MEC&F Expert Engineers : 04/16/15

Thursday, April 16, 2015

2 INJURED IN DIESEL FUEL SPILL, CRASH IN LANHAM, MD. BETWEEN A BOX TRUCK AND A TAXI CAB



Cab severely damaged after diesel spill in Lanham, Thursday, April 16, 2015. (WJLA photo)
 

Truck crashed into fence after diesel spill in Lanham, Thursday, April 16, 2015. (WJLA photo)



APRIL 16, 2015

LANHAM, MD. (WJLA)



Prince George's Fire Department officials reported two people were injured after a diesel fuel spill and crash.
  
The accident occurred when a box truck and taxi cab crashed on Cipriano Road and 4th Street in Lanham, Md. early Thursday morning.

Hazmat crews were called to the scene to clean up the diesel fuel spill and roads will be closed for an extended period of time.

PGFD officials don't know the extent of the people injured and the truck driver involved in the crash is at the scene being evaluated.

No additional details were provided as the investigation continues.

HAZARDS IN GRAIN HANDLING FACILITIES





OSHA has developed this webpage to provide workers, employers, and safety and health professionals useful, up-to-date safety and health information on grain handling facilities.
What are grain handling facilities?
Grain handling facilities are facilities that may receive, handle, store, process and ship bulk raw agricultural commodities such as (but not limited to) corn, wheat, oats, barley, sunflower seeds, and soybeans. Grain handling facilities include grain elevators, feed mills, flour mills, rice mills, dust pelletizing plants, dry corn mills, facilities with soybean flaking operations, and facilities with dry grinding operations of soycake.
What are the hazards in grain handling facilities?
The grain handling industry is a high hazard industry where workers can be exposed to numerous serious and life threatening hazards. These hazards include: fires and explosions from grain dust accumulation, suffocation from engulfment and entrapment in grain bins, falls from heights and crushing injuries and amputations from grain handling equipment.

Suffocation is a leading cause of death in grain storage bins. In 2010, 51 workers were engulfed by grain stored in bins, and 26 died-the highest number on record, according to a report issued by Purdue University (PDF) Suffocation can occur when a worker becomes buried (engulfed) by grain as they walk on moving grain or attempt to clear grain built up on the inside of a bin. Moving grain acts like "quicksand" and can bury a worker in seconds. "Bridged" grain and vertical piles of stored grain can also collapse unexpectedly if a worker stands on or near it. The behavior and weight of the grain make it extremely difficult for a worker to get out of it without assistance. OSHA has sent notification letters to approximately 13,000 grain elevator operators warning the employers to not allow workers to enter grain storage facilities without proper equipment, precautions (such as turning off and locking/tagging out all equipment used so that the grain is no being emptied or moving into the bin) and training.

Grain dust explosions are often severe, involving loss of life and substantial property damage. Over the last 35 years, there have been over 500 explosions in grain handling facilities across the United States, which have killed more than 180 people and injured more than 675. Grain dust is the main source of fuel for explosions in grain handling. Grain dust is highly combustible and can burn or explode if enough becomes airborne or accumulates on a surface and finds an ignition source (such as hot bearing, overheated motor, misaligned conveyor belt, welding, cutting, and brazing). OSHA standards require that both grain dust and ignition sources must be controlled in grain elevators to prevent these often deadly explosions.

Falls from height can occur from many walking/working surfaces throughout a grain handling facility. Examples of such surfaces include (but are not limited to) floors, machinery, structures, roofs, skylights, unguarded holes, wall and floor openings, ladders, unguarded catwalks, platforms and manlifts. Falls can also occur as workers move from the vertical exterior ladders on grain bins to the bin roof or through a bin entrance.

Mechanical equipment within grain storage structures, such as augers and conveyors, present serious entanglement and amputation hazards. Workers can easily get their limbs caught in improperly guarded moving parts of such mechanical equipment.

Storage structures can also develop hazardous atmospheres due to gases given off from spoiling grain or fumigation. Workers may be exposed to unhealthy levels of airborne contaminants, including molds, chemical fumigants (toxic chemicals), and gases associated with decaying and fermenting silage.

Fumigants are commonly used for insect control on stored grain and many have inadequate warning properties. Exposure to fumigants may cause permanent central nervous system damage, heart and vascular disease, and lung edema as well as cancer. These gases may result in a worker passing out and falling into the grain, thus becoming engulfed and suffocating or otherwise injuring themselves.
What can be done to reduce the hazards in grain handling facilities?
On August 4, 2010 and again on February 1, 2011, OSHA issued warning letters to the grain handling industry following a series of incidents including the recent suffocation of 2 teenagers in Illinois grain elevator. In response to the rising number of workers entrapped and killed in grain storage facilities, OSHA has also issued a new fact sheet, Worker Entry Into Grain Storage Bins (PDF*) in August 2010 for workers and employers emphasizing the hazards of grain storage bin entry and the safe procedures that all employers must follow. 

Additionally, OSHA issued a safety and health information bulletin (SHIB) entitled, Combustible Dust in Industry: Preventing and Mitigating the Effects of Fire and Explosions, and a Hazard Alert: Combustible Dust Explosions (PDF*) fact sheet.

The control of worker's exposure to hazards in grain handling facilities are addressed in the OSHA standard for grain handling facilities (29 CFR 1910.272), as well as in other general industry standards. These standards reduce the risk to workers by requiring that employers follow established, common sense safety practices when working in grain handling facilities.

When workers enter storage bins, employers must (among other things):
  1. Turn off and lock out all powered equipment associated with the bin, including augers used to help move the grain, so that the grain is not being emptied or moving out or into the bin. Standing on moving grain is deadly; the grain can act like "quicksand" and bury a worker in seconds. Moving grain out of a bin while a worker is in the bin creates a suction that can pull the workers into the grain in seconds.
  2. Prohibit walking down grain and similar practices where an employee walks on grain to make it flow.
  3. Provide all employees a body harness with a lifeline, or a boatswains chair, and ensure that it is secured prior to the employee entering the bin.
  4. Provide an observer stationed outside the bin or silo being entered by an employee. Ensure the observer is equipped to provide assistance and that their only task is to continuously track the employee in the bin. Prohibit workers from entry into bins or silos underneath a bridging condition, or where a build-up of grain products on the sides could fall and bury them.
  5. Train all workers for the specific hazardous work operations they are to perform when entering and working inside of grain bins.
  6. Test the air within a bin or silo prior to entry for the presence of combustible and toxic gases, and to determine if there is sufficient oxygen.
  7. If detected by testing, vent hazardous atmospheres to ensure that combustible and toxic gas levels are reduced to non hazardous levels, and that sufficient oxygen levels are maintained.
  8. Ensure a permit is issued for each instance a worker enters a bin or silo, certifying that the precautions listed above have been implemented.
To prevent dust explosions and fires, employers must (among other things):
  1. Develop and implement a written housekeeping program with instructions to reduce dust accumulations on ledges, floors, equipment and other exposed surfaces.
  2. Identify "priority" housekeeping areas in grain elevators. The "priority" housekeeping areas include floor areas within 35 feet of inside bucket elevators, floors of enclosed areas containing grinding equipment and floors of enclosed areas containing grain dryers located inside the facility. Dust accumulations in these priority housekeeping areas shall not exceed 1/8th inch. Employers should make every effort to minimize dust accumulations on exposed surfaces since dust is the fuel for a fire or explosion, and it is recognized that a 1/8 inch dust accumulation is more than enough to fuel such occurrences.
  3. Inside bucket elevators can undergo primary explosions. OSHA's grain handling standard requires that belts for these bucket elevators purchased after March 30, 1988 are conductive and have a surface electrical resistance not exceeding 300 megohms. Bucket elevators must have an opening to the head pulley section and boot section to allow for inspection, maintenance, and cleaning. Bearings must be mounted externally to the leg casing or the employer must provide vibration, temperature, or other monitoring of the conditions of the bearings if the bearings are mounted inside or partially inside the leg casing. These bucket elevators must be equipped with a motion detection device which will shut-down the elevator when the belt speed is reduced by no more than 20% of the normal operating speed.
  4. Implement a preventative maintenance program with regularly scheduled inspections for mechanical and safety control equipment, which may include heat producing equipment such as motors, bearings, belts etc. Preventive maintenance is critical to controlling ignition sources. The use of vibration detection methods, heat sensitive tape or other heat detection methods can help in the implementation of the program.
  5. Minimize ignition sources through controlling hot work (electric or gas welding, cutting, brazing or similar flame producing operations).
  6. Install wiring and electrical equipment suitable for hazardous locations.
  7. Design and properly locate dust collection systems to minimize explosion hazards. All filter collectors installed after March 1988 shall be located outside the facility or located in an area inside the facility protected by an explosion suppression system or located in an area that is separated from other areas by construction having at least a one hour fire resistance rating and which is located next to an exterior wall vented to the outside.
  8. Install an effective means of removing ferrous material from grain streams so that such material does not enter equipment such as hammer mills, grinders and pulverizers.
For more information, see OSHA standard (29 CFR 1910.272).

4 WORKERS INJURED IN HUGE GRAIN ELEVATOR EXPLOSION IN LACROSSE, INDIANA










A grain elevator that exploded Thursday morning in LaCrosse, IN, sent four people to the hospital with burn injuries. (Source: WLS/CNN)

APRIL 16, 2015

LACROSSE, IN (RNN) 

A grain elevator explosion has injured four people in a community an hour southeast of Chicago.

The LaPorte County Sheriff's Office said the injuries are mostly burns and not considered serious, according to WLS, although the injured workers had to be flown to the hospital – this is typically done when the injured are in serious condition. The incident happened around 9 a.m. central time.

The victims were flown by helicopter to Lutheran Hospital in Fort Wayne, Ind.
Source: http://abc7chicago.com



//------------------------------//





OSHA has developed this webpage to provide workers, employers, and safety and health professionals useful, up-to-date safety and health information on grain handling facilities.
What are grain handling facilities?
Grain handling facilities are facilities that may receive, handle, store, process and ship bulk raw agricultural commodities such as (but not limited to) corn, wheat, oats, barley, sunflower seeds, and soybeans. Grain handling facilities include grain elevators, feed mills, flour mills, rice mills, dust pelletizing plants, dry corn mills, facilities with soybean flaking operations, and facilities with dry grinding operations of soycake.
What are the hazards in grain handling facilities?
The grain handling industry is a high hazard industry where workers can be exposed to numerous serious and life threatening hazards. These hazards include: fires and explosions from grain dust accumulation, suffocation from engulfment and entrapment in grain bins, falls from heights and crushing injuries and amputations from grain handling equipment.

Suffocation is a leading cause of death in grain storage bins. In 2010, 51 workers were engulfed by grain stored in bins, and 26 died-the highest number on record, according to a report issued by Purdue University (PDF) Suffocation can occur when a worker becomes buried (engulfed) by grain as they walk on moving grain or attempt to clear grain built up on the inside of a bin. Moving grain acts like "quicksand" and can bury a worker in seconds. "Bridged" grain and vertical piles of stored grain can also collapse unexpectedly if a worker stands on or near it. The behavior and weight of the grain make it extremely difficult for a worker to get out of it without assistance. OSHA has sent notification letters to approximately 13,000 grain elevator operators warning the employers to not allow workers to enter grain storage facilities without proper equipment, precautions (such as turning off and locking/tagging out all equipment used so that the grain is no being emptied or moving into the bin) and training.

Grain dust explosions are often severe, involving loss of life and substantial property damage. Over the last 35 years, there have been over 500 explosions in grain handling facilities across the United States, which have killed more than 180 people and injured more than 675. Grain dust is the main source of fuel for explosions in grain handling. Grain dust is highly combustible and can burn or explode if enough becomes airborne or accumulates on a surface and finds an ignition source (such as hot bearing, overheated motor, misaligned conveyor belt, welding, cutting, and brazing). OSHA standards require that both grain dust and ignition sources must be controlled in grain elevators to prevent these often deadly explosions.

Falls from height can occur from many walking/working surfaces throughout a grain handling facility. Examples of such surfaces include (but are not limited to) floors, machinery, structures, roofs, skylights, unguarded holes, wall and floor openings, ladders, unguarded catwalks, platforms and manlifts. Falls can also occur as workers move from the vertical exterior ladders on grain bins to the bin roof or through a bin entrance.

Mechanical equipment within grain storage structures, such as augers and conveyors, present serious entanglement and amputation hazards. Workers can easily get their limbs caught in improperly guarded moving parts of such mechanical equipment.

Storage structures can also develop hazardous atmospheres due to gases given off from spoiling grain or fumigation. Workers may be exposed to unhealthy levels of airborne contaminants, including molds, chemical fumigants (toxic chemicals), and gases associated with decaying and fermenting silage.

Fumigants are commonly used for insect control on stored grain and many have inadequate warning properties. Exposure to fumigants may cause permanent central nervous system damage, heart and vascular disease, and lung edema as well as cancer. These gases may result in a worker passing out and falling into the grain, thus becoming engulfed and suffocating or otherwise injuring themselves.
What can be done to reduce the hazards in grain handling facilities?
On August 4, 2010 and again on February 1, 2011, OSHA issued warning letters to the grain handling industry following a series of incidents including the recent suffocation of 2 teenagers in Illinois grain elevator. In response to the rising number of workers entrapped and killed in grain storage facilities, OSHA has also issued a new fact sheet, Worker Entry Into Grain Storage Bins (PDF*) in August 2010 for workers and employers emphasizing the hazards of grain storage bin entry and the safe procedures that all employers must follow. 

Additionally, OSHA issued a safety and health information bulletin (SHIB) entitled, Combustible Dust in Industry: Preventing and Mitigating the Effects of Fire and Explosions, and a Hazard Alert: Combustible Dust Explosions (PDF*) fact sheet.

The control of worker's exposure to hazards in grain handling facilities are addressed in the OSHA standard for grain handling facilities (29 CFR 1910.272), as well as in other general industry standards. These standards reduce the risk to workers by requiring that employers follow established, common sense safety practices when working in grain handling facilities.

When workers enter storage bins, employers must (among other things):
  1. Turn off and lock out all powered equipment associated with the bin, including augers used to help move the grain, so that the grain is not being emptied or moving out or into the bin. Standing on moving grain is deadly; the grain can act like "quicksand" and bury a worker in seconds. Moving grain out of a bin while a worker is in the bin creates a suction that can pull the workers into the grain in seconds.
  2. Prohibit walking down grain and similar practices where an employee walks on grain to make it flow.
  3. Provide all employees a body harness with a lifeline, or a boatswains chair, and ensure that it is secured prior to the employee entering the bin.
  4. Provide an observer stationed outside the bin or silo being entered by an employee. Ensure the observer is equipped to provide assistance and that their only task is to continuously track the employee in the bin. Prohibit workers from entry into bins or silos underneath a bridging condition, or where a build-up of grain products on the sides could fall and bury them.
  5. Train all workers for the specific hazardous work operations they are to perform when entering and working inside of grain bins.
  6. Test the air within a bin or silo prior to entry for the presence of combustible and toxic gases, and to determine if there is sufficient oxygen.
  7. If detected by testing, vent hazardous atmospheres to ensure that combustible and toxic gas levels are reduced to non hazardous levels, and that sufficient oxygen levels are maintained.
  8. Ensure a permit is issued for each instance a worker enters a bin or silo, certifying that the precautions listed above have been implemented.
To prevent dust explosions and fires, employers must (among other things):
  1. Develop and implement a written housekeeping program with instructions to reduce dust accumulations on ledges, floors, equipment and other exposed surfaces.
  2. Identify "priority" housekeeping areas in grain elevators. The "priority" housekeeping areas include floor areas within 35 feet of inside bucket elevators, floors of enclosed areas containing grinding equipment and floors of enclosed areas containing grain dryers located inside the facility. Dust accumulations in these priority housekeeping areas shall not exceed 1/8th inch. Employers should make every effort to minimize dust accumulations on exposed surfaces since dust is the fuel for a fire or explosion, and it is recognized that a 1/8 inch dust accumulation is more than enough to fuel such occurrences.
  3. Inside bucket elevators can undergo primary explosions. OSHA's grain handling standard requires that belts for these bucket elevators purchased after March 30, 1988 are conductive and have a surface electrical resistance not exceeding 300 megohms. Bucket elevators must have an opening to the head pulley section and boot section to allow for inspection, maintenance, and cleaning. Bearings must be mounted externally to the leg casing or the employer must provide vibration, temperature, or other monitoring of the conditions of the bearings if the bearings are mounted inside or partially inside the leg casing. These bucket elevators must be equipped with a motion detection device which will shut-down the elevator when the belt speed is reduced by no more than 20% of the normal operating speed.
  4. Implement a preventative maintenance program with regularly scheduled inspections for mechanical and safety control equipment, which may include heat producing equipment such as motors, bearings, belts etc. Preventive maintenance is critical to controlling ignition sources. The use of vibration detection methods, heat sensitive tape or other heat detection methods can help in the implementation of the program.
  5. Minimize ignition sources through controlling hot work (electric or gas welding, cutting, brazing or similar flame producing operations).
  6. Install wiring and electrical equipment suitable for hazardous locations.
  7. Design and properly locate dust collection systems to minimize explosion hazards. All filter collectors installed after March 1988 shall be located outside the facility or located in an area inside the facility protected by an explosion suppression system or located in an area that is separated from other areas by construction having at least a one hour fire resistance rating and which is located next to an exterior wall vented to the outside.
  8. Install an effective means of removing ferrous material from grain streams so that such material does not enter equipment such as hammer mills, grinders and pulverizers.
For more information, see OSHA standard (29 CFR 1910.272).


A TOTAL OF $5.037 BILLION (3.63 BILLION POUNDS) HAS BEEN PAID TO 62,162 CLAIMANTS HARMED BY THE 2010 GULF OF MEXICO OIL SPILL




APRIL 15, 2015

The administrator overseeing a BP Plc (BP.L) fund to compensate people and businesses claiming they were harmed by the 2010 Gulf of Mexico oil spill said on Wednesday more than $5 billion has been paid out.

A total of $5.037 billion (3.63 billion pounds) has been paid to 62,162 claimants, the administrator, Patrick Juneau, said in a statement on his website for spill claims.

The money is being paid under a 2012 settlement tied to the explosion of the Deepwater Horizon drilling rig, which killed 11 workers and caused the largest U.S. offshore oil spill. The fifth anniversary of the disaster will be April 20.

BP originally said it expected to pay $7.8 billion to resolve claims under the settlement but by February of this year had boosted its estimate to $9.9 billion.
The London-based oil company had long complained that Juneau was paying out too much, including to claimants who suffered no harm.

But last month, BP ended a bid to oust Juneau, citing steps he had taken to reduce fraud.

According to Juneau, more than half of the payouts so far have compensated businesses that suffered economic losses, with a significant percentage also going to the seafood industry.

MIXING OF LAUNDRY PRODUCT WITH CHLORINE BLEACH CAUSED HAZMAT SITUATION AT A BLOOMINGDALE, NJ NURSING HOME (HEALTH CENTER OF BLOOMINGDALE). ONE EMPLOYEE WAS HOSPITALIZED AFTER BREATHING FUMES FROM MIXING OF AMMONIA WITH BLEACH.




APRIL 16, 2015

BLOOMINGDALE, NEW JERSEY

A worker at a local nursing home was hospitalized Wednesday morning due to a chemical spill that also caused a partial evacuation of the facility. 

According to Police Chief Joe Borell, officers were dispatched to the Health Center of Bloomingdale at 255 Union Ave. on a report of a chemical spill at approximately 10:45 a.m. Personnel from the Bloomingdale Volunteer Fire Department, the Tri-Boro First Aid Squad, and the Passaic County Hazmat Team were also dispatched.  

In addition, SWAT and marine infantry teams arrived, armed with anti-tank missiles, hand grenades and sniper rifles, just in case this was a terrorist act.  Some SWAT team members had to expense their laundry bills after brown stuff appeared on their pants when they got really scared because they thought that this was the terrorist attack they trained all their lives for.

A nursing home worker had taken the sick employee to a local medical facility prior to the police's arrival, said Borell.

"It was determined that a laundry product apparently mixed with bleach had spilled onto the floor, causing one employee to take ill from breathing in fumes," said Borell.  The most common cause of that reaction is the mixing of ammonia and bleach.

According to the chief, the first floor of the building was evacuated, and the facility's air systems were also shut down temporarily.  Local firefighters remediated the spill with Quick Dry and water, and the county hazmat team was recalled.

"Ultimately the scene was deemed safe by the Bloomingdale Volunteer Fire Department," said Borell.

//------------------------------//


THE INAPPROPRIATE MIXING OF HOUSEHOLD CHEMICALS CAN CAUSE HAZMAT SITUATIONS

 by Louis Cook

http://www.fireengineering.com/etc/designs/default/0.gif
In 2006, the American Association of Poison Control Centers reported 214,091 calls associated with household cleaning products, the number 3 category on its list of the top 25 compounds frequently involved in human exposures.1   

My unit is frequently called to the scene where civilians have become ill from inappropriately mixing household cleaning chemicals. Many of these responses are not limited to homes; they have been to hotels, schools, and even a local hospital. The literature also contains reports on two separate mass-casualty incidents involving U.S. Army barracks. What is most troubling to me is the perception among the public and even some first responders that household cleaning products are not dangerous, even when they combine and form a noxious vapor cloud. 

These products include household ammonia, household bleach, and acid-based cleaners. These everyday hazmat incidents do not evoke headlines in the media. Instead, the EMS and fire crews respond to find one patient, maybe two patients, seemingly more embarrassed than ill, where a refusal of medical assistance (RMA) is more likely than decontamination and transport.

A study conducted by the New York State Department of Health from 1993 to 1998 noted that first responders constituted 15 percent of the reported injuries from ammonia incidents.2 These injuries and illnesses were preventable. The cluster of symptoms caused by exposure to these irritant gases is referred to as “Irritant Gas Toxidrome” (Table 1). Chlorine and ammonia are two major chemicals that are responsible for irritant gas toxidrome. When inhaled, they dissolve in the respiratory tract mucosa and cause inflammation. Damage to the respiratory system is related to the solubility and concentration of the gas or gases. The signs and symptoms associated with the Irritant Gas Toxidrome may be acute or delayed. Acute effects include eye, nose, and throat irritation; dyspnea; cough; stridor, bronchospasm; vomiting in some cases; and noncardiogenic pulmonary edema. Later, subacutely, opportunistic bacterial infections can occur with progression to pneumonia and bronchitis.

The duration of exposure and the concentration of the product will vary according to the concentrations of the individual products before mixing. Standard household bleach is actually sodium hypochlorite in solution and ranges from three to 10 percent in solubility, which is described as moderately water soluble. Household ammonia, known as ammonium hydroxide, ranges around five to 10 percent, which is still considered highly water soluble. 

Note: Some literature refers to household ammonia as aqua ammonia, given that it is significantly less concentrated than ammonium hydroxide. There are many other concentrations of these products available for commercial purposes; however, most of the incidents to which we respond involve the household strengths.

Other variables to consider are the relative size and ventilation of the area where the mixing occurs. Since most of these situations occur in and around the bathroom, it is no surprise that the relatively high concentration of vapor in the small area leads to an immediate onset of the signs and symptoms of exposure that are so noxious that they drive the person away. 

Both ammonia and chlorine vapors dissipate in the atmosphere; therefore, after ventilation, the area will be habitable in a relatively short time. Individuals trained in hazardous materials should mitigate the leftover compounds and acids created.

BLEACH AND AMMONIA

Mixing bleach with ammonia cleaners forms monochloramine (NH2Cl), dichloramine (NHCL2), and trichloramine (NCL3— nitrogen trichloride) compounds. Chloramines are inorganic nitrogen compounds that contain one or more chlorine atoms attached to a nitrogen atom.3 The chloramines are alkaline but are slightly less water soluble than ammonia, causing them to bubble out of solution. Many victims have reported seeing a milky white solution that bubbles and creates a noxious cloud.

In the commercial and industrial setting, chloramines are used as a bacteriocidal agent to treat water, since they stay in the water distribution system longer than chlorine. They are also used in the synthesis of many chemicals and plastics. Trichloramine is the most volatile of the three compounds and is more readily released into the air. The chloramine compounds are responsible for what is described as that typical “indoor swimming pool smell.” 

They decompose in water to form hypochlorous acid and free ammonia gas; the former combines with moisture and forms hydrochloric acid. The latter is a respiratory and mucous membrane irritant and can cause ulcerative tracheobronchitis, chemical epiglottitis in the pediatric population, noncardiogenic pulmonary edema (NCPE), and pneumonitis. Persistent hypoxemia as a consequence of exposure to irritant gases is associated with a high mortality. Ocular burns and corneal abrasions have occurred with serious exposure, but damage is rarely permanent.


Patients will often report a burning pain in the chest and upper airway and stinging eye irritation. Those who have asthma or chronic obstructive pulmonary disease will most likely experience an exacerbation of these conditions. Children exposed to the same levels of ammonia vapor as adults may receive a larger dose because they have greater lung surface area to body weight ratios and increased minute volumes per kilogram weight. In addition, they may be exposed to higher levels than adults in the same location because of their short stature and the higher levels of ammonia vapor found nearer to the ground. 

Also, humans exposed to ammonia vapors experience olfactory fatigue, making it difficult to further detect the smell of ammonia, which can in turn increase exposure time. Finally, since chloramines have nitrogen in their chemical composition, it is possible that methemoglobinemia will develop, although the exposure would likely be severe, if not fatal.

BLEACH AND ACID

Another common occurrence is the mixing of bleach and an acid-containing cleaner, which often causes a violent reaction. This generally occurs when the do-it-yourselfer is attempting to clear a stubbornly clogged drain at 3 a.m. In the end, it would have been cheaper and less painful to call a plumber. Common household toilet bowl cleaners and fungicides are usually moderately strong acids like phosphoric acid and sodium bisulfate, which have a pH around two. 

Drain cleaners, like the stronger sulfuric acid, are dense, oily liquids with a pungent odor. Depending on its purity, sulfuric acid may be colorless to dark brown. Simply mixing sulfuric acid and water can be particularly dangerous because the mixing produces a large amount of heat, which can cause violent spattering. Add an alkaline or another product, and you have a fuming corrosive.

Bleach mixed with an acid creates an acid halide that liberates chlorine vapors as well as some water. Chlorine reacts with the water to form hydrochloric and hypochlorous acids. Chlorine gas, which is less alkaline than ammonia, is 30 times more irritating to skin tissues than straight hydrochloric acid. Remember that this substance, which was once used as a weapon in World War I, causes a variety of symptoms in accordance with the severity of the exposure. 

Hydrochloric acid is created when chlorine contacts the moisture in the respiratory mucosa, causing a burn injury. Toxic, free-radical oxygen is released, which also causes tissue inflammatory response and damage. Some bleach and toilet bowl cleaner labels warn against mixing with other chemicals. However, human nature being what it is, these warnings are often unheeded.

The chlorine vapors that are liberated have a detectable odor (odor threshold) as low as 0.021 parts per million (ppm) in air; mild mucous membrane irritation may occur at levels as low as one ppm. A level of at least three ppm may cause extreme irritation of the eyes and respiratory tract. Symptoms following exposure to chlorine include irritation of the eyes, nose, and throat; dizziness; cough; bronchospasm, epigastric burning; and chest pain and atelectasis.4

Chlorine is transformed into chloride ions (normal components of human biochemistry) in the body. An enormous amount of chlorine has to be inhaled or ingested to detect a significant increase in chloride ions in the blood, which leads to a severe metabolic acidosis. 

Severe exposure may cause pulmonary edema and bronchiolar and alveolar damage; the literature contains reports of pneumomediastinum, presumably from the corrosive tissue destruction by the inhaled product.5 Only four case reports on chlorine toxicity from mixing bleach with acid cleaning agents have been published, including one that describes near-fatal pulmonary edema and, two, pneumomediastinum. Chlorine irritates the skin and can cause burning pain, inflammation, and blisters.

Children may be more vulnerable than adults to chlorine’s corrosivity because of the smaller diameter of their airways. Children may also be more vulnerable to gas exposure because of increased minute ventilation per kilogram.

BOTTLE BOMBS

Also known as improvised chemical devices (ICD), bottle bombs most often are created by children who are showing their mastery of chemistry on YouTube or in an attempt to get out of that midterm examination. Reactive chemicals that are mixed begin to combust in a process known as a “hypergolic reaction.” 

The chemical reaction progresses within the container, causing it to bulge or expand until it ruptures explosively. Since force is amplified several times in enclosed spaces, the potential for injuries grows. It takes only one to five pounds per square inch (psi) to break a window or your tympanic membrane. During the New York City crack cocaine epidemic of the 1990s, one form of ICD was deployed at locations where drugs were sold or made, as a deterrent to rival dealers and investigating police officers. 

These devices can be made with any size of plastic soda or drink bottle—from 20-ounce to three-liter bottles to larger containers. After these devices explode, people usually report a strong or unusual chemical odor near the location. Most times, however, the shattered remains of a soda bottle are the only remaining evidence. 

Medical management of these patients is consistent with that for blast trauma. Responders are also reminded to be sure to address the potential inhalation injuries from the liberated gases and chemicals as well as the dermal and ocular chemical splash burns of the caustics involved.6

FUNGICIDES AND CLEANERS

In August 2008, police and fire units in Pasadena, California, responded to a suicide involving hydrogen sulfide. The victim, found dead in his car, had mixed a fungicide and an acid toilet bowl cleaner in a plastic tray. First responders saw the tray with a “bright blue liquid” in the back seat of the vehicle. It was learned in the ensuing investigation that he may have visited one or more of the numerous Japanese Web sites that provide information on how to commit suicide using hydrogen sulfide. 

In Japan, press reports indicated that during the first six months of 2008, more than 100 people had committed suicide by inhaling hydrogen sulfide produced by mixing commonly available chemicals. Mixing acids with certain fungicides, pesticides, dandruff shampoos, and other products containing sulfur or sulfates can liberate hydrogen sulfide gas.

Hydrogen sulfide (H2S), also known as sewer gas, is a highly toxic gas with an odor of rotten eggs at low concentrations. At higher concentrations, olfactory fatigue rapidly occurs, making odor a poor warning symptom of danger. All of these compounds are direct irritants, but their major method of toxicity is interference with the cells’ use of oxygen. Low-level exposures irritate the eyes, nose, and throat and cause a cough, headache, nausea, and dizziness. Higher exposures can cause syncope, seizures, coma, tracheobronchitis, and pulmonary edema (which may occur up to 48 to 72 hours later). Death may occur within minutes of an acute massive exposure.

MANAGEMENT

The first-arriving units must adequately size up the situation, transmit this information to the dispatcher, and request the response of the local hazardous materials unit. By taking into consideration the time of day, the occupancy type, and the victims’ signs and symptoms, you can immediately get a rough idea of how large this incident is and how large an event it can evolve into.

It is imperative that you set up and enforce hazard control zones. Only responders with appropriate personal protective equipment and respiratory protection should enter the area. Protecting yourself and your crew is paramount. Do not rely on odor as a means of determining whether it is safe to enter an area or, worse, to identify the product. Hazardous materials responders should perform air monitoring for chlorine and ammonia and determine if the area is safe to enter.

If you suspect that a bottle bomb has gone off, if you find a suspicious bottle, or if you observe a bottle that is fuming or bulging, do not handle it, because it is impossible to tell when it will detonate. Isolate the device as if it were any other type of explosive. Decontamination is generally done by removing the individual’s outer garments, since the weave of certain fabrics can trap gases and lead to continued exposure by “off-gassing.” Decontaminate individuals with splash injuries in the usual manner—hazardous materials personnel using soap and water. Manage the patient as a caustic injury.

Care in the prehospital setting is generally supportive while following local protocols. However, it is compulsory to monitor oxygen saturation. Textbooks and the literature cite the efficacy of treating symptomatic patients with beta-2 agonists; administer this therapy as per local protocol. 

Treatment of hydrogen sulfide patients consists of administering the contents of the cyanide kit without the sodium thiosulfate; the patients may also benefit from hyperbaric therapy.


Some authors suggest using nebulized sodium bicarbonate in symptomatic chlorine-injured patients; however, the experts do not agree on its benefit for chloramine exposures. They cite a lack of clinical evidence for this therapy. Be aware that this therapy is nothing more than neutralizing an acid in-vitro, creating an exothermic reaction.

Most recently, the Louisiana Department of Public Health’s Morbidity Report on the effects of exposure to bleach/ammonia and bleach and acid exposures during the Hurricane Katrina cleanup recommended that care providers combine three milliliters of sodium bicarbonate 8.4 percent with two milliliters of normal saline for patients experiencing symptomatic exposures to inhale by nebulizer.7
Nelson writes in Goldfrank’s Toxicology that nebulized four percent sodium bicarbonate given to chlorine-poisoned sheep improved oxygenation but failed to reduce overall mortality.8 The use of inhaled or parenteral steroids is reportedly not shown to be helpful in victims of irritant gas explosions.


Patients who develop pulmonary edema benefit from positive end expiratory pressure ventilation and not standard diuresis and nitrate therapy, as in cardiogenic pulmonary edema. Here, the heart is not failing as a pump, but the pathology is a result of an overwhelming inflammatory response and damage to the alveolar basement membrane.

The issue of noncardiogenic pulmonary edema post exposure (NCPE) is most perilous for EMS providers. Mildly symptomatic patients can resolve over time, and many will refuse care and transportation to the hospital. However, the onset of NCPE can depend on the length and severity of the exposures and the patients’ co-morbidities. It could happen within minutes of exposure or can be delayed up to 24 hours. 

Doctor W.P. Herringham explained in the Lancet that the onset of NCPE in chlorine-exposed World War I casualties was hastened by moderate exercise, such as the effort exerted in escaping from a vapor cloud. (3)Therefore, it is perilous to accept an RMA out of hand; it is prudent to consult with your online medical control physician to execute an RMA. Remember the TEST acronym widely used in WMD/hazmat awareness programs: If you don’t Touch, Eat, Smell, or Test a product, you will not end up a patient. In this case, it is the secret to going home with an intact respiratory tract.

References

1. “Bronstein A. et al. (2007) “2006 Annual Report of the American Association of Poison,” Control Centers’ National Poison Data System (NPDS), Clinical Toxicology, 45:8, 815-917. Available online: http://dx.doi.org/10.1080/15563650701754763.
2. “Hazardous Substance Emergency Events Surveillance Project Report, Ammonia Spills, New York State 1993-1998,” New York State Department of Health. Available online: http://www.health.state.ny.us/environmental/chemicals/hsees/ammonia.htm/.
3. Pascuzzi TA, AB Storrow, “Mass casualties from acute inhalation of chloramine gas,” Military Medicine 1998, 163 (2):102-104.
4. “Homemade Chemical Bomb Events and Resulting Injuries--Selected States, January 1996-March 2003,” CDC MMWR. July 18, 2003; 52(28):662-664.
5. Gapany-Gapanavicius M, A Yellin, S Almog, M Tirosh, “Pneumomediastinum--a complication of chlorine exposure from mixing household cleaning agents,” JAMA 1982; 48:349-50.
6. New Jersey Dept. of Community Affairs, Division of Fire Safety, “Bottle Bombs,” 2003, http://www.state.nj.us/dca/dfs/bombs.htm/.
7. Louisiana Dept. of Public Health. Morbidity Report, 17:2, March-April 2006. Accessed at http://www.dhh.louisiana.gov/offices/publications/pubs-205/marapr06DontMixWithBleach.pdf/.
8. Goldfrank L, et al. Goldfrank’s Toxicological Emergencies, 7th edition (USA: McGraw Hill), 1457-1561.


Additional References
Centers for Disease Control and Prevention, “Ocular and Respiratory Illness Associated with an Indoor Swimming Pool—Nebraska, 2006,” MMWR 2007; 56:929-932.
Faigel, HC, “Hazards to health: mixtures of household cleaning agents,” N Engl J Med 1964; 271:618
Gapany-Gapanavicius M, M Molho, M Tirosh, “Chloramine-induced pneumonitis from mixing household cleaning agents,” Br Med J 1982; 285:1086.
Jones, FL, “Chlorine poisoning from mixing household cleaners” [Letter]. JAMA 1972; 222:1312.
Reisz, GR, RS Gammon, “Toxic Pneumonitis from Mixing Household Chemicals,” Chest 1986; 89:49-52.
Urbanetti, S, “Toxic Inhalational Injuries,” Medical Aspects of Chemical and Biological Warfare. Textbook of Military Medicine. Accessed at http://www.au.af.mil/au/awc/awcgate/medaspec/Ch-9electrv699.pdf/.

LOUIS COOK, EMT-P, is a 22-year veteran of EMS and a lieutenant assigned to the Fire Department of New York Special Operations Command, Haz Tac Battalion. He is a rescue technician, hazmat technician, and diver medical technician.