HSE Training.

2019
Hydrogen Sulfide Safety
 COURSE DESCRIPTION

 Course designed in accordance with:

 ANSI Z390.1
 API RP 49
 API RP 55

 Standard Requires refresher training on an

annual basis
1. WHAT IS HYDROGEN SULPHIDE
 WHAT IS H 2 S

 Hydrogen sulfide is a highly toxic gas formed

from one atom of Sulfur and two atoms of
hydrogen.
 NAMES

Scientific Names Common Names

 H 2S  Sour Crude or Sour Gas

 Sulfuretted Hydrogen  Rotten egg gas

 Hydrosulfuric Acid  Swamp gas

 Dihydrogen Sulfide  Stink Damp
 Sulfur Hydride  Devil’s Breath
 Dihydrogen Monosulfide  Sewer gas
2. HOW IS H2S FORMED?
 HOW IS HYDROGEN
SULFIDE FORMED

 H2S is formed naturally when bacteria break down the sulfur rich
proteins found in dead plants and animals.

 In Industrial settings H2S is either a product, byproduct, or waste

material. In these applications H2S is extremely dangerous
because it can be stored in larger quantities.
 INDUSTRIES

 Petroleum Industry Workers  Sewer workers

 Fishing Industry  Land fill workers

 Miners  Pulp and paper operations

 Pipeline Maint. Workers  Slaughter house workers

 Synthetic fiber makers  Tunnel workers

 Well diggers  Wool pullers

 Coal degasification workers  Animal fat and oil processors

 Dye makers  Excavators

 Trench workers  natural gas production

3. LOCATIONS
 LOCATIONS

H2S is largely associated with the oil and gas industry. It is important to
know what locations in your industry and more specifically at your
locations, where the gas can be found.

Areas
 Wellheads or Wellbores
 Vessels
 Pits and low areas
 Shacks, buildings, or containers
 Piping systems
 Tanks
 Confined or enclosed spaces
 Production facilities
 CLOSED SYSTEMS

 Vent Lines
 Fittings
 Seals
 Flanges
 Drain or sampling valves
 Relief Valves
 DRILLING OPERATIONS

 Blow out preventor

 Bell nipple
 Drilling fluid piping
 Shale shaker
 Celler
 Rig floor
 Choke manifold
 Degasser
 Mud tanks
 Flare pit
4. PROPERTIES AND CHARACTERISTICS
 PHYSICAL STATE

In its normal state Hydrogen sulfide

is:
 Highly Toxic
 Colorless
 Gas
 19 % heavier than air

Air

H2S
 PROPERTIES AND
CHARACTERISTICS

 Vapor Density
 Flammability- H2S is a highly flammable gas when in
the correct mixture with air. It has a low auto-Ignition
temperature = 5180F (2600C) H2S will burn from 4.3%
to 46% concentrations with Air.
 PROPERTIES AND
CHARACTERISTICS
Combustibility
 H2S burns with a blue flame
and forms Sulfur dioxide,
another toxic and irritating gas.
Sulfur Dioxide is also heavier
than air and precautions must
be taken to protect against
exposure
 ODOR

 H2S is able to be detected by smell in concentrations

as low as .1ppm. Although it is usually detected by
smell the nose can not be relied on as a dependable
way of detection.
0-20 PPM Rotten Egg smell

20-100 PPM Sweeter metallic odor

> 100 PPM NO Smell

 ODOR

 Hydrogen sulfide has a paralyzing effect on the olfactory nerves which

allow you to smell.

The Sense of smell should never be relied on to detect H2S

 CONCENTRATIONS

 When discussing
concentrations we
must first consider
that concentration is
relative to the sample
size
5. EXPOSURE LIMITS
 EXPOSURE LIMITS

The way in which H2S affects you depends on the length of

time the individual is exposed, and on the concentration

Long-term exposure limit. (LTEL)

(over on 8 hour reference period) of 10ppm.
Short-term exposure limit. (STEL)
(over a 10 minute reference period) of 15ppm.
EXPOSURE LIMITS
 SYMPTOMS
• Hydrogen sulfide can affect many parts of the body and its important to
remember the symptoms.

Throat Irritation

Fluid
 SIGNS AND SYMPTOMS

 Olfactory paralysis  Dizziness

 Eye irritation  Pulmonary edema

 Headaches  Respiratory arrest

 Nausea  Excitement

 Diarrhea  Coughing Acute Toxicity

 Staggering gate  Sneezing

 Brain damage

 Cardiac arrest
 SIGNS AND SYMPTOMS

 Eye irritation

 Headaches

 Respiratory tract
irritation
 Anorexia

 Corneal blistering
Chronic Toxicity
 Nausea

 Sleep disturbances
 VARIABLES

There are many variables which will affect the speed of the onset of
symptoms. The primary variables are exposure concentration, exposure
duration, and individual variables.

 Body mass
 Age
 Personal Biochemistry
 Overall physical condition
 smoker/non-smoker
 Previous exposure to H2S
 DRUGS AND ALCOHOL

 The presence of alcohol, prescription medications and/or illicit drugs in

the body may result in hypersensitivity to the effects of H2S. Multiple
toxins being filtered from the bloodstream by the liver may not be
metabolized at their normal rate compounding their effects on the body.
6. WORK PRACTICES
 SAFE WORK PROCEDURES

 Safe work procedures should include:

• Conduct site-specific safety meetings
• Verify that workers are properly trained
• Maintain compliance with permit requirements
• Provide at least one standby person qualified in
CPR/First Aid
• Verify that proper safety equipment is available,
functioning properly, and is used
• Checking and remaining aware of wind conditions and
direction
• Perform a thorough check for personnel and ignition
sources before starting any potentially hazardous work
• Notify supervisory personnel before initiating
operations that could involve a release of H2S
• Use the buddy system and never work alone in
H2S areas
• Use Monitors to detect the presence of H2S
• Ventilate work areas and purge lines before
beginning work
• Keep non-essential personnel away from work
areas
• Never take shortcuts.
 CONTINGENCY PLANS

 Contingency plans are a logical step by step approach to dealing with

an emergency. Some of the items which may be included in the plan
but are not limited to the following:
• Instructions for alerting employees to emergency

• Procedure for requesting assistance

• Call list of people to notify in the event of an emergency

• Map of area including muster points and location of safety equipment

• Operating procedures to be followed in an emergency

• Any specific job assignments

• Location of where the contingency plan is to be kept

CALL LIST
 IMMEDIATE ACTION PLAN

 This plan is to be followed by designated people any time

there is a potentially hazardous hydrogen sulfide discharge.
The plan should include the following provisions:
 Alert and accountability of facility personnel. Move away from
the source and get out of the affected area
• Don proper personal breathing equipment
• Alert other affected personnel
• Assist personnel in distress Muster
Proceed to designated safe briefing area
Point
•

• Account for onsite personnel

 IMMEDIATE ACTION PLAN

 Take immediate measures to control present

or potential hydrogen sulfide discharges and
eliminating possible ignition sources
• This may include flaring
• Individual responsibilities should be listed
here
• Emergency shut down procedures
initiated as deemed necessary
 IMMEDIATE ACTION PLAN

 When the required action cannot be done in

time to prevent exposure to operators or the
public the following may be required:
• Alert Public
• Initiate evacuation procedures
• Block unauthorized access to the location
• Notify appropriate personnel and agencies
• Monitor ambient air in the area of exposure
 ENGINEERING CONTROLS

 Engineering controls are the preferred method of protection.

Some controls that may be on your site are the following:
• Enclosed worksites
• Ventilation equipment
• Monitoring equipment

• Burning, flaring , or venting of H2S

• Containment
• Dispersion
7. DETECTION EQUIPMENT
 DETECTION EQUIPMENT

 Manufacturer’s recommendations
should be followed for the
installation, maintenance, calibration,
and repair of detection equipment.
An adequate number of fixed or
portable or both type detectors
should be provided for the safety of
personnel working.
 DETECTION EQUIPMENT

Fixed Monitoring Detection Systems

 Fixed hydrogen sulfide monitoring systems
shall include visual and audible alarms, located
where the alarm can be seen or heard
throughout the work area.
 Monitoring equipment should be used during
all drilling, work over, and well servicing
operations where there is a possibility of a
release of hydrogen sulfide above the allowed
levels.
 FIXED DETECTION
EQUIPMENT
 Sensors for fixed detections systems should be used at the following
• Locations as appropriate:
• Bell nipple
• Mud-return line
• Shale shaker
• Trip tank
• Well control fluid pit area
• Driller/operator’s station
• Living quarters

• All other areas where h2S may accumulate

 PORTABLE DETECTORS

There are three main types of portable detection

methods available.
 Lead Acetate tapes can be used to reveal the
presence of Hydrogen Sulfide. H2S reacts with
lead acetate and stains the paper. The amount
of staining is directly proportional to the
concentration.
 Requires constant monitoring as there is no
alarm.
 Takes about three minutes to take a sample.
 PORTABLE DETECTORS

 Colormetric tubes
 Chemical Specific

 Works by chemical reaction

 Tube is graduated with unit of

measure

 Some chemicals have tubes

which cover different ranges
 PORTABLE DETECTORS

Electronic Gas Detectors are the most common type

of detector used. Some models are disposable and some

have a battery which can be replaced. These detectors usually

have an audible, visual, tactile, or combination type alarms. It

is important to read the manual from the manufacturer to

make sure the unit is used properly.

 PORTABLE DETECTORS

 Not keeping the detector clean can lead to

premature sensor failures. These detectors can
come as a single gas detector or a multi-gas
detector. Single gas detectors only test for one
gas and some multi-gas detectors can test up to
five different things. Single gas detectors are
generally more accurate than multi-gas
detectors. Sensors must be directly exposed to
the atmosphere to operate properly so don’t
keep it in your pocket.
 PORTABLE DETECTORS

 Disposable gas detectors usually are maintenance free but do

require daily bump calibration. Bump calibration required
hooking the detector up to a cylinder with a known quantity
of test gas. If the detector reads the same as the cylinder
amount then the detector is calibrated and functioning
properly
8. PERSONAL PROTECTIVE
EQUIPMENT
 PERSONAL
PROTECTIVE
EQUIPMENT
Personal Protective Equipment or PPE should be provided to all personnel
expected to work in areas which may contain hazardous concentrations of
hydrogen sulfide. The primary PPE used for H2S is respiratory protection
which we will discuss further. For personnel working in these areas the
following items should be discussed:

 Location of Supplied Air Respirators

 Locations of spare cylinders, if applicable

 Site specific issues

 Situations that would require respirators

 Limitations and capabilities of positive pressure/full face piece respirators

 Limitations and capabilities of air supplied and air purifying respirators

 Brand/model/ size of respirators available

 A respiratory protection program should be in place

 PERSONAL
PROTECTIVE
EQUIPMENT
 PPE is the least preferred method of
controlling hazards, all attempts
should be made to remove or limit
the hazards to personnel.
 Selection of PPE is very important
and to understand this personnel
must understand the equipment
available.
 RESPIRATORS

 A respirator is a device designed to protect the wearer from

inhaling harmful dusts, fumes, vapors, and/or gases. Respirators
come in a wide range of types and sizes used by the military,
private industry, and the public. Respirators range from cheap
single-use disposable masks, to reusable models with replaceable
cartridges. There are two main types of respirators:
• Air Purifying Respirators
• Supplied Air Respirators
 AIR PURIFYING
RESPIRATORS
All respirators have some type of face piece held to the wearer's head
with straps, a cloth harness, or some other method. Face pieces come in
many different styles and sizes, to accommodate all types of face shapes.
 SUPPLIED AIR
RESPIRATORS
These respirators are supplied with an alternate source of air. Supplied air
respirators are the only type allowed to be used to protect workers from
exposure to H2S. Open circuit are the type most commonly used for
working with Hydrogen Sulfide and will be the type covered here.

Open Circuit Closed Circuit

CLOSED CIRCUIT SCBA

OXYGEN
 SUPPLIED AIR
RESPIRATORS
 There are three basic types of Supplied Air Respirators
(SAR).
 There are many manufactures of fresh air equipment
on the market here are a few.
 Scott and MSA are the two most common
manufacturers and most widely used.
• MSA
• Scott
• Draeger
• ISI
• SurviveAir
• Cairns
 ESCAPE UNITS

 The escape Unit can be used for only one

purpose, ESCAPE. The unit has a minimal
quantity of air and is very limited in its
capabilities. It is designed as a simple easy
to use system with minimal parts and is
designed for quick donning. The cylinder
capacity can vary depending on
manufacturer. The most common are rated
at 5 minute, 10 minute, and 15 minute
capacities. Most models have an anti-fog
hood that lets you see where you're going
and fits comfortably over bulky eyeglasses
and full beards.
 ESCAPE UNIT

 The escape units are made to be donned very quickly and can
usually be applied using these few steps:
• If In a case , remove from the case
• Loop the strap over your neck or over your shoulder
• Slip hood over your head and tighten if the device has this
option
• Turn on the air cylinder
• Leave the area immediately !!!!
 After use, you should clean and air dry the hood. Refill the
cylinder. Return the unit to its proper location. The location of
escape units should have signs alerting personnel to their location.
 WORKLINE UNIT

 Workline Units can be used to work

for extended periods of time in a
hazardous atmosphere. They are
commonly used for confined space
entries because of their relatively
small size
 They usually have a cylinder rated at 5,
10, or 15 minute capacity to be used
to escape in the event of an
emergency. During normal operation
the cylinder valve remains closed and
the user draws air from an external air
source such as a cascade system.
WORKLINE UNIT
 WORKLINE UNITS

 Workline units are equipped with a fitting which allows connection to

external air supplies. In order to work with these units the air must be
drawn from the external source and not the escape cylinder. Care must
be taken to protect the supply hoses from getting caught or cut by
objects. The hose is also a hazard around rotating equipment. Make
sure the hose does not catch on any valve handles or operating controls.
 SELF CONTAINED BREATHING
APPARATUS
(SCBA)

 The SCBA is filled with filtered

compressed air, the same air that we
breathe. The air should be grade “D” or
better in quality. Most new standards
require that the SCBA be of the positive-
pressure type. Positive pressure scba’s
maintain a positive pressure inside the
facepiece during inhalation and
exhalation. This is a safety measure
added to reduce the chance of
contaminated air entering through a
break in the seal of the mask.
 SCBA COMPONENTS
 Backpack and Harness assembly is used to secure the cylinder in place. It
will have some type of strap configuration to attach the device to the
body. The design of these strap configurations can vary from different
manufacturer’s and different models.
SCBA AIR CYLINDER
ASSEMBLY
 SCBA CYLINDER

 SCBA Cylinders come in a variety of sizes, volumes,

and operating pressures. It is important to use the
correct cylinders with the correct model regulator. A
few of the configurations you will see are the
following:
• 30-minute, 3000 psi
• 30-minute, 4500 psi
• 45-minute, 4500 psi
• 60-minute, 4500 psi
 SCBA CYLINDERS

 The ratings that are given to the

cylinders do not take into
consideration the type of activity
being done nor the physical
condition of the user. On low
means they only get a little over
20 minutes of air. The harder the
work, the faster the person will
breathe and use up the air. So
don’t be fooled into thinking you
have 30 actual minutes of
breathing time.
 SCBA CYLINDERS

 The cylinders can be made of solid

metal such as aluminum or a light
weight alloy which is wrapped with
some type of fiber for increased
strength. All cylinders must be
hydrostatically tested.
 Metal cylinders must be tested every
5 years and have an unlimited service
life while composite wrapped
cylinders must be tested every three
years and have a maximum service
life of 15 years
 REGULATOR ASSEMBLY

 Most SCBA’s come with a two stage regulator.

They come in two basic configurations.
• Face Piece mounted regulator
• Belt mounted regulator
 Air moves from the cylinder, travels through
the high-pressure hose and into the regulator.
The regulator reduces the pressure of the
cylinder air to slightly above atmospheric
pressure and controls the flow of air to meet
the respiratory requirements of the wearer.
 REGULATOR ASSEMBLY

 Most newer SCBA’s will have a regulator the connects to the face piece. Face
piece mounted regulators have many benefits compared to belt mounted types:
• Communication is easier
• Less likely to cut or damage low pressure hose
• Easier to shut off air in non hazardous locations which saves air
• Here are a few photos of some face piece mounted regulators
 REGULATOR ASSEMBLY

 The regulator is equipped with a low air alarm to warn the user. This alarm can be
audible, visual, tactile, or a combination. Audible alarms are usually a bell or
whistle. Visual alarms are usually an LED display in the mask. Tactile alarms are
usually a vibration of the Regulator.
 Low air alarms should be set at 25% or 1/4th of the cylinder capacity. They are not
set by minutes because of the varying capacities of cylinders.
 REGULATOR ASSEMBLY

 Always make sure that the cylinder

gauge and regulator gauge read
approximately the same. In low air
situations they may differ so use
the lower. If the cylinder gauge and
regulator gauge differ by more than
100 psi the unit must be taken out
of service and repaired.
 In the event of regulator failure use
the red by-pass. Open, breath,
then close until next breath to save
air. Immediately leave area.
 FACEPIECE ASSEMBLY
The facepiece assembly is made of four basic parts:
• Facepiece
• Nose cup
• Exhalation valve
• Head harness
 Facial hair can interfere with the seal of the mask
an put personnel at risk. Many companies have a
“no facial hair” policy for workers in areas in
which they may need to use respiratory
equipment. Here culturally, many males grow
facial hair, so just be aware you are putting
yourself at risk. The mask to face seal is one of the
most important parts of the system.
 FACEPIECE ASSEMBLY

 Some facepieces have a nose cup inside the mask.

The nose cup is there to minimize fogging to the
mask . If the cold air from the mask mixes with
your hot breath, the mask will fog up minimizing
visibility. The nose cup directs air out the exhaust
port instead of out into the facepiece.
 Always check the strap configuration on the head
harness. Even on the same types of SCBA’s they
may have mask with different strap configurations.
The straps can be rubber or a cloth type. Be
careful with rubber straps that you do not snap
them while tightening. Always pull straps toward
s the rear.
 FACEPIECE ASSEMBLY

Some masks have:

• Two straps
• Four straps
• Five straps

 Don’t pull the straps to tight as it will actually be

harder to get a good seal. Most mask will not be
able to be used with glasses. Masks do come in
different sizes and should be fit tested on users
to get the best possible seal. Always read the
documentation with the SCBA to know the
correct way to attach the regulator to the mask.
 LIMITATIONS

 Facepiece only provides limited protection. It only provides limited

impact resistance. It will only protect the airway if:
• The mask is in good working condition
• The mask is donned properly and the seal is maintained
• Facial hair or improper mask size does not interfere with the
ability of the mask to seal to the face.
 Increased weight of the apparatus will affect stamina and can cause
discomfort in some cases.
 Decreased Mobility- The size of the pack may limit which areas are
accessible to the rescuer/worker. In confined space entries
sometimes it is necessary to remove the pack from the body while
still breathing through unit.
 LIMITATIONS

 Decreased Ability to Communicate- Users will

experience great difficulty in communicating while
breathing air. Some SCBA’s have amplifiers or radio
accessories installed in the facepiece to combat this
problem
 Limited Visibility- The user’s field of view is
narrowed because of the facepiece. It is important
to be very aware of footing when going up and down
stairs or when walking through areas with tripping
hazards.
 LIMITATIONS

 Air Supply Limitations- The work or rescue time is limited

by the quantity of air in the cylinder. It is important to
make sure that the cylinders remain full to capacity so the
maximum amount of air is available. The duration the
cylinder lasts depends on a few factors:
• Physical condition of the user
• Degree of exertion
• Condition of the SCBA
• Cylinder pressure before use
• Training and experience of the user
 STORAGE,
INSPECTION,
MAINTENANCE
 Personal breathing equipment shall be
located so that the equipment is
quickly and easily available to
essential personnel. Breathing
equipment shall be maintained and
stored in a clean sanitary location.
They should be stored to protect them
from damage, contamination, dust,
sunlight, extreme temperatures and
damaging chemicals. The equipment
should be packed and stored to
prevent deformation of the facepiece
and exhalation valve.
 STORAGE,
INSPECTION,
MAINTENANCE
 All breathing equipment shall be
checked before and after each use
and inspected at least monthly to
ensure that it is maintained in a
satisfactory condition. A record
should be kept documenting
inspection results, dates and
findings and maintained for one
year.
 SCBA Masks should be cleaned
after every use using mild soapy
water. Do not use bleach or
sanitizer as they may degrade the
rubber. Hang to dry not in sunlight.
DONNING PROCEDURES
 SCBA SAFETY
PROCEDURES
 Never remove or compromise the seal until you have left
the contaminated area.
 Always use the buddy system when working with
respiratory protection.
 Always use two people and in rescue situations and have a
back up team of two on stand-by.
 If there is a regulator malfunction, use the bypass and
immediately escape to fresh air.
 If making an entry into a confined space, taglines should
be used.
 If working in an IDLH atmospheres, a Rescue standby team
shall be on site comprised of personnel trained in rescue
techniques dealing with H2S. They must have the proper
safety equipment to perform these types of rescue.
9. EMERGENCY RESPONSE
 EMERGENCY RESPONSE

 Effective use of contingency plan, engineering controls,

and personal protective equipment (PPE) should reduce
the chances of personnel being exposed to hydrogen
sulfide gas. In event that these protective measures fail,
it is important to know how to respond to these
emergencies.
 EMERGENCY RESPONSE

 Personnel should always be aware of wind

direction. When an H2S alarm goes off the first
thing personnel should do is check wind direction
and proceed to a safe muster point. All
unnecessary possible ignitions sources should be
eliminated. Equipment can be used to prevent
possible ignition sources:
• Intrinsically safe electronic equipment
• Non-sparking hand tools
• Spark arrestors
• Cooling systems on Rig Motor manifolds
 FIRST AID

 Always immediately remove injured personnel to

fresh air. Rescue personnel should always be
protected prior to attempting a rescue.
 INHALATION EXPOSURE

 Move victims to fresh air. Emergency personnel should

avoid self-exposure to hydrogen sulfide gas.
 Evaluate vital signs including pulse and respiratory rate, and
note any trauma. If no pulse is detected, provide CPR. If not
breathing, provide artificial respiration. If breathing is
labored, administer oxygen or other respiratory support.
 Obtain authorization and/or further instructions from the
local hospital for administration of an antidote or
performance of other invasive procedures.
 RUSH to a health care facility as one side effect of exposure
is delayed onset of pulmonary edema.
 DERMAL/EYE EXPOSURE

 Remove victims from exposure. Emergency personnel should avoid

self- exposure to hydrogen sulfide.
 Evaluate vital signs including pulse and respiratory rate, and note any
trauma. If no pulse is detected, provide CPR. If not breathing, provide
artificial respiration. If breathing is labored, administer oxygen or
other respiratory support.
 Remove contaminated clothing as soon as possible.
 If eye exposure has occurred, eyes must be flushed with lukewarm
water for at least 15 minutes.
 Wash exposed skin areas for at least 15 minutes with soap and water.
 RUSH to a health care facility!
 EMERGENCY RESPONSE

 A well thought out emergency plan is essential

because improperly executed rescue attempts are
most often fatal to the rescuer. There are many H2S
emergencies on record in which there are multiple
fatalities because the personnel were not properly
prepared and educated on how to deal with H2S
emergencies.
 It is important that all rescues are made as soon as
possible. When a victim is not breathing it takes
approximately 6 minutes for brain death to occur and
permanent damage occurs prior to that. The best
chances of survival have been recorded with personnel
which were rescued and resuscitated within 3 minutes.
 EMERGENCY RESPONSE

 A variety of techniques can be used to remove the injured from the

contaminated area. You can use carries and drags to accomplish this:
• Collar Drag
• Extremity carry (2 people)
• Fireman’s Carry
• One arm or two arm carry
SUMMARY
 SUMMARY

 Hydrogen sulfide is a colorless, odorless gas

 H2S at low concentrations smells like rotten eggs and quickly

deadens the sense of smell
 It is heavier than air and will settle in low lying areas or areas
where there is very little natural ventilation.
 Hydrogen sulfide is a flammable gas with an ignition point of 270
0
C and is can be explosive when mixed with air. It burns with a
blue flame and forms sulfur dioxide, another highly toxic gas.
 Hydrogen is soluble in water and can be dissolved in crude oil and
salt water from wells. It can be released anytime these liquids are
agitated, depressurized, or the temperature is increased.
 SUMMARY

 H2S is commonly found in all phases of hydrocarbon production from drilling

to refining.
 Flaring is the most common way of controlling hydrogen sulfide out in the
field.
 It is important to have continuous monitoring devices to detect hydrogen
sulfide because of its very poor warning characteristics.
 Personnel must recognize the signs and symptoms of exposure.
 Personnel must be trained to use the PPE available to protect them
 Emergency procedures must be established before work begins on a location.
 Although there are several protective systems in place to prevent exposure
to personnel it is still a very hazardous chemical to work around which
causes many deaths every year despite the training and protection available.