From a non-academic perspective the best place to send a chemical exposure
is to an occupational medicine facility. The one that we work with is next
door to the emergency room so they can take you in there immediately if they
deem it severe enough. There is no waiting in the emergency room since you
being escorted by a medical professional. Fortunately we have not required
the use of the occupational medicine group, but I have greater confidence in
their ability to respond to chemical exposures. They are more current on how
to handle work place related injuries and chemical exposures then the e.r.
staff.

I don't know if an academic institution has access to an occupational
medicine facility, since most require that the organization sign up in
advance. This allows the occupational medicine doctors to meet with the
organization and prepare a file as to what types of injuries/exposures they
might possibly see from your facility. The physicians that we have worked
with have been very knowledgeable and helpful. 

Sincerely,

Dennis Compton

=======================
Dennis R. Compton, Ph.D
Chemistry Manager
Obiter Research, LLC
60 Hazelwood Drive St 245
Champaign, IL 61820
Phone (217) 265-7677
drcompton**At_Symbol_Here**obiterresearch.com
 

-----Original Message-----
From: DCHAS-L Discussion List [mailto:DCHAS-L**At_Symbol_Here**LIST.UVM.EDU] On Behalf Of
McCartney, Alan
Sent: Tuesday, April 17, 2007 8:27 AM
To: DCHAS-L**At_Symbol_Here**LIST.UVM.EDU
Subject: [DCHAS-L] FW: [DCHAS-L] Undergraduate Accident

Ed

You action regarding dilution with water and sending the patient to a
professional healthcare provider is the best recommended action.  You should
never consider neutralization.  None of the recommended texts or any dermal
exposure guidelines (including ASTDR http://www.atsdr.cdc.gov & their
medical management guidelines http://www.atsdr.cdc.gov/MHMI/mmg.html)
recommend neutralization of the material directly upon the skin as the 1st
aid treatment.  

It is hoped that either a hard copy of the MSDS or an instantly retrievable
electronic copy is available to all in the labs.

In my experience, most college / university healthcare centers do not have
the knowledge or capabilities to properly evaluate and treat chemical
exposures. Some might.  For the majority of institutions, the best place for
the student is the local emergency room.

As an emergency paramedic for over 25 years, (who has also worked as an
Industrial Hygienist around medical research labs at a Boston hospital a
number of years ago), I understand that any adult (over 18 years of age) has
the legal right to refuse medical care and treatment.  

This concept is very hard for those of us who have health coverage as well
as an understanding of the chemical risks to accept or even understand.
However, it is reality.  Nothing you as the instructor can do can force the
student to seek medical treatment unless they are unconscious or mentally
incapacitated.  Treatment at that time can be instituted and is called
"implied consent".

Unless the lab has a formalized written policy (& educational program) that
addresses chemical safety, and prior to all students (employees, PIs,
instructors, etc)  working in the lab; (and as part of the written policy) a
requirement exists that all chemical exposures be treated at a hospital
emergency room, with a  written statement from the hospital accompanying
their discharge (called a discharge summary, given to all patients), you
can't force medical treatment.

Therefore when the student understands up-front the chemical exposure,
health risk and lab requirement, and has agreed to these requirements in
writing as a binding condition of their use of the lab, then and only then
might you be able to force the student to seek medical treatment, solely by
threat of refusing them re-entry into the lab.

Otherwise, you can not force anyone 18 years old or older to go to the
hospital.

Who is / could be liable?  This depends upon many, many varying
circumstances, all of which (if pushed into court) would be decided by a
jury of your peers.

The school could potentially be liable, if they do not have a clear,
coherent, chemical safety plan & procedure in place that covers all aspects
of chemical use (receiving virgin material, waste handling, and use in the
labs, by instructors, students, researchers, PIs, etc).

The school could be potentially liable if they have a written a plan, but
the school does not equitably utilize and implement all aspects of the
written plan (including instructors, employees, PIs and students).

The instructor / PI / could be potentially liable if the school has a plan,
and does not equitably utilize and implement all aspects of the written
plan.

The instructor / PI / could be potentially liable if the school doesn't have
a plan (or inadequate plan), and due to their extensive knowledge of the
chemical hazards and risks, does not implement procedures in those areas
under their direct control, to ensure safety of those in the area.

The instructor / PI / school could be potentially liable if the school
doesn't have, or has  inadequate personal protective equipment, or doesn't
train, or inadequately trains in the use of the PPE.

And possibly other liability exposures not included.

Just some ramblings of someone who has worked in ESH in various industries
and environments over the years.

Sincerely,

Alan P. McCartney

Alan P. McCartney CSP CHCM EMT-P
Senior Technical Consultant - Property
Agency Markets Loss Prevention

Liberty Mutual Agency Markets
62 Maple Avenue
Keene, New Hampshire 03431
(603) 358-4560
(603) 357-9531 (fax)
alan.mccartney**At_Symbol_Here**libertymutual.com

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-----Original Message-----
From: DCHAS-L Discussion List [mailto:DCHAS-L**At_Symbol_Here**LIST.UVM.EDU] On Behalf Of
Edward Senkbeil
Sent: Thursday, April 12, 2007 2:53 PM
To: DCHAS-L**At_Symbol_Here**LIST.UVM.EDU
Subject: [DCHAS-L] Undergraduate Accident

Recently we had an accident in the general chemistry lad where a student
spilled some 4.0M NaoH on her wrist.
The protocol we have followed in the past is to wash with water for 15
minutes and then send to the University Health Center.  We. normally
follow the protocol to "Protect, but not treat".  The skin was slightly
red due to the spill.

When the student reached (was escorted to) the Health Center, they said
they could not treat chemical burns.
They wanted to send her to the hospital emergency room, but the student
didn't go because of lack of insurance.

Three days after the accident, the student's wrist still has a few pink
spots.

The questions are:

1. Should we (lab instructors) treat by neutralizing the base with
something like vinega, rather than just washing?

2. Who should be responsible (or maybe liable) for appropriate
treatment?  Howd do university health centers handle someting like this
incident at other universities?

Thanks for any information,
Ed Senkbeil
Chemistry Department
Salisbury University

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