Prevention and first aid requirements for facilities with chemical hazards

Prevention and first aid

requirements for facilities with chemical hazards Bernard R Bla,s

An update on OSHA guzdehnes for emergency shower and eyewash equzpment hemlcals that are toxic to the skin the r e s p i r a t o r y system and the eye are found in the home on the farm, in the laboratory and at industrial sites Chemical Injuries can cause extensive damage to the external surfaces of the eyehds eye ball and skin as well as cardlopul m o n a r y and vascular collapse Trauma can also result from explosions and implosions Never w o r k with cheml cals in a l a b o r a t o r y t h a t is not equtpped with safety equipment

Hazard prevention The use of h a z a r d o u s m a t e r i a l s whether at the m d u s t n a l workplace in the laboratory or at h o m e - r e q u i r e s a hazard assessment (1) An adequate p r e v e n t i o n p r o g r a m should h m l t xnlurles significantly In fact 90% of eye mlurtes are preventable Assessment 29 C F R 1910 132 requires employers and users of chem lcals to assess the workplace to deter mine whether hazards that require the use of personal protective equipment (PPE) are present or likely to be pre sent (2) If hazards or the h k e h h o o d of hazards are found, employers must select properly fitted PPE suttable for protection from existing hazards and require that affected employees use it The employer is also required to do the following • C o m m u n i c a t e selection decisions to each affected employee • Select PPE that properly fits each affected employee 18 Chemical Health & Safety May/June 1999

• Verify that the required workplace hazard assessment has been per formed in a written document that identifies the workplace evaluated the person who certtfles that the evaluatton has been p e r f o r m e d and the date(s) of the hazard assess ment This document serves as a certfflcat~on of c o m p l e t i o n of the assessment P e r s o n a l protective e q m p m e n t should not be used as a substttute for engineering w o r k practice and administrative controls and it should be used in conlunchon with other con trois to provide for employee safety and health Analysis Personnel who are revolved with physical chemical or radtologlcal hazards must have a job hazard analysis to identify the protec tlve eye equipment reqmred for thetr lob or task (2, 3) Preventable lnlurles often result from workers' lack of attention to operations and process or failure to identify operations that are hazardous Operations that have the potentml to cause eye injury include those In which hardened metal tools are struck together equtpment or material is struck with metal hand tools or the cutting action of a tool causes parttcles to fly Welding presents a potenttal radlologlcal hazard to the unshtelded eye The handling of chemicals, corro slves, acids, and cryogemc hqmds also can be dangerous to the eye Training I n d i v i d u a l s must be trained m the use and maintenance of

PPE (2) and perform their own per sonal hazard assessments and eqmp ment selection m the workplace at home at school and m sports Protective equipment PPE includes all clothing and work acces sones designed to create a barrier but should be used m conlunctlon wtth these controls to provide for employee safety and health in the workplace PPE must be provided used and maintained whenever it is deemed necessary for gtven hazards, processes, or e n w r o n m e n t s The e q u t p m e n t should protect the user from chemical h a z a r d s radlologlcal h a z a r d s or mechanical irritants capable of caus lng mlury to or impaired function of any part of the body through absorp tlon, inhalation or physical contact (2) The employer or supervisor must verify that the proper PPE is used by all individuals potentially exposed to the hazard

Eye and face protection Employers must provide protectors suitable to the w o r k to be performed, and employees must use them These stipulations also apply to supervisors, management personnel and visitors m hazardous areas Eyeglasses A U S F D A regulation reqmres that all eyeglass and sunglass lenses sold to the general public be m a d e of shatter resistant material Normal prescription eyeglasses how ever do not provide appropriate eye p r o t e c t i o n m the l a b o r a t o r y even

1074 9098/99/$10 00 © 1999 American Chemical Society

though they meet FDA standards and the voluntary directives ANSI Z80 series (4) for shatter resistance Labo ratory work requires industrial quahty eye protection that fulfills the require ments of 29 CFR 1910 133 (5) ANSI Z87 l(a) 1991 requlrements-includ lng hardened glass or plastic lenses with a minimum thickness of 3 m m lens retaining, nonflammable frames and other attributes not covered by the FDA regulation-should be consld ered the minimum protection (6) In chemical work areas or any eye hazardous area where goggles are required, the goggles must be worn in addition to eyeglasses and at all times-even when not performing chemical operations Contact lenses The wearing of con tact lenses in the laboratory, previous ly forbidden, is now sanctioned by the American Chemical Society (ACS), the American Academy of Ophthal mology (7), the American College of Occupational and Environmental Medicine, and other national and International organizations as long as the personal protective safety goggles are used Although contact lenses pro vide some eye protection, they are never a substztute or proper eye pro tectlon (7, 8) Goggles Everyone in a laboratory or an eye hazardous area-including supervisors, management personnel, and visitors-must wear safety goggles (ANSI Z871(a) 1991 types G, H, or K) as outlined in 29 CFR 1910 132 (2),

Figure 1 Typical ANSi Z87 l a 1991 cover goggles (type H) (Uvex Stealth)

29 CFR 1910133 (5), and ANSI Z871(a) 1991 (6) Because there is always a danger of splashing chemicals or flying particles, safety goggles that protect the top, bottom, front, and sides of the eyes are mandatory, side shields do not provide adequate pro tectlon from chemical splashes Gog gles also should be worn when work lng with compressed gases The selection chart in ANSI Z871(a) 1991 recommends goggles that conform to protector types G, H, or K when working with chemicals (6) Typical indirect cover goggles (type H) are illustrated in Figure 1 and goggles with prescription insert are shown in Figure 2 (Uvex Optical Co, Smithfield RI) Face shields In addition to goggles, face shields are necessary when work ing with severely corrosive liquids, glassware under reduced or elevated pressure, or glass apparatus used in combustion or other high temperature operations-whenever there is any pos Slblhty of explosion or Implosion (6) According to ANSI Z871(a)1991, face shields alone are not considered adequate eye protection they must be used in conjunction with safety goggles (6) The problem with wearing a face shield over goggles over eyeglasses (as in the case of a nearsighted worker) IS that the individual has to look through three layers of plastic, light is reflected off each surface, and light rays are defracted by each medium OSHA approved standing shields and face shields (Figure 3) that protect the neck ears and face must be used when appropriate A new system called the Space Face Shield (Space Face Shield Inc, Cald well, TX) incorporates the goggles and face shield into one unit, thus ehml nating one layer of plastic and is much more protective of the forehead hair, ears, and chin (9) The shield is molded such that the ears are protect ed from chemicals and other physical hazards, and a lip under the chin pre vents chemicals from running down the neck When putting on the required goggles, the user also puts on the required face shield limiting the

Figure 2 Typical ANSi Z 8 7 l a 1991 goggles with prescription insert (type N) (Uvex Stealth) posslblhty of forgetting to put on the face shield This fulfills the OSHA requirements for face shield and gog gles (see Figure 3) Special eye protection Consider able discomfort and damage to the eye can result from exposure to ultraviolet (UV) light Absorption of this radia tlon by the cornea and conlunctlva (outer layers of the eye) produces ker atltlS and conjunctivitis, respectively Per ANSI Z871 UV absorbing protec tlve glasses should be worn whenever exposure to erythemlcally effective radiation is likely (6) The use of lasers requires special eye protection as specified in ANSI Z136 1 (10)

Chemical spills cleanup Clean up all spills promptly, efficient ly, and properly to prevent contamlna tlon and spread of hazard Notify the person in charge for help Warn all individuals at risk of involvement to spare them exposure to and minimize spread of the hazard (11, 12) Often the volume spilled is not as important as the toxicity of the substance Containment Containing the spill rapidly is a primary concern, because the smaller the area involved, the eas ler the cleanup Wear protective gloves Dike liquids by surrounding the involved area with an absorbent retaining material After the spill has been contained, clean it up with appropriate materials Commercially available or homemade spill control kits can be useful here If there is no fire hazard and the mater1 al is not believed to be volatile or toxic, clean it up as directed by the person in charge Refer to the appro pnate MSDS Chemical Health & Safety May/June 1999 19

Q How long is response time, and what is "near proximity ,,?

1910 151(c) O S H A requires that the employer tram a person(s) to render

A In areas where accidents resulting In suffocation, severe bleeding, or other life threatening inlury or ill ness can be expected, O S H A requires a 3 to 4 m m response time (from time of lnlUry to the adminls tratlon of first aid) U n d e r other clr cumstances (where a life threatening Inlury is an unlikely outcome of an accident for example) a 15 mln response time is acceptable The Eye Irrigator provides current, state of the art capability to the first responder for immediate irrigation of eyes without traumatizing the eyelids and the eyeball Final medical care must be provided by an ophthalmol oglst in all b u t m i n o r c h e m i c a l splashes

first aid

Q Should e m p l o y e e s be tramed in first aid *

A If an employer can take employ ees to an infirmary, clinic, or hospital or if outside emergency assistance can arrive w i t h i n the r e q u i r e d response time the employer is not required to train employees in first aid If employees w o r k in areas where emergency transportation is not available the employer must m a k e p r o v i s i o n s for a c c e p t a b l e e m e r g e n c y t r a n s p o r t a t i o n to an appropriate facility If an employer complies with 29 CFR 1910 151(a) (12) but has areas where the body or eyes of any person may be exposed to injurious corro sive materials as specified in 29 CFR

Nontomc spzlls W e a r protective gloves Many small (<100 mL) liquid spills can be cleaned up with p a p e r towels, sand, or another absorbent material (e g , commercial absorbents such as Oll Dri or Zorb All verml cuhte cat litter, or small (about 50 mesh) clay particles) Paper towels however can increase the surface area 20 Chemical Health & Safety May/June 1999

Q What constitutes a serious mlury ? A O S H A defines serious inJUry as an impairment of the body In which

part of the body is made functionally useless or is substantially reduced in efficiency on or off the lob (13) Such impairment may be p e r m a n e n t or t e m p o r a r y chronic or acute and usually would require treatment by a doctor Such mlurles include • amputation (loss of all or part of a bodily appendage that includes the loss of bone) • b u m s or scalds including electric and chemical burns • concussion, • crushing (internal, even though skin surface may be intact), • cuts lacerations or punctures that involve significant b l e e d i n g or require suturing, and • simple or c o m p o u n d bone frac tures Q What does first aid entad "a A As defined by OSHA first azd is

the emergency treatment of lnlunes before regular medical care is avail able The guidelines for first aid pro grams are found in O S H A CPL 2 2 53 (14) which provides guidelines for restitutions that teach first aid and consumers of such courses The instruction also outlines the basic and essential elements of an O S H A sanctioned first aid program

and rate of evaporation increasing the fire hazard To clean up large liquid spills use an absorbent material that will neutralize the liquids if possible (trisodmm phos phate sand followed by sodium blcar bonate solution or powder for acids sodmm thlosulfate solution for bromine) dry sand is less effective

Use a dustpan and brush to sweep up the absorbed spill Wash the contaml nated area with soap and water If the spill was on the floor sprinkle more absorbent on the area until it dries C o n t a i n the a r e a appropriately, because vermiculite and some other absorbents create a slipping hazard when wet Most solid spills can be brushed up and disposed of m appropriate solid waste containers but be careful to avoid reactive combinations Do not leave paper towels or other materials used to clean up a spill in open trash cans In the work area

Volatile flammable or tomc spills Immediately warn personnel to extin guish flames and turn off spark pro ducing equipment ( e g , brush type motors) Shut down all equipment and leave the area until it is decon tamlnated Remove clothing contaml hated by spills or splashes immediate ly to prevent skin penetration The supervisor will be responsible for des lgnatlng the extent of evacuation and the proper cleanup procedure After cleanup Dispose of all mate rials Including paper towels used in the cleanup as hazardous wastes Be p a m c u l a r l y careful that flammable hq ulds absorbed during cleanup do not present a continuing fire hazard Medical services and first aid 29 CFR 1910 151 specifies the require ments for medical services and first aid services (12) P a r t a The employer shall ensure the ready availability of medical per sonnel for advice and consultation on matters of plant health P a r t b In the absence of an lnflr mary clinic or hospital in near prox lmity to the workplace to be used for the treatment of all in}ured employees, a person or persons shall be adequate ly trained to provide first aid treat ment First aid supplies approved by the consulting physician shall be read ]ly available (13, 14)

P a r t c Where the eyes or body of any person may be exposed to ln]urI ous corrosive materials suitable faclh ties for quick drenching or flushing of

the eyes and body shall be provided within the work area for immediate emergency use Although students and visitors are not covered under 29 CFR 1910 151 (12), the same services are Indicated under tort law (liability) O S H A Letters of Interpretation pro vide guidance on this O S H A regula tion (see box, First aid facts) Preparing for emergencies The requirements for medical services and first aid are given in 29 CFR 1910 151 (12) O S H A CPL 2 2 53 (14), in which proper handling techniques and symp toms of overexposure to certain select ed chemicals are explained, should be followed The ACS Committee on Chemical Safety strongly recommends that for all chemicals used in the laboratory, both the M S D S s and competent medical authorities be consulted regarding first aid treatment (see box ACS recommends) Other preparations should be made in advance for handling medical emer gencles that involve laboratory chemi cals For example, if first aid treatment IS not described In the MSDS then add this information to the MSDS without delay Examples of emergen cies that one should anticipate are • chemical or electrical asphyxiation, • cuts and puncture wounds from glass or metal that is contaminated with chemicals, • chemicals (hquld, dust, or glass) in the eye • lachrymatory vapor irritation, • skin Irritation by chemicals • poisoning by ingestion, Inhalation, skin absorption, or injection, and • thermal cryogenic, or chemical bums The general program includes basic elements of the required training, first aid supplies, and trainee assessments (see box, Guidehnes for first md programs) Chemical inlunes If a chemical splashes on the body the body part(s) should be irrigated as soon as possible with copious amounts of nontoxic liquid In a DuPont study, it was shown that a pathophyslological change takes

place within 10 s of a chemical touch lng the surface of a tissue Immediately after the accident, the affected individual should be placed under an emergency shower or use an eye/facewash or eyewash station to irrigate the body face, or eyes while a first responder IS called to the scene The first responder should be alerted as early as possible (depending on the kind of incident and the clrcum stances of the accident) and must have eye irrigation equipment immediately available

Figure 3 Space face shaeld, a corn binabon of ANSI Z 8 7 l a 1 9 9 1 cover goggles (type H) and face shield (type N)

On skm For spills that cover a small amount of skin, flush the area with flowing water immediately and con tinue for at least 15 mln (11) If there is no visible burn, wash the area with warm water and soap, remove lewelry to faclhtate the removal of any residu al materials Consult the MSDS to determine whether any delayed effects should be expected It is advisable to seek medical attention for even minor chemical burns On clothes For spills on clothes, do not attempt to wipe off or flush the clothing (11) Quickly remove con taminated clothing, shoes, and jewelry while using the safety shower Seconds count, and no time should be wasted because of modesty

ACS recommends

In planning for potential emergencies as advtsed by OSHA CPL 2 2 53 consult w~th local emergency personnel in advance and estabhsh plans for the ban dhng of chemtcal emergencies and other tnlunes or medical emergencies and other tnlunes At a mimmum make the follow ing preparattons • Always have first aid equipment readtly avatlable • Prominently post the location and phone numbers of the first responders and local physicians who are qualified and have agreed to handle chemical emergency cases as well as local medical facihhes that are similarly qualified and have agreed Also post the location of the MSDS file • Train sufficient staff per OSHA requtrements Jn bastc ftrst aid and car diopulmonary resuscttation (CPR) Red Cross certification or ~ts equtvalent should be encouraged for all personnel Contact the local Red Cross chapter for informatmon about approprtate trammg modules Make arrangements to ensure that someone knowledgeable about the accadent always accompames the mlured person to medical asststance and that a copy of the MSDS for chemical(s) mvolved go with the victim if at all possible Maintain a file of extra copies of all MSDSs for th~s purpose Establish procedures to ensure that following any first aid by first responder only a nurse or phys0c~an who is quahfied and has agreed to handle chemical emergencies prowdes further exam~natton and treatment Source Reference 14

Be careful not to spread the chemi cal over the skin, especially into the eyes Use caution when removing pullover shirts or sweaters it may be better to cut off the garments Contin ue flooding the affected body area(s) with tempered water for at least 15 rain Resume flushing if pain returns ChernlcalHealth& Safety May/June1999 21

Uvex Stealth ¢=oggles Uvex Safety Inc Smithfield RI (800 343 3411) Space Face Shield Space FaceSh)eld Inc Caldwell TX (888-44O-3223) The Eye irr~aler American Health & Safety Mad)son Wl (80O 522 7554)

Do not use creams lotions, or salves Seek medical attention as soon as pos sible Launder contaminated clothes separately or discard as r e c o m m e n d ed in the M S D S In the eye(s) Under current 29 CFR 1910 151(c) (12) and A N S I 358 1 (15) requirements, it is imperative that i m m e d i a t e a n d t h o r o u g h first aid treatment and good medical care be provided as soon as possible to pre vent loss of vision (16 19) OSHA, in accordance with 29 CFR 1910 151(c) and A N S I Z258 1998, reqmres emergency eye/facewash sta tions and emergency shower equip ment The initial irrigation should last 15 minutes with the clothing removed during the showering pertod before fur ther medical treatment or until relieved by the first responder My article in the January/February issue of Chemtcal Health & Safety New procedures in the treatment of chemical injuries of the eyes;' details the methods of first aid for chemical lnlurles to the eye The first responder should be alert ed at the earliest possible time based on the type of incident and clrcum stances of the a c c i d e n t The first responder must have the most state of the art instrument (Eye Irrigator) to irrigate the eye Final medical care must be provided by an ophthalmolo gist in all but m i n o r chemical splashes

Emergency flushing equ,pment In accordance with 29 CFR 1910 151(c) (12), O S H A requires the availability of emergency showers and

22

Chemical Health & Safety May/June 1999

emergency eyewash stations, which provide quick drenching or flushing of the body and eyes, respectively (12) The initial Irrigation should last 15 mIn and the clothing s h o u l d be removed under the shower before fur ther medical t r e a t m e n t or until relieved by the first responder Showers Emergency showers are designed to provide a deluge of fluid large enough to rinse the entire body (•5) In a c c o r d a n c e with 29 CFR 1910 151(c) and A N S I Z358 1 1998 (15) all laboratories should have this eqmpment In accessible locations Spectfzcatlons Emergency showers must delwer a pattern of flushing fired (defined later) at least 50 8 cm (20 in ) across which flows at a rate of at least 75 7 L/rain (20 gal/mln) and a veloc lty low enough not to inlure the user This diameter ensures that the entwe body recewes a direct, flesh supply of flushing fluid A smaller d i a m e t e r could result in the flushing fluid being directed only to the top of the user s head giving the victim's arms legs back and torso only a limited rinse Use Because of the potentially high velocity and volume of water they pro duce emergency showers are not to be c o n s i d e r e d or used for irrigating chemicals from the dehcate tissues of the face or eyes Eyewash stations A N S I Z358 1 1998 requires that each laboratory area be equipped with safety eyewash stations (devices used to irrigate and flush the eyes) (/5) The standard describes three kinds of s t a t i o n s plumbed, self contained, and person a l - t h a t are specifically designed to provide a controlled flow of flushing fluid to both eyes simultaneously To maintain a soft controlled flow to the eyes volume and pressure regulation are required The stations must supply an uninterrupted, 15 min flush of water Plumbed stattons As a general rule select a plumbed unit if plumbing is available Plumbed units are recom m e n d e d because of the greater volume of flushing fluid available to the u s e r between 75 and 13 25 L / m m (2 0-3 5 g a l / m l n ) - a n d the ease of identifying

emergency stations by hghtIng signs, or painted floors Plumbed stations are permanently connected to a facility water supply and dehver only water as a flushing fluid Self contained statmns Self con t a m e d (portable) eyewash stations provide at least the m i m m u m volume, 1 5 L (0 4 gall, and satisfy the need for emergency equipment in areas where plumbed potable (statable for drink rag) water is not available Bollas and Coffey r e c o m m e n d self contained eye wash stations for off site warehousing mobile crew work sites temporary work areas and locations where prl m a r y eyewash equipment has been temporarily taken out of service (18) Self contained units currently avail able can be filled with (19) • water alone • water and a water additive or preser vatlve formulated to prevent bacte n a fungi and algae growth • water and a concentrate formulated to provide a preserved buffered saline solution or • factory sealed cartridges that con tam isotonic preserved, buffered sahne solution Personal stattons The personal eye wash stahon is ' a supplementary eye wash that supports plumbed units self contained units or both by dehv erlng immediate flushing fluid' (15) Relatively inexpensive it can be locat ed almost anywhere and can be used while m transit to a permanent eye wash station a n d / o r medical fac]lltles The A N S I standard requires that an emergency eyewash station supply a m i n i m u m rinse of 1 5 L/rain ( 0 4 gal/mln) for a minimum of 15 mln Because personal eyewash stations do not meet A N S I reqmrements they are intended to supplement not replace standard eyewash equipment These dewces may have capacmes larger than 32 oz but dehver less than the minimum 0 4 gal/mln for 15 mln (19) In most cases personal eyewash sta tlons have the same flushing fluid options as self contained stations The Eye Irrigator (American Health & Safety Madison WI) for example is a state of the art instrument that

provides immediate eye irrigation without traumatizing the eyehd and eyeball Eye/facewash stations One enhancement of the eyewash station is the eye/facewash station (18), a device designed to irrigate the eyes and face simultaneously An eye/facewash sta hon delivers a substantially greater volume of flushing fluid (mlmmum 11 4 L/mln [3 0 gal/mln]) than an eye wash station to irrigate a larger target area In selecting equipment, one should recognize that a chemical splash to the eyes probably will affect the face as well With this in mind, eye/facewash stations are strongly recommended over eyewash stations for plumbed chemical splash Irrigation equipment Drench hoses Part of Industrial emergency stations for many years, drench hoses are particularly c o m m o n in laboratories They provide first aid capabtllty in con}unction with eye wash and eye/facewash equipment Drench hoses are used • to spot drench an affected area when a full shower is not required • to irrigate exposures w h e n the victim is unconscious or unable to stand, and • to irrigate under clothing before clothes are removed It IS important to note that drench hoses are supplementary equipment and do not replace emergency showers or eyewash stations Combination eqmpment This term refers to multiple use stations with a c o m m o n plumbing unit Comblna tions of shower, eyewash, eye/face wash, and drench hose equipment are available in a variety of conflgurattons Combination stations help control unit installation costs and piping requirements in the workplace When combination stations are used the water line must be at least 3 2 cm (1 25 In ) m diameter to readily supply many pieces of equipment W h e n planning system require ments, it is Important to note that standards require both shower and eyewash devices to be able to operate simultaneously

Flushing fluids Flushing fluid is defined as "potable water, preserved water, preserved buffered sahne solu tlon, or other medtcally acceptable solution manufactured and labeled in accordance with apphcable govern ment regulations" (15) Under no circumstances should an attempt be made to neutralize one offending substance with another The materials used to construct plumbed and self contained units should not corrode in the presence of this fluid and the fluid should be protected against airborne contaminants Quahty At a minimum, the hquld used for flushing should be clean and nontoxtc Water should be suitable for dnnklng (15) Ideally, It should be bacteria free (16) have a pH of 7, and be Isotonic, preserved and physiological ly balanced to reduce the likelihood of additional damage to the eye For self contained units, which offer a range of flushing fluid options, a buffered lSO tonic solution and antibacterial agent may be less irritating to the eye when used for a 15 rain flush Temperature Providing flushing flu lds at temperatures conducive to use for the recommended irrigation period is considered an integral part of pro vldIng first aid faclhtles Fluids at a temperature of 38 °C (100 °F) can be harmful to the eyes and can enhance chemical Interaction with the eyes and skin and although flushing with cold fluid can provide an immediate coolIng effect, prolonged exposure to cold fluids can affect body temperature and cause first aid treatment to be term1 nated prematurely Medical profes slonals recommend that the tempera ture of a flushing fluid on delivery to chemically lnlured tissue should be ' tepid" Bollas and Coffey report that, in the absence of a specific temperature range in the standard tepid tempera tures would be consistent with the normal surface temperature of the eye (26 7-29 4 °C [80-85 °F]) (18) Pedl atrlc temperature definitions for tepid (29 4-32 2 °C ) provide a slightly high er temperature range From these data a reasonable temperature range would

be 25 5-55 3 °C (78-92 °F) In support of previous ANSI standard appendLx references, a high temperature thresh old of 35 °C (95 °F) is recommended In cases where flushing fluid tempera ture may accelerate chemical reactlvl ty with the body, a medical advisor should be consulted in selecting the optimal fluid temperature range Composition Hurley (19) maintains that in the absence of turbulent flowas is usually the case in plumbed and self contained eyewash u n i t s - a n d under favorable ambient conditions water • contains impurities, • is not physiologically compatible (in isotonicity and pH) with the eye, • contains microorganisms that may be a source of infection and harmful to an injured eye and • contains nutrients that support bacterial growth Preservatives or additives are avail able in liquid and powder form for use in self contained eyewash stations to control the growth of bacteria, fungi, and algae Bacterlostatxc in nature, these additives must be used in the correct proportions and be suitable for use in the human eye The ability of these additives to control microbial growth effectively is hmlted by factors such as flutd pH, temperature, water hardness, Incompatibility of agents, cleanliness of equipment, the initial microbial load of the water, and con tact time Also water systems and containers must be cleaned before the preservative is added because there is usually a surface film on the inside wall of the feed water piping or the self contained device Eyewash solution concentrates, when mixed in the proper ratio with water, provide a preserved buffered saline solution The concentrate con tams a preservative chemical(s) to provide the proper tonlcxty, and buffers Solutions of mixed concentrate and water are more compatible with the eye than water alone or water with a preservative However, the quahty of the flushing solution depends on the quality of the water used The fluid must be replaced as Chemical Health & Safety May/June 1999 23

E~ght OSHA standards have first a~d requ,re ments OSHA CPL 2 2 53 prov,des gutde hnes for instttut,ons that teach first aid and students of first aid programs (13 14) The standard outhnes the bas,c and essent,al ele ments of a first a,d program The gu,dehnes also may be helpful to comphance officers who evaluate ~nd~wdualplant first aid pro grams dur,ng ,nspect,ons I Overview OSHA does not teach first a,d courses or cer tCy first a,d tra,n,ng courses for ,nstructors or tra,nees The goal of these gutdehnes ts to hst the essenttalelements of what OSHAcon s~dersa basic first a~dprogram to ,nst0tut,ons that teach first aid courses consumers of these courses and OSHA personnel who review courses

STANDARDS II Introduction In the United States Jnlunes (all kinds) may represent the single most tmportant pubhc health problem The outcome of occupational ,njur,es depends not only on the seventy of the ,nlury but also the rendenng of first a~d care Prompt properly admm,stered first a,d care can mean the difference between hfe and death raptd and prolonged recovery or tern porary and permanent dlsabthty Given the potenhal postt~veimpact first a~d care can prowde several OSHA standards ,nclude first a,d prows,ons General Industry (29 CFR 1910 151) Construct,on (29 CFR 1926 50) Shipyard (29 CFR 1915 98) Long shonng (29 CFR 1918 96) Dtwng (29 CFR

r e c o m m e n d e d by the manufacturer For best results self contained umts should be cleaned and dlsmfected before refflhng Planning and use Bollas and Cof fey provide gmdance on the use of e q m p m e n t (18) The following factors should be considered Locatmn The locahon of a safety shower, eyewash station fire extra gmsher, fire hose or escape respirator is critical to tts usefulness Because many chemicals are extremely 24 Chemical Health & Safety May/June 1999

1910 410) HazardousWaste and Emergency Response (29 CFR 1910 120) Temporary Labor Camps (29 CFR 1910 142) and F,rst A,d and Lifesawng Facilities (29 CFR 1917 26) Although these standards require first aid tra,nmg they do not speofy what const,tutes adequatetra,nmg In the Untted States most first a,d training Is prov,ded through the American Red Cross the Nat,onal Safety Council and pr,vate Instl tuttons The Amer,can Red Cross offers stan dard and advancedfirst aid courses through out the Untted States v,a local chapters After completing the course and successfully passing the written and pract,cal tests tra,nees rece,ve two certificates one ,n adult card,opulmonary resuscttatton (CPR) and the other Jn f,rst atd The National Safety Counc,I provides educational mater,als to tram Md,v,duals tn basic first aid knowledge and skills however tt does not conducttram ing courses or certify trainers or trainees Prtvate ~nst~tutlons also teach courses ~n basic first aid but they do not certtfy the,r trainees

,ntervenhons are dtscussed 4 The duration of the tra,mng should allow enough t~me for emphas,s on s,tuations hkely to be encountered in parhcular workplaces 5 An emphas,s on qu,ck response to ftrst atd sftuat~ons should be ~ncorpo rated throughout the program

III General Program Elements A Teaching Methods 1 Tra,nees should develop hands on skills through the use of mannequins and trainee partners during thefr tratnmg 2 Trainees should be exposed to acute injury and ,llness setttngs as well as the appropriate response to those settings through the use of visual a~ds such as videotapes and shdes 3 Trainees should have a course work book tn which first aid pnnc~plesand responses to sethngs that require

Methods of Surveying the Scene and the Victim(s) The training program should include instruct,on in the following areas 1 The assessment of scenes that requtre first a,d serv,ces ,ncludlng a general scene safety b hkely event sequence c rap,d estimate of the number of persons ~nlured and d tdent~f,cattonof others able to help at the scene 2 Pen(ormlng a primary survey of each wcttm that ~ncludesassess,ng airway

destructwe emergency shower and eyewash equipment should be accessl ble from the tdenhfled hazard within a travel ttme of 10 s Specific distance references have been removed from the 1998 stan dard Thus the planner must select a location on the basis of the estimated time of travel of a person with corn promised vision (The average adult walking 4 M P H can travel 50 fl in 10 s ) The emergency eqmpment should also be located far enough away from

Pnnctples of Respond,ng to a Health Emergency The tratn,ng program should include instruction In the follow,ng areas 1 Injury and acute ~llness as a health problem 2 Interactions with the local emergency med,cal services system Traineesare respons,ble for ma0ntatn,ng a current hst of emergency telephone num bers--poltce fire ambulance pouson control--easily accessible to all employees 3 The pr,nc,ples of triage 4 The legal aspects of prowd,ng first a,d services

the ldentxfled hazard so the user 1S no longer m the chemically hazardous spray area The p l a n n e r should ensure that there are no stairways changes In floor levels, other potential trip haz ards or doors that could be u n k n o w lngly locked between the work area and the emergency eqmpment The equipment also must be a safe distance from electrical equtpment power out lets and sources of c o n t a m i n a t e d water

breathing and ctrculation as well as the presenceof any bleeding The techmques and pnnc~ples of taking a wchm s h=story at the scene of an emergency Performing a secondary survey of the wct~m that includes assessing vttal stgns skin appearance head and neck eye chest abdomen back extremittes and medical alert symbols D Basic Adult Cardtopulmonary Resuscl tatlon (CPR) 1 Bastc adult CPR training should be included tn the program and first atd prowders should be retested every year The training program should include mstructton in a estabhshtngand maintaining an open atrway m an adult b performing adult breathing resusc~ ration c performing adult circulatory resusc~ tat~on d performing choking assessments and appropriate first atd mterven ttons and e resuscttatmga drowmng wcttm E BastcRrst Aid Intervenhon Trainees should receive instructton m the pnnclples and performance of the following techniques 1 Bandaginghead chest shoulder arm leg wrist elbow foot ankle finger toe and knee 2 Sphntmg arm elbow clavicle finger hand forearm nbs hip femur lower

Depending on the location of the hazardous materials, it may be neces sary to install emergency equipment outdoors If there is a possibility of freezing conditions the equipment should incorporate freeze protection features that meet or exceed climate zone requirements Vtstbthty Equipment visibility 1s an important factor Locating emergency showers and eyewash stations along normal entrance and erat paths in the work area helps reinforce the location to potential users, who will pass the equipment dally Mounting high visi

leg ankle knee foot and toe 3 Mowng and rescuing wct~ms mclud mg one- and two person hfts ankle and shoulder pulls and the blanket pull F UniversalPrecauttons 1 Trainees should be provided with adequate instruction on the need for and use of universal precautions per 29 CFR 1910 1053 Thts mstru~on should cover a the mean,ng of untversal precau tions which body fluids are considered potentially infectious and which body fluids are regarded as hazardous b the value of universal precaut=ons for tnfectlous d~seasessuch as AIDS and hepatitis B c a copy of the OSHA standard for occupational exposure to blood borne pathogens or reformation on how to obtain a copy d the necessttyfor keeping gloves and other protechve equipment readily avatlableand their appropriate use e the appropnate tagging and disposal of any sharp ~tem or instrument requirtng specialdtsposal measures such as blood soaked matenal and f the appropriate management of blood spills G Rrst Aid Supphes Rrst aid providers should be responst ble for the kind amount and maintenance of first atd supphes needed for their particular plant

blhty signs that can be seen anywhere within the area served by the equip ment is required and a low cost, no maintenance approach Another way to i n c r e a s e visibility is to paint the floors walls, or the equipment itself in a bright color that contrasts with the surroundings If this approach is cho sen, ongoing maintenance is required to ensure that the paint remains bright The area around the emergency equipment should be well lit to help users identify the area and to assist in conducting first aid activities If emer gency equipment cannot be found

(facdrty) These supphes need to be stored ~na convenientarea availablefor emergency access H TraineeAssessments Assessment of successful completion of the first aid training program should include instructor observat=on of acquired skills and wntten performance assessments Rrst aid skills and knowl edge should be reviewed every three years I Program Update The training program should be penodt cally rewewed with current first atd techniques and knowledge Outdated matenal should be replaced or removed IV Specfftc Program Elements A Kind of Inlury Training 1 Shock 2 Bleeding 3 Poisoning 4 Burns 5 Temperatureextremes 6 Musculoskeletalmlunes 7 B~tesand stings 8 Medical emergenctes 9 Confinedspaces B S=teof Inlury Training 1 Headand neck 2 Eye 3 Nose 4 Mouth and teeth 5 Chest 6 Abdomen 7 Hand finger and foot mlunes

when it is needed, first aid treatment will likely be delayed and the victim's health greatly compromised Controls Activation devices ( e g , pull rods, push plates, flags, trays pull cords, triangles, or treadles) are required to start the flow of flushing fluid Key characteristics to consider in choosing controls are user visibility and durability Stay open valve devices are specified In the ANSI stan dard to ensure the continuous flow of flushing fluid while the hands remain free to remove clothing or hold the eyelids open Chemtcal Health& Safety May/June1999 25

According to A N S I requirements, activation of an emergency shower or eyewash station should provide flush lng fluid within 1 s Alarm systems Systems for alerting rescue personnel that an emergency as an progress are increasingly being installed with emergency shower and eyewash equtpment Audible visual and remote alarm systems immediate ly alert rescue personnel that assis tance ts needed at a specific location Alarm systems should be a priority consideration for remote plant areas and areas where employees may be working alone W a t e r d i s p o s a l H o w to dispose of c h e m i c a l l y c o n t a m m a t e d flushing flutd is a growing concern W h e t h e r a chemical, even in a diluted state can be released Into the sewer system without violating local codes is a ques tion that each individual workplace must answer Many companies do not install floor drains near emergency showers and eyewash stations Some companies send the fluid to purlfica tlon stations to filter out unsuitable c h e m i c a l s before releasing it into municipal sewer systems Training Although the steps Involved in training personnel h o w to use emergency showers and eyewash stations are quite simple employee training is often overlooked The stan dard requires personnel to k n o w how, when, where, and h o w long to use e m e r g e n c y s h o w e r and e y e w a s h equipment as well as what they should do after the initial irrigation Employ ee safety training regularly scheduled for o t h e r e m e r g e n c y e q u i p m e n t should cover showers and eyewash stations at the same time Testing, m s p e c t m n , a n d m a m t e nance Regular equipment testing is the best possible preventive malnte nance program Broken or worn parts should be repaired or replaced imme dlately and records should be kept of all tests Plumbed emergency showers and eyewash stations must be tested w e e k ly to verify flow and proper operation (•5) Activation also clears the water lines, allowing any dirt or pipe scale to 26 Chemical Health & Safety May/June 1999

pass The National Safety Council rec o m m e n d s flushing plumbed eyewash installations for 3 rain w e e k l y to reduce the threat of eye infections As part of the in plant potable water sys tem, plumbed emergency stations are sublect to vibration, debris traffic, and fluctuating ambient temperatures and can be rendered lnoperatwe by any of these factors Self c o n t a i n e d stations require inspection according to the manufac t u r e r s instructions Because of the nature of self contained equipment physical testing may render the equip ment incapable of providing a 15 min flush without additional flushing fluid or c o m p l e t e r e f u r b i s h m e n t A N S I does not require weekly testing of self contained equipment, however it is r e c o m m e n d e d that the p l a n n e r or owner determine whether a self con t a m e d station should be tested on a periodic basis Eyewash stations and shower units should be clearly marked with tags that record the Inspection date, tame, and inspector's name as a record of inspection and maintenance Annual Inspections of all emergency equip ment are now required per the A N S I standard to ensure equipment confor mince In brmf A hazard analysts must be provided for all faclhties Properly educating person nel about hazard prevention could greatly reduce the number of such injuries, however as long as InJuries continue to occur we must know how best to treat them If 29 CFR 1910 132 (2), 29 CFR 1910 133 (5) and A N S I Z87 l(a) 1991 are followed 900/0 of all chemical and other inlurles to the eyes are preventable W h e n prevention falls, treatment must follow an algorithm in which the affected eye(s) or body part(s) are irrl gated immediately and completely to remove all hazardous material (20) The Eye Irrigator provides the current state of the art instrument to the first responder for Immediate irrigation of eyes without traumatizing the eyehds and eyeball Fmal medical care must be

The current requirements for emergency showers and eyewash stattons m ANSI Z358 1-1998 promde new guidance on the equtpment for tmrnedtate treatment of chemtcal mlurtes provided by an ophthalmologist in all but minor chemical splashes The cur rent requirements for emergency show ers and eyewash stations in A N S I Z358 1 1998 provide new guidance on the equipment for immediate treatment of chemical injuries and should be i m p l e m e n t e d by all institutions in which chemical hazards are found (15) Chemical injuries are among the most challenging situations in the workplace Adequate prevention and emergency preparation for chemical lnlurles are Important to hmltlng their frequency and seventy All institutions must develop a plan of action to follow in the event of an accident and mstitu tlons a n d / o r their subcontractors must provide first aid training to personnel References (1)

(2)

(3)

(4)

(5)

Blals

B

R

Treating

Chemical

Injuries Occup Health Saf Septem ber 1996 Personal Protective Equipment 29 CFR 1910 132 Occupational Safety and Health Administration U S Gov ernment Printing Office Washington DC revised April 6 1994 at FR 16334 Blals B R Eye and Face Personal Protective Equipment Occup Health Saf March 1997 Ophthalmlcs-Lenses ANSI Z80 Series (80 1-80 9) American Nation al Standards Institute New York Eye and Face Protection 29 CFR 1910 133 Occupational Safety and

(6)

(7)

(8)

(9) (10)

Health Administration U S Govern ment Printing Office Washington DC revised April 6 1994 at FR 16361 Eye and Face Protection ANSI Z871 1989-1991 American National Stan dards Instatute New York Blals B R Does Wearing of Contact Lens in the Workplace Pose a Direct Threat ? The OEM Report 1998 •2(3) 17-32 Blals B R Contact Lens m Industry The Ongoing Discussion Chem Health Saf 1997 4(4) 22-26 Beard J Space Face Shield Brochure Space Face Shield Caldwell TX 1998 Safe Use of Lasers ANSI Z136 1 1993 American National Standards Inst3tute New York

(11) Safety zn Academzc Chemistry Labora tones 6th ed American Chemical Society Washington DC 1995 (12) Medical and First Aid 29 CFR 1910 151 Occupational Safety and Health Adrmnlstratlon U S Govern ment Printing Office Washington DC 1994 (revised) (13) Emergency Eyewash and Shower Equipment In Government and Indus

Industrial & Engineering Chemistry Research ENGINEERING YOUR COMPETITIVE ADVANTAGE -

try Standards Cross Reference First Azd/Emergency Eyewash and Shower Equipment J J Keller Neeha WI 1998 (14) Gmdehnes for First Aid Programs O S H A CPL 2 253 Occupational Safety and Health Administration U S Government Printing Office Washington DC (15) Emergency Eyewash and Shower Eqmpment ANSI Z358 1 1998 American National Standards Insti tute New York (16) Blals B R Treating Chemical Eye Injuries Occup Health Saf September 1996 pp 23-26 (17) Bla]s B R New procedures In the treatment of chemical inlur3es of the eyes Chem Health Saf 1999 6(1) 11-15 (18) Bollas C Coffey J In Case of Emer gency Occup Health Saf May 1998 pp 50-58 (19) Hurley R B More Than Meets the Eye Occup Health Saf November 1998 pp 53-57 (20) Blais B R Acute Eye Complaints In

Occupational Medzczne Practice Gmdehnes Hams J S Ed OEM Press Beverly MA 1997 Chapter 17 pp 17 1-17 24

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