TEMS Chemical Emergency Response Training

1. TEMS Chemical Emergency Response Training For Members of Tulane Emergency Medical Services (TEMS) August 2011 Tulane University - Office of Environmental Health & Safety (OEHS)

2. Tulane University - Office of Environmental Health & Safety (OEHS)

3. Tulane University - Office of Environmental Health & Safety (OEHS)

4. Tulane University - Office of Environmental Health & Safety (OEHS)

5. Objectives • To learn how to identify chemicals • To learn how chemicals can enter the body and the types of effects they may have • To learn how to protect yourself from chemicals • To learn some of the chemical classifications and where different types of chemicals can be found on Tulane’s Uptown campus Tulane University - Office of Environmental Health & Safety (OEHS)

6. Objectives (cont.) • To learn the proper response for a TEMS member when encountering a chemical incident • To understand the role of Tulane’s Office of Environmental Health & Safety in emergency response incidents • To know your role in hazardous materials spill response Tulane University - Office of Environmental Health & Safety (OEHS)

7. Information About Chemicals • Information about a chemical can be found on the label and the Material Safety Data Sheet (MSDS) • MSDSs can be obtained on the OEHS website: http://tulane.edu/oehs, or call OEHS at 988-5486, then press 1 • Most laboratory doors at Tulane have signs showing types of chemicals within the lab and emergency contact information Tulane University - Office of Environmental Health & Safety (OEHS)

8. Chemical Routes of Entry • Inhalation • Ingestion • Skin Contact/Absorption • Injection Tulane University - Office of Environmental Health & Safety (OEHS)

9. Types of Effects of Chemicals • Acute effect – characterized by sudden and severe exposure and rapid absorption of the substance. Adverse health effects are often reversible. (Example: carbon monoxide poisoning) • Chronic effect – characterized by prolonged or repeated exposures of a duration measured in days, months, or years. Symptoms may not be immediately apparent. Health effects are often irreversible. (Example: mercury poisoning) Tulane University - Office of Environmental Health & Safety (OEHS)

10. Types of Effects of Chemicals • Local effect – an adverse health effect that takes place at the point or area of contact. Absorption does not necessarily occur. (Example: strong acid) • Systemic effect – an adverse health effect that takes place at a location distant from the body’s initial point of contact and presupposes absorption has taken place. (Example: benzene affects bone marrow) Tulane University - Office of Environmental Health & Safety (OEHS)

11. Types of Effects of Chemicals • Cumulative poisons– characterized by materials that tend to build up in the body as a result of numerous chronic exposures. Effects are not seen until a critical body burden is reached. (Example: heavy metals) Tulane University - Office of Environmental Health & Safety (OEHS)

12. Types of Effects of Chemicals • Synergistic effect – When two or more hazardous materials are present at the same time, the resulting effect can be greater than the effect predicted based on the additive effect of the individual substances. (Example: smoking and asbestos) Tulane University - Office of Environmental Health & Safety (OEHS)

13. Other Factors Affecting Exposure • Rate of entry, chemical dose • Age, lifestyle, state of health, and genetic disposition of individual exposed • Previous exposures (can lead to tolerance or increased sensitivity) • Environmental factors: temperature and pressure Tulane University - Office of Environmental Health & Safety (OEHS)

14. Chemical Classifications/Possible Locations (Uptown Campus TU) Carcinogens – Chemicals which can cause or are suspected of causing cancer • Examples: Benzene, Chloroform, Formaldehyde, Carbon Tetrachloride, Dichloromethane • Possible Locations: Stern Hall, Israel (ESB) Building, Boggs Building • Cancer is a chronic effect – it takes a long time to develop. Tulane University - Office of Environmental Health & Safety (OEHS)

15. Chemical Classifications/Possible Locations (Uptown Campus TU) Compressed Gases – Gases which are stored in a container (cylinder, lecture bottle) under pressure • Examples: Argon, Nitrogen, Chlorine, Carbon Dioxide, Oxygen, Acetylene • Possible Locations: Stern Hall, Israel (ESB) Building, Boggs Building, Art, Facilities Services • Exhaust Ventilation is needed when using compressed gases to prevent asphyxiation. • Cylinders must be chained and have protective caps in place. If valve is damaged, cylinder can act as a missile. Tulane University - Office of Environmental Health & Safety (OEHS)

16. Chemical Classifications/Possible Locations (Uptown Campus TU) Corrosives – Chemicals which can cause irreversible alterations/chemical burns to human tissue (Acids/Caustics) • Examples: Sulfuric Acid, Nitric Acid, Hydrofluoric Acid, Ammonia Gas, Hydrochloric Acid • Possible Locations: Stern Hall, Israel (ESB) Building, Boggs Building, Art, Facilities Services, Blessey • Hydrofluoric Acid - will attack glass – use benzalkonium chloride solution or calcium gluconate gel for first aid treatment. • For other acids or caustics, get victim to emergency shower or eyewash and wash for at least 15 minutes. Tulane University - Office of Environmental Health & Safety (OEHS)

17. Chemical Classifications/Possible Locations (Uptown Campus TU) Cryogenic Liquids/Gases – Liquefied gases used at very low temperatures (below -200C) • Examples: Liquid Nitrogen, Liquid Oxygen • Possible Locations: Stern Hall, Israel (ESB) Building, Boggs Building • Heavy gloves, face shield, and eye protection are needed when handling cryogenic liquids/gases Tulane University - Office of Environmental Health & Safety (OEHS)

18. Chemical Classifications/Possible Locations (Uptown Campus TU) Explosives – Chemicals which can release pressure, gas, and heat when subjected to shock, pressure, or high temperature • Examples: Nitroglycerin, TNT, Picric Acid, Sodium Azide • Possible Locations: Stern Hall, Israel (ESB) Building, Boggs Building Tulane University - Office of Environmental Health & Safety (OEHS)

19. Chemical Classifications/Possible Locations (Uptown Campus TU) Flammables – Chemicals which can ignite easily and burn rapidly, either spontaneously (pyrophoric) or from exposure to a high-temperature environment (autoignition), or a spark or open flame • Examples: Solvents, Ether, Hexane, Mineral Spirits, Diesel Fuel, Gasoline • Possible Locations: Stern Hall, Israel (ESB) Building, Boggs Building, Art, Facilities Services • Fire triangle: Ignition source + oxygen + fuel Tulane University - Office of Environmental Health & Safety (OEHS)

20. Chemical Classifications/Possible Locations (Uptown Campus TU) Flammable Gases – Gases which can form flammable mixtures with air • Examples: Hydrogen, Acetylene • Possible Locations: Stern Hall, Boggs Building, Art, Facilities Services • Flammable gases are extremely dangerous fire hazards and require precisely regulated storage conditions. Tulane University - Office of Environmental Health & Safety (OEHS)

21. Chemical Classifications/Possible Locations (Uptown Campus TU) Irritants – Chemicals which can cause reversible inflammatory reactions (watery eyes, itchy skin) • Examples: Formaldehyde, Ammonia, Hydrogen Sulfide • Possible Locations: Stern Hall, Israel (ESB) Building, Boggs Building • Some irritants have distinctive odors. • Get exposed person to fresh air. Tulane University - Office of Environmental Health & Safety (OEHS)

22. Chemical Classifications/Possible Locations (Uptown Campus TU) Oxidizers – Chemicals which promote combustion • Examples: Oxygen, Perchloric Acid, Nitric Acid • Possible Locations: Stern Hall, Israel (ESB) Building, Boggs Building, Art • Keep oxidizers away from flammables. Tulane University - Office of Environmental Health & Safety (OEHS)

23. Chemical Classifications/Possible Locations (Uptown Campus TU) Sensitizers – Chemicals which can cause allergic reactions in normal tissue after repeated exposure to the chemical • Examples: Chromium compounds, Nickel compounds, Toluene Diisocyanate • Possible Locations: Stern Hall, Israel (ESB) Building, Boggs Building, Art • Not everyone reacts to chemicals in the same way. • Reaction may be as mild as a rash or as serious as anaphylactic shock. Tulane University - Office of Environmental Health & Safety (OEHS)

24. Chemical Classifications/Possible Locations (Uptown Campus TU) Toxic – The ability of a chemical to produce a health effect or injury once it reaches a susceptible site in or on the body • Examples: Lead and its salts, Arsenic, Dimethyl Mercury, Silica Dust, Cyanides, Hydrogen Bromide • Possible Locations: Stern Hall, Israel (ESB) Building, Boggs Building, Art, Blessey • All chemicals will exhibit a toxic effect if given a large enough dose. Tulane University - Office of Environmental Health & Safety (OEHS)

25. Chemical Classifications/Possible Locations (Uptown Campus TU) Water Reactives – Chemicals that react with water • Examples: Sodium metal, Potassium • Possible Locations: Stern Hall, Israel (ESB) Building • Combustible metals need special type fire extinguishers (Class D). Tulane University - Office of Environmental Health & Safety (OEHS)

26. Chemicals May Have More Than One Property • Example: Acetic Acid – flammable and corrosive – Possible locations: Stern Hall, Israel (ESB) Building, Boggs • Example: Pyridine – flammable and toxic (bad odor) – Possible locations: Stern Hall, Israel (ESB) Building • Example: Nitric Acid – oxidizer and corrosive – Possible locations: Stern Hall, Israel (ESB) Building, Boggs Building, Art Tulane University - Office of Environmental Health & Safety (OEHS)

27. Summary • There are many types of chemicals at this university. • The potential effect a chemical can have on a body depends on many factors. Not everyone reacts the same to chemical exposures. • The dose and route of entry of a chemical affects the body’s response. • Many chemicals have more than one property. • Information about chemicals can be found on the label and the MSDS. • Chemical effects are not always additive. Tulane University - Office of Environmental Health & Safety (OEHS)

28. Emergency Response - Who is a First Responder? • First Responders respond to the site or point of release • Includes Supervisors, Fire Fighters, Public Safety, HAZMAT teams, Emergency Medical Technicians Tulane University - Office of Environmental Health & Safety (OEHS)

29. First Responder Job Functions • Secure the area of hazardous materials spill incident • Protect lives and environment • Give medical treatment - Care for sick or injured people - Transport injured persons to appropriate medical facility - Protect first receivers (at medical facility) Tulane University - Office of Environmental Health & Safety (OEHS)

30. Hot Zone – An area in and immediately surrounding a hazardous materials release, which extends far enough to prevent adverse effects from hazardous materials releases to personnel outside the zone. Definition of HOT ZONE: Tulane University - Office of Environmental Health & Safety (OEHS)

31. Beware Hazard Transmission to First Responders • Secondary Exposures from hair, skin and clothing of victims are possible. • Influenced by • Inherent characteristics of the toxin • Concentration of the release • Contact time with victim • Less than at the site of release Tulane University - Office of Environmental Health & Safety (OEHS)

32. Response to a Major Chemical Incident at Tulane • Role of Supervisor • Role of Tulane Dept. of Public Safety • Role of OEHS • Role of TEMS Tulane University - Office of Environmental Health & Safety (OEHS)

33. Role of Supervisor • Attend to injured or contaminated persons. Remove them from further exposure. • As needed, immediately flush the eyes with water using the eyewash fountain or use the safety shower for body exposure. Flush for at least 15 minutes. • Alert others in area to evacuate. • Turn off or remove sources of ignition in the vicinity of the spill. Tulane University - Office of Environmental Health & Safety (OEHS)

34. Role of Supervisor (Cont.) • Confine the spill (e.g., upright container, close doors, pull down sash of hood) • Evacuate the area • Close doors to affected area • Notify OEHS (988-5486, ext. 1), and Tulane Police/TUPD • Standby to assist emergency personnel in uncontaminated area Tulane University - Office of Environmental Health & Safety (OEHS)

35. Role of Tulane Dept. of Public Safety • Secure the scene of the incident • Prevent all unauthorized personnel from entering the chemical spill area • Provide necessary support for transportation, traffic control, and security Tulane University - Office of Environmental Health & Safety (OEHS)

36. Role of OEHS • Secure spill area • Help facilitate clean up activities • Act as a Liaison between Tulane and outside response agencies • Ensure that all Tulane personnel and injured persons are properly decontaminated if medical treatment is necessary Tulane University - Office of Environmental Health & Safety (OEHS)

37. Role of TEMS • Know there is a high probability of exposure to chemicals • Look for signs of chemicals on • Clothing • Skin • Shoes • Hair • Face Tulane University - Office of Environmental Health & Safety (OEHS)

38. Role of TEMS (cont.) • Do not enter chemical spill area without Public Safety and/or OEHS knowledge • Contact OEHS for instructions/advice • Cautiously provide medical care and transport for injured persons – DO NOT rush in to contaminated area • Protect yourself by wearing appropriate PPE Tulane University - Office of Environmental Health & Safety (OEHS)

39. Role of TEMS (cont.) • Decontaminate victim when possible before transport by using eyewash, emergency showers • Remove contaminated clothing at the incident site for removal by OEHS Tulane University - Office of Environmental Health & Safety (OEHS)

40. Summary • Emergency response to a chemical incident is a team effort. The supervisor, TUPD, TEMS, and OEHS each have a distinctive role. • Never rush in when chemicals are involved. • Recognize the need to decontaminate injured personnel before transporting to a medical facility and to wear personal protective equipment. • Seek and follow advice from OEHS – 988-5486. Tulane University - Office of Environmental Health & Safety (OEHS)

41. Personal Protective Equipment (PPEs) - Basics For TEMS Employees of Tulane University August 2011 Tulane University - Office of Environmental Health & Safety (OEHS)

42. Objectives To know how to assess the area for PPE needs To understand the importance of providing adequate amounts and various sizes of personal protective equipment To understand why potentially contaminated PPE should not be worn outside the work area To know how to properly select, use, and store PPE Tulane University - Office of Environmental Health & Safety (OEHS)

43. Proper Dress • Dress appropriately for your job • Usually best to wear closed-toe shoes and appropriate clothing (no shorts, sandals, flip flops) • Wear PPE as needed Tulane University - Office of Environmental Health & Safety (OEHS)

44. Control of Workplace Hazards • Engineering controls (Ex. Ventilation) • Administrative and work practice controls (Ex. Proper written procedures) • PPE is to be used when work practices and/or engineering controls do not lessen or eliminate the hazards, and in emergency situations. It is important to select and use PPE properly to reduce and/or eliminate exposure to the hazard. Tulane University - Office of Environmental Health & Safety (OEHS)

45. PPE/Hazard Assessment • Assessment for personal protective equipment application must be done per hazard (physical and chemical): - Chemical - Impact - Biological - Penetration - Radiological - Compression - Noise - Heat/Cold - Vibration - Harmful Dust - Light radiation Tulane University - Office of Environmental Health & Safety (OEHS)

46. PPE/Hazard Assessment • Assessment must include the following areas of the body which may be affected: • Head – eyes, ears, face, respiratory • Hand – wrist, fingers and palms • Body – torso and legs • Foot – shins and feet Tulane University - Office of Environmental Health & Safety (OEHS)

47. PPE/Hazard Assessment • Proper PPE must be provided for each worker that the hazard affects. • PPE must be made available in adequate amounts and different sizes. • PPE must be stored as per manufacturer recommendations to prevent damage, distortion or contamination. • Bag respirators; don’t hang from straps • Rinse reusable gloves • Don’t leave in sunlight Tulane University - Office of Environmental Health & Safety (OEHS)

48. Use of PPE • All who wear PPE must be trained on its uses, limitations and proper decontamination/storage. • Those who wear PPE must not wear it outside their work area. • If PPE is reusable, it must be properly cleaned and decontaminated after use. • All PPE must be stored in a clean and safe manner. Tulane University - Office of Environmental Health & Safety (OEHS)

49. Eye Protection • Safety glasses (with side shields and brow guard) – impact hazards • Safety goggles – liquid chemicals • Face shield – used with eye protection • For impact protection, face shields alone do not offer eye protection. They must be used with approved safety glasses or goggles. • Notes: • The American Chemical Society advises that contact lenses may be worn around hazardous materials as long as the appropriate type of eye protection is used. Contact lenses do not provide adequate eye protection. Tulane University - Office of Environmental Health & Safety (OEHS)

50. Protective Clothing • Aprons -Clean if contaminated with hazardous materials - Replace if torn, ripped or tattered • Laboratory Coats - Must be worn only inside the work area - Must be removed before leaving work area for breaks, lunch and end of the work day. - Must be cleaned by a professional cleaning service. DO NOT TAKE CONTAMINATED CLOTHING HOME FOR WASHING. • Fluid Resistant Clothing - When working with bloodborne pathogens, disposable clothing and/or laboratory coats may not be adequate protection for the employee. Such clothing must be resistant to blood and body fluid splashes. Tulane University - Office of Environmental Health & Safety (OEHS)