Documenting Hazardous Exposures

Industrial hygiene hazards are almost constant for first responders. In the end, they must be proactive about their own education and awareness.

Fiery crashes of automobiles, school buses, and other motor vehicles often require emergency responders to extricate victims from a tangle of twisted steel and shattered glass. Hazardous chemical spills can bring them within range of toxic fumes. Law enforcement officers closing down a smoldering methamphetamine lab may be walking into a site contaminated with corrosives, solvents, acids, and other hazards that can be inhaled or absorbed through the skin.

The ultimate in responder stress—building fires or a terror attack—may result in dangerous falling debris that can include asbestos, anthrax, and many more. Add to the airborne hazards the smoke or dust that are so thick on some calls that you bump into other rescuers and don’t even see them; the ear-shattering noise; lead exposures; confined spaces; human bites from frightened victims; radiation; asphyxiation; raw sewage; fungus and mold exposure; and even critters that bite.

These are the IH hazards to which first responders are sometimes exposed. Of course, there are physical hazards, too—heavy lifting, difficult terrain, climbs and descents, the hazards of emergency transportation to the scene, and more.

When we talk about workplace exposures, it’s hard to conceive of a more varying and serious set of hazards than what first responders encounter. There are none more courageous and none more exposed to known and unknown industrial hygiene hazards in the regular course of their work than those who deal with front-line lifesaving.

Who’s Monitoring?
First response situations are often much more complex exposures than those of other workplaces because of the fast-paced, transient nature of the incident. Frequently the residue of any exposure is gone before the effects register. Records may not be kept. Other unknown elements are hidden because of criminal intent. Dust, vapors, and gases from fires can dissipate unmeasured; spills may be cleaned up and hauled off with few samples taken. Heat and cold stress are constant foes. A first responder is apt to be met with this: “You’ll be all right. You just need a good night’s sleep.”

My personal opinion is that this is not malice, but ignorance of the toxic nature of unknown substances. Rescue calls today are completely different from the calls of years gone by. Take, for example, the materials we use to construct our offices. No longer consisting of wood and sheetrock, our office equipment is likely to be made of plastics of varying composition that can emit toxic gases when heated. Today there are no simple rescue calls because each victim has the potential to be a carrier of potential exposures to the first person on the scene.

First responders themselves are one of the worst exposure documentation hindrances. Very few of these stalwarts are inclined to report anything unusual, either not realizing potential hazards or fearing teasing or negative reactions from others in the organization for the report. Large-scale disasters have assisted by educating first responders in the need to report anything and everything, but all too often those on the front line were not even aware of the potential exposure. Education and awareness are critical for the first-on-scene caregivers.

At the very least, you can plan on the basics of noise, dust, fire, heat stress, cold stress, toxin exposures, and bloodborne pathogen exposures. Documentation is all-important in order to determine the exposure of individual personnel. Telling a first responder he or she “may” be exposed is not effective; the immediacy of the call usually will take precedence over any fear of exposure.

Raising Awareness
Each first responder has to be made aware of the expected and unexpected industrial hygiene hazards he/she may face on a call any given day. While large-scale disasters are a possibility, daily exposures on the job may generate few headlines but can add up in a cumulative effect over a lifetime. Responders must balance potential exposures with the call and their ability to rescue the victim. Knowing the potential toxics, how they are dispersed, and what PPE will help protect them is a priority. Getting each to wear the needed PPE becomes a personal responsibility for every responder facing a call.

First responders perform their tasks based on awareness and repetitive instruction. Full awareness goes beyond the basics of how toxins or other industrial hygiene exposures can invade the body. (The simple routes of entry are inhalation, skin absorption, ingestion, and injection.) Each first responder must know the warning signs for potential exposures and how to relate what they experience in a way that can document exposures completely. Some rescue cases can result in multiple exposures that may not appear as life-altering as later testing can show—and exposures to public health emergencies, such as cholera, or anthrax, or even Ebola contamination, may not even be immediately apparent to the first responder. Quality follow-up is needed to ensure those exposed are cared for appropriately.

Following up every exposure may depend on awareness of the incident aftermath and which toxic materials were present. It is unfortunate but true that responders have to be proactively involving in their own safety, both because it is a priority thanks to the nature of their jobs and because of the isolation the job entails.

How Do We Protect Them?
Protection comes from going beyond education. More than the exercises each first responder carries out to make sure all training is to second nature, departments have to go the extra effort to ensure each first responder understands what to look for with exposures and how to correctly report any problems. Handouts, charts, and discussion groups may help.

For each potential industrial hygiene exposure, minimum contact routes and times for exposure and the symptoms are needed. Family members’ feedback can help to fill in blank areas. We tend to treat what we see first, such as physical injuries, without always considering the long-term health exposures.

In the end, first responders must be proactive about their own education and awareness.

This article originally appeared in the December 2007 issue of Occupational Health & Safety.

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