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Hazardous Materials

FIELD GUIDE
Second Edition

Ar ma ndo Bevela.cqua
Richard Stiip
- THOMSON

DELMAR LEARNING
*"

Hazardous Materials Field Guide, Second Edition


Armondo Bevelacqua, Richard Stilp
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David Garza Bevelacqua, Armando S., 1956-
Marketing Coordinator: Hazardous materials field guide / Armando Bevelacqua, Richard Stilp.
Director of Learning Solutions: Patti Garrison p. cm.
Sandy Clark ISBN 1-4180-3828-8 ISBN 978-1-4180-3828-1
Director of Production:
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CONTENTS
HAZARD RECOGNITION Benzoyl peroxide ..............................&0 Parathion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Bromine .....................................&1 Phenol .......................................90
Emergency contacts .............................3 Butadiene ....................................&2 Phosgene ....................................91
Response to hazardous materials incident .............4 Butyl acetate ..................................&3 Phosphoric acid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...92
NIMS ........................................& Calcium carbide ...............................&4 Phosphorus trichloride ..........................93
Zones .......................................10 Curnene .....................................65 Propylene ....................................94
Complete decon corridor ......................... 11 Carbon dioxide ................................&Ii Sodium ......................................!15
Clandestine lab operations .......................13 Carbon monoxide ..............................r7 Sodium carbonate ..............................96
Confined space operations ........................15 Chlorine .....................................&1 Sodium hydroxide .............................. w
Placards .....................................17 Ethyl alcohol ..................................69 Sulfuric acid ........ . . . . . . . . . . . . . . . . . . . . . . ....98
NFPA 704 ....................................'11 Ethylene dichloride .............................70 Toluene ......................................99
GHS ........................................21 Ethylene glycol ................................71 Vtkane gas ...................................100
Tankers ......................................31 Ethylene oxide ................................72 Vinyl chloride ................................101
Railcars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..39 Ethyl ether ...................................73 Terrorism considerations ... . . . . . . . . . . . . . . . . . . . . .102
Bulk and radioactive ............................_ Ethyl mercaptan ............................. , 74
Non-bulk .....................................49 Formaldehyde .................................75
Toxicological terminology ........................50
CBRNE
Hydrazine ....................................7&
Hydrochloric acid ..............................77 Chemical ....................................104
CHEMICAL SPECIFIC Hydrogen cyanide ..............................71 Biological ...................................109
INFORMATION Hydrogen fluride ...............................79 Nuclear .....................................122
Hydrogen peroxide .............................11 Explosive ...................................124
Acetic acid ...................................51
Hydrogen sulfide . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...11
Acetone .....................................52
Acetylene ....................................53
Liquified petroleum gas .................. .......12 SPECIAL TREATMENT
Acrolein .....................................54
Methyl bromide ...............................13 MODALITIES
Methylene chloride .............................14
Acrylonitrile ..................................55 CyanideJhydrogen sulfide ..................... ..121
Methyl methacrylate ............................15
Ammonia, anhydrous ...........................5& Hydrofluoric acid burns and poisoning .............129
Nitrogen .....................................1&
Ammonium nitrate ............................. 57 Nitrite, nitrate and organic nitrogen compounds ......130
Nitric acid ....................................f1
Arsine .......................................51 Organophosphate/carbamate .....................131
Paraquat .....................................1&
Benzene .....................................59 Other treatment modalities .................... ..132
~

CHEMICAL EMERGENCIES RESOURCE PHONE NUMBERS CLANDESTINE LABORATORIES RESOURCE PHONE NUMBERS
Chemical Transportation Emcrgency Center (800) 424-9300 CHEMTREC Federal Bureau of Investigation (local office) FBI

National Rehponse Center ( 8 0 )424-8802 NRC Drug Enforcement Agency (local office) DEA

State Emergency Operations SEOC Metropolitan Bureau of Investigation MBI


Center/warning point
State Environmental Agency
Public Health
Local Public Health
Local hazardous materials response teams CBRNE RESOURCE PHONE NUMBERS
Local hazardous materials response team Centers for Disease Control and Prevention (888) 232-3228 CDC
Local hazardous materials response teams U.S. Public Health Service (800) USA-NDMS NDMS
Local hazardous materials response team Nuclear Regulatory Commission (301) 492-7000 NRC
Local Environmental Protection Agency EPA Department of Defense Joint (703) 325-2102 DOD
representative Nuclear Accident Center
Local Poison Control Center U.S. Army Operations Center (703) 697-0218/0219
Defense Logistics Agency (800) 851-8061
FBI Joint Terrorism Task Force

3 Emergency Contacts
4 Response to the Hazardous Materials (HazMat) Incident

Sizeup
I
- Dispatch
Container \iie and \h;ipc (see p a p 31-49)
Product name
Multiple alarms within ii defined ; i r w
Multiple medical alarms with same sipn/syniptoms
within an occupancy . Mass evacuations
Sounds (high-pitched whistle)
Location (Heavily traveled roadways. railroads. waterways) Odor investigation or present
Gather information Occupancy (type of industry. light or heavy)
Smoke
Preplans available
Container shape (see pages 3 1-49) 1
Placards/labels (see pages 17-30)
NFPA 704 marking system (see page 27)
I Expansion ratios
Collect reference information (see page I 8)
Product name
Chemical name
+Interpret information Synonyms

- Manufacturer phone numbers


License plate numbers (traced through Police Department)
Reference numbers on side of containers-DOT.
- Trade names
Shipping papers
Material safety data sheets
I ' I

Isolate immediate area Notification of additional resources Initiate local emergency notifications
Shut down access, deny entry HazMat Team Local State Warning Point
Protective actions based on recommendations from Poison Control Water Department
HazMat Teams Hospitals Sewer Department
CHEMTREC Police Wastewater
ERG Fire State EPA
Manufacturer EMS Local EPA
EODlBomb Squad Local DOT
State DOT
State EPA
I
Ensure personal safety Potential population density
Upwinduphillhpstream
Report found conditions
Product name
I Potential of patient load
Streadwater involvement
Weather conditions, wind direction, speed, humidity, dew point
Container size and shape
Amount of contents I 1I II

1
Amount normally within container
Mass decontamination of Nonambulatory
Amount that has been released
exposed ambulatory Retrieval by trained personnel
State of matter
Remove all clothes Gross decon
Control zones
Secondary decontamination Secondary decon
Emergency decontamination (decon)
HazMat team with appropriate Treatment
7
level of personal protection
Outside evacuation (per DOT ERG)
Treatment after decontamination
Evacuate 500 to loo0 feet for small spills (smaller than 55 gallons)
Evacuate loo0 to 1500 feet for large spills (larger than 55 gallons) Inside evacuation
Evacuate 2500 feet for tankers or rail cars if fire impingement Recommended distances by environmental specialist
Consider downwind evacuation Isolate area and deny entry to entire structure
Control heat and ventilation systems
Initial Control immediate area, protect others in place

\and isolate1 evacuation I


Protective
action zone
mum Evaluate the progress of initial actions
Communicate the present and possible future conditions
Status recommendations based upon information gathering
Repeat the process

5 Response to the Hazardous Materials (HazMat) Incident


6 NlMS

Command/Unified
Coininand

i Safety Officer

FinanceJAdmin Chief Planning Chief

Command is comprised of the incident commander and the command staff. Command staff includes the public informiition officer. safety
officer. and liaiwn officer a s assigned by the incident coniniander.

Commmd can i d w include a number o f commanders from different legal. geographic. and functional responsibilitie\ uorking togethe!
making decision5 for the incident.

General Staff is coinprised of four major functional elements and are headed u p by operation$ section chief. planning wction chief.
logistics jection chief. a n d finance/ndiiiini\tr~itioiijection chief.
-
SUBCATEGORIES OF THE
NATIONAL INCIDENT MANAGEMENT STRUCTURE

~-

I I
~gisticssection planningsection
I- Operations section

Supply Unit Compensation Unit Resource Unit I Branches

Food Unit Procurement Unit Situation Unit I Divisions/Groups I


Ground Support Unit Cost Unit Demobilization Unit I Resources

Communic. Unit Time Unit Documentation Unit

Facilities Unit

I Medical Unit I

NlMS
8 NlMS

HAZMAT OPERATIONS BRANCH

ReferenceJScience
1 HazMat Branch

Equipmentnogistics DecodCRZ MedicalEMS

HazMat Branch Officer - Responsible for all functions within the immediate hazard area.
Safety - Oversees all safety functions within the HazMat branch.
Site Control Officer-Reports to HazMat branch director, establishment of control zones, control
of equipment and personnel movement, control of contaminants.
EntrylBackup - Entry procedures into the hot zone.
Reference/Science - Identifies the hazard risk assessment.
Equipmentnogistics - Organizes equipment and logistics utilized in the incident.
DecodChemical Reduction Zone - Control all decontamination functions inclusive of medical decon.
MedicaVEMS - Oversees triage, treatment, and transportation within the cold zone.
CONTINUUM OF COMMAND FROM LOCAL TO FEDERAL RESPONSE

Federal

National
state Eoc Response
Plan
Stafford Act
FEMA
Incident Local USAR
Command Resources DEMAT
HMTtXlIl FBI
Scene SWAT DHS
Bomb USCG
Incident EPA
Management POE
TMlXl

9 NlMS I
10 Zones

Inner Perimeter

COMMAND
AREA OF POST
SAFEREFUGE
WARM ZONE
HOT ZONE
GROSS
DECON
COLD ZONE
TOOL DROP
BACK-UP
TEAM EQ-
ANDSuppoRT

EMERGENCY
CORRIDOR ACCESS MEDICAL
CONTROL POINTS TREATMENT
DECONTAMINATION
CORRIDOR Outer Perimeter
Public
TRANSPORTATION
Wind Direction
TRUE HOT ZONE True Hot Zone
Perimeter

The first initial


responders set
up an initial
solution decon
and second stage
soap-and-water
wash, securing
a water source
at two hydrants.

11 Complete Decon Corridor1


12 Complete Decon Corridor

Secured HOT ZONE Perimeter

TRIAGE To the left of this line is the


Initial responder dirty side, to the right is the
Ambulatory clean side. All staging of
decontamination access patient Non-
ambulatory equipment and supportive
equipment is on the clean side.

Clothes

Used GROSS DECON GROSS DECON Equipment for decon


equipment
HOT DRY DECON DRY DECON Staging of equipment

SHUFFLE PIT
Fquipment for monitoring
used
WET DECON WET DECON and emergency medical
equipment
Emergency
Medical Tx

WARM DECON EVALUATION


HOT LINE between the
warm and cold zone
COLD
MEDICAL FIELD STATION

TRANSPORTATIONor DMAT FIELD HOSPITAL


1- Sizeup
Windows always covered or painted
- Odor investigation

Windows and doors secured with bars


Unusual pipes or duct work coming from windows or walls
Evidence of chemical containers or glassware
Unusual odors or tastes 4 Smells including but not limited to:
Persons going outside of the structure to smoke (atypical for structure) bittersweet
Continuously running fans in inappropriate places ammonia
Portable generators for outdoor sites acetone
Stressed vegetation cat urine

Booby traps including but not limited to: - metalic taste in mouth
See CBRNE pages 102-127
Foil bombs
Sophisticated bombs
Chemical bombs
- Turning on or off may trigger bombs located within: TV
VCR
Trip wires Light switches
Antipersonnel devices 50-100 220 ft
Radio (RF)-triggered bombs 250-1,000
Restrict cellular radio
to outside 800-1 ,OOO-ft (radio-free area of 1,OOO ft) perimeter
Common chemicals used:
Acids Flammable Irritants Poisons Bases
Acetic anhydride Mercuric chloride Sodium hydroxide
Hydriodic acid Diethyl ether
Hydriodic acid Lead acetate Methylamine
Hydrochloric acid Petroleum ether
Nitric acid Ethanol Methylamine Cyanide Piperidine
Sulfuric acid Isopropyl alcohol acid
Hydrogen chloride Acetone
Coleman fuel

13 Clandestine Lab Operations


14 Clandestine Lab Operations

I PLAN I Call local law enforcement and/or DEA DEA Method for Lab Shutdown
This is a law enforcement scene rn Examinc and determinc if heating or cooling is taking place.
(crime scene). It is also a hazardous rn Some reactions involve heating of a chemical and then condensing utilizing tap
materials emergency. Within a structure water. In these cases remove the heat and allow the glassware to cool before
may have components of confined space. turning off the water.
rn If vacuum or gravity filtration is occurring allow this process to finish.
rn If compressed gas is being used in a reaction. it should be first shut off at the
cylinder top, then the regulator should be shut down.
rn If vacuum is used within the system. the system should be slowly brought back
to atmospheric pressure. then the vacuum pump turned off.
If there is an exothermic reaction (heat-producing) taking place, it should be
left until the process is completed, then the reaction cooled to room temperature.

IIMPLE#ENTI With coordination from law enforcement


Chemical Over the counter product Lab Type
Evacuation of an area may be necessary Toluene, acetone Carburetor cleaner Methamphetamine, amphetamine,
I I I Ecstasy, Quaalude
Atmospheric monitoring may be necessary Ethyl ether Computer aerosol, starting PCP
PPE support for law enforcement may fluid
be necessary Ethanol, methanol, Denatured alcohol, HEET, Methamphetamine, amphetamine,
isoDroDvl alcohol antifreeze Ecstasv
Decon for law enforcement may be necessary
Sulfuric acid Drain opener Methamphetamine, amphetamine

1- Evaluate the emergency with law enforcement, Sodium hydroxide Drain opener, lye, grout
cleaner
Methamphetamine, amphetamine
PCP,GHB,Ecstasy
fire, HAZMAT, and EMS
Hydrochloric acid Pool acid Methamphetamine, amphetamine.
PCP,Ecstasy
Ephedrine Sudafed Methamphetamine, amphetamine
D up Dispatch OSHA CONFINED SPACE DEFINITION
Location of patienuvictim 1. The space has an atmosphere that is hazardous or has the potential to
Multiple patientshictims become hazardous.
within a container 2. The internal configuration of the space is such that a person may be trapped
Product name within the space. or may lead to asphyxiation, by inward converging walls.
Occupancy floors that slope inward and downward to a tapering smaller cross-section.
3. The material within the confined space can ot has the potential possibility
of victim engulfment.
4 Any other recognizable hazard that may cause serious safety andor health
effects that may be present.

Gather information * Secure the scene


Hazard identification Limit access, deny entry
Atmospheric hazards Protective actions based on information
Oxygen deficiency Secure site manager or supervisor
Oxygen-enriched Determine the number of patients and their level of
Flammable contamination
Toxic, irritating Diagram the space from manager’s information
Physical hazards
Mechanical equipment Establish a perimeter
Electrical equipment Limit the numbers of personnel
Pneumatic equipment Stage equipment at a distance
Hydraulic equipment Distance dependent on integrity of entrance point
Liquids, powders, gases Earthen opening (perimeter based on soil classification)
Thermal conditions All equipment should be shut off such that atmospheric
Engulfment by finely divided particles integrity can be maintained
Radiological Confined space rescue team notified
Corrosives

15 Confined Space Operations


Confined Space Operations

PLAN Confined space rescue team procedures (evaluate permitted vs. nonpermitted)
Atmospheric monitoring
Ventilation of the space Continue air monitoring throughout the event
Control of hazards Lockout and tagout of all:
Incident management system established (personal accountability) Energy sources
Communications between entry members Mechanical devices
Personnel protective equipment (PPE) Pneumatic devices
Patient-retrieval equipment Electrical devices

IMPLEMENT Entry procedures


Evaluate the atmospheric monitoring
Confirm lockout and tagout procedures have been performed
Ensure entry team and back-up team is ready Stage back-up team in an area of refuge
Hazards have been controlled close to the entry point
Ventilation
Air monitoring
Explosion-proof lighting or contingency plan for control of lighting Ventilation has reduced the potential of explosion
Communication has been secured between team members and checked Equipment is intrinsically safe
Retrieval systems are in place, secure and functional Monitoring of lighting source for increased
Perform rescue temperature build-up
Airway, breathing, and circulation support
Control spinal immobilization Decontamination may have to occur
Extricate depending on the’chcmicaland type
ofexpure
EVALUATE If rescue has not occurred reevaluate the space
Length of time, chemical, mechanism of injury: situation may become one of body recovery
Reverse entry procedures once all personnel have left the space
Evaluate air monitoring
Postincident analysis performed on each incident
CLASS

EXPLOSIVES EXPLOSIVES BLAST1NG EXPLOSIVES HIGH EXPLOSIVES


AGENTS
1 1:: 1-49: 1.5::: 1.6* Ammonium nitrate
Ammonium perchlorate
1 1 1 1 Ammonium picrate
Composition 3
* = subclasses and compatibility codes Composition 4
Chlorate powder
Dynamite
DIVISIONS HAZARDS EXAMPLES
Ethylenedinitramine
1.1 Mass explosion hazard TNT, black powder
(EDNA)
I .2 Projection hazard Flares. detonating cord
Nitroguanidine
I .3 Fire hazard Propellant explosives, flash powder
Nitroglycerine
I .4 Minor explosion hazard Common fireworks, small arms ammunition
Picric acid
I .5 Materials considered insensitive Blasting agents
Tetryl
1.6 Extremely insensitive NOS (not otherwise specified)
Trinitroanaline
Trinitroanisol
Trinitroknzene
BLAST EFFECTS
Potential Injury Pressure in psi Structural Effects
Trinitromethylentriammine
off balance 0.5-3 psi Glass shatters, facade failure
Rupture of eardrums
Internal organ damage 5-6 psi Cinderblack shatters, steel structures fail, DO NOT
containers collapse FIGHT FIRES
Multisystem trauma 15 psi Structure failure of typical construction INVOLVING
Lung collapse 30 psi Reinforced construction failure EXPLOSIVES

17 Class One - Explosives


Next Page

Class Two - Gases

CLASS
FLAMMABLE NON-FLAMMABLE OXYGEN POISON INHALATION
GAS GAS GAS HAZARD
2 2 2 2 2

DIVISIONS HAZARDS EXAMPLES EXPANSION RATIOS


2. I Is a gas at 68°F or less or boiling point (BP) of 68°F or less, Methane Air mixture 728:l
which is ignitable in a mixture of 13% or less or has a Propane Anhydrous ammonia 855 :I
flammable range of 12% or greater Methyl chloride Argon 842: I
2.2 Nonflammable, nonpoisonous compressed gas. including Anhydrous ammonia Carbon monoxide 680: I
liquefied gas, pressurized cryogenic gas, asphyxiating Liquid nitrogen Chlorine 458:l
Cryogenic argon fluorine 981 :I
Oxygen Helium 745 :1
2.3 Hydrogen 85O:l
Poisonous gas at room temperature with a BP of 68°F Methyl mercaptan
Krypton 693:l
Carbon monoxide
LNG 635:l
Methane 693 :I
Neon 1,445:l
CONTAINER PRESSURES INHALATION Nitrogen 696: I
Atmospheric pressure 0-5 psi HAZARD ZONE TOXICITY Oxygen 860: I
Low pressure 5-100 psi A LCso less than or equal Propane 270: I
High pressure 100-3,000 to 200 ppm Xenon 559: I
Ultrahigh pressure 3,000-6.000 B LC50 greater than 200 ppm and less
than or equal to I ,000 ppm
C LC50 greater than I ,000 ppm and
less than or equal to 3,000 ppm
D LC, greater than 3,000 ppm and
less than or equal to 5.000 ppm
UEL I 19.9% - 199,m ppni
----. --
SIGNS 8 SYMPTOMS i
APPEARANCE
LEL f 4% 40,000 ppn Enters though all routes. Causes irritation and bums to . Colorless liquid or crystals
10% of LEL 4,000 ppm slriILeyes,anduppernspiratorY system. H W k m CAS
nausealvomiting.Larynseal spasms,pulmonaryedema 2789 (80% solutiq) 64-19-7
c h e m i i pneumonitis. 2790 (lo-80% solution)
W o s e Irritation 10 ppm
....-__-_.__..__.-._.-_....-....----.I

TLV-TWA 10 ppm I
a012 ppm I TREATMENT
LRem<mpatientfNnndmga. I
! CHEMISTRY
vapo~pressure 11.4 mm Hg
2. Ranove contamhtcdclathing. I vapordensity 2.1
odor: Sour, pungent odor 3. waohexposedskinwith~andw~for15minutes ; Flash point 103OF
while giviq medical aid. I Autoignition temperame %l0F
Synonyms: Ethanoic acid, vinegar acid, 4. If abort of brrruh (SOB) give oxygen and support i
i Solubility Miscible
!
methane carboxylic acid, glacial acetic acid nspiratians. specific gravity 1.053
5. Observe for and treat shock. 1 Boiling point 244OF
- Molecular weight 60.1
IP 10.66eV

Bklogiocll monitoring: Follow-up medical exams should conceatrateon rwpiratory function, eye examination, and the evaluation of exposed skin for
evidence of acid bwns.

-
2 0 2789 2790
Isolatcimmdatd
' y for at least 160-330 feet in all dinctions.
3
l Dl

I' 81 ' I
Ac~~IcA~I~CHI.~C
UEL
LEL
IDLH
- I-
128%
2.5%
,
128,000 ppm
25,000 pprn
20,000 ppm
SIGNS & SYMPTOMS
Enters through all routes Central nervous system (CNS)
depression (more severe than ethanol) Erythema. Dryness.
I APPEARANCE
Clear colorless liquid
DOT
1090
CAS
I
67-64-
10% of LEL Headache. Fatigue. Bronchial irritatiodspasm. Narcosis.
TLV-C 1,800 ppm Paralysis. 1091
STEL 1,000 ppm
PEL ~ ~ _ _
1,000 ppm
Eye/Nose Irritation 500 ppm TREATMENT CHEMISTRY
TLV-TWA 250 ppm 1. Remove patient from danger. Vapor pressure 180 mm Hg
2. Remove contaminated clothing. Vapor density 2.0
Odor 13 PPm
3. Wash exposed skin with soap and water for 15 minutes. Flash point 0°F
4. Give oxygen and support respirations. Autoignition temperature 896°F
Odor: Pungent. sweet odoi
5. Treat symptoms of CNS depression. Solubility Miscible
6. Support respiration intubation may be necessary. Specific gravity 0.8
Synonyms: 2-propanone, dimethyl ketone
Boiling point 133°F
beta-ketopropane, pyroacetic ether
Molecular weight 58.08
IP 9.69 eV

Biological monitoring: Major excretory route is lungs and can take 2-3 days. Monitor respiratory status through pulmonary
should include: blood glucose, blood and urine ketone, serum bicarbonate, and arterial pH.

3 1 FUMMABLEUWID
Emergency Response Guidebook
< 1 0 1090 1091 Isolation Distances
~ Isolate immediately for at least 80-1 60 feet in all direction5
.3. 3
,
I UEL
/ LEL
;!
of LEL

TLV-C
100% 7,000,000 ppm
2.5% 25,000 ppm
2,500 ppm
250 ppm
SIGNS & SYMPTOMS
Enters primarily through respiratory system. Causes
imtation of skin, eyes, and respiratory system. Headache.
Nausea and vomiting. Anesthetic action.

TREATMENT
DOT
1001
APPEARANCE
Colorless gas

CHEMISTRY
CAS
74-86-2

I TLV-TWA 1. Remove patient from danger. Vapor pressure 44.2 atm


Eye/Nose Irritation 2. Give oxygen and support respirations. Vapor density 0.9
i Flash point Gas
Odor
Autoignition temperature 581°F
Specific gravity 0
Odor: Ethereal, garlic-like odor Boiling point Sublimes
Molecular weight 26.04
Synonyms: Ethyne, ethine IP 1 1.40 eV

-- - - - - --

g-term eftech are reported

FLAMMABLE GAS

Emergency Response Guidebook


Isolation Distances
Isolate immediately for at least 330 feet in all directions

Acetylene H C i C H
310~100
~pm SIGNS B SYMPTOMS
28AOoppm ~ t t n u a g h a l l r o u t c s . ~ b t o ~ , ~ d
PQm W r- L a r m 8- IJ-
2ppm e&ma,~~~.stronglaaimatar.-
Imhtolppnl send--
0.3 ppm
nv-TWA 0.1 ppm
TREATMENT CHEMISTRY
Odor
Vap~rpnSS~ 136 mm Hg
v ~ u t y 1.9
3. wash expoeed skin with soapham. Plash point -26°F
4. If SOB give oxygadsuppurt mpimiolls. Autoignition temperatwe 445°F
5. I f e y c s i n i m r e d ~ w i t h ~ Solubility Soluble
Specificgravity 0.84
7. M o n i t a r f o r c a r d i a c ~ ~ s t W I V , d a a t Boiling point 127OF
rhythm-. Molccuh weight 56.07
IP 10.13 eV

BMogbl IIIOo(C:Exposed patknfa rhould be observed fa 24 hairs for alowdevdoping prlmonary ederm Long-tam monitoring should include
paiodicrarpiraboyfuncdon~toidsatifychroaicrespiraaorydic#ase.

E m a q p q R m p o ~ Gidd&vk
e
sdrpm Isolate 400fat in all directions.
1-( Protect 0.3 miles downwind.
LWFrpm Isolate 1,000 feet in all directions.
1-( Protect 1.2 miles dawnwind.
SIGNS & SYMPTOMS APPEARANCE
Enm through all routes. Causes initation to skin, eyes. Pale yellow liquid
and upper respiratory system. Laryngeal spasms. DOT CAS
pulmonary edema. Cyanmis. Symptoms of cyanidc 1093 . 107-13-1
poisoning.

.- ..--......-... ~ ~

TREATMENT CHEMISTRY
1. Remonpatientfromdanger. vaporpressure 83 mm Hg
2. Remove C a n t a m i ~ t ~clothing.
d vapordensity 1.8
odor: Mild odor 3. Wash exposed skin with soaphater. plash point 30°F
4 Give oxygen and support respirations. Autoignition temperature 898°F
synonymr: viiyl cyanide. 5. Use cyanide antid& kit to treat patimtswho display Solubility 7% in water
ppnenitde, cym&ylene, cacbaayl symptoms of cyanide poisoning. Rx:Amy1 nitrate. specificgravity 0.81
sodium nitrate, sodium thiosulfate. Boihgpoint 172°F
Molecular weight 53.1
IP 10.91 eV

-
count (CBC). glucose, elearolyte d c t m u m'ons. and urinary cyanide. Exposed patients should be monitond far potanial bone marcow dkcts.

RAMMABUrUQUID
3 Emergency Response Guidebook
4 2 1093 Isolation Distances
Isolate immediately for at least 330-660 feet in all directions.
kil

66 Acrylonitrile CHpCHCN
66 Ammonia, Anhydrous NH3

Eye/Nose Irritation
71.5%
I
;
i
SIGNS & SYMPTOMS
Respiratory tract spa..ms causing asphyxia. Severe skin
bums and mucosa damage. Exposure to concentration
can cause pulmonary edema. blindness. loss of smell.
headaches. nausea and vomiting (NN).
TLC-C
PEL TREATMENT
STEL CHEMISTRY
1. ~ ~ t o s a f c t y . Vapor pressure 8.5 atm
TLV-MA 2. Pnwide oxygen. consider updraft if bronchospasm Vapor density 0.6
Odor noted upon exam. Boiling point -28'F
3. If exposed to a high concentration intubate and Flash point (gas) 280'F
Odor: Strong irritating odor establish IV. Autoignition temperature 2.I97"F
4. If pulmomy edema provide positive pressure mti- Solubility Water soluble 34%
Synonymr: Anhydrous ammonia. lation with pitiveuld expiratory pIessure (PEEP). Specific gravity 0.77 I
ammonium hydroxide. aqua ammonia 5. Bnmchodilatm may be helpful. Molecular weight 17.04
IP 10.18 eV

Blologiccll monitoring: Baseline medical data before entry. Always consider 24-48 hour medical observation if exposed to concentrations greater than
2,000 ppm. Glottal edema, dyspnea, chemical pneumonitis may occur hours after the exposure. Complete assessment of the respiratory system and mucosB is
recommended before entry and during follow-up procedures.

- 2073 2672 1005


1 1 Emergency Response Guidebook
3 0 2 0 1005 small spill
(Dqytime)
Isolate 100 feet in all directions.
Protect 0. I miles downwind.
Liquid Gas 71 Large spill Isolate 300 feet in all directions.
(Dqytime) Protect 0.2 miles downwind.
UEL FLAMMABLE SKiM a SVMPTOMS APPLARANQ
LEL AND TOXIC Primarily a dust-inhalation hazard. Also may cause Wbik or grcylkpwn solid
10% of LEL Ll MITS irritation to skin and eyes. E x p u n can cruse vasodilation Dm <:AS
IOLH ARE NOT and mcthunogobinania Cyamis, nausea, and head.che I942(oqanicc~) W.=:1
STEL APPLICABLE nportcd. 2426 (liquid)
Eyernose Irritation
TLV-TWA CHEMISTRY
Odor TREATMENT Vapor pressure 0 mm Hg
1. Remwe patient fFom danger. Vapor density Solid
2. Remwe contaminated clothing. Flesh point NA
Odoc Sour, pungent odor
3. Wash exposed skin with soap and water for 15 minutes. Autoignition tempuatun NA
4. Give oxygen and support respirations. Solubility Soluble
8ynonymr:Ammonium salt, nitram 5. Observe for and rnat vasogenid shock by positioning Specific gravity Solid
and giving fluids. Boiling paint Solid
6. Antidote is methaline blue given IV. MAY JXFWIDE IF CONFINED
UNDERFIRECONDlTIONS!
Molecular weight' 80.04

OXIDIZER
0 Emergency Response Guidebook
1 3 1942 2426 Isolation stances
OX 5 5 Isolate immediately for at least 30-80 feet in all directions.
58 Alvlne A m H 3

7
UEL SIGNS 8 SYMPTOMS APPEARANCE
LEL my PPm primary mute of entry is the regpiratmy system. Irritation to Colorless liquid or crystals
10% of LEL 5
m PPm DOT CAS
IDLH-CA vomiting,numbness, malaise, abdominal md back pain, 2188 1784-42- I .
3 PPm
Odor bronze skin, garlic odor on breath. i
TLV-TWA CHEMISTRY
Vapor pressure >I atm
TREATMENT Vapor density 2.66
1. Remove patient from danger. Flash point ND(gas)
Odor: Mild garlic-like odor
2. If SOB give oxygen and srrppoa respirations. Autoignition Decomposes
3. Ifoeededintnbateandgivepositive~ temperature at 57OOF
Synonyms: Arsenic trihydride,
ventilation (PFY). Solubility 20%
hydrogen ansenide, arsenic anhydride
4 Observeforandtmtshoclt Specific gravity GaS
Boiling point -81°F
Molecular weight 77.95
IP -

Biologioal monkorlng: Follow-up medical exams should concentrate on respiratory,kidney, and liver function. If the patient was hypoxic for an extended
periodexam should evaluate CNS.

4 Emergency Response Guidebook


4 2 2188 small spill
(DaYtiW
Isolate 400 feet in all directions.
protect 0.4 miles downwind.
2 Large SPW Isolate 1,100 feet in all directions.
(Daytime) Protect 1.3 miles downwind.
UEL
LEL
7.8%
1.2%
78,OOO ppm
12,OOO ppm '
2
Enters through all routes. Exposure causes euphoria,
APPEARANCE
Colorless or light-yellow liquid
EyelNose Irritation 3,000 ppm dizziness, weakness, headache, blurred vision, mucous DOT CAS
lOYo 01 LEL 0.12% 1,200 ppm i membrane irritation, tremors, ataxia, chest tightness, 1114 7 1-43-2
I0LH -CA 500 ppm respiratory depression, cardiac arrhymias, convulsions, -~
__.__
. __
STEL 1.0 ppm coma.
CHEMISTRY
Odor
~~

4.68 ppm vapor pressure 75 mi11 Hg


PEL 0.1 ppm Vapor densit) 2.8
TLV-TWA
._
1 PPm TREATMENT Flash point 12°F
1. Remove patient from danger. Autoignition temperature I .097"F
2. Remove contaminated clothing. Solubility Insoluble
3. Wash exposed skin with soaplwater. Specific gravity 0.88
4. If SOB give oxygen and support respirations. Boiling point 176°F
5. Observe and treat seizures with IV diazapam. Molecular weight 78.12
6. Monitor and treat dysrhythmias. IP 9.24 CV

Biological monitoring: Follow-up medical exams should include EKG, urinalysis, BUN (blood urea nitrogen), creatine, liver function, arterial blood gas,
blood level of benzene and phenol, urinary phenol. Exposed persons should be monitored for 6-12 hours for cardiac dysrhythmias and 72 hours for late onset
of pneumonitis. Benzene is a carcinogen and causes potential bone marrow effects.

3
Einerg erz cy R esp on s e (hi idehook
2 8 1114 Isolation Distances

59
Next Page
,- . . .. . ._ . . . . . . - . . . ......,. . . . ._.. ..

UEL APPEARANCE
LEL Colorless liquid or drystah
10% of E L Dur w
IDLH 2085,2086.= Wb6-0
PEL 2088,2089,2090
Eye/Nosa irritation 3074
TLV-C
Odor CHEMISTRY
Vapor pressure 4 . 1 m m Hg
Vapor density NA
Odor: Faint odor of benzaldehyde Flash point 103OF
Autoignition ternpalm 176OF
Symnymm: Bemoperoxide, Solubility Insoluble
dibnzoyl peroxide Specific gravity 1.33
Boiling point NA
Molecular weight 242.24
LP -
Blologlcal monttorlng: Follow-up medical exams should concentrate on respiratory function,eye examination, and the evaluation of exposed skin for
evidence of irritation or sensitivities.

4
1 4
ox
104 CBRNE - Chemical
CBRNE Chemical Biological Radiological Nuclear Explosive
CBRNE agents are classes of hazardous materials that are unique to military arsenals. These agents will be difficult to recognize, identify, and treat.
"Whether or not a gas will be employed in future wars is a matter of conjecture but the effect is so a'eadly to the unprepared that we can never afford to neglect rhe question."
Geneml Pershing. 1919

NERVE AGENTS
Chemical ~ l l u Militarv abbrevkation
Sarin Isopmpyl methylphosphonofluoridate GB
soman Pinacolyl methylphosphonoflddate GD
Tabun Ethyl N,N-dimethylphosphoma&docyanidate GA
Cycloliexyl methylphosphonofluoridate GF
V agent O-ethyl S-(%diisopmpylaminoethyl) methylphosphonothiolate vx

BP (F") MP (F") vp (=Hs) TwAmEL (mg/nr') LDSo/Lcso (w-)(md


Sarin 316 -68.8 2.90 0.m1 100
soman 388 4 0.4 O.ooOo3 70
'Igbun 464 -58 0.037 0.0001 400
Cyclo saram 239 -22 0.068 0.0001-0.m1 1-50
V agent 568.4 -59.8 0.0007 ' o.ooOo1 1-10
Mustard 442.4 58.1 0.1 1 0.003 1,500
Lewisite 374.0 8.6 0.420 0.003 1.000-1.500
Phosgene oxime 262 95 11.2 ? 1.500-2,000
I- dosslct~
F%enyldichlomnine PD 16 mg &m3
Fihyldichlomnine ED 5-10 mg min/m3
VESlcAwrs (BUSlER AGENTS)
Chemical nawe TWA mg midd M i l b y &mvWon
Mustard IBis-(2-chloroethyl) sulfide] 0.003 HD
Lewisite Dichlm-(2-chlorovinyl) mine 0.003 L
Nitrogen mustard (HN2 methylamine hydrochloride) 0.003 HN. HN2, HN3
Phosgene oxime DichloroformoxineCC1,NOH 0.4 cx
Variant of Lewisite Phenyldichloroarsine 0.003 PD
Other blister agents Ethyldichloroarsine ED
Methy ldichloroarsinc MD
BLOOD AGENTS
M ~ ~ M N v @ & TWAmgmMd Lethaldose (Wdmg miw"
Hydrogen cyanide AC 5.0 2,500-5.000
Cyanogen chloride CK 0.6 11,m

LACRIMATOR AGENTS (RIOT CONTROL AGENTS)


Abbmvirrlion Chemidnarnc -1 ' g&se(ICtd

CA Bmobenzylcyanide 30 mg min/m3
cs O-chlorobenzylidenemaloronitrile I 0-u)mg midm3
CR Dibenoxazepine = I mg midin3
CN 2-chlaroacetophenone 80 mg midm3
CNC Chloroacetophenonein chlomfonn 80 mg midm3
CNS Chloroacetophcnone and chloropicrin in chloroform 60 mg midm3
VOMIT AGENTS (RIOT CONTROL AGENTS)
AbbmMon CIcsnricrrlname IncqmcWing h e (ICtso)
DA Diphenylchlanuvsine 12 mg minhn3
Dc Diphenylcyanminine 20 mg minhn3
DM Adamsite Diphenylaminochldne 22 mg m ~ m 3

105 CBRNE - Chomicbl


106 CBRNE Chemicai - Nerve Agenb
.... .
Nerve Agents Include: NERVE AGENTS (MILITARY)
Sxin (GB)isopropyl
methylphosphonofluoridate Liquid ranging in viscosity from water-
Soman (GD)pinacolyl SIGNS & SYMPTOMS like to motor oil-thick.
methylphephonofluoridate
0 Tabun (GA O-ethyl N. N- Nose: Rhmorrhea
dimethylphosphoramidmyanidate , Eyes:Constricted pupils, lacrimation.
VX o-ethyl S-(2-diibpropylamino) ethyl CHEMISTRY
conjunctivitis (dimlblurred vision, pain)
methylphosphonorhiolatc BP VD TWA
. .. j Reb;piratory: Hyperseaetions,
. ._.-I__. .. - .. .... .__. . - . .. __ 1 bronchospasms (dyspnea, cough) Sarin 316°F 4.86 0.00002ppm
TREATMENT Primaryentry: Skin
Gastrointestinal: Cramps, diarrhea, ,
1. Remove patient from danger. vomiting, hypermotility
2.Decontaminate immediately. Soman 388°F 6.33 0.000004ppm
3. Maintain an open airway and give 4. Somatic: Weakness, fasciculations, Primaryentry: Skin
4. Give 2-4 mg atropine lVF' every 5 minutes. seizures
T a b u 464°F 5.63 O.ooOo1 ppm
5. Give 1 km pralidoxime over 2 minutes. CNS: Anxiety,restlessness, coma, Mmaryentry: Skin
6. Prepare to give Valium for seiflues. respiratory and circulatory depression
7. Monitor patient and suction as needed. Other: Salivation, sweating VX 568°F 9.20 0.0000009ppn
Mark I kit can be substitutedfor steps 4 and 5. Primaryentry: Skin
. . .. _______ . ... .._..- . . . . -... ......- .. . _ - - _.- - -. -

For thc most part nerve agents arc clear, colorless. and odorlcss. They a s found in liquid fcm with low vapor pressurn and viscosity ranging from water-like
to motor oil-thick. The most volatile of the group is sarin. which can evaporate at about the rate of water. Thcse agcnts can enter through all mutcK, but
inhalation causcs the most rapid effects.

These agents work by binding with the enzyme acctylcholinesteme, allowing the neurotransmitteracetylcholine to overstimulate nerve pathways. The nerve
pathways affected by acctylcholine are primarily IocatLd in the pmasyrnpthctic nervous system, hut are also found in the central and somatic system.
VESICANTS
(MILITARY BLI!STER AGENTS)

Blibter Agents Include: SIGNS & SYMPTOMS


Mustard (H.HD) bis (2-chlo~thyl)sulfide Liquid ranging in viscosity from water-
These sOong irritants cause: like to motor oil-thick.
Phosgeneoxime(CX) Eixtrampain.
dichloroformoxime If skin is expoeed large blistas mdt.
Lcwisitc (L) dichlom-(2chlorovinyl) arsin~ Chm~breaLitwilllaave~
opanwomsd~lytofonnMecdall.

If.inhaled
. . cam#cl sevbn raspinrtorY
TREATMENT mmmn and ainvay obstmction.
1. h o v e patient from danger. ~edanaamtakeplawwithin
2 immediately. horns.
3. Maintain an open airway and give 02.
4. If needed upper airways can be dilated
using alupent ar al-1.
5. P m p e to give PPV utilizQ PEW valve SymptomeamtaLeplacawithin2horns
OfCPAPtocombatChemicallyinduced daxposmaabedelayedas long as 24
pllmonary- boma.

Mustard harr a f d n g point of 57°F so it is not a good cboicc for c o b climates. At tc- of 100°F or higher mustard becomes a s c v m m r p i w
toxin. Both phosgene oxime and Lcwisitc vaporize more readily than mustard making them more of a respiratory hazard.

Decontnmination must take place immediately. The use of soap and water is recommendedf a all decontaminationefforts. A bleach solution can be u . 4
f a decontamination of toohi and equipment.
108
, .,
u-".,--,->.---m--,...>,. -,.,,"-,"-
CBRNE Chemical
---
. .-L>.,m.r. :m".m.,,mm-
- Cyanides
T = = . m m ~ ~ : > , - . ~ . ~ . ~ . > . - - " . - ~ m m - m
I
CYANIDES (MILITARY BLOOD AGENTS)

Bl(lod Agents Include: SlCiNS k SYMPTOMS


Hydrogen cyanide {AC) HCN Can be found as a gas or a Iiquid. AC is
Respir;~torysyslein cl'fects incIudc:
Early: Tachypnea (rapid breathing) a liquid at less than 79°F but vaporizes
Cyanogen chloride (CK)CNCI Hyperpnea (deep breathing) rapid1y
Dyspnen (short~lessof breath)
L a ~ e : Decreased respiratory rate
Respiratory depression CHEMISTRY
I ~ u mdanger.
1. I i e m o ~ epaiic~~t Respiratory arrest
BP VD TWA
2. Decuntarninatc immcdiiltely .
3. Maintain an upcn airway and give 02. Cardiovascular system effects include: Hydrogen cyanide (AC)
Early: Flushing of skin 79°F 0.93 4.7 ppm
4. Once cyanidc poisoning has been confi~med
Hypertension Odor of bitter almonds or
give: Irregular heart beat
a. Amy1 nitrite perles (inhaled for 15-30 Late: Acidosis peach kernels
secunds cvc~yminute until IV is established) I Tachycardia
b. Administer sodium nitrite, 300 Ing per Extensive EKG changes Cyanogen chloride (CK)
I 0 cc IV slowly. Cardiac arrest 55°F 2.1 0.3 ppm
c. Administer sodium thiosul'i~e, 50 mi or a Cyanogen chloride also causes severe
Faint bitter almonds odor
25% solution IV over !O ~ninules. I respiratory irritation.

The most commonly used chemical asphyxiant is cyanide. Cyanide is used for heat treating and plating, fumigation, and chemical synthesis in the production
of plastics. It is found as a gas (hydrogen cyanide), as a solid (cyanide salt: potassium cyanide and sodium cyanide), or as a liquid, and is a common
component of many compounds containing carbon and nitrogen.

These chemicals were developed into military chemical warfare agents and because of their differing properties (one heavier than air and one lighter) they
had different applications to kill and injure opposing miIitary forces.
BIOLOGICAL
Incubation pcrsirence lXs#minalion
BACTERIA
Anthrax 1-5 days 3-5 drys fatal Very stable Aemsol
Cholertr 12 hours-6 days Low with tx Unstable Aerosol
High without tx Stable in saltwater Sabotage of water
Plague 1-3 days 1-6 days fatal Extremely stable ACrosOl
Tularemia 1-10 days 2 wks modcrate Very stable Aerosol
Q fever 14-26 days Weeks? Stable Aerosollylibolage
VIRUSES
Smallpox 10-12 days Hi& Very stable Aerowl
Venezuelan equine encephalitis 1-6 days Low ' Unstable Aerosvllvecm
Ebola 4-6 days 7-16 days fatal Unstablc AervwVdirect contact
B1Ou)61CAL TOXINS
Botulinum toxins Hours to days High without tx Stable Amsollsabvtage
Staphylococcal enteroloxin B 1-6 hours LOW Stable Aemsollsabotagc
Ricin Hours to days 1&12 days fatal Stable A€?lVSOllSalX)tage
Trichothecene mycotoxins (T2) 2-4 hours Moderate Extremely stable Aerosollsabvtage

OTHER BIOWGICALTOXlNS LDm (cI&flrg)


Saxitoxin 210
MiCIOCyStin 50
Abrin 0.04
Diphtheria toxin 0.10
Maitotoxin 0.10
110 CBRNE BiolmiCd - Catwow A

CDC BIOTERRORISM AGENT CLASSIFICATIONSYSTEM

Category A Agents
Easily disseminated or transmitted person to person. Causes high mortality with major public health impact.
Require special action for public health preparedness.

Bacillus anthracis (anthrux)-Backrial infection that creates a toxin


Cbstridium botulinum toxin (botu1ism)Xaused from a toxin created by a bacteria
Viublu nurjor virus (smaUpox)-Viral infection
Francisellu tuluremis (tuluremia)-Bacterial infection
~ Yersinia pestis @lugue)-Bacterial infection
Ebolu, Marburg, Larsa,and South American hemorrhagk fever viruses
I
(vim2 hemorrhagic fever)-Viral infection
CDC BIOTERRORISM AGENT CLASSIFICATIONSYSTEM

Moderately easy to disseminate. Cause moderate morbidity and low mortality. Require specific enhancements of
diagnostic capacity and disease surveillance.

Coxiek burnetti (Qfever)-Rickettsial infection


Alpha viruses (Venezueltur encephalomyelitisand eastern and western equine encephalomyelitk)-Vid infection
Brucek species (brucebsis)-Bacterial infection
Toxins (e.g., Rich toxinfromRicinus communis [castor bean], toxin
Staphylococcus enterotoxin B)-Bacterial infection
Burkholderia mallei (gkizndem)-Backrial infection
CMMy& psi#aci @sitttrcosis)-Bacterial infection
112 CBRNE. B l o l ~ i ~ b
l -- 0 ~ C

CDC BIOTERRORISM AGENT CLASSIFICATION SYSTEM

L Category C Agents

Include emerging pathogens that could be engineered for mass dissemination.

N@uh virusviral infection


Tickborne encephalitis virus-Viral infection
Hun& viruses-Viral infection
YeUow fever virusviral infection
Tickborne hemorrhagicfever viruses-Viral infection
Multidnrg-resisantMycobucteriumtuberculosis-Bacterial infection
INFEC'I'ION CONTROL MEASURES
Siandai d Pi ecaution5

* E>,cretion\
* Nonintact sitin (inciuditig r ~ i 4 i e ~aiici
).
* Mucous membranes
Standard precaution measures include:
Hand washing and v,earing gloves when in contact w i t h blood or body fluids,
Using mask with eye protectioniface shield while performing procedures that can cause splashispray, and
* Wearing gowns to protect the skin and clothing during procedures.
L Contact Precautions
Used in addition to standard precautions and include:
Gloves arc worn by everyone who enters the patient's roomhrea.
* Gowns if contact with the patient, bed, or eyuipmcnt.
All PPE is removed prior to leaving the room and hands are washed immediately afterwards.
- ........ . . - .............. ~- ~ . .
Droplet Precautions
.... ........
-. -. . . . . . . . . . . . . . . . .. -~ ................... I

Used in addition to standard precautions to prevent the spread of large droplet particles expelled from the nose or mouth of a patient and include:
A mask is worn any time one i s within 3 feet of the patient.
Mask is removed prior to leaving the room and hands are washed immediately

I_ ..... ...... Airborne RGcautions


Used in addition to standard precautions to prevent the spread of particles expelled from the nose or mouth that remain suspended for long periods of time in the
air and include:
Placed in negative flow rooms.
0 Everyone who enters must wear an N95 respirator.

113 CBRNE Biological - Infection Control -


114 CBRNI B i d o p b l -

BACTERIA SIGNS P SYMPTOMS


Category A Agent Cutamour: Skin lesions begins like un in- bitc then pmgmwmto hlwk necrotic center in 2-6 hys.
* Most dangmus by '
G w t m i ~ i n U lN u "AI).UhJOmid pin.Moody d i d m within 9 A days.
: ~ u d v o n'ting
inhalation (air) . . ..
' I
Inhalptional: Hu-likc symptoms. NN. SOB. hdwhe. chest pain. Smrc respintoy
.*can.be spread:$l:.'.:. : divtnmw in 2-5 days. W W malimtinum d pkunlethion on ChnJ x-ray.
poodaudwa~..:".:;;.
I
*canalsoinfect::.. '. ' .
.d

Gastrointestinalsystem
NOT CONTAGIOUS TREATMENT LETAALITY
1. Fluroquindonhdoxycyclii. cutaneous: 20% if untreated
Can live in the environment for more than 2 COnniJcr pcnicillin if t
k strain is wuaceptibk. Gastrointestinal 100% if untreated
40 years 3.If Ruwpedalrrrclrmanrhouldnabepoatponed Inhalational: Once respiratory
famfirmotionofanhn~~infectiun. distress present 90%
Synonyms: Wool sorters disease
I

Personal Protective Qdpment: Standard precautions should be practiced when handling these patients. If entering contaminated space (with danger of
'
spores), full body protection and SCBA is recommended with decontaminationupon exiting the contaminated environment.

H;icillu\ ;mthr;K.i\ i s a spm-forming bacterium that causes 8 rqklly posrrSringinfection. Once Ihe infeaion is d i s h e d . Ihe viclim is said to have a n t h a .
B;lr-illu\ anthracis derives its MIIK fnnn Ihe WQd f o r d (mrbnldr)krvnr ofthe blrlr.d-libkrion it ce#tcI. AnIhax can develop fmm inhrlrtion.
inpc\ticin. or cxpcnum of mintact skin to the brtai..
Next Page

I,ETHAI,ITY
Bubonic: 50% if untrcntcd
Pncumonic: 100% if untreated ot
not treated within
71 hours

-. . - .-. .- .. .- -. ... ...... ..- . . ..- . .-.


.. .

Personal Protective Equipment: Standard and droplet precautions should be practiced w h w hiindling thcsc patient>. Privatc rooni i n the hospital or cohun i n
iiiass casualty CLCIII. If entering coiitarniri~ttxlspace (with danger of aerosoliicd t o x i n ) . lull body protection ;ind SCUA i \ rcconirncndcd with decon~imination
upon cviting the contariiinatcd cni ironinent.

.I
h p u r c to Ycrwna pe\tt\ can c a u w thrcc loriiis of the plague: bubonic. wpttccniic. and pneunwnic. Huhmrc plague I\ usuall\ Ilea-home diwa.w that I\
transmitted from an infected rodent. Ilirect contact of open skin with infected tissue o r lluids can a h cauw huhonic plague. Pncumonic plague results from
inhalation of the hacteria from intentional aerowlization o r from the talking. coughing. o r weering of an infected patient.

115 CBRNE Biological - Plague


128 Cyanide/Hydrogen Sulfide Treatment Card
r
FORMS OF CYANIDE PATHOPHYSIOLOGY OF CYANIDE POISONING HYDROGEN SULFIDE H2S
Hydrogen cyanide (gas) Enterr through all routes but I \ most efficient when
Hydrocyanic acid (liquid) inhaled or ingested Once i n the body, the cyanide ion
Pnissic acid (liquid) I enters the cell binding with the enzyme cytochrome
Formonitrile (liquid) ~ oxidae This enzyme is necessary for cellular respiiahon y diminishes in the
~ (glucose + oxygen = energy + H20 + CO,) Once
n. aerobic respiration in the

COMMON SIGNS AND SYMPTOMS TREATMENT


Cyanide and HzS poisoning affect vmudly all of the cell ‘ Nitrites convert hemoglobin into methemoglobin. Methemoglobin
is the CNS, where the competes with the cytochrome oxidase for the cyanide and sulfide ion,
restlessness, dizziness, actually attracting them away from the cytochrome oxidase. This com-
pound is then broken down by the body and eliminated through filtration.
DO NOT USE STEP 3 FOR H2S!!
DECONTAMINATION RESPIRATORY EFFECTS To give the correct dowge of nitrates. use a cyanidc antidote kit as
Cyanide and compounds of cyanide
are for the most part water-soluble.
A victim exposed to cyanide in the
liquid or solid forin should be
..
Early
Rapid breathing
Deep breathing
Late
Decreased respiratory
rate
prescribed.
1. Amy1 nitrite perle inhaled for 15-30 seconds every minutc while the
IV is being established. If the patient is unconscious, then the perle
can be placed in the bag of a BVM given during ventilation?.
Feeling of shortness rn Respiratory depression
decontaminated by: of breath Apnea, death 2. Once the IV is established give sodium nitrite 300 mgil0 cc IVP
1. Completely removing the clothing. slowly. These nitrites also cause profuse vasodilation so expect a drop
2. Washing the victim completcly CARDIOVASCULAR EFFECTS in blood pressure (BP).
using soap (mild detergent) and
water.
3. If exposed to H2S or the gaseous
.
Early
Flushing
rn Hypertemion ...
Late
rn Hypotension
Acidosis
3. Once the initial dose of both nitrites is given, follow up with sodium
thiosnlfate-50 cc of a 25% solution over 10 minutes. This agent acts
as a clean-up drug converting any remaining cyanide into a relatively
form of cyanide, the victim should
be decontaminated by rapidly
removing the clothing. This should
be sufficient to remove the possi-
.
rn Reflex bradycardia
Atrioventricular (AV)
Tachycardia
ST changes and cardio-
nodal or idioventricular vascular collapse
harmless substance, thiocyanite.
Children’s dose
1. Amy1 nitrite remains the same.
2. Sodium nitrite 0.33 mlikg or 10 mg of a 3% solution per kilogram.
rhythm5 Death
bility of secondary contamination. 3. Sodium thiosulfate 1.65 mlikg of the 25% solution.
. .. ~

FORMS OF HF
Hyhfluoric acid comes in mimy stten&. f i 3% in
.-
i
-- .-
PATHOPHYSIOLO6Y OF HYDRORUORK BURNSAN0 POISONING !
Entus through all mutes. Hydroflunric acid is ablc to maintain its ionic
I HYDROFLUORIC SYSTEMIC
POISONING
'

..mixturn with aher chwoids to 99.Wpwe for nmi-


d u c t o r manufacturing
H Y W ~ n-de ga
used to fluoridate WWXin the form of hydn~flmsilicic
acid
.

i
bond. allowing it to penar~cedeep into the sublayen of skin and tissue
bfon disfiociating with the hydrogen ion. Because of this HF is apable of
pIoduring a coITusive injury much likc a strong alkali. Once dissociucul the
flu&& ion .seeks 001 and bond$with calcium Md magnesium. Bones. tis-
sue. nerve pathways. and the blood provide the source of these elemeno.
1. Fluoride binds with thc calciuni
found in the bme. causing Jecalcifi-
cation and destruction of the bone.
2. HF enters the bloods~eamand dis-
sociates thm.The hydrogen ion
causes serum acidosis whik the flu-
oride ion binds with calcium and
COMMON SIGNS AND TREATMENT CPUIYS hypmlcemu, . Cydiacdys-
mMPrOMS The goal in treating HF exposure is to give the fluoride ion something else to bond with other than tlythmirs,anddtah.
Ifialukd:Bumiclg and swelling of the calcium or magnesium found in the body. The disruption of these elements within the body can be 3. Fluor& binds witb calcium on the
cell mmbruv and incruru pemw-

-
dm u v s I md uppa airways. Delayed so severe that death will be the end result.
skin rrposurr ability to potassium. lhir kadt to
S Y w O m s OfpllmMPry edema
I f d J s o r b d ~ m r d t i nMay : not 1. Mix 10 cc of 10% calcium gluconate solution into a 2-02 tube of KY jelly. spo~~unour depolariution of the
2. Continuously massage liberal amounts into bum site. lKNe pathways and uuuciating
have immediate pain. In low conccnm-
tiom may have s l w onset o f t i r . dam- 3. If calcium gluconate is not available use epsom salt or antacids containing calcium or magne- pain.
age only becormng dap k. In sium such as Maalox. Mylanta, or crushed Tums.
higher coacenmtionspain is mm mne 4. If severe bums are noted and topical agents do not relieve pain, prepare 5% calcium gluconate to
and nyxtanic sympmmq rppeu more be subcutaneously injected in the amount of 0.5 cc every 114 inch into the wound. DECONTAMINATION
WlY. Eye bums Hydrofluoric acid and compounds of
ueya expaad: sknrghiig of epithelial 1. Immediately irrigate the eyes with water or saline. HF are water soluble. Decontamination
ticvuc uwl cloudin*. of m e a may k 2. Mix 50 cc of 10% calcium gluconate into 500 cc of normal saline. of a victim exposed to HF should
n o t e d Expect deeper injury to the 3. Apply 1-2 drops of ponticaine topical ophthalmic anesthetic. include:
comeal tisue and a slaw 01lsd( of pain. 4. Insert Morgan lens and irrigate using the calcium gluconate solution. 1. Completely removing the clothing.
S y s t a n k m Thcbiggcstcomm InhaWon injury 2. Wash the victim completely using
with HF pokming is Ihe c ~ ~ u l a r 1. Start patient on 100% oxygen via nonrebmther mask. soap (mild detergent) and water.
effect. EKG will indicate a pohmgation 2. Mix 6 cc of sterile water with 3 cc of 10% calcium gluconate. This will provide enough solution 3. If the eyes are exposed immediate
of the QT interval indicating hypocrl- for 2 updrafi treatments effort should be made to irrigate the
cunia. A h cxpect that acidosis m y 3. Place solution into a nebulizer and provide an updraft treatment. eyes with water or saline.
redult from s i p h i n t utporurr to the Cardicrc~nQtOnrs 4. If epsom salt (magnesium sulfate) or
skin ar mpirarory system. If not rapidly 1. h v i d e continuous cardiac monitoring. calcium hydroxide (lime water)
diagnosed and trrucd.systemic effects 2. Muscle contractions or cardiac arrest should be treated with an IV bolus of 5 cc of 10% calcium is available a decontamination using
may cause death. chloride or 10 cc of 10% calcium gluconate. these solutions should be performed.

129 Hydrofluoric Acid (HF) Burns and Poisoning Treatment Card


~ - . - ~

130 Nitrite (NO2), Nitrate (NO3) and Organic Nitrogen Compound Treatment Card
... .. ~

FORMS OF (NO,) AND (NOS) PATHOPHYSIOLOGY OF NITROGEN POISONING NlTRATE/NlTRlTE POISONING SYMPTOMS
Found in most fertilizers Enters through all routes but the most efficient is throu&h inges- RELATED TO METHEMOGLOBINEMIA
Paints and dyes tion. Once in the bloodstream. nitrogen compounds bond with of ferric Hemoglobin Signs and Symptoms
Colognes hemoglobin and change the iron molecule, ferrous iron (Fc++) I0-15'7r Mild cyanosis in extremities
Food preservatives into ferric iron (I++++).Because oxygen is carried on the ferrou\ Xb3M Shortness of breath. change.;
Fires produce it molecule, once changed hemoglobin can no longer carry oxy- in mental status and V.S.
Medications like nitro-glycerine gen. The other physiologic change that occurs i s a vasodilating 50-60% Lethargy
and the cyanide antidate kit cffect that nitrites and nitrates are used for therapeutically. Death duc to hypoxia
More than 7 0 1
.. .- - .. .- . . ~. .. ..... ..

SIGNS AND SYMPTOMS TREATMENT


RELATEDTO VASODKATION The goal of treating nitratehitrite poisoning is to restore the oxygen-carrying capability of the blood. This can
only be accomplished by converting methemoglobin back into hemoglobin. By using the antidote methylene blue
mlluobbing hcadrche and fullness ofthe Mdue to
an enzyme methemoglobin reductase is activated, which reduces ferric iron back into ferrous iron. Treatment is
dilation of the mermgeel vessels.
accomplished in the following sequence:
~Flushingottheneclrendf.cearcsignsofLYlaneous
1. If the patient is breathing, give 100% oxygen via NRB (nonrebreather mask).
capillary and vesodilplioa
2. If unconscious, consider intubation and provide positive pressure ventilation utilizing a PEEP valve set at
m Divinessand syncope an due to caebalischemia
4 cdwater.
relatedtoprofusevruodilationand~
3. Treat hypotension with position, fluids, and dopamine if necessary.
oxygen-csnyingcapability.
4. If the sigcs and symptoms support your suspicion of methemoglobinemia, then give 2 mgkg methylene blue
T ~ y c a d i asweating,
, and pallor arc responses of
over 5 minutes IVP.
the s y m p h t k llcrvous system to hypotentiOn.
5. Studies have indicated that hyperbaric oxygen is useful on this type of poisoning. Therefore, consider trans-
portation to a hyperbaric facility.
MOST COMMON FORMS OF PATHOPHYSIOWGY OF ORGANOPHOSPHATE COMMON SIGNS AND SYMPTOMS
AND CAREAMATE POISONING The signs and symptoms reflect the run-away stimulation
Parprhiim, TWP Capable of &ng thmugh all m w s . Once in thc body it targets throughrhe pathways that use acxtylcholine as the neum
(wailable mnmcrciallyj the ncmus system. primarily (hr! parpsympafheticsystem. Both OP hmmitter. Cornmanly the acmnym SLUD, SLUDGE, or
Maluthiunand Diezion DUMBELS rn used to describe the symptoms. Although the
(iwr the wuntcr) Paresympathericsystem is the primary site, there are acetyl-
SARIN. TABLi", and SOMAK choline pathways in the CNS, somatic,and sympahtk sys-
(milimry anripcrwnncl newe aprcnrs) tems.siofthepoisoningwillbepresentthaealso.

DECONTAMINATION TREATMENT ACRONYMS FOR SIGNS AND SYMPTOMS


Organophosphates and carbarnates are 'Ihe goal in the treatment of acetylcholhsmaw.inhibitors is to saliva&ion salivation D i
found in solids and liquids. Although they eitha breeL the bond between the w o p h m w and acetyl- urination
are not found as a gas they are applied in choliiesterase or block the acetylcholine from entering the synapse. lhination thinstion Mio& (pinpoint pupils)
an aerosol form and can be readily In the case. of orgmophosphstesthe treatment is -fold. Since the lkhaticril Defecstion BronchospaPm(wbeeziog)
inhaled.Avictimwrposedtothesechemi- carbamate bond is temporary and somewhat short-livedonly one G~tcstiual Emesis
cals must be thoroughly decontaminated. treatment is recommended. The.physiologic antidote for both poi- W S Lanimation
sonings is atropine. The emergency medical provida must use cau- .Salivation '
The cerrying compoundsof these poisons
tion when giving atropine and ensure that the patient is well oxy-
may not be Completely water-soluble so
genated. In mere cases of poisoning this may be dif6culL Because
additional efforts may beRquiItd to totel-
of the.extreme production of saliva end upperrespiretory muwus.
ly clean the.patient. F4llow these steps:
the airway may be partiaUy ohucted. Suction and provide 1009b
1. Complmly remove and bag all cloth- oxygen as quickly as possible.
ingfordispod inapropermanner. Usegrwtcrurlion whgivinsabvpine to a ihrparic hemi!
2 Wash the victim completely using scap 1. Insure proper deconeamination and prepare for toxic body fluids.
(mild detergent) and water. 2. Suction airway if necessary and give 1004b oxygen, inubate if
3. If the patient still smells &pesticides necessary and pIwide @tive presslm ventilations.
a second cleaning with ethyl alcohol is 3 Staa lV withnormal saline using a large bore cauuulafor drug
recommended. adminiseationand fluid replacement.
ABepreparedto~theprocessand 4. Administer ennpine 1 4mg IV slowly. monitoring heart rate.
emxcbecareduring traaspoaas a 1ItIatedose to stropinization (drying of the mouth, flushing,
toxic patient may have grossly contam- &latellpupils). continue 1 4 mg every 5 minutes to continue
inated body fluids. abopinization.
5. ~sterprotopam1gmIvPover2minutes. ,

131 Organophosphate/Carbamate Treatment Card


~ 132 Treatment Modalities

TACHYDYSRHYTHMIAS PHENOL CARBON MONOXIDE POISONING


Establish an IV lock and give: 1. Decontaminate initially with large volumes 1. Immediately administer 100% oxygen if conscious. If victim is
1. 0.5 mg per kilogram of Breviblock of water, then imgate burned area with unconscious, consider intubation and PPV utilizing a PEEP setting of
1P or mineral oil, olive oil, or isopropyl alcohol. 4 cm of water.
2. Adenocard 6 mg rapid IV push 2. Support respirations, control seizures, and 2. start 1v.
followed by 10 cc of saline IVP. ventricular ectopy with recognized means 3. Prepare to treat seizures.
of treatment. 4. If CO poisoning due to suicide attempt, give Narcan 2 mg IVP.

CHWRAMINE AND CHWRINE oc (OLEORESIN CAPSICUM) PEPPER BROCHOSPASMS SECONDARY TO TOXIC INHALATIONS
After the patient is removed from the SPRAY AND OTHER LACRIMATORS 1. Immediately give 100% humidiiied oxygen.
atmosphere and appropriate decontami- Since the agent does not cause significanttis- 2. Issue an updraft of either Alupent or hventil, 1 unit dose n e b u l i i .
nation completed give: sue damage the treatment is aimed at relieving 3. If wheezing continues administer terbutalii (Brethine) 0.25 ml
1. 100% oxygen via NRB mask. the pain caused by nerve stimulation. injected SQ.
2. Assemble a nebulizer and administer 1. Initially determine the history of the injury. 4 Repeat the dose after 30 minutea if needed.
5 cc of sterile water. If a detamination can be made establish-
3. If b u m i persists titrate half strength ing that the pain is caused from capsicum
adult bicarb (3.75% or 4.2%) and spray then the eyes should be immediately
administer 5 cc through a nebulizer. numbed. CHEMICAL BURNS TO M S
This is the only time a chemical will be 2. Once it has been assured that the patient is 1. lmlmwel . y start eye irrigation by whatever means possible.
neutralized in or on the body by field not allergic to caine derivatives apply 2. Ensure all particulate matter or contact lenses are out of the eyes by
medical personnel. I Alcaine, Ponticaine, or Opthalmacaine. digitally opening the lids and pouring irrigation fluid across the globe.
3. When the blephmospasm is relieved, a 3. Prepare the Morgen lens by attaching an IV solution of NS ar LR.
visual exam is performed to assess far Ensure that the tubing is full and a stkady drip of solution is running
trauma of the eye. from the lens.
4 Assess for clear lung sounds and BP 4 Apply 1-2 drops of ponticaine hydrochlorideinto the injured eye.
changes to ensure that a sensitivity has not 5. Iuszxt the lens by lowering the bottom lid and inserting. then raising
occurred. the upper lid and placing the lens against the globe.
6. Adjust the flowso that a continuous solution is flowing from the eye.
7. Continue irrigation until arrival at the hospital.