Module 3: Health and Safety - IAFF

Student Text IAFF Training for Hazardous Materials: Technician© 

Module 3: 

Health and Safety 

Module 3: Health and Safety 3-1

IAFF Training for Hazardous Materials: Technician© Student Text 

3-2 Module 3: Health and Safety


Module 3: Health and Safety 

Module Description 

This module addresses health and safety issues by classes of chemicals, and toxic effects on 

specific body systems. Medical surveillance and proactive health and safety planning are also 

covered. 

Prerequisites 

• Students should have completed a hazardous materials operations level training program. 

• Students should be certified emergency medical technicians or paramedics. 

• Students should have access to the equipment and materials common to a fire department 

EMS unit. 



Objectives 

Upon completion of this module, participants will be able to: 

Objectives 

• Describe the risk/benefit approach and how it applies to decisionmaking 

during emergency incidents. 

• List the key elements of a proactive health strategy. 

• List the key elements of proactive safety strategy. 

• List basic health and safety principles. 

• Define hazardous materials toxic effects terms. 

• Discuss the elements of medical surveillance. 

• Explain the basic toxic effects on the human body. 

• Describe the toxic effects in specific organ systems. 

• Discuss toxicity specific to the DOT classes of hazardous materials. 

NFPA 

Standards 

NFPA 1500 

6-2.1.1 

NFPA 1500 

9-2.1 

NFPA 1500 

9-2.1 

NFPA 1582 

NFPA 1500 

8-1.3 

NFPA 473 

3-2.1 (d) 

NFPA 473 

3-2.1 (d) 

NFPA 472 

3-2.3.8 

OSHA 

Standards 

29 CFR 1910.120 

(q) (6) (iii) (E) 

29CFR1910.1200 

(h) (3) (ii) 

29CFR1910.1200 

(h) (3) (ii) 

29CFR1910.1200 

(h) (3) (ii) 

29CFR1910.1200 

(h) (3) (ii) 

29CFR1910.1200 

(h) (3) (ii) 

29CFR1910.1200 

(h) (3) (ii) 

29CFR1910.1200 

(h) (3) (ii) 

Instructor Preparation 

Obtain and become familiar with the following regulations: 

NFPA 473 

NFPA 1500 

NFPA 1580 

CFR 1910.120 

CFR 1910.1200 

CFR 1910.20 

CFR 1910.3040 

CFR 54.390 

IAFF Wellness Initiative 

Obtain a facility preplan for a site in the local area and become familiar with it. 

Research the most prevalent health and safety hazards in the local area. (For example, pesticides 

may be a significant hazard in agricultural areas.) 

Data on local fire fighter illnesses and injuries on duty may be beneficial. 



Find out about departmental Employee Assistance Programs (EAPs), community clinics, citysponsored 

organizations, or any other programs designed to help people maintain a healthy 

lifestyle. 

Plan on giving the Prerequisite Quiz at the beginning of this module. If any students fail to 

answer at least half the questions correctly, they should be directed to read Training for Hazardous 

Materials Response: Your Rights and Responsibilities and Hazardous Materials Training for 

First Responders (Unit 3-Hazardous Materials). Both programs are available through the IAFF’s 

Hazardous Materials Department. 

This module requires that students be certified EMTs or paramedics. Consequently, much of the 

information reviews material in EMS training. If possible, find out how much experience and 

knowledge your students have to gauge the level of detail you need to teach. 

Equipment and Supplies 

• IAFF Fire Fighter Line of Duty Death and Injury Investigation 

• Transparencies and overhead transparency projector 

• Chalkboard or flip chart 

• Copies of the NIOSH Pocket Guide to Chemical Hazards 

• DOT placards for the nine hazardous materials classes 

• Copies of your department’s medical surveillance plan and related forms 

• Copies of a comprehensive site pre-plan 

• “Silly String” or other non-staining substance to spray on clothing 

• Air freshener 

• Materials for Application Exercise (at end of module before appendices) 

• VCR and videotapes: 

• Team Member: Health and Safety (formerly Exposure and the Body’s 

Response) 

• Salem, NH Nitric Acid Spill 

• Team Member: Medical Surveillance 

• Wellness/Fitness Initiative 

Approximate Length 

This module requires six to eight hours to complete. Fewer hours may be needed if the class is 

experienced and up-to-date on EMS. 





Module 3 

Prerequisite Quiz 

1. Medical surveillance for emergency responders is part of which federal regulation? 

A. NFPA 1500 

B. NFPA 473 

C. 29 CFR 1910.1200 

D. 29 CFR 1910.120 

2. The primary route of chemical exposure for fire fighters is: 

A. Inhalation 

B. Skin absorption 

C. Ingestion 

D. Injection/puncture 

3. Secondary contamination refers to: 

A. Contamination from a second chemical during one incident 

B. Contamination of the public 

C. Contamination from someone who has already been contaminated 

D. Contamination from more than one source 

4. Which of the following statements is not true of the skin? 

A. Intact skin is usually a good barrier to chemicals. 

B. Skin can be both a route of entry and a target site for chemicals. 

C. Water-soluble substances are more easily absorbed by the skin. 

D. Areas of the body with more hair follicles allow greater chemical absorption. 

5. Which of the following items will provide minimum shielding from gamma radiation? 

A. Several inches of lead 

B. Chemical protective gear 

C. Bunker gear 

D. Nothing can protect you from gamma radiation 

6. Under federal regulations, medical surveillance is required for: 

A. All fire fighters 

B. Members of EMS and hazardous materials teams 

C. Members of EMS teams only 

D. Members of hazardous materials teams only 

7. Biological monitoring measures: 

A. The amount of absorbed radiation 

B. The amount of an agent in your body 

C. Chemical exposure over long periods of time 

D. Baseline body chemistry 



8. Simple asphyxiants displace oxygen in the air. Chemical asphyxiants: 

A. Absorb oxygen in the air 

B. Combine with oxygen molecules to create a chemical reaction 

C. Prevent the respiratory system from inhaling oxygen 

D. Prevent the body from using inhaled oxygen 

9. Etiologic means that an agent is: 

A. Airborne 

B. Bloodborne 

C. Infectious 

D. Carcinogenic 

10. Which of the following organs is considered the primary “transfer point” for chemicals in 

the body? 

A. The heart 

B. The brain 

C. The gastrointestinal system 

D. The lungs 



Introduction 

Questions 

1. What are two common examples of chemical 

asphyxiants? 

2. What are mutagens? 

3. Which of the following is a standard, and which is a 

guideline? 

Threshold Limit Value (TLV) 

Permissable Exposure Limit (PEL) 

Short Term Exposure Limit (STEL) 

Immediately Dangerous to Life or Health (IDLH) 

4. OSHA/EPA requires employers to maintain medical 

records on exposed workers for how many years? 

Making a safe and effective emergency response at the 

technician level requires a complex approach that integrates 

personnel, protective equipment and other resources. The 

most important resources at the scene of any emergency, 

including one involving hazardous materials, are the fire 

fighters and paramedics who will do the work. 

An effective response begins long before the incident with a 

set of initiatives that helps guarantee the long term health of 

team members. Emergency response is characterized by a 

high stress environment where many unknowns are at work. 

Responders must be able to quickly size up the situation 

and implement protective measures. Being effective in this 

high pressure role means making sure you operate at peak 

effectiveness. No one can operate at peak efficiency without 

good health. 






Emergency Responders 

and Health 

Good health is characterized by physical and mental wellbeing. 

It’s the absence of disease, injury and pain. Good 

health allows us to perform at our highest level and to enjoy 

what we do. Having good health is not a chance occurrence. 

For most of us it means being aware of our bodies 

and making wise decisions that take into account the 

stresses we are under in our work. Few professions are 

more stressful than fire fighting and emergency response. 

As a result, good health is extremely important. 

Emergency Responders 

and Safety 

It is widely recognized that fire fighting and emergency 

medical response, including hazardous materials emergencies, 

is highly dangerous work. The rate of worker injury is 

high; about 25% are injured each year. Some of these 

injures are serious, resulting in disability retirement. In 

addition to these injuries, members are constantly exposed 

to hazardous materials and other emergency events that 

take a toll on their long term health. 

While you often operate in a chaotic environment, you 

must always work safely. This includes making the scene 

as secure as possible while reducing the opportunity for 

injury to occur. Professional response personnel understand 

that many elements of emergency response can be 

identified and planned for in advance. 



Proactive Hazardous 

Materials Emergency 

Response 

To the public, fire department actions at the scene of a 

burning gasoline tanker might seem confused and chaotic. 

Dozens of fire fighters moving quickly, thousands of 

gallons of foam in all directions, hoselines scattered everywhere—only 

a trained professional would look at the same 

scene and see a carefully planned event that includes a 

coordinated attack using well managed resources. They 

would see that the coordination involves downhill control 

of the product and that there are sufficient resources on 

scene to allow for effective rehabilitation of crews working 

in the Hot Zone. While it may be an emergency event in 

the eyes of the public, professional responders have carefully 

planned in advance the key elements of the response 

that will ensure the health and the safety of fire fighters and 

paramedics. It’s what is known as proactive planning. 

Proactive planning means identifying key needs and creating 

a strategy to meet them before they arise. You may not 

know exactly when the specific emergency will occur, but 

you can identify in advance many of the things you will 

need to respond effectively and safely. Chief among these 

needs is good personal health. 

As an emergency responder you are constantly risking your 

personal health and safety to complete objectives at an 

emergency incident. A key component of an effective 

health and safety strategy is ensuring that these risks are 

appropriate. The only way to know if the risk is appropriate 

is to understand the benefit. 

The Risk/Benefit Approach 

All risks on an emergency scene are not equal. Some of 

them, like securing the scene or shutting down the fuel flow 

from a remote location, can be achieved with little personal 

danger. Other actions, such as moving directly into the Hot 

Zone to stop a leak or attempt a rescue can put emergency 

responders at extremely high risk. If anything goes wrong, 



or if there is a rapid change in conditions, responders can 

be killed or injured. 

Unfortunately, there are many instances where fire fighters 

have either died or been seriously injured taking risks that 

were not equal to the benefits that would likely result from 

their actions. Often these events involve close-up fire 

suppression in areas where there was little if any life threat 

to the community. In many instances the only lives endangered 

in the event were those of response personnel. The 

saving of any amount of property is not worth the life of an 

emergency responder. 

Accordingly, you need to always ask yourself: What risk 

am I taking, and what benefit can I expect to receive? If 

risks outweigh benefits, you should reduce the risk. Generally 

speaking, fire fighters should only be exposed to low 

risk to save property. They may be put at slightly higher 

risk in marginal rescues where a professional evaluation 

concludes that there is not a high probability that the victim 

will survive. Responders should be put at high risk only if 

there is a clearly savable life. 

A risk/benefit assessment means that members must carefully 

evaluate an incident, including patient viability and 

adequacy of emergency resources to safely handle the 

event. If proper resources are not present or if the rescue is 

extremely complicated with little chance for success, 

aggressive actions should be carefully scrutinized. 

Activity 





Hazardous Materials 

and Their Effect on the 

Human Body 

The next step in understanding and preventing hazardous 

materials exposure is to review a substance’s overall effect 

on the body and specific body systems. We can also learn 

about toxic exposure by studying some of the hazards 

presented by each of the nine classes of hazardous materials. 

This approach provides a broad picture of exposure 

concerns and organ systems, then links these issues to DOT 

hazardous materials classifications. 

Categories of Toxic 

Substances 

Asphyxiants 

Asphyxiants deprive the body of oxygen. The normal 

concentration of oxygen in air is 20.9 %. Lower concentrations 

result in an oxygen-deficient atmosphere, especially if 

oxygen content is less than 19.5 %. 

There are two types of asphyxiants: simple and chemical. 

Simple asphyxiants simply displace oxygen in the environment. 

Examples of common simple asphyxiants include 

carbon dioxide, nitrogen, methane, propane, and argon. 

Chemical asphyxiants prevent the body from using oxygen, 

even though it may be present. Carbon monoxide, hydrogen 

sulfide, and hydrogen cyanide are examples. 

Signs and symptoms of oxygen deficiency include progressive 

problems such as: restlessness, agitation, drowsiness, 

confusion, stupor, coma, and death. Some asphyxiants can 

also create other hazards such as flammable atmospheres 

that may initially be above the flammable range but become 

flammable during operations. 



Confined spaces such as tanks, underground areas and 

enclosed rooms are especially hazardous. Without selfcontained 

breathing apparatus, you can be quickly overcome 

in an oxygen-deficient atmosphere. 

Equipment that measures the oxygen level is becoming 

increasingly available to technicians. Always remember to 

monitor in teams of two and be aware that a decreasing 

oxygen reading can mean the presence of a lethal gas with 

multiple hazardous properties. 

Corrosives 

Corrosives are divided into two categories: acids and bases. 

A primary danger from corrosives is that they can cause 

irreversible tissue damage. Their effects depend on the 

concentration of the material, that is, the amount of product 

in solution (for example, 40% hydrochloric acid, or 

80% sodium hydroxide) and the strength of the acid or 

base. Hydrochloric acid, for instance, is a stronger acid 

than acetic acid and is consequently more toxic. 

The skin, eyes and mucous membranes of the upper respiratory 

system are all very sensitive to corrosives. Acids 

tend to cause irritation, pain, or a burning sensation upon 

contact. Bases, or alkalis, can cause tissue destruction that 

may initially be painless. If inhaled, general signs of 

respiratory tract irritation may include coughing or difficulty 

breathing. Skin or eyes affected by acids or alkalis 

should be decontaminated with large amounts of water as 

soon as possible. Structural fire fighter protective clothing 

will provide limited protection against corrosive exposure. 

The effects of corrosives, however, will affect the thermal 

properties of the garment. 

Irritants 

Irritants cause temporary, but occasionally severe, inflammation 

of the eyes, skin, or respiratory tract. There can be 

permanent damage if exposure is repeated over time. 

Symptoms depend on the tissue that is affected. You may 

be familiar with the itching, redness, and discomfort of 

irritated skin and eyes. Coughing and difficulty breathing 

are symptoms of respiratory exposure to an irritant. Many 

solvents, such as benzene, cause skin irritation. Other 



irritants include ammonia, chlorine, and hydrogen chloride. 

Keep in mind that these substances have other toxic properties 

as well. 

Sensitizers 

Sensitizers cause allergic reactions after repeated exposures. 

A reaction can appear several hours after exposure to 

a sensitizing agent. In case of skin exposure, a rash may 

not appear until several hours after exposure. Reactions 

vary depending on the route of exposure and an individual’s 

susceptibility to a specific toxin. Allergic reactions tend to 

become worse with repeated exposures. Inhalation may 

cause an asthma-like reaction in the short term with longer 

term exposures resulting in permanent lung disease. 

Examples of sensitizing agents include: formaldehyde, 

mercury, and toluene diisocyanate (TDI). 

Carcinogens 

Carcinogens cause cancer. Some carcinogens have been 

definitely linked to cancer in humans. Others are known to 

cause cancer in laboratory animals and are suspected of 

causing cancer in humans. Studying the cancer-causing 

potential of chemicals is difficult since the latency period 

(the time that it takes cancer to develop) can be up to 30 

years. The exact levels of exposure can be difficult to 

document. Very little is known about the health effects of 

exposure to multiple carcinogens. Fire fighters and emergency 

responders may be exposed to multiple carcinogens 

during fire fighting or hazardous materials response. 

Carcinogens may affect an organ or organs remote from the 

route of entry. Some examples include benzene, which is 

associated with leukemia; vinyl chloride, which is associated 

with a specific type of liver cancer; and asbestos, 

which causes a specific type of lung cancer and increases 

the risk of all lung cancers among exposed individuals, 

particularly those who smoke. Other examples of cancer 

causing agents include coal tar and cigarette smoke. 



Neurotoxins 

Neurotoxic chemicals can cause both temporary or permanent 

damage to the central nervous system (the brain and 

spinal cord) or the peripheral nervous system (the nerves 

responsible for sensation and movement in the arms, hands, 

legs, and feet). Exposures to neurotoxins during an emergency 

are likely to be short-term and high-level. 

Many solvents are neurotoxic. Their effects include dizziness, 

euphoria, and impaired judgment and reflex time. 

Pesticides are common neurotoxic chemicals that can have 

system-wide effects including loss of muscle control, 

wheezing, muscle tremors and gastrointestinal disorders. 

Some neurotoxins are also convulsants, which produce 

seizures. These include chlorinated hydrocarbon insecticides 

such as aldrin and dieldrin; halogen fumigants such as 

methyl bromide and sulfuryl fluoride; organophosphates 

such as diazinon and dursban; and solvents such as phenol, 

ethylene oxide, and carbon disulfide. 

Mutagens 

Mutagens are toxic agents that cause genetic changes. 

These changes occur in the genetic material in eggs and 

sperm. As a result, the characteristics of future generations 

can be altered after exposure to mutagens. For example, 

one of the hazards of radiation exposure can be genetic 

alterations. Such hazards were apparent after the nuclear 

reactor incident at Chernobyl where thousands of people 

were exposed to significant amounts of radiation in the 

days and weeks after the explosion. 

Examples of mutagens include ethylene oxide, ionizing 

radiation, hydrogen peroxide, and benzene. 

Teratogens 

Teratogens are substances that cause malformations in an 

unborn child. Fetuses are particularly susceptible to hazardous 

materials exposure because their cells are developing 

and reproducing at a very high rate. Examples of 

teratogens include anesthetic gases, organic mercury 

compounds, ionizing radiation and German measles. 



Infectious Agents 

Infectious agents gain access to the body primarily through 

inhalation, ingestion, and absorption through the skin. 

Many infectious agents have a preferred route of entry. 

Infectious agents include viruses such as hepatitis A, 

hepatitis B, hepatitis C, human immunodeficiency virus 

(HIV), and the herpes virus. Avoiding exposures to blood 

and body fluids by using body substance isolation (BSI) 

can help to protect you from exposure. Body substance 

isolation can be defined as the use of personal protective 

equipment and procedures designed to protect emergency 

responders against exposure to infectious agents. EMTs 

and paramedics should be thoroughly familiar with these 

procedures. 

Bacteria are also infectious organisms that can cause 

disease in humans. Different types of bacteria cause tuberculosis, 

strep throat, and most wound infections. Tuberculosis 

infections are increasing and should be of concern to 

responders who have direct patient contact. Routine tuberculosis 

screening can detect infection early, so the disease 

can be promptly treated. Your department and participating 

health care facilities must have procedures for follow-up if 

you are in direct contact with a patient infected by tuberculosis. 

Other organisms include fungi (plant-like organisms that 

cause disease, such as oral thrush and athlete’s foot), 

parasites (organisms that live on other organisms, such as 

those that cause trichinosis and dysentery), and rickettsia 

(microorganisms transmitted by insects, such as the tick 

that carries Lyme disease). 

Activity 





The Language of 

Hazardous Materials 

Toxicity 

There are a number of good reasons why you should 

understand toxic effects. Even though you may operate 

safely and efficiently, there is an still an opportunity for 

exposure. You already know that routine structural fire 

fighting results in exposures to toxic materials. If you are 

also engaged in hazardous materials response at the Technician 

level, your potential for exposure increases. 

A high profile element of a safe response is the ability to 

thoroughly research a toxic material as part of incident 

response. Research will help you better determine the toxic 

properties of the material(s) involved in the incident. 

Knowing and understanding key terms and principles can 

help in your research. 

Toxicological Terms 

Toxicology: The study of poisons 

Toxicity: The inherent capacity of an agent to produce 

injury 

Toxin or Toxicant: An agent or substance capable of 

causing harm 

Exposure: The process in which a toxicant reaches a 

susceptible body tissue 

Target organs: The organs that are selectively affected by 

a particular agent or substance 



What Makes a 

Substance Toxic? 

For a substance to be considered toxic it must have certain 

properties and be present under certain conditions. These 

properties and conditions work in concert to create a negative 

health effect. Toxic materials must: 

• Have physical and chemical properties capable of 

causing harm. Many times, solid materials are less 

toxic than gases because their potential to spread easily 

and cause harm is much less. Chlorine gas can diffuse 

rapidly and is extremely toxic in even small amounts. 

• Be present in sufficient amounts to do harm. That is, 

the dose must be large enough. Carbon dioxide in small 

amounts is virtually undetectable. However, in larger 

quantities it can replace oxygen in the atmosphere and 

result in asphyxiation. 

• Be present for a sufficient amount of time. Some 

materials pose little threat if the exposure time is small. 

However, remaining in the contaminated area for 

extended amounts of time can result in significant 

exposure. Prolonged exposure to such common hazardous 

materials as gasoline can result in chemical burns 

and long-term health effects such as cancer. 

• Have a route of entry into the body. Intact skin is a 

good barrier because it provides some protection 

against exposure. Intact skin is not, however, a replacement 

for proper personal protective equipment. Some 

materials such as solvents can be easily absorbed 

through the skin and damage target organs such as the 

liver. 

• Reach a susceptible body organ or tissue. Many 

materials have an affinity for specific body organs. 

Tuberculosis, an increasingly common infectious agent 

spread through respiratory contact, lodges in the lungs 

and can result in serious disease if undetected. 



Exposed, Contaminated, 

or Both? 

Understanding the difference between exposure and contamination 

will help you avoid the negative effects of toxic 

materials. 

Exposure 

Although there is often overlap between exposure and 

contamination, it is possible to distinguish between the two. 

If you enter a confined space where carbon monoxide is 

present, without sufficient respiratory protection, you 

breathe these fumes into your lungs. You are exposed to the 

material and the toxic effects that it produces. If you remain 

in this atmosphere for a sufficient amount of time, you will 

begin to suffer the negative effects of exposure to carbon 

monoxide. If, however, you leave the area and return to 

fresh air, you are no longer in the presence of the gas and 

the exposure stops. You have been exposed to the gas by 

being in the area and breathing it into your body. 

Exposure occurs when a toxic substance or infectious 

agent is taken into the body or is in direct contact with 

the body. 

Contamination 

If, during the course of operations at a large flammable 

liquid spill, you saturate part of your clothing with the 

product, you are contaminated. This hazardous material 

will remain on your clothing and possibly on your skin until 

you take steps to leave the area and remove the contaminant. 

You have been contaminated with the material and 

you may be receiving an exposure if the material is on, or in 

the body. 

Contamination occurs when the material clings to or 

saturates clothing, or parts of your body. 

It is possible to be contaminated at an incident without 

being exposed if you are using the correct personal protective 

equipment in the Hot Zone and you undergo thorough 

decontamination when you have completed your assignment. 



Similarly, it is possible to be exposed to a hazardous material 

but not contaminated by it. One example would be 

conducting rescue operations in close proximity to a sealed 

source emitting radioactive gamma rays. You are exposed 

to the powerful wave of energy from the source, but when 

you leave the area, you are not contaminated. 

Understanding these principles helps you avoid the negative 

health effects of hazardous materials. 

Determining Toxic Effects 

If you have been exposed to a hazardous material, you need 

additional information to determine its likely effects. 

Potential toxic effects. You must know how the specific 

material will harm the body once it enters. Later sections 

in this module discuss how some materials target different 

body systems and how some classes of hazardous materials 

also have specific health effects. 

Amount present. Estimating or determining the amount of 

toxic substance involved can provide important information 

about the severity of the effects. 

Route and conditions of the exposure. Knowing how the 

material entered the body provides clues to the body tissues 

it will affect, and to what degree. 

Characteristics of the susceptible person. Some persons 

are more susceptible to exposure than others. Young 

children and persons with pre-existing medical conditions 

can be especially vulnerable. Knowing these individual 

characteristics can help you estimate the severity of the 

exposure event. 



Concentration and Duration 

Two of the most important factors determining chemical 

toxic effects are concentration of the substance and duration 

of the exposure. 

The concentration of vapors and gases is measured in parts 

of vapor or gas per parts of air (by volume). The standard 

units of measure are parts per million (ppm) and parts per 

billion (ppb). For example, a carbon monoxide concentration 

measured as 1,500 ppm contains 1,500 parts of carbon 

monoxide for every 1,000,000 parts of air. 

Concentrations of solids can be measured according to the 

weight per volume of air—milligram/cubic meter (mg/m 3 ). 

Solids suspended in air can be dusts, mists and fumes. 

Though ammonia is primarily an irritant gas, at a high 

enough concentration (around 150,000 ppm) it becomes a 

flammable gas, creating a whole new set of hazards for 

hazardous materials technicians. 

Duration refers to the length of contact with a substance. 

Duration is one factor affecting how much is absorbed. 

Longer and more frequent exposure periods usually result 

in greater absorption. 

The dose of the agent is how much of the agent reaches a 

target organ. The higher the concentration and longer the 

duration of exposure, the higher the dose. 

The severity of effects depends on the situation. For example, 

exposure even to low concentrations of most toxic 

products of combustion will produce severe health effects if 

the exposure occurs over a long enough duration. On the 

other hand, a very short duration exposure to high concentrations 

of toluene can produce severe effects as well. 



Acute and Chronic Exposures 

The toxic effects of hazardous materials can result from 

acute or chronic exposure. 

Acute 

Acute exposure occurs over a short period of time to a 

relatively high concentration of a substance. An acute 

exposure may have effects that are both immediate and 

long-term. For example, the immediate effects of acute 

exposure to carbon monoxide include headache, weakness, 

dizziness, and loss of consciousness. Days or weeks after 

“recovery” from the initial exposure there may be delayed 

symptoms of brain impairment such as confusion, lack of 

coordination and behavioral changes. Other effects from 

acute exposure may not be detected until years later. 

Chronic 

Chronic exposures are long-term (over several days to 

weeks or longer) and involve repeated periods of contact at 

relatively low concentrations. 

Effects of Acute and Chronic Exposures 

In many cases, the effects of acute exposure are very 

different from the effects of chronic exposure. For example, 

the primary acute toxic effect of benzene exposure 

is central nervous system (CNS) depression, whereas 

chronic exposures to benzene can cause leukemia. Acute 

exposure to carbon monoxide causes asphyxiation, while 

chronic exposure can cause heart problems. 

Measures of Toxicity 

The toxicity of a substance is usually determined through 

cell or animal testing. A frequently used measure is LD 50 

. 

This is the lethal dose for 50% of the animals being tested 

under specific conditions. Other measures include LD 100 

, 

the lethal dose for 100% of the population studied, the LC 50 

and LC 100 

, the lethal concentrations of a substance that 

will kill 50% and 100% of the population, respectively. 



These measures are often found in references and indicate a 

relative toxicity, that is, the toxicity of one substance 

compared with another. A substance whose LD 50 

is 0.5 mg 

(of substance) per kilogram (of animal body weight) is 

considered much more toxic than one with an LD 50 

of 2.0 

mg/kg. The lower the LD or LC, the higher the toxicity. 

There is almost no reliable information about the toxic 

effects of combinations of chemicals. For this reason, take 

every precaution to avoid exposure. 

Standards and Guidelines 

Related to Toxic Exposure 

Threshold Limit Value (TLV), Permissible Exposure Limit 

(PEL), Short Term Exposure Limit (STEL), and the Immediately 

Dangerous to Life or Health (IDLH) level are key 

terms describing standards and guidelines related to the 

exposure limits of hazards. Some of these levels are determined 

by the relationship between the dose of the substance 

and the resulting toxic effect. Most are based on 

time-weighted averages unless otherwise noted. 

LIMIT EXPOSURE IS IT LAW? COMMENTS 

DURATION 

TLV 8 hours/day up to NO Determined by 

40 hours/week a professional 

organization 

PEL 8 hours/day up to YES Set by OSHA 

40 hours/week 

STEL 15 minutes YES Set by OSHA 

IDLH 30 minutes NO Determined by 

NIOSH - for 

escape only 

REL-TWA up to 10 hrs/day NO Determined by 

during 40 hrs/ NIOSH 

week 



Threshold Limit Value (TLV) is the average airborne 

concentration of substances to which it is believed nearly 

all adults may be repeatedly exposed in the working environment 

for an eight hour workday or a forty hour work 

week, without adverse effects. However, maintaining levels 

below these levels does not guarantee there will not be any 

adverse effects. The Threshold Limit Value, Ceiling (TLV- 

C), or ceiling level, refers to the level that should never be 

exceeded, even for a moment. TLVS are reviewed and 

updated annually. 

Permissible Exposure Limit (PEL) is the average airborne 

concentration of a potentially toxic substance to which an 

employee may be exposed for an eight-hour period. This 

standard is the legal limit of exposure allowed in a workplace 

according to a federal law, the Occupational Safety 

and Health Act. Most of these limits were adopted from 

existing TLVs. 

Short Term Exposure Limit (STEL) is a standard or legal 

limit, like the PEL. The maximum duration of exposure at 

this level is usually 15 minutes with no more than four 

exposures in an eight-hour day and one hour between 

exposures. At the STEL, it is believed that exposure will 

not result in permanent damage. There is no margin of 

error in the STEL, and individuals who are more susceptible 

may experience toxic effects at lower levels. 

The Immediately Dangerous to Life or Health (IDLH) 

level is defined as “a condition that poses a threat of exposure 

to airborne contaminants when that exposure is likely 

to cause death or immediate or delayed permanent adverse 

health effects or prevent escape from such an environment.” 

Substances that are suspected to cause cancer generally do 

not have IDLH levels since there is a potential for developing 

permanent health effects. 

These standards (legal limits) and guidelines (recommended 

limits) should not be regarded as the division 

between “safe” and “dangerous” levels. These levels are 

only defined for single levels. They do not account for 

exposure to multiple toxicants. Sometimes the combined 

toxic effects of substances is far greater than the individual 

properties of the materials. As an example, smokers with a 

history of asbestos exposure are at much greater risk for 



cancer than nonsmoking asbestos workers or smokers who 

are not exposed to asbestos. Because they are routinely 

exposed to asbestos during overhaul and other fire fighting 

duties, fire fighters should not smoke. 

Activity 

How Toxic Materials 

Enter the Body 

There are four major routes of exposure: skin absorption, 

inhalation, swallowing (ingestion), and injection or puncturing. 

The eyes can also be a route of toxic exposure. 

Skin Absorption 

Toxic substances can be absorbed through the skin, or may 

enter the bloodstream through broken skin. The skin can 

act as a barrier to provide varying degrees of protection. 

The longer a material is in contact with the skin, the greater 

the amount absorbed. The higher the concentration of the 

chemical, the greater the amount absorbed. Skin temperature 

and blood flow also affect the rate of absorption. Areas 

with hair follicles allow for greater absorption. For example, 

the scrotum is 300 times more susceptible to absorption 

than the foot. The type of chemical also affects exposure. 

For example, fat soluble chemicals, like solvents, are 

more readily absorbed. The integrity of the skin can be 

damaged by trauma, heat/cold, humidity and moisture, and 

previous chemical exposures. 

Inhalation 

The lungs act as a transfer point in the human body. 

Chemicals and infectious agents can enter the body through 

inhalation. The rate and depth of respiration affect the 

amount of the material absorbed. Faster and deeper respiration 

rates increase exposure. This route of exposure is 

most common for fire fighters unless SCBA is used. 



Ingestion 

Toxic materials can be swallowed if contaminated hands or 

clothes come in contact with the mouth. Ingested materials 

can affect other organs as well as the gastrointestinal system. 

To avoid exposure through ingestion, always complete 

decontamination before you eat or drink. 

Injection and Puncturing 

Injection or puncturing can be: 

• Intradermal (into the skin) 

• Subcutaneous (under the skin) 

• Intravenous (into a vein) 

• Intramuscular (into a muscle) 

Injections and punctures result from contact with physical 

agents such as syringes, high pressure devices or sharp 

objects (e.g., jagged pieces of glass or metal). Injuries from 

injection and puncture can be more serious than surface 

contact because chemicals can penetrate deep into the 

tissues. Consequently, it may be difficult to determine the 

extent of the exposure. Injection also damages the integrity 

of the skin, allowing an opening for other chemicals. 

The Eyes 

Up to 90% of hazardous materials can be absorbed through 

the eyes. Only 10% of all eye injuries involve hazardous 

chemicals, however, with chemical burns causing the most 

severe injuries. Chemicals that are both water and fat 

soluble penetrate the farthest and do the most damage. 

Most chemical injuries to the eye are caused by alkali 

splashes. Common chemical injuries involving the eye 

include: lye, quick lime, ammonia, sulfuric acid, and hydrocarbons. 

Activity 



Toxicity Specific to 

Classes of Hazardous 

Materials 

DOT classes describe the most significant hazard associated 

with a regulated substance. These materials may pose 

multiple hazards. For example, uranium hexafluoride, 

which has a primary hazard of radiation, is also corrosive. 

A knowledge of chemistry is extremely important in understanding 

hazard classes. 

Explosives and Blasting Agents 

Class 1 

Many of these agents contain nitrates, which cause dilation 

of blood vessels. Symptoms include headache, nausea, 

abdominal cramping, and reduced blood pressure. Severe 

exposures can cause heart irregularities and shortness of 

breath. If inhaled or absorbed, nitrates can cause eye and 

skin irritation as well as reducing the capacity of red blood 

cells to carry oxygen. Explosives with names containing 

“azo-” and “azid-” can emit toxic fumes of nitrogen oxides 

when they heat and decompose. These oxides can produce 

severe lung injury. 

Poison Gases and Poison 

Class 2, Division 2.3 

Class 6, Division 6.1 

Poison Gas, Class 2, Division 2.3 materials are extremely 

toxic and a small amount of vapor or gas is dangerous to 

life. Cyanogen gas, phosgene gas, and organic phosphates 

mixed with compressed gas are included in this category. 

The primary route of exposure is inhalation. Even brief or 

low-level exposure requires immediate attention in a hospital. 

Materials classified as Poisons, Division 6.1 are considered 

somewhat less dangerous than those classified as poison 

gas because they exist in either a solid or liquid state. 



Solids and liquids are not inhaled as readily as gases, but 

they still pose a significant hazard. Arsenic compounds 

found in liquid or solid state, such as arsenic iodide, or even 

pure arsenic in its solid form, are classified as poisons. Yet 

arsine gas results from the combination of these materials. 

These substances can be absorbed through inhalation, 

ingestion, or skin absorption and may be highly toxic. 

Immediate medical attention is required for exposure. 

Some of these compounds may cause cancer. Other examples 

of poisons are carbon tetrachloride and hydrocyanic 

acid. 

During a fire, many materials in the poison class can produce 

gases that would be classified as poison gases. 

Flammable Gases 

Class 2 Division 2.1 

Many of these gases displace oxygen and can cause asphyxiation 

in confined spaces. Acetylene is a simple 

asphyxiant as well as a narcotic in high concentrations. 

Another gas, ethylene oxide, produces cancer and birth 

defects in lab animals and may be a reproductive hazard in 

humans as well. Ethylene oxide, like many flammable 

gases, is a strong irritant to skin, eyes, and mucous membranes. 

Non-Flammable Gases and Oxygen 

Class 2 Division 2.2 

This class includes oxygen, carbon dioxide, ammonia, and 

inert gases. Oxygen-enriched environments are not toxic to 

humans, but the danger of fire is very great. Carbon dioxide 

and the inert gases are simple asphyxiants, rapidly 

causing death because they displace oxygen in the atmosphere. 

Ammonia is extremely irritating and can burn even 

at relatively low concentrations. 

This class also includes the halogen acid gases, such as 

hydrogen fluoride, hydrogen chloride, and hydrogen bromide. 

All the halogens (chlorine, bromine, and fluorine) 

and their acids are highly irritating to the skin and mucous 

membranes. Inhalation can cause pulmonary edema, which 

impairs breathing. Any material that reacts with water will 

react with water found in body tissues. 



Flammable/Combustible Liquids 

Class 3 

The majority of these materials are hydrocarbons and 

hydrocarbon derivatives. Hydrocarbons target several 

organs and can cause central nervous system depression, 

resulting in dizziness, lack of concentration, or sleepiness. 

The peripheral system may also be damaged, affecting both 

the motor and the sensory nerves. Some hydrocarbons can 

also cause dysrhythmias. High levels of inhalation exposure 

can result in irritation of the respiratory tract or pulmonary 

edema. 

Halogenated hydrocarbons are toxic to the liver. Some may 

cause kidney damage as well. Benzene is a commonly 

known carcinogen. Chloroform and trichlorethylene are 

known animal carcinogens and potential human carcinogens. 

In addition to inhalation exposure to vapors, many of 

these agents are easily absorbed through the skin. In fact, 

skin exposure of one hydrocarbon may enhance absorption 

of other hydrocarbons. 

Flammable/Water-Reactive Solids 

Class 4 

Flammable solids include lithium compounds. These 

compounds can cause irritation to the skin, eyes, and 

mucous membranes. Some may irritate the lungs if inhaled. 

Also in this class are some nitrogen compounds that 

liberate oxides of nitrogen when they decompose in a fire. 

Several nitrogen compounds cause liver, kidney, cardiac, or 

central nervous system effects. 

Oxidizers and Organic Peroxides 

Class 5 

Oxidizers include several families of agents such as organic 

peroxides. Organic peroxides can cause skin or mucous 

membrane irritation, or pulmonary/laryngeal edema. The 

halogens are also members of the oxidizers class. They are 

highly irritating to eyes and mucous membranes. In addition, 

chlorine and fluorine are well known as powerful 

caustic irritants to tissue. 



Other oxidizers include nitrate compounds, as previously 

discussed. Ammonium compounds are also represented in 

this class. They can liberate toxic fumes such as ammonia 

and oxides of nitrogen when they decompose. In addition, 

some oxidizers, such as ammonium, are possibly carcinogenic. 

Radioactive Materials 

Class 7 

Radioactive materials will generally cause long-term or 

chronic problems rather than short-term effects. Acute 

effects from high exposures are very rare. Acute exposures 

can result in neurologic problems, nausea, and vomiting, 

and skin and mucous membrane irritation. Chronic exposures 

are generally linked to increased rates of cancer and 

birth defects. 

Corrosives 

Class 8 

The corrosives hazard class includes acids and bases that 

can cause severe injury to skin and mucous membranes on 

direct contact. Inhalation of corrosives may damage the 

lungs, and ingestion may cause severe injury to the gastrointestinal 

tract. 

Miscellaneous Hazardous Materials 

Class 9 

Class 9 includes materials that are hazardous during transport, 

but are not included in another hazard class. These 

include anesthetic or noxious materials, as well as those 

that are subject to DOT requirements for hazardous substances 

or hazardous wastes. Examples of Class 9 materials 

include PCBs and molten sulfur. 

ORM-D Materials 

An ORM-D material presents a limited hazard during 

transportation because of its form, quantity, and packaging. 

Small arms ammunition are examples of ORM-D materials. 



Activity 





Toxic Effects in 

Specific Organ 

Systems 

This section briefly reviews some of the body’s major organ 

systems and how they can be affected by hazardous materials 

exposure. By understanding your body’s response, you 

can take steps to protect yourself before, during, and after 

an emergency incident. Remember that preventing exposure 

is the key. 

Respiratory System 

Major components of the respiratory system include the 

nose, pharynx, larynx, trachea and lungs. 



The upper respiratory system includes the nose and physiological 

structures down the airway to the larynx. It provides 

a means for drawing air down into the lungs and 

provides some protection for the lower respiratory tract. 

The upper respiratory system is lined with mucous membranes, 

which can trap foreign matter and deliver it to the 

digestive tract where it can be safely excreted. Toxic effects 

on the digestive system are discussed later. 

The lower portion of the respiratory tract consists of the 

trachea, bronchial “tree” and the lungs. The trachea extends 

from the larynx to the middle of the chest. At that point, it 

divides into the right and left bronchi. The bronchi are also 

lined with mucous membranes that trap dirt and other 

foreign matter. Each bronchus further leads into a grapelike 

cluster of tiny air sacs called alveoli. Each of these 

alveoli is enveloped by a network of microscopic blood 

vessels called capillaries. Oxygen enters the bloodstream 

by diffusing, or crossing from these air sacs into the capillaries. 

The lung is both a route of entry and a target organ. Occasionally, 

a chemical that will eventually harm the lungs 

enters through the skin or the mouth. This is a systemic 

effect, and is the case with the herbicide Paraquat, which 

can be absorbed through the skin but damages the lungs. 

More commonly, however, inhaled substances are responsible 

for direct respiratory system damage. 

Factors affecting toxic response in the lung include: 

• Rate and depth of respiration 

• Duration of the exposure 

• Nature and concentration of the exposure 

• Route of entry 

• Site of deposition 

Individual characteristics also affect the body’s protective 

mechanisms and predisposal to injury. Age, genetic background, 

and other exposures such as smoking are examples 

of such characteristic factors. 

Two chemical properties determine how a substance affects 

the lungs: solubility and particle size. 



Solubility refers to the ability of the substance to dissolve 

in water. Water soluble chemicals are often rapidly absorbed 

within the lungs and carried to other parts of the 

body before damaging lung tissue. 

Particle size influences how far a substance penetrates the 

respiratory system. There are protective respiratory system 

mechanisms to remove particle deposits from the body. 

Large particles are trapped in the mouth or nose and removed 

by nose blowing, sneezing, and swallowing. 

Smaller particles are removed by cilia in the trachea and 

bronchial tree. Cilia are hairlike projections from cells that 

beat in a coordinated wave. Cilia move foreign substances 

up to the throat where they are removed. Most of the 

smallest particles are removed through cells in the immune 

system and cilia motion. Protective mechanisms can be 

weakened by toxic exposure. 

Individuals with chronic bronchitis can have narrowed 

repiratory mucous layer passages. This increases the 

velocity of particles moving through the airways, and more 

particles can be deposited. In addition, exposure to irritants 

can cause bronchial constriction and also increase particle 

deposition. 

Toxic Effects 

The responses of the respiratory system to toxic agents 

generally fall into one of the following general categories: 

• Irritation: Airway constriction, abnormal fluid accumulation, 

infection and cell damage 

• Sensitization: An allergic response that can restrict 

airways 

• Production of fibrosis: Fibrotic tissue blocking air 

passages 

• Carcinogens: Cancer of the lung 



Signs and Symptoms 

Even though lungs may be damaged in many ways, there 

are only a few signs and symptoms of injury, such as 

productive (producing sputum and saliva) or dry cough, or 

difficult or labored breathing (dyspnea). In some cases 

breathing becomes more difficult when the person lies 

down. Breathlessness may be accompanied by increased 

respiratory rate, posturing (such as hand and arm rigidity, 

or hand curling resulting from brain stem injury) and 

cyanosis (the slightly bluish color of skin due to a lack of 

oxygen). 

The Cardiovascular System 

The cardiovascular system consists of the heart and a 

system of blood vessels. This system circulates blood from 

the heart to the body and vice versa via its extensive network 

of blood vessels. The main function of the heart is to 

pump oxygenated blood throughout the body. The heart is 

a muscle with its own electrical system. Electrical impulses 

cause the heart to contract, moving blood throughout 

the body. 



The principal types of blood vessels are arteries, capillaries 

and veins. Arteries carry blood away from the heart to 

organs and tissues while veins carry blood back to the 

heart. Capillaries are microscopic blood vessels with thin 

walls through which oxygen, nutrients, and other materials 

diffuse. The collection of blood vessels that provides the 

body’s limbs with oxygen and nutrients is known as the 

peripheral vascular system. 

Toxic Effects 

Toxic substances may affect the heart or peripheral vascular 

system. As with many other body systems, the severity of 

the effect is influenced by the concentration and duration of 

exposure as well as pre-existing health conditions. 

• Electrical conduction disturbances are abnormal 

contractions of the heart muscle, such as potentially 

life-threatening ventricular tachycardia. Materials that 

can cause these effects include solvents, carbon disulfide, 

Freon, and insufficient oxygen. 

• Decrease in the contracting force of the heart muscle 

results in an inadequate force to push the blood through 

the vessels. Ethanol, cobalt, and trichloroethane (TCA) 

can cause this effect. 

• Enhanced arteriosclerosis or hardening of the arteries 

can be caused by carbon monoxide and acrolein. 

• Hypertension or high blood pressure can be due to a 

variety of causes. It can lead to strokes, heart disease 

and kidney failure. Exposure to lead and cadmium are 

linked to hypertension. 

• Hypotension or low blood pressure may be seen with 

toxic exposures that result in dilation of the blood 

vessels. If the body is unable to compensate for this 

dilation, shock can result. Nitrates are known to cause 

these effects. 




Signs and symptoms associated with cardiovascular exposure 

mimic those seen in medical emergencies involving 

solvent exposures. They include: 

• Irregular or rapid pulse 

• Decreased tolerance for exercise or physical activity 

• Dizziness and fatigue 

• Swelling or edema in the ankles 

• Palpitations or the feeling of skipped heart beats 

• A feeling of indigestion 

• Pain in the chest, jaw, or left arm 

Blood and Blood 

Forming Organs 

This body system consists of the blood, bone marrow, 

spleen, and lymphatic tissue. As with other organ systems, 

the longer the duration of the exposure, the more severe the 

toxic response. 

Blood consists of red blood cells that transport oxygen and 

other nutrients to the body; white blood cells that assist the 

body’s immune system; and platelets, which are cell fragments 

required for proper clotting. These are all suspended 

in a pale yellow fluid called plasma. 

Bone marrow is the spongy center of some bones including 

the sternum, ribs, hipbones and a few other bones such as 

the vertebrae, clavicles, and cranial bones. Bone marrow 

forms all types of blood cells except some white blood 

cells. 

Toxic Effects 

The blood system can be damaged by agents that affect 

bone marrow production, the components of the blood (red 

and white blood cells and platelets), or the oxygen carrying 

capacity of red blood cells. 



Toxic effects include: 

• Bone marrow suppression: A decrease in the activity 

of the bone marrow that leads to decreased blood cell 

production. Examples include ionizing radiation and 

benzene. 

• Effects on platelet activity: Results in a change in the 

formation of blood clots. Examples: aspirin, which 

inhibits clotting; benzene, which decreases the number 

of platelets; and perchlorethane, which increases the 

number of platelets. 

• An increase or decrease in the number of white 

blood cells: An increase occurs with leukemia, which 

is a result of bone marrow cancer. Benzene and other 

solvents may cause the white blood cell count to decrease, 

as can chronic phosphorus exposure. A decrease 

in white blood cell count impairs the body’s 

ability to fight infection. 

• Effects on the white blood cells responsible for the 

immune response: Certain chemicals, such as toluene 

diisocyanate (TDI), trigger an allergic response that is 

regulated by specialized white blood cells. 

• Destruction of red blood cells: When red blood cells 

are destroyed, the oxygen-carrying capacity of the 

blood is decreased. Examples: arsine, trinitrotoluene 

(TNT), and naphthalene (the active ingredient in mothballs). 

• Effects on hemoglobin, the oxygen-carrying part of 

red blood cells: Aniline, nitrobenzene, and dinitrobenzene 

alter the hemoglobin molecule so that it cannot 

form oxygen. Other chemicals, such as carbon monoxide, 

do not alter the molecule but combine with it much 

more easily than oxygen so that the hemoglobin’s 

ability to carry oxygen is severely reduced. 




Signs and symptoms include: 

• Weakness 

• Fatigue 

• Unusually pale skin or mucous membranes 

• A resting heart rate of more than 100 beats per minute 

• Frequent bleeding from the gums or nose 

Gastrointestinal System 

The gastrointestinal system consists of the alimentary canal 

and three accessory organs: the salivary glands, the liver 

and the pancreas. 



The alimentary canal or the digestive tract is a system of 

organs that extend from the mouth to the anus. It consists 

of the mouth, pharynx, esophagus, stomach, small intestine, 

and large intestine. The gastrointestinal tract digests and 

absorbs food and can also absorb chemicals and other 

hazardous materials that enter the mouth. Most orally 

administered chemicals can produce their effects on other 

body systems only after absorption has occurred from the 

gastrointestinal tract or, less frequently, from the mouth. 

The chemicals can also affect the GI system itself. 

Most chemicals absorbed in the stomach and the small 

intestine go to the liver first via the blood supply. The liver 

metabolizes chemicals and other toxic substances and 

changes them into a form that can be excreted. This 

process is called biotransformation. Most biotransformation 

occurs in the liver, where enzyme systems modify the 

toxicant. The products of this process are less toxic than 

the original compound, but in some cases they are more 

toxic. 

Toxic Effects 

Liver toxicity depends on the specific chemical agent 

involved in the exposure, the length of the exposure, and 

the physical condition of the individual. Once again, preexisting 

conditions such as liver problems (e.g. cirrhosis or 

hepatitis) increase susceptibility. A hepatoxin affects the 

liver’s ability to detoxify, or rid itself, of other substances. 

Diet, hormone activity, and alcohol consumption can also 

affect biotransformation in the liver. 

Examples of toxic effects of hepatoxins include: 

• Cell death or necrosis 

• Cirrhosis, which is a progressive fibrotic disease of the 

liver 

• Malignant tumors 



Urinary System 

The kidneys and bladder are the primary organs of the 

urinary system. The kidneys act as filters to remove wastes 

from the blood. These wastes are excreted as urine. From 

the kidneys, urine flows to the urinary bladder via ureters. 

The bladder collects and stores urine, which is eventually 

discharged from the body through the urethra. The kidneys 

maintain a balance of water, salt, and pH in the body. They 

are the body’s primary means of excreting metabolic wastes 

such as urea and uric acid, as well as certain toxic materials. 

Poorly or non-functioning kidneys may be unable to 

eliminate toxic substances from the body. 

The kidney and bladder are susceptible to toxins for several 

reasons. Blood flow to them is much higher than to most 

other organs. As a result, large amounts of circulating 

toxins can reach the kidneys and the bladder fairly quickly. 

The kidneys have a high oxygen and nutrient requirement 

because of this heavy work load. They are affected by any 

factor (such as shock, hemorrhage, or dehydration) that 

reduces blood flow. Systemic effects of toxins elsewhere in 

the body can also indirectly affect kidney function. 



Because they adjust the amount of water and other components 

in the blood and urine, the kidneys are capable of 

increasing the concentration of a toxic substance. In fact, a 

non-toxic concentration of a chemical in the blood can 

suddenly become very toxic in the kidneys. The same is 

true for the bladder, where the concentration and amount of 

urine control the amount of toxin in contact with bladder 

tissue. Dehydration due to lack of fluid intake can cause 

urine to be more concentrated. 

Toxic Effects 


• Renal failure: Toxins that affect the kidneys are 

known as nephrotoxins. If these substances, or their 

metabolites, cause direct damage to the kidneys, the 

kidneys’ ability to filter blood will be partially or totally 

destroyed. This failure to function is known as renal 

(kidney) failure. Heavy metals such as mercury, cadmium, 

arsenic, and lead can cause renal failure. 

• Carcinogenesis: Many organic compounds such as 

carbon tetrachloride, chloroform, and the herbicide 

Paraquat are also examples of nephrotoxins that cause 

cancer. 


Signs and symptoms include: 

• Change in the volume of urine unrelated to fluid intake, 

any difficulty or pain during urination, blood in the 

urine (usually difficult to see with the naked eye) 

• Edema, or swelling in the feet or hands that is usually 

equal on both sides of the body 

• Flank pain (in the back, just above the hips) 



Reproductive System 

The reproductive system in males includes testes, accessory 

glands (prostate), penis, and conducting tubes that lead 

from the testes to the outside of the body. Specific hormones 

act on the testes, stimulating them to produce testosterone 

and sperm. A number of toxicants have been 

associated with impairment of sperm and testosterone 

production and may even lead to sterility. 

In females, the principal reproductive organs consist of the 

ovaries and the uterus. Hormone production such as estrogen 

and the development and maturation of the ovum (egg) 

are key functions of the ovaries. These functions can be 

impaired by exposure to hazardous materials. Exposing a 

fertilized egg (either an embryo or a fetus) to a toxic substance 

may be harmful. 



Certain individuals may be more susceptible to reproductive 

system toxicants because of their age, nutritional 

status, or other exposures. 

Toxic Effects 


• Sperm production: A decrease in sperm production 

can reduce fertility or even cause sterility. Examples of 

chemicals that reduce sperm production include 

dibromochloropropane (DBCP) and ethylene dibromide 

(EDB). 

• Infertility: The result of effects on the production of 

ovum (egg) or the pathway of the ovum 

• Impotence: Resulting from effects on the parasympathetic 

nervous system 

• Hormonal changes: Hormones regulate the male and 

female reproductive cycles. 

• Premature delivery or spontaneous abortion 

• Congenital malformations of developing embryos 

Examples of agents that have been associated with reproductive 

dysfunction in men are ionizing radiation, carbon 

disulfide, dibromochloropropane (DBCP), ethylene oxide, 

hexane, and lead. 

Examples that have been associated with reproductive 

dysfunction in women include ionizing radiation, carbon 

disulfide, methyl mercury, and lead. 



Skin 

The skin has two layers: the outer layer (epidermis) and the 

inner layer (dermis). The skin preserves the body’s balanced 

environment in several ways. It protects the body 

from extremes in the environment. The extensive capillary 

network and sweat glands are an important part of temperature 

regulation. Other functions of the skin include the 

regulation of water balance and the excretion of some water 

and waste products from the body. It also protects against 

mechanical and some thermal injury, as well as serving as a 

barrier against many living organisms. 

The skin is less able to protect against toxicants and chemicals. 

Even when intact, chemicals can travel through the 

epidermis or enter the body through the hair follicles. In 

general, fat soluble liquids and solids are more capable of 

penetrating the skin because of the fat content in underlying 

tissue. The amount absorbed depends on the amount of 

time in contact with the skin; the longer the contact, the 

more will be absorbed. Local skin factors such as temperature 

and blood flow at the site will also influence the rate of 

absorption. 

Intact skin is normally an excellent barrier to foreign 

substances; however, the skin can be damaged by trauma, 

heat, cold, humidity, and previous chemical exposures. If 



exposure does occur, the amount of the chemical that is 

absorbed depends on how much was applied, the concentration, 

length of contact, and the exposed surface area. 

The permeability of skin varies according to the body 

region. Areas that are rich in hair follicles allow greater 

absorption. These include scalp, forehead, jaw area, underarm 

and scrotum/perineal area. Moisture, particularly 

sweat, increases absorption; so may the presence of other 

chemicals. Solvents, in particular, can increase permeability. 

The presence of surfactants, such as soaps and detergents, 

will increase the absorption of water soluble substances. 

Also, any breaks in the skin caused by chapping, 

cuts or abrasions will enhance absorption. 

Toxic Effects 

There are five types of toxic skin reactions: 

• Irritation: A substance acts on normal skin at the site 

of contact and produces a local inflammatory response, 

known as dermatitis. This is different from an allergic 

reaction. Dermatitis can result from an acute exposure 

or repeated contact. Examples of substances causing 

irritation include trioxides, dichromates, and most 

solvents. 

• Corrosion: The result of direct chemical action on skin 

that results in its disintegration at the site of contact. 

Ulceration, tissue death, and subsequent scar formation 

can occur. An example of a corrosive material is chromium. 

• Photosensitization: Exposure to a chemical followed 

by exposure to sunlight, with resulting sunburning, skin 

thickening, or pigment changes. Examples include 

soaps, detergents and medicines. 

• Sensitization: An allergic reaction after prolonged or 

repeated exposure. Potassium dichromate, turpentine, 

and formaldehyde can cause sensitization. 

• Carcinogenesis: Cancer of the skin. Any type of skin 

cell (in the dermis or epidermis) may be transformed 

from a normal cell to a cancerous one. Causes of skin 



cancer include exposure to ultraviolet light, ionizing 

radiation, arsenic, and polycyclic aromatic hydrocarbons 

(PAHs). 


Signs and symptoms of toxic skin effects mainly appear on 

exposed areas of the skin and may include: 

• Rash or redness 

• Localized swelling 

• Peeling 

• Skin thickening and the appearance of vesicles (blisters) 

• Itching or burning 

The Nervous System 

The nervous system allows the body to detect and respond 

to stimuli. The two principal divisions are the central 

nervous system (CNS), consisting of the brain and spinal 

cord, and the peripheral nervous system (PNS), consisting 

of the nerves that link the CNS with the skin, other body 

organs and muscles. 

Toxic effects are partially controlled by predisposing 

factors such as alcohol consumption, and health conditions 

that affect the nerves, such as diabetes. The primary concern 

is nerve cell injury because these cells have little 

capacity to regenerate. Though normal nerve function 

sometimes returns, as other nerves begin to compensate for 

the injury, recovery is slow. 

Toxic Effects 

Fat soluble chemicals are more likely to affect the nervous 

system. Many solvents and organic metals can easily reach 

brain tissue after absorption. Tetraethyl lead is one example. 

But not all brain cells are affected in the same way 

since certain areas receive different doses and some cells 

are more sensitive to toxic exposure. 



CNS toxicants may cause subtle effects such as personality 

changes, or dramatic ones, such as loss of balance. Testing 

can be done to evaluate the seriousness of the effect. PNS 

toxicants can interfere with motor function (strength and 

movement), sensory function (ability to sense touch, vibration 

or pain), or both. Some of these effects are reversible 

while others are not. 

Like many other body systems, the partially developed 

nervous system, as in the very young, is much more sensitive 

to toxins. Low level lead poisoning in children is 

characterized by central nervous system effects such as 

hyperactivity and learning disabilities. 

In adults, effects on the PNS are seen first. 


Signs and symptoms of toxic effects in the nervous system 

include: 

• Personality changes 

• Loss of balance 

• Changes in motor function 

• Changes in sensory function 

Eyes 

The eyes are affected by the same chemicals that affect the 

skin but they are more sensitive. Several types of compounds 

can burn the eyes by direct contact. Factors that 

determine the extent of injury include concentration, pH, 

duration, eye defense mechanisms such as tearing and 

blinking, and of course, the specific chemical involved. 

Toxic Effects 

Acid burns such as sulfuric, hydrochloric, hydrofluoric, and 

tannic acids can cause scarring of the lids and conjunctiva, 

and can damage other structures of the eyes. Alkali burns 

from ammonia, sodium hydroxide, and potassium hydroxide 

may initially appear to be mild, but can later result in 

ulceration, perforation, or clouding of the cornea or lens. 



Lacrimators such as chlorocetophen (tear gas) cause tearing 

at low concentrations. They are distinguished from other 

eye irritants such as hydrogen chloride by their ability to 

cause an instant reaction without damaging tissue. At very 

high concentrations they can cause chemical burns and 

destroy the cornea. 

Some chemicals reach the eyes and cause damage by way of 

the blood system. The route of exposure could be inhalation, 

ingestion, or absorption instead of direct contact. 

Some examples include naphthalene, carbon disulfide, and 

methanol. 

Ears 

Hearing loss can be due to a number of factors, such as 

trauma, recurrent infections, obstruction by a foreign body, 

antibiotics, some infections, other medical conditions, as 

well as advancing age. The primary work-related agent 

responsible for hearing loss is noise. The ear’s response to 

noise depends on three factors: noise intensity, duration, and 

the frequency or composition. 

Toxic Effects 

When a person is subjected to a loud noise in a certain 

frequency range, hearing may be impaired, resulting in 

decreased ability to hear low volume noises. Such hearing 

losses are usually temporary; however, higher intensity 

noises of prolonged duration can permanently damage 

hearing. 

There is some new evidence that fire fighter exposure to 

carbon monoxide and hydrogen cyanide can also be responsible 

for hearing loss. It is essential that you protect all 

routes of entry and use hearing protection routinely in loud 

environments. Of course, the first goal is to reduce or 

eliminate the source of the noise whenever possible. 

Activity 



Medical Surveillance 

Emergency response work takes a direct toll on the health 

of emergency responders. In 1997, 34 fire fighters died 

from occupational diseases. Another 72 members were 

forced to retire as the result of occupational disease. In 

fact, service separations related to injury and disease 

represent nearly one in three retirements. 

While we have always been aware of fire fighters who die 

from traumatic injuries at emergency scenes, it is only 

relatively recently that we have become aware of the 

number who die as the result of occupational exposures to 

hazardous materials. This is because the negative health 

effects of these exposures can be very subtle and can take 

years, even decades to become apparent. Heart and lung 

diseases and cancer are a few of the many health conditions 

now associated with fire fighting and hazardous materials 

response. 

Confronting this health reality means developing programs 

that will protect you and your fellow fire fighters during 

emergency response. These include the use of standard 

response procedures and personal protective equipment 

including positive pressure self-contained breathing apparatus. 

It also means going the extra step to carefully monitor 

your health to detect any effects from hazardous materials 

exposure. 

It’s a Good Idea and 

It’s also the Law 

The Occupational Safety and Health Administration’s final 

rule (29 CFR1910.120) regarding Hazardous Waste Operations 

and Emergency Response specifies minimum requirements 

in a number of areas of hazardous material emergency 

response. One area covers the provision of a medical 

surveillance program. Similarly, the Environmental Protection 

Agency has established equal protection for all employees 

not covered by OSHA. Hazardous materials team 

members have a right to medical surveillance. In addition, 



the National Fire Protection Association has developed a 

standard for fire department occupational safety and health 

programs (NFPA 1500). This standard specifically addresses 

the need for a comprehensive approach to the health 

and safety of fire fighters and emergency medical care 

providers. 

A medical surveillance program can help to determine if 

you can safely perform job duties and use personal protective 

equipment. It is also designed to detect early changes 

in body system functions that may have been caused by 

exposures. Early detection encourages early treatment so 

that permanent damage does not occur. It is important to 

remember that medical surveillance programs do not take 

the place of other health and safety strategies or your annual 

medical exam with your private physician. All of these 

programs working together help to protect your health. 

The Importance of Monitoring 

Health Status 

To effectively track the status of your health, you must have 

a baseline physical and assessment followed by routinely 

scheduled evaluations. It is from these snapshots that key 

information about health changes can be detected. These 

snapshots are made up of information from a number of 

different sources. The sources, when taken together, give a 

detailed portrait of your personal health. 

Sources of information include: 

• Questionnaire data 

• Physical examinations 

• Diagnostic medical testing 

• Biological monitoring 

Questionnaire Data 

Questionnaires provide important information regarding 

your medical, occupational, family, and other personal 

background. A special emphasis is placed on current 

symptoms that might be related to hazardous materials 

exposure. 



A key component of the questionnaire is determining risk 

factors. Risk factors are areas that might predispose you to 

a negative health effect. For example, someone with 

cardiac or respiratory disease history might not be able to 

wear fully encapsulating chemical protective clothing or 

self-contained breathing apparatus in strenuous situations. 

Other risk factors include chronic obstructive pulmonary 

disease (COPD), severe asthma, or previous heart attack. 

Also, a history of difficulty breathing, heat intolerance, or 

current obesity may indicate potential problems using 

personal protective equipment. 

In addition to risk factors, questionnaires should also 

include an area devoted to occupational history. This 

section looks at current job duties, previous employment 

and part-time work. This type of information, including 

non-occupational exposures, (perhaps from hobbies such as 

car repair) can help to pinpoint areas of potential concern. 

Previous known exposures to asbestos and solvents such as 

benzene are other examples. 

Physical Examinations 

There are a variety of medical examinations that may be 

appropriate during your participation in a comprehensive 

medical surveillance program. Some of these examinations 

are routine and others are specific to known or possible 

exposures. Knowing the different types can help to ensure 

that you participate successfully. 

Pre-placement Exams 

A pre-placement exam is given at the time of hiring or 

change in job duties. It is an important opportunity to gain 

baseline or initial data for use in future comparison. It 

allows the physician to determine if you can safely wear 

protective equipment while working in a hazardous environment. 

Pertinent history includes allergies, illnesses, risk 

factors, dietary and exercise habits, as well as an occupational 

history. 



Minimal items included in the comprehensive physical 

examination include: 

• Physical evaluation 

• Body composition 

• Laboratory tests 

• Vision tests 

• Hearing evaluation 

• Spirometry 

• EKG 

• Cancer screening 

• Immunizations and infectious disease screening 

These and other tests are described in detail in Appendix C. 

Periodic Medical Examination 

It is strongly recommended that hazardous materials technicians 

receive an annual medical review or interval examination. 

This new medical data is compared to the baseline in 

order to detect any changes in body systems. These 

changes can be the basis for further testing or starting 

medical treatment if necessary. Test results can also provide 

evidence for changes in personal protective equipment 

or work practices. These examinations can be performed 

more frequently if necessary, based on special hazards, 

exposures, symptoms, or your age or health profile. Any 

exposures during the interval since the last exam should be 

carefully reviewed. 

You might also have a targeted examination focusing on 

organs most likely affected by exposures. Other medical 

testing may be based on exposure information, medical 

history and the results of the physical exam. For example, 

blood tests that reflect liver function may be performed if a 

responder has been exposed to large amounts of petroleumbased 

solvents. 

Acute Medical Care 

There is always a chance that hazmat technicians will 

require medical attention as a result of operations at the 

scene of an emergency. Team members may become 

injured or ill from exposures or heat stress. It is essential 

that provisions be made for emergency medical care at the 

site. Because of the nature of the work, Advanced Life 



Support should be available to treat and transport team 

members requiring attention. 

As part of your pre-planning process, identify hospitals in 

your area that are equipped to handle chemical and toxicological 

emergencies. These facilities may have specially 

trained providers and equipment that could make the 

difference in an emergency. 

Activity 

Post-Exposure Monitoring 

Post-exposure monitoring may be necessary even if members 

are not experiencing symptoms. Testing may also be 

required even after medical treatment has been completed. 

In some cases, depending on the type of exposure, specific 

tests can be administered to quantify the exposure. These 

tests can serve as the basis for determining whether or not 

additional medical treatment is necessary. 

It is very important that all confirmed or suspected exposures 

be carefully documented in written form. These 

records are very useful during the annual medical review 

and can also be used as claims evidence in applicable 

workers compensation cases. 

These evaluations are designed to assist in the early identification 

of illness or injury that may be related to the 

adverse effect of a work site exposure or the working 

environment. In addition, any employer having workers 

with occupational exposures to infectious diseases is 

required to establish a written exposure control plan designed 

to eliminate or minimize exposures and to handle 

them properly when they occur. 

A typical follow-up procedure for a common exposure, 

asbestos, is detailed below: 

• Upon confirmation of an exposure to asbestos, the 

following baseline evaluations should be completed if 



documentation does not exist that these evaluations 

were done within the previous 12 months or other 

identified schedule: 

• Basic physical evaluation and examination 

• Pulmonary function tests (FVC FEV1.0) 

• Chest X-ray, 14"x 17" post./ant. 

• Members known to have been exposed are subject to the 

following schedule for continued testing: 

Years since first exposure Age 15 to 35 Age 35 to 45 Age 45+ 

to hazardous materials 

0 to 10 years Every 5 years Every 5 years Every 5 years 

10+ years Every 5 years Every 2 years Every 1 year 

• In addition to the above evaluations, the OSHA Asbestos 

Standard Periodic Medical Questionnaire shall be 

completed. 

• This information shall be reviewed and evaluated by the 

physician to ensure that appropriate medical follow-up 

is identified and communicated to personnel. Information 

concerning the occupational risks of exposure to 

asbestos should be provided to applicants during initial 

training and on a yearly basis to incumbents. Training 

and education should describe the nature of asbestos, 

proper respiratory protection and use of respirators, and 

procedures for minimizing the risk of exposure to 

asbestos. 

Exit Examination 

This examination is performed when you leave your department 

or transfer to work that does not involve continued 

exposure to hazardous materials. The purpose of an exit 

exam is to establish the state of a member’s health at the 

conclusion of a specific job assignment. The components 

of the exam are similar to those of the periodic exam. 



Physician Qualifications 

The physician conducting surveillance exams must be well 

acquainted with the fire/rescue service and the special 

needs of hazardous materials emergency responders. 

Physicians trained in occupational medicine or toxicology 

are ideally suited to conduct surveillance programs. It is 

essential that all physicians be familiar with OSHA/EPA 

requirements and NFPA standards as well as common work 

practices. Physicians must also be aware of and follow 

applicable confidentiality and reporting requirements. 

Record Keeping 

Maintenance and access to your medical records must be in 

accordance with OSHA regulations. The procedures set 

forth in NFPA 1500 should also be included in department 

policies. If you are exposed, OSHA regulations require that 

your medical records be maintained for 30 years after you 

leave employment. 

The results of medical tests must be made available to you 

on request. The employer is only informed about limitations 

in your work duties, not specific information about 

medical conditions. The cornerstone of a professional, 

successful medical surveillance program is confidentiality. 

Without the trust afforded by confidentiality, the program 

will fail. 

In addition, medical surveillance record keeping must 

follow these guidelines: The employer must retain your 

name and social security number, the physician’s written 

opinion, any employee medical complaint related to exposures, 

and a copy of information provided to the examining 

physician by the employer regarding employee exposures. 

Record keeping and reporting of occupational injuries and 

illnesses must be performed yearly. This function helps 

reveal injury trends related to equipment and procedures. 

Finally, you must remember the importance of routinely 

documenting work-related exposures. You must retain your 

own copy of these exposure records. Some local unions 

and state associations also keep exposure records. This 



documentation serves as the basis for needed changes and 

improvements in emergency operations. Documentation 

also plays a crucial role in diagnosis, treatment and coverage 

for some medical conditions. 

Annual Program Review 

Just like any other program, the medical surveillance 

component should undergo review to ensure that it is 

effective. This review, which should occur annually at a 

minimum, can also help to identify injury trends and special 

health effects. Review elements should include: 

• Assessments of injuries and illnesses to determine the 

cause. This process allows you to modify health and 

safety procedures when necessary. 

• A review of medical testing for exposures and environmental 

monitoring to ensure that they are useful 

• An examination of emergency response capabilities and 

treatment procedures and an updated list of emergency 

contacts and facilities. Through the on-going planning 

process, response capabilities should address new 

hazards and possible exposure. 

• A careful analysis of group data to detect trends that 

may not be apparent through individual results. From 

these findings, deficiencies in such areas as training or 

personal protective equipment can be corrected. 

• A review of hazardous materials responses, medical 

records, and exposure reports to ensure that team members 

are receiving proper follow-up care 

• A review of confidentiality procedures and safeguards 

to ensure that member privacy is protected. An audit of 

reporting procedures can ensure that only information 

on work status and restrictions is communicated to 

management. This element builds trust in the medical 

surveillance system and will encourage members to 

participate fully and completely in the process. 



Activity 

A thorough medical surveillance program is a central part 

of an effective emergency response. It enhances planning 

and serves as a guide for improvements in training, equipment 

and procedures. Most importantly, it safeguards the 

health of responders by creating a system for consistent and 

thorough review of exposures and their effects. 





Elements of a 

Proactive Health 

Strategy 

Every emergency responder should achieve—and maintain—extremely 

good health. Good health can help you 

enjoy a full life while offsetting the demands of emergency 

response. Even routine emergency events (as well as how 

you prepare for them) can be highly stressful. This stress 

can result in disease processes that have both physical and 

mental dimensions. 

Negative health effects such as serious accidents or health 

problems such as heart disease and cancer are essentially 

emergency incidents for our bodies. Our goal is to avoid 

these emergencies whenever possible and to provide adequate 

resources to deal with them if they occur. We do 

this in the same way we deal with any emergency—by 

preplanning and providing adequate resources to overcome 

the incident. As with emergency incidents, the more care 

we give to preparation and planning for our health, the 

move effectively we can deal with a health event if it does 

occur. 

The goal then, is to remain as healthy as possible through a 

comprehensive personal program that takes into account 

our physical, emotional and medical needs. If you pay 

daily attention to these needs, you will reap significant 

benefits—not only in emergency performance, but also in 

your ability to enjoy life. The benefits of a sustained 

commitment to well-rounded personal health include: 

• Less risk of death or injury or a disabling disease 

• Improved physical performance 

• Decreased levels of stress, tension and anxiety 

• Enhanced ability to rest and sleep 

• Better ability to bounce back from strenuous events 

Some key components of a proactive health strategy are: 

medical review, fitness, diet, and stress management. 



Medical Review 

Emergency responders are exposed to a complex and 

dangerous work environment that includes exposure to a 

wide range of toxins and infectious materials. The work 

environment also includes a high degree of on-going stress 

that can cause a variety of diseases. Because of these 

factors, you must participate in a comprehensive annual 

medical review program designed to detect and treat adverse 

medical conditions. Such a program is vital to ensuring 

good health. (Many of these components are also 

included in the Medical Surveillance section). 

A comprehensive medical examination includes: 

• Physical evaluation 

• Body composition 

• Laboratory tests 

• Vision tests 

• Hearing evaluation 

• Spirometry 

• EKG 

• Cancer screening 

• Immunizations and infectious disease screening 

An annual medical review helps ensure that emergency 

responders are well informed about their physical health. A 

life-long, consistent comparison of essential health data can 

help detect changes that require follow-up to eliminate the 

possibility of disease. It is a critical element in a proactive 

health strategy. 



Personal Fitness 

Physical fitness is critical to your overall health and your 

ability to perform safely and effectively as an emergency 

responder. Higher levels of aerobic fitness, muscular 

endurance, and muscular strength are key assets in the 

emergency response profession. All members participating 

in fitness programs should be medically cleared prior to 

doing so. This clearance can establish a health baseline and 

rule out any existing medical issues that might preclude 

participating in a fitness program. 

Aerobic Capacity 

Aerobic capacity is an integral part of a fitness program. 

Improved aerobic capacity leads to better cardiovascular 

fitness and keeps blood pressure, weight, and body chemistry 

in the normal ranges. There is little debate that a high 

aerobic capacity is a prime goal for fire fighters and other 

emergency responders. 

Flexibility 

Because emergency response work is physically demanding 

and often requires intense physical labor in restricted areas, 

the majority of injuries are sprains and strains. In addition, 

many fire fighters are forced into retirement each year 

because of disabling back injuries. An important part of 

injury prevention is a flexibility program that creates full 

range of movement for joints and muscles. 

Muscular Strength and Endurance 

Muscular endurance is defined as the ability of a muscle 

group to perform work over a period of time sufficient to 

cause muscle fatigue. Fire fighting and emergency response 

work frequently requires maximum exertion. Maintaining 

an appropriate level of muscular strength not only 

allows you to perform your work efficiently, it establishes a 

reserve that can prevent sprains and strains. A routine 

strength training component is a standard part of responder 

fitness. 



Promoting Good Health 

Through Positive Behaviors 

Wellness is critically linked to your personal behavior in a 

number of key areas. The decisions you make and the ways 

in which you choose to manage stress are all linked to your 

overall health. Behavioral health encompasses many areas, 

including: 

Smoking: The use of tobacco in any form is associated 

with a wide range of negative health effects including heart 

disease and cancer. Effective programs to stop the use of 

tobacco are essential. 

Substance abuse: The abuse of alcohol is by far the largest 

concern. An effective program to educate members and 

new hires about the problems associated with alcohol and 

drug abuse is an important part of health promotion. In 

addition, treatment at reasonable cost should be made 

available for those who require it. 

Stress management: To manage stress effectively you 

must first be aware that you are subject to a variety of 

stressors. Among these are typical job stress, critical 

incident stress, stress from financial and legal concerns, 

family relations, and stress from issues such as infectious 

disease exposure. To manage stress, you need to recognize 

common reactions such as loss of appetite, trouble sleeping, 

and anger. Every responder needs to make full use of 

programs to combat stress. Such programs include professional 

counseling, peer support, and education. The value 

of regular exercise as a tool to relieve stress should also be 

emphasized. 

Nutrition 

Proper nutrition is a key part of proactive health maintenance. 

The basic fuel necessary to respond safely and 

effectively to any emergency is found in our daily diet. The 

higher the quality of the fuel you consume, the more effective 

and efficient we can be. High quality nutrition improves 

the quality of life and the performance of emergency 

responders. Some of the positive aspects of a good diet are 



increased energy, shortened recovery time, and improved 

resistance to diseases. 

Two of the major risks of emergency response work— 

cancer and heart disease—can be lessened through good 

nutrition. A diet low in total fats, saturated fats, cholesterol 

and salt, and high in fruits, vegetables, and fibers is a 

nutritional game plan that may help offset these disease 

processes. 

Following are some basic daily guidelines for a healthy 

diet: 

• Carbohydrates: 50% to 70% 

• Proteins: 15% to 30% (A typical serving of protein for 

an adult male would be the size of the palm of the hand 

and about the thickness of the hand.) 

• Fats: No more than 30% 

• Eat five or more servings of fruits and vegetables 

• Reduce the amount of cholesterol, salt, and fats, particularly 

saturated fat 

• Replace high fat meats with lean cuts 

• Increase fiber intake 

• Drink plenty of non-caffeinated and alcohol free beverages. 

Signs of dehydration include dark urine, a small 

volume of urine, and headaches. Remaining adequately 

hydrated is essential for emergency response personnel. 






Response Principles 

Always Have a Plan 

In many cases, hazardous materials events involve patients 

who are exposed or injured. Operating safely in such a 

dynamic environment requires that you maintain your 

composure and only take those actions that are reasonable 

and appropriate. One of the best ways to ensure that you 

operate safely is to have a plan and follow it. 

• Analyze the Problem. Using your size-up and hazardous 

materials skills, determine exactly what is occurring. 

Is the environment dynamic? Is there an immediate 

rescue problem? Do you have resources and 

equipment to rescue a viable patient? What are the full 

range of hazards present? What will happen if you take 

no action at all? 

• Plan the Response. Based on your analysis, decide 

which actions are appropriate. Ensure that the necessary 

resources are present or en route. Plan your steps 

carefully, keeping safety as a top priority. Use the risk/ 

benefit scenario to gauge your level of hazard and 

exposure. 

• Implement Your Plan. Take the actions you have 

determined to be appropriate based on your 

department’s procedures. Operate as a team, and ensure 

that you have back-up. Minimize exposure to the 

hazardous substance and keep your time and actions in 

the Hot Zone to a minimum. If you are contaminated, 

ensure that you are properly decontaminated and assessed 

after you leave the Hot Zone. 

• Evaluate Progress and Adjust as Necessary. Observe 

your progress and remain aware of your effectiveness 

and the presence of new or additional hazards. Adjust 

your plan if necessary to reflect changing conditions. 

Think ahead and always keep a margin of safety for you 

and your crew members. 



Stay Alert to Changes 

Planning is an essential component to a safe response. It is 

important to remember that these incidents are very dynamic. 

Based on the type and amount of materials involved 

and other factors such as the location, time of day, and the 

weather conditions, the incident can change rapidly. Whenever 

possible, create contingency plans during the planning 

process that take into account some of these dynamic 

variables. 

Often it will be very difficult to identify all the possibilities. 

Changes in wind direction and air temperature, settling of 

contents in a container, and changes in smoke color or fire 

intensity are just some of the indications that the incident 

may be escalating or creating new dangers for responders. 

In many cases, the longer you work at an incident the more 

likely you are to be lulled into a false sense of safety. The 

challenge for professional responders is to stay alert at 

every stage of the event, all the way through wrap-up and 

termination. 

Take Only Appropriate 

Actions 

Your priority list: 

• Safety of emergency responders 

• Safety of civilians 

• Preservation of property 

• Preservation of the environment 

The actions that we take at the scene of an emergency 

should be in line with our established health and safety 

priorities. Our highest priority is to save a savable life. In 

this scenario, you could justifiably be placed at significant 

risk. For those incidents where no life threat exists, you 

should be placed at low or minimal risk. 

Making sure that our actions are appropriate means establishing 

a realistic plan based on what is occurring, what we 

expect to achieve, and our available resources. In addition, 

you must be must be fully aware of : 



• The materials involved 

• Weather conditions 

• Accessibility to the incident 

• Ignition sources 

• Containment systems (piping, dikes, tanks) 

• Damage to storage containers 

• Vulnerable populations 

Making wise response decisions based on a realistic appraisal 

of what is happening— and what is likely to happen— 

is the best way to ensure the safety of team members. 

Take All Steps to Protect 

Against Exposure 

Enter the Hot Zone or contaminated area only if there is 

some clear benefit from doing so, such as lives that can be 

saved. 

Before entering the Hot Zone, take the following precautions: 

• Review and plan control actions 

• Work upwind and uphill and avoid contact with product 

• Use remote shutdown sources, tools, and equipment to 

help reduce or avoid contamination 

• Select and use the proper type and level of personal 

protective equipment 

Good decontamination procedures offer additional safeguards 

that remove contaminants from PPE. The decontamination 

process should allow team members to exit the 

Warm Zone with the knowledge that all of the contaminants 

have been removed. 

Site security and clear designation of zones and work areas 

can lessen the opportunity for exposure by eliminating the 

likelihood that contaminants will spread outside the Warm 

Zone. 



Pre- and post-entry assessments and the use of personal 

hygiene showers are an additional safeguard that helps team 

members leave the incident area free of contaminants. 

Avoid Secondary 

Contamination 

Each technician must work together to closely monitor the 

flow of potentially contaminated personnel, patients, tools 

and equipment. The strict use of control zones and implementation 

of safe work practices and decontamination 

procedures can reduce the opportunity for secondary 

contamination. 

Continuously monitoring members and equipment reduces 

the chance of contaminants spreading outside the Warm 

Zone. In addition, take all possible steps to ensure that 

patients are properly decontaminated prior to treatment and 

transport. Often, simply removing the patient’s clothing 

can remove up to 75% of the hazardous material. Taking 

the time to remove contaminants ensures that EMS personnel 

and hospital staff will not be unnecessarily exposed. 

One of your chief responsibilities is to strictly limit the 

opportunity for contamination outside of the incident area. 

Keep Your Health and Safety 

a Top Priority 

Remaining healthy and safe in the hazardous materials 

emergency response setting means having a proactive plan. 

Much like emergency response preparation, it requires 

learning in advance what the risks are and determining the 

special problems you may encounter. 

Learn the personal health program components that make a 

difference. Medical reviews, exercise, diet, and rest create 

a healthy responder with a strong reserve capacity. 

Taking a planning approach to incident safety helps you 

take the “guess” out of the work and focus instead on the 

safest, most efficient way to accomplish the tasks. A good 

plan includes analyzing the hazard, having sufficient 



resources, and creating a comprehensive site safety assessment. 

Finally, examine the risks and the potential benefits and 

take only those actions that are wise, prudent and safe. 

Activity 





Elements of a 

Proactive Safety 

Strategy 

The safest possible emergency scene is one where careful 

observation and planning results in a strategy that takes into 

account all of the known hazards. Unnecessary guesswork 

can create an incident scene where responders take the 

wrong actions with catastrophic results. Having a proactive 

safety strategy helps plan for the emergency in advance so 

you have as much information as possible when you go to 

work. 

Thorough Planning 

Effective pre-planning is the keystone of a safe response. 

This is particularly true where hazardous materials emergencies 

are concerned. Thoroughly pre-plan high hazard 

occupancies; those that frequently have problems, or areas 

where an event could be catastrophic should be thoroughly 

planned in advance. Gaining key information about the 

processes and products used at these facilities can make 

initial emergency actions more safe and effective. Good 

planning means that you will know essential information 

such as building construction, in-place protection procedures, 

and professionals who can be contacted both on and 

off site. 

Many transportation corridors are sites of repeated hazardous 

materials incidents involving roll-overs and fires. 

These target transportation hazards can be pre-planned to 

determine the safest and most effective way to handle a 

spill if it occurs. Be sure to identify critical items such as 

water supply and storm drainage. In addition, you can 

identify local and state resources who can respond during 

an incident. Knowing these contacts in advance ensures a 

safer response. 



Adequate Resources 

While you can never know exactly when or where an 

incident will occur, you can identify the available resources 

in advance. In addition to traditional fire and rescue companies, 

specialized department resources such as technical 

rescue and hazardous materials teams should be noted. The 

availability of mutual aid departments is also an important 

resource. Often, these mutual aid sources can assist directly 

in an emergency or provide standby service. 

In hazardous materials emergency response, identifying 

resources in advance is particularly crucial. Industry 

experts, chemists, and spill control teams as well as local 

and state governmental agencies, can provide important 

help while the emergency is under way. To make the most 

of these resources, identify them in advance and build a 

working relationship before an emergency occurs. 

Other resources include federal assistance such as the: 

• Coast Guard 

• Environmental Protection Agency 

• Occupational Health and Safety Administration 

Effective, comprehensive development of resources before 

the incident means a safer coordinated response. 

Hazard Analysis and Risk Assessment 

Once target areas have been identified, you can determine 

the likelihood that an event will occur at a particular occupancy. 

When visiting a petroleum tank farm, for example, 

you should learn every aspect about large storage tanks, 

large diameter pipeline delivery systems, and bulk delivery 

by tanker trucks. This process allows you to determine not 

only the full range of hazards, but also the emergencies that 

are most likely to occur. Learn about what goes on at a 

particular facility by reviewing information such as permit 

applications, inspection reports, Material Safety Data 

Sheets, and site drawings. By filling in these important 

blanks ahead of time, you reduce the unknowns and create a 

safer emergency response when you arrive on the scene. 



Site-Specific Safety and Health Plan 

Before beginning operations at a hazardous materials 

incident, develop a basic safety and health plan that takes 

into account the special concerns and risks associated with 

that incident. Doing this ensures that, at each incident, you 

take the time to determine the incident characteristics that 

pose the greatest risk. For example, have you taken the 

time to evaluate the secondary hazards of all materials 

involved? Have you clearly identified the hazards associated 

with each of the tasks that may be performed? Observing 

the incident scene from a safety plan point of view 

will help to ensure a low-risk response. Many of the items 

included in a safety and health plan review can be completed 

during preplanning activities at target hazard locations. 

• Safety and health risk or hazard analysis for each site 

task and operation in the work plan. For example, if a 

drum filled with a flammable and toxic substance is 

uprighted and moved, are controls and tools in place to 

safely move the container and avoid creating sparks? 

• Adequacy of personal protective equipment. Research 

for chemical hazards to ensure that the protective 

clothing you choose meets the needs of the wearer and 

the tasks that will be performed. 

• Environmental and air monitoring. A primary 

component of the safety plan is the reconnaissance and 

characterization effort. The use of appropriate instrumentation 

can help determine exactly what hazards are 

present, and in what concentrations. 

• Decontamination procedures. Review and verify 

proper decontamination procedures during the research 

process. These procedures outline the steps that must 

be taken to ensure that team members are free of all 

contaminants when they exit the Hot Zone. 

• Emergency action plan. Just because you have responded 

to an emergency does not mean that an emergency 

can not occur once you have begun operating. 

Protective equipment failures and sudden product 



releases can necessitate quick action on the part of the 

emergency response team. The plan must identify these 

likely scenarios and how the team will respond if an 

emergency occurs. These items include emergency exit 

routes, decontamination procedures, and the provision 

of emergency care. 

• Confined space operations. If the emergency event 

involves confined spaces, then appropriate procedures, 

equipment, and personnel must be in place to ensure a 

safe entry, if one is deemed appropriate. 

• Pre-entry briefing. Prior to any crew entering the 

Warm or Hot Zone, or performing tasks where personal 

protective equipment is required, they should receive a 

briefing by an operations officer who defines the tasks, 

equipment required, special conditions or concerns, and 

relevant emergency procedures. 

The site safety plan should also include information on site 

security and control, general evacuation routes and procedures, 

personnel roles, lines of authority, and communication. 

With this information, everyone knows who is in 

charge of the incident and exactly what to do if an emergency 

occurs during operations. 



Application Exercises 





Application Exercise 

You will need: 

• Five drums or other containers that could be used for hazardous materials 

• Descriptions of five very short incident scenarios incorporating hazardous materials 

common in your local area 

• Do not specifically identify the hazardous materials in the scenarios 

• Use at least three hazard classes 

• Use different levels of toxicities for each chemical 

• Incorporate victims, vulnerable areas, etc. 

• UN ID numbers for the hazardous materials used in your scenarios 

• North American Emergency Response Guidebooks 

• Additional reference books and other resource material normally used within the department 

• Twenty-five copies of the questions on the following page 

Preparation: 

This exercise is intended to help students understand the effects of hazardous materials and take 

appropriate actions to protect themselves. Set up the drums or containers at various places 

around the training facility. Tape one scenario and the related UN ID number to each container. 

(Make sure the containers are appropriate for the chemical.) 

Divide the class into five groups. Give each group a North American Emergency Response 

Guidebook, and any other reference materials they would have access to in their department, and 

five copies of the questions on the following page. Do not allow them to use their Student Texts. 

Assign one group to each container. Tell the groups to read the scenario, identify the chemical 

using the UN number and the Guidebook, and answer the questions on the following page. After 

about 30 minutes, rotate groups to different containers. Continue the rotation until all groups 

have had the opportunity to work through each scenario. Reconvene the class and discuss each 

group’s responses to the questions. 





Application Exercise 

Read the scenario attached to the container and identify the chemical. Using any other resources 

to which you would normally have access, research the chemical and answer the following 

questions. 

1. From what you know about the hazardous material and the situation, how would you 

assess the risks and benefits of taking offensive action in this scenario? 

Material Involved Risk Benefit Assessment 

(Action taken) 

2. What is the DOT hazard class for this material? 

3. What are the health effects of this material, both acute and chronic? 

4. Has the victim(s) been exposed, contaminated, or both? 

5. What signs and symptoms should you look for in the victim(s)? 

6. Which body system will suffer the most serious effects? 

7. What action would you take if you were exposed to this material? 





Action Statement 





Action Statement 

You have just completed the third module of the Hazardous Materials Technician course. The 

topics included: 

• Assessment of the risks and benefits of taking action in a hazardous materials incident 

• Categories of hazardous materials and their health effects 

• Terms related to hazardous materials 

• Toxicities of specific classes of hazardous materials 

• Toxic effects in specific organ systems 

• Elements of a proactive health strategy 

• Health and safety response principles 

• Elements of a proactive safety strategy 

Knowing how you respond to emergencies in your first due areas, would you change your actions 

or habits based on the information covered in this module? Listed below are some suggested 

actions. Some you may already do, and others may not fit your work environment. If there are 

actions you have not done in the past, do you think you will begin doing them as a result of this 

training? 

As a result of this training, I will: 

1. More carefully assess the risks and benefits of taking action in a hazardous materials 

incident 

2. Take greater measures to protect myself from the toxic effects of specific classes of 

hazardous materials 

3. During an incident, look for signs and symptoms in the public and fellow responders that 

could indicate possible exposures to hazardous materials 

4. Discuss the specific elements of my medical surveillance plan with an occupational 

health physician 

5. Promote my own well-being through more exercise and healthier personal habits 

6. Conduct more and more thorough pre-incident plans 

7. (Create my own action statement) 

________________________________________________________________________ 

________________________________________________________________________ 

________________________________________________________________________ 





Appendix A 

Activities 





Risk/Benefit Activity 1 

List the risks and benefits of the following situations. As a class, assess each situation and 

determine the action you would take. 

Scenario 

You arrive at the scene of an 

overturned diesel truck. The 

driver is trapped and calling 

for help. 

You respond to the scene of a 

fully involved corner grocery 

store fire at 0200. 

Risks of Offensive Action 

Benefits of Offensive Action 

You are called to the scene of 

an abandoned building where 

you discover several containers 

and a leaking drum 

labeled “muriatic acid”. 

You respond to a tank car 

leaking ammonia in an 

isolated area around 1300 

hours. Approximately 10 

yards away ammonia readings 

are 100 ppm; approximately 

1,000 yards away 

readings are 0. 

You respond to a tank car 

leaking chlorine gas behind a 

manufacturing plant on 

Sunday. A calm wind is 

blowing toward a residential 

area 2,000 yards away. 

Chlorine readings are 500 

ppm in the area of the plant. 





Categories of Toxic Substances Activity 2 

For each of the categories below, have the students list at least one chemical example and three 

signs or symptoms of exposure. This exercise can be conducted verbally or in writing. 

Category Chemical Signs/Symptoms 

Simple Asphyxiant 

Chemical Asphyxiant 

Corrosive (Acid) 

Corrosive (Base) 

Irritant 

Sensitizer 

Carcinogen 

Neurotoxin 

Mutagen 

Teratogen 

Infectious Agent 





Definitions Activity 3 

Read the definitions below, and ask the class to verbally respond with the appropriate term. 

Definition 

Term 

The study of poisons 

The lethal dose for 50% of animals being 

tested; a measure of toxicity 

Refers to how long a substance remains 

in contact with the body 

High level, short-term exposure 

Milligrams per cubic meter; a measurement 

of concentrations of solids 

The average airborne concentration of a 

potentially toxic substance for which an 

employee can be exposed for eight hours 

Low level, long term exposure 

Toxic level determined by NIOSH for 

escape only 

An agent or substance capable of 

causing harm 

The average airborne concentration of a 

substance to which most adults are 

exposed during an eight-hour workday 





Exposure Activity 4 

Complete the Routes of Exposure and Health Effects columns. 

Situation Product Released Route of Exposure Health Effects 

Ruptured cylinder valve 

1001B chlorine 

Chlorine vapor 

Broken fiberboard 

container, sodium 

hydroxide spill 

Granular dust 

Overturned low-pressure 

transport container, 

gasoline 

Flammable liquid 

Broken one-liter 

containers, 

pesticide 

Liquid 

organophosphate 





Chemical Explosion Case Study Activity 5 

In May 1996, a large chemical manufacturing company in the northeast exploded, killing five 

people. The company made pharmaceutical products and used a wide variety of hazardous 

materials. Two other fatal chemical explosions had occurred in the same area in the past. At the 

time of the event, approximately 400,000 pounds of chemicals were stored in the complex. 

On the night of the explosion, workers were mixing hazardous materials as part of a routine 

chemical process. As a result of a repair procedure, a small amount of water was added to the 

mixture causing a flammable gas to slowly develop. While employees were operating in the 

immediate area of the container, it vented a large amount of flammable gas and a deadly explosion 

occurred, killing the five workers and injuring several others. Some 75,000 square feet of 

plant space was involved in fire or damaged by the blast. Included in the fire were a wide range 

of hazardous materials including aluminum powder, dipropylketone, lead, benzene, and methyl 

chloride. 

Fire fighters arrived and initiated a primarily defensive attack with truck companies entering the 

building to conduct search and rescue operations. One severely burned employee was removed 

from the structure. 

While fire fighters were wearing SFPC and SCBA, it is likely that some contamination or exposure 

occurred, particularly to truck company members who conducted the search. 

Use the NIOSH Pocket Guide to determine possible routes of exposure, target organs, and 

medical surveillance options. 

1. What are the routes of exposure for lead? 

What are the target organs for lead? 

What first aid steps are appropriate for a lead exposure? 

Is medical monitoring possible? 

2. What are the routes of exposure for aluminum powder? 

What are the target organs for aluminum powder? 



What are the symptoms of exposure? 

3. What are the routes of exposure for dipropylketone? 

What are the target organs for dipropylketone? 


4. What are the routes of exposure for benzene? 

What are the target organs for benzene? 

What first aid steps are appropriate for a benzene exposure? 


5. What are the routes of exposure for methyl chloride? 

What are the target organs for methyl chloride? 

What first aid steps are appropriate for a methyl chloride exposure? 




Mt. Helena, Arkansas Case Study Activity 6 

Pesticide-fueled factory blaze spreads toxic fumes in Arkansas. 

May 9, 1997 

West Helena, Arkansas (CNN) 

Three fire fighters died fighting a raging fire as a plume of black, “very toxic” smoke covered 

this small Mississippi River town, forcing hundreds of people to leave their homes and businesses. 

State police say 16 people were injured in the explosion that preceded the fire at the BPS Inc. 

chemical packaging plant. 

Francis Huddleston of the Arkansas Office of Emergency Services said the blast released an 

“unknown quantity of toxic gas.” Another source at the OES described the fumes as “very 

toxic.” 

The fire fighters who were killed were outside the warehouse when the smoldering chemical 

triggered the blast, a fire official said. 

“They suspect the cinder block wall and parts of the roof fell on them,” said Tim Snyder, the 

assistant fire chief in neighboring Helena. 

Gov. Mike Huckabee praised their heroism. “These are the folks who got right in the middle and 

go where angels fear to tread,” he said after going to the plant. Huckabee declared a state of 

emergency, allowing the community to use state personnel to deal with the crisis. 

The cause of the fire is believed to have been a smoldering bag of pesticide which caught fire and 

ignited the explosion shortly after 1 p.m. 

“We saw white smoke and heard an explosion...and then we saw a lot of fire,” said Vickie 

Bolden, who works at Helena Chemical, a short distance from BPS. “The flames were so high--- 

150 feet---then the smoke turned black, and it was dark from then,” she said. “The fumes would 

burn your nose, it smelled bad, like ammonia, where it would take your breath”. 

A source from the state Department of Pollution Control and Ecology said the primary chemical 

involved was azinphosmethyl. Other pesticides were involved as well, and all are considered 

dangerous. 

The city’s regional hospital, Helena Regional Medical Center, was evacuated because of the 

fumes. Some of the hospital’s 44 patients and 150 employees were taken to a local community 

college. Other patients were taken to a hospital in Clarksdale, Mississippi, 30 minutes away. 

“It was like a thunderbolt that landed outside the building,” said hospital spokeswoman Jan 

Chambers. “It smells pitiful. It’s a strong odor. Very strong.” 



The smoke could be seen billowing above the plant after the explosion from three miles, and was 

carried by the wind across the river toward Mississippi. Areas up to a mile away were evacuated, 

including the southern part of Helena. A spokesperson for the Chamber of Commerce said a 

residential subdivision near the plant was also evacuated. 

Others in Helena and West Helena, with populations totaling about 18,000, were told to stay 

inside and shut their windows and doors. “We haven’t left our building,” said Nota Johnson of 

the Helena Chamber of Commerce. 

The Lady Luck and casinos across the river in Lula, Mississippi considered closing, but gambled 

on staying open and won. Winds carried the worst of the fumes south of the casino complex. 

Reuters contributed to this report. 

Edited from 1997 Cable News Network, Inc. 

Questions 

1. Using your resources, list the hazards and toxic effects of azinphosmethyl. 

2. What is the acronym that describes the symptoms associated with this type of pesticide? 

3. How do you treat exposure to this type of pesticide? 



Henderson, Nevada Case Study Activity 7 

In May of 1991, the National Institute for Occupational Safety and Health (NIOSH) received a 

request for a health hazard evaluation (HHE) from the International Association of Fire Fighters 

(IAFF), on behalf of members in the Clark County, Nevada and Henderson, Nevada fire departments. 

Fire fighters in these departments responded on May 6, 1991, to a chlorine leak at the 

Pioneer Chlor Alkali plant located just outside the Henderson city limits. The IAFF reported that 

several fire fighters who responded to this incident had developed respiratory symptoms that they 

attributed to chlorine exposure. 

Three weeks after the incident, NIOSH investigators held joint meetings with representatives 

from local fire departments. Information from these meetings, various records, and interviews 

were used to reconstruct events and procedures followed during the incident response and to 

review incident medical care and fire fighter symptoms. Six months following the May 6 chlorine 

leak, 150 medical questionnaires were sent by mail to the involved police and fire departments 

for completion by workers potentially exposed during the incident. 

According to available figures, approximately 200 fire fighters were involved in the response to 

this emergency. Eleven fire fighters were hospitalized or held for observation, and several others 

were reportedly injured by exposure to the chlorine. Many of the fire fighters complained of skin 

irritation and respiratory difficulty, even though they were wearing self-contained breathing 

apparatus (SCBA) and structural fire fighter protective clothing. Although a Community Awareness 

and Emergency Response (CAER) plan had previously been devised by the chemical manufacturers 

at the industrial complexes where the Pioneer plant is located and the local emergency 

response units, this plan was reportedly not activated. Air monitoring performed by the Clark 

County Health District (CCHD) indicated that chlorine concentrations during the incident ranged 

from less than 0.2 to 17 parts per million (ppm). Due to the weather conditions, the chlorine 

plume was unpredictable, and the command post was relocated on four occasions. Representatives 

from the responding agencies indicated that there were several instances of coordination 

and communication difficulties. Reported concerns and problems encountered during the incident 

response included delays in the response of the hazardous materials teams; deployment and 

use of appropriate personal protective equipment; the lack of a common communications frequency 

for all participating agencies; and the need for appropriate decontamination procedures. 

NIOSH received a total of 59 completed questionnaires: 42 from fire fighters and 17 from 

individuals other than fire fighters. Most fire fighters responding to the questionnaire reported 

inhaling chlorine gas, even though most used SCBA during the incident. Symptoms included 

coughing, tightness in the chest, wheezing, tearing eyes, sore throat, and/or headache after 

exposure to chlorine. Among the questionnaire respondents, symptom occurrence and severity 

were greatest among those stationed at the leak site. The duration of symptoms also appeared to 

increase with proximity to the chlorine leak. Symptom resolution was faster among respondents 

who did not wear SCBA, which suggests that the intensity of exposure experienced, the personal 

perception of respirator need, and improper respirator use were related to symptom duration. 



Questions 

1. Was structural fire fighting clothing sufficient in this incident? If not, what type of 

protective equipment should have been worn? 

2. What type of post-explosive monitoring should be done? 

3. What long-term effects should be investigated as a result of this exposure during an exit 

exam? 



Health Strategy Activity 8 

Discuss the importance of each of the fitness data questions below. 

In an average week during the past month, how often did you walk a mile or more at a time 

without stopping? 

In an average week during the past month, how often did you engage in aerobic exercise for 20 

minutes or more without stopping? 

In an average week during the past month, how often did you lift weights? 

Compared with yourself 10 years ago, would you say that you are more active now, less active 

now, or about the same? 

Aerobic Capacity 

• Test type treadmill, stair machine, exercise cycle, or step test? 

• Capacity ml O 2 

per minute 

• Capacity ml O 2 

/Kg body weight/minute 

Flexibility 

• Sit and reach measured in inches 

Strength 

• Hand dynamometer measured in kilograms 

• Leg dynamometer measured in kilograms 

• Arm dynamometer measured in kilograms 

Endurance 

• Push-ups # in 60 seconds 

• Sit-ups # in 60 seconds 





Four-Step Plan Activity 9 

Scenario 

Hazardous materials technicians respond to assist FRO units already on the scene of an emergency 

incident in an architectural firm located on the fifth floor of an eleven story office highrise. 

The first responding fire fighters responded to a fire alarm in the structure and were met by a 

security guard who indicated there was a strong odor on the fifth floor. The guard is familiar 

with the firm and says there are four to six large ammonia cylinders used in a printing process. 

He reports that there is no one in the firm but there may be cleaning crews on the tenth and 

eleventh floors. 

Divide into four groups and spend three to five minutes listing key safety and health actions, 

including risk/benefit issues, in each of the four steps: 

Analyze 

Plan 

Implement 

Evaluate 





Response Principles Case Study Activity 10 

In May of 1995, a 36-inch pipeline carrying natural gas at a working pressure of 975 psi ruptured 

late in the evening, raining large chunks of debris over a wide area. Located in relatively close 

proximity to the pipeline were a number of apartment complexes, an interstate highway, and an 

asphalt manufacturing plant. Shortly after the rupture of the pipeline, the escaping gas ignited, 

creating a huge fireball that generated intense radiant heat for a significant distance in all directions. 

This radiant energy almost immediately began to ignite occupied buildings in the garden 

apartment complex. Shortly, eight apartment buildings were on fire. 

Hazardous materials problems, primarily at the asphalt plant, included residual gas fires from the 

nearby pipeline, propane, acetylene, asphalt and a burning 20,000 gallon tank of #2 fuel oil. In 

addition, cooling water falling on white hot rocks created a constant projectile hazard as the 

rocks shattered. 

Health and safety response principles include the following steps: 

• Always have a plan 

• Stay alert to changes 

• Only take appropriate actions 

• Take all steps to protect against exposure 

• Avoid secondary contamination 

• Keep your health and safety as a top priority 

Divide into groups and write a list of objectives for each of the principles noted above. Allow ten 

minutes, then report back to the class. 

Always have a plan: 

Stay alert to changes: 



Only take appropriate actions: 

Take all steps to protect against exposure/ Avoid secondary contamination: 

Keep your health and safety as a top priority: 



Appendix B 

Hazardous Toxicants, 

Their Health Effects, 

and Medical Monitoring 





Hazardous Substance 

or Chemical Group 

Target Organs 

Potential Health Effects 

Medical Monitoring 

Aromatic 

Hydrocarbons: 

Benzene 

Ethyl benzene 

Toluene 

Xylene 

Blood 

Bone marrow 

Central Nervous System 

(CNS) 

Eyes 

Respiratory system 

Skin 

Liver 

Kidney 

All cause: 

CNS depression: decreased 

alertness, headache, sleepiness, 

and loss of consciousness. 

Defatting dermatitis. 

Benzene suppresses the 

functioning of bone marrow 

(which makes white and red 

blood cells). Chronic exposure 

can cause leukemia. 

Occupational/general medical 

history emphasizing prior 

exposure to these or other toxic 

agents. 

Medical examination with focus 

on liver, kidney, nervous system, 

and skin. 

Laboratory testing: 

Complete blood count (CBC) 

Platelet count 

Note: Because other aromatic 

hydrocarbons may be contaminated 

with benzene, related 

health effects should be 

considered when exposure to 

any of these agents is suspected. 

Measurement of kidney and 

liver function. 

Asbestos (or 

asbestiform 

particles) 

Lungs 

Gastrointestinal system 

Chronic effects: 

Lung cancer 

Mesothelioma 

Asbestosis 

Gastrointestinal malignancies 

Asbestos exposure coupled with 

cigarette smoke has been shown 

to have a synergistic effect in the 

development of lung cancer. 

History and physical examination 

should focus on the lungs 

and gastrointestinal system. 

Laboratory tests should include 

a stool test for occult blood 

evaluation as a check for 

possible hidden gastrointestinal 

malignancy. 

A high quality chest x-ray and 

pulmonary function test may 

help to identify long-term 

changes associated with asbestos 

diseases; however, early 

identification of low-dose 

exposure is unlikely. 

Halogenated 

Aliphatic 

Hydrocarbons: 

Carbon tetrachloride 

Chloroform 

Ethyl chloride 

Ethylene dibromide 

Ethylene dichloride 

Methyl chloride 

Methyl chloroform 

Methylene chloride 

Tetrachloroethane 

(perchloroethylene) 

Trichloroethylene 

Vinyl chloride 

CNS 

Kidney 

Liver 

Skin 

All cause: 

CNS depression: decreased 

alertness, headache, sleepiness, 

and loss of consciousness. 

Kidney changes: decreased urine 

flow, swelling (especially 

around eyes), and anemia. 

Liver changes: fatigue, malaise, 

dark urine, liver enlargement, 

and jaundice. 

Vinyl chloride is a known 

carcinogen; several others in this 

group are potential carcinogens. 

Occupational/general medical 

history emphasizing prior 

exposure to these or other 

agents. 

Medical examination with focus 

on liver, kidney, nervous system, 

and skin. 

Laboratory testing for liver and 

kidney function; carboxyhemoglobin, 

where relevant. 





Target Organs 



Heavy Metals: 

Arsenic 

Beryllium 

Cadmium 

Lead 

Mercury 

Multiple organs and 

systems including: 

Blood 

Cardiopulmonary 

Gastrointestinal 

Kidney 

Liver 

Lung 

CNS 

Skin 

All are toxic to the kidneys. 

Each heavy metal has its own 

characteristic symptom cluster. 

For example, lead causes 

decreased mental ability, 

weakness (especially hands), 

headache, abdominal cramps, 

diarrhea, and anemia. Lead can 

also affect the blood-forming 

mechanism, kidneys, and the 

peripheral nervous system. 

Long-term effects (in 10 to 30 

years) also vary. Lead toxicity 

can cause permanent kidney and 

brain damage; cadmium can 

cause kidney or lung disease. 

Chromium, beryllium, arsenic, 

and cadmium have been 

implicated as human carcinogens. 

History-taking and physical exam: 

search for symptom clusters 

associated with specific metal 

exposure, e.g. for lead, look for 

neurological deficit, anemia, and 

gastrointestinal symptoms. 

Laboratory testing: 

Measurement of metallic content in 

blood, urine, and tissues (e.g., 

blood lead level; urine screen for 

arsenic, mercury, chromium, and 

cadmium). 

CBC 

Measurement of kidney function, 

and liver function where relevant. 

Chest x-ray or pulmonary function 

testing where relevant. 

Herbicides: 

Chlorophenoxy 

compounds: 

2,4-dichlorophenoxyacetic 

acid (2,4-D) 

2,4,5-trichlorophenoxyacetic 

acid (2,4,5-T) 

Dioxin 

Kidney 

Liver 

CNS 

Skin 

Chlorophenoxy compounds can 

cause chloracne, weakness or 

numbness of the arms and legs, 

and may result in long-term 

nerve damage. 

Dioxin causes chloracne and 

may aggravate pre-existing liver 

and kidney diseases. 

History and physical exam should 

focus on the skin and nervous 

system. 

Laboratory tests include: 

Measurement of liver and kidney 

function, where relevant. 

Urinalysis. 

Organochlorine 

Insecticides: 

Chlorinated ethanes: 

DDT 

Cyclodienes: 

Aldrin 

Chlordane 

Dieldrin 

Endrin 

Chlorocyclohexanes: 

Lindane 

Kidney 

Liver 

CNS 

All cause acute symptoms of 

apprehension, irritability, 

dizziness, disturbed equilibrium, 

tremor, and convulsions. 

Cyclodienes may cause 

convulsions without any other 

initial symptoms. 

Chlorocyclohexanes can cause 

anemia. Cyclodienes and 

chlorocyclohexanes cause liver 

toxicity and can cause permanent 

kidney damage. 

History and physical exam should 

focus on the nervous system. 


Measure of kidney and liver 

function. 

CBC for exposure to 

chlorocyclohexanes. 





Target Organs 



Organophosphate and 

Carbamate Insecticides: 

Organophosphate: 

Diazinon 

Dichlorovos 

Dimethoate 

Trichlorfon 

Malathion 

Methyl parathion 

Parathion 

Carbamate: 

Aldicarb 

Baygon 

Zectran 

CNS 

Liver 

Kidney 

All cause a chain of internal 

reactions leading to neuromuscular 

blockage. 

Depending on the extent of 

poisoning, acute symptoms 

range from headaches, fatigue, 

dizziness, increased salivation 

and crying, profuse sweating, 

nausea, vomiting, cramps, and 

diarrhea to tightness in the chest, 

muscle twitching, and slowing 

of the heartbeat. 

Severe cases may result in rapid 

onset of unconsciousness and 

seizures. A delayed effect may 

be weakness and numbness in 

the feet and hands. Long-term, 

permanent nerve damage is 

possible. 

Physical exam should focus on the 

nervous system. 

Laboratory tests should include: 

Red Blood Cell (RBC) 

cholinesterase levels for recent 

exposure (plasma chloinesterase 

for acute exposures). 

Measurement of delayed neurotoxicity 

and other effects. 

Polychlorinated 

Biphenyls (PCBs) 

Liver 

CNS (speculative) 

Respiratory system 

(speculative) 

Skin 

Various skin ailments, including 

chloracne; may cause liver 

toxicity; carcinogenic to 

animals. 

Physical exam should focus on the 

skin and liver. 


Serum PCB levels. 

Triglycerides and cholesterol. 

Measurement of liver function. 

This table was adapted from DHHS, 1985, Occupational Safety and Health Guidance Manual for Hazardous Waste Site Activities. 

DHHS (NIOSH) Publication Number 85-115. 





Appendix C 

Physical Examination Overview 





Physical Examination Overview 

A comprehensive physical examination involves many areas of assessment. Below is a listing 

and description of specific components: 

1. General Survey 

Apparent state of health, signs of distress, skin color, stature, weight, posture, gait, dress, grooming, 

hygiene, odors, facial expressions, manner, mood, relationship to surroundings, speech and 

state of awareness. 

2. Vital Signs 

The pulse (normal resting pulse is 60-100 beats per minute), respiratory rate (normal resting rate 

is 12-16 breaths per minute), and blood pressure (normal resting is 120/80). Cardiac or heart 

disorders may be giving clues, such as irregular pulse or elevated blood pressure. 

3. Skin 

The color, vascularity (circulation), lesions, edema, moisture, temperature, texture, and mobility 

are examined. Some diseased states have definite skin changes, i.e. liver disease. Also, infectious 

skin problems may be evident. 

4. Head 

The hair, scalp, skull, and face are examined for appearance. General protein production is 

inhibited in starvation (poor diet), which is reflected in reduced hair growth and dullness in hair 

appearance. Drugs can cause abnormal hair loss. Tumors can cause increased hair growth in 

normal sites. 

The skull is assessed for size and shape. The shape is generally round with several prominences 

over underlying bones. Previous fractures or hereditary traits may show up in the shape of the 

skull. 

Obviously your facial appearance can change at a moment’s notice (i.e. where the doctor’s hand 

is) but, in general, your face is observed for symmetry in size, position, and movement. Pulmonary 

disease may be detected through bluish lips. Edema may be evident in puffy eyelids. 

Prolonged illness may produce the appearance of sunken eyes, cheeks, and temple. Signs of 

nerve damage may show up in each side of the face being different from the other. 

5. Eyes 

The visual acuity and fields of your actual vision, position of eyes, lacrimal apparatus (tear 

ducts), conjunctiva and sclera, cornea, iris, pupils, extraocular movements and eye muscles are 



examined. A fundoscopic exam (looking at blood vessels behind the eye’s surface) is performed 

where the doctor can look at the course of blood vessels as they emerge from the center of the 

eye. High blood pressure and diabetes may be evident when abnormal blood vessels are present 

in the discs of the eyes. 

6. Ears 

Stretching across the back (inside) portion of the ear canal is the tympanic membrane (ear drum). 

This membrane separates the external ear from the inside ear or middle ear. The doctor will 

insert a light source instrument into the external ear and assess the tympanic membrane for tears 

or scars, wax build up in the canal, membrane inflammation, or discharge. A hearing check will 

be conducted by a technician who assesses your ability to hear high and low sound frequencies. 

High frequency hearing loss may be the result of exposure to noise. 

7. Nose and Sinuses 

The external nose, inner-septum mucous and turbinates (thin plicated membranes on nasal wall) 

are examined. 

8. Mouth and Pharynx 

The lips, mucosae (mucous membranes), gums, dentition (teeth), tongue and pharynx are examined. 

Any growth, oral lesions, or gum disease are noted, if present. 

9. Neck 

The trachea and thyroid are palpated and inspected for lymph nodes which will show a reaction 

to infection and other problems. The thyroid gland is situated in the front and on the sides of the 

neck and produces hormones vital to normal growth and metabolism (body’s chemical process to 

use food for energy). An enlarged thyroid gland may indicate excessive thyroid activity which 

increases metabolism. 

10. Back 

The spine and back muscles are palpated for tenderness. The CVA (costovertebral angle) or 

flank is checked for tenderness which could indicate kidney problems. 

11. Thorax and Lungs 

The thorax and lungs are inspected and listened to for evidence of asthma, chronic obstructive 

pulmonary disease (COPD), or other problems. Wheezing sounds are indicative of asthma; 

coarse breath sounds could be the result of a simple cold or early signs of heart failure. 



12. Breasts and Axilla (Armpit) 

In a woman, the breasts are examined with arms relaxed, then elevated and then again with hands 

pressed against the hips. Inspection and palpation are used in the examination; no special equipment 

is necessary. The breasts are examined for symmetry of shape, color, size, and surface 

characteristics. The axilla is likewise examined. 

Male breast cancer accounts for approximately 1% of all breast cancers. Every male should be 

given a thorough breast examination with an adaptation of the technique used for females. If you 

are male, your physician may or may not do a breast exam on you. If you have changes in your 

breast size or soreness, tell your doctor. 

13. Heart 

The heart is inspected and auscultated. It will be listened to in several areas, with the bell of the 

stethoscope. Your doctor will be listening for heart rate, regularity, presence or absence of 

murmurs, rales (funny sounds), or other unusual sounds. The jugular pulse and carotid pulses are 

checked and compared. 

14. Abdomen 

The abdomen is inspected, percussed, and palpated. Tenderness, masses, organ enlargement, and 

previous surgical scars are all evaluated. 

15. Inguinal Area 

The inguinal (groin) area will be palpated over the femoral vessels checking for various types of 

hernias that may show up as bulges or impulses. An impulse may be felt when you turn your 

head and cough. Your doctors may also have you bear down as this elicits a more sustained 

pressure. 

16. Genitalia and Rectal Examination in Men 

The penis, scrotal contents, anus, rectum, and prostate are examined checking for any unexpected 

growth, nodes, hemorrhoids, or prostate enlargement. Cancerous growth may be present 

and detected only by growth, as many are painless. 

17. Legs 

Vascularity (circulation), muscles evaluation and legs are palpated for edema. Edema may 

indicate poor cardiac muscle or possibly an insufficient venous system which inhibits the blood 

return. 



18. Musculoskeletal 

The range of spine motion, leg alignment, and feet are evaluated. If there is evidence of arthritis 

or scoliosis (spine curvature), an evaluation of each joint may be done. 

19. Neurological Exam 

The mental status, cranial nerves, motor system, sensory system, and reflexes are examined. 

Many parts of the neurological examination may be incorporated into other parts of the physical 

examination. You may expect to stick out your tongue, shrug your shoulder, demonstrate eyehand 

coordination, walk on your toes, or walk the line. A more detailed exam will be done, if 

there is any question or abnormality. 

20. Flexible Sigmoidoscopic Exam 

In the proctoscopic examination, your doctor looks into the lower rectum and colon area with a 

flexible scope. This can detect ulcers, hemorrhoids, and silent cancer of the lower colon, which 

is common in men and women over the age of 40. This examination is uncomfortable and not 

too popular, but is very effective in detecting cancer. 



Laboratory and Other Medical Tests 

In addition to the physical examination, various medical tests will be completed as described 

below: 

21. Audiometry 

The hearing test (in a testing booth) will check for any abnormal hearing losses, such as high-end 

frequency loss from nerve damage to the ear. In the testing booth, the hearing for each ear is 

measured from 125 to 8,000 Hz by air conduction (using earphones). Hearing loss is measured 

in decibels. Test results are run through some formulas and plotted on a graph. The results are 

explained by the doctor. 

22. Urinalysis 

A urinalysis is a common test that gives evidence of kidney and other internal abnormalities. 

Urinalysis is usually routine and done with all periodic health examinations. The first part is the 

specific gravity, which is the ability of the kidneys to concentrate urine allowing the kidneys to 

hold water inside the body. The other part of the test is the microscopic examination of the urine, 

checking for white blood cells, which would be indicative of an infection in the urinary tract 

system, the bladder, or the kidneys. Under microscope, the urine is evaluated for crystals that 

would be indicative of gout or other abnormalities. The urinalysis can also show tumors or 

kidney stones. 

23. Electrocardiogram 

The electrocardiogram checks the electrical activity of the heart. Numerous leads are placed on 

your body to measure the electrical activity from different planes. This test can show evidence 

or suspicion of abnormalities in the coronary arteries, and hardening or thickening of the heart 

muscle. In the treadmill stress test, a continuous electrocardiogram is taken. The treadmill stress 

test may show abnormalities of the heart that a resting EKG might not show. In fact, the treadmill 

stress test is normally done when the resting EKG test appears normal but you have been 

experiencing pain. With the EKG leads in place, you walk on a treadmill at a set speed and 

incline. Normally no EKG change is observed other than a heart rate increase. But if the extra 

physical activity cuts down the amount of oxygen reaching the heart muscle, it may show up on 

the EKG. If this occurs, the treadmill stress is stopped immediately and your heart will be 

evaluated for clogged arteries, etc. through additional specialized tests. These additional specialized 

tests are not part of your routine medical exam at the Health Center but rather referred to 

your primary care physician. 



24. Radiology 

A chest x-ray is taken annually if you smoke, otherwise, every three years unless other findings 

are detected during the medical exam. In radiology, an x-ray beam passes through the heart and 

lungs from the posterior to the anterior part of the body (back to front); it also runs from side to 

side (left to right). The x-ray shows bony structures of the spine, and those bony structures 

surrounding the heart, lungs, and rib cage. It can identify broken ribs and abnormalities of the 

trachea and its branches. It shows a limited view of the lung tissue itself. Other abnormalities 

like tuberculosis, some tumors, and cancers will show up as white spots on a black view. The 

heart also makes a shadow on the x-ray that can be measured. An enlargement of the heart may 

be indicative of such things as congestive heart failure. 

25. Pulmonary Function Test 

The pulmonary function test measures the amount of air that goes through the mouth and trachea 

into the lungs and is broken down into two functions. The first function is the flow test, which 

measures the amount of air expelled from the lungs. This is referred to as forced expiratory 

volume. Forced expiratory volume is the amount of air that you can blow out as fast as possible 

from your lungs. It measures the ability of someone to breathe. Decreased pulmonary function 

may be traced to cigarette smoking, asthma, or chronic bronchitis. The second function is the 

test that measures the volume of air held in the lungs after expiration. The results can be indicative 

of emphysema, infection, or other exposures, such as chemicals. 

Blood Tests 

Blood tests can provide your doctor with a database for use in analyzing your health and to 

verify information found in your physical examination. In the comprehensive blood test, four 

tubes of blood are needed. This is taken from a vein in your arm. The more common tests are 

listed below. 

26. Hemoglobin 

The blood’s ability to carry oxygen is dependent on the amount and effectiveness of the hemoglobin. 

Exposure to toxic substances can alter the hemoglobin, as can iron deficiency and some 

states such as sickle cell anemia. 

27. Complete Blood Count (CBC) 

The complete blood count is evaluated for several different things. The first is the white blood 

count (the number of white blood cells in the blood). The white corpuscles are basically the 

body’s defense mechanism. They are divided into two main groups, the neutrophils and the 

lymphocytes. The neutrophils fight bacterial infections such as strep throat, pneumonia, bacterial 

meningitis, and other common and serious infections. The lymphocyes are cells that fight such 

things as the flu and gastroenteritis. The CBC also measures the eosinophils which respond to 

allergies. 



28. SGPT and SGOT 

These two tests are part of the chemistry panel evaluated at each physical. These are enzymes 

(catalysts for biochemical reactions) that can screen for organ damage, such as liver inflammation 

from hepatitis or toxic chemical exposures. 

29. Uric Acid 

This is the chemical responsible for gout (painful inflammation of the joints), which is a form of 

arthritis. Uric acid levels in your body can vary depending on your diet. If your doctor feels the 

uric acid level is high, he may question you about the types of foods you eat. 

30. Cholesterol 

This is a solid alcohol called a steroid (steroid compounds also include hormones and vitamins), 

which is vital for proper brain and nervous system function. Elevated cholesterol levels are 

thought to be a high risk for heart attacks. Your doctor will evaluate your cholesterol level 

against your diet and physical exam findings. 

31. Triglycerides 

Triglycerides are essentially blood fats that may contribute to cardiac disease. High triglycerides 

can also be a sign of alcoholism and obesity. 

All of these intensive, technological tests and doctor’s examination combine to provide a comprehensive 

review of your mental and physical well being. Each component helps to confirm 

findings found on either the physical exam or other medical tests. Additional tests are many 

times needed in order to further identify the severity of a disease process. These tests are recommended 

by the Health Center physician but referral is made back to your primary care physician 

for follow through. 





Appendix D 







The fire department physician must be chosen with care. The fire department is involved with 

the health, wellness, fitness and safety of uniformed personnel from the beginning of their careers 

(candidate evaluations), throughout their careers (annual health/fitness evaluations), during 

injury/illness (referrals, rehabilitation, counseling, and reevaluations), at retirement from active 

duty (retirement evaluations), and, in many jurisdictions, during their retirement years. 

Ideally, this professional should be board certified in occupational medicine, internal medicine, 

or family medicine. The fire department would also benefit from physicians specializing in 

fields relevant to the fire service such as occupational toxicology, industrial hygiene, epidemiology, 

infectious disease, pulmonary care, cardiology, critical care, orthopedics, physiatry, burn 

care, and/or emergency medicine. 

The ability to interact successfully with other professionals is essential since no single person can 

be a specialist in all of the prescribed areas. The fire department physician must have a thorough 

knowledge of job related activities, physical demands of the occupation and stresses associated 

with fire fighting. The individual must be able to conduct job analyses, remain current on medical 

literature pertaining to fire service related issues, and conduct ongoing research related to fire 

fighters’ health, safety, and fitness. 

Additionally, the fire department physician must have knowledge of local, state, provincial, and 

federal laws as well as the roles of labor and management relating to occupational medicine, 

health, and safety. 

The fire department physician must be capable of intervening to prevent illnesses and injuries of 

other fire fighters doing the same job as those currently being treated for occupational exposures 

or physical injury, while maintaining personal credibility and patient confidentiality. 





Appendix E 

Salem, NH Nitric Acid Spill 





Salem, New Hampshire Nitric Acid Spill 

Quick action by workers for two companies and emergency response teams kept a chemical spill 

in Salem, N.H. from becoming a disaster. 

Two chemists from Safety Kleen, a North Andover company that cleans up and removes hazardous 

materials, were removing a bottle of nitric acid from Dames and Moore, a Salem environmental 

consulting firm. The bottle disintegrated in the hands of one of the chemists, spilling 

about a gallon of the corrosive liquid. 

The chemists were wearing protective clothing, but a Dames and Moore engineer, Mark Kirouac, 

who was standing nearby, was not. The acid splashed on him, burning him severely. 

Nitric acid is a corrosive liquid often used to strip metal. It burns the skin and can be deadly. Its 

vapors can irritate the eyes, ears, throat, and lungs. 

The Safety Kleen employees and Mr. Kirouac’s coworkers at Dames and Moore rushed him into 

a nearby shower to wash the acid off. Mr. Kirouac sustained serious injuries requiring skin graft 

surgery, but his doctor and fire officials credited the quick action of those around him with 

sparing him further injury. 

Dames and Moore is located in a building at Five Industrial Way that houses two other businesses, 

Nexus Systems and RAScom. Fire officials evacuated the building, fearing toxic fumes 

from the spilled acid. 

A hazardous materials team formed of specially trained fire fighters from 14 communities set up 

a decontamination area and suited up with protective gear to go inside and locate the spill. They 

found the acid, determined it was not reacting with anything, and allowed Safety Kleen workers 

in to remove it. The Southeastern New Hampshire Hazardous Materials Mutual Aid District was 

formed last November to deal with just such an emergency. 

The response of the hazardous materials team, Safety Kleen, and Dames and Moore workers 

helped get a dangerous situation under control quickly. 

In rushing Mr. Kirouac into a shower, they may have saved his life. The hazardous materials 

team prevented anyone else from being seriously injured by the acid and prevented the contamination 

from spreading. 

Their actions show the value of training and preparation in dealing with emergencies. 





OCCUPATIONAL HEALTH SERVICES — NITRIC ACID - NITRIC ACID,TECHNICAL 

MATERIAL SAFETY DATA SHEET 

NSN: 6810002229655 

Manufacturer’s CAGE: 0G9K0 

Part No. Indicator: A 

Part Number/Trade Name: NITRIC ACID 

=========================================================================== 

General Information 

=========================================================================== 

Item Name: NITRIC ACID,TECHNICAL 

Company’s Name: OCCUPATIONAL HEALTH SERVICES, INC 

Company’s Street: 11 WEST 42ND, 12TH FLOOR 

Company’s City: NEW YORK 

Company’s State: NY 

Company’s Country: US 

Company’s Zip Code: 10036 

Company’s Emerg Ph #: 212-789-3535/615-366-2000 

Company’s Info Ph #: 212-789-3535/800-445-MSDS 

Record No. For Safety Entry: 004 

Tot Safety Entries This Stk#: 014 

Status: SE 

Date MSDS Prepared: 14JUL93 

Safety Data Review Date: 29AUG95 

Supply Item Manager: CX 

MSDS Serial Number: BXQDC 

Specification Number: O-N-350C 

Hazard Characteristic Code: D4 

Unit Of Issue: BT 

Unit Of Issue Container Qty: 500 MLS 

Type Of Container: BOTTLE 

Net Unit Weight: 500 MLS 

=========================================================================== 

Ingredients/Identity Information 

=========================================================================== 

Proprietary: NO 

Ingredient: NITRIC ACID (SARA 302/313) (CERCLA) 

Ingredient Sequence Number: 01 

Percent: 70 

NIOSH (RTECS) Number: QU5775000 

CAS Number: 7697-37-2 

OSHA PEL: 2 PPM 

ACGIH TLV: 2 PPM/4 STEL; 9495 

Other Recommended Limit: NONE RECOMMENDED 

——————————————————- 

Proprietary: NO 

Ingredient: WATER 

Ingredient Sequence Number: 02 

Percent: 30 

NIOSH (RTECS) Number: ZC0110000 

CAS Number: 7732-18-5 

OSHA PEL: NOT ESTABLISHED 

ACGIH TLV: NOT ESTABLISHED 

Other Recommended Limit: NONE RECOMMENDED 



=========================================================================== 

Physical/Chemical Characteristics 

=========================================================================== 

Appearance And Odor: COLORLESS TO PALE YELLOW LIQUID WITH A SUFFOCATING 

ODOR. 

Boiling Point: 181F,83C 

Melting Point: -44F,-42C 

Vapor Pressure (MM Hg/70 F): 47.9 @20C 

Vapor Density (Air=1): 3.2 

Specific Gravity: 1.5027 @25C 

Solubility In Water: VERY SOLUBLE 

pH: ACID 

=========================================================================== 

Fire and Explosion Hazard Data 

=========================================================================== 

Extinguishing Media: WATER,DRY CHEMICAL OR SODA ASH. LG FIRES:FLOOS AREA 

W/WATER FROM A DISTANCE. 

Special Fire Fighting Proc: MOVE CNTNR FRM FIRE W/O RISK.APPLY COOL WATER 

TO CNTNR SIDES EXPO TO FLAME TIL WELL AFAT FIRE IS OUT.STAY AWAY FRM TKS 

ENDS.MASSIVE FIRE IN CARGO AREA USE(SUPP 

Unusual Fire And Expl Hazrds: MAY IGN OTHER COMBUST MATLS(WOOD,PAPER,OIL, 

ETC).RXS VIOLENTLY W/H2O/FUEL.FLAMM,POISONOUS GAS MAY ACCUMU IN TKS/HOPPER 

CARS.RUNOFF TO SEWER CREATE FIRE/EXPLO HAZ 

=========================================================================== 

Reactivity Data 

=========================================================================== 

Stability: YES 

Cond To Avoid (Stability): RXS W/WATER EXOTHERMICALLY. 

Materials To Avoid: COMBUST MATLS,METALLIC POWDERS,HYDROGEN SULFIDE, 

CARBIDES,ALCOHOLS,CORR TO METALS,TURPENTINE,ORG ACIDS,READILY OXID MATLS 

Hazardous Decomp Products: THERMAL DECOMPOSITION PRODUCTS MAY INCLUDE 

TOXIC OXIDES OF NITROGEN. 

Hazardous Poly Occur: NO 

Conditions To Avoid (Poly): NOT APPLICABLE 

=========================================================================== 

Health Hazard Data 

=========================================================================== 

LD50-LC50 Mixture: UNKNOWN 

Route Of Entry - Inhalation: YES 

Route Of Entry - Skin: YES 

Route Of Entry - Ingestion: YES 

Health Haz Acute And Chronic: CORR INHAL/SKIN/EYE/INGEST.HIGHLY TOXIC BY 

INHAL.INHAL:100PPM IMMED DANGEROUS TO LIFE/HEALTH.SEV RESP IRRIT.PULM 

EDEMA,CYANOSIS,RAPID PULSE,TEETH EROSION.SKIN:SEV PAIN,BUNRS,EYLLOW STAINS, 

DERM.EYE:PAIN,LACRIMATIN,PHOTOPHOBIA,BUNRS,BLINDNESS,CONJ.INGEST:CORR OF 

MUC MEMB OF MOUTH/THROAT/EXOPHAGUS,PAIN,UNABLE TO (SUPPLEM) 

Carcinogenicity - NTP: NO 

Carcinogenicity - IARC: NO 

Carcinogenicity - OSHA: NO 

Explanation Carcinogenicity: PER MSDS:CARCINOGEN:NONE. 

Signs/Symptoms Of Overexp: INHAL:COUGH,CHOKE,YELLOWISH BURNS OF MUC 

MEMB.DIZZ,HEAD,NAU,WEAK,TIGHTNESS IN CHEST,DYSPNEA,FROTHY SPUTUM.SKIN:DERM, 

BURNS,YELLOW STAINS.EYE:PAIN,EYE DESTROYED,YELLOW EYE COLOR,CONJ,CORNEA 

VASCULARIZED/OPAQUE.INGEST:SHOCK,WEAK,RAPID PULSE,SHALLOW RESP,CLAMMY SKIN, 



CIRCULARTORY COLLAPSE,ESOPHAGEAL/GASTRIC/PYLORIC STRICTUR 

Med Cond Aggravated By Exp: PERSONS WITH IMPAIRED PULMONARY FUNCTION, 

PRE-EXISTING EYE & SKIN DISORDERS. 

Emergency/First Aid Proc: INHAL:REMOVE TO FRESH AIR IMMED.STOP BREATH GIVE 

ART RESP.GIVE OXY IF AVAILABLE BY QUAL PERSON.SKIN:REMOE CONTAMIN 

CLOTH/SHOE IMMED.WASH W/SOAP/MILD DETERGENT/LOTS OF WATER 15-20MINS.CHEM 

BURN COVER W/STERILE DRY DRESS.BANDAGE SECURELY.EYE:WASH IMMED W/LOTS OF 

WATER OPENING EYELIDS 15-20MINS.CONT W/NORMAL SALINE TIL PH NORMAL(3- 

60MINS).COVER W/STERILE BANDAGES.INGEST:NO GASTRIC LAVAGE/EMESIS.(SUP) 

=========================================================================== 

Precautions for Safe Handling and Use 

=========================================================================== 

Steps If Matl Released/Spill: DIG HOLDING AREA(PIT/POND)TO CONTAIN.DIKE 

SURFACE FLOW(SOIL BARRIER/SANDBAGS)ABSORB LIQ MASS W/FLY ASH/CEMENT POWDER. 

NEUTRALIZE.APPLY WATERSPRAY TO RED VAP.DIKE RUNOFF.DO NOT TOUCH SPILL.STOP 

LEAK W/O RISK.ISOLATE/DENY ENTRY.VENTI CLSD SPACE BEF ENTR 

Neutralizing Agent: SLAKED IME, SODIUM BICARBONATE OR CRUSHED LIMESTONE. 

Waste Disposal Method: SARA TPQ&RQ/CERCLA RQ:1000LBS.OSHA TQ:500LBS.SUBJ 

TO REPORTING.OBSERVE ALL FED/STATE/LOC REGS WHEN DISPOSING THIS SUBSTANCE. 

DISPOSAL MUST BE IAW STD APPLICABLE TO GENERATORS OF HAZ WASTE.EPA HAZ 

WASTE:D002. 

Precautions-Handling/Storing: OBSERVE ALL FED/STATE/LOC REGS WHEN STORING 

MATL.PROT AGAINST PHYS DMG.SEPARTE FRM INCOMPA MATLS.PROVIDE GOOD VENTI. 

AVOID DIRECT SUNLIGHT.SEE NFPA 43A 

Other Precautions: NONE SPECIFIED BY MANUFACTURER. 

=========================================================================== 

Control Measures 

=========================================================================== 

Respiratory Protection: SPEC RESP SELECTED MUST BE BASED ON CONTAMIN 

LEVELS IN WORKPLACE,MUST NOT EXCEED WORKING LIMITS OF RESP,JOINTLY APPROVED 

BY NIOSH/MSHA.ONLY NON-OXIDIZABLE SORBENTS ALOWED(NOT CHARCOAL). 

Ventilation: PROCESS ENCLOSURE RECOMMENDED TO MEET PUBLISHED EXPO LIMITS. 

Protective Gloves: APPROPRIATE PROT GLOVES.(PVC,NITRILE) 

Eye Protection: SPLASH-PROOF/DUST-RESIST SAF GOGG,FACSLD 

Other Protective Equipment: APPROP PROT IMPERV CLOTH/EQPMT TO PREVENT SKIN 

CONTACT.EYEWASH FOUNTIAN,QUICK DRENCH SHOWER W/IN IMMED WORKAREA. 

Work Hygienic Practices: WASH HANDS AFTER HANDLING. 

Suppl. Safety & Health Data: FIREFIGHT:UNMANNED HOSE HOLDER/MONITOR NOZZ. 

IF IMPOSSIBLE W/D LET FIRE BURN.USE FLOOD AMTS OF H2O AS FOG.AVOID BREATH 

VAP.KEEP UPWIND.CONSIDER EVACU DOWNWIND IF LEAKING. HEAL HAZ:SWALLOW/TALK, 

THIRST,DIARR,VOMITUS W/BLOOD/MUCOSA,RENAL FAILURE,DEATH,CONV. 1STAID:DILUTE 

W/100X.IN ALL CASES GET MED ATTN IMMED.NO ANTIDOTE. 

=========================================================================== 

Transportation Data 

=========================================================================== 

Trans Data Review Date: 95241 

DOT PSN Code: KFC 

DOT Proper Shipping Name: NITRIC ACID 

DOT Class: 8 

DOT ID Number: UN2031 

DOT Pack Group: I 

DOT Label: CORROSIVE 

IMO PSN Code: KPF 

IMO Proper Shipping Name: NITRIC ACID 



IMO Regulations Page Number: 8195 

IMO UN Number: 2031 

IMO UN Class: 8 

IMO Subsidiary Risk Label: - 

IATA PSN Code: RWF 

IATA UN ID Number: 2031 

IATA Proper Shipping Name: NITRIC ACID 

IATA UN Class: 8 

IATA Label: CORROSIVE 

AFI PSN Code: RWF 

AFI Symbols: 0 

AFI Prop. Shipping Name: NITRIC ACID, 

AFI Class: 8 

AFI ID Number: UN2031 

AFI Pack Group: II 

AFI Basic Pac Ref: 12-14 

Additional Trans Data: PER MSDS:DOT SHIPPING NAME:NITRIC ACID, UN2031, 

CORR MATL CLASS 8, PG I, LABEL:CORR. 

=========================================================================== 

Disposal Data 

=========================================================================== 

=========================================================================== 

Label Data 

=========================================================================== 

Label Required: YES 

Technical Review Date: 29AUG95 

Label Status: F 

Common Name: NITRIC ACID 

Signal Word: WARNING! 

Acute Health Hazard-Moderate: X 

Contact Hazard-Moderate: X 

Fire Hazard-Slight: X 

Reactivity Hazard-None: X 

Special Hazard Precautions: INHAL:SEV RESP IRRIT.PULM EDEMA,CYANOSIS,RAPID 

PULSE,TEETH EROSION.SKIN:SEV PAIN,BUNRS,EYLLOW STAINS,DERM.EYE:PAIN, 

LACRIMATION,PHOTOPHOBIA,BUNRS,BLIND,CONJ.INGEST:HI TOXIC,MUC MEMB OF MOUTH/ 

THROAT/EXOPHAGUS CORR,PAIN,UNABLE TO SWALLOW/TALK.1STAID:INHAL:MOVE TO 

FRESH AIR IMMED.STOP BREATH GIVE ART RESP.GIVE OXY IF AVAIL BY QUAL PERSON. 

SKIN:REMOVE CONTAMIN CLOTH/SHOE IMMED.WASH W/SOAP/MILD DETERG/LOTS OF WATER 

15-20MINS.CHEM BURN COVER W/STERILE DRY DRESS.BANDAGE SECURELY.EYE:WASH 

IMMED W/LOTS OF WATER OPEN EYE 15-20MINS.CONT W/NORMAL SALINE TIL PH 

NORMAL(3-60MINS).INGEST:NO GASTRIC LAV/EMESIS/DILUTE W/WATER/MILK.IN ALL 

CASES GET MED ATTN IMMED 

Protect Eye: Y 

Protect Skin: Y 

Protect Respiratory: Y 

Label Name: OCCUPATIONAL HEALTH SERVICES, INC 

Label Street: 11 WEST 42ND, 12TH FLOOR 

Label City: NEW YORK 

Label State: NY 

Label Zip Code: 10036 

Label Country: US 

Label Emergency Number: 212-789-3535/615-366-2000 



Appendix F 

Products of Combustion 





Products of Combustion 

Date 

Type of 

Structure 

Details 

Gases present in 

cone above published 

guidelines 

6/13/98 

Single family 

house 

Fire originated in storage shed behind carport and 

extended to include the minivan parked in the carport 

as well as the kitchen/living area 

CO, SO 2 

acetaldehyde, acrolein, 

benzene, formaldehyde, 

glutaraldehyde, PNAs 

6/22/98 

Single family 

house 

Suspected arson fire. Fire began in two places on top 

of the roof and in the engine compartment of a car in 

front of the house. Minimal contents damage. 

SO 2 

, acetaldehyde, 

formaldehyde 

6/24/98 

Apartment 

Fire originated in the kitchen and extended to the 

living room. The entire apartment was approximately 

555 s.f. in size. Ventilation had begun prior to starting 

air monitoring. 

NO 2 


formaldehyde 

6/24/98 

Single family 

house 

Fire began in a single family garbage dumpster and 

extended to the house. Two bedrooms were gutted in 

the fire. 

Acetaldehyde, 

formaldehyde, 

glutaraldehyde 

6/25/98 

2-story vacant 

house 

No furniture in this house. The fire destroyed the 

entire second floor. Because there were no contents to 

salvage, the fire was suppressed with significant 

amounts of foam and water. 

Acetaldehyde 

6/26/98 

Mobile home 

Fire originated in living room. 

Acetaldehyde, 

formaldehyde, 


6/29/98 

Single family 

house 

Fire originated in living room of a small house, 

approximately 800 s.f.in size. Fire was mainly 

contained in the living room. 

Acetaldehyde, 

formaldehyde 

6/30/98 

Commercial 

building 

Fire originated in the mansard in the roof and extended 

to the attic. No fire involvement inside the structure, 

however, there was heavy smoke damage noted. 

CO, NO 2 

, SO 2 

, 

acetaldehyde, benzene, 

formaldehyde, 




Products of Combustion (continued) 

Date 

Type of 

Structure 

Details 



guidelines 

7/5/98 

2-story condo 

Apparent electrical fire concealed between walls. No 

flames were visible but there were materials smoldering 

in between the walls of the condo unit. 

CO, acetaldehyde, 

formaldehyde, 

7/7/98 

2-story 

apartment 

Fire originated in a bedroom located on the second 

floor of an apartment. Room and contents completely 

involved in the fire. 

Acetaldehyde, 

formaldehyde 

7/25/98 

Vacant house 

Small vacant house. Two out of three rooms total were 

involved in the fire. Center room was area of fire 

origin. Fire control was achieved just prior to air 

monitoring. 

Acetaldehyde 

7/27/98 

Single family 

house 

Suspected arson fire. Fire originated in two places: 

kitchen and hallway. Ventilation of the area had begun 

prior to air monitoring. 

Acetaldehyde, 

formaldehyde, 

7/31/98 

Single family 

house 

Suspected arson fire. All four fire fighters stayed in 

one place due to unstable roof conditions. 

Formaldehyde, PNAs 

8/2/98 

Vacant house/ 

commercial 

office 

Suspected arson. All four fire fighters removed air 

packs and placed them on the floor due to heat stress 

issues. 

--- 

8/7/98 

2-story 

apartments 

Fire started in the attic by a lightening strike. Fire was 

somewhat isolated in between the walls of two 

apartments. 

Formaldehyde 

8/8/98 

2nd floor 

apartment 

Fire originated in the couch. The couch was removed 

from the apartment during fire suppression. There was 

no fire extension and no structural damage. Data 

collected from this fire was eliminated from analysis. 

This fire did not represent typical overhaul activities. 

N/A 

8/21/98 

Furniture 

warehouse 

Fire sprinklers suppressed the fire. The fire continued 

to smolder in a 40 foot tower of stacked, cellophane 

covered couches. 

SO 2 


formaldehyde 



Products of Combustion (continued) 

Date 

Type of 

Structure 

Details 



guidelines 

8/23/98 

Commercial 

building 

Fire originated in attic from an apparent electric source 

on the roof. During monitoring, air monitoring team 

noted that a gas powered lamp inside the structure was 

contributing to CO concentrations inside the structure. 

SO 2 

acetaldehyde, 

formaldehyde, 

8/24/98 

House 

Fire originated in the kitchen. Ventilation had begun 

before air monitoring. Overhaul activities were 

completed before air monitoring was complete. 

Acetaldehyde, 

formaldehyde 

8/26/98 

House 

Area of origin was in the living room. A vent hole was 

cut above the area of origin. Fire was confined to the 

living room and attic. Suspected arson fire. Ventilation 

had started prior to air monitoring. 

Acetaldehyde, 

formaldehyde 

8/26/98 

House 

Fire originated in the bedroom by a 3 year old child. 

Fire extended to the hallway. Ventilation fans were up 

and running at the time of air monitoring team arrival. 

Acetaldehyde, 

formaldehyde, 

PNAs 

8/31/98 

Commercial 

building 

Fire originated in the attic. The fire was still working 

at the time of air monitoring team arrival. A vent hole 

was cut in the area of origin 

Acetaldehyde, 

formaldehyde 

9/19/98 

House 

Fire originated in the front of the house and extended 

to another room. The entire front end of the house was 

well involved in the fire. Horizontal ventilation was 

completed at the time of air monitoring team arrival. 

Acetaldehyde, 

formaldehyde 

9/20/98 

Apartment 

Fire originated in attic. Fire vented through roof. No 

interior apartment fire damage. Fire fighters noted that 

when the ventilation fans were redirected to exhaust-- 

CO levels dropped and when they were readjusted to 

positive pressure CO levels increased. 

CO, acetaldehyde, 

formaldehyde 

9/22/98 

House 

Fire originated in bedroom. Room and contents fire. 

Acetaldehyde, 

formaldehyde

Module 3: Health and Safety - IAFF

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