. 1992. results of tests for cresol exposure would have to be compared to results of tests taken from the same person both before and several days after the exposure. evaluate. Breathing high levels of cresols for a short time results in irritation of the nose and throat. Department of Health and Human Services. brain. 1600 Clifton Road NE.000 pounds or more of cresols be reported. coma. anemia. and effects on the blood and nervous system. GA: U. Atlanta. eyes. Ingesting high levels results in kidney problems. Milligram (mg): One thousandth of a gram. It is not known what the effects are from long-term ingestion or skin contact with low levels of cresols. and throat. The Occupational Safety and Health Administration (OSHA) has set an exposure limit of 22 milligrams per cubic meter (22 mg/m3) for cresols in workplace air for an 8-hour workday. How likely are cresols to cause cancer? The Environmental Protection Agency (EPA) has determined that cresols are possible human carcinogens. The tests must be performed within one day of Agency for Toxic Substances and Disease Registry (ATSDR).cdc. Their specialists can recognize. exposure since cresols break down quickly in the body. Long-term: Lasting one year or longer. Mailstop E-29. very little is known about the effects of breathing cresols. Toxicological profile for cresols: o-cresol. liver and kidney damage. Federal Recycling Program Printed on Recycled Paper . vomiting. Division of Toxicology. References Is there a medical test to show whether I’ve been exposed to cresols? Tests are available that measure the amount of cresols in the urine. p-cresol. ToxFAQs Internet address via WWW is http://www. Atlanta. Since cresols occur naturally in the body. No human or animal studies have shown harmful effects from cresols on the ability to have children. These tests are usually not available in your doctor’s office. abdominal pain. Glossary Carcinogen: A substance that can cause cancer. mouth. abdominal pain and vomiting.gov/toxfaq. Short-term: Lasting 14 days or less. and death. 40-hour workweek. contact the Agency for Toxic Substances and Disease Registry.html ATSDR can tell you where to find occupational and environmental health clinics.S.cdc. No studies are available in people on the carcinogenic effects of cresols.Page 2 CRESOLS CAS # 1319-77-3 ToxFAQs Internet address via WWW is http://www. blood. Public Health Service. mouth and throat burns. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. FAX: 404-498-0093. liver. at lower levels over longer times. heart damage. Aside from these effects. and treat illnesses resulting from exposure to hazardous substances. Phone: 1-888-422-8737. facial paralysis.

‘ Crotonaldehyde is soluble in water. and smoke from wood burning.S. Therefore. Therefore. and smoke from wood burning. personal traits and habits. many foods contain crotonaldehyde in small amounts. which is a yeast and mold inhibitor. ‘ Crotonaldehyde is a highly mobile liquid and does not stick to soil surfaces. and in leather tanning. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Contact with the skin or eye can result in severe injury. the burning of wood and the burning of tobacco. ‘ Crotonaldehyde is a liquid chemical used to synthesize other chemicals. call the ATSDR Information Center at 1-888-422-8737. Public Health Service Agency for Toxic Substances and Disease Registry . What happens to crotonaldehyde when it enters the environment? ‘ When released to air. the duration. as alcohol denaturant. waters and can also be degraded by bacteria. as stabilizer for tetraethyl-lead. colorless to straw colored liquid with a strong. It will only persist in the atmosphere for several hours to a few days before being degraded. gasoline and diesel engine exhausts. For more information. the general population may be exposed to crotonaldehyde through inhalation of tobacco smoke. if it is released to soil it can travel below the soil surface and contaminate groundwater. ‘ Crotonaldehyde does not accumulate in the food chain. crotonaldehyde will exist solely as a gas. Crotonaldehyde is mainly used in the manufacture of sorbic acid. It is important you understand this information because this substance may harm you.CROTONALDEHYDE CAS #4170-30-3 Division of Toxicology ToxFAQsTM April 2002 This fact sheet answers the most frequently asked health questions (FAQs) about crotonaldehyde. how you are exposed. The effects of exposure to any hazardous substance depend on the dose. Therefore workers employed in occupations where crotonaldehyde is used may inhale crotonaldehyde vapors or get the liquid on their skin. Crotonaldehyde is found naturally in emissions of some vegetation and volcanoes. HIGHLIGHTS: The general population can be exposed to crotonaldehyde by inhaling tobacco smoke. This substance has been found in at least 3 of the 1. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Crotonaldehyde has been used as a warning agent in fuels. Crotonaldehyde also evaporates from water. ‘ People living near uncontrolled hazardous waste sites may be exposed to higher than normal levels of crotonaldehyde.585 National Priorities List sites identified by the Environmental Protection Agency (EPA). in the preparation of rubber accelerators. Damage to the respiratory system may occur if you breathe in crotonaldehyde vapors. suffocating odor. It can be broken down by reacting with substances found in sunlit surface U. People working with crotonaldehyde to manufacture other chemicals may be exposed to higher levels. Crotonaldehyde can also evaporate from soil or be degraded by bacteria commonly found in soil. It is highly flammable and produces toxic vapors at room temperature. What is crotonaldehyde? Crotonaldehyde is a clear. How might I be exposed to crotonaldehyde? ‘ Crotonaldehyde is emitted from the combustion of gasoline. gasoline and diesel engine exhausts. Crotonaldehyde gas is degraded rapidly in the atmosphere by reacting with substances commonly found in the air. and whether other chemicals are present.

which may result in death. These tests could be performed in a doctor’s office. Their specialists can recognize. The International Agency for Research on Cancer (IARC) concluded that crotonaldehyde is not classifiable as to its carcinogenicity to humans. and treat illnesses resulting from exposure to hazardous substances. Has the federal government made recommendations to protect human health? The Occupational Safety and Health Administration (OSHA) sets a limit of 2 parts of crotonaldehyde per million parts of workroom air (2 ppm) for an 8-hour work shift. throat. even at very low exposure levels. mouth. FAX: 404-498-0093. 40-hour work week.html How can crotonaldehyde affect my health? Crotonaldehyde in the air can irritate your eyes.gov/toxfaq. 1600 Clifton Road NE. ATSDR can tell you where to find occupational and environmental health clinics. Mailstop E-29. and stomach if you were to ingest crotonaldehyde. However. respiratory function tests and a chest x-ray may show whether damage has been done to the lungs. How can families reduce the risk of exposure to crotonaldehyde? Families are not likely to be exposed to levels of crotonaldehyde that would be high enough to cause problems. and lungs.html . you might experience chemical burns of the lips. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. We do not know if exposure to crotonaldehyde will result in reproductive effects in humans. contact the Agency for Toxic Substances and Disease Registry. possibly causing you to cough and experience chest tightness and shortness of breath. Where can I get more information? For more information.atsdr. GA 30333. We do not know whether children differ from adults in their susceptibility to crotonaldehyde. throat. We do not know if exposure to crotonaldehyde will result in birth defects or other developmental effects in people. nose. evaluate. crotonaldehyde has been shown to cause degeneration of sperm cells in mice. or hospital as long as they have the proper test equipment.atsdr. esophagus.Page 2 CROTONALDEHYDE CAS #4170-30-3 ToxFAQsTM Internet address is http://www.gov/toxfaq. If a severe exposure has occurred. Atlanta. Some people may become sensitive to crotonaldehyde and develop a reaction to crotonaldehyde. Phone: 1-888-422-8737. How likely is crotonaldehyde to cause cancer? The EPA considers crotonaldehyde to be a possible human carcinogen. ToxFAQsTM Internet address is http://www. If you come into contact with liquid crotonaldehyde. Division of Toxicology. Federal Recycling Program Printed on Recycled Paper . How can crotonaldehyde affect children? Children are probably affected by exposure to crotonaldehyde in the same ways as adults. it can cause serious burns to your skin or eyes.cdc. clinic.cdc. High levels of crotonaldehyde can cause a build-up of fluid in your lungs. Is there a medical test to show whether I’ve been exposed to crotonaldehyde? There are no specific blood or urine tests for crotonaldehyde. Some people may become allergic to crotonaldehyde upon skin contact. Since crotonaldehyde is known to be irritating.

The effects of exposure to any hazardous substance depend on the dose. 143-33-9.CYANIDE CAS # 74-90-8. Cyanide can be produced by certain bacteria. which are potatolike tubers of cassava plants grown in tropical countries. Cyanide has been found in at least 415 of the 1. 506-77-4 Agency for Toxic Substances and Disease Registry ToxFAQs September 1997 This fact sheet answers the most frequently asked health questions (FAQs) about cyanide. What is cyanide? (Pronounced sº“…-nºd”) Cyanide is usually found joined with other chemicals to form compounds. almond-like odor in damp air. In the body. and photography. Cyanide occurs naturally in cassava roots. Exposure to high levels of cyanide harms the brain and heart. G It takes about 1–3 years for half of the hydrogen cyanide to disappear from the air. Sodium cyanide and potassium cyanide are both white solids with a bitter. cyanide combines with a chemical to form Vitamin B12. personal traits and habits. How can cyanide affect my health? In large amounts. G Cyanide in water does not build up in the bodies of fish. the duration. It’s important you understand this information because this substance may harm you. How might I be exposed to cyanide? G Breathing air.S. fumigating ships. headaches. G At high concentrations. 592-01-8. Expo- U. G In air. Exposure to lower levels may result in breathing difficulties. and algae.430 National Priorities List sites identified by the Environmental Protection Agency (EPA). making plastics. G Working in an industry where cyanide is used or produced. DEPARTMENT OF HEALTH AND HUMAN SERVICES. photographic development. Examples of simple cyanide compounds are hydrogen cyanide. metal cleaning. or eating foods containing cyanide. almond-like odor. Public Health Service Agency for Toxic Substances and Disease Registry . production of chemicals. such as electroplating. touching soil. and whether other chemicals are present. G Smoking cigarettes and breathing smoke-filled air during fires are major sources of cyanide exposure. cyanide is mainly found as gaseous hydrogen cyanide. 544-92-3. a small amount is present as fine dust particles. For more information. how you are exposed. 506-61-6. heart pains. Hydrogen cyanide is a colorless gas with a faint. 460-19-5. What happens to cyanide when it enters the environment? G Cyanide enters the environment from both natural processes and human industrial activities. and may cause coma and death. G Eating foods containing cyanide compounds. Cyanide and hydrogen cyanide are used in electroplating. drinking water. and it is found in a number of foods and plants. 151-50-8. blood changes. such as cassava roots. call the ATSDR Information Center at 1-888-422-8737. G Most cyanide in surface water will form hydrogen cyanide and evaporate. bitter. lima beans. and almonds. cyanide is very harmful to people. and enlargement of the thyroid gland. and some mining processes. G Breathing air near a hazardous waste site containing cyanide. sodium cyanide and potassium cyanide. metallurgy. metallurgy. HIGHLIGHTS: Cyanide is a very poisonous chemical. cyanide becomes toxic to soil microorganisms and can pass through soil into underground water. fungi. vomiting. This fact sheet is one in a series of summaries about hazardous substances and their health effects.

Milligram (mg): One thousandth of a gram. There are no reports that cyanide can cause cancer in people or animals. and loss of consciousness. ToxFAQs Internet address via WWW is http://www. People with high blood cyanide levels have also shown harmful effects such as weakness of the fingers and toes. blood changes. Laws today protect the welfare of research animals and scientists must follow strict guidelines. Mailstop E-29. Exposure to lower levels of cyanide for a long time may result in breathing difficulties. Effects on the reproductive system were seen in rats and mice that drank water containing sodium cyanide. and may cause coma and death. Atlanta. Federal Recycling Program Printed on Recycled Paper . 506-77-4 ToxFAQs Internet address via WWW is http://www.cdc. An almond-like odor in the breath may alert a doctor that a person was exposed to cyanide. and may die. Tissue levels of cyanide can be measured if cyanide poisoning is suspected. Department of Health and Human Services. U. but chemicals other than cyanide may have contributed to these effects. Skin contact with cyanide can produce irritation and sores. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. People who eat large amounts of cyanide may have symptoms including deep breathing and shortness of breath.cdc. 40-hour workweek. 143-33-9. headaches. ppm: Parts per million.CYANIDE Page 2 CAS # 74-90-8.html sure to high levels of cyanide in the air for a short time harms the brain and heart. and treat illnesses resulting from exposure to hazardous substances. 151-50-8. Source of Information This ToxFAQs information is taken from the 1997 Toxicological Profile for Cyanide (update) produced by the Agency for Toxic Substances and Disease Registry. however. evaluate. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. CAS: Chemical Abstracts Service. Has the federal government made recommendations to protect human health? The EPA has set a maximum contaminant level of cyanide in drinking water of 0.html ATSDR can tell you where to find occupational and environmental health clinics. 1600 Clifton Road NE. difficulty walking. Public Health Service in Atlanta. The Occupational Safety and Health Administration (OSHA) and (other recommendations) the American Conference of Governmental Industrial Hygienists (ACGIH) have set a permissible exposure limit of 5 milligrams of cyanide per cubic meter of air (5 mg/m3) in the workplace during an 8-hour workday. GA. It is not known whether cyanide can directly cause birth defects in people.gov:/toxfaq. 460-19-5. sodium cyanide. potassium cyanide. dimness of vision. Division of Toxicology. after the exposure. calcium cyanide or copper cyanide be reported to the EPA. How likely is cyanide to cause cancer? The EPA has determined that cyanide is not classifiable as to its human carcinogenicity. Public Health Service. small amounts of cyanide are always detectable in blood and urine. and decreased thyroid gland function.2 mg/L). vomiting. Phone:1888-422-8737.2 milligrams cyanide per liter of water (0.S. 544-92-3. but cyanide is rapidly cleared from the body. heart pains. The EPA requires that spills or accidental releases into the environment of 1 pound or more of hydrogen cyanide. Birth defects were seen in rats that ate diets of cassava roots. 506-61-6. 592-01-8. contact the Agency for Toxic Substances and Disease Registry. FAX: 404-498-0093. GA 30333. Use of cassava roots as a primary food source in tropical Africa has led to high blood cyanide levels.gov/toxfaq. Is there a medical test to show whether I’ve been exposed to cyanide? There are medical tests to measure blood and urine levels of cyanide. and enlargement of the thyroid gland. so the tests must be done soon Where can I get more information? For more information. Their specialists can recognize.atsdr. convulsions.atsdr. Glossary Carcinogenicity: Ability to cause cancer. deafness.

DDE. but levels are very low. was banned in 1972 because of damage to wildlife. DDE. fatty meat. ‘ Infants fed on breast milk from mothers who have been exposed. call the ATSDR Information Center at 1-888-422-8737. and DDD in air are rapidly broken down by sunlight. How might I be exposed to DDT. and DDD? DDT (dichlorodiphenyltrichloroethane) is a pesticide once widely used to control insects in agriculture and insects that carry diseases such as malaria. tremors and seizures. People who accidentally swallowed large amounts of DDT became excitable and had tremors and seizures. DDE. build up in plants and in fatty tissues of fish. AND DDD CAS # 50-29-3. personal traits and habits. most DDT in soil is broken down slowly to DDE and DDD by microorganisms. DDE. crystalline solid with no odor or taste. and DDD? ‘ Eating contaminated foods. they do not dissolve easily in water. These effects went away after the exposure stopped. DDE (dichlorodiphenyldichloroethylene) and DDD (dichlorodiphenyldichloroethane) are chemicals similar to DDT that contaminate commercial DDT preparations. High levels of DDT can affect the nervous system causing excitability. 72-55-9. DDD was also used to kill pests. What are DDT. and poultry. ‘ Only a small amount will go through the soil into groundwater. How can DDT. ‘ DDT. DDE can cause a reduction in the duration of lactation and an increased chance of having a premature baby. Half of what’s in air breaks down within 2 days. the duration. This fact sheet is one in a series of summaries about hazardous substances and their health effects.613 National Priorities List sites identified by the Environmental Protection Agency (EPA). ‘ Breathing or swallowing soil particles near waste sites or landfills that contain these chemicals. and DDD when they enter the environment? ‘ DDT entered the environment when it was used as a pesticide. particularly meat. DEPARTMENT OF HEALTH AND HUMAN SERVICES. ‘ DDE enters the environment as contaminant or breakdown product of DDT. DDE. half the DDT in soil will break down in 2-15 years. DDT. Its use in the U. It is important you understand this information because this substance may harm you. ‘ Eating contaminated imported foods from countries that still allow the use of DDT to control pests. DDT is a white. and especially DDE. A study in humans showed that women who had high amounts of a form of DDE in their breast milk were unable to U. In women. but its use has also been banned. and other animals.DDT. fish and poultry. depending on the type of soil. Public Health Service Agency for Toxic Substances and Disease Registry . One form of DDD has been used medically to treat cancer of the adrenal gland.S. it still enters the environment due to current use in other countries. and whether other chemicals are present. and DDD affect my health? DDT affects the nervous system. The effects of exposure to any hazardous substance depend on the dose. how you are exposed. No effects were seen in people who took small daily doses of DDT by capsule for 18 months. DDE. and DDD. What happens to DDT. For more information. birds. ‘ They stick strongly to soil. 72-54-8 Division of Toxicology ToxFAQsTM September 2002 This fact sheet answers the most frequently asked health questions (FAQs) about DDT. but is still used in some countries. HIGHLIGHTS: Exposure to DDT. and DDD have been found in at least 441 of the 1. DDD also enters the environment as a breakdown product of DDT. such as root and leafy vegetables.S. ‘ DDT. DDE. DDE. DDE has no commercial use. and DDD occurs mostly from eating foods containing small amounts of these compounds. fish. DDE. ‘ Breathing contaminated air or drinking contaminated water near waste sites and landfills that may contain higher levels of these chemicals.

Mailstop E-29. and DDE? ‘ Most families will be exposed to DDT by eating food or drinking liquids contaminated with small amounts of DDT. Has the federal government made recommendations to protect human health? The Occupational Safety and Health Administration (OSHA) sets a limit of 1 milligram of DDT per cubic meter of air (1 mg/m3) in the workplace for an 8-hour shift. while long-term exposure to smaller amounts affected the liver.Page 2 DDT. A study in mice showed that exposure to DDT during the first weeks of life may cause neurobehavioral problems later in life. blood. 72-55-9.S. The reason for the discrepancy between these studies is unknown.html breast feed their babies for as long as women who had little DDE in the breast milk. and treat illnesses resulting from exposure to hazardous substances. 2002. and DDD in fat. and DDD to cause cancer? Studies in DDT-exposed workers did not show increases in cancer. contact the Agency for Toxic Substances and Disease Registry. or DDD.atsdr. Studies in rats have shown that DDT and DDE can mimic the action of natural hormones and in this way affect the development of the reproductive and nervous systems. A study showed that teenage boys whose mothers had higher DDE amounts in the blood when they were pregnant were taller than those whose mothers had lower DDE levels. 40-hour workweek. ToxFAQs Internet address via WWW is http://www. However. Studies in animals given DDT with the food have shown that DDT can cause liver cancer.gov/toxfaq. Division of Toxicology. We can assume that children exposed to large amounts of DDT will have health effects similar to the effects seen in adults.atsdr. FAX: 404-498-0093. Atlanta. or DDD cause birth defects in people.cdc. There is no evidence that DDT. Public Health Service. a different study found the opposite in preteen girls. This could possibly happen in humans.gov/toxfaq. The International Agency for Research on Cancer (IARC) determined that DDT may possibly cause cancer in humans. 72-54-8 ToxFAQsTM Internet address is http://www. DDE. Another study in humans showed that women who had high amounts of DDE in breast milk had an increased chance of having premature babies. Where can I get more information? For more information. DDE. or excessive exposure to these compounds. Their specialists can recognize. and DDD affect children? There are no studies on the health effects of children exposed to DDT.cdc. How can DDT. The Department of Health and Human Services (DHHS) determined that DDT may reasonable be anticipated to be a human carcinogen. and DDD? Laboratory tests can detect DDT. Department of Health and Human Services. AND DDD CAS # 50-29-3. short-term exposure to large amounts of DDT in food affected the nervous system.DDE. urine. How can families reduce the risk of exposure to DDT. ‘ Cooking will reduce the amount of DDT in fish. Also in animals. However. Toxicological Profile for DDT/DDE/DDD (Update). The Food and Drug Administration (FDA) has set limits for DDT. DDE. but cannot tell the exact amount you were exposed to. These tests may show low. GA 30333. Is there a medical test to show whether I’ve been exposed to DDT. and DDD are probable human carcinogens. Puberty was delayed in male rats given high amounts of DDE as juveniles. 1600 Clifton Road NE. The EPA determined that DDT. and breast milk. In animals. ATSDR can tell you where to find occupational and environmental health clinics. Phone: 1-888-4228737. ‘ Follow health advisories that tell you about consumption of fish and wildlife caught in contaminated areas. semen. or whether you will experience adverse effects. shortterm oral exposure to small amounts of DDT or its breakdown products may also have harmful effects on reproduction. moderate.html. These tests are not routinely available at the doctor’s office because they require special equipment. and DDD in foodstuff at or above which the agency will take legal action to remove the products from the market. GA: U. DDE. DDE. DDE. DDE. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. DDE. we do not know whether children differ from adults in their susceptibility to these substances. evaluate. ‘ Washing fruit and vegetables will remove most DDT from their surface. Atlanta. DDE. Federal Recycling Program Printed on Recycled Paper . Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). How likely are DDT.

DEPARTMENT OF HEALTH AND HUMAN SERVICES. personal traits and habits. on ornamental plants. Diazinon has been found in at least 18 of the 1. What happens to diazinon when it enters the environment? q Most environmental diazinon contamination comes from agricultural and household application to control insects. q Diazinon may also enter the environment during the manufacturing process. it may be present in the soil. For more information. It is also used to control household pests such as flies. and not being able to see clearly. This fact sheet is one in a series of summaries about hazardous substances and their health effects. but the levels in food are far below the levels that might cause any harmful health effects.DIAZINON CAS # 333-41-5 Agency for Toxic Substances and Disease Registry ToxFAQs September 1997 This fact sheet answers the most frequently asked health questions (FAQs) about diazinon. but it is possible to be exposed to the chemical in a solid form. so small particles of the chemical may be carried away from the field or yard before falling to the ground. q Diazinon on soil and plant surfaces may be washed into surface waters by rain. This chemical is manufactured and does not occur naturally in the environment. Most of the diazinon used is in liquid form. constriction of the pupils of the eye. and on the surface of the plants. Public Health Service Agency for Toxic Substances and Disease Registry . q After diazinon has been applied. and on fruit and vegetable field crops. q Exposure may occur by contact with contaminated soils or contaminated runoff water or groundwater. q It is often sprayed on crops and plants. It can move through the soil and contaminate ground water. fleas. how you are exposed. feelings of anxiety. call the ATSDR Information Center at 1-888-422-8737. surface waters. How can diazinon affect my health? Most cases of unintentional diazinon poisoning in people have resulted from short exposures to very high concentra- U. q Small amounts have been detected in foods. HIGHLIGHTS: Exposure to diazinon is most significant in people who work in the manufacture and professional application of this insecticide.430 National Priorities List sites identified by the Environmental Protection Agency (EPA). Very high levels of exposure to diazinon have resulted in death.S. Diazinon preparations available for home and garden use contain 1–5% diazinon in a liquid or as solid granules. q In the environment. This information is important because this substance may harm you. and cockroaches. the duration. diazinon is rapidly broken down into a variety of other chemicals. Preparations used in agriculture and by exterminators contain 85–90% diazinon and appear as a pale to dark-brown liquid. Diazinon does not burn easily and does not dissolve easily in water. The effects of exposure to any hazardous substance depend on the dose. dizziness. weakness. q Diazinon is not likely to build up to high or dangerous levels in animal or plant foods that you might eat. How might I be exposed to diazinon? q People who work in the manufacture and professional application of diazinon have the most significant exposure to this insecticide. and whether other chemicals are present. The pure chemical is a colorless and practically odorless oil. Some mild symptoms of exposure include headache. What is diazinon? (Pronounced dº-²z“…-n¼n) Diazinon is the common name of an organophosphorus insecticide used to control pest insects in soil.

dizziness.S. Division of Toxicology.Substances and Disease Registry. and coma.atsdr. Public Health Service. The Department of Health and Human Services Microgram (mg): One millionth of a gram. Source of Information Is there a medical test to show whether I’ve been exposed to diazinon? This ToxFAQs information is taken from the 1996 Toxicological Profile for Diazinon produced by the Agency for Toxic The most common test for exposure to diazinon is to deter. 1600 Clifton Road NE. weakness. U. but can be done at special laboratories that have the right equipment. This test requires only a small amount of blood and vice in Atlanta. Laws today protect the welfare of Specific tests are available to determine the presence of research animals and scientists must follow strict guidelines. and the EPA have not classified diazinon as to its carciand other compounds. animals.Page 2 DIAZINON CAS # 333-41-5 ToxFAQs Internet address via WWW is http://www. (maximum recommended drinking water concentrations) for abdominal cramps. and not being able to see The EPA has developed 1. (IARC). Carcinogenicity: Ability to cause cancer.cdc. Public Health Sermine the level of cholinesterase activity in the red blood cells or plasma. and treat illnesses resulting from exposure to hazardous substances.gov/toxfaq. More severe symptoms include nausea and vomiting. Federal Recycling Program Printed on Recycled Paper .cdc. Damage to the pancreas has developed in some people and in laboratory animals exposed to large amounts of diazinon. contact the Agency for Toxic Substances and Disease Registry. recommendations to protect human health? constriction of the pupils of the eye. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. (DHHS). high doses of diazinon produced effects on the nervous system similar to those seen in people. feelings of anxiety. nogenicity. the International Agency for Research on Cancer Organophosphate: Chemicals made of phosphorus. this test Animal testing is sometimes necessary to find out how does not specifically show exposure to diazinon. Department of Health and Human Services. diazinon or its breakdown products in blood. Very high levels of exposure to diazinon have resulted in death in people accidentally exposed and in those who have swallowed large amounts of the chemical to commit suicide. carbon. GA 30333. Diazinon has not been shown to cause cancer in people or Long-term: 365 days or longer.gov/toxfaq. GA. Mailstop E-29.and 10-day health advisories clearly. Some mild symptoms Has the federal government made include headache. and Where can I get more information? For more information. FAX: 404-498-0093. urine.html tions of the material.atsdr. Diazinon affects the nervous system.html ATSDR can tell you where to find occupational and environmental health clinics. slow pulse. Their specialists can recognize. body tissue. Phone: 1-888-422-8737. CAS: Chemical Abstracts Service. is routinely available in your doctor’s office. diarrhea. These tests aren't routinely available at most doctors' offices. Dissolve: To disappear gradually. Atlanta. How likely is diazinon to cause cancer? Insecticide: A substance that kills insects. evaluate. ToxFAQs Internet address via WWW is http://www. Cholinesterase: An enzyme found in the blood. however. pinpoint pupils. diffiadults and children of 20 micrograms per liter of water culty breathing. toxic substances might harm people and how to treat people who have been exposed. (20 mg/L). There is no evidence that long-term exposure to low levels of diazinon causes any harmful health effects in people. In Glossary animal studies.

as a rubber vulcanizer. ‘ Diborane is a very toxic. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Workers employed in occupations that manufacture or use diborane may be exposed to this compound by breathing in its vapors. It is important you understand this information because this substance may harm you. What is diborane? Diborane is a colorless gas at room temperature with a repulsive. This substance has been found in at least 3 of the 1. as a catalyst for hydrocarbon polymerization. Exposure can occur primarily during manufacture or use in industry. U. For more information. Diborane is used in rocket propellants. If released to soil it is likely that it would react violently and spontaneously combust. ‘ Diborane does not accumulate in the food chain. as a flame-speed accelerator. How might I be exposed to diborane? ‘ Diborane is a very dangerous gas that is only used in chemical laboratories by experienced professionals. and whether other chemicals are present. It can also cause skin irritation. Exposure to diborane can cause irritation of the eyes. how you are exposed. flammable gas. toxic. as a reducing agent. flammable. personal traits and habits. ‘ Diborane is a gas that is not found in soil. and respiratory airway. What happens to diborane when it enters the environment? ‘ Diborane is a gas that can spontaneously burn or explode in air at normal room temperatures. How can diborane affect my health? The toxic effects of diborane are primarily due to its irritant properties.DIBORANE CAS #19287-45-7 Division of Toxicology ToxFAQsTM April 2002 This fact sheet answers the most frequently asked health questions (FAQs) about diborane. shortness of breath. Diborane will ignite spontaneously in moist air at room temperature.585 National Priorities List sites identified by the Environmental Protection Agency (EPA). call the ATSDR Information Center at 1-888-422-8737. the duration. throat.S. The general population is not exposed to diborane. nose. This fact sheet is one in a series of summaries about hazardous substances and their health effects. gas used by chemists to make other compounds. It mixes well with air and easily forms explosive mixtures. It is also used in electronics to impart electrical properties in pure crystals. Short-term exposure to diborane can cause a sensation of tightness of the chest. sweet odor. but it will decompose rapidly when in contact with water producing boric acid and hydrogen gas which is very flammable. and as a doping agent. ‘ Diborane is slightly soluble in water. Public Health Service Agency for Toxic Substances and Disease Registry . HIGHLIGHTS: Diborane is a manufactured. The general population will not be exposed to diborane. The effects of exposure to any hazardous substance depend on the dose.

40-hour work week. These signs and symptoms can occur immediately or be delayed for up to 24 hours.cdc. Is there a medical test to show whether I’ve been exposed to diborane? There are no tests for measuring diborane levels in the body. seizures.cdc. The Department of Health and Human Services (DHHS). If you suspect that you have been exposed to diborane. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. Federal Recycling Program Printed on Recycled Paper . People exposed for a long time to low amounts of diborane have experienced respiratory irritation. evaluate. ATSDR can tell you where to find occupational and environmental health clinics. Although exposure of children to diborane is unlikely. the International Agency for Research on Cancer (IARC). Has the federal government made recommendations to protect human health? The Occupational Safety and Health Administration (OSHA) sets a limit for diborane in workplace air of 0. We do not know if exposure to diborane will result in birth defects or other developmental effects in people.1 parts of diborane per million parts of air (0. and wheezing. There is no information to determine whether exposure to diborane affects the reproductive system in humans or in animals.Page 2 CAS #19287-45-7 ToxFAQsTM Internet address is http://www. and treat illnesses resulting from exposure to hazardous substances. confusion. Studies in animals have shown that diborane causes the same type of effects observed in humans. How likely is diborane to cause cancer? There are no studies of carcinogenicity of diborane in humans or in animals. Atlanta.html DIBORANE cough. fatigue. 1600 Clifton Road NE. drowsiness.gov/toxfaq.atsdr.html . Skin and eye irritation can also occur. These tests are usually not available in the doctor’s office.atsdr. How can families reduce the risk of exposure to diborane? It is unlikely that the general population will be exposed to diborane.1 ppm) for an 8-hour workday. Their specialists can recognize. but can be done in a hospital or clinic. How can diborane affect children? There are no studies on the health effects of children exposed to diborane. FAX: 404-498-0093. Mailstop E-29. it is reasonable to assume that it will cause health effects similar to those seen in adults. ToxFAQsTM Internet address is http://www.gov/toxfaq. GA 30333. Where can I get more information? For more information. a chest x-ray and pulmonary function tests may be appropriate to determine if your lungs have been damaged. and the EPA have not classified diborane as to its carcinogenicity. and occasional transient tremors. Phone: 1-888-422-8737. contact the Agency for Toxic Substances and Disease Registry. Division of Toxicology.

lightheadedness. This fact sheet is one in a series of summaries about hazardous substances and their health effects.2-dibromo-3-chloropropane affect my health? The main effect from breathing high levels of 1.2-Dibromo-3-chloropropane is a manufactured chemical and is not found naturally in the environment.314 National Priorities List sites identified by the Environmental Protection Agency. DEPARTMENT OF HEALTH AND HUMAN SERVICES.2-dibromo-3-chloropropane is damage to the male's ability to reproduce. How can 1. and whether other chemicals are present. personal traits and habits. Animals breathing high levels of the chemical were not What happens to 1. How might I be exposed to 1. It can be tasted in water at very low concentrations.2-dibromo-3-chloropropane were used in the past on certain farms to kill pests that harmed crops. this chemical may cause damage to the male reproductive system. Studies on workers have shown that men may produce fewer sperm. Public Health Service Agency for Toxic Substances and Disease Registry . q In soil. call the ATSDR Information Center at 1-888-422-8737. how you are exposed. It is a colorless liquid with a sharp smell. produce sperm that results in more girl than boy babies.2-dº“br½“m½-3-klôr ½ pr½“p³n”) 1.2-dibromo-3-chloropropane was used in the past. We do not know exactly how much of it is currently made or used by industry. Large amounts of 1. and weakness in workers.2-DIBROMO-3-CHLOROPROPANE CAS # 96-12-8 Agency for Toxic Substances and Disease Registry ToxFAQs September 1995 This fact sheet answers the most frequently asked health questions (FAQs) about 1. q Breathing air or touching soil at or near agricultural areas where 1. q Breathing air at hazardous waste sites where improper disposal methods were used. This information is important because this substance may harm you. while small amounts may stay in the soil for several years. or ponds.2-dibromo-3-chloropropane? (Pronounced 1. The effects of exposure to any hazardous substance depend on the dose. At high levels.2-dibromo-3-chloropropane occurs mainly from drinking water or eating food that contains the chemical. lakes. nausea. and eventually become unable to father children. Hawaii stopped using it in 1985.2-dibromo-3chloropropane. U. the duration. q It takes several months for it to break down in air. Farmers in all states other than Hawaii stopped using this chemical in 1979.2-dibromo-3-chloropropane when it enters the environment? q Most of it that enters surface water evaporates into the air within several days or a week.S.1. This chemical has been found in at least 10 of 1. but it is probably a small amount. q It doesn't stick to soil at the bottom of rivers.2-dibromo3-chloropropane? q Drinking water or eating food that contains the chemical. For more information. some evaporates into the air. It can also cause headaches. Some industries use it to make another chemical that is used to make materials that resist burning. q Working in an industry that uses 1. SUMMARY: Exposure to 1. What is 1.2-dibromo-3chloropropane.

blood. we can count the number of sperm and blood levels of certain hormones in exposed men to determine whether harmful effects have occurred. These tests may require special equipment and they may not be available in your doctor’s office. Mailstop E-29. Has the federal government made recommendations to protect human health? The Environmental Protection Agency (EPA) has set a limit of 0. evaluate. kidneys.2-dibromo-3-chloropropane in one billion parts of air (1 ppb) for an 8-hour workday over a 40-hour workweek. Toxicological profile for 1. Because exposure to this chemical lowers the number of sperm. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. Public Health Service.2-dibromo3-chloropropane.2-dibromo-3-chloropropane as a pesticide in the United States in the early 1980s. Department of Health and Human Services. 1992. contact the Agency for Toxic Substances and Disease Registry. Atlanta. Division of Toxicology.2-dibromo-3-chloropropane per billion parts of drinking water (0.2-dibromo-3-chloropropane to cause cancer? The Department of Health and Human Services has determined that 1.Page 2 1.2-dibromo-3-chloropropane be reported. 1600 Clifton Road NE.atsdr. Breathing low to moderate levels also caused damage to the reproductive system. References Agency for Toxic Substances and Disease Registry (ATSDR). Atlanta.cdc.2-dibromo3-chloropropane and there was no increase in the number of birth defects. ppb: Parts per billion. Ingesting: Taking food or drink into your body. brains. Rats exposed to high levels did. FAX: 404-498-0093. livers.gov/toxfaq.cdc. Federal Recycling Program Printed on Recycled Paper . and samples of tissues from the body.2-dibromo-3-chloropropane as possible.2 ppb).html able to reproduce and had damaged stomachs. The National Institute for Occupational Safety and Health (NIOSH) currently recommends that workers breathe as little 1. and cancer of the stomach and skin in animals who had skin contact with the chemical. Their specialists can recognize.html ATSDR can tell you where to find occupational and environmental health clinics.2-dibromo-3-chloropropane in exhaled air. The Occupational Safety and Health Administration (OSHA) has set an occupational exposure limit of 1 part of 1. Glossary Is there a medical test to show whether I’ve been exposed to 1. GA: U. EPA banned the use of 1. cancer of the stomach and kidney in animals that ingested the chemical.atsdr. these changes cannot tell the level or length of exposure to the chemical.2-dibromo-3-chloropropane may reasonably be anticipated to be a carcinogen.2-DIBROMO-3-CHLOROPROPANE CAS # 96-12-8 ToxFAQs Internet address via WWW is http://www. ToxFAQs Internet address via WWW is http://www.2 parts of 1. The ability of people to reproduce was not affected by drinking water contaminated with low levels of 1.gov/toxfaq. however. EPA requires that discharges or spills into the environment of 1 pound or more of 1. and lungs.2-dibromo-3-chloropropane? Tests are available that measure the amount of 1. blood. and treat illnesses resulting from exposure to hazardous substances. Carcinogen: A substance that can cause cancer. We do not know if these same cancers would occur in people.S. How likely is 1. Phone: 1-888-422-8737. GA 30333. It can also cause skin and eye damage from direct contact. Where can I get more information? For more information. spleens. have an increase in birth defects. However. Animal studies found cancer of the nose in animals exposed by breathing the chemical.

We don't know the effects on people of breathing high levels. Another major use was as an additive in leaded gasoline. and hardly at all in groundwater. it quickly moves to air and will evaporate from surface water and soil to the air.2-dibromoethane is generally much. G When released. and whether other chemicals are present.2-Dibromoethane can affect the brain. How might I be exposed to 1. Most of these uses have been stopped by the Environmental Protection Agency (EPA) since 1984. G Touching it while bathing or swimming in contaminated water. probably by algae and kelp. how you are exposed. G Breathing contaminated workplace air. This is most likely to occur in the workplace or from living near a hazardous waste site. Trade names include Bromofume and Dowfume. How can 1.2-dibromoethane? G Drinking contaminated water.2-dibromoethane affect my health? Your exposure to 1.S. control of moths in beehives. Public Health Service Agency for Toxic Substances and Disease Registry . For more information. it is no longer used for this purpose.2-dibromoethane when it enters the environment? G It moves into the environment from manufacturing use and leaks at waste sites. U.2-dibromoethane? (Pronounced 1. This information is important because this substance may harm you. however. Redness and inflammation. This chemical has been found in at least 27 of 1.2-dibromoethane can result from drinking groundwater or breathing air that is contaminated. damage sperm in males. It also occurs naturally in small amounts in the ocean where it is formed. 1. Other names for 1.1. G It breaks down slowly in air (over 4–5 months). but animal studies with short-term exposures to high levels caused depression and collapse. and even cause death if exposure is very high.2-Dibromoethane is a manufactured chemical. the duration. since leaded gasoline is now banned. The effects of exposure to any hazardous substance depend on the dose. especially well water near farms or waste sites. sweet odor. SUMMARY: Exposure to 1.2-dibromoethane are ethylene dibromide. and glycol bromide. call the ATSDR Information Center at 1-888-422-8737. more quickly in surface water (2 months). vegetable.2-DIBROMOETHANE CAS # 106-93-4 Agency for Toxic Substances and Disease Registry ToxFAQs September 1995 This fact sheet answers the most frequently asked health questions (FAQs) about 1.416 National Priorities List sites identified by the Environmental Protection Agency.2-Dibromoethane has been used as a pesticide in soil. G Small amounts remain attached to soil particles. and as a preparation for dyes and waxes. G It dissolves in water and will move through soil into the groundwater. much lower than levels that can harm you. G It is not expected to build up in plants or animals. DEPARTMENT OF HEALTH AND HUMAN SERVICES. This fact sheet is one in a series of summaries about hazardous substances and their health effects. and on citrus. personal traits and habits.2-dibromoethane. and grain crops. Uses today include treatment of logs for termites and beetles.2-dº“br½“m½ µth“³n”) 1. EDB. damage skin. It is a colorless liquid with a mild. What is 1. indicating effects on the brain. including skin blisters and mouth and stomach ulcers. G Playing in contaminated soils at waste sites. 1. can occur if large amounts are What happens to 1.

2-dibromoethane? There is no reliable medical test to determine whether you have been exposed to 1.045 ppm for up to a 10-hour workday over a 40-hour workweek.2-dibromoethane.000 pounds or more of 1. Mailstop E-29. Experimental methods exist to measure 1. and treat illnesses resulting from exposure to hazardous substances. Lower levels caused liver and kidney damage. but your doctor may be able to send samples to a special laboratory.2-DIBROMOETHANE CAS #106-93-4 ToxFAQs Internet address via WWW is http://www. 1.2-dibromoethane per million parts of air (ppm) for an 8-hour workday over a 40-hour workweek.2-dibromoethane.2-dibromoethane in air to an average of 0. Federal Recycling Program Printed on Recycled Paper .html ATSDR can tell you where to find occupational and environmental health clinics.2-dibromoethane for several years. Division of Toxicology. Changes in the brain and behavior were also seen in young rats whose male parents had breathed 1. Atlanta. rats and mice that breathed.2-dibromoethane be reported. in blood.Page 2 1. GA 30333. ppm: Parts per million. Is there a medical test to show whether I’ve been exposed to 1. death occurred from breathing high levels for a short time. evaluate. However. a breakdown product of 1. How likely is 1. One accidental swallowing caused death in a woman. and birth defects were observed in the young of animals that were exposed while pregnant.2-dibromoethane per billion parts of drinking water (0. No other long-term effects are known in people.atsdr. Atlanta.2-dibromoethane. ppb: Parts per billion. The Occupational Health and Safety Administration (OSHA) has limited workers' exposure to an average of 20 parts of 1. or touched it for long periods had cancer in many organs. Glossary Carcinogen: A substance that can cause cancer.2-dibromoethane may reasonably be anticipated to be a carcinogen. EPA requires that spills into the environment of 1. Although very little is known about the effects from breathing 1.atsdr. Department of Health and Human Services.S.2-dibromoethane or the bromide References Agency for Toxic Substances and Disease Registry (ATSDR). ToxFAQs Internet address via WWW is http://www. Phone: 1-888-422-8737. When rats breathed air or ate food containing 1. they were less fertile or had abnormal sperm. FAX: 404-498-0093. some male workers had reproductive effects including damage to their sperm.05 ppb).cdc. Long-term: Lasting one year or longer. contact the Agency for Toxic Substances and Disease Registry.cdc.2-dibromoethane for short or long periods of time. There are no reports of cancer in workers or other people exposed to 1. You can also contact your community or state health or environmental quality department if you have any more questions or concerns. GA: U. ion. Public Health Service. 1600 Clifton Road NE.2-dibromoethane. The National Institute for Occupational Safety and Health (NIOSH) has limited workers' exposure to 1.05 parts of 1. Has the federal government made recommendations to protect human health? The EPA has set a limit of 0.2-dibromoethane to cause cancer? The Department of Health and Human Services has determined that 1.html swallowed.gov/toxfaq. Where can I get more in