First

SUMMARY

• Terminate exposure and support vital functions

• The victim should be moved to an uncontaminated area

• Rescuers should, ideally, be trained personnel and must be careful not to put themselves at risk and so wear appropriate protective clothing and, if available, breathing apparatus

• If the casualty is unconscious a clear airway should be established and maintained; give 100% oxygen if available

• Inhalation exposure: If the patient stops breathing, expired air resuscitation should be started immediately using a pocket mask with a one-way valve, if available. It is important where the face is contaminated that expired air resuscitation (i.e., mouth-to-mouth) is NOT attempted unless an airway with rescuer protection is used

• Dermal exposure: Remove contaminated clothing, if possible under a shower and place in double, sealed, clear bags and label; store the bags in a secure area away from patients and staff

• Wash skin thoroughly with copious amounts of water

• Eye exposure: Irrigate thoroughly with water or saline (normal, 0.9% NaCl) for 15 minutes

• Oral exposure: If the patient/victim is conscious and alert and able to cooperate, encourage small quantities of oral fluids (no more than 50-100 ml in total)

Only general information on first aid is given below. In an emergency call for medical assistance and take steps to limit exposure to others.

DECONTAMINATION

Decontamination is essential following a chemical spill. Although some chemicals can be absorbed through the skin it is more likely that a greater proportion will be absorbed through the lungs from inhalation of the chemical from contaminated skin and clothing.

Dermal decontamination

Contaminated clothing should always be removed and place in double, sealed, clear polythene labelled bags. They should be stored in a secure area to prevent further contamination. Clothing should not be removed if it is stuck to the skin as this may cause further damage. Copious amounts of water should be used, if possible a shower, in cases of extensive contamination. Care should be taken to ensure the runoff water is disposed of appropriately and does not contaminate others.

Eye decontamination

Water or normal saline (0.9% NaCl) should be used for irrigation. Eye washes should be available in the workplace. It is essential to ensure that the whole eye has been irrigated including under both lids. The head should be positioned to ensure that the contaminated irrigating fluid does not run into the other eye or the mouth.

Ingestion

The victim should not be made to vomit. Many solvents are an aspiration hazard and may pose more of a risk if they enter the lungs than by ingestion. Aspiration may occur when drinking the solvent or if the victim subsequently vomits. If the victim is conscious and alert and able to cooperate, with no evidence of oral burns, a small drink of water may be given, but they should not be forced to drink. Ingestion of large quantities of oral fluids is not recommended because this may result in vomiting. Care should be taken to avoid contact with vomit as it may be contaminated and it should be removed from the victim's face and clothing.

Inhalation exposure

Removal from the source of exposure is essential. Rescuers should take care not to put themselves at risk. There are many cases reported where the initial rescuers on scene have needed to be rescued themselves as a result of overexposure. Protective equipment should be used to remove a victim from a contaminated area. Some solvents are heavier than air (those with a relative vapour density of more than 1) and will collect in low areas, for example, at the bottom of storage tanks. In these cases it is particularly important to use protective equipment. It should be noted that the extra effort and exertion that may be required to lift or drag an unconscious victim away from the source of the exposure, may increase the respiratory uptake of the solvent by rescuers.

GENERAL POINTS

If the victim is unconscious they should be placed in the recovery position. It is essential to ensure the airway is clear and to remove any obstruction (e.g., vomit, false teeth). Ensure the tongue is not blocking the airway. Nothing should be given by mouth to an unconscious or convulsing victim and nothing should be placed in the mouth of a victim who is convulsing.

In the case of a chemical incident such as a spill or leak it is essential to determine the chemical(s) involved to ensure that a proper risk assessment of the situation can be made.

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