From: Alan Hall <ahalltoxic**At_Symbol_Here**MSN.COM>
Subject: Re: [DCHAS-L] Academic Medical Policy Question
Date: April 12, 2012 2:24:03 PM EDT
Reply-To: DCHAS-L <DCHAS-L**At_Symbol_Here**MED.CORNELL.EDU>
Message-ID: <CE82A091FC41F7488B2C2E8F0FFF6BC81B4E93CEF7**At_Symbol_Here**>

Karalyn et al,
Let the old Emergency Physician and current Medical Toxicologist  (also Advanced HAZMAT Life Support verified Provider and Instructor and D-CHAS EC Member) chime in for 2 cents worth.
In any chemical exposure, the first priority is removal of the person from the poison and removal of the poison from the person.  This  is accomplished through moving the person from the contaminated area, removing contaminated clothing (gets about 80% off in most estimations), and decontamination with whatever flushing fluid and means of delivery of that flushing fluid are available as soon as possible.  Further decontamination may be needed later depending on the individual circumstances.  Be aware that some chemicals are water reactive and that dry wiping should be done first.  Those handling such chemicals in a laboratory ought to know this or they shouldn't be allowed to be handling them in the first place!
The next step is triage:  Consider the extent of the exposure (area of the  body, Total Body Surface Area [TBSA] involved), chemical involved, concentration of the chemical, and any additional factors such as temperature of the chemical and of the environment). 
Another important consideration is whether the involved chemical has systemic as well as local effects (consider such things as hydrofluoric acid (HF), for example).
Then whether you call EMS or let the student go to the Academic Health Center depends on the individual circumstances.  For example, a < 1% Total Body Surface Area splash of dilute hydrocloric acid (HCL) on the back of the hand may result in a minor chemical skin injury with no anticipated or likely systemic toxicty and could be treated in many Adacemic Health Centers as a minor skin burn with well-known and accepted topical treatments,  checking current tetanus immunization status, minor pain medications, etc.  A 1-5% 70% HF splash on the face or the groin area, on the other hand, not only carries the risk of significant local skin injury but also a risk of life-threatening systemic toxicity.  In this case, calling EMS and transporting as soon as possible to a hospital equipped and trained to deal with such emergencies would be appropriate.  Consultation with your Certifiied Regional Poison Center (see the inside of any phone book for the nationwide 800 number -- 1-800-222-1222) might be appropriate.
In all cases, education of the Health Care Providers at the Academic Health Center prior to any incidents would be desirable (perhaps should be mandatory if students are to be referred there).  If the AHC is not comfortable with evaluating and treating such patients and has no desire to become educated as to how to do so, then such students should be referred elsewhere where they can receive proper evaluation, treatment, and follow-up.
Hope that helps.
For those interested, there is a new online 4-Hour Basic HAZMAT Life Support Course available through the University of Arizona Emergency Medicine Research Center (the same folks who sponsor the Advanced HAZMAT Life Support Course [AHLS]).  The details are available at  DISCLOSURE:  I receive no funding from this organization although I am a Research Affiliate Member and am a member of the Scientific Advisory Committee.
Alan H. Hall, M.D.
Medical Toxicologist


Date: Thu, 12 Apr 2012 11:34:30 -0500
From: Karalyn_Humphrey**At_Symbol_Here**BAYLOR.EDU
Subject: [DCHAS-L] Academic Medical Policy Question



My university is currently involved in discussions concerning how to medically respond to chemical exposures.  Our health center is currently only for routine illness and injury among students.  On one hand we have the opinion that the best course of action is to do what we can (remove and rinse if appropriate) and call the EMTs.  On the other hand, we have the opinion that the health center should become more robust or that we should either hire trained emergency personnel or train all our personnel to be emergency personnel.


I wanted to poll the academic members and see (1)  what role does your campus health center play (2) what role do your lab personnel play and (3) who are your emergency responders?


What I have been able to find online all seems to point to a policy of lab people rendering basic first aid and calling the EMTs.


Right now our policy has become to bypass the student health center, since they are not equipped to handle chemical exposures, and call the EMTs.  This is raising concern among our lab personnel, who consistently have the question of what is minor that we can deal with ourselves and what is major enough to call an ambulance.  The university stance is "when in doubt, call", but the personnel seem to want more guidance.  The problem is that every chemical exposure is different because every chemical is different, so we really can't provide hard and fast guidelines.


Thanks in advance,


Dr. Karalyn (Karen) Humphrey


Laboratory Coordinator, Department Safety Officer & Part-Time Lecturer

Baylor University Department of Chemistry & Biochemistry

Office: BSB E.111

Phone:  254-710-2002

"Vast worlds lie within the hollows of each atom, multifarious as the motes in a sunbeam."  ~Yoga Vasishtha


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