The driver realized too late that the highway would soon end. He had seconds to make the choice. He could negotiate the sharp right turn, or plow smack dab into the south central bridge located in southeast Dallas, Texas.

He slammed on his brakes and the semitrailer loaded with 8,000 gallons of flammable liquid screeched to a stop and tipped up on its side. “The cab teetered up on its wheels for a minute, then laid over on its side,” the driver said. He luckily scampered out of the cab unhurt, but visibly shaken. 

Flammable liquids began to pour out of the truck into the storm sewer. Since the highway was situated next to a neighborhood, fumes begin releasing in and around the homes. Evacuations began on the cold winter night at bedtime for citizens. 

As the incident command technician, I began setting up the command post. Ordering extra companies to help evacuate and obtaining the paperwork about the chemical load was my first order of business. This paperwork is usually found in the driver’s door, behind the driver’s seat or when away from the truck can be found with the driver. 

This incident happened back when chemical paperwork was referred to as Material Safety Data Sheets (MSDS). Flipping through the MSDS, I remember being highly frustrated because I was not able to find the information I needed.

The problem with MSDS is there was no organization, and information was haphazard at best. Today, the 2012 Global Harmonizing Standard (GHS) of Hazard Communication has evolved; information is organized and renamed Safety Data Sheet or (SDS).

Safety Data Sheet: 16 Sections

Safety data sheets are now organized so that information is in 16 categories and in an order that make sense. Sections 2, 4 and 11 are bolded below because they are primary for EMS responders to rely on.

Section 8 covers controls and personal protective equipment for rescue, but EMS personnel should not be in the hot zone (near the chemical release) and standing by in the warm zone waiting for the patient once fully and appropriately decontaminated.  

  1. Identification – includes product identifier; manufacturer or distributor name, address, phone number, emergency phone number, recommended use; restrictions on use.
  2. Hazard identification – includes all hazards regarding the chemical; required label elements. 
  3. Composition/Ingredients – includes information on chemical ingredients; trade secret claims.
  4. First Aid Measures – includes important symptoms, effects, acute, delayed and required treatment.
  5. Fire Fighting Measures – list suitable extinguishing media techniques, equipment; chemical hazards from fire. 
  6. Accidental Release Measures – list emergency procedures; protective equipment; proper method of containment and cleanup.
  7. Handling and Storage – list precautions for safe handling and storage, including incompatibilities. 
  8. Exposure Controls and PPE – list OSHA’s Permissible Exposure Limits (PELs), ACGIH Threshold Limit Values (TLV); and any other exposure limit used or recommended by the chemical manufacturer, importer, or employer preparing the SDS where available, as well as appropriate engineering controls; personal protective equipment (PPE)
  9. Physical and Chemical Properties – list the chemical’s characteristics.
  10. Stability and Reactivity – list chemical stability and possibility of hazardous reactions.
  11. Toxicological Information – includes routes of exposure; related symptoms, acute and chronic effects, numerical measures of toxicity. 
  12. Ecological Information (EPA) – may list the environmental properties of the chemical that have been investigated, this section will share information regarding releases into the environment.
  13. Disposal Considerations (EPA) – This section covers disposal procedures and the specific provisions that must be considered such as not washing down the drain or storm sewers. 
  14. Transport Information (DOT) – If the material is regulated for transportation such as a hazardous material or dangerous goods, it may have quantities allowed, proper shipping information, UN numbers and more. 
  15. Regulatory Information (SARA) – Reportable amounts may be listed here, clean air act information, US state regulations and right to know information. 
  16. Other Information – Legal information regarding this version replaces all previous versions and is correct to the best of the manufacture’s knowledge.

EMS Responders Response

The Center for Disease Control has emergency procedures for chemical hazard emergencies that begin with determining the agent. Use of appropriate personal protective equipment, appropriate decon supplies and antidotes are examples. Take a copy of the SDS with you to the hospital if available. 

Initial treatments include airway, CPR and controlling bleeding.  Check for symptoms of organophosphate poisoning.  Poisoning signs and symptoms vary depending on the chemical but can include:

Central Nervous System Signs and Symptoms

  • Miosis (unilateral or bilateral)
  • Headache
  • Restlessness
  • Convulsions
  • Loss of consciousness
  • Coma

Respiratory signs and symptoms:

  • Rhinorrhea (perfuse watery runny nose)
  • Bronchorrhea (excessive bronchial secretions)
  • Wheezing
  • Dyspnea (shortness of breath)
  • Chest tightness
  • Hyperpnea (increased respiratory rate/depth) – early (increased respiratory rate/depth)
  • Bradypnea (decreased respiratory rate) – late (decreased respiratory rate)

Cardiovascular signs resulting from blood loss:

  • Tachycardia (increased heart rate) – early (increased heart rate)
  • Hypertension (high blood pressure) – early (high blood pressure)
  • Bradycardia (decreased heart rate) – late (decreased heart rate)
  • Hypotension (low blood pressure) – late (low blood pressure)
  • Arrhythmias Dysrhythmias (prolonged QT on EKG, ventricular tachycardia)

Gastrointestinal signs and symptoms:

  • Abdominal pain
  • Nausea & and vomiting
  • Diarrhea
  • Urinary incontinence, frequency

Musculoskeletal signs and symptoms:

  • Weakness (may progress to paralysis)
  • Fasciculations (local or generalized)

Skin and mucous membrane signs and symptoms:

  • Profuse sweating (local or generalized)
  • Lacrimation (tear formation)
  • Conjunctival injection

Emergency responders tend to rely on the Emergency Response Guide (ERG) for general emergency information, but the SDS provides specific information on the exact chemical in which you are dealing. Obtaining this information before you leave the scene is going to be helpful to you, your patient, and the healthcare providers treating at the hospital.

Section 2 of the SDS covers the specific health hazards.  Knowing this information is important because it covers the body organs affected. An example of this information could be: “Affects the lungs and respiratory track.”  Knowing this information would help the responder to keep an eye on the airway. 

Section 4 covers first aid measures and shares information such as, “Move the patient to fresh air,” or, “Eye irritant, rinse the eyes for 15 minutes.” No matter what you do medically, decontamination at the scene is key to treating a patient of a chemical injury. 

Section 11 Toxicology includes routes of exposure, related symptoms, and numerical measures of toxicity. Hospitals will find the SDS helpful too, as section 11 covers more detailed toxicological information, as well as, toxicological information on acute and chronic issues with the chemical. Other information such as corrosion irritations, target organ issues, carcinogenicity, mutagenicity and reproductive toxicity have been found with this chemical. 

Decontamination

Decontamination (Decon) is to be performed prior to EMS interventions, otherwise you risk exposure for the healthcare provider. Decontamination is imperative as hospitals will not be happy if you drag a patient into their facility that has not been decontaminated properly prior to entry. Generally, decon is performed at the scene for at least 20 minutes and sometimes longer depending on the chemical involved. 

Pictograms and Hazards

EMS personnel must be able to recognize potential health hazards based on the pictograms.

It is important to note that the OSHA pictograms do not replace the diamond shaped labels that the US Department of Transportation (DOT) requires for the transport of chemicals, including chemical drums, chemical totes, tanks or other containers.  Those labels must be on the external part of a shipped container and must meet the label from the chemical manufacturer, or the product identifier and words, pictures, symbols or a combination thereof, which in combination with other information immediately available to employees, provide specific information regarding the hazards of the chemical. 

Six elements are now required on workplace labels including: (1) Product identifier, (2) Signal words, (3) Hazards statements, (4) Pictograms, (5) Precautionary statements, and (6) Name, address, telephone number of the chemical manufacturer, importer, or other responsible party.

OSHA is maintaining its current approach to allowing an alternative to labels on each stationary process container. There is an exception for portable containers under the control of the person who filled them. Labels on an incoming container are not to be removed or defaced unless immediately replaced by another label. Workplace labels are to be prominently displayed in English, although other languages are permitted as well. 

The incident described in the first paragraph ended on a good note, however, one of the challenges we faced was citizens, once awakened wanted to smoke cigarettes. With flammable fumes floating in the air, this incident could have been disastrous. Those assigned to evacuate citizens did an excellent job of not only preventing smoking, but cutting off ignition sources in the area. 

Thankfully, EMS crews had very few patients. The wind picked up and carried off the fumes. The fire crews located the sewer maps from the City of Dallas, located the spillway and filled it with sand to stop the flow from entering the Trinity River which serves as a water source to communities south of Dallas. The product was then siphoned off and loaded onto another container.

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