Cutting clothing should be included in all accident response training, not just laboratory.

I observed this technique during my first major laboratory accident response (Cornell, previously detailed on the list an immortalized on Usenet archives).

The simple brilliance of this stuck with me.  When the second major one rolled around (MIT, also detailed previously) and I saw one of the victims about to remove an acid-splattered shirt by pulling it over his head and face, I was able to stop him and cut it off before he could spread the acid over a greater skin area.

Last month, I had another encounter with the tight clothing problem when a student volunteer on a Habitat for Humanity job site dislocated her shoulder when she brushed against a doorway. Apparently, her shoulder had a tendency to do that.  And since it was an early March cold day she was wearing one of those really tight/skinny (and expensive) North Face jackets.  She was in considerable pain at the ER, and the nurses wanted to get the jacket off to get her BP before seeing the doctor. It is nearly impossible to remove such a jacket with a dislocated shoulder without taking the pain level up a couple orders of magnitude. I mentioned to the student that cutting the jacket off was an option, but it was her call, and within seconds a couple pairs of trauma scissors appeared out of thin air.

Ultimately, the scissors were not necessary.  Two nurses were working on the jacket sleeve, one trying to pull the jacket and the other trying to keep the extended arm from moving while two other nurses tried to stabilize the girl's elbow and shoulder. She was screaming at them to stop as it hurt so much, and was writhing in pain, but the nurse team persisted.  Apparently, it hurt so much that when she twisted in pain the shoulder popped back in on its own.

Interestingly, that brought up an immediate dilemma. Leave the ER at that point as no actual medical treatment had been administered, and avoid all kinds of expensive charges, or stay and get checked out, X-rays etc.  We had stepped out of the triage area to discuss her the options when a nurse came running over and snapped a hospital bracelet on her. I got a definite "Ha, now you're billable" vibe out of that.  Ah, the efficiency of the US medical system.

Anyway, take-home message: it's always a good idea to have a pair of sturdy scissors readily available.

Rob Toreki

From: Margaret Rakas
Sent: Wednesday, April 17, 2019 2:07 PM
To: DCHAS-L**At_Symbol_Here**PRINCETON.EDU
Subject: Re: [DCHAS-L] C&EN article on emergency decon

 

this scenario--minus actually cutting the jeans--would be a great role play, especially making sure that proper PPE for the 'helper' was selected....

 

On Wed, Apr 17, 2019 at 2:37 PM Samuella Beth Sigmann <sigmannsb**At_Symbol_Here**appstate.edu> wrote:

I suggest scissors for those!

On 4/17/2019 11:13 AM, Cathleen Eldridge wrote:

There could potentially be a situation calling for a combined effort.  Removing pants ("skinny jeans") that are tight at the ankles can be a struggle while dry, wet ones could be even more difficult to remove.  Someone helping to remove this type of garment and someone dry wiping at the same time may conceivably speed up the process of decon before hitting the shower?

 

Cathy Eldridge

Director

Environmental Health and Safety

518-564-5009

plattsburgh.edu

 

From: ACS Division of Chemical Health and Safety <DCHAS-L**At_Symbol_Here**PRINCETON.EDU> On Behalf Of ILPI Support
Sent: Wednesday, April 17, 2019 9:51 AM
To: DCHAS-L**At_Symbol_Here**PRINCETON.EDU
Subject: Re: [DCHAS-L] C&EN article on emergency decon

 

I concur. The immediate priority is to get the stuff off you by the most efficient means possible.

 

Question: You spill sulfuric acid on shirt and jeans.  Which will work better? I hope this is painfully rhetorical:

 

            1. Grab paper towels, wipe the acid off you, remove clothing, wipe some more, and then shower or

 

            2. Stand under shower, pull handle, remove clothing.

 

So the take-home from the article is that if no shower is available, wiping stuff off is certainly better than not doing anything. Hmm, this is going right back to the Common Sense=E2=84=A2 thread...

 

Rob Toreki

 

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On Apr 17, 2019, at 9:15 AM, Margaret Rakas <mrakas**At_Symbol_Here**SMITH.EDU> wrote:

 

Ok, reading the article it appears 'dry decon' is the first step at least partially because 

 

1) "Responders may need 10-20 min to set up the water spray, called a pipe-and-ladder system. The warm shower system takes even longer to install and get operational.." and

2) 'Dry decontamination provides several other benefits besides speed and effectiveness. For one, it helps prevent hypothermia, " mentioning the water from a  fire hydrant may be 10C (50F).  

 

So I don't see either of these reasons impacting the current "get them under the safety shower first" protocols for those facilities which have access to safety showers plumbed with tempered water....

 

Anyone's thoughts?

Margaret

 

On Tue, Apr 16, 2019 at 4:25 PM Wilhelm, Monique <mwilhelm**At_Symbol_Here**umflint.edu> wrote:

Thank you, Ralph.  I also noticed that.  I was surprised that I hadn't heard this in any other venue.



Sent from my Verizon, Samsung Galaxy smartphone


-------- Original message --------
From: DCHAS Membership Chair <membership**At_Symbol_Here**DCHAS.ORG>
Date: 4/16/19 1:32 PM (GMT-05:00)
To: DCHAS-L**At_Symbol_Here**PRINCETON.EDU
Subject: [DCHAS-L] C&EN article on emergency decon

There's an interesting article in this week's copy of C&EN on updated protocols for decontamination of victims of chemical exposures. It can be found at
https://cen.acs.org/safety/New-step-better-chemical-decontamination/97/i15
and suggests that dry wiping of affected areas should proceed dousing with water.

I wonder if this will affect protocols for use of laboratory safety showers any time soon?

- Ralph

Ralph Stuart, CIH, CCHO
membership**At_Symbol_Here**dchas.org

Membership chair
American Chemical Society
Division of Chemical Health and Safety