antidote course - ohio 2016 course - ohio.pdf · •ohio hazmat teams conference •11/4/2017 •2...

•Ohio Hazmat Teams Conference •11/4/2017

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ToxMedic Hazmat Antidotes

Ohio Hazmat Teams Conference - 2017

Solon, Ohio

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ObjectivesObjectives

Purpose of the Training

– Discuss the benefits of specially trained ToxMedics working with Hazmat Teams

– Understand the toxic effects and specific treatments for:• Organophosphate and Carbamate Poisoning• Cyanide Poisoning• Hydrogen Sulfide Poisoning• Hydrofluoric Acid Exposure


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National Governors Association January 5, 2006

Mark Vedder• Battalion Chief, Solon Fire-Rescue, Solon, OH - 1979 – (retired)

• Asst Fire Chief, Chagrin Falls FD, Chagrin Falls, OH - 1974

• Hazmat/WMD Specialist, Chagrin/SE Hazmat Team – 1990

• Hazmat/WMD Team Leader, Cuyahoga County Type 1 – 2010

• Co-Chair, Ohio Hazmat TAC, Ohio EMA – 2004

• Hazmat Instructor, Ohio Fire Academy

• Fire Service & Paramedic Instructor, Ohio Dept of Public Safety

• Hazmat Instructor, Cuyahoga Community College - 1982

• Advanced Hazmat Life Support Instructor

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Legal StuffLegal Stuff

Disclaimer– This presentation is for education and discussion

purposes only. Always follow your local medical protocols and departmental policies. Read and follow package inserts on all medications.


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ReferencesReferences

• Course Materials Based Upon:– Advanced Hazmat Life Support – Univ of AZ– Hazmat IQ ToxMedic Course – Hazmat ALS Course - NFA– Domestic Preparedness Training - DHS– Antidote Manufacturer’s Instructions– UHHS Hazmat EMS Protocols– ATSDR-CDC Medical Management Guidelines– Hazardous Materials Field Guide, Delmar Publishers– Recommended Treatment for HF Exposure, Honeywell– Material Safety Data Sheets– IAFC Hazmat Fusion Center Website

ToxMedic ConceptToxMedic Concept• ToxMedic

– EMT-Paramedic– Hazmat/WMD Technician– Then Add

• More Specialized Medical Training

• Specific Antidotes to Drug Box– Supports

• Pre and Post Entry Screening• Liaison with Hospitals• Treatment of Exposure• Hazmat Team Rehab


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General Hazmat PrinciplesGeneral Hazmat Principles

• Always:– Assure Scene Safety– Risk Based Zones and PPE– Remove Patient From Continued Exposure– Decontaminate– Assessment– Treatment– Transport

Layout of MaterialsLayout of Materials

• Toxic Products– Family of Toxins– Names of Chemicals– Prevalence, History and Uses– Pathophysiology– Sign and Symptoms of Exposure– Treatment and Antidotes Available


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ORGANOPHOSPHATES

NeuroToxinsNeuroToxins

• Neuro Toxins– Organophosphate Pesticides

• Parathion, Malathion, Methyl Parathion

– Carbamate Pesticides• Sevin, Carbofuran, Furodan, Aldicarb

– Chemical Weapons - Nerve Agents• Sarin, Soman, VX, Tabun


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Organophosphate PesticidesOrganophosphate Pesticides

• Highly Toxic– Tetraethyl

Pyrophosphate (TEEP)

– Fensulfothion– Mevinphos

(Phosdrin)– Ethyl parathion– Cyanofenphos

(Surecide)– Methyl Parathion

• Moderately Toxic– Leptophos

– Ethion

– Chlorpyrifos (Dursban)

– Diazinon

– Malathion

NeuroToxinsNeuroToxinsReaction time (onset of symptoms) depends on:

• Type of agent involved (concentration, specific agent)

• Dose (how much patient absorbed)

• Duration (how long are they exposed)

• Route of exposure (inhalation, absorption, ingestion)

• Sensitivity of patient's system


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• More than 12,000 exposures treated annually in the US

• Most common in agricultural workers, who may under report.

• Most exposures are from skin absorption.

• Suicides and homocides.

Pesticide PoisoningPesticide Poisoning

• Acetylcholine normally stimulates contraction of muscles and/or secretion of glands

• Acetylcholinesterase breaks down acetylcholine to relax the muscle contraction or stop gland from secreting

• Organophosphates block acetylcholinesterase causing excess parasympathetic nervous system activity

Organophosphate PoisoningOrganophosphate Poisoning


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Organophosphate PoisoningOrganophosphate Poisoning

• Symptoms usually within 4 hours of exposure

• Flu-like with headache, N/V• Muscle twitching, loss of coordination• Abdominal cramps and diarrhea• Hypersecretion• Blurred, darkened vision• Wheezing, cough, secretions • Pulmonary edema

Organophosphate ToxicityOrganophosphate Toxicity

• Muscarinic effects tend to dominate– Bradycardia

– Hypersecretion

– Bronchospasm

– SLUDGEM

– Diaphoresis

– Blurred vision

• Some Nicotinic effects commonly seen– Skeletal muscle

fasciculations

– Cramping

– Respiratory muscle weakness


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OP Presentation - continuedOP Presentation - continued

• Bradycardia– may be preceded by tachycardia

– early nicotinic stimulation

– may progress to sinus arrest

• Toxic psychosis

• Respiratory depression, convulsions, unconsciousness, flaccid paralysis

OP Treatment - 1OP Treatment - 1

• With strong clinical indications of OP poisoning, do not delay treatment while waiting on proof

• Protect all who will handle the patient

• Decontaminate

• If OP is ingested, beware of emesis


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• Atropine– 2 - 4 mg IVP every 5 minutes

– May require massive doses

– No arbitrary end point in atropine dosage (NOT tachycardia)

– Titrate dose to drying of secretions

– Then IV maintenance drip .2-2mg/hr

– Long term therapy may be needed

AtropineAtropine

What does the Atropine do?• Atropine blocks

effects of over-stimulation

• Relieves smooth muscle constriction

• Dries up respiratory secretions


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• Pralidoxime (2 PAM)– 1-2 g in 100cc saline IV over 15-30 min

– binds to the Organophosphate

– releases it from the ACHE

– acts at Nicotinic and Muscarinic sites

– may result in need for less Atropine

– most effective early in the event

– onset of actions within 30 minutes

2-PAM Chloride2-PAM Chloride

What does 2-PAM Chloride do?

• Reactivates acetylcholinesterase• Helps re-establish normal skeletal muscle

contraction• Helps relieve twitching and paralysis of respiratory

muscles


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• Conventional pulmonary edema therapy should not be used until the full benefit of Atropine has been realized

• Monitor respirations

• Anticonvulsants for seizures PRN

CARBAMATES


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Carbamate PesticidesCarbamate Pesticides

• Highly Toxic– Aldicarb (temik)

– Methiocarb

– Carbofuran

– Aminocarb

– Clethocarb

– Bendiocarb

• Moderately Toxic– Dioxicarb

– Promecarb

– Bufencarb

– Trimethacarb

– Carbaryl (Sevin)

– Isoprocarb

Carbamate PesticidesCarbamate Pesticides

Carbamates• Same symptoms as Organophosphates

• Tend to be less toxic than OP

• Not as long lasting

• Carbamates do not age

• Higher survival rates


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WEAPONIZEDNEUROTOXINS

World War II 1930’s Agricultural Pesticide

Production “G” Series Nerve Agents

GA – Tabun GB – Sarin GD – Soman

No extensive use of chemicals in battle

Chemicals were used in German death camps


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1950’s – VX Developed British scientists develop

new pesticide and invent “VX” Nerve Agent

Much more potent than “G” series agents

Extremely toxic and persistent

Iran-Iraq War – 1980-88 Iraq (Saddam Hussein) Used

Mustard and Sarin on Iranians

100,000 exposed 20,000 killed 5,000 still receiving

treatment today


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Matsumoto, Japan - 1994 Aum Shinri-kyo

“Supreme Truth”

Sarin nerve agent released in residential neighborhood from van

Attempt to kill judges who had decided a lawsuit against the group

7 killed 150 injured Over 200 sought medical

care

Tokyo, Japan - 1995 Aum Shinri-kyo Release of Sarin from plastic

bags into five subway cars at morning rush hour

12 killed 54 severely injured 980 symptomatic 5,500 sought medical care

Substance not identified Hospitals contaminated


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Comparative Toxicities

0 100 200 300 400 500 600

Chlorine

Cyanogen Chloride

Phosgene

Hydrogen Cyanide

Mustard

Sarin

VX

Acute Exposure GuidelinesAcute Exposure Guidelines

Agent Acute Exposure Guideline Level

1(discomfort, non-

disabling)

Acute Exposure Guideline Level

2(irreversible, long lasting,

or escape impairing)

Acute Exposure Guideline Level

3(life-threatening effects)

NIOSH

IDLH

HCN 2.5 ppm

10 min

17 ppm

10 min

27 ppm

10 min

50 ppm

SARIN 0.0012 ppm

10 min

0.015 ppm

10 min

0.064 ppm

10 min

0.017 ppm

VX 0.000052 ppm

10 min

0.00065 ppm

10 min

0.0027 ppm

10 min

0.00027 ppm


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Signs and SymptomsSigns and Symptoms• Miosis and blurred vision• Headache and pressure sensation• Runny nose and nasal congestion• Localized diaphoresis• Salivation• Tightness in chest• Nausea and vomiting• Giddiness, anxiety, difficulty thinking• Muscle twitching, tremors, weakness• Abdominal cramps, diarrhea• Involuntary urination and defecation• Convulsions• Flaccid Paralysis• Respiratory Failure• Death

Signs and SymptomsSigns and SymptomsSLUDGEM• Salivation• Lacrimation• Urination• Defecation• Gastrointestinal• Emesis• Miosis

DUMBELS• Defecation, Diaphoresis

• Urination

• Miosis

• Brochorrhea, Bradycardia, Bronchospasm

• Emesis

• Lacrimation

• Salivation


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MARK 1 or Duodote Nerve Agent Antidote Kit

Auto Injector

Atropine – 2mg

2 PAM Chloride – 600 mg

Administration of Antidote• Emergency Responders with

symptoms and kits can administer NAAK to themselves or buddies and then leave the area to be decontaminated– NAAK can be administered through

clothing

• However…Civilian patients should be rapidly evacuated, decontaminated, and then be provided with medical care– NAAK based upon symptoms


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Adult - Signs and SymptomsAdult - Signs and SymptomsNo Symptoms Mild Exposure Moderate

ExposureSevere Exposure

None Sweating

Muscle Twitching

Chest Tightness

Chest Tightness

Pinpoint pupils

Drooling

Runny Nose

Headache

Wheezing

Nausea

Diarrhea

Cramping

Unconsciousness

Apnea

Seizures

Flaccid

Decontamination and Observation Only

1 Duodote Kit 1-2 Duodote Kits and repeat atropine every 5-10 minutes until secretions stop

3 Duodote Kits and repeat atropine every 5-10 minutes until secretions stop AND 1 Valium Auto-injector for seizures, if present

Peds - Signs and SymptomsPeds - Signs and Symptoms

No Symptoms Mild Exposure Moderate Exposure

Severe Exposure

None Miosis

Mild Rhinorrhea

Miosis and ANY Other Symptom of Exposure

Unconsciousness

Apnea

Seizures

Flaccid



Atropine 0.05 mg/kg IV or IM, repeated every 5-10 minutes until respirations improve

2-PAM 25-50 mg/kg IV or IM may repeat at 1 hour

Atropine and 2-PAM as shown.

Valium 0.05 to 0.3 mg/kg IV or IM may also be given if seizures are present

<10 yrs or < 40 kg


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WarningsWarnings

• Antidotes counter or relieve effects of poisons such as nerve agents. Use antidotes only when signs and symptoms of exposure are present.

• They will not protect if given before exposure.

• Not effective on blister agents, blood agents, pepper spray, mace, tear gas or other TICs

Hazmat Team Caches

• NAAK Cached at Cuyahoga County Hazmat Teams and Other Strategic Locations


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CHEMPACKSCHEMPACKS

Forward Deployed Hospital Caches

CHEMPACKSCHEMPACKS

EMS CHEMPACKS


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CHEMPACKSCHEMPACKS

Hospital CHEMPACKS

CHEMPACKSCHEMPACKS• Each Hospital CHEMPACK contains a quantity of

medical supplies to treat 1000 patients.

• Each EMS CHEMPACK contains a quantity of medical supplies to initiate the treatment of up to 454 patients.

• The primary difference between the Hospital and EMS CHEMPACK is that the EMS CHEMPACK contains significantly more pre-filled nerve agent antidote auto-injectors.


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Incident Commander (IC) on scene,Known or suspected Nerve agent or

Organophosphate Exposure-or -

SLUDGEM S&S present

IC contacts local Medical Control (MC)

CHEMPAC NEEDED ? NO

EMS Utilizes appropriate local

care protocols

YES

IC contacts Ohio Joint Dispatch Center and requests CHEMPACK

LERP identifies closest CHEMPACK

Hospital Host is notified

Closest OSHP or law enforcement agency is

dispatched to Host Hospital

Contact with County EMA/Disaster personnel

LERP contacts Ohio EMA duty officer.

CHEMPACK picked up by law

enforcement

Additional CHEMPACK asset use coordinated by state EOC

Law enforcement

delivers CHEMPACK to staging area

Incident Commander (IC) on scene,Known or suspected Nerve agent or

Organophosphate Exposure-or -

SLUDGEM S&S present

IC contacts local Medical Control (MC)

CHEMPACK NEEDED ? NO

EMS Utilizes appropriate local

care protocols

YES

IC contacts Ohio Joint Dispatch Center and requests CHEMPACK

LERP identifies closest CHEMPACK

Hospital Host is notified

Closest OSHP or law enforcement agency is

dispatched to Host Hospital

Contact with County EMA/Disaster personnel

LERP contacts Ohio EMA duty officer.

CHEMPACK picked up by law

enforcement

Additional CHEMPACK asset use coordinated by state EOC

Law enforcement

delivers CHEMPACK to staging area

CHEMICAL

ASPHYXIANTS


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ASPHYXIANTSASPHYXIANTS• Chemical Asphyxiants

• Affect all cells by inhibiting cellular respiration causing systemic hypoxia.

• Binds with cytochrome oxidase enzyme which prevents ATP (energy) production in the cells, causing anaerobic metabolism and acidosis

Chemical Asphyxiants

Examples:• Cyanides

– 1982 Tylenol Contamination– 1978 Peoples Temple – Mass Suicide


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Chemical Asphyxiants

Examples:• Hydrogen Sulfide

– Sewer Gas – organic decomposition– Chemical Suicide - drain cleaner and

garden products

CYANIDE(CN)


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CyanideCyanide• What is it?

• Carbon & Nitrogen (CN)• Very strong triple bond• Aka: Hydrocyanic acid/prussic acid

• Physical Properties of HCN• Colorless gas or pale blue liquid• BP = 78 degrees F• VP = 630 mmHg at 68 degrees F• VD = 0.94• LEL = 5.6%

CyanideCyanide• Where does it come from?

• Found in some seeds and fruit stones• Apple, mango, peach, cherry

• Produced as a by-product of incomplete combustion• Many plastic materials release it when heated or burned

• What is it used for?• In mining, cyanide dissolves silver and gold from ore• Medical uses in vasodilators and vitamin B12• Nitrile production• Electroplating of metals


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CyanideCyanide• Smoke Inhalation?

• Part of the “Toxic Twins” – CO and CN• Increased use of synthetics in building materials and

contents• No strong correlation between CO and CN levels• They may potentiate each other• Cyanide causes a “knock down effect” at sub lethal levels• Should be suspected if

• Closed space fire• Soot around nose and mouth• Altered LOC• Hypotension

CyanideCyanide• Smoke Inhalation?

• Must be a presumptive diagnosis• Blood Test results take hours to days


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HCN SymptomsHCN Symptoms• Mild Exposure

• Headache, drowsiness, dizziness, disorientation• Chest Tightness• Tachypnea (late decrease in RR)• Hypertension (late hypotension)• Nausea and vomiting

• Moderate to Severe Exposure• Dyspnea & Oxygen Hunger• Anaerobic metabolism and acidosis• Dysrhythmias & Cardiovascular Collapse • CNS Damage, Convulsions, Coma• Death

Hydrogen Cyanide (HCN)

IDLH 50 ppm

STEL 15 ppm

PEL 10 ppm -SKIN

Odor Threshold 2-5 ppm

Single Breath May Cause Unconsciousness 270 ppm

LC50 150 ppm (Rat) 30 min

LEL 5.6% = 56,000 ppm

UEL 40% = 400,000 ppm

LC50 180 ppm (Human) 10 min


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CN TreatmentCN TreatmentTreatment• Protect Rescuers – Scene Control and PPE• Ventilate if appropriate• Remove from atmosphere• Decontaminate• Assess and Control Airway• 100% Oxygen• Cyanide Antidote• Supportive Care - Maintain BP

Traditional Cyanide KitsTraditional Cyanide KitsLily Cyanide Kit (CAK)

•Amyl Nitrite Pearls – inh – 30 sec intervals•Sodium Nitrite – 300mg/10ml IVP – 3 min (adults)•Sodium Thiosulfate – 12.5gm/50ml IVP -10 min (adults)


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Traditional Cyanide KitsTraditional Cyanide KitsTherapeutic Action• Nitrites change some hemoglobin to methemoglobin. • Cyanides & sulfides prefer and are attracted to

methemoglobin. They bind and reduce the toxic effect.• Thiosulfate then helps convert the cyanomethemoglobin to

the much less toxic thiocyanate and be excreted in urine.• Side effects: hypotension, nausea, hypoxia

• NOT FOR USE WITH SMOKE INHALATION

CN TreatmentCN TreatmentCyanokit• Hydroxocolbalamin – Precursor to B12• Attracts cyanide and binds to form

cyanocobalamin (vitamin B12)• Does not affect hemoglobin• Contraindications: None for

cyanide poisoning


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CN TreatmentCN Treatment

Cyanokit


Cyanokit Bottle


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Spike from Cyanokit


Vented IV Tubing in Cyanokit


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CN TreatmentCN TreatmentCyanokit• Hydroxocobalamin is freeze-dried, packaged 2.5G or new 5G• Use spike in kit to add 100/200 cc normal saline to bottle• Mix for 30 seconds (slow rocking motion, do not shake)• Use VENTED IV tubing in kit to hang and infuse IV at 70

mg/kg (max dose 5 G) over 15 minutes• Do not piggyback IV tubing, keep in it’s own IV line & site• 5 G Dose may be repeated once if needed



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CN TreatmentCN TreatmentMost Common Transcient Adverse Reactions• Chromaturia (red colored urine)• Erythema (skin redness up to 2 weeks)• Acne like rash 7-28 days after injection• Nausea and Headache• Transient increase in BP• Interference with colormetric lab testsA few allergic reactions have been noted

Skin Redness in Healthy Volunteers

After 10 g treatment, photos on Day 1 and on Day 8.

Day 1*

Day 8†

*No flash photography. †Flash photography used.OHCo, hydroxocobalamin. Uhl W, et al. Clin Toxicol. 2006;44:17-28.


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HYDROGEN SULFIDE(H2S)

ASPHYXIANTSASPHYXIANTSHydrogen Sulfide

•AKA “Sewer Gas”• Rotten egg odor

• Self Alarming• Olfactory Nerve Paralyzer• Colorless Gas

• Extremely toxic by inhalation• Commonly found in confined

spaces


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Hydrogen Sulfide (H2S)

IDLH 100 ppm

STEL 15 ppm

PEL 10 ppm

Odor Threshold <0.1 ppm

Single Breath May Cause Unconsciousness 1,000 ppm

Olfactory Nerve Damage 150 ppm

LC50 444ppm (Rat) 30 min

LEL 4.3% = 43,000 ppm

UEL 44% = 440,000 ppm

LC50 800ppm (Human) 5 min

ASPHYXIANTSASPHYXIANTSHydrogen Sulfide

•Affects cytochrome oxidase in the same manner as Cyanide•Prevents cellular respiration•Results in anerobic metabolism•Same signs and symptoms as Cyanide Poisoning.


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Hydrogen SulfideHydrogen SulfideHydrogen Sulfide• Cyanokit will not work for H2S

• Break Amyl Nitrite Pearls and hold near mouth or nose for 15 seconds and then away for 15 seconds. This is immediate first aid only while IV is established.

• After IV established, inject 300 mg (10 mL of 3% solution) of Sodium Nitrite at a rate of 2.5 – 5 mL per minute

• NO Sodium Thiosulfate is administered for H2S.

• Closely monitor EKG and Blood Pressure

HYDROGEN FLUORIDEOR

HYDROFLUORIC ACID(HF)


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Hydrofluoric AcidHydrofluoric AcidHydrogen Fluoride or Hydrofluoric Acid• Anhydrous or Solution of Hydrogen Fluoride in water• Considered a weak acid (pH of 3 – 4.5)• But highly corrosive acid capable of corroding many

materials, including highly reactive to glass

Used in:• Metal manufacturing/finishing• Glass etching & Ceramic production• Oil Refining• Electronic component production• Production of Teflon and Freon• Pharmaceutical manufacturing• Some consumer products

Hydrofluoric AcidHydrofluoric AcidHydrofluoric Acid• Used in various concentrations from 3% to 99.9%• Commonly in 99.9%, 70%, 49%• Clear, colorless liquid• Over 40% concentration will produce pungent vapors• Most non-industrial products are < 15%• Many industrial processes use 50-100%


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Hydrofluoric AcidHydrofluoric AcidHydrofluoric Acid• Penetrates tissue more rapidly than

mineral acids• Cause deep burns followed by tissue

death• Systemically toxic from dermal

exposure • HF gas can injure eyes, lungs and

skin• HF gas is also released as a by-

product of combustion from materials like Teflon

Hydrofluoric AcidHydrofluoric AcidHydrofluoric Acid• HF interferes with nerve function which may reduce and

delay pain at lower concentrations• Once absorbed, seeks calcium and magnesium

• Draws calcium from cells affecting cellular function• Decalcifies bone (chemical osteoporosis)• Affects cardiac muscle cells causing V-Tach and V-Fib


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Hydrofluoric AcidHydrofluoric AcidSeverity• Concentrated HF liquid or vapor may cause

• Severe Burns• Metabolic imbalance due to fluoride toxicity• Pulmonary Edema• Life threatening cardiac dysrhythmias

Hydrofluoric AcidHydrofluoric AcidSeverity of Burns• Depends upon concentration, temperature and duration • High concentrations (over 50%)

• Immediate severe burning pain• Whitish discoloration of skin• Formation of blisters

• Concentration 20-50%• Delay of clinical signs for 1-8 hours

• Concentration <20%• Latent period of up to 24 hours


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Hydrofluoric AcidHydrofluoric AcidHypocalcemia• Burns larger than 25 sq inches may result

in systemic toxicity• Causes intermittent QT prolongation• Life threatening cardiac electrical instability• High risk of torsades de pointes (v-tach)

Hydrofluoric AcidHydrofluoric AcidBurns• HF burns are different than most acid burns as they cause

liquefaction necrosis• HF skin burns are accompanied by severe throbbing pain• Relief of pain is an important guide to the success of

treatment!• Treatment of HF burns is different than other chemical burn

care


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Hydrofluoric AcidHydrofluoric AcidSkin Burn Treatment• Directed toward binding the fluoride ions to

prevent tissue destruction.• Wash with water, then:• Iced or chilled Benzalkonium Chloride (Zephiran) as

soaking agents; and/or • Calcium Gluconate (2.5%) as gel or ointment; and/or• Calcium Gluconate solution (5%) injected SQ or IV• Continue until pain subsides• Speed is of the essence!!

Hydrofluoric AcidHydrofluoric AcidEye Exposure Treatment• Directed toward binding the fluoride ions to

prevent tissue destruction.• Flush with water or saline, then:• Topical Tetracaine Hydrochloride for pain relief• Irrigate with calcium gluconate (1%) solution

• NEVER use Zephiran to irrigate eyes• Speed is of the essence!!


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Hydrofluoric AcidHydrofluoric AcidInhalation Treatment• Oxygen (100% NRB)• Consider 2.5% Calcium Gluconate Solution

by Nebulizer• Observe and treat for:

• Bronchospasm and Bronchitis• Pulmonary Edema• Systemic Toxicity


Hydrofluoric Acid Kit


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Hydrofluoric Acid Kit


2.5% Calcium Gluconate Gel


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2.5% Calcium Gluconate for Nebulizer


1% Calcium Gluconate for Eye Flush


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CN TreatmentCN Treatment10% Calcium Gluconate Injectable

And for mixing

Inject into tissue at 5%


Injectable Saline


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CN TreatmentCN TreatmentIced .13% Zephiran

Solution


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CN TreatmentCN TreatmentIced Zephiran Solution

Towels for SoakingNebulizer Masks and

Nasal Cannulaes


1% Calcium GluconateSolution for Eye

Irrigation


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Quick Reference Protocol

CN TreatmentCN TreatmentMSDS for HF


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101

ObjectivesObjectives

Purpose of the Training

– Discuss the benefits of specially trained ToxMedics working with Hazmat Teams

– Understand the toxic effects and specific treatments for:• Organophosphate and Carbamate Poisoning• Cyanide Poisoning• Hydrogen Sulfide Poisoning• Hydrofluoric Acid Exposure

Summaryand

Questions?

Mark [email protected]

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