D. Emergency Procedures for Selected Emergencies

the affected area should be removed to ensure thorough cleansing. No neutralizing agents

should be employed. If the original exposure was due to a dry chemical, normally the best

course would be to brush off loose material and then follow the same course of action.

While washing is taking place, emergency medical help should be summoned, normally by

calling 911. Chemical injuries, due to their possible complexity, probably should elicit a

response from a crew capable of providing advanced life support-level care. If a severe

physical injury has occurred in addition to the chemical exposure, appropriate first aid

measures should be taken while waiting for assistance. In order of priority, restoration of

breathing and restoration of blood circulation, stopping severe bleeding, and treatment for

shock should be done first. These injuries are life threatening. Training in these techniques

are available from many sources, such as the Red Cross, the American Heart Association,

local rescue squads, and hospitals, usually at minimal or no cost.

Persons involved in the accident or the subsequent treatment of the injured person or

persons should remain at the scene until emergency medical aid arrives. It is important that

those treating the victim know what chemical was involved. In addition, the person s providing assistance can provide emotional support to the victim. Generally, it is preferable that

transport to a hospital be done by the emergency rescue personnel. They are not only trained

and qualified to handle many types of medical emergencies, but they will also have communication capability with an emergency medical treatment center. Through this radio contact,

they can advise the emergency center physician of the situation and the physician can

instruct the emergency team of actions they can initiate immediately. In addition, if special

preparations are needed to treat the injured person upon arrival at the emergency center,

these can be started during the transport interval.

Some materials, such as mercury, do not appear to pose much of an obvious hazard upon

a spill and a cursory clean up may seem to be sufficient. However, mercury can divide into

extremely small droplets which can get into cracks and seams in the floor and laboratory



Figure 2.5



Accident due to poorly installed and weak shelving.



furniture. Mercury remains in metallic form for a long time after a spill, capable of creating a

significant concentration of mercury vapor pressure in a confined, poorly ventilated space.

Exposure to these fumes over an extended period can lead to mercury poisoning. After gross

visible quantities have been cleaned up by carefully collecting visible drops (preferably with

an aspirator), absorbent material specifically intended to absorb mercury should be spread on

the floor and left there for several hours. Afterwards, the area of the spill should be vacuumed

with a special version of a HEPA filtered vacuum cleaner adapted for merc u r y c l e a n u p . A

penknife can be used to check seams in floor tiles and cracks to check if the cleanup has been

thoroughly done.



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The preceding material on spills assumed that the incident only involved one

chemical. Figure 2.5 shows what could have been, but miraculously was not, a major disaster

which could have injured several persons. A set of wall shelv es put up by laboratory

personnel, loaded with a large variety of chemicals, collapsed while no one was working in the

area. Here, unlike the incident involving chemicals from containers mixing in a t r a s h t r u c k ,

several bottles broke with chemicals becoming mixed, no reaction occurred and the damage

was limited to the loss of the chemicals. If a vigorous reaction had occurred between the

contents of any two of the broken bottles, the resulting heat might well have caused more of

the unbroken containers to have ruptured and a major disaster could have resulted. Where

multiple chemicals are involved, the same techniques as those used in a simple i n c i d e n t

should be applied, with the additional stipulation that unnecessary mixing of chemicals

should be carefully avoided.

Spills which result in a substantial release of toxic liquids or airborne vapors such that the

release extends beyond the facility boundaries invoke the requirements of the Community

Right-To-Know Act. Notification of the local emergency coordinator by the dispatcher would

be the first legal step to get the mechanisms moving.

While all of the corrective measures are being taken, the affected area should be secured

to ensure that no one is allowed in who is not needed. “Tourists” are not welcome. If

necessary, help should be obtained from security or police forces to exclude nonessential

persons.

2.



Fire

A second common laboratory emergency involves fire. Laboratory fires stem from many

sources, the ubiquitous Bunsen burner, runaway chemical reactions, electrical heating units,

failure of temperature controls on equipment left unattended, such as heat baths, stills, etc.,

overloaded electrical circuits, and other equipment. With a fire, the possibility of the

immediate laboratory personnel being qualified and able to cope with the emergency depends

very strongly on the size of the fire. A s indicated earlier, only if it is clear that the fire can be

safely put out with portable extinguishers should a real attempt be made by laboratory

personnel to do so. However, trained personnel temporarily can use portable extinguishers for

moderate fires which are not gaining ground rapidly to gain time to initiate evacuation

procedures.

In order to use an extinguisher effectively, laboratory personnel must receive training in

their use. If possible, this training should include hands-on experience. They should be

familiar with the different types of extinguishers and the type of fires for which they would be

effective.

Class A extinguishers are intended to be used on fires involving solid fuels such as paper,

wood, and plastics. Generally a class A extinguisher contains water under pressure. Water

acts to cool the fuel during the extinguishing process, which has the advantage that the fuel

has to regain kindling temperature once the fire has been put out. The large amount of energy

required to convert liquid water into vapor places an added burden on the energy requirement

to rekindle the fire in wet fuel. An extinguisher rated IA is intended to be able to put out a fire

of 64 square feet if used properly. A typical extinguisher will throw a stream of water up to 30

to 40 feet for approximately 1 minute.

Class B extinguishers, intended for u s e on petroleum and solvent fires, usually contain

carbon dioxide or a dry chemical, such as potassium or sodium bicarbonate. The first of these

puts out the fire by removing one of the essential components of a fire, oxygen, by displacing

the air in the vicinity of the fire. The second uses a chemical in direct contact with the burning

material. Some chemical extinguishers contain materials such as monoammonium phosphate or

potassium carbamate, which, even in small sizes, have very impressive ratings for putting out

a solvent fire. Chemical extinguishers are messy and can damage electronic equipment.

Typical dry chemical or carbon dioxide portable units last on the order of 15 to 30 seconds ,

and in the case of carbon dioxide units, it is necessary to be within 10 feet of the fire to u s e

them effectively. A third type of unit, no longer being produced, which does not have this

latter negative characteristic, contains one of a class of chlorinated fluorocarbons called



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Halon™. The Montreal Protocol, regulating chlorinated fluorocarbons because of the

deteriorating effect of these materials on the atmospheric ozone layer, will eliminate the two

major types of Halon™ within a relatively few years. It has not been permitted to produce

these materials since January 1, 1994 although existing stocks can continue to be used. For

the time being, existing systems will continue to be acceptable, but replenishing units will

become increasingly difficult as existing stocks are depleted.

The chlorinated fluorocarbons used are Halon™ 1211 and Halon™ 1301, distinguished

chiefly by the fact that the first of these operates at a lower pressure than the second and thus

is more common as a portable extinguisher. The following points will apply to the alternative

materials now available, which will be described in succeeding paragraphs. Permanently installed systems have tended to be Halon™ 1301. Both types work by interrupting the

chemistry of the fire; however, Halon™, being gaseous, can be dissipated easily. Once the air

concentration falls below the level at which it is effective, it no longer provides any residual

fire protection. One way in which the Halon™ units have been used effectively has been to

install them in small storage rooms as ceiling-mounted units. Reasonably priced units were

available which went off automatically at temperatures set by fusible links in the heads of the

units.

Alternatives to these two types are being sought and hundreds of compounds have been

tested and several are now produced commercially. The requirements for the alternatives are

1) comparably effective fire fighting characteristics, 2) low or zero ozone depletion, and 3) low

toxicity. The last requirement can be neglected if there is no possibility of human exposure.

The compound CF3CH2CF3 (FE-36) is a s u b s titute for Halon™ 1211 and CHF 3 (FE-13) is a

substitute for Halon 1301™.

Class C extinguishers are intended for electrical fires, which, because of the potential

shock hazard, preclude the use of water. Many class B extinguishers are also rated for use on

electrical fires. Class D extinguishers are used primarily for reactive metal fires and a few other

specialized applications. Due to the extra cost of these units, only those laboratories which

actively use reactive metals need to be equipped with class D units.

A s has already been noted in several instances, training is required to u s e a portable

extinguisher effectively since the available supply of fire suppression materials last less than

1 minute in most cases. To be most effective, the extinguishing material should be aimed at

the base of the fire and worked from the point immediately in front of the extinguisher

operator progressively toward the rear of the fire, away from the operator. If more than one

person is present, additional extinguishers should be brought to the scene so that as one is

used up, another can be quickly bro ught into use to prevent the fire from regaining vigor.

More than one unit at a time can be used, of course. About half of all fires that can be put out

with portable extinguishers require only one, but conversely, the other half require more than

one.

To be effective, an extinguisher must be full. Units can leak, and unfortunately individuals

with juvenile mentalities apparently feel that extinguishers are toys, provided for their

amusement. This seems to be an attitude especially prevalent on college and university

camp uses (most of the problems exist in resident dormitories, but not exclusively so).

Therefore, extinguishers in laboratories should be checked frequently by laboratory personnel as well as by fire safety staff. If the unit has a gauge, it should be in the acceptable range.

Empty and full weights are indicated on the extinguisher, so weighing will confirm if the unit is

full or not. Breakable wire or plastic loops through the handles, which are broken when the

unit is used, should be checked to see if they are intact. If a loop is found to be broken, the

unit should be checked. Any units found to be discharged should be replaced immediately,

preferably as a practical matter within one working day.

Since a hood is where most hazardous laboratory operations should be carried out, a

substantial number of laboratory fires occur in them. In the event of a fire in a hood, a simple

and often effective procedure to control the fire is to close the sash. This serves two

purposes: it isolates the fire from the laboratory and reduces the amount of air available to

support combustion. Since a properly installed hood exhausts either directly to the outside or

through a fire-rated chase, in many instances a fire in a hood can safely be left to burn itself

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out, or at least can reas onably be counted upon not to spread while an extinguisher is

obtained. If the risk of a fire within a hood is substantial, automatic extinguishers are available

that can be mounted within the hood.

In the event a person’s clothing catches on fire, it is important not to run because this

provides additional air to support the flames. Many authorities recommend that a person

aflame should roll on the floor to attempt to smother the flames. In a crowded laboratory there

is often a risk of involving solvents and other materials in the fire, however. A deluge shower

is an effective way to put out the fire if it is in the immediate area, or, if a fire blanket is

available, the fire can be smothered by the person quickly wrapping himself in it. If others are

present, they can help smother the flames or they might employ a fire extinguisher to put the

fire out. A s with any other type of injury or burn, call for emergency medical assistance as

quickly as possible. Perform whatever first aid is indicated, if qualified, while waiting for

assistance.

3. Explosions

Among many other possibilities, an explosion may result from a runaway chemical reaction, a ruptured high-pressure vessel, reactive metals coming into contact with moisture,

degraded ethers set off by friction or shock, or perhaps ignition of confined gases or fumes.

Fortunately, explosions are less common in the laboratory than a fire but they still occur too

frequently. The u s e of protective shields and personal protective equipment should be

mandatory where the potential is known to be appreciable. Heavy gloves with gauntlets will

offer protection to arms and hands. A mask and goggles should be used to protect the eyes,

face, and throat. When an explosion does occur, in addition to the shock wave and the

extreme air pressures which also may occur, flying debris, possibly secondary fires, and

spilled chemicals may exacerbate the situation and feed a fire or lead to further reactions.

Often there are toxic fumes releas ed which may be the most serious hazard, not only to the

persons immediately involved but to others outside the area and to emergency personnel.

Initiation of procedures to handle resultant fires and chemical spills are appropriate if the

situation is manageable. The most likely physical complications are personal injuries,

including injuries to the eye, lacerations, contusions, broken bones, and loss of consciousness. Toxic fumes may cause respiratory injuries, possibly leading to long-lasting,

permanent effects, possibly even death. In addition, chemic als may be splashed over the

body even more extensively than in a spill, so it may be even more imperative to wash them

off. However, it is essential to establish priorities. If breathing is impaired, artificial respiration

should be administered, and if heavy bleeding occurs, pressure should be applied to the

wound to stop it. These two problems are immediately life threatening. If there is time, and if it

appears safe to do so, i.e., it does not appear that the spine has been injured or that other

injuries will be worsened by the movement, then injured persons should be removed from the

immediate vicinity of the accident. This is partially to protect the rescuer as well as the victim

from the effects of chemicals, fumes, and smoke. Basically the same criteria apply as in a fire.

Unless it is possible to safely handle the situation with the personnel present, then at least

the immediate area should be evacuated, if necessary the building as well, and the fire

department and other professional aid summoned. Care should be exercised by the emergency

responder that in their efforts to assist injured personnel, that they do not incur injuries to

themselves, such as coming into contact with spilled acids.

For most fire departments, a fire or an explosion in a laboratory represents an uncommon

occurrence. It would be highly desirable, in the absence of a knowledgeable person

immediately on the scene, if information on the contents of the laboratory could be found

posted either on the door or close by. Preferably this information should be brief, legible from

a distance, and be in a format already familiar to fire personnel. Many localities have

attempted to meet these needs by requiring the laboratory to be posted with the NFPA

universal hazard diamond in which the degree of danger for reactivity flammability, and health

effects are indicated by a numerical rating, with the numerical rating referring to the contents

of the laboratory instead of a specific chemical.

An example of an NFPA symbol is shown in Figure 2.6. There are four small diamonds,

which together are assembled into a larger one. The four smaller diamonds are blue for health

or toxicity, red for flammability, yellow for reactivity, and white for special warnings, such as

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radiation or carcinogenicity Printed in each segment is a prominent black number showing the

degree of hazard involved, ranging from 0 to 4.

The numerical ratings are

0

2

3

4



= according to present data, no known hazard = slight hazard

= moderate hazard

= severe hazard

= extreme hazard



Although this system appears simple, it is difficult to implement meaningfully in practice,

since, in a typical laboratory, there may literally be hundreds of chemicals on the shelves.



Figure 2.6 NFPA Diamond symbol with arbitrary ratings in the

individual diamonds.



How should the rating for the laboratory be established? Should it be determined by the

rating of the worst material present for each category or should the rating also depend upon

the total amount of each of the chemicals present? For example, if the most flammable

chemical present in a laboratory were ether, there would be a substantial difference in risk to

firemen responding to a laboratory fire where the amount present was a single 500 milliliter

container compared to one in which several 200 liter containers were present. If no allowance

is made for the quantity present, both would have the same flammability rating. An alternative

would be a subjective rating, combining both the worst-case type of chemical with the

amount present to give a rating which in the judgment of the individual doing the rating

properly takes into account both factors. The NFPA symbol is best applied to a single

container or to an area with a very limited variety of materials present.

Another problem with the u s e of the NFPA symbol alone is that it may be too concise.

Obviously, it does not inform fire personnel of exactly what is present. Under SARA Title III,

corporations and institutions are required to provide information to the fire department on the

locations and quantities of their hazardous chemical holdings. However, there are some

important exceptions, one of the most important of which applies to research laboratories. A

hazardous chemical used in a laboratory, under the direction of a competent scientist, even in

excess of a reportable quantity (which may range from I to 5000 pounds, depending upon the

chemical), need not be reported. Reporting all of the contents of laboratories in a major

research facility could overwhelm the ability of a fire department to absorb data. In a major

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research institution, there may be literally hundreds of laboratories, each with potentially

hundreds of different chemicals, with the inventory changing daily. Although a record of the

contents would be helpful, even if not completely current, it would be very clumsy to use as a

first response tool. In a later chapter, a means of providing computerized data to emergency

groups will be discussed.



Figure 2.7

Additional information such as these posted on the outside of laboratory doors can inform

emergency responders of possible risks and needed precautions within the facility.



Possible alternatives that offer the advantage of providing information in a form with

which fire departme nts are familiar would include posting symbols such as those shown in

Figure 2.7, or u s e the DOT placard system, with a space to fill in the approximate amounts of

each class present. An advantage of this latter alternative is that every fire and rescue group

normally will have an Emergency Response Guide in their vehicles at all times. The response

procedures recommended in the guide are very conservative, which is generally desirable.

4. Toxic Air Quality

An uncommon laboratory emergency situation that does need to be mentioned because it

often leads to a fatality when it occurs is the danger of entering a space filled with a toxic gas

or which is deficient in oxygen. OSHA has issued an updated confined space standard which

offers some guidance, although most laboratories would not be anticipated to fall under the

provisions of the standard. However, as a result of a fire, a spill of an IDLH substance, a

leaking gas cylinder, or an improperly vented experiment releasing toxic fumes, it would be

possible for a laboratory to be full of fumes and gases which would be fatal. Even a cylinder

full of a nontoxic gas, such as nitrogen, can rupture and displace normal air sufficient to cause

asphyxiation. The common practice of riding in an elevator with a 30-L dewar full of liquid

nitrogen could prove fatal should the dewar rupture. The volume of the elevator is small, there

is no rapid means of escape, and the speed of many freight elevators could mean that it could

take far longer to reach the intended floor than most persons could hold their breath. The

same concern could exist when riding elevators with full gas cylinders. Not all gases which

may be found fairly commonly in u s e in the laboratory have adequate warning properties. No

one should enter a space where this could conceivably be a problem without using a selfcontained air breathing apparatus, nor should an individual go in such a space without others

being aware of it. There should always be a backup set of self-contained breathing equipment

with personnel available, trained, and able to use it to effect a rescue if necessary.

5. Radioactive and Contagious Biological Material Releases

Releases of radioactive material and active contagious biological materials represent two

different types of emergencies which cause unusual concern because of the potential danger,

perceived by the public, of the problem spreading beyond the immediate scene. In almost

every instance, the levels of these two classes of materials used in ordinary laboratories are

sufficiently small that the risk to the general public, as well as to properly trained laboratory

workers is minimal.

©2000 CRC Press LLC



a. Biological Accident

In recent years, the Centers for Disease Control has established a system of classification

of laboratories for biological safety defining biological safety levels 1 through 4. Research

w ith organisms posing little or moderate risk, requires only level 1 or 2 facilities, wh i c h a r e

essentially open laboratories. Work with organisms, which do pose considerable or substantial risks, requires level 3 or 4 facilities. A characteristic of both level 3 and 4 laboratory

facilities is that they are essentially self-contained, with entrance through an anteroom or

airlock and with access restricted to authorized personnel. This has greatly limited the

possibility of an accident spreading beyond the confines of the facility. The major risks are

accidents that cause direct exposures to individuals working in the laboratories. The facilities,

especially those intended for higher risk use, are built to allow ease of decontamination to

minimize the chances of a continuing source of infection in the event of a spill. Whenever a

possibly infectious spill occurs, the immediate emergency procedure is to obtain medical care

for the potentially exposed person as quickly as possible and to perform tests to determine if

in fact the person involved has received the suspected exposure. Of course, concurrently,

care must be taken to contain any spread of the affected area. A baseline medical examination

(including a medical history) for each employee at the time of employment, with a serum

sample taken for storage at that time, is of great value for comparison at the time of an

accident. Because there may be delayed effects, records of any suspected incident need to be

maintained indefinitely. A s long as contaminated materials removed from the facility are

autoclaved or double-bagged followed by incineration, there is little risk to the general public

from laboratory research involving biological materials. Recent concerns about the disposal

of infectious waste or ‘‘regulated medical waste” (as is now becoming the acceptable term)

have caused a major increase in research into alternative means of rendering these types of

waste harmless and unrecognizable by the general public. Materials made biologically safe

by steam sterilization would still have to be mechanically processed to change their

appearance. The concern, of course, is based on the fear that an individual coming into

contact with improperly disposed of regulated medical waste could contract a serious disease,

specifically AIDS or hepatitis B. Further discussion of these processes will be found in

Chapter 4. In addition, the impact of this concern about bloodborne pathogens on emergency

responders will be discussed later in this chapter.

Individuals not involved directly in the accident should evacuate the laboratory and the

area must be decontaminated by persons wearing proper protective clothing. Only those individuals who have received documented training as required by the OSHA Bloodborne

Pathogen standard are allowed to clean up any materials that might be contaminated by

human blood, other bodily fluids, mucous, or tissue. It may be necessary to chemically

decontaminate the entire exposed space. However, each incident needs to be treated on a

case-by-case basis.

If it is necessary to transfer individuals to an emergency facility, all information available

should be given to the emergency response personnel and also transmitted to the personnel

at the hospital facility. Both of thes e groups may wish to activate isolation procedures to

protect themselves and others.

b. Radiation Incident

Radioactive spills represent another class of accident of special concern. There are

circumstances that ameliorate the risk in actual accidents. Although laboratories in which

radioactive materials are used are not classified as to the degree of risk as are laboratories

using pathogens, they do operate under unusually stringent regulations established by the

Nuclear Regulatory Commission (NRC) or an equivalent state agency. The regulations are

intended to minimize the amount of material involved in a single incident and to limit the

number of persons involved to authorized, trained, and experienced personnel. As a result, an

individual involved in a spill generally knows to restrict access to the area of the accident and

to avoid spreading the material to uncontaminated areas. Unfortunately, not all researchers

exercise the required care, and as a result, there are occasions when radioactive materials may



©2000 CRC Press LLC



be spread unnecessarily. Every institution licensed to use radioactive materials is required to

have a radiation safety program and a radiation safety officer who should be notified immediately in case of an accident. In obtaining the license to use radioactivity, the institution or

corporation must demonstrate to the NRC that it has the capability of managing accidents

properly In addition, there are requirements governing reports to the NRC, or to the

equivalent state agency in an “Agreement” statement, spelled out in Title 10 of the Code of

Federal Regulations, Part 20, when an accident occurs. Thus, the response to an emergency

involving a release of radio active material is relatively straightforward. Individuals working

with many classes of radioactive materials must wear personal dosimeters (usually a badge

containing a material with a known d o s e response relationship), so that in the event of an

incident, their total external exposure can be read from these badges. Nasal swipes can be

taken to check for inhaled materials. The clothes and skin of persons in the area and those

allowed to leave can be checked with survey meters, which should be present in laboratories

using radioactive materials or brought to the scene by radiation safety personnel. Surface

contamination within the laboratory and on personnel can be cleaned up with little risk, using

proper personal protective equipment to protect those doing it. The protective equipme n t

normally would consist of a cartridge respirator and filter, coveralls of Tyvek™ or a similar

material, head and foot covers (these may need to be impregnated with an appropriate plastic

material), and “impermeable” gloves (unless chemical solvents are involved, the gloves most

commonly used are made of polyethylene). Duct tape is an invaluable asset to seal gaps in

the protective clothing around wrists, ankles, and the front opening. If the possibility exists

that anyone ingested or inhaled radioactive material, then the individual should undergo

further testing. This would include a bioassay for radioactive materials and, possibly, whole

body counting at a facility with this capability. Whole body counters are available as mobile

units which can be brought to a site should the need be justified. A major advantage of

radioactive materials is that instruments exist which can detect radiation from spilled materials

to levels well below any defined risk.

A situation in which personal injury is accompanied by a spill of radioactive material onto

that person introduces significant complications in the emergency medical response.

Radioactive material may have entered the body through a wound, and there is a possibility

that both the emergency transport vehicle and the emergency room at the hospital could

become contaminated. Due to the small quantities used in most laboratories, the contamination is unlikely to actually be a serious problem, but could be perceived as one by

emergency medical personnel. In order to reassure them, a radiation safety person should

accompany the victim to the emergency center, if possible, and be able to provide information

on the nature of the radioactive material, the radiation levels to be expected, and advice on the

risks posed by the exposure to the patient and to others. The type of radiatio n a n d t h e

chemical or material in which it is present can have a major impact on the actions of the

emergency room personnel. Some materials are much worse than others if they have entered

the body. As noted above, a bioassay, other specialized tests, and a whole body count of the

victim may be needed in order to ascertain that no internal contamination exists.

A sheet of plastic placed between the injured person and the backboard or stretcher and

brought up around the person will effectively reduce the amount of contamination of loose

material from the patient to the ambulance and the equipment being used, and will serve the

same purpose later at the emergency room. If it is felt to be necessary, the emergency

personnel can wear particulate masks or respirators to avoid inhalation of any contaminants.

Due to the low level of material being used in most laboratories, it is unlikely that emergency

personnel will need to be protected from direct radiation from the victim. There have been

cases of industrial accidents where this last statement definitely was not true. Emergency

equipment used in the course of the emergency response can be readily checked and, if

necessary, decontaminated after the patient has been transferred to the emergency room. The

patient should be separated from any other occupants of the emergency reception area to

avoid any unnecessary exposures, even if they are well within safe limits, again because of

the public concern regarding exposures to radioactivity at any level. In the very unusual

event that substantial levels of radiation might be involved, the victim should be placed in an



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isolated room and emergency equipment brought to the room rather than using the normal

emergency room. A possible location would be the morgue. In such an incident, it is

important to document exposures for everyone involved in the emergency response. Even in

low-activity situations, it is good standard practice to survey the interior of the ambulance,

the parts of the emergency facility which might have been contaminated, equipment that may

have been used, and the emergency personnel involved and make wipe tests for loose

contamination. All radiation survey data should be care fully recorded and the records

maintained for future use. The records should include estimated d o s e levels of all personnel

participating in the event, based on the proximity to the radiation an d t h e d u r a t i o n o f t h e

exposure. There could easily be a need for these data in court at a later time.

6. Multiple Class Emergencies ***

Emergency response procedures will need to incorporate sufficient flexibility to serve in

many nonstandard situations. Unfortunately, one cannot depend upon an accident being of a

single type or even limited to one or two complicating factors. Consider the following

hypothetical scenario: a laboratory worker puts a beaker containing a volatile solvent, to

which a radioactive compound has been added, into an ordinary refrigerator. Due to

carelessness, it is not covered tightly. During the next several hours, the concentration of

vapors builds up in the confined space and at some point the refrigerator goes through a

defrost cycle. The vapor ignites explosively, the refrigerator door is blown off, strikes a

worker, and knocks several bottles of chemicals off a shelf. Chemicals from the broken bottles

spill onto the floor and onto the injured person. The solvent in the beaker, as well as in

several other containers, spills on the floor and ignites. The radioactive material in the beaker

and in some of the other containers is spread throughout the laboratory and into adjacent

rooms. Although this is posed as a hypothetical situation, it could happen and with the

exception of there being no injured person has happened at the author’s facility.

In a complicated incident such as the one described, the first priority is preservation of

life, even ahead of possible future complications. In the presence of a fire which, in a laboratory containing solvents, always has at least the potential of spreading uncontrollably,

evacuation of the injured party should be considered as the first priority, followed by or

paralleled by initiating evacuation of the rest of the building. Note that in every case of injury,

the comparative risk of further injuring a person by moving them must be compared to the risk

o f not moving them. Notifying emergency medial services should be done as s o o n a s

possible after the removal of the victim to a safe location so treatment of the physical and

chemical injuries to the victim can begin. Preliminary steps can be taken prior to the arrival of

the emergency medical personnel if done with care not to exacerbate any of the injuries. In

the case of the scenario described above, summoning the fire department can take the next

priority. Of course, if adequate personnel are available, this step can be taken concurrently

with the ones already mentioned. Generally, it is desirable to make these contacts with outside

agencies from a place outside of the incident area. Assuming that the fire is manageable, then

preliminary steps can be taken for cleanup and decontamination of the spilled chemicals and

radioactive material. Unless there appears to be a risk that the contaminated area will spread,

perhaps due to runoff of water used in fighting the fire, it is not necessary for these last steps

be done in any haste. However, the surrounding area must be cordoned off until

measurements and surveys are completed by trained radiation safety and, perhaps, chemical

safety personnel. This isolation must be maintained until a formal release of the area by the

individual in charge, based on the information provided by the safety specialists.

After the incident is over, a review of the causes of the accident and the emergency

response should be conducted by the appropriate safety committee or committees. In this

case, the laboratory safety committee and the radiation safety committee would probably

jointly conduct the review. Basically, there were two root causes of this specific incident.

Solvents should not be stored in any container which cannot be tightly sealed, but this would



*



The Editor is indebted to Dr. Richard F. Desjardins, M.D. for his input for this section.



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not have caused the explosion if the refrigerator had been suitably designed for storage of

flammable materials. These are commercially available, although at a price two to three times

more than a unit not designed to be explosion safe against internal flammable vapor releases.

Note that the words “explosion proof” are not used here, since this implies that they could

operate in an atmosphere of flammable vapors safely. Units meeting this more stringent

criteria do exist but at a much higher price.

The subsequent review should consider if anything could have made the incident worse.

For example, in the hypothetical accident, the worker could have been alone, although this

was not assumed to be the case. In academic research laboratories, research workers, and

especially graduate students, tend to work unusual hours as they try to work around their

class schedules to meet deadlines imposed by the framework of timetables, deadlines for

submission of theses and dissertations, etc. If the injured person had been alone, the

potential for a loss of life would have existed.

The situation described in an earlier paragraph illustrates not only that in the real world

emergencies can be very complicated, but also illustrates that some emergency responses can

wait but others cannot. Components of the emergency that are immediately life thre a t e n i n g

mu s t be dealt with promptly, but others, such as cleaning up, can wait to be done carefully

and properly after appropriate planning. Any incident also should be treated as a learning

opportunity. There were basic operational errors leading to the postulated incident which

could be repeated in other laboratories. There were aspects to the incident which would have

permitted it to be worse. These should be factored into the emergency plan for the facility if

they had not already been considered. If violations of policy had occurred, then the review

should point these out and recommend courses of action to prevent future violations. It is not

necessary to deliberately embarrass someone but it is important that this concern not conceal

true erro rs which could have been avoided. An emergency plan should not only cover

responses to classes of emergencies which have occurred, but should have the capability of

reducing the possibility that emergencies will occur.

E. Artificial Respiration, Cardiopulmonary Resuscitation (CPR), and First Aid

In several examples of responses to various emergencies, allusions were made to emergency medical procedures which should be performed. Most of these procedures require prior

training. Because of the relatively high probability of accidents in laboratories, it would be

desirable if at least a cadre of trained persons was available in every laboratory building.

Both first aid and CPR classes are taught by a number of organizations in almost every

community. Among these are the Red Cross, American Heart Association, r e s c u e s q u a d s ,

other volunteer organizations, and many hospitals. Usually, except for a small fee to cover the

c o s t of materials, the classes are free. In addition, labeling regulations and t h e O S H A

Hazardous Communication Standard now require that emergency information be made

available on the labels of chemical containers and as part of the training programs. Since in

most cases involving a chemical injury the chemical causing the injury will be known, and

thus information will be available, the following material on first aid for chemical injuries will

be restricted to the case of basic first aid for an injury caused by an unknown chemical.

Similarly, since formal class instruction in CPR, which will also cover artificial res piration, is

almost always available, the material on CPR will be very basic. CPR should be done only by

properly trained individuals, with the training including practice on mannequins. Certification

in CPR is easily and readily acquired. It is also important to periodically become recertified, as

new concepts and procedures are frequently evolving and presented in the training programs.

In all the following s ections, it is assumed that emergency medical assistance will be

called for immediately. Emergency medical personnel are trained to begin appropriate

treatment upon their arrival. Depending upon the level of training and the availa b i l i t y o f

telemetry, they normally will have radio contact with a hospital emergency facility or a trauma

center and can receive further instruction from a physician while providing immediate care

during transit to the treatment center.

The following material is a composite of the information gleaned from a number of different sources. Where sources differed slightly, the more conservative approach was t a k e n ,



©2000 CRC Press LLC



i.e., that approach which appeared to offer the most protection to an injured person, with a

second priority being the approach offering the least risk to the individuals providing the

assistance. A third criterion was simplicity and the feasibility of performing the procedure

with materials likely to be available. It was compiled explicitly in the context of injuries that are

likely to occur as a result of laboratory accidents and is not intended to provide a comprehensive treatment of emergency medical care. It has been reviewed and, where needed,

revised by a physician.

Except where mandated by the nature of the problem, such as removal from a toxic atmosphere, or other circumstances immediately dangerous to life and health, no stress is

placed on evacuation. Unless there are obvious fractures, there may be injuries to the spine,

or broke n bones that may puncture vital organs which are not immediately apparent. If it is

essential to move the victim, do so very carefully. Use a backboard or as close to an equivalent as possible to keep the body straight, and support the head so that it does not shift. Any

inappropriate movement of a fractured neck may damage or even sever the spinal cord and

result in paralysis, death, or in a compromising of the patient’s airway.

To repeat, before performing any of the more complicated first aid procedures, formal

training classes taught by certified instructors should be taken. It is possible for an inexperienced person to cause additional injuries.

1. Artificial Respiration

The lack of oxygen is the most serious problem that might be encountered. If the victim is

not breathing or the heart is not beating, then oxygen will not be delivered to the brain. If this

condition persists for more than 4 to 6 minutes, it is likely that brain damage will occur. In this

first section, it will be assumed that the heart is beating but that the victim is not breathing.

This is checked by the lack of motion of the chest.

a. Artificial Respiration, Manual Method

Although mouth-to-mouth or mouth-to-nose artificial respiration is much more effective,

an alternative method of artificial respiration will be discussed first. There are occasions when

it is not safe to perform direct mouth-to-mouth resuscitation, such as when poisoning by an

unknown or dangerous chemical substance is involved, or when the victim has-suffered major

facial injuries which make mouth-to-mouth impossible. Since the first of these conditions can

be expected to occur in some laboratory accidents, it is good to know that there is an

alternative procedure available. The method considered the best alternative is described

below.

1. Check the victim’s mouth for foreign matter. To do this, insert the middle and forefinger into the mouth, inside one cheek and then probe deeply into the mouth to the

base of the tongue and the back of the throat, finally sliding your fingers out the

opposite side of the mouth. Be aware that a semiconscious patient may bite down on

your fingers. It would be wise to insert a folded towel or object that would not break

teeth between the teeth while you are doing your examination.

2. Place the victim on his back on a hard surface in a face up position. Problems with

aspirating vomitus can be reduced by having the head slightly lower than the trunk of

the body. An open airway is essential and can be maintain ed by placing something,

such as a rolled up jacket, under the victim’s shoulders to raise them several inches.

This will permit the head to drop backwards and tilt the chin up. Turn the head to the

side. Important! Do not do this if there is any suspicion of neck or spinal trauma.

3. Kneel just behind the victim’s head, take the victims wrists, and fold the victim’s arms

across the lower chest.

4. Lean forward, holding onto the wrists, and use the weight of your upper body to exert

steady, even pressure on the victim’s ches t. Your arms should be approximately

straight up when in the forward position. This will cause air to be forced out of the

victim’s chest. Perform this step in a smooth, flowing motion.

5. A s soon as step 4 is completed, take your weight off the victim’s chest by s traight-



©2000 CRC Press LLC