Exposures - Chemical

For the next few weeks we’ll focusing on a particularly scary and unpredictable type of exposure – Chemical Exposure.

The good news about Chemical Exposures is that they are relatively few and far between, though when something does happen it can be devastating, and they can have long-term effects, including Cancer.  The total number Chemical Exposures we’ve seen in 2011 is 119.  This is less than five percent of the total injuries reported.  The most reported Chemical Exposures occur during Fire Suppression, with the next largest number occurring during Station Duties.  

Chemical Exposures by Activity (2011) - click to enlarge

 

The Chemical Exposures you’re reportedly coming into contact with include: household cleaning items, gasoline, hydraulic fluid, foam, battery acid, H202 (hydrogen peroxide), CO (carbon monoxide), pesticides, Freon, Ammonium Persulfate, chlorine fumes, paint and unknown hazardous chemicals.  

86 percent of these exposures were reported without noted reaction or symptoms; 15 percent reported respiratory system effects via inhalation; 1 percent report physical effects, such as blistering and redness; and 1 percent report allergic-type effects, such as hives and rash.

Chemical Exposures by Symptoms (2011) - click to enlarge

 

Check out some examples of Chemical Exposures occurring during Fire Suppression:

Structure fire involving a pesticide business. Possible exposure to 70 plus hazardous chemicals according to MSDS sheets on location.

While fighting a dumpster fire containing Ammonium Persulfate the plume of smoke momentarily change directions and engulfed firefighter. He was in full PPE with SCBA per SOP and ERG recommendations. He later complained of a feeling like "sunburn" on face and burning eyes.

Attempting to put out paint cans, which exploded, with reaction to water causing exposure to chemical w/ a PH of 14.

A chemical mixing company burned. They had approximately 300 chemicals in various amounts in, and around, their building. This firefighter was exposed to the smoke and/or fumes of the fire. Department has had base line blood work done on employees and has filled out exposure forms for future reference.

Check out some examples of Chemical Exposures occurring during Station Duties, Skills Training & Rescue Non-Fire activities:

Fire personnel was emptying out a one gallon pressurized garden sprayer that had Superall in it and as personnel was walking to sink to drain product into sink the wand hose came unattached from the sprayer and discharged the product into personnel's right eye.

Firefighter was filling fuel tank on vent fan at fire station. While pouring gasoline from contain into funnel which was connected to fuel tank, gasoline splashed from funnel into firefighter’s face and right eye when funnel was removed from fuel tank spout. 

Employee was running a weekly test on our stand-by generator at their assigned fire station when the battery exploded. A very small amount of acid from the battery landed on employee's face. The employee was wearing protective glasses at the time of the incident and no acid entered his eyes. 

Firefighter was in a training exercise and was hooking up a 1 3/4 supply line to pumper. Before he had completed his connection another firefighter opened up the valve to the discharge outlet. When this valve opened up it sprayed water and foam in the face of the firefighter. 

Employee was checking the ambulance and while he was moving H2O2 he started to have a burning sensation on his hands. He washed his hands and the burning stopped. H2O2 was removed and replaced. Possible reaction with rubbing alcohol and H2O2

While working major accident, firefighter had burning sensation on finger tips. Skin was turning white and scaly in appearance. Believing to be chemical burn, firefighter rinsed hands at scene. Firefighter believed he contacted substance from gloves being used.

Records & Exams

Not only must you report your Chemical Exposures to us, but you must also keep good records on any exposures occurring within your department, due to long term issues that can arise.  OSHA regulations instruct you on these records management requirements.   Additionally, NFPA 1500 Standard on Fire Department Occupational Safety and Health Program, states that you must conduct baseline medical exams (including blood work) for all staff (or at least those on the HazMat teams) each year, or after an exposure.  These can be compared with new blood tests through the years to uncover work-related exposures.

Does your department conduct these regular medical exams?

Are you surprised at how often you can be exposed to harmful chemicals?

Does your department have SOPs on these exposures?

Exposures - Blood-Borne Pathogens

This week we are focusing on the Exposures to the Blood-Borne Pathogens (BBPs) that have been reported to us.  For the purposes of our injury reporting system the definition we are using for Blood-Borne is “A fluid or liquid based contaminant.” Your departments have reported BBPs exposures via needle sticks, staph, blood, bodily fluids (via coughs and sneezes), vomit, and saliva.  Like Airborne Pathogens you’re most often exposed to BBPs during Rescue-Non Fire activities – probably while attending to patients.  These BBPs can also be passed to and from people who live in close quarters, so keep that in mind when you’re in the firehouse.

The chart below shows the types of ways that you are getting exposed to BBPs.  169 incidents of BBP exposure have been reported.

BBP Exposure by Type of Exposure (2011) - click to enlarge

The next chart shows the number of known BBPs that you are being exposed to.  You’ve reported 23 known pathogens.  This number reflects a small percentage of the exposures you’ve reported.  That is the good news.  The bad news is that very dangerous pathogens, such as MRSA and HIV/HepC, are being reported. 

BBP Exposure by Type of Known Pathogen (2011) - click to enlarge

Like Airborne Pathogens, you can try and protect yourself from BBPs, but it is not always possible.  Make sure you take the necessary precautions and follow up with your phyisician to make sure any exposures are investigated and taken care of.

This is scary stuff:

MRSA (CDC)

MRSA is commonly spread at fire houses (Fire Chief Magazine), Are You Safe? (Fire Engineering)

HIV (CDC)

Hepatitis C for Health Professionals (CDC)

Staph (Mayo Clinic)

Staph in Health Care Settings (CDC)

Ringworm (Mayo Clinic)

Ringworm on arm image courtesy of cdc.gov

MRSA bacteria image courtesy of cdc.gov

Quick tips for avoiding Exposures to Blood-Borne Pathogens:  

• Avoid touching blood and fluids, even if they are dry.
• Wear PPE when working with blood or other bodily fluids (Latex or vinyl gloves; protective gowns when working in high-trauma incidents; heavy-weight or tear-resistant gloves when cleaning ambulances or emergency scenes; eye wear and surgical masks to prevent blood splatter.)
• Change gloves between patients.
• Learn to remove PPE without touching the outside of the PPE.
• Use caution around sharp or blood-covered tools.
• Place biohazard warning labels on any container or equipment that has been contaminated or areas that contain potentially infectious material.
• Don’t share personal hygeine tools that could hold blood or bodily fluids (razors, toothbrushes, etc.).
• Don’t share inanimate objects, like towels and pillowcases, that can hold staph infections.
• Have puncture-proof containers available to dispose of needles, scalpels, borken glass, or other sharp objects.
• Put up informational information at your departments to convey the dangers of these diseases (MRSA, HIV, HepC, Ringworm, Exposure to Blood)

Also, keep these facts in mind:

• Although you may not know if there is anything infectious present, report all exposures to bodily fluids. 
• If you are exposed to a needle prick, get checked out.
• If you learn someone in the firehouse or a patient is infected with BBP, get checked out.
• Infections like Staph and MRSA can look like a boil, or spider bite, so get all skin irritations checked out.

Ringworm on arm image courtesy of cdc.gov

Learn more to keep your department safe

• Blood Borne Pathogen Refresher (Firehouse.com)
• Bloodborne Pathogen Standard (BBPS) (OSHA)
• Bloodborne Pathogens and Needlestick Prevention (OSHA)

Borrow TCFP Library materials to teach your team about BBPs

• BLOODBORNE & AIRBORNE INSTRUCTOR KIT
• BLOODBORNE PATHOGENS AND INFECTIOUS DISEASES 
• BLOODBORNE PATHOGENS, 4TH ED. 
• HEPATITIS C 
• INFECTIOUS DISEASES 

What is your policy on dealing with these types of exposures?

What type of awareness training do you have in regards to this issue?

Has the training changed over the years based on new medical information?

Exposures - Airborne Pathogens

This month we’re focusing on Exposure, and while the fire service is vulnerable to all kinds of communicable diseases, this week we’ll take a look at the Airborne Pathogen Exposures (aka Atmospheric Disbursed Contaminants) that you’ve been reporting to us.  The most prevalent Airborne Pathogens that Texas departments are reporting to us are Meningitis and Tuberculosis (TB), but check out the other pathogens you’re being exposed to out there: 

Airborne Pathogen Exposure by Type (2011) - click to enlarg

Most of these Airborne Pathogen Exposures are occurring during Rescue-Non Fire activities.  Thus, we believe most of them are occurring when you come in contact with patients. 

Airborne Pathogen Exposure by Duty (2011) - click to enlarge

Because we’re seeing so many Meningitis and TB cases during the Rescue-Non Fire calls, we’re going to focus on giving you information about these diseases, how you might be getting exposed to these diseases, and how you might avoid exposure to these diseases.

Meningitis bacteria image courtesy of Sanofi Pasteur on flickr

Meningitis (CDC)

 Meningitis symptoms can develop over several hours, or they may take 1 to 2 days to surface, so keep your eye out on yourself and your team members.  Unfortunately, these symptoms often mimic flu symptoms, so if you know you’ve been exposed, see a doctor ASAP.

Bacterial Meningitis is spread not via common contact, but through the exchange of respiratory and throat secretions.  In your line of work, this could mean something like mouth to mouth resuscitation.  It can also be passed to those living in close contact with someone with one of these pathogens.  Delaying treatment for bacterial meningitis increases the risk of permanent brain damage or death.  It’s important to see a doctor as soon as you observe symptoms or know you’ve been exposed.

While Bacterial Meningitis can be fatal in vulnerable populations, Viral Meningitis usually only lasts 7-10 days, BUT it’s easier to acquire.  It is most often spread during Summer and Fall months, and caused by enteroviruses such as: mumps, Epstein-Barr virus, herpes simplex viruses, and varicella-zoster virus—the cause of chickenpox and shingles, measles, and influenza.  It can also be spread via mosquitoes.  Avoid these viruses (and mosquitoes) and avoid Viral Meningitis.

Quick tips for avoiding viruses leading to Viral Meningitis:

·        Get the MMR and Chicken Pox vaccines

 image courtesy of the CDC

·        Clean up properly if you come in contact with a rodent infestation

·        Avoid mosquito bites

·        Wash your hands

·        Disinfect surfaces

·        Cough into your sleeve or a tissue

·        Do not kiss, or exchange saliva with infected people

Tuberculosis (CDC)

Aside from coughing up blood, the symptoms of TB mimic the flu or a bad cold, so again, get yourself tested if you observe any symptoms. 

TB image courtesy of Sanofi Pasteur on flickr

TB is not passed on through direct contact, so it’s not easy to avoid.  If someone with TB coughs, sneezes, or just breaths heavily into the air, it can then be inhaled by others and they can get infected.  You are at risk of being infected if you spend time around someone with TB or if you have a compromised immune system.  If you are infected, you can have Latent TB (meaning you are carrying it, but not affected by it, and you can’t pass it on, BUT it CAN turn in to TB Disease!) or TB Disease/Active TB.  If you have either, you need to get treated.  Since responding to sick patients is sometimes your job you should get tested for TB even if you don’t have symptoms.  And if you know you’re near someone with TB, take precautions to avoid sharing the air they breathe.

Flu vaccine courtesy of samantha celera on flickr

Seasonal Influenza (CDC)

And even though your departments aren’t sending us reports of Flu Exposure, we thought we’d remind you about it since it’s that time of year.  Again, since you are around sick people fairly often, AND you share a space with a number of people at the station, consider getting your flu shots to prevent illness.

Flu Attack! How A Virus Invades Your Body

Check out these resources to train yourself or your team on avoiding Airborne Exposures:

• BLOODBORNE & AIRBORNE INSTRUCTOR KIT  
• BLOODBORNE PATHOGENS AND INFECTIOUS DISEASES 
• INFECTIOUS DISEASES 
• SILENT WAR: INFECTION CONTROL FOR EMERGENCY RESPONDERS, 2ND ED.

 These are free of charge to you, so click the titles to learn more and reserve your copies today!

Check out these articles about avoiding Airborne Pathogens:

• Body Substance Isolation (Firehouse.com)
• Keep Your Department Healthy During Flu Season (Fire Engineering, Sept. 2011)