Date: Tue, 17 Apr 2007 09:54:23 -0500
Reply-To: Dennis Compton <drcompton**At_Symbol_Here**OBITERRESEARCH.COM>
Sender: DCHAS-L Discussion List <DCHAS-L**At_Symbol_Here**LIST.UVM.EDU>
From: Dennis Compton <drcompton**At_Symbol_Here**OBITERRESEARCH.COM>
Subject: Re: FW: [DCHAS-L] Undergraduate Accident
Comments: To: "McCartney, Alan"
In-Reply-To: <FE88990C2A43C646A0248A47621AFD3E08EF919B**At_Symbol_Here**>

From a non-academic perspective the best place to send a chemical exposure is to an occupational medicine facility. The one that we work with is next door to the emergency room so they can take you in there immediately if they deem it severe enough. There is no waiting in the emergency room since you being escorted by a medical professional. Fortunately we have not required the use of the occupational medicine group, but I have greater confidence in their ability to respond to chemical exposures. They are more current on how to handle work place related injuries and chemical exposures then the e.r. staff. I don't know if an academic institution has access to an occupational medicine facility, since most require that the organization sign up in advance. This allows the occupational medicine doctors to meet with the organization and prepare a file as to what types of injuries/exposures they might possibly see from your facility. The physicians that we have worked with have been very knowledgeable and helpful. Sincerely, Dennis Compton ======================= Dennis R. Compton, Ph.D Chemistry Manager Obiter Research, LLC 60 Hazelwood Drive St 245 Champaign, IL 61820 Phone (217) 265-7677 drcompton**At_Symbol_Here** -----Original Message----- From: DCHAS-L Discussion List [mailto:DCHAS-L**At_Symbol_Here**LIST.UVM.EDU] On Behalf Of McCartney, Alan Sent: Tuesday, April 17, 2007 8:27 AM To: DCHAS-L**At_Symbol_Here**LIST.UVM.EDU Subject: [DCHAS-L] FW: [DCHAS-L] Undergraduate Accident Ed You action regarding dilution with water and sending the patient to a professional healthcare provider is the best recommended action. You should never consider neutralization. None of the recommended texts or any dermal exposure guidelines (including ASTDR & their medical management guidelines recommend neutralization of the material directly upon the skin as the 1st aid treatment. It is hoped that either a hard copy of the MSDS or an instantly retrievable electronic copy is available to all in the labs. In my experience, most college / university healthcare centers do not have the knowledge or capabilities to properly evaluate and treat chemical exposures. Some might. For the majority of institutions, the best place for the student is the local emergency room. As an emergency paramedic for over 25 years, (who has also worked as an Industrial Hygienist around medical research labs at a Boston hospital a number of years ago), I understand that any adult (over 18 years of age) has the legal right to refuse medical care and treatment. This concept is very hard for those of us who have health coverage as well as an understanding of the chemical risks to accept or even understand. However, it is reality. Nothing you as the instructor can do can force the student to seek medical treatment unless they are unconscious or mentally incapacitated. Treatment at that time can be instituted and is called "implied consent". Unless the lab has a formalized written policy (& educational program) that addresses chemical safety, and prior to all students (employees, PIs, instructors, etc) working in the lab; (and as part of the written policy) a requirement exists that all chemical exposures be treated at a hospital emergency room, with a written statement from the hospital accompanying their discharge (called a discharge summary, given to all patients), you can't force medical treatment. Therefore when the student understands up-front the chemical exposure, health risk and lab requirement, and has agreed to these requirements in writing as a binding condition of their use of the lab, then and only then might you be able to force the student to seek medical treatment, solely by threat of refusing them re-entry into the lab. Otherwise, you can not force anyone 18 years old or older to go to the hospital. Who is / could be liable? This depends upon many, many varying circumstances, all of which (if pushed into court) would be decided by a jury of your peers. The school could potentially be liable, if they do not have a clear, coherent, chemical safety plan & procedure in place that covers all aspects of chemical use (receiving virgin material, waste handling, and use in the labs, by instructors, students, researchers, PIs, etc). The school could be potentially liable if they have a written a plan, but the school does not equitably utilize and implement all aspects of the written plan (including instructors, employees, PIs and students). The instructor / PI / could be potentially liable if the school has a plan, and does not equitably utilize and implement all aspects of the written plan. The instructor / PI / could be potentially liable if the school doesn't have a plan (or inadequate plan), and due to their extensive knowledge of the chemical hazards and risks, does not implement procedures in those areas under their direct control, to ensure safety of those in the area. The instructor / PI / school could be potentially liable if the school doesn't have, or has inadequate personal protective equipment, or doesn't train, or inadequately trains in the use of the PPE. And possibly other liability exposures not included. Just some ramblings of someone who has worked in ESH in various industries and environments over the years. Sincerely, Alan P. McCartney Alan P. McCartney CSP CHCM EMT-P Senior Technical Consultant - Property Agency Markets Loss Prevention Liberty Mutual Agency Markets 62 Maple Avenue Keene, New Hampshire 03431 (603) 358-4560 (603) 357-9531 (fax) alan.mccartney**At_Symbol_Here** Helping People Live Safer More Secure Lives Our loss prevention service is advisory only. We assume no responsibility for management or control of customer safety activities nor for implementation of recommended corrective measures. We have not tried to identify all hazards. We do not warrant that requirements of any federal, state, or local law, regulation or ordinance have or have not been met. This e-mail, and any attachments thereto, is intended only for the use of the addressee or addresses named herein and may contain legally privileged and/or confidential information. If you are not the intended recipient of this e-mail, you are hereby notified that any dissemination, distribution or copying of this e-mail, and any attachments thereto, is strictly prohibited. If you have received this e-mail in error, please notify me via return e-mail and via telephone at (603) 358-4560 and permanently delete the original and any copy of any e-mail and any printout thereof. -----Original Message----- From: DCHAS-L Discussion List [mailto:DCHAS-L**At_Symbol_Here**LIST.UVM.EDU] On Behalf Of Edward Senkbeil Sent: Thursday, April 12, 2007 2:53 PM To: DCHAS-L**At_Symbol_Here**LIST.UVM.EDU Subject: [DCHAS-L] Undergraduate Accident Recently we had an accident in the general chemistry lad where a student spilled some 4.0M NaoH on her wrist. The protocol we have followed in the past is to wash with water for 15 minutes and then send to the University Health Center. We. normally follow the protocol to "Protect, but not treat". The skin was slightly red due to the spill. When the student reached (was escorted to) the Health Center, they said they could not treat chemical burns. They wanted to send her to the hospital emergency room, but the student didn't go because of lack of insurance. Three days after the accident, the student's wrist still has a few pink spots. The questions are: 1. Should we (lab instructors) treat by neutralizing the base with something like vinega, rather than just washing? 2. Who should be responsible (or maybe liable) for appropriate treatment? Howd do university health centers handle someting like this incident at other universities? Thanks for any information, Ed Senkbeil Chemistry Department Salisbury University

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