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First Aid for Pesticide Poisoning

Goals of This Module:

• Recognize the signs of pesticide poisoning and know the first aid treatment for it.
• Know the importance of a pesticide first aid kit and what it should contain.
• Understand the importance of poison control centers and how to get immediate information on types of poisonings and their treatment.

Call a Doctor

First Aid is the initial effort to help a victim while medical help is on the way. Step one in any poisoning emergency is to call an ambulance or doctor. The only exception is when you are all alone with the victim. Then you must see that he is breathing and that he is not further exposed before leaving him to make your phone call. Always save the pesticide and label for the doctor.

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While Waiting

Do This For:

Poison on the Skin

• The faster the poison is washed off the patient, the less injury that will result.
• Drench skin and clothing with water (shower, hose, faucet, pond).
• Remove clothing.
• Cleanse skin and hair thoroughly with soap and water. Detergents and commercial cleansers are better than soap.
• Dry and wrap in a blanket.

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WARNING: Do not allow any pesticide to get on you while you are helping the victim.

Chemical Burns of the Skin

• Wash with large quantities of slow running water.
• Remove contaminated clothing.
• Immediately cover loosely with a clean, soft cloth.
• Avoid use of ointments, greases, powders, and other drugs in first aid treatment of burns.
• Recognize the signs of pesticide poisoning and know first aid treatment for it.
• Know the importance of a pesticide first aid kit and what it should contain.
• Understand the importance of poison control centers and how to get immediate information on types of poisonings and their treatment.

Poison in the Eye

• It is most important to wash the eye out quickly but as gently as possible.
• Hold eyelids open and wash eye with a gentle stream of clean running water.
• Continue washing for fifteen minutes or more. It is important to use a large volume of water. If possible, at least five gallons should be used to flush the eye properly.
• Do not use chemicals or drugs in wash water. They may increase the extent of the injury.
• Cover the eye with a clean piece of cloth and seek medical attention immediately.

Inhaled Poisons (dusts, vapors, gases)

• If victim is in an enclosed space, do not go in after him unless you are wearing an air-supplied respirator.
• Carry patient (do not let him walk) to fresh air immediately.
• Open all doors and windows.
• Loosen all tight clothing.
• Apply artificial respiration if breathing has stopped or is irregular.
• Keep victim as quiet as possible.
• If victim is convulsing, watch his breathing and protect him from falling and striking his head. Keep his chin up so his air passage will remain free for breathing.
• Prevent chilling (wrap patient in blankets but don't overheat).
• Do not give the victim alcohol in any form.

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Swallowed Poisons -- When should you make the victim vomit?

The most important choice you have to make when aiding a person who has swallowed a pesticide, is whether or not to make him vomit. The decision must be made quickly and accurately, by a health care professional because the victim's life may depend on it. Usually it is best to get rid of the swallowed poison fast ...

But you should know this:

• Never induce vomiting if the victim is unconscious or is having convulsions. The victim could choke to death on the vomitus.
• Never induce vomiting if the victim has swallowed a corrosive poison. Find out what poison the person has ingested. A corrosive poison is strong acid or alkali. The victim will complain of severe pain and will show signs of severe mouth and throat burns. A corrosive poison will burn the throat and mouth as severely coming up as it did going down. Dilute the poison as quickly as possible. For acids or alkalis, use milk or water. For patients one to five years old, use one to two cups; for patients five years and older, use up to one quart. For acids, milk of magnesia may also be used (two tablespoons in one cup of water).
• Never induce vomiting if the person has swallowed petroleum products such as kerosene, gasoline, oil, or lighter fluid. Most pesticides which come in liquid formulations are dissolved in petroleum products. The words "emulsifiable concentrate" or "solution" on the pesticide label are signals NOT to induce vomiting in the poison victim if he has swallowed the concentrates. Concentrated petroleum products (like corrosive poisons) cause severe burns. They will burn as severely when vomited up. If he has swallowed a dilute form of these formulations, he should be forced to vomit immediately.

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How to Induce Vomiting

Do not waste a lot of time inducing vomiting. Use it only as first aid until you can get the victim to a hospital. Make sure the victim is lying face down or kneeling forward while retching or vomiting. Do not let him lie on his back, because vomitus could enter the lungs and do more damage.

• First give the patient large doses of milk or water. One to two cups for victims up to five years old; up to a quart for victims five years and older.
• If victim is alert and respiration is not depressed, give syrup of ipecac followed by one to two glasses of water to induce vomiting. Adults (twelve years and over): 30 ml (two tablespoons); children under twelve years: 15 ml (one tablespoon). Activity hastens the effect of the syrup of ipecac.
• Collect some of the vomitus for the doctorhe may need it for chemical tests.

The best first aid is to dilute the poison as quickly as possible with milk or preferably with water. It is very important that the victim get to the hospital without delay. Many communities have rescue units with ambulances manned by Emergency Medical Technicians who can communicate with the hospital and can begin treatment enroute.

If a rescue unit is not available in your area, you will have to transport the patient. Call the hospital emergency room or poison control center for instructions so that they can prepare for the victim's arrival. If the poison control center agrees, use activated charcoal as a "sponge" to absorb excess poisons after the instructions for corrosive or noncorrosive poisons are followed.

• Activated charcoal it absorbs many poisons at a high rate. Mix it with water into a thick syrup for the victim to drink. Activated charcoal is available from a drug store.
• Atropine tablets should not be taken in a poisoning emergency. The dose is much too small. Often the victim cannot or should not take oral medicine. The atropine can hide or delay early symptoms of poisoning. The victim may be fooled into thinking he is okay and may even go back to work. It is possible that a doctor may not detect the problem because the symptoms are hidden by the atropine. WARNING: Atropine can be poisonous if misused. It should never be used to prevent poisoning. Workers should not carry atropine for first aid purposes. It should be given only under a doctor's directions.

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Shock

Sometimes poisoning victims go into shock. If untreated or ignored, the victim can die from shock even if the poisoning injuries would not be fatal.

Symptoms

• The skin will be pale, moist, cold and clammy. The eyes are vacant and lackluster with dilated pupils. The breathing will be shallow and irregular. The pulse is very weak, rapid and irregular. The victim may be unconscious or in a faint.
• Unless he is vomiting, keep the victim flat on his back with his legs up
• 1-1 1/2 feet above his head.
• Keep the victim warm enough to prevent shivering. Do not overheat.
• Keep the victim quiet and reassure him often.

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WARNING: Never try to give anything orally to an unconscious victim.

Poison Control Centers

Poison control centers have been established to give pertinent information on all types of poisonings, including pesticide poisoning. The applicator should have posted near his phone the telephone number of the nearest poison control center, and his doctor should also have the number available.

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In any poisoning emergency, think first of water. Your first aim is to dilute the pesticide no matter where it is. Then get the victim to a doctor fast.

First Aid Kit for Field and On-the-Job Use

A well equipped first aid kit which is always readily available can be important in a pesticide emergency. Make up your own pesticide first aid kit from a lunch pail, tool box, or a sturdy wooden box. It should have a tight fitting cover with a latch, so that it won't come open or allow pesticides to leak inside. Label it clearly with paint or a water proof marker.

Contents

1. A small plastic bottle of a common Detergent. It is used to wash pesticides quickly off the skin.
2. A small package or bag of Activated Charcoal . Mixed with water and swallowed, activated charcoal acts as an absorber of all pesticides.
3. A Shaped Plastic Airway for mouth-to-mouth resuscitation.
4. A thermos or large plastic bottle (at least one quart) of Clean Water. If there is no clean water in an emergency, use any pond or stream water that is available.
5. Simple Band Aids, Bandages and Tape. All cuts and scrapes should be covered to prevent pesticides from easily entering the body.
6. A Blanket is very useful. It should be kept in a place where it will not be contaminated by pesticides.
7. Suitable Coins should always be taped to the inside cover of the first -aid kit. They are for an emergency phone call.
8. A small, plastic Empty Jar with a tight fitting lid is useful as a drinking glass for the victim, in order to induce vomiting or feed activated charcoal. It can also be used for collecting vomitus to take to the doctor.

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Medical Antidotes for Pesticide Poisoning

For Your Physician's Use if Needed!!

Antidotes such as those described below should be prescribed or given only by a qualified physician. They can be very dangerous if misused.

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Group I Organophosphates

Azodrin, Bidrin, Bomyl, Carbophenothion (Trithion), Co-Ral, Dasanit, DDVP (Vapona), demeton (Systox), Diazinon, dimethoate (Cygon), dioxathion (Delnav), Di-Syston, Dursban, Dyfonate, EPN, ethion, famphur (Warbex), fenthion (Baytex), Guthion, Metasystox-R, Methyl parathion, Monitor, parathion, phorate (Thimet), Phosdrin, phosphamidon, Schradan (OMPA), Supracide, TEPP.

Antidotes:

1. 1. Atropine Sulfate is used to counteract the effects of cholinesterase inhibitors. Injections should be repeated as symptoms recur.
2. 2. Protopam Chloride (2-PAM) should also be injected to counteract organophosphate poisonings. It is given intravenously.

Do Not Use morphine, theophyllin, aminophyllin or barbituates.

Group II Carbamates

Carzol SP, mexacarbate (Zectran), aldicarb (Temik), carbofuran (Furadan), methomyl (Lannate), carbaryl (Sevin).

Antidotes:

1. Atropine Sulfate is used to counteract the effects of cholinesterase inhibitors. Injections should be repeated as symptoms recur.
2. Do Not Use Protopam Chloride (2-PAM).

Group III Chlorinated Hydrocarbons

endrin, dieldrin, aldrin, lindane, endosulfan (Thiodan).

Antidotes:

1. Barbiturates for convulsions or restlessness.
2. Calcium Gluconate given intravenously.
3. Do Not Use epinephrine (adrenalin).

Group IV Inorganic Arsenicals

sodium arsenite, Paris green.

Antidotes:

1. BAL (dimercaprol) is specific for arsenic poison. Inject intramuscularly.

Group V Cyanides

For Poisons Such As: hydrogen cyanide, Cyanogas.

Antidotes:

1. Amyl Nitrite through inhalation.
2. Sodium Nitrite given intravenously.
3. Sodium Thiosulfate given intravenously.

Group VI Anticoagulants

For Poisons Such As: warfarin, Fumarin, Pival, PMP (Valone), diphacinone (Diphacin).

Antidotes:

1. Vitamin K orally, intramuscularly, or intravenously.
2. Vitamin C useful adjunct.

Group VII Fluoroacetates

For Poisons Such As: sodium fluoroacetate (1080).

Antidotes:

1. Monacetin (glycol monoacetate) intramuscularly.

Group VIII Dinitrophenols

For poisons such as: DNOC, DNOCHP.

1. Do Not Use atropine sulfate.
2. Maintain life supports.
3. Sodium Methyl Thiouracil may be used to reduce basal metabolic rate.

Group IX Bromides and Carboxides

For poisons such as: methyl bromide, Carboxide, ethylene dibromide.

Antidotes:

1. BAL (dimercaprol) may be given before symptoms appear.
2. Barbiturates for convulsions.

Group X Chlorophenoxy Herbicides, Ureas, Miscellaneous

For Poisons Such As: 2,4-D, 2,4,5-T, monuron (Telvar), diuron (Karmex), Hyvar-X, endothall, Diquat,Paraquat.

Antidotes:

1. None.
2. Maintain life supports.

A Checklist for Preventing Pesticide Accidents

Everyone can improve their methods for safe handling of pesticides. Experienced pesticide applicators, unfortunately, may become so familiar with the equipment and materials used that they become careless or take shortcuts. An accident is waiting to happen.

The following checklist of questions is drawn from data showing the common causes of pesticide accidents. Check it against your pesticide handling practices and see how many accidents are waiting to happen to you. Just one "No" may be the one that gets you in trouble!

Store Your Pesticides Safely

• Do you have a separate space to store pesticides?
• Do you keep it locked and are the windows tight, barred or boarded over?
• Do you keep all your pesticides in this storage rather than in the garage, feed room, basement, porch, kitchen or refrigerator
• Do you store herbicides separately from other pesticides?
• Are there signs on your storage so firemen and others are warned?
• Do you check periodically for leaking containers?

Use the Recommended Clothing and Protective Equipment

• Do you read the label to see what protective clothing you should wear?
• Do you start each spraying day with clean spray clothing?
• Do you check the signal words and precautions for use on the label to see what protective equipment is necessary?
• Do you wear the protective equipment recommended on the label?
• Do you clean and maintain your protective equipment regularly and often?
• Do you throw away rubber gloves that have only tiny holes in them?

Keep the Original Container So the Label Is There!

• Do you always keep pesticides in the original container instead of old "coke" bottles, milk cartons or other food containers?
• When people ask you for a little spray mix out of your tank do you refuse?
• Do you always remember what is in an unlabeled container?
• Do you always remember the safety precautions, antidotes and directions for use, even though the container is not labeled?
• Do you safely dispose of unlabeled pesticides, rather than take a chance with your memory?

Spills and Splashes of Concentrates can be Very Hazardous!

• Do you know what to do if you should spill a pesticide on yourself while mixing?
• Do you wear adequate footgear with your pant cuffs on the outside, so pesticides won't run into your footgear?
• Do you have sawdust, vermiculite, kitty litter or some other absorbent on hand to soak up spills?
• Do you always watch your sprayer tank when filling so it won't run over and spill on the ground?
• Do you have a check valve or other device on your equipment to prevent back-siphoning into the water supply?
• Is your application equipment well maintained so it doesn't leak and leave toxic puddles or piles of pesticide on the ground?
• Do you avoid draining leftover spray mix on the ground?
• Do you discard old high pressure hose instead of patching it and hoping no one will be nearby when it bursts?
• Do you clean nozzles with a brush, by rinsing, etc., instead of blowing them out with your mouth?

Poor Container Disposal May Cause Bad Accidents!

• Do you rinse each "empty" liquid container at least three times and dump the rinse water into the tank?
• Do you keep your used containers in your storage area until disposal?
• Do you collect every container for disposal before leaving a job, instead of leaving them in the field or at your tank filling station?
• Do you puncture, break or crush nonburnable containers so that they can't be reused?
• Do you keep or return to the manufacturer 30 and 55 gallon pesticide drums, rather than giving them away for floats, trash barrels, etc.?

Attractive Nuisances Can Result in Lawsuits!

• Do you keep your sprayer equipment where children cannot play on it?
• Do you keep your spray equipment clean so that those touching it will not be contaminated?
• Do you always release pressure on your equipment so spray guns won't be accidentally triggered?

Care in Application Prevents Accidents

• Do you check the wind direction and the area downwind before applying pesticides?
• Do you consider substituting a safer chemical if you are spraying near a sensitive area?
• Do you check for the possibility of showers and damaging runoff before applying pesticides?
• Do you plan your pesticide application so it will have little or no effect on bees, birds, fish or other wildlife?
• Do you remove, turn over or cover up pet dishes, sand boxes, plastic pools, etc., before spraying a private property?
• Do you make sure that children and pets are out of the area and stay out until the spray dries?