1. Introduction
For any developing economy industries are very important to sustain the growth. Most of the
developing countries like India and China in the last decade had shown tremendous industrial
growth. In the state of Gujarat, one of the rapidly growing states in India, Ahmedabad is a city in
which five Industrial Pocket are there namely Odhav, Vatva, Narol, Naroda and Kathvada.
Amongst these, Vatva GIDC has total 2500 industries and around 500 industries are chemical.
These chemical Industries have been in news for their ability to impose hazards like that of fire,
explosion and toxic release (spill or leak). Considering there are total 160,000 workers working
in Vatva GIDC, they can be exposed to the different chemicals being processed or stored. The
major hazards related to these chemicals can be toxic release (spill and leak), fire and explosion.
Amongst these, there can be severe health effects to the people who are getting directly affected
by the chemicals, which need treatment of antidotes.
Every chemical has an antidote to reduce the acute/immediate impact on human body. To be
very specific, antidote is a type of chemical compound which reacts to the chemicals affecting
the human body as a counter agent. It works on the priority principle of bonding with the
chemical molecules before they attach themselves to the human protein or enzymes. The
effectiveness of the antidote depends on the dose, time and concentration of the chemical by
which the victim has been severely affected.
This Booklet is prepared for the response during chemical accident especially for the reference of
chemical industrial unit owners and experienced workers. This guidebook takes its reader to
understand details like that of Physical properties (colour and odour), Affect on eye, skin,
respiratory tract and GI tract. This information manual can be of tremendous help during the time
of emergency when though the chemicals are known to the response personnel yet there’s basic
understanding related to their medical treatment is lacking.
Antidote and General Response Book – Industrial Accidents
Page 1
2.
No.
Antidotes must be available at Disaster Management Cell
Name of
Chemical
Treatment / Antidotes
Availability at
1.
Acetic-acid
Milk, White Eggs, Calcium Hydroxide, Milk of
Magnesia
All Govt. hospitals
All medical stores
2.
Acetonitrile
Cyanide antidotes: Due to delayed toxicity, repeated
doses of Cyanide antidotes may be needed for
acetonitrile poisoning irrespective of route of exposure.
Troika Laboratory
Throl Ta. Kadi
Dist. Mehsana
3.
Acids
Ingestion: Give the person half to one glass of
milk/water within 30 minutes of ingestion. Antacids like
Aluminium hydroxide or milk of Magnesia. Do not
induce vomiting.
Dermal/Eye exposure: Wash with plenty of water or
saline for 15-20 minutes
Inhalation: Move to fresh air. 100% oxygen.
Complete rest for 24-48 hours.
Antacids
All Medical Storse
All Govt. Hospitals
4.
Acrylonitrile
Cyanide antidotes and N-acetyl cysteine should be
administered in by I/V route as follows 150 mg/kg in
200 ml of 5% Dextrose over 60 min, then 50 mg/kg in
500 ml of 5% Dextrose over 4 hr then 100 mg/kg in 1 L
of 5% Dextrose over 16 hr.
Troika Laboratory
Throl Ta. Kadi
Dist. Mehsana
5.
Alkali
Ingestion: Give the person half to one glass of
milk/water.
Do not induce vomiting
Dermal/Eye exposure: Wash with plenty of water or
saline for 15-20 minutes
Inhalation: Supportive treatment.
6.
Ammonia
Inhalation: Move the person to fresh air
Dermal/Eye exposure: Wash with plenty of water or
saline for 15-20 minutes
Ingestion: Give the person half to one glass of
milk/water. Do not induce vomiting.
Saline
All medical stores
All govt.hospitals
7.
Aniline,
Nitrobenzene,
Toluidine and
other dye
intermediates
Cyanosis occurs when methemoglobin levels exceed
15%.
Give 1-2 mg/kg of 1% Methylene blue I/V slowly over
a period of five minutes. Repeat doses of methylene
blue may be needed. Do not exceed total dose of 7
mg/kg.
Inj. Methylene blue
Vatva Ind. Association
dispensory.Ph.5833496
Dr.S.I.Trivedi,5891048
Deepak medical stores,
stadium char rasta.
Aquafine injecta pvt ltd.
C/29/30, MIDC, Jijuri, TaPurandhar, Dist-Pune.
Antidote and General Response Book – Industrial Accidents
Page 2
8.
Arsenic
Gastric decontamination – Aggressive
decontamination with gastric lavage is recommended. If
X-ray demonstrates arsenic in the lower GI tract, whole
bowel irrigation should be considered.
Chelation 1. BAL - Symptomatic patients unable to tolerate oral
medication should be treated with BAL 3 to 5
mg/kg/dose IM every 4 to 12 hours. The dose and
frequency depend on the degree of toxicity seen. Higher
doses of BAL invariably cause adverse effects.
2. DMSA - Dimercaptosuccinic acid (DMSA) should be
used as soon as the patient is able to tolerate oral
medication. DOSE: 10 mg/kg every 8 hours for 5 days,
then decrease dosing to every 12 hours for 14 days. It
may be more effective and causes fewer side effects
than BAL.
3. Penicillamine - An alternative in patients able to
tolerate oral medications. DOSE: D-penicillamine 100
mg/kg/day up to 2 g daily in four divided doses.
4. Endpoint - In severely ill patients, combined therapy
with both BAL and an oral agent should be considered.
Chelation therapy should be stopped when the urinary
arsenic level falls below 50 mcg per 24 hours. If renal
failure exists, dose of BAL and penicillamine should be
decreased after loading dose.
CMOS
Civil hospital
Gandhinagar
9.
Benzene,
Toluene,
Xylene
Dermal exposure: Wash with plenty of water and soap
for 15-20 minutes
Inhalation: Move the person to fresh air. Give oxygen
In case of convulsions, give Diazepam 10 mg I/V
Slowly.
Oxygene
British oxygene ltd., Rakhial
Ahmedabad.
Diazepam
All Govt. hospitals
All medical stores
10.
Bromine
Ingestion: Give the person half to one glass of
milk/water. Do not induce vomiting.
Inhalation: Move the person to fresh air. Give oxygen.
Caution: The rescuer should use protective clothing.
Oxygen
British oxygene ltd.,
Rakhial, Ahmedabad
11.
Carbon
Dioxide
Oxygen
Oxygen
BOL, Ahmedabad
12.
Carbon
monoxide
Oxygen: Administer 100% O2 by tight-fitting face
mask until asymptomatic.
Hyperbaric oxygen is recommended in patients with
neurologic abnormalities, myocardial ischemia,
acidosis, hypotension, pregnancy.
Oxygen
British oxygene ltd.,
Rakhial Ahmedabad
13.
Caustic Soda
Vinegar
Antidote and General Response Book – Industrial Accidents
Page 3
14.
15.
Chlorine
Cyanides
includes
Sodium/Potass
ium cyanide,
Hydrogen
cyanide,
Cyanogen and
its
halides(chlorid
e/bromide/
iodide)
16. Dichlorometha
ne
Inhalation: Move patient to fresh air. Monitor for
respiratory distress. If cough or difficulty in breathing
develops, evaluate for respiratory tract irritation,
bronchitis, or pneumonitis. Administer 100 percent
humidified supplemental oxygen with assisted
ventilation as required.
Caution: Rescuers should wear self-contained
breathing apparatus and have protective clothing, if
needed.
Eye exposure: Exposed eyes should be irrigated with
copious amounts of lukewarm water for at least 15
minutes.
Dermal exposure: Wash exposed area extremely
thoroughly with soap and water.
Oxygen
British oxygene ltd.,
Rakhial Ahmedabad
Caution: Rescuers must not enter areas with potential
high airborne concentrations of this agent without
SELF-CONTAINED BREATHING APPARATUS
(SCBA) to avoid becoming secondary victims.
ADMINISTER 100% OXYGEN ESTABLISH
SECURE LARGE BORE IV.
PREPARE THE CYANIDE ANTIDOTE KIT FOR
USE IN SYMPTOMATIC PATIENTS.
1. AMYL NITRITE AMPULE – Give one ampule by
inhalation for 30 seconds every minute until sodium
nitrite is administered. Use a new ampule every 3
minutes.
2. SODIUM NITRITE – Administer IV (ADULT: 10
mL of a 3% solution over 5 minutes.
a. Repeat one-half of initial sodium nitrite dose 30
minutes later if there is inadequate clinical response.
Monitor blood pressure carefully. Reduce nitrite
administration rate if hypotension occurs.
3. SODIUM THIOSULFATE - Administer IV
immediately following sodium nitrite (ADULT: 50 mL
of 25% solution). Repeat one-half of initial sodium
thiosulfate dose 30 minutes later if there is inadequate
clinical response.
4. SODIUM BICARBONATE - Administer 1 mEq/kg
IV to severely acidotic patients.
SEIZURES: Administer IV DIAZEPAM (ADULT: 5
to 10 mg, repeat every 10 to 15 minutes as needed) or
LORAZEPAM (ADULT: 4 to 8 mg).
- Consider phenobarbital and/or phenytoin if seizures
are uncontrollable or recur after diazepam 30 mg.
Troika laboratory
Throl, Ta. Kadi
Dist.Mehsana
Hydrocortisone
All Govt. Hospitals
All medical stores
Antidote and General Response Book – Industrial Accidents
Page 4
17.
Dichloromethane
(Methyle-ne
chloride)
Give 100% oxygen as it is converted to carbon
monoxide in the body
Ingestion: Dilute with 4 to 8 ounces (120 to 240 mL) of
milk or water. Do not induce vomiting.
Inhalation Move patient to fresh air. Administer 100
percent oxygen.
Eye Exposure: Exposed eyes should be irrigated with
copious amounts of lukewarm water for at least 15
minutes.
Dermal Exposure: Wash exposed area extremely
thoroughly with soap and water.
Oxygen
British oxygene ltd
Rakhial Ahmedabad
18.
Di-methylsulphate
Ingestion: Immediately dilute with 4 to 8 ounces (120
to 240 mL) of milk or water . Do not induce vomiting.
Inhalation: Move patient to fresh air. Administer 100
percent humidified supplemental oxygen with assisted
ventilation as required.
Eye exposure: Exposed eyes should be irrigated with
copious amounts of lukewarm water for at least 15
minutes.
Dermal exposure: Wash exposed area
Extremely thoroughly with soap and water.
Oxygen
British oxygene ltd
Rakhial ahmedabad
19.
Di-nitrophenol
Prevent absorption with emesis, gastric lavage, and/or
activated charcoal.
Control the fever WITHOUT using salicylates and
correct any fluid and electrolyte derangements.
Control seizures and manage cerebral or pulmonary
edema.
All Govt. hospitals
20.
Ethanol
Ingestion:
GASTRIC LAVAGE: Consider after ingestion of a
potentially life-threatening amount of poison if it can be
performed soon after ingestion (generally within 1
hour).
ACTIVATED CHARCOAL - Does NOT appreciably
reduce ethanol absorption.
THIAMINE - Administer 100 mg of thiamine
intramuscularly or intravenously.
HYPOGLYCEMIA - Administer IV glucose if blood
sugar is below 60 mg/dL. Administration of IV glucose
should be preceded by 100 mg of thiamine IM or IV.
HYPOTHERMIA - Rewarm slowly using blankets,
warm IV fluids, and/or warmed mist inhalation. Monitor
for and treat rewarming arrhythmias.
HEMODIALYSIS - Effectively removes ethanol;
should be considered in those patients who deteriorate
despite conventional therapy.
ETHANOL WITHDRAWAL - Managed with oral or
parenteral administration of benzodiazepines.
All Govt. hospitals
All medical stores
Antidote and General Response Book – Industrial Accidents
Page 5
21. Ethylene glycol
and Diethylene
glycol
Decontamination: gastric lavage, activated charcoal.
Ipecac contraindicated.
SEIZURES: benzodiazepines, barbiturates.
ACIDOSIS: NaHCO3 1-2 meq/kg every 1-2 hrs if pH
< 7.1.
ETHANOL: Loading dose 10 ml/kg 10% EtOH IV.
Maintenance dose 1-2 ml/kg/hr 10%
4-Methyl Pyrazole (Fomepizole) - A loading dose of
15 milligrams/kilogram is intravenously infused over 30
minutes followed by doses of 10 milligrams/kilogram
every 12 hours for 4 doses, then 15 milligrams/kilogram
every 12 hours until ethylene glycol levels are below 20
milligrams/deciliters.
THIAMINE/PYRIDOXINE - ADMINISTER
THIAMINE AND PYRIDOXINE - 100 mg IV daily.
All Govt. hospitals
All medical stores
22.
Fluorine
Ingestion: Immediately dilute with 4 to 8 ounces (120
to 240 mL) of milk or water. Gastric lavage
Eye Exposure: Exposed eyes should be irrigated with
copious amounts of lukewarm water for at least 15
minutes.
Dermal Exposure: Wash exposed area extremely
thoroughly with soap and water.
Inhalation: Move patient to fresh air. Administer 100
percent humidified supplemental oxygen with assisted
ventilation as required.
Oxygen
British oxygene ltd
Rakhial Ahmedabad
23.
Formaldehyde
(Formalin)
INHALATION EXPOSURE
Decontamination: Move patient to fresh air. Monitor
for respiratory distress. If cough or difficulty in
breathing develops, evaluate for respiratory tract
irritation, bronchitis, or pneumonitis. Administer 100
percent humidified supplemental oxygen with assisted
ventilation as required.
EYE EXPOSURE:
Irrigation: In a medical facility, irrigate with sterile
saline for at least an hour or until the superior and
inferior cul-de-sacs have been examined for particulate
matter and returned to neutrality (pH paper touched to
lower cul-de-sac).
DERMAL EXPOSURE DECONTAMINATION:
Wash exposed area extremely thoroughly with soap and
water.
Ingestion: Following ingestion and/or prior to gastric
evacuation, immediately dilute with 4 to 8 ounces (120
to 240 mL) of milk or water Prevent absorption with
gastric lavage, and/or activated charcoal.
Troika laboratory
Throl, Ta. Kadi
Dist. Mehsana
Antidote and General Response Book – Industrial Accidents
Page 6
24.
Hydrofluoric
acid
(Hydrogen
fluoride)
Ingestion: Attempt immediate administration of a
fluoride binding substance: milk (one-half to one
glassful), chewable calcium carbonate tablets, milk of
magnesia or a liquid antacid. Avoid large amounts of
liquid, as this may induce vomiting.
DO NOT INDUCE VOMITING.
- Hypocalcaemia may occur. Correct with IV
CALCIUM CHLORIDE (10 percent solution).
ADULT: 2 to 4 mg/kg (0.02 to 0.04 mL/kg) infused
slowly and repeated as necessary.
- Hypomagnesaemia may occur. Correct with IV
MAGNESIUM SULFATE: ADULT 2 grams is
diluted in 50 to 100 mL of 5% Dextrose and
administered over 5 minutes.
DERMAL EXPOSURE:
DECONTAMINATION - Remove all exposed
clothing and jewelry taking necessary precautions to
prevent secondary exposure to health care providers.
Irrigate exposed areas promptly with copious amounts
of water for at least 30 minutes.
CALCIUM GLUCONATE OR CARBONATE GEL
- Use of 2.5 percent to 33 percent calcium gluconate or
carbonate gel or slurry, either placed into a surgical
glove into which the affected hand is then placed, or
applied onto the exposed dermis, has been
recommended. This therapy is more easily administered
and less painful than infiltration.
CALCIUM INFUSION - Regional intravenous
infusion of calcium gluconate is a therapeutic option in
HF burns of the forearm, hand, or digits as adjunct to
topical therapy. Intra-arterial calcium infusion for
digital HF burn is also a therapeutic option and may be
considered if regional intravenous calcium gluconate is
ineffective.
CALCIUM GLUCONATE INFILTRATION
- Continued tissue destruction and pain may be
minimized by SC administration of calcium gluconate
Infiltrate each square cm of affected dermis and SC
tissue with about 0.5 mL of 10 percent
DO NOT USE CALCIUM CHLORIDE
- Calcium chloride is irritating to the tissues and may
cause injury.
Antidote and General Response Book – Industrial Accidents
All govt. hospital
All medical stores
Page 7
25.
Hydrogen
sulfide
Inhalation: Move the victim to an area of fresh air and
immediately provide respiratory support using 100
percent humidified oxygen.
NITRITE THERAPY - Amyl nitrite by inhalation and
IV sodium nitrite (found in cyanide antidote kit) may be
beneficial by forming sulfmethemoglobin, thus
removing sulfide from combination in tissue. Do NOT
use sodium thiosulfate.
- Hyperbaric oxygen may be given to those who
continue to be symptomatic after standard therapy.
- Control seizures, pulmonary edema, arrhythmias and
hypotension.
- Exposed mucocutaneous surfaces should be
thoroughly washed with copious amounts of water
and/or soap.
- Rescuers should wear a self-contained breathing
apparatus, special chemical protective clothing, and a
safety line during rescue operations.
- Many would-be rescuers have become victims when
entering contaminated enclosed areas without proper
protective equipment.
- Observe for delayed onset (up to 72 hours) acute
respiratory effects.
Troika laboratory
Throl, Ta. Kadi
Dist.Mehsana.
26.
Methanol
DECONTAMINATION: gastric lavage, activated
charcoal.
ACIDOSIS: IV NaHCO3 1-2 mEq/kg starting dose if
pH < 7.1.
ETHANOL THERAPY - LOADING DOSE - 10
mL/kg of 10 percent ethanol in D5W IV over 30
minutes. MAINTENANCE DOSE - 1 to 2 mL/kg/hr of
10 percent ETHANOL in D5W by IV infusion.
Maintain blood ethanol levels at 100 to 130 mg/dL.
Monitor blood glucose and blood ethanol levels.
INDICATIONS: metabolic acidosis or blood methanol
level greater than 20 mg/dL.
FOMEPIZOLE - FDA approved for methanol
poisoning in the USA; LOADING DOSE - 15 mg/kg
IV over 30 minutes.
HEMODIALYSIS - Maintenance ethanol dose must
be increased during dialysis. Fomepizole dosing should
be increased to every 4 hr during hemodialysis.
INDICATIONS:
1) blood methanol level greater than 50 mg/dL (15
mmol/L);
2) Severe acid-base and/or fluid-electrolyte
abnormalities despite conventional therapy; 3) renal
failure.
LEUCOVORIN/FOLIC ACID - If symptomatic - IV
leucovorin 1 mg/kg once (up to 50 mg/dose) followed
by IV folic acid 1 mg/kg (up to 50 mg/dose) every 4
hours for 6 doses.
All govt. hospitals
All medical stores
Antidote and General Response Book – Industrial Accidents
Page 8
27.
Naphthalene
ORAL/PARENTERAL EXPOSURE
A. Induced emesis is more useful for mothballs because
of size. Mothballs dissolve slowly; gastric
decontamination should be considered even in patients
presenting late after ingestion.
B.URINARY ALKALINIZATION - If hemolysis
occurs, urine alkalinization with intravenous sodium
bicarbonate infusion (maintaining a urine pH of 7 to 8)
may help to avoid renal injury.
C. Supportive treatment
All govt. hospitals
All medical stores
28.
Nitrogen
oxides (Nox)
- Treatment of toxic pulmonary edema caused by
nitrogen oxide inhalation should be directed towards
reversal of ventilator failure by using oxygen in
assisting ventilation.
- In patients with toxic bronchiolitis, steroids may be
beneficial in decreasing the amount of inflammation.
- Methemoglobinemia and mild acidosis may be
present, but specific treatment for these conditions will
probably not be necessary.
Oxygen
British oxygene ltd.,
Rakhial Ahmedabad
Methylene blue
Vatva Ind. Association
Dr. S.I.Trivedi
29.
Phenol and
derivatives
Ingestion: Consider gastric lavage after ingestion of a
potentially life-threatening amount of phenol (more than
1.5 gms) if it can be performed soon after ingestion
(generally within 1 hour).
Eye exposure:
DECONTAMINATION: Irrigate exposed eyes with
copious amounts of tepid water for at least 15 minutes.
DERMAL EXPOSURE
Remove phenol with undiluted polyethylene glycol 300
to 400 ml or isopropyl alcohol prior to washing, if
readily available. Wash exposed areas twice with large
quantities of water.
INHALATION: Move patient to fresh air. Monitor for
respiratory distress. Administer oxygen and assist
ventilation as required. Treat bronchospasm with beta2
agonist and corticosteroid aerosols.
All govt. hospitals
All medical stores
30.
Phosgene
INHALATION EXPOSURE
- Move patient to fresh air. Monitor for respiratory
distress. Administer oxygen and assist ventilation as
required. Treat bronchospasm with beta2 agonist and
corticosteroid aerosols.
- Carefully observe patients with inhalation exposure for
the development of any systemic signs or symptoms and
administer symptomatic treatment as necessary.
- Monitor for 12 to 24 hrs after exposure even if the
person is asymptomatic.
PULMONARY EDEMA (NONCARDIOGENIC):
- Maintain ventilation and oxygenation and evaluate
with frequent arterial blood gas or pulse oximetry
monitoring. Early use of PEEP and mechanical
Oxygen
BOL.
Antidote and General Response Book – Industrial Accidents
All govt. hospitals
All medical stores
Page 9
ventilation may be needed.
- There is no specific antidotal therapy for phosgeneinduced pulmonary edema.
31.
Phosphides
(Aluminium
phosphide
,Zinc
phosphide)
and phosphine
Oral/parenteral exposure: Zinc phosphide and
aluminum phosphide will release phosphine gas in the
stomach.
- Gastric lavage with 1:10000 potassium
permanganate followed by activated charcoal ( 50- 100
gm in water)
I/V fluids with dopamine 8-10 g/kg/minute for
management of shock
- Treat metabolic acidosis with Sodium bicarbonate I/V
- Treat cardiac arrhythmias, Magnesium sulphate 3 gm
I/V in first 24 hours followed by 6 gm in nexr 24 hours
for 3-5 days
- No specific antidote
All govt. hospitals
All medical stores
32.
Potassium
permangnate
Ingestion: Ipecac/neutralization contraindicated. Dilute
with 4 oz water. Activated charcoal/gastric lavage
controversial.
EYES - Copious irrigation to neutral pH.
HYPOTENSION: IV NS 10-20 mL/kg, dopamine,
norepineprine.
ENDOSCOPY: Within 24 hours, consider
corticosteroids for 2nd degree burns.
MONITORING PARAMETERS: Electrolytes, renal
& hepatic function, amylase, Prothrombin time, MetHb
levels in severe cases.
All govt. hospitals
All medical stores
CMSO Gandhinagar
33.
Sulfur dioxide
Inhalation: Move victims from the toxic environment
and administer 100 percent humidified supplemental
oxygen with assisted ventilation as required.
- Endotracheal intubation, cricothyroidotomy, or
tracheostomy may be needed if upper airway
obstruction is present.
- Inhaled sympathomimetic bronchodilators can be used
to treat bronchospasm. Steroids are controversial.
Antibiotics may be useful for pulmonary infectious
complications.
- Exposed eyes should be copiously irrigated. Rewarming and a variety of topical treatments are useful
for frostbite injury.
Oxygen
BOL Ahmedabad
All govt. hospital
All medical stores
34.
Oleum
Treatment consists in the prompt use of magnesia, soap,
chalk, lime-water as antidotes. After neutralization of
the acid give mucilaginous drinks, milk or other bland
drinks.
All govt. Hospitals
And clinic
TREATMENT: Fresh air, rest. Half-upright position.
Remove contaminated clothes.
Use plenty of water.
Antidote and General Response Book – Industrial Accidents
Page 10
EYE EXPOSURE: Immediately irrigate each affected
eye with copious amounts of water or sterile 0.9% saline
for about 30 minutes. Irrigating volumes up to 20 L or
more have been used to neutralize the pH. After this
initial period of irrigation, the corneal pH may be
checked with litmus paper and a brief external eye exam
performed. Continue direct copious irrigation with
sterile 0.9% saline until the conjunctival fornices are
free of particulate matter and returned to pH neutrality
(pH 7.4). Once irrigation is complete, a full eye exam
should be performed with careful attention to the
possibility of perforation.
The extent of eye
injury (degree of corneal opacification and perilimbal
whitening) may not be apparent for 48 to 72 hours after
the burn.
DERMAL EXPOSURE: Remove contaminated
clothing and jewellery and irrigate exposed areas with
copious amounts of water. A physician may need to
examine the area if irritation or pain persists. Treat
dermal irritation or burns with standard topical therapy.
Patients developing dermal hypersensitivity reactions
may require treatment with systemic or topical
corticosteroids or antihistamines.
35. Chlorosulfonic
Acid
36. Sulphuric acid
Milk of magnesia in case of ingestion. For the inhalation
and ocular effects only clean water or natural saline can
be used. Soap or any diluted alkali can be used in
supportive treatment when required.
All govt. Hospitals
And clinic
Treatment consists in the prompt use of magnesia, soap,
chalk, lime-water as antidotes. After neutralization of
the acid give mucilaginous drinks, milk or other bland
drinks.
TREATMENT-:
Use water or milk to dilute; possible gastric lavage if
amount of alkali granules ingested is large Skin and Eye
Contact:-Flushing with water for 15 minute. For basic
treatment: Establish a patent airway. Watch for signs of
respiratory insufficiency and assist respirations if
needed. Administer oxygen by non-re-breather mask at
10 to 15 L/min. Monitor for pulmonary edema and treat
if necessary.
All govt. Hospitals
And clinic
Antidote and General Response Book – Industrial Accidents
Page 11
3. List of rarely usable Antidotes for the disaster management centre
No.
Name of
Chemical
1.
Aconite
2.
Argot
3.
Treatment / Antidotes
Availability at
Tanic Acide 2% Potassium lodide
All Govt. hospitals
All medical stores
Sodium nicotinate 140mg IV
CMSO Gandhinagar
Alkali
phosphate
Calcium Gluconate
All Govt. Hospitals
All medical stores
4.
Andrime
Paraldihyde
CMSO
Gandhinagar
5.
Anti
Coagulants,
Aspirin
Vitamin-K
All govt. hospitals
All medical stores
6.
Antimony
A. Treatment is primarily symptomatic. There are no
specific antidotes, but DMSA, D-penicillamine, BAL,
and DMPS (Unithiol) have been used as chelating
agents.
B. Metallic antimony is not highly toxic and usually
only causes gastrointestinal effects. Various salt forms
may cause significantly more irritation, and stibine is a
highly toxic, hemolytic gas.
CMOS
Civil hospital
Gandhinagar
7.
Argote
Vitamin-K
All govt. hospitals
All medical stores
8.
Barbiturates
Bemegride 0.5%
CMSO Civil hospital
Gandhinagar
9.
Barium
- Charcoal administration is not advised
- Magnesium sulfate when given orally results in the
formation of non absorbable barium sulfate within the
gastrointestinal tract.
- Dose: 30 g for adults. Sodium sulfate is an alternative.
ADULT: 30 g in 250 ml water orally.
- Monitor serum potassium. Treat hypokalemia and
associated cardiac dysrhythmias by infusing with
potassium intravenously, slowly.
All Govt. Hospitals
All medical stores
10.
Beryllium
In acute exposures, symptomatic treatment
In chronic pulmonary disease, corticosteroids may be
given.
All Govt. Hospitals
All medical stores
Antidote and General Response Book – Industrial Accidents
Page 12
11.
Bleaching
solution
12.
Borates
13.
Boric Acid
14.
Cadmium
Ingestion: Give the person half to one glass of
milk/water.
- Do not induce vomiting.
Note: Do not use acid to neutralize alkali
Supportive treatment
Ingestion: Gastric lavage and ACTIVATED
CHARCOAL: as slurry (240 mL water/30 g charcoal).
Usual dose: 25 to 100 g in adults/adolescents.
All Govt. Hospitals
Activated Charcoal
5% Dextrose
CMSO Civil hospital
Gandhinagar
All Govt. hospital
All medical stores
CHELATION - chelation therapy may be of benefit
immediately following acute exposure. Administer
CaNa2 EDTA 75 mg/kg/day deep IM or slow IV
infusion given in 3 to 6 divided doses for up to 5 days.
May be repeated for a second course after a minimum of
two days drug holiday; each course should not exceed a
total of 500 mg/kg body weight. CAUTION: BAL must
not be used with cadmium since the complex is
nephrotoxic.
Troika laboratory
Throl, Ta.Kadi,
Dist.Mehsana
INHALATION: Move patient to fresh air. Monitor for
respiratory distress. If cough or difficulty in breathing
develops, evaluate for respiratory tract irritation,
bronchitis, or pneumonitis. Administer 100 percent
humidified supplemental oxygen with assisted
ventilation as required.
15.
Calotropiz,
Cocaine
16.
Carbamate
pesticides
Potassium permanganate
All govt. hospitals
All medical stores
ADMINISTER ATROPINE SULFATE - in repeated
doses intravenously until atropinization is achieved
(indicated by drying of pulmonary secretions).
All Govt. Hospitals
All medical stores
ADULT DOSE - 2 to 4 milligrams every 10 to 15
minutes.
Administer pralidoxime if severe toxicity develops.
17.
Carbonyls
Oxygen
18.
Cardiac
Glycosides
Potassium Chloride 0.5%
Antidote and General Response Book – Industrial Accidents
BOL Ahmedabad
Page 13
19.
Chlorates
Sodium bicarbonates 5%
BOL Ahmedabad
20.
Chromium
- Intravenous administration of ascorbic acid can help
reduce hexavalent chromium to trivalent chromium and
thus lower the tissue penetration seen with hexavalent
chromium. Administer ascorbic acid (1 g per 0.135 g of
elemental chromium).
All Govt. Hospitals
All medical stores
Ingestion: Immediately dilute with 4 to 8 ounces (120
to 240 mL) of milk or water. Do not induce vomiting.
Dermal Exposure: Wash the exposed area with water
or 10 to 20 percent ascorbic acid solution for 15
minutes.
Inhalation: Move patient to fresh air. Administer 100
percent humidified supplemental oxygen with assisted
ventilation as required.
21.
Chlorates
Ingestion: Gastric Lavage: Consider soon after
ingestion (generally within 1 hour).
All Govt. hospitals
Troika laboratory
ACTIVATED CHARCOAL: Administer charcoal as
slurry (240 mL water/30 g charcoal). Usual dose: 25 to
100 g in adults/adolescents,
Throl, Ta.Kadi,
Dist. Mehsana
A. SODIUM THIOSULFATE: Consider
administering sodium thiosulfate to symptomatic
patients to inactivate the chlorate ion. Administer 2 to 5
g orally or IV in 200 mL of 5% sodium bicarbonate.
B. ALKALINE DIURESIS: Assure adequate
hydration and renal function. Administer 88 to 132
mEq/L sodium bicarbonate and 20 to 40 mEq KCl (as
needed) in dextrose 5% in water or other fluid to
produce adequate urine flow and urine pH of at least
7.5. Additional doses may be needed to maintain
alkaline urine.
C. METHEMOGLOBINEMIA: Administer 1 to 2
mg/kg of 1% methylene blue slowly IV if the patient is
symptomatic. Additional doses may be required.
22.
Copper
DILUTION: Following ingestion and/or prior to gastric
evacuation, immediately dilute with 4 to 8 ounces (120
to 240 mL) of milk or water
CMSO
Civil hospitals
- Emesis is rapid and spontaneous in most patients
Antidote and General Response Book – Industrial Accidents
Page 14
following ingestion of copper salts.
Gandhinagar
Chelation: There is little clinical experience in the use
of chelators in acute copper intoxication. BAL,
penicillamine, DMPS and EDTA have been used. Dpenicillamine is considered the drug of choice for
Wilson's disease, a condition of chronic copper
overload.
D-PENICILLAMINE: 1000 to 1500 mg/day divided
every 6 to 12 hours. Avoid if penicillin allergic. Monitor
for proteinuria, hematuria, rash, leukopenia, and
thrombocytopenia.
- Administer BAL (Dimercaprol) 3 to 5 mg/kg/dose IM
every 4 hours for 2 days; then every 4 to 6 hours for an
additional 2 days; then every 4 to 12 hours for up to 7
additional days.
23.
Cosmetics
Sodium Thisulfate 10%
Troika Lab
Throl. Ta. Kadi
Dist. Mehsana
24.
Digitolise
Trisodium EDTA
Troika Lab
Throl, Ta. Kadi
Dist. Mehsana
25.
Heparin
Protamin Sulfate 1%
Vitamin – K 1%
All Govt. Hospitals
All medical stores
26.
Herbicide –
INGESTION - No specific antidote.
CMSO
- Gastric lavage and activated charcoal/cathartic are
probably more useful decontamination methods.
Monitor respiratory status, electrolytes, renal and liver
function tests, CBC, platelet count, and cardiac status.
Civil Hospital
2,4-D
Gandhinagar.
- Observe for adequate hydration, myoglobinuria, or
metabolic acidosis. Alkaline diuresis may be necessary.
27.
Herbicide –
All cases of paraquat ingestion must be treated as
potentially fatal poisonings.
CMSO
Civil hospital
Paraquat
Ingestion of, or dermal exposure to, even small amounts
of paraquat can result in severe toxicity and death
within 24 hours.
Gandhinagar
Survivors of severe paraquat poisoning often develop
Antidote and General Response Book – Industrial Accidents
Page 15
progressive pulmonary fibrosis within 5 to 10 days or
longer after exposure. Continued survival is dependent
on the extent of lung involvement.
Treatment is primarily supportive and symptomatic
28.
Iodine
Ingestion: ORAL/PARENTERAL EXPOSURE
GASTRIC LAVAGE: Consider after ingestion of a
potentially life-threatening amount of poison if it can be
performed soon after ingestion (generally within 1
hour). Administer charcoal as slurry, Usual dose: 25 to
100 g in adults/adolescents, C. 0.4.3
Oxygen
British oxygene ltd.
Rakhial Ahmedabad
All govt. hospitals
INHALATION EXPOSURE Move patient to fresh air.
Monitor for respiratory distress. If cough or difficulty
breathing develops, evaluate for respiratory tract
irritation, bronchitis, or pneumonitis. Administer
oxygen and assist ventilation as required. Treat
bronchospasm with beta2 agonist and corticosteroid
aerosols.
EYE EXPOSURE
DECONTAMINATION: Irrigate exposed eyes with
copious amounts of tepid water for at least 15 minutes.
DERMAL EXPOSURE
Wash the exposed area twice with soap and water.
Apply starch to ensure all iodine has been removed (ie,
no blue color).
29.
Iron salts
Ingestion:
All govt hospitals
1. Removal of iron from the gastrointestinal tract.
Decontamination is recommended with syrup of ipecac
(at home, if recent ingestion) or gastric lavage (in health
care facility) if greater than 20 mg/kg or unknown
amount of ingestion OR symptomatic.
All medical stores
2. Maintain electrolytes, treating shock, hypotension,
and hyperglycemia.
3. Removal of iron from the patient's system.
Deferoxamine chelation may be indicated in
symptomatic patients or those with a peak serum iron
Antidote and General Response Book – Industrial Accidents
Page 16
greater than 350 micrograms/deciliter.
Deferoxamine - Administer by continuous intravenous
infusion at a rate of up to 15 milligram/kilogram/hour.
Patients with moderate toxicity are generally treated for
8 to 12 hours; those with severe toxicity may require
deferoxamine for 24 hours or longer.
30.
Lead
ACUTE EXPOSURE -
All govt. hospitals
ACTIVATED CHARCOAL: Administer charcoal as
slurry (240 mL water/30 g charcoal). Usual dose: 25 to
100 g in adults/adolescents,
All medical stores
CMSO
Civil hospital
CHELATION THERAPY - Should be instituted in all
patients with blood lead level equal to or greater than 45
mcg/dL even if asymptomatic, Symptoms and signs,
along with the EP and blood lead level, determine the
route, dose, and agent to be used for chelation.
Gandhinagar
BAL (dimercaprol) - 3 to 5 mg/kg/dose deep IM every
4 hours for 2 days; then every 4 to 6 hours for 2 more
days; then every 4 to 12 hours up to an additional 7
days.
CALCIUM EDTA - 50 to 75 mg/kg/day deep IM in 3
to 6 divided doses for up to 5 days. EDTA should only
be administered after BAL in patients with
encephalopathy or children with levels >69 mcg/dL.
D-PENICILLAMINE - 250 mg 4 times a day PO for
up to 5 days. Do not exceed 40 mg/kg/day. OSHA
prohibits prophylactic chelation therapy in workers
occupationally exposed to lead.
DMSA (Succimer) - 30 milligrams/kilogram/day in 3
divided doses for 5 days followed by 20
milligrams/kilogram/day in 2 divided doses for 14 days.
31.
Magnesium
salts
DECONTAMINATION: Gastric lavage; activated
charcoal does NOT effectively adsorb magnesium salts.
All govt. hospitals
All medical stores
Monitor ECG/vital signs, magnesium and calcium
levels and electrolytes frequently.
CALCIUM: For respiratory depression, give IV
calcium gluconate 10% (DOSE: 0.2 to 0.5 mL/kg/dose
Antidote and General Response Book – Industrial Accidents
Page 17
up to 10 mL/dose over 5 to 10 minutes). Repeat as
indicated.
HYPOTENSION: IV NS 10-20 mL/kg, dopamine,
norepinephrine.
HEMODIALYSIS: Most effective treatment for severe
poisoning; may reverse severe effects within 30
minutes.
32.
Manganese
Most exposures to manganese are chronic. Emesis and
activated charcoal may not be useful in chronic cases.
All govt. hospitals
All medical stores
CHELATION THERAPY with EDTA may enhance
the urinary excretion and mobilization of manganese
from the blood and tissue but its effectiveness in
improving existing neurological findings or preventing
neurologic deterioration have not been clearly
demonstrated.
LEVODOPA THERAPY (up to 3.5 to 12 grams per
day in divided doses in an adult) may result in
improvement of neurological toxicity. Concomitant
administration of carbidopa may result in greater
benefit. An animal model suggested that L-dopa may
actually enhance dopamine depletion, at least during the
early or acute phase.
INTENTION TREMOR may respond to
trihexyphenidyl hydrochloride (Adult: 1 to 5 mg per day
in divided doses).
33.
Mercury
Ingestion: Elemental (Metallic) Mercury - is usually
not absorbed, and usually does not produce acute
toxicity. Decontamination is not necessary in normal
adults
All govt. hospitals
All medical stores
Inhalation: Move patient to fresh air. Monitor for
respiratory distress. If cough or difficulty breathing
develops, evaluate for respiratory tract irritation,
bronchitis, or pneumonitis. Administer oxygen and
assist ventilation as required. Treat bronchospasm with
beta2 agonist and corticosteroid aerosols.
Chelating agents that have been used to treat mercury
poisoning include:
Antidote and General Response Book – Industrial Accidents
Page 18
1. SUCCIMER 10 mg/kg orally every 8 hrs. for 5 days,
followed by 10 mg/kg every 12 hours for 14 days.
2. DMPS 5 mg/kg IV or IM every 6 to 8 hours for 2
days, then reduce to once or twice daily administration.
3. PENICILLAMINE Adults 1000 to 1500 mg per day
divided every 8 to 12 hours.
4. N-acetyl- penicillamine Adults 250 to 500
milligrams every 6 hours.
5. BAL 3 to 5 mg/kg/dose every 4 hours by deep IM for
2 days; 2.5 to 3 mg/kg/dose IM every 6 hours for 2
days; then 2.5 to 3 mg/kg/dose IM every 12 hours for a
week.
34.
Metaldehyde
35.
Methyl
Mercaptan
No specific antidote, give supportive treatment
INHALATION EXPOSURE: Move patient to fresh
air. Monitor for respiratory distress. Administer oxygen
and assist ventilation as required. Treat bronchospasm
with beta2 agonist and corticosteroid aerosols.
Oxygen
British oxygene ltd.,
Rakhial Ahmedabad
METHEMOGLOBINEMIA: Administer 1 to 2 mg/kg
of 1% methylene blue slowly IV in symptomatic
patients.
Methylene blue
EYE EXPOSURE Irrigate exposed eyes with copious
amounts of tepid water for at least 15 minutes.
Dr. S.I.Trivedi
Vatva Ind. Association
DERMAL EXPOSURE
Remove contaminated clothing and wash exposed area
thoroughly with soap and water. Treat dermal irritation
or burns with standard topical therapy. Patients
developing dermal hypersensitivity reactions may
require treatment with systemic or topical
corticosteroids or antihistamines.
36.
Nickel
CHELATING AGENTS - Although penicillamine has
an effect, diethyldithiocarbamate (DDC) is the preferred
chelating agent for nickel.
a. Blood levels less than 10 mcg/dL DDC is
Antidote and General Response Book – Industrial Accidents
CMSO
Civil hospital
Gandhinagar
Page 19
unnecessary.
b. 10 to 50 mcg/dL: DDC should be administered orally
(50 mg/kg/day on day 1, then 400 mg every 8 hours
until the patient is symptom free and urine nickel is
under 10 mcg/dL.
c. Greater than 50 mcg/dL: the dose of DDC
parenterally is 25 mg/kg. Severe cases may use 100
mg/kg for the first 24 hours.
37.
Organochlorin
e pesticides
( DDT, BHC,
Lindane,
Endosulfan)
Ingestion: Ipecac-induced emesis is not recommended
because of the potential for CNS depression and
seizures.
All Govt. Hospitals
All medical Stores
GASTRIC LAVAGE: Consider after ingestion of a
potentially life-threatening amount soon after ingestion
(generally within 1 hour). Protect airway by placement
in Trendelenburg and left lateral decubitus position or
by endotracheal intubation. Control any seizures first.
ACTIVATED CHARCOAL: Administer charcoal as
slurry (240 mL water/30 g charcoal). Usual dose: 25 to
100 g in adults/adolescents,
SEIZURES: Administer a benzodiazepine IV;
DIAZEPAM (ADULT: 5 to 10 mg, repeat every 10 to
15 min as needed) or LORAZEPAM (ADULT: 4 to 8
mg). Consider phenobarbital if seizures recur after
diazepam 30 mg (adults)
REFRACTORY SEIZURES: Consider continuous
infusion of midazolam, propofol, and/or pentobarbital.
Do not give oils by mouth.
Do not administer adrenergic amines, which may
further increase myocardial irritability and produce
refractory ventricular arrhythmias.
CHOLESTYRAMINE- Oral administration may
enhance the excretion of kepone and chlordane which
are trapped in the enterohepatic circulation.
EYE EXPOSURE
DECONTAMINATION: Irrigate exposed eyes with
copious amounts of tepid water for at least 15 minutes.
Antidote and General Response Book – Industrial Accidents
Page 20
DERMAL EXPOSURE
If clothing is contaminated remove, and wash skin and
hair three times; do an initial soap washing followed by
an alcohol washing followed by a soap washing.
38.
Organophosph
ate pesticides
(Chlorpyripho
s, phorate,
Dimethoate,
Monocrotopho
s, Malathion,
Fenitrothion,
Fenthion,
Quinalphos
etc.)
Ingestion: GASTRIC LAVAGE: Consider after
ingestion of a potentially life-threatening amount of
poison if it can be performed soon after ingestion
(generally within 1 hour). Protect airway by placement
in Trendelenburg and left lateral decubitus position or
by endotracheal intubation. Control any seizures first.
All Govt. Hospitals
All medical stores
ATROPINE THERAPY - If symptomatic, administer
IV atropine until atropinization is achieved. Adult - 2 to
5 mg every 10 to 15 minutes; Child - 0.05 mg/kg every
10 to 15 minutes. Atropinization may be required for
hours to days depending on severity.
PRALIDOXIME .Treat moderate to severe poisoning
(fasciculations, muscle weakness, respiratory
depression, coma, seizures) with 2-PAM in addition to
atropine; most effective if given within 48 hours, but
has had efficacy up to 6 days. May require
administration for several days. INITIAL DOSE:
ADULT: 1 to 2 g in 100 to 150 ml 0.9% saline IV over
30 min. Repeat these doses in 1 hour and then every 6
to 12 hours if muscle weakness or fasciculations persist,
or begin continuous infusion.
CONTINUOUS INFUSION: Administer as a 2.5%
solution in 0.9% saline. ADULT: 500 mg/hour.
Inhalation Exposure: Move patient to fresh air.
Monitor for respiratory distress. If cough or difficulty
breathing develops, evaluate for respiratory tract
irritation, bronchitis, or pneumonitis. Administer
oxygen and assist ventilation as required. Treat
bronchospasm with beta2 agonist and corticosteroid
aerosols. Treat with atropine and PAM as in case of
ingestion
DERMAL EXPOSURE
Systemic effects can occur from dermal exposure to
organophosphates. Remove contaminated clothing and
jewelry; wash skin, hair and nails vigorously with
Antidote and General Response Book – Industrial Accidents
Page 21
repeated soap washings. Leather absorbs pesticides; all
contaminated leather should be discarded. Rescue
personnel and bystanders should avoid direct contact
with contaminated skin, clothing, or other objects. Treat
with atropine and PAM as in case of ingestion
39.
Oxalic acid
INGESTION EXPOSURE -
All govt. hospitals
Do NOT induce emesis due to the potential for
gastrointestinal tract irritation or burns, seizures, and
coma. Immediately dilute with milk or water.
Administer calcium gluconate or calcium lactate 150
mg/kg orally; may repeat if necessary.
All Medical Stores
Administer activated charcoal following ingestion of
dilute solutions.
EYES - Immediately wash the eyes with large amounts
of water, occasionally lifting the lower and upper lids
DERMAL - Flush the contaminated skin with water
promptly and remove the clothing.
INHALATION - Move the exposed person to fresh air
at once.
40.
Phosphorus
DERMAL EXPOSURE
1. Prompt removal of all clothing, including jewelry,
and copious irrigation with water should occur as soon
as possible.
All govt. hospitals
All medical stores
2. Immerse exposed areas in water or cover with wet
dressings at all times.
3. Wash several times with a solution of 5% sodium
bicarbonate AND 3% copper sulfate AND 1% hydroxyethyl-cellulose AND 1% sodium lauryl sulfate; rinse
thoroughly with saline between washings .If this
solution is not readily available, continuous tepid water
irrigation can prevent further oxidation and allow
removal of phosphorous particles from the skin without
ignition
4. Avoid application of any lipid or oil based ointments
as these may increase the absorption of phosphorous
through the skin.
Antidote and General Response Book – Industrial Accidents
Page 22
5. Visualization of phosphorus particles may be
enhanced under an ultraviolet light source (black light,
Wood's lamp). Phosphorus particles should fluoresce
under UV light. With the exposed areas immersed in
water, loose or imbedded phosphorus particles that are
visualized under UV light can be mechanically but
delicately removed safely under water.
6. Monitor the patient for the development of systemic
signs or symptoms of phosphorus poisoning.
41.
Silver nitrate
and other
silver salts
ORAL/PARENTERAL EXPOSURE
Troika Lab.
DILUTION: Following ingestion and/or prior to gastric
evacuation, immediately dilute with 4 to 8 ounces (120
to 240 mL) of milk or water.
Throl, Ta. kadi
METHEMOGLOBINEMIA: Administer 1 to 2 mg/kg
of 1% methylene blue slowly IV in symptomatic
patients. Additional doses may be required.
Dist. Mehsana
V.I.A.
Dr. S.I. Trivedi
Vatva
EYE EXPOSURE: Irrigate exposed eyes with copious
amounts of tepid water for at least 15 minutes.
DERMAL EXPOSURE Remove contaminated
clothing and wash exposed area thoroughly with soap
and water.
42.
Tobacco &
Nucotine
43.
Vinyl chloride
Atropine
Oxygen
Oxyen
BOL Ahmedabad
All govt. hospitals
All medical stores
ACUTE - Inhalation exposures to high concentrations
may cause CNS and respiratory depression. Patients
significantly exposed need appropriate supportive care.
Oxygen
EYE EXPOSURE
Irrigate exposed eyes with copious amounts of tepid
water for at least 15 minutes.
BOL Ahmedabad
All govt. hospitals
All medical stores
DERMAL EXPOSURE: Remove contaminated
clothing and wash exposed area thoroughly with soap
and water.
CHRONIC - Workers exposed may require monitoring
for liver cancer, scleroderma, pneumonitis, clotting
Antidote and General Response Book – Industrial Accidents
Page 23
abnormalities, and acro-osteolysis.
There are no specific antidotes. Treatment is directed at
minimizing exposure and monitoring for the above
symptoms.
44.
Zinc fumes
and metal
fume fever
Oral/Parenteral Exposure: Some zinc salts are highly
corrosive and induced emesis or gastric lavage should
be avoided. With corrosive zinc salts, dilute rapidly with
water or milk. Activated charcoal (Usual dose: 25 to
100 g), may be beneficial in patients exposed to salts of
zinc that are NOT highly corrosive or following
substantial ingestions of zinc tablet or capsule
preparations. However, most lighter metals (including
zinc) are not significantly adsorbed to activated
charcoal.
CMSO
Gandhinagar
All govt. hospitals
All medical stores
Supportive Care - Maintain hydration and observe for
metabolic acidosis, hypocalcemic tetany, anuria, liver
damage, gastric perforation, and pyloric stenosis.
Chelation - Calcium disodium edetate and BAL have
been used following zinc overdose with mixed results.
Inhalation Exposure: Aspirated zinc stearate may
cause severe respiratory irritation.
Pulmonary Edema (Noncardiogenic): Maintain
ventilation and oxygenation and evaluate with frequent
arterial blood gas or pulse oximetry monitoring. Early
use of PEEP and mechanical ventilation may be needed.
Eye Exposure
Zinc salts will precipitate protein in the eye and cause
corneal and lens changes.
Irrigate exposed eyes with copious amounts of tepid
water for at least 15 minutes. If irritation, pain, swelling,
lacrimation, or photophobia persist, the patient should
be seen in a health care facility.
Rinsing with a 0.05 M neutral sodium edetate solution
may help prevent or reverse a portion of the protein
precipitation.
Antidote and General Response Book – Industrial Accidents
Page 24
4. Protection of Human Health and Safety assurance during an emergency by
the use of chemical neutralizers
IMMEDIATE ACTION to be taken by all Involved Employees.
A. CLEAR the affected area.
B. CHECK for individual involvement. Isolate the spill, if safe to do so.
C. CONTACT Emergency at the facility emergency number.
Any personnel contaminated with chemicals must be decontaminated for at least 15 minutes and
taken to medical assistance. Any time a person is contaminated, emergency response at the
facility emergency number must be notified and the spill team must be activated.
The supervisor present and trained in spill response procedures is the Spill Response Leader
(until relieved) and is responsible for all aspects of the response.
5. Guidelines for spill response
Guide number 1: ACIDS
Quantity: Acid spills larger than 1 liter or 1 pound will be handled by the Emergency Response
Team.
Minimum PPE: Level B or C protection.







Full neoprene boots
Kappler CPF suits
Triple gloves
Neoprene
Solvex gloves
N-dex
Respiratory protection acid gas cartridge (with hepa pre-filter) with full face respirator
or SCBA hard hat with face shield.
Note: SCBA should be used, but some facilities have determined that they will only respond to
incidents which can be handled with air purifying respirators.
Procedures:
liquid acid spills
The persons nearest the spill will throw polypropylene pillows around and on the spill, if it is
safe to do so. The pillows will be placed in such a manner as to prevent the spread of the spill,
indicate its boundaries, and reduce fuming by covering the surface. If this has not been done
Antidote and General Response Book – Industrial Accidents
Page 25
prior to the arrival of the Emergency Response Team, it will be performed as soon as possible.
The following sections describe the use of solid and liquid spill response materials to mitigate a
release of acid.
Liquid Neutralizer Methods
The excess acid liquid will be absorbed on polypropylene pads. If absorption is slow because of
the viscosity of the spilled material, careful application of a minimum amount of liquid acid
neutralizer to the spill boundary will enhance absorption. The acid residue remaining on the
contaminated area will be neutralized using more liquid acid neutralizer. The neutralized residue
will be absorbed on pads and the used pads will be placed in designated waste containers.
This neutralization treatment will be done at least three times, after which the contaminated site
will be analyzed using pH paper. Responders should attempt obtain a final pH reading in the
range of 6 to 10, Additional treatment will continue until all acid residue is neutralized. The area
will be washed with soap and water solution after the neutralization process is complete.
If floor tiles or equipment are involved, the responders must be certain to examine all surfaces
and hidden areas for free liquid or residual contamination. Raised-floor tiles usually must be
removed for neutralization with liquid acid neutralizer.
The waste containers (5-gal plastic pals or lined drums) will be secured and transported to the
wastewater treatment facility or the hazardous waste yard for treatment or disposal. This material
will be treated as a hazardous waste until determined otherwise.
Solid Sodium Bicarbonate
The released liquid will be dike and contained with the solid neutralizer. Sufficient material
should be spread over the spill to cover the surface with a light coating. The solid neutralizer will
then be thoroughly mixed with the acid to effect absorption of all free liquid.
A small quantity of water may be added to cool the slurry or increase the rate of neutralization, if
necessary. The progress of the neutralization reaction should be confirmed using pH paper.
Responders should attempt obtain a final pH reading in the range of 6 to 10, More sodium
bicarbonate will be added, if needed, to achieve this pH range.
After all free liquid is absorbed and the residue is containerized, the area should be rinsed at least
twice with water to remove residual contamination and excess solid neutralizer. Precautions
about equipment and floors, as described previously should be observed.
The waste containers (5-gal plastic pals or lined drums) will be secured and transported to the
wastewater treatment facility or the hazardous waste yard for treatment or disposal. This material
will be treated as a hazardous waste until determined otherwise.
solid acid spills
Small spills of solid acid can be cleaned-up mechanically with a dust pan and brush. Larger spills
should be cleaned-up using a high efficiency particulate filter vacuum. The material should be
placed in an appropriate container (5-gal plastic pals or lined drums), secured, and transported to
the wastewater treatment facility or the hazardous waste yard for treatment or disposal.
Antidote and General Response Book – Industrial Accidents
Page 26
Remaining solid acid residue may be neutralized using a liquid acid neutralizer. The neutralized
residue will be absorbed on pads and placed in appropriate containers. This material will be
treated as a hazardous waste until determined otherwise.
NOTE: If it is appropriate to wet the acid to reduce dusting, prior to clean-up, water is
usually NOT AN APPROPRIATE CHOICE. Frequently, a non-reactive, viscous liquid such
as ethylene glycol is best used. The Emergency Response Team must make this determination
for each solid spill.
Guide number 2: WATER-REACTIVE ACID PRODUCER
Quantity: Water-reactive, acid producer spills larger than 1 liter or 1 pound will be handled by
the Emergency Response Team.
Minimum PPE: Level B or C protection.







Full neoprene boots
Kappler CPF suits
Triple gloves
Neoprene
Solvex Gloves
N-dex
Respiratory protection acid gas cartridge (with hepa pre-filter) with full face respirator
or SCBA hard hat with face shield
Note: SCBA should be used, but some facilities have determined that they will only respond to
incidents which can be handled with air purifying respirators.
Procedures:
An acid (liquid or solid) neutralizer will be used in this clean-up procedure. Prior to using the
acid neutralizer, the contaminated area should be dike, and Ice water should be slowly and
carefully added to the spilled material until reaction ceases. After the reaction is complete, the
appropriate response procedures described in GUIDE NUMBER 1 should be implemented.
WARNING: EXTREME HEAT MAY BE GENERATED WHICH MAY CAUSE THE
SPILLED MATERIAL TO BOIL! SAFETY MUST BE ADDRESSED PRIOR TO
IMPLEMENTING THESE PROCEDURES!
Antidote and General Response Book – Industrial Accidents
Page 27
Guide Number 3: CAUSTICS
Quantity: Caustic spills larger than 1 liter or 1 pound will be handled by the Emergency
Response Team.
Minimum PPE: Level B or C protection.







Full neoprene boots
Kappler CPF suits
Triple gloves
Neoprene
Solvex gloves
N-dex
Respiratory protection acid gas cartridge (with hepa pre-filter) with full face respirator
or SCBA hard hat with face shield
Note: SCBA should be used, but some facilities have determined that they will only respond to
incidents which can be handled with air purifying respirators.
Procedures:
LIQUID CAUSTIC SPILLS
The persons nearest the spill, if it is safe to do so, will throw polypropylene pillows around and
on the spill in such a manner as to prevent the spread of the spill, indicate its boundaries, and
reduce fuming by covering the surface. If this has not been done prior to the arrival of the
Emergency Response Team it will be performed as soon as possible. The following sections
describe the use of solid or liquid spill response materials in the mitigation of releases involving
liquid, caustic chemicals.
Liquid Caustic Neutralizer Methods
The excess caustic liquid will be absorbed on polypropylene pads. If absorption is slow because
of the viscosity of the spilled material, careful application of a minimum amount of liquid caustic
neutralizer to the spill boundary will enhance absorption. After the majority of the liquid has
been absorbed and removed, the responders will begin applying liquid caustic neutralizer to any
caustic residue. Allow several minutes of soaking to provide for neutralization of spilled caustic
which has may have leached into porous surfaces.The neutralized residue will be absorbed on
pads and placed in designated waste containers.
This neutralization treatment will be done at least three times, after which the contaminated site
will be analyzed using pH paper. Additional treatment will continue until all caustic residue is
neutralized.
If floor tiles or equipment are involved, the responders must be certain to examine all surfaces
and hidden areas for free liquid or residual contamination. Clean Room floor tiles usually must
be removed for neutralization with liquid caustic neutralizer at least two (2) water rinses of the
area must be performed to completely remove residual liquid caustic neutralizer.
Antidote and General Response Book – Industrial Accidents
Page 28
The waste materials will be placed in an appropriate container (5-gal plastic pals or lined drums),
secured and then transported to the wastewater treatment facility or the hazardous waste yard for
treatment or disposal. This material will be treated as a hazardous waste until determined
otherwise.
SOLID CITRIC ACID
Free liquid will be diked and contained with the solid neutralizer. Sufficient material will be
spread over the spill to just cover the surface with a light coating. The solid neutralizer will be
thoroughly mixed with the caustic to effect absorption of all free liquid.
A small quantity of water may be added to cool the slurry or increase the rate of neutralization, if
necessary. The progress of the neutralization reaction should be checked using pH paper. The
responders should attempt to obtain a final pH reading in the range of 4 to 8. More neutralizer
should be added, if needed, to obtain that goal. Precautions about equipment and floors, as
described previously should be observed.
After all free liquid is absorbed and the residue is containerized, the area should be rinsed at least
twice with water to remove residual contamination and excess solid neutralizer.
SOLID CAUSTIC SPILLS
Small spills can be cleaned-up mechanically with a dust pan and brush. Larger spills should be
cleaned-up using a high efficiency particulate filter vacuum. The waste material should be placed
in an appropriate container (5-gal plastic pals or lined drums), secured, and transported to the
wastewater treatment facility or the hazardous waste yard for treatment or disposal.
Any remaining caustic residue may be neutralized using a liquid caustic neutralizer. The
neutralized residue will be absorbed on pads and placed in appropriate containers. This material
will be treated as a hazardous waste until determined otherwise.
NOTE: If it is appropriate to wet the caustic to reduce dusting, prior to clean up, water is
usually NOT AN APPROPRIATE CHOICE. Frequently, a non-reactive, viscous liquid such
as ethylene glycol is best used. The Emergency Response Team must make this determination
for each solid spill.
Guide number 4: OXIDIZERS
Quantity: Oxidizer spills larger than 1 liter will be handled by the Emergency Response Team.
Minimum PPE: Level B or C protection.






Full neoprene boots
Kappler CPF suits
Triple gloves
Neoprene
Solvex gloves
N-dex
Antidote and General Response Book – Industrial Accidents
Page 29
 Respiratory protection acid gas cartridge (with hepa pre-filter) with full face respirator
or SCBA hard hat with face shield
Note: SCBA should be used, but some facilities have determined that they will only respond to
incidents
which
can
be
handled
with
air
purifying
respirators.
Procedures:
LIQUID OXIDIZER SPILLS
Before initiating clean-up procedures:
Remove or moisten all combustible materials affected by the spilled substance.
If oxidizer is not water reactive, dilute to less than 5% (estimated) and absorb with
polypropylene wipes or MAGICSORB(tm).
The excess oxidizer should be absorbed with polypropylene wipes or MAGICSORB(tm). The
waste materials should be placed in an appropriate container (5-gal plastic pals or lined drums),
secured, and then transported to the wastewater treatment facility or the hazardous waste yard for
treatment or disposal.
If neutralization of the oxidizer is necessary, use dilute (5%) sodium thiosulfate in water.
SOLID OXIDIZER SPILLS
Small spills can be cleaned-up mechanically with a dust pan and brush. Larger spills should be
cleaned-up using a high efficiency particulate filter vacuum. The waste material should be placed
in an appropriate container (5-gal plastic pals or lined drums), secured, and transported to the
wastewater treatment facility or the hazardous waste yard for treatment or disposal. This material
will be treated as a hazardous waste until determined otherwise.
Any remaining oxidizer residue may be neutralized using dilute (5%) sodium thiosulfate in
water. The neutralized residue will be absorbed on pads and placed in designated waste
containers.
Guide number 5: REDUCERS
Quantity: Reducer spills larger than 1 liter will be handled by the Emergency Response Team.
Minimum PPE: Level B or C protection.







Full neoprene boots
Kappler CPF suits
Triple gloves
Neoprene
Solvex gloves
N-dex
Respiratory protection acid gas cartridge (with hepa pre-filter) with full face respirator
or SCBA hard hat with face shield
Antidote and General Response Book – Industrial Accidents
Page 30
Note: SCBA should be used, but some facilities have determined that they will only respond to
incidents which can be handled with air purifying respirators.
Procedures:
LIQUID REDUCER SPILLS
If reducer is not water reactive, the material should be diluted to less than 5% (estimated) with
water and absorbed with polypropylene wipes or MAGICSORB(tm). If neutralization of the
reducer is necessary, use household bleach or a 5% hypochlorite solution. All excess liquid
should be absorbed with polypropylene wipes or MAGICSORB(tm), placed in an appropriate
container (5-gal plastic pals or lined drums), secured, and then transported to the wastewater
treatment facility or the hazardous waste yard for treatment or disposal.
SOLID REDUCER SPILLS
Small spills can be cleaned-up mechanically with a dust pan and brush. Larger spills should be
cleaned-up using a high efficiency particulate filter vacuum. Waste materials should be placed in
an appropriate container (5-gal plastic pals or lined drums), secured, and transported to the
wastewater treatment facility or the hazardous waste yard for treatment or disposal. Any
remaining reducer residue contaminating the area may be neutralized using household bleach or
a 5% hypochlorite solution. The neutralized residue will be absorbed on pads and placed in
designated waste containers. This material will be treated as a hazardous waste until determined
otherwise.
Guide number 6: POISONS
Quantity: Poison spills larger than 1 liter or 1 pound will be handled by the Emergency
Response Team.
Minimum PPE: Level B or C protection.







Full neoprene boots
Kappler CPF suits
Triple gloves
Neoprene
Solvex gloves
N-dex
Respiratory protection acid gas cartridge (with HEPA pre-filter) with full face respirator
or SCBA hard hat with face shield
Note: SCBA should be used, but some facilities have determined that they will only respond to
incidents which can be handled with air purifying respirators.
Antidote and General Response Book – Industrial Accidents
Page 31
Procedures:
LIQUID POISON SPILLS
The free liquid should be absorbed using polypropylene pads or MAGICSORB(tm). The waste is
placed in an appropriate container (5-gal plastic pals or lined drums), secured, and then
transported to the wastewater treatment facility or the hazardous waste yard for treatment or
disposal.
Remove spill residue which may be contaminating area by carefully washing area with water and
detergent. (If material is water reactive or insoluble in water, use appropriate solvent.) Absorb
wash water on pads or MAGICSORB and place in designated waste container. Treat this
material as a hazardous waste until testing determines otherwise.
SOLID POISONS SPILLS
A liquid (water or other solvent) should be used to moisten the solid, preventing the spread of
dust particulates. The liquid must be selected based on the reactivity of the spilled solid.
Small spills can be cleaned-up mechanically with a dust pan and brush. Larger spills should be
cleaned-up using a high efficiency particulate filter vacuum. The waste materials should be
placed in plastic bags, which are then sealed. The plastic bags should be placed in an appropriate
container (5-gal plastic pals or lined drums), secured, and transported to the wastewater
treatment facility or the hazardous waste yard for treatment or disposal
Guide number 7: REACTIVES
The following procedures are recommended guidelines for handling releases of air reactive and
water reactive chemicals.
WATER REACTIVE MATERIALS
Special Actions: CONSIDER EVACUATION OF BUILDING!
Quantity: ALL spills of water reactive materials must be handled by the Emergency Response
Team.
Minimum PPE: Level B or C protection.







Full neoprene boots
Kappler CPF suits
Triple gloves
Neoprene
Solvex gloves
N-dex
Respiratory protection acid gas cartridge (with hepa pre-filter) with full face respirator
or SCBA hard hat with face shield
Antidote and General Response Book – Industrial Accidents
Page 32
Note: SCBA should be used, but some facilities have determined that they will only respond to
incidents which can be handled with air purifying respirators.
Procedures:
Before initiating clean-up procedures, the spilled material should be diluted with appropriate
substance to reduce reactivity, if possible. If potential exists for contact with water, the spilled
material should be covered with mineral oil.
Spilled material should be absorbed with polypropylene wipes or MAGICSORB(tm), placed in an
appropriate container (5-gal plastic pals or lined drums), secured, and then transported to the
wastewater treatment facility or the hazardous waste yard for treatment or disposal.
WARNING: EXTREME HEAT MAY BE GENERATED WHICH MAY CAUSE THE
SPILLED MATERIAL TO BOIL! SAFETY MUST BE ADDRESSED PRIOR TO
IMPLEMENTING THESE PROCEDURES!
AIR REACTIVE MATERIALS
Special Actions: CONSIDER EVACUATION OF BUILDING!
Quantity: ALL spills of air reactive materials must be handled by the Emergency Response
Team.
Minimum PPE: Level B or C protection.







Full neoprene boots
Kappler CPF suits
Triple gloves
Neoprene
Solvex gloves
N-dex
Respiratory protection acid gas cartridge (with hepa pre-filter) with full face respirator
or SCBA hard hat with face shield.
Note: SCBA should be used, but some facilities have determined that they will only respond to
incidents
which
can
be
handled
with
air
purifying
respirators.
Procedures:
Spilled material should be covered with mineral oil or other non-reactive barrier and absorbed
with MAGICSORB(tm). The waste should be placed in an appropriate container (5-gal plastic
pals or lined drums), secured, and then transported to the wastewater treatment facility or the
hazardous waste yard for treatment or disposal.
Antidote and General Response Book – Industrial Accidents
Page 33
WARNING: EXTREME HEAT MAY BE GENERATED WHICH MAY CAUSE THE
SPILLED MATERIAL TO BOIL! SAFETY MUST BE ADDRESSED PRIOR TO
IMPLEMENTING THESE PROCEDURES!
Guide number 8: GASES
Special Actions: If the gas is an atmospheric gas (nitrogen, oxygen, carbon dioxide) clear the
affected floor, otherwise,
CONSIDER EVACUATION OF BUILDING!
Fire department support may be needed.
Quantity: ALL uncontrolled, compressed gas releases must be handled by the Emergency
Response Team.
Minimum PPE: SCBA and appropriate skin protection, as needed.
Simple asphyxiant gases, with no fire hazard: SCBA and work gloves
Simple asphyxiant gases with a fire hazard: SCBA and fire protective clothing (if above 10%
of the LEL). Entry into areas above 10% of the LEL is normally not recommended.
Gases with TLVs less than 10 ppm:
 Kappler CPF response suits (level B)
 Triple gloves
 Neoprene gloves
 Solvex gloves
 N-dex gloves
 SCBA
 Hard hat with face shield
Gases with TLVs less than 10 ppm which are corrosive or known to absorb into the body
through the skin:
 Kappler CPF response suits (level a) or full encapsulating level b
 Triple gloves:
 Neoprene gloves
 Solvex gloves
 N-dex gloves
 SCBA
 Hard hat with face shield
Antidote and General Response Book – Industrial Accidents
Page 34
Procedures:
If possible, the leak should be controlled without approach to the point of release. If this is not
possible, the cylinder should be moved out of the building or allowed to completely vent inplace.
Guide number 9: FLAMMABLE MATERIALS
Special Actions: If the vapor concentration is over 10% of the LEL:
CONSIDER EVACUATION OF THE BUILDING!
ADEQUATE FIRE PROTECTION MUST BE PROVIDED.
A response team member, properly protected, must have immediate access to a (minimum) 20
LB ABC dry chemical fire extinguisher or equivalent.
Quantity: Flammable spills larger than 1 liter will be handled by the Emergency Response
Team.
Minimum PPE: Level B or C protection.
 Kappler CPF response suits (level B)
 Triple gloves
 Neoprene gloves
 Solvex gloves
 N-dex gloves
 SCBA
 Hard hat with face shield
Note: SCBA should be used, but some facilities have determined that they will only respond to
incidents which can be handled with air purifying respirators.
Procedures:
In general, solvent spills of 1 gallon or less will rapidly evaporate. However, until vapors
disperse, the risk of fire or explosion and the health hazards may be quite high. Solvent spills in
areas where flammable vapors can accumulate should be monitored with a combustible gas
meter. If the concentration of combustible gas exceeds 10% of the Lower Explosion Limit (LEL)
responders should withdraw until the atmosphere can be appropriately modified via ventilation.
Where dust is not a problem, activated charcoal will be used to adsorb the solvent spill and to
control the vapors. If dust is a problem, low dust polypropylene, absorbent pads will be used
whenever possible. Flammable solids must be covered with a non-reactive material.
Charcoal should be placed in a plastic pail or lined drum. The residue may be vacuumed with a
high efficiency particulate filter protected, explosion proof, industrial vacuum. Solvent soaked
pads will immediately be placed into a safety can for removal from the work area.
Antidote and General Response Book – Industrial Accidents
Page 35
If spill is not controlled quickly, EVACUATION OF THE BUILDING MUST BE
CONSIDERED. The local fire department should be called.
WARNING: ENTRY INTO AN ATMOSPHERE WHICH CONTAINS MORE THAN 10% OF
THE LEL IS NOT RECOMMENDED!
Guide number 10: LOW-HAZARD MATERIALS
Area workers may clean up spills of low-hazardous materials (sodium chloride solid, for
example) at the DISCRETION of the emergency response leader. If the leader is in doubt, the
Emergency Response Team may be used. Only dispose of low-hazardous chemical materials in
the municipal disposal system if they are determined to be NON-HAZARDOUS in the
regulatory sense of the word. This will be determined by applicable Federal, State, and local
regulations. All containers must be clearly labeled "NON-HAZARDOUS" when disposed of as
non-hazardous. Use care in making this choice.
Antidote and General Response Book – Industrial Accidents
Page 36
Caller
Information
Incident
Caller Name:
Caller Location:
6. EMERGENCY INCIDENT TELEPHONE LOG
Date:
Time:
Nature of Incident: Fire/Explosion
Chemical Spill
Gas Release
Injury/Illness
Severe Weather
Bomb Threat
Provide Specific Details:
Fire Emergency What is burning:
Information
Chemical
Emergency
Information
Medical
Emergency
Information
Other Information
What is the spilled chemical?
Where is the Spill?
How much is spilled?
Was anyone contaminated?
Victim Name and Location:
Nature of the Medical Problem:
Communication On-Site:
Response
Security
Off-Site:
Fire Dept.
ERT
Police Dept.
First-Aid
EMS
Nurse/MD
Other:
Antidote and General Response Book – Industrial Accidents
Page 37
7. First Aid and Treatment of Chemical Exposure:
First aid:
An immediate treatment given to the victim of an accident or sudden illness before medical help
is obtained.
It is a combination of simple but quite expedient active measures to save the victim's life and
prevent possible complications.
It needs to be immediate in severe accidents complicated by bleeding, shock and loss of
consciousness.
Majority of the accidents are trifle and curable by first aid only
Even otherwise all industrial injuries need immediate first aid for which statutory provisions are
also made.
General principles for rendering first aid:
Aims
1.
To preserve life
2.
To promote or assist recovery
3.
To prevent worsening or aggravation of the casualty's condition
4.
To minimize complication, and
5.
To mange transportation to hospital, if necessary
First aider:
May not be a doctor
Should observe carefully, think clearly and act quickly
Should be calm, cool and confident and should not get excited
He should ask someone to call a doctor/inform hospital immediately giving some details of cases
involved
While waiting for the doctor, he should give first aid methodically
After the doctor takes charge, the first aider's responsibility ends
He can then stand by to help the doctor
Antidote and General Response Book – Industrial Accidents
Page 38
General meaning of first aid:
1. First thing first
2. Inform the doctor
3. Reassure the victim
4. Shock prevention or treatment
5. Tourniquet, control bleeding
6. Artificial respiration
7. Immobilize fractures
8. Disposal, send victim to hospital
First Aid for minor Burns and Scalds:
In the case of minor burns
1. Clean the area gently with clean water.
2. Submerge the burned area in cold water.
3. Apply a solution of salt and water (one teaspoonful to a pint of water) in out the way places.
4. Cover with dry dressing.
5. Do not apply cotton wool direct to the burnt.
6. Do not apply any greasy substance.
7. Give warm drinks for example sweetened tea or coffee.
First Aid of Serious Burns and Scalds:
Immediate attention that required in serious burns are
1. Keep the casualty quiet and reassure him.
2. Wrap him up in clean cloth.
3. Do not remove adhering particles of charred clothing.
4. Cover burnt area with sterile or clean dressing and bandage. In case of burns covering a large
part of the body, it is sufficient to cover the area with a clean sheet or towel.
5. Keep him warm but do not overheat hint.
6. If the hands are involved, keep them above the level of the victim's heart.
7. Keep burned feet or legs elevated.
8. If victim's face is burnt, sit up or prop him up and keep him under continuous observation for
breathing difficulty. If respiratory problems develop, an open airway must be maintained.
Antidote and General Response Book – Industrial Accidents
Page 39
9. Do not immerse the extensive burned area or apply ice-water over it because cold may intensify
the shock reaction. However, cold pack may be applied to the face or to the hands or feet.
10. Shift the casualty to the nearest hospital if he is fit to be moved. If you cannot take him to a
hospital, wait for the doctor to arrive. Mean while do not open blisters and keep him wrapped up
in clean cloth. If needed treat for shock.
11. Remove quickly from the body anything of a constricting nature like rings, bangles, belt and
boots. If this is not done early, it would be difficult to remove them later as the limb begins to
swell.
12. If medical help or trained ambulance personnel cannot reach the scene for an hour or more and
the victim is conscious and not vomiting give him a weak solution of salt and soda at home and
enroute:- One level tea-spoonful of salt and half level tea-spoonful of baking soda to each quart
of water, neither' hot not cold. Allow the casualty to sip slowly. Give above four ounces to adult
over a period of 15 minutes: two ounces to a child between 1 and 12 years of age and about one
ounce to an infant under one year of age and about one ounce to an infant under one year of age.
Discontinue fluid if vomiting occurs. Do not apply ointment or any form of grease or other home
remedy.
First Aid of Chemical Bums:
1. Wash off the chemical with a large quantity of water for 15 minutes by using a shower or hose if
available as quickly as possible. This flooding with water will wash away most of the irritant.
2. Cut out contaminated clothing.
3. Do not touch.
4. Treat as for burns.
Burns of the Eye:
Acid Burns:
1. First aid for acid burns of the eye should be given as quickly as possible by thoroughly washing
the face, eyelids and the eye for at least fifteen minutes by water.
2. If the casualty is lying down, turn his head to the side, hold the eyelids open and pour water from
the inner corner of the eye outward. Make sure that the chemical does not enter into the other
eye. Cover the eye with a dry, clean protective dressing (do not use cotton) and bandage.
3. Neutralising agents or ointments should not be used.
4. Caution the victim against rubbing his eye.
5. Get medical help immediately (preferably an eye specialist).
Antidote and General Response Book – Industrial Accidents
Page 40
Alkali Burns:
Alkali burns of the eye can be caused by drain cleaner or other cleaning solution. An eye that
first appears to have only a slight surface injury may develop deep inflammation and tissue
destruction and the sight may be lost.
1. Flood the eye thoroughly with water for 15 minutes.
2. If the casualty is lying down, turn his head to the side. Hold the lids open and pour water from
the inner corner outward. Remove any loose particles of dry chemicals floating on the eye by
lifting them off gently with sterile gauze or a clean handkerchief.
3. Do not irritate with soda solution.
4. Mobilize the eye by covering with a dry pad or protective clothing. Seek immediate medical aid.
Poisoning, First Aid and Antidotes
Some substances when taken into the body in fairly large quantities or lethal doses can be
dangerous to health or can cause death. Such substances are called poisons.
Poisons get in to the body by swallowing or by breathing poisonous gases, or by injection
through skin.
Poisoning by Swallowing (Mouth route):
Sometimes acids, alkalis, disinfectants etc. are swallowed by mistake. They burn the lips, tongue,
throat, and food passage and stomach and cause great pain. Other swallowed poisons cause
vomiting, pain and later on diarrhea. Poisonous fungi, berries metallic poisons and stale food
belong to the later group. Some swallowed poisons affect the nervous system. To this group (a)
alcoholic drink (methylated spirit, wine, whisky etc.) when taken in large quantities and (b)
tablets for sleeping, tranquillisers and pain killing drugs (Aspirin or largectil). All these victims
must be considered as seriously ill. The symptoms are either delirium or fits or coma
(unconsciousness). Some poisons act on nervous system (belladonna, strychnine).
Poisoning by Gases (Nose route):
Fumes or gases from charcoal, stoves, gas, motor exhausts, chemicals and smoke explosions
etc.; cause choking (asphyxia) which may result in unconsciousness, in addition to difficulty in
breathing.
Poisoning by Injection (Skin route):
Poisons get into the body through injection, of poisonous snakes and rabid dogs or stings
scorpions and insects. Danger to life is again choking and coma.
Antidote and General Response Book – Industrial Accidents
Page 41
General First Aid in Poisoning:
1. Poisoning is a serious matter. Patient must be removed to a hospital/or a doctor be sent or, at
once with a note of the findings and, if possible, the name of the poison.
2. Preserve packets or bottles which you suspect contained the poison and also any vomits, sputum
etc., for the doctor to deal with.
3. If poison is not known:
Make a quick assessment of the likely route of exposure by examining the eyes, mouth, nose and
skin of the victim for signs of the chemical itself or damage it has caused such as swelling,
redness, bleeding, burns, discharge of fluid or mucous or pallor. Drooling, difficulty in
swallowing, a distended, painful, hard or rigid abdomen all indicates possible ingestion of a
corrosive or caustic substance. If respiration is rapid, shallow, noisy or laboured, suspect
inhalation. If the face has been splashed with chemical, eye contact is likely.
4. Poisoning by inhalation
Remove victim from exposure while protecting yourself from exposure.
If breathing has stopped, administer artificial respiration using a bag-valve mask. Do not use
mouth-to-mouth resuscitation. Instead, use chest pressure-arm lift technique.
Maintain an open airway.
Arrange for transport of the victim to a medical facility.
5. Poisoning by Ingestion
Do not induce vomiting if he has abdominal pain or burns in mouth. If no such problem, then
induce vomiting by syrup of ipecac. Lastly give 1 or 2 cups of water to drink.
6. Poisoning by skin contact
Remove the victim from the contaminated area. Be careful to protect your lungs, skin and eyes
while doing so. Remove the victim's clothing. Remove shoes and jewelry from the affected
areas, cutting them off if necessary. Do this under a shower or while flushing with water.
Continue to flush with water until all traces of the chemical are gone and any feeling of
soapiness has disappeared also. Rinse for at least 15 minutes cover the victim with a blanket or
dry clothing. Inform and refer the victim immediately to a physician for his advice.
In case of inflammation, burns, blisters or pain:
Loosely apply a dry sterile dressing if available or use a clean dry cloth for it. Inform and refer
the victim immediately to a physician for his advice.
If the victim is in a state of shock:
Lay him down on his side and cover him with a blanket. Elevate his feet. Inform and refer the
victim immediately to a physician for his advice. Do not break open blisters or remove skin. If
clothing is stuck to the skin after flushing with water, do not remove it. Do not rub or apply
pressure to the affected as well no oily substance or hot water shall be applies to the affected
skin.
Antidote and General Response Book – Industrial Accidents
Page 42
7. Poisoning by eye contact:
Remove the victim from the contaminated area. Be careful to protect your lungs, skin and eves
while doing so. Act quickly. Flush the victim's eyes with dean tepid water for at least 15 minutes.
Has the victim lie or sit down and nit his head back Hold his eyelids open and pour water slowly
over the eyeballs starting at the inner corners by the nose and letting the water run out of the
corners.
The victim may be in great pain and want to keep his eyes closed or rub them but you must rinse
the chemical out of the eyes in order to prevent possible damage
Ask victim to look up, down and side to side as you rinse
Transport victim to the medical facility as soon as possible. Even if there is no pain and vision is
good, a physician should examine the eyes since delayed damage may occur.
If eyes are painful,
Cover loosely with gauze or a clean, dry cloth.
Maintain verbal and physical contact with the victim.
8.
If unconscious:
Do not induce vomiting
Make the casualty lie on his back on a hard, flat bed without any pillow and turn the head to one
side. As there no pressure on the stomach and the gullet is horizontal the vomited matter will not
get into the voice box and the tongue will not close the air passage. This is also the best posture
for giving artificial respiration, if needed
Sometimes when there is excess of vomiting the three-quarter-prone posture (i.e. the casualty is
made to lie on his side with one leg stretched, the other bent at knee and thigh) will make things
easier for the casualty
If breathing is very slow or stopped, start artificial respiration and keep it up till the doctor
comes.
Maintain open airways
Do not use mouth to mouth resuscitation
Do not give any thing by mouth
In case of signs of shock, elevate his feet, 20-30 cm and cover him with a blanket
Arrange for sending to medical facility.
Antidote and General Response Book – Industrial Accidents
Page 43
If conscious:
Aid vomiting by tickling the back of throat or make him drink tepid water mixed with 2
tablespoons of common salt for a tumbler of water
Even if conscious, when the poison is a corrosive do not induce vomiting. Signs of corrosives:
Lips, mouth and skin show grey white or yellow, patches, which are to be looked for: acids,
alkalis etc., cause such burns.
First Aid: Factories, which use certain poisons, shall have the respective antidotes ready and
displayed in an easily available place. The personnel should be taught about the use of antidotes so that anyone can render assistance in case of emergency.
The poison must be diluted by giving large quantities of cold water (chilled, if possible). This
will dilute the irritant and delay absorption and will replace fluid lost by vomiting. Tender
coconut water will be even better as this will be a food and also a diuretic.
Soothing drinks should be given. Milk, eggs beaten and mixed with water or sojee congee are
good for the purpose.
Poisoning with Acids and Alkalis:
In poisoning with concentrated acids and alkalis, a grave condition rapidly develops, in the first
place, to extensive burns in the mouth, throat, oesophagus, stomach and often the larynx. Later,
the absorbed toxins affect the vital organs (e.g. liver, kidneys, lungs, or heart). Concentrated
acids and alkalis are able to destroy tissues. The mucous membranes, being less resistant than the
skin, are destroyed and necrosis occurs are rapidly involving deeper layers.
Burns and scabs form on the mucous membrane of the mouth and lips. In a bum due to sulphuric
acid, the scabs are black; in a burn due to nitric acid they are grayish-yellow, in one due to
hydrochloric acid they are yellowish-green and in one due to acetic acid grayish-white.
Alkalis more easily penetrate the skin and affect deeper layers. The burnt surface is loose,
decomposed and whitish in colour.
As soon as an acid or alkali is swallowed the patient feels strong pain in the mouth, behind the
breastbone and in the epigastrium. When laid down he tosses in bed from unbearable pain. There
is almost always tormenting vomiting often with admixtures of blood. Painful shock rapidly
develops. The larynx may swell and asphyxia develops. When an acid or alkali is taken in great
amount, cardiac weakness and collapse rapidly develop.
Poisoning with ammonium hydroxide takes a grave course. The pain syndrome is attended by
asphyxia because the airways are also affected.
Antidote and General Response Book – Industrial Accidents
Page 44
The person who is rendering first aid must find out at once which chemical caused the poisoning
because the treatment varies according to the type of poison
If the poisoning was caused by concentrated acids and the symptoms of oesophageal or gastric
perforation are absent, the stomach should be leveraged through a thick stomach tube using for it
6-10 liters of warm water mixed with magnesium oxide (20 g per liter of liquid) or line water.
Sodium Carbonate is contraindicated for a gastric lavage. "Minor lavage" i.e. drinking 4-5
glasses of water and then inducing vomiting, will not alleviate the patient’s condition and
sometimes may even promote absorption of the poison.
If a stomach tube is unavailable, the patient may be given milk, oil, egg, white, mucilaginous
decoctions or smoothing substances. In poisoning with (Phenol, Lysol) milk, oil or fat should not
be taken. Magnesium oxide mixed with water or limewater should be given in this case, as in
poisoning by all other acids. Cold compresses or ice should be put on the epigastric region to
lessen pain.
When the poisoning is due to concentrated alkalis, the stomach should be immediately lavaged
with 6-10 liters of tepid water or a 1 per cent citric or acetic acid solution within four hours of the
poisoning. When a stomach tube is unavailable and the patient’s grave condition (swelling of the
larynx) prevents a stomach lavage, mucilaginous solutions are given, 2-3 percent citric or acetic
acid solution (1 tablespoonful every 5 minutes), or lemon juice. Rinsing of the mouth or
administration of sodium hydrochloride solution is contraindicated.
The patient should be immediately admitted to a medical institution where he will be given the
necessary urgent medical help.
It should be kept in mind that when a perforation of the oesophagus or stomach is suspected, they
being manifested by severe pain in the stomach and unbearable pain behind the breast bone,
drinking and moreover, lavage of the stomach are not permitted.
Poisoning with Toxic Chemicals:
The latent course of the disease is 15-60 minutes, after which the symptoms of the affection of
the nervous system appear (e.g. enhanced salivation, discharge of sputum and perspiration).
Breathing accelerates and becomes noisy, as rail heard at a distance. The patient becomes restless
and excited. Cramp appears in the legs and the intestine undergoes increased peristalsis, which is
followed by muscular paralysis of the respiratory muscles. The respiratory arrest that follows
causes asphyxia and death.
In accidents connected with the inhalation of the toxic chemicals the victim must be immediately
hospitalised. If possible, he should be given 6-8 drops of a 0.1 percent atropine solution or 1-2
tablets of belladonna. When respiration is arrested, artificial respiration should be carried out
When the poisoning is caused by toxins getting into the gastro-intestinal tract, the stomach
should be washed with water mixed with suspension of activated carbon Saline purgatives
should also be prescribed. The toxic substances should be removed from the skin and mucous
membranes with running water.
Antidote and General Response Book – Industrial Accidents
Page 45
Carbon Monoxide Poisoning:
Carbon monoxide poisoning may occur in the chemical industry where it is used for synthesizing
certain organic compounds (acetone, methyl alcohol, phenol etc.), in poorly ventilated garages,
in furnaces or in stuffy, freshly painted premises. It may also happen in households when the
stove shutters are closed too early in premises with stove heating.
The early symptoms are headache, heaviness in the head, nausea, dizziness, noise in the ears and
palpitation. Late muscular weakness and vomiting occur. If the victim remains in the poisonous
atmosphere, the weakness intensifies, somnolence, clouding of consciousness and dyspnoea
develop. The skin turns pale and sometimes bright red spots appear on the body. In future
exposure to carbon monoxide the patient's respiration becomes shallow, convulsions develop and
paralysis of the respiratory centre terminates in death.
First Aid: The victim must be immediately removed from the poisonous surrounding, better into
the open air in warm weather. If his breathing is weak and shallow or arrested, artificial
respiration should be continued until adequate natural breathing or the true signs of biological
death appear. Rubbing should be carried out and hot water bottles applied to the legs. A brief
whiff of ammonium hydroxide is beneficial A patient with severe carbon monoxide poisoning
must be immediately hospitalised in order to prevent possible grave complications in the lungs
and nervous system which may develop later.
Antidote and General Response Book – Industrial Accidents
Page 46