a. Initial response and decontamination

• A potentially dangerous situation exists. The initial condition of the victim is not a good indicator of the urgency of the problem. Recognize that the symptoms from many inhalation exposures take up to 12 hours to appear, and the result may lead to pulmonary edema and death.
  
• Alert nearby co-workers of the potential danger from exposure to the released chemical.
  
• Remove the injured person form the area of exposure. Do this only if you can do it without injury to yourself!! If you have protective equipment suitable for the hazard, don this first before entry into the contaminated area. If you do not have adequate protective equipment, DO NOT ENTER. Instead, wait for properly attired emergency personnel to perform the rescue.
  
• From a safe location call for emergency medical assistance:

DIAL 9-911

a) Give the location of the emergency- Building 484. Specify the Wing, if known
b) Give the extent and nature of injury, if known.
c) Give any details that may be important in a rescue situation - what chemicals are involved, are there toxic fumes involved, etc.

• Notify the Chemistry Business Office of the emergency so that the University HazMat Emergency Team may be activated.

  5-3335

• If you are able to remove the individual to a safe location, do so. The primary concern initially should be to determine if the person has normal respiratory and circulatory functions. If the person is not breathing or does not have a pulse, do not begin CPR until the person has been decontaminated unless you can protect yourself adequately against exposure in the process.
  
• Begin decontamination. Place the person under an emergency shower and flush the skin with copious amounts of water. All contaminated clothing must be removed, including shoes. Make certain that the person's hair is also thoroughly flushed if the possibility of contamination exists.
  
• If the chemical splash affected the persons eyes, reaction time is critical. The person should be led or forced to the eyewash area and the eyes flushed thoroughly for at least 15 minutes. The victim will most likely be in great pain and panic stricken. I may take several people to get the person to the eyewash and perform the needed washing. Make certain that the eyes are held open while the water washes the eyes and face.
  
• While decontamination is taking place, steps should be taken to identify the chemical. Material Safety Data Sheets should be consulted, as well as any co-workers who may have information as to what was in use and what happened. This information should be collected and ready for the attending emergency medical personnel.
  
• After decontamination is complete, the individual should be kept warm with blankets until professional medical attention arrives.
  
• If the material in use has a specific antidote, it should be administered immediately. Certain gases such as hydrogen cyanide and hydrogen sulfide do not respond to oxygen alone; their effect must be counteracted. Persons knowingly working with such materials should always make certain that all co-workers know the location of any antidotal agents.
  
• It is important that all personnel suffering from an accidental chemical exposure be examined by a medical professional before they return to work or leave for home. Many chemicals have a delayed reaction period of several hours before the onset of symptoms.

b. General guidelines in case of exposure to unknown chemicals

It is important that all Chemistry Building personnel know what to do in case of a medical emergency. The following guidelines should be read and understood BEFORE an emergency occurs, so that the appropriate actions may be taken without delay. Please read over these guidelines on a regular basis to refresh your memory regarding the correct response.

• Follow the Golden Rules:
  1. Protect yourself before attending to the injured!
  2. Decontaminate the injured person.
  3. Treat cessation of breathing first.
  4. Check for pulse and begin CPR if no pulse is present.
  5. Treat eye injuries next
  6. Treat injuries resulting from skin contact.
  7. Treat shock.
  8. Call for help.
  
• Make a quick assessment of the most likely route of exposure. Check the eyes, nose, mouth and skin for signs of the chemical itself, or signs of damage such as swelling, redness, bleeding, burns, discharge of fluids, or excessive paleness or pallor. Signs of ingestion of a corrosive might be drooling, difficulty in swallowing, noisy or labored breathing. If a splash has occurred to the face, assume eye contact. The following general guidelines should be followed for poisoning by inhalation, ingestion, skin or eye contact.

   

  i. Poisoning by Inhalation

1) After protecting yourself, remove victim from area of exposure.
2) If breathing has stopped, administer artificial respiration using a bag valve mask, or if this is not available, use the chest pressure-arm lift technique. DO NOT use mouth to mouth respiration if the nature of the chemical is not known!
3) Once the airway has been opened, maintain it and monitor.
4) Notify emergency medical personnel of nature of exposure and arrange transport of injured.

ii. Poisoning by Ingestion

1) If the injured person is conscious:

• Have the person rinse out mouth with water.
• Give the person 1 or 2 cups of water or milk to drink. If the person becomes nauseated or cannot swallow, STOP!
• Vomiting should not be induced if the person has swallowed an corrosive substance since this could result in aspiration into the lungs. Signs of ingestion of a corrosive substance include abdominal pain, a distended abdomen or a rigid, hard abdomen. Do not induce if there are signs of burns in or around the mouth or if person can not swallow.
• Vomiting may be induced if there are no signs of burns around the mouth, swallowing difficulty or abdominal pain, and if the ingested material is suspected to be highly toxic.

  a) Vomiting may be induced by giving person 2 teaspoons of syrup of ipecac. If this is not available, induce vomiting by having the person touch back of throat with their finger or other blunt instrument.

• Make sure the person is sitting up and leaning forward while vomiting.
• The vomitus should be saved for analysis by the medical team.
• After vomiting, the person should be made to drink 1 or 2 cups of water. This will help to dilute the ingested chemical.
• Do not allow the person to go to sleep.

  2) If the injured person is unconscious:

• Lay the person on their left side, bending the right hip.
• Make sure the airway is open and maintain it.
• Immediately arrange for transport to the nearest medical facility.

  DIAL 9-911

• Stand by to administer artificial respiration and CPR if breathing and/or heartbeat cease. Maker certain that all traces of chemical have been removed from in and around the mouth before providing artificial respiration. If the nature of chemical is unknown, DO NOT give mouth to mouth respiration. Instead use a bag-valve mask or the chest-arm lift technique.
• If the person vomits, save the vomitus for analysis by the medical team.
• If the person shows signs of shock (weak, rapid pulse; pale, clammy skin; cold hands and feet) elevate the feet 8 to 12 inches and cover the person with a blanket.
• NEVER give an unconscious person anything to drink!
• NEVER give a convulsing person anything to drink!

  iii. Poisoning by Skin Contact

  1) Remove the person from the contaminated area, taking care not to contaminate yourself.
  2) Remove the person's contaminated clothing, including shoes and jewelry, from the affected areas. This should be done under an emergency or while flushing with water.

  3) Flushing should continue until all traces of the chemical are gone and any slippery feeling to the skin has disappeared. Continue rinsing for at least 15 minutes.
  4) Cover the person with a blanket or clean dry clothing.
  5) If there exists inflammation, burns or blisters, apply a loose, dry sterile dressing, or cover area with a clean, dry cloth.

• DO NOT break blisters or remove skin. If clothing is stuck to skin after rinsing, do not try to remove it.

• DO NOT rub or apply pressure to affected skin.

• DO NOT apply any oily substance to skin.

• DO NOT use hot water.

• DO NOT apply a neutralizing agent to the skin, the heat evolved could cause even more serious injury.
  
  6) If the person is in a state of shock, have them lie down on their side, elevate the feet, and cover with a blanket.
  7) Notify emergency personnel of the nature of the accident and arrange for transport to the nearest medical facility. If the identity of the chemical is known, a Material Safety Data Sheet should accompany the medical personnel to the hospital.

  iv. Poisoning by Eye Contact

  1) Remove injured person from contaminated area, taking care not contaminate yourself.
  2) ACT QUICKLY! Every second counts when chemicals are in contact with the eye. Flush the eyes with clean, tepid water for at least 15 minutes. If an eyewash unit is available, use that. If not, have the injured person down and tilt head back while you slowly pour water into their eyes, starting at the inner corners and letting the water run out of the outer corners. Eyes must be held open so that the chemical can be removed from the eyeball. Ask the person to roll their eyes as you rinse to make certain that all surfaces of the eye are cleansed.
  3) The injured person will quite likely be in great pain and will want to keep the eyes closed or rub them. It may take several people to restrain the person to allow rinsing of the eyes to continue.
  4) Arrange for immediate transport to a medical facility, even if no pain remains after rinsing. Depending upon the nature of the chemicals, delayed damage may occur. If there is pain, cover the eyes loosely with sterile dressing. It is important to maintain verbal and physical contact with the injured person until help arrives.

2) Medical Emergency Arising from a Non-Chemical Situation

Whether an emergency situation arises from an accident in the lab, or a co-worker is struck by a sudden illness, it is important that all personnel know how to react to the emergency and do so immediately. Often the few moments it may take to search the literature on how to treat an illness or injury can be the difference between life and death fro the victim. You must know how to react before a crisis arises. If doubts surface as to the best course of action in the event of an emergency, remember that your best course of action may be to call for emergency assistance and to simply make the victim as comfortable as possible while awaiting professional help. To call for immediate emergency assistance have someone

DIAL 9-911

After emergency service is on the way, have someone call

5-3335

and notify the Business Office of the situation.

The first section that follows outlines the steps that should be taken if you, the first aider, comes upon the scene of an accident. The second section outlines steps to be taken if a co-worker becomes suddenly ill.

a. Person is the Victim of an Accident

The potential for accidents in the laboratory is high. It is important that all laboratory personnel know at least the most rudimentary aspects of first aid and how to react in an emergency situation. The most common types of accidents encountered in the lab are those involving cuts and lacerations, most commonly resulting from broken glassware. Burns are another class of injuries that are frequently encountered in the laboratory setting. Far less frequent are serious injuries related to shock or broken bones. All of these topics are examined briefly in the following pages. It is important that all personnel read this material to refresh their memory as to the appropriate response before injury occurs. All personnel are encouraged to participate in a First Aid training course.

i. Severe Bleeding

• It is important that severe bleeding be attended to quickly. Rapid loss of blood may lead to shock and loss of consciousness, therefore, the first aider must know how to stop the flow of blood immediately and know how to treat shock. If yo come upon a scene where a victim is bleeding severely from an accident, it is important that you quickly assess the situation and act accordingly. If it is immediately apparent that professional help is needed, assign a co-worker or bystander the task of calling for help. To do this

  DIAL 9-911

• Once this has been accomplished, have the same person notify the Business Office by dialing

  5-3335

• There are several techniques that may be used to stop bleeding. These are listed below in the order of preference. Please follow this order unless a preferred method is not possible.

  1) Direct Pressure

  a) Apply direct pressure on a bandage over the wound. This prevents loss of blood from the body without disrupting normal circulation. The bare hands may be used if a compress cannot be found, though some sort of protective barrier should be placed between your hands and the victim's blood to prevent contamination and transmittal of blood borne pathogens.
  b) A thick pad of cloth held tightly over the would will absorb blood and enhance clotting. Do not disturb the clots once formed. If blood soaks through the cloth add additional layers of cloth and continue applying pressure.
  c) A pressure bandage may be applied to most parts of the body to allow the first-aider more freedom. To apply the pressure bandage, place and hold the bandage directly over the pad; maintain a steady pressure on the bandage so that the pad remains in place as you wrap the bandage around the limb. End by tying a knot in the bandage directly above the pad and wound.

  2) Elevation

  a) If a pressure bandage or suitable substitute is not available, make use of gravity by elevating the wound above the level of the victim's heart. The force of gravity will help reduce the blood pressure and decrease the loss of blood.
  b) Direct pressure on a pad of cloth directly over the wound must be continuously maintained.

  ii. Shock

• Injury-related shock is referred to as traumatic shock. Shock results in depression of many vital body functions and can result in death, even if the causing injury is not itself life threatening.
  
• Shock can result from severe body injuries such as hemorrhaging, infection, heart attack, poisoning or obstruction of breathing. The severity of the shock is dependent on internal and external factors, such as the victim's stress level and rapid changes in body temperature. The condition is aggravated by pain, rough handling, and delay of treatment.
  
• Early symptoms of shock include skin that looks pale and feels cold and clammy. Usually the victim is very weak. Pulse will be rapid (over 100) and may be difficult to pick up at the wrist. If so, check the carotid artery in the neck or the femoral artery in the groin area. Breathing may be increased, shallow and irregular. Shock caused by hemorrhaging may be accompanied by thrashing about of the victim ( a sign of lack of oxygen) and complaints of thirst.
  
• In the late stages of shock, the victim may become apathetic and relatively unresponsive. The eyes may become expressionless or have a distant look; the pupils may become widely dilated. The skin may take on a mottled appearance, signaling a serious drop in blood pressure. If not treated immediately, the victim will lose consciousness and may die.
  
• The primary objectives for treating a person in shock are to improve circulation, raise the body temperature and to ensure an adequate supply of oxygen.
  
• The causes of shock should be eliminated by tending to the hemorrhaging, the breathing obstruction or severe pain.
  
• Keep the victim lying down. Cover him only as needed to prevent loss of body heat. Emergency medical responders should be notified.

  Dial 9-911

  Next, notify the Business Office by dialing

  5-3335

  and alert them to the situation.

• If a head injury is involved, the victim's head should be kept higher than the rest of the body. I f the victim is nauseous, he may be placed carefully on his side to guard against aspiration of body fluids. Improvement is often seen if the victim's feet are elevated slightly above the head (if there no head injuries). If breathing is difficult, it may be eased if the victim is propped up slightly. If in doubt regarding the best position to keep the victim, leave him lying flat.
  
• If the victim is chilled, he should be covered with blankets or clothing to keep the body temperature from dropping. Heating devices should not be used.
  
• Giving the victim fluids by mouth has real value in the treatment of shock if the following guidelines are followed:
  a) fluids should never be given to an unconscious or vomiting person,
  b) do not administer liquids if surgery or anesthesia is likely to be necessary, or if it appears that abdominal injury has occurred,
  c) liquids should only be administered when it is apparent that medical treatment will be delayed for an hour or more; drinking should be allowed at the rate of 1/2 glass every 15 minutes for an adult, 1/4 glass every 15 minutes for a child.
  d) liquids should be discontinued if the person becomes nauseated.
  
• Stay with the victim until professional help arrives.
  

  iii. Burns

• Burns may be caused by heat, chemical agents or radiation. This section is concerned with burns resulting from heat. Burns are usually classified by the depth or degree of skin damage (first, second, and third degree)- first degree burns are least serious, third degree burns are most serious.
  
  1) First Degree Burns

  a) Usually result of light contact with hot surface or scalding by hot water.
  b) Symptoms include redness, mild swelling and pain. Healing is usually rapid.
  c) Treat by applying cold water to affected area. Apply a dry dressing if necessary.

  2) Second Degree Burns

a) Usually the result of a very deep sunburn, contact with hot liquids or flash burns from flammable liquids. These can be more painful than deeper burns because the nerve endings in the skin are not destroyed.
b) Symptoms are a red, mottled appearance to the skin, blistering, considerable swelling over several days, and a wet appearance due to loss of plasma through the skin.
c) Treat by immersing burned area in cold water (not ice water) until pain subsides. Apply cloth that has been soaked in ice water and wrung out. Gently blot dry. Apply dry sterile gauze to protect wound. Do not break blisters or remove damaged tissue. Do not apply ointments, sprays, or home remedies on severe burns. If an arm or leg is affected, elevation of the limb may be beneficial.

3) Third Degree Burns

a) Usually the result of fire, burning clothing, immersion in hot water, contact with hot objects or electricity. Temperature and duration of contact are crucial in determining the extent of tissue destruction.
b) Symptoms are deep tissue destruction, white or charred appearance and complete loss of all layers of skin.
c) Do not remove charred clothing. Cover burns with thick layers of sterile dressing or clean cloth. Elevate limbs above heart level. Victims with face burns should be propped up in a sitting position and continuously monitored for difficulties in breathing. Do not immerse a significant portion of the body in cold water since this could result in shock. Cold packs may be applied to the face or limbs as needed. Do not apply ointments, grease or home remedies.
d) If it has not already been arranged, arrange for transport to medical facility as rapidly as possible.

DIAL 9-911

Also, call the Business Office and alert them to the situation.

iv. Bone Injuries

• Broken bones may either be closed fractures (broken bone does not protrude through skin) or open fracture (broken bone does protrude through the skin). X-rays are generally required to confirm a closed fracture. With open fractures it is generally quite evident that a bone is broken since the bone is protruding through the open wound.
• Symptoms or signs that a bone is broken are as follows:

  a) the person heard or felt the bone snap,
  b) there is difficulty moving the part,
  c) there is a grating sensation when the broken bones rub together,
  d) the injured part moves abnormally,
  e) difference in the length or shape between the uninjured and injured body part,
  f) swelling,
  g) discoloration, and/or
  h) pain or tenderness to the touch.

• The primary objectives are to immobilize the broken bone ends to keep them from rubbing to treat for shock as needed and to call for the necessary medical assistance.
  
• Do not attempt to set the fracture or to push the protruding bones back under the skin.
  
• Do not attempt to move the person if medical assistance is on the way and if there is no danger to the victim.
  If possible, bind the injured leg to the good one to immobilize it, or the injured arm to the chest or side.
  
• If it is necessary to move the victim, treat him as though there were a head or neck injury.
  
• Delegate others to phone for help, if possible. Have them obtain medical assistance; to do this

  DIAL 9-911

  and then notify the Business Office by dialing

  5-3335

  to alert them of the emergency situation.

• If an open fracture is involved, treat the wound as outlined previously:
  
  1) Remove or cut away clothing covering the wound area.
  2) Control hemorrhage by applying large sterile dressing over wound.
  3) Do not wash or probe wound.
  4) If the bone is protruding through, cover the entire area; do not try to replace the bone.
  
• Apply a splint to the injured bone and elevate affected area slightly.
  
• Splints may be fashioned out of cardboard, newspapers, straight sticks, or rolled up blankets. They may be held in place by any torn piece of material. The should extend past the joint on either side of the suspected fracture.
  
• Remember that body parts below the broken bone can often still be moved. Do not let someone attempt to walk on a potentially broken leg.

  b. Person is Struck by Sudden Illness
  
  Not all first aid situations are centered around an accidental injury. All personnel should be aware of how to handle a situation where a co-worker is struck by a sudden unexpected illness, such as a heart attack or fainting, or crisis brought on by a chronic illness, such as epilepsy or diabetes. The following pages discuss certain illnesses that may require immediate first aid attention.

  i. Pulmonary Resuscitation
  ( if the injured is not breathing)

• If you arrive upon a scene and find a person lying on the ground, you should first check to see if the person is responsive to shaking or shouting.
  
• If the victim is unresponsive, it is important to determine if the person is still breathing. Place the person flat on their back on a firm surface, such as the floor or a table.
  
• Establish an airway by placing one hand firmly on the forehead and applying backward pressure. Use your other hand to raise the jaw by lifting with your fingertips near the chin.
  
• Check the victim's mouth to make certain there are no obstructions.
  
• Place your ear next to the victim's mouth to listen for breathing; watch the chest to see if it rises and falls.
  
• If there are no signs of breathing, have a co-worker call for medical assistance immediately.

  DIAL 9-911

• It is important that mouth-to-mouth resuscitation begins immediately. Delay increases the chance of death or serious disability.
  
• Pinch the victim's nose shut and blow into the mouth by sealing your mouth over theirs.
  
• Give two full breaths allowing adequate time (1-1.5 seconds per breath) between breaths to prevent gastric distention.
  
• Again pause to look and listen for restored breathing. If breathing has not started check for a pulse at the carotid artery for at least five seconds. If there is no pulse begin CPR.
  
• If there is a pulse but no breathing, continue with mouth-to-mouth resuscitation until help arrives. The breath rate should be 1 breath every 5 seconds, or 12 per minute for an adult. Check to see that the chest wall rises as each breath is delivered.
  
• Do not stop mouth-to-mouth resuscitation until

  a) professional help arrives,
  b) the victim begins breathing on his own,
  c) a physician says to stop,
  d) you become completely fatigued.

  
  ii. Cardiac Resuscitation
  (If the injured has no heartbeat)

• If you are the first to find an unconscious person, check first to see if there is any sign of breathing. If none is present, go through the previous procedure to try and restore breathing.
  
• If this is unsuccessful, check immediately for a pulse at the carotid artery. If no pulse is present, begin CPR.
  
• Under no circumstances, may CPR be attempted if the responder has not been trained and certified in the use of this technique.
  
• As a reminder only, the CPR sequence guidelines are as follows:
  
  1. determine unconsciousness (better known as "shake and shout"),
  2. call for help (generalized call for anyone to come),
  3. alert EMS (pick someone - "YOU go get help"),

  DIAL 9-911

  4. open airway (tilt head, push jaw),
  5. look-listen-feel for breathing (5 seconds),
  6. two long breaths,
  7. feel for carotid artery pulse for 5-10 seconds (major decision step-begin CPR or not??),
  8. if no pulse, locate correct hand position and correct body position,
  9. begin cardiac compressions at correct rate and compression/ventilation ratio,
  10. stop CPR after first minute and check for possible return of pulse for 5 seconds unless a body response is seen before this time. If no pulse continue CPR until

  a) professional help arrives,
  b) a physician says stop,
  c) you, the rescuer, becomes totally fatigued or
  d) the victim responds to CPR and breathing and a pulse returns.

iii. Heart Attack

• A heart attack is the result of lack of blood supply to the heart. There may or may not be early indications that a heart attack is likely.
  
• Symptoms of a heart attack include persistent chest pains, usually under the breast bone. The pain frequently radiates out to one or both shoulders or arms or the neck or jaw or both. Gasping or shortness of breath is likely. The skin, lips and beds of the fingernails may take on a bluish hue or extreme paleness. The victim may be completely overcome. Shock will set in as the symptoms progress.
  
• Make the victim as comfortable as possible, preferably sitting up with pillows as support. Keep the air moving around the person but avoid drafts and cold.
  
• Stay with the victim and have a co-worker or bystander call for medical assistance. To do this

  
  DIAL 9-911

  Specify the person who should do this ("YOU, go call 9-911!"). Also have the victim's doctor notified if possible. When these calls have been made, the person should notify the Business Office by dialing

  5-3335

  and alert them to the situation.

• If the victim has medicine prescribed for a heart condition, help him with his medication. If the person is unconscious, do not give any liquids.
  
• Be ready to perform mouth-to-mouth resuscitation if breathing stops.
  
• Do not attempt to transport the victim yourself since this will place additional strain on him. Obviously, if medical assistance will take more than a reasonable amount of time, you must take the additional risk and transport, since time is also critical.

  iv. Convulsions

• Convulsions or seizures may be a side effect of a head injury or brain disease, or they could be the result of epilepsy. Symptoms include rigidity and jerking of body muscles; usually affecting a select group of muscles but can affect entire body. During the period of time that the body is rigid, the person may stop breathing, bite their tongue severely and/or lose control of bladder and bowel functions.
  
• The primary first aid objective is to try to keep the victim from injuring himself for the duration of the convulsion or seizure. For this by removing any obstacles that might be struck during the course of the seizure.
  
• If breathing has stopped, begin artificial respiration.
  
• Do not place blunt objects between the victim's teeth. A soft, rolled up piece of clothing or cloth may be placed between the teeth to try to prevent damage to the tongue.
  
• Do not restrain him. This may result in further injury to the victim or to you.
  
• Do not pour any liquid into his mouth. If the victim vomits, roll him on his side to prevent the vomitus from entering the lungs.
  
• If the convulsions are due to a chronic medical condition such as epilepsy, call for medical attention if the convulsions do not subside. To do this

  DIAL 9-911

• If the seizure is due to an injury, presumably medical assistance is already on the way and you should remain with the victim until help arrives.

  
  v. Fainting

• Fainting involves the total or partial loss of consciousness due to the loss of blood to the brain. Consciousness is usually always regained when the victim falls, although injury may occur from the fall itself.
  
• Symptoms include extreme paleness, sweating, clamminess of the skin, dizziness, nausea, and numbness of the hands and feet.
  
• If the victim is conscious and is not lying down, have them do so before they fall down. If the victim has already fallen, examine him to determine if further injury resulted from the fall.
  
• If the victim vomits, make certain that the victim's head is turned to the side so that the mouth may remain cleared and that the airway remains open.
  
• Do not try to get an unconscious person to drink. Do not pour liquid over the victim's face. Instead, dampen a cloth with cool water and wipe the face.
  
• Unless recovery is prompt and there is a reasonable explanation for the cause (skipping breakfast, heat exhaustion, medication effect, etc.), medical attention should be sought. To obtain medical assistance

  DIAL 9-911

  and then notify the Business Office by dialing

  5-3335

  and alert them as to the situation. Remain with the victim until help arrives.