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Managing Hazardous Materials Incidents

A Planning Guide for the Management of Contaminated Patients


U.S. Department Of Health And Human Services Public Health Service Agency for Toxic Substances and Disease Registry

Volume I Volume II Volume III


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ToxFAQs

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1,1,1-Trichloroethane 1,3-Butadiene Acrolein Acrylonitrile Ammonia Aniline Arsenic Trioxide Arsine Benzene Blister Agents (H, HD, HT) Blister Agents (HL, L) Blister Agents (HN-1, HN-2, HN-3) Calcium-Sodium Hypochlorite Carbon Disulfide Chlordane Chlorine Crotonaldehyde Diborane Ethylene Dibromide Ethylene Glycol Ethylene Oxide Formaldehyde Gasoline Hydrogen Chloride Hydrogen Cyanide

Hydrogen Fluoride Hydrogen Peroxide Hydrogen Sulfide Malathion Mercury Methyl Bromide Methyl Isocyanate Methyl Mercaptan Methylene Chloride Nerve Agents Nitrogen Oxides Parathion Phenol Phosgene Oxime Phosgene Phosphine Selenium Hexafluoride Sodium Hydroxide Sulfur Dioxide Tetrachloroethylene Toluene Diisocyanate Toluene Trichloroethylene Unidentified Chemical Vinyl Chloride Xylene

MANAGING HAZARDOUS MATERIALS INCIDENTS A Three Volume Series


Agency for Toxic Substances and Disease Registry March 2001

Under the authority of the Superfund Amendments and Reauthorization Act of 1986 (SARA), the Agency for Toxic Substances and Disease Registry (ATSDR) works to prevent or mitigate adverse human health effects and diminished quality of life resulting from exposure to hazardous substances in the environment. In pursuit of this mission, Managing Hazardous Materials Incidents, Volume I , II, & III, and the training video have been developed to provide emergency medical services (EMS) personnel and hospital emergency departments (EDs) with the necessary guidance to plan for, and improve their ability to respond to, incidents that involve human exposure to hazardous materials. The guidelines inform emergency personnel how to appropriately decontaminate, treat, and recommend follow-up care to exposed persons, as well as take measures to protect themselves.

HIGHLIGHTS: ATSDR's Managing Hazardous Materials Incidents is a three volume


set (with video) comprised of recommendations for on-scene (prehospital), and hospital medical management of patients exposed during a hazardous materials incident. Volume I - Emergency Medical Services: A Planning Guide for the Management of Contaminated Patients and Volume II - Hospital Emergency Departments: A Planning Guide for the Management of Contaminated Patients are planning guides to assist first responders and hospital emergency department personnel in planning for incidents that involve hazardous materials. Volume III - Medical Management Guidelines for Acute Chemical Exposures is a guide for health care professionals who treat persons who have been exposed to hazardous materials. Community Challenge: Hazardous Materials Response and the Emergency Medical System - is a training video for Volumes I & II (50 minutes total; 25 minutes for each volume).
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MANAGING HAZARDOUS MATERIAL INCIDENTS A Three Volume Series The ATSDR Internet address is < http://www.atsdr.cdc.gov >

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INTENDED AUDIENCE: HAZMAT Teams, Emergency Medical Personnel, Hospital Emergency Department Personnel, DHHS, DOD, DOE, FBI, FEMA, U.S. Marine Corps Chemical and Biological Incident Response Force (CBIRF), U.S. Uniformed Services University, City and County Emergency Management Agencies, International/Foreign Agencies and Organizations.

For more information about the Managaing Hazardous Mateerial Incidents publications including the Medical Management Guidlines contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-57, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-6396359. The ATSDR Internet address is < http://www.atsdr.cdc.gov >.

Federal Recycling Program

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Managing Hazardous Materials Incidents

Volume I
(Revised)

Emergency Medical Services:


A Planning Guide for the Management of Contaminated Patients

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES


Public Health Service Agency for Toxic Substances and Disease Registry

The Agency for Toxic Substances and Disease Registry (ATSDR) has produced a three-volume series entitled Managing Hazardous Material Incidents. The series is designed to help emergency response and health care professionals plan for and respond to hazardous material emergencies. Volume I Emergency Medical Services: A Planning Guide for the Management of Contaminated Patients Hospital Emergency Departments: A Planning Guide for the Management of Contaminated Patients Medical Management Guidelines for Acute Chemical Exposures

Volume II

Volume III

Volumes I and II are planning guides to assist first responders and hospital emergency department personnel in planning for incidents that involve hazardous materials. Volume III is a guide for health care professionals who treat persons who have been exposed to hazardous materials.

Agency for Toxic Substances and Disease Registry.........................................Jeffrey P. Koplan, Ph.D., M.P.H., Administrator Henry Falk, M.D., M.P.H., Assistant Administrator Division of Toxicology.........................................Christopher T. DeRosa, Ph.D., Director

Additional copies of this report are available from: Agency for Toxic Substance and Disease Registry (ATSDR) Division of Toxicology Information Center (E57) 1600 Clifton Road, N.E. Atlanta, Georgia 30333 (404) 639-6357 Internet address: www.atsdr.cdc.gov/prevent.html

2 Printed on recycled paper

DEPARTMENT OF HEALTH & HUMAN SERVICES


Public Health Service Agency for Toxic Substances and Disease Registry (MS-E57) Atlanta, GA 30333 Official Business Penalty for Private Use $300

SPECIAL FOURTH-CLASS RATE POSTAGE & FEES PAID PHS/CDC Permit No. G-284

Volume I - Table of Contents

Page Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iii Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v I. Systems Approach to Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 The Role of EMS in a Systems Approach to Planning . . . . . . . . . . . . . . . . . . . . . . . . . 1 Prehospital Response Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 The Spectrum of Hazardous Materials Incidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SARA Title III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 The State Emergency Medical Services (EMS) Agency . . . . . . . . . . . . . . . . . . . . . . . . 4 Federal Emergency Response Activities Hazard Analysis Training ...................................6

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Selected Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 II. Emergency Medical Services Response to Hazardous Materials Incidents . . . . . . . . .13 Hazard Recognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Principles of Toxicology for Emergency Medical Service Personnel . . . . . . . . . . . . . 21 Personnel Protection and Safety Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Respiratory Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Site Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Decontamination of Emergency Medical Service Personnel . . . . . . . . . . . . . . . . . . . . 38 Communications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Selected Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 III. Response and Patient Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 En Route to a Hazardous Materials Scene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Assessment, Decontamination, and Initial Treatment of Patients . . . . . . . . . . . . . . . . 49 Considerations for Patient Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Patient Transport to the Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Critique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 60 Patient Management Under Mass Casualty Conditions Involving Hazardous Chemicals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60 Critical Incident Stress Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Selected Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Appendix A Appendix B Appendix C Hazardous Materials Classification Systems . . . . . . . . . . . . . . . . . . . . . . . . . A1 Types of Respiratory Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B1 Levels of Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C1

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Acknowledgments
This document was first published in 1992 and updated in 2000. ATSDR wishes to thank all those who participated in making this a useful guidance document, including:
2000 Revision of Volume I Emergency Medical Services: A Planning Guide for the Management of Contaminated Patients: 2000 Revision of Volume II Hospital Emergency Departments: A Planning Guide for the Management of Contaminated Patients:

Craig DeAtley, P.A.-C., C.C.T.

George C. Rodgers, Jr., M.D., Ph.D.

Associate Professor, Emergency Medicine Professor of Pediatrics and Pharmacology/Toxicology Disaster Medicine and Special Operations Section University of Louisville George Washington University School of Medicine Louisville, KY and Health Sciences Washington, D.C.

Peer Review Panel for revised (2000) Volumes I and II:1


Sella Burchette (U.S. Environmental Protection Agency) Keith Burkhart, M.D., F.A.C.E.P. (American College of Emergency Physicians) Andrea Carlson (Physicians for Social Responsibility) Linda Cochiarella, M.D. (American Medical Association) Paul Cousins (The National Association of Emergency Medical Technicians) Richard Duffy (International Association of Firefighters) Philip Edelmen, M.D. (Association of Occupational and Environmental Clinics) Robert McCunney, M.D. (American College of Occupational and Environmental Medicine) Kent Olson, M.D. (American Association of Poison Control Centers) Leslie Stein-Spencer, R.N. (Emergency Nurses Association) Milton Tenenbein, M.D. (American Academy of Pediatrics) John Turley (Emergency Management Institute)
1

The above reviewers were recommended by the organizations listed but do not necessarily represent them.

This project was directed by Scott V. Wright, ATSDR. For the 2000 revision, Linda Stein of Eastern Research Group, Inc. (ERG) was the project manager, and Chris Reid of ERG was the editor (under ATSDR Contract No. 205-93-0641). The following panel of experts contributed to the original (1992) development of Volumes I and II: Phillip Currance, EMT-P; Ralph B. Monty Leonard, Ph.D., M.D., F.A.C.E.P.; Mary Beth Michos, R.N.; Eric Noji, M.D., M.P.H., F.A.C.E.P.; Martin J. ONeill; Paul Seidlitz, R.N. The following experts served as peer reviewers for the original 1992 Volumes I and II: Ben Blankeshire, Kenneth Bouvier, MacNeil Cross, Robert Daughdril, Craig DeAtley, Eileen Faries, Steve Finefrock, John Friery, Niel Holtz, Winston E. Jones, William J. Keffer, Gus A. Koehler, Kenneth Kuntz, Paul Manascalo, Kent Olson, Chappell D. Pierce, Alonzo Smith, Clark Staten, Dave Tauber, Joe E. Taylor, Sandra L. Tirey, Wallace Weaver, Steve White

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Introduction
The presence of hazardous materials or toxic chemicals at an incident location or other emergency situation adds a new dimension of risk to those handling and treating casualties. The fundamental difference between a hazardous materials incident and other emergencies is the potential for acute risk from contamination to both patient and responder. In some cases, traditional practices must be altered to avoid compounding a critical situation. Emergency medical services (EMS) must protect their personnel on site and en route to the hospital, and other people within the hospital, while providing the best care for the chemically contaminated patient. This guide is intended to help emergency medical services plan for incidents that involve hazardous chemicals and improve their ability to respond to these incidents. To ensure appropriate and timely patient care, as well as optimal response protection, emergency personnel must understand decontamination procedures and personal protective equipment, neither of which are routinely covered in the course of their professional training. They should also be aware of community resources that could be called upon to assist with an emergency response. Current training curricula for emergency room physicians and nurses and emergency medical technicians (EMTs) often do not adequately prepare these professionals to manage the contaminated individual or to decontaminate patients exposed to toxic substances. Accurate, specific, and concise guidance is needed to describe appropriate procedures to be followed by emergency medical personnel to safely care for a patient(s), as well as to protect responders, equipment, hospital personnel, and others from risk of secondary exposure. In response to this need, the Agency for Toxic Substances and Disease Registry (ATSDR) contracted for the production of a three-volume series entitled Managing Hazardous Materials Incidents: I. Emergency Medical Services: A Planning Guide for the Management of Contaminated Patients; II. Hospital Emergency Departments: A Planning Guide for the Management of Contaminated Patients; and III. Medical Management Guidelines for Acute Chemical Exposures. The second document is designed for use by emergency department personnel to minimize their risks of exposure within the emergency department, and to provide for the safe and effective treatment of chemically contaminated patients. This volume, written for emergency response personnel, is designed to familiarize readers with the terminology, concepts, and key operational considerations that affect the proper management of incidents of chemical contamination. It is designed not only to present uniform guidance for the emergency care of chemically contaminated patients, but also to provide basic information necessary to comprehensive planning and implementation of EMS strategies. It is intended to illustrate the characteristics of hazardous materials (hazmat) incidents that compel emergency response personnel to modify their preparations and response procedures. Not all hospitals and community emergency response systems are prepared to respond to a hazardous chemical incident to the same degree. This document may be used to assess the capabilities of EMS with respect to potential community hazards and to develop response plans using national and community-specific resources. Employee safety and training are also key factors in effective management of medical emergencies. This document is intended to provide source material for developing local training and safety protocols.

Section I, Systems Approach to Planning, introduces guidelines for emergency preparedness and prehospital response planning. Government and private planning activities are outlined, including those established under Title III of the Superfund Amendments and Reauthorization Act (SARA); the National Response Team; the Community Awareness Emergency Response (CAER) program; and the Chemical Emergency Preparedness Program (CEPP). This chapter discusses the need for hazard identification and risk analysis pertaining to hazardous materials located in a community or transported through it. Recommended training for EMS personnel is also included. Section II, Emergency Medical Services Response to Hazardous Materials Incidents, outlines general principles for hazard recognition, chemical exposure, and personal protective equipment. In addition, the hazard recognition section presents generalized guidance for determining whether a given situation constitutes a hazardous materials incident, and details various hazardous materials classification systems. This section provides basic toxicological and chemical terminology that emergency personnel need to understand to effectively conduct patient assessments. It also presents an outline of personal protective equipment, such as respiratory devices and protective clothing. Section III, Response and Patient Management, includes guidelines for EMS preparation and response to a potential hazardous materials incident. This chapter also discusses patient assessment, clinical management, and decontamination guidelines. This guidance document is intended to improve the safety of responders as well as of patients. It is not, however, all-encompassing, nor can it be regarded as a substitute for comprehensive instruction and training for hazardous materials incidents. Supplemental material that is vital to successful response to hazardous materials contamination is cited within the document. These materials should be carefully reviewed before preparing any strategic plans or conducting training exercises on this topic. Also, this document generally does not cover issues associated with weapons of mass destruction (WMD), although some of the information presented is pertinent to these situations as well. Other ATSDR documents specifically address WMD concerns.

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Section I.

Systems Approach To Planning

THE ROLE OF EMS IN A SYSTEMS APPROACH TO PLANNING


The potential for hazardous materials incidents exists almost everywhere. While infrequent, chemical incidents are capable of endangering the health of the individuals involved and the emergency personnel directed to assist them. People who have been seriously injured by a hazardous material have a greater chance of recovery without complications when appropriate emergency treatment is provided by trained prehospital Emergency Medical Service (EMS) personnel at the scene, and when the patient is transported to a facility having the most appropriate personnel and technical resources to manage his or her care. This requires an integrated emergency medical response. However, many local governments, private businesses, and hospitals do not have a tested hazardous materials response plan in place that integrates all of the responding agencies and personnel. This has resulted in several problems:
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Incidents have been poorly managed on site by first responders. Communication channels between the private and public sectors, or among public responders, have not been clearly identified and formalized. The medical community has not been firmly integrated into many response systems and may not be prepared to treat multiple casualties resulting from a serious hazardous materials incident.

EMS agencies are a crucial link in the community response system for emergency preparedness planning. EMS personnel are often the first to arrive at an incident scene and must assess the nature and extent of the hazard as well as attend to the immediate needs of victims, including initial treatment of people who may have been chemically contaminated. For effective coordination and communication, hospitals, EMS agencies, and other response agencies must participate jointly in local meetings involving hazmat planning, incident management, and protocol review. EMS agencies must acknowledge their role and responsibility as a component of the communitywide emergency response system. Administrators should familiarize themselves with the contingency plans of other participants, such as fire, police, and health departments and area hospitals, and understand what services are expected from each participant. Optimally, EMS staff should be represented on planning committees that develop and periodically review these contingency plans. A common characteristic of the successful management of chemical incidents is adequate contingency planning. Local emergency planning committees are mandated under federal law to identify high-risk locations and ensure adequate response planning and training. Planning requires the involvement of an array of community institutions, including fire, EMS and police departments, community hospitals, other health facilities, and the regional Poison Control Center.

PREHOSPITAL RESPONSE PLANNING


To ensure an effective and safe response to a hazardous materials accident, an EMS agency must develop a written response plan which becomes an integral part of the local community response plan. This agency plan should include important definitions, incident command practices to follow,

operational policies and procedures, safety practices, medical practices, and transportation guidelines. The plan should be developed in collaboration with other response agencies and hospitals, and reviewed annually. Training sessions based on the plan should be given on a regular basis to all agency personnel. Various types of disaster drills should be held each year to evaluate the effectiveness of the plan, as well as of the training sessions. The plan should be revised, and further training offered, based on feedback from its use.

THE SPECTRUM OF HAZARDOUS MATERIALS INCIDENTS


Local and state EMS agencies should be able to participate in the response to a range of hazmat incidents from the individual level, through the multi-casualty, to the mass-casualty level. The hospital(s) and emergency medical responders are key components of the local response system. Planning should integrate hospital(s) and EMS personnel, equipment, and supply needs into state and local hazmat plans. In turn, the hospital must be familiar with these plans and know how to use them if it is involved in an incident that overwhelms its capabilities.
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Individual patient: A single individual is contaminated and must be transported to an emergency department:
;

Can occur in the workplace, in a public place, or at home. May pose a problem in rural areas with small hospitals, or where there are low levels of hazmat skills and experience among EMTs.

Multi-casualty: This situation is usually limited to a single location:


;

Involves normal systems of transportation. Patients are usually treated at the same level facility as a single emergency response, but the demand on all systems is much greater.

Mass-casualty: Disrupts a large segment of the community:


;

Involves several locations. Involves additional units to the normal responders (mutual aid); such units may not be part of the local EMS system, and these units may not know how the system works. Involves long-range mutual aid; normal systems of transportation (ambulances) are inadequate or disrupted. Patients may be treated locally at different facilities that provide various levels of care, or even outside of the area altogether. May be an intentional criminal act with secondary harmful devices present.

While transportation incidents attract larger media attention, statistics show that almost 75 percent of acute hazardous materials events, excluding fuel spills, occur in the fixed locations where the chemicals are used or stored. In addition, events resulting in death and injury occur almost 1.5 times as often in fixed locations as in transit.

Hazardous material incidents range from small releases at a factory site to rapidly expanding events that may endanger a community. Regardless of the size or location of an incident, its successful management depends on preplanning. This preplanning often requires coordination among local, state, and federal agencies; industries; medical personnel; military hospitals; the Health Department; the regional Poison Control Center, as well as those in the community who use and maintain stocks of potentially hazardous materials. Contributions to hazardous materials planning come from a variety of sources. These include regulations from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), state and local planning committees established under Title III of the Superfund Amendments and Reauthorization Act (SARA), state EMS agencies, and federal agencies.

SARA TITLE III


Title III of the 1986 Superfund Amendments and Reauthorization Act (SARA) provides for an infrastructure in states and local communities to plan for effective response to hazardous materials emergencies. The legislation also provides for public access to information on the presence and releases of specified hazardous chemicals in communities. Title III, The Emergency Planning and Community Right-to-Know Act of 1986, requires that each state establish a State Emergency Response Commission (SERC), consisting of members with technical expertise in emergency response, environmental and natural resources, public health, occupational safety, media, and transportation. The SERC is responsible for establishing local emergency planning districts (usually on a county level), appointing and overseeing local emergency planning committees (LEPCs), establishing procedures for handling public requests for information, and reviewing LEPC emergency plans. SARA Title III requires that the local committees include, at a minimum, representatives from the following groups: state and local officials, law enforcement, civil defense, firefighters, environmental, hospital, media, first aid, health, transportation, and facility owners or operators subject to the emergency planning requirements. LEPCs were primarily responsible for preparing a comprehensive emergency response plan for their districts by October 1988, using information about the presence of potentially hazardous chemicals reported by businesses and other facilities under Title III. LEPCs were also charged with making information on hazardous chemicals available to the public. As part of the planning process, each LEPC must evaluate available resources for developing, implementing, and exercising its plan. The plan must include:
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Identification of facilities subject to planning provisions under Title III Identification of transportation routes for extremely hazardous substances Identification of risk-related facilities Methods and procedures for response Designated community and facility coordinators Procedures for public notification

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Methods for determining release occurrence and the area affected Description of emergency equipment and facilities, and those responsible for them Evacuation plans and training programs

Under Title III s planning provisions, EPA was mandated by Congress to establish a list of chemicals to help focus local emergency planning activities. In April 1987, EPA listed 406 Extremely Hazardous Substances (EHSs) and established a Threshold Planning Quantity (TPQ) for each. Any business or facility that contains one or more of these EHSs in an amount equal to or greater than its respective TPQ is required to notify the SERC and LEPC. These facilities must also appoint a coordinator to work with the LEPC for specific inclusion of that facility in the local plan. Representative facilities covered under the planning provisions include not only major chemical manufacturing facilities but a wide variety of chemical users, such as farmers, dry cleaners, and other service-related businesses. Exemptions under this provision apply only to vessels (ship/boat), federal facilities, and transportation operations. Storage incidental to transportation is exempt provided that the EHSs are still moving under active shipping papers and have not reached the final consignee. Accidental releases of EHSs and other hazardous substances identified in the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) must be reported to the LEPC and SERC. This requirement ensures immediate notification of local response personnel. Other provisions of Title III provide further information on the presence, storage, and emissions of hazardous and toxic chemicals. These data further assist the LEPC in obtaining a comprehensive picture of chemical risk in the local district. Emergency medical personnel can be better prepared to respond to incidents that involve contaminated victims by actively participating in the LEPC planning process. Title III provides for the submission of information on hazardous and toxic chemicals as presented above. In addition, Title III contains a specific provision requiring facility owners or operators to disclose the chemical identity of substances for which companies have made trade secret claims. Access to chemical identities assists health professionals, physicians, and nurses in obtaining further information for diagnostic and treatment recommendations during emergencies, and for prevention and treatment measures during nonemergencies.

THE STATE EMERGENCY MEDICAL SERVICES (EMS) AGENCY


Planning for hazardous materials incidents should include the appropriate linkage to the state EMS agency. The state agencies are responsible for overseeing a network of local EMS units, and thus are an essential part of the planning process. This body is often part of the SERC. The duties of these agencies vary from state to state. However, EMS agencies are usually responsible for medical management of civilians and injured first responders. EMS agencies must develop medical mutual aid agreements between counties and establish procedures for distribution of casualties between hospitals. In addition, EMS agencies should maintain an inventory of disaster medical supplies. EMS agencies should also develop and maintain communications protocols for onsite activities

(e.g., between receiving hospitals and the base hospital, between base hospitals and ambulances, between all hospitals and the regional Poison Control Center). Further, EMS agencies must work with local and state officials in designating field casualty decontamination and collection points for a major disaster, and in arranging for the acquisition and distribution of additional equipment, supplies, and pharmaceuticals. Suggested planning activities include:
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Incident Management: Establish with fire and police departments a unified command approach to mitigating a hazmat or Weapons of Mass Destruction (WMD) incident. Triage: Outline triage procedures to be utilized in prioritizing decontamination and transport of multiple patients. Decontamination: Institute a regional standard for performing decontamination of ambulatory and nonambulatory patients, in coordination with the fire department, hazmat team(s), and hospitals. Planning should also address how to handle children, pregnant women, the elderly and the infirm, as well as large numbers of patients (mass decontamination). Medical Management Protocols: The literature on the clinical management of hazardous materials exposures is sometimes inconsistent in its recommendations. Provisions should be made in the plan for obtaining field and hospital medical management information from experienced physicians. For example, the regional Poison Control Center can provide decontamination and medical management protocols via fax, e-mail, or telephone to all receiving hospitals, and through the base hospital or via cellular telephone to EMTs in the field. Planning should address antidote utilization and the rapid acquisition of additional supplies and pharmaceuticals, if needed. Volume III in this series, Medical Management Guidelines for Acute Chemical Exposures, contains useful emergency care recommendations for prehospital and hospital personnel. Patient Destination: Hospital emergency departments are able to provide supportive care. In some cases, however, it may be more appropriate to take the patient to a hospital that has expertise in handling certain kinds of poison exposures or injuries. The plan should include directions for obtaining this information. One option is to contact the regional Poison Control Center or the base hospital. The Poison Center will often know which hospitals are best prepared to handle exposures to which substances. Coordination with Burn Centers, Trauma Centers, Hyperbaric Chamber Facilities, Health Department(s), and Other Specialty Centers: Provisions should be made to alert and coordinate patient destination with various specialty care centers. Mental Health: Identify mental health resources, such as critical incident stress debriefing teams, to assist with meeting the mental health needs of patients, response personnel, and the general public. Documentation: Identify the required incident documentation that must be completed during and after the hazardous materials incident. Media Relations: Appoint an individual who will handle all media requests for information.

FEDERAL EMERGENCY RESPONSE ACTIVITIES


Contingency planning is essential to the successful implementation of any system designed to manage chemically contaminated patients and to promptly contain the hazard itself. Contingency plans require a coordinated community response that may also involve state and federal agencies. Preplanning and coordination of services are equally critical at the national level. The federal government established a National Contingency Plan (NCP) to promote coordination of resources and services of federal and state response systems. To oversee this plan, a National Response Team (NRT) and a National Response Center, a network of Regional Response Teams (RRTs), and a group of On-Scene Coordinators (OSCs) have been established. In addition, with passage of the NunnLugar-Domenici Anti-Terrorism Bill in 1996, the U.S. Public Health Service developed a series of strategically placed Metropolitan Medical Response Teams (NMRTs) to respond in the event of Nuclear, Biological, or Chemical (NBC) terrorism. These multidisciplinary teams, consisting of police, hazmat, EMS, and hospital personnel, are specially trained and equipped to respond to serious hazmat incidents as well as to NBC-related situations. The Hazardous Materials Emergency Planning Guide, referred to as NRT-1, provides guidance to help local communities prepare for potential hazardous materials incidents. NRT-1 can be used by local communities developing their own plans, as well as by LEPCs formed in accordance with the Emergency Planning and Community Right-to-Know Act of 1986 (SARA Title III). The objectives of the Hazardous Materials Emergency Planning Guide are to:
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Focus communities on emergency preparedness and response. Provide communities with information that can be used to organize the emergency planning task. Furnish criteria for risk and hazard assessments, and to assist communities in determining whether a hazardous materials incident plan is needed in addition to the districtwide plan developed by the LEPC. Help LEPCs and individual communities prepare a plan that is appropriate for their needs and consistent with their capabilities. Provide a method for revising, testing, and maintaining community emergency plans.

NRT-1 is published by the National Response Team, and was developed cooperatively by its federal member agencies, including the Department of Defense, Department of the Interior, Department of Transportation, U.S. Coast Guard, Environmental Protection Agency (EPA), Department of Commerce (National Oceanic and Atmospheric Administration [NOAA]), Federal Emergency Management Agency (FEMA), Department of State, Department of Agriculture, Department of Health and Human Services (Agency for Toxic Substances and Disease Registry [ATSDR]), Department of Justice, General Services Administration (GSA), Department of the Treasury, Department of Labor (Occupational Safety and Health Administration [OSHA]), Nuclear Regulatory Commission (NRC), and the Department of Energy (DOE). NRT-1 represents a concerted effort by federal agencies to consolidate their general hazardous materials planning guidance into an integrated federal document.

NRT-1 states that an emergency plan must include response procedures of facilities and local emergency and medical personnel, as well as a description of emergency equipment and facilities in the community. It also recommends that hospital, emergency medical service, and health department personnel be included as members of an emergency planning team. As previously mentioned, SARA Title III requires medical, hospital, and first aid personnel to be members of the local emergency planning committee. NRT-1 describes relevant publications that provide specific operational guidance to emergency responders, such as the DOT s North American Emergency Response Guidebook (NAERG), which provides guidance for firefighters, police, and other emergency services personnel to help them protect themselves and the public during the initial minutes immediately following a hazardous materials incident. In addition, the document provides information on the Chemical Manufacturers Association s (CMA) Community Awareness Emergency Response (CAER) and Chemical Transportation Emergency Center (CHEMTREC) programs. The CAER program encourages local chemical manufacturing facilities to inform area residents, public officials, and emergency response organizations about industry operations and to integrate their onsite emergency response plans with the planning efforts of the local community. In some areas of the country, the chemical industry has established physician networks to encourage better dialogue between company physicians and local health authorities. CAER has outlined specific steps for industrial plants:
l l l l l l l l l

Review the plant s emergency plan Improve employee awareness and training Prepare a community relations plan Inventory the status of local emergency planning Develop a briefing paper Prepare a list of initial contacts Meet with initial contacts and identify key officials Establish a coordinating group Begin implementation steps

On the federal level, EPA and FEMA provide technical assistance and guidance to local and state planners through the SARA Title III program. The NRT-1 document also recommends that contingency plans include standard operating procedures for entering and leaving sites, accountability for personnel entering and leaving sites, decontamination procedures, recommended safety and health equipment, and personal safety precautions. The document suggests that emergency plans include a list of emergency response equipment appropriate to the various degrees of hazard based on EPA s four levels of protection (Levels A through D; see Section II). Further, it recommends that the list include the type of respirator (i.e., self-contained breathing apparatus, supplied-air respirator, or air-purifying respirator) that should be used, the type of clothing that must be worn, and the equipment needed to protect the head, eyes, face, ears, hands, arms, and feet.

In addition, NRT-1 recommends that medical personnel be made aware of significant chemical hazards in the community to prepare for possible hazardous materials incidents. It also states that emergency medical teams and hospital personnel must be trained in the proper methods for decontaminating and treating individuals exposed to hazardous chemicals.

HAZARD ANALYSIS
Hazard analysis is a necessary component of comprehensive emergency planning for a community. It is a three-step decisionmaking process comprised of hazard identification, vulnerability analysis, and risk analysis. This section focuses primarily on hazard identification. Hazard analysis is usually the task of an agency (e.g., the fire department), the Disaster Committee, or the LEPC. EMS personnel should consult with the LEPC or their agency head to review the hazard analysis information for their area. The first task in conducting such an analysis is to complete an inventory of the hazardous materials present in the community and to determine the nature of the hazard. This is a key step because it permits planners to describe and evaluate risks, and to allocate resources accordingly. However, the task of analyzing all relevant hazards may not prove cost effective for many communities. The planning committee should, therefore, assign priorities to the hazards found in its community and establish affordable limits for analysis. It should be noted that several federal agencies (e.g., DOT, FEMA, EPA) report that frequently encountered substances often pose the most prevalent dangers. These materials include fuels and chemicals, such as chlorine, ammonia, and hydrochloric and sulfuric acids. Such materials should be given special attention (vulnerability analysis) by the LEPC in the planning process. In this context, a hazard is any situation that is capable of causing injury or impairing an individual s health. During the process of identifying hazards, facilities or transportation routes will be pinpointed that contain materials that are potentially dangerous to humans. The identification of hazards also should provide information on: (1) the types, quantities, and location(s) of hazardous materials in the community, or transported through a community; and (2) the nature of the hazard that would accompany incidents, such as explosions, spills, fires, and venting to the atmosphere. Hazards should be identified at as many facilities in the community as possible. These include the obvious ones such as chemical plants, refineries, petroleum plants, storage facilities, and warehouses. In requesting information directly from facilities, remember that the planning provisions under SARA Title III require certain facilities to provide the LEPC with any information on the facility that the committee needs to develop and implement its plan. The LEPCs may provide assistance here, particularly if the committee includes industry representatives. It is essential that these industries or businesses understand the role this information plays in ensuring a sound emergency response plan. As previously stated, placing airport, business, or industrial representatives on the communitywide planning committee, as required under SARA Title III, should facilitate their cooperation. The assistance and cooperation of a facility that regularly deals with hazardous materials also presents the local planning unit with a wide array of services. For example, such a facility can provide technical experts, Spill Prevention Control and Countermeasure (SPCC) plans, training and safe handling instructions, and cleanup capabilities.

In identifying hazards, hospitals and educational and governmental facilities should not be overlooked since they all contain a variety of chemicals. Major transportation routes and transfer points, such was airports, vessels in port, railroad yards, and trucking terminals, should also be included in the overall hazards identification plan. SARA Title III planning provisions address many of these potential transportation risk areas by requiring facility cooperation in plan preparation and by including specific risk areas as well as a wide range of chemical handlers, from manufacturers to service-related businesses. Risk analysis includes the probable damage that may occur if a chemical incident occurs. Information that is necessary for risk analysis includes:
l l l

The type of risk to humans, such as an acute, chronic, or delayed reaction. The groups that are most at risk. The type of risk to the environment, such as permanent damage or a recoverable condition.

Many documents can be of assistance in conducting a risk analysis. Risk analysis in transportation settings is outlined in the DOT s Community Teamwork: Working Together To Promote Hazardous Materials Safety, A Guide for Local Officials. In conjunction with FEMA and DOT, EPA published a supplement to NRT-1 in December 1987. This document, entitled Technical Guidance for Hazardous Analysis and often referred to as the Green Book, provides technical assistance to LEPCs in assessing the lethal hazards associated with potential airborne releases of extremely hazardous substances.

TRAINING
Each member of an EMS agency (career, volunteer, or combined service) is mandated to receive 8 hours of hazmat awareness training each year. This training provides an introduction to basic response principles: the importance of incident recognition, assessment, and taking defensive strategies until more qualified assistance arrives. The National Fire Protection Association (NFPA) has published several standards for fire departments regarding hazardous materials response. In 1997 it released Standards for Professional Competence of EMS Responders to Hazardous Materials Incidents (NFPA 473), which outlines desired levels of competence for EMS personnel responding to hazmat incidents. Level I EMS/HM-trained responders are prepared with the knowledge and skills to safely deliver emergency medical care in the Support (Cold) Zone, whereas Level II EMS/HM responders are prepared to provide care to individuals who still may pose a risk of secondary contamination (i.e., working in the Contamination Reduction (Warm) Zone). Personnel at this level are also able to coordinate EMS activities at a hazardous materials incident and provide medical support for hazmat response personnel. All EMS agency administrators should familiarize themselves with this standard, as well as with NFPA 472, Standards for Professional Competence of Responders to Hazardous Materials Incidents. These two courses and other instructional programs, such as the Domestic Preparedness: Weapons of Mass Destruction Training program, are recommended for all EMS personnel who will be responding to hazardous materials calls. A growing number of commercially available audiovisual and computer-based training programs are becoming available which provide accurate, timely, and cost-effective instruction. In addition, numerous sites on the Internet offer free access to educational materials pertaining to hazardous materials (e.g., www.NLM.NIH.gov/pubs/FactSheets/toxnctfs.html; www.ATSDR.cdc.gov/hazdat.html).

SELECTED BIBLIOGRAPHY
Auf der Heide, E. 1989. Disaster Response: Principles of Preparation and Coordination. St. Louis, MO: Mosby. Auf der Heide, E. (ed.). 1995. Community Medical Disaster Planning and Evaluation Guide. Dallas, TX: American College of Emergency Physicians. Brunancini, A.V. 1985. Fire Command. Quincy, MA: National Fire Protection Association. Fire Protection Publications. 1983. Incident Command System. Stillwater, OK: Oklahoma State University Press. National Emergency Training Center. 1998. Guidelines for Public Sector Hazardous Materials Training. Emmitsburg, MD: HEMP Curriculum Guidelines. National Fire Protection Association. 1992. Recommended Practice for Responding to Hazardous Materials Incidents, NFPA 471. Quincy, MA: National Fire Protection Association. National Fire Protection Association. 1992. Standards for Professional Competence of Responders to Hazardous Materials Incidents, NFPA 472. Quincy, MA: National Fire Protection Association. National Fire Protection Association. 1997. Standards for Professional Competence of EMS Responders to Hazardous Materials Incidents, NFPA 473. Quincy, MA: National Fire Protection Association. National Response Team. 1987. Hazardous Materials Emergency Planning Guide. Washington, DC: Government Printing Office. Noll, G.G., M.S. Hildebrand, and J.G. Yvonna. 1995. Hazardous Materials: Managing the Incident. 2nd ed. Stillwater, OK: Fire Protection Publications. SARA Title III Compliance Guidebook. 1988. Government Institutes, Inc. ISBN: 0-86587-749-1. Sullivan, J.B. and G.R. Krieger. 1992. Hazardous Materials Toxicology: Clinical Principles of Environmental Health. Baltimore, MD: Williams & Wilkins. U.S. Department of Defense, U.S. Army, USAMRICD Chemical Casualty Division. 1998. Medical Response to Chemical Warfare and Terrorism. 3rd ed. Edgewood, MD. U.S. Department of Transportation. 1983. Community Teamwork: Working Together To Promote Hazardous Materials Safety, A Guide for Local Officials. Washington, DC: Government Printing Office. U.S. Department of Transportation. 1996. 1996 North American Emergency Response Guidebook. Washington, DC: Government Printing Office. [available in English, Spanish and French][http://hazmat.dot.gov/gydebook.htm]

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U.S. Environmental Protection Agency. 1992. EPA Standard Safety Operating Guidelines. Washington, DC: Government Printing Office. U.S. Environmental Protection Agency and U.S. Federal Emergency Management Agency. 1987. Technical Guidance for Hazardous Analysis: Emergency Planning for Extremely Hazardous Substances. Washington, DC: Environmental Protection Agency. U.S. Federal Emergency Management Agency. 1996. Guide for all Hazard Emergency Operations Planning. Washington, DC: Government Printing Office.

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Section II.

Emergency Medical Services Response to Hazardous Materials Incidents

HAZARD RECOGNITION
When dispatched to the scene of an incident, emergency response personnel may not be aware that the situation involves hazardous materials. As a result, emergency medical services personnel should always be alert to the possibility that they may be dealing with a chemically contaminated individual, and should ask the dispatch personnel and victims about the nature of the event. An injury at a hazardous materials incident need not invariably involve chemical exposure: it could have resulted from a physical accident, such as slipping off a ladder. But as a routine precaution, the involvement of hazardous materials should be considered a possibility on every call. The manual Recognizing and Identifying Hazardous Materials (produced by the National Fire Academy and the National Emergency Training Center) states that there are six primary clues that may signify the presence of hazardous materials. These clues are included below to facilitate and expedite the prompt and correct identification of any hazardous materials at the scene of an incident. Dispatch protocols should seek to obtain information about these clues and relay the information to field personnel as soon as possible. Certain combinations of patient symptoms such as nausea, dizziness, burning eyes or skin, or cyanosis should also suggest to the dispatch staff the presence of hazardous materials. The six principle clues to hazardous materials incidents are:
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Occupancy and Location. Community preplanning should identify the specific sites that contain hazardous materials. In addition, emergency personnel should be alert to the obvious locations in their communities that use and/or store hazardous materials (e.g., laboratories, factories, farm and paint supply outlets, construction sites). The Department of Labor s Material Safety Data Sheets (MSDSs) should also be available, especially for any particularly dangerous chemicals kept on site. It should be kept in mind, however, that these data sheets may have incomplete information and that the medical information provided is generally at a basic first aid level. Container Shape. Department of Transportation (DOT) regulations delineate container specifications for the transport of hazardous materials. There are three categories of packaging: stationary bulk storage containers at fixed facilities that come in a variety of sizes and shapes; bulk transport vehicles, such as rail and truck tank cars, that vary in shape depending upon the cargo; and labeled fiberboard boxes, drums, or cylinders for smaller quantities of hazardous materials. The shape and configuration of the container can often be a useful clue to the presence of hazardous materials. Markings/Colors. Certain transportation vehicles must use DOT markings, including identification (ID) numbers. Identification numbers, located on both ends and both sides, are required on all cargo tanks, portable tanks, rail tank cars, and other packages that carry hazardous materials. Railcars may have the names of certain substances stenciled on the side of the car. A marking scheme designed by the National Fire Protection Association (NFPA 704M System) identifies hazard characteristics of materials at terminals and industrial sites, but does not provide productspecific information. This system uses a diamond divided into four quadrants. Each quadrant represents a different characteristic: the left, blue section refers to health; the top, red quarter pertains to flammability; the right, yellow area is for reactivity; and the bottom, white quadrant highlights special information (e.g., W indicates dangerous when wet, Oxy stands for oxidizer).

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A number from zero through four in each quadrant indicates the relative risk of the hazard, with zero representing the minimum risk. This system does not indicate what the product is, the quantity, or its exact location. In addition, it does not reveal the compound s reactivity with other chemicals. The military also uses distinctly shaped markings and signs to designate certain hazards. These markings may be found on vehicles, on the products themselves, or on shipping papers.
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Placards/Labels. These convey information through use of colors, symbols, Hazard Communication Standards, American National Standard Institute (ANSI) Standards for Precautionary Labeling of Hazardous Industrial Chemicals, United Nations Hazard Class Numbers, and either hazard class wording or four-digit identification numbers. Placards are used when hazardous materials are being stored in bulk (usually over 1,001 lb), such as in cargo tanks. Labels designate hazardous materials kept in smaller packages. Caution must be exercised, however, because the container or vehicle holding a hazardous material may be improperly labeled or recorded, or it may not have any exterior warning. Shipping Papers. Shipping papers can clarify what is labeled as dangerous on placards. They should provide the shipping name, hazard class, ID number, and quantity, and may indicate whether the material is waste or poison. Shipping papers, which must accompany all hazardous material shipments, are now required to list a 24-hour emergency information telephone number. The location where the shipping papers are stored can be problematical; often they are found in close proximity to the hazardous material(s) or in other locations not easily accessible during an emergency. Shipping papers should remain at the incident scene for use by all response personnel. Senses. Odor, vapor clouds, dead animals or fish, fire, and skin or eye irritation can signal the presence of hazardous materials. Generally, if one detects an odor of hazardous materials, it should be assumed that exposure has occurred and the individual is still in the danger area, although some chemicals have a detectable odor at levels below their toxic concentrations. Some chemicals, however, can impair an individual s sense of smell (e.g., hydrogen sulfide), and others have no odor, color, or taste at all (e.g., carbon monoxide). Binoculars are helpful to ascertain visible information from a safe distance.

Appendix A provides greater detail on NFPA s 704M system; the DOT s hazardous materials marking, labeling, and placarding guide; and the Department of Labor s MSDS. It is important that any and all available clues are used in substance identification, especially obvious sources such as the information provided on a label or in shipping papers.

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The aim of emergency personnel should be to make a chemical-specific identification while exercising caution to prevent exposure to any chemicals. Identifying the hazardous material and obtaining information on its physical characteristics and toxicity are vital steps to the responder s safety and effective management of the hazardous materials incident. Since each compound has its own unique set of physical and toxicological properties, early and accurate identification of the hazardous material(s) involved allows emergency personnel to initiate appropriate management steps at the scene. Many resources are available to provide information concerning response to and planning for hazardous materials incidents. A selected bibliography of written material is included at the end of each section of this guidebook; it is not, however, a complete list of the materials available. Printed reference materials provide several advantages: they are readily available, they can be kept in the response vehicle, they are not dependent on a power source or subject to malfunction, and they are relatively inexpensive. Disadvantages include the difficulty of determining the correct identity for an unknown chemical through descriptive text, the logistics of keeping the materials current, the increased risk of the documents being lost or damaged because of their small size and soft cover bindings, and the problem that no single volume is capable of providing all the information that may be needed. EMS personnel should have immediate access to and be proficient at using the DOT s North American Emergency Response Guidebook and other medically-oriented response documentation. There is also a vast array of telephone and computer-based information sources concerning hazardous materials. They can help by describing the toxic effects of a chemical, its relative potency, and the potential for secondary contamination. They may also recommend decontamination procedures, clinical management strategies, and advice on the adequacy of specific types of protective gear. Exhibit II-lA is a partial listing of the many information resources available by telephone. Exhibit II-1B is a list of suggested telephone numbers that should be filled in for your community. The regional Poison Control Center, the Soldier and Biological Chemical Command (SBCCOM), and the Centers for Disease Control (CDC) can be contacted 24 hours a day to provide vital information on the medical management of hazardous materials exposure. Exhibit II-2 provides a partial listing of the available computerized and online information sources. Note, however, that not all online databases are peer reviewed; some medical management information may be based only on DOT or MSDS data. Care should be exercised when selecting information sources. Planning is an essential part of every response, and many of these resources can provide guidance in the formation of an effective response plan.

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Exhibit II-1A Telephone Information and Technical Support References


Resource
Chemical Transportation Emergency Center (CHEMTREC)

Contact

Services Provided

1-800-424-9300

24-hour emergency number connecting with manufacturers and/or shippers. Advice provided on handling, rescue gear, decontamination considerations, etc. Also provides access to the Chlorine Emergency Response Plan (CHLOREP).

Agency for Toxic Substances and Disease Registry (ATSDR) 1-404-639-6360

24-hour emergency number for health-related support in hazardous materials emergencies, including onsite assistance. Contact number for technical questions about railway transport of hazardous materials. For emergencies, call CHEMTREC (1-800-424-9300). Available 9:00 a.m. to 6:00 p.m. (EST). Provides information on SARA Title III, list of extremely hazardous substances, and planning guidelines.

Bureau of Explosives

1-719-585-1881

Emergency Planning and Community 1-800-424-9346 Right-to-Know Act (EPCRA) and Resource Conservation and Recovery Act (RCRA) Information Hotline Environmental Protection Agency (EPA) Regional Offices Region I (CT, ME, MA, NH, RI, VT) Region II (NJ, NY, PR, VI) Region III (DE, DC, MD, PA, VA, WV)

Region IV (AL, FL, GA, KY, MS, NC, SC, TN)

Region V (IL, IN, MI, MN, OH, WI) Region VI (AR, LA, NM, OK, TX) Region VII (IA, KS, MO, NE) Region VIII (CO, MT, ND, SD, UT, WY) Region IX (AZ, CA, HI, NV; Pacific Islands AS, FM, GU, MH, MP, PW) Region X (AK, ID, OR, WA)

website: Environmental response teams www.epa.gov/regional available for technical assistance. 1-617-918-1111 1-212-637-3000 1-215-814-2900; intra-regional only: 1-800-438-2474 1-404-562-9900; Emergency Response & Removal Branch: 1-800-564-7577 1-312-353-2000 1-214-665-2200 1-913-551-7003 1-303-312-6312 1-415-744-1500; emergencies: 1-415-744-2000 1-206-553-1200

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Exhibit II-1A (continued)

Resource
National Animal Poison Control Center

Contact
1-800-548-2423 1-888-426-4435

Services Provided
24-hour consultation services concerning animal poisonings or chemical contamination. Provides an emergency response team to investigate incidents and to perform laboratory analysis.

National Pesticides Information Retrieval System 1-765-494-6616 Contact information for help in searching (NPIRS) website: NPIRS database to get fact sheets on ceris.purdue.edu/npirs pesticides, insecticides, fungicides, and state and federally registered chemicals. National Pesticide Telecommunications Network (NPTN) (Oregon State University) 1-800-858-7378 Provides information about pesticide-related website: topics, including pesticide products, ace.orst.edu/info/nptn recognition and management of pesticide poisoning, toxicology, environmental chemistry, referrals for laboratory analyses, investigation of pesticide incidents, emergency treatment, safety, health and environmental effects, cleanup, and disposal procedures. 1-800-424-8802 A federal hotline for reporting oil and chemical spills where hazardous materials are responsible for death, serious injury, property damage in excess of $50,000, or continuing danger to life and property. 24-hour consultation service for threats and releases pertaining to chemical and biological agents.

National Response Center

U.S. Army Soldier and Biological Chemical Command (SBCCOM)

1-800-368-6498

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Exhibit II-1B Local Telephone Information and Technical Support Resource Worksheet
Resource Contact (fill in for future reference) Services Provided (fill in for future reference)

EPA Regional or State Office Regional Poison Control Center State Emergency Response Commission State Health Department State Emergency Management Office Local Fire Department Local Hazardous Materials Response Team Community Police Department Local Emergency Planning Committee Local Health Department State Department of Natural Resources FEMA Regional Office State Agriculture Office State Lab Office State EMS Office Hyperbaric Medicine Chamber Burn Center CDC U.S. Army Soldier and Biological Chemical Command

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Exhibit II-2 Computerized Data Sources for Information and Technical Support
Data System
CAMEO

Contact
CAMEO Database Manager National Oceanic and Atmospheric Administration (NOAA) Hazardous Materials Response Division 7600 Sand Point Way, N.E. Seattle, Washington 98115 (206) 526-6317 website: www.epa.gov/ceppo/cameo CIS, Inc. c/o Oxford Molecular Group 11350 McCormick Road Executive Plaza, Suite 1100 Hunt Valley, Maryland 21031 (800) 247-8737 website: www.oxmol.com/software/cis/ details/CHRIS.shtml Micromedex, Inc. Suite 300 6200 S. Syracuse Way Englewood, Colorado 80111-4740 (800) 525-9083 website: www.micromedex.com/products/ pd-main.htm Kevin Coburn Information Systems Manager U.S. Department of Transportation D.H.M. 63 - Room 8104 400 7th Street SW Washington, D.C. 20590-0001 website: www.dlis.dla.mil/hmis.htm HSDB Representative National Library of Medicine Specialized Information Systems 8600 Rockville Pike Bethesda, Maryland 20894 (301) 496-6531 website: sis.nlm.nih.gov/sis1

Description
Computer-aided management of emergency operations available to on-scene responder(s). Chemical identification database assists in determining substance(s) involved, predicting downwind concentrations, providing response recommendations, and identifying potential hazards.

CHRIS

Chemical Hazard Response Information System, developed by the Coast Guard and comprised of reviews on fire hazards, fire-fighting recommendations, reactivities, physicochemical properties, health hazards, use of protective clothing, and shipping information for over 1,000 chemicals.

HAZARDTEXT

Assists responders dealing with incidents involving hazardous materials, such as spills, leaks, and fires. Provides information on emergency medical treatment and recommendations for initial hazardous response.

HMIS

Hazardous Material Information Systems contains information on hazardous materials. Transportation-related incidents may be reported on DOT form 5800.1 (Hazardous Materials Incident Report Form).

HSDB

Hazardous Substances Data Bank, compiled by the National Library of Medicine, provides reviews on the toxicity, hazards, and regulatory status of over 4,000 frequently used chemicals.

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Exhibit II-2 (continued)

Data System

Contact

Description
Helps develop training programs and establish protocols for first aid or initial workplace response to a medical emergency.

1st MEDICAL RESPONSE Micromedex, Inc. PROTOCOLS Suite 300 6200 S. Syracuse Way Englewood, Colorado 80111 (800) 525-9083 website: www.micromedex.com/products/ pd-main.htm MEDITEXT Micromedex, Inc. Suite 300 6200 S. Syracuse Way Englewood, Colorado 80111 (800) 525-9083 website: www.micromedex.com/products/ pd-main.htm Oxford Molecular Group, Inc. 11350 McCormick Rd. Executive Plaza 3, Suite 1100 Hunt Valley, Maryland 21031 (800) 247-8737 website: www.oxmol.com/software/cis/ details/OHMTADS.shtml Micromedex, Inc. Suite 300 6200 S. Syracuse Way Englewood, Colorado 80111 (800) 525-9083 website: www.micromedex.com/products/ pd-main.htm

Provides recommendations regarding the evaluation and treatment of exposure to industrial chemicals.

OHMTADS

Oil and Hazardous Materials/Technical Assistance Data Systems provides information on the effects of spilled chemical compounds and their hazardous characteristics and properties, assists in identifying unknown substances, and recommends procedures for handling cleanups. The Tomes Plus Information Systems is a series of comprehensive databases on a single CD-ROM disc. It provides information regarding hazardous properties of chemicals and medical effects from exposure. The Tomes Plus database contains Meditext, Hazardtext, HSBD, CHRIS, OHMTADS, and 1st Medical Response Protocols. A computerized system of three toxicologically oriented data banks operated by the National Library of Medicine the Hazardous Substances Data Bank, the Registry of Toxic Effects of Chemical Substances, and the Chemical Carcinogenesis Research Information System. TOXNET provides information on the health effects of exposure to industrial and environmental substances.

TOMES

TOXNET

Toxicology Data Network (TOXNET) National Library of Medicine Specialized Information Services 8600 Rockville Pike Bethesda, Maryland 20894 (301) 496-6531 website: sis.nlm.nih.gov/sis1

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PRINCIPLES OF TOXICOLOGY FOR EMERGENCY MEDICAL SERVICE PERSONNEL


Exposure to hazardous chemicals may produce a wide range of adverse health effects. The likelihood of an adverse health effect occurring, and the severity of the effect, are dependent on: (1) the toxicity of the chemical; (2) the route of exposure; (3) the nature and extent of exposure; and (4) factors that affect the susceptibility of the exposed person, such as age and the presence of chronic disease. To better understand potential health effects, emergency medical personnel should understand the basic principles and terminology of toxicology. Toxicology is the science that deals with poisons and their effect on living organisms. Examples of these adverse effects, sometimes called toxic end points, include carcinogenicity (development of cancer), hepatotoxicity (liver damage), neurotoxicity (nervous system damage), and nephrotoxicity (kidney damage). This is merely a sample list of toxic end points that might be encountered (Exhibit II-3). Toxic chemicals often produce injuries at the site which they come into contact with the body. A chemical injury at the site of contact, typically the skin and the mucous membranes of the eyes, nose, mouth, or respiratory tract, is termed a local toxic effect. Irritant gases such as chlorine and ammonia can, for example, produce a localized toxic effect in the respiratory tract, while corrosive acids and bases can result in local damage to the skin. In addition, a toxic chemical may be absorbed into the bloodstream and distributed to other parts of the body, producing systemic effects. Many pesticides, for example, are absorbed through the skin, distributed to other parts of the body, and produce adverse effects such as neurological, cardiac, respiratory, or other problems. It is important for medical providers to recognize that exposure to chemical compounds can result not only in the development of a single systemic effect but also in the development of multiple systemic effects or a combination of systemic and local effects. Some of these effects may be delayed, sometimes for as long as 48 hours or more. Health effects can also be acute or chronic. Acute health effects are short-term effects that manifest within hours or days, such as vomiting or diarrhea. Chronic health effects are long-term effects that may take years to manifest, such as cancer.

Routes and Extent of Exposure


There are three main routes of chemical exposure: inhalation, dermal contact (with skin or mucous membranes), and ingestion. Inhalation results in the rapid introduction of toxic compounds into the respiratory system. Most of the compounds that are commonly inhaled are gases or vapors of volatile liquids. However, solids and liquids can be inhaled as dusts or aerosols. Inhalation of toxic agents generally results in a rapid and effective absorption of the compound into the bloodstream because of the large surface area of the lung tissue and number of blood vessels in the lungs. Knowing a chemical s vapor pressure (VP) can be useful in determining the inhalation risk for a particular exposure. The lower the VP, the less likely the chemical will produce an inhalable gas and vice versa. Water solubility is also an important contributor for symptom development. Irritant agents that are water soluble usually cause early upper respiratory tract irritation, resulting in coughing and throat irritation. Partially water-soluble chemicals penetrate into the lower respiratory system, causing delayed symptoms (12 to 24 hours) which include trouble breathing, pulmonary edema, and coughing up blood. Asphyxiants are chemicals that impede the body s ability to obtain or utilize oxygen. Simple asphyxiants are inert gases (e.g., argon, propane, nitrogen) that displace oxygen in inspired air. Chemical asphyxiants produce harm by preventing oxygen delivery or utilization for energy production by the body s cells. Carbon monoxide and cyanide are examples of asphyxiants.

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Exhibit II-3 Examples of Adverse Health Effects from Exposure to Toxic Chemicals
Toxic End Point Target Organ Systems Example of Causative Agent
Benzene

Health Effect Acute

Health Effect Chronic

Carcinogenicity

All

Dermatitis Headache Dizziness Sleepiness Vomiting Abdominal pain Dizziness Nausea Vomiting Abdominal pain Vomiting Diarrhea Chest pain

Acute myelogenous leukemia

Hepatotoxicity

Liver

1, 1, 1-1 trichloroethane

Liver necrosis Fatty liver

Neurotoxicity

Nervous system

Lead

Wrist drop IQ deficits Encephalopathy Kidney damage Anemia

Nephrotoxicity

Kidney

Cadmium

Dermal contact does not typically result in as rapid absorption as inhalation, although some chemicals are readily taken in through the skin. Many organic compounds are lipid (fat) soluble and can therefore be rapidly absorbed through the skin and mucus membranes. Absorption is increased by damage to the skin and by warm weather, and some areas of the body (e.g., the groin) absorb chemicals faster than others (e.g., the hands). Ingestion is a less common route of exposure for emergency response personnel at hazardous materials incidents. However, incidental hand-to-mouth contact, smoking, and swallowing of saliva and mucus that contains contaminants may also result in exposure by this route. In addition, emergency medical personnel in both hospital and prehospital settings treat chemical exposures in patients who have ingested toxic substances as a result of accidental poisonings or suicide attempts. Compounds may also be introduced into the body through injection, although this is a relatively uncommon scenario in spills or discharges of hazardous materials. Explosions may result in injection injuries and lead to imbedded foreign bodies, which may themselves be chemically contaminated.

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The route by which personnel are exposed to a compound plays a role in determining the total amount of the compound taken up by the body because a compound may be absorbed by one route more readily than by another. In addition, the route of exposure may affect the nature of the symptoms that develop. The amount of the compound absorbed by the body also depends on the duration of exposure and the concentration of the compound to which one is exposed. It is important to recognize that children may be more susceptible to many toxic exposures. A child s immature central nervous system, liver, and renal system increases his or her susceptibility to injury as a result of exposure to chemicals. Children are also likely to receive a higher dose relative to body weight than an adult. This occurs for a number of reasons. First, children are shorter than adults and since most toxic gases are heavier than air, the concentrations increase as you get closer to the ground. Second, children have a larger lung surface area relative to their weight than adults, as well as a greater respiratory volume (liters/min/kg of body weight). It is also probable that the child s lung is a more effective absorbent surface than that of the adult. Third, children have a larger skin area relative to their weight than do adults, allowing more effective surface area for absorption in dermal exposures. A child s skin is more easily penetrated by chemicals, allowing for a more rapid and effective dermal absorption. Finally, children are more likely to ingest toxic chemicals because of increased hand-to-mouth behavior, including pica. All of these factors may lead to an increased dose relative to size in children as compared to adults, even when they all are exposed to the same scenario. A complex relationship exists between the total amount of the compound absorbed by the body (dose) and the concentration of that compound in the environment. This relationship is important for emergency response personnel to understand because the adverse effects produced by a toxic compound are often related to the dose of that compound received by a patient. However, because we usually only monitor the concentration of the toxic substance in the environment (e.g., parts per million (ppm) of a compound in air), the actual dose of the compound received by the patient is seldom known. Factors specific to the exposed individual, such as area of skin surface exposed, presence of open wounds or breaks in the skin, and the rate and depth of respirations, are important in estimating the dose of the compound received by the patient. Injuries that disrupt the skin may lead to absorption of chemicals that would not normally penetrate the skin.

Dose-Response Relationship
The effect produced by a toxic compound is primarily a function of the dose. This principle, termed the dose-response relationship, is a key concept in toxicology. Many factors affect the normal doseresponse relationship and they should be considered when attempting to extrapolate toxicity data to a specific situation (Exhibit II-4).

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Exhibit II-4 Classification of Factors Influencing Toxicity


Type
Factors related to the chemical

Examples
Composition (salt, freebase, etc.); physical characteristics (size, liquid, solid, etc.); physical properties (volatility, solubility, etc.); presence of impurities; breakdown products; carriers Dose; concentration; route of exposure (inhalation, ingestion, dermal); duration Heredity; immunology; nutrition; hormones; age; sex; health status; preexisting diseases; pregnancy Media (air, water, soil, etc.); additional chemicals present; temperature; humidity; air pressure; and fire

Factors related to exposure

Factors related to the exposed person

Factors related to environment

Typically, as the dose increases, the severity of the toxic response increases. Humans exposed to 100 ppm of tetrachloroethylene, a solvent that is commonly used for dry-cleaning fabrics, may experience relatively mild symptoms, such as headache and drowsiness. However, exposure to 200 ppm tetrachloroethylene can result in a loss of motor coordination in some individuals, and exposure to 1,500 ppm tetrachloroethylene for 30 minutes may result in loss of consciousness (Exhibit II-5). As shown in Exhibit II-5, the severity of the toxic effect also depends on the duration of exposure, a factor that influences the dose of the compound in the body. Toxicity information is often expressed as the dose of a compound that causes an effect in a percentage of the exposed subjects, which are usually experimental animals. These dose-response terms are often found in the Material Safety Data Sheets (MSDSs) and other sources of health information. One dose-response term that is commonly used is the lethal dose 50 (LD50). This is the dose that is lethal to 50 percent of an animal population from exposure by a specific route (except inhalation) when given all in one dose. A similar term is the lethal concentration 50 (LC50), which is the concentration of a material in air that on the basis of respiratory exposure in laboratory tests is expected to kill 50 percent of a group of test animals when administered as a single exposure (usually 1 hour). Exhibit II-6 lists a number of chemicals that may be encountered in dealing with hazardous materials incidents, and the reported acute LD50 values of these compounds when they are administered by ingestion to rats.

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Exhibit II-5 Dose-Response Relationship for Humans Inhaling Tetrachloroethylene Vapors


Levels in Air
50 ppm 100 ppm 200 ppm 600 ppm 1,000 ppm 7 hours 2 hours 10 minutes 1-2 minutes

Duration of Exposure

Effects on Nervous System


Odor threshold Headache, drowsiness Dizziness, uncoordination Dizziness, loss of inhibitions Marked dizziness, intolerable eye and respiratory tract irritation Coma

1,500 ppm

30 minutes

From Exhibit II-6 it can be seen that a dose of 3,000 to 3,800 mg/kg tetrachloroethylene is lethal to 50 percent of rats that received the compound orally; however, only 6.4 to 10 mg/kg of sodium cyanide is required to produce the same effect. Therefore, compounds with low LD50 values are more acutely toxic than substances with higher LD50 values. The LD50 values that appear on an MSDS or in the literature must be used with caution by emergency medical personnel. These values are an index of only one type of response and give no indication of the ability of the compound to cause nonlethal, adverse or chronic effects. They also do not reflect possible additive effects from the mixture of chemicals sometimes found with exposure to hazardous materials. Furthermore, LD50 values typically come from experimental animal studies. Because of the anatomical and physiological differences between animals and humans, it is difficult to compare the effects seen in experimental animal studies to the effects expected in humans exposed to hazardous materials in the field. LC50 and LD50 values are also usually determined in healthy adult animals. Values determined in young animals may be quite different, as may values determined in animals with an underlying disease. It is known that many chemicals are more toxic (lower LD50 or LC50 values) in young or newborn animals than in adults. This same age dependence may exist in humans. Because several organs, particularly the brain, are still developing in young children, damage to these organs may be more extensive and can be permanent. Also, infants may not be able to excrete chemicals from the body as efficiently as adults because their kidneys and liver are not fully developed. This may lead to longer and greater exposure to the chemical than would occur in an adult with the same relative exposure. The immaturity of metabolizing enzymes in the liver may lead to either increased or decreased toxicity in infants relative to adults. Which may occur is difficult to predict for many chemicals. Therefore, emergency medical personnel should remember that the LD50 and LC50 values are only useful for comparing the relative toxicity of compounds.

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Exhibit II-6 Acute LD50 Values for Representative Chemicals When Administered Orally to Rats
Chemical Acute Oral LD50 (mg/kg)1
6.4-10 50-230 83-560 88-91 2,600-7,000 3,000-3,800

Sodium cyanide Pentachlorophenol Chlordane Lindane Toluene Tetrachloroethylene

Milligrams of the compound administered per kilogram body weight of the experimental animal.

Responses to toxic chemicals may differ among individuals because of the physiological variability that is present in the human population. Some individuals, for example, are more likely to experience adverse health effects after exposure to a toxic chemical because of a reduced ability to metabolize that compound. The presence of preexisting medical conditions (e.g., chronic obstructive pulmonary disease (COPD), diabetes, renal disease) can also increase one s susceptibility to toxic chemicals. Respiratory distress in patients or workers with asthma may be triggered by exposure to toxic chemicals at lower levels than might be expected to produce the same effect in individuals without respiratory disease. Factors such as age, personal habits (e.g., smoking, diet), previous exposure to toxic chemicals, and medications may also increase an individual s sensitivity to toxic chemicals. Therefore, exposure to concentrations of toxic compounds that would not be expected to result in the development of a toxic response in most individuals may cause an effect in susceptible individuals. Not all chemicals, however, have a threshold level. Some carcinogens (cancer-causing chemicals) may produce a response (tumors) at any dose level, and any exposure to these compounds may be associated with some risk of developing cancer. Thus, literature values for levels which are not likely to produce an effect do not guarantee that an effect will not occur. EMS personnel need a strong knowledge of toxicology principles to assess the degree of hazard in a hazmat incident. Among the key questions to consider are:
l l

What is the route of exposure and how can further exposure be minimized? Do the acute symptoms give clues as to the potential exposure and chronic health effects?

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Is this individual at increased risk because of greater susceptibility: for example, a child or an adult with preexisting health problems? Can an exposure dose be estimated and will this help to estimate short- and long-term health effects?

Exposure Limits
The various occupational exposure limits found in the literature or in an MSDS are based primarily on time-weighted average limits, ceiling values, or ceiling concentration limits to which the worker can be exposed without adverse effects. Examples of these are listed in Exhibit II-7A. The values listed in Exhibit II-7A were established to provide worker protection in occupational settings. Because the settings in which these values are appropriate are quite different than an uncontrolled spill site, it is difficult to interpret how these values should be used by emergency medical personnel dealing with a hazardous materials incident. These values are designed for a healthy adult working population and have limited utility when applied to some of the at risk groups previously mentioned. At best, TLV, PEL, IDLH, and REL values can be used as benchmarks for determining relative toxicity, and perhaps to assist in selecting appropriate levels of personal protective equipment (PPE). Furthermore, these occupational exposure limits are only useful if trained personnel with special detection equipment are available for measuring the levels of toxic chemicals at the spill site. Of the occupational exposure limit values shown in Exhibit II-7A, only the OSHA values are regulatory limits. The ACGIH values are for guidance only and have certain caveats that may or may not affect the usefulness of the values. Some of these conditions are individual susceptibility or aggravation of a preexisting condition. Because of the limitations of PELs and TLVs, special exposure limits have been established. Emergency Response Planning Guidelines (ERPGs), Short-term Public Emergency Guidance Levels (SPEGLs), and Acute Exposure Guidelines (AEGLs, under development by the EPA), have been designed to assist emergency response personnel in making decisions regarding nonworkplace exposure (Exhibit II-7B). Emergency medical personnel responsible for the management of chemically contaminated patients should be familiar with all of these exposure limits because they will be encountered in various documents dealing with patient care or the selection of PPE. Additional expertise can be obtained by taking classes offered by the ACGIH or at many colleges and universities. This brief discussion highlights some fundamental concepts of toxicology. Emergency medical personnel responsible for managing chemically contaminated patients are encouraged to obtain further training in their recognition and treatment. A list of general toxicology references is provided at the end of this section that will allow emergency medical personnel to undertake a more in-depth examination of the principles of toxicology.

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Exhibit II-7A Occupational Exposure Limits


Value
Threshold Limit Value (ACGIH)1

Abbreviation
TLV

Definition
Refers to airborne concentrations of substances and represents conditions under which it is believed that nearly all workers may be repeatedly exposed day after day without adverse effect. The time-weighted average concentration for a normal 8-hour work day and a 40-hour work week, to which nearly all workers may be repeatedly exposed, day after day, without adverse effect.

Threshold Limit Value: Time-Weighted Average (ACGIH)1

TLV-TWA

Threshold Limit Value: Short-Term Exposure Limit (ACGIH)1

TLV-STEL

The concentration to which workers can be exposed continuously for a short period of time without suffering from (1) irritation, (2) chronic or irreversible tissue damage, or (3) narcosis of a sufficient degree to increase the likelihood of accidental injury, to impair self-rescue, or to materially reduce work efficiency; and provided that the daily TLV-TWA is not exceeded. The concentration that should not be exceeded during any part of the working exposure. Same as TLV-TWA. A maximum airborne concentration from which one could escape within 30 minutes without any escape-impairing symptoms or any irreversible health effects. Highest allowable airborne concentration that is not expected to injure a worker; expressed as a ceiling limit or time-weighted average for an 8- or 10-hour work day.

Threshold Limit Value: Ceiling (ACGIH)1 Permissible Exposure Limit (OSHA)2 Immediately Dangerous to Life and Health (OSHA)2

TLV-C

PEL IDLH

Recommended Exposure Limit (NIOSH)3

REL

1 2

American Conference of Governmental Industrial Hygienists Occupational Safety and Health Administration 3 National Institute for Occupational Safety and Health

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Exhibit II-7B General Population Exposure Limits


Value Abbreviation Definition
Maximum airborne concentration below which it is believed that nearly all individuals could be exposed for up to 1 hour without (1) experiencing other than mild transient adverse health effects or perceiving a clearly defined objectionable odor (ERPG-1), (2) experiencing or developing irreversible or other serious health effects or symptoms that could impair an individual s ability to take protective action (ERPG-2), or (3) experiencing or developing life-threatening health effects (ERPG-3). An acceptable concentration for unpredicted, single, short-term exposure of the general public in emergency situations. May be developed for different exposure periods (e.g., 1, 2, 4, 8, 16, 24 hours). Proposed short-term threshold or ceiling exposure value intended for the protection of the general public, including susceptible or sensitive individuals but not those who are hypersusceptible or hypersensitive. Represents the airborne concentration of a substance at or above which it is predicted that the general population (as defined above) could experience (1) notable discomfort (AEGL-1), (2) irreversible or other serious, long-lasting effects or impaired ability to escape (AEGL-2), or (3) life-threatening effects or death (AEGL-3). Developed for four exposure periods: 30 minutes, and 1, 4 , and 8 hours. Synonymous with the NAS4 term, Community Emergency Exposure Levels (CEELs).

Emergency Response Planning Guidelines (AIHA)1 ERPG

Short-term Public Emergency Guidance Level (NRC)2

SPEGL

Acute Exposure Guidelines (EPA NAC/AEGL)3

AEGL

1 2

American Industrial Hygiene Association National Research Council 3 EPA National Advisory Committee/AEGL Committee 4 National Academy of Sciences

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PERSONNEL PROTECTION AND SAFETY PRINCIPLES


This section provides emergency medical services personnel with information on protective equipment and safety principles. In the majority of cases, however, EMS staff will not experience incidents involving chemically contaminated patients frequently enough to keep them optimally trained or their equipment properly maintained. Staff must be trained initially in the proficient use of personal protective equipment (PPE), specifically respiratory equipment, and must maintain that proficiency. According to state and federal regulations, equipment must be maintained according to OSHA specifications; for example, respirators and their cartridges have to be properly fitted, tested, and stored. Many EMS agencies, given their workload and fiscal constraints, may not be able to expend the funds and time necessary to provide the highest level of PPE protection for their employees. EMS personnel should, at a minimum, be prepared to work in Level C attire (see below, Levels of Protection). In cases where EMS personnel have no PPE, they should make arrangements with the local fire department or hazmat team to be ready, if the situation warrants, to completely decontaminate patients, especially those who are to be transported to a hospital. Considerations in determining what an EMS s capabilities should be include the number of incidents occurring locally (several per week versus only a few per year), proximity to industries or transportation routes that have the potential for a hazardous materials incident (see Section I SARA Title III), and risks posed from terrorism.

Federal Regulations Pertaining to Use of Personal Protective Equipment (PPE)


The term personal protective equipment (PPE) is used in this document to refer to both clothing and equipment. The purpose of PPE is to shield or isolate individuals from the chemical, physical, and biological hazards that may be encountered at a hazardous materials incident. Training is essential before any individual attempts to use PPE. OSHA standards mandate specific training requirements (8 hours of initial training or sufficient experience to demonstrate competency) for personnel engaged in emergency response to hazardous substances incidents at the First Responder Operations Level. In addition, each agency must develop a health and safety program and provide for emergency response. These standards also are intended to provide particular protection for those who respond to hazardous materials incidents, such as firefighters, police officers, and EMS personnel. OSHA s final rule (March 6, 1989, 29 CFR (1910.120)) as it applies to emergency medical personnel states: Training shall be based on the duties and functions to be performed by each responder of an emergency response organization. No single combination of protective equipment and clothing is capable of protecting against all hazards. Thus, PPE should be used in conjunction with other protective methods. The use of PPE can itself create significant worker hazards, such as heat stress, physical and psychological stress, and impaired vision, mobility, and communication. In general, the greater the level of PPE protection, the greater are the associated risks. For any given situation, equipment and clothing should be selected that provide an adequate level of protection. Excessive protection can be as hazardous as underprotection, and should be avoided. In addition, personnel should not be expected to use PPE without adequate training. The two basic objectives of any PPE program are to protect the wearer from safety and health hazards and to prevent injury to the wearer from incorrect use and/or malfunction of the PPE. To

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accomplish these goals, a comprehensive PPE program should include: (1) hazard identification; (2) medical monitoring; (3) environmental surveillance; (4) selection, use, maintenance, and decontamination of PPE; and (5) training.

PPE Complications
Personnel wearing PPE are likely to encounter a number of potential problems, including limited visibility, reduced dexterity, claustrophobia, restricted movement, suit breach, insufficient air supply, dehydration, and the effects of heat and cold. Only individuals who are physically fit and have met the OSHA/NIOSH/NFPA training requirements should be wearing PPE during an incident. Proper donning and doffing procedures must be followed, with assistance from other onsite personnel. Medical surveillance evaluations should be conducted on all personnel both before and immediately after their use of PPE. Personnel not meeting prescribed inclusion criteria set by the hazmat team or by the EMS Medical Director should be reassigned to an area not requiring the use of PPE. The actions of all personnel wearing PPE should be closely observed by the Safety Officer and others during each work period. In addition, an emergency distress signal should be identified in the briefing before individuals enter the work area. Following the completion of technical decontamination, all personnel should be examined to ascertain marked changes in health. Appropriate medical care should be initiated when illness or injury is discovered.

Levels of Protection
EPA has designated four levels of protection to assist in determining which combinations of respiratory protection and protective clothing should be employed: Level A protection should be worn when the highest level of respiratory, skin, eye, and mucous membrane protection is needed. It consists of a fully-encapsulated, vapor-tight, chemical-resistant suit, chemical-resistant boots with steel toe and shank, chemical-resistant inner/outer gloves, coveralls, hard hat, and self-contained breathing apparatus (SCBA). Level B protection should be selected when the highest level of respiratory protection is needed, but a lesser degree of skin and eye protection is required. It differs from Level A only in that it provides splash protection through use of chemical-resistant clothing (overalls and long-sleeved jacket, two-piece chemical splash suit, disposable chemical-resistant coveralls, or fully- encapsulated, non-vapor-tight suit and SCBA). Level C protection should be selected when the type of airborne substance(s) is known, concentration is measured, criteria for using air-purifying respirators are met, and skin and eye exposures are unlikely. This involves a full facepiece, air-purifying, canister-equipped respirator and chemicalresistant clothing. It provides the same degree of skin protection as Level B, but a lower level of respiratory protection. Level D is primarily a work uniform. It provides no respiratory protection and minimal skin protection, and it should not be worn on any site where respiratory or skin hazards exist. Exhibit II-8 illustrates these four levels of protection. For more information on this subject, Appendix C outlines the protective equipment recommended for each level of protection.

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Level A

Level B

Level C

Level D

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Exhibit II-8 Levels of Protection


Factors to be considered in selecting the proper level of protection include the potential routes of entry for the chemical(s), the degree of contact, and the specific task assigned to the user. Activities can also be undertaken to determine which level of protection should be chosen. The EPA and NIOSH recommend that initial entry into unknown environments or into a confined space that has not been chemically characterized be conducted wearing at least Level B, if not Level A, protection.

Routes of Entry
PPE is designed to provide emergency medical personnel with protection from hazardous materials that can affect the body by one of three primary routes of entry: inhalation, ingestion, and direct contact. Inhalation occurs when emergency personnel breathe in chemical fumes or vapors. Respirators are designed to protect the wearer from contamination by inhalation but they must be worn properly and fit-tested frequently to ensure continued protection. Ingestion usually is the result of a health care provider transferring hazardous materials from his hand or clothing to his mouth. This can occur unwittingly when an individual wipes his mouth with his hand or sleeve, eats, drinks, or smokes tobacco. Direct contact refers to chemical contact with the skin or eye. Skin is protected by garments, and full-face respirators protect against ingestion and direct eye contact. Mucous membranes in the mouth, nose, throat, inner ear, and respiratory system may be affected by more than one of these routes of entry. Many hazardous materials adhere to and assimilate with the moist environment provided by these membranes, become trapped or lodged in the mucus, and are subsequently absorbed or ingested.

Chemical Protective Clothing (CPC)


Protective clothing is designed to prevent direct contact of a chemical contaminant with the skin or body of the user. There is, however, no one single material that will afford protection against all substances. As a result, multilayered garments may be employed in specific situations despite their negative impact on dexterity and agility. CPC is designed to afford the wearer a known degree of protection from a known type, a known concentration, and a known length of exposure to a hazardous material, but only if it is properly fitted and worn correctly. Improperly used equipment can expose the wearer to danger. Another factor to keep in mind when selecting CPC is that most protective clothing is designed to be impermeable to moisture, thus limiting the transfer of heat from the body through natural evaporation. This is a particularly important factor in hot environments or for strenuous tasks since such garments can increase the likelihood of heat-related injuries. Research is now underway to develop lightweight suits that are breathable but still protective against a wide range of chemicals. Cooling vests are sometimes used in warm weather situations to keep the body temperature normal, but with mixed results. Essential to any protective ensemble are chemical resistant boots with steel toe and shank. Chemical resistant inner and outer layered gloves must also be worn. Compatibility charts should be consulted to determine the appropriate type of boot and gloves to use, since no one material presently provides protection against all known chemicals. Wearing multiple layers of gloves impairs dexterity and makes performing basic aspects of patient assessment (e.g., checking breathing, taking a pulse) difficult without constant practice.

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The effectiveness of CPC can be reduced by three actions: degradation, permeation, and penetration. Chemical degradation occurs when the characteristics of the material in use are altered through contact with chemical substances or aging. Examples of degradation include cracking and brittleness, and other changes in the structural characteristics of the garment. Degradation can also result in an increased permeation rate through the garment. Permeation is the process by which chemical compounds cross the protective barrier of CPC because of passive diffusion. The rate at which a compound permeates CPC is dependent on factors such as the chemical properties of the compound, the nature of the protective barrier in the CPC, and the concentration of the chemical on the surface of the protective material. Most CPC manufacturers provide charts on the breakthrough time the time it takes for a chemical to permeate the material of a protective suit for a wide range of chemical compounds. Penetration occurs when there is an opening or a puncture in the protective material. These openings can include unsealed seams, buttonholes, and zippers. Often such openings are the result of faulty manufacture or problems with the inherent design of the suit. Protective clothing is available in a wide assortment of forms, ranging from fully-encapsulated body suits to gloves, hard hats, earplugs, and boot covers. CPC comes in a variety of materials, offering a range of protection against a number of chemicals. Emergency medical personnel must evaluate the properties of the chemical versus the properties of the protective material. Selection of the appropriate CPC will depend on the specific chemical(s) involved, and on the specific tasks to be performed.

RESPIRATORY PROTECTION
Substantial information is available for the correct selection, training, and use of respirators. The correct respirator must be employed for the specific hazard in question. Material Safety Data Sheets (if available) often specify the type of respirator that will protect users from risks. In addition, manufacturers suggest the types of hazards against which their respirators can offer protection. OSHA has set mandatory legal minimum requirements (29 CFR (1910.134)) for respiratory protection. In addition, NIOSH has established comprehensive requirements for the certification of respiratory protection equipment. Personnel must be fit-tested for use of all respirators. Even a small space between the respirator and you could permit exposure to a hazardous substance(s) by allowing in contaminated air. Anyone attempting to wear any type of respirator must be trained and drilled in its proper use. Furthermore, equipment must be inspected and checked for serviceability on a routine basis. There are two basic types of respirators: air-purifying and atmosphere-supplying. Atmospheresupplying respirators include self-contained breathing apparatus (SCBA) and supplied-air respirators (SAR).

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Air-Purifying Respirators (APRs)


An air-purifying respirator purifies ambient air by passing it through a filtering element before inhalation. The major advantage of the APR system is the increased mobility it affords the wearer. However, a respirator can only be used where there is sufficient oxygen (19.5 percent) since it depends on ambient air to function. In addition, APRs should not be used when substances with poor warning properties are known to be involved or, if the agent is unknown, when environmental levels of a substance exceed the filtration capacity of the canisters. Three basic types of APRs are used by emergency personnel: chemical cartridges or canisters, disposables, and powered air-purifiers. The most commonly used APR depends on cartridges (Exhibit II-9) or canisters to purify the air by chemical reaction, filtration, adsorption, or absorption. Cartridges and canisters are designed for specific materials at specific concentrations. To aid the user, manufacturers have color-coded the cartridges and canisters to indicate the chemical or class of chemicals for which the device is effective. NIOSH recommends that use of a cartridge not exceed one work shift. However, if breakthrough of the contaminant occurs first, then the cartridge or canister must be immediately replaced. After use, cartridges and canisters should be considered contaminated and disposed of accordingly. Disposable APRs are usually designed for use with particulates, such as asbestos, although some are approved for use with other contaminants. These respirators are typically half-masks that cover the face from nose to chin, but do not provide eye protection. Once used, the entire respirator is usually discarded. This type of APR depends on a filter to trap particulates. Filters may also be used in combination with cartridges and canisters to provide an individual with increased protection from particulates. The use of half-mask APRs is not generally recommended by most emergency response organizations.

Exhibit II-9 Chemical Cartridge Air-Purifying Respirator

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Powered Air-Purifying Respirators (PAPRs) have the advantage of creating an improved facemask seal, thus reducing the risk of inhalation injury. Air being blown into the mask can also have a cooling affect. PAPRs come with either full facemasks or pullover hoods. Some individuals find the hooded system to be more comfortable and less claustrophobic than the mask. According to OSHA guidelines, men with beards can wear the hooded system but not the full facemask.

Atmosphere-Supplying Respirators
Atmosphere-supplying respirators consist of two basic types: the self-contained breathing apparatus (SCBA), which contains its own air supply, and the supplied-air respirator (SAR), which depends on an air supply provided through a line linked to a distant air source. Exhibit II-10 illustrates an example of each.

Exhibit II-10 Self-Contained Breathing Apparatus and Supplied-Air Respirators

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Self-Contained Breathing Apparatus (SCBA)


A self-contained breathing apparatus respirator is composed of a facepiece connected by a hose to a compressed air source. There are three varieties of SCBAs: open-circuit, closed-circuit, and escape. Open-circuit SCBAs, most often used in emergency response, provide clean air from a cylinder to the wearer, who exhales into the atmosphere. Closed-circuit SCBAs, also known as rebreathers, recycle exhaled gases and contain a small cylinder of oxygen to supplement the exhaled air of the wearer. Escape SCBAs provide air for a limited amount of time and should only be used for emergency escapes from a dangerous situation. One disadvantage of SCBAs is that they are bulky and heavy, and can be used for only the period of time allowed by air in the tank. The most common SCBA is the open-circuit, positive-pressure type. In this system, air is supplied to the wearer from a cylinder and enters the facepiece under positive pressure. In contrast to the negative-pressure units, a higher air pressure is maintained inside the facepiece than outside. This affords the SCBA wearer the highest level of protection against airborne contaminants since any leakage in the facepiece may force the contaminant out. When wearing a negative-pressure-type apparatus, there is always the potential danger that contaminants may enter the facemask if it is not properly sealed. The use of a negative-pressure SCBA is prohibited by OSHA under 29 CFR (1910.120(q)(iv)) in incidents where personnel are exposed to hazardous materials.

Supplied-Air Respirators (SARs)


Supplied-air respirators differ from SCBAs in that the air is supplied through a line that is connected to a source away from the contaminated area. SARs are available in both positive- and negativepressure models. However, only positive-pressure SARs are recommended for use at hazardous materials incidents. One major advantage the SAR has over the SCBA device is that it allows an individual to work for a longer period. In addition, SARs are less bulky than the SCBAs. By necessity, however, a worker must retrace his steps to stay connected to the SAR, and therefore cannot leave the contaminated work area by a different exit. SARs also require the air source to be in close proximity (within 300 feet) to the work area. In addition, personnel using an SAR must carry an immediately operable emergency escape supply of air, usually in the form of a small, compressed air cylinder, for use in case of an emergency.

SITE CONTROL
Hazardous materials incidents often attract large numbers of people and equipment. This complicates the task of minimizing risks to humans, property, and the environment. An Incident Command System (ICS) coordinates management of facilities, equipment, personnel, and communications during a hazardous materials incident. An Incident Commander (IC) is responsible for control of the scene and for keeping contaminants on site. This includes delineating work zones, establishing levels of protection, and implementing decontamination activities. To enhance control at the site of a chemical incident, rules regarding access to the site must be implemented. Inactive individuals and equipment should be kept at a safe distance from the area of possible contamination, and public access from all directions must be restricted promptly.

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In addition, media access should be limited to an area established as the Public Information Sector by a designated Public Information Officer. All access to the incident site must be approved by the Incident Commander and the press personnel who enter the site must be escorted by a Public Information Officer.

Work Zones
NIOSH, OSHA, USCG, and EPA recommend dividing the incident area into three zones, establishing access control points, and delineating a contamination reduction corridor. Exhibit II-11 illustrates the recommended zones. The Exclusion (Hot) Zone should encompass all known or suspected hazardous materials contamination. The respective radius of the Contamination Reduction (Warm) Zone is determined by the length of the decontamination corridor, which contains all of the needed decontamination stations. The Support (Cold) Zone should be clean, meaning it is free of all hazardous materials contamination, including discarded protective clothing and respiratory equipment. The command post and staging areas for necessary support equipment should be located in the Support Area, upwind and uphill of the Exclusion Zone. Personnel in charge of each sector should be easily recognized (e.g., with a command vest). Equipment that may eventually be needed should be kept in staging areas beyond the crowd control line. Access to the different zones should be tightly controlled and limited to as few people as possible. Communication between work areas should be face-to-face whenever possible. Use of radios or other electronic devices (e.g., bullhorns) may be restricted depending on the hazards involved.

DECONTAMINATION OF EMERGENCY MEDICAL SERVICE PERSONNEL


Decontamination is the process of removing or neutralizing harmful materials that have gathered on personnel and/or equipment during the response to a chemical incident. Many incidents have occurred involving seemingly successful rescue, transport, and treatment of chemically contaminated individuals by unsuspecting emergency personnel who, in the process, contaminate themselves, the equipment, and the hospital where the patient is taken. Decontamination is of the utmost importance because it:
l

Protects all hospital personnel by sharply limiting the transfer of hazardous materials from the contaminated area into clean zones. Protects the community by preventing transportation of hazardous materials from the hospital to other sites in the community by secondary contamination. Protects workers by reducing the contamination and resultant permeation of, or degradation to, their protective clothing and equipment. Protects other patients already receiving care at the hospital.

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Exhibit II-11 NIOSH/OSHA/USCG/EPA Recommended Zones

39

This section only addresses the steps necessary for dealing with worker decontamination. Patient decontamination is addressed in Section III, Response and Patient Management. It should be stressed that to carry out proper decontamination, personnel must have received at least the same degree of training as required for workers who respond to hazardous materials incidents. The design of the decontamination process should take into account the degree of hazard and should be appropriate for the situation. For example, a nine-station decontamination process need not be set up if only a bootwash station would suffice. Avoiding contact is the easiest method of decontamination that is, not to get the material on the worker or his protective equipment in the first place. However, if contamination is unavoidable, then proper decontamination and/or disposal of the worker s outer gear will be necessary. Segregation and proper placement of the outer gear in a polyethylene bag or steel drum will be necessary until thorough decontamination is completed. With extremely hazardous materials, it may be necessary to dispose of the contaminated items altogether. Physical decontamination of protective clothing and equipment (known as technical decontamination) can be achieved by several different means. These all include the systematic removal of contaminants by physical methods, such as dilution, brushing, scraping, and vacuuming, and by chemical methods where the contaminant is degraded, neutralized, solidified, or disinfected through some type of chemical process. There is an increasing trend toward using disposable clothing (e.g., suits, boots, gloves) and systematically removing these garments in a manner that precludes contact with the contaminants. The used items of clothing are then thrown away in a sealed container. Reusable suits will require thorough cleaning and testing after each use. The appropriate decontamination procedure will depend on the contaminant and its physical properties, and on the type of CPC being worn. Thoroughly researching the chemicals involved and their properties, or consultation with an expert, is necessary to make these kinds of decisions. In addition to understanding the technical decontamination steps to be used for CPC and equipment, EMS responders must be familiar with the emergency procedures to be followed if a responder wearing PPE becomes ill or is injured and needs to be quickly decontaminated prior to normal removal of his suit. Care must be taken at all times to ensure that the decontamination methods being used do not introduce fresh hazards into the situation. In addition, the residues of the decontamination process must be treated as hazardous wastes. The decontamination stations and process should be confined to the Contamination Reduction Zone (see Exhibit II-11). Steps for personnel decontamination are outlined in Exhibit II-12, and the technical decontamination process is discussed below.

40

Exhibit II-12 Nine-Step Personnel Decontamination Plan

41

Technical Decontamination Process for EMS Personnel


Personnel should remove protective clothing in the following sequence. 1. Remove tape (if used) securing gloves and boots to suit. 2. Remove outer gloves, turning them inside out as they are removed. 3. Remove suit, turning it inside out and folding it downward. Avoid shaking. 4. Remove boot/shoe cover from one foot and step over the clean line. Remove other boot/shoe cover and put that foot over the clean line. 5. Remove mask. The last person removing his/her mask may want to wash all masks with soapy water before removing his/her suit and gloves. Place the masks in plastic bag and hand the bag over the clean line for placement in second bag held by another staff member. Send bag for decontamination. 6. Remove inner gloves and discard them in a drum inside the dirty area. 7. Secure the dirty area until the level of contamination is established and the area is properly cleaned. 8. Personnel should then move to a shower area, remove undergarments and place them in a plastic bag. Double-bag all clothing and label bags appropriately.

9. Personnel should shower and redress in normal working attire and then report for medical surveillance.

COMMUNICATIONS
Effective communications are essential to maintaining incident control. These include a dedicated radio frequency and a sufficient number of radios for distribution to all participating agencies. Another network should link the onsite command post to support groups, such as the regional Poison Control Center, the Health Department, and CHEMTREC. Other networks that may have to be activated include one linking EMTs to the hospital emergency department or medical control and one dedicated for use by the teams in the Exclusion and Contamination Reduction Zones. If a sufficient number of radios are not available or cannot be used in the Exclusion Zone, then line of sight must be maintained at all times for personnel in those Zones. Use of whiteboards, PA systems, or designated hand signals may be useful alternatives. When an Incident Command System is activated, one person should be assigned to manage communications.

SELECTED BIBLIOGRAPHY
American Conference of Governmental Industrial Hygienists. 1988. Guidelines for the Selection of Chemical Protective Clothing. Cincinnati, OH. American Academy of Pediatrics. 1994. Handbook of Common Poisonings in Children. 3rd ed. Elk Grove Village, IL.

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Borak, J., M. Callan, and W. Abbott. 1991. Hazardous Materials Exposure-Emergency Response and Patient Care. Englewood Cliffs, NJ: Brady. Bowen, J. E. 1995. Emergency Management of Hazardous Materials Incidents. Quincy, MA: National Fire Protection Association. Bronstein, A.C. and P.L. Currance. 1994. Emergency Care for Hazardous Materials Exposure. 2nd ed. St. Louis, MO: Mosby. Budavari, S., A. Smith, P. Heckelman and J. Kinneary. 1996. The Merck Index: An Encyclopedia of Drugs, Chemicals, and Biologicals. 12th ed. Chapman & Hall. Chemical Manufacturers Association (CMA) and the Association of American Railroads. 1987. Terms for Personal Protective Equipment. Washington, DC: CMA. Clayton, G.D. and F.E. Clayton. 1994. Patty s Industrial Hygiene and Toxicology. 4th ed.New York, NY: John Wiley and Sons. Currance, P.L. and A.C. Bronstein. 1999. Hazardous Materials for EMS. St. Louis, MO: Mosby. DeLorenzo, R.A. and R.S. Porter. 1999. Weapons of Mass Destruction Emergency Care. NJ: Prentice Hall. Ellenhorn, M.J. and D.G. Barceloux. 1997. Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. New York, NY: Elsevier. Forsberg, K. and S.Z. Mansdorf. 1993. Quick Selection Guide to Chemical Protective Clothing. 2nd ed. New York, NY: Van Nostrand Reinhold. Goldfrank, L.R. 1998. Goldfrank s Toxicological Emergencies. 6th ed. Stamford, CT: Appleton and Lange. Hayes, A.W. (ed.). 1994. Principles and Methods of Toxicology. 2nd ed. Books on Demand. Hodgson, E. and P.E. Levi. 1997. A Textbook of Modern Toxicology. 2nd ed. Stamford, CT: Appleton and Lange. Klaassen, C.D., M.O. Amdur, and J. Doull (eds.). 1996. Casarett and Doull s Toxicology: The Basic Science of Poisons. 5th ed. McGraw-Hill Health Professions Division. Levine, S.P. and W.F. Martin (eds.). 1993. Protecting Personnel at Hazardous Waste Sites. 2nd ed. Boston, MA: Butterworth Publishers. Lu, F.C. 1996. Basic Toxicology: Fundamentals, Target Organs, and Risk Assessment. 3th ed. Taylor & Francis, Inc. National Emergency Training Center. 1998. Guidelines for Public Sector Hazardous Materials Training. Emmitsburg, MD: HMEP Curriculum Guidelines. National Fire Academy and National Emergency Training Center. 1985. Recognizing and Identifying Hazardous Materials. Capitol Heights, MD: National Audio-Visual Center.

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National Fire Protection Association. 1992. Recommended Practice for Responding to Hazardous Materials Incidents, NFPA 471. Quincy, MA: National Fire Protection Association. National Fire Protection Association. 1997. Standards for Professional Competence of EMS Responders to Hazardous Materials Incidents, NFPA 473. Quincy, MA: National Fire Protection Association. Noll, G.G., M.S. Hildebrand, and J.G. Yvonna. 1995. Hazardous Materials: Managing the Incident. 2nd ed. Stillwater, OK: Fire Protection Publications. Olson, K.R. (ed.). 1999. Poisoning and Drug Overdose. 3rd ed. Stamford, CT: Appleton and Lange. Proctor, N.H., J.R. Hughes, and M.L. Fishman. 1989. Chemical Hazards of the Workplace. 2nd ed. New York, NY: Van Nostrand Reinhold. Rom, W. 1992. Environmental and Occupational Medicine. 2nd ed. Boston, MA: Little, Brown. Sax, N.I. 1992. Dangerous Properties of Industrial Materials. 8th ed. New York, NY: Van Nostrand Reinhold. Schwope, A.D., P.P. Costas, J.O. Jackson, and D.J. Weitzman. 1987. Guidelines for the Selection of Chemical Protective Clothing. 3rd ed. Cincinnati, OH: American Conference of Governmental Industrial Hygienists. Stutz, R. and S. Ulin. 1992. Handbook for Prehospital Care. 3rd ed. Beltsville, MD: Bradford. Stutz, R. and S. Ulin. 1993. HAZTOX EMS Response For Hazardous Materials Incidents. Miramar, FL: GDS Communications. Sullivan, J.B., Jr. and G.R. Krieger. 1992. Hazardous Materials Toxicology: Clinical Principles of Environmental Health. Baltimore, MD: Williams & Wilkins. Tokle, G. (ed.). 1993. Hazardous Materials Response Handbook. 2nd ed. Quincy, MA: National Fire Protection Association. U.S. Department of Defense, U.S. Army, USAMRICD Chemical Casualty Division. 1998. Medical Response to Chemical Warfare and Terrorism. 3rd ed. Edgewood, MD. U.S. Environmental Protection Agency, Region VII. 1989. Chemical Response Planning and Operations. Washington, DC: Environmental Protection Agency. U.S. Federal Emergency Management Agency and U.S. Fire Administration. 1999. Hazardous Materials Guide for First Responders. Washington, DC: Government Printing Office. Varla, J. (ed.). 1996. Hazardous Materials Handbook for Emergency Responders. New York, NY: Van Nostrand Reinhold. Viccellio, P. 1993. Handbook of Medical Toxicology. Boston: Little Brown.

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Section III. Response and Patient Management


An EMS protocol for responding to potential hazardous materials incidents should consider: (1) activities to undertake en route and upon arrival at the scene; (2) guidelines for assessment, decontamination, and treatment of affected persons; and (3) patient transport to the hospital. Steps in the protocol must be practiced before a hazardous materials emergency occurs. EMS personnel should know their responsibilities and how to perform them, and all required equipment should be readily accessible and ready to use.

EN ROUTE TO A HAZARDOUS MATERIALS SCENE


First responders must be alert for hazardous materials when responding to every call. The dispatcher may provide information such as unusual signs and symptoms (e.g., pungent odor, eye irritation) or the address might suggest that the call may involve a chemical release. The presence of hazardous materials may be obvious, as in the case of noxious fumes, gasoline, or corrosive liquid spills. In other situations, the hazardous nature of the chemical(s) may not be immediately apparent, as with odorless but poisonous and/or flammable vapors and liquids, or radioactive materials. If a vehicle has a diamond-shaped placard or an orange-numbered panel on the side or rear, the cargo should be assumed to be hazardous. Unfortunately, not all hazardous materials transport vehicles are clearly marked. Many delivery trucks regularly carry hazardous materials that could be released in a collision, yet the appropriate signage is often missing. Therefore, first responders should use caution when attempting rescues at any incident scene. The hazard, or lack thereof, must be determined immediately before first responders enter a chemically contaminated area. While in transit to an incident scene, the responder should pay attention to clues that suggest the possibility of hazardous materials. For example, billowing smoke or clouds of vapor could indicate the presence of a dangerous substance(s). The senses are among the best tools for detecting chemicals, particularly the sense of smell. Should an odor be detected, however, responders are advised to move a safe distance away until they ascertain its source. Failure to do so could result in injury, illness, or death. Despite their value, sensory signals, such as smell, color, and nasal or eye irritation, are not always reliable indicators. Their presence depends on the chemical(s) involved and on the surrounding conditions. The nature of an incident is also key to identifying the possibility of hazardous materials. Accidents involving railroad tank cars or tanker trucks, or incidents at fixed locations where chemicals are used or stored, often indicate the presence of hazardous materials. Emergency responders should pay attention to factors such as wind direction and topography when approaching a suspected hazardous materials incident and advance upwind and upgrade of suspected chemical emissions. They also need to consider that low-lying areas such as streambeds and gulleys, or in urban areas places such as courtyards or near tall buildings, may contain vapor clouds protected from dispersal by the wind.

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Responders should attempt to gather as much information as possible while traveling to an incident. A checklist to help determine initial actions should be developed and made available to all EMS personnel. It should include:
l l l l l l l l l l

Type and nature of incident Caller s telephone number Knowledge of whether a chemical(s) may be involved Chemical and trade name(s) of substance(s) involved Number and ages of victims Signs and symptoms being experienced by the patients Nature of injuries State of the material (solid, liquid, gas) Routes of exposure (inhalation, dermal contact, etc.) Length of exposure

Using as much information as can be gleaned en route, emergency responders should relay their observations to a predesignated resource center (e.g., regional Poison Control Center, ATSDR) for information regarding definitive care procedures. If a hazardous substance has been identified, responders should locate specific information on the chemical(s) by consulting reference guidebooks, websites, database networks, telephone hotlines, MSDSs, and the DOT s North American Emergency Response Guidebook, in addition to the designated resource center (see Section I Hazard Recognition). Chemical-specific information can help identify possible health hazards, including: (1) the nature of possible injuries; (2) potential routes of exposure; (3) risk of secondary contamination; (4) required PPE; (5) the need for decontamination; (6) decontamination procedures; and (7) the appropriate safe distance from the hazard to protect EMS personnel, the public, and property from exposure to contaminants or other dangers such as fire or explosion. If available, preplans should be reviewed to assist with locating proper vehicle staging locations, evacuation routes, and patient treatment centers. This information may also be available from a command post, if one has been established. Communications with other agencies or services should also be initiated while en route to the event site. If an Incident Command System (ICS) has been implemented, the Incident Commander (IC) will identify the best approach route, the possible dangers involved, and the estimated number of injuries. Communications between onsite response personnel and receiving facilities should be kept open to relay as much advance information as possible. Communications should also be established with local fire and police departments, and with the hazmat response team, if appropriate.

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ARRIVAL AT THE SCENE


Many first responders (e.g., police officers, the fire-rescue squad, EMS personnel) are accustomed to immediately attending an injured victim, often disregarding the possibility of danger to themselves. In such cases, a rescuer entering a contaminated area also risks exposure and the potential to become another victim. Even though rescue of an injured patient is important, it should only be attempted without undue risk to the responder(s). While training and experience are valuable in these situations, often these types of decisions are, at best, a judgment call. Rescue should only be attempted by trained and equipped EMS, fire department, or hazardous materials response team personnel. Exhibit III-1 illustrates a typical decision tree for making choices about risk and response. Upon arrival at a scene, an initial assessment of the nature and extent of the incident should be conducted and additional support requested, if necessary. A first-in responder should also confirm that local authorities have been notified and are aware that hazardous materials might be involved. Onsite assistance should include police, fire, and health departments; the hazmat response team(s); and the local industry response team(s). Unless otherwise directed, responders should park at a safe distance that is upwind, upgrade, and pointing away from any incident where hazardous materials are suspected. Safe distances for specific chemicals may be determined from the DOT s North American Emergency Response Guidebook, or by consulting CHEMTREC or other written or electronic references. Responders must also remain alert to the possibility that the incident is the result of an intentional criminal act, with the presence of secondary devices intended to injure emergency personnel. General guidelines for responders include:
l

Do not drive or walk through any spilled or released materials, including smoke, vapors, and puddles. Avoid unnecessary contamination of equipment. Do not attempt to recover shipping papers or manifests unless adequately protected. Avoid exposure while approaching a scene. Do not approach anyone coming from contaminated areas. Do not attempt rescue unless trained and equipped with appropriate PPE for the situation. Report all suspicious packages, containers, or people to the command post.

l l l l l l

The first units to arrive at a large industrial or storage facility, transportation accident, or a mass gathering location should anticipate a rush by evacuating victims. Proper steps must be taken to keep responders from becoming contaminated or otherwise harmed (e.g., use of a PA system to give instructions). The top priority for first responders is scene isolation. Keep others away! Keep unnecessary equipment from becoming contaminated by giving exact information on safe routes of arrival and vehicle staging locations, and by reporting anything suspicious. First responders should immediately establish an Exclusion (Hot) Zone, taking care not to become exposed during the process (see Exhibit II-11). The Exclusion Zone should encompass all contaminated

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Exhibit III-1 Sample EMS Decision Tree for Chemical Incidents

Chemical Accident/ Injury Event

YES

Contaminants Potentially Life Threatening or Unknown

YES

Self- or buddy-rescue

OR

Fire dept. or hazmat rescue

NO Perform gross decontamination (remove/bag clothing, rinse patient from head to toe with water)1

Simultaneously perform gross decontamination (e.g., remove/ bag clothing, rinse patient from head to toe with water),1 initiate stabilization of ABCs

Patient(s) moved to safe area out of the hazardous environment and evaluated by emergency personnel wearing appropriate PPE

Environmental or patient conditions prevent furthur decontamination

YES

Cover or wrap patient to prevent spread of contamination; avoid causing the patient to sweat; continue needed medical care (e.g., O 2 ,IV, medications)

NO Place patient in Contamination Reduction (Warm) Zone Perform secondary decontamination (wash and rinse until patient is as clean as possible (ACAP 2 ) Ensure that transport crew(s) and vehicle(s) are adequately protected to avoid secondary contamination

Lifesaving Procedures Required?

Further medical attention or surveillance required NO

YES

Notify and transport to appropriate medical facility NO Notify incident command and get further instructions

1 2

No patient should be transported without a minimum of gross decontamination performed. Contamination reduced to a level that is no longer a threat to patient or responder (once achieved, move patient to the Support [Cold] Zone).

48

areas, and no unauthorized personnel should be allowed to enter that Zone. Anyone leaving the Exclusion Zone should be considered contaminated, requiring assessment and possible decontamination. Additional zones, including a Contamination Reduction (Warm) Zone and a Support (Cold) Zone, should be delineated at the first available opportunity. Depending upon available personnel, this may be the primary responsibility of the Incident Commander (IC) or of responders other than EMS. Do not remove nonambulatory patients from the Exclusion Zone unless properly trained personnel with the appropriate PPE are available and a decontamination corridor has been established. The IC should coordinate patient evacuation and emergency care activities. A public address system (e.g., bullhorn, siren PA system) can be effective for directing ambulatory patients on what to do and where to go. EMS responders who are not properly trained and equipped should stay out of the Exclusion and Contamination Reduction Zones. While it is recommended that all EMS personnel be trained and equipped to work (at a minimum) in Level C PPE protective attire (see Section II), this does not provide maximum skin or respiratory protection. Entry into a Hot or Warm Zone requires a determination that the level of PPE being worn affords adequate protection. In addition to providing patient care in the Support Zone, qualified EMS personnel may be asked to assume any of the following roles: Safety Officer, EMS Section Officer (e.g., Triage, Treatment, Transportation, Communications), Rehabilitation Officer, or Public Information Officer. EMS personnel also frequently provide medical surveillance for the hazmat team.

ASSESSMENT, DECONTAMINATION, AND INITIAL TREATMENT OF PATIENTS


The primary goals for emergency personnel in a hazardous materials incident include cessation of patient exposure, patient stabilization, removal of the patient from danger, containment of the hazard to prevent further contamination, and patient treatment all without jeopardizing their own safety. While not all chemicals pose a hazard for secondary contamination, until the risk is known, termination of exposure is best accomplished by removing the patient from the incident area and then decontaminating the patient. If the victim is removed from the possibility of additional exposure or other dangers and is no longer considered contaminated, the level of required PPE for emergency personnel can be downgraded to a level that will better facilitate patient care. The potential for injury to the patient or to response personnel prohibits any treatment other than basic life support inside the Exclusion Zone. The dangers of hazardous substances, fire, or explosion, as well as the mobility restrictions inherent in PPE, outweigh the benefits of time saved by patient care in the Hot Zone. The essential requirements for any decontamination task are:
l l l l l

A safe area to keep a patient while undergoing decontamination A method for washing contaminants off a patient A means of containing the rinsate Adequate protection for personnel treating the patient Disposable or cleanable medical equipment to treat the patient

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Gross Patient Decontamination


Primary assessment can be undertaken while simultaneously performing gross decontamination in the outer edge of the Exclusion Zone or in the Contamination Reduction Zone. Priority should be given to the fundamentals of emergency treatment airway, breathing, and circulation (ABCs). Once life-threatening matters have been addressed, rescue personnel can direct their attention to more thorough decontamination and secondary patient assessment. Appropriate personal protective equipment and clothing must be worn until the threat of secondary exposure no longer exists. The sooner the patient is decontaminated, the sooner he or she can be transferred to the Support Zone for further evaluation and treatment. If there is a risk of secondary contamination, gross decontamination should be performed simultaneously with initial patient stabilization. This consists of cutting away or otherwise removing all potentially contaminated clothing, including jewelry and watches. All removed items should be doubled-bagged in plastic bags, sealed, and labeled. Any obvious contamination should be brushed or wiped off, followed by a 1-minute-long rinsing from head to toe with tepid water. If the suspected chemical is water-reactive, a longer rinsing period and a greater volume of water is required. Care should be taken to protect any open wounds from contamination by covering them with a waterrepellent dressing (e.g., Chux). Throughout these procedures, every effort should be made by emergency personnel to avoid contact with any potentially hazardous substance(s).

Secondary or Definitive Decontamination


Effective decontamination consists of making the patient As Clean As Possible (ACAP). If conditions permit (appropriate personnel, supplies, water, weather), a more deliberate decontamination process known as secondary or definitive decontamination should be initiated on each patient before transfer into the Support Zone. This process includes washing the individual, usually with soap and water, in an organized and thorough manner. Initiating this step implies that contamination has been reduced to a level that is no longer a threat to the patient or to the responder. Determining the adequacy of decontamination can be very difficult, however, and is often based on a best clinical judgment rather than on objective data. Detection monitors (to indicate how clean an area is) have limited value and are not generally available to most fire departments or EMS agencies. When a patient cannot be definitively decontaminated, then he or she should be loosely wrapped in a cocoon-like fashion with a blanket or sheet prior to transfer to the Support Zone. Exhibit III-2 outlines the minimum equipment that is required for patient decontamination by emergency response personnel. These lists are not comprehensive, and are provided to guide departments in developing their own equipment lists based on community needs and requirements. With few exceptions, intact skin is more resistant to hazardous materials than injured flesh, mucous membranes, or eyes. Therefore, secondary decontamination should begin at the head and proceed downward, with initial attention paid to contaminated eyes and open wounds. Once wounds have been cleaned, care should be exercised not to recontaminate them. This can be aided by covering the wounds with a waterproof dressing. For some chemicals, such as strong alkaline substances, it may be necessary to flush exposed skin and eyes with water or normal saline for a minimum of 15 minutes.

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Exhibit III-2 Suggested Decontamination Equipment


The equipment and supplies listed are the minimum necessary to undertake decontamination procedures. In addition, PPE used by decontamination personnel should be no less than one level below that used for entry into the hazardous environment. Positive-pressure self-contained breathing apparatus (SCBA) and fully-encapsulated suits may be necessary in extreme cases.
l

Containment equipment
; ; ;

l l

Towels and blankets Disposable clothes and shoes for ambulatory patients Large plastic bags for contaminated clothing with predetermined unique ID tags to go on the bag and patient wrist/neck Small plastic bags for patients valuables (clear freezer bags are preferable) Tags and waterproof pens to mark bags Clear, zip-front body suits or large water repellant blankets to minimize contamination to transport personnel and ambulances Tape (duct, 4-inch) Triage tags

Pool or tank

Tarps
l

6-mil construction plastic

l l l l l l l l

Fiberglass backboards Supports for ambulatory patients Sawhorses to support backboards Water supply Scissors for clothing removal Mild detergent (dishwashing liquid) Five-gallon buckets Sponges and soft brushes
l l l

l l

Washing should be done using warm water, soft bristle brushes or sponges, and a mild soap, such as dishwashing liquid. Hot water, stiff brushes, and vigorous scrubbing should seldom be used because they cause vasodilation, abrasion, and increased entry of toxicants through the skin. The skin of young children is particularly sensitive and should be treated accordingly. Responders should try to contain all run-off from decontamination procedures for proper disposal. Whenever possible, men and women should be provided separate treatment areas. Allowing ambulatory patients to decontaminate themselves under supervision may accelerate the process and reduce the need for response personnel. In such cases, it may be necessary to provide instructions in multiple languages, preferably using a prerecorded message, to assure that patients understand the problem and follow instructions. Patient compliance with clothing removal and decontamination instructions will likely be influenced by their perception of the threat to their life and health, as well as by the clarity and authoritative nature of the instructions given. Decontamination of nonambulatory patients is more difficult and labor-intensive. Careful attention must be paid to cleaning the back, buttocks, axilla, hair, and genitalia. The backboard and collar

51

along with any other medical equipment used to transport the patient must either be decontaminated or exchanged prior to the individual entering the Support Zone. If a patient is seriously ill, ventilation support and the administration of medicines may be required while he or she is undergoing decontamination. However, invasive procedures (e.g., intubation) should not be initiated in the Contamination Reduction Zone unless absolutely necessary. All potentially contaminated patient clothing and belongings that have been removed and bagged should remain in the decontamination area. They should not be transported with the patient in the ambulance unless approved by the Decontamination Officer or Safety Officer. Many chemical substances, even though highly toxic, carry no intrinsic risk for contamination to others. Most toxic gases, such as carbon monoxide or arsine, are highly poisonous, but once the victim has been brought out of the exposure area and into the fresh air, the amount of leftover gas in and around the patient is unlikely to poison others, especially when the patient s clothes are removed. Even many chemicals that have the potential for spreading contamination can be rendered less hazardous by clothing removal and simple dilution of contaminants with copious amounts of water.

Pediatric Decontamination Considerations


The complexity of managing a hazardous materials incident is increased when children are involved. While protective to the wearer, PPE may be frightening to a young child, resulting in less cooperation and greater psychological trauma. Whenever possible, children and parents (or other adults known to them) should remain together while undergoing decontamination, medical treatment, and transport to the hospital. Constant reassurance and compassion will be especially important if a child is separated from his or her parent(s). Efforts at reuniting parent and child should be made as early as is safely possible, either at the scene or at the hospital. Older children, while likely to be more compliant with instructions and self-sufficient during the decontamination process, may nevertheless be more susceptible to mass hysteria if not properly informed and reassured. Increased susceptibility to hypothermia is an important consideration in determining to what degree a child is decontaminated in the field as opposed to being grossly decontaminated, wrapped in a blanket for transport, and then given definitive decontamination at the hospital or other heated location.

Mass Population Decontamination


Certain hazmat incidents result in large numbers of patients being exposed (or believing they were exposed) to a chemical agent. In this situation, responding personnel will find it necessary to implement proper triage to prioritize patients entry through the decontamination process, or to quickly expand the decontamination system to clean more patients simultaneously. Gaining quick control of the escaping crowd and initiating immediate decontamination procedures (if indicated) is essential to minimize secondary contamination, morbidity, mortality and panic. Large volumes of water from charged hose lines, and specially-mounted nozzles or deluge guns on fire engines, can be used to quickly rinse large numbers of individuals. Some fire departments or hazmat teams use portable trailers and/or aerial ladder trucks with special spray systems containing both soap and water (or bleach and water) to provide gross and/or secondary decontamination for large-scale efforts. Once through the decontamination steps, patients should be given towels, temporary clothing (e.g., a plain

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Decontamination
l l l

Make sure all clothing is removed. Brush or vacuum particulate matter off of skin. Decontaminate systematically from the head down with water:
;

Water-wash contaminated area gently under a stream of water, and scrub with a soft brush or surgical sponge along with soap Limit mechanical or chemical irritation of the skin by overzealous scrubbing or forceful water flow Use warm, never hot, water Decontaminate exposed wounds and eyes before intact skin areas Cover wounds with a waterproof dressing after decontamination Take care not to introduce contaminants into open wounds Remember the back, under skin folds and genitalia Watch for any changes in the patient s condition

; ; ; ; ; ;

Remove contaminants to the level that they are no longer a threat to the patient or response personnel, or as far as the situation or their clinical condition allows. Isolate the patient from the environment by wrapping in blanket/sheet to prevent the spread of any remaining contaminants. If possible, contain all runoff from decontamination procedures for proper disposal. Ensure that all potentially contaminated patient clothing and belongings have been bagged and tagged:
; ;

l l

Properly label the bags that contain clothing or other potentially contaminated articles Consult with proper officials (e.g., Safety Officer, Hazmat Officer) regarding disposition of bags containing patient valuables

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Tyvek suit with hood, booties, and gloves), and a blanket, and then directed to the Treatment Sector for evaluation. Mass decontamination planning should also address issues such as non-Englishspeaking patients, caring for physically impaired patients (e.g., nonambulatory, blind, wheelchairbound), and large numbers of worried but well victims.

CONSIDERATIONS FOR PATIENT TREATMENT


In most aspects, a contaminated patient is like any other patient except that responders must protect themselves and others from dangers due to secondary contamination. Response personnel must first address life-threatening issues and gross decontamination before taking supportive measures. If spinal immobilization appears necessary, it should be initiated as soon as feasible. Primary surveys should be accomplished simultaneously with decontamination, and secondary surveys completed as conditions allow. In treating patients, personnel should consider the chemical-specific information received from the Poison Control Center and other information resources. In multiple patient situations, proper triage procedures should be implemented using local emergency response plans (see Section I SARA Title III).

Patient Treatment
l l

Assign highest priorities to ABCs and decontamination. Complete primary and secondary surveys as conditions allow. Bear in mind the chemical-specific information received from the designated poison control or medical control center. Treat for spinal injury, if indicated. In multiple patient situations, begin proper triage procedures. Administer antidotes and dosages per local protocol. Delay prophylactic measures until the patient is decontaminated. Perform invasive procedures only in uncontaminated areas. Reassess the patient frequently because many chemicals have latent physiological effects.

l l l l l l

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The patient should undergo frequent reassessments because many hazardous materials have latent physiological effects. Unless required by life-threatening conditions, prophylactic invasive procedures, such as intravenous injections or intubation, should be performed only in fully decontaminated areas and where conditions permit because they may create a direct route for introducing hazardous material(s) into the patient. Oxygen should be given using a bag valve mask with reservoir device (rebreather) or with a manually triggered oxygen-powered breathing device. Oxygen bottles and regulators should be encapsulated in plastic to facilitate decontamination, and every effort should be made to avoid mixing contaminated air with the oxygen. Caution must also be exercised when dealing with patients who are vomiting; off-gassing of a product or absorption through the skin or mucous membranes can occur from the emesis in some cases. While some contaminated patients may require treatment with antidotes, most cases can be handled with symptomatic care. Antidote administration should be based on patient condition, antidote availability, and proximity to the hospital. Emergency personnel must have a thorough understanding and familiarity with authorized antidotes since they can have significant side effects. Medication dosing for children must be carefully checked because they are most often administered on a mg/kg basis, and therapeutic and toxic levels can be very close. Exhibit III-3 lists frequently used antidotes and selected other pharmacologic treatment agents.

Exhibit III-3 Antidotes and Select Pharmacologic Treatment Agents


Antidote Atropine1 Pralidoxime chloride (2-PAM Chloride)1 Cyanide antidote kit Methylene blue 1% Activated charcoal Calcium gluconate (Gel and IV) Oxygen Toxicant Organophosphate pesticides and nerve agents Organophosphate pesticides and nerve agents Cyanide Methemoglobinema Certain ingested substances Hydrofluoric acid and fluoride toxicity Carbon monoxide

Can be found combined in auto-injection kit known as Mark I.

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PATIENT TRANSPORT TO THE HOSPITAL


When transporting a contaminated patient (i.e., only gross decontamination performed) by ambulance, special care should be exercised to prevent contamination of the vehicle and subsequent patients. Exposed surfaces that the patient is likely to contact should be protected by disposable sheeting. The use of both chemically resistant backboards and disposable sheeting are highly recommended. If a wooden backboard is used, it should be wrapped in a disposable cover or it may have to be discarded. Unnecessary equipment should be stored in a safe location or removed; equipment that does come in contact with the patient should be segregated for decontamination or disposal. Exhibit III-4 outlines suggested equipment for the care and transport of contaminated patients. Items should be added or deleted based on local needs and experience. The patient should be as clean as reasonably possible before transport, and further contact with contaminants should be avoided. No patient should be transported who has not, at a minimum, undergone gross decontamination. Protective clothing should be worn by response personnel, as appropriate. If secondary decontamination cannot be performed prior to transport, responders should attempt to prevent the spread of contamination by wrapping the patient loosely but completely in a large blanket or sheet. Body bags are not recommended for encapsulating patients for physiological and mental health reasons. Consideration should also be given to chemicals that present the added danger of accelerated skin absorption due to heat. The name(s) of the involved chemicals, if identified, and any other data available, should be recorded before leaving the scene. Oxygen should be administered by rebreather mask for any victim with respiratory problems unless contraindicated (e.g., end-stage chronic obstructive pulmonary disease (COPD)). Eyes that have been exposed should be irrigated with available saline or water, and irrigation should be continued en route to the hospital. Personnel should also be alert for any signs of respiratory distress, cardiovascular collapse, or gastrointestinal complaints. Seizures may occur and should be treated according to local protocol. Patients experiencing pain as a result of their injuries should be treated per medical control or agency protocol. Various types and degrees of burns may be seen and should be treated per local burn protocol or Burn Center instructions. In the case of acid and alkaline burns to the eyes, they should be continuously irrigated en route to the hospital. Control and proper disposal of the run-off is necessary to avoid injury to the patient and prehospital caregiver(s). Verbal reassurances and other forms of psychological support will also be important to minimize further fear and anxiety. During transport, ambulance personnel should use appropriate respiratory protection. Provide the maximum fresh air ventilation (e.g., open windows) that weather conditions permit to the patient s and driver s compartments, regardless of the presence or absence of odors. Contact the receiving hospital and provide an update on treatment provided or required and any other pertinent clinical information. Instructions for the procedure to enter the hospital with a contaminated patient should also be requested. Facilities receiving a potential hazardous materials patient will need as much information as possible, as soon as possible.

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Exhibit III-4 Supplies Needed to Prepare the Ambulance for Care of a Patient Contaminated with Hazardous Materials
l Sufficient 6-mil construction plastic1 cut to size to:
; ; ;

Cover floor of ambulance Cover squad seat Cover litter

l Disposable sheet(s) l Plastic trash bags to contain contaminated medical supply waste, gloves and the victim s clothes, and vomitus l Personal Protection:
; ; ;

CPC disposable suits with built-in hoods and booty/boot covers Positive-pressure SCBA2 Full-facemask respirator with an orange- and purple-type cartridge (acid gas, organic vapor, highly toxic dust, mist and fumes, and radionuclides-rated, HEPA cartridge)2 Polyvinyl chloride (PVC) or duct tape for taping closures Two-piece rainwear Rubber boots with steel toes Nitrile gloves with 14-inch cuffs Duct tape to seal suit seams, if necessary

; ; ; ; ;

1 2

Wet plastic is slippery; stability is important. Must not be used without prior training and fit testing. NOTE: The protective equipment listed is to be used for patient care situations after initial decontamination. It is meant to be used when complete decontamination of the patients cannot be guaranteed or when assisting with decontamination procedures (in extreme cases positive-pressure SCBA and encapsulated suites may be required for decontamination procedures). It is not meant to be used in rescue operations of victims found in a hazardous area. Under no circumstances should this equipment be relied upon for entry into hazardous environments. Protective equipment for entry must be appropriate to and compatible with the products involved. This may include positive-pressure SCBA and fully encapsulated suits. Many factors must be taken into consideration when determining the appropriate level of protection. Consequently, selection of protective equipment must be done by a qualified individual.

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A radio report checklist should be developed and made available for all vehicles and telephone or radio communication centers. This information will aid in initiating appropriate actions:
l l l l l l l l

Type and nature of incident Number and ages of patients Signs and symptoms being experienced by the patients Nature of injuries Name of chemical(s) involved, including trade names Information available at the site concerning the chemical(s), including the MSDSs Extent of patient decontamination in the field Estimated time of arrival

The ambulance should park in an area away from the emergency room or go directly to a predesignated decontamination location, thereby limiting exposure to hospital facilities. To protect hospital staff and other patients, the victim should not be brought into the emergency department before ambulance personnel receive permission from the hospital staff. Upon release of the patient to the hospital, any nondisposable equipment that is believed to be contaminated should be double-bagged. Contaminated articles should be kept sealed until the Incident Commander or his designee gives further instructions. Whenever possible, the use of disposable equipment is recommended. Inquiries should be made at the hospital to determine where the ambulance can be safely decontaminated, and whether equipment is available for this purpose. The method of decontamination should be based on the chemical(s) involved and the extent of patient decontamination prior to transport. In most cases soap and water are adequate for vehicle decontamination. The ambulance should not go back into service until it is determined to be safe by an appropriately trained individual (e.g., a hazmat team coordinator). This again emphasizes the benefits of thorough patient decontamination prior to transport; if the patient is clean, then the vehicle s interior will also be clean.

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Transport to the Hospital


l l

Get patient as clean as possible prior to transport. Avoid contact with contaminants; provide protection to the vehicle; wear protective clothing as appropriate. Provide other patient care according to condition and local protocol. Before leaving the scene, write down the name of the involved chemical(s) and any other available data. Provide fresh air ventilation to the patient s and the driver s compartments. Contact the receiving hospital ASAP; provide information on the patient and treatment rendered; identify the chemical, its toxicology, MSDS, and any other pertinent information. Obtain instructions on approaching and entering the hospital. Have open bag ready in case of vomiting and carefully isolate vomitus since off-gassing can occur. Be alert for any respiratory distress; administer oxygen by mask for any patient with respiratory problems (except as contraindicated). Continue to irrigate eyes as needed with normal saline or water. Park the ambulance in a location away from the emergency department or go directly to a predesignated decontamination area. Do not bring patients into the emergency department before receiving permission from the hospital staff. After unloading the patient, check with the hospital to determine where the ambulance can be safely decontaminated, and the availability of equipment for this purpose. Decontaminate exposed emergency personnel.

l l

l l

l l

l l

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Air Transportation of Chemically Exposed Patients


The role of aeromedical support for hazmat incidents is limited because of the potential danger in transporting patients by helicopter from a hazardous materials site. Especially in cases involving more severe injuries, decontamination is often incomplete before removal, and as a result the flight crew risks becoming seriously ill in transit. The flight path to the site may also require their traveling through an unsafe area. Furthermore, the down draft from the helicopter can affect vapor or fume dispersion at the scene. In many areas, flight program policies specifically preclude the use of helicopters for these types of incidents.

CRITIQUE
As soon as possible following a hazardous materials incident, all participating units should send knowledgeable representatives to meet and review the measures that were taken by each unit or agency. The purpose of this review is to examine which activities succeeded and which did not, and to evaluate the overall coordination effort with an aim toward making necessary improvements. The results of the discussion should be shared with all agency personnel. Identified weaknesses or omissions in the response plan should be corrected, and training given on new policies and procedures.

PATIENT MANAGEMENT UNDER MASS CASUALTY CONDITIONS INVOLVING HAZARDOUS CHEMICALS


Basic medical procedures in a large-scale hazardous materials incident are not substantially different from life-saving measures in other mass casualty disasters. Primary attention should focus on the ABC fundamentals of emergency care, with decontamination performed at the same time. There are, however, several important differences in disasters involving hazardous materials. A hazmat disaster may require setting up mass screening and decontamination centers. It may also be necessary to establish casualty collection points to provide stabilizing care in the field prior to transport. A major chemical incident may overwhelm any one hospital, especially if it occurs along with another disaster such as an earthquake. Such an event would drastically increase the number of casualties and the complexity of the medical care that must be provided (e.g., crushing injuries or spinal trauma, combined with gas inhalation). This would require increased numbers of personnel, perhaps more sophisticated medical equipment, and a better transport system for taking stabilized victims out of the area. Training in the appropriate procedures to be followed is essential for potential responders to a hazardous materials incident involving mass casualties. Triage may also be complicated for chemical exposures associated with the delayed onset of signs and symptoms. If necessary, the patient, injured or not, must be decontaminated before being transported to the emergency department to protect EMS and emergency department staff.

CRITICAL INCIDENT STRESS MANAGEMENT


Situations involving large numbers of ill or injured individuals, and risks of harm to the responder(s), are sources of critical incident stress. To minimize the occurrence of acute or long- term psychological consequences in response personnel, stress debriefing sessions should be held shortly after the incident. Acute stress reactions recognized during and after the incident should be immediately addressed by qualified peer debriefers or other mental health professionals.

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SELECTED BIBLIOGRAPHY
Cashman, J.R. 1995. Hazardous Materials Emergencies: The Professional Response Team. 3rd ed. Lancaster, PA: Technomic Publishing Co. Currance, P.L. and A.C. Bronstein. 1994. Emergency Care for Hazardous Materials Exposure. 2nd ed. St. Louis, MO: Mosby. Haddad, L.M. and J.F. Winchester. 1998. Clinical Management of Poisoning and Drug Overdose. 3rd ed. Philadelphia, PA: W.B. Saunders Co. Leonard, R.B. and R. Ricks. 1980. Emergency Department Radiation Accident Protocol. Annals of Emergency Medicine. September. Noji, E.K. and G.D. Kelen. 1989. Manual of Toxicologic Emergencies. Chicago, IL: Year Book. Reigart, J. R. and J.R. Roberts, JR (eds.). 1998. Recognition and Management of Pesticide Poisonings. 5th ed. National Pesticide Telecommunications & Network (NPTN), U.S. Environmental Protection Agency. U.S. Department of Health and Human Services. Agency for Toxic Substances and Disease Registry (ATSDR). 1996. Managing Hazardous Materials Incidents: Medical Management Guidelines for Acute Chemical Exposures. Vol. III. Atlanta, GA: US-DHHS. U.S. Department of Transportation. 1996. 1996 North American Emergency Response Guidebook. Washington, DC: Government Printing Office. [available in English, Spanish, and French][http://hazmat.dot.gov/gydebook.htm] U.S. Federal Emergency Management Agency. 1981. Hazardous Materials Management System: A Guide for Local Emergency Managers. Prepared by the Office of Emergency Management. Washington, DC: Federal Emergency Management Agency. U.S. Federal Emergency Management Agency. 1985. Guidance for Developing State and Local Radiological Emergency Response Plans and Preparedness for Transportation Accidents. Washington, DC: Federal Emergency Management Agency. U.S. Federal Emergency Management Agency and U.S. Fire Administration. 1999. Hazardous Materials Guide for First Responders. Washington, DC: Government Printing Office.

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Appendix A

HAZARDOUS MATERIALS CLASSIFICATION SYSTEMS


National Fire Protection Association, 704M System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A3 Department of Transportation, DOT Chart 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A5 U.S. Department of Labor, Material Safety Data Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A9

A1

A2

NATIONAL FIRE PROTECTION ASSOCIATION, 704M SYSTEM


The marking system designed by the National Fire Protection Association identifies hazard characteristics of materials at terminal and industrial sites. It uses a diamond divided into four quadrants, with each quadrant representing a different characteristic, as explained below. The risk level ratings, ranging from four (highest risk) to zero (minimum risk), are based upon protective equipment normally used by firefighters.

Health (Blue)
Health hazards in firefighting generally result from a single exposure, which may vary from a few seconds up to an hour. Only hazards arising out of an inherent property of the material are considered. It should be noted, however, that the physical exertion demanded in firefighting or other emergency conditions tends to intensify the effects of any exposure. Risk level 4: Materials too dangerous to human health to expose firefighters. A few whiffs of the vapor could cause death or the vapor or liquid could be fatal on penetrating the firefighter s normal full protective clothing. The normal full protective clothing and breathing apparatus available to the average fire department will not provide adequate protection against inhalation or skin contact with these materials. Risk level 3: Materials extremely hazardous to health, but areas may be entered with extreme care. Full protective clothing including self-contained breathing apparatus, coat, pants, gloves, and boots, with bands around the legs, arms, and waist should be provided. No skin surface should be exposed. Risk level 2: Materials hazardous to health, but areas may be entered freely with full facemask self-contained breathing apparatus that also provides eye protection. Risk level 1: Materials only slightly hazardous to health. It may be desirable to wear self-contained breathing apparatus. Risk level 0: Materials which on exposure under fire conditions would offer no hazard beyond that of ordinary combustible materials.

Flammability (Red)
Susceptibility to burning is the basis for assigning risk levels within this category. The method of attacking the fire is influenced by the material s susceptibility factor. Risk level 4: Very flammable gases or very volatile flammable liquids. Shut off flow and keep cooling water streams on exposed tanks or containers. Risk level 3: Materials that can be ignited under almost all normal temperature conditions. Water may be ineffective because of the low flash point.

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Risk level 2: Materials that must be moderately heated before ignition will occur. Water spray may be used to extinguish the fire because the material can be cooled below its flash point. Risk level 1: Materials that must be preheated before ignition will occur. Water may cause frothing if it gets below the surface of the liquid and turns to steam. However, water fog gently applied to the surface will cause a frothing that will extinguish the fire. Risk level 0: Materials that will not burn.

Reactivity/Stability (Yellow)
The assignment of degrees in the reactivity category is based upon the susceptibility of materials to release energy either by themselves or in combination with water. Fire exposure is one of the factors considered, along with conditions of shock and pressure. Risk level 4: Materials that (in themselves) are readily capable of detonation or of explosive decomposition or reaction at normal temperatures and pressures. Includes materials that are sensitive to mechanical or localized thermal shock. If a chemical with this hazard rating is in an advanced or massive fire, the area should be evacuated. Risk level 3: Materials that (in themselves) are capable of detonation or of explosive decomposition or reaction that require a strong initiating source that must be heated under confinement before initiation. Includes materials that are sensitive to thermal or mechanical shock at elevated temperatures and pressures, or that react explosively with water without requiring heat or confinement. Firefighting should be done from an explosive-resistant location. Risk level 2: Materials that (in themselves) are normally unstable and readily undergo violent chemical change, but do not detonate. Includes materials that can undergo chemical change with rapid release of energy at normal temperatures and pressures, or that can undergo violent chemical change at elevated temperatures and pressures. Also includes those materials that may react violently with water or that may form potentially explosive mixtures with water. In advanced or massive fires, firefighting should be done from a safe distance or from a protected location. Risk level 1: Materials that (in themselves) are normally stable but that may become unstable at elevated temperatures and pressures or that may react with water with some release of energy, but not violently. Caution must be used in approaching the fire and applying water. Risk level 0: Materials that (in themselves) are normally stable even under fire exposure conditions and that are not reactive with water. Normal firefighting procedures may be used.

Special Information (White)


The quadrant includes information on specific characteristics of the material (e.g., reactivity with water, tendency to oxidize).

A4

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A7

A8

MATERIAL SAFETY DATA SHEETS


The Material Safety Data Sheet (MSDS) has become a major source of chemical information. It is the key document used to provide hazard information to employees and can become an invaluable tool for emergency response personnel when used in a chemical emergency. The Occupational Safety and Health Administration s (OSHA) Hazard Communication Standard (29 CFR 1910.1200) requires all manufacturers of pure chemicals and/or mixtures to evaluate their products and relate, via MSDSs, any hazards that may be encountered while handling these materials. This standard is intended for all workplaces, manufacturing and nonmanufacturing alike. The Environmental Protection Agency s (EPA) Emergency Response and Community Right-to-Know Act of 1986 ensures the availability of MSDSs to emergency response personnel, such as fire departments, first aid crews, and hospital emergency room staff. The MSDS contains a wealth of information that may be understood with a minimum of training. Below is a brief explanation of the format and information found in a properly prepared MSDS.

Section 1
This section identifies the material by product or trade name and chemical name. It is the product or trade name that is usually found on the container labels, although the chemical name is also required by some states. Section I also contains the manufacturer s name, address, and telephone number.

Section 2
Section 2 provides physical data about the product that can be utilized for proper identification. Included are specifics such as color, odor, specific gravity (weight), vapor pressure, and boiling point.

Section 3
This section lists the chemical ingredients of the material, if they are known or suspected to be hazardous. Hazardous materials that are not carcinogens must be reported if they represent 1 percent or more of the product. Carcinogens must be reported and identified as such if their levels are 0.1 percent or higher. Also included in Section 3 are Threshold Limit Values (TLVs) and the OSHA Permissible Exposure Limit (PEL).

Section 4
Section 4 includes fire and explosion hazard data. This information is especially useful when devising both in-house and community contingency plans. Plant first responders, local fire departments, and hazmat teams need unlimited access to this information.

Section 5
Section 5 contains health hazard data. It describes any acute (short-term exposure) and/or chronic (long-term exposure) effects on the body. These include routes of exposure (inhalation, dermal contact, ingestion) and the bodily organs affected, as well as the signs and symptoms of overexposure. First

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aid procedures are also be found in this section. (NOTE: First aid measures recommended in MSDSs are not always correct and should be confirmed.)

Section 6
This section contains information on the reactivity of the product. It lists other chemicals that, when mixed with the product, will result in a chemical reaction. If a product is water reactive, it will be noted. Also included in Section 6 is information on hazardous decomposition products, such as carbon monoxide and other hazardous gases, that are formed and emitted during chemical reactions or fires. It is imperative that this section be carefully noted by both in-house and local firefighters.

Section 7
Section 7 lists the procedures that should be used if the product spills or leaks, including waste disposal methods.

Section 8
Section 8 contains information regarding the proper personal protective equipment (PPE) necessary to handle the product in a manner that will minimize exposure. Ventilation practices are also listed in this section.

Summary
A Material Safety Data Sheet can aid in making the right decisions on health and safety issues in a plant or in a community. It must be noted, however, that it is but one of many references that should be used to make final determinations. MSDSs are offered by manufacturers for identification and verification and are not the last word on safety and health practices.

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Appendix B

TYPES OF RESPIRATORY PROTECTION

B1

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Appendix B Types of Respiratory Protection


Type of Respirator Air Purifying
Air-Purifying Respirator (including powered sea level) [PAPRs]) Enhanced mobility Cannot be used in IDLH or oxygen-deficient atmospheres (less than 19.5 percent oxygen at air-purifying respirators Limited duration of protection; may be hard to gauge safe operating time in field conditions Only protects against specific chemicals, and up to specific concentrations Use requires monitoring of contaminant and oxygen levels Can only be used: (1) against gas and vapor contaminants with adequate warning properties; or (2) for specific gases or vapors provided that the service is known and a safety factor is applied, or if the unit has an ESLI (end-of-service-life-indicator)

Advantages

Disadvantages

Lighter in weight than an SCBA; generally weighs 2 pounds or less (except for PAPRs)

Atmosphere-Supplying
Self-Contained Breathing Apparatus (SCBA) Provides the highest available level of protection against airborne contaminants and oxygen deficiency Provides the highest available level of protection under strenuous work conditions Bulky, heavy (up to 35 pounds) Finite air supply limits work duration May impair movement in confined spaces

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Appendix B (continued)

Type of Respirator

Advantages

Disadvantages
Not approved for use in IDLH or oxygendeficient atmospheres (less 19.5 percent oxygen at sea level) unless equipped with an emergency egress unit, such as an escape-only SCBA, that can provide immediate emergency respiratory protection in case of air line failure Impairs mobility Mine Safety and Health Administration/ NIOSH certification limits hose length to 300 feet As the length of the hose is increased, the minimum approved airflow may not be delivered at the faceplate Air line is vulnerable to damage, chemical contamination, and degradation. Decontamination of hoses may be difficult Worker must retrace steps to leave work area Requires supervision/monitoring of the air supply line

Positive Pressure Supplied- Enables longer work periods than an SCBA Air Respirator (SAR)
(also called air line respirator) Less bulky and heavy than an SCBA; SAR equipment weigh less than 5 pounds (or around 15 pounds, if escape SCBA protection is included) Protects against most airborne contaminants

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Appendix C

LEVELS OF PROTECTION

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Appendix C Levels of Protection1


Level of Protection Equipment
A

Protection Provided

Should be used when:


The chemical substance has been identified and requires the highest level of protection for skin, eyes, and the respiratory systems based on: -measured (or potential for) high concentration of atmospheric vapors, gases, or particulates; or -site operations and work functions involving a high potential for splash, immersion, or exposure to unexpected vapors, gases, or particulates of materials that are harmful to skin or capable of being absorbed through the intact skin Substances with a high degree of hazard to the skin are known or suspected to be present, and skin contact is possible Operations must be conducted in confined, poorly ventilated areas until the absence of conditions requiring Level A protection is determined

Limiting Criteria
Fully-encapsulated suit; material must be compatible with the substances involved

Recommended: The highest available Pressure-demand, full level of respiratory, facepiece SCBA or pressure- skin, and eye protection demand, supplied-air respirator with escape SCBA Fully-encapsulated, chemicalresistant suit Inner chemical-resistant gloves Chemical-resistant safety boots/shoes Two-way radio communication

Optional: Cooling unit Coveralls Long cotton underwear Hard hat Disposable gloves and boot covers

Reprinted from NIOSH/OSHA/USCG/EPA, 1985. Occupational Safety and Health Guidance Manual for Hazardous Waste Site Activities. Washington, DC: Department of Health and Human Services.

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Appendix C Levels of Protection (continued)


Level of Protection Equipment
B Recommended: Pressure-demand, full-facepiece SCBA or pressure-demand, suppliedair respirator with escape SCBA

Protection Provided

Should be used when:

Limiting Criteria

The type and atmospheric concentration of substances have been identified and require a high level of respiratory protection, but less skin It is the minimum level protection. This involves: Chemical-resistant clothing recommended for initial (overalls and long sleeved site entries until the -atmosphere with IDLH jacket; hooded, one- or hazards have been concentrations of specific two-piece chemical splash further identified substances that do not suit; disposable chemicalrepresent a severe skin resistant one-piece suit) hazard; or Inner and outer chemicalresistant gloves Chemical-resistant safety boots/shoes Hard hat Two-way radio communications -atmosphere containing less than 19.5 percent oxygen Presence of incompletely identified vapors or gases is indicated by direct-reading organic vapor detection instrument, but vapors and gases are not suspected of containing high levels of chemicals harmful to skin or capable of being absorbed through intact skin

The same level of respiratory protection, but less skin protection than Level A

Use only when the vapor or gases present are not suspected of containing high concentrations of chemicals that are harmful to skin or capable of being absorbed through intact skin Use only when it is highly unlikely that the work being done will generate either high concentrations of vapors, gases, or particulates or splashes of material that will affect exposed skin

Optional: Coveralls Disposable boot covers Face shield Long cotton underwear

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Appendix C Levels of Protection (continued)


Level of Protection
C

Equipment

Protection Provided

Should be used when:

Limiting Criteria

Recommended: Full-facepiece, air-purifying, No respiratory canister-equipped respirator protection; minimal skin protection Chemical-resistant clothing (overalls and long sleeved jacket: hooded, one- or twopiece chemical splash suit; disposable chemical-resistant one-piece suit) Hard hat Optional: Gloves Escape mask Face shield

The atmosphere contains no known hazard Work functions preclude, splashes immersion, or the potential for unexpected inhalation of or contact with hazardous levels of any chemicals

This level should not be worn in the Exclusion Zone The atmosphere must contain at least 19.5 percent oxygen

Recommended: Coveralls Safety boots/shoes Safety glasses or chemical splash goggles Hard hat Optional: Gloves Escape mask Face Shield

No respiratory protection; minimal skin protection

The atmosphere contains no known hazard Work functions preclude splashes, immersion, or the potential for unexpected inhalation of or contact with hazardous levels of any chemicals

This level should not be worn in the Exclusion Zone The atmosphere must contain at least 19.5 percent oxygen

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Comments
The Agency for Toxic Substances and Disease Registry would greatly appreciate your comments and suggestions for improving future editions of this guidance document. Comments may be addressed to: Scott V. Wright Emergency Response and Scientific Assessment Branch (MS E57) Agency for Toxic Substances and Disease Registry (ATSDR) 1600 Clifton Road, N.E. Atlanta, GA 30333

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Managing Hazardous Materials Incidents

Volume II
(Revised)

Hospital Emergency Departments:


A Planning Guide for the Management of Contaminated Patients

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES


Public Health Service Agency for Toxic Substances and Disease Registry

The Agency for Toxic Substances and Disease Registry (ATSDR) has produced a three-volume series entitled Managing Hazardous Material Incidents. The series is designed to help emergency response and health care professionals plan for and respond to hazardous material emergencies. Volume I Emergency Medical Services: A Planning Guide for the Management of Contaminated Patients Hospital Emergency Departments: A Planning Guide for the Management of Contaminated Patients Medical Management Guidelines for Acute Chemical Exposures

Volume II

Volume III

Volumes I and II are planning guides to assist first responders and hospital emergency department personnel in planning for incidents that involve hazardous materials. Volume III is a guide for health care professionals who treat persons who have been exposed to hazardous materials.

Agency for Toxic Substances and Disease Registry.........................................Jeffrey P. Koplan, Ph.D., M.P.H., Administrator Henry Falk, M.D., M.P.H., Assistant Administrator Division of Toxicology.........................................Christopher T. DeRosa, Ph.D., Director

Additional copies of this report are available from: Agency for Toxic Substance and Disease Registry (ATSDR) Division of Toxicology Information Center (E57) 1600 Clifton Road, N.E. Atlanta, Georgia 30333 (404) 639-6357 Internet address: www.atsdr.cdc.gov/prevent.html

2 Printed on recycled paper

DEPARTMENT OF HEALTH & HUMAN SERVICES


Public Health Service Agency for Toxic Substances and Disease Registry (MS-E57) Atlanta, GA 30333 Official Business Penalty for Private Use $300

SPECIAL FOURTH-CLASS RATE POSTAGE & FEES PAID PHS/CDC Permit No. G-284

Volume II - Table of Contents

Page Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iii Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v I. Systems Approach to Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 The Role of the Hospital in a Systems Approach to Planning . . . . . . . . . . . . . . . . . . . . .1 The Spectrum of Hazardous Materials Incidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) . . . . . . . . . . .3 SARA Title III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 The State Emergency Medical Services (EMS) Agency . . . . . . . . . . . . . . . . . . . . . . . . .4 Federal Emergency Response Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Hazard Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Selected Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 II. Emergency Department Response to Hazardous Materials Incidents . . . . . . . . . . . . . .11 Hazard Recognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Principles of Toxicology for Emergency Department Personnel . . . . . . . . . . . . . . . . . . 19 Personnel Protection and Safety Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Respiratory Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Emergency Department Personnel Decontamination . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Communications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Selected Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Volume II - Table of Contents (Continued)

III.

Patient Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Emergency Department Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Patient Arrival . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Patient Decontamination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Considerations for Patient Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Community Education and Briefing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48 Critique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..48 Patient Management Under Mass Casualty Conditions Involving Hazardous Chemicals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Critical Incident Stress Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Selected Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Appendix A Appendix B Appendix C

Hazardous Materials Classification Systems . . . . . . . . . . . . . . . . . . . . . . . . . A1 Types of Respiratory Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B1 Levels of Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C1

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Acknowledgments
This document was first published in 1992 and updated in 2000. ATSDR wishes to thank all those who participated in making this a useful guidance document, including:
2000 Revision of Volume I Emergency Medical Services: A Planning Guide for the Management of Contaminated Patients: 2000 Revision of Volume II Hospital Emergency Departments: A Planning Guide for the Management of Contaminated Patients:

Craig DeAtley, P.A.-C., C.C.T.

George C. Rodgers, Jr., M.D., Ph.D.

Associate Professor, Emergency Medicine Professor of Pediatrics and Pharmacology/Toxicology Disaster Medicine and Special Operations Section University of Louisville George Washington University School of Medicine Louisville, KY and Health Sciences Washington, D.C.

Peer Review Panel for revised (2000) Volumes I and II:1


Sella Burchette (U.S. Environmental Protection Agency) Keith Burkhart, M.D., F.A.C.E.P. (American College of Emergency Physicians) Andrea Carlson (Physicians for Social Responsibility) Linda Cochiarella, M.D. (American Medical Association) Paul Cousins (The National Association of Emergency Medical Technicians) Richard Duffy (International Association of Firefighters) Philip Edelmen, M.D. (Association of Occupational and Environmental Clinics) Robert McCunney, M.D. (American College of Occupational and Environmental Medicine) Kent Olson, M.D. (American Association of Poison Control Centers) Leslie Stein-Spencer, R.N. (Emergency Nurses Association) Milton Tenenbein, M.D. (American Academy of Pediatrics) John Turley (Emergency Management Institute)
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The above reviewers were recommended by the organizations listed but do not necessarily represent them.

This project was directed by Scott V. Wright, ATSDR. For the 2000 revision, Linda Stein of Eastern Research Group, Inc. (ERG) was the project manager, and Chris Reid of ERG was the editor (under ATSDR Contract No. 205-93-0641). The following panel of experts contributed to the original (1992) development of Volumes I and II: Phillip Currance, EMT-P; Ralph B. Monty Leonard, Ph.D., M.D., F.A.C.E.P.; Mary Beth Michos, R.N.; Eric Noji, M.D., M.P.H., F.A.C.E.P.; Martin J. ONeill; Paul Seidlitz, R.N. The following experts served as peer reviewers for the original 1992 Volumes I and II: Ben Blankeshire, Kenneth Bouvier, MacNeil Cross, Robert Daughdril, Craig DeAtley, Eileen Faries, Steve Finefrock, John Friery, Niel Holtz, Winston E. Jones, William J. Keffer, Gus A. Koehler, Kenneth Kuntz, Paul Manascalo, Kent Olson, Chappell D. Pierce, Alonzo Smith, Clark Staten, Dave Tauber, Joe E. Taylor, Sandra L. Tirey, Wallace Weaver, Steve White

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iv

Introduction
The presence of hazardous materials or toxic chemicals at an incident location or other emergency situation adds a new dimension of risk to those handling and treating casualties. The fundamental difference between a hazardous materials incident and other emergencies is the potential for acute risk from contamination to both patient and responder. In some cases, traditional practices must be altered to avoid compounding a critical situation. Hospital emergency departments must protect their personnel and other people within the hospital, while providing the best care for the chemically contaminated patient. This guide is intended to help hospital emergency departments plan for incidents that involve hazardous materials and to improve their ability to respond to these incidents. To ensure appropriate and timely patient care, as well as optimal worker protection, emergency personnel must understand decontamination procedures and personal protective equipment, neither of which are routinely covered in the course of their professional training. They should also be aware of community resources that could be called upon to assist with an emergency response. Current training curricula for emergency room physicians and nurses and emergency medical technicians (EMTs) often do not adequately prepare these professionals to manage the contaminated individual or to decontaminate patients exposed to toxic substances. Accurate, specific, and concise guidance is needed to describe appropriate procedures to be followed by emergency medical personnel to safely care for a patient, as well as to protect equipment, hospital personnel, patients, and others from risk of secondary exposure. In response to this need, the Agency for Toxic Substances and Disease Registry (ATSDR) contracted for the production of a three-volume series entitled Managing Hazardous Materials Incidents: I. Emergency Medical Services: A Planning Guide for the Management of Contaminated Patients; II. Hospital Emergency Departments: A Planning Guide for the Management of Contaminated Patients; and III. Medical Management Guidelines for Acute Chemical Exposures. The first document is designed for use by emergency medical technicians and other prehospital care providers to minimize their risks of exposure during the prehospital period and to provide for the safe and effective treatment of chemically contaminated patients. This volume, written for emergency department personnel, is designed to familiarize readers with the concepts, terminology, and key operational considerations that affect the management of incidents of chemical contamination. It presents uniform guidance for the emergency care of chemically contaminated patients; provides basic information critical to advance planning and implementation of emergency medical strategies; illustrates the characteristics of hazardous materials incidents that compel modifications to traditional emergency response procedures; and presents effective preparatory response actions.

Not all hospital and community emergency response systems are prepared to respond to a hazardous chemical incident to the same degree. This document may be used to assess a hospital s capabilities with respect to potential community hazards and to develop response plans using national and community-specific resources. Employee safety and training are also key factors in the effective management of medical emergencies. This document also is intended to provide source material for developing local training and safety protocols. Section I, Systems Approach to Planning, introduces the guidelines for emergency preparedness and hazardous materials and waste programs of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Government and private planning activities are also outlined, including those established under Title III of the Superfund Amendments and Reauthorization Act (SARA); the National Response Team; the Community Awareness Emergency Response (CAER) program; and the Chemical Stockpile Emergency Preparedness Program (CSEPP). This chapter discusses the need for hazard identification and risk analysis pertaining to hazardous materials located in a community or transported through it. Section II, Emergency Department Response to Hazardous Materials Incidents, outlines general principles for hazard recognition, chemical exposure, and personal protective equipment. In addition, the hazard recognition section presents general guidance for determining whether a given situation constitutes a hazardous materials incident and details various hazardous materials classification systems. This section also provides basic toxicological and chemical terminology that emergency personnel need to understand to effectively conduct patient assessments. It also provides an overview of personal protective equipment, such as respiratory devices and protective clothing. Section III, Patient Management, includes guidelines for emergency department preparation and response to a potential hazardous materials incident. This chapter also discusses patient assessment and decontamination guidelines. This guidance document is intended to improve the safety of responders as well as of patients. It is not, however, all-encompassing, nor can it be regarded as a substitute for comprehensive instruction and training for hazardous materials incidents. Supplemental material that is vital to successful response to hazardous materials contamination is cited within the document. These materials should be carefully reviewed before preparing any strategic plans or conducting training exercises on this topic. Also, this document generally does not cover issues associated with weapons of mass destruction (WMD), although some of the information presented is pertinent to these situations as well. Other ATSDR documents specifically address WMD concerns.

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Section I.

Systems Approach To Planning

THE ROLE OF THE HOSPITAL IN A SYSTEMS APPROACH TO PLANNING


The potential for hazardous materials incidents exists almost everywhere. While infrequent, chemical incidents are capable of endangering the health of the individuals involved and the emergency personnel directed to assist them. People who have been seriously injured by a hazardous material have a greater chance of recovery without complications when appropriate emergency treatment is provided by trained EMS personnel at the scene, and when the patient is transported to a facility having the most appropriate personnel and technical resources to manage his or her care. This requires an integrated emergency medical response. However, many local governments, private businesses, and hospitals do not have a tested hazardous materials response plan in place that integrates all of the responding agencies and personnel. This has resulted in several problems:
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Incidents have been poorly managed onsite by first responders. Communication channels between the private and public sectors, or among public responders, have not been clearly identified and formalized. The medical community has not been firmly integrated into many response systems and may not be prepared to treat multiple casualties resulting from a serious hazardous materials incident.

Hospitals are a crucial link in the community response system for emergency preparedness planning. Not only are hospitals asked to treat patients who have been chemically contaminated at remote sites, but as repositories of hazardous materials themselves, they are potential sites of hazardous materials incidents. Coordination and communication between hospitals and other elements of an Emergency Medical Services system can best be achieved by hospital staff, including physicians, fully participating at local meetings for hazardous materials (hazmat) planning and protocol review. Hospitals must acknowledge their role as a component of the communitywide emergency response system. Hospital administrators need to familiarize themselves with the contingency plans of other participants, such as fire, police, Emergency Medical Services (EMS), and health departments, and understand what services are expected from hospitals. Optimally, hospital staff should be represented on planning committees that develop and periodically review these contingency plans. A common characteristic of the successful management of chemical incidents is adequate contingency planning. Local emergency planning committees are mandated under federal law to identify high-risk locations and to ensure adequate response planning and training. Planning requires the involvement of an array of community institutions, including fire and police departments, and community hospitals. Not every hospital in an area needs to have an emergency department capable of handling hazardous materials patients. In fact, many communities have centralized such services into one major area hospital or trauma center. However, all hospitals should be capable of performing decontamination and basic care since some patients may come in on their own and not through EMS systems. In addition, emergency department personnel must be knowledgeable about where to send patients for further specialized care.

THE SPECTRUM OF HAZARDOUS MATERIALS INCIDENTS


EMS agencies and hospitals should be able to participate in the response to a range of hazmat incidents from the individual level, through the multi-casualty, to the mass-casualty level. The hospital and emergency medical responders are key components of the local response system. Planning should integrate hospital personnel, equipment, and supply needs into state and local hazmat plans. In turn, the hospital must be familiar with these plans and know how to use them if it is involved in a incident that overwhelms its capabilities.
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Individual patient: A single individual is contaminated and must be transported to an emergency department:
;

Can occur in the workplace, in a public place, or at home. May pose a problem in rural areas with small hospitals, or where there are low levels of hazmat skills and experience among EMTs.

Multi-casualty: This situation is usually limited to a single location:


;

Involves normal systems of transportation. Patients are usually treated at the same level facility as a single emergency response, but the demand on all systems is much greater.

Mass-casualty: Disrupts a large segment of the community:


;

Involves several locations. Involves additional units to the normal responders (mutual aid); such units may not be part of the local EMS system, and these units may not know how the system works. Involves long-range mutual aid; normal systems of transportation (ambulances) are inadequate or disrupted. Patients may be treated locally at different facilities that provide various levels of care, or even outside of the area altogether.

While transportation incidents attract larger media attention, statistics show that almost 75 percent of all acute hazardous materials events, excluding fuel spills, occur in the fixed locations where the materials are used or stored. In addition, events resulting in death and injury occur almost 1.5 times as often in fixed locations as in transit. Hazardous materials incidents range from small releases at a factory site to rapidly expanding events that may endanger a community. Regardless of the size or location of an incident, its successful management depends on preplanning. This preplanning often requires coordination between local, state, and federal agencies, and industries, as well as those in the community who use and maintain stocks of potentially hazardous materials. Contributions to hazardous materials planning come from a variety of sources: regulations from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), state and local planning committees established under Title III of the Superfund Amendments and Reauthorization Act (SARA), state EMS agencies, and federal agencies.

JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS (JCAHO)


In drawing up contingency plans, hospital administrators have guidance available from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The JCAHO establishes standards that must be met before a hospital can receive accreditation. A comprehensive accreditation survey takes place once every three years, with intermittent evaluation(s) if a specific area of weakness is identified at the time of full review. While the JCAHO has in the past provided very specific guidelines relating to emergency department resources, handling of hazardous materials, and emergency preparedness, current JCAHO guidance takes the form of standards to be met. These standards allow hospitals more leeway in how specific goals are achieved.

SARA TITLE III


Title III of the 1986 Superfund Amendments and Reauthorization Act (SARA) provides for an infrastructure in states and local communities to plan for effective response to hazardous materials emergencies. The legislation also provides for public access to information on the presence and releases of specified hazardous chemicals in communities. Title III, The Emergency Planning and Community Right-to-Know Act of 1986, requires that each state establish a State Emergency Response Commission (SERC), consisting of members with technical expertise in emergency response, environmental and natural resources, public health, occupational safety, media, and transportation. The SERC is responsible for establishing local emergency planning districts (usually on a county level), appointing and overseeing local emergency planning committees (LEPCs), establishing procedures for handling public requests for information, and reviewing LEPC emergency plans. SARA Title III requires that the local committees include, at a minimum, representatives from the following groups: state and local officials, law enforcement, civil defense, firefighters, environmental, hospital, media, first aid, health, transportation, and facility owners or operators subject to the emergency planning requirements. LEPCs were primarily responsible for preparing a comprehensive emergency response plan for their districts by October 1988, using information about the presence of potentially hazardous chemicals reported by businesses and other facilities under Title III. LEPCs were also charged with making information on hazardous chemicals available to the public. As part of the planning process, each LEPC must evaluate available resources for developing, implementing, and exercising its plan. The plan must include:
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Identification of facilities subject to planning provisions under Title III Identification of transportation routes for extremely hazardous substances Identification of risk-related facilities Methods and procedures for response

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Designated community and facility coordinators Procedures for public notification Methods for determining release occurrence and the area affected Description of emergency equipment and facilities and those responsible for them Evacuation plans and training programs

Under Title III s planning provisions, EPA was mandated by Congress to establish a list of chemicals to help focus local emergency planning activities. In April 1987, EPA listed 406 Extremely Hazardous Substances (EHSs) and established a Threshold Planning Quantity (TPQ) for each. Any business or facility that contains one or more of these EHSs in an amount equal to or greater than its respective TPQ is required to notify the SERC and LEPC. These facilities must also appoint a coordinator to work with the LEPC for specific inclusion of that facility in the local plan. Representative facilities covered under the planning provisions include not only major chemical manufacturing facilities but a wide variety of chemical users, such as farmers, dry cleaners, and other service-related businesses. Exemptions under this provision apply only to vessels (ship/boat), federal facilities, and transportation operations. Storage incidental to transportation is exempt provided that the EHSs are still moving under active shipping papers and have not reached the final consignee. Accidental releases of EHSs and other hazardous materials identified in the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) must be reported to the LEPC and SERC. This requirement ensures immediate notification of local response personnel. Other provisions of Title III provide additional information on the presence, storage, and emissions of hazardous and toxic chemicals. These data further assist the LEPC in obtaining a comprehensive picture of chemical risk in the local district. Hospitals can be better prepared to respond to incidents that involve contaminated patients by actively participating in the LEPC planning process. Title III provides for the submission of information on hazardous and toxic chemicals as presented above. In addition, Title III contains a specific provision requiring facility owners or operators to disclose the chemical identity of substances for which companies have made trade secret claims. Access to chemical identities assists health professionals, physicians, and nurses in obtaining further information for diagnostic and treatment recommendations during emergencies, and for prevention and treatment measures during nonemergencies.

THE STATE EMERGENCY MEDICAL SERVICES (EMS) AGENCY


Planning for hazardous materials incidents should include the appropriate linkage to the state EMS agency. These state agencies are responsible for overseeing a network of local EMS units, and thus are an essential part of the planning process. This body is often part of the SERC. The duties of these agencies vary from state to state. However, EMS agencies usually are responsible for medical management and medical control of injured civilians and first responders. EMS agencies must develop medical mutual aid agreements between counties and establish procedures for distribution

of casualties among hospitals. In addition, EMS agencies should maintain an inventory of disaster medical supplies. EMS agencies should also develop and maintain communications protocols for onsite activities (e.g., between receiving hospitals and the base hospital, between base hospitals and ambulances, between all hospitals and the regional Poison Control Center). Further, EMS agencies must work with local and state officials in designating field casualty decontamination and collection points for a major disaster, and in arranging for the acquisition of additional equipment, supplies and pharmaceuticals. State planning activities include:
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Medical Direction: The local EMS agency or base hospital should be contacted for information on how medical control is provided for the EMS system. Patient Destination: Hospital emergency departments are able to provide supportive care. In some cases, however, it may be more appropriate to take the patient to a hospital that has expertise in handling certain kinds of poison exposures. The plan should include directions for obtaining this information. One option is to go through the regional Poison Control Center or through the base hospital. The Poison Center will often know which hospitals are best prepared to handle exposures to which substances. Decontamination and Medical Management Protocols: The literature on the clinical management of hazardous materials exposures is sometimes inconsistent in its recommendations. Provisions should be made in the plan for obtaining field and hospital medical management information from experienced physicians. For example, the regional Poison Control Center can provide decontamination and medical management protocols via fax or telephone to all receiving hospitals, and through the base hospital or via cellular telephone to EMTs in the field. The Poison Center also has rapid access to experts, including its own medical director, who is a medical toxicologist with training and experience in hazardous materials. Volume III in this series, Medical Management Guidelines for Acute Chemical Exposures, provides extensive information on many commonly encountered chemicals. Coordination with Burn Centers, Trauma Centers, Hyperbaric Chamber Facilities, and Other Specialty Centers: Provisions should be made to alert and coordinate patient destination with various specialty care centers.

FEDERAL EMERGENCY RESPONSE ACTIVITIES


Contingency planning is essential to the successful implementation of any system designed to manage chemically contaminated patients and to promptly contain the hazard itself. Contingency plans require a coordinated community response that may also involve state and federal agencies. Preplanning and coordination of services are equally critical at the national level. The federal government established a National Contingency Plan (NCP) to promote coordination of the resources and services of federal and state response systems. To oversee this plan, a National Response Team (NRT) and a National Response Center, a network of Regional Response Teams (RRTs), and a group of On-Scene Coordinators (OSCs) have been established.

The Hazardous Materials Emergency Planning Guide, referred to as NRT-1, provides guidance to help local communities prepare for potential hazardous materials incidents. NRT-1 can be used by local communities developing their own plans, as well as by LEPCs formed in accordance with the Emergency Planning and Community Right-to-Know Act of 1986 (SARA Title III). The objectives of the Hazardous Materials Emergency Planning Guide are to:
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Focus communities on emergency preparedness and response. Provide communities with information that can be used to organize the emergency planning task. Furnish criteria for risk and hazard assessments, and to assist communities in determining whether a hazardous materials incident plan is needed, in addition to the districtwide plan developed by the LEPC. Help LEPCs and individual communities prepare a plan that is appropriate for their needs and consistent with their capabilities. Provide a method for revising, testing, and maintaining community emergency plans.

NRT-1 is published by the National Response Team, and was developed cooperatively by its federal member agencies, including the Department of Defense, Department of the Interior, Department of Transportation, U.S. Coast Guard, Environmental Protection Agency (EPA), Department of Commerce (National Oceanic and Atmospheric Administration [NOAA]), Federal Emergency Management Agency (FEMA), Department of State, Department of Agriculture, Department of Health and Human Services (Agency for Toxic Substances and Disease Registry [ATSDR]), Department of Justice, General Services Administration (GSA), Department of the Treasury, Department of Labor (Occupational Safety and Health Administration [OSHA]), Nuclear Regulatory Commission (NRC), and the Department of Energy (DOE). NRT-1 represents a concerted effort by federal agencies to consolidate their general hazardous materials planning guidance into an integrated federal document. NRT-1 states that an emergency plan must include response procedures for facilities and local emergency and medical personnel, as well as a description of emergency equipment and facilities in the community. It also recommends that hospital, emergency medical service, and health department personnel be included as members of an emergency planning team. As previously mentioned, SARA Title III requires medical, hospital, and first aid personnel to be members of the local emergency planning committee. NRT-1 describes relevant publications that provide specific operational guidance to emergency responders, such as the DOT s North American Emergency Response Guidebook (NAERG), which provides guidance for firefighters, police, and other emergency services personnel to help them protect themselves and the public during the initial minutes immediately following a hazardous materials incident. In addition, the document provides information on the Chemical Manufacturers Association s (CMA) Community Awareness Emergency Response (CAER) and Chemical Transportation Emergency Center (CHEMTREC) programs. The CAER program encourages local chemical manufacturing facilities to inform area residents, public officials, and emergency response organizations about industry operations and to integrate their onsite emergency response plans with the planning efforts

of the local community. In some areas of the country, the chemical industry has established physician networks to encourage better dialogue between company physicians and local health authorities. CAER has outlined specific steps for industrial plants:
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Review the plant s emergency plan Improve employee awareness and training Prepare a community relations plan Inventory the status of local emergency planning Develop a briefing paper Prepare a list of initial contacts Meet with initial contacts and identify key officials Establish a coordinating group Begin implementation steps

On the federal level, EPA and FEMA provide technical assistance and guidance to local and state planners through the SARA Title III program. The NRT-1 document also recommends that contingency plans include standard operating procedures for entering and leaving sites, accountability for personnel entering and leaving sites, decontamination procedures, recommended safety and health equipment, and personal safety precautions. The document suggests that emergency plans include a list of emergency response equipment appropriate to the various degrees of hazard based on EPA s four levels of protection (Levels A through D; see Section II). Further, it recommends that the list include the type of respirator (i.e., self-contained breathing apparatus, supplied-air respirator, or air-purifying respirator) that should be used, the type of clothing that must be worn, and the equipment needed to protect the head, eyes, face, ears, hands, arms, and feet. In addition, NRT-1 recommends that medical personnel be made aware of significant chemical hazards in the community to prepare for possible hazardous materials incidents. It also states that emergency medical teams and hospital personnel must be trained in the proper methods for decontaminating and treating individuals exposed to hazardous chemicals.

HAZARD ANALYSIS
Hazard analysis is a necessary component of comprehensive emergency planning for a community. It is a three-step decisionmaking process comprised of hazard identification, vulnerability analysis, and risk analysis. This section focuses primarily on hazard identification. The first task in conducting such an analysis is to complete an inventory of the hazardous materials present in the community and to determine the nature of the hazard. This is a key step because it permits planners to describe and evaluate risks and to allocate resources accordingly. However, the

task of analyzing all relevant hazards may not prove cost effective for many communities. The planning committee should, therefore, assign priorities to the hazards found in its community and establish affordable limits for analysis. It should be noted that several federal agencies (e.g., DOT, FEMA, EPA) report that frequently encountered substances often pose the most prevalent dangers. These materials include fuels and chemicals, such as chlorine, ammonia, and hydrochloric and sulfuric acids. Such materials should be given special attention by the LEPC in the planning process. In this context, a hazard is any situation that is capable of causing injury or impairing an individual s health. During the process of identifying hazards, facilities or transportation routes will be pinpointed that contain materials that are potentially dangerous to humans. The identification of hazards also should provide information on: (1) the types, quantities, and locations of hazardous materials in the community, or transported through a community; and (2) the nature of the hazard that would accompany incidents, such as explosions, spills, fires, and venting to the atmosphere. Hazards should be identified at as many facilities in the community as possible. These include the obvious ones such as chemical plants, refineries, petroleum plants, storage facilities, and warehouses. In requesting information directly from facilities, remember that the planning provisions under SARA Title III require certain facilities to provide the LEPC with any information on the facility that the committee needs to develop and implement its plan. The LEPCs may provide assistance here, particularly if the committee includes industry representatives. It is essential that these industries or businesses understand the role this information plays in ensuring a sound emergency response plan. As previously stated, placing business or industrial representatives on the communitywide planning committee, as required under SARA Title III, should facilitate their cooperation. The assistance and cooperation of a facility that regularly deals with hazardous materials also presents the local planning unit with a wide array of services. For example, such a facility can provide technical experts, Spill Prevention Control and Countermeasure (SPCC) plans, training and safe handling instructions, and cleanup capabilities. In identifying hazards, hospitals and educational and governmental facilities should not be overlooked since they all contain a variety of chemicals. Major transportation routes and transfer points, such as airports, vessels in port, railroad yards, and trucking terminals, should also be included in the overall hazards identification plan. SARA Title III planning provisions address many of these potential transportation risk areas by requiring facility cooperation in plan preparation and by including specific risk areas as well as a wide range of chemical handlers, from manufacturers to service-related businesses. Risk analysis includes the probable damage that may occur if a chemical incident occurs. Information that is necessary for risk analysis includes:
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The type of risk to humans, such as an acute, chronic, or delayed reaction The groups that are most at risk The type of risk to the environment, such as permanent damage or a recoverable condition

Many documents can be of assistance in conducting a risk analysis. Risk analysis in transportation settings is outlined in the DOT s Community Teamwork: Working Together To Promote Hazardous Materials Safety, A Guide for Local Officials. In conjunction with FEMA and DOT, EPA published a supplement to NRT-1 in December 1987. This document, entitled Technical Guidance for Hazardous Analysis and often referred to as the Green Book, provides technical assistance to LEPCs in assessing the lethal hazards associated with potential airborne releases of extremely hazardous substances.

SELECTED BIBLIOGRAPHY
Auf der Heide, E. 1989. Disaster Response: Principles of Preparation and Coordination. St. Louis, MO: Mosby. Fire Protection Publications. 1983. Incident Command System. Stillwater, OK: Oklahoma State University Press. National Emergency Training Center. 1998. Guidelines for Public Sector Hazardous Materials Training. Emmitsburg, MD: HEMP Curriculum Guidelines. National Fire Protection Association. 1992. Recommended Practice for Responding to Hazardous Materials Incidents, NFPA 471. Quincy, MA: National Fire Protection Association. National Fire Protection Association. 1992. Standards for Professional Competence of Responders to Hazardous Materials Incidents, NFPA 472. Quincy, MA: National Fire Protection Association. National Fire Protection Association. 1997. Standards for Professional Competence of EMS Responders to Hazardous Materials Incidents, NFPA 473. Quincy, MA: National Fire Protection Association. National Response Team. 1987. Hazardous Materials Emergency Planning Guide. Washington, DC: Government Printing Office. Noll, G.G., M.S. Hildebrand, and J.G. Yvonna. 1995. Hazardous Materials: Managing the Incident. 2nd. ed. Stillwater, OK: Fire Protection Publications. SARA Title III Compliance Guidebook. 1988. Government Institutes, Inc. ISBN: 0-86587-749-1. U.S. Department of Transportation. 1983. Community Teamwork: Working Together To Promote Hazardous Materials Safety, A Guide for Local Officials. Washington, DC: Government Printing Office. U.S. Department of Transportation. 1996. North American Emergency Response Guidebook. Washington, DC: Government Printing Office. [available in English, Spanish and French][http://hazmat.dot.gov/gydebook.htm] U.S. Environmental Protection Agency. 1992. EPA Standard Safety Operating Guidelines. Washington, DC: Government Printing Office.

U.S. Environmental Protection Agency and U.S. Federal Emergency Management Agency. 1987. Technical Guidance for Hazardous Analysis: Emergency Planning for Extremely Hazardous Substances. Washington, DC: Environmental Protection Agency. U.S. Federal Emergency Management Agency. 1981. Planning Guide and Checklist for Hazardous Materials, FEMA-10. Washington, DC: Government Printing Office. U.S. Federal Emergency Management Agency. 1985. Guide for Development of State and Local Emergency Operations Plan. Washington, DC: Government Printing Office. U.S. Federal Emergency Management Agency. 1996. Guide for all Hazard Emergency Operations Planning. Washington, DC: Government Printing Office. U.S. National Institute for Occupational Safety and Health and U.S. Occupational Safety and Health Administration. 1997. Pocket Guide to Chemical Hazards. Washington, DC: Government Printing Office.

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Section II.

Emergency Department Response to Hazardous Materials Incidents

HAZARD RECOGNITION
When dispatched to the scene of an incident, emergency response personnel may not be aware that the situation involves hazardous materials. As a result, emergency department personnel should always be alert to the possibility that they may be dealing with a chemically contaminated individual, and they should ask incident victims and prehospital personnel about the nature of the event. Emergency departments should also be prepared for exposed patients who arrive unannounced in privately-owned vehicles. Patients may also originate from situations occurring within the hospital. An injury at a hazardous materials incident need not invariably involve chemical exposure: it could have resulted from a physical accident, such as slipping off a ladder. But as a routine precaution, the involvement of hazardous materials should be considered a possibility in such situations. The manual Recognizing and Identifying Hazardous Materials (produced by the National Fire Academy and the National Emergency Training Center) states that there are six primary clues that may signify the presence of hazardous materials. These clues are included below to facilitate and expedite the prompt and correct identification of any hazardous materials at the scene of an incident. Hospital emergency department personnel who are familiar with these clues will find their communication with field personnel enhanced. For example, patient symptoms reported from the field such as nausea, dizziness, itching and burning eyes or skin, or cyanosis could suggest to hospital staff the presence of hazardous materials. They could then request field personnel to examine the site for these six clues:
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Occupancy and Location. Community preplanning should identify the specific sites that contain hazardous materials. In addition, emergency personnel should be alert to the obvious locations in their communities that use and/or store hazardous materials (e.g., laboratories, factories, farm and paint supply outlets, construction sites). The Department of Labor s Material Safety Data Sheets (MSDSs) should also be available, especially for any particularly dangerous chemicals kept on site. It should be kept in mind, however, that these data sheets may have incomplete information and that the medical information provided is generally at a basic first aid level. Container Shape. Department of Transportation (DOT) regulations delineate container specifications for the transport of hazardous materials. There are three categories of packaging: stationary bulk storage containers at fixed facilities that come in a variety of sizes and shapes; bulk transport vehicles, such as rail and truck tank cars, that vary in shape depending upon the cargo; and labeled fiberboard boxes, drums, or cylinders for smaller quantities of hazardous materials. The shape and configuration of the container can often be a useful clue to the presence of hazardous materials.

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Markings/Colors. Certain transportation vehicles must use DOT markings, including identification (ID) numbers. Identification numbers, located on both ends and both sides, are required on all cargo tanks, portable tanks, rail tank cars, and other packages that carry hazardous materials. Railcars may have the names of certain substances stenciled on the side of the car. A marking scheme designed by the National Fire Protection Association (NFPA 704M System) identifies hazard characteristics of materials at terminals and industrial sites, but does not provide product-specific information. This system uses a diamond divided into four quadrants. Each quadrant represents a different characteristic: the left, blue section refers to health; the top, red quarter pertains to flammability; the right, yellow area is for reactivity; and the bottom, white quadrant highlights special information (e.g., W indicates dangerous when wet, Oxy stands for oxidizer). A number from zero through four in each quadrant indicates the relative risk of the hazard, with zero representing the minimum risk. This system does not indicate what the product is, the quantity, or its exact location. In addition, it does not reveal the compound s reactivity with other chemicals. The military also uses distinctly shaped markings and signs to designate certain hazards. These markings may be found on vehicles, on the products themselves, or on shipping papers. Placards/Labels. These convey information through use of colors, symbols, Hazard Communication Standards, American National Standard Institute (ANSI) Standards for Precautionary Labeling of Hazardous Industrial Chemicals, United Nations Hazard Class Numbers, and either hazard class wording or four-digit identification numbers. Placards are used when hazardous materials are being stored in bulk (usually over 1,001 lb), such as in cargo tanks. Labels designate hazardous materials kept in smaller packages. Caution must be exercised, however, because the container or vehicle holding a hazardous material may be improperly labeled or recorded, or it may not have any exterior warning. Shipping Papers. Shipping papers can clarify what is labeled as dangerous on placards. They should provide the shipping name, hazard class, ID number, and quantity, and may indicate whether the material is waste or poison. Shipping papers, which must accompany all hazardous material shipments, are now required to list a 24-hour emergency information telephone number. The location where the shipping papers are stored can be problematical; often they are found in close proximity to the hazardous material(s) or in other locations not easily accessible during an emergency. Shipping papers should remain at the incident scene for use by all response personnel. Senses. Odor, vapor clouds, dead animals or fish, fire, and skin or eye irritation can signal the presence of hazardous materials. Generally, if one detects an odor of hazardous materials, it should be assumed that exposure has occurred and the individual is still in the danger area, although some chemicals have a detectable odor at levels below their toxic concentrations. Some chemicals, however, can impair an individual s sense of smell (e.g., hydrogen sulfide), and others have no odor, color or taste at all (e.g., carbon monoxide). Binoculars are helpful to ascertain visible information from a safe distance.

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Appendix A provides greater detail on the NFPA s 704M system; the DOT s hazardous materials marking, labeling, and placarding guide; and the Department of Labor s MSDS. It is important that any and all available clues are used in substance identification, especially obvious sources such as the information provided on a label or in shipping papers. The aim of the health provider should be to make a chemical-specific identification while exercising caution to prevent exposure to any chemicals. Identifying the hazardous material and obtaining information on its physical characteristics and toxicity are vital steps to the effective management of a hazardous materials incident. Since each compound has its own unique set of physical and toxicological properties, early and accurate identification of the hazardous material(s) involved allows emergency personnel to initiate appropriate management steps. Many resources are available to provide information concerning response to and planning for hazardous materials incidents. All such information, however, needs to be interpreted with respect to the specific release scenario. A selected bibliography of written material is included at the end of each section of this guidebook; it is not, however, a complete list of the materials available. Printed reference materials provide several advantages: they are readily available, they can be kept in the response vehicle, they are not dependent on a power source or subject to malfunction, and they are relatively inexpensive. Disadvantages include the difficulty of determining the correct identity for an unknown chemical through descriptive text, the logistics of keeping the materials current, and the problem that no single volume is capable of providing all the information that may be needed. There is also a vast array of telephone and computer-based information sources concerning hazardous materials. They can help by describing the toxic effects of a chemical, its relative potency, and the potential for secondary contamination. They may also recommend decontamination procedures, clinical management strategies, and advice on the adequacy of specific types of protective gear. Exhibit II-1A is a partial listing of the many information resources available by telephone. Exhibit II-1B is a list of suggested telephone numbers that should be filled in for your community, including the regional Poison Control Center, which is a ready source of information 24 hours a day. Exhibit II-2 provides a partial listing of computerized and online information sources. Note, however, that not all online databases are peer reviewed; for example, some medical management information may be based only on DOT or MSDS data. Care and planning should be used when selecting information sources. Planning is an essential part of every response, and many of these resources can provide guidance in the formation of an effective response plan.

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Exhibit II-1A Telephone Information and Technical Support References


Resource
Chemical Transportation Emergency Center (CHEMTREC)

Contact

Services Provided

1-800-424-9300

24-hour emergency number connecting with manufacturers and/or shippers. Advice provided on handling, rescue gear, decontamination considerations, etc. Also provides access to the Chlorine Emergency Response Plan (CHLOREP).

Agency for Toxic Substances and Disease Registry (ATSDR) 1-404-639-6360

24-hour emergency number for healthrelated support in hazardous materials emergencies, including onsite assistance. Contact number for technical questions about railway transport of hazardous materials. For emergencies, call CHEMTREC (1-800-424-9300). Available 9:00 a.m. to 6:00 p.m. (EST). Provides information on SARA Title III, list of extremely hazardous substances, and planning guidelines.

Bureau of Explosives

1-719-585-1881

Emergency Planning and Community 1-800-424-9346 Right-to-Know Act (EPCRA) and Resource Conservation and Recovery Act (RCRA) Information Hotline Environmental Protection Agency (EPA) Regional Offices Region I (CT, ME, MA, NH, RI, VT) Region II (NJ, NY, PR, VI) Region III (DE, DC, MD, PA, VA, WV)

Region IV (AL, FL, GA, KY, MS, NC, SC, TN)

Region V (IL, IN, MI, MN, OH, WI) Region VI (AR, LA, NM, OK, TX) Region VII (IA, KS, MO, NE) Region VIII (CO, MT, ND, SD, UT, WY) Region IX (AZ, CA, HI, NV; Pacific Islands AS, FM, GU, MH, MP, PW) Region X (AK, ID, OR, WA)

website: Environmental response teams www.epa.gov/regional available for technical assistance. 1-617-918-1111 1-212-637-3000 1-215-814-2900; intra-regional only: 1-800-438-2474 1-404-562-9900; Emergency Response & Removal Branch: 1-800-564-7577 1-312-353-2000 1-214-665-2200 1-913-551-7003 1-303-312-6312 1-415-744-1500; emergencies: 1-415-744-2000 1-206-553-1200

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Exhibit II-1A (continued)

Resource
National Animal Poison Control Center

Contact
1-800-548-2423 1-888-426-4435

Services Provided
24-hour consultation services concerning animal poisonings or chemical contami nation. Provides an emergency response team to investigate incidents and to perform laboratory analysis. Contact information for help in searching NPIRS database to get fact sheets on pesticides, insecticides, fungicides, and state and federally registered chemicals. Provides information about pesticide-Network related topics, including pesticide products, recognition and management of pesticide poisoning, toxicology, environmental chemistry, referrals for laboratory analyses, investigation of pesticide incidents, emergency treatment, safety, health and environmental effects, cleanup, and disposal procedures. A federal hotline for reporting oil and chemical spills where hazardous materials are responsible for death, serious injury, property damage in excess of $50,000, or continuing danger to life and property. 24-hour consultation service for threats and releases pertaining to chemical and biological agents.

National Pesticides Information Retrieval System (NPIRS)

1-765-494-6616 website: ceris.purdue.edu/npirs

National Pesticide Telecommunications (NPTN) (Oregon State University)

1-800-858-7378 website: ace.orst.edu/info/nptn

National Response Center

1-800-424-8802

U.S. Army Soldier and Biological Chemical Command (SBCCOM)

1-800-368-6498

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Exhibit II-1B Local Telephone Information and Technical Support Resource Worksheet
Resource Contact (fill in for future reference) Services Provided (fill in for future reference)

EPA Regional or State Office Regional Poison Control Center State Emergency Response Commission State Health Department State Emergency Management Office Local Fire Department Local Hazardous Materials Response Team Community Police Department Local Emergency Planning Committee Local Health Department State Department of Natural Resources FEMA Regional Office State Agriculture Office State Lab Office State EMS Office Hyperbaric Medicine Chamber Burn Center CDC U.S. Army Soldier and Biological Chemical Command

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Exhibit II-2 Computerized Data Sources for Information and Technical Support
Data System
CAMEO

Contact
CAMEO Database Manager 7600 Sand Point Way, N.E. Seattle, Washington 98115 (206) 526-6317 website: www.epa.gov/ceppo/cameo

Description
Computer-aided management of National Oceanic and Atmospheric Administration (NOAA) operations available to on-scene responder(s). Chemical identification database assists in Hazardous Materials Response Division determining substance(s) involved, predicting downwind concentrations, providing response recommendations, and identifying potential hazards. Chemical Hazard Response Information System, developed by the Coast Guard and comprised of reviews on fire hazards, fire-fighting recommendations, reactivities, physicochemical properties, health hazards, use of protective clothing, and shipping information for over 1,000 chemicals.

CHRIS

CIS, Inc. c/o Oxford Molecular Group 11350 McCormick Road Executive Plaza, Suite 1100 Hunt Valley, Maryland 21031 (800) 247-8737 website: www.oxmol.com/software/cis/ details/CHRIS.shtml Micromedex, Inc. Suite 300 6200 S. Syracuse Way Englewood, Colorado 80111-4740 (800) 525-9083 website: www.micromedex.com/products/ pd-main.htm Kevin Coburn Information Systems Manager U.S. Department of Transportation D.H.M. 63 - Room 8104 400 7th Street SW Washington, D.C. 20590-0001 website: www.dlis.dla.mil/hmis.htm HSDB Representative National Library of Medicine Specialized Information Systems 8600 Rockville Pike Bethesda, Maryland 20894 (301) 496-6531 website: sis.nlm.nih.gov/sis1

HAZARDTEXT

Assists responders dealing with incidents involving hazardous materials, such as spills, leaks, and fires. Provides information on emergency medical treatment and recommendations for initial hazardous response.

HMIS

Hazardous Material Information Systems contains information on hazardous materials. Transportation-related incidents may be reported on DOT form 5800.1 (Hazardous Materials Incident Report Form).

HSDB

Hazardous Substances Data Bank, compiled by the National Library of Medicine, provides reviews on the toxicity, hazards, and and regulatory status of over 4,000 frequently used chemicals.

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Exhibit II-2 (continued)

Data System

Contact

Description
Helps develop training programs and establish protocols for first aid or initial workplace response to a medical emergency.

1st MEDICAL RESPONSE Micromedex, Inc. PROTOCOLS Suite 300 6200 S. Syracuse Way Englewood, Colorado 80111 (800) 525-9083 website: www.micromedex.com/products/ pd-main.htm MEDITEXT Micromedex, Inc. Suite 300 6200 S. Syracuse Way Englewood, Colorado 80111 (800) 525-9083 website: www.micromedex.com/products/ pd-main.htm Oxford Molecular Group, Inc. 11350 McCormick Rd. Executive Plaza 3, Suite 1100 Hunt Valley, Maryland 21031 (800) 247-8737 website: www.oxmol.com/software/cis/ details/OHMTADS.shtml Micromedex, Inc. Suite 300 6200 S. Syracuse Way Englewood, Colorado 80111 (800) 525-9083 website: www.micromedex.com/products/ pd-main.htm

Provides recommendations regarding the evaluation and treatment of exposure to industrial chemicals.

OHMTADS

Oil and Hazardous Materials/Technical Assistance Data Systems provides information on the effects of spilled chemical compounds and their hazardous characteristics and properties, assists in identifying unknown substances, and recommends procedures for handling cleanups. The Tomes Plus Information Systems is a series of comprehensive databases on a single CD-ROM disc. It provides information regarding hazardous properties of chemicals and medical effects from exposure. The Tomes Plus database contains Meditext, Hazardtext, HSBD, CHRIS, OHMTADS, and 1st Medical Response Protocols. A computerized system of three toxicologically oriented data banks operated by the National Library of Medicine the Hazardous Substances Data Bank, the Registry of Toxic Effects of Chemical Substances, and the Chemical Carcinogenesis Research Information System. TOXNET provides information on the health effects of exposure to industrial and environmental substances.

TOMES

TOXNET

Toxicology Data Network (TOXNET) National Library of Medicine Specialized Information Services 8600 Rockville Pike Bethesda, Maryland 20894 (301) 496-6531 website: sis.nlm.nih.gov/sis1

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PRINCIPLES OF TOXICOLOGY FOR EMERGENCY DEPARTMENT PERSONNEL


Exposure to hazardous chemicals may produce a wide range of adverse health effects. The likelihood of an adverse health effect occurring, and the severity of the effect, are dependent on: (1) the toxicity of the chemical; (2) the route of exposure; (3) the nature and extent of exposure; and (4) factors that affect the susceptibility of the exposed person, such as age and the presence of certain chronic diseases. To better understand potential health effects, emergency department personnel should understand the basic principles and terminology of toxicology. Toxicology is the study of the nature, effects, and detection of poisons in living organisms. Examples of these adverse effects, sometimes called toxic end points, include carcinogenicity (development of cancer), hepatotoxicity (liver damage), neurotoxicity (nervous system damage), and nephrotoxicity (kidney damage). This is merely a sample list of toxic end points that might be encountered (Exhibit II-3). Toxic chemicals often produce injuries at the site which they come into contact with the body. A chemical injury at the site of contact, typically the skin and the mucous membranes of the eyes, nose, mouth, or respiratory tract, is termed a local toxic effect. Irritant gases such as chlorine and ammonia can, for example, produce a localized toxic effect in the respiratory tract, while corrosive acids and bases can result in local damage to the skin. In addition, a toxic chemical may be absorbed into the bloodstream and distributed to other parts of the body, producing systemic effects. Many

Exhibit II-3 Examples of Adverse Health Effects from Exposure to Toxic Chemicals
Toxic End Point Target Organ Systems Example of Causative Agent
Benzene

Health Effect Acute

Health Effect Chronic

Carcinogenicity

Multiple sites

Dermatitis

Acute myelogenous Chest tightness leukemia Dizziness Headache Liver necrosis Abdominal pain Fatty liver Dizziness Rash Wrist drop Vomiting IQ deficits Abdominal pain Encephalopathy Kidney damage Diarrhea Anemia Chest pain

Hepatotoxicity

Liver

Carbon tetrachloride

Vomiting

Neurotoxicity

Nervous system

Lead

Nausea

Nephrotoxicity

Kidney

Cadmium

Vomiting

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pesticides, for example, are absorbed through the skin, distributed to other sites in the body, and produce adverse effects such as seizures or cardiac, pulmonary, or other problems. It is important for medical providers to recognize that exposure to chemical compounds can result not only in the development of a single systemic effect but also in the development of multiple systemic effects or a combination of systemic and local effects. Some of these effects may be delayed, sometimes for as long as 48 or more hours. Health effects can also be acute or chronic. Acute health effects are short-term effects that manifest within hours or days, such as vomiting or diarrhea. Chronic health effects are long-term effects that may take years to manifest, such as cancer.

Routes and Extent of Exposure


There are three main routes of chemical exposure: inhalation, dermal contact (with skin or mucous membranes), and ingestion. Inhalation results in the introduction of toxic compounds into the respiratory system, and potentially into the bloodstream. Most of the compounds that are commonly inhaled are gases or vapors of volatile liquids. However, solids and liquids can be inhaled as dusts or aerosols. Inhalation of toxic agents generally results in a rapid and effective absorption of the compound into the bloodstream because of the large surface area of the lung tissue and number of blood vessels in the lungs. Knowing a chemical s vapor pressure (VP) can be useful in determining the inhalation risk for a particular exposure. The lower the VP, the less likely the chemical will produce an inhalable gas and vice versa. Water solubility is also an important contributor for symptom development. Irritant agents that are water soluble usually cause early upper respiratory tract irritation, resulting in coughing and throat irritation. Partially water-soluble chemicals penetrate into the lower respiratory system causing delayed symptoms (12 to 24 h) which include trouble breathing, pulmonary edema, and coughing up blood. Asphyxiants are chemicals that impede the body s ability to obtain or utilize oxygen. Simple asphyxiants are inert gases (e.g., argon, propane, nitrogen) that displace oxygen in inspired air. Chemical asphyxiants produce harm by preventing oxygen delivery or utilization for energy production by the body s cells. Carbon monoxide and cyanide are examples of asphyxiants. Dermal contact does not typically result in as rapid absorption as inhalation, although some chemicals are readily taken in through the skin. Many organic compounds are lipid (fat) soluble and can therefore be rapidly absorbed through dermal exposure. Some materials that come in contact with the eyes can also be absorbed. Ingestion is a less common route of exposure for emergency response personnel at hazardous materials incidents. However, incidental hand-to-mouth contact, smoking, and swallowing of saliva and mucus that contains contaminants may also result in exposure by this route. In addition, emergency medical personnel in both hospital or prehospital settings treat chemical exposures in patients who have ingested toxic substances as a result of accidental poisonings or suicide attempts. Compounds may also be introduced into the body through injection, although this is an unlikely route of exposure in spills or discharges of hazardous materials. Explosions may result in injection injuries and lead to imbedded foreign bodies, which may themselves be chemically contaminated. The route by which personnel are exposed to a compound plays a role in determining the total amount of the substance taken up by the body because a compound may be absorbed by one route more readily than by another. In addition, the route of exposure may affect the nature of the symptoms that develop. The amount of the compound absorbed by the body also depends on the duration of exposure and the concentration of the compound to which one is exposed.

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It is important to recognize that children may be more susceptible to many toxic exposures, in part because they are likely to receive a higher dose relative to body weight than an adult. This occurs for a number of reasons. First, children are shorter than adults and since most toxic gases are heavier than air, the concentrations increase as you get closer to the ground. Children s immature central nervous system, liver, and renal system also increase their susceptibility to injury as a result of exposure to chemicals. In addition, children have a larger lung surface area relative to their weight than adults, as well as a greater respiratory volume (liters/min/kg of body weight). It is probable that the child s lung is a more effective absorbent surface than that of the adult. Children also have a larger skin area relative to their weight than do adults, allowing more effective surface area for absorption in dermal exposures. A child s skin is also more easily penetrated by chemicals, allowing for more rapid and effective dermal absorption. Finally, children are more likely to ingest toxic chemicals because of increased hand-to-mouth behavior, including pica. All of these factors may lead to an increased dose relative to size in children as compared to adults, even when they all are exposed to the same scenario. A complex relationship exists between the total amount of the compound absorbed by the body (dose) and the concentration of that compound in the environment. This relationship is important for emergency medical personnel to understand because the adverse effects produced by a toxic compound are usually related to the dose of that compound received by a patient. However, because we usually only monitor the concentration of the toxic substance in the environment (e.g., parts per million (ppm) of a compound in air), the actual dose of the compound received by the patient is seldom known. Factors specific to the exposed patient, such as area of skin surface exposed, presence of open wounds or breaks in the skin, and the rate and depth of respirations, are important in estimating the dose of the compound received by the patient.

Dose-Response Relationship
The effect produced by a toxic compound is primarily a function of the dose of the compound. This principle, termed the dose-response relationship, is a key concept in toxicology. Many factors affect the normal dose-response relationship and they should be considered when attempting to extrapolate toxicity data to a specific situation (Exhibit II-4). Typically, as the dose increases, the severity of the toxic response increases. Humans exposed to 100 ppm of tetrachloroethylene, a solvent that is commonly used for dry-cleaning fabrics, may experience relatively mild symptoms, such as headache and drowsiness. However, exposure to 200 ppm tetrachloroethylene can result in a loss of motor coordination in some individuals, and exposure to 1,500 ppm for 30 minutes may result in a loss of consciousness (Exhibit II-5). As shown in Exhibit II-5, the severity of the toxic effect also depends on the duration of exposure, a factor that influences the dose of the compound in the body.

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Exhibit II-4 Classification of Factors Influencing Toxicity


Type
Factors related to the chemical

Examples
Composition (salt, freebase, etc.); physical characteristics (size, liquid, solid, etc.); physical properties (volatility, solubility, etc.); presence of impurities; breakdown products; carriers Dose; concentration; route of exposure (inhalation, ingestion, dermal); duration Heredity; immunology; nutrition; hormones; age; sex; health status; preexisting diseases; pregnancy Media (air, water, soil, etc.); additional chemicals present; temperature; humidity; air pressure; and fire

Factors related to exposure

Factors related to the exposed person

Factors related to environment

Exhibit II-5 Dose-Response Relationship for Humans Inhaling Tetrachloroethylene Vapors


Levels in Air
50 ppm 100 ppm 200 ppm 600 ppm 1,000 ppm 7 hours 2 hours 10 minutes 1-2 minutes

Duration of Exposure

Effects on Nervous System


Odor threshold Headache, drowsiness Dizziness, uncoordination Dizziness, loss of inhibitions Marked dizziness, intolerable eye and respiratory tract irritation Coma

1,500 ppm

30 minutes

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Toxicity information is often expressed as the dose of a compound that causes an effect in a percentage of the exposed subjects, which are usually experimental animals. These dose-response terms are often found in the Material Safety Data Sheets (MSDSs) and other sources of health information. One dose-response term that is commonly used is the lethal dose 50 (LD50). This is the dose that is lethal to 50 percent of an animal population from exposure by a specific route (except inhalation) when given all in one dose. A similar term is the lethal concentration 50 (LC50), which is the concentration of a material in air that on the basis of respiratory exposure in laboratory tests is expected to kill 50 percent of a group of test animals when administered as a single exposure (usually 1 hour). Exhibit II-6 lists a number of chemicals that may be encountered in dealing with hazardous materials incidents, and the reported acute LD50 values of these compounds when they are administered by ingestion to rats. From Exhibit II-6 it can be seen that a dose of 3,000 to 3,800 mg/kg tetrachloroethylene is lethal to 50 percent of rats that received the compound orally; however, only 6.4 to 10 mg/kg of sodium cyanide is required to produce the same effect. Therefore, compounds with low LD50 values are more acutely toxic than substances with higher LD50 values. The LD50 values that appear in an MSDS or in the literature must be used with caution by emergency medical personnel. These values are an index of only one type of response and give no indication of the ability of the compound to cause nonlethal, adverse or chronic effects. They also do not reflect possible additive effects from the mixture of chemicals sometimes found with exposure to hazardous materials. Furthermore, LD50 values typically come from experimental animal studies. Because of the anatomical and physiological differences between animals and humans, it is difficult to compare the effects seen in experimental animal studies to the effects expected in humans exposed to hazardous materials in the field. LC50 and LD50 values are also usually determined in healthy adult animals. Values determined in young animals may be quite different, as may values determined in animals with an underlying disease. It is known that many chemicals are more toxic (lower LD50 or LC50 values) in young or newborn animals than in adults. This same age dependence may exist in humans. Because several organs, particularly the brain, are still developing in young children, damage to these organs may be more extensive and can be permanent. Also, infants may not be able to excrete chemicals from the body as efficiently as adults because their kidneys and liver are not fully developed. This may lead to longer and greater exposure to the chemical than would occur in an adult with the same relative exposure. The immaturity of metabolizing enzymes in the liver may lead to either increased or decreased toxicity in infants relative to adults. Which may occur is difficult to predict for many chemicals. Therefore, emergency medical personnel should remember that the LD50 and LC50 values are only useful for comparing the relative approximate toxicity of compounds.

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Exhibit II-6 Acute LD50 Values for Representative Chemicals When Administered Orally to Rats
Chemical Acute Oral LD50 (mg/kg)1
6.4-10 50-230 83-560 88-91 2,600-7,000 3,000-3,800

Sodium cyanide Pentachlorophenol Chlordane Lindane Toluene Tetrachloroethylene

Milligrams of the compound administered per kilogram body weight of the experimental animal.

Responses to toxic chemicals may differ among individuals because of the physiological variability that is present in the human population. Some individuals, for example, are more likely to experience adverse health effects after exposure to a toxic chemical because of a reduced ability to metabolize that compound. The presence of preexisting medical conditions (e.g., pulmonary, hepatic, or renal disease, diabetes) can also increase one s susceptibility to toxic chemicals. Respiratory distress in people with asthma may be triggered by exposure to toxic chemicals at lower concentrations than might be expected to produce the same effect in individuals without respiratory disease. Factors such as age, personal habits (e.g., smoking, diet), previous exposure to toxic chemicals, and medications may also increase an individual s sensitivity to toxic chemicals. Therefore, exposure to concentrations of toxic compounds that would not be expected to result in the development of a toxic response in most people may cause an effect in susceptible individuals. Not all chemicals, however, have a threshold level. Some carcinogens (cancer-causing chemicals) may produce a response (tumors) at any dose level, and any exposure to these compounds may be associated with some risk of developing cancer. Thus, literature values for levels that are not likely to produce an effect do not guarantee that an effect will not occur.

Exposure Limits
The various occupational exposure limits found in the literature or on an MSDS are based primarily on time-weighted average limits, ceiling values, or ceiling concentration limits to which the worker can be exposed without adverse effects. Examples of these limits are listed in Exhibit II-7A.

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The values listed in Exhibit II-7A were established to provide worker protection in occupational settings. Because the settings in which these values are appropriate are quite different than an uncontrolled spill site, it is difficult to interpret how these values should be used by emergency medical personnel when dealing with a hazardous materials incident. These values are designed for a healthy adult working population and have limited utility when applied to some of the at risk groups mentioned previously. At best, TLV, PEL, IDLH, and REL values can be used as benchmarks for determining relative toxicity, and perhaps to assist in selecting appropriate levels of personal protective equipment (PPE). Furthermore, these occupational exposure limits are only useful if trained personnel and appropriate instrumentation are available for measuring the levels of toxic chemicals in the air at the spill site. Of the occupational exposure limit values shown in Exhibit II-7A, only the OSHA values are regulatory limits. The ACGIH values are for guidance only and are not regulatory limits. In addition, the ACGIH limits have certain caveats that may or may not affect the usefulness of the values. Some of these conditions are individual susceptibility or aggravation of a preexisting condition. Because of the limitations of PELs and TLVs, special exposure limits have been established. Emergency Response Planning Guidelines (ERPGs), Short-term Public Emergency Guidance Levels (SPEGLs), and Acute Exposure Guidelines (AEGLs, under development by the EPA) have been designed to assist emergency personnel in making decisions regarding nonworkplace exposures (Exhibit II-7B). Emergency medical personnel responsible for the management of chemically contaminated patients should be familiar with all of these exposure limits because they will be encountered in various documents dealing with patient care or the selection of PPE. This brief discussion highlights some fundamental concepts of toxicology. Emergency medical personnel responsible for managing chemically contaminated patients are encouraged to obtain further training in their recognition and treatment. A list of general toxicology references is provided at the end of this section that will allow emergency medical personnel to undertake a more in-depth examination of the principles of toxicology.

PERSONNEL PROTECTION AND SAFETY PRINCIPLES


This section provides information on personal protective equipment (PPE) and safety principles to emergency medical personnel who, because of their proximity to a chemical industrial area or transport corridor, may be required to treat chemically contaminated patients. In the majority of cases, hospital staff will not experience incidents involving chemically contaminated patients frequently enough to keep them optimally trained or their equipment properly maintained. Staff must be initially trained in the proficient use of PPE, specifically respiratory equipment, and must maintain that proficiency. According to state and federal regulations, equipment must be maintained according to OSHA specifications, and respirators and their cartridges have to be properly fitted, tested, and stored. Many hospitals, given their workload mix and fiscal constraints, may not be able to expend the funds and time necessary to accomplish this task. In these cases, these hospitals should make arrangements with the local fire department or hazmat team to be ready, if the situation warrants, to decontaminate patients, including those who are transported to a hospital before they are decontaminated. Considerations in determining what a hospital s capabilities should be include the number of incidents occurring locally (several per week versus only a few per year) and proximity to industries or transportation routes that have the potential for a hazardous materials incident (see Section I SARA Title III).

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Exhibit II-7A Occupational Exposure Limits


Value
Threshold Limit Value (ACGIH)1

Abbreviation
TLV

Definition
Refers to airborne concentrations of substances and represents conditions under which it is believed that nearly all workers may be repeatedly exposed day after day without adverse effect. The time-weighted average concentration for a normal 8-hour work day and a 40-hour work week, to which nearly all workers may be repeatedly exposed, day after day, without adverse effect. The concentration to which workers can be exposed continuously for a short period of time without suffering from (1) irritation, (2) chronic or irreversible tissue damage, or (3) narcosis of a sufficient degree to increase the likelihood of accidental injury, to impair self-rescue, or to materially reduce work efficiency; and provided that the daily TLV-TWA is not exceeded. The concentration that should not be exceeded during any part of the working exposure. Same as TLV-TWA. A maximum airborne concentration from which one could escape within 30 minutes without any escape-impairing symptoms or any irreversible health effects. Highest allowable airborne concentration that is not expected to injure a worker; expressed as a ceiling limit or time-weighted average for an 8- or 10-hour work day.

Threshold Limit Value: Time-Weighted Average (ACGIH)1

TLV-TWA

Threshold Limit Value: Short-Term Exposure Limit (ACGIH)1

TLV-STEL

Threshold Limit Value: Ceiling (ACGIH)1 Permissible Exposure Limit (OSHA)2 Immediately Dangerous to Life and Health (OSHA)2

TLV-C

PEL IDLH

Recommended Exposure Limit (NIOSH)3

REL

1 2

American Conference of Governmental Industrial Hygienists Occupational Safety and Health Administration 3 National Institute for Occupational Safety and Health

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Exhibit II-7B General Population Exposure Limits


Value
Emergency Response Planning Guidelines (AIHA)1

Abbreviation
ERPG

Definition
Maximum airborne concentration below which it is believed that nearly all individuals could be exposed for up to 1 hour without (1) experiencing other than mild transient adverse health effects or perceiving a clearly defined objectionable odor (ERPG-1), (2) experiencing or developing irreversible or other serious health effects or symptoms that could impair an individual s ability to take protective action (ERPG-2), or (3) experiencing or developing life-threatening health effects (ERPG-3). An acceptable concentration for unpredicted, single, short-term exposure of the general public in emergency situations. May be developed for different exposure periods (e.g., 1, 2, 4, 8, 16, 24 hours). Proposed short-term threshold or ceiling exposure value intended for the protection of the general public, including susceptible or sensitive individuals but not those who are hypersusceptible or hypersensitive. Represents the airborne concentration of a substance at or above which it is predicted that the general population (as defined above) could experience (1) notable discomfort (AEGL-1), (2) irreversible or other serious, long-lasting effects or impaired ability to escape (AEGL-2), or (3) life-threatening effects or death (AEGL-3). Developed for four exposure periods: 30 minutes, and 1, 4 , and 8 hours. Synonymous with the NAS4 term, Community Emergency Exposure Levels (CEELs).

Short-term Public Emergency Guidance Level (NRC)2

SPEGL

Acute Exposure Guidelines (EPA NAC/AEGL)3

AEGL

1 2

American Industrial Hygiene Association National Research Council 3 EPA National Advisory Committee/AEGL Committee 4 National Academy of Sciences

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Federal Regulations Pertaining to Use of Personal Protective Equipment (PPE)


The term personal protective equipment (PPE) is used in this document to refer to both clothing and equipment. The purpose of PPE is to shield or isolate individuals from the chemical, physical, and biological hazards that may be encountered at a hazardous materials incident. Training is essential before any individual attempts to use PPE. OSHA standards mandate specific training requirements (8 hours of initial training or sufficient experience to demonstrate competency) for personnel engaged in emergency response to hazardous substances incidents at the First Responder Operations Level. In addition, each employer must develop health and safety programs and provide for emergency response. These standards also are intended to provide additional protection for those who respond to hazardous materials incidents, such as firefighters, police officers, and EMS personnel. OSHA s final rule (March 6, 1989, 29 CFR (1910.120)) as it applies to emergency medical personnel states: Training shall be based on the duties and functions to be performed by each responder of an emergency response organization. No single combination of protective equipment and clothing is capable of protecting against all hazards. Thus, PPE should be used in conjunction with other protective methods. The use of PPE can itself create significant worker hazards, such as heat stress, physical and psychological stress, and impaired vision, mobility, and communication. Responders in PPE can also be frightening to pediatric patients. In general, the greater the level of PPE protection, the greater are the associated risks. For any given situation, equipment and clothing should be selected that provide an adequate level of protection. Excessive protection can be as hazardous as under-protection, and should be avoided. In addition, personnel should not be expected to use PPE without adequate training. The two basic objectives of any PPE program should be to protect the wearer from safety and health hazards and to prevent injury to the wearer from incorrect use and/or malfunction of the PPE. To accomplish these goals, a comprehensive PPE program should include: (1) hazard identification; (2) medical monitoring; (3) environmental surveillance; (4) selection, use, maintenance, and decontamination of PPE; and (5) training.

PPE Complications
Personnel wearing PPE are likely to encounter a number of potential problems, including limited visibility, reduced dexterity, claustrophobia, restricted movement, suit breach, insufficient air supply, dehydration, and the effects of heat and cold. Only individuals who are physically fit and have met the OSHA/NIOSH/NFPA training requirements should be wearing PPE during an incident. Proper donning and doffing procedures must be followed, with assistance from other onsite personnel. Medical surveillance evaluations should be conducted on all individuals both before and immediately after their use of PPE. The actions of all personnel wearing PPE should also be closely observed by the safety officer and others during each work period. In addition, an emergency distress signal should be identified in the briefing before individuals enter the work area.

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Levels of Protection
EPA has designated four levels of protection to assist in determining which combinations of respiratory protection and protective clothing should be employed: Level A protection should be worn when the highest level of respiratory, skin, eye, and mucous membrane protection is needed. It consists of a fully-encapsulated, vapor-tight, chemical-resistant suit, chemical-resistant boots with steel toe and shank, chemical-resistant inner/outer gloves, coveralls, hard hat, and self-contained breathing apparatus (SCBA). Level B protection should be selected when the highest level of respiratory protection is needed but a lesser degree of skin and eye protection is required. It differs from Level A only in that it provides splash protection through use of chemical-resistant clothing (overalls and long-sleeved jacket, twopiece chemical splash suit, disposable chemical-resistant coveralls, or fully-encapsulated, nonvapor-tight suit and SCBA). Level C protection should be selected when the type of airborne substances is known, concentration is measured, criteria for using air-purifying respirators are met, and skin and eye exposures are unlikely. This involves a full facepiece, air-purifying, canister-equipped respirator and chemical-resistant clothing. It provides the same level of skin protection as Level B, but a lower level of respiratory protection. Level D is primarily a work uniform. It provides no respiratory protection and minimal skin protection, and it should not be worn on any site where respiratory or skin hazards exist. Exhibit II-8 illustrates these four levels of protection. For more information on this subject, Appendix C outlines the protective equipment recommended for each level of protection. Factors to be considered in selecting the proper level of protection include the potential routes of entry for the chemical(s), the degree of contact, and the specific task assigned to the user. Activities can also be undertaken to determine which level of protection should be chosen. The EPA and NIOSH recommend that initial entry into unknown environments or into a confined space that has not been chemically characterized be conducted wearing at least Level B, if not Level A, protection.

Routes of Entry
PPE is designed to provide emergency medical personnel with protection from hazardous materials that can affect the body by one of three primary routes of entry: inhalation, ingestion, and direct contact. Inhalation occurs when emergency personnel breathe in chemical fumes or vapors. Respirators are designed to protect the wearer from contamination by inhalation but they must be worn properly and fit-tested frequently to ensure continued protection. Ingestion usually is the result of a health care provider transferring hazardous materials from his hand or clothing to his mouth. This can occur unwittingly when an individual wipes his mouth with his hand or sleeve, eats, drinks, or smokes a cigarette. Direct contact refers to chemical contact with the skin or eye. Skin is protected by garments, and full-face respirators protect against ingestion and direct eye contact. Mucous membranes in the mouth, nose, throat, inner ear, and respiratory system may be affected by more than one of these routes of entry. Many hazardous materials adhere to and assimilate with the moist environment provided by these membranes, become trapped or lodged in the mucus, and are subsequently absorbed or ingested.

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Exhibit II-8 Levels of Protection

Level A

Level B

Level C

Level D

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Chemical Protective Clothing (CPC)


Protective clothing is designed to prevent direct contact of a chemical contaminant with the skin or body of the user. There is, however, no single material that will afford protection against all substances. As a result, multilayered garments may be employed in specific situations despite their negative impact on dexterity and agility. CPC is designed to afford the wearer a known degree of protection from a known type, a known concentration, and a known length of exposure to a hazardous material, but only if it is properly fitted and worn correctly. Improperly used equipment can expose the wearer to danger. Another factor to keep in mind when selecting CPC is that most protective clothing is designed to be impermeable to moisture, thus limiting the transfer of heat from the body through natural evaporation. This is a particularly important factor in hot environments or for strenuous tasks since such garments can increase the likelihood of heat-related injuries. Research is now underway to find lightweight suits that are breathable but still protective against a wide range of chemicals. Cooling vests are sometimes used in warm weather situations to keep the body temperature normal, but with mixed results. Essential to any protective ensemble are chemical resistant boots with steel toe and shank. Chemical resistant inner and outer layered gloves must also be worn. Compatibility charts should be consulted to determine the appropriate type of boot and gloves to use, since no one material presently provides protection against all known chemicals. Wearing multiple layers of gloves impairs dexterity and makes performing basic aspects of patient assessment (e.g., checking breathing, taking a pulse) difficult without constant practice. The effectiveness of CPC can be reduced by three actions: degradation, permeation, and penetration. Chemical degradation occurs when the characteristics of the material in use are altered through contact with chemical substances or aging. Examples of degradation include cracking and brittleness, and other changes in the structural characteristics of the garment. Degradation can also result in an increased permeation rate through the garment. Permeation is the process by which chemical compounds cross the protective barrier of CPC because of passive diffusion. The rate at which a compound permeates CPC is dependent on factors such as the chemical properties of the compound, the nature of the protective barrier in the CPC, and the concentration of the chemical on the surface of the protective material. Most CPC manufacturers provide charts on the breakthrough time the time it takes for a chemical to permeate the material of a protective suit for a wide range of chemical compounds. Penetration occurs when there is an opening or a puncture in the protective material. These openings can include unsealed seams, buttonholes, and zippers. Often such openings are the result of faulty manufacture or problems with the inherent design of the suit. Protective clothing is available in a wide assortment of forms, ranging from fully-encapsulated body suits to gloves, hard hats, earplugs, and boot covers. CPC comes in a variety of materials, offering a range of protection against a number of chemicals. Emergency medical personnel must evaluate the properties of the chemical versus the properties of the protective material. Selection of the appropriate CPC will depend on the specific chemical(s) involved, and on the specific tasks to be performed.

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RESPIRATORY PROTECTION
Substantial information is available for the correct selection, training, and use of respirators. The correct respirator must be employed for the specific hazard in question. Material Safety Data Sheets (if available) often specify the type of respirator that will protect users from risks. In addition, manufacturers suggest the types of hazards against which their respirators can offer protection. OSHA has set mandatory legal minimum requirements (29 CFR (1910.134)) for respiratory protection. In addition, NIOSH has established comprehensive requirements for the certification of respiratory protection equipment. Personnel must be fit-tested for use of all respirators. Even a small space between the respirator and you could permit exposure to a hazardous substance(s) by allowing in contaminated air. Anyone attempting to wear any type of respirator must be trained and drilled in its proper use. Furthermore, equipment must be inspected and checked for serviceability on a routine basis. There are two basic types of respirators: air-purifying and atmosphere-supplying. Atmospheresupplying respirators include self-contained breathing apparatus (SCBA) and supplied-air respirators (SAR).

Air-Purifying Respirators (APRs)


An air-purifying respirator purifies ambient air by passing it through a filtering element before inhalation. The major advantage of the APR system is the increased mobility it affords the wearer. However, a respirator can only be used where there is sufficient oxygen (19.5 percent) since it depends on ambient air to function. In addition, APRs should not be used when substances with poor warning properties are known to be involved or, if the agent is unknown, when environmental levels of a substance exceed the filtration capacity of the canisters. Three basic types of APRs are used by emergency personnel: chemical cartridges or canisters, disposables, and powered air-purifiers. The most commonly used APR depends on cartridges (Exhibit II-9) or canisters to purify the air by chemical reaction, filtration, adsorption, or absorption. Cartridges and canisters are designed for specific materials at specific concentrations. To aid the user, manufacturers have color-coded the cartridges and canisters to indicate the chemical or class of chemicals for which the device is effective. NIOSH recommends that use of a cartridge not exceed one work shift. However, if breakthrough of the contaminant occurs first, then the cartridge or canister must be immediately replaced. After use, cartridges and canisters should be considered contaminated and disposed of accordingly. Disposable APRs are usually designed for use with particulates, such as asbestos, although some are approved for use with other contaminants. These respirators are typically half-masks that cover the face from nose to chin, but do not provide eye protection. Once used, the entire respirator is usually discarded. This type of APR depends on a filter to trap particulates. Filters may also be used in combination with cartridges and canisters to provide an individual with increased protection from particulates. The use of half-mask APRs is not generally recommended by emergency response organizations.

32

Exhibit II-9 Chemical Cartridge Air-Purifying Respirator

Powered Air-Purifying Respirators (PAPRs) have the advantage of creating an improved facemask seal, thus reducing the risk of inhalation injury. Air being blown into the mask can also have a cooling affect. PAPRs come with either full facemasks or pullover hoods. Some individuals find the hooded system to be more comfortable and less claustrophobic than the mask. According to OSHA guidelines, men with beards can wear the hooded system but not the full facemask.

Atmosphere-Supplying Respirators
Atmosphere-supplying respirators consist of two basic types: the self-contained breathing apparatus (SCBA), which contains its own air supply, and the supplied-air respirator (SAR), which depends on an air supply provided through a line linked to a distant air source. Exhibit II-10 illustrates an example of each.

Self-Contained Breathing Apparatus (SCBA)


A self-contained breathing apparatus respirator is composed of a facepiece connected by a hose to a compressed air source. There are three varieties of SCBAs: open-circuit, closed-circuit, and escape. Open-circuit SCBAs, most often used in emergency response, provide clean air from a cylinder to the wearer, who exhales into the atmosphere. Closed-circuit SCBAs, also known as rebreathers, recycle exhaled gases and contain a small cylinder of oxygen to supplement the exhaled air of the wearer. Escape SCBAs provide air for a limited amount of time and should only be used for emergency escapes from a dangerous situation. One disadvantage of all SCBAs is that they are bulky and heavy, and can be used for only the period of time allowed by air in the tank. The most common SCBA is the open-circuit, positive-pressure type. In this system, air is supplied to the wearer from a cylinder and enters the facepiece under positive pressure. In contrast to negativepressure units, a higher air pressure is maintained inside the facepiece than outside. This affords the SCBA wearer the highest level of protection against airborne contaminants since any leakage may

33

Exhibit II-10 Self-Contained Breathing Apparatus and Supplied-Air Respirators

force the contaminant out. When wearing a negative-pressure-type apparatus, there is always the potential danger that contaminants may enter the facemask if it is not properly sealed. The use of a negative-pressure SCBA is prohibited by OSHA under 29 CFR (1910.120(q)(iv)) in incidents where personnel are exposed to hazardous materials.

Supplied-Air Respirators (SARs)


Supplied-air respirators differ from SCBAs in that the air is supplied through a line that is connected to a source away from the contaminated area. SARs are available in both positive- and negativepressure models. However, only positive-pressure SARs are recommended for use at hazardous materials incidents. One major advantage the SAR has over the SCBA device is that it allows an individual to work for a longer period. In addition, SARs are less bulky than SCBAs. By necessity, however, a worker must retrace his steps to stay connected to the SAR, and therefore cannot leave the contaminated work area by a different exit. SARs also require the air source to be in close proximity to the work area. In addition, personnel using an SAR must carry an immediately operable emergency escape supply of air, usually in the form of a small, compressed air cylinder, for use in case of an emergency.

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EMERGENCY DEPARTMENT PERSONNEL DECONTAMINATION


Decontamination is the process of removing or neutralizing harmful materials that have gathered on personnel and/or equipment during the response to a chemical incident. Many incidents have occurred involving seemingly successful rescue, transport, and treatment of chemically contaminated individuals by unsuspecting emergency personnel who, in the process, contaminate themselves, the equipment, and the facilities to which they bring the victim. Decontamination is of the utmost importance because it:
l

Protects all hospital personnel by sharply limiting the transfer of hazardous materials from the contaminated area into clean zones. Protects the community by preventing transportation of hazardous materials from the hospital to other sites in the community by secondary contamination. Protects workers by reducing the contamination and resultant permeation of, or degradation to, their protective clothing and equipment. Protects other patients already receiving care at the hospital.

This section only addresses the steps necessary for dealing with worker decontamination. Patient decontamination will be addressed in Section III, Patient Management. It should be stressed that to carry out proper decontamination, personnel must have received at least the same degree of training as required for workers who respond to hazardous materials incidents. The design of the decontamination process should take into account the degree of hazard and should be appropriate for the situation. For example, a nine-station decontamination process need not be set up if only a bootwash station would suffice. Avoiding contact is the easiest method of decontamination that is, not to get the material on the worker or his protective equipment in the first place. However, if contamination is unavoidable, then proper decontamination or disposal of the worker s outer gear will be necessary. Segregation and proper disposal of the outer gear in a polyethylene bag or steel drum will be necessary until thorough decontamination is completed. With extremely hazardous materials, it may be necessary to dispose of equipment as well. Physical decontamination of protective clothing and equipment can be achieved by several different means. These all include the systematic removal of contaminants by washing, usually with soap and water, and then rinsing. In rare cases, the use of solvents may be necessary. There is a trend toward using disposable clothing (e.g., suits, boots, gloves) and systematically removing these garments in a manner that precludes contact with the contaminant. The appropriate decontamination procedure will depend on the contaminant and its physical properties. Thoroughly researching the chemicals involved and their properties, or consultation with an expert, is necessary to make these kinds of decisions. Care must be taken at all times to ensure that the decontamination methods being used do not introduce fresh hazards into the situation. In addition, the residues of the decontamination process must be treated as hazardous wastes. The decontamination stations and process should be confined to the Contamination Reduction Zone (see Exhibit II-11). Steps for personnel decontamination are outlined in Exhibit II-12, and the technical decontamination process is discussed below.

35

Technical Decontamination Process for Hospital Personnel


Personnel should remove protective clothing in the following sequence. 1. Remove tape (if used) securing gloves and boots to suit. 2. Remove outer gloves, turning them inside out as they are removed. 3. Remove suit, turning it inside out and folding it downward. Avoid shaking. 4. Remove boot/shoe cover from one foot and step over the clean line. Remove other boot/shoe cover and put that foot over the clean line. 5. Remove mask. The last person removing his/her mask may want to wash all masks with soapy water before removing his/her suit and gloves. Place the masks in plastic bag and hand the bag over the clean line for placement in second bag held by another staff member. Send bag for decontamination. 6. Remove inner gloves and discard them in a drum inside the dirty area. 7. Secure the dirty area until the level of contamination is established and the area is properly cleaned. 8. Personnel should then move to a shower area, remove undergarments and place them in a plastic bag. Double-bag all clothing and label bags appropriately.

9. Personnel should shower and redress in normal working attire and then report for medical surveillance.

COMMUNICATIONS
Effective communications are essential to maintaining incident control. These include a dedicated radio frequency and a sufficient number of radios for distribution to all participating agencies. Another network should link the onsite command post to support groups, such as the Poison Control Center and the Health Department. Other networks that may have to be activated include one linking the hospital emergency department to EMTs and one dedicated for use by the teams in the Exclusion and Contamination Reduction Zones. When an Incident Command System is activated, one person is often assigned to manage communications.

36

Exhibit II-11 NIOSH/OSHA/USCG/EPA Recommended Zones

37

Exhibit II-12 Nine-Step Personnel Decontamination Plan

38

SELECTED BIBLIOGRAPHY
American Conference of Governmental Industrial Hygienists. 1988. Guidelines for the Selection of Chemical Protective Clothing. Cincinnati, OH. American Academy of Pediatrics. 1994. Handbook of Common Poisonings in Children. 3rd ed. Elk Grove Village, IL. Borak, J., M. Callan, and W. Abbott. 1991. Hazardous Materials Exposure-Emergency Response and Patient Care. Englewood Cliffs, NJ: Brady. Bowen, J. E. 1995. Emergency Management of Hazardous Materials Incidents. Quincy, MA: National Fire Protection Association. Bronstein, A.C. and P.L. Currance. 1994. Emergency Care for Hazardous Materials Exposure. 2nd ed. St. Louis, MO: Mosby. Budavari, S., A. Smith, P. Heckelman, and J. Kinneary. 1996. The Merck Index: An Encyclopedia of Drugs, Chemicals, and Biologicals. 12th ed. Chapman & Hall. Chemical Manufacturers Association (CMA) and the Association of American Railroads. 1987. Terms for Personal Protective Equipment. Washington, DC: CMA. Clayton, G.D. and F.E. Clayton. 1994. Patty s Industrial Hygiene and Toxicology. 4th ed. New York, NY: John Wiley and Sons. Currance, P.L. and A.C. Bronstein. 1999. Hazardous Materials for EMS. St. Louis, MO: Mosby. Ellenhorn, M.J. and D.G. Barceloux. 1997. Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. New York, NY: Elsevier. Forsberg, K. and S.Z. Mansdorf. 1993. Quick Selection Guide to Chemical Protective Clothing. 2nd ed. New York, NY: Van Nostrand Reinhold. Goldfrank, L.R. 1998. Goldfrank s Toxicological Emergencies. 6th ed. Stamford, CT: Appleton and Lange. Grant, W.M. and J.G. Schuman. 1993. Toxicology of the Eye. 4th ed. Springfield, IL: Charles C. Thomas. Hayes, A.W. (ed.). 1994. Principles and Methods of Toxicology. 2nd ed. Books on Demand. Hodgson, E. and P.E. Levi. 1997. A Textbook of Modern Toxicology. 2nd ed. Stamford, CT: Appleton and Lange. Klaassen, C.D., M.O. Amdur, and J. Doull (eds.). 1996. Casarett and Doull s Toxicology: The Basic Science of Poisons. 5th ed. McGraw-Hill Health Professions Division. Levine, S.P. and W.F. Martin (eds.). 1993. Protecting Personnel at Hazardous Waste Sites. 2nd ed. Boston, MA: Butterworth Publishers.

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Lu, F.C. 1996. Basic Toxicology: Fundamentals, Target Organs, and Risk Assessment. 3rd ed. Taylor & Francis, Inc. National Emergency Training Center. 1998. Guidelines for Public Sector Hazardous Materials Training. Emmitsburg, MD: HMEP Curriculum Guidelines. National Fire Academy and National Emergency Training Center. 1985. Recognizing and Identifying Hazardous Materials. Capitol Heights, MD: National Audio-Visual Center. Proctor, N.H., J.R. Hughes, and M.L. Fishman. 1989. Chemical Hazards of the Workplace. 2nd ed. New York, NY: Van Nostrand Reinhold. Rom, W. 1992. Environmental and Occupational Medicine. 2nd ed. Boston, MA: Little, Brown. Sax, N.I. 1992. Dangerous Properties of Industrial Materials. 8th ed. New York, NY: Van Nostrand Reinhold. Schwope, A.D., P.P. Costas, J.O. Jackson, and D.J. Weitzman. 1987. Guidelines for the Selection of Chemical Protective Clothing. 3rd ed. Cincinnati, OH: American Conference of Governmental Industrial Hygienists. Sidell, F.R. and D.R. Franz (eds.). 1997. Medical Aspects of Chemical and Biological Warfare. U.S. Department of the Army. Washington, DC: Borden Institute. Stutz, R. and S. Ulin. 1993. HAZTOX EMS Response For Hazardous Materials Incidents. Miramar, FL: GDS Communications. Sullivan, J.B., Jr. and G.R. Krieger. 1992. Hazardous Materials Toxicology: Clinical Principles of Environmental Health. Baltimore, MD: Williams & Wilkins. Tokle, G. (ed.). 1993. Hazardous Materials Response Handbook. 2nd ed. Quincy, MA: National Fire Protection Association. U.S. Department of Defense, U.S. Army, USAMRICD Chemical Casualty Division. 1998. Medical Response to Chemical Warfare and Terrorism. 3rd ed. Edgewood, MD. U.S. Environmental Protection Agency, Region VII. 1989. Chemical Response Planning and Operations. Washington, DC: Environmental Protection Agency. U.S. Federal Emergency Management Agency and U.S. Fire Administration. 1999. Hazardous Materials Guide for First Responders. Washington, DC: Government Printing Office.

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Section III. Patient Management


Growing concern about the proper treatment of chemically contaminated patients has outpaced adequate guidance on the subject. However, definitive work has been done on cases that bear similar characteristics (e.g., radioactive exposure), and some of the same principles apply. Many of these principles are outlined in the article Emergency Department Radiation Accident Protocol by R.B. Leonard and R.C. Ricks, published in the September 1980 issue of Annals of Emergency Medicine. Further information on radiation response procedures is contained in Hospital Emergency Department Management of Radiation Accidents by R.C. Ricks, prepared for the Federal Emergency Management Agency. When a hospital receives a call that a patient exposed to hazardous materials is being transported to its facility, a planned course of action should be implemented. Steps in the protocol must be practiced before a hazardous materials emergency occurs. Emergency department personnel should know their responsibilities and how to perform them, and all required equipment should be immediately accessible. Individuals receiving a potential hazardous materials call should obtain as much information as possible. A checklist should be developed and made available for all telephone or radio communication centers. Information that will aid in initiating appropriate actions includes:
l l l l l l l l

Type and nature of incident Caller s telephone number Number and ages of patients Signs and symptoms being experienced by the patients Nature of injuries Name of chemical(s) involved, including correct spelling Extent of patient decontamination in the field Estimated time of arrival

After the above information is received, a predesignated resource center (e.g., regional Poison Control Center, ATSDR) should be contacted for information regarding definitive care procedures. This should include the need for decontamination and what methods should be used. Communications should be kept open with onsite response personnel to obtain as much advance information as possible. If incident notification comes through other than usual emergency communication channels, the call should be verified before a hazardous materials response plan is initiated. Ambulance personnel should be notified of any special approach or entrance to the emergency department and also advised

41

not to bring the patient into the emergency department until he or she has been assessed by appropriate emergency department staff. Often patients contaminated by hazardous materials are brought into the emergency department unannounced or not through regular EMS channels. This could be an ambulatory patient or an individual transported by private vehicle. The ideal response to this situation is to call the fire department or a hazmat team that is properly trained and equipped to come to the hospital and set up a decontamination area outside the ambulance entrance. In any event, these individuals should be isolated from other patients and assessed and decontaminated as soon as possible. Preplanning with the fire department and/or hazmat team should determine the location, equipment needs, and logistics for decontamination outside of the hospital during all weather conditions.

EMERGENCY DEPARTMENT PREPARATION


Every member of the emergency department should be familiar with the hospital s hazardous materials response plan and be required to participate in scheduled drills. A written copy of the plan should also be kept in a central location in the emergency department for quick reference. Preparation for arrival of a contaminated patient should include notification of all services involved, preparation of a decontamination area, and suiting up of the decontamination team.

Emergency Department Mobilization


The person receiving a call of an incoming victim(s) should notify the Nursing Supervisor or other designated individual, who will in turn notify the appropriate personnel according to the hospital s response plan. The hospital operator should be instructed to notify security and maintenance, and the nurse on duty should contact the predesignated resource center.

Decontamination Area Preparation


Any victim of a hazardous materials incident must be considered to be contaminated until demonstrated otherwise. Therefore, the route from the emergency entrance to the Decontamination Area may also become contaminated and all persons along that route should be removed by security personnel prior to the arrival of the contaminated patient. Ideally, this area should be protected with a barrier of plastic or paper sheeting taped securely to the floor. Care should be exercised in walking on plastic sheeting because it can become very slippery when wet. Security personnel should be stationed at the main entrance to the emergency department, close to the Decontamination Area, to prevent unauthorized entry, to control the entry of contaminated patients into the department, and to direct the vehicle(s) transporting the patient(s) to the appropriate area. A reception station should be set up just outside the emergency department entrance, where arriving patients can be screened for adequate decontamination before entering. A decontamination area should be large enough to facilitate decontamination of more than one patient and to accommodate the many personnel involved in patient treatment and contamination reduction. The ventilation system should either be separate from the rest of the hospital or turned off to prevent the spread of airborne contaminants through heating and air conditioning ducts to other

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parts of the facility. If the ventilation system is shut off during the handling of a contaminated victim in an enclosed area, the emergency department staff could be endangered. To address this, OSHA regulations on atmospheric monitoring (29 CFR (1910.120)(q)(3)(iv)) should be followed, especially if air-purifying respirators are used. Weather permitting, the best place to evaluate and initially treat contaminated patients is outside, where ambient ventilation will keep airborne cross-exposure low. Some hospitals have radiation decontamination facilities that can be used with minor changes. An outside or portable decontamination system is a viable substitute and would aid in preventing contamination of the emergency department and other patients. A practical alternative for facilities with limited resources is to have a warm shower nozzle, soap, a wading pool, and plastic garbage bags in a predesignated area outside the back door to the emergency department. The patient may be able to remove his or her own contaminated clothing, place it in a double bag, and do his or her own soap and water decontamination. A partial tent or curtain can provide for patient privacy. Under most circumstances, ordinary hospital gowns, plastic goggles, and plain latex gloves will adequately protect hospital staff if they have to assist the patient in removing soaked clothing, washing exposed skin and hair, or performing eye irrigation. With large amounts of concentrated corrosives or very oily materials, such as pesticides, disposable chemical protective clothing and unmilled nitrile gloves offer additional protection. If it is anticipated that your facility is likely to receive heavily contaminated patients who have not received prior decontamination, then it may be advisable to purchase appropriate protective gear and to fit and train emergency department staff in its use. However, no person should wear and use specialized PPE, especially respiratory protective gear, without prior training. To prevent unnecessary contamination, all nonessential and nondisposable equipment should be removed from the decontamination area. Door knobs, cabinet handles, light switches, and other surfaces that have contact with hands should be taped, and the floors should be covered with plastic or paper sheeting. The floor covering should be securely taped to prevent slippage, and the entrance to the room marked with a wide strip of colored tape to indicate a contaminated area. Personnel should not enter the area unless properly protected, and no personnel or equipment should leave the area until properly decontaminated. A clean member of the staff should stand on the clean side of the entrance to hand in supplies and receive medical specimens. The essential requirements for any decontamination task are:
l l l l l

A safe area to keep a patient while undergoing decontamination A method for washing contaminants off a patient A means of containing the rinsate Adequate protection for personnel treating the patient Disposable or cleanable medical equipment to treat the patient

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Decontamination Team Preparation


A decontamination team should be predesignated and trained in appropriate personal protection equipment and procedures. The team should consist of:
l l l l

Emergency department physicians Emergency department nurses and aides A trauma surgeon, if injuries are present Support personnel
;

Nursing Supervisor Occupational Health and Safety Officer Security Maintenance Recorder

The decontamination team should be equipped with personal protective clothing (as discussed in Section II) for whatever level is deemed appropriate for the substance(s) involved. This may be determined by consulting reference guidebooks, websites, database networks, telephone hotlines, or a predesignated resource center (e.g., the regional Poison Control Center). Appropriate dress for the decontamination team should include:
l l l

A scrub suit. Plastic shoe covers. Disposable chemical protective clothing with built-in hood and booties, and with hood taped at the neck. Polyvinyl chloride (PVC) gloves taped to sleeves. Respiratory protection, as appropriate (see Section II). Multiple layers of surgical gloves, neoprene or disposable nitrile gloves, with the bottom layer taped; should be changed whenever torn. Protective eyewear.

l l l

A 2-inch-wide piece of masking tape with the team member s name written on it, and placed on the back of the protective suit, will assist team members in communicating.

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PATIENT ARRIVAL
The emergency physician-in-charge or an emergency department nurse should meet the ambulance upon arrival and assess the condition of the patient(s) as well as the degree of contamination. The recorder should note on a diagram of the body the areas found by the physician to be contaminated. Personnel should keep in mind that the actual contamination may be (or become) a life-threatening condition, and triage procedures should be initiated at this point, if necessary. During initial patient assessment and stabilization, contamination reduction should simultaneously be performed. This consists of cutting away or otherwise removing all suspected contaminated clothing, including jewelry and watches, and brushing or wiping off any contamination. Care should be taken to protect any open wounds from contamination. Emergency department personnel should make every effort to avoid contact with any potentially hazardous substance(s). Ideally, decontamination should be performed before patient transport; however, field decontamination facilities are limited and emergency department personnel should consider that all hazardous materials patients need decontamination unless information has been received indicating that it is not necessary (e.g., in cases of carbon monoxide exposure). If a patient s clothing was not removed at the incident site, it should be removed outside the ambulance but before entry into the emergency department. This will reduce further exposure to the patient and lessen the extent of contamination introduced into the emergency department. Contaminated clothing should be double-bagged in plastic bags, sealed, and labeled. The decontamination team should bring the prepared stretcher to the ambulance, transfer the patient, and take him or her directly to the Decontamination Area along the predesignated route. Priority should be given to the fundamentals of emergency treatment airway, breathing, and circulation simultaneous with contamination reduction. Once life-threatening matters have been addressed, emergency department personnel can then direct their attention to thorough decontamination and secondary patient assessment. Identification of the hazardous materials involved can be simultaneously performed by other personnel. It is important to remember that appropriate personal protective clothing must be worn until personnel are no longer in danger.

PATIENT DECONTAMINATION
The basic purpose of decontamination is to reduce external contamination, contain the contamination present, and prevent the further spread of potentially dangerous substances. In other words, remove what you can and contain what you can t. Effective decontamination consists of making the patient As Clean As Possible (ACAP). This means that the contamination has been reduced to a level that is no longer a threat to the patient or to the responder. With a few exceptions, intact skin is more resistant to hazardous materials than injured flesh, mucous membranes, or eyes. Therefore, decontamination should begin at the head of the patient and proceed downward with initial attention paid to contaminated eyes and open wounds. Once wounds have been cleaned, care should be exercised so that they are not recontaminated. This can be aided by covering the wounds with a waterproof dressing. For some chemicals, such as strongly alkaline substances, it may be necessary to flush exposed skin and eyes with water or normal saline for an extended period of time.

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External decontamination should be performed using the least aggressive methods. Mechanical or chemical irritation to the skin should be limited to prevent damage to the epidermal layer, which results in increased permeability. The skin of young children is particularly sensitive and should be treated accordingly. Contaminated areas should be gently washed under a spray of warm (never hot) tap water, using a sponge and a mild soap. If decontamination is performed outside, care must be taken to avoid hypothermia; young children are particularly sensitive to cold stress. All run-off from decontamination procedures should be collected for proper disposal. The first priority in the decontamination process should be treatment of contaminated open wounds. These areas allow for rapid absorption of hazardous materials. Wounds should be irrigated with copious amounts of normal saline. Deep debridement and excision should be performed only when particles or pieces of material have been embedded in the tissues. Decontamination of eyes should also take high priority. Gentle irrigation of the eyes should be performed with the stream of normal saline diverted away from the medial canthus so that it does not force material into the lacrimal duct. Contaminated nares and ear canals should also be gently irrigated, with frequent suction to prevent any material being forced deeper into those cavities. Washing with soap and tepid water, including the hair, is usually all that is needed to remove contamination. Hot water, stiff brushes, or vigorous scrubbing should seldom be used because they cause vasodilation and abrasion. This increases the chances for absorption of hazardous materials through the skin. Decontamination of young children poses particular problems because they are usually frightened and may not understand what is happening. If a parent is available and can accompany the child through decontamination, this may be desirable. If not, a nurse should be assigned to stay with the child.

CONSIDERATIONS FOR PATIENT TREATMENT


The primary goals for emergency department personnel in handling a contaminated individual include cessation of patient exposure, patient stabilization, and patient treatment all without jeopardizing their own safety. Termination of exposure can best be accomplished by removing the patient from the incident area and by removing contaminants from the patient. In treating patients, personnel should consider the chemical-specific information received from the hazardous materials response resources. In multiple patient situations, proper triage procedures should be implemented. Symptoms and signs being experienced by patients should be treated as appropriate and when conditions allow. The sooner a patient becomes decontaminated the sooner he or she can be treated as a normal patient and protective measures reduced or downgraded. Recommendations from the designated Poison Control Center and orders from the attending physician should be carefully followed. Invasive procedures, such as IVs or intubation, should be used only for life-threatening conditions until decontamination is performed. Patients should be frequently reassessed and monitored because many hazardous materials have latent physiological effects.

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Information on Materials Involved


Identification of the material(s) involved in a hazardous materials incident should be determined as early in the process as possible. Using resources outlined elsewhere in this section, and in Section II under Hazard Recognition, personnel should identify and obtain detailed information involving treatment, decontamination procedures, and possible adverse health effects of the specific chemical(s) involved. Needed information includes:
l l l l l l l l

Chemical name of substance(s) involved Form of the material (solid, liquid, gas) Length of exposure Route(s) of exposure Possible adverse health effects Recommended treatment or antidote therapy PPE required Decontamination procedures

The importance of getting a rapid but comprehensive overview on an unknown substance cannot be overemphasized. Based on past hazmat incidents, NIOSH and EPA recommend that Level B protection is the minimum level to be worn when entering an area containing unknown substances. However, if the substance in question is suspected to involve the skin as a route of exposure or is otherwise noted to be dangerous by absorption, corrosion, and the like, Level A protection should be worn because it provides additional skin protection.

Removal of Patient from Decontamination Room


After the patient has been decontaminated, place a clean piece of plastic on the floor for the patient and staff to use when exiting the clean area. If the patient is not ambulatory, a clean stretcher or wheelchair should be brought to the doorway by an individual who has not been exposed. After the patient is transferred to the clean area, the physician can perform a physical examination and initiate routine patient management. The patient can be discharged home or admitted to the hospital, depending on his or her clinical condition. The attending staff must remember that since exposure to some substances can result in serious delayed effects, sustained observation and monitoring may be required.

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COMMUNITY EDUCATION AND BRIEFING


During a hazardous materials incident, the emergency department will be used as a source of information by the community and the media. A plan must be in place to deal with information requests, whether received by phone or by onsite media representatives. It is essential that all information be delivered by a knowledgeable person and be coordinated with the agency handling the event in the field. In the absence of such coordination, misleading or inaccurate information may be released which may worsen public reaction to an incident. Above all, it is essential that patient confidentiality be respected. The emergency department may opt to defer all information requests to other involved agencies, such as the regional Poison Control Center.

CRITIQUE
As soon as possible following a hazardous materials incident, all participating units should send knowledgeable representatives to review the measures that were taken by each unit or agency. The purpose of this review is to examine which activities succeeded and which did not, and to evaluate the overall coordination effort with an aim toward making necessary improvements.

PATIENT MANAGEMENT UNDER MASS CASUALTY CONDITIONS INVOLVING HAZARDOUS CHEMICALS


Basic medical procedures in a large-scale hazardous materials incident are not substantially different from life-saving measures in other mass casualty disasters. Primary attention should focus on the ABC fundamentals of emergency care, with decontamination performed at the same time. A chemical disaster may overwhelm any one hospital, particularly if it occurs along with another disaster such as an earthquake. Hospitals need to preplan what steps to take if they are unable to handle the number of hazmat patients.

CRITICAL INCIDENT STRESS MANAGEMENT


Situations involving large numbers of ill or injured individuals, and risks of harm to the responder(s), are sources of critical incident stress. To minimize the occurrence of acute or long-term psychological consequences in response personnel, stress debriefing sessions should be held shortly after the incident is terminated. Acute stress reactions recognized during the incident should be immediately addressed by qualified peer debriefers or other qualified mental health professionals.

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SELECTED BIBLIOGRAPHY
American Academy of Pediatrics. 1994. Handbook of Common Poisonings in Children. 3rd ed. Elk Grove, IL: American Academy of Pediatrics. Cashman, J.R. 1995. Hazardous Materials Emergencies: The Professional Response Team. 3rd ed. Lancaster, PA: Technomic Publishing Co. Currance, P.L. and A.C. Bronstein. 1994. Emergency Care for Hazardous Materials Exposure. 2nd ed. St. Louis, MO: Mosby. Ellenhorn, M.J. 1997. Ellenhorn s Medical Toxicology. 2nd ed. Baltimore, MD: Williams & Wilkins. Goldfrank, L.R. 1998. Goldfrank s Toxicological Emergencies. 6th ed. Stamford, CT: Appleton and Lange. Haddad, L.M. and J.F. Winchester. 1998. Clinical Management of Poisoning and Drug Overdose. 3rd ed. Philadelphia, PA: W.B. Saunders Co. Leonard, R.B. and R. Ricks. 1980. Emergency Department Radiation Accident Protocol. Annals of Emergency Medicine. September. National Fire Protection Association. 1992. Recommended Practice for Responding to Hazardous Materials Incidents. NFPA 471. Quincy, MA: National Fire Protection Association. National Fire Protection Association. 1992. Standards for Professional Competence of Responders to Hazardous Materials Incidents. NFPA 472. Quincy, MA: National Fire Protection Association. National Fire Protection Association. 1997. Standards for Professional Competence of EMS Responders to Hazardous Materials Incidents. NFPA 473. Quincy, MA: National Fire Protection Association. Noji, E.K. and G.D. Kelen. 1989. Manual of Toxicologic Emergencies. Chicago, IL: Year Book. Noll, G., M.S. Hildebrand, and J.G. Yvorra. 1995. Hazardous Materials, Managing the Incident. 2nd ed. IFSTA. Reigart, J. R. and J.R. Roberts, JR (eds.). 1998. Recognition and Management of Pesticide Poisonings. 5th ed. National Pesticide Telecommunications & Network (NPTN), U.S. Environmental Protection Agency. Ricks, R.C. 1984. Hospital Emergency Department Management of Radiation Accidents. Oak Ridge, TN: Oak Ridge Associated Universities. Sidell, F.R. and D.R. Franz (eds.). 1997. Medical Aspects of Chemical and Biological Warfare. U.S. Department of the Army. Washington, DC: Borden Institute. Stutz, D.R. and S. Ulin. 1997. Hazardous Materials Injuries: A Handbook for Pre-Hospital Care. 4th ed. Greenbelt, MD: BRADCOMM, Inc.

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Sullivan, J.B. and G.R. Kriege. 1992. Hazardous Materials Toxicology: Clinical Principles of Environmental Health. Baltimore, MD: Williams & Wilkins. U.S. Department of Health and Human Services, Agency for Toxic Substances and Disease Registry (ATSDR). 1996. Managing Hazardous Materials Incidents: Medical Management Guidelines for Acute Chemical Exposures. Vol. III. Atlanta, GA: US-DHHS. U.S. Department of Transportation. 1996. 1996 North American Emergency Response Guidebook. Washington, DC: Government Printing Office. [available in English, Spanish and French][http:// hazmat.dot.gov/gydebook.htm] U.S. Federal Emergency Management Agency. 1981. Hazardous Materials Management System: A Guide for Local Emergency Managers. Prepared by the Multnomah County [OR] Office of Emergency Management. Washington, DC: Federal Emergency Management Agency. U.S. Federal Emergency Management Agency. 1984. Hospital Emergency Department Management of Radiation Accidents. Washington, DC: Federal Emergency Management Agency. U.S. Federal Emergency Management Agency. 1985. Guidance for Developing State and Local Radiological Emergency Response Plans and Preparedness for Transportation Accidents. Washington, DC: Federal Emergency Management Agency. U.S. Federal Emergency Management Agency and U.S. Fire Administration. 1999. Hazardous Materials Guide for First Responders. Washington, DC: Government Printing Office.

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Appendix A

HAZARDOUS MATERIALS CLASSIFICATION SYSTEMS


National Fire Protection Association, 704M System . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A3 Department of Transportation, DOT Chart 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A5 U.S. Department of Labor, Sample Material Safety Data Sheet (MSDS) . . . . . . . . . . . . . .A9

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NATIONAL FIRE PROTECTION ASSOCIATION, 704M SYSTEM


The marking system designed by the National Fire Protection Association identifies hazard characteristics of materials at terminal and industrial sites. It uses a diamond divided into four quadrants, with each quadrant representing a different characteristic, as explained below. The risk level ratings, ranging from four (highest risk) to zero (minimum risk), are based upon protective equipment normally used by firefighters.

Health (Blue)
Health hazards in firefighting generally result from a single exposure, which may vary from a few seconds up to an hour. Only hazards arising out of an inherent property of the material are considered. It should be noted, however, that the physical exertion demanded in firefighting or other emergency conditions tends to intensify the effects of any exposure. Risk level 4: Materials too dangerous to human health to expose firefighters. A few whiffs of the vapor could cause death or the vapor or liquid could be fatal on penetrating the firefighter s normal full protective clothing. The normal full protective clothing and breathing apparatus available to the average fire department will not provide adequate protection against inhalation or skin contact with these materials. Risk level 3: Materials extremely hazardous to health, but areas may be entered with extreme care. Full protective clothing including self-contained breathing apparatus, coat, pants, gloves, and boots, with bands around the legs, arms, and waist should be provided. No skin surface should be exposed. Risk level 2: Materials hazardous to health, but areas may be entered freely with full facemask self-contained breathing apparatus that also provides eye protection. Risk level 1: Materials only slightly hazardous to health. It may be desirable to wear self-contained breathing apparatus. Risk level 0: Materials which on exposure under fire conditions would offer no hazard beyond that of ordinary combustible materials.

Flammability (Red)
Susceptibility to burning is the basis for assigning risk levels within this category. The method of attacking the fire is influenced by the material s susceptibility factor. Risk level 4: Very flammable gases or very volatile flammable liquids. Shut off flow and keep cooling water streams on exposed tanks or containers. Risk level 3: Materials that can be ignited under almost all normal temperature conditions. Water may be ineffective because of the low flash point.

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Risk level 2: Materials that must be moderately heated before ignition will occur. Water spray may be used to extinguish the fire because the material can be cooled below its flash point. Risk level 1: Materials that must be preheated before ignition will occur. Water may cause frothing if it gets below the surface of the liquid and turns to steam. However, water fog gently applied to the surface will cause a frothing that will extinguish the fire. Risk level 0: Materials that will not burn.

Reactivity/Stability (Yellow)
The assignment of degrees in the reactivity category is based upon the susceptibility of materials to release energy either by themselves or in combination with water. Fire exposure is one of the factors considered, along with conditions of shock and pressure. Risk level 4: Materials that (in themselves) are readily capable of detonation or of explosive decomposition or reaction at normal temperatures and pressures. Includes materials that are sensitive to mechanical or localized thermal shock. If a chemical with this hazard rating is in an advanced or massive fire, the area should be evacuated. Risk level 3: Materials that (in themselves) are capable of detonation or of explosive decomposition or reaction that require a strong initiating source that must be heated under confinement before initiation. Includes materials that are sensitive to thermal or mechanical shock at elevated temperatures and pressures, or that react explosively with water without requiring heat or confinement. Firefighting should be done from an explosive-resistant location. Risk level 2: Materials that (in themselves) are normally unstable and readily undergo violent chemical change, but do not detonate. Includes materials that can undergo chemical change with rapid release of energy at normal temperatures and pressures, or that can undergo violent chemical change at elevated temperatures and pressures. Also includes those materials that may react violently with water or that may form potentially explosive mixtures with water. In advanced or massive fires, firefighting should be done from a safe distance or from a protected location. Risk level 1: Materials that (in themselves) are normally stable but that may become unstable at elevated temperatures and pressures or that may react with water with some release of energy, but not violently. Caution must be used in approaching the fire and applying water. Risk level 0: Materials that (in themselves) are normally stable even under fire exposure conditions and that are not reactive with water. Normal firefighting procedures may be used.

Special Information (White)


The quadrant includes information on specific characteristics of the material (e.g., reactivity with water, tendency to oxidize).

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A8

MATERIAL SAFETY DATA SHEETS


The Material Safety Data Sheet (MSDS) has become a major source of chemical information. It is the key document used to provide hazard information to employees and can become an invaluable tool for emergency response personnel when used in a chemical emergency. The Occupational Safety and Health Administration s (OSHA) Hazard Communication Standard (29 CFR 1910.1200) requires all manufacturers of pure chemicals and/or mixtures to evaluate their products and relate, via MSDSs, any hazards that may be encountered while handling these materials. This standard is intended for all workplaces, manufacturing and nonmanufacturing alike. The Environmental Protection Agency s (EPA) Emergency Response and Community Right-to-Know Act of 1986 ensures the availability of MSDSs to emergency response personnel, such as fire departments, first aid crews, and hospital emergency room staff. The MSDS contains a wealth of information that may be understood with a minimum of training. Below is a brief explanation of the format and information found in a properly prepared MSDS.

Section 1
This section identifies the material by product or trade name and chemical name. It is the product or trade name that is usually found on the container labels, although the chemical name is also required by some states. Section I also contains the manufacturer s name, address, and telephone number.

Section 2
Section 2 provides physical data about the product that can be utilized for proper identification. Included are specifics such as color, odor, specific gravity (weight), vapor pressure, and boiling point.

Section 3
This section lists the chemical ingredients of the material, if they are known or suspected to be hazardous. Hazardous materials that are not carcinogens must be reported if they represent 1 percent or more of the product. Carcinogens must be reported and identified as such if their levels are 0.1 percent or higher. Also included in Section 3 are Threshold Limit Values (TLVs) and the OSHA Permissible Exposure Limit (PEL).

Section 4
Section 4 includes fire and explosion hazard data. This information is especially useful when devising both in-house and community contingency plans. Plant first responders, local fire departments, and hazmat teams need unlimited access to this information.

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Section 5
Section 5 contains health hazard data. It describes any acute (short-term exposure) and/or chronic (long-term exposure) effects on the body. These include routes of exposure (inhalation, dermal contact, ingestion) and the bodily organs affected, as well as the signs and symptoms of overexposure. First aid procedures are also be found in this section. (NOTE: First aid measures recommended in MSDSs are not always correct and should be confirmed.)

Section 6
This section contains information on the reactivity of the product. It lists other chemicals that, when mixed with the product, will result in a chemical reaction. If a product is water reactive, it will be noted. Also included in Section 6 is information on hazardous decomposition products, such as carbon monoxide and other hazardous gases, that are formed and emitted during chemical reactions or fires. It is imperative that this section be carefully noted by both in-house and local firefighters.

Section 7
Section 7 lists the procedures that should be used if the product spills or leaks, including waste disposal methods.

Section 8
Section 8 contains information regarding the proper personal protective equipment (PPE) necessary to handle the product in a manner that will minimize exposure. Ventilation practices are also listed in this section.

Summary
A Material Safety Data Sheet can aid in making the right decisions on health and safety issues in a plant or in a community. It must be noted, however, that it is but one of many references that should be used to make final determinations. MSDSs are offered by manufacturers for identification and verification and are not the last word on safety and health practices.

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Appendix B

TYPES OF RESPIRATORY PROTECTION

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Appendix B Types of Respiratory Protection


Type of Respirator Air Purifying
Air-Purifying Respirator (including powered sea level) [PAPRs]) Enhanced mobility Cannot be used in IDLH or oxygen-deficient atmospheres (less than 19.5 percent oxygen at air-purifying respirators Limited duration of protection; may be hard to gauge safe operating time in field conditions Only protects against specific chemicals, and up to specific concentrations Use requires monitoring of contaminant and oxygen levels Can only be used: (1) against gas and vapor contaminants with adequate warning properties; or (2) for specific gases or vapors provided that the service is known and a safety factor is applied, or if the unit has an ESLI (end-of-service-life-indicator)

Advantages

Disadvantages

Lighter in weight than an SCBA; generally weighs 2 pounds or less (except for PAPRs)

Atmosphere-Supplying
Self-Contained Breathing Apparatus (SCBA) Provides the highest available level of protection against airborne contaminants and oxygen deficiency Provides the highest available level of protection under strenuous work conditions Bulky, heavy (up to 35 pounds) Finite air supply limits work duration May impair movement in confined spaces

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Appendix B (continued)

Type of Respirator

Advantages

Disadvantages
Not approved for use in IDLH or oxygendeficient atmospheres (less 19.5 percent oxygen at sea level) unless equipped with an emergency egress unit, such as an escape-only SCBA, that can provide immediate emergency respiratory protection in case of air line failure Impairs mobility Mine Safety and Health Administration/ NIOSH certification limits hose length to 300 feet As the length of the hose is increased, the minimum approved airflow may not be delivered at the faceplate Air line is vulnerable to damage, chemical contamination, and degradation. Decontamination of hoses may be difficult Worker must retrace steps to leave work area Requires supervision/monitoring of the air supply line

Positive Pressure Supplied- Enables longer work periods than an SCBA Air Respirator (SAR)
(also called air line respirator) Less bulky and heavy than an SCBA; SAR equipment weigh less than 5 pounds (or around 15 pounds, if escape SCBA protection is included) Protects against most airborne contaminants

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Appendix C

LEVELS OF PROTECTION

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Appendix C Levels of Protection1


Level of Protection Equipment
A

Protection Provided

Should be used when:


The chemical substance has been identified and requires the highest level of protection for skin, eyes, and the respiratory systems based on: -measured (or potential for) high concentration of atmospheric vapors, gases, or particulates; or -site operations and work functions involving a high potential for splash, immersion, or exposure to unexpected vapors, gases, or particulates of materials that are harmful to skin or capable of being absorbed through the intact skin Substances with a high degree of hazard to the skin are known or suspected to be present, and skin contact is possible Operations must be conducted in confined, poorly ventilated areas until the absence of conditions requiring Level A protection is determined

Limiting Criteria
Fully-encapsulated suit; material must be compatible with the substances involved

Recommended: The highest available Pressure-demand, full level of respiratory, facepiece SCBA or pressure- skin, and eye protection demand, supplied-air respirator with escape SCBA Fully-encapsulated, chemicalresistant suit Inner chemical-resistant gloves Chemical-resistant safety boots/shoes Two-way radio communication

Optional: Cooling unit Coveralls Long cotton underwear Hard hat Disposable gloves and boot covers

Reprinted from NIOSH/OSHA/USCG/EPA 1985. Occupational Safety and Health Guidance Manual for Hazardous Waste Site Activities. Washington, D.C.: Department of Health and Human Services.

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Appendix C (continued) Levels of Protection


Level of Protection Equipment
B Recommended: Pressure-demand, full-facepiece SCBA or pressure-demand, suppliedair respirator with escape SCBA

Protection Provided

Should be used when:

Limiting Criteria

The type and atmospheric concentration of substances have been identified and require a high level of respiratory protection, but less skin It is the minimum level protection. This involves: Chemical-resistant clothing recommended for initial (overalls and long sleeved site entries until the -atmosphere with IDLH jacket; hooded, one- or hazards have been concentrations of specific two-piece chemical splash further identified substances that do not suit; disposable chemicalrepresent a severe skin resistant one-piece suit) hazard; or Inner and outer chemicalresistant gloves Chemical-resistant safety boots/shoes Hard hat Two-way radio communications -atmosphere containing less than 19.5 percent oxygen Presence of incompletely identified vapors or gases is indicated by direct-reading organic vapor detection instrument, but vapors and gases are not suspected of containing high levels of chemicals harmful to skin or capable of being absorbed through intact skin

The same level of respiratory protection, but less skin protection than Level A

Use only when the vapor or gases present are not suspected of containing high concentrations of chemicals that are harmful to skin or capable of being absorbed through intact skin Use only when it is highly unlikely that the work being done will generate either high concentrations of vapors, gases, or particulates or splashes of material that will affect exposed skin

Optional: Coveralls Disposable boot covers Face shield Long cotton underwear

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Appendix C (continued) Levels of Protection


Level of Protection
C

Equipment

Protection Provided

Should be used when:

Limiting Criteria

Recommended: Full-facepiece, air-purifying, No respiratory canister-equipped respirator protection; minimal skin protection Chemical-resistant clothing (overalls and long sleeved jacket: hooded, one- or twopiece chemical splash suit; disposable chemical-resistant one-piece suit) Hard hat Optional: Gloves Escape mask Face shield

The atmosphere contains no known hazard Work functions preclude, splashes immersion, or the potential for unexpected inhalation of or contact with hazardous levels of any chemicals

This level should not be worn in the Exclusion Zone The atmosphere must contain at least 19.5 percent oxygen

Recommended: Coveralls Safety boots/shoes Safety glasses or chemical splash goggles Hard hat Optional: Gloves Escape mask Face Shield

No respiratory protection; minimal skin protection

The atmosphere contains no known hazard Work functions preclude splashes, immersion, or the potential for unexpected inhalation of or contact with hazardous levels of any chemicals

This level should not be worn in the Exclusion Zone The atmosphere must contain at least 19.5 percent oxygen

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Comments
The Agency for Toxic Substances and Disease Registry would greatly appreciate your comments and suggestions for improving future editions of this guidance document. Comments may be addressed to: Scott V. Wright Emergency Response and Scientific Assessment Branch (MS E57) Agency for Toxic Substances and Disease Registry (ATSDR) 1600 Clifton Road, N.E. Atlanta, GA 30333

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Managing Hazardous Materials Incidents

Volume III
(Revised)

Medical Management Guidelines for Acute Chemical Exposures

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES


Public Health Service Agency for Toxic Substances and Disease Registry

The state of knowledge regarding the treatment of patients potentially exposed to hazardous substances in the environment is constantly evolving and is often uncertain. In this document, the Agency for Toxic Substances and Disease Registry (ATSDR) has made diligent effort to ensure the accuracy and currency of the information presented but makes no claim that the document comprehensively addresses all possible situations related to this topic. This document is intended as an additional resource for physicians and other health professionals in assessing the condition and managing the treatment of patients potentially exposed to hazardous substances. It is not, however, a substitute for the professional judgment of a health care provider and must be interpreted in light of specific information regarding the patient available to such a professional and in conjunction with other sources of authority.

Agency for Toxic Substances and Disease Registry 2000

ATSDR

CONTENTS
Acronyms and Abbreviations Preface Acknowledgments Introduction Chemical Protocols
Acrylonitrile Ammonia Aniline Arsenic Trioxide Arsine Benzene Blister Agent (H, HD, HT) Blister Agent (HN1, HN2, HN3) Blister Agent (HL, L) 1,3-Butadiene Chlordane Chlorine Ethylene Glycol Ethylene Oxide Formaldehyde Gasoline Hydrogen Chloride Hydrogen Cyanide Hydrogen Fluoride Hydrogen Peroxide Hydrogen Sulfide Mercury Methyl Bromide Methylene Chloride Nerve Agent (GA, GB, GD, VX) Nitrogen Oxides Parathion Phenol Phosgene Phosgene Oxime Phosphine Sodium Hydroxide Sulfur Dioxide Tetrachloroethylene Toluene Toluene Diisocyanate 1,1,1-Trichloroethane Trichloroethylene Vinyl Chloride Xylene
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Unidentified Chemical

Appendix I Appendix II Appendix III Appendix IV Glossary

Regional Poison Control Centers

A-1

Association of Occupational and Environmental Clinics State Health Departments


Consultation Resources

A-11 A-20
A-27 G-1

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Acronyms and Abbreviations


AAPCC ABG ABS ACGIH AIHA ALS AOEC ARDS ATSDR BAL BUN C CDC CAS CBC CERCLA CNS CPC CPK DC DHHS dL DMSA DNA DOT ECG ED EEG EMS EMSA EPA ERPG F g GABA GAO GI G6PD HAZMAT HCl HClO HSDB American Association of Poison Control Centers arterial blood gases acrylonitrile/butadiene/styrene American Conference of Governmental Industrial Hygienists American Industrial Hygiene Association advanced life support Association of Occupational and Environmental Clinics acute respiratory distress syndrome Agency for Toxic Substances and Disease Registry British anti-Lewisite (dimercaprol) blood urea nitrogen Celsius Centers for Disease Control and Prevention Chemical Abstract Service complete blood count Comprehensive Environmental Response, Compensation, and Liability Act central nervous system chemical protective clothing creatine phosphokinase direct current Department of Health and Human Services deciliter 2,3-demercaptosuccinic acid deoxyribonucleic acid Department of Transportation electrocardiogram emergency department electroencephalogram emergency medical services Emergency Medical Services Authority Environmental Protection Agency Emergency Response Planning Guideline Fahrenheit gram gamma aminobutyric acid General Accounting Office gastrointestinal glucose-6-phosphate dehydrogenase hazardous material hydrochloric acid hypochlorous acid Hazardous Substances Data Bank

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IARC IDLH IRIS i.v. kg L m mEq mg mL mm Hg m3 MSDS MSHA MTBE MW NAC NFPA NIOSH NO NPIRS NTP OSHA PAM PEG PEL PhAC Po2 ppm PVC RADS RBC SARA SCBA STEL TBA TOCP TSCA TWA TERIS UN UV WHO

International Agency for Research on Cancer immediately dangerous to life and health Integrated Risk Information System intravenous kilogram liter meter milliequivalent milligram milliliter millimeters of mercury cubic meters Material Safety Data Sheet Mine Safety and Health Administration methyl-t-butyl ether molecular weight N-acetylcysteine National Fire Protection Association National Institute for Occupational Safety and Health nitric oxide National Pesticides Information Retrieval System National Toxicology Program Occupational Safety and Health Administration pralidoxime chloride polyethylene glycol permissible exposure limit S-phenyl-N-acetyl cysteine partial pressure of oxygen parts per million polyvinyl chloride reactive airways dysfunction syndrome red blood cel1 Superfund Amendments and Reauthorization Act self-contained breathing apparatus short-term exposure limit t-butyl alcohol tri-o-cresyl phosphate Toxic Substances Control Act time-weighted average Teratogen Information Service United Nations ultraviolet World Health Organization

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Preface
The Agency for Toxic Substances and Disease Registry (ATSDR) is an agency of the Public Health Service in the U.S. Department of Health and Human Services (DHHS). ATSDR was created by the U.S. Congress through the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). The Agencys responsibilities were markedly increased through the Superfund Amendments and Reauthorization Act of 1986 (SARA). The mission of ATSDR is to prevent or mitigate adverse human health effects and diminished quality of life resulting form exposure to hazardous substances in the environment. In pursuit of this mission, ATSDR provides educational and referral resources to health care providers who are responsible for chemically exposed patients. The Medical Management Guidelines for Acute Chemical Exposures (Guidelines) is designed to assist emergency department physicians. It is the third volume in a 3-volume series provided by ATSDR. The Guidelines contain 40 chemical-specific protocols that provide recommendations for the on-scene (prehospital) and hospital (ED) medical management of patients exposed during a hazardous materials (HAZMAT) incident. Other rescue personnel, such as first responders, emergency medical technicians, and public health officials, will also find the information useful, but because of the focus of the protocols, these professions are encouraged to rely on other sources and training in their primary field for more definitive and complete guidance. Each chemical protocol is divided into five sections. (1) Description: Contains synonyms, appearance, routes of exposure; potential for secondary contamination, sources/uses, physical properties, and exposure standards. Health Effects: Contains organ systems affected by acute exposure, potential sequelae, and effects of chronic exposure. Prehospital Management: Contains personal protection, decontamination, support, triage, and transportation. Organized by Hot Zone, Decontamination Zone, and Support Zone. Emergency Department Management: Contains specific medical procedures to treat the exposed patient, and patient disposition. Organized by Decontamination Area and Critical Care Area. Patient Information Sheet: Contains information on exposure, potential effects, and follow-up instructions for the victims of a HAZMAT incident.

(2)

(3)

(4)

(5)

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The Introduction to this volume provides important background information and a brief overview of the activities at a HAZMAT incident. For more information on managing HAZMAT activities, consult Volumes I and II, Emergency Medical Services: A Planning Guide for the Management of Contaminated Patients, and Hospital Emergency Department: A Planning Guide for the Management of Contaminated Patients, respectively. The Introduction also describes the use, rationale, and limitations of the data contained in each section of a chemical protocol. It is written in the format of an individual protocol. The Prehospital Management and Emergency Department Management sections of the Introduction begin with the recommendations form the Unidentified Chemical protocol. The recommendations are followed by the rationale for the procedures suggested. The reader is urged to complete the Introduction before attempting to use the individual protocols. Appendices I through IV contain resources for the emergency department physician seeking consultation in treating chemically exposed patients: AAPCC-Certified Regional Poison Control Centers; Association of Occupational and Environmental Health Clinics; State Health Officials; and private, university, and government consultants are listed. In addition, the Guidelines contains a glossary of chemical and medical terminology.

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Acknowledgments
This document was first published in 1992 and updated in 2000. ATSDR wishes to thank all those who participated in making this a useful guidance document. This project was directed by Scott V. Wright, ATSDR. For the 2000 version, Lisa Ingerman, Ph.D., of Syracuse Research Corporation (SRC) was the project manager, and A. Rosa MacDonald, Ph.D., Fernando Llados, Ph.D., and Susan Little, Ph.D., of SRC were contributing scientists (under ATSDR contract No. 205-1999-00024). The major contributors to the original (1992) Medical Management Guidelines for Acute Chemical Exposures were Jonathan Borak, MD, Kent R. Olson, MD, and Virginia Sublet, PhD. The following experts served as peer reviewers for the original 1992 document and the 2000 update: Eddy Bresnitz, MD, MS, FACP, Frederick M. Burkle. Jr., MD, MPH, Robert Geller, MD, ABMT, Lewis Goldfrank, MD, FACP, FACEP, ABMT, Alan Hall, MD, FACEP, ABMT, William Lixey, David C. Logan, MD, MPH, Linda Rae Murray, MD, MPH, Kent R. Olson, MD, FACEP, ABMT, and Rebecca L. Tominack, MD, ABMT.

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Introduction

This Introduction, which is in the same format as the individual protocols, describes the use and limitations of the information presented. The Prehospital and Emergency Department sections incorporate the Unidentified Chemical protocol as an example. The Introduction is key to the appropriate use of the protocols. Even trained and experienced responders are urged to read it before using the individual protocols in an emergency situation.

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Use of trade names is for identification only and does not imply endorsement by the Public Health Service or the U.S. Department of Health and Human Services.

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General Information Section Chemical Name (Chemical Formula) CAS Number; UN Number
Common synonyms C C C Potential for secondary contamination Common form and important characteristics such as odor and flammability Routes of exposure and potential for absorption Primary contamination refers to direct contact of the victim with the hazardous material. Secondary contamination refers to the transfer of material from the victim to personnel or equipment. The potential for secondary contamination has implications for decontamination and triage of victims and for the protection of rescue and health care personnel. Immediate victim decontamination is recommended for materials that pose risks of secondary contamination; this eliminates both the potential for rescuer contamination and further exposure to the victim. A substance poses a risk of secondary contamination if it is both toxic and likely to be carried on the clothing, skin, or hair of victims in sufficient quantities to threaten other personnel. Substances that present the most serious risks of secondary contamination include the following: C C C highly toxic liquids and solids or finely divided solids (e.g., organophosphate pesticides) radioactive liquids and dusts certain biologic agents (e.g., harmful viruses or bacteria)

Secondary Contamination

Every effort must be made to decontaminate contaminated victims before they are transported to a medical care facility. Examples of substances with little or no risk of secondary contamination include the following: C C C gases (e.g., carbon monoxide, amine) vapors (unless they condense to a liquid state on clothing or skin) substances with no serious toxicity or skin absorption (e.g., propylene glycol, motor oil)

Note that although several of the substances listed above are highly toxic (e.g., arsine, carbon monoxide), they do not pose
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risks of secondary contamination because these chemicals will not contaminate the victim; therefore, they cannot secondarily contaminate rescuers. Secondary contamination also may be a risk in cases of ingestion. Ingested materials may react with stomach acid to produce noxious gases, which can pose risks to both the victim and rescuers. Vomitus may off-gas the hazardous material or a reaction product. Toxic vomitus should be quickly isolated in closed containers. Previously published documents on hazardous materials have recommended zipping patients into body bags to minimize the transfer of chemical from patient to rescuer. This technique is not completely effective for preventing rescuer exposure, and it may pose a significant risk of increased dermal absorption to victims. Body bags are not recommended as an alternative to thorough decontamination.

Description

This section summarizes the color, odor, and physical state (solid, liquid, or gas) of the chemical at room temperature. Methods of shipment or storage and the physical hazards associated with the chemical are also described. The most likely routes of exposure--inhalation, direct contact with the skin or eyes, and ingestion-are described. For each route of exposure, the risk of injury depends on the toxicity of the chemical involved, the concentration of the material, and the duration of con tact. Inhalation is the most common route of exposure to gases and vapors. Liquids and solids may also be inhaled when they are finely divided mists, aerosols, fumes, or dusts. Highly watersoluble gases and vapors and larger mist or dust particles (greater than 10 microns in diameter) generally are deposited in the upper airways. Less soluble gases and vapors and smaller particles can be inhaled more deeply into the respiratory tract. Usually, highly water-soluble materials rapidly produce symptoms of upperairway irritation, whereas less soluble materials may produce delayed symptoms in the lower airways. Inhaled substances may be absorbed into systemic circulation, causing toxicity to various organ systems. When available, information is provided on odor threshold, warning properties, and symptoms to be expected at specific exposure levels. Skin and eye contact can occur by exposure to solids, liquids, or gases. Corrosive agents cause direct damage to tissues by various

Routes of Exposure

Inhalation

Skin/Eye Contact

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mechanisms including low or high pH, chemical reaction with surface tissue, removal of normal skin fats (defatting), or removal of moisture (desiccant effect). Some chemicals absorbed through the skin and eyes can produce systemic toxicity. Absorption, and therefore toxicity, is more likely to occur when the normal skin barrier is disrupted (e.g., chemical bum, cut, or abrasion) or when the chemical is highly fat-soluble (e.g., organophosphate and organochlorine pesticides). Ingestion Ingestion is not a common route of exposure in most hazardous materials (HAZMAT) incidents, although it is common in suicide attempts. Ingestion of corrosive agents can cause severe burns to the mouth, throat, esophagus, and stomach. Ingested chemicals may also be aspirated into the lungs, especially after vomiting, causing chemical pneumonitis. Ingested chemicals may react with stomach acid, creating products that are toxic to the patient, and potentially, the health care provider (e.g., hydrogen cyanide from ingested cyanide salts). This section describes the chemicals most common uses and the methods of production. Government agencies and professional organizations have established standards and guidelines for hazardous chemical exposures. The standards and guidelines address both acute and chronic exposures. The Occupational Safety and Health Administration (OSHA) permissible exposure limit (PEL) is a regulatory limit established to avoid adverse health effects from exposure. PELs are timeweighted-average (TWA) air concentrations. In most cases, a healthy, working adult can be exposed to a chemical at the PEL for an g-hour workday and a 40-hour workweek and suffer no adverse health effects. If the measured air concentration at a HAZMAT incident is less than the PEL and the exposure is shortterm, persons at the scene are probably not at serious risk. The OSHA skin designation indicates the likelihood of dermal absorption. The OSHA ceiling is an instantaneous concentration that must not be exceeded any time. If instantaneous monitoring is not feasible, the ceiling is normally assessed as a 15minute TWA concentration.

Sources/Uses Standards and Guidelines

The OSHA short-term exposure limit (STEL) is a 15-minute (unless otherwise noted) TWA concentration that should not be

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exceeded at any time, even if the 8-hour TWA concentration is below the PEL. The National Institute for Occupational Safety and Health (NIOSH) recommends workplace exposure guidelines. The NIOSH immediately dangerous to life or health (IDLH) level represents the maximum chemical concentration from which one could escape within 30 minutes without a respirator and without experiencing any escape-impairing (e.g., severe eye irritation) or irreversible health effects. The American Industrial Hygiene Association (AIHA) Emergency Response Planning Guidelines (ERPG) state concentrations at which one might reasonably anticipate observing adverse effects from exposure to specific substances. Unlike occupational expo sure standards, ERPG levels are applicable to the general public, including children and the elderly. The three ERPG levels vary with the health effects expected with exposure (transient symptoms, ability impairment, and life-threatening) and apply to practically all persons. The table in the Properties section includes only ERPG-2-the exposure level that could impair a persons ability to take protective action. ERPG levels are defined as follows: ERPG-1 is the maximum airborne concentration below which it is believed that nearly all persons could be exposed for up to 1 hour without experiencing symptoms other than mild transient adverse health effects or perceiving a clearly defined objectionable odor. ERPG-2 is the maximum airborne concentration below which it is believed that nearly all persons could be exposed for up to 1 hour without experiencing or developing irreversible or other serious health effects or symptoms that could impair their abilities to take protective action. ERPG-3 is the maximum airborne concentration below which it is believed that nearly all individuals could be exposed for up to 1 hour without experiencing or developing life-threatening health effects.

Physical Properties

Description: Physical state and useful characteristics of the chemical at room temperature are presented. Warning properties: Odor and irritation are the primary determinants of exposure awareness. When available, an objective description of odor (e.g., garlic-like) and the lowest air

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concentration that can be detected (i.e., odor threshold) is provided. For chemicals with an odor threshold below the toxic air concentration, odor may provide an adequate warning of dangerous exposure conditions. However, a chemical is considered to have inadequate warning properties if it has no detectable odor at toxic air concentrations, has an odor that is not reliably detected because of olfactory fatigue, or does not cause irritation. Molecular weight (MW) is the sum of the weights of the atoms in a molecule. Molecular weight is provided in daltons, a unit that is based on the mass of oxygen- 16. Molecular weight can be used to convert measurements of air concentrations of chemicals from parts per million (ppm) to milligrams per cubic meter (mg/m3) using the following equation: mg/m3 = (ppm x M W) / 22.4 L/mole (1 mole of gas occupies 22.4 L at standard temperature and pressure). Boiling point of a liquid is the temperature at which its vapor pressure is equal to the atmospheric pressure. A boiling point at or below room temperature means that the chemical is in the gaseous state at room temperature. Freezing point is the temperature at which a chemicals solid phase is in equilibrium with the liquid phase. Freezing point and melting point are equal in numeric value. The termfreezing point refers to the temperature at which a liquid forms a solid; melting point refers to the temperature at which a solid forms a liquid. Specific gravity is the ratio of the density of a liquid to the density of a reference material (usually water). A specific gravity less than 1 indicates that the substance will float on water; a specific gravity greater than 1 indicates that the substance will sink in water. Vapor pressure is the pressure (expressed in millimeters of mercury [mm Hg] of a vapor in equilibrium with its liquid or solid form at a given temperature. The higher the vapor pressure, the greater the amount of chemical existing in the vapor phase. A vapor pressure greater than 760 mm Hg at room temperature indicates that the chemical exists as a gas. Gas density is the ratio of the density (weight per volume) of a substance (at a given temperature) to the density of air (at that temperature). A gas density greater than 1 indicates that the vapor or gas is heavier than air. A gas heavier than air may collect in
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low-lying areas where it can displace air, creating an oxygendeficient atmosphere. Water solubility indicates the degree to which a substance dissolves in water at a specific temperature. Water solubility is measured in weight of substance per volume of water (e.g., g/100 ml or %). Water solubility may indicate the effectiveness of water in decontamination. A substance that is water soluble is likely to be removed from the skin and hair with a plain water wash. Substances that are poorly water soluble may require the use of soap. Flammability is the ease with which a material will ignite. Flammable chemicals have flash points below l00 F; combustible chemicals have flashpoints between 100 F and 200F; and nonflammable chemicals have flashpoints above 200 F. Flammable range (lower explosive limit to upper explosive limit) is expressed as the percentage of gas or vapor dispersed in air that will bum when an ignition source is present. The temperature, the flammable range, and the potential for a vapor or gas to travel to an ignition source and flash back may affect rescue activities. The flammable range may indicate the need for special protective clothing. Most chemical-resistant protective clothing is neither heat- nor flame-resistant and may melt if a fire occurs.

Incompatibilities

HAZMAT incidents commonly involve more than one chemical. Incompatibility and reactivity information, primarily from the NIOSH Pocket Guide to Chemical Hazards, is included in this section.

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Health Effects Section


C C Common symptoms Systemic effects and mechanism of action

Health risk depends on the intrinsic toxic potential of the chemical, its concentration, and the duration of exposure. Highly toxic chemicals may pose a risk of illness even if the exposure duration is brief or the concentration of the substance is low. Even mildly toxic substances, however, can be hazardous if the exposure is prolonged or the concentration is high.

Acute Exposure

When suspected or known, the mechanism of action is discussed. Acute exposure is defined as chemical exposure of less than 14 days duration. Most HAZMAT incidents involve acute exposures that last only minutes, but the chemical concentration may be extremely high. Although HAZMAT incident exposures are likely to be short, risks of adverse health effects still exist. The onset of health effects caused by acute exposure can be immediate or delayed. Organ systems or metabolic processes that are adversely affected by the chemical are discussed in the following sections. The organ system or metabolic process mentioned first in each chemical protocol is the most severely affected, those not affected by the chemical are not addressed.

Cardiovascular

Many chemicals have direct depressant or stimulatory effects on cardiac function. Hypotension and dysrhythmias may be aggravated by hypoxia from respiratory depression or pulmonary aspiration of gastric contents. Hypotension may also occur because of volume depletion from excessive vomiting, diarrhea, or severe chemical bums. Certain solvents (e.g., chlorinated hydrocarbons, freons, aromatic hydrocarbons) may lower the myocardial threshold to the dysrhythmogenic effects of catecholamines. For several hours after solvent exposure, a victim may be susceptible to ventricular dysrhythmias (e.g., premature ventricular contractions, ventricular tachycardia, or ventricular fibrillation) especially from administered sympathomimetic drugs such as bronchodilators or dopamine or the increased quantity of endogenous epinephrine produced during intense physical activity.

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CNS

Central nervous system (CNS) depressants (e.g., hydrocarbon solvents) cause a generalized decrease in brain activity. Headache, dizziness, confusion, lethargy, stupor, or coma may result. Severe depression of the brain stem can cause respiratory arrest and cardiovascular collapse. Some chemical depressants have early stimulatory effects, producing euphoria and giddiness similar to ethanol. CNS stimulants (e.g., organophosphate insecticides) can cause agitation, anxiety, delirium, and seizures. Excessive muscular activity associated with seizures can cause hyperthermia.

Dermal

Dermal contact with chemicals can produce local injury; if absorbed, chemicals can also produce systemic effects. Local injuries (e.g., burns from mineral acids) usually are immediately obvious. However, a few chemicals (e.g., alkaline corrosives, hydrofluoric acid) cause a progressive penetrating injury that may not be apparent for hours. The skin generally provides a relatively impermeable protective barrier. Many chemicals disrupt the skins integrity by removing fats, producing chemical burns, or destroying cells. Physical injury such as thermal bums or traumatic events may also result in loss of the skins barrier effect. Disruption of the normal protective barrier allows easier entry of chemicals into systemic circulation. Systemic illness can also occur without skin damage because many fat-soluble chemicals (e.g., some organophosphate insecticides) rapidly penetrate intact skin.

Electrolyte

Some chemicals can produce effects on serum electrolytes (e.g., potassium, calcium, sodium) and total anion gap. Electrolyte imbalance can cause muscle weakness and cardiac dysrhythmias. Nausea, vomiting, abdominal pain, and diarrhea are common symptoms after chemical exposure and may be due to direct gastrointestinal irritation or to systemic effects. Ingestion of some chemicals can also cause severe corrosive injury to the mouth, throat, esophagus, and stomach, with bleeding, perforation, scarring, or stricture formation as potential sequelae. Components of the blood and blood-forming organs can be damaged by many chemicals (e.g., arsine, benzene). Most hematologic changes (e.g., hemolysis, methemoglobinemia, bone marrow suppression, and anemia) can be detected by blood tests or simply by the color or appearance of the blood

Gastrointestinal

Hematologic

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Hepatic

Some chemical exposures result in acute injury to the liver, which typically does not manifest for 2 to 3 days after exposure. At that time, laboratory tests will show abnormal liver function (e.g., elevated bilirubin or aminotransferase levels or increased prothrombin time). Toxic hepatitis may progress to liver failure and death. Immunologic effects may include induced sensitivity and allergy. Metabolic acidosis is the most common adverse metabolic effect that occurs after chemical exposure. Acidosis results from an accumulation of acid anions such as formic, lactic, or oxalic acid. Musculoskeletal damage due to chemical exposure is unusual. Some effects are arthritis and hardening, destruction, or cancer of the bone. Most serious ocular injuries result from direct eye contact with corrosive liquids or solids. High concentrations of or prolonged exposures to gases or vapors may also injure the eye. Severe eye exposure carries a risk of blindness or other visual impairment and demands immediate evaluation by an ophthalmologist. Most patients who have eye injuries involving the conjunctival or cornea1 surfaces experience pain and irritation, excessive lacrimation, and possibly crusting and swelling of the eyelids. Generally, corneal damage causes intense pain and the sensation of a foreign body in the eye.

Immunologic Metabolic

Musculoskeletal

Ocular

Peripheral Neurologic

Peripheral nervous system effects can include changes in sensation, reduced reflexes, and impaired motor function. Effects are pronounced in the largest muscle groups such as those in the lower limbs. Some chemicals injure the kidneys directly. In addition, any poisoning causing massive muscle destruction can lead to kidney injury from excessive myoglobin in the kidney tubules. Inhalation of a chemical irritant (e.g., ammonia, chlorine) usually causes rapid onset of burning and irritation of the nose, throat, and upper respiratory tract. Painful coughing, wheezing, and stridor may develop. If the exposure is massive, death may rapidly ensue from upper airway obstruction, massive alveolar destruction, or asphyxiation. Chest radiography may indicate pulmonary edema when damaged lung cells allow fluid to leak into the alveoli (referred to as noncardiogenic pulmonary edema because the fluid

Renal

Respiratory

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accumulation is not caused by left ventricular failure, which occurs in cardiogenic pulmonary edema). The onset and location of respiratory symptoms is partially related to the water solubility of the inhaled chemical. Highly watersoluble gases, such as ammonia, cause rapid onset of symptoms (burning nose and throat, painful cough, stridor, wheezing) as the gases dissolve in the mucous membranes of the upper respiratory tract. However, less soluble gases such as phosgene are breathed deeply into the lower airways and typically cause only mild or no early symptoms; noncardiogenic pulmonary edema may develop after 12 to 36 hours. Injury to the respiratory tract also can occur after ingestion of a chemical substance. The unconscious or convulsing patient may vomit and then, because of depressed airway protective reflexes, may aspirate gastric contents into the lungs. Pulmonary aspiration of an ingested hydrocarbon can cause severe pneumonitis. Hydrocarbons irritate the lung tissue and interfere with surface tension in the alveoli, disrupting gas exchange. Pulmonary aspiration can sometimes be prevented by inserting a cuffed endotracheal tube into the patients airway or by placing the patient in a head-down, left-side position and using suction immediately if vomiting occurs. Potential Sequelae Known or suspected sequelae and the prognosis for recovery after an acute exposure are described in this section. Signs and symptoms expected at various stages of recovery and the potential for permanent deficits are presented. Repeated, low-level exposures, typically over a long period of time, may produce health effects that differ in type or degree from effects of acute exposure. Most information about chronic toxicity is from epidemiologic studies and case reports of workplace exposures. Because HAZMAT incidents are unlikely to involve repeated or long-term exposures, chronic health effects are outlined only briefly. Some major concerns of patients who have experienced an acute chemical exposure are the risks of cancer, reproductive effects, or impaired fetal development. No data exist on these outcomes from acute exposure to most chemicals. However, to guide the clinician who must address these patient concerns, we have included carcinogenic, reproductive, and developmental effects that have resulted from chronic exposure to the chemical. It is not known whether the data from chronic exposures are applicable to victims who are acutely exposed in a HAZMAT incident.
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Carcinogenicity

The cancer information included in this section is derived from assessments made by the Department of Health and Human Services (DHHS), the International Association for Research on Cancer (IARC), or the Environmental Protection Agency (EPA). These organizations develop ratings of chemicals that indicate the cancer-producing ability of the chemicals. The information included was based on the following hierarchy: DHHS is offered if available, then IARC, then EPA. Failure of these organizations to evaluate a chemical does not necessarily mean that the chemical does not cause cancer.

Reproductive and Developmental Effects

Information about reproductive and developmental effects was obtained primarily from three data files that are included in TOMES Plus, a proprietary database of Micromedex, Inc., Denver, CO. These data files are Reprotext, edited by Betty J. Dabney, PhD; the Teratogen Information System (TERIS), developed by the University of Washington; and Shepards Catalog of Teratogenic Agents, written by Thomas H. Shepard, MD. An additional source of information was Reproductive and Developmental Toxicants, a 1991 report published by the U.S. General Accounting Office (GAO Report no. GAOLPEMD-92-3) that lists 30 chemicals of concern because of widely acknowledged reproductive and developmental consequences. The 30 chemicals are alcohol, arsenic, cadmium, carbon disulfide, carbon monoxide, chlordecone, chloroprene, DDT, DBCP, DES, ethylene dibromide, EGEE, EGME, ethylene oxide, gossypol, hexachlorobenzene, lead, lithium, mercury, nicotine, PBBs, PCBs, 2,4,5-T, TCDD, tobacco smoke, toluene, vinyl chloride, vitamin A, and warfarin. The topic of reproductive hazards is controversial and emotionally charged. Potentially high risk to the fetus may warrant considering termination of the pregnancy. Most clinicians are not adequately prepared to help the patient make this decision. Expert assistance may be available from regional poison control centers, regional reproductive risk/teratogen information centers, or the MotherRisk Program. For more information, see Appendices I and III.

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Prehospital Management Section


The Prehospital Management section describes the activities that typically occur in the three concentric areas surrounding a HAZMAT incident (Figures 1 and 2), particularly those activities that relate to Emergency Medical Services (EMS) personnel. The Hot Zone (or Exclusion Area) is the area surrounding the chemical release; it is assumed to pose an immediate health risk. The Decontamination Zone (or Warm Zone) is the area surrounding the Hot Zone where primary contamination is not expected but where personnel must use protective clothing and equipment to avoid chemical exposure from contaminated victims. The Support Zone (or Cold Zone) is the outermost ring where no exposure or risk is expected. The incident commander, medical personnel, and other support persons and equipment operate in the Support Zone. The information provided in the chemical protocols is an attempt to offer an accurate and practical approach to the management of hazardous materials emergencies. The user of the protocols should be aware that large data gaps exist in the scientific literature. Goals of the EMS HAZMAT Responder C Protect yourself. Approach the Scene cautiously, arriving upwind. Maintain a safe distance and inspect the scene from a nearby elevated area such as a hill. Respect the established exclusion zones and resist the temptation to rush in to attempt a rescue. If a command post has been established, report to the incident commander. Identify the chemical. Be familiar with the Department of Transportation (DOT) placard system, the National Fire Protection Association (NFPA) hazard labeling system, Material Safety Data Sheets (MSDS), and shipping papers. Consult the appropriate protocol and local sources to obtain information about the chemical, its health effects, and medical treatment. Determine the potential for secondary contamination. Understand the risk to yourself and to others in the Support Zone, ambulance, or hospital if decontamination is not completed at the scene. Perform appropriate and thorough decontamination. Provide basic and advanced life support (ALS). Transport victims to an appropriate medical facility as quickly as possible.

C C C C C

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Figure 1. Organization of a HAZMAT incident area

Adapted from Olson, KR, ed. Poisoning and drug overdose. Norwalk, CT: Appleton and Lange, 1990.

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Figure 2. Detail of decontamination zone

Adapted from Hazardous material medical management protocols, 2nd edition. Sacramento, CA: Emergency Medical Services Authority, 1991.

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Prehospital Management Section


C C C Potential for secondary contamination Health effects expected from an acute exposure Patient care (supportive care, antidotes) Secondary contamination is discussed on page 3 of the Introduction. In the prehospital setting, the key factors in determining the potential for secondary contamination are the route and extent of exposure. Victims exposed only to gas or vapor are not likely to carry significant amounts of chemical beyond the Hot Zone and are not likely to endanger personnel outside the Hot Zone. However, victims whose skin, hair, or clothing is grossly contaminated with solid or liquid chemical (including condensed vapor) may contaminate personnel by direct contact or by offgassing vapor. Victims who have ingested a toxic chemical may expose others through toxic vomitus or by vapor off-gassing from toxic vomitus. The bold text below is from the Unidentified Chemical protocol. It is presented as an example of the information presented in each section. The plain g&ace provides details or an explanation.

Hot Zone

Rescuers should be trained and appropriately attired before entering the Hot Zone. If the proper equipment Is not available, or if rescuers have not been trained in its use, assistance should be obtained from a local or regional HAZMAT team or other properly equipped response organization. The Hot Zone includes the area immediately around the chemical spill where persons may be in danger from chemical exposure or physical hazards (e.g., fire or explosion). Only persons who have specialized HAZMAT training should enter the Hot Zone. Although some of these persons may be trained as paramedics, only limited medical care can be provided in the Hot Zone. Advanced medical care is provided in the Decontamination Zone and Support Zone.

Rescuer Protection

When a chemical is unidentified, worst-case possibilities concerning toxicity must be assumed. The potential for severe local effects ( e.g., irritation and burning) and severe systemic

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Introduction

effects (e.g., organ damage) should be assumed when specific rescuer-protection equipment is selected. Respiratory Protection: Pressure-demand, selfcontained breathing apparatus (SCBA) should be used in all response situations. Skin Protection: Chemical-protective clothing should be worn when local and systemic effects are unknown. Trained responders should select protective equipment and clothing based on the general regulations in 29 CFR 1910.120 (OSHA Hazardous waste operations and emergency response). The protocols contain chemical-specific recommendations for rescuer protection. The Rescuer Protection section begins with a summary of the health hazards that are pertinent for one-time, short-term exposures such as those expected at a HAZMAT incident. The respiratory-tract and skin protection (e.g., respirators and chemical-protective clothing) recommendations are based on these health hazards. Two basic types of respiratory protection are available: atmosphere-supplying and air-purifying respirators. Atmospheresupplying respirators provide compressed air at greater than atmospheric pressure to a face mask that is worn by the rescuer and may be supplied-air or self-contained. The self-contained breathing apparatus (SCBA) is often used in HAZMAT incident response to prevent inhalation of hazardous chemicals because it is self-contained, portable, and familiar. SCBA consists of a facepiece that seals, a tank of compressed air carried on the back, and a hose that runs from the air tank to the facepiece. The specific type of SCBA recommended in the Guidelines is pressure demand; that is, although air is always flowing into the facepiece (pressure), the flow increases in response to inhalation (demand). Although commonly used at hazardous waste clean-up sites, the supplied-air respirator should not be used at a HAZMAT incident. The supplied-air respirator consists of a mask or facepiece connected to an air hose supplied by a compressor at a distant site. Because the air hose may be degraded by chemicals or heat and the hose may become tangled, the supplied-air respirator is not practical for operations during an emergency.

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Air-purifying respirators do not supply air to the user; they simply filter the ambient air and are seldom used at HAZMAT incidents. Air-purifying respirators can use the same type of facepiece as an air-supplied respirator. Instead of an air-supply hose, they are connected to a charcoal or other filter-containing cartridge. The cartridge filters the air before it is inhaled. Conditions that preclude the use of an air-purifying respirator include C C C C C oxygen-deficient atmosphere (19.5% O2) unidentified contaminant unknown concentration of contaminant concentration of contaminant above NIOSH IDLH high relative humidity

Most HAZMAT incidents involve at least one of these conditions; therefore, air-purifying respirators are rarely appropriate for emergency response. Dust or surgical masks are also air-purifying-they filter and prevent the inhalation of large particles. However, they offer no protection from the inhalation of chemical vapors or gases and are not recommended in the Guidelines. Regardless of the type of respiratory protection used, all respirators should be approved by NIOSH and the Mine Safety and Health Administration(MSHA).NIOSH and MSHA designate performance characteristics of respirators. Chemical-protective clothing (CPC) is not subject to performance standards set by a government agency. Chemical-specific resistance to degradation, penetration, and permeation are important factors to consider in selecting CPC. CPC that fails can subject the wearer to significant exposure and adverse health effects. Degradation involves the chemical breakdown of the suit material itself, causing exposure. Penetration is movement of a chemical through an opening in the material or article of clothing (e.g., through punctures or zippers). Permeation involves chemical movement through the suit material but not necessarily destruction of it. The NFPA has established performance standards for two types of chemical-protective garments: a vapor-protective suit and a liquid-splash-protective suit. The standards provide methods for testing material and suits to assure chemical resistance, overall durability, and valve/closure construction suitability. The vapor protective suit is completely encapsulating; once the user is attired, even exhaled air is trapped inside until pressure activates
ATSDR Prehospital Management 21

Introduction

one-way release valves. Suits meeting the NFPA guidelines can be used to provide protection according to the EPA classifications described below. The certification accompanying protective clothing that meets NFPA guidelines specifies the chemicals and conditions under which the clothing was tested. The NFPA performance standards do not address respiratory protection; therefore, no assumptions can be made regarding respiratory protection based on the NFPA suit designation. EPA has established a 4-stage classification system to address the levels of protection afforded by respiratory and chemicalprotective clothing combinations commonly used by HAZMAT responders. The four classes, in descending order of protection, are called levels A through D. The EPA definitions do not address NFPA clothing; however, the equivalent NFPA suit is specified below. Level A includes a fully encapsulating chemical-resistant suit (equivalent to an NFPA vapor-protective suit) and a pressure-demand SCBA. Level B includes a nonencapsulating chemical-resistant suit (equivalent to an NFPA splash-protective suit) and an SCBA. Level C includes a nonencapsulating chemical-resistant suit (equivalent to an NFPA splash-protective suit) and an air-purifying respirator. Level D consists of work clothes that do not provide any specific respiratory or skin protection. The EPA classification does not address use of the common firefighting ensemble - SCBA with turnouts or bunker gear. Turnouts are not designed to protect against chemical exposure and should not be worn when hazardous chemical exposure is possible. Specialized personal protective gear should be used only by those with prior training and fitting. The choice of specific chemicalresistant materials (e.g., Tyvek, Saranex, or butyl rubber) is beyond the scope of this document and is generally the responsibility of an expert on the HAZMAT team. Additional protective equipment may be required when risks of fire or explosion exist.

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Introduction

Although CPC provides protection against adverse health effects due to chemical exposure, it contributes to heat stress. CPC prevents both the inward and. outward movement of moisture, decreasing the availability of evaporative cooling. During an incident, body heat builds quickly because of the heavy workload and CPC prevents heat dissipation. Several cooling systems are available for use under CPC; however, they serve only to reduce peripheral body temperature and not core body temperature. Because core body temperature does not decrease, cooling systems may actually be harmful. By cooling the skin and making the user feel more comfortable, cooling systems may encourage rescuers to work longer and build up a dangerously high core body temperature. ABC Reminders Quickly ensure a patent airway. If trauma is suspected, maintain cervical immobilization manually and apply a cervical collar and a backboard when feasible. Only minimal patient care can be performed in the Hot Zone while wearing Level A or Level B protective gear. Rescuers can often perform only simple maneuvers such as ensuring a patent airway, applying a cervical collar, brushing off gross contaminants, and applying direct pressure to stop arterial bleeding. The goal in the Hot Zone is to quickly remove the victim from continued exposure and risk. Victim Removal If victims can walk, lead them out of the Hot Zone to the Decontamination Zone. Victims who are unable to walk may be removed on backboards or gurneys; if these are not available, carefully carry or drag victims to safety. Victims should be removed from the Hot Zone to the Decontamination or Support Zone, as appropriate, in the safest and quickest way possible. Ambulatory victims may need to be guided to the Decontamination Zone. Nonambulatory victims can be removed on backboards, litters, or gurneys, or if necessary, carefully dragged or carried to safety.

Decontamination Zone

Victims exposed only to gas or vapor who have no skin or eye irritation may be transferred immediately to the Support Zone. All others require decontamination (see Basic Decontamination, page 25). The Decontamination Zone is a corridor between the Hot Zone and the Support Zone. The Decontamination Zone may be set up in any convenient location that is safely beyond the Hot Zone, but
ATSDR Prehospital Management 23

Introduction

separate from the Support Zone. If possible, the Decontamination Zone should be established outdoors (preferably upwind and uphill from the Hot Zone) where natural ventilation will allow dispersion of vapor off-gassing from contaminated victims. Because personnel in the Decontamination Zone normally require protective gear, only trained HAZMAT-team members should be present. Decontamination is not required for all victims. Victims exposed only to gases or vapor who do not have skin or eye irritation generally do not need decontamination. Victims who have been decontaminated or who do not require de contamination should be transferred immediately to the Support Zone. Rescuer Protection If the chemical or concentration is unidentified, personnel in the Decontamination Zone should wear the same protective equipment used in the Hot Zone (see Rescuer Protection, page 19). Personnel in the Decontamination Zone normally require protective gear; only personnel with prior fitting and training should be permitted to don protective gear. Generally, the level of clothing is the same as that worn in the Hot Zone. A lower level of protective clothing can be used when the risk of secondary contamination is low. For example, a nonencapsulating suit (NFPA splash protective suit) can be used if an encapsulating suit (NFPA vapor-protective suit) is required in the Hot Zone. If the risk of inhaling off-gassing vapors is also low (i.e., the chemical is not highly volatile or the decontamination area is set up outside with good natural ventilation), it may be acceptable to use a lower level of respiratory protection. Air contaminants must be identified and measured to assure safety before a lesser level of respiratory protection is used. ABC Reminders Quickly ensure a patent airway. Stabilize the cervical spine with a collar and a backboard if trauma Is suspected. Administer supplemental oxygen as required. Assist ventilation with a bag valve-mask device If necessary. To provide airway, breathing, and circulatory support for patients in the Decontamination Zone, the rescuer may have to establish an artificial airway, administer supplemental oxygen or nebulized bronchodilators, and assist ventilation. Direct pressure should be applied to control heavy bleeding. Depending on the concentration of the chemical and its potential for secondary contamination, victims with serious trauma or medical complications (e.g.,

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Introduction

seizures) may have to wait for advanced medical care until gross contamination is removed. Rescuers wearing respirators and heavy gloves will find it difficult to provide advanced medical care such as inserting an intravenous line or performing endotracheal intubation; therefore, this care is not administered until the victim is transferred to the Support Zone. Electronic equipment, such as cardiac monitors, generally are not taken into the Decontamination Zone because the equipment may not be safe to operate and may be difficult to decontaminate. Basic Decontamination Victims who are able and cooperative may assist with their own decontamination. Remove and double-bag contaminated clothing and personal belongings. Consider bagging the victims jewelry and other valuables separately from clothing for easier retrieval later. Nonporous materials such as metal jewelry may be easy to decontaminate by washing, whereas clothing or shoes may require disposal. Leather items can be especially difficult to decontaminate and may need to be incinerated. Consult a HAZMAT specialist affiliated with the local fire department, the ATSDR/CDC Emergency Response 24hour Hotline ([404] 639-0615) or the EPA Environmental Response Team, Edison, New Jersey ([732] 321-6740) for advice on the disposition of contaminated equipment and clothing. Flush exposed or irritated skin and hair with water for 3 to 5 minutes. For oily or otherwise adherent chemicals, use mild soap on the skin and hair. Flush exposed or irritated eyes with plain water or saline for at least 5 minutes. Remove contact lenses if present and easily removable without additional trauma to the eye. If a corrosive material is suspected or if pain or injury is evident, continue irrigation while transferring the victim to the Support Zone. Many chemicals react violently with water, liberating toxic gases or creating explosions. Cautions about water reactivity (e.g., statement in the DOT Emergency Response Guidebook or in an MSDS) generally do not apply to flushing eyes, skin, and hair in the Decontamination Zone. There is little risk of creating a serious reaction hazard by adding large amounts of water to the small amount of residual chemical on the victims body. In fact, the naturally occurring moisture on the skin is already reacting with

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25

Introduction

the chemical; hastening removal from the skin is preferable to leaving the chemical to further injure the victim. Solids should be gently brushed from hair, skin, and clothing. During brushing, protect the victims eyes, nose, and mouth. The length of time recommended for flushing exposed skin or eyes will vary with the chemical and the circumstances of exposure. Removal of oily or insoluble materials from the skin and hair requires washing with soap. Any liquid hand- or dish-washing soap will be satisfactory. Use only soft-bristled brushes; abrasive brushing may enhance skin injury and penetration. Most chemicals that cause only mild skin or eye irritation can be removed by flushing for 3 to 5 minutes. Ten to 15 minutes may be required for concentrated or strongly alkaline materials. Eye decontamination after exposure should be continued while the patient is transferred to the Support Zone and even during transport to a medical facility. An attempt should be made to remove contact lenses. Avoid forceful removal, which may inflict injury. Irrigation and transfer to the Support Zone should not be delayed because of difficulty in removing contact lenses. Bleach, vinegar, or other solutions used for equipment decontamination should not be used for washing skin, hair, or eyes. Likewise, neutralizing agents should not be used for decontamination because the heat from neutralization may cause added injury. Dilution with large volumes of water is preferred for decontamination. In cases of ingestion, do not induce emesis. Victims who are conscious and able to swallow should be given 4 to 8 ounces of water. Obtain medical care immediately. Generally, vomiting should not be induced. Vomiting is relatively ineffective in emptying the stomach after a chemical ingestion and may be harmful to the victim. Vomiting may increase damage to the esophagus and stomach if irritating or corrosive chemicals have been ingested. The risk of pulmonary aspiration is also increased when vomiting occurs. Activated charcoal adsorbs many chemicals and is relatively easy to administer. Unless a corrosive chemical has been ingested, a slurry of 50 to 60 grams of activated charcoal should be given to an adult patient who is awake and has a gag reflex. Charcoal may obscure the view when endoscopy is performed (at the hospital) to determine the extent of injury. See Ingestion Exposure, page

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40, for further decontamination. Transfer to Support Zone

discussion

of

gastrointestinal-tract

As soon as basic decontamination is complete, move the victim to the Support Zone. Victims should be moved from the Decontamination Zone to the Support Zone as soon as possible. Ambulatory patients can walk; others may require transport on a gurney.

Support Zone

Be certain that victims have been decontaminated properly. Victims who have undergone decontamination or have been exposed only to gas or vapor and who have no evidence of skin or eye irritation generally pose no serious risks of secondary contamination. In such cases, Support Zone personnel require no specialized protective gear. Because the Support Zone is set up away from the dangers of physical hazards or chemical exposures, primary contamination is not a serious problem in this area. Personnel in the Support Zone do not require special protective clothing if victims have been decontaminated properly. An exception involves victims exposed to a potent and adherent chemical (e.g., an organophosphate pesticide), in which case the Support Zone team should wear disposable aprons or gowns and latex gloves.

ABC Reminders

Quickly ensure a patent airway. If trauma is suspected, maintain cervical immobilization manually and apply a cervical collar and a backboard when feasible. Ensure adequate respiration; administer supplemental oxygen as required. Ensure a palpable pulse. Establish intravenous access if necessary. Attach a cardiac monitor. More sophisticated medical management can begin in the Support Zone where rescuer movement is less encumbered and more equipment and personnel are available. Initially, this care is centered on airway, breathing, and circulatory support for the patient. Intravenous lines should be inserted as soon as possible. A cardiac monitor should be attached because of the potential for some chemicals (e.g., halogenated or aromatic hydrocarbons) to produce dysrhythmogenic effects. Continue irrigating exposed skin and eyes, as appropriate. In cases of ingestion, do not induce emesis. If the patient is conscious and able to swallow, administer 4
ATSDR Prehospital Management 27

Additional Decontamination

Introduction

to 8 ounces of water if it has not been given previously. Obtain medical care immediately. Some victims may require continued irrigation of irritated skin and eyes. If a cardiac monitor is required, irrigation should be completed before the monitor is attached. The additional decontamination recommendations do not imply that the victim poses a risk of secondary contamination. Exposure to a concentrated or strongly alkaline material may require continued irrigation of eyes and skin during transport and in the hospital. Eye irrigation is easily and conveniently accomplished using saline or water and intravenous tubing attached to a nasal canula placed over the bridge of the nose with the prongs pointed down toward the eyes. Ingestion exposure is an uncommon occurrence in a HAZMAT incident. If ingestion has occurred and initial gastrointestinal decontamination has not been carried out in the Decontamination Zone, appropriate treatment must be instituted in the Support Zone. Gastrointestinal decontamination procedures should be carried out only if the patient is alert and has a gag reflex. For most chemicals, the protocols do not recommend emesis and in some cases (e.g., exposure to corrosives or hydrocarbons), emesis is contraindicated. Many chemicals are effectively adsorbed on the surface of charcoal. When indicated in the protocol, a slurry of activated charcoal should be administered as soon as possible to prevent gastrointestinal absorption. If the chemical is corrosive or has not been identified, rinse the mouth and throat by administering 6 to 8 ounces of water. The water will also dilute the hazardous material in the stomach. Advanced Treatment Intubate the trachea in cases of respiratory compromise. When the patients condition precludes endotracheal intubation, perform cricothyroidotomy if equipped and trained to do so. Treat patients who have bronchospasm with aerosolized bronchodilators. Use these and all catecholamines with caution because of the enhanced risk of cardiac dysrhythmias after exposure to certain chemicals. Patients who are comatose, hypotensive, or have seizures or cardiac dysrhythmias should be treated according to ALS protocols.
28 Prehospital Management ATSDR

Introduction

In the Support Zone, more advanced medical care can be readily administered. Contact the regional poison control center (see Appendix 1) or the hospital base station for advice specific to the incident. Bronchodilators, such as metaproterenol (Alupent or Metaprel) or albuterol (Proventil or Ventolin), can be administered by metereddose inhaler, or preferably, by hand-held nebulizer. However, these medications increase heart rate and may provoke cardiac dysrhythmias in victims who have been exposed to certain chlorinated or aromatic hydrocarbons. When bronchodilators are needed, the lowest effective dose should be given and cardiac rhythm should be monitored. Evaluate the patient for possible opioid overdose or hypoglycemia and administer naloxone (Narcan) and dextrose according to standard ALS protocols. Consider the possibility that coma or seizures may be the result of trauma (e.g., head injury) rather than of chemical poisoning. Administer specific antidotes as described in the chemical-specific protocols if within the prehospital scope of practice. Transport to Medical Facility Report to the base station and the receiving medical facility the condition of the patient, treatment given, and estimated time of arrival at the medical facility. If a chemical has been ingested, prepare the ambulance in case the victim vomits toxic material. Have ready several towels and open plastic bags to quickly clean up and isolate vomitus. The base station and receiving medical facility should be apprised of the patients status. Special procedures for patient care en route can be discussed, especially if transport time will be lengthy. Notifying the medical facility of your arrival time ensures appropriate emergency department preparation. Before transporting patients who have ingested hazardous materials, prepare the ambulance by lining a basin or bucket with open plastic bags to catch and isolate toxic vomitus. Some chemicals are converted to poisonous gases by the action of stomach acids (e.g., cyanide salts create hydrogen cyanide gas; sodium azide can produce hydrazoic acid gas). Toxic vomitus can contaminate personnel and equipment by direct contact or by offgassing volatile chemicals.

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29

Introduction

Ambulances that transport HAZMAT victims require only standard equipment. Most supplies recommended in the Guidelines are standard equipment or are easily obtained from grocery or drug stores. The specific equipment most likely to be used in HAZMAT response will vary with the training and policies of individual emergency medical services agencies, but at a minimum include the following: C disposable gloves C splash goggles C waterproof disposable shoe covers C disposable gowns to cover EMS personnel clothing and to be used by stripped and decontaminated patients C large supply of oxygen C plastic garbage bags C large wash basin or bucket (lined with plastic to isolate toxic vomitus) C liquid soap C saline and intravenous tubing for eye irrigation C disposable towels to soak up toxic vomitus Only decontaminated patients or patients not requiring decontamination should be transported. Some earlier HAZMAT protocols called for zipping patients into body bags without proper decontamination. If patients have been decontaminated effectively, no danger of secondary contamination exists. Use of the body bag technique is not effective and puts the victim at risk of substantial skin injury and absorption.

Multi-Casualty Triage

All exposed patients should be transported to a medical facility for evaluation. Asymptomatic patients who have not had direct chemical exposure can be discharged from the scene after their names, addresses, and telephone numbers are recorded. Those discharged should be advised to seek medical care promptly if symptoms develop. Consult with the base station physician or regional poison control center for further advice regarding triage of multiple victims. Triage is a complex process that identifies victims who have the most serious injuries and who can benefit most from rapid treatment and transport. The Multi-Casualty Triage section in each protocol makes general recommendations for transport

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priorities based only on the chemical; however, the base station physician or regional poison control center (see Appendix I) should give advice for specific situations.

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Introduction

Emergency Department Management Section


The Guidelines, which represent a state-of-the-art, practical approach to the management and treatment of HAZMAT victims, are based on the consensus of a panel of experts. However, the user of the protocols should be aware that large data gaps exist in the scientific literature and knowledge regarding the treatment of patients exposed to hazardous substances is constantly evolving. The protocols are not a substitute for the professional judgment of a health care provider and must be interpreted in light of specific information regarding the patient and in conjunction with other sources of authority.

Goals of the Hospital Provider in HAZMAT Incidents: C C C C C Determine the potential for secondary contamination. If necessary, decontaminate patients. Provide supportive and antidotal emergency care (resources for toxicity information include the Guidelines and a regional poison control center [Appendix I]). Obtain appropriate laboratory tests. Arrange for observation, hospital admission, and follow-up care as needed.

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ATSDR

Emergency Department Management

33

Introduction

Emergency Department Management Section


C C C Potential for secondary contamination Health effects expected from an acute exposure Patient care (supportive care, antidotes) Secondary contamination is discussed on page 3 of the introduction. Victims who were exposed only to gas or vapor or who were decontaminated at the scene are not likely to pose a risk of secondary contamination to hospital personnel. However, victims whose skin, hair, or clothing is grossly contaminated with solid or liquid chemical (including condensed vapor) may endanger health care personnel by direct contact or by off-gassing vapor. Toxic vomitus can also expose hospital personnel directly or through off-gassing vapor.

Decontamination Area

Previously decontaminated patients and patients exposed only to gas or vapor who have no evidence of skin or eye irritation may be transferred immediately to the Critical Care Area. Other patients will require decontamination as described below. Basic decontamination should be carried out at the scene of the incident before the victim is transports, however, this does not always occur. For example, a contaminated victim might be brought directly to the emergency department by a coworker. Hospitals should plan for the arrival of contaminated victims. Contaminated victims received in indoor facilities create potentially serious risks of secondary contamination to hospital personnel, especially if materials are volatile. Many hospital protocols suggest shutting off the ventilation system to protect the hospital from cross-contamination. However, lack of ventilation may compound the risk to emergency department personnel attending the victim. Very few hospitals have the financial resources to properly construct a separate decontamination room with appropriate ventilation. Basic decontamination is safely and practically performed outside in a naturally ventilated area adjacent to the ambulance entrance. Suggested equipment and supplies for an outdoor hospital Decontamination Area include the following: C Gurney with plastic tub or run-off collector. (Several companies make disposable or reusable decontamination

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Introduction

C C C C C C C C C C C C C C

tables or foldable rubber tubs that can be placed on top of a gurney.) A warm-water source with a hose and soft-stream shower head Disposable chemical-resistant jumpsuits (e.g., of Tyvek or Saranex) Chemical-resistant gloves (e.g., of butyl rubber) in different sizes Rubber aprons Mild soap and shampoo Soft-bristled brushes Splash-protective goggles or other protective eye wear Wading pool for decontamination of ambulatory patients Plastic garbage bags Oxygen tanks with delivery supplies Disposable towels and gauze Surgical scrubs for decontaminated patients Extra blankets and sheets for patient privacy and warmth Portable privacy barriers (do not totally enclose decontamination area or natural ventilation will be lost)

ABC Reminders

Evaluate and support airway, breathing, and circulation. Intubate the trachea in cases of respiratory compromise. If the patients condition precludes Intubation, surgically create an airway. Treat patients who have bronchospasm with aerosolized bronchodilators; use these and all catecholamines wlth caution because of the potential enhanced risk of cardiac dysrhythmias. Patients who are comatose, hypotensive, or have seizures or ventricular dysrhythmias should be treated in the conventional manner. Generally, decontamination is performed before treatment is started. However, basic airway, breathing, and circulation must be addressed in victims who have life-threatening symptoms. Patients heavily contaminated with highly toxic organophosphate insecticides pose great risks of secondary contamination to health care personnel; patients should not be touched until staff is appropriately gloved and gowned. Persons soaked with flammable materials cannot be treated with DC countershock until decontamination has been carried out because of risk of fire and explosion. Simultaneous treatment and decontamination of patients should be carried out whenever possible.

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Emergency Department Management

35

Introduction

Basic Decontamination

Patients who are able and cooperative may assist with their own decontamination. Remove and double-bag contaminated clothing and personal belongings. For easier retrieval, consider bagging the victims jewelry and other valuables separately from clothing. Nonporous materials such as metal jewelry may be easy to decontaminate by washing, whereas clothing or shoes may require disposal. Leather items can be especially difficult to decontaminate and may need to be incinerated. Flush exposed or irritated skin and hair with plain water for 3 to 5 minutes. For oily or otherwise adherent chemicals, use mild soap on the skin and hair. Rinse thoroughly with water. Flush exposed or irritated eyes with plain water or saline for at least 5 minutes. Remove contact lenses if present and easily removable without additional trauma to the eye. If a corrosive material is suspected or if pain or injury is evident, continue irrigation while transferring the patient to the Critical Care Area. Some chemicals react violently with water, liberating toxic gases or creating explosions. Cautions about water reactivity (e.g., the statements in the DOT Emergency Response Guidebook or in an MSDS) generally do not apply when decontaminating victims with water. Adding large amounts of water to the small amount of residual chemical on the victims body poses little risk of creating a serious reaction hazard. In fact, the naturally occurring moisture on the skin will react with the chemical; hastening removal of the chemical from the skin is preferable to leaving it to potentially cause further injury. Solid contaminants should be gently brushed from hair, skin, and clothing. During brushing, protect the victims eyes. The length of time for flushing exposed skin or eyes with water will vary with the chemical and the circumstances of exposure. Chemicals that cause only mild skin or eye irritation can be flushed for 3 to 5 minutes. Concentrated or strongly alkaline materials may require 10 to 15 minutes. Eye decontamination may be continued while the patient is transferred to the Critical Care Area. An attempt should be made to remove contact lenses. Avoid forceful removal that may inflict injury. Difficulty in removing contact lenses should not delay irrigation or transfer to the Critical Care Area.

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Introduction

Removal of oily or insoluble materials from the skin and hair requires washing with soap or shampoo. Any liquid hand- or dishwashing soap is satisfactory. Use only soft-bristled brushes; abrasive brushing may enhance skin injury and penetration. Bleach, vinegar, or solutions used for decontaminating equipment should not be used for washing skin, hair, or eyes. Neutralizing agents should not be used because the heat of the neutralization may cause added injury. Flooding volumes of water are preferable. In cases of ingestion, do not induce emesis. Administer 4 to 8 ounces of water to dilute stomach contents if the patient is conscious and able to swallow. Immediately transfer the patient to the Critical Care Area. Emesis is not generally recommended in the protocols. Vomiting is relatively ineffective in emptying the stomach after a chemical ingestion and may be harmful to the victim. Vomiting may increase the risk of pulmonary aspiration or damage to the esophagus and stomach if irritating or corrosive chemicals have been ingested. Activated charcoal adsorbs many chemicals and is relatively easy to administer. For most chemical ingestions, a slurry of 50 to 60 grams of activated charcoal should be administered to an adult patient who is awake and has a gag reflex. If a corrosive chemical has been ingested, do not administer activated charcoal because it may obscure the view when endoscopy is performed. See Critical Care Area below for further discussion of gastrointestinal decontamination.

Critical Care Area

If appropriate decontamination efforts have been completed before entry to the Critical Care Area, special precautions, such as covering floors and walls with plastic or shutting off the ventilation system, are not needed. However, if the patient has ingested a chemical, prepare to isolate toxic vomitus quickly (see Ingestion Exposure, page 40). Be certain that appropriate decontamination has been carried out. (See Decontamination Area, page 33.) ED personnel in the Critical Care Area generally do not need specialized protective gear. However, if risk of residual skin contamination exists (e.g., potent chemicals, such as some organophosphate pesticides, or radioactive dust), water-resistant gowns or aprons, latex gloves, and eye-splash protection ate
ATSDR Emergency Department Management 37

Introduction

necessary. Emergency medical care providers usually carry these protective items for universal infection control or communicable disease control. ABC Reminders Evaluate and support airway, breathing, and circulation as in ABC Reminders, page 34. Establish intravenous access in seriously ill patients. Continuously monitor cardiac rhythm. Patients who are comatose, hypotensive, or have seizures or ventricular dysrhythmias should be treated in the conventional manner. Many chemicals can cause progressive airway injury or systemic illness with delayed onset. Watch for signs of laryngeal edema and respiratory system compromise, such as progressive hoarseness, strider, hypoventilation, or cyanosis. Consider the possibility of exposure to multiple chemicals as well as multiple-system injuries. For example, smoke inhalation can cause airway injury because of heat and irritant chemicals and coma from asphyxiants such as carbon monoxide and cyanide. Consider possible opioid overdose and evaluate for hypoglycemia; administer naloxone (Narcan) and dextrose according to usual protocols. Treat patients who have seizures with conventional anticonvulsants (e.g., diazepam, phenytoin, or phenobarbital). Consider the possibility that coma or seizures may be from a head injury or from alcohol or other drug intoxication, rather than from hazardous material exposure. Place an intravenous line in all patients who are unconscious, obtunded, hypotensive, or may become so. Patients exposed to substances that may cause cardiac sensitization or intravascular hemolysis may also require intravenous access. An initial bolus of an appropriate intravenous solution should be given. The fluid should be titrated to maintain acceptable urine output and blood pressure. Care must be taken not to overhydrate the patient. Treat patients who have hypotension using rapid infusions of normal saline (250 mL to 1 L in adults). Use dopamine or other inotropic drugs for persistent hypotension. Hypotension may be complicated by hypothermia or hyperthermia. Hypothermia should be considered if the victim was stripped and decontaminated with cold water or in a cold ambient setting. Hyperthermia may result from certain systemic poisons (e.g., dinitrophenol).

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Inhalation Exposure

Administer supplemental oxygen by mask to patients who have respiratory complaints. Treat patients who have bronchospasm with aerosolized bronchodilators; use these and all catechola mines with caution because of the potential or possible enhanced risk of cardiac dysrhythmias. Bronchodilators may provoke ventricular dysrhythmias in some patients who have been exposed to aromatic or halogenated hydrocarbons. Although pulse oximetry is a convenient way to continuously monitor oxygenation in patients, it is unreliable or falsely normal in patients who have dyshemoglobinemias (e.g., methemoglobinemia or carboxyhemoglobinemia) because it measures only oxygen dissolved in the blood and not the status of tissue oxygenation. In patients who have altered hemoglobins, the pulse oximeter does not reflect the impaired oxygen carrying or delivery capacity of the red cells. In these situations, a CoOximeter should be used to measure specific levels of hemoglobins unable to transport oxygen. Chemically induced pulmonary edema is due to leaky pulmonary alveoli, not left ventricular failure as is cardiogenic pulmonary edema. Patients who have chemically induced pulmonary edema do not benefit from digoxin, morphine, afterload reduction, or diuretics. Supplementary oxygen, delivered by mechanical ventilation and positive end-expiratory pressure, if needed, are standard treatments for chemically induced (noncardiogenic) pulmonary edema. Corticosteroids and antibiotics have been commonly recommended for treatment of chemical pneumonitis, but their effectiveness has not been substantiated. Soluble irritants (e.g., ammonia or hydrogen chloride) rapidly produce respiratory effects; poorly soluble irritants (e.g., phosgene and some nitrogen oxides) produce slow onset of airway irritation and respiratory distress. Poorly soluble agents are commonly associated with delayed (12 to 72 hours) onset pulmonary edema. The time period for developing pulmonary edema varies with the chemical and is noted in each individual protocol. Watch for signs of respiratory distress and intubate if necessary.

Skin Exposure

If chemical burns are present, treat as thermal burns.

ATSDR

Emergency Department Management

39

Introduction

The extent and depth of injury in a chemical burn is often not immediately apparent; hence the severity of the bum is frequently underestimated. Loss of circulating fluid may occur. In addition, dermal absorption of a corrosive chemical may contribute to systemic toxicity. Patients who have been exposed to highly corrosive, penetrating, oily, or persistent chemicals may require additional or continuous decontamination. Residues may remain in the armpits, groin, buttocks, hair, ears, nostrils, and under the fingernails and toenails. If the material is highly contaminating (e.g., organophosphate pesticides or radioactive dust), care givers should wear gowns and gloves to protect themselves. Use liquid soap for cleansing the skin and hair. Special decontaminating agents are recommended for only a few chemicals (see specific protocols). Eye Exposure Ensure that adequate eye irrigation has been completed. Test visual acuity. Examine the eyes for corneal damage using a magnifying device or a slit lamp and fluorescein stain. For small corneal defects, use ophthalmic antibiotic ointment or drops, analgesic medication, and an eye patch. Immediately consult an ophthalmologist for patients who have corneal injuries. Ensure that contact lenses have been removed, that no visible residual material is in the conjunctival sac, and that the pH of the conjunctival fluid is normal. Irrigation is easily continued in a hospital setting using intravenous tubing to provide a steady, low-pressure stream of water or saline. A Morgan Lenscan also be placed to provide continuous, thorough eye decontamination. Do not use neutralizing or other decontaminating solutions. A corneal burn or abrasion can easily be seen with the aid of fluorescein stain, a UV light source, and a magnifier or slit lamp. The disrupted corneal surface allows accumulation of the fluorescein, which fluoresces under UV light. If serious injury is evident (e.g., extensive corneal fluorescein accumulation, cloudy or bloody material in the anterior chamber, or obvious perforation of the globe), an ophthalmologist should be consulted immediately.

40

Emergency Department Management

ATSDR

Introduction

Ingestion Exposure

Do not Induce emesis. If the patient is alert and charcoal has not been given previously, administer a slurry of activated charcoal. If a corrosive material is suspected, administer 4 to 8 ounces of water; do not give a slurry of activated charcoal. Consider endoscopy to evaluate the extent of gastrointestinaltract injury. If a large dose has been ingested and the patients condition is evaluated within 30 minutes after ingestion, consider gastric lavage. Ingested chemicals and products formed by their reaction with stomach acid may be hazardous to ED personnel through direct contact with vomitus or by inhalation of the gases liberated from the vomitus. For example, ingested cyanide salts are converted to highly toxic hydrogen cyanide gas in the stomach. Staff must take measures, therefore, to isolate toxic vomitus or gastric washings. This can be done by attaching the lavage tube to isolated wall suction or other closed container. Activated charcoal is capable of adsorbing most chemicals and should be given as early as possible. Even chemicals that have relatively poor adsorption to charcoal (e.g., cyanide and alcohols) are still bound to some extent. Charcoal may need to be removed by gastric washing before endoscopy can be performed. Corrosive liquids should be removed from the stomach as early as possible. However, care must be taken when placing the gastric tube because blind gastric-tube placement may further injure the chemically damaged esophagus or stomach.

Antidotes and Other Treatments

Treatment consists of supportive measures. The individual guidelines provide information on the use of specific antidotes.

Laboratory Tests

Routine laboratory studies for all exposed patients include CBC, glucose, and electrolyte determinations. Additional studies for patients exposed to an unidentified chemical Include ECG monitoring, renalfunction tests, and liver-function tests. Chest radiography and pulse oximetry (or ABG measurements) are recommended for severe inhalation exposure. All patients should have CBC, glucose, and electrolyte determinations. Additional, specific recommendations are listed in the laboratory tests section to aid both diagnosis and treatment.

ATSDR

Emergency Department Management

41

Introduction

Laboratory test results are often within normal range immediately after an exposure but may become abnormal after a delay of several hours or even days, depending on the specific chemical exposure. For example, chest radiography may not show signs of pulmonary edema for 12 to 24 hours and signs of liver injury may not appear for 2 to 3 days following exposure. Pulse oximetry and routine arterial blood gas determination of Po2 tests may provide falsely normal, unreliable, or misleading results in patients with abnormal hemoglobin states (e.g., methemoglobinemia or carboxyhemoglobinemia). Tests to measure a specific chemical contaminant in biologic samples are rarely available on an emergency basis. The turnaround time may be several hours to days; hence, these tests rarely are clinically useful. However, the results of these tests may aid in confirming or documenting exposure. A regional poison control center (Appendix I) can assist with the selection and interpretation of specialized laboratory tests.

Disposition and Followup

Consider hospitalizing patients who have a suspected serious exposure and persistent or progressive symptoms. Patient disposition should be determined based on the symptoms, the intrinsic toxicity of the chemical, and course of illness. Some patients may be safely discharged from the emergency department while others will require prolonged observation or intensive care.

Delayed Effects

When the chemical has not been identified, the patient should be observed for an extended period or admitted to the hospital. The usual duration of observation in an emergency department is 6 to 8 hours. If the chemical agent is known to produce delayedonset illness or is unidentified, the asymptomatic patient should be admitted for observation.

Patient Release

Asymptomatic patients who have minimal exposure, normal initial examinations, and no signs of toxicity after 6 to 8 hours of observation may be discharged with instructions to seek medical care promptly if symptoms develop. Each protocol includes a detailed Patient Information Sheet with a list of possible delayed symptoms. This sheet should be reviewed with the patient before discharge. A signed copy should be

42

Emergency Department Management

ATSDR

Introduction

included in the medical chart, and a copy sent home with the patient. Do not release clothing or personal items to the patient before a determination of residual contamination is made. Most items can be reused after washing. However, some contaminated articles cannot be rendered safe for reuse (e.g., leather goods, such as shoes, that are contaminated with methyl bromide or organophosphate pesticides). Some articles will require disposal at a hazardous waste site or by incineration. Consult a HAZMAT specialist affiliated with the local fire department or the ATSDR/CDC Emergency Response 24-hour Hotline ([404] 6390615) for advice on the disposition of contaminated personal effects. Followup Provide the patient with follow-up instructions to return to the emergency department or a private physician to reevaluate initial findings. Patients who have corneal injuries should be reexamined within 24 hours. Appendix II contains the telephone numbers and addresses of members of the Association of Occupational and Environmental Clinics (AOEC). These clinics employ specialists in the diagnosis and treatment of chemically exposed patients. They may provide consultation and follow-up advice.

Reporting

If a work-related incident has occurred, you may be legally required to file a report; contact your state or local health department. Other persons may still be at risk in the setting where this incident occurred. If the incident occurred in the workplace, discussing it with company personnel may prevent future incidents. If a public health risk exists, notify your state or local health department or other responsible public agency. When appropriate, inform patients that they may request an evaluation of their workplace from OSHA or NIOSH. See Appendices III and IV for a list of agencies that may be of assistance. Appendix III contains the telephone numbers of state health departments. In addition to filing a report, state health departments or the EPAs Environmental Response Team, Edison, New Jersey ([732] 321-6740) may be able to assist in determining procedures for the cleaning of hospital facilities and equipment.

ATSDR

Emergency Department Management

43

Introduction

You may also advise your patients to call the regional OSHA office to report a suspected violation of safe work practices. Appendix IV contains the numbers of the NIOSH office that may be of assistance.

44

Emergency Department Management

ATSDR

Introduction

ATSDR

Emergency Department Management

45

Introduction

Patient Information Sheet


The Patient Information Sheet provides information and follow-up instructions for persons who have been exposed to the chemical. It is written in an easy to understand question and answer format and addresses the questions most often asked. It is intended to be given to the patient. The follow-up instructions on the back of the Patient Information Sheet are statements that the clinician can check off if they apply to the patient. The instructions include a list of signs and symptoms specific to each chemical (and directions to the patient to seek medical care if they occur); directions for obtaining follow-up appointments; and restrictions on activities, medications, alcohol and cigarette smoke. Space is provided for the clinician to write other instructions.

46

Patient Information Sheet

ATSDR

Introduction

ATSDR

Patient Information Sheet

47

Appendix I

Appendix I

AAPCC-Certified Regional Poison Control Centers

ATSDR

A-1

Appendix I

A-2

ATSDR

Appendix I

AAPCC-Certified Regional Poison Control Centers


Poison Control Centers were established around 1953 to help physicians deal with poisoning of adults and children in the United States. In 1983, the American Association of Poison Control Centers (AAPCC) was established as the professional organization for Poison Control Centers. The Regional Poison Control Centers can act as a valuable resource in providing information about the toxicity and health effects of hazardous exposures involved in poisonings.

ALABAMA Alabama Poison Center 2503 Phoenix Drive Tuscaloosa AL35405 Emergency: (800) 462-0800 (AL only) (205)345-0600 Childrens Hospital of Alabama Poison Control Center 1600 7th Avenue South Birmingham AL 35233 Emergency: (800) 292-6678 (AL only) (205) 933-4050 ALASKA Anchorage Poison Control Center 3200 Providence Drive P.O. Box 196604 Anchorage AK 99519 Emergency: (800) 478-3193 (907) 261-3193 ARIZONA Arizona Poison and Drug Information Center Arizona Health Sciences Center Room 1156 1501 North Campbell Avenue Tuscon AZ 85724 Emergency: (800) 362-0101 (AZ only) (602) 626-6016 Samaritan Regional Poison Center Good Samaritan Regional Medical Center 1111 E. McDowellAncillary 1 Phoenix AZ 85006 Emergency:(800) 362-0101 (AZ only) (602) 253-3334

ARKANSAS Arkansas Poison and Drug Information Center College of Pharmacy University of Arkansas for Medical Sciences Mail Slot 552 4301 W. Markham Little Rock AR 77205 Emergency: (800) 376-4766 TDD/TTY (800) 641-3805 CALIFORNIA California Poison Control SystemFresno/Madera Valley Childrens Hospital 9300 Valley Childrens Place Madera CA 93638 Emergency: (800) 876-4766 (CA only) California Poison Control System-Sacramento UC Davis Medical Center 2315 Stockton Boulevard Sacramento CA 95817 Emergency: (800) 876-4766 (CA only) California Poison Control System-Dan Diego UC San Diego, Medical Center 200 West Arbor Drive San Diego CA 92103 Emergency: (800) 876-4766 California Poison Control System-San Francisco San Francisco General Hospital 1001 Potrero Avenue, Room 1E86 San Francisco CA 94110 Emergency: (800) 876-4766 (CA only) COLORADO Rocky Mountain Poison and Drug Center 9902 E. Ninth Avenue Denver CO 80220 Emergency: (800) 332-3073 (CO only/outside metro area) (303) 739-1123 (Denver metro)

ATSDR

A-3

Appendix I

CONNECTICUT Connecticut Poison Control Center University of Connecticut Health Center 263 Farmington Avenue Farmington CT 06030 Emergency: (800) 343-2722 (CT only) (860) 679-3456 DELAWARE The Poison Control Center 3535 Market Street, Suite 985 Philadelphia PA 19104 Emergency: (800) 772-7112 (215) 386-2100 DISTRICT OF COLUMBIA National Capitol Poison Control Center 3201 New Mexico Avenue, NW Suite 310 Washington DC 20016 Emergency: (202) 625-3333 TDD/TTY: (202) 362-8563 (TTY) FLORIDA Florida Poison Information Center-Jacksonville 655 West Eighth Street Jacksonville FL 32209 Emergency: (800) 282-3171 (FL only) (904) 549-4480 Florida Poison Information Center-Miami University of Miami Department of Pediatrics P.O. Box 016960 (R-131) Miami FL 33101 Emergency: (800) 282-3171 (FL only) (305) 585-5253 FLORIDA (continued) Florida Poison Information Center-Tampa Tampa General Hospital P.O. Box 1289 Tampa FL 33601 Emergency: (800) 282-3171 (FL only) (813) 253-4444 GEORGIA Georgia Poison Center Hughes Spalding Childrens Hospital Grady Health System 80 Butler Street, SE, P.O. Box 26066
A-4 ATSDR

Atlanta GA 30335 Emergency: (404) 606-9000 TDD/TTY: (404) 606-9287 (TDD) HAWAII Hawaii Poison Center 1319 Punahou Street Honolulu HI 96826 Emergency: (808) 941-4411 IDAHO Rocky Mountain Poison and Drug Center 8802 E. Ninth Avenue Denver CO 80220 Emergency: (800) 860-0620 (ID only) ILLINOIS Illinois Poison Center 222 S. Riverside Plaza, Suite 1900 Chicago IL 60606 Emergency: (800) 942-5969 (IL only) INDIANA Indiana Poison Center Methodist Hospital I-65 at 21st Street Indianapolis IN 46206 Emergency: (800) 382-9097 (IN only) (317) 929-2323 TDD/TTY: (317) 929-2336 (TTY) IOWA Iowa Poison Center St. Lukes Regional Medical Center 2720 Stone Park Boulevard Sioux City IA 51104 Emergency: (800) 352-2222 (712) 277-2222 IOWA (continued) Poison Control Center Department of Pharmaceutical Care,CC101 GH The University of Iowa Hospitals and Clinics 200 Hawkins Drive Iowa City IA 52242 Emergency: (800) 272-6477 (IA only) KANSAS Mid-American Poison Control Center University of Kansas Medical Center 3901 Rainbow Blvd., Room B-400

Appendix I

Kansas City KS 66160 Emergency: (800) 332-6633 (913) 588-6633 TDD/TTY: (913) 588-6639 (TDD) KENTUCKY Louisville Kentucky Regional Poison Center Medical Towers South, Suite 572 234 East Gray Street Louisville KY 40202 Emergency: (502) 589-8222 LOUISIANA Louisiana Drug and Poison Information Center Unitversity of Louisiana at Monroe College of Pharmacy Sugar Hall Monroe, LA 71209 Emergency: (800) 256-9822 (LA only) MAINE Maine Poison Control Center Maine Medical Center 22 Bramhall Street Portland ME 04102 Emergency: (800) 442-6305 (ME only) (207) 871-2950 MARYLAND Maryland Poison Center University of MD at Baltimore School of Pharmacy 20 North Pine Stree, PH230 Baltimore MD 21201 Emergency: (800) 492-2414 (MD only) (410) 528-7701 TDD/TTY: (410) 706-1858 National Capitol Poison Control Center 3201 New Mexico Avenue, NW Suite 310 Washington DC 20016 Emergency: (202) 625-3333 TDD/TTY: (202) 362-8563 (TTY) MASSACHUSETTS Regional Center for Poison Control and Prevention Services for Massachusetts and Rhode Island 300 Longwood Avenue Boston MA 02115

Emergency: (800) 682-9211 (MA and RI only) (617)232-2120 MICHIGAN Regional Poison Control Center Chidrens Hospital of Michigan 4160 John R Harper Professional Office Bldg, Suite 616 Detroit MI 48201 Emergency: (800) 764-7661 (MI only) (313) 745-5711 TTD/TTY: (800) 356-3232 (TTY) Spectrum Health Regional Poison Center 1840 Wealthy S.E. Grand Rapids MI 49506 Emergency: (800) 764-7661 (MI only) TTD/TTY: (800) 356-3232 (TTY)

MINNESOTA Hennepin Regional Poison Center Hennepin County Medical Center 701 Park Avenue Minneapolis MN 55415 Emergency: (800) POISON1 (MN and SD only) (612) 347-3141 TDD/TTY: (612) 904-4691 (TTY) PROSAR International Poison Control Center 1295 Bandana Boulevard Suite 335 St. Paul MN 55108 Emergency: (888) 779-7921 MISSISSIPPI Mississippi Regional Poison Control Center University of Mississippi Medical Center 2500 N. State Street Jackson MS 39216 Emergency: (601) 354-7660 MISSOURI Regional Poison Center Cardinal Glennon Childrens Hospital 1465 S. Grand Blvd. St. Louis MO 63104 Emergency: (800) 366-8888 (314) 772-5200 MONTANA
ATSDR A-5

Appendix I

Rocky Mountain Poison and Drug Center 8802 E. Ninth Avenue Denver CO 80220 Emergency: (800) 525-5042 (MT only) NEBRASKA The Poison Center Childrens Hospital 8301 Dodge Street Omaha NE 68114 Emergency: (800) 955-9119 (NE and WY only) (402) 354-5555 NEVADA Oregon Poison Center Oregon Health Sciences University 3181 SW Sam Jackson Park Road Portland OR 97201 Emergency: (503) 494-8968 NEVADA (continued) Rocky Mountain Poison and Drug Center 8802 E. Ninth Avenue Denver CO 80220 Emergency: (800) 446-6179 (NV only) NEW HAMPSHIRE New Hampshire Poison Information Center Dartmouth-Hitchcock Medical Center One Medical Center Drive Lebanon NH 03756 Emergency: (800) 562-8236 (NH only) (603) 650-8000 NEW JERSEY New Jersey Poison Information and Education System 201 Lyons Avenue Newark NJ 07112 Emergency: (800) POISON-1 (NJ only) NEW MEXICO New Mexico Poison and Drug Information Center Health Science Center Library Room 125 University of New Mexico Albuquerque NM 87131 Emergency: (800) 432-6866 (NM only) (505) 272-2222 NEW YORK
A-6 ATSDR

Central New York Poison Center 750 East Adams Street Syracuse NY 13210 Emergency: (800) 252-5655 (NY only) (315) 476-4766 Finger Lakes Regional Poison and Drug Information Center University of Rochester Medical Center 601 Elmwood Avenue P.O. Box 321 Rochester NY 14642 Emergency: (800) 333-0542 (NY only) (716) 275-3232 TDD/TTY: (716) 273-3854 (TTY) NEW YORK (continued) Hudson Valley Regional Poison Center Phelps Memorial Hospital Center 701 North Broadway Sleepy Hollow NY 10591 Emergency: (800) 336-6997 (NY only) (914) 366-3030 Long Island Regional Poison Control Center Winthrop University Hospital 259 First Street Mineola NY 11501 Emergency: (516) 542-2323 (516) 663-2650 TTD/TTY: (516) 924-8811 (TDD Suffolk) (516) 747-3323 (TDD Nassau) New York City Poison Control Center NYC Department of Health 455 First Avenue Room 123, Box 81 New York NY 10016 Emergency: (800) 210-3985 (212) 340-4494; (212) POI-SONS; (212) VEN-ENOS TDD/TTY: (212) 689-9014 (TDD) Western New York Regional Poison Control Center Childrens Hospital of Buffalo 219 Bryant Street Buffalo NY 14222 Emergency: (800) 888-7655 (NY western regions only) (716)-878-7654

Appendix I

NORTH CAROLINA Carolinas Poison Center Carolinas Medical Center 5000 Airport Center Parkway, Suite B Charlotte NC 28208 Emergency: (800) 848-6946 (NC only) (704) 355-4000 NORTH DAKOTA North Dakota Poison Information Center Meritcare Medical Center 720 4th Street North Fargo ND 58122 Emergency: (800) 732-2200 (ND, MN, SD only) (701) 234-5575 OHIO Central Ohio Poison Center 700 Childrens Drive, Room L032 Columbus OH 43205 Emergency: (800) 682-7625 (OH only) (800) 762-0727 (Dayton, OH only) TDD/TTY: (614) 228-2272 Cincinnati Drug and Poison Information Center Regional Poison Control System 2368 Victory Parkway, Suite 300 Cincinnati OH 45206 Emergency: (800) 872-5111 (OH only) (513) 558-5111 Greater Cleveland Poison Control Center 11100 Euclid Avenue Cleveland OH 44106 Emergency: (888) 231-4455 (216) 231-4455 OKLAHOMA Oklahoma Poison Control Center Childrens Hospital of Oklahoma 940 N.E. 13th Street, Room 3512 Oklahoma City OK 73104 Emergency: (800) 764-7661 (OK only) (405) 271-5454 OREGON Oregon Poison Center Oregon Health Sciences University 3181 SW Sam Jackson Park Road Portland OR 97201 Emergency: (800) 452-7165 (OR only) (503)494-8968

PENNSYLVANIA Central Pennsylvania Poison Center Penn State Geisinger Health System The Milton S. Hershey Medical Center MC HO453 PO Box 850 500 University Drive Hershey PA 17033 Emergency: (800) 521-6110 TDD/TTY: (717) 531-8335 Pittsburgh Poison Center Childrens Hospital of Pittsburgh 3705 Fifth Avenue Pittsburgh PA 15213 Emergency: (412) 681-6669 The Poison Control Center 3535 Market Street, Suite 985 Philadelphia PA 19104 Emergency: (800) 772-7112 (215) 386-2100 RHODE ISLAND Regional Center for Poison Control and Prevention Services for Massachusetts and Rhode Island 300 Longwood Avenue Boston MA 02115 Emergency: (617) 232-2120 SOUTH CAROLINA Palmetto Poison Center College of Pharmacy University of South Carolina Columbia SC 29208 Emergency: (800) 922-1117 (SC only) (803) 777-1117 SOUTH DAKOTA Hennepin Regional Poison Center Hennepin County Medical Center 701 Park Avenue Minneapolis MN 55415 Emergency: (800) POISON1 (MN and SD only) (612) 347-3141 TDD/TTY: (612) 904-4691 (TTY)

ATSDR

A-7

Appendix I

TENNESSEE Middle Tennessee Poison Center The Center for Clinical Toxicology 501 Oxford House 1161 21st Avenue South Nashville TN 37232 Emergency: (800) 288-9999 (TN only) (615) 936-2034 (Greater Nashville) TDD/TTY: (615) 936-2047 (TDD) Southern Poison Center 875 Monroe Avenue Suite 104 Memphis TN 35163 Emergency: (800) 288-9999 (TN only) (901) 528-6048 TEXAS Central Texas Poison Center Scott and White Memorial Hospital 2401 South 31st Street Temple TX 76508 Emergency: (800) POISON-1 (TX only) (254) 724-7401 North Texas Poison Center Texas Poison Center Network Parkland Health and Hospital System 5201 Harry Hines Blvd. P.O. Box 35926 Dallas TX 75235 Emergency: (800) POISON-1 (TX only) South Texas Poison Center The University of Texas Health Science CenterSan Antonio Forensic Science Building, Room 146 Department of Surgery 7703 Floyd Curl Drive San Antonio TX 78284 Emergency: (800) 764-7661 (TX only) Southeast Texas Poison Center The University of Texas Medical Branch 3.112 Trauma Building Galveston TX 77555 Emergency: (800) 764-7661 (TX only) (409) 765-1420

TEXAS (continued) Texas Panhandle Poison Center 1501 S. Coulter Armarillo TX 79106 Emergency: (800) 764-7661 (TX only) West Texas Regional Poison Center Thomason Hospital 4815 Alameda Aveue El Paso TX 79905 Emergency: (800) 764-7661 (TX only) UTAH Utah Poison Control Center 410 Chipeta Way, Suite 230 Salt Lake City UT 84108 Emergency: (800) 456-7707 (UT only) (801) 581-2151 VERMONT Vermont Poison Center Fletcher Allen Health Care 111 Colchester Avenue Burlington VT 05401 Emergency: (877) 658-3456 (toll free) VIRGINIA Blue Ridge Poison Center University of Virginia Health System PO Box 800774 Charlottesville VA 22908 Emergency: (800) 451-1428 (VA only) National Capitol Poison Control Center 3201 New Mexico Avenue, NW Suite 310 Washington DC 20016 Emergency: (202) 625-3333 TDD/TTY: (202) 362-8563 (TTY) Virginia Poison Center Medical College of Virginia Hospitals Virginia Commonwealth University PO Box 980552 Richmond VA 23298 Emergency: (800) 552-6337

A-8

ATSDR

Appendix I

WASHINGTON Washington Poison Center 155 NE 100th Street, Suite 400 Seattle WA 98125 Emergency: (800) 732-6985 (WA only) (206) 526-2121 TDD/TTY: (206) 517-2394 (TDD) (800) 572-0638 (TDD WA only) WEST VIRGINIA West Virginia Poison Center 3110 MacCorkle Ave., S.E. Charleston WV 25304 Emergency: (800) 642-3625 (WV only) WISCONSIN Childrens Hospital of Wisconsin Poison Center PO Box 1997 Milwaukee WI 53201 Emergency: (800) 815-8855 (WI only) (608) 262-3702 WYOMING The Poison Center Childrens Hospital 8301 Dodge Street Omaha NE 68114 Emergency: (800) 955-9119 (NE and WY only) (402) 354-5555 ANIMAL POISON CENTER ASPCA National Animal Poison Control Center 1717 South Philo Road Suite 36 Urbana IL 61802 Emergency: (888) 426-4435 (900) 680-0000

ATSDR

A-9

Appendix I

A-10

ATSDR

Appendix II

Appendix II

Association of Occupational and Environmental Clinics

ATSDR

A-11

Appendix II

A-12

ATSDR

Appendix II

Association of Occupational and Environmental Clinics (AOEC)


Professionals in the AOEC act as consultants for treatment of persons exposed to hazardous substances. ALABAMA University of Alabama at Birmingham 930 20th Street South Birmingham, AL 35205 (205) 975-2767; FAX (205) 975-4377 Timothy J. Key, MD, MPH ARIZONA Samaritan Occupational and Environmental Toxicology Clinic Department of Medical Toxicology 925 E. McDowell Rd., Second Floor Phoenix AZ 85006 (602) 239-6690; FAX (602) 239-4138 Kevin Wallace, MD CALIFORNIA Occupational & Environmental Medicine Clinic University of California at San Francisco/SFGH Building 30, 5th floor, 1001 Potrero Avenue SanFrancisco CA 94110 (415) 206-4320; FAX (415) 206-8949 Patricia Quinlan, MPH, CH Alt. Contact: Denise Souza, RN, MSN, OHNP, COHN-S UCSF Occupational Health Services University of California at San Francisco 2380 Sutter Street, 3rd Floor San Francisco, CA 94115 (415) 885-7580; FAX (415) 771-4472 Robert Harrison, MD, MPH Alt. Contact: Leslie Israel, DO, MPH Occupational & Environmental Health Clinic Employee Health Services University of California, Davis Medical Center Primary Care Building, Suite A 2221 Stockton Blvd. Sacramento CA 95817 (916) 734-8393; FAX (916) 734-7510 Appointments: (916) 734-8393 Stephen McCurdy, MD, MPH Occupational & Health Environmental Clinic University of California at Irvine Center for Occupational and Environmental Health 19722 MacArthur Blvd. Irvine CA 92715 (949)-824-8641; FAX (949) 824-2345 Dean Baker, MD, MPH COLORADO Division of Environmental & Occupational Health Sciences National Jewish Medical Research Center Center 1400 Jackson Street Denver CO 80206 (303) 398-l520; FAX (303) 398-l452 Appointments (303) 398-1733 Peggy Mroz, MSPH Alt. Contact: Cecile Rose, MD, MPH Toxicology Associates 2555 S. Downing Street #260 Denver CO 80210 (303) 765-3800; FAX (303) 765-3804 Scott Phillips, MD, FACP CONNECTICUT Yale Occupational & Environmental Medicine Program 135 College Street, 3rd Floor New Haven, CT 06510 (203) 785-7267; FAX (203) 785-7391 Mark R. Cullen, MD Alt. Contact: Peter M. Rabinowitz, MD, MPH University of Connecticut Occupational and Environmental Medicine Program 263 Farmington Avenue Farmington, CT 06030 (860) 679-2893; FAX (860) 679-4587 Eileen Storey, MD, MPH

CALIFORNIA (continued)
ATSDR A-13

Appendix II

CONNECTICUT (continued) Northwest Connecticut Occupational Medical Center 333 Kennedy Drive, Suite 202 Torrington CT 06790 (860) 482-4552; FAX (860) 489-4647 Gregory E. McCarthy, MD DISTRICT OF COLUMBIA Division of Occupational and Environmental Medicine School of Medicine, George Washington University 2300 K Street, NW Washington, DC 20037 (202) 994-1734; FAX (202) 994-0011 Tee L. Guidotti, MD, MPH Alt. Contact: Katherine Hunting, PhD, MPH Section of Occupational & Environmental Medicine Washington Hospital Center 110 Irving St., NW Washington, DC 20010-2975 (202) 877-5466; FAX (202) 877-4136 Laura Welch, MD GEORGIA Environmental and Occupational Medicine Consultative Clinic The Emory Clinic 1525 Clifton Road, NE, Rm 404 Atlanta, GA 30322 (404) 778-5978; FAX (404) 727-8744 Howard Frumkin, MD, Dr. PH ILLINOIS Occupational Medicine Clinic Cook County Hospital 1900 W. Polk, Rm 500 Chicago IL 60612 (312) 633-5310; FAX (312) 633-6442 Rachel Rubin, MD, MPH Alt. Contact :Ann Naughton, RN, MPH, COHN University of Illinois Occupational Medicine Program 914 S. Wood, M/C 684 Chicago IL 60612 (312) 996-7420; FAX (312) 413-8485 Linda Forst, MD, MPH

IOWA University of Iowa, Occupational Medicine Clinic Department of Internal Medicine, College of Medicine 200 Hawkins Drive, C33-GH Iowa City, IA 52242 (319) 356-4419; FAX (319) 356-7147 Gary Hunninghake, MD KENTUCKY University of Kentucky Occupational Medicine Program 2400 Greatstone Point Lexington, KY 40504 (606) 257-5150; FAX (606) 257-8982 Terrence Collins, MD, MPH LOUISIANA Ochsner Center for Occupational Health 1514 Jefferson Highway New Orleans, LA 70121 (504) 842-3955; FAX (504) 842-3977 Gregg A. Bendrick, MD, MPH Alt. Contact: Lori Brown Tulane Centers for Occupational Health 1415 Tulane Avenue, Box HC31 New Orleans LA 70112 (540) 736-5333; FAX (504) 736-4835 Douglas A. Swift, MD, MPH MARYLAND Johns Hopkins University Center for Occupational and Environmental Health 5501 Hopkins Bayview Circle Baltimore, MD 21224 (410) 550-2322; FAX (410) 550-3355 Edward J. Bernacki, MD, MPH Occupational Health Project University of Maryland School of Medicine 405 Redwood Street Baltimore, MD 21201 (410) 706-7464; FAX (410) 706-4078 Janie Gordon, ScM

A-14

ATSDR

Appendix II

MASSACHUSETTS Caritas Good Samaritan Occupational Health Services Merchants Building 75 Stockwell Dr. Avon MA 02322 (508) 427-3900; FAX (508) 427-3905 Robert Naparstek, MD Center for Occupational and Environmental Medicine Massachusetts Respiratory Hospital 2001 Washington Street South Braintree, MA 02184 (781) 848-2600; FAX (718) 849-3290 Dianne Plantamura, MSW, Coordinator Alt. Contact: David Christiani, MD, MPH, MS Occupational Health Program Department of Family and Community Medicine University of Massachusetts 55 Lake Avenue North Worcester, MA 10655 (508) 856-2818; FAX (508) 856-l 680 Tom Hicks, MD, MPH Occupational and Environmental Health Center Cambridge Hospital 1493 Cambridge Street Cambridge, MA 02139 (617) 665-1580; FAX (617) 665-1671 Rose Goldman, MD, MPH Occupational & Environmental Health Center Childrens Hospital 300 Longwood Ave Boston MA 02115 (617) 355-8177; FAX (617) 738-0032 Michael Shannon, MD, MPH Alt. Contact: Alan Woolf, MD, MPH MICHIGAN Michigan State University Department of Medicine 117 Est Fee East Lansing, MI 48824 (517) 353-1846; FAX (517) 432-3606 Appointments: (517) 353-4941 Kenneth Rosenman, MD

Health Wayne State/Department of Family Medicine 4201 Street Antoine, Suite 4J Detroit, Ml 48201 (313) 577-l 420; FAX (313) 577-3070 Appointments/Clinic: (313) 745-4093 Maryjean Schenk, MD, MPH Occupational Health Program School of Public Health, University of Michigan 1420 Washington Heights Ann Arbor, Ml 48109 (734) 764-2594; FAX (734) 763-8095 David Garabrant, MD, MPH Alt. Contact: Alfred Franzblau, MD Center for Occupational and Environmental Medicine 22255 Greenfield Rd., Suite 440 Southfield, MI 48075 (248) 559-6663; FAX (248) 559-8254 Laura Harbut, EMT, MBA Occupational Health Service St. Lawrence Hospital Work and Health Institute 1210 W. Saginaw Lansing, MI 48915 (517) 377-0309; FAX (517) 377-0310 R. Michael Kelly, MD, MPH MINNESOTA HealthPartners-Regions Hospital Occupational & Environmental Medicine 640 Jackson St. St. Paul, MN 55101-2595 (651) 221-3771; FAX (651) 221-8848 Paula Geiger Alt. Contact: William H. Lohman, MD Columbia Park Medical Group Occupational Medicine Department 6401 University Ave., NE #200 Minneapolis MN 55432 (612) 572-5710; FAX (612) 571-3008 Donald Johnson, MD Alt. Contact: Dorothy Quick

MICHIGAN (continued) Division of Occupational and Environmental


ATSDR A-15

Appendix II

NEW JERSEY Environmental and Occupational Health Clinical Center Environmental and Occupational Health Sciences Institute UMDNJ-Robert Wood Johnson Medical School 170 Frelinghuysen Rd. Piscataway, NJ 08854 (732) 445-0123; FAX (732) 445-0127 Howard Kipen, MD, MPH Alt. Contact: Gail Buckler, RN, MPH, COHN-S NEW MEXICO Presbyterian Occupational Medicine Clinic 5901 Harper, NE PO Box 26666 Albuquerque NM 87125 (505) 823-8450; FAX (505) 823-8484 William I. Christensen, MD, MPH Occupational and Environmental Medicine Clinic 2400 Tucker NE, Rm 177 Albuquerque NM 87131 (505) 272-2900; FAX (505) 272-4494 Karen B. Mulloy, DO, MSCH NEW YORK Eastern NY Occupational & Environmental Health Center 155 Washington Avenue Albany NY 12210 (518) 436-5511; FAX (518) 436-9110 Anne Tencza, BS, RN, COHN-S Alt. Contact: Eckardt Johanning, MD Mount Sinai -Irving J. Selikoff Center for Occupational and Environmental Medicine P.O. Box 1058 Gustave Levy Place New York, NY 10029 (212) 241-0176; FAX (212) 996-0407 Appointments: (212) 987-6043 Stephen Mooser, MPH Alt. Contact: Stephen Levin, MD

NEW YORK (continued) Center for Occupational & Environmental Medicine School of Medicine Health Sciences Center, Level 3-086 University at Stony Brook Stony Brook, NY 11794 (516) 444-2196; FAX (516) 444-7525 Wajdy Hailoo, MD, Msc, DIH Central NY Health Clinical Center 6712 Brooklawn Parkway Suite 204 Syracuse, NY 13211 (315) 432-8899; FAX (315) 431-9528 Michael B. Lax, MD, MPH New York University/Bellevue Hospital Occupational and Environmental Medicine Clinic Bellevue Hospital, Room CD 349 462 1st Avenue New York, NY 10016 (212) 562-4572; FAX (212) 562-4574 George Friedman-Jimenez, MD Finger Lakes Occupational Health Services 980 Westfall Road, Suite 210 Rochester NY 14618 (716) 256-0843; FAX (716) 256-2271 Deanna Woodhams, MA NORTH CAROLINA Division of Occupational and Environmental Medicine Duke University Medical Center Box 3834 Durham, NC 27710 (919) 286-3232; FAX (919) 286-1021 Dennis J. Darcey, MD, MSPH Alt. Contact: Gary Greenberg, MD, MPH

OHIO Community Health Partners Occupational


A-16 ATSDR

Health Center The Lorain Clinic for Occupational Medicine &

Appendix II

Rehabilitation 1800 Livingston Ave Lorain OH 44052 (440) 233-1068; FAX (440) 246-4560 Kathleen Fagan, MD, MPH Alt. Contact: Ann Wise, MD Center for Occupational Health Holmes Hospital-Tate Wing University of Cincinnati College of Medicine Eden and Bethesda Avenue Cincinnati, OH 45267 (513) 584-1234; FAX (513) 584-1010 James Donovan, MD, MS Alt. Contact: Susan Pinney, MD OKLAHOMA University Occupational Health Services Division of Occupational and Environmental Medicine Oklahoma Memorial Hospital 900 NE 10th Street, #2400 Oklahoma City, OK 73104 (405) 271-6177; FAX (405) 271-4125 David Paul, MD, MPH OREGON Occupational Health Program Oregon Health Sciences University (OHSU) 3181 SW Sam Jackson Park Rd. Mail Code OP-20C Portland OR 97201 (503) 494-1027; FAX (503) 494-4457 Nina Wolf, RN, BSN, COHN-S PENNSYLVANIA Occupational and Environmental Medicine Program University of Pittsburgh 3708 Fifth Avenue, Suite 401, Medical Arts Bldg. Pittsburgh, PA 15261 (412) 647-5360; FAX (412) 647-1140 Joseph J. Schwerha, MD, MPH

PENNSYLVANIA (continued) University of Pennsylvania School of Medicine Occupational Medicine-Silverstein Pavilion 3400 Spruce Street Philadelphia, PA 19104 (215) 349-5708; FAX (215) 662-3953 Appointments: (215) 662-2354 Edward A. Emmett, MD Center for Occupational and Environmental Health Abington Memorial Hospital 2510 Maryland Road, Suite 101 Willow Grove, PA 19090 (215) 481-5909; FAX (215) 481-5920 Lora S. Regan, MD, MPH TENNESSEE Occupational and Environmental Medicine Clinic Meharry Medical College 1005 D.B. Todd Boulevard Nashville TN 37208 (615) 327-6736; FAX (615) 327-6717 Otis Cosby, MD, MPH Alt. Contact: Herman Ellis, MD, MPH TEXAS Texas Institute of Occupational Safety & Health 11937 U.S. Highway 271 Tyler, TX 75708 (903) 877-5900; FAX (903) 877-7982 Jeffrey Levin, MD, MPH University of Texas Health Services 7000 Fannin, Suite 1620 Houston TX 77030 (713) 500-3267; FAX (713) 500-3263 Thomas Mackey, RNC, PhD

UTAH Rocky Mountain Center for Occupational and Environmental Health 75 South 2000 East University of Utah

Salt Lake City, UT 84112 (801) 581-3841; FAX (801) 581-7224 Appointments: (801) 581-5056 Anthony Suruda, MD, MPH Alt. Contact: Royce Moser, MD, MPH
ATSDR A-17

Appendix II

VIRGINIA Carillon Occupational Medicine Falin Center 903 S. Jefferson Street Roanoke, VA 24016 (540) 985-9820; FAX (540) 985-8118 Elaine Gill Alt. Contact: Hetzal Hartley, MD, MPH WASHINGTON Occupational and Environmental Medicine Program University of Washington Harborview Medical Center 325 9th Avenue, #359739 Seattle, WA 98104 (206) 731-3005; FAX (206) 731-8247 Drew Brodkin, MD, MPH Alt. Contact: Scott Barnhart, MD, MPH WEST VIRGINIA Division of Occupational & Environmental Health Department of Family and Community Medicine Marshall University School of Medicine 1600 Medical Center Huntington, WV 25755 (304) 691-1178; FAX (304) 691-1153 Chris McGuffin, MSCH, MSOSH Alt. Contact: James Becker, MD WEST VIRGINIA (continued) Institute of Occupational & Environmental Health West Virginia University School of Medicine 3801 Robert F. Byrd health Science Center South Morgantown WV 26506 (304) 293-3693; FAX (304) 293-2629 Alan Ducatman, MD, Msc CANADIAN CLINICS ALBERTA Occupational Medicine Consultation Clinic University of Alberta 13-103 Clinical Science Bldg. Edmonton Alberta, CD T6G 2G3 (780) 492-6291; FAX (780) 492-0364 Jim Cheng, MD MANITOBA MFL Occupational Health Centre, Inc. 102-275 Broadway
A-18 ATSDR

Winnipeg, Manitoba, CD R3C 4M6 (204) 949-0811; FAX (204) 956-0848 Shiela Braidek ONTARIO Occupational Health Clinics for Ontario Workers 15 Gervais Drive, Suite 308 Toronto ON, Canada M3C 1Y8 (416) 449-0009; FAX (416) 449-7772 Andrew King, Executive Director Occupational Health Clinics for Ontario Workers 848 Main Street East Hamilton ON, Canada L8M 1L9 (905) 549-2552; FAX (905) 549-7993 Chuck Emberson, Executive Director Occupational Health Clinics for Ontario Workers 1780 Regent Street South Times Square Mall Sudbury ON, Canada P3C 3Z8 (705) 523-2330; FAX (705) 522-8957 Donna Campbell, Executive Director ONTARIO (continued) Occupational Health Clinics for Ontario Workers 547 Victoria Ave. Windsor ON, Canada N9A 4N1 (519) 973-4800; FAX (519) 973-1906 Jim Brophy, Executive Director Occupational Health Clinics for Ontario Workers 171 Kendall St. Point Edward ON, Canada N7V 4G6 (519) 337-4627; Jim Brophy, Executive Director PEDIATRIC ENVIRONMENTAL HEALTH SPECIALITY UNITS CALIFORNIA The University California-San Francisco/ University of California-Irvine Pediatric Environmental Health Speciality Unit Contact: (415) 206-4320* Contact for both sites-San Francisco and Irvine GEORGIA The Southeast Pediatric Environmental Health Speciality Unit Emory University Atlanta GA (877) 33PEHSU (877-337-3478)

Appendix II

ILLINOIS Pediatric Environmental Health Center Cook County Hospital Chicago IL (312) 633-5310 MASSACHUSETTS Pediatric Environmental Health Center at Childrens Hospital Occupational and Environmental Health Center at Cambridge Hospital Boston MA (888) CHILD14 (888-244-5314)

NEW YORK Mt. Sinai Pediatric Environmental Health Unit Mt. Sinai-Irving J Selikoff Center for Occupational and Environmental Medicine New York NY (212) 241-6173 WASHINGTON Childrens Environmental Health Center University of Washington Occupational and Environmental Medicine Program Seattle WA (877) KID-CHEM (877-543-2463) ALBERTA Pediatric Environmental Health Clinic Misericordia Child Health Centr Edmonton AB (780) 930-5794

ATSDR

A-19

Appendix III

Appendix III

State Health Departments

A-20

ATSDR

Appendix III

ATSDR

A-21

Appendix III

State Health Departments Alabama Department of Public Health The RSA Tower, Suite 1552 201 Monroe Street Montgomery, AL 36130 (334) 206-5200 Alaska Department of Health and Social Services Alaska Office Building PO Box 110610 Juneau, AK 99811-0610 (907) 465-3090 American Samoa Department of Health Government of American Samoa LBJ Tropical Medical Center Pago Pago AS 96799 011-684-6334606 Arizona Department of Health Services 1740 W. Adams Street, Room 407 Phoenix, AZ 85007 (602) 542-1025 Arkansas Department of Health 4815 W. Markham Street Little Rock, AR 72205-3867 (501) 661-2417 California Department of Health Services 714 P Street Sacramento, CA 95814 (916) 657-1431 Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, CO 80246 (303) 692-2011 Connecticut Department of Public Health 410 Capitol Avenue Hartford, CT 06134 (860) 509-7101 Delaware Division of Public Health Jesse Cooper Bldg. PO Box 637 Dover, DE 19903 (302) 739-4700
A-22 ATSDR

District of Columbia Department of Health 825 North Capitol St., NW, Suite 4400 Washington, DC 20002 (202) 442-5999 Florida Department of Health 2585 Merchants Row Blvd., Suite 140 Tallahassee, FL 32399 (850) 245-4321 Georgia Department of Human Resources 2 Peachtree Street NW, Suite 15-470 Atlanta, GA 30303 (404) 657-2700 Guam Department of Public Health and Social Services PO Box 2816 Agana, GU 96910 011-671-7357102 Hawaii Department of Health 1250 Punchbowl Street PO Box 3378 Honolulu, HI 96813 (808) 586-4410 Idaho Department of Health and Welfare 450 W. State Street, Box 83720 Boise, ID 83720 (208) 334-5945 Illinois Department of Public Health 535 W. Jefferson Street Springfield, IL 62761 (217) 782-4977 Indiana Department 2 North Meridan Indianapolis, IN 46204 (317) 233-7400 Iowa Department of Public Health Lucas State Office Bldg. 312 E. 12th Street Des Moines, IA 50319 (515) 281-5605 Kansas Department of Health and Environment 900 SW Jackson, 6th Floor Topeka, KS 66612 (785) 296-1086

Appendix III

Kentucky Department for Health Services 275 E. Main Street Frankfort, KY 40621 (502) 564-3970 Louisiana Department of Health and Hospitals PO Box 3214 Baton Rouge, LA 70821 (225) 342-8093 Maine Bureau of Health Department of Human Services State House Station #11 Augusta, ME 04333 (207) 287-8016 Maryland Department of Health and Mental Hygiene 201 W. Preston Street, Suite 500 Baltimore, MD 21201 (410) 767-6505 Massachusetts Department of Public Health 250 Washington Street, 2nd Floor Boston, MA 02108 (617) 624-5200 Michigan Department of Community Health 3423 N. Martin Luther King, Jr. Blvd PO Box 30195 Lansing, Ml 48909 (517) 335-8024 Micronesia Government of the Federal States of Micronesia P.O. Box PS 70, Palikir Stn Pohnpei FM 96941 011-691-3202619 Minnesota Department of Health 85 East 7th Place, Suite 400 St. Paul, MN 55101 (651) 251-5813 Mississippi State Department of Health PO Box 1700 2423 N. State Street Jackson, MS 39215 (601) 960-7634

Missouri Department of Health 920 Wildwood Drive Jefferson City, MO 65102 (573) 751-6002 Montana Department of Health and Human Services 111 North Sanders, 3rd Floor Helena, MT 59604 (406) 444-5622 North Mariana Islands Department of Public Health P.O. Box 409, CK Saipan MP 96950 (670) 234-8950 Nebraska Department of Regulation and Licensure PO Box 95007 Lincoln, NE 68509 (402) 471-8566 Nevada State Health Division Nevada Department of Human Resources 505 E. King Street, Room 201 Carson City, NV 89701 (775) 684-4200 New Hampshire Department of Health and Human Services 6 Hazen Drive Concord, NH 03301 (603) 271-8560 New Jersey Department of Health and Senior Services PO Box 360, Room 805 Trenton, NJ 08625 (609) 292-7837 New Mexico Health 1190 St. Francis Drive Santa Fe, NM 87502 (505) 827-2613 New York Department of Health Corning Tower Building, 14th Floor Empire State Plaza Albany, NY 12237 (518) 474-2011 North Carolina Department of Environment,
ATSDR A-23

Appendix III

Health and Natural Resources Division of Health Services 101 Blair Drive Adams Building Raleigh, NC 27626 (919) 733-4392 North Dakota Department of Health 600 E. Boulevard Avenue Bismark, ND 58505-0200 (701) 328-2372 Ohio Department of Health 246 N. High Street PO Box 118 Columbus, OH 43266-0588 (614) 466-2253 Oklahoma State Department of Health 1000 NE 10th Street Oklahoma City, OK 73117 (405) 271-4200 Oregon Department of Human Services 800 NE Oregon Street, #21 Portland, OR 97232 (503) 731-4000 Pennsylvania Department of Health PO Box 90, Room 802. Harrisburg, PA 17108 (717) 787-6436 Puerto Rico Department of Health PO Box 70184 San Juan, PR 00936 (787) 274-7600 Rhode Island Department of Health 3 Capitol Hill Providence, RI 02908 (401) 222-2231 South Carolina Department of Health and Environmental Control 2600 Bull Street Columbia, SC 29201 (803) 898-3300

South Dakota State Department of Health 600 East Capitol c/o 500 East Capitol Pierre, SD 57501 (605) 773-3361 Tennessee Department of Health 3rd Floor, Cordell Hull Bldg. 425 5th Avenue N Nashville, TN 37247-0101 (615) 741-3111 Texas Department of Health 1100 W. 49th Street Austin, TX 78756 (512) 458-7376 Utah Department of Health 288 North 1460 West PO Box 142802 Salt Lake City, UT 84114 (801) 538-6111 Vermont Department of Health PO Box 70 Burlington, VT 05402 (802) 863-7280 Virgin Islands Social and Health Services 48 Sugar Estate St. Thomas, VI 00802 (340) 774-0117 Virginia Department of Health 1500 East Main Street PO Box 2448 Richmond, VA 23219 (804) 786-3561 Washington State Department of Health 1112SE Quince Street, Mail Stop 7890 Olympia, WA 98504-7890 (360) 236-4015 West Virginia Department of Health and Human Services 1900 Kanawha Blvd., Bldg. 3, Room 518 Charleston, WV 25305 (304) 558-2971

A-24

ATSDR

Appendix III

Wisconsin Division of Health PO Box 309 Madison, WI 53701-0309 (608) 266-1511 Wyoming Department of Health 117 Hathaway Bldg. Cheyenne, WY 82002 (307) 777-7656

ATSDR

A-25

Appendix IV

Appendix IV

Consultation Resources

A-26

ATSDR

Appendix IV

ATSDR

A-27

Appendix IV

Consultation Resources
American College of Occupational and Environmental Medicine 114 N. Arlington Heights Road Arlington Heights, IL 60004 (847) 818-1800 American Board of Medical Toxicology Heather Miller, Executive Director 777 E. Park Drive PO Box 8820 Harrisburg PA 17105-8820 (717) 558-7846 Association of Occupational and Environmental Clinics Katherine Kirkland, Executive Director 1010 Vermont Avenue Suite 513 Washington, DC 20005 (202) 347-4976 The Association of Occupational and Environmental Clinics (AOEC) is a network of clinics affiliated with medical schools throughout the U.S. Member clinics provide professional training, community education about toxic substances, exposure and risk assessment, clinical evaluations, and consultation. A lending library of training materials is maintained for use by members. Membership is open to any person who shares the goals of the Association. Clinicians can contact the AOEC office for referrals. Teratogen Exposure Registry and Surveillance (TERAS) Frederick Bieber, Ph.D. Department of Pathology Brigham and Womens Hospital 75 Francis Street Boston, MA 02115 (617) 732-6507 TERAS is a network of geneticists and pathologists studying human embryos and fetuses exposed to teratogens. TERAS maintains information networks for consultation and evaluations. University programs in occupational health, industrial hygiene, or toxicology Schools of public health or schools of medicine at universities function as resources to local communities. In addition, some hospitals have occupational or environmental health clinics that accept referrals.

A-28

ATSDR

Appendix IV

MotherRisk Program Gideon Koren, M.D., Director Hospital for Sick Children 555 University Avenue Toronto, Ontario M5G lX8 (416) 813-6780 The MotherRisk Program will counsel callers about t he safety of an exposure to drugs, chemicals, or radiation during pregnancy or breast feeding. The team of physicians and information specialists give advice on whether medications, X-rays, or chemicals in the work environment will harm the developing fetus or breast-fed baby. Genetic counseling is available from the Hospital for Sick Childrens Genetic Department.

ATSDR

A-29

Appendix IV

State/Federal/National Resources
Chemical Emergencies National Response Center (800) 424-8802 http://nrc.uscg.mil/index.htm Hazardous Waste Emergency Planning and Community RightTo-Know Hotline (EPA) Developing chemical contingency plans, gathering site-specific information, list of more than 400 acutely toxic chemicals (800) 535-0202 http://www.epa.gov/epaoswer/hotline/in dex.htm Superfund Order and Information Line Provides information about Superfund Records of Decision-hazardous waste sites to be cleaned up, actions being taken (800) 775-5037 http://www.epa.gov/superfund/sites/ phonefax/index.htm Integrated Risk Information System (IRIS) Hazardous chemicals information, including health effects (513) 569-7254 http://www.epa.gov/iris/ IRIS User Support (513) 569-7254 Lung Disease Lungline/National Jewish Hospital Information on lung disease from chemical exposure (800) 222-5864 http://www.NationalJewish.org Lead National Center for Environmental Health and Injury Control (CDC) Lead poisoning prevention (404) 488-4880 http://www.cdc.gov Child and Maternal Health Clearinghouse Publications on lead poisoning (888) 434-4MCH http://www.nmchc.org/ Occupational Health NIOSH Information and publications on health effects of occupational exposures (800) 356-4674 http://www.cdc.gov.niosh/ homepage.html Medical Section/Diagnosis and Treatment (513) 841-4388 Industrial Hygiene (513) 841-4374 OSHA (Occupational Safety and Health Administration) Regulations for toxic and hazardous substances in the workplace For emergencies: (800) 321-6742 For other inquires: (202) 693-1999 http://www.osha.gov Pesticides National Pesticide Hotline (800) 858-7378 http://www.growinglifestyle.com/article/ 73p5/a1656.html National Pesticide Telecommunications Network (800) 858-7378 http://ace.orst.edu/info/nptn/ National Pesticide Information Retrieval System (NPIRS) Help number for searching NPIRS database to get fact sheets on pesticides, insecticides, fungicides, state and federally registered chemicals. Funded by EPA/USDA, managed by Purdue University (765) 494-6616 http://ceris.purdue.edu/npirs/ npirs.html

A-30

ATSDR

Appendix IV

Radon Radon Hotline (800) SOS-RADON http://www.epa.gov/iaq/radon/ index.html EPA Radon Information Center (800) 438-4318 http://www.epa.gov/iaq/iaqinfo.html Toxic Substances Toxicology Information Response Center (Oak Ridge) General toxics information, searches on chemicals (865) 576-1746 http://www.ornl.gov/ TechResources/tirc/hmepg.html Agency for Toxic Substances and Disease Registry (ATSDR) Emergency Response Section. Rapid assistance provided about health issues from chemical exposures. (404) 639-0615 (24 hours) (404) 639-6360 (24 hours) (404) 639-6363 (fax) http://www.atsdr.cdc.gov/ Toxic Substances Control Act (TSCA) Hotline/Public Information Office (EPA) Answers questions and gives general technical assistance on TSCA. Guidance on TSCA regulations (202) 554-1404 Http://es.epa.gov/oeca/ccsmd/ tsca.html Toxic Chemical Release Inventory System (EPA) Information about which chemicals are used, stored, released by companies (800) 535-0202 http://toxnet.nlm.nih.gov CHEMTREC (Chemical Manufacturers Association) Nonemergency health and safety information on chemicals (800) 282-8200 http://memberexchange.cmahq.co m/chemtrec.nsf

Water EPA Safe Drinking Water Hotline (800) 426-4791 www.epa.gov.safewater

ATSDR

A-31

Appendix IV

A-32

ATSDR

Glossary

Chemical Glossary

Chemical Formula

Structural Formula

Chemical Name

AsH3 As2O3 CHCl2NO CHN CH2Cl2 CH2O CH3Br C2Cl4 C2HCl3 C2H3Cl C2H3Cl3 C2H4O C2H6O2 C3H3N C4H6 C6H6 C6H6O C6H7N C7H8 C8H10 C9H6N2O2 C10H6Cl8 C10H14NO5PS COCl2 Cl2 HCI HF Hg H2O2 H2S NH3 NOx PH3 NaOH SO2

AsH3 As2O3 ClC[NOH]Cl HCN CH2Cl2 HCHO CH3Br Cl2CCCl2 CICHCCl2 CH2CHCl CH3CCl3 [CH2]2O HO[CH2]2OH CH2CHCN CH2[CH]2CH2 C6H6 C6H5-OH C6H5NH2 C6H5-CH3 CH3-C6H4-CH3 CH3C6H3[NCO]2 C10H6Cl8 [C2H5O]2P[S]OC6H4NO2 COCl2 Cl2 HCI HF Hg H2O2 H2S NH3 NOx PH3 NaOH O2S

Arsine Arsenic trioxide Phosgene oxime Hydrogen cyanide Methylene chloride Formaldehyde Methyl bromide Tetrachloroethylene Trichloroethylene Vinyl chloride 1,1,1-Trichloroethane Ethylene oxide Ethylene glycol Acrylonitrile 1,3-Butadiene Benzene Phenol Aniline Toluene Xylene Toluene diisocyanate Chlordane Parathion Phosgene Chlorine Hydrogen chloride Hydrogen fluoride Mercury Hydrogen peroxide Hydrogen sulfide Ammonia Nitrogen oxides Phosphine Sodium hydroxide Sulfur dioxide

ATSDR

G-1

Glossary

G-2

ATSDR

Glossary

Chemical Index
Listed below are names of chemical protocols and their synonyms. Subjects of chemical protocols are in boldface italics (e.g., Arsine)
Acetylene trichloride See Trichloroethylene Acrylonitrile Alkron See Parathion Alleron See Parathion Aminobenzene See Aniline Aminophen See Aniline Ammonia Ammonia gas See Ammonia Ammonia solution See Ammonia Ammonium hydroxide See Ammonia Amprolenne See Methylene oxide AN See Acrylonitrile Anammonide See Hydrogen cyanide Anhydrous ammonia See Ammonia Aniline Aqueous ammonia See Ammonia Arsenic hydride See Arsine Arsenic trihydride See Arsine Arsenic trioxide Arseniuretted hydrogen See Arsine Arsenous acid See Arsenic trioxide Arsenous oxide See Arsenic trioxide Arsenous hydride See Arsine Arsine Arylamine See Aniline Benzene Benzenamine See Aniline Benzenol See Phenol Benzol See Benzene Bis(beta-chloroethyl) sulfide See Blister agent (H, HD, HT) Bis(2-chloroethyl) sulfide See Blister agent (H, HD, HT) Bis(2-chloroethyl)ethylamine See Blister agent (HN1, HN2, HN3) Bis(2-chloroethyl)methylamine See Blister agent (HN1, HN2, HN3) Blister Agent (H, HD, HT) Blister Agent (HN1, HN2, HN3) Blister Agent (HL, L) Bromoethane See Methyl bromide 1,3-Butadiene Bivinyl See 1,3-Butadiene C-100 See Chlordane Carbolic acid See Phenol Carbon oxychloride See Phosgene Carbonic acid dichloride See Phosgene Carbonic dichloride See Phosgene Carbonyl chloride See Phosgene Caustic soda See Sodium hydroxide Caryolysin See Blister agent (HN1, HN2, HN3) CD-68 See Chlordane Chlordan See Chlordane Chlordane Chlorine Chlor-Kil See Chlordane Chlormethine See Blister agent (HN1, HN2, HN3) 1-Chloro-2(beta-chloroethylthio)ethane See Blister agent (H, HD, HT) 2-Chloro-N-(2-chloroethyl)-N-ethylethanamine See Blister agent (HN1, HN2, HN3) Chloroethene See 1,1,1-Trichloroethane Chloroethylene See vinyl chloride Chloroformyl chloride See Phosgene Chlorohydric acid See Hydrogen chloride 2-Chloro-N,N-bis(2-chloroethyl)ethanamine See Blister agent (HN1, HN2, HN3) Coal tar naptha See Benzene CX See Phosgene oxime Cyanocthylene See Acrylonitrile Cyclohexatriene See Benzene Danthion See Parathion 2,2'-Dichloroethyl sulfide See Blister agent (H, HD, HT) Di-2-chloroethyl sulfide See Blister agent (H, HD, HT) Dichloromethane See Methylene chloride 2,2'-Dichloro-N-methyldiethylamine See Blister agent (HN1, HN2, HN3) Dichloren See Blister agent (HN1, HN2, HN3)

Dichloroformoxime See Phosgene oxime.


2,2'-Dichlorotriethylamine See Blister agent (HN1, HN2, HN3) Dihydrogen dioxide See Hydrogen peroxide Dihydrogen sulfide See Hydrogen sulfide Diisocyanatotoluene See Toluene diisocyanate Dimethylbenzene See Xylene Dimethylene oxide See Ethylene oxide Dinitrogen tetroxide See Nitrogen oxides DNTP See Parathion

ATSDR

G-3

Glossary

DPP See Parathion E-605 See Parathion Epoxyethane See Ethylene oxide 1,2-Ethanediol See Ethylene glycol Ethyl-S See Blister agent (HN1, HN2, HN3) Ethylbis(2-chloroethyl)amine See Blister agent (HN1, HN2, HN3) Ethyl parathion See Parathion Ethylene glycol Ethylene oxide Ethylene tetrachloride See Tetrachloroethylene Ethylene trichloride See Trichloroethylene Ethinyl trichloride See Trichloroethylene Etilon See Parathion ETO See Ethylene oxide Fluoric acid See Hydrogen fluoride Fluorine monohydride See Hydrogen fluoride Formaldehyde Formalin See Formaldehyde Formic aldehyde See Formaldehyde Formonitrile See Hydrogen cyanide Gasoline Gas See Gasoline HL See Blister agent (HL, L) HN1 See Blister agent (HN1, HN2, HN3) HN2 See Blister agent (HN1, HN2, HN3) HN3 See Blister agent (HN1, HN2, HN3) Hydrochloric acid See Hydrogen chloride Hydrocyanic acid See Hydrogen cyanide Hydrofluoric acid See Hydrogen fluoride Hydrofluride See Hydrogen fluoride Hydrogen arsenide See Arsine Hydrogen chloride Hydrogen cyanide Hydrogen dioxide See Hydrogen peroxide Hydrogen fluoride Hydrogen peroxide Hydrogen phosphide See Phosphine Hydrogen sulfide Hydroperoxide See Hydrogen peroxide Hydroxybenzene See Phenol Iprit See Blister agent (H, HD, HT) Iscobrome See Methyl bromide Kampstoff Lost See Blister agent (H, HD, HT) L See Blister agent (HL, L) Lewisite See Blister agent (HL, L) Liquid ammonia See Ammonia Lye See Sodium hydroxide MBA See Blister agent (HN1, HN2, HN3)

Mechlorethamine See Blister agent (HN1, HN2, HN3) Mercury Methanal See Formaldehyde Methane dichloride See Methylene chloride Methyl aldehyde See Formaldehyde Methyl benzene See Toluene Methyl benzol See Toluene Methyl bromide Methylchloroform See 1,1,1-Trichloroethane Methyl toluene See Xylene Methylene bichloride See Methylene chloride Methylene chloride Methylene dichloride See Methylene chloride Methylene oxide See Formaldehyde Mixed xylenes See Xylene Molecular chlorine See Chlorine Monobromomethane See Methyl bromide Monohydride See Hydrogen fluoride Monohydroxybenzene See Phenol Mononitrogen monoxide See Nitrogen oxides Monophenol See Phenol Motor fuel See Gasoline Muriatric acid See Hydrogen chloride Mustard gas See Blister agent (H, HD, HT) Mustard-Lewisite See Blister agent (HL, L) Mustine See Blister agent (HN1, HN2, HN3) Nerve agent (GA, GB, GD, VX) Nitric oxide See Nitrogen oxides Nitrogen dioxide See Nitrogen oxides Nitrogen monoxide See Nitrogen oxides Nitrogen peroxide See Nitrogen oxides Nitrogen tetroxide See Nitrogen oxides

G-4

ATSDR

Glossary

NTO See Nitrogen oxides Nitrogen fumes See Nitrogen oxides Nitrous fumes See Nitrogen oxides Nitrogen oxides Octachlor See Chlordane Oxirane See Ethylene oxide Oxacyclopropane See Ethylene oxide Oxomethane See Formaldehyde Paraform See Formaldehyde Parathion Perc See Tetrachloroethylene Perchloroethylene See Tetrachloroethylene Peroxide See Hydrogen peroxide Petrol See Gasoline Phenic acid See Phenol Phenol Phenyl alcohol See Phenol Phenyl hydroxide See Phenol Phenylic acid See Phenol Phenylic alcohol See Phenol Peroxide See Hydrogen peroxide Phenyl hydride See Benzene Phenylamine See Aniline Phenylmethane See Toluene Phosgene Phosgene oxime Phosphine Phosphorus hydride See Phosphine Phosphorus trihydride See Phosphine Phosphoretted hydrogen See Phosphine Propenenitrile See Acrylonitrile Prussic acid See Hydrogen cyanide Pyrrolyene See 1,3-Butadiene Quick silver See Mercury Sarin See Nerve agent (GA, GB, GD, VX) Senfgas See Blister agent (H, HD, HT) Sewer gas See Hydrogen sulfide Soda lye See Sodium hydroxide Sodium hydrate See Sodium hydroxide Sodium hydroxide Soman See Nerve agent (GA, GB, GD, VX) Spirits of salt See Hydrogen chloride S-yperite See Blister agent (H, HD, HT) Stathion See Parathion Stink damp See Hydrogen sulfide Sulfur dioxide Sulfur hydride See Hydrogen sulfide Sulfur mustard agent H See Blister agent (H, HD, HT)

Sulfur mustard agent HD See Blister agent (H, HD, HT) Sulfur mustard agent HT See Blister agent (H, HD, HT) Sulfur mustards See Blister agent (H, HD, HT) Sulphos See Parathion Sulfuretted hydrogen See Hydrogen sulfide Sulfur mustard/lewisite See Blister agent (HL, L) Sulfurous anhydride See Sulfur dioxide Sulfurous oxide See Sulfur dioxide TCE See Trichloroethylene TDI See Toluene diisocyanate Tabun See Nerve agent (GA, GB, GD, VX) Termicide C-100 See Chlordane Tetrachloroethylene Thiophos See Parathion Toluene Toluene diisocyanate Toluol See Toluene Tolylene diisocyanate See Toluene diisocyanate Topichlor See Chlotdane Toxichlor See Chlordane Tri See Trichloroethylene 1,1,1-Trichloroethane Trichloroethene See Trichloroethylene Trichloroethylene 2,2',2"-Trichlorotriethylamine See Blister agent (HN1, HN2, HN3) Tris(2-chloroethyl)amine See Blister agent (HN1, HN2, HN3) VCN See Actylonittile Velsicol 1068 See Chlordane Vinyl ethylene See 1,3-Butadiene Vinyl chloride Vinyl cyanide See Acrylonitrile VX See Nerve agent (GA, GB, GD, VX) White arsenic See Arsenic trioxide Xylene Xylol See Xylene Yellow cross liquid See Blister agent (H, HD, HT) Yperite See Blister agent (H, HD, HT)

ATSDR

G-5

Glossary

G-6

ATSDR

Glossary

Absorption. The incorporation of liquids or gases into the body. Absorption is also the process by which liquid hazardous materials are soaked up by sand, sawdust, or other material to limit the spread of contamination. Acute effect. A pathologic process caused by a single substantial exposure. Acute exposure. A single encounter to toxic concentrations of a hazardous material or multiple encounters over a short period of time (usually 24 hours). Adaptation. The tendency of certain receptors to become less responsive or cease to respond to repeated or continued stimuli. Adsorption. The property of a substance to attract and hold to its surface a gas, liquid, or other substance. Air purification devices. Respirators or filtration devices that remove particulate matter, gases, or vapors from the atmosphere. These devices range from full-facepiece, dual-cartridge respirators with eye protection to halfmask, facepiece-mounted cartridges with no eye protection. Air-supplied respirators. A device that provides the user with compressed air for breathing. Airways. Any parts of the respiratory tract through which air passes during breathing. Albuminuria. The presence of protein (primarily albumin) in the urine; usually indicative of transient dysfunction or disease. Alkali. A basic substance (pH greater than 7) that has the capacity to neutralize an acid and form a salt. Alveolar ducts. The smallest of the lungs airways that connect terminal bronchioles and alveolar sacs. Sometimes called bronchioles. Alveoli (singular alveolus). Microscopic air sacs in which gas exchange between the blood and the lungs occurs. Anemia. Any condition in which the number of red blood cells, the amount of hemoglobin, and the volume of packed red blood cells per 100 milliliters of blood are less than normal. Anhydrous. Containing no water. Anisocytosis. Considerable variation in the size of blood cells. Anorexia. Lack of appetite; aversion to food. Anoxia. Lack of oxygen in inspired air, blood, or tissues. Anterior chamber of the eye. The fluid-filled front portion of the eye between the cornea and the lens. Antidote. An agent that neutralizes a poison or counteracts its effects. Anuria. Absence of urine production.

ATSDR

G-7

Glossary

Aplastic anemia. A condition characterized by a decrease in the amount of hemoglobin in the blood due to incomplete or defective development of red blood cells; usually accompanied by defective regeneration of white blood cells and platelets. Apnea. Cessation of breathing. Asphyxia. A condition in which the exchange of oxygen and carbon dioxide in the lungs is absent or impaired. Aspiration pneumonia. Inflammation of the lungs due to inhalation of foreign material, usually food or vomitus, into the bronchi. Asthma. A chronic condition in which constriction (spasm) of the bronchial tubes occurs in response to irritation, allergy, or other stimuli. Ataxia. Incoordination of voluntary movement, especially affecting gait and speech. Atelectasis. Lung collapse. Atomic weight. The average weight (or mass) of all the isotopes of an element, as determined from the proportions in which they are present in a given element, compared with the mass of the 12 isotope of carbon (taken as precisely 12.000), which is the official international standard; measured in daltons. Atopy. A tendency or predisposition to allergic reactions. Autoignition temperature. The lowest temperature at which a gas or vapor-air mixture will ignite from its own heat source or a contacted heated surface without a spark or flame. Axon. The part of a nerve cell that conducts nervous impulses away from the nerve cell body to the remainder of the cell (i.e., dendrites); large number of fibrils enveloped by a segmented myelin sheath. Axonal. Pertaining to an axon. Bilirubin. A red pigment that results from normal and abnormal destruction of red blood cells. Blepharospasm. Involuntary spasmodic blinking or closing of the eyelids due to severe irritation. Boiling point. The temperature at which the vapor pressure of a liquid equals the atmospheric pressure and the liquid becomes vapor. Bradycardia. Slow heart rate, usually under 60 beats per minute. Bronchi (singular bronchus). Large divisions of the trachea that convey air to and from the lungs. Bronchiole. A small-diameter airway branching from a bronchus. Bronchitis. Inflammation of the mucous membrane of the bronchial tubes, usually associated with a persistent cough and sputum production. Bronchorrhea. Increased bronchial secretions.

G-8

ATSDR

Glossary

Bronchospasm. Contraction of the smooth muscle of the bronchi, causing narrowing of the bronchi. This narrowing increases the resistance of air flow into the lungs and may cause a shortness of breath, typically associated with wheezing. Bullae. Large fluid-filled blisters. Carcinogenic. Causing cancer. Cardiac dysrhythmia. Abnormality in the rate, regularity, or sequence of the heart beat. Formerly referred to as cardiac arrhythmia. Cataract. Loss of transparency (clouding) of the lens of the eye. Catecholamines. Substances of a specific chemical nature (pyrocatechols with an alkylamine side chain). Catecholamines of biochemical interest am those produced by the nervous system (e.g., epinephrine [adrenaline] or dopamine) to increase heart rate and blood pressure, or medicines with the same general chemical structure and effect. Caustic. Substance that strongly irritates, bums, corrodes, or destroys living tissue. Cerebellar abnormalities. Any irregularity in the cerebellum of the brain. Cerebellum. The large brain mass located at the posterior base of the brain, responsible for balance and coordination of movement. Cerebral infarctions. Death of tissue in the cerebrum due to lack of blood flow to the area. Cerebrum. The largest portion of the brain; includes the cerebral hemispheres (cerebral cortex and basal ganglia). Chemexfoliation. Chemical skin peeling; use of chemicals to remove scars or pigmentation defects. Chemical formula. The collection of atomic symbols and numbers that indicates the chemical composition of a pure substance. Chemical-protective clothing. Clothing specifically designed to protect the skin and eyes from direct chemical contact. Descriptions of chemical-protective apparel include nonencapsulating and encapsulating (referred to as liquid-splash protective clothing and vapor-protective clothing, respectively). Chronic effect. A pathologic process caused by repeated exposures over a period of long duration. Chronic exposure. Repeated encounters with a hazardous substance over a period of long duration. Cognitive function. The ability to think. Coma. State of profound unconsciousness from which the patient cannot be aroused. Combustible liquid. Any liquid that has a flash point at or above 100 EF (37.7 EC) and below 200 EF (93.3 EC). Compressed gas. Gas whose volume has been reduced by pressure. Congenital anomalies. Birth defects.
ATSDR G-9

Glossary

Conjunctiva (plural conjuctivae). The delicate mucous membrane that covers the exposed surface of the eyeball and lines the eyelids. Conjunctivitis. Inflammation of the conjunctiva; can result in redness, irritation, and tearing of the eye. Contact dermatitis (allergic). A delayed-onset skin reaction caused by skin contact with a chemical to which the individual has been previously sensitized. Contact dermatitis (irritant). Inflammatory skin reaction caused by a skin irritant. Control zones. Areas at a hazardous materials incident whose boundaries are based on safety and the degree of hazard; generally includes the Hot Zone, Decontamination Zone, and Support Zone. Cornea. Transparent membrane that covers the colored part of the eye. Cornea1 opacification. Clouding of the cornea. Corrosive. Ability to destroy the texture or substance of a tissue. Critical Care Area. That area in a hospital designated for the treatment of severely ill patients. Cyanosis. Bluish discoloration of the skin and mucous membranes due to deficient oxygenation of the blood; usually evident when reduced hemoglobin (i.e., hemoglobin unable to carry oxygen) exceeds 5%. Decontamination. The process of removing hazardous materials from exposed persons and equipment at a hazardous materials incident. Decontamination Zone. The area surrounding a chemical hazard incident (between the Hot Zone and the Support Zone) in which contaminants are removed from exposed victims. Defat. To remove natural oils from the skin. Degradation. The process of decomposition. When applied to protective clothing, a molecular breakdown of material because of chemical contact; degradation is evidenced by visible signs such as charring, shrinking, or dissolving. Testing clothing material for weight changes, thickness changes, and loss of tensile strength will also reveal degradation. Delirium. A condition of extreme mental (and sometimes motor) excitement marked by defective perception, impaired memory, and a rapid succession of confused and unconnected ideas, often with illusions and hallucinations. Dementia. A general deterioration of mental abilities. Demyelination. Removal (destruction) of the myelin sheath that surrounds and protects nerves. Denervation atrophy. Shrinkage or wasting of muscles due to loss of nerve supply. Dermal. Relating to the skin. Dermatitis. Skin inflammation.

G-10

ATSDR

Glossary

Dermis. The layer of the skin just below the epidermis or outer layer. The dermis has a rich supply of blood vessels, nerves, and skin structures. Desiccation. Removal of moisture; drying. Desiccant effect. Drying of the skin caused by removal of soluble oils. Dilution. The use of water to lower the concentration or amount of a contaminant. Diaphoresis. Excessive perspiration. Diplopia. Double vision. Dyscrasia. Blood disorder. Dysphagia. Difficulty in swallowing. Dyspnea. Shortness of breath; difficult or labored breathing. Dysuria. Painful or difficult urination. Edema. Accumulation of fluid in body cells or tissues; usually identified as swelling. Embolization. Obstruction of a blood vessel by a transported clot or other mass. Embryo. In humans, the developing conceptus up to 8 weeks after fertilization of the egg. See also fetus. Embryotoxicity. Ability to harm the embryo. Emergency. A sudden and unexpected event requiring immediate remedial action. Emesis. Vomiting. Encephalopathy. Any disease of the brain. Environmental hazard. A condition capable of posing an unreasonable risk to air, water, or soil quality, or plant or animal life. Epidermis. The outermost layer of the skin. Erythroderma. Intense, widespread reddening of the skin. Erythema. Redness of the skin. Esophageal strictures. Narrowing of the esophagus that causes difficulty in swallowing; often due to scar formation following extensive bums. Esophagus. The portion of the digestive canal extending from the throat to the stomach. Also referred to as the gullet.

ATSDR

G-11

Glossary

Euphoria. An intense and exaggerated feeling of well-being. Exfoliative dermatitis. A skin condition that involves scaling or shedding of the superficial cells of the epidermis. Exothermic reaction. Chemical reactions that produce heat. Explosives. Compounds that are unstable and break down with the sudden release of large amounts of energy. Explosivity. The characteristic of undergoing very rapid decomposition (or combustion) to release large amounts of energy, Fasciculation. Muscle twitching. Fetotoxic. Having the ability to harm the fetus. Fetus. In humans, the conceptus from 8 weeks after fertilization until birth. See also embryo. Flame-resistant. Slow or unable to bum. Flammable. The ability of a substance to ignite and bum. Flammable (explosive) range. The range of gas or vapor concentration (percentage by volume in air) that will bum or explode if an ignition source is present. Limiting concentrations are commonly called the lower explosive limit and upper explosive limit. Below the lower explosive limit, the mixture is too lean to bum; above the upper explosive limit, the mixture is too rich to bum. Flash point. The minimum temperature at which a liquid produces enough vapor to ignite. Flashback. The movement of a flame to a fuel source; typically occurs via the vapor of a highly volatile liquid or by a flammable gas escaping from a cylinder. Fluorosis. Accumulation of excessive fluoride in the body; characterized by increased bone density and mineral deposits in tendons, ligaments, and muscles. Followup. Constant or intermittent contact with a patient after diagnosis or therapy. Freezing point. Temperature at which crystals start to form as a liquid is slowly cooled; alternatively, the temperature at which a solid substance begins to melt as it is slowly heated. Fume. Fine particles (typically of a metal oxide) dispersed in air that may be formed in various ways (e.g., condensation of vapors, chemical reaction). Gangrene. Death of tissue due to lack of blood supply. Gas. A physical state of matter that has low density and viscosity, can expand and contract greatly in response to changes in temperature and pressure, readily and uniformly distributes itself throughout any container.

G-12

ATSDR

Glossary

Glaucoma. A disease of the eye characterized by abnormal and damaging high pressure inside the eye; usually due to a blockage of the channel that normally allows the outflow of fluid from the eye. Glomerulus (plural glomeruli). A tuft formed of capillary loops that filter blood in the kidney. Hazard. A circumstance or condition that can cause harm. Hazardous materials. Substances that, if not properly controlled, pose a risk to people, property, or the environment. Hazardous materials incident. The uncontrolled release or potential release of a hazardous material from its container into the environment. Hematuria. Condition in which the urine contains an abnormal amount of blood or red blood cells. Hemodialysis. Removal of soluble substances from the blood by their diffusion through a semipermeable membrane. Hemoglobinuria. Condition in which the urine contains an abnormal amount of hemoglobin. Hemolysis. Destruction or dissolution of red blood cells in such a manner that hemoglobin is liberated into the medium in which the cells are suspended. Hemolytic anemia. Any anemia resulting from destruction of red blood cells. Hemoptysis. The spitting of blood derived from hemorrhage in the lungs or bronchial tubes. Hepatic. Pertaining to the liver. Hepatomegaly. Enlargement of the liver. Hot Zone. The area immediately surrounding a chemical hazard incident, such as a spill, in which contamination or other danger exists. Hyperbilirubinemia. A condition in which an abnormally large amount of bilirubin is found in the blood. Jaundice becomes apparent when the level of bilirubin is double the normal level. Hyperesthesia. Increased sensitivity to touch, pain, or other sensory stimuli. Hyperpigmentation. An excess of pigment in a tissue or part of the body. Hyperreflexia. A condition in which the deep tendon reflexes are exaggerated. Hypersensitization. Increased sensitivity of the immune system; induced by initial exposure with subsequent exposures eliciting a greater than expected immunologic response. Hypertension. High blood pressure. Hypocalcemia. A condition in which an abnormally low concentration of calcium ions is present in the blood.

ATSDR

G-13

Glossary

Hypokalemia. A condition in which an abnormally low concentration of potassium ions is present in the blood. Hypomagnesemia. A condition in which the plasma concentration of magnesium ions is abnormally low; may cause convulsions and concurrent hypocalcemia. Hypophosphatemia. Condition in which an abnormally low concentration of phosphate is found in the blood. Hypotension. Low arterial blood pressure. Hypotonia. A condition in which there is a loss of muscle tone. Hypoxemia. A condition in which inadequate oxygen is present in arterial blood, short of anoxia. Hypoxia. Condition in which below-normal levels of oxygen are present in the air, blood, or body tissues, short of anoxia. Ignition (autoignition) temperature. The minimum temperature required to ignite gas or vapor without a spark or flame being present. Immediately dangerous to life and health (IDLH). That atmospheric concentration of a chemical that poses an immediate danger to the life or health of a person who is exposed but from which that person could escape without any escape-impairing symptoms or irreversible health effects. A companion measurement to the permissible exposure limit (PEL), IDLH concentrations represent levels at which respiratory protection is required. IDLH is expressed in parts per million (ppm) or mg/m3. Inadequate warning property. Characteristic (e.g., odor, irritation) of a substance that is not sufficient to cause a person to notice exposure. Incident commander. The person responsible for establishing and managing the overall operational plan at a hazardous material incident. The incident commander is responsible for developing an effective organizational structure, allocating resources, making appropriate assignments, managing information, and continually attempting to mitigate the incident. Insecticide. An agent that has the ability to kill insects. Intention tremor. Trembling of the extremities during movement. Interstitial pneumonitis. Inflammation of the alveolar walls and the spaces between them. Iritis. Inflammation of the colored part of the eye (iris). Ischemia. Obstruction of blood flow (usually by arterial narrowing) that causes lack of oxygen and other bloodborne nutrients. Ischemic necrosis. Death of cells as a result of decreased blood flow to affected tissues. Jaundice. Yellowing of the skin and whites of the eyes due to an accumulation of bile pigments (e.g., bilirubin) in the circulating blood.

G-14

ATSDR

Glossary

Keratitis. Inflammation of the cornea. Lacrimation. Secretion of tears, especially in excess. Laryngeal edema. Swelling of the voice box due to fluid accumulation. Laryngitis. Inflammation of the mucous membrane of the larynx. Laryngospasm. Spasmodic closure of the vocal apparatus. Lethargy. A state of extreme tiredness or fatigue. Leukemia. Progressive proliferation of abnormal leukocytes found in blood and blood-forming tissues and organs; due to cancer of the bone marrow cells that form leukocytes. Leukocyte. White cell normally present in circulating blood. Material safety data sheet (MSDS). Documents prepared by the chemical industry to transmit information about the physical properties and health effects of chemicals, and about emergency response plans. Methemoglobin. A transformation product of hemoglobin in which normal Fe+2 is oxidized to Fe+3. Methemoglobin contains oxygen that is firmly bound to the Fe+3 ion, which prevents the release of oxygen to the tissues. Methemoglobinemia. Condition in which methemoglobin is present in the circulating blood. Methemoglobinuria. Condition in which methemoglobin is present in the urine. Miosis. Contraction of the pupil to a pinpoint. Miscible. Able to mix (but not chemically combine) in any ratio without separating into two phases (e.g., water and alcohol). Mist. Liquid droplets dispersed in air. Mitigation. Actions taken to prevent or reduce the severity of harm. Monocytic leukemia. A form of bone marrow cancer characterized by an increase in the number of large, mononuclear white blood cells in tissues, organs, and the circulating blood. Molecular weight. The sum of the atomic weights (q.v.) of the atoms in a molecule; measured in daltons. Myalgia. Severe muscle pain. Mydriasis. Dilation of the pupil. Myelocytic leukemia. A form of bone marrow cancer characterized by the presence of large numbers of granular white blood cells in tissues, organs, and the circulating blood. Myocardial ischemia. Insufficient oxygen supply to meet the metabolic demands of heart muscles.

ATSDR

G-15

Glossary

Myocarditis. Inflammation of the muscles of the heart. Myoclonus. Involuntary spasm or twitching of a muscle or group of muscles. Myoglobin. The oxygen-transporting, pigmented protein of muscle; resembles blood hemoglobin in function. Myoglobinuria. Presence of myoglobin in urine. Nasopharynx. Relating to the nasal cavity and that part of the throat that lies above the level of the soft palate. Necrosis. Death of one or more cells or a portion of a tissue or organ. Nephrotoxic. Capable of damaging the kidney. Neuropathy. A disorder of the nervous system; in contemporary usage, a disease involving the cranial or spinal nerves. Noncardiogenic pulmonary edema. An accumulation of an excessive amount of fluid in the lungs as a result of leakage from pulmonary capillaries; not due to heart failure. Nystagmus. Involuntary rapid movements of the eyeballs, either rhythmical or jerky. Ocular. Pertaining to the eye. Odor threshold. The lowest concentration of a vapor or gas that can be detected by smell. Off-gassing. Giving off a vapor or gas. Olfactory fatigue. Temporary loss of the sense of smell due to repeated or continued stimulation. Oliguria. Condition in which abnormally small amounts of urine are produced. Opisthotonos. Tetanic spasm in which the spine and extremities are bent up and forward so that a reclining body rests on the head and the heels. Optic atrophy. Shrinkage or wasting of the optic nerve that may lead to partial vision loss or blindness. Optic neuritis. Inflammation of the optic nerve. Osteosclerosis. Abnormal hardening or increase in density of the bone. Paresthesias. An abnormal sensation such as burning, prickling, or tingling. Percutaneous absorption. Passage of a substance through unbroken skin. Peripheral neuropathy. A disorder of the peripheral nerves. Permeation. The passage of chemicals, on a molecular level, through intact material such as protective

G-16

ATSDR

Glossary

clothing. Permissible exposure limit (PEL). The maximum time-weighted average concentration mandated by the Occupational Safety and Health Administration (OSHA) to which workers may be repeatedly exposed for 8 hours per day, 40 hours per week without adverse health effects. Photophobia. Abnormal sensitiveness to light, especially of the eyes. Physical state. The state (solid, liquid, or gas) of a chemical under specific conditions of temperature and pressure. Pneumonitis. Inflammation of the lungs. Poikilocytosis. The presence of irregularly shaped red blood cells in the peripheral blood. Posthypoxic encephalopathy. Condition in which the brain has been damaged as a result of insufficient oxygen. Proteinuria. A condition in which an abnormal amount of protein is present in the urine. See also albuminuria. Pruritic. Pertaining to itching. Psychosis. A mental disorder characterized by derangement of personality and loss of touch with reality. Pulmonary edema. Accumulation of extravascular fluid in the lungs that impairs gas exchange; usually due to either increased intravascular pressure or increased permeability of the pulmonary capillaries. Pupil. The circular opening in the center of the iris through which light rays enter the eye. Reactivity. The ability of a substance to chemically interact with other substances. Rescuer protection equipment. Gear necessary to prevent injury to workers responding to chemical incidents. Respiratory depression. Slowing or cessation of breathing due to suppression of the function of the respiratory center in the brain. Response organization. An organization prepared to provide assistance in an emergency (e.g., fire department). Response personnel. Staff attached to a response organization (e.g., HAZMAT team). Retrobulbar neuritis. Inflammation of the portion of the optic nerve behind the eyeball. Rhinitis. Inflammation of the mucous membranes of the nasal passages. Rhinorrhea. A discharge from the nasal mucous membrane. Routes of exposure. The manner in which a chemical contaminant enters the body (e.g., inhalation, ingestion).
ATSDR G-17

Glossary

Sclera. The tough, white supporting tunic of the eyeball. Secondary contamination. Transfer of a harmful substance from one body (primary body) to another (secondary body), thus potentially permitting adverse effects to the secondary body. Self-contained breathing apparatus (SCBA). Protective equipment consisting of an enclosed facepiece and an independent, individual supply (tank) of air; used for breathing in atmospheres containing toxic substances or underwater. Sensory neuropathy. Damage to the nerves that carry information about sensation (e.g., touch, pain, temperature) to the brain. Sequela (plural sequelae). A condition that follows as a consequence of injury or disease. Sloughing. The process by which necrotic cells separate from the tissues to which they have been attached. Solubility. The ability of one material to dissolve in or blend uniformly with another. Soluble. Capable of being dissolved. Solution. A homogeneous mixture of two or more substances, usually liquid. Solvent. A substance that dissolves another substance. Specific gravity. The ratio of the mass of a unit volume of a substance to the mass of the same volume of a standard substance (usually water) at a standard temperature. Status epilepticus. Severe seizures in which recovery does not occur between major episodes. Stridor. A harsh, high-pitched respiratory sound often heard in acute respiratory obstruction. Support Zone. That area beyond the Decontamination Zone that surrounds a chemical hazard incident in which medical care can be freely administered to stabilize a victim. Surfactant. An agent that reduces surface tension (e.g., wetting agents, detergents, dispersing agents). Tachycardia. Rapid heartbeat (typically greater than 100 beats per minute). Tachypnea. Rapid breathing. Teratogenic. Having the ability to cause congenital anomalies. Tetany. A condition marked by involuntary muscle contractions or spasms. Thrombocytopenia. A condition in which there is an abnormally small number of platelets in the blood. Thrombosis. Blood vessel clotting. Time-weighted average (TWA) air concentration. That concentration of a substance in air that is measured by collecting it on a substrate at a known rate for a given period of time.
G-18 ATSDR

Glossary

Tinnitus. Ringing in the ears. Toxic potential. The inherent ability of a substance to cause harm. Toxic. Having the ability to harm the body, especially by chemical means. Tracheitis. Inflammation of the membrane lining the trachea. Trismus. Lockjaw. Tubular necrosis. Death of the cells lining the kidney tubules. Uremia. Condition in which an abnormally high level of urea or other nitrogenous waste is found in the blood; due to kidney dysfunction. Urticaria. Hives. Vapor density. The weight of a given volume of vapor or gas compared to the weight of an equal volume of dry air, both measured at the same temperature and pressure. Vapor pressure. A measure of the tendency of a liquid to become a gas at a given temperature. Vapor. The gaseous form of a substance that is normally a solid or liquid at room temperature and pressure. Vascular. Pertaining to blood vessels. Vasodilation. Increased diameter of the blood vessels. Ventricular fibrillation. Rapid, tremulous movement of the ventricle that replaces normal contractions of the heart muscle; results in little or no blood being pumped from the heart Vertigo. Sensation of spinning or revolving. Vesicant. An agent that produces blisters. Vesiculation. The presence or formation of blisters. Water-reactive material. A substance that readily reacts with water or decomposes in the presence of water, typically with substantial energy release. Wheezing. Breathing noisily and with difficulty; usually a sign of spasm or narrowing of the airways.

ATSDR

G-19

Glossary

G-20

ATSDR

Glossary

ATSDR

G-21

In 1998, the Agency for Toxic Substances and Disease Registry (ATSDR) joined with the Association of Occupational and Environmental Clinics (AOEC) to develop the Pediatric Environmental Health Specialty Unit (PEHSU) Program as a national resource for pediatricians, other health care providers, and communities. The Program is designed to (1) reduce environmental health threats to children, (2) improve access to expertise in pediatric environmental medicine, and (3) strengthen public health prevention capacity. The key focus areas of the units are medical education and training, clinical consultation, and clinical specialty referral for children who may have been exposed to hazardous substances in the environment. Five units are fully operational. By the end of 2000, a total of nine units are scheduled to be in operation in the United States.

Pediatric Environmental Health Center Childrens Hospital Boston, Massachusetts


The Pediatric Environmental Health Center was established in 1998 as a regional center for pediatric environmental health, with support from ATSDR and AOEC. The Center is a joint program of the Childrens Hospital in Boston; the Occupational and Environmental Health Program at Cambridge Hospital; Harvard Medical School; and the Occupational and Environmental Medicine Program, Harvard School of Public Health. The Center at Childrens Hospital offers multidisciplinary evaluation and management of children with known or suspected exposure to environmental toxins. Staffed by pediatricians, medical toxicologists, nurses, and resource specialists, the Center provides medical management for illnesses or intoxications resulting from heavy metals, indoor air pollutants, outdoor pollutants, and adolescent occupational exposures. The Center also provides consultative services by telephone; publishes articles advancing the field of pediatric environmental medicine; and conducts educational activities for medical students, residents, and other health care providers. Recently, the center staff developed a teaching tool entitled the Pediatric Environmental Health History. This tool is available in a CD-ROM format. The Director of the Center is Michael Shannon, MD, MPH. Alan Woolf, MD, MPH, and Rose Goldman, MD, MPH, serve as Co-Directors. Howard Hu, MD, MPH, ScD, is affiliated with the Center. The Pediatric Environmental Health Center can be contacted by phoning 888-Child14.

Mt. Sinai-Irving J. Selikoff Center for Occupational and Environmental Medicine New York, New York
The Pediatric Environmental Health Unit was established in 1998 as a regional center for pediatric environmental health, with support from ATSDR, the National Center for Environmental Health, and the American College of Preventive Medicine. It is a multi-disciplinary program of research, education, clinical service, and community partnership. The major purposes of the Unit are to provide clinical services to children with diseases of toxic environmental origin and to children who have sustained toxic exposures in their environment. The clinical services provided by the Unit are available on-site at the Mt. SinaiIrving J. Selikoff Center for Environmental and Occupational Medicine. serve as a regional source of referral and consultation in environmental pediatrics increase pediatricians knowledge of environmental threats to childrens health. (This is being done through unit-sponsored special education opportunities such as grand rounds and seminar series, by holding conferences such as Environmental Influences on Children: Brain, Development, and Behavior, by publishing articles, and by training health fellows under the supervision of faculty of the Departments of Pediatrics and Community and Preventive Medicine, Mt. Sinai School of Medicine, Mt. Sinai Hospital, Mt. Sinai Medical Center.)

Philip Landrigan MD, MSc is the Principal Investigator at the Mt. Sinai PEHSU.

The Mt. Sinai Unit can be contacted by phoning 212241-6173.

The Southeast Pediatric Environmental Health Specialty Unit Emory University Atlanta, Georgia
The Southeast Pediatric Environmental Health Unit was established in Fall 1999 as a regional center for pediatric environmental health, with support from ATSDR, the U.S. Environmental Protection Agency (EPA), and AOEC. The Unit links Emory Universitys Department of Environmental and Occupational Health, Rollins School of Public Health, and the Department of Pediatrics, School of Medicine; the Georgia Poison Center; the Marcus Institute; and a variety of Emory University-affiliated clinical facilities, including Childrens Health Care of Atlanta and the Hughes Spalding Childrens Hospital. The objectives of the Unit are to develop a variety of educational materials on childrens environmental health; provide information and carry out health education activities for families, communities, and health care providers throughout the Southeast (Region IV) regarding environmental hazards and the most effective ways to protect childrens health; provide clinical consultation to agencies and health care providers in the region; create an infrastructure for delivering pediatric environmental health care, including maintaining a database of conditions linked to environmental hazards and consulting with government agencies to formulate solutions; and provide clinical pediatric environmental health services, including evaluation of children, referral of those needing treatment, and establishment of a network of expert clinicians.

The Center for Childrens Environmental Health Cook County Hospital Chicago, Illinois
The Center for Childrens Environmental Health was established in 1999 as a regional center for pediatric environmental health, with support from ATSDR, the U.S. Environmental Protection Agency (EPA), and AOEC. The Center is a joint program of the Division of Occupational and Environmental Medicine and the Department of Pediatrics at Cook County Hospital. The Center is affiliated with the Great Lakes Center for Occupational and Environmental Safety and Health at the University of Illinois and Chicagos Toxikon Consortium. The Center works closely with the Illinois Poison Control Center; local, state, and federal environmental and public health agencies; and local health care institutions. The Center exists to evaluate, treat, and prevent environmental illnesses in infants, children, and adolescents. The Center has a multi-disciplinary staff with experts in environmental medicine, pediatrics, clinical toxicology, and industrial hygiene. train pediatricians and other health care professionals in pediatric environmental health issues. The Center offers a monthly lecture series at Cook County Hospital as well as continuing educational programs and workshops throughout Region V. The Center is also developing interactive, web-based case presentations that can be accessed through the Centers website at www.uic.edu. The future website address is www.uic.edu/sph/glakes/kids. environmental health problems through research. The Centers faculty includes clinical and public health scientists who conduct research on the most effective ways to diagnose, treat, and prevent childrens environmentassociated illnesses. promote childrens environmental health in communities. The Center is part of the Health Hazard Evaluation (HHE) Program which investigates health hazards in communities through environmental monitoring, epidemiology, and clinical evaluations.

expand the knowledge of childrens

Howard Frumkin, MD, DrPH is the Principal Investigator for the Southeast PEHSU. Robert Geller, MD; Leslie Rubin, MD; and Gerald Teague, MD, are Co-Investigators. Janice Nodvin is the Project Administrator. The Southeast Unit can be contacted by phoning 87733PEHSU (877-337-3478).

The Centers Director is Daniel Hryhorczuk, MD, MPH, FACMT. The Associate Directors are Jay Mayefsky, MD, MPH, and Carl Baum, MD, FAAP, ACMT. The Center for Childrens Environmental Health can be contacted by phoning 312-633-5310.

pollution, allergens, food-related hazards, and drinking water quality. To learn more about training opportunities, visit the PEHSU website at http://depts.washington.edu/ oemp/pehsu/index.html. The Director of the Harborview PEHSU is C. Andrew Brodkin, MD, MPH. William O. Robertson, MD, is the Co-Director. The Harborview PEHSU can be contacted by phoning 877-KID-CHEM (west of the Mississippi River) and 206-526-2121.

Pediatric Environmental Health Specialty Unit Harborview Medical Center Seattle, Washington
The Harborview Pediatric Environmental Health Specialty Unit (PEHSU) was established in 1998 and currently serves as a regional center for pediatric environmental health, with support from ATSDR, the U.S. Environmental Protection Agency (EPA), and AOEC. This PEHSU was created by the University of Washingtons Occupational and Environmental Medicine Program, together with the Washington Poison Control Center and Childrens Hospital and Regional Medical Center. The PEHSUs goal is to provide expertise on childhood environmental health risk to health care providers, educators, communities, and families. The PEHSU staff provide clinical consultations with experts at the Washington Poison Center for those concerned about childhood environmental exposures. Callers concerns have included the consumption of well water contaminated with pesticides and solvent exposures from painting a childs bedroom. The Poison Center experts address some 2,000 such inquiries every month.

University of California - San Francisco (UCSF)/University of California Irvine (UCI) Pediatric Environmental Health Specialty Unit
The University of California Pediatric Environmental Health Unit was established in the winter of 2000 as a regional center for pediatric environmental health, with support from the Agency for Toxic Substances and Disease Registry (ATSDR), the U.S. Environmental Protection Agency (EPA), and the Association of Occupational and Environmental Clinics (AOEC). As a joint collaborative project providing services in both the northern (UCSF) and southern (UCI) areas of the state, the unit links the Occupational and Environmental Medicine Programs at the respective campuses with the UCSF-Mount Zion Hospital and UCSF-San Francisco General Hospital, California Poison Center and the Departments of Pediatrics at UCSF and UCI. The objectives for the UC-PEHSU are to provide consultative services to health professionals, governmental agencies and the California Poison Control System through an effective network of pediatrics specialists in collaboration with the Occupational and Environmental Medicine Program at both sites; to conduct educational activities; to provide clinical and diagnostic services either on site or through the Department of Pediatrics; and to coordinate program evaluation activities for the PEHSU.

clinical services on a case-by-case basis to see children and their families. Providers are specifically trained in both pediatrics and environmental medicine. Clinic visits are available at Childrens Hospital and Regional Medical Center. training for health care providers as well as the public on childhood environmental health issues. Much of the training curriculum is based on results from an environmental health survey completed by school nurses, physicians, parents of children in Head Start Programs, ParentTeacher Association (PTA) leaders, and others. The topics of greatest concern reported were air

John Balmes, M.D. is the principal investigator and Dean Baker, M.D., MPH is the co-prinicipal investigator. Denise Souza, MSN, C-NP, COHN-S is the project coordinator. Mary Koebler, RN, COHN-S serves as the UCI liaison for the project components. The University of California - San Francisco/ University of California - Irvine PEHSU can be reached at 415-206-4320 (for both sites).

reached at (903) 877-5919 or e-mailed at larry.lowry@uthct.cdu. Both Dr. Levin and Dr. Lowry can be faxed at (903) 877-7060.

George Washington University Medical Center Washington, DC.


The George Washington University specialty unit will be starting on October 1, 2000. The unit is a project of the George Washington University Medical Center (GWUMC) and the Childrens National Medical Center, and includes collaboration between the GWUMC Division of Occupational Medicine and Toxicology and the Department of Pediatrics. It was established with support from ATSDR, the U.S. Environmental Protection Agency (EPA), and AOEC. In addition, they have assembled a team which includes the Howard University College of Nursing and faculty from the University of Maryland School of Medicine and the Medical College of Pennsylvania. The goals of the George Washington University PEHSU are to increase the cooperation and exchange of information between pediatricians and occupational and environmental health professionals. conduct educational activities that will assist both health professionals and communities in addressing environmental risks to children. improve the recognition, evaluation, and management of environmental health problems in children. develop new knowledge about communications between clinicians, parents, and patients about environmental health issues. reduce the environmental health disparities among children in EPA/ATSDR Region 3. John Balbus, MD, MPH, Jerome Paulson, MD, and Benjamin Gitterman, MD, MPH, will serve as coprincipal investigators. Questions concerning the PEHSU can be directed to Dr. Paulson at (202) 9949914, faxed to (202) 994-4861, or e-mailed at hcsjap@gwumc.edu.

Southwest Center for Pediatric Environmental Health University of Texas Health Center Tyler, Texas
The Southwest Center for Pediatric Health began operation on September 1, 2000, and is a collaboration between UTHCTs Occupational Medicine Program and the Departments of Pediatrics and Allergy. It was established with support from ATSDR, the U.S. Environmental Protection Agency (EPA), and AOEC. In addition, the Southwest Center has assembled a team that includes the Texas Poison Center Network and its North Texas Poison Center, the New Mexico Poison and Drug Information Center and the Program of Occupational and Environmental Health at the University of New Mexico. The specific aims for the SW-CPEH are to develop materials and present training to health professionals and public health officials on environmental health issues and their impact on childrens health. answer requests for information regarding pediatric environmental health and risk communication from health care professionals, public health agencies, and concerned parents. provide clinical consultation services for patients and their health care providers.

The toll-free number for the Southwest Center for Pediatric Environmental Health is (888) 901-5665. Jeffrey Levin, MD, MSPH, and Larry K. Lowry, PhD, serve as co-principal investigators. Dr. Levin can be reached directly at (903) 877-5900 or emailed at jeffrey.levin@uthct.cdu. Dr. Lowry can be

Additional information on the PEHSU Program can be obtained by calling Katherine Kirkland, MPH, Executive Director, AOEC, at 202-347-4976 or Christine Rosheim, DDS, MPH, Project Officer, ATSDR, at 404-639-6351. For more information about ATSDR contact ATSDRs toll-free information line at (888) 42-ATSDR...thats (888) 422-8737 or website at www.atsdr.cdc.gov.

OVERVIEW
Division of Toxicology ToxFAQs

ToxFAQs
April 2003

The ToxFAQs sheets are a series of two page summaries about hazardous substances and their health effects. They provide answers to the most frequently asked questions (FAQs) about health effects possible from exposure.

What is a ToxFAQs sheet?


Each ToxFAQs sheet is a two page summary of information about the health effects possible from exposure to one of a variety of individual hazardous (chemical) substances.
The ToxFAQs are written in an easy to read terms in a question and answer format and address issues of important interest, such as how can it affect your health or can it cause cancer. The complete list of questions is shown at the right.

What is a ToxFAQs sheet?

1 1 1 1 1 1 1 1 1 1

What is [substance X] ? What happens to [substance X] when it enters the environment ? How may I be exposed to [substance X] ? How can [substance X] affect my health ? How likely is [substance X] to cause cancer ? How can [substance X] affect children ? How can families reduce their exposure to [substance X] ? Is there a medical test to show whether I have been exposed to [substance X] ? Has the federal government made recommnendations to protect human health ? Where can I get further information on [substance X] ?

The ToxFAQs are useful whenever a quick review or background is needed about Where can I get further information? that substance, such as during an emergency re- 1 You may call during normal business hours, 1-888-4228737 or 404-498-0160, or fax the Division of Toxicology sponse or at community meetings. If needed, a at 404-498-0093. slightly larger version, the Public Health State- 1 You may visit our web site < http://www.atsdr.cdc.gov>. ment, is also available for each substance from 1 You may write to ATSDR Division of Toxicology, 1600 ATSDR. Clifton Road Mailstop E-29 Atlanta, GA 30333.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

ToxFAQs Substance List


Division of Toxicology ToxFAQs April 2003

This is a complete hyperlinked list of the 182 ToxFAQs information sheets available on this CD-ROM.

You may click on any specific name below to go directly to that substance's ToxFAQs sheet.
Acetone Acrolein Acrylonitrile Aldrin/Dieldrin Aluminum Americium Ammonia Aniline Antimony Arsenic Arsenic Trioxide Arsine Asbestos Atrazine Barium Benzene Benzidine 2,3-Benzofuran Beryllium Bis(2-chloroethyl)ether Bis(chloromethyl)ether Blister Agents: Lewisite(L) Mustard-Lewisite Mixture(HL) Blister Agents: HN-1,HN-2,HN-3 (Nitrogen Mustards) Blister Agents: Sulfur Mustard Agents H/HD, HT Boron Bromodichloromethane Bromoform Bromomethane 1,3-Butadiene 2-Butanone 2-Butoxyethanol Cadmium Calcium Hypochlorite/ Sodium Hypochlorite Carbon Disulfide Carbon Tetrachloride Cesium Chlordane Chlorfenvinphos Chlorinated Dibenzo-p-Dioxins (CDDs) Chlorine Chlorine Dioxide Chlorobenzene Chlorodibenzofurans (CDFs) Chloroethane Chloroform Chloromethane Chlorophenols Chlorpyrifos Chromium Cobalt Copper Crankcase Oil, Used Creosote Cresols Crotonaldehyde Cyanide DDT, DDE, DDD Diazinon Diborane Dibromochloropropane 1,2-Dibromoethane 1,4-Dichlorobenzene 3,3'-Dichlorobenzidine 1,1-Dichloroethane 1,2-Dichloroethane 1,1-Dichloroethene 1,2-Dichloroethene 1,2-Dichloropropane 1,3-Dichloropropene Dichlorvos Di(2-ethylhexyl)phthalate (DEHP) Diethyl Phthalate Diisopropylmethylphosphonate (DIMP) Di-n-butylphthalate 1,3-Dinitrobenzene Dinitrocresols Dinitrophenols 2,4- and 2,6-Dinitrotoluene 1,2-Diphenylhydrazine Di-n-octylphthalate (DNOP) Disulfoton Endosulfan Endrin Ethion Ethylbenzene Ethylene Oxide Ethylene Glycol Fluorides, Hydrogen Fluoride, and Fluorine Formaldehyde Fuel Oils (Kerosene) Gasoline, Automotive Heptachlor and Heptachlor Epoxide Hexachlorobenzene Hexachlorobutadiene Continued on page 2 ...

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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Substance List
The ToxFAQs Internet address is http://www.atsdr.cdc.gov/toxfaq.html
Mirex and Chlordecone Mustard Gas N-Nitrosodimethylamine N-Nitrosodiphenylamine N-Nitrosodi-n-propylamine Naphthalene Nerve Agents (GA,GB,GD,VX) Nickel Nitrobenzene Nitrogen Oxides Nitrophenols Otto Fuel II Pentachlorophenol Phenol Phosgene Phosgene Oxime Phosphine Phosphorus, White Plutonium Polybrominated Biphenyls (PBBs) Polychlorinated Biphenyls (PCBs) Polycyclic Aromatic Hydrocarbons (PAHs) Propylene Glycol Pyrethrins/Pyrethroids Pyridine Radium Radon RDX (Cyclonite) Selenium Selenium Hexafluoride Silver Sodium Hydroxide Stoddard Solvent Strontium Styrene Sulfur Dioxide Sulfur Trioxide Sulfuric Acid Synthetic Vitreous Fibers 1,1,2,2-Tetrachloroethane Tetrachloroethylene (PERC) Tetryl Thallium Thorium Tin Titanium Tetrachloride Toluene Toluene Diisocyanate Total Petroleum Hydrocarbons (TPH) Toxaphene 1,1,1-Trichloroethane 1,1,2-Trichloroethane Trichloroethylene (TCE) 1,2,3-Trichloropropane 1,3,5-Trinitrobenzene 2,4,6-Trinitrotoluene (TNT) Uranium Vanadium Vinyl Acetate Vinyl Chloride Xylene Zinc

ToxFAQs

Hexachlorocyclohexane (HCH or Lindane) Hexachlorocyclopentadiene Hexachloroethane Hexamethylene Diisocyanate(HDI) Hexane 2-Hexanone HMX (Octogen) Hydraulic Fluids Hydrazines Hydrogen Chloride Hydrogen Peroxide Hydrogen Sulfide Iodine Ionizing Radiation Isophorone Jet Fuels JP-4 and JP-7 Jet Fuels JP-5 and JP-8 Kerosene (Fuel Oils) Lead Malathion Manganese Mercury Methoxychlor Methyl Isocyanate Methyl Mercaptan Methyl Parathion Methyl t-Butyl Ether (MTBE) 4,4'-Methylenebis(2-chloroaniline) (MBOCA) Methylene Chloride Methylenedianiline

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease

Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. The ToxFAQs Internet address is < http://www.atsdr.cdc.gov/toxfaq.html >. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

Federal Recycling Program

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ACETONE
CAS # 67-64-1
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about acetone. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to acetone results mostly from breathing air, drinking water, or coming in contact with products or soil that contain acetone. Exposure to moderateto-high amounts of acetone can irritate your eyes and respiratory system, and make you dizzy. Very high exposure may cause you to lose consciousness. This chemical has been found in at least 572 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is acetone? (Pronounced s-tn)
Acetone is a manufactured chemical that is also found naturally in the environment. It is a colorless liquid with a distinct smell and taste. It evaporates easily, is flammable, and dissolves in water. It is also called dimethyl ketone, 2-propanone, and beta-ketopropane. Acetone is used to make plastic, fibers, drugs, and other chemicals. It is also used to dissolve other substances. It occurs naturally in plants, trees, volcanic gases, forest fires, and as a product of the breakdown of body fat. It is present in vehicle exhaust, tobacco smoke, and landfill sites. Industrial processes contribute more acetone to the environment than natural processes.
G Acetone doesnt bind to soil or build up in animals. G Its broken down by microorganisms in soil and water. G It can move into groundwater from spills or landfills. G Acetone is broken down in water and soil, but the time required for this to happen varies.

How might I be exposed to acetone?


G Breathing low background levels in the environment. G Breathing higher levels of contaminated air in the workplace or from using products that contain acetone (for example, household chemicals, nail polish, and paint). G Drinking water or eating food containing acetone. G Touching products containing acetone. G For children, eating soil at landfills or hazardous waste sites that contain acetone.

What happens to acetone when it enters the environment?


G A large percentage (97%) of the acetone released during its manufacture or use goes into the air. G In air, about one-half of the total amount breaks down from sunlight or other chemicals every 22 days. G It moves from the atmosphere into the water and soil by rain and snow. It also moves quickly from soil and water back to air.

G Smoking or breathing secondhand smoke.

How can acetone affect my health?


If you are exposed to acetone, it goes into your blood which then carries it to all the organs in your body. If it is a small amount, the liver breaks it down to chemicals that are not harmful and uses these chemicals to make energy for normal body functions. Breathing moderate- to-high levels

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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of acetone for short periods of time, however, can cause nose, throat, lung, and eye irritation; headaches; light-headedness; confusion; increased pulse rate; effects on blood; nausea; vomiting; unconsciousness and possibly coma; and shortening of the menstrual cycle in women. Swallowing very high levels of acetone can result in unconsciousness and damage to the skin in your mouth. Skin contact can result in irritation and damage to your skin. The smell and respiratory irritation or burning eyes that occur from moderate levels are excellent warning signs that can help you avoid breathing damaging levels of acetone. Health effects from long-term exposures are known mostly from animal studies. Kidney, liver, and nerve damage, increased birth defects, and lowered ability to reproduce (males only) occurred in animals exposed long-term. It is not known if people would have these same effects. people have naturally in their bodies varies with each person. The tests can't tell you if you will experience any health effects from the exposure. The test must be performed within 2-3 days after exposure because acetone leaves your body within a few days. These tests are not routinely performed at your doctor's office, but your doctor can take blood or urine samples and send them to a testing laboratory.

Has the federal government made recommendations to protect human health?


The EPA requires that spills of 5,000 pounds or more of acetone be reported. The Occupational Safety and Health Administration (OSHA) has set a maximum concentration limit in workplace air of 1,000 parts of acetone per million parts of air (1,000 ppm) for an 8-hour workday over a 40-hour week to protect workers. The National Institute for Occupational Safety and Health (NIOSH) recommends an exposure limit of 250 ppm in workplace air for up to a 10-hour workday over a 40-hour workweek.

How likely is acetone to cause cancer?


The Department of Health and Human Services, the International Agency for Research on Cancer, and the Environmental Protection Agency (EPA) have not classified acetone for carcinogenicity. Acetone does not cause skin cancer in animals when applied to the skin. We don't know if breathing or swallowing acetone for long periods will cause cancer. Studies of workers exposed to it found no significant risk of death from cancer.

Glossary
Carcinogenicity: Ability to cause cancer. Evaporate: To change into a vapor or a gas. Ingesting: Taking food or drink into your body. Long-term: Lasting one year or longer.

Is there a medical test to show whether Ive been exposed to acetone?


Methods are available to measure the amount of acetone in your breath, blood, and urine. The test can tell you how much acetone you were exposed to, although the amount that

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1994. Toxicological profile for acetone. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

Federal Recycling Program

Printed on Recycled Paper

ACROLEIN
CAS # 107-02-8
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about acrolein. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to acrolein occurs mostly from breathing it in the air. Cigarette smoke and automobile exhaust contain acrolein. Acrolein causes burning of the nose and throat and can damage the lungs. This chemical has been found in at least 7 of the 1,177 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is acrolein? (Pronounced kr-ln)


Acrolein is a clear or yellow liquid with a disagreeable odor. It dissolves in water very easily and quickly changes to a vapor when heated. It also burns easily. Small amounts of acrolein can be formed and can enter the air when trees, tobacco, other plants, gasoline, and oil are burned. Acrolein is used as a pesticide to control algae, weeds, bacteria, and mollusks. It is also used to make other chemicals.

How might I be exposed to acrolein?


q Breathing contaminated air near hazardous waste sites that contain acrolein. q Smoking tobacco or breathing air containing tobacco smoke or automobile exhaust. q Working in, or living near, industries where it is manufactured or used to make other chemicals. q Drinking water containing small amounts of acrolein. q Eating foods, such as fried foods and roasted coffee, that may contain small amounts of acrolein.

What happens to acrolein when it enters the environment?


q Acrolein may be found in soil, water, or air. q It breaks down fairly rapidly in the air (about half will disappear within 1 day) by reacting with other chemicals and sunlight. q Acrolein evaporates rapidly from soil and water. q Once dissolved in water, acrolein can be broken down to other chemicals by reactions with water or bacteria. q Acrolein does not build up in the food chain.

How can acrolein affect my health?


There is very little information about how exposure to acrolein affects people's health. The information we have indicates that breathing large amounts damages the lungs and could cause death. Breathing lower amounts may cause eye watering and burning of the nose and throat and a decreased breathing rate. Animal studies show that breathing acrolein causes irritation to the nasal cavity, lowered breathing rate, and damage to

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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the lining of the lungs. We do not know if acrolein causes reproductive effects or birth defects in people or animals.

must be reported to the EPA. The Occupational Safety and Health Administration (OSHA) has set a limit of 0.1 ppm over an 8-hour workday, 40-hour workweek. The National Institute of Occupational Safety and Health (NIOSH) recommends that average workplace air should not exceed 0.1 ppm acrolein averaged over a 10-hour period or a 40-hour workweek. The federal recommendations have been updated as of July 1999.

How likely is acrolein to cause cancer?


There are no definitive studies on the carcinogenic effects of acrolein in people or animals. The International Agency for Research on Cancer (IARC) has determined that acrolein is not classifiable as to human carcinogenicity.

Is there a medical test to show whether Ive been exposed to acrolein?


Methods have been developed to detect acrolein or breakdown products of acrolein in biological or environmental samples; however, there are no specific medical tests available in a doctor's office to determine if you have been exposed to acrolein.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. National Priorities List: A list of the nations worst hazardous waste sites. Pesticide: A substance that kills pests. ppm: Parts per million.

Has the federal government made recommendations to protect human health?


The EPA recommends that levels in lakes and streams should be limited to 0.32 parts of acrolein per million parts of water (0.32 ppm) to prevent possible health effects from drinking water or eating fish contaminated with acrolein. Any release to the environment of more than 1 pound of acrolein

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1990. Toxicological profile for acrolein. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

Federal Recycling Program

Printed on Recycled Paper

ACRYLONITRILE
CAS # 107-13-1
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about acrylonitrile. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to acrylonitrile occurs mostly from breathing it in the air. Acrylonitrile primarily affects the nervous system and lungs. If it is spilled on the skin, the skin will turn red and blisters may form. This chemical has been found in at least 3 of the 1,177 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is acrylonitrile? (Pronounced -krl n-trl)
Acrylonitrile is a colorless, liquid, man-made chemical with a sharp, onion- or garlic-like odor. It can be dissolved in water and evaporates quickly. Acrylonitrile is used to make other chemicals such as plastics, synthetic rubber, and acrylic fibers. A mixture of acrylonitrile and carbon tetrachloride was used as a pesticide in the past; however, all pesticide uses have stopped. q It is broken down by bacteria in surface water. q When it is released to soil, some of it will be broken down by bacteria, but most of it will evaporate to the air or filter to groundwater. q Acrylonitrile does not build up in the food chain.

How might I be exposed to acrylonitrile?


q Unless you live near a factory where acrylonitrile is made or near a hazardous waste site that contains acrylonitrile, you are unlikely to be exposed to it. q Breathing contaminated air near hazardous waste sites that contain acrylonitrile. q Working in, or living near, industries where it is manufactured or used. q Swallowing food and water that contains small amounts of acrylonitrile.

What happens to acrylonitrile when it enters the environment?


q Acrylonitrile may be found in the soil, water, or air near industrial sites where it is made, or at hazardous waste sites where it has been disposed of. q Because acrylonitrile evaporates easily, most of it is released to the air from facilities where it is produced and used. q In air, acrylonitrile breaks down quickly (about half will disappear within 5 to 50 hours) by reacting with other chemicals and sunlight. q Acrylonitrile can enter groundwater by filtering through the soil, but it is not commonly found in groundwater.

How can acrylonitrile affect my health?


Breathing high concentrations of acrylonitrile will cause nose and throat irritation, tightness in the chest, difficulty breathing, nausea, dizziness, weakness, headache, impaired judgment, and convulsions. These symptoms usually disappear when exposure is stopped. If spilled on the skin, acrylonitrile will burn the skin and produce redness and blisters.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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ACRYLONITRILE CAS # 107-13-1

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Animal studies show effects from breathing acrylonitrile. These effects include irritation to the nasal cavity and lungs, changes in the breathing rate, fluid accumulation in the lungs, weakness, and paralysis. Decreased fertility and birth defects have been observed in some laboratory animals exposed to high concentrations of acrylonitrile in air or drinking water. There is evidence that children are much more sensitive to acrylonitrile than adults. In a few cases, children have died following exposure to acrylonitrile vapors that caused only minor nose and throat irritation in adults. from drinking water or eating fish contaminated with acrylonitrile. Any release to the environment greater than 100 pounds of acrylonitrile must be reported to the EPA. The Occupational Safety and Health Administration (OSHA) has set a limit of 2 ppm over an 8-hour workday, 40-hour workweek. The National Institute of Occupational Safety and Health (NIOSH) recommends that average workplace air should not exceed 1 part per million (1 ppm) acrylonitrile averaged over a 10-hour period. The federal recommendations have been updated as of July 1999.

How likely is acrylonitrile to cause cancer?


The Department of Health and Human Services (DHHS) has determined that acrylonitrile may reasonably be anticipated to cause cancer in people. Studies of people are inconclusive, while animal studies have shown cancers of the brain and mammary glands.

Glossary
CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. National Priorities List: A list of the nations worst hazardous waste sites. Pesticide: A substance that kills pests. ppb: Parts per billion. ppm: Parts per million.

Is there a medical test to show whether Ive been exposed to acrylonitrile?


There is a test that can detect acrylonitrile in blood. Other tests can be used to measure the breakdown products (metabolites) of acrylonitrile in urine. One of the metabolites (cyanide) could come from other chemicals you might have been exposed to, so it is not a definite indicator of acrylonitrile exposure. The results of these tests could also be affected by cigarette smoking. Special equipment is needed for these tests, and they are not routinely available in a doctors office.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1990. Toxicological profile for acrylonitrile. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Has the federal government made recommendations to protect human health?


The EPA recommends that levels in lakes and streams should be limited to 0.058 parts of acrylonitrile per billion parts of water (0.058 ppb) to prevent possible health effects

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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ALDRIN and DIELDRIN


CAS # 309-00-2 and 60-57-1
Division of Toxicology ToxFAQsTM September 2002

This fact sheet answers the most frequently asked health questions (FAQs) about aldrin and dieldrin. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to aldrin and dieldrin happens mostly from eating contaminated foods, such as root crops, fish, or seafood. Aldrin and dieldrin build up in the body after years of exposure and can affect the nervous system. Aldrin has been found in at least 207 of the 1,613 National Priorities List sites identified by the Environmental Protection Agency (EPA). Dieldrin has been found in at least 287 of the 1,613 sites.
What are aldrin and dieldrin?
Aldrin and dieldrin are insecticides with similar chemical structures. They are discussed together in this fact sheet because aldrin quickly breaks down to dieldrin in the body and in the environment. Pure aldrin and dieldrin are white powders with a mild chemical odor. The less pure commercial powders have a tan color. Neither substance occurs naturally in the environment. From the 1950s until 1970, aldrin and dieldrin were widely used pesticides for crops like corn and cotton. Because of concerns about damage to the environment and potentially to human health, EPA banned all uses of aldrin and dieldrin in 1974, except to control termites. In 1987, EPA banned all uses. Eating food like fish or shellfish from lakes or streams contaminated with either chemical, or contaminated root crops, dairy products, or meats. Air, surface water, or soil near waste sites may contain higher levels. Living in homes that were once treated with aldrin or dieldrin to control termites.

How can aldrin and dieldrin affect my health?


People who have intentionally or accidentally ingested large amounts of aldrin or dieldrin have suffered convulsions and some died. Health effects may also occur after a longer period of exposure to smaller amounts because these chemicals build up in the body. Some workers exposed to moderate levels in the air for a long time had headaches, dizziness, irritability, vomiting, and uncontrolled muscle movements. Workers removed from the source of exposure rapidly recovered from most of these effects. Animals exposed to high amounts of aldrin or dieldrin also had nervous system effects. In animals, oral exposure to lower levels for a long period also affected the liver and decreased their ability to fight infections. We do not know whether aldrin or dieldrin affect the ability of people to fight disease. Studies in animals have given conflicting results about whether aldrin and dieldrin affect reproduction in male animals and whether these chemicals may damage the sperm.

What happens to aldrin and dieldrin when they enter the environment?
Sunlight and bacteria change aldrin to dieldrin so that we mostly find dieldrin in the environment. They bind tightly to soil and slowly evaporate to the air. Dieldrin in soil and water breaks down very slowly. Plants take in and store aldrin and dieldrin from the soil. Aldrin rapidly changes to dieldrin in plants and animals. Dieldrin is stored in the fat and leaves the body very slowly.

How might I be exposed to aldrin or dieldrin?


Dieldrin is everywhere in the environment, but at very low levels.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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ALDRIN and DIELDRIN


CAS # 309-00-2 and 60-57-1
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

We do not know whether aldrin or dieldrin affect reproduction in humans.

Is there a medical test to show whether Ive been exposed to aldrin and dieldrin?
There are laboratory tests that can measure aldrin and dieldrin in your blood, urine, and body tissues. Because aldrin changes to dieldrin fairly quickly in the body, the test has to be done shortly after you are exposed to aldrin. Since dieldrin can stay in the body for months, measurements of dieldrin can be made much longer after exposure to either aldrin or dieldrin. The tests cannot tell you whether harmful health effects will occur. These tests are not routinely available at the doctors office because they require special equipment.

How likely are aldrin and dieldrin to cause cancer?


There is no conclusive evidence that aldrin or dieldrin cause cancer in humans. Aldrin and dieldrin have been shown to cause liver cancer in mice. The International Agency for Research on Cancer (IARC) has determined that aldrin and dieldrin are not classifiable as to human carcinogenicity. The EPA has determined that aldrin and dieldrin are probable human carcinogens.

How can aldrin and dieldrin affect children?


Children can be exposed to aldrin and dieldrin in the same way as adults. There are no known unique exposure pathways for children. Children who swallowed amounts of aldrin or dieldrin much larger than those found in the environment suffered convulsions and some died, as occurred in adults. However, we do not know whether children are more susceptible than adults to the effects of aldrin or dieldrin. We do not know whether aldrin or dieldrin cause birth defects in humans. Pregnant animals that ingested aldrin or dieldrin had some babies with low birth weight and some with alterations in the skeleton. Dieldrin has been found in human breast milk, therefore, it can be passed to suckling infants.

Has the federal government made recommendations to protect human health?


The EPA limits the amount of aldrin and dieldrin that may be present in drinking water to 0.001 and 0.002 milligrams per liter (mg/L) of water, respectively, for protection against health effects other than cancer. The EPA has determined that a concentration of aldrin and dieldrin of 0.0002 mg/L in drinking water limits the lifetime risk of developing cancer from exposure to each compound to 1 in 10,000. The Occupational Safety and Health Administration (OSHA) sets a maximum average of 0.25 milligrams of aldrin and dieldrin per cubic meter of air (0.25 mg/m3) in the workplace during an 8-hour shift, 40 hour week. The National Institute for Occupational Safety and Health (NIOSH) also recommends a limit of 0.25 mg/m3 for both compounds for up to a 10-hour work day, 40-hour week. The Food and Drug Administration (FDA) regulates the residues of aldrin and dieldrin in raw foods. The allowable range is from 0 to 0.1 ppm, depending on the type of food product.

How can families reduce the risk of exposure to aldrin and dieldrin?
Since aldrin and dieldrin are no longer produced or used, exposure to these compounds will occur only from past usage. Because aldrin and dieldrin were applied to the basement of some homes for termite protection, before buying a home families should investigate what, if any, pesticides have been used within the home.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2002. Toxicological Profile for Aldrin/Dieldrin (Update). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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ALUMINUM
CAS # 7429-90-5
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about aluminum. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Everyone is exposed to low levels of aluminum from food, air, and water. Exposure to high levels of aluminum may result in respiratory problems. Aluminum has been found in at least 427 of the 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is aluminum? (Pronounced -lm-nm)
Aluminum occurs naturally and makes up about 8% of the surface of the earth. It is always found combined with other elements such as oxygen, silicon, and fluorine. Aluminum metal is silver-white and flexible. It is often used in cooking utensils, containers, appliances, and building materials. It is also used in paints and fireworks; to produce glass, rubber, and ceramics; and in consumer products such as antacids, astringents, buffered aspirin, food additives, and antiperspirants. G Breathing higher levels of aluminum dust in workplace air. G Drinking water with high levels of aluminum near waste sites, manufacturing plants, or areas naturally high in aluminum. G Eating substances containing high levels of aluminum (such as antacids) especially when eating or drinking citrus products at the same time. G Very little enters your body from aluminum cooking utensils.

How can aluminum affect my health?


Low-level exposure to aluminum from food, air, water, or contact with skin is not thought to harm your health. Aluminum, however, is not a necessary substance for our bodies and too much may be harmful. People who are exposed to high levels of aluminum in air may have respiratory problems including coughing and asthma from breathing dust. Some studies show that people with Alzheimers disease have more aluminum than usual in their brains. We do not know whether aluminum causes the disease or whether the buildup of aluminum happens to people who already have the disease. Infants and adults who received large doses of aluminum as a treatment for another problem developed bone

What happens to aluminum when it enters the environment?


G It binds to particles in the air. G It can dissolve in lakes, streams, and rivers depending on the quality of the water. G Acid rain may dissolve aluminum from soil and rocks. G It can be taken up into some plants from soil. G It is not known to bioconcentrate up the food chain.

How might I be exposed to aluminum?


G Eating small amounts of aluminum in food.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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ALUMINUM CAS # 7429-90-5

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


diseases, which suggests that aluminum may cause skeletal problems. Some sensitive people develop skin rashes from using aluminum chlorohydrate deodorants. caps so children will not accidentally eat them. Some soybased formulas may contain high levels of aluminum, so parents may want to consult with their physician when choosing an infant formula.

How likely is aluminum to cause cancer?


The Department of Health and Human Services, the International Agency for Research on Cancer, and the EPA have not classified aluminum for carcinogenicity. Aluminum has not been shown to cause cancer in animals.

Is there a medical test to show whether Ive been exposed to aluminum?


There are tests to measure aluminum in blood, urine, and feces. The amount in your urine can tell you whether you have been exposed to higher than normal levels of aluminum. Tests can also detect aluminum in your hair and fingernails. Not all of these tests are routinely performed at your doctors office, but your doctor can take samples and send them to a testing laboratory.

How can aluminum affect children?


Children with kidney problems who were given aluminum in their medical treatments developed bone diseases. Other health effects of aluminum on children have not been studied. It is not known whether aluminum affects children differently than adults, or what the long-term effects might be in adults exposed as children. Large amounts of aluminum have been shown to be harmful to unborn and developing animals because it can cause delays in skeletal and neurological development. Aluminum has been shown to cause lower birthweights in some animals.

Has the federal government made recommendations to protect human health?


EPA requires that spills or accidental releases of 5,000 pounds or more of aluminum sulfate be reported. Special regulations are set for aluminum phosphide because it is a pesticide. EPA recommends that the concentration of aluminum in drinking water not exceed 0.2 parts of aluminum per million parts of water (0.2 ppm) because of aesthetic effects, such as taste and odor problems. The Food and Drug Administration (FDA) has determined that aluminum cooking utensils, aluminum foil, antiperspirants, antacids, and other aluminum products are generally safe.

How can families reduce the risk of exposure to aluminum?


The most important way families can lower exposure to aluminum is to know about the sources of aluminum and lessen exposure to these sources. Since aluminum is so common and widespread in the environment, families cannot avoid exposure to aluminum. Exposure to the low levels of aluminum that are naturally present in food and water and the forms of aluminum present in dirt and aluminum cookware is generally not harmful. The best way to reduce exposure to aluminum is to avoid taking large quantities of soluble forms of aluminum such as aluminum-containing antacids and buffered aspirin. Make sure these products have child-proof

Source of information
Agency for Toxic Substances and Disease Registry (ATSDR). 1999. Toxicological profile for aluminum. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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AMERICIUM
CAS #7440-35-9
Division of Toxicology ToxFAQsTM July 2001

This fact sheet answers the most frequently asked health questions (FAQs) about americium. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Very low levels of americium occur in air, water, soil, and food. Exposure to very large amounts of radioactive americium may result in increased cancer risk. Americium has been found in at least 8 of the 1,585 National Priorities List (NPL) sites identified by the Environmental Protection Agency (EPA).
What is americium?
Americium is a man-made radioactive chemical. Americium has no naturally occurring or stable isotopes. Two important isotopes of americium are americium 241 (241Am) (read as americium two-forty-one) and 243Am. Both isotopes have the same chemical behavior in the environment and the same chemical effects on your body.
241

241Am strongly sticks to soil particles and does not travel very far into the ground. Plants may take up small amounts of 241Am from the soil. Fish may take up 241Am, but little builds up in the fleshy tissue. In shellfish, 241Am is attached to the shell and not to the parts you normally eat.

How might I be exposed to americium?


Americium is used in ionization smoke detectors. There is no commercial use for 243Am. Nuclear explosions or degradation of plutonium generate Am. 243Am is produced inside nuclear reactors from 241Am or from the decay of plutonium 241. Both americium isotopes decay into radioactive elements. Both isotopes give off alpha particles as they decay. It takes about 432 years for half of 241Am to give off its radiation and about 7,370 years for 243Am; this period of time is called the halflife.
241

The general population may be exposed to very small amounts of 241Am in air, water, soil, and food. They may also be exposed to very low levels of radiation from smoke detectors. People working at sites where nuclear waste is stored or at nuclear power plants may be exposed to higher levels of americium. People producing or handling 241Am in smoke detectors or other devices may be exposed to higher levels of radiation. As a result of a nuclear accident, people may be exposed to higher than normal levels of radiation.

What happens to americium when it enters the environment?


241Am released to the air (from nuclear weapon tests) will be associated with particles and will settle to the soil and water in rain or snow. Small particles in air can travel far from the point of release. 241Am released into water will stick to particles in the water or the sediment at the bottom.

How can americium affect my health?


The radiation from exposure to americium is the primary cause of adverse health effects from americium. Inside your body, americium is concentrated in your bones, where it remains for a long time. The radiation given off by 241Am can change the genetic material of the bone cells and this could result in the formation of bone cancers. The chance of getting cancer is low at low doses, and increases as the dose increases.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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AMERICIUM
CAS #7440-35-9
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Laboratory animals exposed to very high levels of americium had damage to the lungs, liver, and thyroid. However, americium is accumulated in these organs for only a relatively short time. It is unlikely that you would be exposed to amounts of americium large enough to cause harmful effects in these organs.

In the unlikely case that you are exposed to high levels of radioactive americium because of accidental release at a manufacturing facility, at a nuclear plant, or because a nuclear weapon has been damaged or detonated, follow the advice of public health officials who will publish appropriate guidelines for reducing exposure.

How likely is americium to cause cancer?


No human studies specifically associate exposure to radioactive americium with an increased cancer risk. Because radioactive americium emits ionizing radiation, the same types of cancers as those observed in Japanese survivors of the atomic bombing incidents might be expected among individuals acutely exposed to high levels of radiation from a radioactive americium source. Studies in animals have demonstrated that internal exposure to 241Am results in the development of cancer in the tissues that store this element.

Is there a medical test to show whether Ive been exposed to americium?


If americium were to enter your body from americiumcontaminated air or food, radiation detectors could measure radiation from your blood, urine, feces, tissue samples, or teeth. Radiation detectors are not normally available in your doctors office, so the samples must be sent to a special laboratory. Special radiation detectors could also be used to measure the radiation that leaves your whole body from americium that is inside your body.

How can americium affect children?


Children can be affected by americium in the same ways as adults. However, exposure as children would let the americium build up in bone to higher levels. This could cause bone cancer after many years. While this may occur, there are no actual data showing that children are more sensitive than adults to americium.

Has the federal government made recommendations to protect human health?


The Nuclear Regulatory Commission (NRC) has set limits of 0.00000002 microcuries per cubic meter of air for 241Am released to the air and 0.00002 microcuries per liter of water for releases to water by licensed facilities (microcurie is a radiation unit).

How can families reduce the risk of exposure to americium?


Higher-than-normal levels of americium may be in soil near a nuclear waste site, nuclear reactor, or plant that manufactures ionization smoke detectors. Consequently, prevent your children from eating dirt and make sure they wash their hands frequently.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for Americium (Draft for PublicComment). Atlanta, GA: U.S. Department of Health and Human Services.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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AMMONIA
CAS # 7664-41-7
Division of Toxicology ToxFAQsTM September 2002

This fact sheet answers the most frequently asked health questions (FAQs) about ammonia. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Ammonia is a gas that occurs naturally in the environment and is also manmade. Liquid ammonia is found in many household cleaners. Ammonia is irritating to the skin, eyes, nose, throat, and lungs. Exposure to high concentrations can cause serious burns. Ammonia has been found in at least 134 of the 1,613 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is ammonia?
Ammonia is a colorless gas with a very sharp odor. It is made both by humans and by nature. It dissolves easily in water and evaporates quickly. It is commonly sold in liquid form. The amount of ammonia produced by humans every year is almost equal to that produced by nature. Ammonia is produced naturally in soil by bacteria, decaying plants and animals, and animal wastes. Ammonia is essential for many biological processes. Most of the ammonia produced in chemical factories is used to make fertilizers. The remaining is used in textiles, plastics, explosives, pulp and paper production, food and beverages, household cleaning products , refrigerants, and other products. It is also used in smelling salts. ! Plants and bacteria rapidly take up ammonia from soil and water. ! Some ammonia in water and soil is changed to nitrate and nitrite by bacteria. ! Ammonia released to air is rapidly removed by rain or snow or by reactions with other chemicals. ! Ammonia does not build up in the food chain, but serves as a nutrient source for plants and bacteria.

How might I be exposed to ammonia?


! Everybody is regularly exposed to low levels of ammonia in air, food, soil, and water. ! Ammonia has a strong irritating odor that people can easily smell before it may cause harm. ! If you use ammonia cleaning products at home, you will be exposed to ammonia released to the air and through contact with your skin. ! If you apply ammonia fertilizers or live near farms where these fertilizers have been applied, you can breathe ammonia released to the air. ! You may be exposed to ammonia from leaks and spills from production plants, storage facilities, pipelines, tank trucks, and rail cars.

What happens to ammonia when it enters the environment?


! Because ammonia occurs naturally, it is found throughout the environment in soil, air, and water. ! Most of the ammonia in water changes to ammonium, an odorless liquid. Ammonia and ammonium can change back and forth in water. ! Ammonia is recycled naturally in the environment as part of the nitrogen cycle. It does not last very long in the environment.

How can ammonia affect my health?


Exposure to high concentrations of ammonia in the air may cause severe burns to your skin, eyes, throat, and lungs. In

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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AMMONIA
CAS # 7664-41-7
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

extreme cases, blindness, lung damage, or death could occur. Breathing lower concentrations will cause coughing and nose and throat irritation. If you swallow ammonia, you could suffer burns in your mouth, throat, and stomach. Concentrated ammonia spilled on the skin will cause burns. Animal studies show effects similar to those observed in people. We do not know if ammonia affects reproduction in humans.

! Maintain adequate room ventilation when using cleaners containing ammonia and wear proper clothing and eye protection. ! Prevent children from entering a room where ammonia is being used. ! Never store cleaning solutions in containers that may be attractive to children, such as soda bottles. ! Avoid entering fields when ammonia fertilizer is being applied.

How likely is ammonia to cause cancer?


We do not know whether ammonia can cause cancer in humans or in laboratory animals. The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified ammonia for carcinogenicity.

Is there a medical test to show whether Ive been exposed to ammonia?


There are tests that can detect ammonia in blood and urine. However, these tests cannot definitely determine if you have been exposed because ammonia is normally found in the body. If you were exposed to harmful amounts of ammonia you would notice it immediately because of the strong, unpleasant smell and strong taste. Your skin, eyes, nose, and throat would also be irritated.

How can ammonia affect children?


Children are less likely to be exposed to concentrated ammonia because most exposures of that kind occur in occupational settings. Children can still be exposed the same way as adults to ammonia gas from spills or leaks from ammonia tanks or pipelines, especially on farms where it is used as a fertilizer. Children can also be exposed to dilute ammonia solutions from household cleaners containing ammonia. The effects of ammonia on children are likely to be the same as for adults. We do not know if exposure to ammonia causes birth defects, or if it can pass to the fetus across the placenta or to infants via breast milk.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) has set a limit of 25 parts of ammonia per million parts of air (25 ppm) in the workplace during an 8-hour shift and a shortterm limit (15 minutes) of 35 ppm.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2002. Toxicological Profile for Ammonia (Draft for Public Comment). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

How can families reduce the risk of exposure to ammonia?


! Keep products containing ammonia out of the reach of children.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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ANILINE
CAS #62-53-3
Division of Toxicology ToxFAQsTM April 2002

This fact sheet answers the most frequently asked health questions (FAQs) about aniline. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Aniline is a manufactured chemical used by a number of industries. Significant exposure may occur only if you work with aniline. The main effect of aniline by any route of exposure is a blood disorder in which oxygen delivery to the tissues is impaired. This may have mild to severe consequences depending on the duration and amount of exposure. Acute exposure to high amounts of aniline may lead to coma and death. Aniline has been found in at least 59 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is aniline?
Aniline is a clear to slightly yellow liquid with a characteristic odor. It does not readily evaporate at room temperature. Aniline is slightly soluble in water and mixes readily with most organic solvents. Aniline is used to make a wide variety of products such as polyurethane foam, agricultural chemicals, synthetic dyes, antioxidants, stabilizers for the rubber industry, herbicides, varnishes and explosives.

How might I be exposed to aniline?


The general population may be exposed to aniline by eating food or drinking water containing aniline, but these amounts are usually very small. If you work in a place that makes products like dyes, varnishes, herbicides, and explosives, you may be exposed to aniline. Aniline has also been detected in tobacco smoke, so people who smoke or breath in second-hand smoke may also be exposed to aniline. People living near uncontrolled hazardous waste sites may be exposed to higher than normal levels of aniline.

What happens to aniline when it enters the environment?


Aniline in air will be broken down rapidly by other chemicals and by sunlight. It will be broken down within a few days. Aniline in water can stick to sediment and particulate matter or evaporate to the air. Most of it will be broken down by bacteria and other microorganisms. Aniline will partially stick to the soil. Small amounts may evaporate into air or pass through the soil to groundwater. Most of the aniline in soil will be broken down by bacteria and other microorganisms. Aniline does not accumulate in the food chain.

How can aniline affect my health?


Aniline can be toxic if ingested, inhaled, or by skin contact. Aniline damages hemoglobin, a protein that normally transports oxygen in the blood. The damaged hemoglobin can not carry oxygen. This condition is known as methemoglobinemia and its severity depends on how much you are exposed to and for how long. Methemoglobinemia is the most prominent symptom of aniline poisoning in humans, resulting in cyanosis (a purplish blue skin color) following acute high exposure to aniline. Dizziness, headaches, irregular heart beat, convulsions, coma, and

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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CAS #62-53-3
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ANILINE

death may also occur. Direct contact with aniline can also produce skin and eye irritation. Long-term exposure to lower levels of aniline may cause symptoms similar to those experienced in acute high-level exposure. There is no reliable information on whether aniline has adverse reproductive effects in humans. Studies in animals have not demonstrated reproductive toxicity for aniline.

How can families reduce the risk of exposure to aniline?


Most families will not be exposed to significant levels of aniline. Children should avoid playing in soils near uncontrolled hazardous waste sites where aniline may have been discarded.

How likely is aniline to cause cancer?


The available studies in humans are inadequate to determine whether exposure to aniline can increase the risk of developing cancer in people. Rats that ate food contaminated with aniline for life developed cancer of the spleen. The International Agency for Research on Cancer (IARC) determined that aniline is not classifiable as to its carcinogenicity to humans. The EPA has determined that aniline is a probable human carcinogen.

Is there a medical test to show whether Ive been exposed to aniline?


Aniline can be measured in the urine. This test shows that you have been exposed to aniline but not to how much or how recently. A breakdown product of aniline in the body, p-aminophenol, also can be measured in the urine; however, this breakdown product is not specific for aniline exposure. Methemoglobin can be measured in the blood, but exposure to many other chemicals also increase methemoglobin levels in the blood. Methemoglobin levels in blood can be used to determine the appropriate treatment that exposed individuals should receive. These tests are not routinely done in a doctors office.

How can aniline affect children?


There are no studies on the health effects of children exposed to aniline. It is likely that the health effects seen in children exposed to aniline will be similar to the effects seen in adults. Newborn infants are more susceptible than adults to development of methemoglobinemia caused by exposure to aniline. We do not know if exposure to aniline will result in birth defects or other developmental effects in people. The studies on developmental effects in animals are not conclusive.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) sets a limit of 5 parts of aniline per million parts of air (5 ppm) in workplace air in any 8-hour shift, 40-hour workweek.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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ANTIMONY
CAS # 7440-36-0
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about antimony. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to antimony occurs in the workplace or from skin contact with soil at hazardous waste sites. Breathing high levels of antimony for a long time can irritate the eyes and lungs, and can cause problems with the lungs, heart, and stomach. This chemical has been found in at least 403 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is antimony? (Pronounced nt-mn)
Antimony is a silvery-white metal that is found in the earths crust. Antimony ores are mined and then mixed with other metals to form antimony alloys or combined with oxygen to form antimony oxide. Little antimony is currently mined in the United States. It is brought into this country from other countries for processing. However, there are companies in the United States that produce antimony as a by-product of smelting lead and other metals. Antimony isn't used alone because it breaks easily, but when mixed into alloys, it is used in lead storage batteries, solder, sheet and pipe metal, bearings, castings, and pewter. Antimony oxide is added to textiles and plastics to prevent them from catching fire. It is also used in paints, ceramics, and fireworks, and as enamels for plastics, metal, and glass.
G Most antimony ends up in soil, where it attaches strongly to particles that contain iron, manganese, or aluminum. G Antimony is found at low levels in some rivers, lakes, and streams.

How might I be exposed to antimony?


G Because antimony is found naturally in the environment, the general population is exposed to low levels of it every day, primarily in food, drinking water, and air. G It may be found in air near industries that process or release it, such as smelters, coal-fired plants, and refuse incinerators. G In polluted areas containing high levels of antimony, it may be found in the air, water, and soil. G Workers in industries that process it or use antimony ore may be exposed to higher levels.

How can antimony affect my health?


Exposure to antimony at high levels can result in a variety of adverse health effects. Breathing high levels for a long time can irritate your eyes and lungs and can cause heart and lung problems, stomach pain, diarrhea, vomiting, and stomach ulcers. In short-term studies, animals that breathed very high levels of antimony died. Animals that breathed high levels

What happens to antimony when it enters the environment?


G Antimony is released to the environment from natural sources and from industry. G In the air, antimony is attached to very small particles that may stay in the air for many days.

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had lung, heart, liver, and kidney damage. In long-term studies, animals that breathed very low levels of antimony had eye irritation, hair loss, lung damage, and heart problems. Problems with fertility were also noted. In animal studies, problems with fertility have been seen when rats breathed very high levels of antimony for a few months. Ingesting large doses of antimony can cause vomiting. We don't know what other effects may be caused by ingesting it. Long-term animal studies have reported liver damage and blood changes when animals ingested antimony. Antimony can irritate the skin if it is left on it. Antimony can have beneficial effects when used for medical reasons. It has been used as a medicine to treat people infected with parasites. tests are not usually performed in most doctors' offices and may require special equipment to conduct them.

Has the federal government made recommendations to protect human health?


The EPA allows 0.006 parts of antimony per million parts of drinking water (0.006 ppm). The EPA requires that discharges or spills into the environment of 5,000 pounds or more of antimony be reported. The Occupational Safety and Health Administration (OSHA) has set an occupational exposure limit of 0.5 milligrams of antimony per cubic meter of air (0.5 mg/m3) for an 8-hour workday, 40-hour workweek. The American Conference of Governmental Industrial Hygienists (ACGIH) and the National Institute for Occupational Safety and Health (NIOSH) currently recommend the same guidelines for the workplace as OSHA.

How likely is antimony to cause cancer?


The Department of Health and Human Services, the International Agency for Research on Cancer, and the Environmental Protection Agency (EPA) have not classified antimony as to its human carcinogenicity. Lung cancer has been observed in some studies of rats that breathed high levels of antimony. No human studies are available. We don't know whether antimony will cause cancer in people.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Ingestion: Taking food or drink into your body. Long-term: Lasting one year or more. Milligram (mg): One thousandth of a gram. Parasite: An organism living in or on another organism. ppm: Parts per million. Short-term: Lasting 14 days or less.

Is there a medical test to show whether Ive been exposed to antimony?


Tests are available to measure antimony levels in the body. Antimony can be measured in the urine, feces, and blood for several days after exposure. However, these tests cannot tell you how much antimony you have been exposed to or whether you will experience any health effects. Some

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for antimony. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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ARSENIC
CAS # 7440-38-2
Division of Toxicology ToxFAQsTM July 2001

This fact sheet answers the most frequently asked health questions (FAQs) about arsenic. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to higher than average levels of arsenic occurs mostly in the workplace, near hazardous waste sites, or in areas with high natural levels. At high levels, inorganic arsenic can cause death. Exposure to lower levels for a long time can cause a discoloration of the skin and the appearance of small corns or warts. Arsenic has been found at 1,014 of the 1,598 National Priority List sites identified by the Environmental Protection Agency (EPA).
What is arsenic?
Arsenic is a naturally occurring element widely distributed in the earths crust. In the environment, arsenic is combined with oxygen, chlorine, and sulfur to form inorganic arsenic compounds. Arsenic in animals and plants combines with carbon and hydrogen to form organic arsenic compounds. Inorganic arsenic compounds are mainly used to preserve wood. Organic arsenic compounds are used as pesticides, primarily on cotton plants.

How might I be exposed to arsenic?


[ Eating food, drinking water, or breathing air containing arsenic. [ Breathing contaminated workplace air. [ Breathing sawdust or burning smoke from wood treated with arsenic. [ Living near uncontrolled hazardous waste sites containing arsenic. [ Living in areas with unusually high natural levels of arsenic in rock.

What happens to arsenic when it enters the environment?


[ Arsenic cannot be destroyed in the environment. It can only change its form. [ Arsenic in air will settle to the ground or is washed out of the air by rain. [ Many arsenic compounds can dissolve in water. [ Fish and shellfish can accumulate arsenic, but the arsenic in fish is mostly in a form that is not harmful.

How can arsenic affect my health?


Breathing high levels of inorganic arsenic can give you a sore throat or irritated lungs. Ingesting high levels of inorganic arsenic can result in death. Lower levels of arsenic can cause nausea and vomiting, decreased production of red and white blood cells, abnormal heart rhythm, damage to blood vessels, and a sensation of pins and needles in hands and feet. Ingesting or breathing low levels of inorganic arsenic for a long time can cause a darkening of the skin and the

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ARSENIC CAS # 7440-38-2


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appearance of small corns or warts on the palms, soles, and torso. Skin contact with inorganic arsenic may cause redness and swelling. Organic arsenic compounds are less toxic than inorganic arsenic compounds. Exposure to high levels of some organic arsenic compounds may cause similar effects as inorganic arsenic.

Is there a medical test to show whether Ive been exposed to arsenic?


There are tests to measure the level of arsenic in blood, urine, hair, or fingernails. The urine test is the most reliable test for arsenic exposure within the last few days. Tests on hair and fingernails can measure exposure to high levels or arsenic over the past 6-12 months. These tests can determine if you have been exposed to above-average levels of arsenic. They cannot predict how the arsenic levels in your body will affect your health.

How likely is arsenic to cause cancer?


Several studies have shown that inorganic arsenic can increase the risk of lung cancer, skin cancer, bladder cancer, liver cancer, kidney cancer, and prostate cancer. The World Health Organization (WHO), the Department of Health and Human Services (DHHS), and the EPA have determined that inorganic arsenic is a human carcinogen.

Has the federal government made recommendations to protect human health?


EPA has set limits on the amount of arsenic that industrial sources can release to the environment and has restricted or canceled many uses of arsenic in pesticides. EPA has set a limit of 0.05 parts per million (ppm) for arsenic in drinking water. The EPA arsenic drinking water standard of 0.01 ppm (10 ppb) reported in the ATSDR February 2001 Arsenic ToxFAQs was based on the EPA final rule for arsenic in drinking water, published on January 22, 2001, in the Federal Register. However, the EPA is currently reviewing the science and cost estimate supporting this rule, and, in the interim, has reverted to the previous standard for arsenic. Thus, the current EPA arsenic drinking water standard remains at 0.05 ppm (50 ppb). The Occupational Safety and Health Administration has set limits of 10 g arsenic per cubic meter of workplace air (10 g/m3) for 8 hour shifts and 40 hour work weeks.

How can arsenic affect children?


We do not know if exposure to arsenic will result in birth defects or other developmental effects in people. Birth defects have been observed in animals exposed to inorganic arsenic. It is likely that health effects seen in children exposed to high amounts of arsenic will be similar to the effects seen in adults.

How can families reduce the risk of exposure to arsenic?


[ If you use arsenic-treated wood in home projects, you should wear dust masks, gloves, and protective clothing to decrease exposure to sawdust. [ If you live in an area with high levels of arsenic in water or soil, you should use cleaner sources of water and limit contact with soil.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2000. Toxicological Profile for Arsenic. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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ASBESTOS
CAS # 1332-21-4
Division of Toxicology ToxFAQsTM September 2001

This fact sheet answers the most frequently asked health questions (FAQs) about asbestos. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, individual susceptibility and personal habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to asbestos usually occurs by breathing contaminated air in workplaces that make or use asbestos. Asbestos is also found in the air of buildings that are being torn down or renovated. Asbestos exposure can cause serious lung problems and cancer. This substance has been found at 83 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is asbestos?
Asbestos is the name given to a group of six different fibrous minerals (amosite, chrysotile, crocidolite, and the fibrous varieties of tremolite, actinolite, and anthophyllite) that occur naturally in the environment. Asbestos minerals have separable long fibers that are strong and flexible enough to be spun and woven and are heat resistant. Because of these characteristics, asbestos has been used for a wide range of manufactured goods, mostly in building materials (roofing shingles, ceiling and floor tiles, paper products, and asbestos cement products), friction products (automobile clutch, brake, and transmission parts), heat-resistant fabrics, packaging, gaskets, and coatings. Some vermiculite or talc products products may contain asbestos.

How might I be exposed to asbestos?


We are all exposed to low levels of asbestos in the air we breathe. These levels range from 0.00001 to 0.0001 fibers per milliliter of air and generally are highest in cities and industrial areas. People working in industries that make or use asbestos products or who are involved in asbestos mining may be exposed to high levels of asbestos. People living near these industries may also be exposed to high levels of asbestos in air. Asbestos fibers may be released into the air by the disturbance of asbestos-containing material during product use, demolition work, building or home maintenance, repair, and remodeling. In general, exposure may occur only when the asbestos-containing material is disturbed in some way to release particles and fibers into the air. Drinking water may contain asbestos from natural sources or from asbestos-containing cement pipes.

What happens to asbestos when it enters the environment?


Asbestos fibers can enter the air or water from the breakdown of natural deposits and manufactured asbestos products. Asbestos fibers do not evaporate into air or dissolve in water. Small diameter fibers and particles may remain suspended in the air for a long time and be carried long distances by wind or water before settling down. Larger diameter fibers and particles tend to settle more quickly. Asbestos fibers are not able to move through soil. Asbestos fibers are generally not broken down to other compounds and will remain virtually unchanged over long periods.

How can asbestos affect my health?


Asbestos mainly affects the lungs and the membrane that surrounds the lungs. Breathing high levels of asbestos fibers for a long time may result in scar-like tissue in the lungs and in the pleural membrane (lining) that surrounds the lung. This disease is called asbestosis and is usually found in workers exposed to asbestos, but not in the general public. People with asbestosis have difficulty breathing, often a cough, and in severe cases heart enlargement. Asbestosis is a serious disease and can eventually lead to disability and death.

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Breathing lower levels of asbestos may result in changes called plaques in the pleural membranes. Pleural plaques can occur in workers and sometimes in people living in areas with high environmental levels of asbestos. Effects on breathing from pleural plaques alone are not usually serious, but higher exposure can lead to a thickening of the pleural membrane that may restrict breathing.

suspect that you may be exposed to asbestos in your home, contact your state or local health department or the regional offices of EPA to find out how to test your home and how to locate a company that is trained to remove or contain the fibers.

How likely is asbestos to cause cancer?


The Department of Health and Human Services (DHHS), the World Health Organization (WHO), and the EPA have determined that asbestos is a human carcinogen. It is known that breathing asbestos can increase the risk of cancer in people. There are two types of cancer caused by exposure to asbestos: lung cancer and mesothelioma. Mesothelioma is a cancer of the thin lining surrounding the lung (pleural membrane) or abdominal cavity (the peritoneum). Cancer from asbestos does not develop immediately, but shows up after a number of years. Studies of workers also suggest that breathing asbestos can increase chances of getting cancer in other parts of the body (stomach, intestines, esophagus, pancreas, and kidneys), but this is less certain. Early identification and treatment of any cancer can increase an individuals quality of life and survival. Cigarette smoke and asbestos together significantly increase your chances of getting lung cancer. Therefore, if you have been exposed to asbestos you should stop smoking. This may be the most important action that you can take to improve your health and decrease your risk of cancer.

Is there a medical test to show whether Ive been exposed to asbestos?


Low levels of asbestos fibers can be measured in urine, feces, mucus, or lung washings of the general public. Higher than average levels of asbestos fibers in tissue can confirm exposure but not determine whether you will experience any health effects. A thorough history, physical exam, and diagnostic tests are needed to evaluate asbestos-related disease. Chest x-rays are the best screening tool to identify lung changes resulting from asbestos exposure. Lung function tests and CAT scans also assist in the diagnosis of asbestos-related disease.

Has the federal government made recommendations to protect human health?


In 1989, EPA banned all new uses of asbestos; uses established before this date are still allowed. EPA established regulations that require school systems to inspect for damaged asbestos and to eliminate or reduce the exposure by removing the asbestos or by covering it up. EPA regulates the release of asbestos from factories and during building demolition or renovation to prevent asbestos from getting into the environment. EPA has proposed a concentration limit of 7 million fibers per liter of drinking water for long fibers (lengths greater than or equal to 5 m). The Occupational Safety and Health Administration has set limits of 100,000 fibers with lengths greater than or equal to 5 m per cubic meter of workplace air for 8-hour shifts and 40hour work weeks.

How can asbestos affect children?


We do not know if exposure to asbestos will result in birth defects or other developmental effects in people. Birth defects have not been observed in animals exposed to asbestos. It is likely that health effects seen in children exposed to high levels of asbestos will be similar to the effects seen in adults.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for Asbestos. Update. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

How can families reduce the risk of exposure to asbestos?


Materials containing asbestos that are not disturbed or deteriorated do not, in general, pose a health risk and can be left alone. If you

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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ATRAZINE
CAS #1912-24-9
Division of Toxicology ToxFAQsTM September 2001

This fact sheet answers the most frequently asked health questions (FAQs) about atrazine. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: The general population is probably not exposed to atrazine. However, exposure to atrazine may occur at farms where it has been sprayed. Atrazine may affect pregnant women by causing their babies to grow more slowly than normal. Birth defects and liver, kidney, and heart damage has been seen in animals exposed to high levels of atrazine. This chemical has been found in at least 20 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is atrazine?
Atrazine is an herbicide that does not occur naturally. Pure atrazine is an odorless, white powder that is not very volatile, reactive, or flammable and that will dissolve in water. Atrazine is used to kill weeds, primarily on farms, but has also been used on highway and railroad rights-of-way. The EPA now restricts how atrazine can be used and applied; only trained people are allowed to spray it.

How might I be exposed to atrazine?


Most people are not exposed to atrazine on a regular basis. Farm workers, chemical sprayers, and people who work in factories that make atrazine may be exposed. People may also be exposed to atrazine by digging in dirt that has atrazine in it. Individuals may also be exposed by drinking water from wells that are contaminated with the herbicide.

What happens to atrazine when it enters the environment?


Atrazine enters the environment primarily through spraying on farm crops. In soil, atrazine is taken up by the plants growing in the soil or is broken down over a period of days to months. It may also wash from soil into streams or groundwater where it will stay for a long time, because breakdown of the chemical is slow in water. If atrazine enters the air, it may be broken down by reactions with chemicals in the air, or it may adhere to particles such as dust which eventually settle out of the air. Atrazine does not accumulate in living organisms such as algae, bacteria, clams, or fish.

How can atrazine affect my health?


Liver, kidney, and heart damage has been observed in animals exposed to atrazine; we do not know if this would also occur in humans. Atrazine has also been shown to cause changes in blood hormone levels in animals that affected ovulation and the ability to reproduce. These effects are not expected to occur in humans because of specific biological differences between humans and these types of animals.

How likely is atrazine to cause cancer?


Available information is inadequate to definitely state whether atrazine causes cancer in humans. There are limited

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ATRAZINE
CAS #1912-24-9
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human and animal data that suggest that there may be a link between atrazine exposure and various types of cancer. A Cancer Assessment Review Committee (CARC) sponsored by EPA has classified atrazine as not likely to be carcinogenic to humans. The International Agency for Research on Cancer (IARC) has determined that atrazine is not classifiable as to its carcinogenicity to humans.

individuals should avoid swimming in or drinking from contaminated water sources and may desire to have personal well water tested for the presence of atrazine. Children should avoid playing in soils near uncontrolled hazardous waste sites where atrazine may have been discarded.

How can atrazine affect children?


Little information is available regarding the effects of atrazine in children. It is likely that the health effects seen in children should be similar to the effects seen in adults. We do not know whether children differ from adults in their susceptibility to atrazine. A few studies are available that suggest that atrazine could affect pregnant women by causing their babies to grow more slowly than normal or by causing them to give birth early. However, the women in these studies were also exposed to other chemicals that may have caused or contributed to these effects. In pregnant animals, exposure to atrazine causes a decrease in fetal growth and birth defects. Exposure to high levels of atrazine during pregnancy caused reduced survival of fetuses. It is unclear whether or at what level of exposure this might occur in humans.

Is there a medical test to show whether Ive been exposed to atrazine?


Atrazine can be detected in your blood and some other body tissues within 24 to 48 hours after your last exposure. These tests are not usually available at your doctors office, but your doctor can send the samples to a laboratory that can perform the tests. None of these tests, however, can predict whether you will experience any health effects.

Has the federal government made recommendations to protect human health?


The EPA allows 0.2 milligrams of atrazine per liter of drinking water (0.2 mg/L) for lifetime exposure of adults. The Occupational Safety and Health Administration (OSHA) has set a limit of 5 milligrams of atrazine per cubic meter of workplace air (5 mg/m3) for an 8-hour workday and 40-hour work week. The EPA has determined maximum levels allowed in foods of 0.02-15 parts atrazine per million parts of food (0.02-15 ppm).

How can families reduce the risk of exposure to atrazine?


The general population is not likely to be exposed to large amounts of atrazine. Populations living in the areas where atrazine is used on crops, however, may be exposed to greater amounts of atrazine. Therefore, staying away from fields that have been recently sprayed may reduce exposure. Atrazine may be washed from fields where it is sprayed into streams and rivers or may migrate into wells used for drinking and bathing. In areas of high atrazine use,

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for Atrazine (Draft for Public Comment) Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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BARIUM
CAS # 7440-39-3
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about barium. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to barium occurs mostly in the workplace or from drinking contaminated water. Ingesting high levels of barium can cause problems with the heart, stomach, liver, kidneys, and other organs. This chemical has been found in at least 649 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is barium? (Pronounced br-m)
Barium is a silvery-white metal found in nature. It occurs combined with other chemicals such as sulfur or carbon and oxygen. These combinations are called compounds. Barium compounds can also be produced by industry. Barium compounds are used by the oil and gas industries to make drilling muds. Drilling muds make it easier to drill through rock by keeping the drill bit lubricated. They are also used to make paint, bricks, tiles, glass, and rubber. A barium compound (barium sulfate) is sometimes used by doctors to perform medical tests and to take x-rays of the stomach.

How might I be exposed to barium?


G Breathing very low levels in air, drinking water, and eating food. G Breathing higher levels in air while working in industries that make or use barium compounds. G Drinking water containing high levels of barium from natural sources. G Breathing air near barium mining or processing plants.

How can barium affect my health?


The health effects of the different barium compounds depend on how well the compound dissolves in water. Barium compounds that do not dissolve well in water are not generally harmful and are often used by doctors for medical purposes. Those barium compounds that dissolve well in water may cause harmful health effects in people. Ingesting high levels of barium compounds that dissolve well in water over the short term has resulted in G Difficulties in breathing G Increased blood pressure G Changes in heart rhythm G Stomach irritation.

What happens to barium when it enters the environment?


G Barium gets into the air during the mining, refining, and production of barium compounds, and from the burning of coal and oil. G Some barium compounds dissolve easily in water and are found in lakes, rivers, and streams. G Barium is found in most soils and foods at low levels. G Fish and aquatic organisms accumulate barium.

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BARIUM CAS # 7440-39-3

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G Brain swelling G Muscle weakness G Damage to the liver, kidney, heart, and spleen. We dont know the effects in people of ingesting low levels of barium over the long term. Animal studies have found increased blood pressure and changes in the heart from ingesting barium over a long time. We dont know the effects of barium from breathing it or from touching it. environment of 10 pounds or more of barium cyanide be reported. The Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH), and the American Conference of Governmental Industrial Hygienists (ACGIH) have set an occupational exposure limit of 0.5 milligrams of soluble barium compounds per cubic meter of air (0.5 mg/m3) for an 8-hour workday, 40-hour workweek. The OSHA exposure limit for barium sulfate dust in air is 5 to 15 milligrams of barium per cubic meter of air (5 15 mg/m3). NIOSH currently recommends that a level of 50 mg/m3 be considered immediately dangerous to life and health. This is the exposure level of barium that is likely to cause permanent health problems or death.

How likely is barium to cause cancer?


The Department of Health and Human Services, the International Agency for Research on Cancer, and the Environmental Protection Agency (EPA) have not classified barium as to its human carcinogenicity. Barium has not been classified because there are no studies in people and the two available animal studies were inadequate to determine whether or not barium causes cancer.

Glossary Is there a medical test to show whether Ive been exposed to barium?
There is no routine medical test to show whether you have been exposed to barium. However, doctors can measure barium in the blood, bones, urine, and feces, using very complex instruments. Due to the complexity of the tests, these tests are usually done only for cases of severe barium poisoning and for medical research. Carcinogenicity: Ability to cause cancer. Ingesting: Taking food or drink into your body. Long-term: Lasting one year or longer. Milligram (mg): One thousandth of a gram. ppm: Parts per million. Short-term: Lasting 14 days or less. Soluble: Dissolves well in liquid.

References Has the federal government made recommendations to protect human health?
EPA allows 2 parts of barium per million parts of drinking water (2 ppm). EPA requires that discharges or spills into the Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for barium. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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BENZENE
CAS # 71-43-2
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about benzene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Benzene is a widely used chemical formed from both natural processes and human activities. Breathing benzene can cause drowsiness, dizziness, and unconsciousness; long-term benzene exposure causes effects on the bone marrow and can cause anemia and leukemia. Benzene has been found in at least 813 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is benzene? (Pronounced b nzn)
Benzene is a colorless liquid with a sweet odor. It evaporates into the air very quickly and dissolves slightly in water. It is highly flammable and is formed from both natural processes and human activities. Benzene is widely used in the United States; it ranks in the top 20 chemicals for production volume. Some industries use benzene to make other chemicals which are used to make plastics, resins, and nylon and synthetic fibers. Benzene is also used to make some types of rubbers, lubricants, dyes, detergents, drugs, and pesticides. Natural sources of benzene include volcanoes and forest fires. Benzene is also a natural part of crude oil, gasoline, and cigarette smoke. G It breaks down more slowly in water and soil, and can pass through the soil into underground water. G Benzene does not build up in plants or animals.

How might I be exposed to benzene?


G Outdoor air contains low levels of benzene from tobacco smoke, automobile service stations, exhaust from motor vehicles, and industrial emissions. G Indoor air generally contains higher levels of benzene from products that contain it such as glues, paints, furniture wax, and detergents. G Air around hazardous waste sites or gas stations will contain higher levels of benzene. G Leakage from underground storage tanks or from hazardous waste sites containing benzene can result in benzene contamination of well water. G People working in industries that make or use benzene may be exposed to the highest levels of it. G A major source of benzene exposures is tobacco smoke.

What happens to benzene when it enters the environment?


G Industrial processes are the main source of benzene in the environment. G Benzene can pass into the air from water and soil. G It reacts with other chemicals in the air and breaks down within a few days. G Benzene in the air can attach to rain or snow and be carried back down to the ground.

How can benzene affect my health?


Breathing very high levels of benzene can result in death, while high levels can cause drowsiness, dizziness, rapid heart rate, headaches, tremors, confusion, and unconsciousness. Eating or drinking foods containing high levels of benzene can cause vomiting, irritation of the stomach, dizziness, sleepiness, convulsions, rapid heart rate, and death.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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BENZENE CAS # 71-43-2


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The major effect of benzene from long-term (365 days or longer) exposure is on the blood. Benzene causes harmful effects on the bone marrow and can cause a decrease in red blood cells leading to anemia. It can also cause excessive bleeding and can affect the immune system, increasing the chance for infection. Some women who breathed high levels of benzene for many months had irregular menstrual periods and a decrease in the size of their ovaries. It is not known whether benzene exposure affects the developing fetus in pregnant women or fertility in men. Animal studies have shown low birth weights, delayed bone formation, and bone marrow damage when pregnant animals breathed benzene.

Has the federal government made recommendations to protect human health?


The EPA has set the maximum permissible level of benzene in drinking water at 0.005 milligrams per liter (0.005 mgL). The EPA requires that spills or accidental releases into the environment of 10 pounds or more of benzene be reported to the EPA. The Occupational Safety and Health Administration (OSHA) has set a permissible exposure limit of 1 part of benzene per million parts of air (1 ppm) in the workplace during an 8-hour workday, 40-hour workweek.

Glossary
Anemia: A decreased ability of the blood to transport oxygen. Carcinogen: A substance with the ability to cause cancer. CAS: Chemical Abstracts Service. Chromosomes: Parts of the cells responsible for the development of hereditary characteristics. Metabolites: Breakdown products of chemicals. Milligram (mg): One thousandth of a gram. Pesticide: A substance that kills pests.

How likely is benzene to cause cancer?


The Department of Health and Human Services (DHHS) has determined that benzene is a known human carcinogen. Long-term exposure to high levels of benzene in the air can cause leukemia, cancer of the blood-forming organs.

Is there a medical test to show whether Ive been exposed to benzene?


Several tests can show if you have been exposed to benzene. There is test for measuring benzene in the breath; this test must be done shortly after exposure. Benzene can also be measured in the blood, however, since benzene disappears rapidly from the blood, measurements are accurate only for recent exposures. In the body, benzene is converted to products called metabolites. Certain metabolites can be measured in the urine. However, this test must be done shortly after exposure and is not a reliable indicator of how much benzene you have been exposed to, since the metabolites may be present in urine from other sources.

Source of Information
This ToxFAQs information is taken from the 1997 Toxicological Profile for Benzene (update) produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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BENZIDINE
CAS #92-87-5
Division of Toxicology ToxFAQsTM September 2001

This fact sheet answers the most frequently asked health questions (FAQs) about benzidine. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Benzidine is a manufactured chemical that was used to produce dyes. Most people are not exposed to benzidine in the environment. Occupational exposure has been associated with increased risk of urinary bladder cancer. This substance has been found in at least 28 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is benzidine?
Benzidine is a manufactured chemical that does not occur naturally. It is a crystalline solid that may be grayish-yellow, white, or reddish-gray. In the environment, benzidine is found in either its free state (as an organic base), or as a salt. Benzidine was used to produce dyes for cloth, paper, and leather. It is no longer produced or used commerically in the U.S.

How might I be exposed to benzidine?


The general population is not likely to be exposed to benzidine through contaminated air, water, soil, or food. People living near uncontrolled hazardous waste sites may be exposed to benzidine.

How can benzidine affect my health?


Except for the cancer discussed next, benzidine has not been definitely shown to cause major adverse health effects in humans. If it comes in contact with your skin it may cause a skin allergy. Liver, kidney, immune, and neurological effects have been observed in laboratory animals given relatively high amounts of benzidine. We do not know if these effects would also occur in humans.

What happens to benzidine when it enters the environment?


Benzidine in the air exists as a vapor or attached to very small particles. The benzidine in air will eventually settle over land and water. Only very small amounts of free benzidine will dissolve in water; benzidine salts can dissolve more readily in water. Benzidine released into waterways will sink and become part of the bottom sludge. Benzidine in soil is likely to be strongly attached to soil particles and will not easily pass into underground water. Benzidine is not likely to accumulate in the food chain.

How likely is benzidine to cause cancer?


It is known that long term occupational exposure to benzidine can increase the risk of developing cancer in people. The main type of cancer found in workers is cancer of the urinary bladder.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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BENZIDINE
CAS #92-87-5
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

The Department of Health and Human Services (DHHS), the World Health Organization (WHO), and the EPA have determined that benzidine is a human carcinogen. In addition dyes made from benzidine, such as Direct Blue 6, Direct Black 38, and Direct Brown 95, have been shown to cause cancer in humans. The DHHS has determined that Direct Blue 6 and Direct Black 38 cause cancer in animals and WHO determined that Direct Blue 6, Direct Black 38, and Direct Brown 95 cause cancer in animals.

Is there a medical test to show whether Ive been exposed to benzidine?


Benzidine and its breakdown products can be detected in your urine, but only within about 2 weeks after your last exposure. Benzidine and its breakdown products can also bind to proteins within your red blood cells, and this can be detected for up to 4 months. These tests are not usually available at your doctors office, but your doctor can send the samples to a laboratory that can perform the tests. None of these tests, however, can predict whether you will experience any health effects.

How can benzidine affect children?


There are no studies on health effects on children exposed to benzidine. It is likely that health effects seen in children exposed to high levels of benzidine will be similar to the effects seen in adults. We do not know if exposure to benzidine will result in birth defects or other developmental effects in people.

Has the federal government made recommendations to protect human health?


The EPA recommends that the amount of benzidine in drinking water be less than 1 part benzidine in a trillion parts of water (1 ppt). The Food and Drug Administration (FDA) allows a maximum of 1 part benzidine per billion parts of some color additives for food.

How can families reduce the risk of exposure to benzidine?


Most families will not be exposed to benzidine. Children should avoid playing in soils near uncontrolled hazardous waste sites where benzidine may have been discarded.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for Benzidine Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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2,3-BENZOFURAN
CAS # 271-89-6
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about 2,3-benzofuran. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to 2,3-benzofuran is most likely to occur from breathing contaminated air at the workplace. Animal studies have shown effects on the liver, kidneys, lungs, and stomach from exposure to high levels of 2,3-benzofuran. This chemical has been found in at least 11 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is 2,3-benzofuran? (Pronounced 2,3-bn-zfyrn)
2,3-Benzofuran is a colorless, sweet-smelling, oily liquid made by processing coal into coal oil. It may also be formed during other uses of coal or oil. 2,3-Benzofuran is not used for any commercial purposes, but the part of the coal oil that contains 2,3-benzofuran is made into a plastic called coumarone-indene resin. This resin resists corrosion and is used to make paints and varnishes. The resin also provides water resistance and is used in coatings on paper products and fabrics. It is used as an adhesive in food containers and some asphalt floor tiles. The resin has been approved for use in food packages and as a coating on citrus fruits. We do not know how often the resin is used or whether any 2,3-benzofuran in the coating or packaging gets into the food.
waste sites. G It does not readily dissolve in water, but may enter the groundwater near manufacturing or hazardous waste sites. G Limited information indicates that it will move into soil and sediment from water, but more information is needed. G 2,3-Benzofuran is not expected to accumulate in fish or aquatic animals to any great extent. G One study reported detecting 2,3-benzofuran in human breast milk, indicating that the mother had been exposed.

How might I be exposed to 2,3-benzofuran?


G Breathing contaminated air or touching the chemical in the workplace. G Breathing contaminated air around manufacturing or hazardous waste sites. G Eating foods from packaging material that contain coumarone-indene resins, but not much is known about how much gets into the food. G Smoking cigarettes. G Drinking contaminated water near manufacturing or hazardous waste sites. G Drinking contaminated human breast milk.

What happens to 2,3-benzofuran when it enters the environment?


G Very little is known about the stability or breakdown of 2,3-benzofuran or of the coumarone-indene resin. G 2,3-Benzofuran may enter the air, water, and soil during its manufacture, use, or storage at hazardous waste sites.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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2,3-BENZOFURAN CAS # 271-89-6


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How can 2,3-benzofuran affect my health?


Very little is known about the possible harmful effects of 2,3-benzofuran to human health. There are no studies that have looked at the effects in people from exposures to air, water, or food, or through skin contact. There are some studies in animals from exposures in food or water. Rats and mice that ingested high levels of 2,3-benzofuran over a short time had liver and kidney damage. Those exposed over a long time to moderate levels had liver, kidney, lung, and stomach damage. In one study, the ability of animals to reproduce was not affected. We do not know if people will experience health effects similar to those seen in animals.

This test may only measure 2,3-benzofuran from a recent exposure. It is not known how long 2,3-benzofuran remains in your body after you have been exposed. The test can't tell whether you may develop any health problems from an exposure.

Has the federal government made recommendations to protect human health?


There are no standards or recommendations specific for 2,3-benzofuran. The Food and Drug Administration (FDA) allows 200 parts of coumarone-indene resin per million parts of coating on the peels of citrus fruits (200 ppm). FDA also allows the use of coumarone-resin as a component of adhesives used in food packaging and as a substance in plastics intended for repeated use in contact with food.

How likely is 2,3-benzofuran to cause cancer?


The Department of Health and Human Services has not classified 2,3-benzofuran as to its human carcinogenicity. The International Agency for Research on Cancer and the Environmental Protection Agency (EPA) have also not classified 2,3-benzofuran as to its human carcinogenicity. Cancer of the kidneys, lungs, liver, or stomach was seen in rats and mice that ingested 2,3-benzofuran for long periods of time. There are no studies on 2,3-benzofuran's potential to cause cancer in people.

Glossary
Carcinogenicity: Ability to cause cancer. Ingesting: Taking food or drink into your body. ppm: Parts per million. Short time: Lasting 14 days or less. Long time: Lasting one year or longer.

Is there a medical test to show whether Ive been exposed to 2,3-benzofuran?


There is a test to measure 2,3-benzofuran in the blood or in breast milk. However, this test requires special equipment and is not usually available in your doctors office.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for 2,3-benzofuran. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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BERYLLIUM
CAS #7440-41-7
Division of Toxicology ToxFAQsTM September 2002

This fact sheet answers the most frequently asked health questions (FAQs) about beryllium. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: People working or living near beryllium industries have the greatest potential for exposure to beryllium. Lung damage has been observed in people exposed to high levels of beryllium in the air. About 1-15% of all people occupationally-exposed to beryllium in air become sensitive to beryllium and may develop chronic beryllium disease (CBD), an irreversible and sometimes fatal scarring of the lungs. CBD may be completely asymptomatic or begin with coughing, chest pain, shortness of breath, weakness, and/or fatigue. Beryllium has been found in at least 535 of the 1,613 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is beryllium?
Beryllium is a hard, grayish metal naturally found in mineral rocks, coal, soil, and volcanic dust. Beryllium ore is mined, and the beryllium is purified for use in nuclear weapons and reactors, aircraft and space vehicle structures, instruments, xray machines, and mirrors. Beryllium oxide is used to make speciality ceramics for electrical and high-technology applications. Beryllium alloys are used in automobiles, computers, sports equipment (golf clubs), and dental bridges. of beryllium in air, food, and water. People working in industries where beryllium is mined, processed, machined, or converted into metal, alloys, and other chemicals may be exposed to high levels of beryllium. People living near these industries may also be exposed to higher than normal levels of beryllium in air. People living near uncontrolled hazardous waste sites may be exposed to higher than normal levels of beryllium.

How can beryllium affect my health?


Beryllium can be harmful if you breathe it. The effects depend on how much you are exposed to, for how long, and individual susceptibility. If beryllium air levels are high enough (greater than 1000 ug/m3), an acute condition can result. This condition resembles pneumonia and is called acute beryllium disease Occupational and community air standards are effective in preventing acute lung damage. Some exposed workers (1-15%) become sensitive to beryllium. These individuals may develop an inflammatory reaction in the respiratory system. This condition is called chronic beryllium disease (CBD), and can occur years after exposure to higher than normal levels of beryllium (greater than 0.2 ug/m3). This disease can make you feel weak and tired, and can cause difficulty in breathing. It can also result in anorexia, weight loss, and may also lead to right side heart

What happens to beryllium when it enters the environment?


Beryllium dust enters the air from burning coal and oil. This beryllium dust will eventually settle over the land and water. It enters water from erosion of rocks and soil, and from industrial waste. Some beryllium compounds will dissolve in water, but most stick to particles and settle to the bottom. Most beryllium in soil does not dissolve in water and remains bound to soil. Beryllium does not accumulate in the food chain.

How might I be exposed to beryllium?


The general population is normally exposed to low levels

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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BERYLLIUM
CAS #7440-41-7
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

enlargement and heart disease in advanced cases. Some people who are sensitized to beryllium may not have any symptoms. The general population is unlikely to develop chronic beryllium disease because ambient air levels of beryllium are normally very low (0.00003-0.0002 ug/m3). Swallowing beryllium has not been reported to cause effects in humans because very little beryllium is absorbed from the stomach and intestines. Ulcers have been seen in dogs ingesting beryllium in the diet. Beryllium contact with skin that has been scraped or cut may cause rashes or ulcers.

Children should avoid playing in soils near uncontrolled hazardous waste sites where beryllium may have been discarded.

Is there a medical test to show whether Ive been exposed to beryllium?


Beryllium can be measured in samples from your blood, urine, skin, or lungs. These tests are rarely done because they are not reliable measures of your exposure over time. Also, these tests do not show if you have become sensitized to beryllium. Another test, the beryllium lymphocyte proliferation test (BeLPT), can help your doctor decide if you are sensitized to beryllium. This test is only done in a few specialized laboratories, but doctors familiar with the test can collect blood samples and send them for testing by overnight carrier. The BeLPT is most often done for people who work with beryllium. It is also useful for separating chronic beryllium disease from diagnoses that resemble it (for example, sarcoidosis). Depending on your exposure history, clinical findings, and test results, your doctor may also recommend additional specialized testing.

How likely is beryllium to cause cancer?


Long term exposure to beryllium can increase the risk of developing lung cancer in people. The Department of Health and Human Services (DHHS) and the International Agency for Research on Cancer (IARC) have determined that beryllium is a human carcinogen. The EPA has determined that beryllium is a probable human carcinogen. EPA has estimated that lifetime exposure to 0.04 ug/m3 beryllium can result in a one in a thousand chance of developing cancer.

How can beryllium affect children?


It is likely that the health effects seen in children exposed to beryllium will be similar to the effects seen in adults. We do not know whether children differ from adults in their susceptibility to beryllium. We do not know if exposure to beryllium will result in birth defects or other developmental effects in people. The studies on developmental effects in animals are not conclusive.

Has the federal government made recommendations to protect human health?


The EPA restricts the amount of beryllium that industries may release into the air to 0.01 ug/m3, averaged over a 30day period. The Occupational Safety and Health Administration (OSHA) sets a limit of 2 ug/m3 for an 8-hour work shift measured as a personal sample.

How can families reduce the risk of exposure to beryllium?


Individuals working at facilities that use beryllium should make sure that contaminated clothing and objects are not brought home.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2002. Toxicological Profile for Beryllium Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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BIS(2-CHLOROETHYL) ETHER
CAS # 111-44-4
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about bis(2-chloroethyl) ether. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Bis(2-chloroethyl) ether is mainly used as a chemical intermediate to make pesticides, but some of it is used as a solvent and cleaner. It is irritating to the skin, eyes, nose, throat, and lungs. Bis(2-chloroethyl) ether has been found at 81 of the 1,518 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is bis(2-chloroethyl) ether? (Pronounced bs 2 klr thl thr)


Bis(2-chloroethyl) ether is a colorless, nonflammable liquid with a strong unpleasant odor. It dissolves easily in water, and some of it will slowly evaporate to the air. It does not occur naturally. Bis(2-chloroethyl) ether is made in factories, and most of it is used to make pesticides. Some of it is used as a solvent, cleaner, component of paint and varnish, rust inhibitor, or as a chemical intermediate to make other chemicals.

How might I be exposed to bis(2-chloroethyl) ether?


q You are most likely to be exposed to bis(2-chloroethyl) ether if you work in a factory where it is made or used. q People who live near a waste site or industrial facility containing bis(2-chloroethyl) ether may be exposed to it in the air they breathe or by touching contaminated soil. q You could be exposed if you drank water that was contaminated with bis(2-chloroethyl) ether.

What happens to bis(2-chloroethyl) ether when it enters the environment?


q Bis(2-chloroethyl) ether released to air can be broken down by reactions with other chemicals and sunlight or can be removed by rain. q In water, it can be broken down by bacteria. q When released to soil, some will filter through the soil to groundwater, some will be broken down by bacteria, and some will evaporate to the air. q Bis(2-chloroethyl) ether does not build up in the food chain.

How can bis(2-chloroethyl) ether affect my health?


Bis(2-chloroethyl) ether causes irritation to the skin, eyes, throat, and lungs. In some cases, damage to the lungs can be severe enough to cause death. Breathing low concentrations will cause coughing and nose and throat irritation. Animal studies show effects similar to those observed in people. These effects include irritation to the skin, nose, and lungs; lung damage; and a decrease in growth rate. Animals that survived the exposures recovered fully in 4 to 8 days.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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BIS(2-CHLOROETHYL) ETHER CAS # 111-44-4

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


Some animal studies indicate that bis(2-chloroethyl) ether can affect the nervous system resulting in sluggish and slow movement, staggering, unconsciousness, and death. We do not know if bis(2-chloroethyl) ether causes reproductive effects or birth defects in people or animals. The Occupational Safety and Health Administration (OSHA) has set a limit of 15 parts per million (15 ppm) over an 8-hour workday, 40-hour workweek. The National Institute of Occupational Safety and Health (NIOSH) recommends that workplace air should not exceed 5 ppm bis(2-chloroethyl) ether averaged over a 10-hour workday or 40-hour workweek. Their recommended short-term exposure limit (up to 15 minutes) is 10 ppm averaged over an 8-hour period. The federal recommendations have been updated as of July 1999.

How likely is bis(2-chloroethyl) ether to cause cancer?


The ability of bis(2-chloroethyl) ether to cause cancer in humans has not been established. There is some evidence that bis(2-chloroethyl) ether causes cancer in mice. The International Agency for Research on Cancer (IARC) has determined that bis(2-chloroethyl) ether is not classifiable as to its carcinogenicity in humans.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. National Priorities List: A list of the nations worst hazardous waste sites. Pesticide: A substance that kills pests. ppb: Parts per billion. ppm: Parts per million.

Is there a medical test to show whether Ive been exposed to bis(2-chloroethyl) ether?
There are tests that can detect bis(2-chloroethyl) ether in some animal tissues and in environmental samples, but these tests have not been developed for measuring bis(2-chloroethyl) ether in people.

Source of Information Has the federal government made recommendations to protect human health?
The EPA recommends that levels in lakes and streams should be limited to 0.03 parts per billion parts of water (0.03 ppb) to prevent possible health effects from drinking water or eating fish contaminated with bis(2-chloroethyl) ether. Any release to the environment greater than 10 pounds of bis(2-chloroethyl) ether must be reported to the EPA. Agency for Toxic Substances and Disease Registry (ATSDR). 1989. Toxicological profile for bis(2-chloroethyl) ether. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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BIS(CHLOROMETHYL) ETHER
CAS # 542-88-1
Agency for Toxic Substances and Disease Registry ToxFAQs Jul.y 1999

This fact sheet answers the most frequently asked health questions (FAQs) about bis(chloromethyl) ether. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Bis(chloromethyl) ether is only used in small amounts inside fully enclosed systems to make other chemicals. Use of this chemical is highly restricted, so chances for exposure are very low. Bis(chloromethyl) ether is highly irritating to the skin, eyes, nose, throat, and lungs and it is a carcinogen. Bis(chloromethyl) ether has been found at 2 of the 1,518 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is bis(chloromethyl) ether? (Pronounced bs klr mthl thr)
Bis(chloromethyl) ether is a clear liquid with a strong unpleasant odor. It does not occur naturally. It dissolves easily in water, but degrades rapidly and readily evaporates into air. In the past, it was used to make several types of polymers, resins, and textiles, but its use is now highly restricted. Only small quantities of bis(chloromethyl) ether are produced in the United States. The small quantities that are produced are only used in enclosed systems to make other chemicals. However, small quantities of bis(chloromethyl) ether may be formed as an impurity during the production of another chemical, chloromethyl methyl ether. q When released to soil, some will evaporate to the air but most of it will be broken down by reacting with soil moisture. q Bis(chloromethyl) ether does not build up in the food chain and does not last long in the environment.

How might I be exposed to bis(chloromethyl) ether?


q Because bis(chloromethyl) ether does not last long in the environment and because of its restricted use, you are not likely to be exposed to this chemical. q The most likely way to be exposed is by breathing it in the air if you work at, or live near, an industrial facility that makes or uses chemicals that may contain bis(chloromethyl) ether as a contaminant.

What happens to bis(chloromethyl) ether when it enters the environment?


q Bis(chloromethyl) ether released to air can be broken down by reactions with other chemicals and sunlight, or it can be removed by rain. q In water, it is broken down quickly to formaldehyde and hydrochloric acid.

How can bis(chloromethyl) ether affect my health?


Bis(chloromethyl) ether causes irritation to the skin, eyes, throat, and lungs. In some cases, damage to the lungs can be severe enough to cause death. Breathing low concentrations will cause coughing and nose and throat irritation.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

Page 2

BIS(CHLOROMETHYL) ETHER CAS # 542-88-1

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


Animal studies show effects similar to those observed in people. These effects include irritation to the skin, nose, and lungs and lung damage (swelling and bleeding). Application of the liquid to the skin of mice and rabbits has produced hair loss, bleeding, swelling, and destruction of tissue. We do not know if bis(chloromethyl) ether causes reproductive effects or birth defects in people or animals. ing water or eating fish contaminated with bis(chloromethyl) ether. Any release to the environment greater than 10 pounds of bis(chloromethyl) ether must be reported to the EPA. The Occupational Safety and Health Administration (OSHA) has set a limit of 1 ppb as the highest acceptable level in workplace air, and strict controls have been established to minimize exposure to this chemical. The federal recommendations have been updated as of July 1999.

How likely is bis(chloromethyl) ether to cause cancer?


There is evidence that bis(chloromethyl) ether causes lung cancer and other tumors in people and animals. The Department of Health and Human Services (DHHS) has determined that bis(chloromethyl) ether is a known human carcinogen.

Glossary
Carcinogen: A substance that can cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. National Priorities List: A list of the nations worst hazardous waste sites. Polymer: Chemical compounds consisting of repeating structural units. ppb: Parts per billion. Tumor: An abnormal mass of tissue.

Is there a medical test to show whether Ive been exposed to bis(chloromethyl) ether?
Because bis(chloromethyl) ether is broken down rapidly in the body, there are no specific tests to determine if someone has been exposed to this chemical. The only available medical tests involve physical examination of the nose and throat, chest X-rays, or other tests to identify damage to the respiratory tract. However, these tests are not specific for this chemical and can only be used after damage has occurred.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1989. Toxicological profile for bis(chloromethyl) ether. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Has the federal government made recommendations to protect human health?


The EPA recommends that levels in lakes and streams should be limited to 0.0000038 parts per billion parts of water (0.0000038 ppb) to prevent possible health effects from drink-

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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BLISTER AGENTS:
LEWISITE (L) CAS #541-25-3 MUSTARD-LEWISITE MIXTURE (HL) CAS # NOT AVAILABLE
Division of Toxicology ToxFAQsTM April 2002

This fact sheet answers the most frequently asked health questions (FAQs) about the blister agents, Lewisite and Mustard-Lewisite. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: It is unlikely that the general population will be exposed to blister agents Lewisite or Mustard-Lewisite. People who breathe in vapors of Lewisite or Mustard-Lewisite may experience damage to the respiratory system. Contact with the skin or eye can result in serious burns. Lewisite or Mustard-Lewisite also can cause damage to bone marrow and blood vessels. Exposure to high levels may be fatal. Blister agents Lewisite and MustardLewisite have not been found in any of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are Lewisite and Mustard-Lewisite?
Lewisite is an oily, colorless liquid with an odor like geraniums. Mustard-Lewisite Mixture is a liquid with a garlic-like odor. Mustard-Lewisite is a mixture of Lewisite and a sulfur mustard known as HD. Lewisite might have been used as a chemical weapon by Japan against Chinese forces in the 1930s, but such reports have not been confirmed. Any stored Lewisite in the United States must be destroyed before April 2007, as mandated by the Chemical Weapons Convention. Lewisite and Mustard-Lewisite will be broken down in moist soil quickly, but small amounts may evaporate. Lewisite and Mustard-Lewisite do not accumulate in the food chain.

How might I be exposed to Lewisite and Mustard-Lewisite?


The general population will not be exposed to blister agents Lewisite or Mustard-Lewisite. Lewisite and Mustard-Lewisite are no longer produced in the United States. People that are potentially exposed to Lewisite or Mustard-Lewisite are soldiers who might be exposed to chemical weapons or people who work at military sites where these compounds are stored.

What happens to Lewisite and Mustard-Lewisite when they enter the environment?
Blister agents Lewisite and Mustard-Lewisite could enter the environment from an accidental release. In air, blister agents Lewisite and Mustard-Lewisite will be broken down by compounds that are found in the air, but they may persist in air for a few days before being broken down. Lewisite and Mustard-Lewisite will be broken down in water quickly, but small amounts may evaporate.

How can Lewisite and Mustard-Lewisite affect my health?


If you breathe Lewisite or Mustard-Lewisite vapors, your airways will immediately become irritated. You could experience burning pain in the nose and sinuses, laryngitis,

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

Page 2

BLISTER AGENTS:
LEWISITE (L) CAS #541-25-3 MUSTARD-LEWISITE MIXTURE (HL) CAS # NOT AVAILABLE
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

cough, shortness of breath, nausea, and vomiting. You could also experience airway tissue damage and accumulation of fluid in your lungs, which could result in death. Contact of the skin with Lewisite or Mustard-Lewisite vapors or liquid will result in local pain, swelling, and rash, followed by blistering that might be delayed for hours. If Lewisite or Mustard-Lewisite vapors or liquid contact your eyes, you will suffer immediate pain and rapid swelling, as well as serious damage to the cornea and other parts of the eye. Ingestion of Lewisite or Mustard-Lewisite will burn your mouth and throat, will cause severe stomach pain, nausea, vomiting, and bloody stools. If some of the Lewisite and Mustard-Lewisite that you breathe, touch, or ingest, pass to your blood stream, it can cause bone marrow damage and fluid loss from your blood vessels, which could result in low blood pressure and damage to the rest of your body. We do not know if exposure to Lewisite or Mustard-Lewisite causes reproductive effects in humans.

How can Lewisite and Mustard-Lewisite affect children?


There is no information on children exposed to Lewisite or Mustard-Lewisite, but children would probably be affected in the same ways as adults. We do not know whether children differ from adults in their susceptibility to these blister agents. We do not know whether Lewisite or Mustard-Lewisite can cause developmental effects in humans.

How can families reduce the risk of exposure to Lewisite and Mustard-Lewisite?
It is unlikely that families will be exposed to Lewisite or Mustard-Lewisite.

Is there a medical test to show whether Ive been exposed to Lewisite and Mustard-Lewisite?
There are no specific tests to indicate whether you have been exposed to Lewisite or Mustard-Lewisite. The presence of arsenic in the urine could indicate if you have been exposed to one of these blister agents.

How likely are Lewisite and Mustard-Lewisite to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified Lewisite as to its carcinogenicity. Both the DHHS and IARC have classified the blister agent H/HD (the sulfur mustard used in the Mustard-Lewisite mixture) as a human carcinogen. We to not know whether the Mustard-Lewisite mixture might also be a human carcinogen.

Has the federal government made recommendations to protect human health?


An Airborne Exposure Limit (as recommended by the Surgeon Generals Working Group, U.S. Department of Health and Human Services) of 0.003 milligrams of Lewisite and Mustard-Lewisite per cubic meter of air (0.003 mg/m3) has been established as a time-weighted average (TWA) for the workplace.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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BLISTER AGENTS HN-1, HN-2, HN-3 (nitrogen mustards)


CAS #538-07-8 (HN-1); CAS #51-75-2 (HN-2); CAS #555-77-1 (HN-3)
Division of Toxicology ToxFAQsTM April 2002

This fact sheet answers the most frequently asked health questions (FAQs) about nitrogen mustards. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: It is unlikely that the general public will be exposed to nitrogen mustards agents HN-1, HN-2, and HN-3. Exposure to vapors of nitrogen mustards can damage the respiratory airways. Contact with the skin or eyes may cause burns. When nitrogen mustards are absorbed by the body, they may cause damage to bone marrow and the immune system. Exposure to high levels can cause death. Nitrogen mustards HN-1, HN-2, and HN-3 have not been identified in any of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are nitrogen mustards?
Nitrogen mustards (HN-1, HN-2, HN-3) are colorless to yellow, oily liquids that evaporate very slowly. HN-1 has a faint, fishy or musty odor. HN-2 has a soapy odor at low concentrations and a fruity odor at higher concentrations. HN-3 may smell like butter almond. Although nitrogen mustards could be used in chemical warfare, there are presently no records of such use. HN-1 has been used to remove warts in the past, and HN-2 has been used sparingly in chemotherapy. Nitrogen mustards will be broken down in water quickly, and only small amounts may evaporate. Nitrogen mustards will be broken down in moist soil quickly, and only small amounts may evaporate. Nitrogen mustards do not accumulate in the food chain.

How might I be exposed to nitrogen mustards?


The general population will not be exposed to nitrogen mustards. The nitrogen mustards HN-1, HN-2, and HN-3 are not manufactured in significant commercial quantities in the United States. Although several of the nitrogen mustards have medicinal uses and as chemical warfare agents, they were never stockpiled as part of the U.S. chemical warfare inventory.

What happens to nitrogen mustards when they enter the environment?


Nitrogen mustards HN-1, HN-2, and HN-3 could enter the environment from an accidental release. When released to air, nitrogen mustards will be broken down by compounds that are found in the air, but they may persist in air for a few days before being broken down.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

Page 2 BLISTER AGENTS HN-1, HN-2, HN-3 (nitrogen mustards)


CAS #538-07-8 (HN-1); CAS #51-75-2 (HN-2);CAS #555-77-1 (HN-3)
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

How can nitrogen mustards affect my health?


If you breathe nitrogen mustard vapors, you will likely experience such effects as nasal and sinus pain or discomfort, pharyngitis, laryngitis, cough, and shortness of breath. Damage to cells lining your airways may begin within hours and get worse over the next several days. Exposure to high levels could cause death. Skin contact with nitrogen mustard vapors or liquid, will likely cause initial swelling and rash, followed by blistering. Contact with high levels of nitrogen mustards can result in second- and third-degree burns. If nitrogen mustards touch the eye, you may experience eye inflammation, pain, swelling, corneal damage, burns, and even blindness. If you swallow nitrogen mustards, you will probably experience burning of the mouth, esophagus, and stomach. When nitrogen mustards are absorbed by the body, they may cause damage to your immune system and bone marrow. There is some evidence that nitrogen mustard treatment in humans may result in decreased fertility.

How can nitrogen mustards affect children?


Children exposed to nitrogen mustards would probably experience the same effects seen in exposed adults. But we do not know whether children differ from adults in their susceptibility to nitrogen mustards. A few case reports have linked treatment with HN-2 in pregnant mothers to changes in the unborn child. Nitrogen mustards have been shown to cause damage to the fetus in animals.

How can families reduce the risk of exposure to nitrogen mustards?


Families are not likely to be exposed to nitrogen mustards.

Is there a medical test to show whether Ive been exposed to nitrogen mustards?
There are no specific tests to indicate whether you have been exposed to nitrogen mustards.

How likely are nitrogen mustards to cause cancer?


The International Agency for Research on Cancer (IARC) has classified nitrogen mustard HN-2 as probably carcinogenic to humans, based on evidence that it causes leukemia in humans and cancers of the lung, liver, uterus, and large intestine in animals.

Has the federal government made recommendations to protect human health?


An Airborne Exposure Limit (as recommended by the Surgeon Generals Working Group, U.S. Department of Health and Human Services) of 0.003 milligrams of HN-1 per cubic meter of air (0.003 mg/m3) has been established as a timeweighted average (TWA) for the workplace.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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BLISTER AGENTS
SULFUR MUSTARD AGENT H/HD CAS #505-60-2 SULFUR MUSTARD AGENT HT CAS #6392-89-8
Division of Toxicology ToxFAQsTM April 2002

This fact sheet answers the most frequently asked health questions (FAQs) about sulfur mustard blister agents H/HD and HT. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to sulfur mustard agents H/HD and HT can occur due to accidental release from a military storage facility. Exposure to sulfur mustards can burn the skin and eyes, cause blisters, and cause respiratory effects such as coughing and bronchitis. Higher levels may cause death. Sulfur mustard agent H/HD has been identified at 3 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are sulfur mustards agents H/HD and HT?
Sulfur mustards H/HD and HT are manufactured compounds. They are colorless when pure, but are typically yellow to brown oily liquids with a slight garlic or mustard odor. Agent H contains about 20-30% impurities. The nearly pure substance is called HD. HT is a mixture of 60% HD and 40% of another substance called agent T. They do not dissolve much in water, but dissolve easily in oils, fats, and other solvents. They are stable at ambient temperatures. Sulfur mustards were introduced as chemical warfare agents during World War I. More than a dozen countries have sulfur mustard agents in their chemical arsenals. Destruction of U.S. stockpiles of chemical agents, including sulfur mustards, was mandated by the Chemical Weapons Convention to take place before April 2007. Sulfur mustards will be broken down in water quickly, but small amounts may evaporate. Sulfur mustards may remain in dry soil, but will be broken down gradually in moist soil, and some might evaporate. Sulfur mustard agents H/HD and HT do not accumulate in the food chain.

How might I be exposed to sulfur mustard agents H/HD and HT?


The general population will not be exposed to sulfur mustard agents H/HD and HT unless an accidental release were to occur at military sites where they are stored. Sulfur mustards are no longer produced in the United States. People who might be exposed to chemical weapons or who work at military sites where these compounds are stored have the potential of being exposed to these chemicals.

What happens to sulfur mustards agents H/HD and HT when they enter the environment?
Sulfur mustards agents H/HD and HT could enter the environment from an accidental release. When released to air, sulfur mustards will be broken down by substances that are found in the air, but they may persist in air for a few days before being broken down.

How can sulfur mustard agents H/HD and HT affect my health?


The primary routes of potential human exposure to sulfur mustards are inhalation and dermal contact. Sulfur mustards are chemical warfare agents that can cause skin burns and

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

Page 2

BLISTER AGENTS SULFUR MUSTARD AGENT H/HD CAS #505-60-2 SULFUR MUSTARD AGENT HT CAS #6392-89-8
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

blisters and damage to the respiratory airways. Sulfur mustards burn your skin and cause blisters within a few days of exposure. Exposure is particularly harmful around sweaty parts of the body. It is also more harmful to the skin on hot, humid days, or in tropical climates. Sulfur mustards make your eyes burn, your eyelids swell, and cause you to blink a lot. If you breath sulfur mustards, it can cause coughing, bronchitis, and long-term respiratory disease. If you are exposed to large amounts of sulfur mustards, you can eventually die from it. Sulfur mustards did not affect reproduction in rats that breathed it. We do not know if sulfur mustards can affect peoples ability to reproduce.

because of the smaller diameter of their airways. Sulfur mustards did not cause birth defects in rats that breathed it. We do not know if these substances can cause birth defects or other developmental effects in humans.

How can families reduce the risk of exposure to sulfur mustard agents H/HD and HT?
It is unlikely that the general population will be exposed to sulfur mustard agents H/HD or HT.

Is there a medical test to show whether Ive been exposed to sulfur mustard agents H/HD and HT?
There is no effective medical test to determine if you have been exposed to sulfur mustards. A breakdown product of sulfur mustards can be measured in urine, but this chemical can also be found in people who have not been exposed to sulfur mustards.

How likely are sulfur mustard agents H/HD and HT to cause cancer?
The Department of Heath and Human Services (DHHS) has determined that blister agent H/HD is a known human carcinogen. The International Agency for Research on Cancer (IARC) has classified agent H/HD as carcinogenic to humans. Studies in humans indicate that long-term exposure to sulfur mustards may lead to cancer of the upper respiratory airways.

Has the federal government made recommendations to protect human health?


An Airborne Exposure Limit (as recommended by the Surgeon Generals Working Group, U.S. Department of Health and Human Services) of 0.003 milligrams of H/HD or HT per cubic meter of air (0.003 mg/m3) has been established as a time-weighted average (TWA) for the workplace.

How can sulfur mustard agents H/HD and HT affect children?


There are no studies of children exposed to sulfur mustard agents H/HD or HT. Children exposed to sulfur mustard agents H/HD or HT are likely to experience the same toxic effects experienced by exposed adults. In general, children may be more vulnerable to corrosive agents than adults

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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BORON
CAS # 7440-42-8
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about boron. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to boron occurs in the workplace or from using certain consumer products. Breathing moderate levels of boron irritates the nose, throat, and eyes. This chemical has been found in at least 142 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is boron? (Pronounced brn)
Boron is a compound that occurs in nature. It is often found combined with other substances to form compounds called borates. Common borate compounds include boric acid, salts of borates, and boron oxide. Several companies in the United States produce most of the world's borates by processing boron compounds. Borates are used mostly to produce glass. They are also used in fire retardants, leather tanning industries, cosmetics, photographic materials, soaps and cleaners, and for high-energy fuel. Some pesticides used for cockroach control and some wood preservatives also contain borates. G Boron accumulates in plants and is found in foods, mainly fruits and vegetables.

How might I be exposed to boron?


G In air, water, and food at low levels. G Drinking water that contains it from areas where boron is found naturally at high levels in the earth. G Eating foods containing high levels. G Working in borax mining and refining plants and at sites where boric acid is manufactured. G Using consumer products that contain it, such as cosmetics and laundry products.

How can boron affect my health?


There is little information on the health effects of longterm exposure to boron. Most of the studies are on short-term exposures. Breathing moderate levels of boron can result in irritation of the nose, throat, and eyes. Reproductive effects, such as low sperm count, were seen in men exposed to boron over the long-term. Animal studies have shown effects on the lungs from breathing high levels of boron. Ingesting large amounts of boron over short periods of time can harm the stomach, intestines, liver, kidney, and

What happens to boron when it enters the environment?


G Boron is released to the environment from natural sources such as oceans, volcanoes, and geothermal steam. G Boron is also released from industries that use it. G No information is available on how long boron remains in air, water, or soil. G Boron does not appear to accumulate in fish or other organisms in water.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

Page 2

BORON CAS # 7440-42-8

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


brain. Animal studies of ingestion of boron found effects on the testes in male animals. Birth defects were also seen in the offspring of female animals exposed during pregnancy. We don't know what the effects are in people from skin contact with boron. Animal studies have found skin irritation when boron was applied directly to the skin. The EPA requires that discharges or spills into the environment of 100 pounds of more of boron trichloride and boron trifluoride be reported. The Occupational Safety and Health Administration (OSHA) has set an occupational exposure limit of 15 milligrams per cubic meter (15 mg/m3) for boron oxide dust in workplace air for an 8-hour workday, 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) currently recommends an occupational exposure limit of 10 mg/m3 for boron oxide dust. NIOSH also recommends that 25 ppm boron trifluoride be considered immediately dangerous to life and health. This is the exposure level of a chemical that is likely to cause permanent health problems or death. The Food and Drug Administration (FDA) allows no more than 310 ppm of boron as a food additive.

How likely is boron to cause cancer?


The Department of Health and Human Services, the International Agency for Research on Cancer, and the Environmental Protection Agency (EPA) have not classified boron as to its human carcinogenicity. One animal study found no evidence of cancer after lifetime exposure to boric acid in food. No human studies are available.

Is there a medical test to show whether Ive been exposed to boron?


Tests are available to measure boron levels in blood and urine. These tests must be done shortly after exposure, because most excess boron leaves the body through the urine within a few days of exposure. These tests are not usually performed in doctors' offices because special equipment is needed to conduct them. It is not known whether boron levels measured in the body can be used to predict whether health problems will occur.

Glossary
Carcinogenicity: Ability to cause cancer. Ingesting: Taking food or drink into your body. Long-term: Lasting one year or longer. Milligram (mg): One thousandth of a gram. Pesticides: Chemicals used to kill pests. ppm: Parts per million. Short-term: Lasting 14 days or less.

References Has the federal government made recommendations to protect human health?
The EPA allows no more than 30 parts of boron per million parts of cottonseed oil (30 ppm) and 8 ppm of boron in or on citrus fruits. Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for boron. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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BROMODICHLOROMETHANE
CAS # 75-27-4
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about bromodichloromethane. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Most bromodichloromethane is formed as a by-product when chlorine is added to water-supply systems. Bromodichloromethane is not known to cause adverse health effects in people, but animal studies show that high concentrations can damage the liver and kidneys and affect the brain. Bromodichloromethane has been found at 5 of the 1,518 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is bromodichloromethane? (Pronounced brm d-klr mthn)
Bromodichloromethane is a colorless, nonflammable liquid. Small amounts are formed naturally by algae in the oceans. Some of it will dissolve in water, but it readily evaporates into air. Only small quantities of bromodichloromethane are produced in the United States. The small quantities that are produced are used in laboratories or to make other chemicals. However, most bromodichloromethane is formed as a by-product when chlorine is added to drinking water to kill bacteria. G When released to soil, most will evaporate to the air but some of it will be broken down by bacteria. G Some bromodichloromethane may filter into the groundwater. G Bromodichloromethane does not build up in the food chain.

How might I be exposed to bromodichloromethane?


G The most likely way people are exposed to bromodichloromethane is by drinking chlorinated water. G You may breathe vapors released from chlorinated water in a swimming pool or in the home (cooking, washing dishes, bathing, etc.). G Some bromodichloromethane may enter your body directly through your skin when bathing or swimming. G People who live near a waste site containing bromodichloromethane could be exposed by drinking contaminated groundwater or breathing vapors released to the air. G People who work at or live near a laboratory or factory that makes or uses this chemical could be exposed by breathing bromodichloromethane in the air.

What happens to bromodichloromethane when it enters the environment?


G Bromodichloromethane released to air is slowly broken down by reactions with other chemicals and sunlight or it can be removed by rain. G In water, it will evaporate to the air and/or be broken down slowly by bacteria.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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BROMODICHLOROMETHANE CAS # 75-27-4

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html How can bromodichloromethane affect my health?
No studies are available regarding health effects in people exposed to bromodichloromethane. Animal studies indicate that the liver, kidney, and central nervous system are affected by exposure to bromodichloromethane. The effects of high doses on the central nervous system include sleepiness and incoordination. Longer exposure to lower doses causes damage to the liver and kidneys. There is some evidence from animal studies that bromodichloromethane may cause birth defects at doses high enough to make the mother sick. It is not known if lower doses would cause birth defects.

Has the federal government made recommendations to protect human health?


The EPA has set a Maximum Contaminant Level (MCL) of 0.1 parts per million (ppm) for the combination of bromodichloromethane and a group of similar compounds (called trihalomethanes) that occur in chlorinated water. The EPA recommends that levels of halomethanes in lakes and streams should be limited to 0.19 ppm to prevent possible health effects from drinking water or eating fish contaminated with this group of chemicals. Any release to the environment greater than 5,000 pounds of bromodichloromethane must be reported to the EPA. The federal recommendations have been updated as of July 1999.

How likely is bromodichloromethane to cause cancer?


There is evidence that eating or drinking bromodichloromethane causes liver, kidney, and intestinal cancer in rats and mice. The Department of Health and Human Services (DHHS) has determined that bromodichloromethane is reasonably anticipated to be a human carcinogen.

Glossary
Carcinogen: A substance that can cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. National Priorities List: A list of the nations worst hazardous waste sites. ppm: Parts per million.

Is there a medical test to show whether Ive been exposed to bromodichloromethane?


Methods are available to measure low levels of bromodichloromethane in human blood, breath, urine, and fat, but not enough information is available to use such tests to predict if any health effects might occur. Because special equipment is needed, these tests are not usually done in the doctor's office.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1989. Toxicological profile for bromodichloromethane. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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BROMOFORM and CHLORODIBROMOMETHANE


CAS # 75-25-2 and 124-48-1
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about bromoform and chlorodibromomethane. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Small amounts of bromoform and chlorodibromomethane are naturally produced by ocean plant life. They are also formed as by-products when chlorine is added to water-supply systems. High levels of bromoform and chlorodibromomethane can damage the liver and kidneys and affect the brain. Bromoform and chlorodibromomethane have been found at 14 of the 1,177 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are bromoform and chlorodibromomethane?
(Pronounced brm frm and klr d brm mthn) Bromoform and chlorodibromomethane are colorless, nonflammable liquids with a sweet odor. Small amounts are formed naturally by plants in the oceans. They are somewhat soluble in water and readily evaporate into air. Most of the bromoform and chlorodibromomethane that enters the environment is formed as by-products when chlorine is added to drinking water to kill bacteria. Only small quantities of bromoform and chlorodibromomethane currently are produced in the United States. These chemicals were used in the past as solvents and flame retardants, or to make other chemicals, but now they are used mainly as laboratory reagents. G When released to soil, most will evaporate to the air, some will be broken down by bacteria, and some may filter into the groundwater. G Bromoform and chlorodibromomethane do not build up in the food chain.

How might I be exposed to bromoform and chlorodibromomethane?


G The most likely way people are exposed to bromoform and chlorodibromomethane is by drinking chlorinated water. G You may breathe vapors released from chlorinated water in a swimming pool or in the home (cooking, washing dishes, bathing, etc.). G Some bromoform and chlorodibromomethane may enter your body directly through your skin while bathing or swimming. G People that live near a waste site containing bromoform or chlorodibromomethane could be exposed by drinking contaminated groundwater or breathing vapors released to the air. G Exposure could occur by breathing bromoform and chlorodibromomethane in the air in or near a laboratory or factory that makes or uses this chemical; however, this is not likely for most people.

What happens to bromoform and chlorodibromomethane when they enter the environment?
G When released to air, bromoform and chlorodibromomethane are slowly broken down by reactions with other chemicals and sunlight or can be removed by rain. G In water, these chemicals will evaporate to the air and/or be broken down slowly by bacteria.

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BROMOFORM AND CHLORODIBROMOMETHANE CAS # 75-25-2 AND 124-48-1

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html How can bromoform and chlorodibromomethane affect my health?
No studies are available about health effects in people exposed to chlorodibromomethane. Bromoform was used as a sedative to treat children with whooping cough during the early 1900s. Several recorded cases of overdose indicate that high doses affect the central nervous system causing unconsciousness, loss of reflexes, shallow breathing, erratic heart rate, and respiratory failure. Milder cases resulted in rapid breathing, constricted pupils, and tremors. Animal studies indicate that the liver, kidney, and central nervous system are affected by exposure to bromoform and chlorodibromomethane. The effects on the central nervous system appear quickly after exposure to high doses and include labored breathing, incoordination, sedation, and death. Longer-term exposure to lower doses causes drowsiness, increased liver weight, and liver and kidney damage. We do not know if bromoform and chlorodibromomethane cause birth defects or infertility. predict if any health effects might occur. Because special equipment is needed, these tests are not usually done in the doctors office.

Has the federal government made recommendations to protect human health?


The EPA has set a Maximum Contaminant Level (MCL) of 0.1 parts per million (0.1 ppm) for the combination of bromoform and chlorodibromomethane and a group of similar compounds (called trihalomethanes) that occur in chlorinated water. The EPA recommends that levels of halomethanes in lakes and streams should be limited to 0.19 ppm to prevent possible human health effects from drinking water or eating fish contaminated with this group of chemicals. Any release to the environment greater than 100 pounds of bromoform or chlorodibromomethane must be reported to the EPA. Because chlorodibromomethane has such a limited use in industry, the Occupational Safety and Health Administration (OSHA) has not set limits of exposure for workplace air. OSHA has set a workplace air concentration limit of 0.5 ppm for bromoform over an 8-hour workday, 40-hour workweek. The federal recommendations have been updated as of July 1999.

How likely are bromoform and chlorodibromomethane to cause cancer?


There is evidence that ingestion of bromoform causes intestinal cancer in rats and ingestion of chlorodibromomethane causes liver cancer in mice. It is not known if they cause cancer in people. The International Agency for Research on Cancer (IARC) has determined that the human carcinogenicity of bromoform and chlorodibromomethane is not classifiable.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1989. Toxicological profile for bromoform and chlorodibromomethane. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Is there a medical test to show whether Ive been exposed to bromoform or chlorodibromomethane?
Methods are available to measure low levels of bromoform and chlorodibromomethane in human blood, breath, and fat, but not enough information is available to use such tests to

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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BROMOMETHANE
CAS # 74-83-9
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about bromomethane. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to bromomethane occurs mostly from breathing contaminated air in the workplace or at waste sites. It is usually not found in surface water, soil, or food. Exposure to high levels can affect your lungs and cause breathing difficulty. It can also damage your kidneys and nervous system, and can even cause death. This chemical has been found in at least 74 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is bromomethane? (Pronounced brmmthn)
Bromomethane is a manufactured chemical. It also occurs naturally in small amounts in the ocean where it is formed, probably by algae and kelp. It is a colorless, nonflammable gas with no distinct smell. Other names for bromomethane are methyl bromide, mono-bromomethane, and methyl fume. Trade names include Embafume and Terabol. Bromomethane is used to kill a variety of pests including rats, insects, and fungi. It is also used to make other chemicals or as a solvent to get oil out of nuts, seeds, and wool. G It breaks down in groundwater over a period of several months. G It does not build up in plants or animals.

How might I be exposed to bromomethane?


G Breathing very, very low background levels in the environment. G Breathing contaminated air with high levels near waste sites. G Breathing air where it has been used as a pesticide. G Breathing workplace air where it is made or used. G Usually not found in surface water, soil, or food.

How can bromomethane affect my health?


If you breathe bromomethane you may develop a headache and begin to feel weak and nauseated several hours later. If you breathe large amounts, fluid may build up in your lungs and it may be hard to breathe. It could cause muscle tremors, seizures, kidney damage, nerve damage, and even death. Exposure levels leading to death vary from 1,600 to 60,000 parts of bromomethane in 1 million parts of air (1,60060,000 ppm), depending on the length of the exposure. These

What happens to bromomethane when it enters the environment?


G It moves very quickly into the air when released to the environment or when present in soil or water. G It breaks down slowly in air over several years. G It breaks down quickly in soil over a few days. G Small amounts can move from the soil into the groundwater.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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BROMOMETHANE CAS # 74-83-9

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levels are much, much higher than those to which you would normally be exposed to. The respiratory, kidney, and neurologic effects are of the greatest concern to people. No cases of severe effects on the nervous system from long-term exposure to low levels have been noted in people, but studies in rabbits and monkeys have shown moderate to severe injury. Swallowing bromomethane may cause stomach irritation. If bromomethane gets on your skin, it can cause itching, redness, and blisters. These effects are caused by levels that are higher than levels you might normally encounter. We do not know if it affects our ability to reproduce. Studies in animals suggest that bromomethane does not cause birth defects and does not interfere with reproduction, except at high exposure levels. Another test measures the main breakdown product of bromomethane (bromide) in your blood or urine. Bromide is normally present in your blood, but the level would be higher if you had been exposed to bromomethane. This test is only useful if done within 1-2 days following exposure and cannot predict if any health effects will occur. These tests are not routinely performed at doctors' offices, but your doctor can take blood or urine samples and send them to a testing laboratory.

Has the federal government made recommendations to protect human health?


EPA requires that spills or accidental releases into the environment of 1,000 pounds or more of bromomethane be reported. The Food and Drug Administration (FDA) set a limit of 125-400 parts of bromide per million parts of food (ppm) for food treated with bromomethane. The Occupational Safety and Health Agency (OSHA) limits the average level of bromomethane in workplace air to 20 ppm for an 8-hour workday over a 40-hour week, and recommends that exposure be reduced as low as possible.

How likely is bromomethane to cause cancer?


The Environmental Protection Agency (EPA) has determined that bromomethane is not classifiable as to its human carcinogenicity. There are no studies available to indicate that bromomethane is carcinogenic to people. Animal studies do not provide conclusive evidence.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Long-term: Lasting one year or longer.

Is there a medical test to show whether Ive been exposed to bromomethane?


Several tests are available to tell if you have been exposed to bromomethane. It can be measured in your blood or in the air you breathe out. This test is not very useful because most bromomethane doesn't stay in your body long.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for bromomethane. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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1,3-BUTADIENE
CAS # 106-99-0
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about 1,3-butadiene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to 1,3-butadiene occurs mainly from breathing contaminated air. Effects on the nervous system and irritations of the eyes, nose, and throat have been seen in people who breathed contaminated air. This chemical has been found in at least 7 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is 1,3-butadiene? (Pronounced 1,3-byt-dn)
1,3-Butadiene is a chemical made from the processing of petroleum. It is the 36th highest volume chemical produced in the United States. It is a colorless gas with a mild gasolinelike odor. About 75% of the manufactured 1,3-butadiene is used to make synthetic rubber. Synthetic rubber is widely used for tires on cars and trucks. 1,3-Butadiene is also used to make plastics including acrylics. Small amounts are found in gasoline.

G 1,3-Butadiene may be broken down by microorganisms in the soil. G It is not expected to accumulate in fish.

How might I be exposed to 1,3-butadiene?


G Breathing urban and suburban air, but these levels are generally very low except in polluted cities or near chemical, plastic, and rubber facilities that use it. G Breathing contaminated workplace air where it is manufactured or used. G Breathing contaminated air from car and truck exhaust, waste incineration, or wood fires. G Breathing cigarette smoke. G Drinking contaminated water near production or waste sites. G Ingesting foods contained in plastic or rubber food containers, but levels are generally very low or not present at all. G Skin contact with gasoline, but levels are low.

What happens to 1,3-butadiene when it enters the environment?


G It quickly evaporates to the air as a gas from leaks during production, use, storage, transport, or disposal. G It breaks down quickly in air by sunlight; in sunny weather, half of it breaks down in about 2 hours. G When not sunny, it takes a few days for about half of it to break down in the air. G It evaporates very quickly from water and soil. G Since it evaporates so easily, it is not expected to be found in water or soil, but adequate tests are not available to measure the amounts.

How can 1,3-butadiene affect my health?


Most of the information on the health effects of 1,3-butadiene comes from studies where the exposure was from breathing contaminated air.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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1,3-BUTADIENE CAS # 106-99-0

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Breathing very high levels of 1,3-butadiene for a short time can cause central nervous system damage, blurred vision, nausea, fatigue, headache, decreased blood pressure and pulse rate, and unconsciousness. There are no recorded cases of accidental exposures at high levels that caused death in humans, but this could occur. Breathing lower levels may cause irritation of the eyes, nose, and throat. Studies on workers who had longer exposures with lower levels have shown an increase in heart and lung damage, but these workers were also exposed to other chemicals. We dont know for sure which chemical (or chemicals) caused the effects. We also do not know what levels in the air will cause these effects in people when breathed over many years. Animal studies show that breathing 1,3-butadiene during pregnancy can increase the number of birth defects. Other effects seen in animals that breathed low levels of 1,3-butadiene for one year include kidney and liver disease, and damaged lungs. Some of the animals died. There is no information on the effects of eating or drinking 1,3-butadiene. Skin contact with liquid 1,3-butadiene can cause irritation and frostbite.

Is there a medical test to show whether Ive been exposed to 1,3-butadiene?


There is currently no reliable medical test to determine whether you have been exposed to 1,3-butadiene. However, scientists are working on methods to measure it in the blood.

Has the federal government made recommendations to protect human health?


The Environmental Protection Agency (EPA) requires that discharges or spills into the environment of 1 pound or more of 1,3-butadiene be reported. The Occupational Safety and Health Administration (OSHA) has set an occupational exposure limit of 1,000 parts of 1,3-butadiene per million parts of air (1,000 ppm). The National Institute for Occupational Safety and Health (NIOSH) recommends that 1,3-butadiene be kept to the lowest feasible concentration because of its potential to cause cancer.

Glossary
Carcinogen: A substance that can cause cancer. Ingesting: Taking food or drink into your body. ppm: Parts per million. Tumor: An abnormal mass of tissue.

How likely is 1,3-butadiene to cause cancer?


The Department of Health and Human Services has determined that 1,3-butadiene may reasonably be anticipated to be a carcinogen. This is based on animal studies that found increases in a variety of tumor types from exposure to 1,3butadiene. Studies on workers are inconclusive because the workers were exposed to other chemicals in addition to 1,3-butadiene.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for 1,3-butadiene. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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2-BUTANONE
CAS # 78-93-3
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about 2-butanone. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to 2-butanone occurs in the workplace or from using consumer products containing it. Mild irritations of the eyes, nose, and throat were seen in people who breathed 2-butanone. This chemical has been found in at least 472 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is 2-butanone? (Pronounced 2-byt-nn)
2-Butanone is a manufactured chemical but it is also present in the environment from natural sources. It is a colorless liquid with a sharp, sweet odor. It is also known as methyl ethyl ketone (MEK). 2-Butanone is produced in large quantities. Nearly half of its use is in paints and other coatings because it will quickly evaporate into the air and it dissolves many substances. It is also used in glues and as a cleaning agent. 2-Butanone occurs as a natural product. It is made by some trees and found in some fruits and vegetables in small amounts. It is also released to the air from car and truck exhausts.
G It does not stick to soil and will travel through the soil to the groundwater. G Some of the 2-butanone in soil or water will evaporate into the air. G It does not deposit in the bottom of rivers or lakes. G It is not expected to concentrate in fish or increase in the tissues of animals further up the food chain.

How might I be exposed to 2-butanone?


G Breathing contaminated air from the production or use of paints, glues, coatings, or cleaning agents containing it. G Breathing contaminated air near hazardous waste sites. G Breathing cigarette smoke. G Sniffing glues. G Drinking contaminated water from wells near manufacturing or hazardous waste sites. G Skin contact with the liquid during production or use.

What happens to 2-butanone when it enters the environment?


G 2-Butanone enters the air during production, use and transport, and from hazardous waste sites. G In air, one-half of it will break down from sunlight in 1 day or less. G It dissolves in water and is broken down more slowly to a simpler chemical form in about 2 weeks.

How can 2-butanone affect my health?


The known health effects to people from exposure to 2-butanone are irritation of the nose, throat, skin, and eyes. No one has died from breathing 2-butanone alone. If 2-butanone is breathed along with other chemicals that damage health, it can increase the amount of damage that occurs.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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2-BUTANONE CAS # 78-93-3

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Serious health effects in animals have been seen only at very high levels. When breathed, these effects included birth defects, loss of consciousness, and death. When swallowed, rats had nervous system effects including drooping eyelids and uncoordinated muscle movements. There was no damage to the ability to reproduce. Mice who breathed low levels for a short time showed temporary behavioral effects. Mild kidney damage was seen in animals that drank water with lower levels of 2-butanone for a short time. There are no long-term studies with animals either breathing or drinking 2-butanone.

doctor can take blood or urine samples and send them to a testing laboratory.

Has the federal government made recommendations to protect human health?


The EPA requires that discharges or spills into the environment of 5,000 pounds of more of 2-butanone be reported. The Occupational Safety and Health Administration (OSHA) set an occupational exposure limit of 200 parts of 2-butanone per million parts of workplace air (200 ppm) for an 8-hour workday, 40-hour workweek. The American Conference of Governmental Industrial Hygienists (ACGIH) and the National Institute for Occupational Safety and Health (NIOSH) have established the same guidelines as OSHA for the workplace.

How likely is 2-butanone to cause cancer?


The Department of Health and Human Services has not classified 2-butanone as to its human carcinogenicity. The International Agency for Research on Cancer and the Environmental Protection Agency (EPA) have also not classified 2-butanone as to its human carcinogenicity. Two studies of workers exposed to 2-butanone and other chemicals did not find an increase in cancer. No animal studies are available that examine the potential for 2-butanone to cause cancer.

Glossary
Carcinogenicity: Ability to cause cancer. Evaporate: To change into a vapor or a gas. ppm: Parts per million. Long-term: Lasting one year or longer. Short time: Lasting 14 days or less.

Is there a medical test to show whether Ive been exposed to 2-butanone?


Tests are available to measure 2-butanone or its breakdown products in blood, breath, and urine. These tests are useful only to measure recent exposures because 2-butanone and its breakdown products leave the body rapidly. These tests are not usually performed at your doctor's office, but your

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for 2-butanone. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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2-BUTOXYETHANOL and 2-BUTOXYETHANOL ACETATE CAS # 112-07-2 and 111-76-2


Agency for Toxic Substances and Disease Registry ToxFAQs August 1999

This fact sheet answers the most frequently asked health questions (FAQs) about 2-butoxyethanol and 2-butoxyethanol acetate. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to 2-butoxyethanol and 2-butoxyethanol acetate occurs mainly from breathing air or having skin contact with household products containing them. Breathing in large amounts of 2-butoxyethanol or 2-butoxyethanol acetate may result in irritation of the nose and eyes, headache, and vomiting. 2-Butoxyethanol has been found in at least 20 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency.
What are 2-butoxyethanol and 2-butoxyethanol acetate? (Pronounced 2-bytks th-nl and 2-bytks th-nl s-tt)
2-Butoxyethanol is a clear colorless liquid that smells like ether. It has many names including ethylene glycol monobutyl ether, ethylene glycol butyl ether, ethylene glycol n-butyl ether, Butyl Cellusolve, butyl glycol, and butyl Oxitol. It is used as a solvent in spray lacquers, enamels, varnishes, and latex paints and as an ingredient in paint thinners and strippers, varnish removers, and herbicides. It is also used in liquid soaps, cosmetics, industrial and household cleaners, and dry-cleaning compounds. 2-Butoxyethanol acetate is a colorless liquid with a fruity odor. It is also known as ethylene glycol monobutyl ether acetate, butoxyethyl acetate, butyl glycol acetate, ethylene glycol butyl ether acetate, and acetic acid 2-butoxyethyl ester. It is used as a solvent for lacquers, varnishes, enamels, and epoxy resins. It is also used in some ink and spot remover compounds.

What happens to 2-butoxyethanol and 2-butoxyethanol acetate when they enter the environment? G 2-Butoxyethanol and 2-butoxyethanol acetate may be
released into the air when they are used as solvents and in household products.

G In air, 2-butoxyethanol and 2-butoxyethanol acetate may


be removed by rain, ice, or snow.

G 2-Butoxyethanol and 2-butoxyethanol acetate may break


down in air into other compounds within a few days.

G Both compounds may pass into air from water and soil. G 2-Butoxyethanol and 2-butoxyethanol acetate do not
build up in plants and animals.

How might I be exposed to 2-butoxyethanol and 2-butoxyethanol acetate? G Many people are exposed to small amounts of 2-butoxyethanol and 2-butoxyethanol acetate every day.

G Breathing air or having skin contact with household


cleaners or other liquids that contain these compounds.

G Drinking contaminated water.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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2-BUTOXYETHANOL and 2-BUTOXYETHANOL ACETATE CAS # 111-76-2 and 112-07-2

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html G Working in occupations such as silk-screening, printing, G Living near a hazardous waste site where 2-butoxyethanol and 2-butoxyethanol acetate are disposed of.

furniture production and finishing, spray-painting operations, and automobile repair shops that use materials containing 2-butoxyethanol and 2-butoxyethanol acetate.

Is there a medical test to show whether Ive been exposed to 2-butoxyethanol and 2-butoxyethanol acetate?
Breakdown products of 2-butoxyethanol can be measured in your blood and urine to see if you have been recently exposed to the chemical. These tests need to be done within a day after exposure because 2-butoxyethanol and its breakdown products leave your body within 24-48 hours. These tests cannot tell how much you have been exposed to or whether health effects will occur. Certain blood tests can tell if your red blood cells are damaged, but this effect is not specific to 2-butoxyethanol.

How can 2-butoxyethanol and 2-butoxyethanol acetate affect my health?


People exposed to high levels of 2-butoxyethanol for several hours reported irritation of the nose and eyes, headache, a metallic taste in their mouths, and vomiting. No harmful effects were seen on their lungs or hearts. People who swallowed large amounts of cleaning agents containing 2-butoxyethanol have shown breathing problems, low blood pressure, low levels of hemoglobin (the substance in the blood that carries oxygen to organs of the body), acidic blood, and blood in the urine. It is not known whether 2-butoxyethanol or 2-butoxyethanol acetate can affect reproduction or cause birth defects in people. Animal studies have shown hemolysis (destruction of red blood cells that results in the release of hemoglobin) from exposure to 2-butoxyethanol and 2-butoxyethanol acetate. High doses of 2-butoxyethanol can also cause reproductive problems and minor birth defects in animals.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration has set an exposure limit of 50 parts of 2-butoxyethanol per million parts of air (50 ppm) for an 8-hour workday, 40-hour workweek.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Herbicides: Substances used to stop plant growth. Solvents: Chemicals that can dissolve other substances.

How likely are 2-butoxyethanol and 2-butoxyethanol acetate to cause cancer?


The Department of Health and Human Services, the International Agency for Research on Cancer, and Environmental Protection Agency have not classified 2-butoxyethanol and 2-butoxyethanol acetate as to their human carcinogenicity. No carcinogenicity studies on 2-butoxyethanol and 2-butoxyethanol acetate are available in people or animals.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1998. Toxicological Profile for 2-butoxyethanol and 2-butoxyethanol acetate. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CADMIUM
CAS # 7440-43-9
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about cadmium. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to cadmium happens mostly in the workplace where cadmium products are made. The general population is exposed from breathing cigarette smoke or eating cadmium contaminated foods. Cadmium damages the lungs, can cause kidney disease, and may irritate the digestive tract. This substance has been found in at least 776 of the 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is cadmium? (Pronounced kdm-m)
Cadmium is a natural element in the earths crust. It is usually found as a mineral combined with other elements such as oxygen (cadmium oxide), chlorine (cadmium chloride), or sulfur (cadmium sulfate, cadmium sulfide). All soils and rocks, including coal and mineral fertilizers, contain some cadmium. Most cadmium used in the United States is extracted during the production of other metals like zinc, lead, and copper. Cadmium does not corrode easily and has many uses, including batteries, pigments, metal coatings, and plastics. G It doesnt break down in the environment, but can change forms. G Fish, plants, and animals take up cadmium from the environment. G Cadmium stays in the body a very long time and can build up from many years of exposure to low levels.

How might I be exposed to cadmium?


G Breathing contaminated workplace air (battery manufacturing, metal soldering or welding). G Eating foods containing it; low levels in all foods (highest in shellfish, liver, and kidney meats). G Breathing cadmium in cigarette smoke (doubles the average daily intake). G Drinking contaminated water. G Breathing contaminated air near the burning of fossil fuels or municipal waste.

What happens to cadmium when it enters the environment?


G Cadmium enters air from mining, industry, and burning coal and household wastes. G Cadmium particles in air can travel long distances before falling to the ground or water. G It enters water and soil from waste disposal and spills or leaks at hazardous waste sites. G It binds strongly to soil particles. G Some cadmium dissolves in water.

How can cadmium affect my health?


Breathing high levels of cadmium severely damages the lungs and can cause death. Eating food or drinking water with very high levels severely irritates the stomach, leading to vomiting and diarrhea. Long-term exposure to lower levels of cadmium in air, food, or water leads to a buildup of cadmium in the kidneys and possible kidney disease.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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Other long-term effects are lung damage and fragile bones. Animals given cadmium in food or water had high blood pressure, iron-poor blood, liver disease, and nerve or brain damage. We dont know if humans get any of these diseases from eating or drinking cadmium. Skin contact with cadmium is not known to cause health effects in humans or animals. children. If you work with cadmium, use all safety precautions to avoid carrying cadmium-containing dust home from work on your clothing, skin, hair, or tools. A balanced diet can reduce the amount of cadmium taken into the body from food and drink.

How likely is cadmium to cause cancer?


The Department of Health and Human Services (DHHS) has determined that cadmium and cadmium compounds may reasonably be anticipated to be carcinogens.

Is there a medical test to show whether Ive been exposed to cadmium?


Tests are available in some medical laboratories that measure cadmium in blood, urine, hair, or nails. Blood levels show recent exposure to cadmium, and urine levels show both recent and earlier exposure. The reliability of tests for cadmium levels in hair or nails is unknown.

How can cadmium affect children?


The health effects in children are expected to be similar to those in adults (kidney, lung and intestinal damage). We don't know if cadmium causes birth defects in people. Cadmium does not readily go from a pregnant woman's body into the developing child, but some portion can cross the placenta. It can also be found in breast milk. The babies of animals exposed to high levels of cadmium during pregnancy had changes in behavior and learning ability. Cadmium may also affect birth weight and the skeleton in developing animals. Animal studies also indicate that more cadmium is absorbed into the body if the diet is low in calcium, protein, or iron, or is high in fat. A few studies show that younger animals absorb more cadmium and are more likely to lose bone and bone strength than adults.

Has the federal government made recommendations to protect human health?


The EPA has set a limit of 5 parts of cadmium per billion parts of drinking water (5 ppb). EPA doesn't allow cadmium in pesticides. The Food and Drug Administration (FDA) limits the amount of cadmium in food colors to 15 parts per million (15 ppm). The Occupational Safety and Health Administration (OSHA) limits workplace air to 100 micrograms cadmium per cubic meter (100 g/m3) as cadmium fumes and 200 g cadmium/m3 as cadmium dust.

How can families reduce the risk of exposure to cadmium?


In the home, store substances that contain cadmium safely, and keep nickel-cadmium batteries out of reach of young

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1999. Toxicological profile for cadmium. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CALCIUM HYPOCHLORITE SODIUM HYPOCHLORITE


CAS #7681-52-9
Division of Toxicology ToxFAQsTM April 2002

CAS #7778-54-3

This fact sheet answers the most frequently asked health questions (FAQs) about sodium and calcium hypochlorite. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: The general public can be exposed to small amounts of sodium and calcium hypochlorite by using household products that contain these chemicals. Workers in occupations that use these chemicals have the highest risk of being exposed. Sodium and calcium hypochlorite can cause irritation of the eyes, skin, respiratory and gastrointestinal tract. Exposure to high levels can result in severe corrosive damage to the eyes, skin, respiratory and gastrointestinal tissues and can be fatal. Sodium and calcium hypochlorite have been found 6 times each in the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are sodium and calcium hypochlorite?
Sodium hypochlorite is generally used dissolved in water at various concentrations. Although available, solid sodium hypochlorite is not commercially used. Sodium hypochlorite solutions are clear, greenish to yellow liquids with an odor of chlorine. Calcium hypochlorite is a white solid that readily decomposes in water releasing oxygen and chlorine. It also has a strong chlorine odor. Neither compound occur naturally in the environment. Sodium and calcium hypochlorite are used primarily as bleaching agents or disinfectants. They are components of commercial bleaches, cleaning solutions, and disinfectants for drinking water and waste water purification systems and swimming pools. is an electrically charged atom or molecule). These ions may react with other substances found in the water. Sodium and calcium hypochlorite do not accumulate in the food chain.

How might I be exposed to sodium and calcium hypochlorite?


You can be exposed to low levels of sodium and calcium hypochlorite if you use disinfectants like household bleach. You can also be exposed by swimming in pools where these chemicals were added to kill bacteria. Drinking water from public drinking water supplies where these chemicals were added to kill bacteria. Workers employed in occupations where these compounds are used to bleach paper and textiles may be subject to slightly higher levels of exposure.

What happens to sodium and calcium hypochlorite when they enter the environment?
When released to air, sodium and calcium hypochlorite are broken down by sunlight and compounds commonly found in the air. In water and soil, sodium and calcium hypochlorite separate into sodium, calcium and hypochlorite ions (an ion

How can sodium and calcium hypochlorite affect my health?


The toxic effects of sodium and calcium hypochlorite are due primarily to the corrosive properties of hypochlorite. If you ingest a small amount of household bleaches (3-6%

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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hypochlorite) you may experience gastrointestinal irritation. If you ingest a more concentrated commercial bleach (10% or higher hypochlorite) or hypochlorite powder you may suffer severe corrosive injuries to the mouth, throat, esophagus and stomach with bleeding, perforation, and eventually death. Permanent scars and narrowing of the esophagus may occur in survivors of severe intoxication. If you inhale chlorine gas released from concentrated hypochlorite solutions you may experience nasal irritation, sore throat, and coughing. Contact of strong hypochlorite solutions with your skin may cause burning pain, inflammation, and blisters. Contact of the eye with mild bleach solutions may cause mild and transitory irritation. More concentrated solutions may cause severe eye injuries. Long-term exposure to low levels of hypochlorite can cause dermal irritation. We do not know if exposure to chlorine can result in reproductive effects. We do not know if exposure to sodium and calcium hypochlorite can result in birth defects or other developmental effects.

How can families reduce the risk of exposure to sodium and calcium hypochlorite?
Most families will not be exposed to high levels of sodium or calcium hypochlorite. Household products containing sodium or calcium hypochlorite should be stored in safe locations, out of the reach of children.

Is there a medical test to show whether Ive been exposed to sodium and calcium hypochlorite?
Specific tests for the presence of sodium, calcium or chlorine in the blood or urine are not generally useful. If a severe exposure has occurred, blood and urine analyses and other tests may show whether damage has occurred to the lungs and gastrointestinal tract. Some of these tests can be performed in a doctors office. Some testing may require hospital facilities.

How likely are sodium and calcium hypochlorite to cause cancer?


The International Agency for Research on Cancer (IARC) has determined that hypochlorite salts are not classifiable as to their carcinogenicity to humans.

Has the federal government made recommendations to protect human health?


The Food and Drug Administration (FDA) has set a limit for chlorine, as sodium hypochlorite or calcium hypochlorite, not to exceed 0.0082 or 0.0.036 pounds, respectively, of chlorine per pound of dry food starch.

How can sodium and calcium hypochlorite affect children?


Children are probably affected by exposure to sodium and calcium hypochlorite in the same ways as adults. We do not know whether children differ from adults in their susceptibility to sodium and calcium hypochlorite. In general, children may be more vulnerable to corrosive agents than adults because of the smaller diameter of their airways.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CARBON DISULFIDE
CAS # 75-15-0
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about carbon disulfide. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to carbon disulfide can occur by breathing it in the air and by drinking water or eating foods that contain it. Breathing very high levels can be life threatening because of its effects on the nervous system. Breathing low levels for long periods may result in headaches, tiredness, trouble sleeping, and slight changes in the nerves. Carbon disulfide has been found in at least 210 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
q Carbon disulfide evaporates rapidly when released to the environment. q Most carbon disulfide in the air and surface water is from manufacturing and processing activities. q It is found naturally in coastal and ocean waters. q Carbon disulfide does not stay dissolved in water very long, and it also moves through soils fairly quickly. q Carbon disulfide does not appear to be taken up in significant amounts by the organisms living in water.

What is carbon disulfide? (Pronounced krbn d-slfd)


Pure carbon disulfide is a colorless liquid with a pleasant odor that is like the smell of chloroform. The impure carbon disulfide that is usually used in most industrial processes is a yellowish liquid with an unpleasant odor, like that of rotting radishes. Carbon disulfide evaporates at room temperature, and the vapor is more than twice as heavy as air. It easily explodes in air and also catches fire very easily. In nature, small amounts of carbon disulfide are found in gases released to the earths surface as, for example, in volcanic eruptions or over marshes. Commercial carbon disulfide is made by combining carbon and sulfur at very high temperatures.

How might I be exposed to carbon disulfide?


q The people most often exposed to carbon disulfide are workers in plants that use carbon disulfide in their manufacturing processes. q People may be exposed by breathing air, drinking water, or eating foods that contain it. q People may also be exposed through skin contact with soil, water, or other substances that contain carbon disulfide.

What happens to carbon disulfide when it enters the environment?


q The amount of carbon disulfide released into the air through natural processes is difficult to judge because it is so small.

How can carbon disulfide affect my health?


At very high levels, carbon disulfide may be life-threatening because of its effects on the nervous system. People who

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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CARBON DISULFIDE CAS # 75-15-0

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breathed carbon disulfide near an accident involving a railroad car showed changes in breathing and some chest pains. Some workers who breathed high levels during working hours for at least 6 months had headaches, tiredness, and trouble sleeping. However, these workers may have been exposed to other chemicals besides carbon disulfide. Among workers who breathed lower levels, some developed very slight changes in their nerves. Studies in animals indicate that carbon disulfide can affect the normal functions of the brain, liver, and heart. After pregnant rats breathed carbon disulfide in the air, some of the newborn rats died or had birth defects. High concentrations of carbon disulfide have caused skin burns when the chemical accidentally touched people's skin. These tests arent available at most doctors offices, but can be done at special laboratories that have the right equipment.

Has the federal government made recommendations to protect human health?


The EPA requires that spills or accidental releases into the environment of 100 pounds or more of carbon disulfide be reported to the EPA. The Occupational Safety and Health Administration (OSHA) has set a limit of 20 parts of carbon disulfide per million parts of air (20 ppm) for an 8-hour workday for a 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) recommends that workroom air levels of carbon disulfide not exceed 1 ppm for a 10-hour workday, 40hour workweek.

How likely is carbon disulfide to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified carbon disulfide for carcinogenicity. There are no definitive data in humans or animals that indicate a carcinogenic potential for carbon disulfide.

Glossary
Carcinogenicity: Ability of a substance to cause cancer. CAS: Chemical Abstracts Service. Dissolve: To disappear gradually. Evaporate: To change into vapor or a gas.

Is there a medical test to show whether Ive been exposed to carbon disulfide?
One chemical test using urine can be done to tell whether the levels of breakdown substances from carbon disulfide are higher than normal. However, the test is not specific for carbon disulfide exposure. A second test based on a specific breakdown substance is more sensitive and specific. It also requires special equipment and cannot tell you exactly how much carbon disulfide you were exposed to or predict whether harmful effects will occur.

Source of Information
This ToxFAQs information is taken from the 1996 Toxicological Profile for Carbon Disulfide produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CARBON TETRACHLORIDE
CAS # 56-23-5
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about carbon tetrachloride. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to carbon tetrachloride results mostly from breathing air, drinking water, or coming in contact with soil that is contaminated with it. This is most likely to occur around hazardous waste sites or in the workplace. In people, exposure to very high amounts of carbon tetrachloride can damage the liver, kidneys, and nervous system. This chemical has been found in at least 326 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is carbon tetrachloride? (Pronounced krbn ttr klrd)
Carbon tetrachloride is a manufactured compound that does not occur naturally. It's a clear liquid with a sweet smell that can be detected at low levels. It's also called carbon chloride, methane tetrachloride, perchloromethane, tetrachloroethane, or benziform. Trade names include Benzinoform, Freon 10, Halon 104, Tetraform, or Tetrasol. Carbon tetrachloride is most often found as a colorless gas. It's not flammable and doesn't dissolve in water very easily. It was used in the production of refrigeration fluid and propellants for aerosol cans, as a pesticide, as a cleaning fluid and degreasing agent, in fire extinguishers, and in spot removers. Because of its harmful effects, these uses are now banned and it is only used in some industrial applications. G It can be broken down or transformed in soil and water within several days. G When it does break down, it forms chemicals that can destroy ozone in the upper atmosphere. G It doesn't build up in animals. We do not know if it builds up in plants.

How might I be exposed to carbon tetrachloride?


G Breathing contaminated air near manufacturing plants or waste sites. G Breathing workplace air when it is used. G Drinking contaminated water near manufacturing plants and waste sites. G Breathing contaminated air and skin contact with water while showering or cooking with contaminated water. G Swimming or bathing in contaminated water. G Contact with or eating contaminated soil at waste sites.

What happens to carbon tetrachloride when it enters the environment?


G It moves very quickly into the air upon release, so most of it is in the air. G It evaporates very quickly from soil and surface water. G Only a small amount sticks to soil particles; the rest evaporates or moves into the groundwater. G It is very stable in air (lifetime of 30-100 years).

How can carbon tetrachloride affect my health?


High exposure to carbon tetrachloride can cause liver, kidney, and central nervous system damage. These effects result from either eating, drinking, or breathing it, and possibly from exposure to the skin. The liver is especially sensitive to carbon tetrachloride because it swells and cells

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are damaged or destroyed. Kidneys are also damaged, causing a buildup of wastes in the blood. If exposure is low and then stops, the liver and kidneys can repair the damaged cells and function normally again.

Has the federal government made recommendations to protect human health?

The Environmental Protection Agency (EPA) has set a limit of 0.005 parts of carbon tetrachloride per million parts If exposure is very high, the nervous system, including the of drinking water (0.005 ppm). The EPA recommends that brain, is affected. People may feel intoxicated and experience drinking water exposures should not exceed 0.3 ppm for headaches, dizziness, sleepiness, and nausea and vomiting. adults and 0.07 ppm for children for long periods of time (7 These effects may subside if exposure is stopped, but in severe years). cases, coma and even death can occur. The EPA has also set limits on how much carbon tetraThere have been no studies in people on carbon chloride can be released from an industrial plant into wastetetrachloride's effects on reproduction or development, but water and is preparing to set limits on how much can be studies in rats showed no adverse effects. released into outside air.

How likely is carbon tetrachloride to cause cancer?


The Department of Health and Human Services has determined that carbon tetrachloride may reasonably be anticipated to be a carcinogen. Animals that ingested carbon tetrachloride over a long time developed liver cancer. We do not know if breathing carbon tetrachloride causes cancer in animals. We also do not know if breathing or ingesting it will cause cancer in people.

The Occupational Safety and Health Administration (OSHA) set a maximum concentration limit in workplace air of 10 ppm for an 8-hour workday over a 40-hour workweek.

Glossary
Carcinogen: A substance that can cause cancer. Evaporate: To change into a vapor or a gas. Ingesting: Taking food or drink into your body.

Is there a medical test to show whether Ive been exposed to carbon tetrachloride?
Several sensitive and specific tests are available to measure the amount of carbon tetrachloride in your breath, blood, urine, and body tissues. The tests can't tell you how much carbon tetrachloride you were exposed to or whether there will be any effects on your health. The tests must be done soon after exposure because it leaves your body quickly. These tests aren't routinely performed in doctors' offices, but your doctor can tell you where to obtain such a test.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1994. Toxicological profile for carbon tetrachloride. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Case studies in environmental medicine. Carbon tetrachloride toxicity. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CESIUM
CAS #7440-46-2
Division of Toxicology ToxFAQsTM July 2001

This fact sheet answers the most frequently asked health questions (FAQs) about cesium. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to stable or radioactive cesium occurs from ingesting contaminated food or drinking water or breathing contaminated air. High levels of radioactive cesium can cause nausea, vomiting, diarrhea, bleeding, coma, and even death. This may occur after nuclear accidents or detonation of atomic bombs. Stable (non-radioactive) cesium has been found in at least 10 of the 1,585 National Priority List (NPL) sites identified by the Environmental Protection Agency (EPA). Radioactive cesium has been found in at least 22 of the 1,585 NPL sites identified by the EPA.
What is cesium?
Cesium is a naturally occurring element found combined with other elements in rocks, soil, and dust in low amounts. Naturally occurring cesium is not radioactive and is referred to as stable cesium. There is only one stable form of cesium naturally present in the environment, 133Cs (read as cesium one-thirty-three). Nuclear explosions or the breakdown of uranium in fuel elements can produce two radioactive forms of cesium, 134Cs and 137Cs. Both isotopes decay into non-radioactive elements. 134 Cs and 137Cs generate beta particles as they decay. It takes about 2 years for half of 134Cs to give off its radiation and about 30 years for 137Cs; this period of time is called the half-life.

How might I be exposed to cesium? You can be exposed to low levels of stable or radioactive
cesium by breathing air, drinking water, or eating food containing cesium. Food and drinking water are the largest sources of exposure to cesium. You can be exposed to radioactive cesium if you eat food that was grown in contaminated soil. Working in industries that process or use natural cesium or cesium compounds. Living near uncontrolled radioactive waste sites containing cesium.

How can cesium affect my health?


It is highly unlikely that you would be exposed to high enough amounts of stable cesium to cause harmful health effects. Laboratory animals given very large amounts of cesium compounds showed changes in behavior, such as increased or decreased activity. Exposure to large amounts of radioactive cesium can damage cells in your body from the radiation You might also experience acute radiation syndrome which includes nausea, vomiting, diarrhea, bleeding, coma, and even death in the case of very high exposures.

What happens to cesium when it enters the environment?


Stable cesium in air can travel long distances before settling to the ground or water. Most cesium compounds dissolve in water. In most soils, most cesium compounds are very soluble. Cesium binds strongly to most soils and does not travel far below the surface of the soil. Radioactive decay is the only way of decreasing the amount of 134Cs and 137Cs in the environment.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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How likely is cesium to cause cancer?


There are no studies regarding non radioactive cesium and cancer. There are no human studies that specifically associate exposure to radioactive cesium with increased cancer risk. Because radioactive cesium emits ionizing radiation, carcinogenic effects similar to those observed in Japanese survivors of the atomic bombing incidents might be expected among individuals acutely exposed to very high levels of radiation from a radioactive cesium source. Rats exposed to high doses of radiation from 137Cs had increased risk of mammary tumors. Older rats seemed more resistant than younger ones.

Is there a medical test to show whether Ive been exposed to cesium?


Everyone has small amounts of cesium in their bodies. There are special laboratory tests to measure cesium in blood, urine, feces, and tissues. These tests are most useful for people exposed to high levels, but will not predict whether harmful effects will occur. If a person has been exposed to radioactive cesium, special tests can be used to measure levels of radiation in blood, feces, or urine. However, it is difficult to determine if a person has been exposed only to external radiation from radioactive cesium.

How can cesium affect children?


Children can be affected by cesium in the same ways as adults. Infants born to atomic bomb survivors exposed to high doses of ionizing radiation while pregnant, showed later signs of decreased mental abilities. Exposure to the radiation from radioactive cesium has caused birth defects in animals.

Has the federal government made recommendations to protect human health?


The EPA has established a maximum contaminant level of 4 millirem per year for beta particles and photon radioactivity for man-made radionuclides (including radioactive cesium The National Institute for Occupational Safety and Health (NIOSH) recommends a limit of 2 milligrams of cesium hydroxide per cubic meter of air (2 mg/m3) as an average for a 10-hour workday, 40-hour workweek. The Nuclear Regulatory Commission (NRC) has set occupational air limits of 0.04 Ci/m3 for 134Cs and 0.06 Ci/ m3 for 137Cs. NRC also set a limit intake of 0.1 mCi for 134Cs and 0.2 mCi for 137Cs for on-the-job exposure.

How can families reduce the risk of exposure to cesium?


Since cesium is naturally found in the environment, we cannot avoid being exposed to it. However, these relatively low amounts do not warrant immediate steps to reduce exposure. In the unlikely case that you are exposed to high levels of radioactive cesium because of accidental release at a nuclear plant or a nuclear weapon has been detonated, follow the advice of public health officials who will publish appropriate guidelines for reducing exposure.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for Cesium (Draft for Public Comment). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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CHLORDANE
CAS # 57-74-9
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about chlordane. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to chlordane occurs mostly from eating contaminated foods, such as root crops, meats, fish, and shellfish, or from touching contaminated soil. High levels of chlordane can cause damage to the nervous system or liver. This chemical has been found in at least 171 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is chlordane? (Pronounced klrdn)
Chlordane is a manufactured chemical that was used as a pesticide in the United States from 1948 to 1988. Technical chlordane is not a single chemical, but is actually a mixture of pure chlordane mixed with many related chemicals. It doesn't occur naturally in the environment. It is a thick liquid whose color ranges from colorless to amber. Chlordane has a mild, irritating smell. Some of its trade names are Octachlor and Velsicol 1068. Until 1983, chlordane was used as a pesticide on crops like corn and citrus and on home lawns and gardens. Because of concern about damage to the environment and harm to human health, the Environmental Protection Agency (EPA) banned all uses of chlordane in 1983 except to control termites. In 1988, EPA banned all uses. q It can stay in the soil for over 20 years. q Most chlordane leaves soil by evaporation to the air. q It breaks down very slowly. q Chlordane doesnt dissolve easily in water. q It builds up in the tissues of fish, birds, and mammals.

How might I be exposed to chlordane?


q By eating crops grown in soil that contains chlordane. q By eating fish or shellfish caught in water that is contaminated by chlordane. q By breathing air or touching soil near homes treated for termites with chlordane. q By breathing air or by touching soil near waste sites or landfills.

How can chlordane affect my health?


Chlordane affects the nervous system, the digestive system, and the liver in people and animals. Headaches, irritability, confusion, weakness, vision problems, vomiting, stomach cramps, diarrhea, and jaundice have occurred in people who breathed air containing high concentrations of chlordane or accidentally swallowed small amounts of chlordane. Large amounts of chlordane taken by mouth can cause convulsions and death in people.

What happens to chlordane when it enters the environment?


q Chlordane entered the environment when it was used as a pesticide on crops, on lawns and gardens, and to control termites. q Chlordane sticks strongly to soil particles at the surface and is not likely to enter groundwater.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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CHLORDANE CAS # 57-74-9

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


A man who had long-term skin contact with soil containing high levels of chlordane had convulsions. Japanese workers who used chlordane over a long period of time had minor changes in liver function. Animals given high levels of chlordane by mouth for short periods died or had convulsions. Long-term exposure caused harmful effects in the liver of test animals. than 60 parts of chlordane per billion parts of drinking water (60 ppb) for longer than 1 day. EPA has set a limit in drinking water of 2 ppb. EPA requires spills or releases of chlordane into the environment of 1 pound or more to be reported to EPA.

The Food and Drug Administration (FDA) limits the amount of chlordane and its breakdown products in most We do not know whether chlordane affects the ability of fruits and vegetables to less than 300 ppb and in animal fat people to have children or whether it causes birth defects. Ani- and fish to less than 100 ppb. mals exposed before birth or while nursing developed behavThe Occupational Safety and Health Administration ioral effects later. (OSHA), the National Institute for Occupational Health and Safety (NIOSH), and the American Conference of Governmental Industrial Hygienists (ACGIH) set a maximum level of 0.5 How likely is chlordane to cause cancer? milligrams of chlordane per cubic meter (mg/m3) in workThe International Agency for Research on Cancer has place air for an 8-hour workday, 40-hour workweek. These determined that chlordane is not classifiable as to its carcinoagencies have advised that eye and skin contact should be genicity to humans. Studies of workers who made or used avoided because this may be a significant route of exposure. chlordane do not show that exposure to chlordane is related to cancer, but the information is not sufficient to know for sure. Mice fed low levels of chlordane in food developed liver canGlossary cer. Carcinogenicity: Ability to cause cancer.

Is there a medical test to show whether Ive been exposed to chlordane?

Long-term: Lasting one year or longer. Milligram (mg): One thousandth of a gram.

Laboratory tests can measure chlordane and its breakdown Pesticide: A substance that kills pests. products in blood, fat, urine, feces, and breast milk. The ppb: Parts per billion. amount of breakdown products measured in body fat or breast milk does not tell how much or how long ago you were exposed to chlordane or if harmful effects will occur. References

Has the federal government made recommendations to protect human health?


In 1988, the EPA banned all uses of chlordane. The EPA recommends that a child should not drink water with more

Agency for Toxic Substances and Disease Registry (ATSDR). 1994. Toxicological profile for chlordane (update). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CHLORFENVINPHOS
CAS # 470-90-6
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about chlorfenfinphos. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Chlorfenvinphos is an insecticide which is no longer used in the United States. Ingesting chlorfenvinphos results primarily on nervous system effects, such as headaches, blurred vision, weakness, and confusion. Chlorfenvinphos been found in at least 1 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
q It may leach into soil and underground water. q It may also be found in surface waters from rain. q Chlorfenvinphos may move from soil to the air by evaporation. q It does not appear to accumulate in plants, fish, or freshwater animals.

What is chlorfenvinphos? (Pronounced klr fn vn-fs)


Chlorfenvinphos is an insecticide that is a colorless liquid with a mild odor. It was commonly used until 1991 when all products containing chlorfenvinphos as an active ingredient were canceled in the United States. Commercial preparations commonly sold in stores were usually 90% chlorfenvinphos. Most of the chlorfenvinphos used was in liquid form. Chlorfenvinphos was widely used to control household pests such as flies, fleas, and mice. The chemical is manufactured and does not occur naturally in the environment. It was sold under common trade names including Birlane, Dermaton, Sapercon, Steladone, and Supona. Use of trade names is for identification only and does not imply endorsement by the Agency for Toxic Substances and Disease Registry, the Public Health Service, or the U.S. Department of Health and Human Services.

How might I be exposed to chlorfenvinphos?


q The most common way to be exposed is by eating imported agricultural products contaminated with it. q Another way to be exposed is by using pharmaceutical products that contain lanolin, a natural grease from sheeps wool (chlorfenvinphos is often used to control flies in animal buildings and can contaminate sheeps wool). q If you breathe air or touch soil near a hazardous waste site containing chlorfenvinphos, you could be exposed to it. q If you work in the disposal of chlorfenvinphos or its wastes you are most likely to be exposed.

What happens to chlorfenvinphos when it enters the environment?


q Chlorfenvinphos enters the environment from runoff after rainfall and leaching from hazardous waste sites.

How can chlorfenvinphos affect my health?


The major effect of chlorfenvinphos is on the nervous system. Ingesting large doses may cause nausea and vomit-

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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ing, abdominal cramps, diarrhea, difficulty in breathing, and fainting. Lower doses may cause headaches, dizziness, weakness, confusion, runny nose, and inability to see clearly. These symptoms may start within 30-60 minutes and reach their maximum effect after 6-8 hours. There is no evidence that long-term exposure to small amounts of chlorfenvinphos causes any harmful health effects in people. It is not known whether chlorfenvinphos can affect reproduction or cause birth defects in people. One animal study reported decreased fertility in rats given chlorfenvinphos in their food, and another study reported that chlorfenvinphos interfered with the development of rats when the pregnant animals were fed chlorfenvinphos. Specific tests are available to identify chlorfenvinphos or its breakdown products in your blood, body tissue, and urine. These tests arent available at most doctors offices, but can be done at special laboratories that have the right equipment.

Has the federal government made recommendations to protect human health?


The EPA requires that spills or accidental releases into the environment of 500 pounds or more of chlorfenvinphos be reported to the EPA. The Food and Drug Administration (FDA) has set tolerances for chlorfenvinphos for agricultural products ranging from 0.005 to 0.2 parts chlorfenvinphos per million parts of food (0.005-0.2 ppm).

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Fertility: Ability to have children. Ingest: To eat or drink something. Insecticide: A substance that kills insects. Long-term: 365 days or longer. ppm: Parts per million.

How likely is chlorfenvinphos to cause cancer?


It is not known whether chlorfenvinphos causes cancer in people. The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified chlorfenvinphos for carcinogenicity.

Source of Information Is there a medical test to show whether Ive been exposed to chlorfenvinphos?
There is a general test that can be used to determine if you have been exposed to a group of insecticides, including chlorfenvinphos. This test measures the activity of an enzyme called acetylcholinesterase in the blood. This test requires only a small amount of blood and can be done in your doctors office. It does not specifically show exposure to chlorfenvinphos. This ToxFAQs information is taken from the 1997 Toxicological Profile for Chlorfenvinphos produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CHLORINATED DIBENZO-p-DIOXINS (CDDs)


Agency for Toxic Substances and Disease Registry ToxFAQs February 1999

This fact sheet answers the most frequently asked health questions (FAQs) about chlorinated dibenzo-p-dioxins (CDDs). For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to chlorinated dibenzo-p-dioxins (CDDs) (75 chemicals) occurs mainly from eating food that contains the chemicals. One chemical in this group, 2,3,7,8-tetrachlorodibenzo-p-dioxin or 2,3,7,8-TCDD, has been shown to be very toxic in animal studies. It causes effects on the skin and may cause cancer in people. This chemical has been found in at least 91 of 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are CDDs?
CDDs are a family of 75 chemically related compounds commonly known as chlorinated dioxins. One of these compounds is called 2,3,7,8-TCDD. It is one of the most toxic of the CDDs and is the one most studied. In the pure form, CDDs are crystals or colorless solids. CDDs enter the environment as mixtures containing a number of individual components. 2,3,7,8-TCDD is odorless and the odors of the other CDDs are not known. CDDs are not intentionally manufactured by industry except for research purposes. They (mainly 2,3,7,8-TCDD) may be formed during the chlorine bleaching process at pulp and paper mills. CDDs are also formed during chlorination by waste and drinking water treatment plants. They can occur as contaminants in the manufacture of certain organic chemicals. CDDs are released into the air in emissions from municipal solid waste and industrial incinerators. q When released in waste waters, some CDDs are broken down by sunlight, some evaporate to air, but most attach to soil and settle to the bottom sediment in water. q CDD concentrations may build up in the food chain, resulting in measurable levels in animals.

How might I be exposed to CDDs?


q Eating food, primarily meat, dairy products, and fish, makes up more than 90% of the intake of CDDs for the general population. q Breathing low levels in air and drinking low levels in water. q Skin contact with certain pesticides and herbicides. q Living near an uncontrolled hazardous waste site containing CDDs or incinerators releasing CDDs. q Working in industries involved in producing certain pesticides containing CDDs as impurities, working at paper and pulp mills, or operating incinerators.

How can CDDs affect my health? What happens to CDDs when they enter the environment?
q When released into the air, some CDDs may be transported long distances, even around the globe. The most noted health effect in people exposed to large amounts of 2,3,7,8-TCDD is chloracne. Chloracne is a severe skin disease with acne-like lesions that occur mainly on the face and upper body. Other skin effects noted in people exposed to high doses of 2,3,7,8-TCDD include skin rashes, dis-

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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CHLORINATED DIBENZO-p-DIOXINS (CDDs)

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coloration, and excessive body hair. Changes in blood and urine that may indicate liver damage also are seen in people. Exposure to high concentrations of CDDs may induce longterm alterations in glucose metabolism and subtle changes in hormonal levels. In certain animal species, 2,3,7,8-TCDD is especially harmful and can cause death after a single exposure. Exposure to lower levels can cause a variety of effects in animals, such as weight loss, liver damage, and disruption of the endocrine system. In many species of animals, 2,3,7,8-TCDD weakens the immune system and causes a decrease in the systems ability to fight bacteria and viruses. In other animal studies, exposure to 2,3,7,8-TCDD has caused reproductive damage and birth defects. Some animal species exposed to CDDs during pregnancy had miscarriages and the offspring of animals exposed to 2,3,7,8-TCDD during pregnancy often had severe birth defects including skeletal deformities, kidney defects, and weakened immune responses.

How can families reduce the risk of exposure to CDDs?


q Children should avoid playing in soils near uncontrolled hazardous waste sites. q Discourage children from eating dirt or putting toys or other objects in their mouths. q Everyone should wash hands frequently if playing or working near uncontrolled hazardous waste sites. q For new mothers and young children, restrict eating foods from the proximity of uncontrolled sites with known CDDs.

Is there a medical test to show whether Ive been exposed to CDDs?


Tests are available to measure CDD levels in body fat, blood, and breast milk, but these tests are not routinely available. Most people have low levels of CDDs in their body fat and blood, and levels considerably above these levels indicate past exposure to above-normal levels of 2,3,7,8-TCDD. Although CDDs stay in body fat for a long time, tests cannot be used to determine when exposure occurred.

How likely are CDDs to cause cancer?


Several studies suggest that exposure to 2,3,7,8-TCDD increases the risk of several types of cancer in people. Animal studies have also shown an increased risk of cancer from exposure to 2,3,7,8-TCDD. The World Health Organization (WHO) has determined that 2,3,7,8-TCDD is a human carcinogen. The Department of Health and Human Services (DHHS) has determined that 2,3,7,8-TCDD may reasonably be anticipated to cause cancer.

Has the federal government made recommendations to protect human health?


The EPA has set a limit of 0.00003 micrograms of 2,3,7,8-TCDD per liter of drinking water (0.00003 g/L). Discharges, spills, or accidental releases of 1 pound or more of 2,3,7,8-TCDD must be reported to EPA. The Food and Drug Administration (FDA) recommends against eating fish and shellfish with levels of 2,3,7,8-TCDD greater than 50 parts per trillion (50 ppt).

How can CDDs affect children?


Very few studies have looked at the effects of CDDs on children. Chloracne has been seen in children exposed to high levels of CDDs. We don't know if CDDs affect the ability of people to have children or if it causes birth defects, but given the effects observed in animal studies, this cannot be ruled out.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1998. Toxicological profile for chlorinated dibenzop-dioxins. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CHLORINE
CAS #7782-50-5
Division of Toxicology ToxFAQsTM April 2002

This fact sheet answers the most frequently asked health questions (FAQs) about chlorine. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: People working in facilities that use chlorine to manufacture other chemicals have the highest risk of being exposed to chlorine. Chlorine gas can cause irritation of the eyes, skin, and respiratory tract. Exposure to high levels can result in corrosive damage to the eyes, skin, and respiratory tissues, and could lead to pulmonary edema and even death in extreme cases. Chlorine gas has been found in at least 60 of the 1,591 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is chlorine?
At room temperature, chlorine is a yellow-green gas that is heavier than air and has a strong irritating odor. It can be converted to a liquid under pressure or cold temperatures. Chlorine is mainly used as a bleach in the manufacture of paper and cloth and to make a wide variety of products.

How might I be exposed to chlorine?


The general population is probably not exposed to chlorine gas, but may be exposed to products which are made from chlorine like sodium hypochlorite which is used as a disinfectant in public drinking water and swimming pools and as a common household bleach. Chlorine gas is used to synthesize other chemicals and to make bleaches and disinfectants. Therefore workers employed in occupations where these products are made may inhale chlorine gas or get it on their skin.

What happens to chlorine when it enters the environment?


When released to air, chlorine will react with water to form hypochlorous acid and hydrochloric acid, which are removed from the atmosphere by rainfall. Chlorine is slightly soluble in water. It reacts with water to form hypochlorous acid and hydrochloric acid. The hypochlorous acid breaks down rapidly. The hydrochloric acid also breaks down; its breakdown products will lower the pH of the water (makes it more acidic). Since chlorine is a gas it is rarely found in soil. If released to soil, chlorine will react with moisture forming hypochlorous acid and hydrochloric acid. These compounds can react with other substances found in soil. Chlorine does not accumulate in the food chain.

How can chlorine affect my health?


Chlorine gas is irritating and corrosive to the respiratory tract, eyes, and skin. The effects depend on how much you are exposed to and for how long. Exposure to low concentrations of chlorine gas (1 to 10 ppm) may cause sore throat, coughing, and eye and skin irritation. Exposure to higher levels could cause burning of the eyes and skin, rapid breathing, narrowing of the bronchi, wheezing, blue coloring of the skin, accumulation of fluid in the lungs, and pain in the lung region. Exposure to even higher levels can produce severe eye and skin burns, lung collapse, and death.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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CHLORINE
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CAS #7782-50-5

Some people may develop an inflammatory reaction to chlorine. This condition is called reactive airways dysfunction syndrome (RADS), a type of asthma caused by some irritating or corrosive substances. If you were to come into skin contact with liquified chlorine, you could experience frostbite. If you swallow a product that contains sodium hypochlorite, corrosive chlorine gas could be produced in your stomach and cause serious corrosive injury. We do not know if exposure to chlorine can result in reproductive effects.

How can families reduce the risk of exposure to chlorine?


Most families will not be exposed to high levels of chlorine gas. Household products containing substances such as sodium hypochlorite (which may release chlorine gas) should be stored in safe locations, out of the reach of children.

Is there a medical test to show whether Ive been exposed to chlorine?


Specific tests for the presence of chlorine in the blood or urine are not generally useful. If a severe exposure has occurred, blood and urine analyses and other tests may show whether damage has occurred to the lungs and gastrointestinal tract. Some of these tests can be performed in a doctors office. Some testing may require hospital facilities.

How likely is chlorine to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified chlorine as to its carcinogenicity. There is no additional information to determine whether exposure to chlorine might cause cancer.

Has the federal government made recommendations to protect human health?


The EPA has set a limit for drinking water of 4 milligrams of chlorine per liter of water (4 mg/L) and also recommends that levels of chlorine in lakes and streams be limited to 10 mg/L to prevent possible human health effects from drinking water or eating fish contaminated with this chemical. The Occupational Safety and Health Administration (OSHA) set a ceiling limit of 1 part of chlorine per million parts of workplace air (1 ppm). The American Conference of Governmental Industrial Hygienists (ACGIH) recommends a time-weighted average (TWA) threshold limit value (TLV) of 0.5 ppm of chlorine for an 8-hour per day, 40-hour work week, and a short-term exposure level (STEL) of 1 ppm of chlorine.

How can chlorine affect children?


Children can be affected by exposure to chlorine in the same ways as adults. We do not know whether children differ from adults in their susceptibility to chlorine. In general, children may be more vulnerable to corrosive agents than adults because of the smaller diameter of their airways. We do not know if exposure to chlorine can result in birth defects or other developmental effects.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CHLORINE DIOXIDE and CHLORITE


CAS # 10049-04-4 and 7758-19-2
Division of Toxicology ToxFAQsTM September 2002

This fact sheet answers the most frequently asked health questions (FAQs) about chlorine dioxide and chlorite. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Chlorine dioxide is a gas that does not occur naturally in the environment. It is used to disinfect drinking water and make it safe to drink. Chlorite is formed when chlorine dioxide reacts with water. High levels of chlorine dioxide can be irritating to the nose, eyes, throat, and lungs. Chlorine dioxide and chlorite have not been found in any of the 1,613 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are chlorine dioxide and chlorite?
Chlorine dioxide is a yellow to reddish-yellow manufactured gas. It does not occur naturally in the environment. Chlorine dioxide is used as a bleach at paper manufacturing plants, and in public water treatment facilities to make water safe to drink. About 5% of the water treatment facilities serving more than 100,000 people in the United States use chlorine dioxide to treat drinking water. In 2001, chlorine dioxide was used to decontaminate a number of public buildings following the release of anthrax spores in the United States. When it reacts in water, chlorine dioxide forms chlorite ion, a compound which is also very reactive. Chlorite ions in water combine with metal ions to form soluble salts, like sodium chlorite. ! Chlorite ions in water may move into groundwater, although reaction with soil and sediments may reduce the amount chlorite ions reaching groundwater. ! Neither chlorine dioxide nor chlorite ions build up in the food chain.

How might I be exposed to chlorine dioxide and chlorite?


! Chlorine dioxide is added to drinking water to protect people from harmful bacteria and other microorganisms. ! Most people will be exposed to small amounts chlorine dioxide and chlorite ions by drinking water treated with chlorine dioxide. ! Individuals who are employed at pulp and paper mills, municipal water treatment facilities, and other facilities that use chlorine dioxide as a disinfectant may have high exposures to chlorine dioxide and chlorite (ions or salts).

What happens to chlorine dioxide and chlorite when they enter the environment?
! Chlorine dioxide is a very reactive compound and will not exist in the environment for long periods of time. ! In air, sunlight will rapidly break down chlorine dioxide into chlorine gas and oxygen. ! In water, chlorine dioxide will quickly form chlorite ions. ! Chlorite ions do not exist in air.

How can chlorine dioxide and chlorite affect my health?


Both chlorine dioxide and chlorite react quickly in water or moist body tissues. Breathing air containing chlorine dioxide gas may cause nose, throat, and lung irritation. Eating or drinking large amounts of chlorite salts may cause irritation in the mouth, esophagus, or stomach. There is no evidence that chlorine dioxide or chlorite affect reproduction in humans.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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CHLORINE DIOXIDE and CHLORITE


CAS # 10049-04-4 and 7758-19-2
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

Studies in animals exposed to high amounts of chlorine dioxide or chlorite have shown effects similar to those seen in exposed people.

Is there a medical test to show whether Ive been exposed to chlorine dioxide and chlorite?
There are no routine medical tests available to measure chlorine dioxide or chlorite in the body. There is a special test to measure chlorite in tissues, blood, urine, and feces, but the test cannot tell the extent of the exposure or whether harmful effects will occur.

How likely are chlorine dioxide and chlorite to cause cancer?


There are no studies on cancer in humans exposed to chlorine dioxide or chlorite. Based on inadequate information in humans and in animals, the International Agency for Research on Cancer (IARC) and the EPA have determined that chlorine dioxide and sodium chlorite are not classifiable as to human carcinogenicity.

Has the federal government made recommendations to protect human health?


The EPA has set a maximum contaminant level of 1 milligram of chlorite per liter (1 mg/L) of drinking water. The EPA also has set a goal of 0.8 mg/L for both the maximum residual disinfectant level for chlorine dioxide and the maximum contaminant level for chlorite in drinking water treated with chlorine dioxide as a disinfectant. The Occupational Safety and Health Administration (OSHA) has set a limit of 0.1 parts of chlorine dioxide per million parts of air (0.1 ppm) in the workplace during an 8-hour shift, 40-hour workweek.

How can chlorine dioxide and chlorite affect children?


There are no unique exposure pathways for children to chlorine dioxide and chlorite. Children exposed to large amounts of chlorine dioxide or chlorite would be expected to be affected in the same manner as adults. Studies in rats have shown that exposure of pregnant animals to chlorine dioxide and chlorite or exposure of pups shortly after birth may cause delays in the development of the brain. However, the exposure levels in these studies were much higher than what humans are usually exposed to in the drinking water. There are no reliable studies of effects of chlorine dioxide or chlorite in developing humans.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2002. Toxicological Profile for Chlorine Dioxide and Chlorite (Draft for Public Comment). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

How can families reduce the risk of exposure to chlorine dioxide and chlorite?
! Families that drink water treated with chlorine dioxide may reduce the risk of exposure to chlorine dioxide and chlorite by drinking bottled water that has not been treated with these chemicals.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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CHLOROBENZENE CAS # 108-90-7


Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about chlorobenzene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Chlorobenzene is used as a solvent for some pesticide formulations, as a degreaser, and to make other chemicals. High levels of chlorobenzene can damage the liver and kidneys and affect the brain. It has been found at 97 of the 1,177 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is chlorobenzene? (Pronounced klr-bnzn)
Chlorobenzene is a colorless, flammable liquid with an aromatic, almond-like odor. Some of it will dissolve in water, but it readily evaporates into air. It does not occur naturally in the environment. Chlorobenzene production in the United States has declined by more than 60% from its peak in 1960. It was used in the past to make other chemicals, such as phenol and DDT. Now chlorobenzene is used as a solvent for some pesticide formulations, to degrease automobile parts, and as a chemical intermediate to make several other chemicals. q Chlorobenzene does not build up in the food chain.

How might I be exposed to chlorobenzene?


q If you work where chlorobenzene is made or used you could be exposed by breathing air with chlorobenzene vapors or by spilling or splashing chlorobenzene on your skin. q People that live near a waste site containing chlorobenzene could be exposed by drinking contaminated groundwater, breathing vapors released to the air, or getting contaminated soil on their skin. q You could be exposed by eating food contaminated with chlorobenzene but there is not enough information to determine how often this occurs.

What happens to chlorobenzene when it enters the environment?


q Chlorobenzene released to air is slowly broken down by reactions with other chemicals and sunlight or can be removed by rain. q In water, chlorobenzene will rapidly evaporate to the air and/or be broken down by bacteria. q When released to soil, it is broken down rapidly by bacteria, but some will evaporate to the air and some may filter into the groundwater.

How can chlorobenzene affect my health?


Workers exposed to high levels of chlorobenzene in the air complained of headaches, nausea, sleepiness, numbness, and vomiting. We cannot be certain that all of these effects were due to chlorobenzene exposure because the workers may have been exposed to other chemicals. Animal studies indicate that the liver, kidney, and central nervous system are affected by exposure to chlorobenzene.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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CHLOROBENZENE CAS # 108-90-7

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


Effects on the central nervous system from breathing chlorobenzene include unconsciousness, tremors, restlessness, and death. Longer exposure has caused liver and kidney damage. The limited data available indicate that chlorobenzene does not cause birth defects or infertility. should be limited to 0.488 ppm to prevent possible health effects from drinking water or eating fish contaminated with this group of chemicals. Any release to the environment greater than 100 pounds of chlorobenzene must be reported to the EPA. The Occupational Safety and Health Administration (OSHA) has set a workplace air concentration limit of 75 ppm over an 8-hour workday, 40-hour workweek. The federal recomendations have been updated as of July 1999.

How likely is chlorobenzene to cause cancer?


It is not known whether chlorobenzene causes cancer in people. Although chlorobenzene did not produce cancer in animal studies with rats and mice, liver nodules which can lead to cancer were produced in male rats. The EPA has determined that chlorobenzene is not classifiable as to human carcinogenicity based on inadequate evidence in both humans and animals.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. National Priorities List: A list of the nations worst hazardous waste sites. Pesticide: A substance that kills pests. ppm: Parts per million. Solvent: A substance that dissolves another substance. Tremor: Trembling or shaking caused by disease or stress.

Is there a medical test to show whether Ive been exposed to chlorobenzene?


Exposure to chlorobenzene can be determined by measuring it or its metabolites in urine, exhaled air, blood, and body fat, but these tests cannot be used to predict whether harmful health effects will occur. These tests are not usually done in the doctors office because special equipment is needed.

Source of Information Has the federal government made recommendations to protect human health?
The EPA has set a Maximum Contaminant Level (MCL) of 0.1 parts per million (0.1 ppm) for chlorobenzene in drinking water. Concentrations in drinking water for short-term exposures (up to 10 days) should not exceed 2 ppm. The EPA recommends that levels of chlorinated benzenes (a group of chemicals that includes chlorobenzene) in lakes and streams Agency for Toxic Substances and Disease Registry (ATSDR). 1990. Toxicological profile for chlorobenzene. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CHLORODIBENZOFURANS (CDFs)
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about chlorodibenzofurans (CDFs). For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to chlorodibenzofurans (CDFs) occurs mainly by eating certain contaminated foods. In people, exposure to CDFs is most likely to cause skin and eye irritation, and increased vulnerability to respiratory infection and nervous system effects. This chemical has been found in at least 51 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What are chlorodibenzofurans (CDFs)? (Pronounced klr d bn-z fyrn)
Chlorinated dibenzofurans, or CDFs, are a family of chemicals that contain one to eight chlorine atoms attached to the carbon atoms of the parent chemical, dibenzofuran. There are 135 different types of CDFs with varying harmful health and environmental effects. The compounds that contain chlorine atoms at the 2,3,7,8-positions of the dibenzofuran molecule are known to be especially harmful. Not all of the different types have been found in large enough quantities to study the physical properties. However, of those that have been studied, they do not dissolve in water easily and appear to be in the form of colorless solids. There is no known use for these chemicals. Other than for research purposes, they are not deliberately produced by industry. Most CDFs are produced in small amounts as undesirable by-products of certain processes, such as manufacturing other chemicals or bleaching at paper and pulp mills. CDFs can also be released from incinerators. G CDFs exist in the air as solid particles and sometimes vapors. G They can enter the environment from car exhausts or from burning coal, wood, or oil for home heating, and the production of electricity. G Vaporized CDFs are broken down by other chemicals in the atmosphere. G They can be removed from the air in snow and rain. G They attach to soil and sediment in lakes and rivers. G They are not likely to move into groundwater from soil. G They accumulate in fish to tens of thousands times higher levels than in the water or sediment. G They also build up in other animals, birds, and people that are exposed to CDFs in their food.

How might I be exposed to CDFs?


G Eating contaminated foods, such as meat, fish, and milk (90% of daily exposure, which is only a few picograms [pg], results from eating contaminated food). G Breathing air or drinking water that is contaminated, or coming in contact with contaminated soil. G Using products such as milk cartons, coffee filters, and tampons could result in very low exposures. G Breathing contaminated workplace air.

What happens to CDFs when they enter the environment?

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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CHLORODIBENZOFURANS (CDFs)

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

How can CDFs affect my health?


Very little is known about the health effects in people or animals from breathing or touching CDFs. A study in mice showed that skin exposure to low levels over several weeks produced effects similar to those from ingesting CDFs. Most of the information on the adverse health effects comes from studies in people who were accidentally exposed to food contaminated with CDFs. The amounts that these people were exposed to were much higher than are likely from environmental exposures or from a normal diet. CDFs caused skin and eye irritations, including severe acne, darkened skin color, and swollen eyelids with discharge from the eyes. CDF poisoning also caused vomiting and diarrhea, anemia, more frequent lung infections, numbness, effects on the nervous system, and mild changes in the liver. Children born to exposed mothers had skin irritation and more difficulty learning. Many of the same effects that occurred in people also occurred in laboratory animals that ate CDFs. Animals also had severe weight loss, and their stomachs, livers, kidneys, and immune systems were seriously injured. Some animals had birth defects and testicular damage, and in severe cases, some animals died. These effects in animals were seen when they were fed large amounts of CDFs over a short time, or small amounts over several weeks or months.

breathed CDFs. One study found that when CDFs were applied to the skin of animals, they did not cause cancer, but when they were applied with another compound called MNNG, which is known to initiate tumors, cancer did develop.

Is there a medical test to show whether I've been exposed to CDFs?


There are tests available to measure CDFs in your blood, body fat, and breast milk. The tests can tell you if you have been exposed, but they can't tell you the exact amount of CDFs or for how long you were exposed. The tests also cannot predict whether you will experience harmful health effects. Nearly everyone in the United States and other industrialized countries has been exposed to low levels of CDFs because they are in the environment.

Has the federal government made recommendations to protect human health?


There are no federal guidelines or recommendations for protecting human health or the environment from exposure to CDFs.

Glossary
Anemia: A decreased ability of the blood to transport oxygen. Carcinogenicity: Ability to cause cancer. Picogram (pg): One trillionth of a gram.

How likely are CDFs to cause cancer?


The Department of Health and Human Services, the International Agency for Research on Cancer, and the Environmental Protection Agency (EPA) have not classified CDFs for carcinogenicity. It is not definitely known if CDFs cause cancer in people. There are no cancer studies in animals that ate or

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1994. Toxicological profile for chlorodibenzofurans. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information?

For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CHLOROETHANE
CAS # 75-00-3
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about chloroethane. For more information, call the ATSDR Information Center at 1-888-422-08737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to chloroethane can occur from breathing air or drinking water containing it. Exposure to high levels of chloroethane can affect your nervous system, causing lack of muscle control and unconsciousness. This substance has been found in at least 282 of the 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is chloroethane? (Pronounced klr th n)


Chloroethane is a colorless gas at room temperature and pressure. It has a characteristically sharp smell. It is a liquid when stored in pressurized containers; however, the liquid evaporates quickly when exposed to room air. Chloroethane catches fire easily. It was used in leaded gasoline, but strict new government regulations have reduced that use dramatically. It is used in the production of cellulose, dyes, medicinal drugs, and other commercial products, and as a solvent and refrigerant. It is also used to numb the skin before medical procedures such as ear piercing and skin biopsies and as a treatment in sports injuries.

G G G G

It breaks down fairly rapidly (about half disappears within 40 days) by reacting with other substances in the air. Small amounts can enter groundwater by filtering through the soil. In groundwater, chloroethane is slowly changed into a simpler form by reaction with water. Some types of bacteria in water may break it down to smaller compounds.

How might I be exposed to chloroethane?

G G G G G G

Chloroethane can be released to air from factories that manufacture or use it. It can evaporate from landfills. It can be released during its use as a solvent, refrigerant, and anesthetic. Chloroethane may be present in drinking water as a result of chlorination. People may be exposed through skin contact if it is used in a medical procedure. Workers who may be exposed include doctors, nurses, mechanics, plumbers, and painters.

What happens to chloroethane when it enters the environment?

Most chloroethane exists as a gas in the atmosphere.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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CHLOROETHANE CAS # 75-00-3

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html How can chloroethane affect my health?
Brief exposure to high levels can produce temporary feelings of drunkenness. At higher levels, it can cause lack of muscle coordination and unconsciousness. It can also cause stomach cramps, nausea, vomiting, and eye irritation. Chloroethane is sometimes applied to the skin as a numbing agent before surgery. If it is applied for too long, frostbite can result. Some people had allergic reactions to it, and others experienced mild pain after being sprayed for 10 seconds.

G G G

Make sure containers are tightly covered. Make your children aware of the harmful effects of sniffing glue, paints, and other solvents. Store products containing it safely and follow directions carefully.

Is there a medical test to show whether Ive been exposed to chloroethane?


There are complex analytical tests that chemists use to measure chloroethane in blood, milk, or urine. However, no commonly used medical tests are available to determine whether or not a person has been exposed to chloroethane.

How likely is chloroethane to cause cancer?


Laboratory tests in animals have shown that long-term exposure can cause cancer in mice. It is not known whether it causes cancer in humans. The International Agency for Research on Cancer (IARC) has concluded that chloroethane is not classifiable as to its carcinogenicity in humans.

Has the federal government made recommendations to protect human health?


EPA requires industries to report accidental discharges or spills of 100 pounds or more of chloroethane to EPA. The Occupational Safety and Health Administration (OSHA) regulates the amount of chloroethane in workplace air. The limit for an 8-hour workday, over a 40-hour workweek, is 1,000 parts per million (1,000 ppm). The American Conference of Governmental Industrial Hygienists (ACGIH) recommends a limit of 100 ppm chloroethane in workplace air.

How can chloromethane affect children?


We don't know whether chloroethane exposure can affect development in people. In animal studies, the babies of mice exposed to chloroethane during pregnancy had delayed development. It is not known whether children differ from adults in their susceptibility to chloroethane.

How can families reduce the risk of exposure to chloroethane?

G G G

Avoid using products that contain chloroethane if you are pregnant. Limit the use of consumer products that contain it. Open windows and doors when such products are used in the home.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1998. Toxicological profile for chloroethane. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CHLOROFORM
CAS # 67-66-3
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about chloroform. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to chloroform can occur when breathing contaminated air or when drinking or touching the substance or water containing it. Breathing chloroform can cause dizziness, fatigue, and headaches. Breathing chloroform or ingesting chloroform over long periods of time may damage your liver and kidneys. It can cause sores if large amounts touch your skin. This substance has been found in at least 717 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is chloroform? (Pronounced klr-frm)
Chloroform is a colorless liquid with a pleasant, nonirritating odor and a slightly sweet taste. It will burn only when it reaches very high temperatures. In the past, chloroform was used as an inhaled anesthetic during surgery, but it isnt used that way today. Today, chloroform is used to make other chemicals and can also be formed in small amounts when chlorine is added to water. Other names for chloroform are trichloromethane and methyl trichloride. G Chloroform dissolves easily in water and some of it may break down to other chemicals. G Chloroform lasts a long time in groundwater. G Chloroform doesnt appear to build up in great amounts in plants and animals.

How might I be exposed to chloroform?


G Drinking water or beverages made using water containing chloroform. G Breathing indoor or outdoor air containing it, especially in the workplace. G Eating food that contains it. G Skin contact with chloroform or water that contains it, such as in swimming pools.

What happens to chloroform when it enters the environment?


G Chloroform evaporates easily into the air. G Most of the chloroform in air breaks down eventually, but it is a slow process. G The breakdown products in air include phosgene and hydrogen chloride, which are both toxic. G It doesnt stick to soil very well and can travel through soil to groundwater.

How can chloroform affect my health?


Breathing about 900 parts of chloroform per million parts air (900 ppm) for a short time can cause dizziness, fatigue, and headache. Breathing air, eating food, or drinking water containing high levels of chloroform for long periods of time may damage your liver and kidneys. Large amounts of chloroform can cause sores when chloroform touches your skin.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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CHLOROFORM CAS # 67-66-3

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

It isnt known whether chloroform causes reproductive effects or birth defects in people. Animal studies have shown that miscarriages occurred in rats and mice that breathed air containing 30 to 300 ppm chloroform during pregnancy and also in rats that ate chloroform during pregnancy. Offspring of rats and mice that breathed chloroform during pregnancy had birth defects. Abnormal sperm were found in mice that breathed air containing 400 ppm chloroform for a few days.

Has the federal government made recommendations to protect human health?


The EPA drinking water limit for total trihalomethanes, a class of chemicals that includes chloroform, is 100 micrograms per liter of water (100 g/L). The EPA requires that spills or accidental releases of 10 pounds or more of chloroform into the environment be reported to the EPA. The Occupational Safety and Health Administration (OSHA) has set the maximum allowable concentration of chloroform in workroom air during an 8-hour workday in a 40-hour workweek at 50 ppm.

How likely is chloroform to cause cancer?


The Department of Health and Human Services (DHHS) has determined that chloroform may reasonably be anticipated to be a carcinogen. Rats and mice that ate food or drank water with chloroform developed cancer of the liver and kidneys.

Glossary
Carcinogenicity: A substance with the ability to cause cancer. CAS: Chemical Abstracts Service. Ingesting: Taking food or drink into your body. Microgram (g): One millionth of a gram.

ppm: Parts per million. Although the amounts of chloroform in the air that you exhale and in blood, urine, and body tissues can be measured, Source of Information there is no reliable test to determine how much chloroform you This ToxFAQs information is taken from the 1997 Toxicohave been exposed to or whether you will experience any logical Profile for Chloroform (update) produced by the harmful effects. Agency for Toxic Substances and Disease Registry, Public The measurement of chloroform in body fluids and tissues Health Service, U.S. Department of Health and Human Services, may help to determine if you have come into contact with Public Health Service in Atlanta, GA. large amounts of chloroform, but these tests are useful for only Animal testing is sometimes necessary to find out how a short time after you are exposed. Chloroform in your body might also indicate that you have come into contact with other toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of chemicals. research animals and scientists must follow strict guidelines.

Is there a medical test to show whether Ive been Miscarriage: Pregnancy loss. exposed to chloroform?

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CHLOROMETHANE
CAS # 74-87-3
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about chloromethane. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to high levels of chloromethane can cause serious problems to your nervous system, including convulsions and coma. It can also affect your liver, kidneys, and heart. This substance has been found in at least 172 of the 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is chloromethane? (Pronounced klr mth n)


Chloromethane is also known as methyl chloride. It is a clear, colorless gas. It has a faint, sweet odor that is noticeable only at levels that may be toxic. It is heavier than air, and it is extremely flammable.

Most of the chloromethane that is released into the environment is from natural sources, such as chemical reactions that occur in the oceans. It is also given off when materials like grass, wood, charcoal, and plastics are burned. It is present in lakes and streams and has been found in drinking water. Chloromethane is an impurity in vinyl chloride; exposure could occur from disposal of vinyl chloride waste. Other sources of exposure are cigarette smoke, polystyrene insulation, aerosol propellants, and chlorinated swimming pools.

K K K K

What happens to chloromethane when it enters the environment?


K K K K K K Chloromethane is found in air, surface water, groundwater, soil, and sediment. It is present at very low concentrations throughout the atmosphere. Chloromethane breaks down very slowly in air. It breaks down slowly in water, but certain microorganisms can break it down more quickly. Most of the chloromethane in soil will move to air. It does not concentrate in plants, animals, or fish.

How can chloromethane affect my health?


Breathing very high levels, even for a short time, can have serious effects on your nervous system, including convulsions and coma. Lower exposures can also cause staggering, blurred or double vision, dizziness, fatigue, personality changes, confusion, tremors, nausea, or vomiting. These symptoms can last for several months or years. Exposure to chloromethane can harm your liver and kidneys. It could also affect your heart rate and blood pressure.

How might I be exposed to chloromethane?


K Some chloromethane is produced by industry.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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CHLOROMETHANE CAS # 74-87-3

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Some animal studies showed that animals that breathed low levels of chloromethane experienced slower growth and had brain damage. In other animal studies, males that were exposed to chloromethane were less fertile, or even sterile, or produced damaged sperm. Females that became pregnant by these males lost their developing young. K Teach children the dangers of breathing smoke from burning vinyl plastic or silicone rubber products (chloromethane is released). Have your drinking water tested if you are concerned about it. Check product labels for ingredients; contact manufacturers for additional information if you need it.

K K

How likely is chloromethane to cause cancer?


There is no evidence that chloromethane causes cancer in people. In animal studies, male mice that breathed contaminated air for 2 years developed tumors in their kidneys, but female mice, and male and female rats did not. The EPA has determined that chloromethane is a possible human carcinogen.

Is there a medical test to show whether Ive been exposed to chloromethane?


There are no known reliable medical tests to determine whether you have been exposed to chloromethane. Symptoms resembling drunkenness and food poisoning, along with a sweet odor of the breath, may suggest to a doctor that a person has been exposed to chloromethane.

How can chloromethane affect children?


There are no studies on the health effects on children from exposure to chloromethane. We do not know if chloromethane exposure will harm developing fetuses or young children. Animal studies show that female rats exposed to chloromethane during pregnancy had young that were smaller than normal, with underdeveloped bones, and possibly abnormal hearts (this effect remains uncertain).

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) has set a permissible exposure limit for chloromethane of 100 parts per million (100 ppm) for an 8-hour workday in a 40-hour workweek.

Source of Information How can families reduce the risk of exposure to chloromethane?
K K K Keep children away from contaminated areas, such as workplaces that use chloromethane. Properly dispose of the older types of refrigerators that used chlormethane as a refrigerant. Become familiar with safety practices if you work with or near chloromethane. Agency for Toxic Substances and Disease Registry (ATSDR). 1998. Toxicological profile for chloromethane. Atlanta: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information?

For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CHLOROPHENOLS
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about chlorophenols. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Chlorophenols are a group of compounds that are used in a number of industries and products. Exposure to high levels can cause damage to the liver and immune system. These substances have been found in at least 166 of the 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are chlorophenols? (Pronounced klr-f-nlz)
Chlorophenols are a group of chemicals that are produced by adding chlorines to phenol. Phenol is an aromatic compound derived from benzene. There are 5 basic types of chlorophenols and 19 different chlorophenols. Most chlorophenols are solid at room temperature. They have a strong, medicinal taste and smell. Small amounts can be tasted in water. Some chlorophenols are used as pesticides. Others are used in antiseptics. Small amounts are produced when water is disinfected with chlorine. They are also produced while bleaching wood pulp with chlorine to make paper. G Chlorophenols stick to soil and sediments at the bottom of lakes, streams, and rivers. G Low levels of chlorophenols in water, soil, or sediment are broken down and removed from the environment in a few days to weeks by microorganisms.

How might I be exposed to chlorophenols?


G Most people are exposed to very low levels of chlorophenols in chlorinated drinking water. G There are some chlorophenols in city air. G You can be exposed if you work with chlorophenols or use them as pesticides. G You can be exposed if you make or use treated wood.

What happens to chlorophenols when they enter the environment?


G Chlorophenols can enter the environment when they are being made or used as pesticides. G Most chlorophenols released to the environment go into water. G Small amounts of chlorophenols enter the air. G In the air, sunlight helps destroy these compounds and rain washes them out of the air.

How can chlorophenols affect my health?


Workers exposed to pesticides that contain chlorophenols have developed acne and mild injury to their livers. In laboratory studies, animals that received high levels of chlorophenols in food or water developed liver and immune system effects. They did not gain as much weight as animals not fed the compounds. High levels of chlorophenols given to pregnant female

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CHLOROPHENOLS

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rats in their drinking water reduced the number of babies they had, and caused low birth weights. Chlorophenols have not been shown to cause birth defects in animals. original containers. Never store chemicals in containers that children might find attractive to eat or drink from, such as soda bottles.

How likely are chlorophenols to cause cancer?


There is evidence to suggest that people exposed to chlorophenols for a long time may have slightly higher incidences of cancer. However, the people studied were exposed to other chemicals as well. In animal studies, one chlorophenol, 2,4,6-trichlorophenol, caused leukemia in rats and liver cancer in mice. The Department of Health and Human Services (DHHS) has determined that 2,4,6-trichlorophenol may reasonably be anticipated to be a carcinogen.

Is there a medical test to show whether Ive been exposed to chlorophenols?


There is no test to show if you have been exposed to chlorophenols. There are tests for certain compounds that are produced in your body when chlorophenols break down. However, exposure to other substances could also produce the same test results.

Has the federal government made recommendations to protect human health?


EPA recommends that drinking water contain no more than 0.04 milligrams per liter (0.04 mg/L) of 2-chlorophenol for a lifetime exposure for an adult, and 0.05 mg/L for a 1-day, 10-day, or longer exposure for a child. For 2,4-dichlorophenol, EPA recommends that drinking water contain no more than 0.03 mg/L for a 1-day, 10-day, or longer exposure for a child.

How can chlorophenols affect children?


Children can be exposed in the same ways as adults; however, children may be more sensitive than adults to the effects of chlorophenol-based pesticides and herbicides. Chlorophenols leave the body quickly, so they are not likely to accumulate in the mothers tissues or breast milk. There are no human studies on the effects of chlorophenols on developing fetuses. Studies in rats showed that chlorophenols can pass through the placenta and produce toxic effects to the developing fetuses. The most common problems are delayed hardening of the bones of the breastbone, spine, and skull.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1999. Toxicological profile for chlorophenols. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

How can families reduce the risk of exposure to chlorophenols?


Parents should keep children away from areas where chlorophenols have been used as pesticides. Always check labels on household products, and store them safely in their

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CHLORPYRIFOS
CAS # 2921-88-2
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about chlorpyrifos. For more information, all the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Chlorpyrifos is an insecticide which has been widely used in homes and on farms. Breathing or ingesting chlorpyrifos may result in a variety of nervous system effects, ranging from headaches, blurred vision, and salivation to seizures, coma, and death, depending on the amount and length of exposure. Chlorpyrifos has been found in at least 7 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is chlorpyrifos ? (Pronounced H F H]= B I)


Chlorpyrifos is an insecticide that is a white crystal-like solid with a strong odor. It does not mix well with water, so it is usually mixed with oily liquids before it is applied to crops or animals. It may also be applied to crops in a capsule form. Chlorpyrifos has been widely used in homes and on farms. In the home, it is used to control cockroaches, fleas, and termites; it is also used in some pet flea and tick collars. On the farm, it is used to control ticks on cattle and as a spray to control crop pests.

G Once in the environment, it is broken down by sunlight, bacteria, or other chemical processes.

How might I be exposed to chlorpyrifos?


G Using it to control household pests such as termites, fleas or cockroaches. G Breathing air outside of homes or other buildings where chlorpyrifos was applied to the ground around the foundation to control termites. G Breathing air in a field where chlorpyrifos was sprayed on to crops. G Touching soil or crops in a field where it was sprayed or touching freshly sprayed areas in a house. G Putting food or other chlorpyrifos contaminated items in your mouth.

What happens to chlorpyrifos when it enters the environment?


G Chlorpyrifos enters the environment through direct application to crops, lawns, houses and other buildings. G It may also enter the environment through volatilization, spills, and the disposal of chlorpyrifos waste. G Chlorpyrifos sticks tightly to soil particles. G It does not mix well with water, so it rarely enters local water systems.

How can chlorpyrifos affect my health?


Breathing the air in an area in which chlorpyrifos has recently been sprayed may produce a variety of effects on the nervous system including headaches, blurred vision, watering of the eyes (called lacrimation), excessive salivation, runny nose, dizziness, confusion, muscle weakness or tremors, nau-

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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CHLORPYRIFOS CAS # 2921-88-2

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sea, diarrhea, and sudden changes in heart rate. The effect depends on the amount in the air and length of time exposed. environment of 1 pound or more of chlorpyrifos be reported to the EPA.

Ingesting chlorpyrifos orally through contaminated food The EPA also recommends that children not drink water containers or, in the case of children, putting objects of hands in with chlorpyrifos levels greater than 0.03 milligrams per liter of their mouth after touching chlorpyrifos, may cause similar water (0.03 mg/L) for periods of 110 days. symptoms. The Food and Drug Administration (FDA) has set tolerExposure to high levels may cause severe sweating, loss of ances for chlorpyrifos for agricultural products ranging from bowel control, severe muscle tremors, seizures, loss of con0.05 to 15 parts chlorpyrifos per million parts of food (0.05 sciousness (coma), or death. 15 ppm). There is no information at present to show that chlorpyrifos either effects the ability of humans to reproduce or causes human birth defects.

Glossary
Carcinogen: A substance with the ability to cause cancer. CAS: Chemical Abstracts Service.

How likely is chlorpyrifos to cause cancer?

Ingest: To eat or drink something. It is not known whether chlorpyrifos can cause cancer in people. Animal studies have not shown that chlorpyrifos causes Insecticide: A substance that kills insects; a pesticide. cancer. Milligram (mg): One thousandth of a gram. The EPA has not classified chlorpyrifos for carcinogenicity. ppm: Parts per million (1 ppm is equal to 1 mg/L in water).

Is there a medical test to show whether Ive been exposed to chlorpyrifos?


There is a general test that can be used to determine if you have been exposed to a ceratin group of insecticides, including chlorpyrifos. This test measures the activity of an enzyme called acetylcholinesterase in the blood. There is also a test which measures a metabolite, or breakdown product (known as TCP), of chlorpyrifos in the urine. The metabolite TCP can usually be found in the urine for several days after the exposure to chlorpyrifos occurred.

TCP: Metabolite of chlorpyrifos. Volatilization: The changing of a liquid into a vapor or a gas.

Source of Information
This ToxFAQs information is taken from the 1997 Toxicological Profile for Chlorpyrifos produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Has the federal government made recommendations to protect human health?


The EPA requires that spills or accidental releases into the

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CHROMIUM
CAS # 7440-47-3
Division of Toxicology ToxFAQsTM February 2001

This fact sheet answers the most frequently asked health questions (FAQs) about chromium. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to chromium occurs from ingesting contaminated food or drinking water or breathing contaminated workplace air. Chromium(VI) at high levels can damage the nose and can cause cancer. Chromium has been found at 1,036 of the 1,591 National Priority List sites identified by the Environmental Protection Agency (EPA).

What is chromium?
Chromium is a naturally occurring element found in rocks, animals, plants, soil, and in volcanic dust and gases. Chromium is present in the environment in several different forms. The most common forms are chromium(0), chromium(III), and chromium(VI). No taste or odor is associated with chromium compounds. Chromium(III) occurs naturally in the environment and is an essential nutrient. Chromium(VI) and chromium(0) are generally produced by industrial processes. The metal chromium, which is the chromium(0) form, is used for making steel. Chromium(VI) and chromium(III) are used for chrome plating, dyes and pigments, leather tanning, and wood preserving.

amount can dissolve in water and move deeper in the soil to underground water. [ Fish do not accumulate much chromium in their bodies from water.

How might I be exposed to chromium?


[ Eating food containing chromium(III). [ Breathing contaminated workplace air or skin contact during use in the workplace. [ Drinking contaminated well water. [ Living near uncontrolled hazardous waste sites containing chromium or industries that use chromium.

How can chromium affect my health?


Chromium(III) is an essential nutrient that helps the body use sugar, protein, and fat. Breathing high levels of chromium(VI) can cause irritation to the nose, such as runny nose, nosebleeds, and ulcers and holes in the nasal septum. Ingesting large amounts of chromium(VI) can cause stomach upsets and ulcers, convulsions, kidney and liver damage, and even death.

What happens to chromium when it enters the environment?


[ Chromium enters the air, water, and soil mostly in the chromium(III) and chromium(VI) forms. [ In air, chromium compounds are present mostly as fine dust particles which eventually settle over land and water. [ Chromium can strongly attach to soil and only a small

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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CHROMIUM
CAS # 7440-47-3
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

Skin contact with certain chromium(VI) compounds can cause skin ulcers. Some people are extremely sensitive to chromium(VI) or chromium(III). Allergic reactions consisting of severe redness and swelling of the skin have been noted.

[ Although chromium(III) is an essential nutrient, you should avoid excessive use of dietary supplements containing chromium.

How likely is chromium to cause cancer?


Several studies have shown that chromium(VI) compounds can increase the risk of lung cancer. Animal studies have also shown an increased risk of cancer. The World Health Organization (WHO) has determined that chromium(VI) is a human carcinogen. The Department of Health and Human Services (DHHS) has determined that certain chromium(VI) compounds are known to cause cancer in humans. The EPA has determined that chromium(VI) in air is a human carcinogen.

Is there a medical test to show whether Ive been exposed to chromium?


Since chromium(III) is an essential element and naturally occurs in food, there will always be some level of chromium in your body. There are tests to measure the level of chromium in hair, urine, and blood. These tests are most useful for people exposed to high levels. These tests cannot determine the exact levels of chromium that you may have been exposed to or predict how the levels in your tissues will affect your health.

Has the federal government made recommendations to protect human health?


EPA has set a limit of 100 g chromium(III) and chromium(VI) per liter of drinking water (100 g/L). The Occupational Safety and Health Administration (OSHA) has set limits of 500 g water soluble chromium(III) compounds per cubic meter of workplace air (500 g/m3), 1,000 g/m3 for metallic chromium(0) and insoluble chromium compounds, and 52 g/m3 for chromium(VI) compounds for 8-hour work shifts and 40-hour work weeks.

How can chromium affect children?


We do not know if exposure to chromium will result in birth defects or other developmental effects in people. Birth defects have been observed in animals exposed to chromium(VI). It is likely that health effects seen in children exposed to high amounts of chromium will be similar to the effects seen in adults.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2000. Toxicological Profile for Chromium. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

How can families reduce the risk of exposure to chromium?


[ Children should avoid playing in soils near uncontrolled hazardous waste sites where chromium may have been discarded.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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COBALT
CAS #7440-48-4
Division of Toxicology ToxFAQsTM September 2001

This fact sheet answers the most frequently asked health questions (FAQs) about cobalt. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: The general population is exposed to low levels of cobalt in air, water, and food. Cobalt has both beneficial and harmful effects on health. At low levels, it is part of vitamin B12, which is essential for good health. At high levels, it may harm the lungs and heart. This chemical has been found in at least 11 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is cobalt?
Cobalt is a naturally occurring element found in rocks, soil, water, plants, and animals. There are non radioactive and radioactive forms of cobalt. Non radioactive cobalt, referred to as stable cobalt, is used to produce alloys (mixtures of metals) used in the manufacture of aircraft engines, magnets, grinding and cutting tools, artificial hip and knee joints. Cobalt compounds are also used to color glass, ceramics and paints, and used as a drier for porcelein enamel and paints. The two most commercially important radioactive cobalt isotopes are 60Co (read as cobalt sixty), and 57Co. 60Co is used as a source of gamma rays for sterilizing medical equipment and consumer products, radiation therapy for treating cancer patients, for manufacturing plastics, and food irradiation. 57Co is used in medical and scientific research. It takes about 5.7 years for half of 60Co to give off its radiation and about 272 days for 57Co; this period of time is called the half-life. Cobalt released into water or the soil will stick to particles. Some cobalt compounds may dissolve in water. Cobalt cannot be destroyed in the environment. It can only change its form or become attached or separated from particles. Radioactive decay is the only way of decreasing the amount of radioactive cobalt in the environment.

How might I be exposed to cobalt?


You can be exposed to low levels of cobalt by breathing air, eating food, or drinking water. Food and drinking water are the largest sources of exposure to cobalt for the general population. Working in industries that make or use cutting or grinding tools; mine, smelt, refine, or process cobalt metal or ores; or that produce cobalt alloys or use cobalt. The general population is rarely exposed to radioactive cobalt unless a person is undergoing radiation therapy. However, workers at nuclear facilities, irradiation facilities, or nuclear waste storage sites may be exposed to 60Co or 58Co.

How can cobalt affect my health?


Cobalt has both beneficial and harmful effects on human health. Cobalt is beneficial for humans because it is part of vitamin B12. Exposure to high levels of cobalt can result in lung and heart effects and dermatitis. Liver and kidney effects have also been observed in animals exposed to high levels of cobalt.

What happens to cobalt when it enters the environment?


Cobalt enters the environment from natural sources and the burning of coal or oil or the production of cobalt alloys. In the air it will be associated with particles which will settle to the ground within a few days.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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COBALT
CAS #7440-48-4
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Exposure to large amounts of radioactive cobalt or the radiation it emits can damage cells in your body from the radiation You might also experience acute radiation syndrome which includes nausea, vomiting, diarrhea, bleeding, coma, and even death.

Is there a medical test to show whether Ive been exposed to cobalt?


There are reliable tests that can measure cobalt in the urine and blood within a couple of days of exposure. These tests are not available at your doctors office, but your doctor can send the samples to a laboratory that can perform the tests. The amount of cobalt in your blood or urine can be used to estimate how much cobalt you were exposed to. However, these tests cannot predict whether you will experience any health effects. If a person has been exposed to radioactive cobalt, special tests can be used to measure levels of radiative cobalt in blood, feces, urine, or the total amount in the body. However, it is difficult to determine if a person has been exposed only to external radiation from radioactive cobalt.

How likely is cobalt to cause cancer?


Non radioactive cobalt has not been found to cause cancer in humans or animals following exposure in food or water. Cancer has been shown, however, in animals who breathed cobalt or when cobalt was placed directly into the muscle or under the skin. Based on the laboratory animal data, the International Agency for Research on Cancer (IARC) has determined that cobalt and cobalt compounds are possibly carcinogenic to humans. Exposure to high levels of cobalt radiation can cause changes in the genetic materials within cells and may result in the development of some types of cancer.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) has set a limit of 0.1 milligrams of non radioactive cobalt per cubic meter of workplace air (0.1 mg/m3) for an 8-hour workday and 40-hour work week. The Nuclear Regulatory Commission (NRC) has set annual occupational air limits of 200 Ci for 60Co and 3000 Ci for 57 Co.

How can cobalt affect children?


Little information is available regarding the effects of cobalt in children. It is likely that the health effects seen in children should be similar to the effects seen in adults. We do not know whether children differ from adults in their susceptibility to cobalt. Studies in animals suggest that children may absorb more cobalt than adults from foods and liquids containing cobalt. We do not know if exposure to cobalt will result in birth defects or other developmental effects in people. Birth defects have been observed in animals exposed to non radioactive cobalt. Exposure to cobalt radiation can also result in developmental effects.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for Cobalt (Draft for Public Comment). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

How can families reduce the risk of exposure to cobalt?


Children should avoid playing in soils near uncontrolled hazardous waste sites where cobalt may have been discarded.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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COPPER
CAS # 7440-50-8
Division of Toxicology ToxFAQsTM September 2002

This fact sheet answers the most frequently asked health questions (FAQs) about copper. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Copper is a reddish metal that occurs naturally in the environment. It also occurs naturally in plants and animals. Low levels of copper are essential for maintaining good health. High levels can cause harmful effects such as irritation of the nose, mouth and eyes, vomiting, diarrhea, stomach crumps, and nausea. Copper has been found in at least 884 of the 1,613 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is copper?
Copper is a reddish metal that occurs naturally in rocks, soil, water, and air. Copper also occurs naturally in plants and animals. Metallic copper can be easily molded or shaped. Metallic copper can be found in the U.S. penny, electrical wiring, and some water pipes. Metallic copper is also found in mixtures (called alloys) with other metals such as brass and bronze. Copper is also found as part of other compounds forming salts. Copper salts occur naturally, but are also manufactured. The most common copper salt is copper sulfate. Most copper compounds are blue-green in color. Copper compounds are commonly used in agriculture to treat plant diseases like mildew, for water treatment and, as preservatives for wood, leather, and fabrics. ! Copper that dissolves in water becomes rapidly bound to particles suspended in the water. ! Copper does not typically enter groundwater. ! Copper carried by particles emitted from smelters and ore processing plants is carried back to the ground by gravity or in rain or snow. ! Copper does not break down in the environment.

How might I be exposed to copper?


! Breathing air, drinking water, eating food, and by skin contact with soil, water, or other copper-containing substances. ! Some copper in the environment can be taken up by plants and animals. ! Higher exposure may occur if your water is corrosive and you have copper plumbing and brass water fixtures. ! You may be exposed to higher amounts of copper if you drink water or swim in lakes or reservoirs recently treated with copper to control algae or receive cooling water from a power plant that may have high amounts of dissolved copper. ! Using some garden products (e.g., fungicides) to control plant diseases. ! Living near bronze and brass production facilities may expose you to higher copper levels in soil. ! You may breathe copper-containing dust or have skin contact if you work in the industry of mining copper or

What happens to copper when it enters the environment?


! Copper can enter the environment from the mining of copper and other metals and from factories that make or use metallic copper or copper compounds. ! It can also enter the environment through domestic waste water, combustion of fossil fuels and wastes, wood production, phosphate fertilizer production, and natural sources (e.g., windblown dust from soils, volcanoes, decaying vegetation, forest fires, and sea spray). ! Copper in soil strongly attaches to organic material and minerals.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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COPPER
CAS # 7440-50-8
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

processing the ore. You may breathe high levels if you grind or weld copper metal.

How can copper affect my health?


Copper is essential for good health, but high amounts can be harmful. Long-term exposure to copper dust can irritate your nose, mouth, and eyes, and cause headaches, dizziness, nausea, and diarrhea. Drinking water with higher than normal levels of copper may cause vomiting, diarrhea, stomach cramps, and nausea. Intentionally high intakes of copper can cause liver and kidney damage and even death.

copper home on your skin, clothes, or tools. You can avoid this by showering, and changing clothing before leaving work, and your work clothes should be kept separate from other clothes and laundered separately.

Is there a medical test to show whether Ive been exposed to copper?


Copper is normally found in all tissues of the body, blood, urine, feces, hair, and nails. High levels of copper in these samples can show that you have been exposed to higher than normal levels of copper. Tests to measure copper levels in the body are not routinely available at the doctors office because they require special equipment. These tests cannot tell the extent of exposure or whether you will experience harmful effects.

How likely is copper to cause cancer?


We do not know whether copper can cause cancer in humans. The EPA has determined that copper is not classifiable as to carcinogenicity.

How can copper affect children?


Exposure to high levels of copper will result in the same type of effects in children and adults. Studies in animals suggest that the young children may have more severe effects than adults; we do not know if this would also be true in humans. There is a very small percentage of infants and children who are unusually sensitive to copper. We do not know if copper can cause birth defects or other developmental effects in humans. Studies in animals suggest that ingestion of high levels of copper may cause a decrease in fetal growth.

Has the federal government made recommendations to protect human health?


The EPA has determined that drinking water should not contain more than 1.3 milligrams of copper per liter of water (1.3 mg/L). The Occupational Safety and Health Administration (OSHA) has set a limit of 0.1 mg per cubic meter (0.1 mg/m3) of copper fumes (vapor generated from heating copper) and 1 mg/m3 of copper dusts (fine metallic copper particles) and mists (aerosol of soluble copper) in workroom air during an 8-hour work shift, 40-hour workweek. The Food and Nutrition Board of the Institute of Medicine recommends dietary allowances (RDAs) of 340 micrograms (340 g) of copper per day for children aged 1-3 years, 440 g/day for children aged 4-8 years, 700 g/day for children aged 9-13 years, 890 g/day for children aged 14-18 years, and 900 g/day for adults.

How can families reduce the risk of exposure to copper?


! The greatest potential source of copper exposure is through drinking water, especially in water that is first drawn in the morning after sitting in copper pipes and brass faucets overnight. ! To reduce exposure, run the water for at least 15-30 seconds before using it. ! If you are exposed to copper at work, you may carry

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2002. Toxicological Profile for Copper (Draft for Public Comment). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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USED MINERAL-BASED CRANKCASE OIL CAS # 8002-05-9


Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about used mineral-based crankcase oil. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Used mineral-based crankcase oil is also called used engine oil. Exposure to this oil can occur when you change the oil of your car or another type of engine. Exposure to very high levels of used oil can cause skin rashes, headaches and tremors. Used oil has been found in at least 85 of the 1,416 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is used mineral-based crankcase oil?
Used mineral-based crankcase oil is the brown-to-black, oily liquid removed from the engine of a motor vehicle when the oil is changed. It is similar to unused oil except it contains additional chemicals from its use as an engine lubricant. The chemicals in oil include hydrocarbons, which are distilled from crude oil, and various additives that improve the oil's performance. Used oil also contains chemicals formed when the oil is exposed to high temperatures and pressures inside an engine. It also contains some metals from engine parts and small amounts of gasoline, antifreeze, and chemicals that come from gasoline when it burns inside the engine. The chemicals found in used mineral-based crankcase oil vary depending on the brand and type of oil, whether gasoline or diesel fuel was used, the mechanical condition of the engine that the oil came from, and the amount of use between oil changes. Used oil is not naturally found in the environment. q The hydrocarbon components of the oil generally stick to the soil surface. q Some hydrocarbons evaporate into the air very quickly, and others evaporate more slowly. q Hydrocarbon components of the oil that enter surface water bind to small particles in the water and eventually settle to the bottom. q Hydrocarbons from used mineral-based crankcase oil may build up in shellfish or other organisms. q Some metals in used mineral-based crankcase oil dissolve in water and move through the soil easily and may be found in surface water and groundwater.

How might I be exposed to used mineral-based crankcase oil?


q When you change the engine oil in your car. q Breathing a small amount of the chemicals from the oil in exhaust fumes or from burning the oil as heating fuel. q Touching contaminated soil or drinking contaminated water.

What happens to used mineral-based crankcase oil when it enters the environment?
q Used mineral-based crankcase oil enters the air through the exhaust system during engine use. q It may enter water or soil when disposed of improperly.

How can used mineral-based crankcase oil affect my health?


The health effects of used mineral-based crankcase oil vary depending on the brand and type of oil used and the

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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USED MINERAL-BASED CRANKCASE OIL CAS # 8002-05-9

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

characteristics of the engine it came from. Mechanics and other auto workers who are exposed to used mineral-based crankcase oil from a large number of cars have experienced skin rashes, blood effects (anemia), and headaches and tremors. However, these workers are also exposed to other chemicals, which may have caused these health effects. Volunteers who breathed mists of used mineral-based crankcase oil for a few minutes had slightly irritated noses, throats, and eyes. Animals that ate large amounts of this oil developed diarrhea. Thus, people who swallow used mineralbased crankcase oil may also have diarrhea. Some cows that ate used oil containing metals such as molybdenum and lead in contaminated pastures experienced anemia and tremors. Some of the cows died. We do not know if exposure to used mineral-based crankcase oil affects the reproductive ability of men or women or whether it causes birth defects.

Is there a medical test to show whether Ive been exposed to used mineral-based crankcase oil?
Used mineral-based crankcase oil is a mixture of a large number of chemicals. Its composition depends on the brand of oil and the characteristics of the engine in which it was used. However, there are methods for determining if you have been exposed to some of the chemicals in used oil. These tests arent available at most doctors offices, but can be done at special laboratories that have the right equipment.

Has the federal government made recommendations to protect human health?


The EPA and most states have developed regulations regarding disposal of used oil, its recycling, spraying used oil onto road surfaces for dust control, or burning it as a fuel.

Glossary
Anemia: A decreased ability of the blood to transport oxygen. Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To enter the air as a vapor. PAHs: Polyaromatic hydrocarbons; a group of chemicals found in oil and other minerals.

How likely is used mineral-based crankcase oil to cause cancer?


Long-term exposure (365 days or longer) of the skin to used mineral-based crankcase oil causes skin cancer in mice. Oils contain PAHs. Some PAHs have been identified as the cancer-causing agents. Animal tests have shown that the higher the PAH content in oil, the more likely for the oil to be carcinogenic. The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified used mineral-based crankcase oil with regard to its carcinogenicity in people.

Source of Information
This ToxFAQs information is taken from the 1997 Toxicological Profile for Used Mineral-based Crankcase Oil produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CREOSOTE
CAS # 8021-39-4, 8001-58-9, 8007-45-2
Division of Toxicology ToxFAQsTM September 2002

This fact sheet answers the most frequently asked health questions (FAQs) about creosote. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Creosote is a mixture of many chemicals. Eating food or drinking water with high levels of creosote may cause burning in the mouth and throat, and stomach pain. Long-term contact with creosote has been associated with increased risk of contracting cancer. Creosote has been found in at least 46 of the 1,613 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is creosote?
Creosote is the name used for a variety of products: wood creosote, coal tar creosote, coal tar, coal tar pitch, and coal tar pitch volatiles. These products are mixtures of many chemicals created by burning of beech and other woods, coal, or from the resin of the creosote bush. Wood creosote is a colorless to yellowish greasy liquid with a smoky odor and burned taste. Coal tar creosote is a thick, oily liquid typically amber to black in color. Coal tar and coal tar pitch are usually thick, black, or dark-brown liquids or semi-solids, with a smoky odor. Wood creosote has been used as a disinfectant, a laxative, and a cough treatment, but has since been replaced by better medicines. Coal tar products are used in medicines to treat skin diseases such as psoriasis, and also as animal and bird repellents, insecticides, animal dips, and fungicides. Coal tar creosote is the most widely used wood preservative in the United States. Coal tar, coal tar pitch, and coal tar pitch volatiles are used for roofing, aluminum smelting, and coking. Once in groundwater, it may take years for it to break down. Coal tar creosote can build up in plants and animals. We do not know what happens to wood creosote when it enters the environment.

How might I be exposed to creosote?


Using products that contain creosote to improve skin problems such as eczema or psoriasis. Eating herbal remedies containing the leaves from the creosote bush, which are sold as dietary supplements. Working in the wood preservative, coke-producing, or asphalt industries. Using creosote-treated wood in building fences, bridges, or railroad tracks, or installing telephone poles. Living in treated-wood houses that may result in air or skin contact with creosote. Drinking water contaminated by a hazardous waste site.

How can creosote affect my health?


Eating food or drinking water contaminated with high levels of creosotes may cause a burning in the mouth and throat, and stomach pains. Taking large amounts of herbal remedies containing creosote bush leaves may cause damage to the liver or kidney. Brief direct contact with large amounts of coal tar creosote may result in a rash or severe irritation of the skin, chemical burns of the surfaces of the eyes, convulsions and mental confusion, kidney or liver problems, unconsciousness, and even death. Longer direct skin contact with low levels of

What happens to creosote when it enters the environment?


Coal tar creosote is released to water and soil mainly as a result of its use in the wood preservation industry. Components of creosote that do not dissolve in water will remain in place in a tar-like mass. Some components of coal tar creosote dissolve in water and may move through the soil to groundwater.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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CREOSOTE
CAS # 8021-39-4, 8001-58-9, 8007-45-2
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

creosote mixtures or their vapors can result in increased light sensitivity, damage to the cornea, and skin damage. Longer exposure to creosote vapors can cause irritation of the respiratory tract.

How can families reduce the risk of exposure to creosote?


If you live in a residential area that used to have a wood preservation facility or gas manufacturing plant nearby, wear long-sleeved shirts and long pants when working or playing outside and avoid using water contaminated with creosote. Instruct children not to come in contact with creosotetreated wood when playing on or near railroad tracks, in ditches close to utility poles, in old barns or other farm structures, or on bridges or piers. Avoid using herbal remedies containing the leaves of the creosote bush and seek alternatives to skin remedies containing creosote. If you are exposed to creosote in the workplace, make sure you do not carry the chemical home in your clothing, skin, hair, tools, or other objects from the workplace (shower before going home).

How likely is creosote to cause cancer?


Long-term exposure to low levels of creosote, especially direct contact with the skin during wood treatment or manufacture of coal tar creosote-treated products, has resulted in skin cancer and cancer of the scrotum. Cancer of the scrotum in chimney sweeps has been associated with long-term skin exposure to soot and coal tar creosotes. Animal studies have also shown skin cancer from skin exposure to coal tar products. The International Agency for Research on Cancer (IARC) has determined that coal tar is carcinogenic to humans and that creosote is probably carcinogenic to humans. The EPA has determined that coal tar creosote is a probable human carcinogen.

Is there a medical test to show whether Ive been exposed to creosote?


There is no medical test to determine if you have been exposed to creosote. Some components of creosote mixtures can be measured in body tissues, urine, or blood after exposure to creosote. These tests cannot tell whether harmful health effects will occur. The tests are not routinely available at the doctors office because they require special equipment.

How can creosote affect children?


There is no unique exposure pathway of children to creosote. Children exposed to creosote will probably experience the same health effects seen in adults exposed to creosote. Children who played on soil contaminated with creosote had more skin rashes than children who played in uncontaminated areas. We do not know whether children differ from adults in their susceptibility to health effects from creosote. Studies in animals have shown birth defects in the young of mothers exposed to high levels of creosote during pregnancy, but we do not know whether the same effects would occur in humans. Some animal studies indicate that creosotes may cross the placenta and reach the fetus. Because chemical components (PAHs, cresol, phenols) of coal tar creosote may be stored in body fat, they may be found in breast milk and could pass to nursing infants.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) has set an exposure limit of 0.2 milligrams of coal tar pitch volatiles per cubic meter of air (0.2 mg/m3) in workplace air during an 8-hour day, 40-hour workweek.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2002. Toxicological Profile for Creosote (Update). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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CRESOLS
CAS # 1319-77-3
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about cresols. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to cresols occurs mainly from breathing air containing car exhaust, breathing air from homes heated with coal or wood, and smoking cigarettes. Cresols, when breathed at very high levels, may cause irritation of the nose and throat. These chemicals have been found in at least 314 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What are cresols? (Pronounced kr-slz)
Cresols are a widely occurring natural and manufactured group of chemicals. In their pure form, they are colorless solids and may be liquids if they are mixtures. Cresols smell like medicine. There are three forms of cresols that are only slightly different in their chemical structure: ortho-cresol (o-cresol), meta-cresol (m-cresol), and para-cresol (p-cresol). These forms occur separately or as a mixture. They are used to dissolve other chemicals, as disinfectants and deodorizers, and to make certain chemicals that kill insect pests. Cresols are found in many foods and in wood and tobacco smoke, crude oil, coal tar, and in brown mixtures such as creosote and cresylic acids, which are wood preservatives. Small organisms in soil and water produce cresols when they break down materials in the environment.
G In air, cresols quickly break down into other chemicals. G Cresols do not evaporate quickly from water, but they can be removed by bacteria. G Cresols may last longer in deep groundwater or water that does not have bacteria. G In soil, half the total amount of cresols will break down in about a week. G Cresols do not appear to accumulate in fish or meat.

How might I be exposed to cresols?


G Breathing contaminated air from car exhaust, coal or wood combustion, oil refineries, or cigarette smoke. G Breathing workplace air or skin contact in the workplace. G Eating foods, including ketchup, tomatoes, cheese, butter, and bacon, but generally the levels are not harmful. G Drinking contaminated water near manufacturing sites, waste sites, or landfills.

What happens to cresols when they enter the environment?


G Cresols enter the environment from natural sources, car exhaust, combustion, manufacturing use, and waste sites. G Cresols appear everywhere in our environment, but usually at low levels, because they quickly break down.

How can cresols affect my health?


Most exposures to cresols are at very low levels that are not harmful. When cresols are breathed, ingested, or applied to the skin at very high levels, they can be very harmful. Effects observed in people include irritation and burning of

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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CRESOLS CAS # 1319-77-3

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

skin, eyes, mouth, and throat; abdominal pain and vomiting; heart damage; anemia; liver and kidney damage; facial paralysis; coma; and death. Breathing high levels of cresols for a short time results in irritation of the nose and throat. Aside from these effects, very little is known about the effects of breathing cresols, for example, at lower levels over longer times. Ingesting high levels results in kidney problems, mouth and throat burns, abdominal pain, vomiting, and effects on the blood and nervous system. Skin contact with high levels of cresols can burn the skin and damage the kidneys, liver, blood, brain, and lungs. Short-term and long-term studies with animals have shown similar effects from exposure to cresols. No human or animal studies have shown harmful effects from cresols on the ability to have children. It is not known what the effects are from long-term ingestion or skin contact with low levels of cresols.

exposure since cresols break down quickly in the body. Since cresols occur naturally in the body, results of tests for cresol exposure would have to be compared to results of tests taken from the same person both before and several days after the exposure. These tests are usually not available in your doctors office.

Has the federal government made recommendations to protect human health?


The EPA requires that discharges or accidental spills of 1,000 pounds or more of cresols be reported. The Occupational Safety and Health Administration (OSHA) has set an exposure limit of 22 milligrams per cubic meter (22 mg/m3) for cresols in workplace air for an 8-hour workday, 40-hour workweek. OSHA advises avoiding eye and skin contact because this may be a route of significant exposure.

How likely are cresols to cause cancer?


The Environmental Protection Agency (EPA) has determined that cresols are possible human carcinogens. No studies are available in people on the carcinogenic effects of cresols. Animal studies show that cresols may increase the ability of some carcinogenic chemicals to cause tumors.

Glossary
Carcinogen: A substance that can cause cancer. Ingesting: Taking food or drink into your body. Long-term: Lasting one year or longer. Milligram (mg): One thousandth of a gram. Short-term: Lasting 14 days or less.

References Is there a medical test to show whether Ive been exposed to cresols?
Tests are available that measure the amount of cresols in the urine. The tests must be performed within one day of Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for cresols: o-cresol, p-cresol, & m-cresol. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information?

For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CROTONALDEHYDE
CAS #4170-30-3
Division of Toxicology ToxFAQsTM April 2002

This fact sheet answers the most frequently asked health questions (FAQs) about crotonaldehyde. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: The general population can be exposed to crotonaldehyde by inhaling tobacco smoke, gasoline and diesel engine exhausts, and smoke from wood burning. People working with crotonaldehyde to manufacture other chemicals may be exposed to higher levels. Damage to the respiratory system may occur if you breathe in crotonaldehyde vapors. Contact with the skin or eye can result in severe injury. This substance has been found in at least 3 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is crotonaldehyde?
Crotonaldehyde is a clear, colorless to straw colored liquid with a strong, suffocating odor. It is highly flammable and produces toxic vapors at room temperature. Crotonaldehyde is found naturally in emissions of some vegetation and volcanoes; many foods contain crotonaldehyde in small amounts. Crotonaldehyde is mainly used in the manufacture of sorbic acid, which is a yeast and mold inhibitor. Crotonaldehyde has been used as a warning agent in fuels, as alcohol denaturant, as stabilizer for tetraethyl-lead, in the preparation of rubber accelerators, and in leather tanning. waters and can also be degraded by bacteria. Crotonaldehyde also evaporates from water. Crotonaldehyde is a highly mobile liquid and does not stick to soil surfaces. Therefore, if it is released to soil it can travel below the soil surface and contaminate groundwater. Crotonaldehyde can also evaporate from soil or be degraded by bacteria commonly found in soil. Crotonaldehyde does not accumulate in the food chain.

How might I be exposed to crotonaldehyde?


Crotonaldehyde is emitted from the combustion of gasoline, the burning of wood and the burning of tobacco. Therefore, the general population may be exposed to crotonaldehyde through inhalation of tobacco smoke, gasoline and diesel engine exhausts, and smoke from wood burning. Crotonaldehyde is a liquid chemical used to synthesize other chemicals. Therefore workers employed in occupations where crotonaldehyde is used may inhale crotonaldehyde vapors or get the liquid on their skin. People living near uncontrolled hazardous waste sites may be exposed to higher than normal levels of crotonaldehyde.

What happens to crotonaldehyde when it enters the environment?


When released to air, crotonaldehyde will exist solely as a gas. Crotonaldehyde gas is degraded rapidly in the atmosphere by reacting with substances commonly found in the air. It will only persist in the atmosphere for several hours to a few days before being degraded. Crotonaldehyde is soluble in water. It can be broken down by reacting with substances found in sunlit surface

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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CROTONALDEHYDE
CAS #4170-30-3
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

How can crotonaldehyde affect my health?


Crotonaldehyde in the air can irritate your eyes, nose, throat, and lungs, possibly causing you to cough and experience chest tightness and shortness of breath. High levels of crotonaldehyde can cause a build-up of fluid in your lungs, which may result in death. Some people may become sensitive to crotonaldehyde and develop a reaction to crotonaldehyde, even at very low exposure levels. Since crotonaldehyde is known to be irritating, you might experience chemical burns of the lips, mouth, throat, esophagus, and stomach if you were to ingest crotonaldehyde. If you come into contact with liquid crotonaldehyde, it can cause serious burns to your skin or eyes. Some people may become allergic to crotonaldehyde upon skin contact. We do not know if exposure to crotonaldehyde will result in reproductive effects in humans. However, crotonaldehyde has been shown to cause degeneration of sperm cells in mice.

How can crotonaldehyde affect children?


Children are probably affected by exposure to crotonaldehyde in the same ways as adults. We do not know whether children differ from adults in their susceptibility to crotonaldehyde. We do not know if exposure to crotonaldehyde will result in birth defects or other developmental effects in people.

How can families reduce the risk of exposure to crotonaldehyde?


Families are not likely to be exposed to levels of crotonaldehyde that would be high enough to cause problems.

Is there a medical test to show whether Ive been exposed to crotonaldehyde?


There are no specific blood or urine tests for crotonaldehyde. If a severe exposure has occurred, respiratory function tests and a chest x-ray may show whether damage has been done to the lungs. These tests could be performed in a doctors office, clinic, or hospital as long as they have the proper test equipment.

How likely is crotonaldehyde to cause cancer?


The EPA considers crotonaldehyde to be a possible human carcinogen. The International Agency for Research on Cancer (IARC) concluded that crotonaldehyde is not classifiable as to its carcinogenicity to humans.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) sets a limit of 2 parts of crotonaldehyde per million parts of workroom air (2 ppm) for an 8-hour work shift, 40-hour work week.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CYANIDE
CAS # 74-90-8, 143-33-9, 151-50-8, 592-01-8, 544-92-3, 506-61-6, 460-19-5, 506-77-4
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about cyanide. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Cyanide is a very poisonous chemical. Exposure to high levels of cyanide harms the brain and heart, and may cause coma and death. Exposure to lower levels may result in breathing difficulties, heart pains, vomiting, blood changes, headaches, and enlargement of the thyroid gland. Cyanide has been found in at least 415 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is cyanide? (Pronounced s-nd)
Cyanide is usually found joined with other chemicals to form compounds. Examples of simple cyanide compounds are hydrogen cyanide, sodium cyanide and potassium cyanide. Cyanide can be produced by certain bacteria, fungi, and algae, and it is found in a number of foods and plants. In the body, cyanide combines with a chemical to form Vitamin B12. Cyanide occurs naturally in cassava roots, which are potatolike tubers of cassava plants grown in tropical countries. Hydrogen cyanide is a colorless gas with a faint, bitter, almond-like odor. Sodium cyanide and potassium cyanide are both white solids with a bitter, almond-like odor in damp air. Cyanide and hydrogen cyanide are used in electroplating, metallurgy, production of chemicals, photographic development, making plastics, fumigating ships, and some mining processes. G It takes about 13 years for half of the hydrogen cyanide to disappear from the air. G Most cyanide in surface water will form hydrogen cyanide and evaporate. G Cyanide in water does not build up in the bodies of fish. G At high concentrations, cyanide becomes toxic to soil microorganisms and can pass through soil into underground water.

How might I be exposed to cyanide?


G Breathing air, drinking water, touching soil, or eating foods containing cyanide. G Smoking cigarettes and breathing smoke-filled air during fires are major sources of cyanide exposure. G Breathing air near a hazardous waste site containing cyanide. G Eating foods containing cyanide compounds, such as cassava roots, lima beans, and almonds. G Working in an industry where cyanide is used or produced, such as electroplating, metallurgy, metal cleaning, and photography.

What happens to cyanide when it enters the environment?


G Cyanide enters the environment from both natural processes and human industrial activities. G In air, cyanide is mainly found as gaseous hydrogen cyanide; a small amount is present as fine dust particles.

How can cyanide affect my health?


In large amounts, cyanide is very harmful to people. Expo-

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sure to high levels of cyanide in the air for a short time harms the brain and heart, and may cause coma and death. Exposure to lower levels of cyanide for a long time may result in breathing difficulties, heart pains, vomiting, blood changes, headaches, and enlargement of the thyroid gland. People who eat large amounts of cyanide may have symptoms including deep breathing and shortness of breath, convulsions, and loss of consciousness, and may die. Use of cassava roots as a primary food source in tropical Africa has led to high blood cyanide levels. People with high blood cyanide levels have also shown harmful effects such as weakness of the fingers and toes, difficulty walking, dimness of vision, deafness, and decreased thyroid gland function, but chemicals other than cyanide may have contributed to these effects. Skin contact with cyanide can produce irritation and sores. It is not known whether cyanide can directly cause birth defects in people. Birth defects were seen in rats that ate diets of cassava roots. Effects on the reproductive system were seen in rats and mice that drank water containing sodium cyanide. after the exposure. An almond-like odor in the breath may alert a doctor that a person was exposed to cyanide.

Has the federal government made recommendations to protect human health?


The EPA has set a maximum contaminant level of cyanide in drinking water of 0.2 milligrams cyanide per liter of water (0.2 mg/L). The EPA requires that spills or accidental releases into the environment of 1 pound or more of hydrogen cyanide, potassium cyanide, sodium cyanide, calcium cyanide or copper cyanide be reported to the EPA. The Occupational Safety and Health Administration (OSHA) and (other recommendations) the American Conference of Governmental Industrial Hygienists (ACGIH) have set a permissible exposure limit of 5 milligrams of cyanide per cubic meter of air (5 mg/m3) in the workplace during an 8-hour workday, 40-hour workweek.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Milligram (mg): One thousandth of a gram. ppm: Parts per million.

How likely is cyanide to cause cancer?


The EPA has determined that cyanide is not classifiable as to its human carcinogenicity. There are no reports that cyanide can cause cancer in people or animals.

Source of Information
This ToxFAQs information is taken from the 1997 Toxicological Profile for Cyanide (update) produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Is there a medical test to show whether Ive been exposed to cyanide?


There are medical tests to measure blood and urine levels of cyanide; however, small amounts of cyanide are always detectable in blood and urine. Tissue levels of cyanide can be measured if cyanide poisoning is suspected, but cyanide is rapidly cleared from the body, so the tests must be done soon

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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DDT, DDE, AND DDD


CAS # 50-29-3, 72-55-9, 72-54-8
Division of Toxicology ToxFAQsTM September 2002

This fact sheet answers the most frequently asked health questions (FAQs) about DDT, DDE, and DDD. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to DDT, DDE, and DDD occurs mostly from eating foods containing small amounts of these compounds, particularly meat, fish and poultry. High levels of DDT can affect the nervous system causing excitability, tremors and seizures. In women, DDE can cause a reduction in the duration of lactation and an increased chance of having a premature baby. DDT, DDE, and DDD have been found in at least 441 of the 1,613 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are DDT, DDE, and DDD?
DDT (dichlorodiphenyltrichloroethane) is a pesticide once widely used to control insects in agriculture and insects that carry diseases such as malaria. DDT is a white, crystalline solid with no odor or taste. Its use in the U.S. was banned in 1972 because of damage to wildlife, but is still used in some countries. DDE (dichlorodiphenyldichloroethylene) and DDD (dichlorodiphenyldichloroethane) are chemicals similar to DDT that contaminate commercial DDT preparations. DDE has no commercial use. DDD was also used to kill pests, but its use has also been banned. One form of DDD has been used medically to treat cancer of the adrenal gland. Only a small amount will go through the soil into groundwater; they do not dissolve easily in water. DDT, and especially DDE, build up in plants and in fatty tissues of fish, birds, and other animals.

How might I be exposed to DDT, DDE, and DDD?


Eating contaminated foods, such as root and leafy vegetables, fatty meat, fish, and poultry, but levels are very low. Eating contaminated imported foods from countries that still allow the use of DDT to control pests. Breathing contaminated air or drinking contaminated water near waste sites and landfills that may contain higher levels of these chemicals. Infants fed on breast milk from mothers who have been exposed. Breathing or swallowing soil particles near waste sites or landfills that contain these chemicals.

What happens to DDT, DDE, and DDD when they enter the environment?
DDT entered the environment when it was used as a pesticide; it still enters the environment due to current use in other countries. DDE enters the environment as contaminant or breakdown product of DDT; DDD also enters the environment as a breakdown product of DDT. DDT, DDE, and DDD in air are rapidly broken down by sunlight. Half of whats in air breaks down within 2 days. They stick strongly to soil; most DDT in soil is broken down slowly to DDE and DDD by microorganisms; half the DDT in soil will break down in 2-15 years, depending on the type of soil.

How can DDT, DDE, and DDD affect my health?


DDT affects the nervous system. People who accidentally swallowed large amounts of DDT became excitable and had tremors and seizures. These effects went away after the exposure stopped. No effects were seen in people who took small daily doses of DDT by capsule for 18 months. A study in humans showed that women who had high amounts of a form of DDE in their breast milk were unable to

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breast feed their babies for as long as women who had little DDE in the breast milk. Another study in humans showed that women who had high amounts of DDE in breast milk had an increased chance of having premature babies. In animals, short-term exposure to large amounts of DDT in food affected the nervous system, while long-term exposure to smaller amounts affected the liver. Also in animals, shortterm oral exposure to small amounts of DDT or its breakdown products may also have harmful effects on reproduction.

A study in mice showed that exposure to DDT during the first weeks of life may cause neurobehavioral problems later in life.

How can families reduce the risk of exposure to DDT,DDE, and DDE?
Most families will be exposed to DDT by eating food or drinking liquids contaminated with small amounts of DDT. Cooking will reduce the amount of DDT in fish. Washing fruit and vegetables will remove most DDT from their surface. Follow health advisories that tell you about consumption of fish and wildlife caught in contaminated areas.

How likely are DDT, DDE, and DDD to cause cancer?


Studies in DDT-exposed workers did not show increases in cancer. Studies in animals given DDT with the food have shown that DDT can cause liver cancer. The Department of Health and Human Services (DHHS) determined that DDT may reasonable be anticipated to be a human carcinogen. The International Agency for Research on Cancer (IARC) determined that DDT may possibly cause cancer in humans. The EPA determined that DDT, DDE, and DDD are probable human carcinogens.

Is there a medical test to show whether Ive been exposed to DDT, DDE, and DDD?
Laboratory tests can detect DDT, DDE, and DDD in fat, blood, urine, semen, and breast milk. These tests may show low, moderate, or excessive exposure to these compounds, but cannot tell the exact amount you were exposed to, or whether you will experience adverse effects. These tests are not routinely available at the doctors office because they require special equipment.

How can DDT, DDE, and DDD affect children?


There are no studies on the health effects of children exposed to DDT, DDE, or DDD. We can assume that children exposed to large amounts of DDT will have health effects similar to the effects seen in adults. However, we do not know whether children differ from adults in their susceptibility to these substances. There is no evidence that DDT, DDE, or DDD cause birth defects in people. A study showed that teenage boys whose mothers had higher DDE amounts in the blood when they were pregnant were taller than those whose mothers had lower DDE levels. However, a different study found the opposite in preteen girls. The reason for the discrepancy between these studies is unknown. Studies in rats have shown that DDT and DDE can mimic the action of natural hormones and in this way affect the development of the reproductive and nervous systems. Puberty was delayed in male rats given high amounts of DDE as juveniles. This could possibly happen in humans.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) sets a limit of 1 milligram of DDT per cubic meter of air (1 mg/m3) in the workplace for an 8-hour shift, 40-hour workweek. The Food and Drug Administration (FDA) has set limits for DDT, DDE, and DDD in foodstuff at or above which the agency will take legal action to remove the products from the market.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2002. Toxicological Profile for DDT/DDE/DDD (Update). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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DIAZINON
CAS # 333-41-5
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about diazinon. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to diazinon is most significant in people who work in the manufacture and professional application of this insecticide. Very high levels of exposure to diazinon have resulted in death. Some mild symptoms of exposure include headache, dizziness, weakness, feelings of anxiety, constriction of the pupils of the eye, and not being able to see clearly. Diazinon has been found in at least 18 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is diazinon? (Pronounced d-z-nn)
Diazinon is the common name of an organophosphorus insecticide used to control pest insects in soil, on ornamental plants, and on fruit and vegetable field crops. It is also used to control household pests such as flies, fleas, and cockroaches. This chemical is manufactured and does not occur naturally in the environment. The pure chemical is a colorless and practically odorless oil. Preparations used in agriculture and by exterminators contain 8590% diazinon and appear as a pale to dark-brown liquid. Diazinon preparations available for home and garden use contain 15% diazinon in a liquid or as solid granules. Most of the diazinon used is in liquid form, but it is possible to be exposed to the chemical in a solid form. Diazinon does not burn easily and does not dissolve easily in water. q It is often sprayed on crops and plants, so small particles of the chemical may be carried away from the field or yard before falling to the ground. q After diazinon has been applied, it may be present in the soil, surface waters, and on the surface of the plants. q Diazinon on soil and plant surfaces may be washed into surface waters by rain. q In the environment, diazinon is rapidly broken down into a variety of other chemicals. It can move through the soil and contaminate ground water. q Diazinon is not likely to build up to high or dangerous levels in animal or plant foods that you might eat.

How might I be exposed to diazinon?


q People who work in the manufacture and professional application of diazinon have the most significant exposure to this insecticide. q Exposure may occur by contact with contaminated soils or contaminated runoff water or groundwater. q Small amounts have been detected in foods, but the levels in food are far below the levels that might cause any harmful health effects.

What happens to diazinon when it enters the environment?


q Most environmental diazinon contamination comes from agricultural and household application to control insects. q Diazinon may also enter the environment during the manufacturing process.

How can diazinon affect my health?


Most cases of unintentional diazinon poisoning in people have resulted from short exposures to very high concentra-

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tions of the material. Very high levels of exposure to diazinon have resulted in death in people accidentally exposed and in those who have swallowed large amounts of the chemical to commit suicide.

urine. These tests aren't routinely available at most doctors' offices, but can be done at special laboratories that have the right equipment.

Diazinon affects the nervous system. Some mild symptoms Has the federal government made include headache, dizziness, weakness, feelings of anxiety, recommendations to protect human health? constriction of the pupils of the eye, and not being able to see The EPA has developed 1- and 10-day health advisories clearly. More severe symptoms include nausea and vomiting, (maximum recommended drinking water concentrations) for abdominal cramps, slow pulse, diarrhea, pinpoint pupils, diffiadults and children of 20 micrograms per liter of water culty breathing, and coma. (20 mg/L). Damage to the pancreas has developed in some people and in laboratory animals exposed to large amounts of diazinon. In Glossary animal studies, high doses of diazinon produced effects on the nervous system similar to those seen in people. Carcinogenicity: Ability to cause cancer. There is no evidence that long-term exposure to low levels of diazinon causes any harmful health effects in people. CAS: Chemical Abstracts Service. Cholinesterase: An enzyme found in the blood. Dissolve: To disappear gradually.

How likely is diazinon to cause cancer?

Insecticide: A substance that kills insects. Diazinon has not been shown to cause cancer in people or Long-term: 365 days or longer. animals. The Department of Health and Human Services Microgram (mg): One millionth of a gram. (DHHS), the International Agency for Research on Cancer Organophosphate: Chemicals made of phosphorus, carbon, (IARC), and the EPA have not classified diazinon as to its carciand other compounds. nogenicity.

Source of Information Is there a medical test to show whether Ive been exposed to diazinon?
This ToxFAQs information is taken from the 1996 Toxicological Profile for Diazinon produced by the Agency for Toxic The most common test for exposure to diazinon is to deter- Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Sermine the level of cholinesterase activity in the red blood cells or plasma. This test requires only a small amount of blood and vice in Atlanta, GA. is routinely available in your doctors office; however, this test Animal testing is sometimes necessary to find out how does not specifically show exposure to diazinon. toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of Specific tests are available to determine the presence of research animals and scientists must follow strict guidelines. diazinon or its breakdown products in blood, body tissue, and

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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DIBORANE
CAS #19287-45-7
Division of Toxicology ToxFAQsTM April 2002

This fact sheet answers the most frequently asked health questions (FAQs) about diborane. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Diborane is a manufactured, toxic, flammable gas. Exposure can occur primarily during manufacture or use in industry. The general population is not exposed to diborane. Exposure to diborane can cause irritation of the eyes, nose, throat, and respiratory airway. It can also cause skin irritation. This substance has been found in at least 3 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is diborane?
Diborane is a colorless gas at room temperature with a repulsive, sweet odor. It mixes well with air and easily forms explosive mixtures. Diborane will ignite spontaneously in moist air at room temperature. Diborane is used in rocket propellants, as a reducing agent, as a rubber vulcanizer, as a catalyst for hydrocarbon polymerization, as a flame-speed accelerator, and as a doping agent. It is also used in electronics to impart electrical properties in pure crystals.

Diborane is a gas that is not found in soil. If released to soil it is likely that it would react violently and spontaneously combust. Diborane does not accumulate in the food chain.

How might I be exposed to diborane?


Diborane is a very dangerous gas that is only used in chemical laboratories by experienced professionals. The general population will not be exposed to diborane. Diborane is a very toxic, flammable, gas used by chemists to make other compounds. Workers employed in occupations that manufacture or use diborane may be exposed to this compound by breathing in its vapors.

What happens to diborane when it enters the environment?


Diborane is a gas that can spontaneously burn or explode in air at normal room temperatures. Diborane is slightly soluble in water, but it will decompose rapidly when in contact with water producing boric acid and hydrogen gas which is very flammable.

How can diborane affect my health?


The toxic effects of diborane are primarily due to its irritant properties. Short-term exposure to diborane can cause a sensation of tightness of the chest, shortness of breath,

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CAS #19287-45-7
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DIBORANE

cough, and wheezing. These signs and symptoms can occur immediately or be delayed for up to 24 hours. Skin and eye irritation can also occur. Studies in animals have shown that diborane causes the same type of effects observed in humans. People exposed for a long time to low amounts of diborane have experienced respiratory irritation, seizures, fatigue, drowsiness, confusion, and occasional transient tremors. There is no information to determine whether exposure to diborane affects the reproductive system in humans or in animals.

How can families reduce the risk of exposure to diborane?


It is unlikely that the general population will be exposed to diborane.

Is there a medical test to show whether Ive been exposed to diborane?


There are no tests for measuring diborane levels in the body. If you suspect that you have been exposed to diborane, a chest x-ray and pulmonary function tests may be appropriate to determine if your lungs have been damaged. These tests are usually not available in the doctors office, but can be done in a hospital or clinic.

How likely is diborane to cause cancer?


There are no studies of carcinogenicity of diborane in humans or in animals. The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified diborane as to its carcinogenicity.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) sets a limit for diborane in workplace air of 0.1 parts of diborane per million parts of air (0.1 ppm) for an 8-hour workday, 40-hour work week.

How can diborane affect children?


There are no studies on the health effects of children exposed to diborane. Although exposure of children to diborane is unlikely, it is reasonable to assume that it will cause health effects similar to those seen in adults. We do not know if exposure to diborane will result in birth defects or other developmental effects in people.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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1,2-DIBROMO-3-CHLOROPROPANE CAS # 96-12-8


Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about 1,2-dibromo-3chloropropane. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to 1,2-dibromo-3-chloropropane occurs mainly from drinking water or eating food that contains the chemical. At high levels, this chemical may cause damage to the male reproductive system. This chemical has been found in at least 10 of 1,314 National Priorities List sites identified by the Environmental Protection Agency.
What is 1,2-dibromo-3-chloropropane? (Pronounced 1,2-dbrm-3-klr prpn)
1,2-Dibromo-3-chloropropane is a manufactured chemical and is not found naturally in the environment. It is a colorless liquid with a sharp smell. It can be tasted in water at very low concentrations. Some industries use it to make another chemical that is used to make materials that resist burning. Large amounts of 1,2-dibromo-3-chloropropane were used in the past on certain farms to kill pests that harmed crops. Farmers in all states other than Hawaii stopped using this chemical in 1979. Hawaii stopped using it in 1985. We do not know exactly how much of it is currently made or used by industry, but it is probably a small amount.
q In soil, some evaporates into the air, while small amounts may stay in the soil for several years.

How might I be exposed to 1,2-dibromo3-chloropropane?


q Drinking water or eating food that contains the chemical. q Breathing air or touching soil at or near agricultural areas where 1,2-dibromo-3-chloropropane was used in the past. q Breathing air at hazardous waste sites where improper disposal methods were used. q Working in an industry that uses 1,2-dibromo-3chloropropane.

How can 1,2-dibromo-3-chloropropane affect my health?


The main effect from breathing high levels of 1,2-dibromo-3-chloropropane is damage to the male's ability to reproduce. Studies on workers have shown that men may produce fewer sperm, produce sperm that results in more girl than boy babies, and eventually become unable to father children. It can also cause headaches, nausea, lightheadedness, and weakness in workers. Animals breathing high levels of the chemical were not

What happens to 1,2-dibromo-3-chloropropane when it enters the environment?


q Most of it that enters surface water evaporates into the air within several days or a week. q It takes several months for it to break down in air. q It doesn't stick to soil at the bottom of rivers, lakes, or ponds.

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able to reproduce and had damaged stomachs, livers, kidneys, brains, spleens, blood, and lungs. Breathing low to moderate levels also caused damage to the reproductive system. The ability of people to reproduce was not affected by drinking water contaminated with low levels of 1,2-dibromo3-chloropropane and there was no increase in the number of birth defects. Rats exposed to high levels did, however, have an increase in birth defects. It can also cause skin and eye damage from direct contact. Because exposure to this chemical lowers the number of sperm, we can count the number of sperm and blood levels of certain hormones in exposed men to determine whether harmful effects have occurred. However, these changes cannot tell the level or length of exposure to the chemical.

Has the federal government made recommendations to protect human health?


The Environmental Protection Agency (EPA) has set a limit of 0.2 parts of 1,2-dibromo-3-chloropropane per billion parts of drinking water (0.2 ppb). EPA requires that discharges or spills into the environment of 1 pound or more of 1,2-dibromo-3-chloropropane be reported. EPA banned the use of 1,2-dibromo-3-chloropropane as a pesticide in the United States in the early 1980s. The Occupational Safety and Health Administration (OSHA) has set an occupational exposure limit of 1 part of 1,2-dibromo-3-chloropropane in one billion parts of air (1 ppb) for an 8-hour workday over a 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) currently recommends that workers breathe as little 1,2-dibromo-3-chloropropane as possible.

How likely is 1,2-dibromo-3-chloropropane to cause cancer?


The Department of Health and Human Services has determined that 1,2-dibromo-3-chloropropane may reasonably be anticipated to be a carcinogen. Animal studies found cancer of the nose in animals exposed by breathing the chemical, cancer of the stomach and kidney in animals that ingested the chemical, and cancer of the stomach and skin in animals who had skin contact with the chemical. We do not know if these same cancers would occur in people.

Glossary Is there a medical test to show whether Ive been exposed to 1,2-dibromo-3-chloropropane?
Tests are available that measure the amount of 1,2-dibromo-3-chloropropane in exhaled air, blood, and samples of tissues from the body. These tests may require special equipment and they may not be available in your doctors office. Carcinogen: A substance that can cause cancer. Ingesting: Taking food or drink into your body. ppb: Parts per billion.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for 1,2-dibromo3-chloropropane. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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1,2-DIBROMOETHANE
CAS # 106-93-4
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about 1,2-dibromoethane. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to 1,2-dibromoethane can result from drinking groundwater or breathing air that is contaminated. This is most likely to occur in the workplace or from living near a hazardous waste site. 1,2-Dibromoethane can affect the brain, damage skin, damage sperm in males, and even cause death if exposure is very high. This chemical has been found in at least 27 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is 1,2-dibromoethane? (Pronounced 1,2-dbrm thn)
1,2-Dibromoethane is a manufactured chemical. It also occurs naturally in small amounts in the ocean where it is formed, probably by algae and kelp. It is a colorless liquid with a mild, sweet odor. Other names for 1,2-dibromoethane are ethylene dibromide, EDB, and glycol bromide. Trade names include Bromofume and Dowfume. 1,2-Dibromoethane has been used as a pesticide in soil, and on citrus, vegetable, and grain crops. Most of these uses have been stopped by the Environmental Protection Agency (EPA) since 1984. Another major use was as an additive in leaded gasoline; however, since leaded gasoline is now banned, it is no longer used for this purpose. Uses today include treatment of logs for termites and beetles, control of moths in beehives, and as a preparation for dyes and waxes. G Small amounts remain attached to soil particles. G It breaks down slowly in air (over 45 months), more quickly in surface water (2 months), and hardly at all in groundwater. G It is not expected to build up in plants or animals.

How might I be exposed to 1,2-dibromoethane?


G Drinking contaminated water, especially well water near farms or waste sites. G Breathing contaminated workplace air. G Touching it while bathing or swimming in contaminated water. G Playing in contaminated soils at waste sites.

How can 1,2-dibromoethane affect my health?


Your exposure to 1,2-dibromoethane is generally much, much lower than levels that can harm you. We don't know the effects on people of breathing high levels, but animal studies with short-term exposures to high levels caused depression and collapse, indicating effects on the brain. Redness and inflammation, including skin blisters and mouth and stomach ulcers, can occur if large amounts are

What happens to 1,2-dibromoethane when it enters the environment?


G It moves into the environment from manufacturing use and leaks at waste sites. G When released, it quickly moves to air and will evaporate from surface water and soil to the air. G It dissolves in water and will move through soil into the groundwater.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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swallowed. One accidental swallowing caused death in a woman. It is highly unlikely that there would be a risk of death to people from low-level exposure. Although very little is known about the effects from breathing 1,2-dibromoethane over a long period of time, some male workers had reproductive effects including damage to their sperm. No other long-term effects are known in people. In rats, death occurred from breathing high levels for a short time. Lower levels caused liver and kidney damage. When rats breathed air or ate food containing 1,2-dibromoethane for short or long periods of time, they were less fertile or had abnormal sperm. Changes in the brain and behavior were also seen in young rats whose male parents had breathed 1,2-dibromoethane, and birth defects were observed in the young of animals that were exposed while pregnant. 1,2-Dibromoethane is not known to cause birth defects in people. ion, a breakdown product of 1,2-dibromoethane, in blood. These tests cannot be done at your doctor's office, but your doctor may be able to send samples to a special laboratory.

Has the federal government made recommendations to protect human health?


The EPA has set a limit of 0.05 parts of 1,2-dibromoethane per billion parts of drinking water (0.05 ppb). EPA requires that spills into the environment of 1,000 pounds or more of 1,2-dibromoethane be reported. The Occupational Health and Safety Administration (OSHA) has limited workers' exposure to an average of 20 parts of 1,2-dibromoethane per million parts of air (ppm) for an 8-hour workday over a 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) has limited workers' exposure to 1,2-dibromoethane in air to an average of 0.045 ppm for up to a 10-hour workday over a 40-hour workweek.

How likely is 1,2-dibromoethane to cause cancer?


The Department of Health and Human Services has determined that 1,2-dibromoethane may reasonably be anticipated to be a carcinogen. There are no reports of cancer in workers or other people exposed to 1,2-dibromoethane for several years. However, rats and mice that breathed, swallowed, or touched it for long periods had cancer in many organs.

Glossary
Carcinogen: A substance that can cause cancer. Long-term: Lasting one year or longer. ppb: Parts per billion. ppm: Parts per million. Short-term: Lasting 14 days or less.

Is there a medical test to show whether Ive been exposed to 1,2-dibromoethane?


There is no reliable medical test to determine whether you have been exposed to 1,2-dibromoethane. Experimental methods exist to measure 1,2-dibromoethane or the bromide

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for 1,2-dibromoethane. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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1,4-DICHLOROBENZENE
CAS # 106-46-7
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about 1,4-dichlorobenzene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to 1,4-dichlorobenzene happens mostly from breathing high levels in indoor air or workplace air. Extremely high exposures can cause dizziness, headaches, and liver problems. 1,4-Dichlorobenzene has been found in at least 281 of 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is 1,4-dichlorobenzene? (Pronounced 1,4-d klr bn zn)
1,4-Dichlorobenzene is a chemical used to control moths, molds, and mildew, and to deodorize restrooms and waste containers. It is also called para-DCB or p-DCB. Other names include Paramoth, Para crystals, and Paracide reflecting its widespread use to kill moths. At room temperature, p-DCB is a white solid with a strong, pungent odor. When exposed to air, it slowly changes from a solid to a vapor. It is the vapor that acts as a deodorizer or insect killer. Most people recognize the odor as the smell of mothballs, and can smell p-DCB in the air at very low levels. Most p-DCB in our environment comes from its use in moth repellent products and in toilet deodorizer blocks. G It evaporates easily from water and soil, so most is found in the air. G It is taken up and retained by plants and fish.

How might I be exposed to 1,4-dichlorobenzene?


G Breathing indoor air in public restrooms and homes that use p-DCB as a deodorizer. G Breathing air around some mothballs (check the label). G Breathing workplace air where p-DCB is manufactured. G Drinking contaminated water around hazardous waste sites. G Eating foods such as pork, chicken, and eggs that are contaminated with p-DCB from its use as an odor control product in animal stalls. G Eating fish from contaminated waters.

How can 1,4-dichlorobenzene affect my health?


There is no evidence that moderate use of common household products that contain p-DCB will result in harmful effects to your health. Harmful effects, however, may occur from high exposures. Very high usage of p-DCB products in the home can result in dizziness, headaches, and liver problems. Some of the patients who developed these symptoms had been using the products for months or even years after

What happens to 1,4-dichlorobenzene when it enters the environment?


G In air, it breaks down to harmless products in about a month. G It does not dissolve easily in water. G It is not easily broken down by soil organisms.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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they first began to feel ill. Workers breathing high levels of p-DCB (1,000 times more than levels in deodorized rooms) have reported painful irritation of the nose and eyes. There are cases of people who have eaten p-DCB products regularly for months to years because of its sweet taste. These people had skin blotches and lower numbers of red blood cells. cides, bathroom deoderizers, and mothballs containg p-DCB should be stored out of reach of young children. Always store household chemicals in their original containers. Never store them in containers children would find attractive to eat or drink from, such as old soda bottles.

Is there a medical test to show whether Ive been exposed to 1,4-dichlorobenzene?


Tests are available to measure your exposure to p-DCB. The most common test measures a breakdown product of pDCB called 2,5-dichlorophenol in urine and blood. If there is 2,5-dichlorophenol in the urine, it indicates that the person was exposed to p-DCB within the previous day or two. The test that measures p-DCB in your blood is less common.

How likely is 1,4-dichlorobenzene to cause cancer?


The Department of Health and Human Services (DHHS) has determined that p-DCB may reasonably be anticipated to be a carcinogen. There is no direct evidence that p-DCB can cause cancer in humans. However, animals given very high levels in water developed liver and kidney tumors.

Has the federal government made recommendations to protect human health?


The EPA has set a maximum contaminant level of 75 micrograms of p-DCB per liter of drinking water (75 g/L). p-DCB is also an EPA-registered pesticide. Manufacturers must provide certain information to EPA for it to be used as a pesticide. The Occupational Safety and Health Administration (OSHA) has set a maximum level of 75 parts of p-DCB per million parts air in the workplace (75 ppm) for an 8-hour day, 40-hour workweek.

How can 1,4-dichlorobenzene affect children?


Children are exposed to p-DCB in many of the same ways that adults are. Children may be at higher risk, due to accidental exposures such as swallowing p-DCB used in the home in mothballs or toilet bowl deoderant blocks. There is very little information on how children react to p-DCB exposure, but children would probably show the same effects as adults. No studies in people or animals show that p-DCB crosses the placenta or can be found in fetal tissues. Based on other similar chemicals, it is possible that this could occur. There is no credible evidence that p-DCB causes birth defects. One study found dichlorobenzenes in breast milk, but p-DCB has not been specifically measured.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1998. Toxicological profile for 1,4-dichlorobenzene. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

How can families reduce the risk of exposure to 1,4-dichlorobenzene?


You should not let children play with or drink toilet bowl water because it may contain p-DCB. Do not let children rub mothballs or cleaners containing p-DCB on their skin. Pesti-

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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3,3'-DICHLOROBENZIDINE
CAS # 91-94-1
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about 3,3'-dichlorobenzidine. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to 3,3'-dichlorobenzidine may cause sore throat, respiratory infections, stomach upset, headache, dizziness, burns, and dermatitis. It has been found to cause tumors in a variety of organs in animals. This substance has been found in at least 32 of the 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is 3,3'-dichlorobenzidine? (Pronounced 3,3-d klr bn z dn)


3,3'-Dichlorobenzidine is a gray-to-purple colored crystalline solid. It changes from a solid to a gas very slowly. 3,3'-Dichlorobenzidine salt is the major form in actual use. It is a stable, off-white colored crystalline solid that does not evaporate. Neither 3,3'-dichlorobenzidine nor its salt are found naturally in the environment. They are manufactured for pigments for printing inks, textiles, plastics and enamels, paint, leather, and rubber.

Under certain conditions, 3,3'-dichlorobenzidine in soil can break down to form another chemical, benzidine.

How might I be exposed to 3,3'-dichlorobenzidine?

G G G G

It is used to make pigments to color various substances. You may be exposed if you work in a place where it is manufactured or used. The most common ways to be exposed are by breathing dust or getting it on your skin. You could be exposed through dirt or water if you lived near a plant that uses it, or a hazardous waster site that contains it.

What happens to 3,3'-dichlorobenzidine when it enters the environment?

G G G G

How can 3,3'-dichlorobenzidine affect my health?


The salt form of 3,3'-dichlorobenzidine may have caused sore throat, respiratory infections, stomach upset, headache, dizziness, caustic burns, and dermatitis (an inflammation of the skin) in workers exposed to the chemical. However, with the exception of dermatitis, it is not certain that 3,3'-dichlorobenzidine caused these effects because the workers were exposed to other chemicals at the same time.

3,3'-Dichlorobenzidine breaks down rapidly when exposed to natural sunlight. About half of the chemical breaks down within 10 hours in air and sunlight. In water exposed to natural sunlight, it will break down even more rapidly. In soil, where no sunlight is present, it may last for several months.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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3,3'-DICHLOROBENZIDINE CAS # 91-94-1

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html How likely is 3,3'-dichlorobenzidine to cause cancer?
Studies show that 3,3'-dichlorobenzidine caused cancer of the liver, skin, breast, bladder, and tissues that form blood (leukemia) and other organs in laboratory animals that ate it in their food. Studies in people are inconclusive. The Department of Health and Human Services (DHHS) has determined that 3,3'-dichlorobenzidine and its salt form may reasonably be expected to be a carcinogen.

Is there a medical test to show whether Ive been exposed to 3,3'-dichlorobenzidine?


There are tests that can determine the presence of 3,3'-dichlorobenzidine in your urine. These tests are not commonly available to the general population, but are available to workers who may have been exposed to potentially harmful levels of the chemical in the workplace. The tests are accurate, but because 3,3'-dichlorobenzidine does not stay in the body for very long, they must be done as soon as possible after exposure.

How can 3,3'-dichlorobenzidine affect children?


There are no studies on the health effects of children exposed to 3,3'-dichlorobenzidine. In studies in which pregnant mice were injected with high amounts of 3,3'-dichlorobenzidine under the skin, the kidneys of their babies did not develop properly and some babies developed kidney tumors. However, it is very unlikely that people will encounter such exposure conditions. There is some evidence that 3,3'-dichlorobenzidine and its breakdown products can cross the placenta. We do not know if it can be transferred to babies by breast milk.

Has the federal government made recommendations to protect human health?


The EPA requires that spills or accidental releases into the environment of 1 pound or more of 3,3'-dichlorobenzidine be reported to the EPA. The National Institute for Occupational Safety and Health (NIOSH) considers 3,3'-dichlorobenzidine a "potential occupational carcinogen" and recommends workplace practices and controls to reduce exposures to the lowest possible level.

Source of Information How can families reduce the risk of exposure to 3,3'-dichlorobenzidine?
Adults who work with 3,3'-dichlorobenzidine should be careful not to bring home contaminated clothing or tools. If you live near a plant that uses 3,3'-dichlorobenzidine or a hazardous waste site that contains it, you and your children should be careful to wash your hands frequently, especially before eating and children should be prevented from putting their dirty hands in their mouths. Agency for Toxic Substances and Disease Registry (ATSDR). 1998. Toxicological profile for 3,3'-dichlorobenzidine. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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1,1-DICHLOROETHANE
CAS # 75-34-3
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about 1,1-dichloroethane. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: 1,1-Dichloroethane is used to make other chemicals and to dissolve and remove grease. Breathing very high levels can affect your heart and animal studies have seen kidney disease from long-term exposure to high levels in air. 1,1-Dichloroethane has been found in at least 248 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is 1,1-dichloroethane? (Pronounced 1,1-d klr th n)


1,1-Dichloroethane is a colorless, oily liquid with a sweet odor. It evaporates easily at room temperature and burns easily. It does not occur naturally in the environment. In the past, 1,1-dichloroethane was used as a surgical anesthetic, but it is no longer used this way. Today it is used primarily to make other chemicals, to dissolve substances such as paint, varnish, and finish removers, and to remove grease.

q 1,1-Dichloroethane does not dissolve easily in water. q Small amounts of 1,1-dichloroethane released to soil can evaporate into the air or move into groundwater. q It is not known how long it stays in soil. q 1,1-Dichloroethane is not expected to build up in the body tissues of animals.

How might I be exposed to 1,1-dichloroethane?


q Breathing air containing it from industrial releases or hazardous waste sites. q Drinking contaminated tap water. q Touching soil containing it. q Touching contaminated materials in the workplace.

What happens to 1,1-dichloroethane when it enters the environment?


q 1,1-Dichloroethane is released from industrial processes primarily to the air. q 1,1-Dichloroethane evaporates from water rapidly into the air. q It can also be found in the air as a breakdown product of another chemical, 1,1,1-trichloroethane.

How can 1,1-dichloroethane affect my health?


Very limited information is available on the effects of 1,1-dichloroethane on peoples health. The chemical was discontinued as a surgical anesthetic when effects on the heart, such as irregular heart beats, were reported.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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1,1-DICHLOROETHANE
CAS # 75-34-3

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

Studies in animals have shown that 1,1-dichloroethane can cause kidney disease after long-term exposure to high levels in air. Delayed growth was seen in the offspring of animals who breathed high concentrations of the chemical during pregnancy.

reported to the EPA. The Occupational Safety and Health Administration (OSHA) has set an occupational exposure limit of 400 milligrams of 1,1-dichloroethane per cubic meter of air (400 mg/m3) for an 8-hour workday, 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) and the American Conference of Governmental Industrial Hygienists (ACGIH) recommend the same exposure limit in air. NIOSH currently recommends that a level of 12,150 mg/m3 be considered immediately dangerous to life and health. This is the exposure level of 1,1-dichloroethane that is likely to cause permanent health problems or death. The federal recommendations have been uipdated as of July 1999.

How likely is 1,1-dichloroethane to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified 1,1-dichloroethane for carcinogenicity. 1,1-Dichloroethane caused cancer in one study in which rats and mice were fed large doses of the chemical for their lifetimes.

Is there a medical test to show whether Ive been exposed to 1,1-dichloroethane?


Tests are available that measure 1,1-dichloroethane in urine, blood, breath, and body tissues. These tests aren't available at most doctors' offices, but can be done at a special laboratory that has special equipment. The tests must be done soon after exposure occurs, because most of the 1,1-dichloroethane that is taken into the body leaves within 2 days. In addition, these tests cannot tell you when you were exposed, or whether health effects will occur.

Glossary
Anesthetic: A substance used to cause numbness. Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or gas. Milligram (mg): One thousandth of a gram.

Source of Information
Agency for Toxic Substances and Disease Registry. 1990. Toxicological profile for 1,1-dichloroethane. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people or to treat those who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Has the federal government made recommendations to protect human health?


The EPA requires that spills or accidental releases into the environment of 1,000 pounds or more of 1,1-dichloroethane be

Where can I get more information?

For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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1,2-DICHLOROETHANE
CAS #107-06-2
Division of Toxicology ToxFAQsTM September 2001

This fact sheet answers the most frequently asked health questions (FAQs) about 1,2-Dichloroethane. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to 1,2-dichloroethane usually occurs by breathing contaminated air in workplaces that use 1,2-dichloroethane. Breathing or ingesting high levels of 1,2-dichloroethane can cause damage to the nervous system, liver, kidneys, and lungs and may cause cancer. This substance has been found in at least 570 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is 1,2-dichloroethane?
1,2-Dichloroethane, also called ethylene dichloride, is a manufactured chemical that is not found naturally in the environment. It is a clear liquid and has a pleasant smell and sweet taste. The most common use of 1,2-dichloroethane is in the production of vinyl chloride which is used to make a variety of plastic and vinyl products including polyvinyl chloride (PVC) pipes, furniture and automobile upholstery, wall coverings, housewares, and automobile parts. It is also used to as a solvent and is added to leaded gasoline to remove lead. 1,2-Dichloroethane released in soil will either evaporate into the air or travel down through the soil and enter underground water.

How might I be exposed to 1,2-dichloroethane?


The general population may be exposed to 1,2-dichloroethane by breathing air or drinking water that contains 1,2-dichloroethane. People who work or live near a factory where 1,2-dichloroethane is used, may be exposed to higher than usual levels. People living near uncontrolled hazardous waste sites may also be exposed to higher than usual levels of 1,2-dichloroethane.

What happens to 1,2-dichloroethane when it enters the environment?


Most of the 1,2-dichloroethane released to the environment is released to the air. In the air, 1,2-dichloroethane breaks down by reacting with other compounds formed by sunlight. It can stay in the air for more than 5 months before it is broken down. 1,2-Dichloroethane can also be released into rivers and lakes. It breaks down very slowly in water and most of it will evaporate to the air.

How can 1,2-dichloroethane affect my health?


Nervous system disorders, liver and kidney diseases, and lung effects have been reported in humans ingesting or inhaling large amounts of 1,2-dichloroethane. In laboratory animals, breathing or ingesting large amounts of 1,2-dichloroethane have also caused nervous system disorders and liver, kidney, and lung effects. Animal studies also suggest that 1,2-dichloroethane may damage the

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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1,2-DICHLOROETHANE
CAS #107-06-2
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

immune system. Kidney disease has also been seen in animals ingesting low doses of 1,2-dichloroethane for a long time. Studies in animals indicate that 1,2-dichloroethane does not affect reproduction.

exposure from this source could be eliminated if these older products were immediately discarded. Children should avoid playing in soils near uncontrolled hazardous waste sites where 1,2-dichloroethane may have been discarded.

How likely is 1,2-dichloroethane to cause cancer?


Human studies examining whether 1,2-dichloroethane can cause cancer have been considered inadequate. In animals, increases in the occurrence of stomach, mammary gland, liver, lung, and endometrium cancers have been seen following inhalation, oral, and dermal exposure. The Department of Health and Human Services (DHHS) has determined that 1,2-dichloroethane may reasonably be expected to cause cancer. The EPA has determined that 1,2-dichloroethane is a probable human carcinogen and the International Agency for Cancer Research (IARC) considers it to be a possible human carcinogen.

Is there a medical test to show whether Ive been exposed to 1,2-dichloroethane?


Tests are available to measure 1,2-dichloroethane in breath, blood, breast milk, and urine of exposed people. Because 1,2-dichloroethane leaves the body fairly quickly, these tests need to be done within a couple of days of exposure. These tests cannot be used to predict the nature or severity of toxic effects. These tests are not usually done in the doctors office.

How can 1,2-dichloroethane affect children?


We do not know if exposure to 1,2-dichloroethane will result in birth defects or other developmental effects in people. Studies in animals suggest that 1,2-dichloroethane does not produce birth defects. It is likely that health effects seen in children exposed to high levels of 1,2-dichloroethane will be similar to the effects seen in adults.

Has the federal government made recommendations to protect human health?


The EPA allows 0.005 milligrams of 1,2-dichloroethane per liter of drinking water (0.005 mg/L). The Occupational Safety and Health Administration has set a limit of 50 parts of 1,2-dichloroethane per million parts of air (50 ppm) in workplace air for 8 hour shifts and 40 hour work weeks.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for 1,2-Dichloroethane. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

How can families reduce the risk of exposure to 1,2-dichloroethane?


The general population is not likely to be exposed to large amounts of 1,2-dichloroethane. In the past, it was used in small amounts in household products such as cleaning agents, pesticides, and wallpaper and carpet glue. Risk of

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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1,1-DICHLOROETHENE
CAS # 75-35-4
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about 1,1-dichloroethene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to 1,1-dichloroethene occurs mainly in the workplace. Breathing high levels of 1,1-dichloroethene can affect the liver, kidney, and central nervous system. This chemical has been found in at least 515 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is 1,1-dichloroethene? (Pronounced 1,1-dklr thn)
1,1-Dichloroethene is an industrial chemical that is not found naturally in the environment. It is a colorless liquid with a mild, sweet smell. It is also called vinylidene chloride. 1,1-Dichloroethene is used to make certain plastics, such as flexible films like food wrap, and in packaging materials. It is also used to make flame retardant coatings for fiber and carpet backings, and in piping, coating for steel pipes, and in adhesive applications.

How might I be exposed to 1,1-dichloroethene?


q Workers may be exposed in industries that make or use 1,1-dichloroethene (these industries are mainly in Texas and Louisiana). q Food that is wrapped in plastic wrap may contain very low levels of 1,1-dichloroethene. The government controls these levels to prevent harm to your health. q A small percentage (3%) of the drinking water supplies may contain very low levels of 1,1-dichloroethene. q Air near factories that make or use 1,1-dichloroethene and air near hazardous waste sites may contain low levels of it.

What happens to 1,1-dichloroethene when it enters the environment?


q 1,1-Dichloroethene enters the environment from industries that make or use it. q 1,1-Dichloroethene evaporates very quickly from water and soil to the air. q In the air, it takes about 4 days for it to break down. q 1,1-Dichloroethene breaks down very slowly in water. q It does not accumulate very much in fish or birds. q In soil, 1,1-dichloroethene is slowly transformed to other less harmful chemicals.

How can 1,1-dichloroethene affect my health?


The main effect from breathing high levels of 1,1dichloroethene is on the central nervous system. Some people lost their breath and fainted after breathing high levels of the chemical. Breathing lower levels of 1,1-dichloroethene in air for a long time may damage your nervous system, liver, and lungs. Workers exposed to 1,1-dichloroethene have reported a loss in liver function, but other chemicals were present.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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Animals that breathed high levels of 1,1-dichloroethene had damaged livers, kidneys, and lungs. The offspring of some of the animals had a higher number of birth defects. We do not know if birth defects occur when people are exposed to 1,1-dichloroethene. Animals that ingested high levels of 1,1-dichloroethene had damaged livers, kidneys, and lungs. There were no birth defects in animals that ingested the chemical. Spilling 1,1-dichloroethene on your skin or in your eyes can cause irritation.

Because 1,1-dichloroethene leaves the body fairly quickly, these methods are useful only for finding exposures that have occurred within the last few days. These tests can't tell you if adverse health effects will occur from exposure to 1,1-dichloroethene.

Has the federal government made recommendations to protect human health?


The EPA has set a limit in drinking water of 0.007 parts of 1,1-dichloroethene per million parts of drinking water (0.007 ppm). EPA requires that discharges or spills into the environment of 5,000 pounds or more of 1,1-dichloroethene be reported. The Occupational Safety and Health Administration (OSHA) has set an occupational exposure limit of 1 ppm of 1,1-dichloroethene in workplace air for an 8-hour workday, 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) currently recommends that workers breathe as little 1,1-dichloroethene as possible.

How likely is 1,1-dichloroethene to cause cancer?


The Environmental Protection Agency (EPA) has determined that 1,1-dichloroethene is a possible human carcinogen. Studies on workers who breathed 1,1-dichloroethene have not shown an increase in cancer. These studies, however, are not conclusive because of the small numbers of workers and the short time studied. Animal studies have shown mixed results. Several studies reported an increase in tumors in rats and mice, and other studies reported no such effects.

Glossary
Carcinogen: A substance that can cause cancer. CAS: Chemical Abstracts Service. Ingesting: Taking food or drink into your body. ppm: Parts per million. Tumor: An abnormal mass of tissue.

Is there a medical test to show whether Ive been exposed to 1,1-dichloroethene?


Tests are available to measure levels of 1,1-dichloroethene in breath, urine, and body tissues. These tests are not usually available in your doctors office. However, a sample taken in your doctors office can be sent to a special laboratory if necessary.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1994. Toxicological profile for 1,1-dichloroethene. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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1,2-DICHLOROETHENE
CAS # 540-59-0, 156-59-2, and 156-60-5
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about 1,2-dichloroethene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to 1,2-dichloroethene occurs mainly in workplaces where it is made or used. Breathing high levels of 1,2-dichloroethene can make you feel nauseous, drowsy, and tired. cis-1,2-Dichloroethene has been found in at least 146 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA). trans-1,2-Dichloroethene was found in at least 563 NPL sites. 1,2Dichloroethene was found at 336 sites, but the isomer (cis- or trans-) was not specified.
What is 1,2-dichloroethene? (Pronounced 1,2-d-klr -thn)
1,2-Dichloroethene, also called 1,2-dichloroethylene, is a highly flammable, colorless liquid with a sharp, harsh odor. It is used to produce solvents and in chemical mixtures. You can smell very small amounts of 1,2-dichloroethene in air (about 17 parts of 1,2-dichloroethene per million parts of air [17 ppm]). There are two forms of 1,2-dichloroethene; one is called cis-1,2-dichloroethene and the other is called trans-1,2-dichloroethene. Sometimes both forms are present as a mixture. q There is a slight chance that 1,2-dichloroethene will break down into vinyl chloride, a different chemical which is believed to be more toxic than 1,2-dichloroethene.

How might I be exposed to 1,2-dichloroethene?


q Breathing 1,2-dichloroethene that has leaked from hazardous waste sites and landfills. q Drinking contaminated tap water or breathing vapors from contaminated water while cooking, bathing, or washing dishes. q Breathing 1,2-dichloroethene, touching it, or touching contaminated materials in the workplace.

What happens to 1,2-dichloroethene when it enters the environment?


q 1,2-Dichloroethene evaporates rapidly into air. q In the air, it takes about 5-12 days for half of it to break down. q Most 1,2-dichloroethene in the soil surface or bodies of water will evaporate into air. q 1,2-Dichloroethene can travel through soil or dissolve in water in the soil. It is possible that it can contaminate groundwater. q In groundwater, it takes about 13-48 weeks to break down.

How can 1,2-dichloroethene affect my health?


Breathing high levels of 1,2-dichloroethene can make you feel nauseous, drowsy, and tired; breathing very high levels can kill you. When animals breathed high levels of trans-1,2dichloroethene for short or longer periods of time, their livers and lungs were damaged and the effects were more severe with longer exposure times. Animals that breathed very high

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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levels of trans-1,2-dichloroethene had damaged hearts. Animals that ingested extremely high doses of cis- or trans-1,2-dichloroethene died. Lower doses of cis-1,2-dichloroethene caused effects on the blood, such as decreased numbers of red blood cells, and also effects on the liver. The long-term (365 days or longer) human health effects after exposure to low concentrations of 1,2-dichloroethene arent known. One animal study suggested that an exposed fetus may not grow as quickly as one that hasnt been exposed. Exposure to 1,2-dichloroethene hasnt been shown to affect fertility in people or animals.

Has the federal government made recommendations to protect human health?


The EPA has set the maximum allowable level of cis-1,2dichloroethene in drinking water at 0.07 milligrams per liter of water (0.07 mg/L) and trans-1,2-dichloroethene at 0.1 mg/L. The EPA requires that any spills or accidental release of 1,000 pounds or more of 1,2-dichloroethene must be reported to the EPA. The Occupational Health Safety and Health Administration (OSHA) has set the maximum allowable amount of 1,2-dichloroethene in workroom air during an 8-hour workday in a 40-hour workweek at 200 parts of 1,2-dichloroethene per million parts of air (200 ppm).

How likely is 1,2-dichloroethene to cause cancer?


The EPA has determined that cis-1,2-dichloroethene is not classifiable as to its human carcinogenicity. No EPA cancer classification is available for trans-1,2dichloroethene.

Glossary
Carcinogenicity: Ability of a substance to cause cancer. CAS: Chemical Abstracts Service. Fertility: Ability to reproduce. Ingest: To eat or drink something. Milligram (mg): One thousandth of a gram. ppm: Parts per million. Solvent: A chemical that can dissolve other substances.

Is there a medical test to show whether Ive been exposed to 1,2-dichloroethene?


Tests are available to measure concentrations of the breakdown products of 1,2-dichloroethene in blood, urine, and tissues. However, these tests arent used routinely to determine whether a person has been exposed to this compound. This is because after you are exposed to 1,2-dichloroethene, the breakdown products in your body that are detected with these tests may be the same as those that come from exposure to other chemicals. These tests aren't available in most doctors' offices, but can be done at special laboratories that have the right equipment.

Source of Information
This ToxFAQs information is taken from the 1996 Toxicological Profile for 1,2-Dichloroethene produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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1,2-DICHLOROPROPANE
CAS # 78-87-5
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about 1,2-dichloropropane. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: 1,2-Dichloropropane is primarily used to make other chlorinated chemicals. Exposure to high levels of 1,2-dichloropropane can damage the liver, kidneys, blood, and lungs, and affect the brain. It has been found at 26 of the 1,177 National Priorities List sites identified by the Environmental Protection Agency (EPA).
G When released to soil, it is not easily broken down by bacteria, but will easily evaporate to the air and filter into the groundwater. G 1,2-Dichloropropane does not build up in the food chain.

What is 1,2-dichloropropane? (Pronounced 1,2-d-klr-prpn)


1,2-Dichloropropane is a colorless, flammable liquid with a chloroform-like odor. It is moderately soluble in water and readily evaporates into air. It does not occur naturally in the environment. 1,2-Dichloropropane production in the United States has declined over the past 20 years. It was used in the past as a soil fumigant, chemical intermediate, and industrial solvent and was found in paint strippers, varnishes, and furniture finish removers. Most of these uses were discontinued. Today, almost all of the 1,2-dichloropropane is used as a chemical intermediate to make perchloroethylene and several other related chlorinated chemicals.

How might I be exposed to 1,2-dichloropropane?


G Most people are not likely to be exposed to 1,2-dichloropropane because of its limited use. G If you work where 1,2-dichloropropane is made or used, you could be exposed by breathing air that contains its vapors or by spilling or splashing it on your skin. G People who live near a waste site containing 1,2-dichloropropane could be exposed by drinking contaminated groundwater, breathing vapors released to the air, or getting contaminated soil on their skin.

How can 1,2-dichloropropane affect my health?


People who intentionally or accidentally breathe high levels of 1,2-dichloropropane have experienced difficulty breathing, coughing, vomiting, nosebleed, fatigue, and damage to blood cells, liver, and kidneys. People who accidently drank cleaning solutions containing 1,2-dichloropropane experienced headaches, dizziness, nausea, liver and kidney damage, anemia, coma, and death.

What happens to 1,2-dichloropropane when it enters the environment?


G 1,2-Dichloropropane released to air can spread to areas far from where it was released because it is not rapidly broken down by reactions with other chemicals and sunlight. G Most of the 1,2-dichloropropane in water will evaporate to the air.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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Animal studies indicate that breathing low levels of 1,2-dichloropropane over short- or long-term periods causes damage to the liver, kidney, and respiratory system. Breathing high levels causes death. Similar effects have been reported when animals were given 1,2-dichloropropane by mouth. Some studies indicate that ingesting 1,2-dichloropropane may cause reproductive effects. One study reported a delay in bone formation of the skull in fetal rats following exposure of the mother rats to 1,2-dichloropropane. dichloropropane in lakes and streams should be limited to 0.52 parts per billion (0.52 ppb) to prevent possible human health effects from drinking contaminated water or eating contaminated fish. Any release to the environment greater than 1,000 pounds of 1,2-dichloropropane must be reported to the EPA. The Occupational Safety and Health Administration (OSHA) has set a workplace air concentration limit of 75 ppm over an 8-hour workday, 40-hour workweek. The federal recommendations have been updated as of July 1999.

How likely is 1,2-dichloropropane to cause cancer?


It is not known whether 1,2-dichloropropane causes cancer in people. The carcinogenicity of 1,2-dichloropropane has been evaluated in animal studies with rats and mice. Liver tumors have been observed in mice, and mammary gland tumors have been found in rats. The International Agency for Research on Cancer (IARC) has determined that 1,2-dichloropropane is unclassifiable as to human carcinogenicity.

Glossary
Anemia: A decreased ability of the blood to transport oxygen. Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. Long-term: Lasting one year or longer. National Priorities List: A list of the nations worst hazardous waste sites. ppb: Parts per billion. ppm: Parts per million. Short-term: Lasting 14 days or less. Tumor: An abnormal mass of tissue.

Is there a medical test to show whether Ive been exposed to 1,2-dichloropropane?


Urine and blood tests can be used to find out if you have been exposed to 1,2-dichloropropane. Levels measured in the urine can be used to predict the levels in the air. These tests cannot predict whether you will suffer harmful effects. Because special equipment is needed, these tests are not usually done in the doctor's office.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1989. Toxicological profile for 1,2-dichloropropane. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Has the federal government made recommendations to protect human health?


The EPA has set a Maximum Contaminant Level (MCL) of 0.005 parts per million (0.005 ppm) for 1,2-dichloropropane in drinking water. The EPA recommends that the level of 1,2-

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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1,3-DICHLOROPROPENE
CAS # 542-75-6
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about 1,3-dichloropropene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to 1,3-dichloropropene occurs mainly on farms where it is used to treat crops or in factories where it is made. When breathed at very high levels, 1,3-dichloropropene may irritate the skin, eyes, nose, and throat, and other effects. This chemical has been found in at least 94 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is 1,3-dichloropropene? (Pronounced 1,3-d klr prpn)
1,3-Dichloropropene is a manufactured chemical that does not occur naturally in the environment. It is a colorless liquid with a sweet smell. There are two forms of 1,3-dichloropropene: cis1,3-dichloropropene and trans-1,3-dichloropropene. These forms are very similar to each other and are usually combined in different amounts to form mixtures. It is used mainly in farming to kill nematodes, which are pests that eat the roots of crops. It is often sprayed undiluted directly on the soils of vegetable and tobacco crops. Much smaller amounts are used to dissolve or to make other chemicals. q It may travel deeper into the ground and reach underground water supplies; however, in states where it is often used, very little has been found in the groundwater. q Other chemicals often found in hazardous waste sites may slow the breakdown of 1,3-dichloropropene. q We do not know if 1,3-dichloropropene accumulates in fish. Studies with animals show that most of it leaves the body within 2 days.

How might I be exposed to 1,3-dichloropropene?


q Breathing contaminated air or touching it during its use to treat farm crops. q Breathing contaminated workplace air or air around hazardous waste sites that contain it. q Drinking contaminated water near where it's produced or used, or near hazardous waste sites that contain it.

What happens to 1,3-dichloropropene when it enters the environment?


q 1,3-Dichloropropene rapidly evaporates from water and soil into the air where it is broken down by sunlight. q When in soil, it is likely to be broken down by small organisms. q It dissolves in water and breaks down slowly in water.

How can 1,3-dichloropropene affect my health?


Most of the adverse health effects from 1,3-dichloropropene come from breathing or touching it when it's produced or used on farm crops. Workers who breathed high

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levels of 1,3-dichloropropene had irritated skin, eyes, nose, and throat, and coughing, nausea, headache, and fatigue. Short-term high level and long-term lower level studies in animals also show damage to the nose and lung tissues. The effects from ingesting 1,3-dichloropropene are not known. Animal studies have reported damage to the stomach lining, lung congestion, difficulty walking, and effects on the liver and kidneys from ingesting high levels. The skin of some workers who made a pesticide that contained 1,3-dichloropropene became sensitive to further exposure. When 1,3-dichloropropene was applied to the skin of animals, irritation of the skin, hair loss, and bleeding from the lungs and stomach occurred. These tests are only accurate for recent exposures, because 1,3-dichloropropene leaves the body within 1 to 2 days. These tests can't determine if adverse health effects will occur from exposure to 1,3-dichloropropene.

Has the federal government made recommendations to protect human health?


The Environmental Protection Agency (EPA) requires that discharges or spills of 100 pounds or more of 1,3-dichloropropene into the environment be reported. The National Institute for Occupational Safety and Health (NIOSH) and the American Conference of Governmental Industrial Hygienists (ACGIH) have recommended an occupational exposure limit of 1 part 1,3-dichloropropene per million parts of workplace air (1 ppm). These agencies advise avoiding eye and skin contact because this may be a route of significant exposure.

How likely is 1,3-dichloropropene to cause cancer?


The Department of Health and Human Services has determined that 1,3-dichloropropene may reasonably be anticipated to be a carcinogen. Studies in animals show an increase in tumors of the stomach, urinary bladder, and lungs from ingestion of 1,3-dichloropropene. Studies in people suggest that 1,3-dichloropropene may be carcinogenic, but no definite conclusion can be made.

Glossary
Carcinogen: A substance that can cause cancer. Ingesting: Taking food or drink into your body. ppm: Parts per million. Short-term: Lasting 14 days or less. Long-term: Lasting one year or longer. Tumor: An abnormal mass of tissue.

Is there a medical test to show whether Ive been exposed to 1,3-dichloropropene?


Tests are available to measure the amount of 1,3dichloropropene or its breakdown products in blood and urine. However, the presence of 1,3-dichloropropene or its breakdown products could also mean that you were exposed to some other chemical that breaks down into 1,3-dichloropropene.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for 1,3-dichloropropene. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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DICHLORVOS
CAS # 62-73-7
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about dichlorvos. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Dichlorvos is an insecticide which is used to control insects primarily in storage areas and barns. It can affect the nervous system where it may cause nausea and vomiting, restlessness, sweating, and muscle tremors at high levels. Dichlorvos been found in at least 3 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is dichlorvos? (Pronounced d-klr vs)
Dichlorvos is an insecticide that is a dense colorless liquid. It has a sweetish smell and readily mixes with water. Dichlorvos used in pest control is diluted with other chemicals and used as a spray. It can also be incorporated into plastic that slowly releases the chemical. Dichlorvos is used for insect control in food storage areas, green houses, and barns, and control of insects on livestock. It is not generally used on outdoor crops. Dichlorvos is sometimes used for insect control in workplaces and in the home. Veterinarians use it to control parasites on pets. q It takes about 2436 hours for half of the chemical to be broken down in water. q Dichlorvos does not appear to accumulate in plants, fish, or animals.

How might I be exposed to dichlorvos?


q The general population is not likely to be exposed to dichlorvos. q It has been found on some fruits, vegetables, and grain, but washing and processing destroys the dichlorvos. q People who live near a hazardous waste site containing dichlorvos could be exposed by breathing contaminated air or touching contaminated soil. q Workers who manufacture the chemical or use it are likely to be exposed. q People whose homes have been sprayed with dichlorvos could be exposed by breathing contaminated air or touching surfaces where dichlorvos was applied.

What happens to dichlorvos when it enters the environment?


q Dichlorvos enters the environment during its manufacture and use, from landfills, and from accidental spills during transport and leaks from storage containers. q It evaporates easily into the air, where it is broken down into less harmful chemicals. q It will dissolve in water, where microorganisms can break it down.

How can dichlorvos affect my health?


The major effect of dichlorvos is on the nervous system. Studies on people who were exposed to dichlorvos by breathing air in the workplace containing low levels of dichlorvos have not shown any harmful effects. Animal studies have shown

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DICHLORVOS CAS # 62-73-7


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that breathing high levels can cause nervous system effects. Ingesting large doses may cause nausea and vomiting, restlessness, sweating, and muscle tremors, while very large doses may cause coma, inability to breathe, and death. Animal studies have also shown effects on the nervous system when animals drank water or ate food containing dichlorvos. It is not known whether dichlorvos can affect reproduction or cause birth defects in people. Animal studies have not reported effects on reproduction or birth defects when animals were exposed to dichlorvos.

breakdown products in your urine. These tests arent available at most doctors offices, but can be done at special laboratories that have the right equipment.

Has the federal government made recommendations to protect human health?


The EPA requires that spills or accidental releases into the environment of 10 pounds or more of dichlorvos be reported to the EPA. The Occupational Safety and Health Administration (OSHA) has set a permissible exposure limit of 1 milligram dichlorvos per cubic meter of air (1 mg/m3) for an 8-hour workday, 40 hour workweek.

How likely is dichlorvos to cause cancer?


It is not known whether dichlorvos causes cancer in people. A study in rats and mice reported that rats had an increase in cancer of the pancreas and in leukemia, and female mice had an increase in stomach cancer after they were fed dichlorvos for 2 years. The Department of Health and Human Services (DHHS) has determined that dichlorvos may reasonably be anticipated to be a carcinogen. The International Agency for Research on Cancer (IARC) has determined that dichlorvos is possibly carcinogenic to humans. The EPA has determined that dichlorvos is a probable human carcinogen.

Glossary
Carcinogen: A substance with the ability to cause cancer. CAS: Chemical Abstracts Service. Ingest: To eat or drink something. Insecticide: A substance that kills insects. Leukemia: Cancer of the blood-forming organs. Milligram (mg): One thousandth of a gram.

Source of Information
This ToxFAQs information is taken from the 1997 Toxico-

Is there a medical test to show whether Ive been logical Profile for Dichlorvos produced by the Agency for exposed to dichlorvos? Toxic Substances and Disease Registry, Public Health Service,
U.S. Department of Health and Human Services, Public Health There is a general test that can be used to determine if you Service in Atlanta, GA. have been exposed to a group of insecticides, including Animal testing is sometimes necessary to find out how dichlorvos. This test measures the activity of an enzyme called acetylcholinesterase in the blood. However, it does not specifi- toxic substances might harm people and how to treat people cally show exposure to dichlorvos. who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines. Specific tests are available to identify dichlorvos or its

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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Di(2-ethylhexyl) phthalate (DEHP)


CAS # 117-81-7
Division of Toxicology ToxFAQsTM September 2002

This fact sheet answers the most frequently asked health questions (FAQs) about di(2-ethylhexyl) phthalate (DEHP). For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Di(2-ethylhexyl) phthalate (DEHP) is found in many plastics. Exposure to DEHP is generally very low. Increased exposures may come from intravenous fluids delivered through plastic tubing, and from ingesting contaminated foods or water. DEHP is not toxic at the low levels usually present in the environment. In animals, high levels of DEHP damaged the liver and kidney and affected the ability to reproduce. DEHP has been found in at least 733 of the 1,613 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is di(2-ethylhexyl) phthlate?
Di(2-ethylhexyl) phthlate (DEHP) is a manufactured chemical that is commonly added to plastics to make them flexible. DEHP is a colorless liquid with almost no odor. DEHP is present in plastic products such as wall coverings, tablecloths, floor tiles, furniture upholstery, shower curtains, garden hoses, swimming pool liners, rainwear, baby pants, dolls, some toys, shoes, automobile upholstery and tops, packaging film and sheets, sheathing for wire and cable, medical tubing, and blood storage bags. DEHP does not break down easily when it is deep in the soil or at the bottom of lakes or rivers. It is in plants, fish, and other animals, but animals high on the food chain are able to break down DEHP, so tissue levels are usually low.

How might I be exposed to DEHP?


DEHP is usually present at very low levels in: Medical products packaged in plastic such as blood products. Some foods packaged in plastics, especially fatty foods like milk products, fish or seafood, and oils. Well water near waste sites. Workplace air or indoor air where DEHP is released, but usually not at levels of concern. Fluids from plastic intravenous tubing if used extensively as for kidney dialysis.

What happens to DEHP when it enters the environment?


DEHP is everywhere in the environment because of its use in plastics, but it does not evaporate easily or dissolve in water easily. DEHP can be released in small amounts to indoor air from plastic materials, coatings, and flooring. It dissolves faster in water if gas, oil, or paint removers are present. It attaches strongly to soil particles. DEHP in soil or water can be broken down by microorganisms into harmless compounds.

How can DEHP affect my health?


At the levels found in the environment, DEHP is not expected to cause harmful health effects in humans. Most of what we know about the health effects of DEHP comes from studies of rats and mice given high amounts of DEHP.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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Di(2-ethylhexyl) phthalate (DEHP)


CAS # 117-81-7
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

Harmful effects in animals generally occurred only with high amounts of DEHP or with prolonged exposures. Moreover, absorption and breakdown of DEHP in humans is different than in rats or mice, so the effects seen in rats and mice may not occur in humans. Rats that breathed DEHP in the air showed no serious harmful effects. Their lifespan and ability to reproduce were not affected. Brief oral exposure to very high levels of DEHP damaged sperm in mice. Although the effect reversed when exposure ceased, sexual maturity was delayed in the animals. High amounts of DEHP damaged the liver of rats and mice. Whether or not DEHP contributes to human kidney damage is unclear. Skin contact with products containing DEHP will probably cause no harmful effects because it cannot be taken up easily through the skin.

manufacturers have discontinued use of DEHP in their products. In pregnant rats and mice exposed to high amounts of DEHP, researchers observed birth defects and fetal deaths.

How can families reduce the risk of exposure to DEHP?


It is almost impossible to completely avoid contact with some DEHP because it is commonly found in plastics. Prevent babies and small children from chewing on plastic objects not designed for that purpose.

Is there a medical test to show whether Ive been exposed to DEHP?


There is a test available that measures a breakdown product of DEHP called mono(2-ethylhexyl) phthalate (MEHP) in your urine or blood. This test can only detect recent exposure because DEHP is rapidly broken down and eliminated from your body. This test is not routinely available at the doctors office because it requires special equipment.

How likely is DEHP to cause cancer?


The Department of Health and Human Services (DHHS) has determined that DEHP may reasonably be anticipated to be a human carcinogen. The EPA has determined that DEHP is a probable human carcinogen. These determinations were based entirely on liver cancer in rats and mice. The International Agency for Research on Cancer (IARC) has stated that DEHP cannot be classified as to its carcinogenicity to humans.

Has the federal government made recommendations to protect human health?


The EPA limits the amount of DEHP that may be present in drinking water to 6 parts of DEHP per billion parts of water (6 ppb). The Occupational Safety and Health Administration (OSHA) sets a maximum average of 5 milligrams of DEHP per cubic meter of air (5 mg/m3) in the workplace during an 8-hour shift. The short-term (15-minute) exposure limit is 10 mg/m3.

How can DEHP affect children?


Children can be exposed to DEHP in the same manner as adults. In addition, small children can be exposed by sucking on or skin contact with plastic toys and pacifiers that contain DEHP, but there is no conclusive evidence of adverse health effects after such exposures. Nonetheless, because of concern for childrens health, many toy

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2002. Toxicological Profile for Di(2-ethylhexyl) phthlate (Update). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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DIETHYL PHTHALATE
CAS # 84-66-2
Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about diethyl phthlate. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to diethyl phthalate occurs when you use plastics that contain it, and when you eat food from plastic containers made with it. Health effects have not been reported in people exposed to diethyl phthalate. This substance has been found in at least 248 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is diethyl phthalate? (Pronounced d thl thlt)
Diethyl phthalate is a colorless liquid that has a bitter, disagreeable taste. This synthetic substance is commonly used to make plastics more flexible. Products in which it is found include toothbrushes, automobile parts, tools, toys, and food packaging. Diethyl phthalate can be released fairly easily from these products, as it is not part of the chain of chemicals (polymers) that makes up the plastic. Diethyl phthalate is also used in cosmetics, insecticides, and aspirin.

How might I be exposed to diethyl phthalate?


q Eating food that was contained in plastic packaging. q Eating contaminated fish and shellfish. q Drinking contaminated water near waste sites and landfills that contain diethyl phthalate. q Using consumer products that contain it.

How can diethyl phthalate affect my health?


No information is available regarding possible effects caused by diethyl phthalate if you breathe, eat, or drink it, or if it touches your skin. Very high oral doses of diethyl phthalate have caused death in animals, but brief oral exposures to lower doses caused no harmful effects. Weight gain was decreased in animals that ate high doses of diethyl phthalate for a long time. The liver and kidneys of these animals were larger than normal, but not from any harmful effects of diethyl phthalate. It is not known if diethyl phthalate causes birth defects in humans. Fewer live babies were born to female animals that were exposed to diethyl phthalate throughout their lives.

What happens to diethyl phthalate when it enters the environment?


q Diethyl phthalate has been found in waste sites and landfills from discarded plastics. q It may break down in the air. q It can become attached to particles of dust in the air, and can settle out. q It is broken down to harmless products by microorganisms in soil and water. q Small amounts of it can build up in fish and shellfish living in water containing it.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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DIETHYL PHTHALATE CAS # 84-66-2


ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

The presence of an extra rib has been noted in newborn rats whose mothers were given very high dietary doses of diethyl phthalate, but this effect is not considered harmful by all scientists. Some birth defects occurred in rats whose mothers received high doses of diethyl phthalate by injection during pregnancy. Humans are not exposed to diethyl phthalate by this route. Diethyl phthalate can be mildly irritating when applied to the skin of animals. It can also be slightly irritating when put directly into the eyes of animals.

tests arent available at most doctors offices, but can be done at special laboratories that have the right equipment.

Has the federal government made recommendations to protect human health?


The EPA requires that spills or accidental releases into the environment of 1,000 pounds or more of diethyl phthalate be reported to the EPA. The National Institute for Occupational Safety and Health (NIOSH) and the American Conference of Governmental Industrial Hygienists (ACGIH) recommend a maximum concentration of 5 milligrams of diethyl phthalate per cubic meter of air (5 mg/m3) in workplace air for an 8- to 10-hour workday, 40-hour workweek.

How likely is diethyl phthalate to cause cancer?


The EPA has determined that diethyl phthalate is not classifiable as to its carcinogenicity in humans. Diethyl phthalate placed directly on the skin of rats daily for 2 years was not carcinogenic. Liver tumors were seen in mice that had diethyl phthalate placed directly on their skin daily for 2 years. This type of tumor is common in mice, and the smallest dose resulted in a similar number of tumors as the largest dose. It is not clear if diethyl phthalate will cause a similar effect in humans. Other studies of cancer in humans or animals exposed to diethyl phthalate were not located.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Insecticide: Substance that kills insects. Milligram (mg): One thousandth of a gram. Oral: Taken by mouth. Synthetic: Made by humans. Tumor: An abnormal mass of tissue.

Is there a medical test to show whether Ive been exposed to diethyl phthalate?
There is no routine medical test to show if you have been exposed to diethyl phthalate. However, it has been measured in semen, fat, and kidney tissue in laboratory studies. These

Reference
Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for diethyl phthalate (update). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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DIISOPROPYL METHYLPHOSPHONATE CAS # 1445-75-6


Agency for Toxic Substances and Disease Registry ToxFAQs August 1999

This fact sheet answers the most frequently asked health questions (FAQs) about diisopropyl methylphosphonate. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to diisopropyl methylphosphonate would only occur if you live near the area where it was made and stored. Diisopropyl methylphosphonate may cause skin rashes if your skin comes in contact with it. This chemical has been found in at least 2 of the 1,416 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is diisopropyl methylphosphonate? (Pronounced d-s-prpl mthl fs f nt)


Diisopropyl methylphosphonate is a chemical by-product resulting from the manufacture of Sarin (GB), a nerve gas that was produced by the Army in the 1950s. A chemical by-product is a chemical that is formed while making another substance. Sarin was produced and stored only in the Rocky Mountain Arsenal outside of Denver, Colorado. Production of Sarin in the United States was discontinued in 1957. Diisopropyl methylphosphonate is not known to occur naturally in the environment. It is not likely to be produced in the United States in the future because of the signing of a chemical treaty that bans the use, production, and stockpiling of poison gases. Diisopropyl methylphosphonate is a colorless liquid. Other names for it are DIMP, diisopropyl methanephosphonate, phosphonic acid, and methyl-,bis-(1-methylethyl)ester.

What happens to diisopropyl methylphosphonate when it enters the environment? q Most diisopropyl methylphosphonate enters the groundwater or surface water. evaporate.

q Most will not enter the air since it does not easily q It does not easily break down in the environment. q It can stay in water and soil for years. q Diisopropyl methylphosphonate can enter the soil
through the flow of irrigation water.

q Plants can store diisopropyl methylphosphonate. q It may enter the food chain when animals eat the plants
containing it.

How might I be exposed to diisopropyl methylphosphonate? q Most people would not be exposed to diisopropyl

methylphosphonate. q Living near the site (the Rocky Mountain Arsenal) where Sarin was produced and stored.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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DIISOPROPYL METHYLPHOSPHONATE CAS # 1445-75-6

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html q Drinking contaminated water. q Eating vegetables irrigated by water contaminated with
diisopropyl methylphosphonate. (IMPA), which is rapidly cleared from the blood. Tests can measure IMPA in the blood or urine. However, these tests are useful only for recent exposure because IMPA leaves the body rapidly.

How can diisopropyl methylphosphonate affect my health?


Little is known about the effects of diisopropyl methylphosphonate on peoples health. Skin rashes were seen in some people who handled dead animals near a pond containing diisopropyl methylphosphonate and other chemicals, but it is not known whether diisopropyl methylphosphonate or another chemical caused the effects. Animal studies have not shown liver or kidneys problems, infertility, or birth defects after the animals ate or drank diisopropyl methylphosphonate. Some effects on the blood and nervous system have been seen in animals who ate or drank diisopropyl methylphosphonate at high levels.

Has the federal government made recommendations to protect human health?


The EPA advises that adults should not drink water containing more than 0.6 milligrams of diisopropyl methylphosphonate per liter (0.6 mg/L) of water for a lifetime. They also advise that children should not drink water containing more than 8 mg/L of diisopropyl methylphosphonate for a 1-day or longer period.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service.

How likely is diisopropyl methylphosphonate to cause cancer?


The EPA has concluded that diisopropyl methylphosphonate is not classifiable as to its carcinogenicity to humans. No carcinogenicity studies on diisopropyl methylphosphonate are available in people or animals.

Milligram (mg): One thousandth of a gram.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1998. Toxicological profile for diisopropyl methylphosphonate. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals, and scientists must follow strict guidelines.

Is there a medical test to show whether Ive been exposed to diisopropyl methylphosphonate?
Once inside the body, diisopropyl methylphosphonate is rapidly converted to isopropyl methylphosphonic acid

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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DI-n-BUTYL PHTHALATE
CAS #84-74-2
Division of Toxicology ToxFAQsTM September 2001

This fact sheet answers the most frequently asked health questions (FAQs) about di-n-butyl phthalate. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Di-n-butyl phthalate is a manufactured chemical that is added to plastics, paint, glue, hair spray, and other household products. It is commonly found in the environment, and most people are exposed to low levels in the air, water, and food. No harmful effects have been found in humans. In laboratory animals, oral exposure to very high levels can cause impaired reproduction and developmental effects. This substance has been found in at least 471 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is di-n-butylphthalate? (Pronounced di n byewtyl thalate)
Di-n-butyl phthalate is a manufactured chemical that does not occur naturally. It is an odorless and oily liquid that is colorless to faint yellow in color. It is slightly soluble in water and does not evaporate easily. Di-n-butyl phthalate is used to make plastics more flexible and is also in carpet backings, paints, glue, insect repellents, hair spray, nail polish, and rocket fuel.

How might I be exposed to di-n-butylphthalate?


Most people are probably exposed to low levels of di-nbutyl phthalate in the air because it is used in so many household products. People who use products which contain di-n-butyl phthalate, such as nail polish, may be exposed by breathing it in the air or getting it on their skin. The general population may also be exposed by eating food containing di-n-butyl phthalate, such as fish and shellfish, or food which is packaged or stored in materials containing di-n-butyl phthalate. If you work or live near a factory where di-n-butyl phthalate is made or used, you could be exposed to higher than usual levels. People living near uncontrolled hazardous waste sites may also be exposed to higher than usual levels of di-n-butyl phthalate.

What happens to di-n-butylphthalate when it enters the environment?


Di-n-butyl phthalate is released to air as a vapor. It can react with other chemicals in the air and is usually broken down within a few days. Di-n-butyl phthalate can also attach to particles in the air and eventually settle to the land and water. Most of the di-n-butyl phthalate in water attaches to sediment and settles out of the water or is broken down by bacteria. Small amounts may evaporate to the air. When released to the soil, it attaches to soil particles and is broken down by bacteria. There is no evidence that it builds up in the food chain.

How can di-n-butylphthalate affect my health?


Di-n-butyl phthalate appears to have relatively low toxicity. Adverse effects have not been reported in humans as a result of exposure to di-n-butyl phthalate. In laboratory animals, studies show that eating large amounts of di-n-butyl phthalate can affect their ability to

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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DI-n-BUTYL PHTHALATE
CAS #84-74-2
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

reproduce. Sperm production can decrease, but returns to near normal levels when exposure stops. Large amounts of di-n-butyl phthalate repeatedly applied to the skin for a long time can cause mild irritation. We do not know if similar effects would occur in humans.

Children should avoid playing in soils near uncontrolled hazardous waste sites where di-n-butyl phthalate may have been discarded.

Is there a medical test to show whether Ive been exposed to di-n-butylphthalate?


Tests are available to measure di-n-butyl phthalate in blood and body tissues, and its major breakdown products in urine. However, these tests cannot determine whether you will experience health effects or be used to predict the nature or severity of any effects. Because special equipment is needed, these tests are not usually done in the doctors office.

How likely is di-n-butylphthalate to cause cancer?


There have been no cancer studies in humans and the one study in laboratory animals is inadequate. The EPA has determined that di-n-butyl phthalate is not classifiable as to human carcinogenicity based on inadequate evidence in both humans and animals.

How can di-n-butylphthalate affect children?


It is likely that health effects seen in children exposed to high levels of di-n-butyl phthalate will be similar to the effects seen in adults. We do not know whether children differ from adults in their susceptibility to di-n-butyl phthalate. We do not know if exposure to di-n-butyl phthalate will result in birth defects or other developmental effects in people. Birth defects have been observed in laboratory animals exposed to high levels of di-n-butyl phthalate during development. Death, low body weights, skeletal effects, cleft palate, and damage to the testes have been observed in animals exposed during development.

Has the federal government made recommendations to protect human health?


The EPA recommends that levels of di-n-butyl phthalate in lakes and streams should be limited to 34 parts of di-n-butyl phthalate per million parts of water (34 ppm) to prevent possible human health effects from drinking water or eating fish contaminated with this chemical. The Occupational Safety and Health Administration (OSHA) has set a limit of 5 milligrams of di-n-butyl phthalate per cubic meter of workplace air (5 mg/m3) for 8 hour shifts and 40 hour work weeks.

How can families reduce the risk of exposure to di-n-butylphthalate?


Di-n-butyl phthalate is used in many household products. The level of di -n-butyl phthalate in a product is higher when the product is new than when the product is old. Because di-n-butyl phthalate may be in some toys, children chewing on such toys could be exposed; however, no measurements have yet been made to show whether children are exposed in this way.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for Di-n-Butyl Phthalate Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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1,3-DINITROBENZENE and 1,3,5-TRINITROBENZENE


CAS # 99-65-0 and 99-35-4
Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about 1,3-dinitrobenzene and 1,3,5-trinitrobenzene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to 1,3-dinitrobenzene and 1,3,5-trinitrobenzene may occur from contaminated water, food, air, and soil near an Army ammunitions plant or other chemical manufacturer. High levels of 1,3-dinitrobenzene affect the ability of blood to carry oxygen. Effects of 1,3,5-trinitrobenzene are expected to be similar. These substances have been found in at least 19 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are 1,3-dinitrobenzene and 1,3,5-trinitrobenzene? (Pronounced 1,3-d-ntr-bnzn and 1,3,5-trntr-bnzn)
1,3-Dinitrobenzene and 1,3,5-trinitrobenzene are synthetic substances that are used in explosives. Both substances are yellow crystal-like solids at room temperature. They may exist in air in very small amounts as dust or a vapor, and can dissolve in certain liquids. If either substance is put under very high heat, it will explode. They have have no odor or taste.

How might I be exposed to 1,3-dinitrobenzene and 1,3,5-trinitrobenzene?


If you live or work near an Army ammunitions plant or other chemical manufacturer, you may be exposed to these compounds by drinking contaminated water, eating contaminated food, breathing contaminated air, or touching or eating contaminated soil.

How can 1,3-dinitrobenzene and 1,3,5-trinitrobenzene affect my health?


Waste discharges from Army ammunitions plants or other chemical manufacturers are the primary sources for release of both compounds to air, water, and soil. 1,3-Dinitrobenzene and 1,3,5-trinitrobenzene are suspected to cause similar health effects. Exposure to high concentrations of 1,3-dinitrobenzene can reduce the ability of blood to carry oxygen and can cause your skin to become bluish in color. If you are exposed to 1,3-dinitrobenzene for a long time, you can develop a reduction (or loss) in the number of red blood cells (anemia). Other symptoms of 1,3-dinitrobenzene exposure include headache, nausea, and dizziness.

What happens to 1,3-dinitrobenzene and 1,3,5trinitrobenzene when they enter the environment?
q Both compounds are likely to break down in air, water, and soil very slowly. q Both compounds are slightly soluble in water. q 1,3-Dinitrobenzene evaporates slowly from water; 1,3,5trinitrobenzene does not evaporate from water. q Neither compound sticks to soil strongly, so they can move through soil into groundwater. q These compounds are not likely to build up in fish or people.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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1,3-DINITROBENZENE and 1,3,5-TRINITROBENZENE CAS # 99-65-0 and 99-35-4


ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

We do not know if there are any long-term health effects from exposure to 1,3-dinitrobenzene or 1,3,5-trinitrobenzene. We also do not know if these chemicals cause birth defects in humans. Results of studies in animals show that effects of 1,3-dinitrobenzene and 1,3,5-trinitrobenzene on the blood are similar to the effects seen in people. Results from animal studies also show some other effects of 1,3-dinitrobenzene exposure, such as behavioral changes and male reproductive system damage. We do not know if these compounds can cause birth defects in animals. We do not know if the effects seen in animals could also occur in people.

The EPA requires that spills or accidental releases into the environment of 100 pounds or more of 1,3-dinitrobenzene, and 10 pounds or more of 1,3,5-trinitrobenzene, must be reported to the EPA. The Occupational Safety and Health Administration (OSHA) regulates levels of 1,3-dinitrobenzene in the workplace. The maximum allowable amount of 1,3-dinitrobenzene in workroom air during an 8-hour workday, 40-hour workweek, is 1 milligram per cubic meter (1 mg/m3). The National Institute for Occupational Safety and Health (NIOSH) and the American Conference of Governmental Industrial Hygienists (ACGIH) also recommend an exposure limit of 1 mg/m3 1,3-dinitrobenzene in workplace air over a 40-hour workweek.

How likely are 1,3-dinitrobenzene and 1,3,5trinitrobenzene to cause cancer?


The EPA has determined that these compounds are not classifiable as to their carcinogenicity in humans. This is because the ability of these compounds to produce cancer has not been studied in humans or animals.

Glossary
Anemia: A decreased ability of the blood to transport oxygen. Breakdown product: A substance that is formed when a chemical breaks down in the body. Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. Long-term: 365 days or longer. Milligram (mg): One thousandth of a gram.

Is there a medical test to show whether Ive been exposed to 1,3-dinitrobenzene or 1,3,5trinitrobenzene?
There is no routine medical test to show if you have been exposed to 1,3-dinitrobenzene or 1,3,5-trinitrobenzene. Tests have been used to detect 1,3-dinitrobenzene and its breakdown products in blood and urine of exposed animals, but these tests have not been used for people.

Reference
Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for 1,3-dinitrobenzene/1,3,5-trinitrobenzene (update). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Has the federal government made recommendations to protect human health?

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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DINITROCRESOLS
4,6-DNOC CAS # 534-52-1
Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about dinitrocresols. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to dinitrocresols occurs mainly from breathing air, drinking water, or eating food that contains the chemicals. At high levels, these chemicals may cause skin rashes or yellowing; increased heart and breathing rates; damage to the liver, stomach, and kidneys; and even death. These chemicals have been found in at least 50 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are dinitrocresols?
(Pronounced d-ntr-krslz) Dinitrocresols are a class of manufactured chemicals that do not occur naturally in the environment. There are 18 different dinitrocresols. The most commercially important dinitrocresol, 4,6-dinitro-o-cresol (DNOC), is a yellow solid with no smell. It is used primarily for insect control and crop protection. It may be sold under several trade names, including Antinonnin, Detal, and Dinitrol. Use of tradenames is for identification only and does not imply endorsement by the Agency for Toxic Substances and Disease Registry, the Public Health Service, or the U.S. Department of Health and Human Services. DNOC was used in diet pills in the 1930s, but has since been banned for this use. G It dissolves slightly in water. G It can be broken down slowly in air, water, and soil by small organisms. G It does not easily evaporate into the air. G DNOC sticks to particles in water, which will cause it to eventually settle to the bottom sediment. G It also sticks to soil particles, which prevents it from moving very deep into the soil with rainwater. G It probably does not build up significantly in fish.

How might I be exposed to dinitrocresols?


G Breathing contaminated workplace air where it is manufactured or used. G Breathing contaminated air from DNOC-containing waste sites, or during DNOC spraying or waste incineration. G Touching contaminated soil or water near DNOC-containing waste sites. G Ingesting contaminated soil or water near DNOC-containing waste sites.

What happens to dinitrocresols when they enter the environment?


G DNOC enters the air, water and soil during its manufacture and use, and may be formed from the reaction of other chemicals in the air. G DNOC may also enter the environment through landfill and storage tank leaks, or accidental spills during manufacture or transport.

How can dinitrocresols affect my health?


Most of the information on the health effects of dinitrocresols comes from old studies on patients who were prescribed diet pills containing DNOC before it was banned for this use.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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DINITROCRESOLS 4,6-DNOC CAS # 534-52-1

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

Exposure to high levels of DNOC for short periods may cause convulsions, unconsciousness, and death. Exposure to lower levels may result in an increased basal metabolic rate (the rate that you use energy at complete rest), increased sweating, weight loss, and increased heart rate, breathing rate, and body temperature. Other effects from DNOC exposure may include difficulty in breathing, headache, drowsiness, dizziness, a yellowing of skin and the whites of the eyes, and mild damage to the stomach, kidneys, and liver. Ingesting DNOC for long periods may cause cataracts and skin rashes.

Has the federal government made recommendations to protect human health?


The EPA lists DNOC as a hazardous air pollutant (HAP). The EPA requires that discharges or spills into the environment of 10 pounds or more be reported. The Occupational Safety and Health Administration (OSHA) has set an exposure limit of 0.2 milligrams of DNOC per cubic meter of air (0.2 mg/m3) for an 8-hour workday, 40hour workweek. The National Institute for Occupational Safety and Health (NIOSH) recommends that average workplace air levels not exceed 1.5 mg of DNOC/m3 of air for a 10-hour workday, 40hour workweek. NIOSH has recommended that 5 mg of DNOC/m3 of air be considered immediately dangerous to life or health. This is the exposure level of a chemical that is likely to cause permanent health problems or death.

How likely are dinitrocresols to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified dinitrocresols for carcinogenicity. There are no studies available in people or animals on the carcinogenic effects of dinitrocresols.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Cataract: A decrease in the transparency of eye lenses. Evaporate: To change into a vapor or a gas. Ingesting: Taking food or drink into your body. Milligram (mg): One thousandth of a gram. Sediment: Mud and debris that have settled to the bottom of a body of water.

Is there a medical test to show whether Ive been exposed to dinitrocresols?


Yellow-stained skin and eyes may indicate that you have been exposed to DNOC, but these symptoms could also be caused by exposure to other chemicals. Tests are available that measure the amount of DNOC in blood, urine, and feces. However, since DNOC may remain in your blood and urine for a long time after exposure, these tests cannot reliably tell you the amount to which you have been exposed. These tests may require special equipment, and they may not be available at your doctors office.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for dinitrocresols. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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DINITROPHENOLS
2,4-DNP CAS # 51-28-5
Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about dinitrophenols. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to dinitrophenols occurs mainly from breathing air, drinking water, or eating food that contains the chemicals. At low levels, these chemicals may cause cataracts, serious skin rashes, and decreases in white blood cells. At high levels, these chemicals may cause increased heart and breathing rates, and even death. These chemicals have been found in at least 61 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are dinitrophenols?
(Pronounced d-ntr-fnlz) Dinitrophenols are a class of manufactured chemicals that do not occur naturally in the environment. There are six different dinitrophenols. The most commercially important dinitrophenol, 2,4-dinitrophenol (DNP), is a yellow solid with no smell. It is used in making dyes, wood preservatives, explosives, insect control substances, and other chemicals, and as a photographic developer. It was used in diet pills in the 1930s but was banned for this use in 1938. It may be sold under several trade names, including Caswell No. 392, Sulfo Black B, and Nitro Kleenup. Use of trade names is for identification only and does not imply endorsement by the Agency for Toxic Substances and Disease Registry, the Public Health Service, or the U.S. Department of Health and Human Services. G It may be formed from reaction of other chemicals in the air. G DNP may also enter the environment through landfill and storage tank leaks, or accidental spills during manufacture or transport. G It dissolves slightly in water, and does not easily evaporate to air. G It can be broken down slowly in water and soil by small organisms or by reacting with other chemicals. G DNP sticks to particles in water, which will cause it to eventually settle to the bottom sediment. G DNP also sticks to some types of soil particles, which may prevent it from moving very deep into the soil with rainwater. G DNP probably does not build up significantly in fish.

How might I be exposed to dinitrophenols?


G Breathing contaminated workplace air where it is manufactured or used. G Breathing contaminated air from DNP-containing waste sites, waste incineration, or automobile exhaust. G Touching contaminated soil or water near DNP-containing waste sites.

What happens to dinitrophenols when they enter the environment?


G DNP enters the air, water, and soil during its manufacture and use.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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DINITROPHENOLS 2,4-DNP CAS # 51-28-5

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


G Ingesting contaminated soil or water near DNP-containing waste sites.

Is there a medical test to show whether Ive been exposed to dinitrophenols?


Tests are available that measure the amount of DNPs or their breakdown products in blood, urine, and samples of tissue from the body. However, these tests may require special equipment and may not be available in your doctors office.

How can dinitrophenols affect my health?


Most of the information on the health effects of dinitrophenols comes from old studies of patients who were prescribed diet pills containing dinitrophenol before it was banned. Deaths have occurred in people who ingested 346 milligrams of dinitrophenols per kilogram of body weight per day (346 mg/kg/day) for short periods, or 14 mg/kg/day for long periods. Also, people who breathed air containing 40 mg dinitrophenols per cubic meter of air (40 mg/m3) for long periods have died. The amount of dinitrophenols ingested that causes harmful effects varies among people. Increased basal metabolic rate (the rate that you use energy at complete rest), increased sweating, a feeling of warmth, weight loss, and increased heart rate, breathing rate, and body temperature have been observed in people who swallowed as little as 1 mg/kg/day or as much as 46 mg/kg/day for short or long periods of time. Ingesting 24 mg/kg/day DNP for short or long periods has caused cataracts in some people, while ingesting 14 mg/kg/day for short or long periods has caused skin rashes and decreases in white blood cells.

Has the federal government made recommendations to protect human health?


The EPA recommends that not more than 70 parts of dinitrophenols per billion parts of water (70 ppb) be present in lakes or streams used for swimming. The EPA lists DNPs as hazardous air pollutants (HAP) under the Clean Air Act. The EPA also requires that discharges or spills into the environment of 10 pounds or more be reported.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstract Service. Cataract: A decrease in the transparency of eye lenses. Evaporate: To change into a vapor or a gas. Ingest: Take food or drink into your body. Kilogram (kg): One thousand grams. Milligram (mg): One thousandth of a gram. Sediment: Mud and debris that have settled to the bottom of a body of water.

How likely are dinitrophenols to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified dinitrophenols for carcinogenicity. There are no studies available in people or animals on the carcinogenic effects of dinitrophenols.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for dinitrophenols. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information?

For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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2,4- and 2,6-DINITROTOLUENE


CAS # 121-14-2 and 606-20-2
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about 2,4- and 2,6-dinitrotoluene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: 2,4- and 2,6-Dinitrotoluene are used in a number of industries. Exposure to high levels may affect the nervous system and the blood. Both are known to cause cancer in laboratory animals. These substances have been found in at least 69 (2,4-DNT) and 53 (2,6-DNT) of the 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are 2,4-dinitrotoluene (2,4-DNT) and 2,6-dinitrotoluene (2,6-DNT)? (Pronounced 2,4- and 2,6-d n tr tl y n)
Both 2,4-DNT and 2,6-DNT are pale yellow solids with a slight odor. They are two of the six forms of the chemical called dinitrotoluene (DNT). DNT is not a natural substance. It is made by mixing toluene with nitric acid. DNT is usually used to make flexible polyurethane foams used in the bedding and furniture industries. DNT is also used to produce explosives, ammunition, and dyes. It is also used in the air bags of automobiles. G In water, DNT tends to be more stable and less likely to break down. G DNT can be transferred to plants by root uptake from contaminated water or soil.

How might I be exposed to 2,4- and 2,6-DNT?


G Most people will not be exposed to 2,4- and 2,6-DNT. G Breathing contaminated air near manufacturing plants. G Drinking contaminated water or eating contaminated food. G Breathing air near a hazardous waste site that contains buried ammunition wastes.

What happens to 2,4- and 2,6-DNT when they enter the environment?
G DNT has been found in the soil, surface and ground water, and air. G It has been found at hazardous waste sites that contain buried ammunition wastes. G DNT does not usually evaporate; it is found mostly in the air of manufacturing plants. G DNT does not stay in the environment because it is broken down by sunlight and by bacteria.

How can 2,4- and 2,6-DNT affect my health?


Workers who have been exposed to 2,4-DNT showed a higher than normal death rate from heart disease. However, these workers were exposed to other chemical as well. 2,4and 2,6-DNT may also affect the nervous system and the blood of exposed workers. One study showed that male workers exposed to DNT had reduced sperm counts, but other studies did not confirm this finding.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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2,4- and 2,6-DINITROTOLUENE


CAS # 121-14-2 and 606-20-2

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


Animals exposed to high levels of DNT had lowered number of sperm and reduced fertility. Animals also showed a reduction in red blood cells, nervous system disorders, and liver and kidney damage.

Is there a medical test to show whether Ive been exposed to 2,4- and 2,6-DNT?
Both 2,4- and 2,6-DNT and the chemicals they change into in the body can be measured in the blood and urine. The urine must be collected within 24 hours of exposure. These tests cannot show how much 2,4- or 2,6-DNT a person has been exposed to. They are not usually available in a doctors office, but they can be performed in special laboratories.

How likely are 2,4- and 2,6-DNT to cause cancer?


In animal studies, both 2,4- and 2,6-DNT caused liver cancer in rats. There are no studies on the effects of 2,4- and 2,6-DNT on people. The International Agency for Research on Cancer (IARC) has determined that 2,4- and 2,6-DNT are possible human carcinogens.

Has the federal government made recommendations to protect human health?


EPA requires that spills or accidental releases of more than 1,000 pounds of DNT be reported to the EPA. The Occupational Safety and Health Administration (OSHA) requires that total DNT (all forms) in workplace air should not exceed 1.5 mg per cubic meter (1.5 mg/m3) for an 8-hour workday, 40-hour workweek. The National Institute of Occupational Safety and Health (NIOSH) recommends a workplace limit of 1.5 mg/m3. This is the average concentration for a 10-hour day over a 40-hour workweek.

How can 2,4- and 2,6-DNT affect children?


It is unlikely that children would be exposed to 2,4- and 2,6-DNT unless they live near a manufacturing plant or a waste site that contains these compounds. Children are at risk of exposure if DNT has leached into a community's drinking water supply from a nearby hazardous waste site, since they drink more fluids in proportion to their body weight than adults. Children playing in DNT-contaminated surface water might be more exposed than adults, because of their larger skin area in proportion to their body weight. The health effects of DNT on children have not been studied. It is not known if DNT affects children differently than adults, or what long-term effects might appear in adults exposed as children.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1998. Toxicological profile for 2,4- and 2,6-dinitrotoluene. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

How can families reduce the risk of exposure to 2,4- and 2,6-DNT?
If your doctor finds that you have been exposed to significant amounts of 2,4- or 2,6-DNT, ask if children may also be exposed. When necessary your doctor may need to ask your state Department of Public Health to investigate.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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1,2-DIPHENYLHYDRAZINE
CAS # 122-66-7
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about 1,2-diphenylhydrazine. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: 1,2-Diphenylhydrazine is a man-made chemical that was once used in fabric dyes but now is only used to make certain medicines. No harmful effects on people have been reported. Animal studies indicate that it may affect the liver, lungs, and digestive system. It has been found at 7 of the 1,177 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is 1,2-diphenylhydrazine? (Pronounced 1,2-d-f-nl-hdr-zn)


1,2-Diphenylhydrazine is a white solid. There is no information on what it smells like or whether it will burn. It does not dissolve easily in water, but when placed in water, it rapidly breaks down into other chemicals. These include the toxic chemicals benzidine and azobenzene. It does not evaporate easily but may be released to air when attached to dust particles. 1,2-Diphenylhydrazine is a man-made chemical that was used in the past to make benzidine, which was used to make various fabric dyes. Benzidine dyes are no longer used in the United States, but may still be used in other countries. The only current use of 1,2-diphenylhydrazine in the United States is in the production of medicines to treat inflammation and a type of arthritis.

G Very little 1,2-diphenylhydrazine is likely to be released to the air because it does not evaporate easily; however, if released to the air, it would probably break down rapidly to other chemicals such as azobenzene. G 1,2-Diphenylhydrazine reacts rapidly with water to form benzidine, azobenzene, and other chemicals. G When released to soil, it will attach to soil particles but is not expected to last very long. G It is not likely to filter through the soil to groundwater. G There is no information about its biomagnification through the food chain, but it would not be expected to bioaccumulate because it does not persist for long in the environment.

How might I be exposed to 1,2-diphenylhydrazine?


G Most people are not likely to be exposed to 1,2-diphenylhydrazine because of its limited use and because it doesn't last long once released to the environment. G People who take medicines made from 1,2-diphenylhydrazine may be exposed to low levels. G If you live near a waste site that contains 1,2-diphenylhydrazine you might be exposed if it was in dust you breathed or dirt that got on your skin.

What happens to 1,2-diphenylhydrazine when it enters the environment?


G 1,2-Diphenylhydrazine rapidly breaks down to other chemicals when released to the environment.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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1,2-DIPHENYLHYDRAZINE CAS # 122-66-7

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


G If you work in a factory where 1,2-diphenylhydrazine is made or used, you could be exposed to it by breathing dust or getting it on your skin.

Has the federal government made recommendations to protect human health?


The EPA recommends that levels of 1,2-diphenylhydrazine in lakes and streams should be limited to 0.041 parts per billion (0.041 ppb) to prevent possible human health effects from drinking water or eating fish contaminated with this chemical. Any release to the environment greater than 10 pounds of 1,2-diphenylhydrazine must be reported to the EPA. The federal recommendations have been updated as of July 1999.

How can 1,2-diphenylhydrazine affect my health?


No harmful effects on people exposed to 1,2-diphenylhydrazine have been reported. Animal studies indicate that ingesting large amounts of 1,2-diphenylhydrazine can cause death. Ingesting smaller amounts over a long period can cause damage to the lungs, digestive tract (stomach and intestines), and liver, and can cause death. We do not know if it can cause birth defects or affect reproduction.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. Ingest: Take food or drink into your body. National Priorities List: A list of the nations worst hazardous waste sites. ppb: Parts per billion.

How likely is 1,2-diphenylhydrazine to cause cancer?


No studies are available on whether 1,2-diphenylhydrazine causes cancer in people. The carcinogenicity of 1,2-diphenylhydrazine has been evaluated in rats and mice in studies that showed it caused liver cancer. The EPA has determined that 1,2-diphenylhydrazine is a probable human carcinogen based on adequate evidence in animals and inadequate data in humans.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1990. Toxicological profile for 1,2-diphenylhydrazine. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Is there a medical test to show whether Ive been exposed to 1,2-diphenylhydrazine?


There are no medical tests to determine if you have been exposed to 1,2-diphenylhydrazine.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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DI-n-OCTYLPHTHALATE (DNOP)
CAS # 117-84-0
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about di-n-octylphthalate (DNOP). For more information, call the ATSDR Information Center at 1-800-447-1544. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to di-n-octylphthalate occurs mainly from eating food or drinking water that is stored in plastic containers. The health effects of breathing, ingesting, or touching di-n-octylphthalate are not known. This substance has been found in at least 300 of the 1,416 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is di-n-octylphthalate? (Pronounced d-n-ktl thl t)


Di-n-octylphthalate is a colorless, odorless, oily liquid that doesnt evaporate easily. It is a man-made substance used to keep plastics soft or more flexible. This type of plastic can be used for medical tubing and blood storage bags, wire and cables, carpetback coating, floor tile, and adhesives. It is also used in cosmetics and pesticides.

q It can also be broken down in reactions with sunlight, other chemicals in the atmosphere, or water. q Small amounts of di-n-octylphthalate can build up in animals that live in water, such as fish and oysters.

How might I be exposed to di-n-octylphthalate?


q Eating foods stored in containers made with di-noctylphthalate that has leaked into the food. q Receiving blood transfusions, dialysis, or other medical treatments in which the equipment is made of plastics containing di-n-octylphthalate. q Breathing contaminated air, drinking contaminated water, or touching contaminated soil near hazardous waste sites or an industrial manufacturing facility that uses or makes di-n-octylphthalate.

What happens to di-n-octylphthalate when it enters the environment?


q Di-n-octylphthalate can be released to water or air during its manufacture, by leaking from plastics in landfills, or from the burning of plastic products. q If di-n-octylphthalate is released into the air, it may be deposited on the ground or to surface water in rain or dust particles. q Di-n-octylphthalate sticks tightly to soil, sediment, and dust particles. q Di-n-octylphthalate is mainly broken down into other substances by microorganisms.

How can di-n-octylphthalate affect my health?


Little information is known about the health effects that might be caused by di-n-octylphthalate. It is not known what happens when you breathe or ingest the chemical.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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DI-n-OCTYLPHTHALATE (DNOP)
CAS # 117-84-0
ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

Some rats and mice that were given very high doses of di-n-octylphthalate by mouth died. Mildly harmful effects have been seen in the livers of some rats and mice given very high doses of di-n-octylphthalate by mouth for short (14 days or less) or intermediate periods (15 to 365 days) of time, but lower doses given for short periods of time generally caused no harmful effects. No information is available on the health effects of having di-n-octylphthalate in contact with human skin. It can be mildly irritating when applied to the skin of animals. It is not known whether or not di-n-octylphthalate could affect the ability to have children, or if it could cause birth defects.

This test is not part of a routine medical examination, but it can be done by the doctor's request at special laboratories.

Has the federal government made recommendations to protect human health?


The EPA has recently determined that there is not enough evidence to say that di-n-octylphthalate causes harmful effects in humans or the environment. The EPA requires that spills or accidental releases into the environment of 5,000 pounds or more of di-n-octylphthalate be reported to the EPA.

Glossary How likely is di-n-octylphthalate to cause cancer?


Di-n-octylphthalate is not known to cause cancer in humans or animals. Di-n-octylphthalate has not been classified as to its carcinogenicity by the Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), or the EPA. CAS: Chemical Abstracts Service. Carcinogenicity: Ability to cause cancer. Evaporate: To change into a vapor or a gas. Ingest: To eat or drink something. Sediment: Mud and debris that have settled to the bottom of a body of water.

Source of Information Is there a medical test to show whether Ive been exposed to di-n-octylphthalate?
Di-n-octylphthalate and its principal breakdown products can be measured in urine, blood, and tissues. However, it is not known if they are specific for di-n-octylphthalate or for how long after exposure occurs the test is useful. These facts cannot be used to determine how much di-n-octylphthalate you were exposed to or predict whether harmful effects will occur. This ToxFAQs information is taken from the 1997 Toxicological Profile for Di-n-octylphthalate produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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DISULFOTON
CAS # 298-04-4
Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about disulfoton. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to disulfoton happens mostly from breathing contaminated air, drinking contaminated water, and eating contaminated food. High exposures can cause harmful effects on the nervous system. Disulfoton has been found in at least 7 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is disulfoton?
(Pronounced d-slf-tn) Disulfoton is a manufactured substance used as a pesticide to control a variety of harmful pests that attack many field and vegetable crops. It does not occur naturally. Pure disulfoton is a colorless oil with an unidentifiable characteristic odor and taste. The technical product is dark yellowish, with an aromatic odor. Common trade names are Di-syston, Disystox, Frumin AL, and Soilvirex. Use of trade names is for identification only and does not imply endorsement by the Agency for Toxic Substances and Disease Registry, the Public Health Service, or the U.S. Department of Health and Human Services. It is used to protect small grains, sorghum, corn, and other field crops; some vegetables, fruit, and nut crops; and ornamental and potted plants against certain insects. Although it is used mostly in agriculture, small quantities are used on home and garden plants, and for mosquito control in swamps. The use of disulfoton has decreased in recent years. G Natural chemical reactions and bacteria remove it from soil and water. G Fish accumulate disulfoton in their bodies. G Disulfoton binds moderately to soil and typically does not travel deep into soil with rainwater. G In water, it takes about 7 days for half of it to break down. G In soil, it takes about 3.5290 days for half of it to break down, depending on soil type, moisture, and temperature.

How might I be exposed to disulfoton?


G Breathing contaminated air, drinking contaminated water, and eating contaminated food. G Living near hazardous waste sites where it is found. G For children, touching or eating soil at or near hazardous waste sites that contain disulfoton. G Working in fields where it is sprayed. G Working in industries that manufacture and formulate it. G Using it in your home or garden.

What happens to disulfoton when it enters the environment?


G Disulfoton enters the environment when it is applied on field crops, vegetables, potted plants, and home gardens. G Disulfoton is found mainly in soil and water.

How can disulfoton affect my health?


In people, disulfoton mainly causes harmful effects to the nervous system. Depending on the amount of disulfoton that enters the body, effects on the nervous system, such as narrowing of the pupils, vomiting, diarrhea, drooling,

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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DISULFOTON CAS # 298-04-4

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


difficulty in breathing, tremors, convulsions, and even death may occur. These effects can occur if you breathe in, ingest, or touch disulfoton. If you ingest disulfoton from food or water for long periods, it may affect your eyes and you may become nearsighted. You may become weak and tired after skin contact with disulfoton. Ingesting high levels of disulfoton can cause similar nervous system (neurologic) effects in animals. Animals that ingested disulfoton for long periods became nearsighted, and the structures of their eyes were damaged. We do not know whether disulfoton causes reproductive or birth defects in people. Some animals that ingested disulfoton during pregnancy had newborns with underdeveloped bones, damaged livers and kidneys, and underdeveloped testes. you were exposed to. Your doctor can send samples of your blood or urine to special laboratories that perform these tests.

Has the federal government made recommendations to protect human health?


The EPA recommends that no more than 10 parts of disulfoton per billion parts of water (10 ppb) be present in water that children drink for periods of up to 10 days. They also recommend that disulfoton should not exceed 3 ppb for children or 9 ppb for adults if they drink water for longer periods of time, and it should not exceed 0.3 ppb for adults who drink the water for a lifetime. The EPA requires that spills or accidental releases of disulfoton into the environment of 1 pound or more must be reported. The American Conference of Governmental Industrial Hygienists (ACGIH) has set a limit of 0.1 milligram of disulfoton per cubic meter of air (0.1 mg/m3) for an 8-hour workday, 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) recommends an exposure limit of 0.1 mg disulfoton/m3 of air for a 10-hour workday, 40-hour workweek.

How likely is disulfoton to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified disulfoton as to its ability to cause cancer. We don't know whether disulfoton will cause cancer in people. No studies in people are available, and animals that ingested disulfoton for long periods did not develop cancer.

Glossary
CAS: Chemical Abstracts Service. Ingest: Take food or drink into your body. Milligram (mg): One thousandth of a gram. Testes: Male reproductive glands that produce sperm.

Is there a medical test to show whether Ive been exposed to disulfoton?


Disulfoton and its breakdown products can be measured in the blood, urine, feces, liver, kidney, or body fat of exposed people. Inhibition of blood cholinesterase (an enzyme in the blood) may also suggest exposure to disulfoton. However, this test is not specific for disulfoton. The measurement of blood cholinesterase and the amount of disulfoton breakdown products in the urine cannot always predict how much disulfoton

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for disulfoton. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information?

For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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ENDOSULFAN
CAS # 33213-65-9
Division of Toxicology ToxFAQsTM February 2001

This fact sheet answers the most frequently asked health questions (FAQs) about endosulfan. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to endosulfan happens mostly from eating contaminated food, but may also occur from skin contact, breathing contaminated air, or drinking contaminated water. Endosulfan affects the function of the central nervous system. Endosulfan has been found in at least 164 of 1,577 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is endosulfan? (Pronounced endo-sul-f n)
Endosulfan is a pesticide. It is a cream- to brown-colored solid that may appear in the form of crystals or flakes. It has a smell like turpentine, but does not burn. It does not occur naturally in the environment. Endosulfan is used to control insects on food and non-food crops and also as a wood preservative. [ Endosulfan does not dissolve easily in water. Endosulfan in surface water is attached to soil particles floating in water or attached to soil at the bottom. [ Endosulfan can build up in the bodies of animals that live in endosulfan-contaminated water;

How might I be exposed to endosulfan?


[ Eating food contaminated with endosulfan, but levels in foods are very low. [ People working in industries involved in making endosulfan or as pesticide applicators. [ Skin contact with soil containing endosulfan.

What happens to endosulfan when it enters the environment?


[ Endosulfan enters the air, water, and soil during its manufacture and use. It is often sprayed onto crops and the spray may travel long distances before it lands on crops, soil, or water. [ Endosulfan on crops usually breaks down in a few weeks, but endosulfan sticks to soil particles and may take years to completely break down.

How can endosulfan affect my health?


Endosulfan affects the central nervous system and prevents it from working properly. Hyperactivity, nausea, dizziness, headache, or convulsions have been observed in adults exposed to high doses. Severe poisoning may result in death.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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ENDOSULFAN
CAS # 33213-65-9
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

Studies of the effects of endosulfan on animals suggest that long-term exposure to endosulfan can also damage the kidneys, testes, and liver and may possibly affect the bodys ability to fight infection. However, it is not known if these effects also occur in humans.

[ Pesticides should be used according to the directions on the label and stored in the original container in a place that children cannot reach.

How likely is endosulfan to cause cancer?


We do not know if endosulfan can cause cancer in humans. Studies in animals have provided inconclusive results.

Is there a medical test to show whether Ive been exposed to endosulfan?


Endosulfan and its breakdown products can be detected in your blood, urine, and body tissues if you have been exposed to a large amount. These tests are not usually available at your doctors office, but your doctor can send the samples to a laboratory that can perform the tests. Because endosulfan leaves the body fairly quickly, these methods are useful only for finding exposures that have occurred within the last few days.

How can endosulfan affect children?


We do not know if children are more sensitive to endosulfan than adults. We do not know if endosulfan can affect the ability of people to have children or if it causes birth defects. Large amounts of endosulfan damaged the testes of animals, but it is not known if this damaged their ability to reproduce. Some birth defects have been seen in the offspring of animals ingesting endosulfan during pregnancy.

Has the federal government made recommendations to protect human health?


The EPA recommends that the amount of endosulfan in rivers, lakes, and streams should not be more than 74 parts per billion (74 ppb). The Food and Drug Administration (FDA) allows no more than 24 parts per million (24 ppm) endosulfan on dried tea. EPA allows no more than 0.1 to 2 ppm endosulfan on other raw agricultural products.

How can families reduce the risk of exposure to endosulfan?


[ Fresh fruits and vegetables should be washed before being eaten. [ Children should not play on grasses that were recently treated with endosulfan. Carefully follow the directions on the pesticide label about how long to wait before re-entering the treated area. [ People working in a factory making endosulfan and people using endosulfan should wash clothing, skin, and hair before going home.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2000. Toxicological Profile for Endosulfan. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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ENDRIN
CAS # 72-20-8
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about endrin. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to endrin can cause various harmful effects including death and severe central nervous system injury. Swallowing very large amounts of endrin may cause convulsions and kill you in a few minutes or hours. Exposure to high doses may result in headaches, dizziness, nervousness, confusion, nausea, vomiting, and convulsions. No long-term health effects have been noted in workers. Endrin has been found in at least 120 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is endrin? (Pronounced n drn)
Endrin is a solid, white, almost odorless substance that was used as a pesticide to control insects, rodents, and birds. Endrin has not been produced or sold for general use in the United States since 1986. Little is known about the properties of endrin aldehyde (an impurity and breakdown product of endrin) or endrin ketone (a product of endrin when it is exposed to light). q Endrin may also be broken down by exposure to high temperatures or light to form primarily endrin ketone and endrin aldehyde. q It is not known what happens to endrin aldehyde or endrin ketone once they are released to the environment. However, the amount of endrin broken down to endrin aldehyde or endrin ketone is very small.

How might I be exposed to endrin?


q You may be exposed to endrin in air, water, or soil if you live near a hazardous waste site. q You may be exposed by eating foods that contain endrin. q Children living near hazardous waste sites could be exposed to endrin in contaminated soils if they eat dirt. q Endrin levels can build up in the tissues of organisms that live in water. q Human breast milk may be a route of exposure for nursing infants.

What happens to endrin when it enters the environment?


q Endrin does not dissolve very well in water. It has been found in groundwater and surface water, but only at very low levels. It is more likely to cling to the bottom sediments of rivers, lakes, and other bodies of water. q Endrin is generally not found in the air except when it was applied to fields during agricultural applications. q The persistence of endrin in the environment depends highly on local conditions. Some estimates indicate that endrin can stay in soil for over 10 years.

How can endrin affect my health?


Exposure to endrin can cause various harmful effects including death and severe central nervous system (brain and spinal cord) injury. Swallowing large amounts of endrin may

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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ENDRIN CAS # 72-20-8


ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

cause convulsions and kill you in a few minutes or hours. Symptoms that may result from endrin poisoning are headaches, dizziness, nervousness, confusion, nausea, vomiting, and convulsions. No long-term health effects have been noted in workers who have been exposed to endrin by breathing or touching it. Studies in animals confirm that endrins main target is the nervous system. Birth defects, especially abnormal bone formation, have been seen in some animal studies.

tests to predict the type or severity of any health effects that might occur.

Has the federal government made recommendations to protect human health?


The EPAs maximum contaminant level (MCL) for endrin in drinking water is 0.0002 milligrams per liter (0.0002 mg/L). The Occupational Safety and Health Administration (OSHA) has established a limit of 0.1 mg endrin per cubic meter of air (0.1 mg/m3) for an 8-hour day in a 40-hour workweek.

How likely is endrin to cause cancer?


In studies using rats, mice, and dogs, endrin did not produce cancer. However, most of these studies did not accurately evaluate the ability of endrin to cause cancer. No significant excess of cancer has been found in exposed factory workers. The EPA has determined that endrin is not classifiable as to its human carcinogenicity because there is not enough information to allow classification.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Dissolve: To disappear gradually. Long-term: 365 days or longer. Milligram (mg): One thousandth of a gram. Pesticide: A substance that kills pests. Sediments: Mud and debris that have settled to the bottom of a body of water.

Is there a medical test to show whether Ive been exposed to endrin?


If you are exposed to endrin, it can be detected in your blood, breast milk, or fatty tissue. Tests can measure endrin in the blood or fat of people recently exposed. These tests arent available at most doctors offices, but can be done at special laboratories that have the right equipment. Although these tests can be used to confirm that a person has been exposed to endrin, it is not yet possible to use these

Source of Information
This ToxFAQs information is taken from the 1996 Toxicological Profile for Endrin produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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ETHION
CAS # 563-12-2
Division of Toxicology ToxFAQsTM February 2001

This fact sheet answers the most frequently asked health questions (FAQs) about ethion. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to ethion happens mostly from skin contact or breathing contaminated air, but may also occur from eating contaminated food or drinking contaminated water. Ethion affects the function of the central nervous system and at high doses can cause nausea, blurring or dimness of vision, muscle tremors, and labored breathing. Ethion has been found in at least 9 of 1,577 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is ethion? (Pronounced -thion)
Ethion is an organophosphate pesticide. Pure ethion is a clear to yellowish liquid with an unpleasant sulfur-like smell. It does not occur naturally in the environment. Ethion is used in agriculture, mainly to control insects on citrus trees, but also on cotton, fruit and nut trees, and some vegetables. It may also be used on lawns and turf grasses, but it is not used in the home for pest control. move from soil to underground water. Ethion in soil breaks down in 112 months. [ It is not known if ethion levels can build up in plants or fish.

How might I be exposed to ethion?


[ Working in industries that make ethion or as a pesticide applicator. [ Eating raw fruits or vegetables that have been treated with ethion, but levels are very low. [ Skin contact with soil containing ethion.

What happens to ethion when it enters the environment?


[ Ethion enters the air, water, and soil during its manufacture and use. [ Ethion in air lasts a short time. It is slowly broken down in water. [ Ethion binds strongly to soil particles and it does not

How can ethion affect my health?


Ethion affects the nervous system. Exposure to high levels of ethion can nausea, sweating, diarrhea, loss of bladder

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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ETHION
CAS # 563-12-2
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

control, blurring or dimness of vision, muscle tremors, and labored breathing. Severe poisoning may result in coma, inability to breathe, and death.

Is there a medical test to show whether Ive been exposed to ethion?


[ The breakdown products of ethion can be measured in your urine. [ There are tests to measure the activity of the enzymes (acetylcholinesterases) that are affected by ethion. These tests cannot tell if you were exposed to ethion because a number of chemicals also affect these enzymes. [ Neither of these tests are routinely available in your doctors office, but samples can be sent to a special laboratory.

How likely is ethion to cause cancer?

We do not know if ethion can cause cancer in humans. No cancer was seen in animals that ate ethion over a long period of time.

How can ethion affect children?

We do not know if children are more sensitive to ethion than adults. We do not know if ethion can affect the ability of people to have children or if it causes birth defects. Some birth defects have been seen in the babies of animals that ate ethion during pregnancy.

Has the federal government made recommendations to protect human health?


[ The EPA has established regulations for the maximum limits of ethion on food products, ranging from 0.1 to 14 parts per million (0.1 to 14 ppm).

How can families reduce the risk of exposure to ethion? Source of Information
[ Children should not play on grasses that were recently treated with ethion. Carefully follow the directions on the pesticide label about how long to wait for re-entering the treated area. [ People working in a factory making ethion and people using ethion should wash clothing, skin, and hair before going home.

Agency for Toxic Substances and Disease Registry (ATSDR). 2000. Toxicological Profile for Ethion. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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ETHYLBENZENE
CAS # 100-41-4
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about ethylbenzene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Ethylbenzene is a colorless liquid found in a number of products including gasoline and paints. Breathing very high levels can cause dizziness and throat and eye irritation. Ethylbenzene has been found in at least 731 of the 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is ethylbenzene? (Pronounced th l bn zn)


Ethylbenzene is a colorless, flammable liquid that smells like gasoline. It is found in natural products such as coal tar and petroleum and is also found in manufactured products such as inks, insecticides, and paints. Ethylbenzene is used primarily to make another chemical, styrene. Other uses include as a solvent, in fuels, and to make other chemicals.

How might I be exposed to ethylbenzene?


G Breathing air containing ethylbenzene, particularly in areas near factories or highways. G Drinking contaminated tap water. G Working in an industry where ethylbenzene is used or made. G Using products containing it, such as gasoline, carpet glues, varnishes, and paints.

How can ethylbenzene affect my health?


Limited information is available on the effects of ethylbenzene on peoples health. The available information shows dizziness, throat and eye irritation, tightening of the chest, and a burning sensation in the eyes of people exposed to high levels of ethylbenzene in air. Animals studies have shown effects on the nervous system, liver, kidneys, and eyes from breathing ethylbenzene in air.

What happens to ethylbenzene when it enters the environment?


G Ethylbenzene moves easily into the air from water and soil. G It takes about 3 days for ethylbenzene to be broken down in air into other chemicals. G Ethylbenzene may be released to water from industrial discharges or leaking underground storage tanks. G In surface water, ethylbenzene breaks down by reacting with other chemicals found naturally in water. G In soil, it is broken down by soil bacteria.

How likely is ethylbenzene to cause cancer?


The EPA has determined that ethylbenzene is not classifiable as to human carcinogenicity.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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ETHYLBENZENE CAS # 100-41-4

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No studies in people have shown that ethylbenzene exposure can result in cancer. Two available animal studies suggest that ethylbenzene may cause tumors.

How can ethylbenzene affect children?


Children may be exposed to ethylbenzene through inhalation of consumer products, including gasoline, paints, inks, pesticides, and carpet glue. We do not know whether children are more sensitive to the effects of ethylbenzene than adults. It is not known whether ethylbenzene can affect the development of the human fetus. Animal studies have shown that when pregnant animals were exposed to ethylbenzene in air, their babies had an increased number of birth defects.

some body tissues of exposed people. The most common way to test for ethylbenzene is in the urine. This test measures substances formed by the breakdown of ethylbenzene. This test needs to be done within a few hours after exposure occurs, because the substances leave the body very quickly. These tests can show you were exposed to ethylbenzene, but cannot predict the kind of health effects that might occur.

Has the federal government made recommendations to protect human health?


The EPA has set a maximum contaminant level of 0.7 milligrams of ethylbenzene per liter of drinking water (0.7 mg/L). The EPA requires that spills or accidental releases into the environment of 1,000 pounds or more of ethylbenzene be reported to the EPA. The Occupational Safety and Health Administration (OSHA) has set an occupational exposure limit of 100 parts of ethylbenzene per million parts of air (100 ppm) for an 8-hour workday, 40-hour workweek.

How can families reduce the risk of exposure to ethylbenzene?


Exposure to ethylbenzene vapors from household products and newly installed carpeting can be minimized by using adequate ventilation. Household chemicals should be stored out of reach of children to prevent accidental poisoning. Always store household chemicals in their original containers; never store them in containers children would find attractive to eat or drink from, such as old soda bottles. Gasoline should be stored in a gasoline can with a locked cap. Sometimes older children sniff household chemicals, including ethylbenzene, in an attempt to get high. Talk with your children about the dangers of sniffing chemicals.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1999. Toxicological profile for ethylbenzene. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people or to treat those who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Is there a medical test to show whether Ive been exposed to ethylbenzene?


Ethylbenzene is found in the blood, urine, breath, and

Where can I get more information?

For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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ETHYLENE OXIDE
CAS # 75-21-8
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about ethylene oxide. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Large amounts of ethylene oxide are produced in the United States. Most of it is used to make other chemicals such as ethylene glycol, but smaller amounts are used as a pesticide or to sterilize medical equipment. Exposure to ethylene oxide can cause irritation of the eyes, skin, nose, throat, and lungs, and damage to the brain and nerves. It has been found at 3 of the 1,177 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is ethylene oxide?
(Pronounced th-ln ksd) Ethylene oxide is a flammable gas with a somewhat sweet odor. It dissolves easily in water. Ethylene oxide is a man-made chemical that is used primarily to make ethylene glycol (a chemical used to make antifreeze and polyester). A small amount (less than 1%) is used to control insects in some stored agricultural products and a very small amount is used in hospitals to sterilize medical equipment and supplies. q When released to soil, most will evaporate to air and some may be broken down by bacteria or by reacting with water in the soil. q Ethylene oxide does not persist long in the environment and is not expected to build up in the food chain.

How might I be exposed to ethylene oxide?


q Most people are not likely to be exposed to ethylene oxide because it is not commonly found in the environment. q If you work where ethylene oxide is made or used, you could be exposed to it by breathing it or getting it on your skin. q Although ethylene oxide has been measured in some foods shortly after being sprayed as a pesticide, it is not known if any ethylene oxide would remain on the food by the time it is processed and eaten.

What happens to ethylene oxide when it enters the environment?


q Ethylene oxide rapidly breaks down when released to the environment. q Because ethylene oxide is a gas, most is expected to be released to the air where it reacts with water vapor and sunlight and breaks down within a few days. q Ethylene oxide will dissolve in water, but most of it will quickly evaporate to the air. The ethylene oxide remaining will be broken down by bacteria, or by reacting with water and other chemicals.

How can ethylene oxide affect my health?


Breathing low levels of ethylene oxide for several months to years has caused irritation of the eyes, skin, and respiratory passages and affected the nervous system (headache, nausea, vomiting, memory loss, numbness, etc.). At higher levels of

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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ETHYLENE OXIDE CAS # 75-21-8

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


in ground spices. Any release to the environment greater than 10 pounds must be reported to the EPA. The Occupational Safety and Health Administration (OSHA) has set a limit of 1 ppm over an 8-hour workday, 40hour workweek with a short-term exposure limit (not to exceed 15 minutes) of 5 ppm. The National Institute of Occupational Safety and Health (NIOSH) recommends that average workplace air should contain less than 0.1 ppm ethylene oxide averaged over a 10-hour workday, 40-hour workweek. The federal recommendations have been updated as of July 1999.

exposure for shorter periods, effects are similar but may be more severe. There is some evidence that exposure to ethylene oxide can cause a pregnant woman to have a miscarriage. Animal studies indicate that in addition to irritation of the respiratory passages, nervous system effects, and reproductive effects, the kidneys, adrenal gland, and skeletal muscles may be affected from long-term exposure to ethylene oxide.

How likely is ethylene oxide to cause cancer?


Increased incidences of leukemia and stomach cancer have been reported for workers exposed to ethylene oxide; however, the data are not considered conclusive. The carcinogenicity of ethylene oxide has been evaluated in rats and mice that breathed it. Leukemia, brain tumors, lung tumors, and other cancers were observed. The Department of Health and Human Services (DHHS) has determined that ethylene oxide may reasonably be anticipated to be a human carcinogen.

Glossary
Carcinogen: A substance that can cause cancer. Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. National Priorities List: A list of the nations worst hazardous waste sites. ppm: Parts per million. Tumor: An abnormal mass of tissue.

Is there a medical test to show whether Ive been exposed to ethylene oxide?
There are two kinds of tests that can determine if you have been recently exposed to ethylene oxide. One test measures ethylene oxide in blood and the other test measures it in your breath. However, these tests cannot be used to predict how it will affect your health. Because special equipment is needed, these tests are not usually done in the doctors office.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1990. Toxicological profile for ethylene oxide. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Has the federal government made recommendations to protect human health?


The Food and Drug Administration (FDA) has set a tolerance limit of 50 parts per million (50 ppm) of ethylene oxide

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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ETHYLENE GLYCOL and PROPYLENE GLYCOL


CAS # 107-21-1 and 57-55-6
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about ethylene glycol and propylene glycol. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Ethylene glycol and propylene glycol are clear liquids used in antifreeze and deicing solutions. Exposure to large amounts of ethylene glycol can damage the kidneys, heart, and nervous system. Propylene glycol is generally regarded as safe for use in food. Ethylene glycol has been found in at least 34, and propylene glycol in at least 5, of the 1,416 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are ethylene glycol and propylene glycol? (Pronounced th-ln and pr p-ln gl kl)
Both ethylene glycol and propylene glycol are clear, colorless, slightly syrupy liquids at room temperature. Either compound may exist in air in the vapor form, although propylene glycol must be heated or briskly shaken to produce a vapor. Ethylene glycol is odorless but has a sweet taste. Propylene glycol is practically odorless and tasteless. Both compounds are used to make antifreeze and deicing solutions for cars, airplanes, and boats; to make polyester compounds; and as solvents in the paint and plastics industries. Ethylene glycol is also an ingredient in photographic developing solutions, hydraulic brake fluids and in inks used in stamp pads, ballpoint pens, and print shops. The Food and Drug Administration (FDA) has classified propylene glycol as an additive that is generally recognized as safe for use in food. It is used to absorb extra water and maintain moisture in certain medicines, cosmetics, or food products. It is a solvent for food colors and flavors. Propylene glycol is also used to create artificial smoke or fog used in fire-fighting training and in theatrical productions.

What happens to ethylene glycol and propylene glycol when they enter the environment?
q Neither compound is likely to exist in large amounts in air. q About half of the compounds that enter the air will break down in 2450 hours. q Both compounds break down within several days to a week in water and soil.

How might I be exposed to ethylene glycol and propylene glycol?


q You can be exposed to ethylene glycol when you use antifreeze, photographic developing solutions, coolants, and brake fluid. q You can be exposed to propylene glycol by eating food products, using cosmetics, or taking medicine that contains it. q If you work in an industry that uses ethylene glycol or propylene glycol, you could be exposed by breathing or touching these substances.

How can ethylene glycol and propylene glycol affect my health?


Eating or drinking very large amounts of ethylene glycol can result in death, while large amounts can result in nausea,

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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ETHYLENE GLYCOL & PROPYLENE GLYCOL CAS # 107-21-1 and 57-55-6


ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

convulsions, slurred speech, disorientation, and heart and kidney problems. Female animals that ate large amounts of ethylene glycol had babies with birth defects, while male animals had reduced sperm counts. However, these effects were seen at very high levels and would not be expected in people exposed to lower levels at hazardous waste sites. Ethylene glycol affects the body's chemistry by increasing the amount of acid, resulting in metabolic problems. Similar to ethylene glycol, propylene glycol increases the amount of acid in the body. However, larger amounts of propylene glycol are needed to cause this effect.

the body, they are very difficult to detect, even though symptoms may be present.

Has the federal government made recommendations to protect human health?


The EPA has set a drinking water guideline for ethylene glycol of 7,000 micrograms (7,000 mg/L) in a liter of water for an adult. The Food and Drug Administration (FDA) has classified propylene glycol as generally recognized as safe, which means that it is acceptable for use in flavorings, drugs, and cosmetics, and as a direct food additive. The American Conference of Governmental Industrial Hygienists (ACGIH) recommends a maximum level of 127 milligrams of ethylene glycol per cubic meter of air (127 mg/m3) for a 15-minute exposure.

How likely are ethylene and propylene glycol to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified ethylene glycol and propylene glycol for carcinogenicity. Studies with people who used ethylene glycol did not show carcinogenic effects. Animal studies also have not shown these chemicals to be carcinogens.

Glossary
Acid: A sour substance. Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Metabolic: Chemical changes in cells that provide energy to the body. Synthetic: Made by humans.

Is there a medical test to show whether Ive been exposed to ethylene or propylene glycol?
Tests are available to determine if you have been exposed to ethylene glycol. These tests are only used on people who are showing symptoms of ethylene glycol poisoning (but they could be used in other situations). The tests are most often used on people who have intentionally consumed, or who suspect they have consumed, large amounts of ethylene glycol. Propylene glycol is generally considered to be a safe chemical, and is not routinely tested for, unless specific exposure, such as to a medicine or cosmetic, can be linked with symptoms. Since both chemicals break down very quickly in

Source of Information
This ToxFAQs information is taken from the 1997 Toxicological Profile for Ethylene Glycol and Propylene Glycol produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CAS# Fluorine 7782-41-4, Hydrogen Fluoride 7664-39-3, Sodium Fluoride 7681-49-4 Division of Toxicology ToxFAQsTM

FLUORINE, HYDROGEN FLUORIDE, AND FLUORIDES


September 2001

This fact sheet answers the most frequently asked health questions (FAQs) about fluorine, hydrogen fluoride, and flourides. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Fluorine and hydrogen fluoride are naturally occurring gases that are very irritating to the skin, eyes, and respiratory tract. Fluorides are also naturally occurring compounds. Low levels of fluoride can help prevent dental cavities. At high doses, fluoride can result in tooth and bone damage. These substances have been found in at least 177 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are fluorine, hydrogen fluoride, and fluorides?
Fluorine, hydrogen fluoride, and fluorides are chemically related. Fluorine is a naturally occurring, pale yellow-green gas with a sharp odor. It combines with hydrogen to make hydrogen fluoride, a colorless gas. Hydrogen fluoride dissolves in water to form hydrofluoric acid. Fluorine also combines with metals to make fluorides such as sodium fluoride and calcium fluoride, both white solids. Sodium fluoride dissolves easily in water, but calcium fluoride does not. Fluorine and hydrogen fluoride are used to make certain chemical compounds. Hydrofluoric acid is used for etching glass. Fluorides are used in making steel, chemicals, ceramics, lubricants, dyes, plastics and pesticides (for ants and roaches). Fluorides are often added to drinking water supplies and to a variety of dental products, including toothpaste and mouth rinses, to prevent dental cavities. industry are carried by wind and rain to nearby water, soil, and food sources. Fluorides in water and soil will form strong associations with sediment or soil particles. Fluorides will accumulate in plants and animals. In animals, the fluoride accumulates primarily in the bones or shell rather than in edible meat.

How might I be exposed to fluorine, hydrogen fluoride, and fluorides?


The general populations can be exposed to fluorides in contaminated air, food, drinking water and soil. People living in communities with fluoridated water or high levels of naturally-occurring fluoride may be exposed to higher levels. People who work or live near industries where fluoridecontaining substances are used may be exposed to higher levels.

What happens to fluorine, hydrogen fluoride, and fluorides when they enter the environment?
Fluorine can not be destroyed in the environment, it can only change its form. Fluorine forms salts with minerals in soil, and doesnt evaporate back into air as a gas. Hydrogen fluoride gas will be absorbed by rain and into clouds and fog to form hydrofluoric acid, which will fall to the ground. Fluorides if released to the air from volcanoes and

How can fluorine, hydrogen fluoride, and fluorides affect my health?


Fluorine and hydrogen fluoride are very irritating to the skin, eyes, and respiratory tract. At high levels, hydrogen fluoride can also damage the heart. Small amounts of fluoride help prevent tooth cavities, but high levels can harm your health. In adults, high fluoride exposure over a long time can lead to skeletal fluorosis with denser bones, joint pain, and a limited range of joint

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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FLUORINE, HYDROGEN FLUORIDE, AND FLUORIDES


CAS# Fluorine 7782-41-4, Hydrogen Fluoride 7664-39-3, Sodium Fluoride 7681-49-4 ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

movement. Although fluoride exposure results in denser bones, the bone appears to be weaker than normal bone and there may be a greater risk of breaking the bone. In animals, exposure to high doses of fluoride can result in decreased fertility and sperm and testes damage.

at most, a small pea size dab of toothpaste on the brush and teach children not to swallow dental products.

Is there a medical test to show whether Ive been exposed to fluorine, hydrogen fluoride, and fluorides?
Tests are available to measure fluoride levels in urine; these tests can determine if you have been exposed to higher-thannormal levels of fluorides. The urine test must be performed soon after exposure because fluoride that is not stored in bones leaves the body within a few days. The test can not be performed in the doctors office, but can be done at most laboratories that test for chemical exposure. The urine fluoride test cannot be used to predict the nature or severity of toxic effects. Bone sampling can be done in special cases to measure long-term exposure to fluorides.

How likely are fluorine, hydrogen fluoride, and fluorides to cause cancer?
Most of the studies of people living in areas with fluoridated water or naturally high levels of fluoride in drinking water did not find an association between fluoride and cancer risk. Two animal cancer studies were inconclusive. The international Agency for Research on Cancer (IARC) has determined that the carcinogenicity of fluoride to humans is not classifiable.

How can fluorine, hydrogen fluoride, and fluorides affect children?


When used appropriately, fluoride is both safe and effective in preventing and controlling cavities. Drinking or eating excessive fluoride during the time teeth are being formed (before 6 years of age) can cause visible changes in teeth. This condition is called dental fluorosis. At very high concentrations of fluoride, the teeth can become more fragile and sometimes develop a greater number of cavities. No studies have addressed whether low levels of fluoride will cause birth defects in humans. Birth defects have not been found in most studies of animals.

Has the federal government made recommendations to protect human health?


The EPA has set a maximum amount of fluoride allowable in drinking water of 4.0 milligrams per liter of water (4.0 mg/L). For the prevention of dental decay, the Public Health Service (PHS) has, since 1962, recommended that public water supplies contain between 0.7 and 1.2 milligrams of fluoride per liter of drinking water. The Occupational Safety and Health Administration (OSHA) has set limits of 0.2 milligrams per cubic meter (0.2 mg/m3) for fluorine, 2.0 mg/m3 for hydrogen fluoride, and 2.5 mg/m3 for fluoride in workroom air to protect workers during an 8-hour shift over a 40-hour work week.

How can families reduce the risk of exposure to fluorine, hydrogen fluoride, and fluorides?
Because fluorides are found naturally in the environment, we cannot avoid being exposed to them. Children may be exposed to high levels of fluorides if they swallow dental products containing fluoridated toothpaste, gels, or rinses. Parents should supervise brushing and place

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for Fluorine, Hydrogen Fluoride, and Fluorides (Draft for Public Comment) Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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FORMALDEHYDE
CAS # 50-00-0
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about formaldehyde. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Everyone is exposed to small amounts of formaldehyde in air and some foods and products. Formaldehyde can cause irritation of the skin, eyes, nose, and throat. High levels of exposure may cause some types of cancers. This substance has been found in at least 26 of the 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is formaldehyde? (Pronounced fr-mld-hd)


At room temperature, formaldehyde is a colorless, flammable gas that has a distinct, pungent smell. It is also known as methanol, methylene oxide, oxymethyline, methylaldehyde, and oxomethane. Formaldehyde is naturally produced in small amounts in our bodies. It is used in the production of fertilizer, paper, plywood, and urea-formaldehyde resins. It is also used as a preservative in some foods and in many products used around the house, such as antiseptics, medicines, and cosmetics.

How might I be exposed to formaldehyde?


q Smog is a major source of formaldehyde exposure. q Cigarettes and other tobacco products, gas cookers, and open fireplaces are sources of formaldehyde exposure. q It is used in many industries and in hospitals and laboratories. q Formaldehyde is given off as a gas from the manufactured wood products used in new mobile homes. q The amount of formaldehyde in foods is very small. q Household sources, such as fiberglass, carpets, permanent press fabrics, paper products, and some househould cleaners.

What happens to formaldehyde when it enters the environment?


q Formaldehyde dissolves easily but does not last a long time in water. q Most formaldehyde in the air breaks down during the day. q The breakdown products of formaldehyde are formic acid and carbon monoxide. q Formaldehyde does not build up in plants and animals.

How can formaldehyde affect my health?


Low levels of formaldehyde can cause irritation of the eyes, nose, throat, and skin. It is possible that people with asthma may be more sensitive to the effects of inhaled formaldehyde. Drinking large amounts of formaldehyde can cause severe pain, vomiting, coma, and possible death.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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FORMALDEHYDE CAS # 50-00-0

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html How likely is formaldehyde to cause cancer?
Some studies of people exposed to formaldehyde in workplace air found more cases of cancer of the nose and throat than expected, but other studies did not confirm this finding. In animal studies, rats exposed to high levels of formaldehyde in air developed nose cancer. The Department of Health and Human Services (DHHS) has determined that formaldehyde may reasonably be anticipated to be a carcinogen.

Is there a medical test to show whether I've been exposed to formaldehyde?


Laboratory tests can measure formaldehyde in blood, urine, and breath. These tests do not tell you how much formaldehyde you have been exposed to or if harmful effects will occur. The tests are not routinely available at your doctor's office.

How can formaldehyde affect children?


The most common route of exposure is by breathing it, which is likely to cause nose and eye irritation (burning, itchy, tearing, and sore throat) in children as well as in adults. Animal studies suggest that formaldhyde will not cause birth defects in humans. It is not likely to be transferred to a child in breast milk.

What recommendations has the federal government made to protect human health?
The EPA recommends that an adult should not drink water containing more than 1 milligram of formaldehyde per liter of water (1 mg/L) for a lifetime exposure, and a child should not drink water containing more than 10 mg/L for 1 day or 5 mg/L for 10 days. The Occupational Safety and Health Administration (OSHA) has set a permissable exposure limit for formaldehyde of 0.75 parts per million (ppm) for an 8-hour workday, 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) recommends an exposure limit of 0.016 ppm.

How can families reduce the risk of exposure to formaldehyde?


Formaldehyde is usually found in the air, and levels are usually higher indoors than outdoors. Opening windows and using fans to bring fresh air indoors are the easiest ways to lower levels in the house. Not smoking and not using unvented heaters indoors can lower the formaldehyde levels. Removing formaldehyde sources in the home can reduce exposure. Formaldehyde is given off from a number of products used in the home. Providing fresh air, sealing unfinished manufactured wood surfaces, and washing new permanent press clothing before wearing can help lower exposure.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1999. Toxicological profile for formaldehyde. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Services. Animal testing is sometimes necessary to find out how toxic substance might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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FUEL OILS
CAS # 8008-20-6, 70892-10-3, 68476-30-2, 68476-34-6, 68476-31-3
Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about fuel oils. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Fuel oils are liquid mixtures produced from petroleum, and their use mostly involves burning them as fuels. Drinking or breathing fuel oils may cause nausea or nervous system effects. However, exposure under normal use conditions is not likely to be harmful. Fuel oils have been found in at least 26 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What are fuel oils? (Pronounced fyl oilz)


Fuel oils are a variety of yellowish to light brown liquid mixtures that come from crude petroleum. Some chemicals found in fuel oils may evaporate easily, while others may more easily dissolve in water. Fuel oils are produced by different petroleum refining processes, depending on their intended uses. Fuel oils may be used as fuel for engines, lamps, heaters, furnaces, and stoves, or as solvents. Some commonly found fuel oils include kerosene, diesel fuel, jet fuel, range oil, and home heating oil. These fuel oils differ from one another by their hydrocarbon compositions, boiling point ranges, chemical additives, and uses.

q Some chemicals found in fuel oils may stick to particles in water, which will eventually cause them to settle to the bottom sediment. q Some of the chemicals found in fuel oils may be broken down slowly in air, water, and soil by sunlight or small organisms. q Some of the chemicals found in fuel oils may build up significantly in plants and animals.

How might I be exposed to fuel oils?


q Using a home kerosene heater or stove, or using fuel oils at work. q Breathing air in home or building basements that has been contaminated with fuel oil vapors entering from the soil. q Drinking or swimming in water that has been contaminated with fuel oils from a spill or a leaking underground storage tank. q Touching soil contaminated with fuel oils. q Using fuel oils to wash paint or grease from skin or equipment.

What happens to fuel oils when they enter the environment?


q Some chemicals found in fuel oils may evaporate into the air from open containers or contaminated soil or water. q Some chemicals found in fuel oils may dissolve in water after spills to surface waters or leaks from underground storage tanks.

How can fuel oils affect my health?


Little information is available about the health effects that may be caused by fuel oils. People who use kerosene

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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FUEL OILS
CAS # 8008-20-6, 70892-10-3, 68476-30-2, 68476-34-6, 68476-31-3

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


stoves for cooking do not seem to have any health problems related to their exposure. Breathing some fuel oils for short periods may cause nausea, eye irritation, increased blood pressure, headache, lightheadedness, loss of appetite, poor coordination, and difficulty concentrating. Breathing diesel fuel vapors for long periods may cause kidney damage and lower your bloods ability to clot. Drinking small amounts of kerosene may cause vomiting, diarrhea, coughing, stomach swelling and cramps, drowsiness, restlessness, painful breathing, irritability, and unconsciousness. Drinking large amounts of kerosene may cause convulsions, coma, or death. Skin contact with kerosene for short periods may cause itchy, red, sore, or peeling skin. the chemicals commonly found in fuel oils are in your blood. However, the presence of these chemicals in blood may not necessarily mean that you have been exposed to fuel oils.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) and the Air Force Office of Safety and Health (AFOSH) have set a permissible exposure level (PEL) of 400 parts of petroleum distillates per million parts of air (400 ppm) for an 8-hour workday, 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) recommends that average workplace air levels not exceed 350 milligrams of petroleum distillates per cubic meter of air (350 mg/m3) for a 40-hour workweek. The Department of Transportation (DOT) lists fuel oils as hazardous materials and, therefore, regulates their transportation.

How likely are fuel oils to cause cancer?


The International Agency for Research on Cancer (IARC) has determined that some fuel oils (heavy) may possibly cause cancer in humans, but for other fuel oils (light) there is not enough information to make a determination. IARC has also determined that occupational exposures to fuel oils during petroleum refining are probably carcinogenic in humans. Some studies with mice have suggested that repeated contact with fuel oils may cause liver or skin cancer. However, other mouse studies have found this not to be the case. No studies are available in other animals or in people on the carcinogenic effects of fuel oils.

Glossary
Carcinogenic: Able to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. Hydrocarbon: Any compound made up of hydrogen and carbon. Milligram (mg): One thousandth of a gram. ppm: Parts per million. Sediment: Mud and debris that have settled to the bottom of a body of water.

Is there a medical test to show whether Ive been exposed to fuel oils?
There is no medical test that shows if you have been exposed to fuel oils. Tests are available to determine if some of

Reference
Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for fuel oils. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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AUTOMOTIVE GASOLINE
CAS # 8006-61-9
Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about automobile gasoline. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to automotive gasoline most likely occurs from breathing its vapor at a service station while filling a cars fuel tank. At high levels, automotive gasoline is irritating to the lungs when breathed in and irritating to the lining of the stomach when swallowed. Exposure to high levels may also cause harmful effects to the nervous system. Automotive gasoline has been found in at least 23 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is automotive gasoline? (Pronounced t-mtv gs-ln)
The gasoline discussed in this fact sheet is automotive used as a fuel for engines in cars. Gasoline is a colorless, pale brown, or pink liquid, and is very flammable. Gasoline is a manufactured mixture that does not exist naturally in the environment. Gasoline is produced from petroleum in the refining process. Typically, gasoline contains more than 150 chemicals, including small amounts of benzene, toluene, xylene, and sometimes lead. How the gasoline is made determines which chemicals are present in the gasoline mixture and how much of each is present. The actual composition varies with the source of the crude petroleum, the manufacturer, and the time of year. q Other chemicals in gasoline dissolve in water after spills to surface waters or underground storage tank leaks into the groundwater. q In surface releases, most chemicals in gasoline will probably evaporate; others may dissolve and be carried away by water; a few will probably stick to soil. q The chemicals that evaporate are broken down by sunlight and other chemicals in the air. q The chemicals that dissolve in water also break down quickly by natural processes.

How might I be exposed to automotive gasoline?


q Breathing vapors at a service station when filling the cars fuel tank is the most likely way to be exposed. q Working at a service station. q Using equipment that runs on gasoline, such as a lawn mower. q Drinking contaminated water. q Being close to a spot where gasoline has spilled or leaked into the soil.

What happens to automotive gasoline when it enters the environment?


q Small amounts of the chemicals present in gasoline evaporate into the air when you fill the gas tank in your car or when gasoline is accidentally spilled onto surfaces and soils or into surface waters.

How can automotive gasoline affect my health?


Many of the harmful effects seen after exposure to gasoline are due to the individual chemicals in the gasoline mix-

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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ture, such as benzene and lead. Inhaling or swallowing large amounts of gasoline can cause death. Inhaling high concentrations of gasoline is irritating to the lungs when breathed in and irritating to the lining of the stomach when swallowed. Gasoline is also a skin irritant. Breathing in high levels of gasoline for short periods or swallowing large amounts of gasoline may also cause harmful effects on the nervous system. Serious nervous system effects include coma and the inability to breathe, while less serious effects include dizziness and headaches. There is not enough information available to determine if gasoline causes birth defects or affects reproduction.

ods are sensitive enough to measure background levels and levels where health effects may occur. These tests aren't available in most doctors' offices, but can be done at special laboratories that have the right equipment.

Has the federal government made recommendations to protect human health?


The EPA has established many regulations to control air pollution. These are designed to protect the public from the possible harmful health effects of gasoline. The American Conference of Governmental Industrial Hygienists (ACGIH) set a maximum level of 890 milligrams of gasoline per cubic meter of air (890 mg/m3) for an 8-hour workday, 40-hour workweek.

How likely is automotive gasoline to cause cancer?


The Department of Health and Human Services (DHHS) and the International Agency for Research on Cancer (IARC) have not classified automotive gasoline for carcinogenicity. Automotive gasoline is currently undergoing review by the EPA for cancer classification. Some laboratory animals that breathed high concentrations of unleaded gasoline vapors continuously for 2 years developed liver and kidney tumors. However, there is no evidence that exposure to gasoline causes cancer in humans.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Crude petroleum: Petroleum that has not been processed. Dissolve: To disappear gradually. Evaporate: To change into a vapor or a gas. Irritant: A substance that causes an abnormal reaction. Mixture: A combination of two or more components. Refining process: The process by which petroleum is purified to form gasoline. Tumor: An abnormal mass of tissue.

Is there a medical test to show whether Ive been exposed to automotive gasoline?
Laboratory tests are available that can measure elevated blood or urine levels of lead (as an indication of exposure to leaded gasoline only), benzene, or other substances that may result from exposure to gasoline or other sources. These meth-

Reference
Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for automotive gasoline. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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HEPTACHLOR/ HEPTACHLOR EPOXIDE


CAS # 76-44-8 and 1024-57-3
Agency for Toxic Substances and Disease Registry ToxFAQs April 1993

This fact sheet answers the most frequently asked health questions (FAQs) about heptachlor/heptachlor epoxide. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to heptachlor and heptachlor epoxide happens mostly from eating contaminated foods and milk, or skin contact with contaminated soil. At high levels, they can cause damage to your nervous system. Heptachlor and heptachlor epoxide have been found in at least 129 and 87 sites, respectively, of 1,300 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are heptachlor/heptachlor epoxide? (Pronounced hpt-klr/hpt-klr -pksd)
Heptachlor is a manufactured chemical and doesnt occur naturally. Pure heptachlor is a white powder that smells like camphor (mothballs). The less pure grade is tan. Trade names include Heptagran, Basaklor, Drinox, Soleptax, Termide, and Velsicol 104. Heptachlor was used extensively in the past for killing insects in homes, buildings, and on food crops, especially corn. Use slowed in the 1970s and stopped in 1988. Heptachlor epoxide is also a white powder and is a breakdown product of heptachlor. The epoxide is more likely to be found in the environment than heptachlor. q Heptachlor epoxide can stay in the soil and water for many years. q Animals change heptachlor to the epoxide. q Plants can take up heptachlor from the soil. q Levels build up in the tissues of fish and cattle.

How might I be exposed to heptachlor and heptachlor epoxide?


q Eating crops grown in soil that contains heptachlor. q Eating fish, dairy products, and fatty meats from animals exposed to heptachlor in their food. q Breathing air, drinking water, or skin contact with soil near waste sites or landfills. q Breast milk (from mothers who had high exposures).

What happens to heptachlor and heptachlor epoxide when they enter the environment?
q Heptachlor doesnt dissolve easily in water; heptachlor epoxide dissolves more easily. q They stick strongly to soil particles and evaporate slowly to air.

How can heptachlor and heptachlor epoxide affect my health?


Heptachlor and heptachlor epoxide are clearly toxic to humans and animals and can damage the nervous system. There are some human data on brief exposures to high levels. A few reports showed that people who accidentally swallowed

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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pesticides containing heptachlor, or who spilled pesticides on their clothes became dizzy, confused, or had convulsions. Most of what we know about the health effects of these pesticides comes from studies on mice and rats fed heptachlor and heptachlor epoxide in the food or water. Very high levels for short periods produce serious liver problems. Mice had trouble walking and rats developed tremors. High levels of heptachlor in the feed for several weeks damaged the livers of rats and the livers and adrenal glands of mice. We do not know if heptachlor or the epoxide affect the ability of men or women to have children. Animals that ate food containing heptachlor before and/or during pregnancy had smaller litters or were unable to reproduce. Some of the offspring had cataracts and some didnt live long after birth.

Has the federal government made recommendations to protect human health?


The EPA banned the sale of all heptachlor products and restricted the use of heptachlor to the control of fire ants in power transformers. EPA recommends a maximum of 2.78 parts of heptachlor and heptachlor epoxide per trillion parts of drinking water or seafood (2.78 ppt) that you eat each day. For longer exposures, a child should not drink water with greater than 5,000 ppt heptachlor or 150 ppt heptachlor epopxide. Quantities greater than 1 pound of heptachlor or heptachlor epoxide that enter the environment must immediately be reported to the National Response Center. The Food and Drug Administration (FDA) limits the amount of heptachlor and heptachlor epoxide on raw food crops and on edible seafood to from 0-10 parts per billion (ppb), depending on the type of food product. The limit on edible seafood is 300 ppb, and for the fat of food-producing animals is 200 ppb. The American Conference of Governmental Industrial Hygienists (ACGIH) and the Occupational Safety and Health Administration (OSHA) recommend a maximum in workplace air over an 8-hour workday for a 40-hour work week of 0.5 milligrams of heptachlor per cubic meter (0.5 mg/m3).

How likely are heptachlor and heptachlor epoxide to cause cancer?


The International Agency for Research on Cancer (IARC) has determined that heptachlor and heptachlor epoxide are not classifiable as to their carcinogenicity to humans because insufficient data are available to establish a clear assessment.

Glossary Is there a medical test to show whether Ive been exposed to heptachlor and heptachlor epoxide?
Laboratory tests can measure heptachlor and heptachlor epoxide following exposure to high levels. The blood tests for these chemicals must be done within a short period after exposure. Levels in fat can be measured for a much longer period after exposure. If heptachlor or heptachlor epoxide are found in your fat, it isnt possible to tell exactly when you were exposed to these chemicals or if harmful health effects will occur. Carcinogenicity: Ability to cause cancer. Milligram (mg): One thousandths of a gram. ppt: Parts per trillion. ppb: Parts per billion.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1993. Toxicological profile for heptachlor and heptachlor epoxide. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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HEXACHLOROBENZENE
CAS # 118-74-1
Division of Toxicology ToxFAQsTM September 2002

This fact sheet answers the most frequently asked health questions (FAQs) about hexachlorobenzene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to hexachlorobenzene occurs primarily from eating low levels in contaminated food. Much lower exposures can occur from drinking water and breathing air contaminated with hexachlorobenzene. The main health effect from eating highly contaminated food is a liver disease. Hexachlorobenzene has been found in at least 106 of the 1,613 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is hexachlorobenzene?
Hexachlorobenzene was widely used as a pesticide to protect the seeds of onions and sorghum, wheat, and other grains against fungus until 1965. It was also used to make fireworks, ammunition, and synthetic rubber. Currently, hexachlorobenzene is not used commercially in the United States. Hexachlorobenzene is a white crystalline solid, that does not occur naturally in the environment. It is formed as a byproduct during the manufacture of other chemicals. Small amounts can also be produced during combustion of municipal waste. Hexachlorobenzene can build up in fish and other aquatic animals.

How might I be exposed to hexachlorobenzene?


Eating low levels in contaminated food (e.g, fish, meat, milk, dairy products) or drinking small amounts in contaminated water. Breathing low levels in contaminated air. Eating or touching contaminated soil. For babies, drinking contaminated breast milk from exposed mothers. Working in a factory that uses or produces it as a byproduct.

What happens to hexachlorobenzene when it enters the environment?


Hexachlorobenzene can remain in the environment for a long time. It breaks down very slowly. It sticks strongly to soil. Half of the hexachlorobenzene in soil will disappear in 3-6 years. It does not dissolve easily in water. Once in water, it binds to sediments and settles to the bottom. Half of the hexachlorobenzene in surface water will disappear in 3-6 years. Under ordinary conditions not much evaporates into the air. Once in air, it can be carried out long distances.

How can hexachlorobenzene affect my health?


A study of people in Turkey who ate, over a long time, bread accidentally contaminated with hexachlorobenzene suffered from a liver disease called porphyria cutanea tarda. This disease can cause red-colored urine, skin sores, change in skin color, arthritis, and problems of the liver, nervous system, and stomach. Studies in animals show that eating hexachlorobenzene for a long time can damage the liver, thyroid gland, nervous system, bones, kidneys, blood, and immune and endocrine systems.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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The immune system of rats that breathed hexachlorobenzene for a few weeks was harmed.

How likely is hexachlorobenzene to cause cancer?


Studies in humans have provided inconclusive evidence of carcinogenicity for hexachlorobenzene. The Department of Health and Human Services (DHHS) has determined that hexachlorobenzene may reasonable be anticipated to be a human carcinogen. The International Agency for Research on Cancer (IARC) has determined that hexachlorobenzene is possibly carcinogenic to humans. The EPA haas concluded that hexachlorobenzene is a probable human carcinogen. Studies in animals suggest that eating this substance for months or years can cause cancer of the liver, kidney, and thyroid.

If hexachlorobenzene is produced in your place of work, make sure you do not carry the chemical home in your clothing, skin, hair, tools, or other objects from the workplace.

Is there a medical test to show whether Ive been exposed to hexachlorobenzene?


Blood, breast milk, urine, and feces may be tested to determine if you have ever been exposed to hexachlorobenzene. Because hexachlorobenzene can collect and remain in breast milk, the test for this substance in breast milk can tell you that you have been exposed, but not when or to how much. The levels in blood, urine, and feces indicate more recent exposure, but will not tell whether harmful health effects will occur. The tests are not routinely available at the doctors office because they require special equipment.

How can hexachlorobenzene affect children?


Breast-fed infants of mothers known to have eaten bread contaminated with hexachlorobenzene developed a disease that produced skin lesions known as pink sore. Other symptoms were weakness and convulsions. Many of the sickened infants died from this disease. Young children older than 2 years of age did not get pink sore, but they developed numerous skin, nervous system, and bone abnormalities later in life. Studies in animals suggest that young animals are especially sensitive to hexachlorobenzene. Effects on the liver, nervous system, and immune system occurred at lower doses in the young developing animals than in adults.

Has the federal government made recommendations to protect human health?


The EPA has set a maximum contaminant level of 0.001 milligram per liter (0.001 mg/L) of drinking water. The EPA also recommends that hexachlorobenzene do not exceed 0.05 mg/L in water that children drink for periods of up 10 days.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2002. Toxicological Profile for Hexachlorobenzene (Update). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

How can families reduce the risk of exposure to hexachlorobenzene?


The main way people are exposed to hexachlorobenzene is through food, especially fatty foods (e.g., dairy products, some fish).

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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HEXACHLOROBUTADIENE
CAS # 87-68-3
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about hexachlorobutadiene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Most exposure to hexachlorobutadiene comes from breathing it in workplace air. People living near hazardous waste sites may be exposed to it by breathing air or by drinking contaminated water. Animal studies suggest that hexachlorobutadiene can damage the kidneys and liver and may cause kidney tumors. This chemical has been found in at least 47 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is hexachlorobutadiene? (Pronounced hks klr byt-dn)
Hexachlorobutadiene is a colorless liquid with a turpentine-like odor. It is also called perchlorobutadiene. Hexachlorobutadiene is not found naturally in the environment. It is formed when other chemicals are made. Most hexachlorobutadiene used commercially in the United States is imported from Germany. It is mainly used to make rubber compounds. It is also used as a solvent, and to make lubricants, in gyroscopes, as a heat transfer liquid, and as a hydraulic fluid.

How might I be exposed to hexachlorobutadiene?


q Working in industries that make or use hexachlorobutadiene. q Breathing air around hazardous waste sites where it has been disposed of. q Drinking water contaminated with hexachlorobutadiene. q Eating fish or other foods contaminated with it.

How can hexachlorobutadiene affect my health?


There are no studies that have looked at the effects of hexachlorobutadiene in people. All of our information has come from studies in animals. Studies in mice have shown irritation of the nose when large amounts were breathed over a short time. The only other effect noted in animals from breathing hexachlorobutadiene was a reduction in the body weights of fetuses when their mothers breathed high levels of the chemical. There are no studies which looked at animals breathing low levels of hexachlorobutadiene over a long time. Rats and mice that drank low levels of hexachlorobutadiene over both short and long periods had kidney and

What happens to hexachlorobutadiene when it enters the environment?


q Hexachlorobutadiene is released to the environment mainly from its disposal following industrial uses. q In air, half of it may be broken down to other chemicals within 60 days. q In water, half of it may be broken down to other chemicals within about 30 days. q Hexachlorobutadiene appears to readily break down in soil. q Hexachlorobutadiene can accumulate in fish and shellfish.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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liver damage. No effects on reproduction or on the developing fetuses were seen when rats and mice drank hexachlorobutadiene. Studies in rabbits found kidney and liver damage from contact with the chemical on the skin for a short time. that exposures in children should not exceed 0.3 milligrams per liter (mg/L) for 10-day periods or more than 0.1 mg/L for longer periods (7 years). Adults should not be exposed to more than 0.4 mg/L for longer periods (7 years). EPA requires that discharges or accidental spills into the environment of 1 pound or more of hexachlorobutadiene be reported. The National Institute for Occupational Safety and Health (NIOSH) has recommended an occupational exposure limit of 0.02 parts hexachlorobutadiene per million parts in air (0.02 ppm) for an 8-hour workday over a 40-hour workweek. The American Conference of Governmental Industrial Hygienists (ACGIH) has established the same guidelines as NIOSH for the workplace. These agencies advise avoiding eye and skin contact because this may be a route of significant exposure.

How likely is hexachlorobutadiene to cause cancer?


The Environmental Protection Agency (EPA) has determined that hexachlorobutadiene is a possible human carcinogen. An animal study found kidney tumors in rats exposed to low levels of hexachlorobutadiene. It is not known whether it may also cause cancer in people.

Is there a medical test to show whether Ive been exposed to hexachlorobutadiene?


Tests are available that measure levels of hexachlorobutadiene and its breakdown products in urine or fat. However, these tests must be performed within several days after exposure because hexachlorobutadiene leaves the body fairly quickly. These tests are not usually performed in most doctors offices because special equipment is needed to conduct them. In addition, these tests cannot determine if adverse health effects will occur from the exposure to hexachlorobutadiene.

Glossary
Carcinogen: A substance that can cause cancer. Long time: Lasting one year or longer. ppm: Parts per million. Short time: Lasting 14 days or less. Solvent: A substance that dissolves another substance. Tumor: An abnormal mass of tissue.

References Has the federal government made recommendations to protect human health?
EPA has recommended guidelines for exposure to hexachlorobutadiene in drinking water. EPA recommends Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for hexachlorobutadiene. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information?

For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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HEXACHLOROCYCLOHEXANES
CAS # 319-84-6, 319-85-7, 319-86-8, 58-89-9
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about hexachlorocyclohexanes. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It's important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to hexachlorocyclohexanes happens mostly from eating contaminated foods or by breathing contaminated air in the workplace. Exposure to high levels of hexachlorocyclohexanes can cause blood disorders, dizziness, headaches; seizures, and changes in the levels of sex hormones. These substances have been found in at least 144 of the 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are hexachlorocyclohexanes? (Pronounced hks-klr-sklhksn)
Hexachlorocyclohexanes (HCH) are a group of manufactured chemicals that do not occur naturally in the environment. HCH has eight chemical forms (called isomers). The four most common are alpha-, beta-, gamma, and delta-HCH. The most common of these is gamma-HCH (also known as lindane). Lindane is a white solid substance that may evaporate into the air as a colorless vapor with a slightly musty odor. It is the common form of hexachlorocyclohexane. Lindane was used as an insecticide on fruit and vegetable crops (including greenhouse vegetables and tobacco) and forest crops (including Christmas trees). It is still used in ointments to treat head and body lice, and scabies. Lindane has not been produced in the United States since 1977. It is still imported to and formulated in the United States. G Particles with attached HCH may be removed from the air by rain. G In soil, sediments, and water, it is broken down by algae, fungi, and bacteria to less harmful substances. G HCH isomers are broken down quickly in water; lindane does not remain in water longer than 30 days. G The length of time that HCH isomers remain in soil is not known. G It can accumulate in the fatty tissue of fish.

How might I be exposed to hexachlorocyclohexanes?


G Eating contaminated foods, such as plants, meat, and milk. G Breathing contaminated air in or near factories where products using HCH are made. G Through skin when applied as a lotion or shampoo to control lice and scabies. G Drinking contaminated water or breathing contaminated air near waste sites or landfills.

What happens to hexachlorocyclohexanes when they enter the environment?


G In air, HCH can be present as a vapor or attached to small particles such as soil or dust. G Lindane can remain in the air for up to 17 weeks and travel long distances.

How can hexachlorocyclohexanes affect my health?


Some people who breathed contaminated workplace air during the namufacturing of pesticides, including lindane,

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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had blood disorders, dizziness, headaches, and changes in the levels of sex hormones. Some people who swallowed large amounts had seizures and sometimes died. Animals fed high levels of HCH had convulsions and some became comatose. Liver and kidney effects and a reduced ability to fight infections occurred at moderate levels. Animal showed a decreased ability to reproduce when they were fed moderate to high levels of HCH.

Is there a medical test to show whether Ive been exposed to hexachlorocyclohexanes?


Laboratory tests can measure HCH in blood, urine, and semen. These tests do not tell you how much HCH youve been exposed to or if harmful effects will occur. The tests are not routinely available at your doctors office.

How likely are hexachlorocyclohexanes to cause cancer?


The Department of Health and Human Services (DHHS) has determined that HCH may reasonably be anticipated to be a carcinogen. Liver cancer has been seen in laboratory rodents that ate HCH for a long period of time.

Has the federal government made recommendations to protect human health?


The EPA has set a limit in drinking water of 0.2 parts of lindane per billion parts of water (0.2 ppb). The EPA requires that spills or accidental discharges of lindane into the environment of 1 pound or more must be reported to the EPA. The Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH), and the American Conference of Governmental Industrial Hygienists (ACGIH) recommend a maximum level of 0.5 milligrams lindane per cubic meter (0.5 mg/m3) of workplace air for an 8-hour workday, 40-hour workweek. These agencies advise avoiding eye and skin contact because this may be a route of significant exposure.

How can hexachlorocyclohexanes affect children?


There are no studies on the effects of HCH on children. It is not known whether HCH can cause birth defects in people. Animal studies have not shown birth defects in the babies of animals fed HCH during pregnancy. HCH has been detected in human breast milk.

How can families reduce the risk of exposure to hexachlorocyclohexanes?


If you work with HCH, take all safety precautions to avoid bringing the dust home on your clothing. If you use products containing HCH, follow directions for use carefully. Make sure that you keep it in tightly covered containers and store the containers safely where children cannot reach them. Always store chemicals in the original labeled containers. Do not store HCH in containers that children would find attractive to eat or drink from, such as soda bottles.

Source of information
Agency for Toxic Substances and Disease Registry (ATSDR) 1999. Toxicological profile for alpha-, beta-, gamma-, and deltahexachlorocyclohexane. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information?

For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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HEXACHLOROCYCLOPENTADIENE (HCCPD)
CAS # 77-47-4
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about hexachlorocyclopentadiene (HCCPD). For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: HCCPD is used in a group of related pesticides, but only two of these are registered for use in the United States. Human data are limited, but it can cause headaches and irritate the nose, throat, eye, and skin. Animal tests suggests that very high levels of HCCPD can cause death. This substance has been found in at least 31 of the 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is hexachlorocyclopentadiene (HCCPD)? (Pronounced hks klr-skl pnt-dn)
HCCPD is a manufactured chemical that does not occur naturally. It is a light, lemon-yellow liquid that has a sharp musty odor. It easily evaporates into the air; the vapor looks like a blue haze. HCCPD is used in the manufacture of certain pesticides. Most of the HCCPD in the environment results from releases during its production and disposal. It is also used to make flame retardants, resins that wont burn, shock-proof plastics, esters, ketones, fluorocarbons, and dyes. G HCCPD that gets into soil binds to decaying plant and animal matter. If the soil is sandy, HCCPD can move through it to reach underground water. G About half of the HCCPD in the soil will be changed to other chemicals by bacteria in 1 to 2 weeks. G Small amounts of HCCPD can accumulate in fish.

How might I be exposed to HCCPD?


G By breathing it when you are working with or producing HCCPD. G By applying pesticides that contain it. G By contact with soils that have recently been treated with the pesticides endosulfan or pentac. G By touching it or something that has been contaminated with it. G By eating or drinking foods contaminated with HCCPD, but only a small amount will enter your blood stream.

What happens to HCCPD when it enters the environment?


G HCCPD is released as vapor during manufacture and use. G It is broken down quickly by sunlight and reactions with other chemicals in the air. G HCCPD doesnt dissolve readily in water. G HCCPD in water will evaporate from the surface. G About half the HCCPD in water will be changed to other chemicals by light in only 4 minutes.

How can HCCPD affect my health?


If you breathe high levels of HCCPD vapors, you may get a sore throat or have shortness of breath and chest discomfort. You may get a headache from breathing HCCPD. Your liver

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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and kidneys could also be affected. If HCCPD comes in contact with your skin, it can cause a sore to form. Animal studies show that when HCCPD is inhaled, it caused bleeding, swelling, and fluid buildup in the lungs. Exposure to large amounts caused breathing difficulty and death. Other studies found that swallowing HCCPD caused lung, liver, kidney, brain and heart damage; most of the animals died during the exposure.

Is there a medical test to show whether Ive been exposed to HCCPD?


If you have been recently exposed to HCCPD, your blood and urine can be tested for its presence. Doctors can collect the specimens and send them to special laboratories for testing. These tests can determine whether you have been exposed to HCCPD, but can't determine how much you were exposed to or whether your health will be affected.

How likely is HCCPD to cause cancer?


There is no information available to show whether HCCPD causes cancer in people. A study in rats and mice did not show an increase in tumors. The EPA has determined that HCCPD is not classifiable as to human carcinogenicity.

Has the federal government made recommendations to protect human health?


EPA has a regulation on how much HCCPD can be present in drinking water. The maximum contaminant level is 50 parts per billion (50 ppb). EPA recommends that exposure in children should not exceed 2 ppm in water for 10-day periods or no more than 0.7 ppm for up to 7 years. EPA requires that spills or accidental releases of 10 pounds or more of HCCPD be reported to the EPA. The Occupational Safety and Health Administration (OSHA) has a permissable exposure limit of 0.01 parts per million (0.01 ppm) in air for an 8-hour workday, 40-hour workweek.

How can HCCPD affect children?


Children are unlikely to be exposed to HCCPD. There is no information on the effects in children or adults who were exposed as children. We do not know if HCCPD causes birth defects in people. Animal studies suggest that it does not cause birth defects or other developmental problems. We do not know if HCCPD can cross the placenta to unborn babies or if it can accumulate in breast milk.

Source of Information How can families reduce the risk of exposure to HCCPD?
If your doctor finds that you have been exposed to significant amounts of HCCPD, ask if children may also be exposed. When necessary, your doctor may need to ask your state public health department to investigate. Agency for Toxic Substances and Disease Registry (ATSDR). 1999. Toxicological profile for hexachlorocyclopentadiene (HCCPD). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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HEXACHLOROETHANE
CAS # 67-72-1
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about hexachloroethane. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Hexachloroethane is a colorless solid that gradually evaporates when it is exposed to air. It is used in the manufacture of aluminum and by the military for smoke-producing devices. Exposure to hexachloroethane can be irritating to the skin, nose, lungs, and eyes. Hexachloroethane has been found in at least 45 of the 1,416 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is hexachloroethane? (Pronounced hks klr thn)
Hexachloroethane is a colorless solid that gradually evaporates when it is exposed to air. It is also called HCE, perchloroethane, and carbon hexachloride. Its vapors smell like camphor. In the United States, about half of the hexachloroethane is used by the military for smoke-producing devices. It is also used to remove air bubbles in melted aluminum. Hexachloroethane may be present as an ingredient in some fungicides, insecticides, lubricants, and plastics. Hexachloroethane does not occur naturally in the environment. It is no longer made in the United States, but it is formed as a by-product in the production of some chemicals. Some hexachloroethane can be formed by incinerators when materials containing chlorinated hydrocarbons are burned. Hexachloroethane itself does not catch fire easily. Some hexachloroethane can also be formed when chlorine reacts with carbon compounds in drinking water. q In air, hexachloroethane does not break down to other compounds. q Some hexachloroethane that is in lakes or streams and surface soils will evaporate into the air. q Microscopic organisms can break it down more easily without oxygen than with oxygen. q Hexachloroethane does not appear to build up in plants or animals used for food.

How might I be exposed to hexachloroethane?


q If you work in an industry that uses hexachloroethane, such as aluminum smelting, you could be exposed by breathing it or touching it. q If you live near a hazardous waste site, you might be exposed to hexachloroethane by breathing contaminated air, by drinking contaminated water, or by touching contaminated soils. q You might be exposed to it from the air near military installations where smoke pots and grenades that contain hexachloroethane are used during training. q You are not likely to be exposed to hexachloroethane from your food.

What happens to hexachloroethane when it enters the environment?


q Hexachloroethane can be released to the environment during its production, use, transport, or disposal.

How can hexachloroethane affect my health?


Mild skin irritation has been reported by workers at a muni-

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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HEXACHLOROETHANE CAS # 67-72-1


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tions factory who were exposed to low levels of hexachloroethane. The workers were wearing protective clothing that greatly reduced exposure. No other information is available concerning health effects in people exposed to hexachloroethane. Based on animal studies, hexachloroethane in air can irritate your nose and lungs and cause some buildup of mucus in your nose, much like an allergy. It can also irritate your eyes and make them tear. If you breathe high levels of hexachloroethane vapor, your facial muscles may twitch or you may have difficulty moving. However, these effects have been seen in animals exposed to levels far greater than those found during its use or those expected in areas near a hazardous waste site. Hexachloroethane is not a very toxic substance. If you are exposed to a large amount for a long time, your liver could be affected. There is also a slight chance that your kidneys could be damaged. Animal studies have not shown hexachloroethane to cause birth defects or to affect reproduction.

you were exposed to hexachloroethane. These tests arent available at most doctors offices, but can be done at special laboratories that have the right equipment. They are useful only if you were exposed 2448 hours before you saw the doctor and cannot predict whether you will experience any health effects.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) has set a limit of 1 part hexachloroethane per million parts of workplace air (1 ppm) over an 8-hour workday, 40hour workweek. The EPA suggests that water consumed over a lifetime contain no more than 1 part hexachloroethane per billion parts water (1 ppb).

Glossary
Carcinogen: A substance with the ability to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To enter the air as a vapor. Fungicide: A substance that kills fungus. Insecticide: A substance that kills insects. Tumor: An abnormal mass of tissue.

How likely is hexachloroethane to cause cancer?


Liver tumors developed in mice that were orally exposed to hexachloroethane for their whole lifetime. Hexachloroethane will not necessarily have the same effect on people. Male rats that were exposed to hexachloroethane for their lifetime developed kidney tumors. This type of tumor is not found in people, so it is unlikely that exposure to hexachloroethane would cause you to develop cancer of the kidney. The Department of Health and Human Services (DHHS) has determined that hexachloroethane may reasonably be anticipated to be a carcinogen.

Source of Information
This ToxFAQs information is taken from the 1997 Toxicological Profile for Hexachloroethane produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Is there a medical test to show whether Ive been exposed to hexachloroethane?


Samples of your blood, urine, or feces can be tested to see if

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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HEXAMETHYLENE DIISOCYANATE
CAS # 822-06-0
Agency for Toxic Substances and Disease Registry ToxFAQs August 1999

This fact sheet answers the most frequently asked health questions (FAQs) about hexamethylene diisocyanate. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to hexamethylene diisocyanate occurs mainly in the workplace, where it is used as a paint hardener. Hexamethylene diisocyanate may cause an allergic, asthma-like syndrome, consisting of coughing, wheezing, and shortness of breath. This chemical has been found in none of the 1,445 National Priorities List sites identified by the Environmental Protection Agency.
What is hexamethylene diisocyanate? (Pronounced hex'uh-meth'el-een di i'so-si'an-ate)
Hexamethylene diisocyanate is a pale yellow liquid with a strong odor. It is an industrial chemical that is not known to occur naturally. It is also commonly known as HDI, 1,6-hexamethylene diisocyanate, 1,6-diisocyanatohexane, Mondur HX, and Desmodur H. Hexamethylene diisocyanate is mainly used to make polyurethane foams and coatings. It is also used as a hardener in automobile and airplane paints.

How might I be exposed to hexamethylene diisocyanate? q By spray-painting a car with a paint that contains it as a
hardening agent.

q Working in an industry or business in which


hexamethylene diisocyanate is used.

q Drinking tap water contaminated with it. q Living near a hazardous waste site where hexamethylene
diisocyanate is disposed of.

How can hexamethylene diisocyanate affect my health?


People exposed to hexamethylene diisocyanate for a long time (a few months to a few years) have shown an allergic, asthma-like syndrome. The symptoms consist of shortness of breath, wheezing, bronchitis, and coughing. These symptoms are not usually seen when the person is not using a product that contains hexamethylene diisocyanate, but will start up again when they begin to use hexamethylene diisocyanate products again. Laboratory animals exposed to very high concentrations of hexamethylene diisocyanate had pneumonia and difficulty in breathing, and some died. Studies in animals

What happens to hexamethylene diisocyanate when it enters the environment? q Hexamethylene diisocyanate may be found in air near
areas where spray paints containing it as a hardening agent are applied.

q It does not appear to be transported long distances in air. q Hexamethylene diisocyanate does not easily evaporate
from water into air.

q Hexamethylene diisocyanate will break down very


quickly into other chemicals in water and soil.

q It does not build up in the food chain.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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have also shown that breathing high concentrations can irritate the eyes, nose, and throat. When placed on the skin of animals, hexamethylene diisocyanate caused redness, irritation, and skin damage. It is not known whether hexamethylene diisocyanate can affect reproduction in people or animals. exposed to low amounts of hexamethylene diisocyanate over many months or years.

Has the federal government made recommendations to protect human health?


The EPA requires that spills or accidental releases into the environment of 100 pounds or more of hexamethylene diisocyanate be reported to the EPA. The National Institute for Occupational Safety and Health and the American Conference of Governmental Industrial Hygienists recommend that workers should not breathe air containing more than 0.035 milligrams of hexamethylene diisocyanate per cubic meter of air (0.035 mg/ m3) during a 10-hour workday, 40-hour workweek.

How likely is hexamethylene diisocyanate to cause cancer?


The Department of Health and Human Services, the International Agency for Research on Cancer, and the Environmental Protection Agency (EPA) have not classified hexamethylene diisocyanate as to its human carcinogenicity. No carcinogenicity studies are available in people. An animal study showed no increase in cancer when rats breathed air containing hexamethylene diisocyanate for 2 years.

Glossary Is there a medical test to show whether Ive been exposed to hexamethylene diisocyanate?
Tests are available that measure the antibodies in your blood made by your body after you have been exposed to hexamethylene diisocyanate. However, there are problems with these tests: antibodies can react with other substances that look like hexamethylene diisocyanate in your blood and indicate that you have been exposed to hexamethylene diisocyanate when you have not been. In addition, some people do not develop antibodies to hexamethylene diisocyanate after they have been exposed. A test is available that measures hexamethylene diisocyanate in your urine. However, this test only works if you were exposed to the chemical within the last 12 to 15 hours. It is not a good test to find out if you have been Antibodies: Substances produced by the body to fight agents causing disease. Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Milligram (mg): One thousandth of a gram.

Source of information
Agency for Toxic Substances and Disease Registry (ATSDR). 1998. Toxicological profile for hexamethylene diisocyanate. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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n-HEXANE
CAS # 110-54-3
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about n-hexane. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: n-Hexane is mixed with solvents for a number of uses. Inhaling n-hexane causes nerve damage and paralysis of the arms and legs. Some people abuse products containing n-hexane by inhaling it to get "high." This substance has been found in at least 60 of the 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is n-hexane? (Pronounced n hk sn)
n-Hexane is a chemical made from crude oil. Pure n-hexane is a colorless liquid with a slightly disagreeable odor. It is highly flammable, and its vapors can be explosive. Pure n-hexane is used in laboratories. Most of the n-hexane used in industry is mixed with similar chemicals called solvents. The major use for solvents containing n-hexane is to extract vegetable oils from crops such as soybeans. These solvents are also used as cleaning agents in the printing, textile, furniture, and shoemaking industries. Certain kinds of special glues used in the roofing and shoe and leather industries also contain n-hexane. Several consumer products contain n-hexane, such as gasoline, quick-drying glues used in various hobbies, and rubber cement. G It evaporates very easily into the air where it is broken down in a few days. G It dissolves only slightly in water. G Most of n-hexane spilled in water will float on the surface where it evaporates into the air. G If n-hexane is spilled on the ground, most of it will evaporate before it can soak into the soil. G n-Hexane is not concentrated by plants, fish, or animals.

How might I be exposed to n-hexane?


G You are most likely to be exposed to n-hexane by breathing in air contaminated with it. G You may be exposed if you use products containing it at work. G Since it is in gasoline, nearly everyone is exposed to very small amounts of n-hexane in the air. G Exposure can occur at home if you use products containing n-hexane without proper ventilation.

What happens to n-hexane when it enters the environment?


G n-Hexane enters the environment during is manufacture and use.

How can n-hexane affect my health?


The only people known to have been affected by exposure to n-hexane used it at work. Breathing large amounts caused numbness in the feet and hands, followed by muscle

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weakness in the feet and lower legs. Continued exposure led to paralysis of the arms and legs. If removed from the exposure, the workers recovered in 6 months to a year. In laboratory studies, animals exposed to high levels of n-hexane in air had signs of nerve damage. Some animals also had lung damage. In other studies, rats exposed to very high levels of n-hexane had damage to sperm-forming cells. G Maintain proper ventilation when using these products. G Never store household chemicals in containers, such as old soda bottles, that children might find attractive.

Is there a medical test to show whether Ive been exposed to n-hexane?


If you have been exposed to harmful amounts of n-hexane, the amount of one of its breakdown products will probably be increased in your urine. Your doctor can send a sample to a specialized laboratory. This test can only detect n-hexane exposure that occurred within 2 to 3 days of testing.

How likely is n-hexane to cause cancer?


There is no evidence that n-hexane causes cancer in people or animals. The Department of Health and Human Services (DHHS), International Agency for Research on Cancer (IARC) and the EPA have not classified n-hexane for carcinogenicity.

Has the federal government made recommendations to protect human health?


The EPA requires that spills or accidental releases of 5,000 pounds or more of n-hexane be reported to the EPA. The National Institute of Occupational Safety and Health (NIOSH) recommends exposure to no more than 50 parts per million (ppm) in workplace air. The Occupational Health and Safety Administration (OSHA) has set a permissible exposure limit of 500 ppm for n-hexane in workplace air.

How can n-hexane affect children?


Since most exposure occurs at work, children aren't likely to be exposed to levels of n-hexane that cause problems. We dont know if the effects seen in children would be different than those seen in adults. Sometimes older children inhale or sniff household chemicals in an attempt to get high. This has caused paralysis of the arms and legs of teenagers in the U.S. and Europe.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1999. Toxicological profile for n-hexane. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

How can families reduce the risk of exposure to n-hexane?


G Teach your children and teenagers the dangers of inhaling products that contain n-hexane. G Keep products containing n-hexane (quick-drying glues and cements) out of the reach of children.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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2-HEXANONE
CAS # 591-78-6
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about 2-hexanone. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to 2-hexanone is most likely to occur from living near or working in plants that make gas from coal, process oil shale, or produce wood pulp. You may also be exposed if you live near a hazardous waste site where 2-hexanone is found. In people, exposure to hexanone is most likely to affect the nervous system. This chemical has been found in at least 199 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is 2-hexanone? (Pronounced 2-hks-nn)
2-Hexanone is also known as methyl n-butyl ketone, MBK, or propyl acetone. It is a clear, colorless liquid with a sharp odor. It dissolves very easily in water, and can evaporate easily into the air as a vapor. It was used in the past in paint and paint thinner, to make other chemical substances, and to dissolve oils and waxes. It is no longer made or used in the United States because it has harmful health effects. It is formed as a waste product resulting from industrial activities such as making wood pulp and producing gas from coal, and in oil shale operations. q Half of the 2-hexanone in river water breaks down or evaporates in about 1015 days. q In the air, half of the 2-hexanone breaks down in about 36 hours. q It is not known how long it takes to break down in soil.

How might I be exposed to 2-hexanone?


q Breathing contaminated air. q Drinking contaminated water. q Absorbing it through your skin if you touch liquid or soil that contains it. q Eating some foods that naturally contain low levels of 2-hexanone. q Using products manufactured before 1982 that contain 2-hexanone (such as paint thinners). q Working in coal gasification, oil shale processing, or wood pulping operations. q Living near hazardous waste sites where it is found.

What happens to 2-hexanone when it enters the environment?


q 2-Hexanone dissolves easily in water. q It evaporates quickly into the air. q It may be broken down into other chemicals in the atmosphere or may be removed by rain or snow. q 2-Hexanone may be broken down by microorganisms in water and soil. q It doesn't usually attach to soils or sediment. q It doesn't usually build up in plants and animals.

How can 2-hexanone affect my health?


Breathing 2-hexanone can harm your nervous system. Workers who were exposed to 2-hexanone in the air for almost a year felt weakness, numbness, and tingling in the skin of the hands and feet.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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Similar effects were seen in different animals that ate or breathed high levels of 2-hexanone. In one study, pregnant rats that breathed 2-hexanone did not gain as much weight during their pregnancy, had fewer babies, and had babies that were smaller and less active than the rats that were not exposed. We do not know if breathing 2-hexanone affects human reproduction or causes birth defects. We do not know whether touching or ingesting 2-hexanone would affect your health. Animal studies have shown that ingesting high levels of 2-hexanone harms the nervous system. Also, animals that ingested 2-hexanone experienced decreased body weight and effects on reproduction. These tests are not routinely performed at your doctors office, but your doctor can take blood or urine samples and send them to a testing laboratory.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Agency (OSHA) has set a limit for exposure of workers to an average level of 100 parts of 2-hexanone per million parts of air (ppm) for an 8hour workday over a 40-hour workweek. The American Conference of Governmental Industrial Hygienists (ACGIH) recommends an exposure limit of 5 ppm for an 8-hour workday over a 40-hour workweek in workplace air. The National Institute for Occupational Safety and Health (NIOSH) recommends that workers be exposed to no more than an average of 1 ppm for up to a 10-hour workday over a 40-hour workweek.

How likely is 2-hexanone to cause cancer?


The Department of Health and Human Services has not classified 2-hexanone as to human carcinogenicity. Also, the International Agency for Research on Cancer and the Environmental Protection Agency (EPA) have not classified 2-hexanone as to human carcinogenicity. There is no information available on the potential carcinogenic effects of 2-hexanone in people or in experimental animals.

Glossary
Carcinogenicity: Ability to cause cancer. Gasification: Conversion of coal to gas. Ingesting: Taking food or drink into your body. ppm: Parts per million.

Is there a medical test to show whether Ive been exposed to 2-hexanone?


Several tests are available to tell whether you have been exposed to 2-hexanone. These tests can measure the levels of 2-hexanone, or its breakdown products, in your blood or urine. This test only tells you if you have been exposed and cannot predict whether your health will be affected.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for 2-hexanone. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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HMX
CAS # 2691-41-0
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about HMX. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: HMX is an explosive. People who work at facilities that make HMX may be exposed to it. In one human study, no adverse effects were reported in workers exposed to unknown concentrations of HMX. Animal studies indicate that HMX may be harmful to the liver and central nervous system if it is swallowed or gets on the skin. HMX has been found in at least 10 of the 1,416 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is HMX?
HMX is an acronym for High Melting eXplosive. It is also known as octogen and cyclotetramethylenetetranitramine, as well as by other names. It is a colorless solid that dissolves slightly in water. Only a small amount of HMX will evaporate into the air; however, it can occur in air attached to suspended particles or dust. The taste and smell of HMX are not known. HMX does not occur naturally in the environment. It is made from other chemicals known as hexamine, ammonium nitrate, nitric acid, and acetic acid. HMX explodes violently at high temperatures. Because of this property, HMX is used in various kinds of explosives, rocket fuels, and burster chargers. A small amount of HMX is also formed in making cyclotrimethylene-trinitramine (RDX), another explosive similar in structure to HMX. q Some HMX may be released to soil as a result of accidental spills, the settling of HMX-containing dust particles from the air, or the disposal of waste that contains HMX in landfills. q Dust particles containing HMX may be carried by the wind for some distance. q In surface water, HMX does not evaporate or bind to sediments to any large extent. Sunlight breaks down most of the HMX in surface water into other compounds, usually in a matter of days to weeks. q HMX is likely to move from soil into groundwater, particularly in sandy soils. q It is not known if plants, fish, or animals living in contaminated areas build up levels of HMX in their tissues.

How might I be exposed to HMX?


There is no information on how often you might be exposed to HMX in the environment or to how much. Most people, however, probably wont be exposed to HMX from the environment. People who work at facilities that make or use HMX or RDX may be exposed to HMX. These workers may be exposed by inhaling dusts that contain HMX or by getting HMX-containing liquids on their skin.

What happens to HMX when it enters the environment?


q Most of the HMX that entered the environment was released into waste water from places that made or used HMX. q A small amount of HMX can be released to the air as dust or ash from facilities that burn waste contaminated with HMX.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

Page 2

HMX CAS # 2691-41-0


ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

People who live near facilities that make or use HMX, or near hazardous waste sites that contain HMX may also be exposed if a release occurs. For these residents, exposure (if any) is most likely to occur from contaminated groundwater.

been exposed to or predict whether or not you will have any health effects. This test isnt available at most doctors offices, but can be done at special laboratories that have the right equipment.

How can HMX affect my health?


Information on the adverse health effects of HMX is limited. In one human study, no adverse effects were reported in workers who breathed HMX. However, the concentrations of HMX in the workplace air were not reported in this study, and only a small number of workers and effects were investigated. Studies in rats, mice, and rabbits indicate that HMX may be harmful to your liver and central nervous system if it is swallowed or gets on your skin. It is not known if HMX can affect the ability to have children, or if it can cause birth defects.

Has the federal government made recommendations to protect human health?


The EPA recommends that the concentration of HMX in an adults drinking water be less than 0.4 milligrams per liter (0.4 mg/L) for a lifetime. EPA regulates waste containing HMX as hazardous and has set restrictions on its disposal in landfills. The Department of State regulates the exportation of HMX, and the Department of Transportation (DOT) regulates its transportation. The Bureau of Alcohol, Tobacco, and Firearms (ATF) regulates the importation, manufacture, distribution, and storage of HMX.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Dissolve: To disappear gradually. Evaporate: To change into a vapor or a gas.

How likely is HMX to cause cancer?


There is no information available as to whether or not HMX can cause cancer in animals or people. The Environmental Protection Agency (EPA) has determined that HMX is not classifiable as to its human carcinogenicity.

Source of Information
This ToxFAQs information is taken from the 1997 Toxicological Profile for HMX produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Is there a medical test to show whether Ive been exposed to HMX?


You can find out if you have been exposed to HMX by having your blood, urine, or feces tested for HMX. Since HMX is poorly absorbed after it is swallowed, the levels of HMX in your blood and urine are likely to be lower than those in your feces. For best results, tests for HMX should be done within a few days after you are exposed. These tests cannot tell you how much HMX you have

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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HYDRAULIC FLUIDS
CAS # 55957-10-3; 68937-40-6; 50815-84-4; 55962-27-1; 66594-31-8; 63848-94-2; 107028-44-4; 28777-70-0 Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about hydraulic fluids. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to hydraulic fluids occurs mainly in the workplace. Drinking certain types of hydraulic fluids can cause death in humans, and swallowing or inhaling certain types of hydraulic fluids has caused nerve damage in animals. Contact with some types of hydraulic fluids can irritate your skin or eyes. These substances have been found in at least 10 of the 1,428 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are hydraulic fluids? (Pronounced h-drlk fldz)
Hydraulic fluids are a large group of liquids made of many kinds of chemicals. They are used in automobile automatic transmissions, brakes, and power steering; fork lift trucks; tractors; bulldozers; industrial machinery; and airplanes. The three most common types of hydraulic fluids are mineral oil, organophosphate ester, and polyalphaolefin. Some of the trade names for hydraulic fluids include Durad, Fyrquel, Skydrol, Houghton-Safe, Pydraul, Reofos, Reolube, and Quintolubric. (Use of trade names is for identification only and does not imply endorsement by the Agency for Toxic Substances and Disease Registry, the Public Health Service, or the U.S. Department of Health and Human Services.) Some hydraulic fluids have a bland, oily smell and others have no smell; some will burn and some will not burn. Certain hydraulic fluids are produced from crude oil and others are manufactured. q If spilled on soil, some of the ingredients in hydraulic fluids will stay on top and others will sink into the groundwater. q In water, some hydraulic fluids' ingredients will transfer to the bottom and can stay there for more than a year. q Certain chemicals in hydraulic fluids may break down in air, soil, or water, but how much breaks down isnt known. q Fish may contain some hydraulic fluids if they live in contaminated water.

How might I be exposed to hydraulic fluids?


q Touching or swallowing hydraulic fluids. q Breathing hydraulic fluids in the air near machines where hydraulic fluids are used. q Touching contaminated water or soil near hazardous waste sites or industrial manufacturing facilities that use or make hydraulic fluids.

What happens to hydraulic fluids when they enter the environment?


q Hydraulic fluids can enter the environment from spills, leaks in machines that use them, or from storage areas and waste sites.

How can hydraulic fluids affect my health?


Little is known about how hydraulic fluids can affect your health. Since hydraulic fluids are actually mixtures of chemicals, some of the effects seen may be caused by additives in the hydraulic fluids.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

HYDRAULIC FLUIDS Page 2


CAS # 55957-10-3; 68937-40-6; 50815-84-4; 55962-27-1; 66594-31-8; 63848-94-2; 107028-44-4; 28777-70-0
ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html
In people, the effects of breathing air with high levels of hydraulic fluids are not known. Drinking large amounts of some types of hydraulic fluids can cause pneumonia, intestinal bleeding, or death in humans. Weakness of the hands was seen in a worker who touched a lot of hydraulic fluids. Rabbits that inhaled very high levels of one type of hydraulic fluid had trouble breathing, congested lungs, and became drowsy. The nervous systems of animals that swallowed or inhaled other hydraulic fluids were affected immediately with tremors, diarrhea, sweating, breathing difficulty, and sometimes several weeks later with weakness of the limbs, or paralysis. The immediate effects are caused because hydraulic fluids stop the action of certain enzymes, called cholinesterases, in the body. There are no reports of people swallowing or breathing the types of hydraulic fluids that cause these effects. When certain types of hydraulic fluids were put into the eyes of animals or allowed to touch the skin of people or animals for short periods of time, redness and swelling occurred. It is not known whether hydraulic fluids can cause birth defects or reproductive effects.

Has the federal government made recommendations to protect human health?


There are no federal government recommendations to protect humans from the health effects of the major hydraulic fluids. However, mineral oil, the major chemical ingredient of one type of hydraulic fluid, is part of the petroleum distillate class of chemicals and there are regulations for these chemicals. The Occupational Safety and Health Administration (OSHA) has set an exposure limit of 2,000 milligram per cubic meter (mg/m3 ) petroleum distillates for an 8-hour workday, 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) recommends an exposure limit of 350 mg/m3 petroleum distillates for a 10-hour workday, 40-hour workweek.

Glossary
Additive: Substance added to another in small amounts to improve its properties. CAS: Chemical Abstracts Service. Carcinogenicity: Ability to cause cancer. Petroleum Distillate: A chemical fraction of petroleum.

How likely are hydraulic fluids to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified hydraulic fluids as to their carcinogenicity.

Source of Information
This ToxFAQs information is taken from the 1997 Toxicological Profile for Hydraulic Fluids produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Is there a medical test to show whether Ive been exposed to hydraulic fluids?
Hydraulic fluids cant be measured in blood, urine, or feces, but certain chemicals in the hydraulic fluids can be measured. Some of the hydraulic fluids stop the activity of certain enzymes, called cholinesterases, in blood and this activity can be measured. However, many other chemicals also cause this effect. This test isnt available at most doctors offices, but can be done at special laboratories that have the right equipment.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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HYDRAZINE CAS # 302-01-2 1,1-DIMETHYLHYDRAZINE CAS # 57-14-7 1,2-DIMETHYLHYDRAZINE CAS # 540-73-8


Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about hydrazine, 1,1-dimethylhydrazine, and 1,2-dimethylhydrazine. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Hydrazines are colorless liquids that are used in rocket fuels, chemical manufacturing, and as boiler water treatments. Exposure to hydrazines may cause nervous system effects, as well as liver and kidney damage. Hydrazines have been found in at least 8 of the 1,416 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are hydrazines? (Pronounced hdr znz)
Hydrazines are clear, colorless liquids with an ammonialike odor. There are many kinds of hydrazine compounds, including hydrazine, 1,1-dimethylhydrazine, and 1,2-dimethylhydrazine. Small amounts of hydrazine occur naturally in plants. Most hydrazines are manufactured for use as rocket propellants and fuels, boiler water treatments, chemical reactants, medicines, and in cancer research. Hydrazines are highly reactive and easily catch fire.

How might I be exposed to hydrazines?


G Breathing contaminated air in or near a facility that makes, processes, or uses hydrazines. G Eating fish contaminated with hydrazines. G Drinking or swimming in water that has been contaminated with hydrazines. G Touching soil contaminated with hydrazines, such as near some military bases or hazardous waste sites. G Breathing cigarette smoke indirectly or using tobacco products may expose you to small amounts of hydrazine or 1,1-dimethylhydrazine. G Working in greenhouses where the chemical Alar is used may result in your being exposed to small amounts of 1,2dimethylhydrazine.

What happens to hydrazines when they enter the environment?


G Hydrazines can be released into the environment during their production or use, or from accidental spills. G Hydrazines easily evaporate to the air, where they are broken down by reactions within minutes or hours. G Hydrazines can also dissolve in water, where they usually break down into less toxic compounds within a few weeks. G Hydrazines may build up in some fish living in contaminated water, but are not expected to remain at high levels over long periods of time. G In soil, hydrazines may stick to particles and be changed within a few days to less harmful compounds.

How can hydrazines affect my health?


Breathing hydrazines for short periods may cause coughing and irritation of the throat and lungs, convulsions, tremors, or seizures. Breathing hydrazines for long periods may cause liver and kidney damage, as well as serious effects on reproductive organs. Eating or drinking small amounts of hydrazines may cause nausea, vomiting, uncontrolled shaking, inflammation of the nerves, drowsiness, or coma.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

Page 2

HYDRAZINE CAS # 302-01-2 1,1-DIMETHYLHYDRAZINE CAS # 57-14-7 1,2-DIMETHYLHYDRAZINE CAS # 540-73-8

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html How likely are hydrazines to cause cancer?
Tumors have been seen in many organs of animals that were exposed to hydrazines by ingestion or breathing, but most tumors have been found in the lungs, blood vessels, or colon. 1,2-Dimethylhydrazine has caused colon cancer in laboratory animals following a single exposure. The Department of Health and Human Services (DHHS) has determined that hydrazine and 1,1-dimethylhydrazine are known carcinogens. The International Agency for Research on Cancer (IARC) has determined that hydrazine, 1,1-dimethylhydrazine, and 1,2dimethylhydrazine are possible human carcinogens. The EPA has determined that hydrazine, 1,1-dimethylhydrazine, and 1,2-dimethylhydrazine are probable human carcinogens. The American Conference of Governmental Industrial Hygienists (ACGIH) currently lists hydrazine and 1,1-dimethylhydrazine as suspected carcinogens, but has recently recommended that the listing of hydrazine be changed to that of animal carcinogen, not likely to cause cancer to people under normal exposure conditions. The National Institute for Occupational Safety and Health (NIOSH) recommends that the levels of hydrazine and 1,1-dimethylhydrazine in workplace air not exceed 0.03 and 0.6 parts of compound per million parts of air (0.03-0.6 ppm), respectively, for a 2-hour period. The Occupational Safety and Health Administration (OSHA) limits the amount of hydrazine and 1,1-dimethylhydrazine in workplace air to 1 and 0.5 ppm, respectively, for an 8-hour workday. The Food and Drug Administration (FDA) has ruled that hydrazine cannot be added to water used for making steam which will contact food. The EPA requires that spills or accidental releases into the environment of 1 pound or more of hydrazine or 1,2-dimethylhydrazine, or more than 10 pounds of 1,1-dimethylhydrazine be reported to the EPA.

Glossary
Carcinogen: A substance with the ability to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or gas. Ingest: To eat or drink something. ppm: Parts per million.

Is there a medical test to show whether Ive been exposed to hydrazines?


There are tests available to detect the presence of hydrazines or their breakdown products in the blood, urine, and feces. These tests must be done soon after exposure, before the compounds are broken down and eliminated from the body. These tests arent available at most doctors offices, but can be done at special laboratories that have the right equipment. These tests cannot be used to tell how much hydrazines you were exposed to or if any health effects will occur.

Source of Information
This ToxFAQs information is taken from the 1997 Toxicological Profile for Hydrazines produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Has the federal government made recommendations to protect human health?

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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HYDROGEN CHLORIDE
CAS #7647-01-0
Division of Toxicology ToxFAQsTM April 2002

This fact sheet answers the most frequently asked health questions (FAQs) about hydrogen chloride. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: People working in occupations in which hydrogen chloride is used have the highest risk of being exposed to this compound. Exposure of the general population is minimal. Hydrogen chloride gas can cause irritation of the eyes, skin, and respiratory tract. Exposure to high levels can result in corrosive damage to the eyes, skin, and respiratory tissues, and could lead to pulmonary edema and even death in extreme cases. This substance has been found in at least 63 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is hydrogen chloride?
At room temperature, hydrogen chloride is a colorless to slightly yellow, corrosive, nonflammable gas that is heavier than air and has a strong irritating odor. On exposure to air, hydrogen chloride forms dense white corrosive vapors. Hydrogen chloride can be released from volcanoes. Hydrogen chloride has many uses, including cleaning, pickling, electroplating metals, tanning leather, and refining and producing a wide variety of products. Hydrogen chloride can be formed during the burning of many plastics. Upon contact with water, it forms hydrochloric acid. Both hydrogen chloride and hydrochloric acid are corrosive. or molecule), which ultimately lowers the pH of the water (makes it more acidic). If released to soil, hydrogen chloride will evaporate from dry soil surfaces and dissociate into chloride anions and hydronium ions in moist soil. Hydrogen chloride does not accumulate in the food chain.

How might I be exposed to hydrogen chloride?


You may breathe in air that contains very low levels of hydrogen chloride gas. Naturally-occurring (i.e., from volcanic eruptions) and other releases of hydrogen chloride are removed by rainfall, limiting the chances of exposure to high levels of this compound by breathing ambient air. Hydrogen chloride is used to produce other chemicals, or for applications such as a metal pickling, ore refining, food processing, manufacture of fertilizers and dyes, and in the rubber and textile industries. Workers in these occupations may inhale hydrogen chloride or get it on their skin. Soldering materials often contain hydrogen chloride and you may be exposed if you use these products during soldering.

What happens to hydrogen chloride when it enters the environment?


Hydrogen chloride released to the atmosphere will be removed by rainfall. Hydrogen chloride dissociates readily in water to chloride and hydronium ions (an ion is an electrically charged atom

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

Page 2

HYDROGEN CHLORIDE
CAS #7647-01-0
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

How can hydrogen chloride affect my health?


Hydrogen chloride is irritating and corrosive to any tissue it contacts. Brief exposure to low levels causes throat irritation. Exposure to higher levels can result in rapid breathing, narrowing of the bronchioles, blue coloring of the skin, accumulation of fluid in the lungs, and even death. Exposure to even higher levels can cause swelling and spasm of the throat and suffocation. Some people may develop an inflammatory reaction to hydrogen chloride. This condition is called reactive airways dysfunction syndrome (RADS), a type of asthma caused by some irritating or corrosive substances. Depending on the concentration, hydrogen chloride can produce from mild irritation to severe burns of the eyes and skin. Long-term exposure to low levels can cause respiratory problems, eye and skin irritation, and discoloration of the teeth. Swallowing concentrated hydrochloric acid will cause severe corrosive injury to the lips, mouth, throat, esophagus, and stomach. We do not know if exposure to hydrogen chloride can result in reproductive effects.

whether children differ from adults in their susceptibility to hydrogen chloride. In general, children may be more vulnerable to corrosive agents than adults because of the smaller diameter of their airways. We do not know if exposure to hydrogen chloride can result in birth defects or other developmental effects.

How can families reduce the risk of exposure to hydrogen chloride?


Most families will not be exposed to significant levels of hydrogen chloride gas. Household products containing hydrochloric acid should be stored in safe containers, in safe locations, out of the reach of children.

Is there a medical test to show whether Ive been exposed to hydrogen chloride?
Specific tests for the presence of hydrogen chloride in the blood or urine are not generally useful. If a severe exposure has occurred, blood and urine analyses and other tests may show whether damage has occurred to the lungs or gastrointestinal tract. Some of these tests can be performed in a doctors office. Some testing may require hospital facilities.

How likely is hydrogen chloride to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified hydrogen chloride as to its carcinogenicity. IARC considers hydrochloric acid to be not classifiable as to its carcinogenicity to humans.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) has set a ceiling limit of 5 parts of hydrogen chloride per million parts of air (5 ppm) in workplace air.

How can hydrogen chloride affect children?


Children are probably affected by exposure to hydrogen chloride in the same ways as adults. We do not know

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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HYDROGEN PEROXIDE
CAS #7722-84-1
Division of Toxicology ToxFAQsTM April 2002

This fact sheet answers the most frequently asked health questions (FAQs) about hydrogen peroxicde. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Hydrogen peroxide is a manufactured chemical, although small amounts of hydrogen peroxide gas may occur naturally in the air. Low exposure may occur from use at home; higher exposures may occur from industrial use. Exposure to hydrogen peroxide can cause irritation of the eyes, throat, respiratory airway, and skin. Drinking concentrated liquid can cause mild to severe gastrointestinal effects. This substance has been found in at least 18 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is hydrogen peroxide?
Hydrogen peroxide is a colorless liquid at room temperature with a bitter taste. Small amounts of gaseous hydrogen peroxide occur naturally in the air. Hydrogen peroxide is unstable, decomposing readily to oxygen and water with release of heat. Although nonflammable, it is a powerful oxidizing agent that can cause spontaneous combustion when it comes in contact with organic material. Hydrogen peroxide is found in many households at low concentrations (3-9%) for medicinal applications and as a clothes and hair bleach. In industry, hydrogen peroxide in higher concentrations is used as a bleach for textiles and paper, as a component of rocket fuels, and for producing foam rubber and organic chemicals. If released to soil, hydrogen peroxide will be broken down by reacting with other compounds. Hydrogen peroxide does not accumulate in the food chain.

How might I be exposed to hydrogen peroxide?


You can be exposed to hydrogen peroxide through its use as a general disinfectant. Hydrogen peroxide solutions used for this purpose are sold at almost all drugstores or supermarkets. Because hydrogen peroxide is used in many industries for a variety of purposes, workers in such industries may be exposed to this chemical through inhalation or contact with the skin.

What happens to hydrogen peroxide when it enters the environment?


Hydrogen peroxide released to the atmosphere will react very rapidly with other compounds found in air. Hydrogen peroxide breaks down rapidly in water.

How can hydrogen peroxide affect my health?


Hydrogen peroxide can be toxic if ingested, inhaled, or by contact with the skin or eyes. Inhalation of household strength hydrogen peroxide (3%) can cause respiratory irritation. Exposure to household strength hydrogen

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

Page 2

HYDROGEN PEROXIDE
CAS #7722-84-1
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

peroxide can cause mild ocular irritation. Inhalation of vapors from concentrated (higher than 10%) solutions may result in severe pulmonary irritation. Ingestion of dilute solutions of hydrogen peroxide may result in vomiting, mild gastrointestinal irritation, gastric distension, and on rare occasions, gastrointestinal erosions or embolism (blockage of blood vessels by air bubbles). Ingestion of solutions of 10-20% strength produces similar symptoms, but exposed tissues may also be burned. Ingestion of even more concentrated solutions, in addition to the above, may also induce rapid loss of consciousness followed by respiratory paralysis. Eye exposure to 3% hydrogen peroxide may result in pain and irritation, but severe injury is rare. More concentrated solution may result in ulceration or perforation of the cornea. Skin contact can cause irritation and temporary bleaching of the skin and hair. Contact with concentrated solutions may cause severe skin burns with blisters. We do not know if exposure to hydrogen peroxide may affect reproduction in humans.

children being accidently exposed to hydrogen peroxide have described effects similar to those observed in adults. We do not know if exposure to hydrogen peroxide may result in birth defects or other developmental effects in people.

How can families reduce the risk of exposure to hydrogen peroxide?


Most families may be exposed to household strength hydrogen peroxide. Hydrogen peroxide should not be stored in containers that may appear attractive to children, such as soda bottles. Containers with hydrogen peroxide should be stored out of the reach of children.

Is there a medical test to show whether Ive been exposed to hydrogen peroxide?
There are no clinical tests that show that you have been exposed to hydrogen peroxide. White foam from the mouth immediately after ingestion of significant amounts may provide a clue to emergency personnel.

How likely is hydrogen peroxide to cause cancer?


The International Agency for Research on Cancer (IARC) has determined that hydrogen peroxide is not classifiable as to its carcinogenicity to humans.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) sets a limit of 1 part of hydrogen peroxide in a million parts of air (1 ppm) in the workplace for an 8-hour work shift, 40hour work week.

How can hydrogen peroxide affect children?


There are no studies on the health effects of children exposed to hydrogen peroxide. Documented cases of

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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HYDROGEN SULFIDE
CAS # 7783-06-4
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about hydrogen sulfide. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Hydrogen sulfide occurs naturally and is also produced by human activities. Just a few breaths of air containing high levels of hydrogen sulfide gas can cause death. Lower, longer-term exposure can cause eye irritation, headache, and fatigue. This substance has been found in at least 24 of the 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is hydrogen sulfide? (Pronounced hdr-jn slfd)
Hydrogen sulfide occurs naturally in crude petroleum, natural gas, volcanic gases, and hot springs. It can also result from bacterial breakdown of organic matter. It is also produced by human and animal wastes. Hydrogen sulfide can also result from industrial activities, such as food processing, coke ovens, kraft paper mills, tanneries, and petroleum refineries. Hydrogen sulfide is a colorless, flammable gas under normal conditions. It is commonly known as hydrosulfuric acid, stink damp, and sewer gas. It smells like rotten eggs. People can smell it at low levels. q Hydrogen sulfide remains in the atmosphere for about 18 hours. q In some instances, it may be released as a liquid waste from an industrial facility.

How might I be exposed to hydrogen sulfide?


q You can be exposed by crude petroleum, natural gas, volcanic gases, and hot springs. q You can be exposed at work if you work in the petroleum refining, petrochemical, or natural gas industry; food processing; wastewater treatment; coke oven plants; tanneries; or pulp and paper mills. q A small amount of hydrogen sulfide is produced by bacteria in your mouth and gastrointestinal tract and by enzymes in your brain and muscle.

What happens to hydrogen sulfide when it enters the environment?


q Hydrogen sulfide is released primarily as a gas and will spread in the air. q When released as a gas, it will form sulfur dioxide and sulfuric acid in the atmosphere. q Sulfur dioxide can be broken down further and is a major component in acid rain.

How can hydrogen sulfide affect my health?


Hydrogen sulfide is considered a broad-spectrum poison, meaning it can poison several different systems in the body. Breathing very high levels of hydrogen sulfide can cause death within just a few breaths. There could be loss of consciousness after one or more breaths.

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Exposure to lower concentrations can result in eye irritation, a sore throat and cough, shortness of breath, and fluid in the lungs. These symptoms usually go away in a few weeks. Long-term, low-level exposure may result in fatigue, loss of appetite, headaches, irritability, poor memory, and dizziness. Animal studies showed that pigs that ate food containing hydrogen sulfide had diarrhea after a few days and weight loss after about 105 days. these places.

Is there a medical test to show whether Ive been exposed to hydrogen sulfide?
In case of life-threatening hydrogen sulfide poisoning, measurements of blood sulfide or urinary thiosulfate levels may be used to confirm exposure. However, samples need to be taken within two hours of exposure to be useful.

How likely is hydrogen sulfide to cause cancer?


Hydrogen sulfide has not been shown to cause cancer in humans. It's ability to cause cancer in animals has not been studied fully. The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified hydrogen sulfide for carcinogenicity.

Has the federal government made recommendations to protect human health?


EPA has established that hydrogen sulfide is a regulated toxic substance and is a hazardous substance as defined under the Federal Water Pollution Control Act. The Occupational Safety and Health Administration (OSHA) has established an acceptable ceiling concentration of 20 parts per million (20 ppm) in the workplace, with a maximum level of 50 ppm allowed for 10 minutes if no other measurable exposure occurs. The National Institute of Occupational Safety and Health (NIOSH) recommends a maximum exposure level of 10 ppm.

How can hydrogen sulfide affect children?


Because it is heavier than air, hydrogen sulfide tends to sink, and because children are shorter than adults, they may be more likely to be exposed to larger amounts than adults in the same situations. It is not known whether hydrogen sulfide can cause birth defects in people. Some animal studies have shown developmental problems from exposure to hydrogen sulfide.

Sources of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1999. Toxicological profile for hydrogen sulfide. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

How can families reduce the risk of exposure to hydrogen sulfide?


Families may be exposed if they live near natural or industrial sources of hydrogen sulfide such as hot springs, or pulp and paper mills. Families may want to restrict visits to

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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IODINE
CAS #7553-56-2
Division of Toxicology ToxFAQsTM September 2001

This fact sheet answers the most frequently asked health questions (FAQs) about iodine. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Iodine is a naturally occurring element that is required for good health. Exposure to high levels of stable or radioactive iodine can cause damage to the thyroid. This chemical has been found in at least 8 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is iodine?
Iodine is a naturally occurring element found in sea water and in certain rocks and sediments. There are nonradioactive and radioactive forms of iodine. Iodine is used as a disinfectant for cleaning surfaces and storage containers and is used in skin soaps and bandages, and for purifying water. Iodine is also added to some table salt to ensure that all people in the United States have enough iodine in their diet. Radioactive iodine also occurs naturally. It is used in medical tests and to treat certain diseases. Most radioactive forms of iodine change very quickly (seconds to days) to stable elements that are not radioactive. However, 129I (read as iodine 129) changes very slowly (over millions of years). can enter the air from nuclear power plants. Larger amounts of radioactive iodine have been released to the air from accidents at nuclear power plants and from explosions of nuclear bombs.

How might I be exposed to iodine?


The general population is exposed to low levels of iodine in air, some food and some beverages. Food (iodized salt, bread, and milk ) is the largest sources of exposure to iodine. The general population is rarely exposed to radioactive iodine, unless they undergo certain medical tests or are given it for the treatment of thyroid disease. People who work at facilities using radioactive iodine may be exposed to higher than normal levels.

How can iodine affect my health?


Iodine has both beneficial and harmful effects on human health. Iodine is needed by your thyroid gland to produce thyroid hormones. However, exposure to unnecessarily high levels of nonradioactive and radioactive iodine can damage the thyroid. Damage to the thyroid gland can result in effects in other parts of your body, such as your skin, lung, and reproductive organs.

What happens to iodine when it enters the environment?


The primary source of non radioactive iodine is the ocean. It enters the air from sea spray or as iodine gas. Once in the air, iodine can combine with water or with particles in air and can enter the soil and surface water, or land on vegetation when these particles fall to the ground or when it rains. Iodine can remain in soil for a long time. It can also be taken up by some plants that grow in the soil but plants are considered a poor source of dietary iodine. Radioactive iodine forms naturally from chemical reactions high in the atmosphere. Small amounts of radioactive iodine

How likely is iodine to cause cancer?


Some human studies have found an increased risk of thyroid cancer in certain populations, particularly populations with iodine deficient diets receiving iodine supplements. Other human studies have not found an association between

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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IODINE
CAS #7553-56-2
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exposure to high levels of iodine and cancer risk. Neither the EPA or the International Agency for Research on Cancer (IARC) have reviewed the carcinogenicity of iodine. Exposure to high levels of radioactive iodine may also increase the risk of thyroid cancer. However, the evidence is inconclusive.

Is there a medical test to show whether Ive been exposed to iodine?


There are reliable tests that can measure iodine in the blood, urine, and saliva. These tests are not available at your doctors office, but your doctor can send the samples to a laboratory that can perform the tests. However, these tests cannot predict whether you will experience any health effects. Radiation detectors can measured radioactive iodine inside your body using the radiation coming from the thyroid gland in your neck. Your body quickly eliminates iodine and radioactive iodine, so tests should be done shortly after exposure.

How can iodine affect children?


Iodine is essential for the growth and development of children. However, children are more sensitive to the harmful effects of excessively high levels of stable and radioactive iodine than adults because their thyroid glands are still growing and they need a healthy thyroid gland for normal growth. If babies and children receive too much iodine, they can develop an enlarged thyroid gland (called a goiter), which does not produce enough thyroid hormone for normal growth. Too much iodine from the mother can cause a babys thyroid gland to be so large that it makes breathing difficult or impossible. Radioactive iodine in food can be more harmful to babies and children than to adults. Because a childs thyroid gland is smaller than that of an adult, a childs thyroid gland will receive a higher radiation dose than the adult exposed to the same amount of iodine.

Has the federal government made recommendations to protect human health?


The National Research Council has established a recommended dietary allowance (RDA) for iodine of 150 micrograms per day (150 g/day), with additional allowances of 25 g/day during pregnancy and 50 g/day during nursing. These dietary intake levels are sufficient to satisfy the metabolic needs of the body. The Nuclear Regulatory Commission (NRC), the National Council of Radiation Protection and Measurement (NRCP), and the International Commission of Radiological Protection (ICRP) have established recommended limits for worker exposures to radioactive iodine and for releases of radioactive iodine to the environment.

How can families reduce the risk of exposure to iodine?


The general population is exposed to iodine in some food and beverages. We do not want to prevent exposure to iodine, but we do want to try to prevent exposure to too much iodine. Foods are not normally expected to have enough iodine to harm your health. Unless you are exposed to radioactive waste or emissions, you generally do not have to worry about excessive exposure.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for Iodine (Draft for Public Comment). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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IONIZING RADIATION
Agency for Toxic Substances and Disease Registry ToxFAQs September 1999

This fact sheet answers the most frequently asked health questions (FAQs) about ionizing radiation. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this material may harm you. The effects of exposure to any hazardous material depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other radioactive materials are present.

HIGHLIGHTS: Ionizing radiation, like heat and light, is a form of energy. It includes particles and rays given off by radioactive material, stars, and high-voltage equipment. Most of it occurs naturally and some is produced by human activities. At very high doses, ionizing radiation can cause illness or death. Any dose could possibly cause cancer, after a severalyear delay. It is not known how many of the 1,517 National Priorities List sites identified by the Environmental Protection Agency give off ionizing radiation above background levels.
What is ionizing radiation? (Pronounced -nzng rd-shn)
Ionizing radiation is any one of several types of particles and rays given off by radioactive material, high-voltage equipment, nuclear reactions, and stars. The types that are normally important to your health are alpha particles, beta particles, x rays, and gamma rays. Alpha and beta particles are small, fast-moving bits of atoms that a radioactive atom gives off when it changes into another substance. X rays and gamma rays are types of electromagnetic radiation. These radiation particles and rays carry enough energy to knock out electrons from atoms and molecules (such as water, protein, and DNA) that they hit or pass near. This process is called ionization, which is why this radiation is called "ionizing radiation." atmosphere, it produces a shower of cosmic rays that constantly expose everything on earth. Some hit gases in the air and change them into radioactive material (such as tritium and carbon 14). Other radioactive materials are naturally part of the environment, such as the uranium that has been here since the earth was formed. Still other radioactive materials are made by industry for smoke detectors, medical tests, and other uses. These radioactive materials give off their ionizing radiation over time until all of the radioactive atoms have decayed. Whenever radioactive material enters the environment, it behaves like other substances, getting into the air, water, soil, plants, and animals, while also giving off radiation. Some ionizing radiation is made on demand, such as when doctors take x rays.

How might I be exposed to ionizing radiation?


You are exposed to low levels of ionizing radiation from the sun, rocks, soil, natural sources in your body, fallout from past nuclear weapons tests, some consumer products, and radioactive materials released from hospitals and from nuclear and coal power plants. You are exposed to more if you work as a pilot, flight attendant, astronaut, industrial and nuclear power plant worker, or x ray or medical personnel. You receive additional exposure with each x ray exam and

What happens to ionizing radiation when it enters the environment?


Ionizing radiation, which travels as fast as the speed of light, hits atoms and molecules in its path and loses some of its energy with each hit. When all the energy is gone, there is essentially nothing left. Ionizing radiation does not make you radioactive - it just leaves some of its energy inside you or whatever else it hits. When ionizing radiation from outer space hits the upper

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IONIZING RADIATION
ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

nuclear medicine test, and the amount depends on the type and number of tests.

How can ionizing radiation affect my health?


Exposure to low levels of ionizing radiation from the environment has not been shown to affect human health. Exposure to high doses of ionizing radiation can result in skin burns, hair loss, nausea, birth defects, illness, and death. How you are affected depends on how much ionizing radiation you received and over what period of time, and personal factors such as sex, age at the time of exposure, and your health and nutritional status. Increasing the dose results in a more severe effect. Increased psychological stress has been shown in large populations exposed to small doses of radiation from nuclear accidents. Mental function has been affected in people exposed before birth to high doses of ionizing radiation.

When you or your children receive an x ray, be sure to correctly wear the protective garments that are provided. The technician will make sure that only the area that needs to be x rayed will be exposed to the x ray beam. If you or your children are treated with a chemical that has some amount of radioactive material in it to help a doctor diagnose or treat a disease, be sure to follow the doctor's directions after you have been treated.

Is there a medical test to show whether Ive been exposed to ionizing radiation?
There are different kinds of tests to see if you have been exposed to very high doses of ionizing radiation. One test examines changes in blood cell counts, but only exposure to high levels of ionizing radiation will produce detectable changes in blood cell counts. Another test studies your chromosomes. This test is useful for doses several times the maximum permissible dose for radiation workers. There are many ways to see if you have radioactive material in your body. Radioactive material can be measured in your blood, feces, saliva, urine, and your entire body by specialized instruments. The instrument is chosen based on the type of radiation that is to be measured. These tests are not available at your doctor's office.

How likely is ionizing radiation to cause cancer?


Exposure to ionizing radiation may increase your chance of getting cancer. As with other health effects, how likely you are to get cancer depends on how much ionizing radiation you received, your age when exposed, and the type of cancer.

How can ionizing radiation affect children?


Like adults, children are exposed to small amounts of ionizing radiation that comes from the soil where they live, the food and water they eat and drink, the air they breathe, and from sources that reach earth from space. There is no evidence that exposure to normal background levels of ionizing radiation causes health effects in children or adults. If a pregnant woman is exposed to high levels of ionizing radiation, it is possible that her child may be born with some brain abnormalities. There is an 8-week period during early pregnancy when an unborn child is especially sensitive to the effects of higher-than-normal levels of ionizing radiation. As the levels of ionizing radiation increase, so does the chance of brain abnormalities.

Has the federal government made recommendations to protect human health?


The EPA limits the dose from radionuclides released to the air to 0.1 millirems (mrem)/year. The EPA has set a drinking water standard for radionuclides of 4 mrem/year for manmade sources of beta emitters. The current federal and state regulations limit workers' doses to 5 rem/year; the limit for an unborn child of a female radiation worker is 0.5 mrem/year; the limit for the general public is 0.1 rem/year, with provisions for a limit of 0.5 rem/year under special circumstances.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1999. Toxicological profile for ionizing radiation. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

How can families reduce the risk of exposure to ionizing radiation?

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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ISOPHORONE
CAS # 78-59-1
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about isophorone. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Isophorone is used in the printing industry. Exposure to high levels causes irritation of the nose and throat, dizziness, and fatigue. This chemical has been found in at least 9 of the 1,177 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is isophorone? (Pronounced s-f'rn)


Isophorone is a clear liquid that smells like peppermint. It can be dissolved in water and evaporates somewhat faster than water. It is an industrial chemical used as a solvent in some printing inks, paints, lacquers, and adhesives. It is also used as an intermediate in the production of certain chemicals. Although isophorone is an industrial chemical, it also occurs naturally in cranberries.

G In soil, it may be be broken down by bacteria, filter to groundwater, or evaporate to the air; however, there is not much information on its presence in soil. G It does not build up in the food chain.

How might I be exposed to isophorone?


G Breathing low levels found in air. G Drinking water contaminated with isophorone. G Eating food that contains isophorone. G Working in the printing, adhesives, and coatings industries where isophorone is used.

What happens to isophorone when it enters the environment?


G Isophorone is released to the air from inks, paints, and other products containing it. G It disappears in air very quickly, half of it disappears in less than 5 hours. G Isophorone may be present in water from industrial releases. G In water, it can be broken down by bacteria over a period of several days to about a month.

How can isophorone affect my health?


The only effects of isophorone reported by people who have been exposed are irritation of the skin, eyes, nose, and throat, and dizziness and fatigue. These effects have occurred in workers who breathed vapors of isophorone and other chemicals in the printing industry. Short-term exposure of animals to high levels of isophorone has caused inactivity and coma. Some animal studies suggest that isophorone may cause birth defects and

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ISOPHORONE CAS # 78-59-1

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slower growth in the offspring of rats and mice that breathed the vapors during pregnancy. These studies found some harmful health effects in adult female animals. When rats and mice were given high doses of isophorone in food or water for a long time, the male rats developed kidney disease. ported to the EPA. The Occupational Safety and Health Administration (OSHA) has set a permissible exposure limit of 140 milligrams of isophorone per cubic meter of air (140 mg/m3) for an 8-hour workday in a 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) recommends an occupational exposure limit of 23 mg/m3 for isophorone for a 10-hour workday in a 40-hour workweek. The federal recommendations have been updated as of July 1999.

How likely is isophorone to cause cancer?


No studies are available on whether isophorone causes cancer in people. In male rats, isophorone caused an increase in tumors of the kidney, liver, and lymph and reproductive glands when they were exposed to it by ingestion. There was no increase in tumors in female rats or mice. The EPA has determined that isophorone is a possible human carcinogen, based on adequate evidence in animals and inadequate evidence in people.

Glossary
Carcinogen: A substance that can cause cancer. CAS: Chemical Abstracts Service. Ingestion: Taking food or drink into your body. Milligram (mg): One thousandth of a gram. National Priorities List: A list of the nations worst hazardous waste sites. ppm: Parts per million. Short-term: Lasting 14 days or less. Solvent: A substance that dissolves another substance. Tumor: An abnormal mass of tissue.

Is there a medical test to show whether Ive been exposed to isophorone?


There is no medical test to determine whether you have been exposed to isophorone. A few studies in rats and rabbits have shown that isophorone and its breakdown products can be found in the urine of these animals, so it may be possible to find a method for testing the urine of people to determine exposure to isophorone. We do not know whether such a measurement would predict how much exposure had occurred or the possible health effects.

Has the federal government made recommendations to protect human health?


The EPA recommends that levels in lakes and streams should be limited to 8.4 parts of isophorone per billion parts of water (8.4 ppb) to prevent possible health effects from drinking water or eating fish contaminated with isophorone. The EPA requires that discharges, spills, or accidental releases of 5,000 pounds or more of isophorone must be re-

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1990. Toxicological profile for isophorone. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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JET FUELS JP-4 and JP-7


CAS # 50815-00-4
Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about jet fuels JP-4 and JP-7. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: JP-4 and JP-7 are liquid mixtures produced from petroleum and used by the U.S. Air Force as aircraft fuels. Breathing large amounts of the vapors from these fuels may cause nausea and nervous system effects. JP-4 has been found in at least 4 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA). JP-7 has not been found at any sites.
q There is no information about what happens to JP-7 when it enters the environment, but it probably acts similarly to JP-4. q There is no information on whether JP-4 and JP-7 build up significantly in plants and animals. q It is likely that some of the chemical components of JP-4 and JP-7 build up in plants and animals.

What are jet fuels JP-4 and JP-7? (Pronounced jt fylz JP-4 and JP-7)
Jet fuels JP-4 and JP-7 (jet propellant-4 and jet propellant-7) are flammable, colorless to straw-colored liquid mixtures that come from crude petroleum. They smell like kerosene. Jet fuels are blends of other chemicals made according to U.S. Air Force standards for use as aircraft fuels. Although JP-4 and JP-7 are liquids at room temperature, they also evaporate easily.

How might I be exposed to JP-4 and JP-7?


q Exposure to JP-4 occurs primarily in workers who manufacture, transport, or use jet fuels. q Exposure to JP-4 is most likely to occur through skin contact or breathing contaminated air. q You may be exposed to JP-4 by breathing some of the chemicals that evaporate from a spill or leak site. q You may also be exposed through drinking or swimming in water that has been contaminated with JP-4, or from touching soil contaminated from a spill or leak. q There is no information about how individuals may be exposed to JP-7, but it is reasonable to assume that you could be exposed in the same ways as for JP-4.

What happens to JP-4 and JP-7 when they enter the environment?
q JP-4 and JP-7 enter the environment when they are spilled or leak into water or soil during their manufacture, storage, disposal, or release from jets during flight. q Some chemicals found in JP-4 may dissolve in water, while others may evaporate into the air. q Some chemicals found in JP-4 may stick to particles in water, which will eventually cause them to settle to the bottom sediment. q Some of the chemicals found in JP-4 may be broken down slowly in air, water, and soil by sunlight or small organisms.

How can JP-4 and JP-7 affect my health?


Little information is available about the health effects

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JET FUELS JP-4 and JP-7 CAS # 50815-00-4

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that may be caused by JP-4 and JP-7. Inhaling large amounts of JP-4 vapor may cause painful breathing and a feeling of suffocation, as well as headache, dizziness, nausea, depression, anxiety, memory loss, and irritability. Animal studies have shown that inhaling extremely large amounts of JP-4 or JP-7 vapor does not cause death. However, animals breathing high levels of JP-4 vapor for short periods exhibited poor coordination and convulsions. A depressed activity level has been seen in animals breathing low levels of JP-4 vapor. Other effects seen in animals breathing JP-4 or JP-7 vapor have been skin and eye irritation, changes in liver cells, and decreased numbers of white blood cells. We do not know whether JP-4 or JP-7 can cause birth defects or if they affect reproduction in people.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) has set an exposure limit of 500 parts of petroleum distillates per million parts of air (500 ppm) for an 8-hour workday, 40-hour workweek. The Air Force Office of Safety and Health (AFOSH) has set an exposure limit of 400 ppm petroleum distillates for an 8-hour workday, 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) recommends that average workplace air levels not exceed 350 milligrams of petroleum distillates per cubic meter of air (350 mg/m3) for a 40-hour workweek. The Department of Transportation (DOT) lists JP-4 and JP-7 as hazardous materials and, therefore, regulates their transportation.

How likely are JP-4 and JP-7 to cause cancer?


The International Agency for Research on Cancer (IARC) has stated there is not enough information to determine how likely JP-4 and JP-7 are to cause cancer in humans. Studies with mice and rats have suggested that skin contact with JP-4 may cause skin cancer, although this is not certain. There is also no clear evidence that breathing, eating, or drinking JP-4 or JP-7 causes cancer in animals.

Glossary
CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. Milligram: One thousandth of a gram. ppm: Parts per million. Sediment: Mud and debris that have settled to the bottom of a body of water.

Is there a medical test to show whether Ive been exposed to JP-4 and JP-7?
There is no medical test that shows if you have been exposed to JP-4 and JP-7. Tests are available to determine if some of the chemicals commonly found in jet fuels are in your blood. However, the presence of these chemicals in blood may not necessarily mean that you have been exposed to JP-4 or JP-7.

Reference
Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for jet fuels JP-4 and JP-7. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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JET FUELS JP-5 and JP-8


CAS # 8008-20-6
Agency for Toxic Substances and Disease Registry ToxFAQs August 1999

This fact sheet answers the most frequently asked health questions (FAQs) about jet fuels JP-5 and JP-8. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to jet fuels JP-5 and JP-8 occurs mainly in the workplace or from accidents or spills. Breathing in large amounts of JP-5 and JP-8 may result in headaches, difficulty in concentrating, coordination problems, and fatigue. These chemicals have been found in at least 22 of the 1,445 National Priorities List sites identified by the Environmental Protection Agency.
What are jet fuels JP-5 and JP-8? (Pronounced jt fylz JP-5 and JP-8)
Jet fuels JP-5 and JP-8 are substances used as aircraft fuels by the military. JP-5 and JP-8 is shorthand for jet propellants 5 and 8. JP-5 is the U.S. Navys primary jet fuel, and JP-8 is one of the jet fuels used by the U.S. Air Force. Both of the substances are composed of a large number of chemicals, and both are colorless liquids that may change into gas vapor. They smell like kerosene, since kerosene is the primary component of both JP-5 and JP-8. They are made by refining either crude petroleum oil deposits found underground or shale oil found in rock.

G Other chemicals in JP-5 and JP-8 will attach to particles in


water and may sink to the bottom sediments. teria and other organisms in soil and water.

G Chemicals in JP-5 and JP-8 may be broken down by bacG JP-5 and JP-8 may stay in the soil for more than 10 years. How might I be exposed to jet fuels JP-5 and JP-8? G Most people would not be exposed to jet fuels JP-5 and G Breathing air in an area where an accident or leak of jet
fuels JP-5 and JP-8 has occurred.

JP-8 unless they work with these substances or live very close to where they are used or spilled.

What happens to jet fuels JP-5 and JP-8 when they enter the environment? G Some chemicals in JP-5 and JP-8 will evaporate into air
from open containers or when they are spilled into water or soil.

G Drinking water contaminated with JP-5 or JP-8. G Touching soil contaminated with jet fuels JP-5 and JP-8. G Working refueling military aircraft or transporting jet
fuels.

G Living near a hazardous waste site where jet fuels JP-5


and JP-8 are disposed of.

G JP-5 and JP-8 in air may break down by reacting with


sunlight or chemicals in air. soil into groundwater.

How can jet fuels JP-5 and JP-8 affect my health?


Little is known about the effects of jet fuels JP-5 and JP-8 on peoples health. Breathing large amounts of JP-5 and JP-8

G Chemicals in JP-5 and JP-8 may slowly move from the

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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JET FUELS JP-5 AND JP-8 CAS # 8008-20-6

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


for a short period may result in headaches, difficulty in concentrating, coordination problems, and fatigue. Breathing lower levels of JP-5 and JP-8 for a longer period could result in lack of initiative, sleep disturbances, and dizziness. Much information is available on accidental poisonings in children from drinking kerosene. Effects seen include vomiting, diarrhea, stomach cramps, coughing, drowsiness, and loss of consciousness. Drinking very large amounts can result in death. Skin exposure to kerosene results in skin irritation, consisting of itchy, red, peeling, and sore skin. It is not known whether jet fuels JP-5 and JP-8 can affect reproduction or cause birth defects in people or animals. However, tests can determine if your blood contains some of the chemicals found in JP-5 and JP-8. However, the concentrations of these chemicals in JP-5 and JP-8 are very low, and if they were detected in your blood, it would not necessarily mean that you were exposed to JP-5 or JP-8.

Has the federal government made recommendations to protect human health?


Very few regulations or advisories are specific to jet fuels JP-5 and JP-8. The following is a recommendation for petroleum products, which are similar to jet fuels JP-5 and JP-8. The Occupational Safety and Health Administration and the Air Force Office of Safety and Health have set an exposure limit of 400 milligrams of petroleum products per cubic meter of air (400 mg/m3) for an 8-hour workday, 40-hour workweek.

How likely are jet fuels JP-5 and JP-8 to cause cancer?
The International Agency for Research on Cancer has concluded that jet fuels are not classifiable as to their carcinogenicity to humans. No carcinogenicity studies on jet fuels JP-5 and JP-8 are available in people. A study on the use of kerosene stoves found no association between their use and bronchial cancer, while another study found an increase in oral cancer in men who used kerosene stoves. Other studies in people are inconclusive. An animal study showed no increase in kidney tumors when rats breathed air containing high levels of JP-5 or JP-8 for 90 days. Skin tumors were seen in mice when their skin was exposed to jet fuel JP-5 for 60 weeks.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Milligram (mg): One thousandth of a gram.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1998. Toxicological profile for jet fuels (JP-5 and JP-8). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals, and scientists must follow strict guidelines.

Is there a medical test to show whether Ive been exposed to jet fuels JP-5 and JP-8?
No test shows if you have been exposed to JP-5 or JP-8.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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FUEL OILS
CAS # 8008-20-6, 70892-10-3, 68476-30-2, 68476-34-6, 68476-31-3
Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about fuel oils. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Fuel oils are liquid mixtures produced from petroleum, and their use mostly involves burning them as fuels. Drinking or breathing fuel oils may cause nausea or nervous system effects. However, exposure under normal use conditions is not likely to be harmful. Fuel oils have been found in at least 26 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What are fuel oils? (Pronounced fyl oilz)


Fuel oils are a variety of yellowish to light brown liquid mixtures that come from crude petroleum. Some chemicals found in fuel oils may evaporate easily, while others may more easily dissolve in water. Fuel oils are produced by different petroleum refining processes, depending on their intended uses. Fuel oils may be used as fuel for engines, lamps, heaters, furnaces, and stoves, or as solvents. Some commonly found fuel oils include kerosene, diesel fuel, jet fuel, range oil, and home heating oil. These fuel oils differ from one another by their hydrocarbon compositions, boiling point ranges, chemical additives, and uses.

q Some chemicals found in fuel oils may stick to particles in water, which will eventually cause them to settle to the bottom sediment. q Some of the chemicals found in fuel oils may be broken down slowly in air, water, and soil by sunlight or small organisms. q Some of the chemicals found in fuel oils may build up significantly in plants and animals.

How might I be exposed to fuel oils?


q Using a home kerosene heater or stove, or using fuel oils at work. q Breathing air in home or building basements that has been contaminated with fuel oil vapors entering from the soil. q Drinking or swimming in water that has been contaminated with fuel oils from a spill or a leaking underground storage tank. q Touching soil contaminated with fuel oils. q Using fuel oils to wash paint or grease from skin or equipment.

What happens to fuel oils when they enter the environment?


q Some chemicals found in fuel oils may evaporate into the air from open containers or contaminated soil or water. q Some chemicals found in fuel oils may dissolve in water after spills to surface waters or leaks from underground storage tanks.

How can fuel oils affect my health?


Little information is available about the health effects that may be caused by fuel oils. People who use kerosene

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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FUEL OILS
CAS # 8008-20-6, 70892-10-3, 68476-30-2, 68476-34-6, 68476-31-3

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


stoves for cooking do not seem to have any health problems related to their exposure. Breathing some fuel oils for short periods may cause nausea, eye irritation, increased blood pressure, headache, lightheadedness, loss of appetite, poor coordination, and difficulty concentrating. Breathing diesel fuel vapors for long periods may cause kidney damage and lower your bloods ability to clot. Drinking small amounts of kerosene may cause vomiting, diarrhea, coughing, stomach swelling and cramps, drowsiness, restlessness, painful breathing, irritability, and unconsciousness. Drinking large amounts of kerosene may cause convulsions, coma, or death. Skin contact with kerosene for short periods may cause itchy, red, sore, or peeling skin. the chemicals commonly found in fuel oils are in your blood. However, the presence of these chemicals in blood may not necessarily mean that you have been exposed to fuel oils.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) and the Air Force Office of Safety and Health (AFOSH) have set a permissible exposure level (PEL) of 400 parts of petroleum distillates per million parts of air (400 ppm) for an 8-hour workday, 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) recommends that average workplace air levels not exceed 350 milligrams of petroleum distillates per cubic meter of air (350 mg/m3) for a 40-hour workweek. The Department of Transportation (DOT) lists fuel oils as hazardous materials and, therefore, regulates their transportation.

How likely are fuel oils to cause cancer?


The International Agency for Research on Cancer (IARC) has determined that some fuel oils (heavy) may possibly cause cancer in humans, but for other fuel oils (light) there is not enough information to make a determination. IARC has also determined that occupational exposures to fuel oils during petroleum refining are probably carcinogenic in humans. Some studies with mice have suggested that repeated contact with fuel oils may cause liver or skin cancer. However, other mouse studies have found this not to be the case. No studies are available in other animals or in people on the carcinogenic effects of fuel oils.

Glossary
Carcinogenic: Able to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. Hydrocarbon: Any compound made up of hydrogen and carbon. Milligram (mg): One thousandth of a gram. ppm: Parts per million. Sediment: Mud and debris that have settled to the bottom of a body of water.

Is there a medical test to show whether Ive been exposed to fuel oils?
There is no medical test that shows if you have been exposed to fuel oils. Tests are available to determine if some of

Reference
Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for fuel oils. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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LEAD
CAS # 7439-92-1
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about lead. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to lead can happen from breathing workplace air or dust, eating contaminated foods, or drinking contaminated water. Children can be exposed from eating lead-based paint chips or playing in contaminated soil. Lead can damage the nervous system, kidneys, and reproductive system. Lead has been found in at least 1,026 of 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is lead? (Pronounced ld)
Lead is a naturally occurring bluish-gray metal found in small amounts in the earths crust. Lead can be found in all parts of our environment. Much of it comes from human activities including burning fossil fuels, mining, and manufacturing. Lead has many different uses. It is used in the production of batteries, ammunition, metal products (solder and pipes), and devices to shield X-rays. Because of health concerns, lead from gasoline, paints and ceramic products, caulking, and pipe solder has been dramatically reduced in recent years.

How might I be exposed to lead?


G Eating food or drinking water that contains lead. G Spending time in areas where lead-based paints have been used and are deteriorating. G Working in a job where lead is used. G Using health-care products or folk remedies that contain lead. G Engaging in certain hobbies in which lead is used (for example, stained glass).

How can lead affect my health?


Lead can affect almost every organ and system in your body. The most sensitive is the central nervous system, particularly in children. Lead also damages kidneys and the reproductive system. The effects are the same whether it is breathed or swallowed. At high levels, lead may decrease reaction time, cause weakness in fingers, wrists, or ankles, and possibly affect the memory. Lead may cause anemia, a disorder of the blood. It can also damage the male reproductive system. The connection between these effects and exposure to low levels of lead is uncertain.

What happens to lead when it enters the environment?


G Lead itself does not break down, but lead compounds are changed by sunlight, air, and water. G When lead is released to the air, it may travel long distances before settling to the ground. G Once lead falls onto soil, it usually sticks to soil particles. G Movement of lead from soil into groundwater will depend on the type of lead compound and the characteristics of the soil. G Much of the lead in inner-city soils comes from old houses painted with lead-based paint.

How likely is lead to cause cancer?


The Department of Health and Human Services has determined that lead acetate and lead phosphate may reasonably

Page 2

LEAD CAS # 7439-92-1

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


be anticipated to be carcinogens based on studies in animals. There is inadequate evidence to clearly determine leads carcinogenicity in people.

Is there a medical test to show whether Ive been exposed to lead?


A blood test is available to measure the amount of lead in your blood and to estimate the amount of your exposure to lead. Blood tests are commonly used to screen children for lead poisoning. Lead in teeth and bones can be measured with X-rays, but this test is not as readily available. Medical treatment may be necessary in children if the lead concentration in blood is higher than 45 micrograms per deciliter (45 g/dL).

How can lead affect children?


Small children can be exposed by eating lead-based paint chips, chewing on objects painted with lead-based paint, or swallowing house dust or soil that contains lead. Children are more vulnerable to lead poisoning than adults. A child who swallows large amounts of lead may develop blood anemia, severe stomachache, muscle weakness, and brain damage. A large amount of lead might get into a child's body if the child ate small pieces of old paint that contained large amounts of lead. If a child swallows smaller amounts of lead, much less severe effects on blood and brain function may occur. Even at much lower levels of exposure, lead can affect a child's mental and physical growth. Exposure to lead is more dangerous for young and unborn children. Unborn children can be exposed to lead through their mothers. Harmful effects include premature births, smaller babies, decreased mental ability in the infant, learning difficulties, and reduced growth in young children. These effects are more common if the mother or baby was exposed to high levels of lead.

Has the federal government made recommendations to protect human health?


The Centers for Disease Control and Prevention (CDC) recommends that children ages 1 and 2 be screened for lead poisoning. Children who are 3 to 6 years old should be tested for lead if they have never been tested for lead before and if they receive services from public assistance programs; if they live in or regularly visit a building built before 1950; if they live in or visit a home built before 1978 that is being remodeled; or if they have a brother, sister, or playmate who has had lead poisoning. CDC considers children to have an elevated level of lead if the amount in the blood is 10 g/dL. The EPA requires lead in air not to exceed 1.5 micrograms per cubic meter (1.5 g/m3) averaged over 3 months. EPA limits lead in drinking water to 15 g per liter. The Occupational Health and Safety Administration (OSHA) develops regulations for workers exposed to lead. The Clean Air Act Amendments of 1990 banned the sale of leaded gasoline. The Federal Hazardous Substance Act bans children's products that contain hazardous amounts of lead.

How can families reduce the risk of exposure to lead?


Avoid exposure to sources of lead. Do not allow children to chew or mouth painted surfaces that may have been painted with lead-based paint (homes built before 1978). Run your water for 15 to 30 seconds before drinking or cooking with it. This will get rid of lead that may have leached out of pipes. Some types of paints and pigments that are used as make-up or hair coloring contain lead. Keep these kinds of products away from children. Wash children's hands and faces often to remove lead dusts and soil, and regularly clean the house of dust and tracked in soil.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1999. Toxicological profile for lead. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information?

For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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MALATHION
CAS #000121-75-5
Division of Toxicology ToxFAQsTM September 2001

This fact sheet answers the most frequently asked health questions (FAQs) about malathion. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: The general population is probably not exposed to malathion regularly. However, malathion is used to treat head lice on humans, to kill fleas on pets, and to kill insects in gardens. Exposure to malathion may also occur at farms where it has been sprayed on crops. Exposure to high amounts of malathion can cause difficulty breathing, chest tightness, vomiting, cramps, diarrhea, blurred vision, sweating, headaches, dizziness, loss of consciousness, and possibly death. This chemical has been found in at least 21 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is malathion?
Malathion is an insecticide that does not occur naturally. Pure malathion is a colorless liquid, and technical-grade malathion, which contains >90% malathion and impurities in a solvent, is a brownish-yellow liquid that smells like garlic. Malathion is used to kill insects on farm crops and in gardens, to treat lice on humans, and to treat fleas on pets. Malathion is also used to kill mosquitos and Mediterranean fruit flies (medflies) in large outdoor areas.

How might I be exposed to malathion?


Most people are not exposed to malathion in the air they breathe or on things they touch, unless they live next to areas being sprayed. Farm workers, chemical sprayers, and people who work in factories that make malathion are most likely to be exposed. People who use it around their homes and people living in areas where malathion is sprayed to control medflies or mosquitos may also be exposed. People who live near landfills where it has been dumped may be exposed. Individuals may also be exposed by going into fields too soon after spraying.

What happens to malathion when it enters the environment?


Malathion enters the environment primarily through spraying on farm crops. Malathion does not stick to soil and is broken down rapidly by bacteria in the soil, so it does not usually move from the soil to groundwater. In water, malathion is broken down by the action of the water and bacteria in the water. In air, malathion is broken down by sunlight. Malathion is not expected to accumulate in the food chain due to rapid metabolism in aquatic organisms.

How can malathion affect my health?


Malathion interferes with the normal way that the nerves and brain function. Exposure to very high levels of malathion for a short period in air, water, or food may cause difficulty breathing, chest tightness, vomiting, cramps, diarrhea, blurred vision, sweating, headaches, dizziness, loss of consciousness, and death. If persons who are exposed to high amounts of malathion are rapidly given appropriate treatment, there may be no long-term harmful effects. If people are exposed to levels of malathion below those that affect nerve function, few or no health problems seem to occur.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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MALATHION
CAS #000121-75-5
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

How likely is malathion to cause cancer?


There is no conclusive proof that malathion causes cancer in humans, although some studies have found increased incidence of some cancers in people who are regularly exposed to pesticides, such as farmers and pesticide applicators. Animal studies also fail to provide conclusive evidence of carcinogenicity. The International Agency for Research on Cancer (IARC) has determined that malathion is unclassifiable as to carcinogenicity to humans.

Is there a medical test to show whether Ive been exposed to malathion?


Malathion can be detected in your blood and its breakdown products can be detected in your urine, but only within a few days after your last exposure. If exposure is known or suspected, a test can be done that measures cholinesterase levels in your blood. Low levels of cholinesterase may be a result of malathion exposure or may be caused by factors other than malathion. These tests are not usually available at your doctors office, but your doctor can send the samples to a laboratory that can perform the tests. None of these tests, however, can predict whether you will experience any health effects.

How can malathion affect children?


It is likely that health effects seen in children exposed to high levels of malathion will be similar to the effects seen in adults. It is not known whether children are more sensitive to the effects of malathion than adults. There is some indication that young rats may be more sensitive than adults to nervous system effects. Birth defects have not been observed in humans exposed to malathion, but developmental effects have been seen in the offspring of animals that ingested enough malathion while pregnant to cause health effects in the mother. Animal studies have shown that malathion can be transferred from a pregnant mother to the developing fetus and from a nursing mother to the newborns through the mothers milk.

Has the federal government made recommendations to protect human health?


The EPA has established a level of 0.1 milligrams of malathion per liter of drinking water (0.1 mg/L) for lifetime exposure of adults as a level that is not expected to cause effects that are harmful to health. The EPA allows a maximum of 0.1-135 parts (0.1-135 ppm) malathion per million parts of certain types of food. The Occupational Safety and Health Administration (OSHA) has set a limit of 15 milligrams of malathion per cubic meter of workplace air (15 mg/m3) for 8-hour shifts and 40-hour work weeks.

How can families reduce the risk of exposure to malathion?


The general population is not likely to be exposed to large amounts of malathion. However, exposure may be reduced by staying away from fields that have been recently sprayed, by wearing protective clothing when applying malathion around the home or in gardens, and by washing fruits and vegetables grown in gardens treated with malathion before eating. Children should avoid playing in soils near uncontrolled hazardous waste sites where malathion may have been discarded.

Sources of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for Malathion (Draft for Public Comment) Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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MANGANESE
CAS # 127-18-4
Division of Toxicology ToxFAQsTM February 2001

This fact sheet answers the most frequently asked health questions (FAQs) about manganese. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Manganese is a trace element and eating a small amount from food
or water is needed to stay healthy. Exposure to excess levels of manganese may occur from breathing air, particularly where manganese is used in manufacturing, and from drinking water and eating food. At high levels, it can cause damage to the brain, liver, kidneys, and the developing fetus. This chemical has been found in at least 603 of 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is manganese? (Pronounced m ng g?-n[z)
Manganese is a naturally occurring metal that is found in many types of rocks. Pure manganese is silver-colored, but does not occur naturally. It combines with other substances such as oxygen, sulfur, or chlorine. Manganese can also be combined with carbon to make organic manganese compounds. Common organic manganese compounds include pesticides, such as maneb or mancozeb, and methylcyclopentadienyl manganese tricarbonyl (MMT), a fuel additive in some gasolines. Manganese is an essential trace element and is necessary for good health. Manganese can be found in several food items, including grains and cereals, and is found in high amounts in other foods, such as tea.

How might I be exposed to manganese?


[ Everyone is exposed to small amounts of manganese in air, water, and food. [ Individuals who work in occupations that mine or use manganese are likely to be exposed to excess levels in their work environment. [ People who improperly use pesticides such as maneb and mancozeb, may be exposed to excess levels.

How can manganese affect my health?


Some individuals exposed to very high levels of manganese for long periods of time in their work developed mental and emotional disturbances and slow and clumsy body movements. This combination of symptoms is a disease called manganism. Workers usually do not develop symptoms of manganism unless they have been exposed to manganese for many months or years. Manganism occurs because too much manganese injures a part of the brain that helps control body movements. Exposure to high levels of airborne manganese, such as in a manganese foundry or battery plant, can affect motor skills such as holding ones hand steady, performing fast hand movements, and maintaining balance. Exposure to high levels of the metal may also cause respiratory problems and sexual dysfunction.

What happens to manganese when it enters the environment?


[ Manganese can enter the air from iron, steel, and power plants, coke ovens, and from dust from mining operations. [ It can enter the water and soil from natural deposits, disposal of wastes or deposits from airborne sources. [ Manganese exists naturally in rivers, lakes, and under-ground water. [ Plants in the water can take up some of the manganese from water and concentrate it.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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MANGANESE
CAS # 127-18-4
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

How likely is manganese to cause cancer?


There are no human cancer data available for manganese. Exposure to high levels of manganese in food resulted in a slightly increased incidence of pancreatic tumors in male rats and thyroid tumors in male and female mice. The EPA has determined that manganese is not classifiable as to human carcinogenicity.

near hazardous waste sites or in areas that may have increased manganese levels in the soil. Manganese is also present in pesticides that may be used around the home. These pesticides should be used in a manner consistent with manufacturers instructions.

Is there a medical test to show whether Ive been exposed to manganese?


Tests are available that show levels of manganese in different body fluids. Measurements of manganese in blood, urine, feces, and scalp hair can be used to determine exposure to excess levels of manganese by testing whether levels of the metal in your body tissues are greater than normal. However, these tests cannot predict how the levels in your tissues will affect your health. Your doctor can take samples and send them to a testing laboratory.

How can manganese affect children?


Daily intake of small amounts of manganese is needed for growth and good health in children. Manganese is constantly present in the mother and is available to the developing fetus during pregnancy. Manganese is also transferred from a nursing mother to her infant in breast milk at levels that are appropriate for proper development. Children, as well as adults, who lose the ability to remove excess manganese from their bodies develop nervous system problems. Because at certain ages children take in more than adults, there is concern that children may be more susceptible to the toxic effects of excess manganese. Animal studies indicate that exposure to high levels of manganese can cause birth defects in the unborn. There is no information on whether mothers exposed to excess levels of manganese can transfer the excess to their developing fetus during pregnancy or to their nursing infant in breast milk.

Has the federal government made recommendations to protect human health?


The EPA has set a non-enforceable guideline for the level of manganese in drinking water at 0.05 milligrams per liter (0.05 mg/L). The Occupational Safety and Health Administration (OSHA) has set a limit of 5 milligrams manganese per cubic meter (5 mg/m 3 ) of workplace air for the average amount of manganese during an 8hour workday, 40-hour workweek. The National Research Council has recommended safe and adequate daily intake levels for manganese that range from 0.3 to 1 mg/day for children up to 1 year, 1 to 2 mg/day for children up to age 10, and 2 to 5 mg/day for children 10 and older.

How can families reduce the risk of exposure to manganese?


In most situations, there is no need to reduce ones exposure to manganese because it is an essential nutrient for good health. Excess levels of manganese may be present in soils, especially at or near hazardous waste sites. Therefore, it is important to discourage hand-to-mouth activity in young children, especially

Source of information
Agency for Toxic Substances and Disease Registry (ATSDR). 2000. Toxicological profile for manganese. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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MERCURY
CAS # 7439-97-6
Agency for Toxic Substances and Disease Registry ToxFAQs April 1999

This fact sheet answers the most frequently asked health questions (FAQs) about mercury. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to mercury occurs from breathing contaminated air, ingesting contaminated water and food, and having dental and medical treatments. Mercury, at high levels, may damage the brain, kidneys, and developing fetus. This chemical has been found in at least 714 of 1,467 National Priorities List sites identified by the Environmental Protection Agency.
What is mercury?
(Pronounced mrky-r)
Mercury is a naturally occurring metal which has several forms. The metallic mercury is a shiny, silver-white, odorless liquid. If heated, it is a colorless, odorless gas. Mercury combines with other elements, such as chlorine, sulfur, or oxygen, to form inorganic mercury compounds or salts, which are usually white powders or crystals. Mercury also combines with carbon to make organic mercury compounds. The most common one, methylmercury, is produced mainly by microscopic organisms in the water and soil. More mercury in the environment can increase the amounts of methylmercury that these small organisms make. Metallic mercury is used to produce chlorine gas and caustic soda, and is also used in thermometers, dental fillings, and batteries. Mercury salts are sometimes used in skin lightening creams and as antiseptic creams and ointments. G Methylmercury may be formed in water and soil by small organisms called bacteria. G Methylmercury builds up in the tissues of fish. Larger and older fish tend to have the highest levels of mercury.

How might I be exposed to mercury?


G Eating fish or shellfish contaminated with methylmercury. G Breathing vapors in air from spills, incinerators, and industries that burn mercury-containing fuels. G Release of mercury from dental work and medical treatments. G Breathing contaminated workplace air or skin contact during use in the workplace (dental, health services, chemical, and other industries that use mercury). G Practicing rituals that include mercury.

How can mercury affect my health?


The nervous system is very sensitive to all forms of mercury. Methylmercury and metallic mercury vapors are more harmful than other forms, because more mercury in these forms reaches the brain. Exposure to high levels of metallic, inorganic, or organic mercury can permanently damage the brain, kidneys, and developing fetus. Effects on brain functioning may result in irritability, shyness, tremors, changes in vision or hearing, and memory problems. Short-term exposure to high levels of metallic mercury vapors may cause effects including lung damage, nausea,

What happens to mercury when it enters the environment?


G Inorganic mercury (metallic mercury and inorganic mercury compounds) enters the air from mining ore deposits, burning coal and waste, and from manufacturing plants. G It enters the water or soil from natural deposits, disposal of wastes, and volcanic activity.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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MERCURY CAS # 7439-97-6

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


vomiting, diarrhea, increases in blood pressure or heart rate, skin rashes, and eye irritation. rooms where liquid mercury has been used. Learn about wildlife and fish advisories in your area from your public health or natural resources department.

How likely is mercury to cause cancer?


There are inadequate human cancer data available for all forms of mercury. Mercuric chloride has caused increases in several types of tumors in rats and mice, and methylmercury has caused kidney tumors in male mice. The EPA has determined that mercuric chloride and methylmercury are possible human carcinogens.

Is there a medical test to show whether Ive been exposed to mercury?


Tests are available to measure mercury levels in the body. Blood or urine samples are used to test for exposure to metallic mercury and to inorganic forms of mercury. Mercury in whole blood or in scalp hair is measured to determine exposure to methylmercury. Your doctor can take samples and send them to a testing laboratory.

How can mercury affect children?


Very young children are more sensitive to mercury than adults. Mercury in the mothers body passes to the fetus and may accumulate there. It can also can pass to a nursing infant through breast milk. However, the benefits of breast feeding may be greater than the possible adverse effects of mercury in breast milk. Mercurys harmful effects that may be passed from the mother to the fetus include brain damage, mental retardation, incoordination, blindness, seizures, and inability to speak. Children poisoned by mercury may develop problems of their nervous and digestive systems, and kidney damage.

Has the federal government made recommendations to protect human health?


The EPA has set a limit of 2 parts of mercury per billion parts of drinking water (2 ppb). The Food and Drug Administration (FDA) has set a maximum permissible level of 1 part of methylmercury in a million parts of seafood (1 ppm). The Occupational Safety and Health Administration (OSHA) has set limits of 0.1 milligram of organic mercury per cubic meter of workplace air (0.1 mg/m3) and 0.05 mg/m3 of metallic mercury vapor for 8-hour shifts and 40-hour work weeks.

How can families reduce the risk of exposure to mercury?


Carefully handle and dispose of products that contain mercury, such as thermometers or fluorescent light bulbs. Do not vacuum up spilled mercury, because it will vaporize and increase exposure. If a large amount of mercury has been spilled, contact your health department. Teach children not to play with shiny, silver liquids. Properly dispose of older medicines that contain mercury. Keep all mercury-containing medicines away from children. Pregnant women and children should keep away from

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1999. Toxicological profile for mercury. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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METHOXYCHLOR
CAS # 72-43-5
Division of Toxicology ToxFAQsTM September 2002

This fact sheet answers the most frequently asked health questions (FAQs) about methoxychlor. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to methoxychlor occurs mainly when workers, farmers, and gardeners use this pesticide. Most people are not exposed to this chemical on a regular basis. In animals, high levels of methoxychlor caused tremors and convulsions, and affected fertility. Little is known about the effects of methoxychlor on human health. Methoxychlor has been found in at least 58 of the 1,613 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is methoxychlor?
Methoxychlor is a manufactured chemical that does not occur naturally in the environment. Pure methoxychlor is a pale-yellow powder with a slight fruity or musty odor. Methoxychlor is used as an insecticide against flies, mosquitoes, cockroaches, chiggers, and a wide variety of other insects. It is used on agricultural crops and livestock, and in barns, grain storage bins, home garden, and on pets. Methoxychlor is also known as DMDT, Marlate, or Metox.

How might I be exposed to methoxychlor?


Most people are not exposed to methoxychlor on a regular basis. Low levels are sometimes found in food, but it is not usually detected in air or water. People who work in factories that make methoxychlor or products containing it may breathe it in the air or get it on their skin. People who work or live near farms that use methoxychlor on crops or livestock may be exposed to above average levels in air, soil, or water. People who use pesticides containing methoxychlor for home gardening or spraying pets may be exposed to aboveaverage levels in air and on their skin. People living near a hazardous waste site that contains methoxychlor may breathe it in air, swallow contaminated soil or water, or get it on their skin.

What happens to methoxychlor when it enters the environment?


Most methoxychlor enters the environment when it is applied to agricultural crops, forests, and farm animals. Methoxychlor released to the air eventually settles to the ground. In the soil it sticks strongly to particles. It does not dissolve easily in water. Once in water, it binds to sediments and settles to the bottom. Methoxychlor breaks down slowly in air, water and soil by sunlight and microscopic organisms. It may take several months. Some breakdown products of methoxychlor can be as harmful as methoxychlor. Methoxychlor does not usually build up in the food chain.

How can methoxychlor affect my health?


There is very little information on how methoxychlor can affect peoples health. Animals exposed to very high amounts of methoxychlor suffered tremors and convulsions and seizures. Because methoxychlor is broken down quickly in the body, you are not likely to experience these effects unless you are exposed to very high levels. Animal studies show that exposure to methoxychlor in food or water harms the ovaries, uterus, and mating cycle in females, and the testes and prostate in males. Fertility is

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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METHOXYCHLOR
CAS # 72-43-5
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decreased in both male and female animals. These effects can occur both in adult and in developing animals and could also occur following inhalation or skin contact. These effects are caused by a breakdown product of methoxychlor which acts as a natural sex hormone. These effects have not been reported in humans, but they could happen.

Never store pesticides in containers that might appear attractive to children, such as soda bottles. Methoxychlor may occur at very low levels in some food. Wash fruit and vegetables before consuming them. Encourage children not to play at or near hazardous waste sites.

How likely is methoxychlor to cause cancer?


Most of the information available from human and animal studies suggests that methoxychlor does not cause cancer. The International Agency for Research on Cancer (IARC) and the EPA have determined that methoxychlor is not classifiable as to its carcinogenicity to humans.

Is there a medical test to show whether Ive been exposed to methoxychlor?


There are laboratory tests that can detect methoxychlor in fat, blood, semen, and breast milk. These tests can only detect exposure within 24 hours because methoxychlor leaves your body quickly. These tests do not tell how much methoxychlor you were exposed to or whether harmful health effects will occur. The tests are not routinely available at the doctors office because they require special equipment.

How can methoxychlor affect children?


Little information is available on the health effects of children exposed to methoxychlor. Children exposed to large amounts of methoxychlor may suffer tremors and convulsions, as would probably occur in adults. However, we do not know whether children differ from adults in their susceptibility to methoxychlor. The process of sexual maturation may be altered in children born to women exposed to methoxychlor during pregnancy or in children exposed shortly after birth. This possibility is based on what we know from studies in animals. There are no studies that examined whether methoxychlor causes birth defects in humans.

Has the federal government made recommendations to protect human health?


The EPA limits the amount of methoxychlor that may be present in drinking water to 0.04 parts of methoxychlor per million parts of water (0.04 ppm). The EPA also limits the amount of methoxychlor present in agricultural products to 1-100 ppm. The Occupational Safety and Health Administration (OSHA) sets a Permissible Exposure Limit (PEL) of 15 milligrams of methoxychlor per cubic meter of air (15 mg/m3) in the workplace during an 8-hour shift. The Food and Drug Administration (FDA) limits the amount of methoxychlor in bottled water to 0.04 ppm.

How can families reduce the risk of exposure to methoxychlor?


Purchase an over-the-counter pesticide product containing methoxychlor that is unopened, labeled, and contains an EPA registration number. Follow the instructions and any warning statements on the label if you use over-the-counter pesticide products that contain methoxychlor. Prevent children from entering rooms or playing on lawns too soon after a pesticide has been applied. Prevent children from coming in contact with family pets or farm animals that have been treated with the pesticide.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2002. Toxicological Profile for Methoxychlor (Update). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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METHYL ISOCYANATE
CAS #624-83-9
Division of Toxicology ToxFAQsTM April 2002

This fact sheet answers the most frequently asked health questions (FAQs) about methyl isocyanate. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: People working in facilities that produce or use methyl isocyanate have the highest risk of being exposed to this chemical. Exposure to low levels of methyl isocyanate can cause eye and throat irritation. People exposed to high levels of methyl isocyanate in the air have experienced severe lung and eye damage. Methyl isocyanate has been found in at least 1 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is methyl isocyanate?
Methyl isocyanate is a colorless highly flammable liquid that evaporates quickly when exposed to the air. It has a sharp, strong odor. Methyl isocyanate is used in the production of pesticides, polyurethane foam, and plastics. Methyl isocyanate does not accumulate in the food chain.

How might I be exposed to methyl isocyanate?


Methyl isocyanate has been found in the smoke from tobacco, so people who smoke or breathe second-hand smoke may be exposed to this compound. You can be exposed to methyl isocyanate by breathing or touching it at workplaces where this compound is produced or used. People living near facilities which manufacture, store or use the chemical may breathe in low levels of it.

What happens to methyl isocyanate when it enters the environment?


When released to air, it will exist solely as a gas. Methyl isocyanate gas is degraded rapidly in the air by reacting with substances commonly found in the air. Methyl isocyanate will also be broken down by moisture from clouds and rainfall. It will only persist in the atmosphere a few hours to a few days before being degraded. Methyl isocyanate is rapidly (minutes to a few hours) degraded in water into other compounds. Most of the methyl isocyanate released to soil will be broken down into other compounds upon contact with moisture. Small amounts of methyl isocyanate may evaporate into air.

How can methyl isocyanate affect my health?


Methyl isocyanate can be harmful if you breathe it. The effects depend on how much you are exposed to and for how long. Exposure to low levels might cause eye and throat irritation that could cause you to cough or wheeze. Higher concentrations of methyl isocyanate gas could cause your lungs to swell, making it difficult to breathe. This could happen quickly or might not be noticed for a day or two. Exposure to high concentrations could result in severe damage to your lungs that might be fatal. If you were to

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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METHYL ISOCYANATE
CAS #624-83-9
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

survive severe damage to your lungs, they would probably heal. But, some damage might not be completely repaired. Long-term exposure to methyl isocyanate could result in long-term lung damage. If you were to get methyl isocyanate gas or liquid on your skin or in your eyes, you could develop chemical burns. Eye damage could be severe; in some cases, it could be permanent. You are not likely to come into skin contact with liquid methyl isocyanate. You are also not likely to swallow methyl isocyanate liquid, but if you did, your mouth, throat, esophagus, and stomach could become damaged. An increased rate of spontaneous abortion was seen in women who were pregnant when they were exposed to methyl isocyanate gas following the explosion of a tank containing liquid methyl isocyanate. But it is not known whether these effects were specifically linked to methyl isocyanate exposure.

similar to the effects seen in adults. We do not know whether children differ from adults in their susceptibility to methyl isocyanate. An increased rate of neonatal death was seen in babies whose mothers had been exposed during pregnancy to methyl isocyanate gas when a tank containing the chemical exploded. But it is not known whether these effects were specifically linked to methyl isocyanate exposure. Animal studies indicate that fetal exposure to methyl isocyanate may result in damage to the fetus.

How can families reduce the risk of exposure to methyl isocyanate?


Most families will not be exposed to significant levels of methyl isocyanate.

Is there a medical test to show whether Ive been exposed to methyl isocyanate?
Animal studies indicate that methyl isocyanate could be detected in your blood or urine. However, specific tests for the presence of methyl isocyanate in blood or urine are not generally useful. If you suspect that you may have been exposed to methyl isocyanate, chest x-rays, blood analyses, and breathing tests might show whether the lungs have been injured.

How likely is methyl isocyanate to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the U.S. EPA have not classified methyl isocyanate as to its carcinogenicity. There is no additional information to determine whether exposure to methyl isocyanate might cause cancer.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) has set an exposure limit of 0.02 parts of methyl isocyanate per million parts of workplace air (0.02 ppm) for an 8-hour workday, 40-hour work week.

How can methyl isocyanate affect children?


There are no studies on the health effects of children exposed to methyl isocyanate. It is likely that the health effects seen in children exposed to methyl isocyanate will be

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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METHYL MERCAPTAN
CAS # 74-93-1
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about methyl mercaptan. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Methyl mercaptan is a natural substance released from decaying matter. Little is known about the health effects of this compound. This chemical has been found in at least 2 of the 1,300 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is methyl mercaptan? (Pronounced mthl mr-kptn)


Methyl mercaptan is a colorless gas with a smell like rotten cabbage. It is a natural substance found in the blood, brain, and other tissues of people and animals. It is released from animal feces. It occurs naturally in certain foods, such as some nuts and cheese. Methyl mercaptan is released from decaying organic matter in marshes and is present in the natural gas of certain regions in the United States, in coal tar, and in some crude oils. It is manufactured for use in the plastics industry, in pesticides, and as a jet fuel additive. It is also released as a decay product of wood in pulp mills.

G Methyl mercaptan may be formed in water from chemical reactions. G It occurs naturally in soil.

How might I be exposed to methyl mercaptan?


G Methyl mercaptan is always present in your body. G You may breathe it in the air if you live near a natural source of the gas, such as a marsh. G You may eat it in certain foods, such as nuts and cheese. G You may be exposed if you work at a wood-pulp mill or sewage treatment plant. G You could also be exposed if you work in a factory that uses it to make other products such as jet fuel, pesticides, or poultry feed.

What happens to methyl mercaptan when it enters the environment?


G Methyl mercaptan is released to the air from both natural and industrial sources. G Most of the methyl mercaptan released to the environment goes into the air. G Sunlight can break it down in the air to other substances.

How can methyl mercaptan affect my health?


Very little is known about the health effects of methyl mercaptan. The only information available is about a worker exposed to very high levels of this compound when he opened and emptied tanks of this compound. He developed anemia, went into a coma, and died about a month later.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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METHYL MERCAPTAN CAS # 74-93-1

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


We do not know whether long-term exposure to low levels of methyl mercaptan can result in harmful health effects. The American Conference of Governmental and Industrial Hygienists (ACGIH) and the National Institute for Occupational Safety and Health (NIOSH) recommend an occupational exposure limit of 1 mg/m3 for methyl mercaptan. The federal recommendations have been updated as of July 1999.

How likely is methyl mercaptan to cause cancer?


There is no information available about whether methyl mercaptan causes cancer in people or animals. The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified methyl mercaptan for carcinogenicity.

Glossary
Anemia: A decreased ability of the blood to transport oxygen. Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Long-term: Lasting one year or longer. Milligram (mg): One thousandth of a gram. National Priorities List: A list of the nations worst hazardous waste sites. Pesticide: A substance that kills pests.

Is there a medical test to show whether Ive been exposed to methyl mercaptan?
Methyl mercaptan is always present in your body. There is a test that can be used to find out if it is present in your blood at levels that are higher than normal. This test requires special equipment and is not usually available in a doctors office. It can be done in a special laboratory. However, this test cannot be used to find out how much methyl mercaptan you were exposed to or to predict whether harmful health effects will occur.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological rofile for methyl mercaptan. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Has the federal government made recommendations to protect human health?


The EPA requires that discharges, spills, or accidental releases of 100 pounds or more of methyl mercaptan must be reported to the EPA. The Occupational Safety and Health Administration (OSHA) has set a permissible exposure limit of 20 milligrams of methyl mercaptan per cubic meter of air (20 mg/m3) for an 8-hour workday in a 40-hour workweek.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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METHYL PARATHION
CAS #298-00-0
Division of Toxicology ToxFAQsTM September 2001

This fact sheet answers the most frequently asked health questions (FAQs) about methyl parathion. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: The general population is probably not exposed to methyl parathion. However, exposure to methyl parathion may occur at farms where it has been used as a pesticide. Under certain exposure conditions, methyl parathion can affect the central nervous system resulting in dizziness, headache, difficulty breathing, vomiting, diarrhea, tremors, blurred vision, sweating, and possibly death. This chemical has been found in at least 16 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is methyl parathion? (Pronounced methul parah-thieon)
Methyl parathion is an insecticide that does not occur naturally in the environment. Pure methyl parathion exists as white crystals. Impure methyl parathion is a brownish liquid that smells like rotten eggs. Methyl parathion is used to kill insects on farm crops, especially cotton. The EPA now restricts how methyl parathion can be used and applied; only trained people are allowed to spray it. Methyl parathion can no longer be used on food crops commonly consumed by children.

How might I be exposed to methyl parathion?


Most people are not exposed to methyl parathion in the air they breathe or on things they touch, unless they live next to areas being sprayed. Farm workers, chemical sprayers, and people who work in factories that make methyl parathion are most likely to be exposed. People who live near farms where methyl parathion is used or near landfills where methyl parathion has been dumped may be exposed. Individuals may also be exposed by going into fields too soon after spraying.

What happens to methyl parathion when it enters the environment?


Methyl parathion enters the environment primarily through spraying on farm crops. Methyl parathion breaks down quickly to other chemical compounds by interacting with water, bacteria in the water, and sunlight. Methyl parathion sticks to soil and generally does not move from the soil to groundwater. Methyl parathion does not appear to accumulate in fish or plants.

How can methyl parathion affect my health?


Methyl parathion interferes with the normal way that the nerves and brain function. Exposure to very high levels of methyl parathion for a short period in air or water may cause death, loss of consciousness, dizziness, confusion, headaches, difficult breathing, chest tightness, wheezing, vomiting, diarrhea, cramps, tremors, blurred vision, and sweating. Changes in mental state may last several months after exposure to high levels of methyl parathion has ended. If people are exposed to levels of methyl parathion below those that affect nerve function, few or no health problems

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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METHYL PARATHION
CAS #298-00-0
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

seem to occur. A reduced ability to fight infections has also been seen in some animal studies; we do not know if this would also occur in humans.

Is there a medical test to show whether Ive been exposed to methyl parathion?
Methyl parathion can be detected in your blood and its breakdown product can be detected in your urine, but only within about 24 hours after your last exposure. If exposure is known or suspected, a test can be done that measures cholinesterase levels in your blood. However, low levels of cholinesterase may be a result of methyl parathion exposure or it could be caused by factors other than methyl parathion. These tests are not usually available at your doctors office, but your doctor can send the samples to a laboratory that can perform the tests. None of these tests, however, can predict whether you will experience any health effects.

How likely is methyl parathion to cause cancer?


There is no evidence that methyl parathion causes cancer in people who are regularly exposed, such as farmers and pesticide applicators, or in animals. The EPA and International Agency for Research on Cancer (IARC) has determined that methyl parathion is not classifiable as to human carcinogenicity.

How can methyl parathion affect children?


It is likely that health effects seen in children exposed to high levels of methyl parathion will be similar to the effects seen in adults. It is not known whether children are more sensitive to the effects of methyl parathion than adults. There is some indication that young rats may be more sensitive than adults to nervous system effects. Birth defects have not been observed in humans exposed to methyl parathion or in the offspring of animals that ingested methyl parathion while pregnant.

Has the federal government made recommendations to protect human health?


The EPA allows 0.002 milligrams of methyl parathion per liter of drinking water (0.002 mg/L) for lifetime exposure of adults. The NIOSH recommends that a person in the workplace not be exposed to more than 0.2 milligram of methyl parathion per cubic meter of air (0.2 mg/m3) for a 10-hour workday, 40-hour workweek. The EPA allows a maximum of 0.1-1 part methyl parathion per million parts (0.1-1 ppm) of certain types of food.

How can families reduce the risk of exposure to methyl parathion?


The general population is not likely to be exposed to large amounts of methyl parathion. Some people living in the areas where methyl parathion is used on crops may be exposed to greater amounts of methyl parathion. Therefore, staying away from fields that have been recently sprayed may reduce exposure. Children should avoid playing in soils near uncontrolled hazardous waste sites where methyl parathion may have been discarded.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for Methyl Parathion Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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METHYL TERT-BUTYL ETHER (MTBE) CAS # 1634-04-4


Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about methyl tert-butyl ether (MTBE). For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Methyl tert-butyl ether (MTBE) is a flammable liquid which is used as an additive in unleaded gasoline. Drinking or breathing MTBE may cause nausea, nose and throat irritation, and nervous system effects. MTBE has been found in at least 11 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is methyl tert-butyl ether? (Pronounced mthl trsh-r bytl thr)
Methyl tert-butyl ether (MTBE) is a flammable liquid with a distinctive, disagreeable odor. It is made from blending chemicals such as isobutylene and methanol, and has been used since the 1980s as an additive for unleaded gasolines to achieve more efficient burning. MTBE is also used to dissolve gallstones. Patients treated in this way have MTBE delivered directly to their gall bladders through special tubes that are surgically inserted. q MTBE may stick to particles in water, which will cause it to eventually settle to the bottom sediment. q MTBE may be broken down quickly in the air by sunlight. q MTBE does not build up significantly in plants and animals.

How might I be exposed to MTBE?


q Touching the skin or breathing contaminated air while pumping gasoline. q Breathing exhaust fumes while driving a car. q Breathing air near highways or in cities. q Drinking, swimming, or showering in water that has been contaminated with MTBE. q Receiving MTBE treatment for gallstones.

What happens to MTBE when it enters the environment?


q MTBE quickly evaporates from open containers and surface water, so it is commonly found as a vapor in the air. q Small amounts of MTBE may dissolve in water and get into underground water. q It remains in underground water for a long time.

How can MTBE affect my health?


Breathing small amounts of MTBE for short periods may cause nose and throat irritation. Some people exposed to MTBE while pumping gasoline, driving their cars, or working

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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METHYL TERT-BUTYL ETHER (MTBE) CAS # 1634-04-4


ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

in gas stations have reported having headaches, nausea, dizziness, and mental confusion. However, the actual levels of exposure in these cases are unknown. In addition, these symptoms may have been caused by exposure to other chemicals. There are no data on the effects in people of drinking MTBE. Studies with rats and mice suggest that drinking MTBE may cause gastrointestinal irritation, liver and kidney damage, and nervous system effects.

Has the federal government made recommendations to protect human health?


The EPA has issued guidelines recommending that, to protect children, drinking water levels of MTBE not exceed 4 milligrams per liter of water (4 mg/L) for an exposure of 110 days, and 3 mg/L for longer-term exposures. The American Conference of Governmental Industrial Hygienists (ACGIH) has recommended an exposure limit of 40 parts of MTBE per million parts of air (40 ppm) for an 8hour workday, 40-hour workweek.

How likely is MTBE to cause cancer?


There is no evidence that MTBE causes cancer in humans. One study with rats found that breathing high levels of MTBE for long periods may cause kidney cancer. Another study with mice found that breathing high levels of MTBE for long periods may cause liver cancer. The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified MTBE as to its carcinogenicity.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or gas. Milligram (mg): One thousandth of a gram. ppm: Parts per million. Sediment: Mud and debris that have settled to the bottom of a body of water.

Source of Information
This ToxFAQs information is taken from the 1996 Toxicological Profile for Methyl tert-Butyl Ether produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Is there a medical test to show whether Ive been exposed to MTBE?


MTBE and its breakdown product, butyl alcohol, can be detected in your breath, blood, or urine for up to 1 or 2 days after exposure. These tests arent available at most doctors offices, but can be done at special laboratories that have the right equipment. There is no other test specific to determining MTBE exposure.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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4,4'-METHYLENEBIS(2-CHLOROANILINE) (MBOCA) CAS # 101-14-4


Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about 4,4'-methylenebis(2chloroaniline (MBOCA). For more information, call the ATSDR Information Center at 1-888-4228737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to 4,4'-methylenebis(2-chloroaniline) (MBOCA) happens mostly in the workplace by touching it or by breathing contaminated air. MBOCA is suspected of causing bladder cancer in people and animals. This chemical has been found in at least 4 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is 4,4'-methylenebis(2-chloroaniline) (MBOCA)? (Pronounced 4,4-mth ln bs 2-klr nln)
MBOCA is a synthetic chemical used primarily to make polyurethane products. Pure MBOCA is a colorless, crystalline solid, but the commonly used form is usually yellow, tan, or brown pellets. It has no smell or taste. Examples of these products include gears, gaskets, sport boots, roller skate wheels, shoe soles, rolls and belt drives in cameras, computers and copy machines, wheels and pulleys for escalators and elevators, components in home appliances, and various military applications. It is also used as a coating in chemical reactions to set glues, plastics, and adhesives. Because plastics have many uses, MBOCA is widely used. Other names for MBOCA include 4,4'-methylenebis(2-chloroaniline), methylene-bis-ortho-chloro-aniline, bisamine, DACPM, MCA, and MOCA. q MBOCA sticks strongly to soil particles. q It is not likely to enter groundwater. q MBOCA is not likely to evaporate from soil or water. q It is broken down by sunlight in air and by microscopic organisms in soil or water. q Levels of MBOCA can build up in the roots of vegetables grown in contaminated soil.

How might I be exposed to MBOCA?


q People who work with MBOCA may get it on their skin and breathe it in air. Skin contact is the most common way to be exposed. q It is sometimes found in root crops (such as carrots and beets) that people eat if the plants were grown in soil containing MBOCA. q People may be exposed through skin contact with soil contaminated with MBOCA or near waste sites or landfills. q It is not usually found in drinking water.

What happens to MBOCA when it enters the environment?


q It enters the environment from the disposal of solid waste from manufacturing plants that use MBOCA. q It doesn't dissolve in water easily.

How can MBOCA affect my health?


There is not much information on how MBOCA can affect peoples health. Studies of human exposure suggest that the small amounts of MBOCA usually found in the air or on surfaces in or near factories do not cause toxic effects.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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4,4'-METHYLENEBIS(2-CHLOROANILINE) (MBOCA) CAS # 101-14-4

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


Exposure to large amounts of MBOCA may cause harm, but no such exposures have been reported. We do not know if there are any other long-term health effects in people caused by MBOCA, other than cancer. One man was accidentally sprayed in his face with hot MBOCA. He felt nauseated and his kidneys were affected, but these effects lasted less than one day. MBOCA is harmful to blood cells and the liver in dogs and rats. Researchers do not know if MBOCA causes birth defects in people.

Has the federal government made recommendations to protect human health?


The Environmental Protection Agency (EPA) has classified MBOCA as a hazardous waste that must meet specific disposal requirements. The EPA requires that spills or accidental releases of MBOCA into the environment of 10 pounds or more must be reported to EPA. The American Conference of Governmental Industrial Hygienists (ACGIH) set a maximum level of 0.11 milligrams of MBOCA per cubic meter (0.11 mg/m3) of workplace air for an 8-hour workday, 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) recommends an exposure limit of 3 micrograms of MBOCA per cubic meter of air (3 mg/m3) over a 10-hour day. These agencies advise avoiding eye and skin contact because this may be a route of significant exposure.

How likely is MBOCA to cause cancer?


The Department of Health and Human Services has determined that MBOCA may reasonably be anticipated to be a carcinogen. MBOCA is suspected of causing bladder cancer in people. Information is being gathered to determine whether bladder cancer in people may result from short-, medium-, or long-term exposures to MBOCA. A few studies have found an above-normal number of bladder tumors in workers exposed to MBOCA for several years. It caused lung, liver, breast, and bladder cancer in rats, mice, and dogs that ate MBOCA for over a year.

Glossary
Carcinogen: A substance that can cause cancer. Microgram (mg): One millionth of a gram. Milligram (mg): One thousandth of a gram.

Is there a medical test to show whether Ive been exposed to MBOCA?


Laboratory tests can measure MBOCA in urine. The test must be done within a short period after you are exposed because it is broken down quickly by your body. The test does not tell how much MBOCA you've been exposed to or if harmful effects will occur. The test is not routinely available at your doctors office, but a sample taken in the doctor's office can be shipped to a special laboratory if necessary.

Tumor: An abnormal mass of tissue.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1994. Toxicological profile for 4,4'-methylenebis(2chloroaniline) (MBOCA). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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METHYLENE CHLORIDE
CAS # 75-09-2
Division of Toxicology ToxFAQsTM February 2001

This fact sheet answers the most frequently asked health questions (FAQs) about methylene chloride. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to methylene chloride occurs mostly from breathing contaminated air, but may also occur through skin contact or by drinking contaminated water. Breathing in large amounts of methylene chloride can damage the central nervous system. Contact of eyes or skin with methylene chloride can result in burns. Methylene chloride has been found in at least 882 of 1,569 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is methylene chloride?
Methylene chloride is a colorless liquid with a mild, sweet odor. Another name for it is dichloromethane. Methylene chloride does not occur naturally in the environment. Methylene chloride is used as an industrial solvent and as a paint stripper. It may also be found in some aerosol and pesticide products and is used in the manufacture of photographic film.

How might I be exposed to methylene chloride?


[ The most likely way to be exposed to methylene chloride is by breathing contaminated air. [ Breathing the vapors given off by products containing methylene chloride. Exposure to high levels of methylene chloride is likely if methylene chloride or a product containing it is used in a room with inadequate ventilation.

What happens to methylene chloride when it enters the environment?


[ Methylene chloride is mainly released to the environment in air. About half of the methylene chloride in air disappears in 53 to 127 days. [ Methylene chloride does not easily dissolve in water, but small amounts may be found in drinking water. [ We do not expect methylene chloride to build up in plants or animals.

How can methylene chloride affect my health?


If you breathe in large amounts of methylene chloride you may feel unsteady, dizzy, and have nausea and a tingling or numbness of your finger and toes. A person breathing smaller amounts of methylene chloride may become less attentive and less accurate in tasks requiring hand-eye coordination. Skin contact with methylene chloride causes burning and redness of the skin.

How likely is methylene chloride to cause cancer?


We do not know if methylene chloride can cause cancer in humans. An increased cancer risk was seen in mice

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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METHYLENE CHLORIDE
CAS # 75-09-2
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

breathing large amounts of methylene chloride for a long time. The World Health Organization (WHO) has determined that methylene chloride may cause cancer in humans. The Department of Health and Human Services (DHHS) has determined that methylene chloride can be reasonably anticipated to be a cancer-causing chemical. The EPA has determined that methylene chloride is a probable cancer-causing agent in humans.

These tests are not routinely available in your doctors office. [ Methylene chloride can be detected in the air you breathe out and in your blood. These tests are only useful for detecting exposures that have occurred within a few days. [ It is also possible to measure carboxyhemoglobin (a chemical formed in the blood as methylene chloride breaks down in the body) in the blood or formic acid (a breakdown product of methylene chloride) in the urine. These tests are not specific for methylene chloride.

How can methylene chloride affect children?


It is likely that health effects seen in children exposed to high amounts of methylene chloride will be similar to the effects seen in adults. We do not know if methylene chloride can affect the ability of people to have children or if it causes birth defects. Some birth defects have been seen in animals inhaling very high levels of methylene chloride.

Has the federal government made recommendations to protect human health?


[ The EPA requires that releases of methylene chloride of 1,000 pounds or more be reported to the federal government. [ The EPA recommends that exposure of children to methylene chloride be limited to less than 10 milligrams per liter of drinking water (10 mg/L) for 1 day or 2 mg/L for 10 days. [ The Food and Drug Administration (FDA) has established limits on the amounts of methylene chloride that can remain after processing of spices, hops extract, and decaffeinated coffee. [ The Occupational Safety and Health Administration (OSHA) has set limits of 25 parts methylene chloride per million parts of workplace air (25 ppm) for 8-hour shifts and 40-hour work weeks.

How can families reduce the risk of exposure to methylene chloride?


[ Families may be exposed to methylene chloride while using products such as paint removers. Such products should always be used in well-ventilated areas and skin contact should be avoided. [ Children should not be allowed to remain near indoor paint removal activities.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2000. Toxicological Profile for methylene chloride. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Is there a medical test to show whether Ive been exposed to methylene chloride?
[ Several tests can measure exposure to methylene chloride.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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4,4'-METHYLENEDIANILINE
CAS # 101-77-9
Agency for Toxic Substances and Disease Registry ToxFAQs August 1999

This fact sheet answers the most frequently asked health questions (FAQs) about 4,4'-methylenedianiline. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to 4,4'-methylenedianiline occurs mainly in the workplace. Liver damage and skin irritation may occur from exposure to high levels of 4,4'-methylenedianiline. This chemical has been found in none of the 1,445 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is 4,4'-methylenedianiline? (Pronounced mthl-n d nln)


4,4'-Methylenedianiline is an industrial chemical that is not known to occur naturally. It is also commonly known as diaminodiphenylmethane or MDA. It occurs as a colorless to pale yellow solid and has a faint odor. 4,4'-Methylenedianiline is used mainly for making polyurethane foams, which have a variety of uses, such as insulating materials in mailing containers. It is also used for making coating materials, glues, Spandex fiber, dyes, and rubber.

q 4,4'-Methylenedianiline becomes strongly attached to


soil and will not easily move into groundwater.

q It may take as long as 10 days for bacteria and microorganisms in soil to break down 4,4'-methylenedianiline.

How might I be exposed to 4,4'-methylenedianiline? q Working in an industry that makes or uses 4,4'-methylenedianiline.

q Touching consumer goods such as polyurethane foams


that contain it.

q Living near a hazardous waste site where 4,4'-methyleneWhat happens to 4,4'-methylenedianiline when it enters the environment? q 4,4'-Methylenedianiline is found in tiny particles in air
which will settle to land or water in rain or snow. dianiline is disposed of.

q Being treated by a kidney dialysis machine. Tiny

amounts are released from the polyurethane parts of the machine when it is sterilized by radiation or heat.

q Most of the 4,4'-methylenedianiline in water will attach


itself to particles and sink to the bottom sediment. ken down by bacteria and other microorganisms.

q 4,4'-Methylenedianiline in water or sediment will be broq It does not build up in the food chain.

How can 4,4'-methylenedianiline affect my health?


Limited information is available on the effects of 4,4'-methylenedianiline on peoples health. The available

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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4,4'-METHYLENEDIANILINE CAS # 101-77-9

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


information shows that it can cause skin irritation and liver damage. People who accidentally ate bread baked from flour contaminated with 4,4'-methylenedianiline became ill with a flu-like condition, consisting of stomach and chest pains. They also exhibited jaundice, a yellowish coloring of the skin or internal organs caused by abnormal functioning of the liver. Animals that breathed very high levels of 4,4'-methylenedianiline showed eye damage, while animals that ate food or drank water with moderate amounts of 4,4'-methylenedianiline for months or years had liver damage and thyroid gland injuries. Exposure of the skin to high levels of the chemical also resulted in liver damage in animals. It is not known whether 4,4'-methylenedianiline can affect the development of the fetus or the ability to fight disease in people or animals. but cannot predict the kind of health effects that might occur. These tests are not routinely available in doctors offices and hospitals because they require special equipment.

Has the federal government made recommendations to protect human health?


The EPA requires that spills or accidental releases into the environment of 1 pound or more of 4,4'-methylenedianiline be reported to the EPA. The Occupational Safety and Health Administration has set an occupational exposure limit of 0.081 milligrams of methylenedianiline per cubic meter of air (0.081 mg/m3) for an 8-hour workday, 40-hour workweek. The National Institute for Occupational Safety and Health recommends that workers should not breathe air containing more than 0.03 mg/m3 of 4,4'-methylenedianiline during a 10-hour workday, 40-hour workweek.

How likely is 4,4'-methylenedianiline to cause cancer?


The International Agency for Research on Cancer has determined that 4,4'-methylenedianiline is possibly carcinogenic to humans. A study on people exposed to bread contaminated with 4,4'-methylenedianiline did not show an increased risk of cancer. An animal study showed cancer of the liver and thyroid after animals drank water over their lifetimes containing 4,4'-methylenedianiline.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Milligram (mg): One thousandth of a gram.

Source of information
Agency for Toxic Substances and Disease Registry (ATSDR). 1998. Toxicological profile for methylenedianiline. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Is there a medical test to show whether Ive been exposed to 4,4'-methylenedianiline?


4,4'-Methylenedianiline can be measured in your urine to see if you have been recently exposed to the chemical. These tests can show you were exposed to 4,4'-methylenedianiline,

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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MIREX AND CHLORDECONE


CAS # 2385-85-5 and 143-50-5
Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about mirex and chlordecone. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to mirex and chlordecone occurs mainly from touching or eating soil or food that contains the chemicals. At high levels, these chemicals may cause damage to the skin, liver, or nervous and reproductive systems. Mirex has been found in at least 7 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA); chlordecone has been found at 2 sites.
What are mirex and chlordecone?
(Pronounced mrks and klrd-kn) Mirex and chlordecone are two separate, but chemically similar, manufactured insecticides that do not occur naturally in the environment. Mirex is a white crystalline solid, and chlordecone is a tan-white crystalline solid. Both chemicals are odorless. Mirex and chlordecone have not been manufactured or used in the United States since 1978. Mirex was used to control fire ants, and as a flame retardant in plastics, rubber, paint, paper, and electrical goods from 1959 to 1972. Chlordecone was used as an insecticide on tobacco, ornamental shrubs, bananas, and citrus trees, and in ant and roach traps. Mirex was sold as a flame retardant under the trade name Dechlorane, and chlordecone was also known as Kepone. Use of trade names is for identification only and does not imply endorsement by the Agency for Toxic Substances and Disease Registry, the Public Health Service, or the U.S. Department of Health and Human Services. G Mirex and chlordecone do not dissolve easily in water, but they easily stick to soil and sediment particles. G They are not likely to travel far through the soil and into underground water. G They can build up in fish or other organisms that live in contaminated water or that eat other contaminated animals.

How might I be exposed to mirex and chlordecone?


G Touching or ingesting contaminated soil near hazardous waste sites. G Ingesting contaminated fish or other animals living near hazardous waste sites. G Nursing infants of mothers living near hazardous waste sites may be exposed to mirex through their mothers' milk. G Drinking water or breathing air is not likely to cause exposure because these compounds do not easily dissolve in water or evaporate.

What happens to mirex and chlordecone when they enter the environment?
G Mirex and chlordecone break down slowly in the environment, and they may stay for years in soil and water. G They do not evaporate to any great extent from surface water or surface soil.

How can mirex and chlordecone affect my health?


We do not know how mirex affects the health of people. Workers who were exposed to high levels of chlordecone over a long period (more than one year) showed harmful effects on the nervous system, skin, liver, and male reproductive system. These workers were probably exposed mainly through touch-

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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MIREX AND CHLORDECONE CAS # 2385-85-5 and 143-50-5

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


ing chlordecone, although they may have inhaled or ingested some as well. Animal studies with chlordecone have shown effects similar to those seen in people, as well as harmful kidney effects, developmental effects, and effects on the ability of females to reproduce. We do not know if these last three effects also occur in people. Animal studies have shown that ingesting high levels of mirex can harm the stomach, intestine, liver, kidneys, eyes, thyroid, and nervous and reproductive systems. from harmful effects. The EPA suggests that ingesting an amount of mirex equal to 200 picograms (pg) per kilogram (kg) of your body weight per day is not likely to cause significant harmful health effects. The Food and Drug Administration (FDA) suggests that eating fish and other foods with concentrations below 100 ppt of mirex, or concentrations of chlordecone below 400 ppt, will not cause harmful health effects in people. The EPA requires that discharges or spills into the environment of 1 pound or more of chlordecone be reported. The National Institute for Occupational Safety and Health (NIOSH) recommends that average workplace air levels not exceed 1 microgram per cubic meter (1 /gm3) of chlordecone over a 10-hour period.

How likely are mirex and chlordecone to cause cancer?


The Department of Health and Human Services (DHHS) has determined that mirex and chlordecone may reasonably be anticipated to be carcinogens. There are no studies available on whether mirex and chlordecone are carcinogenic in people. However, studies in mice and rats have shown that ingesting mirex and chlordecone can cause liver, adrenal gland, and kidney tumors.

Glossary
Carcinogen: A substance that can cause cancer. CAS: Chemical Abstracts Service. Ingesting: Taking food or drink into your body. Insecticide: A substance that kills insects. Kilogram (kg): One thousand grams. Microgram (g): One millionth of a gram. Picogram (pg): One trillionth of a gram. Sediment: Mud and debris that have settled to the bottom of a body of water.

Is there a medical test to show whether Ive been exposed to mirex and chlordecone?
Tests are available that measure the amount of mirex in blood, feces, fat, or milk, and the amount of chlordecone in blood, saliva, feces, or bile. However, these tests may require special equipment and they may not be available at your doctors office.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for mirex and chlordecone. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Has the federal government made recommendations to protect human health?


The EPA has set a limit of 1 part of mirex per trillion parts of surface water (1 ppt) to protect fish and other aquatic life

Where can I get more information?

For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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MUSTARD GAS
CAS #505-60-2
Division of Toxicology ToxFAQsTM September 2001

This fact sheet answers the most frequently asked health questions (FAQs) about mustard gas. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: The general population is not exposed to mustard gas. Mustard gas can cause irritation and burns of the skin, eyes, and respiratory tract, reproductive effects, and may cause cancer of the respiratory tract. This chemical has been found in at least 3 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is mustard gas?
Mustard gas refers to several manufactured chemicals, including sulfur mustard, that do not occur naturally in the environment Mustard gas is actually a liquid and is not likely to change into a gas immediately if it is released at ordinary temperatures. As a pure liquid, it is colorless and odorless, but when mixed with other chemicals, it looks brown and has a garlic-like smell. Mustard gas has been used in chemical warfare and was made in large amounts during World Wars I and II. It was reportedly used in the Iran-Iraq war in 19801988. It is not presently used in the United States, except for research purposes, and the U.S. Department of Defense must destroy all remaining stocks of mustard gas by 2004.

How might I be exposed to mustard gas?


Mustard gas is no longer made in the United States and is only stored at a few military storage sites; therefore, the general public is not exposed to mustard gas. Individuals working at or living near these military storage sites may be exposed to mustard gas if there was an accidental spill or unplanned release. Occupational exposures are currently limited to soldiers in some combat situations; those involved in its shipment, storage, or disposal; and construction workers at storage sites.

How can mustard gas affect my health?


Mustard gas can cause skin burns and blisters, especially around sweaty parts of the body. It is more harmful to the skin on hot, humid days, or in tropical climates. Mustard gas makes your eyes burn, your eyelids swell, and causes you to blink a lot. If you breathe mustard gas, it can cause coughing, bronchitis, and long-term respiratory disease. Exposure to a large amount of mustard gas can cause death. Some men exposed to mustard gas during war have experienced lower sperm counts.

What happens to mustard gas when it enters the environment?


Mustard gas would primarily enter the environment through an accidental release. In soil and water, some mustard gas evaporates into the air and the rest breaks down in minutes to days depending on environmental conditions. Mustard gas reacts with chemicals in the air to form other compounds. Mustard gas does not move from soil to groundwater, and it does not build up in the tissues of animals because it breaks down quickly.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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MUSTARD GAS
CAS #505-60-2
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

How likely is mustard gas to cause cancer?


Studies of people exposed during the production process or during war, as well as animal studies, have shown that mustard gas may cause respiratory cancer. The Department of Health and Human Services (DHHS) and the International Agency for Research on Cancer (IARC) have determined that mustard gas is carcinogenic to humans.

Is there a medical test to show whether Ive been exposed to mustard gas?
Mustard gas or its breakdown products can be detected in your blood and urine within a few weeks after your last exposure. These tests are not usually available at your doctors office, but your doctor can send the samples to a laboratory that can perform the tests. None of these tests, however, can predict whether you will experience any health effects.

How can mustard gas affect children?


Mustard gas causes the eyes and skin of children to burn similarly to adults; however, the burns are more severe and blisters appear sooner in children. Limited human and animal data indicate that mustard gas may cause birth defects or otherwise affect development. It is not known if mustard gas can cross the placenta or be passed to infants in breast milk.

Has the federal government made recommendations to protect human health?


The Centers for Disease Control and Prevention (CDC) has proposed a mustard gas 8-hour time-weighted average (TWA) airborne exposure limit (AEL) of 0.003 milligrams per cubic meter of air (0.003 mg/m3) for agent workers, and a 72-hour TWA AEL of 0.0001 mg/m3 for the general population. A ceiling value indicating a maximum exposure concentration at any time, for any duration, of 0.003 mg/m3 has also been proposed.

How can families reduce the risk of exposure to mustard gas?


The risk of exposure to mustard gas is generally low, but may be greater for those who live or work near Army bases and facilities that store it. Mustard gas is currently being destroyed at these facilities and the risk of exposure due to accidents is minimal. Children should avoid playing near uncontrolled hazardous waste sites where mustard gas may have been discarded.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for Mustard Gas (Draft for Public Comment) Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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n-NITROSODIMETHYLAMINE
CAS #62-75-9
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about n-nitrosodimethylamine. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: n-Nitrosodimethylamine is produced by industry in small amounts but may be formed in the environment from chemical reactions. It causes liver cancer in animals. This chemical has been found in at least 1 of the 1,177 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is n-nitrosodimethylamine? (Pronounced n ntr-s d mth-l-mn)
n-Nitrosodimethylamine is produced by industry only in small amounts for research. At room temperature, it is a yellow liquid with no distinct odor. It was used to make rocket fuel, but this use was stopped after unusually high levels of this chemical were found in air, water, and soil samples collected near a rocket fuel manufacturing plant. It is used in some cosmetic and toiletry products and in cleansers. n-Nitrosodimethylamine is unintentionally formed during various manufacturing processes and in air, water, and soil from reactions involving other chemicals called alkylamines. It is also found in some foods and may be formed in the body. G In water, it may break down when exposed to sunlight or by natural biological processes. G When released to soil, it may evaporate into air. G It could also sink down into deeper soil.

How might I be exposed to n-nitrosodimethylamine?


G Eating food containing it, such as cured meats, fish, and cheese. G Using toiletry and cosmetic products such as shampoos and cleansers that contain it. G Breathing or inhaling cigarette smoke, which may contain low levels. G Eating foods containing alkylamines, which can cause n-nitrosodimethylamine to form in the stomach. G Working in industries such as tanneries, pesticide manufacturing plants, and rubber and tire plants.

What happens to n-nitrosodimethylamine when it enters the environment?


G n-Nitrosodimethylamine may be found in air, water, and soil. G When released to the air, it is broken down by sunlight in a matter of minutes.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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n-NITROSODIMETHYLAMINE CAS # 62-75-9

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html Has the federal government made recommendations to protect human health?
The EPA recommends that levels in lakes and streams should be limited to 0.00069 parts of n-nitrosodimethylamine per billion parts of water (0.00069 ppb) to prevent possible health effects from drinking water or eating fish contaminated with n-nitrosodimethylamine. The EPA requires that spills or accidental releases of 10 pounds or more of n-nitrosodimethylamine be reported to the EPA. The federal recommendations have been updated as of July 1999.

How can n-nitrosodimethylamine affect my health?


When people were exposed to very high levels of n-nitrosodimethylamine, liver damage occurred. Little else is known about the heath effects of n-nitrosodimethylamine in people. Liver effects have also been seen in animals that ate food, drank water, or breathed air containing high levels of n-nitrosodimethylamine. Mice that were fed n-nitrosodimethylamine during pregnancy had offspring that were born dead or died shortly after birth.

How likely is n-nitrosodimethylamine to cause cancer?


n-Nitrosodimethylamine exposure has been shown to result in an increase in liver and lung cancer in animals. No information is available on whether it causes cancer in people. The Department of Health and Human Services (DHHS) has determined that n-nitrosodimethylamine may reasonably anticipated to be a human carcinogen.

Glossary
Carcinogen: A substance that can cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. National Priorities List: A list of the nations worst hazardous waste sites. Pesticide: A substance that kills pests. ppb: Parts per billion.

Is there a medical test to show whether Ive been exposed to n-nitrosodimethylamine?


Samples of your blood and urine can be tested to determine if you have been recently exposed to n-nitrosodimethylamine. These tests must be done soon after the exposure occurred. These tests will not tell you whether your health will be affected by n-nitrosodimethylamine. They are not routinely available in hospitals and clinics because they require special equipment.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1989. Toxicological profile for n-nitrosodimethylamine. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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n-NITROSODIPHENYLAMINE
CAS # 86-30-6
Agency for Toxic Substances and Disease Registry ToxFAQs April 1993

This fact sheet answers the most frequently asked health questions (FAQs) about n-nitrosodiphenylamine. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: The general population and people in the workplace are probably not exposed to n-nitrosodiphenylamine. People living near hazardous waste sites may, however, be exposed to it by drinking contaminated water or by touching or breathing contaminated soil and dust. Limited animal studies suggest that n-nitrosodiphenylamine can damage the bladder and kidneys. It has been found in at least 172 of 1,300 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is n-nitrosodiphenylamine? (Pronounced n-n tr'-s d-fnl mn)
n-Nitrosodiphenylamine is an industrial compound. It is an orange-brown or yellow solid that has been produced since 1945. n-nitrosodiphenylamine is used to make rubber products such as tires or to make other chemicals. In the early 1980s, most U.S. rubber manufacturers replaced it with more efficient chemicals. Today, only one manufacturer in the United States produces n-nitrosodiphenylamine. We do not know if it occurs naturally in the environment. There is some evidence that microorganisms make it. G It dissolves in water, but it binds to soil and does not move quickly through soil. G It breaks down in air, water, and soil within several weeks. G We dont know what the breakdown substances are in humans or whether they are harmful to you. G We dont find it in our normal drinking water, foods, or air. G Water organisms take some into their bodies, but they dont appear to build up high levels. G We dont know if land animals or plants take it up and store it in their bodies.

How might I be exposed to n-nitrosodiphenylamine?


G The likelihood of exposure is very low. G Exposure in the workplace is not likely (only one company makes it today). G Drinking water near hazardous waste sites may be contaminated. G Touching or breathing contaminated waste or soils near hazardous waste sites may result in higher exposures.

What happens to n-nitrosodiphenylamine when it enters the environment?


G It evaporates slowly to the air or leaks into the ground from waste sites. G In air, n-nitrosodiphenylamine attaches to dust particles and can move with the wind.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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n-NITROSODIPHENYLAMINE CAS # 86-30-6

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html How can n-nitrosodiphenylamine affect my health?
There is very little information on the effects of n-nitrosodiphenylamine on human health. There is also not enough information from animal studies to estimate how exposure to it will affect your health. Animal studies have identified levels and exposures that can cause death. Animals given high levels of n-nitrosodiphenylamine in their diets for long periods of time developed swelling, cancer of the bladder, and changes in body weight. We dont know if these effects would occur in humans. We also dont know if it can affect pregnancy or cause birth defects. n-nitrosodiphenylamine and its breakdown products in the blood and urine of exposed animals, but these tests have not been used for people.

Has the federal government made recommendations to protect human health?


The EPA recommends limits on how much n-nitrosodiphenylamine can be present in bodies of water such as lakes and rivers. The recommended levels are 49,000 nanograms or less of n-nitrosodiphenylamine per liter of water (49,000 ng/L). At this level, EPA estimates that your risk of getting cancer is very low. For drinking water, the EPA set a limit of 700 micrograms or less of n-nitrosodiphenylamine per liter of drinking water (700 g/L). n-Nitrosodiphenylamine is also considered to be a hazardous waste, and the EPA requires industry to immediately report a spill of more than 100 pounds to the National Response Center of the federal government.

How likely is n-nitrosodiphenylamine to cause cancer?


The EPA has determined that n-nitrosodiphenylamine is a probable human carcinogen. This is based on a long-term study in rats showing an increase in bladder cancer in the group exposed to high levels of n-nitrosodiphenylamine. There is no evidence that it causes bladder cancer in people. Although EPA has classified n-nitrosodiphenylamine as a probable carcinogen, the animal data are limited. Other public health agencies have concluded that no evaluation of n-nitrosodiphenylamines carcinogenicity in people is currently possible. Additional research is needed.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Ingestion: Taking food or drink into your body. Microgram (g): One millionth of a gram. Nanogram (ng): One billionth of a gram.

References Is there a medical test to show whether Ive been exposed to n-nitrosodiphenylamine?
No tests are available to determine if you have been exposed to n-nitrosodiphenylamine. There are tests to detect Agency for Toxic Substances and Disease Registry (ATSDR). 1993. Toxicological profile for n-nitrosodiphenylamine. Atlanta: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information?

For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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n-NITROSODI-nPROPYLAMINE
CAS # 621-64-7
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about n-nitrosodi-n-propylamine. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: N-Nitrosodi-n-propylamine is a chemical produced by industry in small amounts for research. Evidence from animal studies indicates that it may cause cancer. This chemical has been found in at least 1 of the 1,177 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is n-nitrosodi-n-propylamine? (Pronounced n-n-trs-d'n-prpl-'mn)
n-Nitrosodi-n-propylamine is a chemical produced by industry in small amounts for research. It is a yellow liquid at room temperature. Small amounts of n-nitrosodi-n-propylamine are produced as a side reaction during some manufacturing processes, as a contaminant in some weed killers, and during the manufacture of some rubber products.

How might I be exposed to n-nitrosodi-npropylamine?


G People may be exposed to low levels by eating foods treated with sodium-nitrite preservatives and by drinking certain alcoholic beverages. G Low levels may occur in cigarette smoke. G Workers in the rubber industry could be exposed to n-nitrosodi-n-propylamine. G People applying contaminated weed killers could be exposed to low levels of the chemical.

What happens to n-nitrosodi-n-propylamine when it enters the environment?


G Low levels of n-nitrosodi-n-propylamine could be released to the environment from contaminated products or from disposal of waste containing this chemical. G If released to the air, it is broken down by sunlight within a few hours. G Low levels of n-nitrosodi-n-propylamine could occur in water from use of weed killers containing it. G It is broken down in water within a few hours. G It evaporates from the soil surface or is broken down by bacteria.

How can n-nitrosodi-n-propylamine affect my health?


No information is available on the effects of n-nitrosodin-propylamine in people. Studies in animals have shown effects on the liver, lung, stomach, kidneys, and heart at very high doses.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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n-NITROSODI-n-PROPYLAMINE CAS # 621-64-7

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

How likely is n-nitrosodi-n-propylamine to cause cancer?


No studies are available on whether or not n-nitrosodi-npropylamine causes cancer in people. Animal studies have shown an increase in cancer of the liver, nose, and stomach from n-nitrosodi-n-propylamine exposure. The Department of Health and Human Services (DHHS) has determined that n-nitrosodi-n-propylamine may reasonably be anticipated to be a human carcinogen.

billion parts of water (0.005 ppb) to prevent possible health effects from drinking water or ingesting fish contaminated with n-nitrosodi-n-propylamine. The federal recommendations have been updated as of July 1999.

Glossary
Carcinogen: A substance that can cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. National Priorities List: A list of the nations worst hazardous waste sites. ppb: Parts per billion.

Is there a medical test to show whether Ive been exposed to n-nitrosodi-n-propylamine?


Samples of your blood and urine can be tested to determine if you have been recently exposed to n-nitrosodi-npropylamine. These tests must be done soon after the exposure occurred. These tests will not tell you whether your health will be affected by n-nitrosodi-n-propylamine. The tests are not routinely available in hospitals and clinics because they require special equipment.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1989. Toxicological profile for n-nitrosodi-npropylamine. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Has the federal government made recommendations to protect human health?


The EPA recommends that levels in lakes and streams should be limited to 0.005 parts n-nitrosodi-n-propylamine per

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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NAPHTHALENE
CAS # 91-20-3
Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about naphthalene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to naphthalene happens mostly from breathing air contaminated from the burning of wood or fossil fuels, industrial discharges, tobacco smoke, or moth repellents. Exposure to large amounts of naphthalene may damage or destroy some of your red blood cells. Naphthalene has been found in at least 536 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is naphthalene?
(Pronounced nfth-ln) Naphthalene is a white solid that is found naturally in fossil fuels. Burning tobacco or wood produces naphthalene. It has a strong, but not unpleasant smell. The major products made from naphthalene are moth repellents. It is also used for making dyes, resins, leather, tanning agents, and the insecticide, carbaryl. G If dairy cows are exposed to naphthalene, some of it will be in their milk. G If laying hens are exposed, some of it will be in their eggs.

How might I be exposed to naphthalene?


G Breathing low levels in outdoor air. G Breathing air contaminated from industrial discharges or from burning wood or fossil fuels. G Breathing air in homes or businesses where cigarettes are smoked, wood is burned, or moth repellents are used. G Drinking water from contaminated wells. G Touching clothing, blankets, or coverlets that are treated with naphthalene.

What happens to naphthalene when it enters the environment?


G Naphthalene enters the environment from industrial uses, and from its use as a moth repellent. G It also enters from the burning of wood or tobacco, and from accidental spills. G Naphthalene evaporates easily. G In air, moisture and sunlight break it down, often within 1 day. G Naphthalene in water is destroyed by bacteria or evaporates into the air. G Naphthalene binds weakly to soils and sediment. G It does not accumulate in animals or fish.

How can naphthalene affect my health?


Exposure to large amounts of naphthalene may damage or destroy some of your red blood cells. This could cause you to have too few red blood cells until your body replaces the destroyed cells. People, particularly children, have developed this problem after eating naphthalene-containing mothballs or deodorant blocks. Some of the symptoms of this

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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NAPHTHALENE CAS # 91-20-3

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

problem are fatigue, lack of appetite, restlessness, and pale skin. Exposure to large amounts of naphthalene may also cause nausea, vomiting, diarrhea, blood in the urine, and a yellow color to the skin. Animals sometimes develop cloudiness in their eyes after swallowing naphthalene. It is not clear if this also develops in people. When mice were repeatedly exposed to naphthalene vapors for 2 years, their noses and lungs became inflamed and irritated.

Has the federal government made recommendations to protect human health?


The EPA recommends that children not drink water containing over 0.5 parts of naphthalene per million parts of water (0.5 ppm) for more than 10 days, or 0.4 ppm for longer than 7 years. Adults should not drink water with more than 1 ppm for more than 7 years. For water consumed over a lifetime, the EPA suggests it contain no more than 0.02 ppm naphthalene. The EPA requires that discharges or spills into the environment of 100 pounds or more be reported. The Occupational Safety and Health Administration (OSHA) has set a limit of 10 parts per million (10 ppm) for the level of naphthalene in workplace air over an 8-hour workday, 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) considers more than 250 ppm of naphthalene in air to be immediately dangerous to life or health. This is the exposure level of a chemical that is likely to cause permanent health problems or death.

How likely is naphthalene to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC) and the EPA have not classified naphthalene as to its human carcinogenicity. No studies are available in people. Naphthalene has caused cancer in studies in female mice, but not in male mice or in rats of either sex.

Glossary Is there a medical test to show whether Ive been exposed to naphthalene?
Tests are available that measure levels of naphthalene and its breakdown products in urine, stool, blood, or maternal milk. A small sample of your body fat can also be removed and analyzed for naphthalene. These tests are not routinely available in a doctors office. However, a sample taken in a doctors office can be sent to a special laboratory, if needed. These tests cannot determine exactly how much naphthalene you were exposed to or predict whether harmful effects will occur. Carcinogenicity: Ability of a substance to cause cancer. CAS: Chemical Abstracts Service. Insecticide: A substance that kills insects. Sediment: Mud and debris that have settled to the bottom of a body of water.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for naphthalene, 1-methylnaphthalene, and 2-methylnaphthalene (update). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Services.

Where can I get more information?

For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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NERVE AGENTS (GA, GB, GD, VX)


TABUN (GA) CAS # 77-81-6 SOMAN (GD) CAS # 96-64-0
Division of Toxicology ToxFAQsTM

SARIN (GB) CAS # 107-44-8 VX CAS # 50782-69-9


April 2002

This fact sheet answers the most frequently asked health questions (FAQs) about nerve agents. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to nerve agents can occur due to accidental release from a military storage facility. Nerve agents are highly toxic regardless of the route of exposure. Exposure to nerve agents can cause tightness of the chest, excessive salivation, abdominal cramps, diarrhea, blurred vision, tremors, and death. Nerve agents (GA, GB, GD, VX) have been identified at 5 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are nerve agents GA, GB, GD, and VX?
Nerve agents GA(tabun), GB (sarin), GD(soman), and VX are manufactured compounds. The G-type agents are clear, colorless, tasteless liquids miscible in water and most organic solvents. GB is odorless and is the most volatile nerve agent. GA has a slightly fruity odor, and GD has a slight camphor-like odor. VX is a clear, amber-colored odorless, oily liquid. It is miscible with water and dissolves in all solvents. VX is the least volatile nerve agent. Most of the nerve agents were originally produced in a search for insecticides, but because of their toxicity, they were evaluated for military use. Nerve agents have been used in wars and by terrorists. They are known to be stored by several nations, including the United States. GA, GB, GD, and VX will be broken down in water quickly, but small amounts may evaporate. GA, GB, GD, and VX will be broken down in moist soil quickly. Small amounts may evaporate into air or travel below the soil surface and contaminate groundwater. GA, GB, GD, and VX do not accumulate in the food chain.

How might I be exposed to nerve agents GA, GB, GD, and VX?
The United States no longer produces nerve agents GA, GB, GD, and VX. The general population will not be exposed to nerve agents GA, GB, GD, or VX unless there is an accidental release from a military storage facility. People who work at military sites where these compounds are stored may be potentially exposed to nerve agents GA, GB, GD, and VX.

What happens to nerve agents GA, GB, GD, and VX when they enter the environment?
Nerve agents GA, GB, GD, and VX could enter the environment from an accidental release. When released to air, GA, GB, GD, and VX will be broken down by compounds that are found in the air, but they may persist in air for a few days before being broken down.

How can nerve agents GA, GB, GD, and VX affect my health?
Even in very small amounts, nerve agents are highly toxic if you inhale or swallow them, or if they come in contact with your skin or eyes. In general, the manifestation of toxic

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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TABUN (GA) CAS # 77-81-6 SOMAN (GD) CAS # 96-64-0

NERVE AGENTS (GA, GB, GD, VX)


SARIN (GB) CAS # 107-44-8 VX CAS # 50782-69-9

ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html


effects is faster if you inhale or swallow nerve agents than if they contact your skin. The initial effects also depend on the amount you are exposed to. The onset of mild to moderate effects after dermal exposure may be delayed for as long as 18 hours. Regardless of the route of exposure, the manifestation of nerve agent exposure includes runny nose, chest tightness, pinpoint pupils, shortness of breath, excessive salivation and sweating, nausea, vomiting, abdominal cramps, involuntary defecation and urination, muscle twitching, confusion, seizures, paralysis, coma, respiratory paralysis, and death. Incapacitating effects occur within 1 to 10 minutes and fatal effects can occur within 1 to 10 minutes for GA, GB, and GD, and within 4 to 42 hours for VX. Fatigue, irritability, nervousness, and memory defects may persist for as long as 6 weeks after recovery from an exposure episode. We do not know if exposure to the nerve agents GA, GB, GD, or VX might result in reproductive effects in humans. know whether children differ from adults in their susceptibility to nerve agents. We do not know if exposure to the nerve agents GA, GB, GD, or VX might result in developmental effects in humans.

How can families reduce the risk of exposure to nerve agents GA, GB, GD and VX?
It is unlikely that the general population will be exposed to nerve agents.

Is there a medical test to show whether Ive been exposed to nerve agents GA, GB, GD, and VX?
There are medical tests available to determine whether you have been exposed to nerve agents. There are tests to measure degradation products of nerve agents in the urine, but are not generally useful. A different kind of test measures the levels of a substance called cholinesterase in the blood. If these levels are less than half what they should be, and you were exposed to nerve gases, you may get symptoms of poisoning. Cholinesterase levels in the blood can stay low for months after you have been exposed to nerve agents. Measurement of cholinesterase levels in blood is not specific for exposure to nerve agents.

How likely are nerve agents GA, GB, GD, and VX to cause cancer?
The Department of Heath and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified GA, GB, GD, and VX as to their carcinogenicity to humans. Limited data in animals indicate that nerve agents are not likely to be carcinogenic.

Has the federal government made recommendations to protect human health?


An Airborne Exposure Limit (as recommended by the Surgeon Generals Working Group, U.S. Department of Health and Human Services) of 0.003 micrograms of GA, GB, GD, or VX per cubic meter of air (0.003 g/m3) has been established as a time-weighted average (TWA) for the workplace.

How can nerve agents GA, GB, GD, and VX affect children?
Children exposed to nerve agents are likely to experience the same toxic effects experienced by exposed adults. We do not

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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NICKEL
CAS # 7440-02-0
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about nickel. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Nickel is a hard, silvery-white metal used to make stainless steel and other metal alloys. Skin effects are the most common effects in people who are sensitive to nickel. Workers who breathed very large amounts of nickel compounds have developed lung and nasal sinus cancers. Nickel has been found in at least 709 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is nickel? (Pronounced nkl)
Nickel is a very abundant element. In the environment, it is found primarily combined with oxygen (oxides) or sulfur (sulfides). It is found in all soils and is emitted from volcanos. Pure nickel is a hard, silvery-white metal that is combined with other metals to form mixtures called alloys. Some of the metals that nickel can be alloyed with are iron, copper, chromium, and zinc. These alloys are used in the making of metal coins and jewelry and in industry for making metal items. Nickel compounds are also used for nickel plating, to color ceramics, to make some batteries, and as substances known as catalysts that increase the rate of chemical reactions. Nickel and its compounds have no characteristic odor or taste. G Nickel does not appear to collect in fish, plants, or animals used for food.

How might I be exposed to nickel?


G By breathing air or smoking tobacco containing nickel. G By eating food containing nickel, which is the major source of exposure for most people. G By drinking water which contains small amounts of nickel. G By handling coins and touching other metals containing nickel, such as jewelry.

How can nickel affect my health?


Nickel is required to maintain health in animals. A small amount of nickel is probably essential for humans, although a lack of nickel has not been found to affect the health of humans. The most common adverse health effect of nickel in humans is an allergic reaction. People can become sensitive to nickel when jewelry or other things containing it are in direct contact with the skin. Once a person is sensitized to nickel, further contact with it will produce a reaction. The most common reaction is a skin rash at the site of contact. Less frequently, some people who are sensitive to nickel

What happens to nickel when it enters the environment?


G Small nickel particles in the air settle to the ground or are taken out of the air in rain. G Much of the nickel in the environment is found with soil and sediments because nickel attaches to particles that contain iron or manganese, which are often present in soil and sediments.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

Page 2

NICKEL CAS # 7440-02-0


ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

have asthma attacks following exposure to nickel. People who are sensitive to nickel have reactions when it is in contact with the skin, and some sensitized persons react when they eat nickel in food, drink it in water, or breathe dust containing it. Lung effects, including chronic bronchitis and reduced lung function, have been observed in workers who breathed large amounts of nickel. Current levels of nickel in workplace air are much lower than in the past, and today few workers show symptoms of nickel exposure. People who are not sensitive to it must eat very large amounts of nickel to show adverse health effects. Workers who accidently drank water containing very high levels of nickel (100,000 times more than in normal drinking water) had stomachaches and effects on their blood and kidneys. Animal studies show that breathing high levels of nickel compounds may result in inflammation of the respiratory tract. Eating or drinking large amounts of nickel has been reported to cause lung disease in dogs and rats and to affect the stomach, blood, liver, kidneys, immune system, and reproduction and development in rats and mice.

Measurements of the amount of nickel in your blood, feces, and urine can be used to estimate your exposure to nickel. These measurements are most useful if the type of nickel compound you have been exposed to is known. However, these tests cannot predict whether you will experience any health effects.

Has the federal government made recommendations to protect human health?


The EPA recommends that children drink water containing no more than 0.04 milligrams of nickel per liter of water (0.04 mg/L) for 1-10 days of exposure. The Occupational Safety and Health Administration (OSHA) has set an occupational exposure limit of 1 milligram of nickel per cubic meter of air (l mg/m3) for an 8-hour workday, 40-hour workweek.

Glossary
Carcinogen: A substance with the ability to cause cancer. CAS: Chemical Abstracts Service. Milligram (mg): One thousandth of a gram. Sediments: Mud and debris that have settled to the bottom of a body of water. Soluble: Dissolves in water.

How likely is nickel to cause cancer?


The Department of Health and Human Services (DHHS) has determined that nickel and certain nickel compounds may reasonably be anticipated to be carcinogens. Cancers of the lung and nasal sinus have resulted when workers breathed dust containing high levels of nickel compounds while working in nickel refineries or nickel processing plants. When rats and mice breathed nickel compounds for a lifetime, nickel compounds that were hard to dissolve caused cancer, while a soluble nickel compound did not cause cancer.

Source of Information
This ToxFAQs information is taken from the 1997 Toxicological Profile for Nickel (update) produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Is there a medical test to show whether Ive been exposed to nickel?

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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NITROBENZENE
CAS # 98-95-3
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about nitrobenzene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Nitrobenzene is used mainly as an intermediate to produce another chemical. Repeated exposures to high levels result in a blood disorder in people. This chemical has been found in at least 7 of the 1,177 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is nitrobenzene? (Pronounced ntr-bnzn)


Nitrobenzene is an industrial chemical. It is an oily yellow liquid with an almond-like odor. It dissolves only slightly in water and will evaporate to air. It is produced in large quantities for use in industry. Most of the nitrobenzene produced in the United States is used to manufacture a chemical called aniline. Nitrobenzene is also used to produce lubricating oils such as those used in motors and machinery. A small amount of nitrobenzene is used in the manufacture of dyes, drugs, pesticides, and synthetic rubber.

How might I be exposed to nitrobenzene?


G Breathing air containing it. G Living near a factory where it is used. G Working in a factory that produces nitrobenzene. G Living near a hazardous waste site where it has been disposed of. G Working as a chemist or in other occupations where nitrobenzene is used.

How can nitrobenzene affect my health?


A small amount of nitrobenzene may cause mild irritation if it contacts the skin or eyes directly. Repeated exposures to a high concentration of nitrobenzene can result in methemoglobinemia, a condition in which the bloods ability to carry oxygen is reduced. If you have this condition, your skin may turn a bluish color and you may have nausea, vomiting, and shortness of breath. Effects such as headache, irritability, dizziness, weakness, and drowsiness may also occur. There is also some evidence that breathing high concentrations of nitrobenzene may damage the liver. Animal studies have reported effects on the blood and liver from exposure to nitrobenzene. A single dose of nitro-

What happens to nitrobenzene when it enters the environment?


G Very low levels of nitrobenzene may be found in air. G It may be present in water from industrial releases. G In water, nitrobenzene will be broken down by sunlight. G Nitrobenzene in soil can move into the groundwater, be taken up by plants, evaporate to the air, and be broken down by bacteria. G It does not appear to concentrate in fish or other aquatic animals.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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NITROBENZENE CAS # 98-95-3

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


benzene fed to male rats resulted in damage to the testicles and decreased levels of sperm. ing water or eating fish contaminated with nitrobenzene. The EPA requires that discharges, spills, or accidental releases of 1,000 pounds or more of nitrobenzene must be reported to the EPA. The Occupational Safety and Health Administration (OSHA) has set a permissible exposure limit of 5 milligrams nitrobenzene per cubic meter of air (5 mg/m3) for an 8-hour workday in a 40-hour workweek. The American Conference of Governmental and Industrial Hygienists (ACGIH) and the National Institute for Occupational Safety and Health (NIOSH) also recommend an occupational exposure limit of 5 mg/m3 for nitrobenzene. The federal recommendations have been updated as of July 1999.

How likely is nitrobenzene to cause cancer?


No studies are available on whether nitrobenzene causes cancer in people. In animals, breathing nitrobenzene resulted in an increase in liver, thyroid, and kidney tumors. The International Agency for Research on Cancer (IARC) has determined that nitrobenzene is possibly carcinogenic to humans.

Is there a medical test to show whether Ive been exposed to nitrobenzene?

Nitrobenzene reacts with red blood cells in the body to produce methemoglobin. If you have recently been exposed to Glossary nitrobenzene, the level of methemoglobin in your body may be elevated, and this can be measured. However, since other toxic Carcinogenic: Able to cause cancer. Evaporate: To change into a vapor or a gas. chemicals also produce methemoglobin, this method does not Milligram (mg): One thousandth of a gram. definitely show that you were exposed to nitrobenzene. National Priorities List: A list of the nations worst hazardous waste sites. In cases of long-term exposure to nitrobenzene, the presPesticide: A substance that kills pests. ence of its breakdown products, p-nitrophenol and p-aminoppm: Parts per million. phenol, in the urine indicates nitrobenzene exposure. These Tumor: An abnormal mass of tissue. tests require special equipment and cannot be routinely done in a doctors office. The results of these tests cannot be used to determine the level of nitrobenzene exposure or if harmful health effects can be expected to occur.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1990. Toxicological profile for nitrobenzene. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Has the federal government made recommendations to protect human health?


The EPA recommends that levels in lakes and streams should be limited to 17 parts of nitrobenzene per million parts of water (17 ppm) to prevent possible health effects from drink-

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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CAS #10102-43-9 (nitric oxide); CAS #10102-44-0 (nitrogen dioxide)


Division of Toxicology ToxFAQsTM

NITROGEN OXIDES (nitric oxide, nitrogen dioxide, etc.)

April 2002

This fact sheet answers the most frequently asked health questions (FAQs) about nitrogen oxides (nitric oxide, nitrogen dioxide, etc.). For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Everybody is exposed to small amounts of nitrogen oxides in ambient air. Higher exposure may occur by burning wood or kerosene or near gas stoves or if you smoke. Exposure to high levels of nitrogen oxides can damage the respiratory airways. Contact with the skin or eyes can cause burns. Nitrogen dioxide and nitric oxide have been found in at least 9 and 6 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA), respectively.
What are nitrogen oxides?
Nitrogen oxides are a mixture of gases that are composed of nitrogen and oxygen. Two of the most toxicologically significant nitrogen oxides are nitric oxide and nitrogen dioxide; both are nonflammable and colorless to brown at room temperature. Nitric oxide is a sharp sweet-smelling gas at room temperature, whereas nitrogen dioxide has a strong, harsh odor and is a liquid at room temperature, becoming a reddish-brown gas above 70 EF. Nitrogen oxides are released to the air from the exhaust of motor vehicles, the burning of coal, oil, or natural gas, and during processes such as arc welding, electroplating, engraving, and dynamite blasting. They are also produced commercially by reacting nitric acid with metals or cellulose. Nitrogen oxides are used in the production of nitric acid, lacquers, dyes, and other chemicals. Nitrogen oxides are also used in rocket fuels, nitration of organic chemicals, and the manufacture of explosives. found in the air. The reaction of nitrogen dioxide with chemicals produced by sunlight leads to the formation of nitric acid, which is a major constituent of acid rain. Nitrogen dioxide also reacts with sunlight, which leads to the formation of ozone and smog conditions in the air we breathe. Small amounts of nitrogen oxides may evaporate from water, but most of it will react with water and form nitric acid. When released to soil, small amounts of nitrogen oxides may evaporate into air. However, most of it will be converted to nitric acid or other compounds. Nitrogen oxides do not build up in the food chain.

How might I be exposed to nitrogen oxides?


The general population is primarily exposed to nitrogen oxides by breathing in air. People who live near combustion sources such as coal burning power plants or areas with heavy motor vehicle use may be exposed to higher levels of nitrogen oxides. Households that burn a lot of wood or use kerosene heaters and gas stoves tend to have higher levels of nitrogen oxides in them when compared to houses without these appliances. Nitric oxide and nitrogen dioxide are found in tobacco smoke, so people who smoke or breathe in second-hand smoke may be exposed to nitrogen oxides.

What happens to nitrogen oxides when they enter the environment?


Nitrogen oxides are broken down rapidly in the atmosphere by reacting with other substances commonly

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

Page 2

NITROGEN OXIDES (nitric oxide, nitrogen dioxide, etc.)


CAS #10102-43-9 (nitric oxide); CAS #10102-44-0 (nitrogen dioxide)
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

Workers employed in facilities that produce nitric acid or certain explosives like dynamite and trinitrotoluene (TNT), as well as workers involved in the welding of metals may breath in nitrogen oxides during their work.

also caused changes in the genetic material of animal cells. But we do not know if exposure to nitrogen oxides might cause developmental effects in humans.

How can nitrogen oxides affect my health?


Low levels of nitrogen oxides in the air can irritate your eyes, nose, throat, and lungs, possibly causing you to cough and experience shortness of breath, tiredness, and nausea. Exposure to low levels can also result in fluid build-up in the lungs 1 or 2 days after exposure. Breathing high levels of nitrogen oxides can cause rapid burning, spasms, and swelling of tissues in the throat and upper respiratory tract, reduced oxygenation of body tissues, a build-up of fluid in your lungs, and death. If you were to come into skin or eye contact with high concentrations of nitrogen oxide gases or nitrogen dioxide liquid, you would likely experience serious burns. We do not know if exposure to nitrogen oxides will result in reproductive effects in humans.

How can families reduce the risk of exposure to nitrogen oxides?


Families with indoor gas stoves, space heaters, or indoor cigarette smoke can minimize indoor exposure to nitrogen oxides by periodically allowing fresh outdoor air into the home. Farm families should not allow children to play near silos that contain silage.

Is there a medical test to show whether Ive been exposed to nitrogen oxides?
Specific tests for the presence of nitrogen oxides in blood or urine are not generally useful to the doctor. If a severe exposure has occurred, blood and urine analyses and other tests may show whether damage has been done to your respiratory airways. Some of these tests may be done at the doctors office, others may require a clinic or hospital that have specialized equipment.

How likely are nitrogen oxides to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified nitrogen oxides for potential carcinogenicity.

Has the federal government made recommendations to protect human health?


The EPA has established that the average concentration of nitrogen dioxide in ambient air in a calendar year should not exceed 0.053 parts of nitrogen dioxide per million parts of air (0.053 ppm). The Occupational Safety and Health Administration (OSHA) has set a limit of 25 ppm of nitric oxide in workplace air during an 8-hour workday, 40-hour work week. OSHA has also set a 15-minute exposure limit of 5 ppm for nitrogen dioxide in workplace air.

How can nitrogen oxides affect children?


Children would probably be affected by exposure to nitrogen oxides in the same ways as adults. But we do not know whether children differ from adults in their susceptibility to nitrogen oxides. Exposure of pregnant animals to nitrogen oxides has resulted in toxic effects in developing fetuses. Nitrogen oxides have

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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NITROPHENOLS
CAS # 88-75-5 and 100-02-07
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about nitrophenols. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is mportant because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Everyone is exposed to very low levels of the nitrophenols in air, water, and soil. Workers who make or process the chemicals may be exposed to higher levels of them. Animal studies suggest that 4-nitrophenol may cause a blood disorder. These chemicals have been found in at least 113 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What are nitrophenols? (Pronounced ntr f nolz)
Nitrophenols include two chemicals, 2-nitrophenol and 4-nitrophenol, which are very similar to each other. They are manufactured chemicals that do not occur naturally in the environment. The manufacture of one almost always produces a little of the other, so they are grouped together when discussing their properties and harmful effects. 2-Nitrophenol is a light yellow solid with a peculiar sweet smell. 4-Nitrophenol is a colorless to light yellow solid with very little odor. 2-Nitrophenol is used mainly to make dyes, paint coloring, rubber chemicals, and substances that kill molds. 4-Nitrophenol is used mainly to make drugs, fungicides, dyes, and to darken leather.
G Very little is known about the fate of nitrophenols in air. G They readily break down in surface water. G It takes a long time for nitrophenols to break down in deep soil and in groundwater. G Nitrophenols have not been found in foods. G They are a breakdown product of other pesticides including parathion and fluoridifen. They are also formed in auto exhaust.

How might I be exposed to nitrophenols?


G Exposure to very low levels of nitrophenols in air, water, and soil. G Breathing contaminated workplace air with higher levels of the chemicals (especially during spills). G Breathing contaminated air (during application) or drinking contaminated water near farming areas where certain fungicides are used. G Breathing contaminated air or drinking contaminated water near waste sites and landfills.

What happens to nitrophenols when they enter the environment?


G Most nitrophenols enter the environment during manufacturing and processing. G Nitrophenols can be formed in the air as a result of the breakdown of many other manufactured chemicals. G Most goes to water and soil; little goes to the air.

How can nitrophenols affect my health?


There are no studies that have looked at the effects of the nitrophenols in people. All our information comes from studies in animals. Some studies in animals have shown that

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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NITROPHENOLS CAS # 88-75-5 and 100-02-7

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


4-nitrophenol is more harmful than 2-nitrophenol when given in high amounts over a short time, but we have very little other information on the effects from longer time exposures at lower levels. Rats that breathed moderate levels of 4-nitrophenol for two weeks developed a blood disorder that reduced the ability of the blood to carry oxygen to tissues and organs. However, these abnormalities disappeared a few days after exposure stopped. No other harmful effects to other systems or organs were seen. Skin irritation has been noted in animals that had large amounts of 4-nitrophenol applied to their skin, and eye irritation when it was applied to the eye. These effects are most likely due to the large amount used and not to a specific harmful effect of nitrophenols. No birth defects were seen in the offspring of animals that ingested large quantities of 4-nitrophenol. There is no information from animal studies on the effects of ingesting low levels of nitrophenols. The amounts given to animals that produce the harmful effects are several hundred to several thousand times higher than those people are generally exposed to.

Is there a medical test to show whether Ive been exposed to nitrophenols?


There is a medical test available to measure levels of 4-nitrophenol in urine and blood. However, this test will only detect the chemical when exposure has been very recent because 4-nitrophenol leaves the body through the urine within a few hours. Other chemicals can produce the same effects on the blood as 4-nitrophenol, so it is not possible to tell from the blood test whether the exposure was from 4-nitrophenol only. No tests are available to measure exposure to 2-nitrophenol.

Has the federal government made recommendations to protect human health?


The EPA requires that discharges or accidental spills into the environment of 100 pounds or more of the nitrophenols be reported.

Glossary
Carcinogenicity: Ability to cause cancer. Fungicide: Substance that kills molds. Ingesting: Taking food or drink into your body. Short time: Lasting 14 days or less.

How likely are nitrophenols to cause cancer?


The Department of Health and Human Services, the International Agency for Research on Cancer, and the Environmental Protection Agency (EPA) have not classified the nitrophenols as to their human carcinogenicity. An animal study found no evidence of cancer when 4-nitrophenol was applied to the skin of mice, and no studies in people are available.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for nitrophenols: 2-nitrophenol and 4-nitrophenol. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information?

For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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OTTO FUEL II
AND ITS COMPONENTS CAS # 106602-80-6
Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about Otto Fuel II and its components. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to Otto Fuel II occurs in areas where Otto Fuel II is used as a torpedo fuel or where it is made. Headaches are the most common effects from overexposure. Other effects include loss of balance, poor eye-hand coordination, eye irritation, nasal congestion, nausea, dizziness, and difficulty breathing. This substance has been found in at least 2 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is Otto Fuel II? (Pronounced t fyl 2)
Otto Fuel II is a distinct-smelling, reddish-orange, oily liquid that the U.S. Navy uses as a fuel for torpedoes and other weapon systems. It is a mixture of three synthetic substances: propylene glycol dinitrate (the major component), 2nitrodiphenylamine, and dibutyl sebacate. Propylene glycol dinitrate, a colorless liquid with an unpleasant odor, is explosive. 2-Nitrodiphenylamine is an orange solid used to control the explosion of propylene glycol dinitrate. Dibutyl sebacate is a clear liquid used for making plastics, many of which are used for food packaging. It is also used to enhance flavor in some foods such as ice cream, candy, baked goods, and nonalcoholic drinks, and is found in some shaving creams. G Propylene glycol dinitrate evaporates rapidly; dibutyl sebacate and 2-nitrodiphenylamine do not evaporate easily. G 2-Nitrodiphenylamine does not dissolve easily in water and will be found associated with soil and sediments.

How might I be exposed to Otto Fuel II and its components?


G Breathing contaminated air or touching fuel in areas where Otto Fuel II is used or where it is made. G Eating food that contains dibutyl sebacate.

How can Otto Fuel II and its components affect my health?


Most of the effects of Otto Fuel II on peoples health are believed to be caused by propylene glycol dinitrate. People who work around Otto Fuel II report headaches, poor eye-hand coordination, eye irritation, congested noses, nausea, dizziness, and difficulty breathing. The most common effect of overexposure is headache. The greater the overexposure, the larger the number of reported symptoms. People who have worked around Otto Fuel II, but are no longer exposed to it, might feel chest pain or rapid beating of the heart.

What happens to Otto Fuel II and its components when they enter the environment?
G Otto Fuel II enters the environment mainly in waste water from Naval facilities that produce it or are involved in torpedo operations. G All three components can be broken down by microorganisms in soil and water.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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OTTO FUEL II AND ITS COMPONENTS CAS # 106602-80-6

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


We do not know if Otto Fuel II affects the ability of people to have children or if it causes birth defects. Animal studies show effects of propylene glycol dinitrate that are similar to the effects seen in people. Exposure of animals to moderate-to-large amounts for several weeks causes problems in the blood, such as a decreased ability of blood to carry oxygen. The livers and kidneys of some animals exposed to moderate levels of propylene glycol dinitrate 24 hours a day for several months showed damage. We do not know if these effects might also occur in persons exposed to sufficiently high concentrations. Rats that had Otto Fuel II applied to their skin during pregnancy gave birth to babies with low birth weights. It is not known if propylene glycol dinitrate causes birth defects in animals. The health of animals that ate large amounts of dibutyl sebacate for long periods was not affected. The babies of animals that ate large amounts of dibutyl sebacate grew more slowly than babies of animals that did not eat it. We do not know anything about the health effects of 2-nitrodiphenylamine in animals. whether these compounds are carcinogenic. The carcinogenicity of 2-nitrodiphenylamine has not been studied in animals.

Is there a medical test to show whether Ive been exposed to Otto Fuel II and its components?
No routine medical test shows if you have been exposed to Otto Fuel II. Breakdown products of propylene glycol dinitrate have been measured in blood and exhaled air, but these products leave your body within a day, so the tests must be given within a few hours of exposure. No tests are known for measuring the other two components of Otto Fuel II in your body.

Has the federal government made recommendations to protect human health?


The National Institute for Occupational Safety and Health (NIOSH) recommends that workers not be exposed to air containing more than 0.05 parts propylene glycol dinitrate per million parts of air (0.05 ppm) during a 10-hour workday, 40hour workweek.

Glossary How likely are Otto Fuel II and its components to cause cancer?
The International Agency for Research on Cancer (IARC), the Department of Health and Human Services (DHHS), and the EPA have not reviewed Otto Fuel II to determine whether it is likely to cause cancer. No human studies examine the carcinogenicity of Otto Fuels II or any of its components. Animal studies of propylene glycol dinitrate and dibutyl sebacate haven't determined Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. ppm: Parts per million.

Reference
Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for Otto Fuel II. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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PENTACHLOROPHENOL
CAS #87-86-5
Division of Toxicology ToxFAQsTM September 2001

This fact sheet answers the most frequently asked health questions (FAQs) about pentachlorophenol. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Pentachlorophenol is a manufactured chemical which is a restricted use pesticide and is used industrially as a wood preservative for utility poles, railroad ties, and wharf pilings. Exposure to high levels of pentachlorophenol can cause increases in body temperature, liver effects, damage to the immune system, reproductive effects, and developmental effects. This substance has been found in at least 313 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is pentachlorophenol?
Pentachlorophenol is a manufactured chemical that does not occur naturally. Pure pentachlorophenol exists as colorless crystals. Impure pentachlorophenol (the form usually found at hazardous waste sites) is dark gray to brown and exists as dust, beads, or flakes. Humans are usually exposed to impure pentachlorophenol (also called technical grade pentachlorophenol). Pentachlorophenol was widely used as a pesticide and wood preservative. Since 1984, the purchase and use of pentachlorophenol has been restricted to certified applicators. It is no longer available to the general public. It is still used industrially as a wood preservative for utility poles, railroad ties, and wharf pilings.

How might I be exposed to pentachlorophenol?


The general populations can be exposed to very low levels of pentachlorophenol in contaminated indoor and outdoor air, food, drinking water and soil. People who work or live near a wood treatment facility or in the production of utility poles, railroad ties, or wharf pilings may be exposed to pentachlorophenol in the air or by coming in contact with the treated wood. People living near hazardous waste sites may also be exposed to higher than usual levels of pentachlorophenol.

How can pentachlorophenol affect my health?


Studies in workers show that exposure to high levels of pentachlorophenol can cause the cells in the body to produce excess heat. When this occurs, a person may experience a very high fever, profuse sweating, and difficulty breathing. The body temperature can increase to dangerous levels, causing injury to various organs and tissues, and even death. Liver effects and damage to the immune system have also been observed in humans exposed to high levels of pentachlorophenol for a long time. Damage to the thyroid and reproductive system has been observed in laboratory animals exposed to high doses of pentachlorophenol. Some of the harmful effects of pentachlorophenol are caused by the other chemicals present in technical grade pentachlorophenol.

What happens to pentachlorophenol when it enters the environment?


Pentachlorophenol can be found in the air, water, and soil. It enters the environment through evaporation from treated wood surfaces, industrial spills, and disposal at uncontrolled hazardous waste sites. Pentachlorophenol is broken down by sunlight, other chemicals, and microorganisms to other chemicals within a couple of days to months. Pentachlorophenol is found in fish and other foods, but tissue levels are usually low.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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PENTACHLOROPHENOL
CAS #87-86-5
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

How likely is pentachlorophenol to cause cancer?


Some studies have found an increase in cancer risk in workers exposed to high levels of technical grade pentachlorophenol for a long time, but other studies have not found this. Increases in liver, adrenal gland, and nasal tumors have been found in laboratory animals exposed to high doses of pentachlorophenol. The EPA has determined that pentachlorophenol is a probable human carcinogen and the International Agency for Cancer Research (IARC) considers it possibly carcinogenic to humans.

them especially in the hot summer months. Though pentachlorophenol has been found in some food, its levels are low. You can minimize the risk of your familys exposure by peeling and thoroughly washing fruits and vegetables before cooking. Children should avoid playing in soils near hazardous waste sites where pentachlorophenol may have been discarded.

Is there a medical test to show whether Ive been exposed to pentachlorophenol?


Tests are available to measure pentachlorophenol and its breakdown product in blood, urine, and body tissues. These tests cannot be performed in the doctors office because they require the use of special equipment. Because pentachlorophenol leaves the body fairly quickly, these tests are best for finding exposures that occurred within the last several days. These tests do not tell you how much pentachlorophenol you have been exposed to and cannot be used to predict the occurrence, nature, or severity of toxic effects.

How can pentachlorophenol affect children?


Infants who were exposed to diapers and bedding which was accidentally contaminated with pentachlorophenol had high fevers, a large amount of sweating, difficulty breathing, and harmful effects on the nervous system and liver, and some died. Although these effects are similar to effects seen in adults exposed to pentachlorophenol, we do not know whether children and adults differ in their susceptibility to pentachlorophenol. We do not know if exposure to pentachlorophenol will result in birth defects or other developmental effects in people. Death, low body weights, decreased growth, and skeletal effects have been observed in laboratory animals exposed to high levels of pentachlorophenol during development.

Has the federal government made recommendations to protect human health?


The EPA has set a limit for drinking water of 1 part of pentachlorophenol per billion parts of water (1 ppb). The Occupational Safety and Health Administration (OSHA) has set a limit of 0.5 milligrams of pentachlorophenol per cubic meter of workplace air (0.5 mg/m3) for 8 hour shifts and 40 hour work weeks.

How can families reduce the risk of exposure to pentachlorophenol?


Pentachlorophenol was a widely used pesticide for a long time. Today its use is restricted and it can only be used by certified applicators. You may have old containers of pesticides in your attic, basement, or garage that contain pentachlorophenol. Removing these old containers will reduce your familys risk of exposure to pentachlorophenol. If you live near utility poles and railroad tracks, you should prevent your children from playing, climbing, or sitting on

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for Pentachlorophenol Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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PHENOL
CAS # 108-95-2
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about phenol. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Phenol is a manufactured substance found in a number of consumer products. Skin exposure to high levels of phenol has resulted in liver damage, diarrhea, dark urine, and hemolytic anemia. Phenol has been found in at least 481 of the 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is phenol? (Pronounced f nl)
Phenol is a manufactured substance. It is a colorless-towhite solid when pure. The commercial product is a liquid. It has sickeningly sweet and tarry odor. You can taste and smell it at levels lower than those that are associated with harmful effects. Phenol evaporates more slowly than water, and a moderate amount can form a solution with water. Phenol can catch fire. Phenol is used primarily in the formation of phenolic resins. It is also used in the manufacture of nylon and other synthetic fibers. It is also used in slimicides (chemicals that kill bacteria and fungi in slimes), as a disinfectant, as an antiseptic, and in medicinal preparations, such as mouthwash and sore throat lozenges. q It can remain in water for longer than 9 days. q Larger or repeated releases can remain in the air, water and soil for much longer periods of time. q Small amounts of phenol may be found in organisms that live in contaminated water.

How might I be exposed to phenol?


q You may be exposed to phenol if you work with or manufacture it. q You may be exposed to very low levels in your home because it is found in a number of products, including some medicines, lotions, and ointments. q Low levels of phenol are found in some foods, including smoked summer sausage, fried chicken, mountain cheese, and some species of fish. q Phenol enters the lungs when you inhale tobacco smoke. q It can be present in low levels in air and drinking water.

What happens to phenol when it enters the environment?


q Following small, single releases, phenol does not remain in the air long (generally, half is removed from the air in less than a day). q It generally remains in the soil only about 2 to 5 days.

How can phenol affect my health?


In people, the effects of breathing phenol in air are not known. People who had skin exposure to high levels had liver damage, diarrhea, dark urine, and hemolytic anemia. In animals, breathing air with high levels of phenol re-

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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PHENOL CAS # 108-95-2

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


sulted in irritation of the lungs. Repeated exposures led to muscle tremors and loss of coordination. Exposure to high levels of phenol for several weeks caused paralysis and severe injury to the heart, liver, kidneys, and lungs, and in some cases, death. Phenol can have beneficial effects when used medically as an antiseptic or anesthetic.

Is there a medical test to show whether Ive been exposed to phenol?


There is a urine test that can tell if you have been exposed to phenol recently (within 1 or 2 days). However, the test cannot tell if you were exposed only to phenol since many substances are converted to phenol in the body.

How likely is phenol to cause cancer?


It is not known if phenol causes cancer in people. Cancer occured in mice when phenol was applied to the skin several times each week for the lifetime of the animal. Phenol did not cause cancer in mice or rats when they drank water containing it for 2 years. The International Agency for Research on Cancer (IARC) has determined that phenol is not classifiable as to its carcinogenicity to humans.

Has the federal government made recommendations to protect human health?


EPA has a lifetime health advisory for adults for phenol in drinking water of 4 milligrams per liter (4 mg/L). EPA also recommends that the level of phenol in surface water (lakes, streams) should be limited to 3.5 mg/L to protect people from drinking contaminated water or eating contaminated fish. The Occupational Safety and Health Administration (OSHA) has set a limit of 5 parts per million (5 ppm) for workers during an 8-hour workshift in a 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) recommends that workroom air be limited to 5 ppm over a 10-hour workday and that concentrations should not exceed 16 ppm during a 15-minute period.

How can phenol affect children?


Children are exposed to phenol in the same way adults are. Children are at greater risk of accidently ingesting home products that contain phenol. The effects of exposure to phenol on the human fetus are not known. Pregnant animals that drank water containing high concentrations of phenol gave birth to babies that had low birth weights and minor birth defects.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1998. Toxicological profile for phenol. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

How can families reduce the risk of exposure to phenol?


If your doctor finds that you have been exposed to high levels of phenol, ask if children may also be exposed. Your doctor may need to ask your state department of health to investigate.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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PHOSGENE
CAS #75-44-5
Division of Toxicology ToxFAQsTM April 2002

This fact sheet answers the most frequently asked health questions (FAQs) about phosgene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Phosgene is a colorless, nonflammable gas at room temperature. The general population is not exposed to significant amounts of phosgene. Higher exposure may occur during manufacture or industrial use. Exposure to phosgene in the air can cause eye and throat irritation. High amounts in the air can cause severe lung damage. This substance has been found in at least 10 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is phosgene?
Phosgene is a colorless nonflammable gas that has the odor of freshly cut hay. It is a manufactured chemical, but small amounts occur naturally from the break down of chlorinated compounds. Phosgene is used in the manufacture of other chemicals such as dyestuffs, isocyanates, polycarbonates and acid chlorides; it is also used in the manufacture of pesticides and pharmaceuticals. Phosgene can also be used to separate ores. Phosgene is a gas at room temperature, but is sometimes stored as a liquid under pressure or refrigeration. Phosgene will react with water and be broken down into other products. Some of the phosgene that is not broken down may evaporate into air. When released to soil, phosgene will not stick to the soil. Small amounts may evaporate into air or pass through the soil surface and contaminate groundwater. Most of the phosgene in soil will be broken down when it comes into contact with moisture. Phosgene does not accumulate in the food chain.

How might I be exposed to phosgene?


The general population may be exposed to very low levels of phosgene by breathing in air. Phosgene is released during the welding of metals that have been cleaned up with chlorinated solvents, so welders may be exposed to this compound. Phosgene is used to produce a variety of other compounds like dyes and pesticides, so workers employed in these fields may be exposed to this compound.

What happens to phosgene when it enters the environment?


When released to air, phosgene will exist solely as a gas. Phosgene gas is degraded in the atmosphere by reacting with substances commonly found in the air, but this is a very slow process. Phosgene in the air may also react with moisture in clouds or rain and be broken down into other compounds.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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PHOSGENE
CAS #75-44-5
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

How can phosgene affect my health?


Phosgene can be harmful if you breathe it. Exposure to low levels can cause eye and throat irritation making you to cough or wheeze. Higher levels of phosgene gas can cause your lungs to swell, making it difficult to breathe. This can happen quickly or might not be noticed until the next day. Even higher levels can result in severe damage to your lungs that might lead to death. Available studies of workers exposed for long periods of time to low levels of phosgene gas have not shown increased chances of developing lung problems. If you get phosgene gas or liquid on your skin or in your eyes, you may develop chemical burns. Phosgene liquid may also cause frostbite. However, you are not likely to come into contact with liquid phosgene. In the unlikely case that you swallow phosgene liquid, your mouth, throat, esophagus, and stomach could be damaged. No information is available regarding the potential of phosgene to cause reproductive effects.

in children exposed to phosgene will be similar to the effects seen in adults. We do not know whether children differ from adults in their susceptibility to phosgene. We do not know if exposure to phosgene will result in birth defects or other developmental effects in humans.

How can families reduce the risk of exposure to phosgene?


Most families will not be exposed to significant levels of phosgene. However, the burning of materials such as certain plastics that contain chlorinated hydrocarbons can produce phosgene gas. You should stay away from fires or other heat sources where such materials may be present.

Is there a medical test to show whether Ive been exposed to phosgene?


There are no tests to positively determine whether you have been exposed to phosgene. If you suspect that you may have been exposed to phosgene, a chest X-ray may be the quickest way to determine if your lungs have been damaged. This can be done in a hospital, clinic, or doctors office that has an X-ray machine.

How likely is phosgene to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified phosgene as to its carcinogenicity. There is no information to determine whether exposure to phosgene might cause cancer.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) sets a limit of 0.1 part of phosgene in a million parts of air (0.1 ppm) in the workplace for an 8-hour work shift, 40-hour work week.

How can phosgene affect children?


There are no studies on the health effects of children exposed to phosgene. It is likely that the health effects seen

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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PHOSGENE OXIME
CAS #1794-86-1
Division of Toxicology ToxFAQsTM April 2002

This fact sheet answers the most frequently asked health questions (FAQs) about phosgene oxime. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Phosgene oxime was developed as a chemical warfare agent. Only people working near where phosgene oxime has been stored are at risk of being exposed to this substance. Exposure to high levels of phosgene oxime vapors may cause severe lung damage, and even death. Contact with gaseous, liquid, or solid phosgene oxime may result in severe skin or eye damage. Phosgene oxime has been found in at least 1 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is phosgene oxime?
Phosgene oxime is a manufactured chemical that was developed as a potential chemical warfare agent, but its use on the battlefield has never been documented. It has a disagreeable penetrating odor. Pure phosgene oxime is a colorless, crystalline solid; the munitions grade compound is a yellowish-brown liquid. Both the liquid and the solid can give off vapors at ambient temperatures. Phosgene oxime will not stick to the soil. Small amounts may evaporate into air or travel below the soil surface and contaminate groundwater. Most of the phosgene oxime in soil will be broken down upon contact with moisture or be degraded by bacteria. Phosgene oxime does not accumulate in the food chain.

How might I be exposed to phosgene oxime?


It is not likely that you would be exposed to phosgene oxime; it has never been known to have been used in chemical warfare.

What happens to phosgene oxime when it enters the environment?


When released to air, phosgene oxime will exist solely in the gas-phase. Phosgene oxime vapors are broken down in the atmosphere by reacting with substances commonly found in the air, but this is a very slow process. Phosgene oxime in the air may also react with moisture in clouds or rain and be broken down into other compounds. Phosgene oxime will react with water or be broken down into other products by bacteria. Some of the phosgene oxime that is not broken down may evaporate into air.

How can phosgene oxime affect my health?


Breathing phosgene oxime vapors can cause severe bronchitis and accumulation of fluid in the lungs. Skin contact with phosgene oxime will cause swelling and itching hives that can also result in immediate and painful skin damage. Eye contact may result in severe pain and conjunctivitis. Phosgene oxime is absorbed through the

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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PHOSEGENE OXIME
CAS #1794-86-1
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

skin and eye; this can also result in pulmonary edema. Inhaling or directly contacting significant amounts of phosgene oxime can result in death. We do not know what happens if you swallow phosgene oxime liquid or solid. However, animal studies indicate that if you did, you might suffer swelling and bleeding of the gastrointestinal tract. The effects of long-term exposure to phosgene oxime in humans are not known. We do not know if exposure to phosgene oxime might cause reproductive effects in humans.

We do not know if exposure to phosgene oxime would result in birth defects or other developmental effects in people and no information exist from animal studies.

How can families reduce the risk of exposure to phosgene oxime?


Most families will not be exposed to phosgene oxime.

Is there a medical test to show whether Ive been exposed to phosgene oxime?
There are no tests to positively determine whether you have been exposed to phosgene oxime. If you suspect that you may have been exposed to phosgene oxime, a chest X-ray may be the quickest way to determine if your lungs have been damaged. This can be done in a hospital, clinic, or doctors office that has an X-ray machine.

How likely is phosgene oxime to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified phosgene oxime for carcinogenicity. There is no information to determine whether exposure to phosgene oxime might cause cancer.

Has the federal government made recommendations to protect human health?


No standards or recommendations are available for phosgene oxime.

How can phosgene oxime affect children?


There are no studies on the health effects of children exposed to phosgene oxime. It is likely that the health effects seen in children exposed to phosgene oxime would be similar to the effects seen in adults. We do not know whether children differ from adults in their susceptibility to phosgene oxime.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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PHOSPHINE
CAS #7803-51-2
Division of Toxicology ToxFAQsTM April 2002

This fact sheet answers the most frequently asked health questions (FAQs) about phosphine. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: The general population may be exposed to very small amounts of phosphine in air, food or water. Workers who use this chemical may be exposed to higher levels. Exposure to phosphine can cause abdominal pain, nausea, and vomiting. High levels can cause weakness, bronchitis, pulmonary edema, shortness of breath, convulsions, and death. Phosphine has been found in at least 7 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is phosphine?
Phosphine is a colorless, flammable, and explosive gas at ambient temperature that has the odor of garlic or decaying fish. Small amounts occur naturally from the break down of organic matter. It is slightly soluble in water. Phosphine is used in semiconductor and plastics industries, in the production of a flame retardant, and as a pesticide in stored grain. Phosphine does not accumulate in the food chain.

How might I be exposed to phosphine?


Phosphine breaks down rapidly in the environment so the general population may only be exposed to small amounts of this compound by inhaling air, drinking water and eating foods. Since phosphine is used to kill insects and rodents in stored grain and tobacco, workers who use this product may be exposed to it. People who live near where it is being used may also breathe in small amounts of it.

What happens to phosphine when it enters the environment?


In the air, phosphine will exist solely as a gas. Phosphine gas reacts with substances commonly found in the air. Half of the phosphine in the air degrades in about 1 day. At high concentrations, phosphine vapors may spontaneously combust in air. Phosphine is expected to react with water and be broken down into other products. Some of the phosphine that is not broken down may evaporate into air. When released to soil, phosphine is broken down very quickly.

How can phosphine affect my health?


Inhalation is the most likely route of exposure to phosphine. Early symptoms of acute phosphine intoxication include pain in the diaphragm, nausea, vomiting, excitement, and a phosphorus smell on the breath. Higher levels can cause weakness, bronchitis, pulmonary edema, shortness of breath, convulsions, and death. Some effects, such as pulmonary edema, convulsions, and liver injury, may appear or continue to be present days after an exposure.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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PHOSPHINE
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CAS #7803-51-2

Long-term exposure to very low levels of phosphine can result in anemia, bronchitis, gastrointestinal effects, and visual, speech and motor problems. Liquid phosphine on your skin can cause frostbite. Ingestion of metal phosphides results in release of phosphine in your stomach which can cause nausea, vomiting, abdominal pain, and diarrhea. No information is available regarding reproductive effects in humans exposed to phosphine gas. Phosphine has not been shown to cause reproductive effects in laboratory animals.

with metal phosphide pesticide can produce phosphine intoxication when the solid phosphide contacts acid in the stomach. Phosphine and metal phosphides are used to kill rats in areas used for grain storage, but should not be used in family dwellings. Always store pesticides in safe containers, in a safe place out of the reach of children.

How likely is phosphine to cause cancer?


The EPA has determined that phosphine is not classifiable as to its human carcinogenicity.

Is there a medical test to show whether Ive been exposed to phosphine?


There are no specific blood or urine tests for phosphine itself. Breakdown products of phosphine can be measured in urine. If a severe exposure has occurred, blood and urine analyses and other tests may show whether the lungs and heart have been damaged. These tests would most likely be performed in a hospital following severe exposure to phosphine.

How can phosphine affect children?


Children appear to be affected by exposure to phosphine in the same ways as adults. Accidental exposure of children has resulted in vomiting, headache, fatigue, and damage to the heart. In a fatal case, a 2-year-old child died with congestive heart failure, pulmonary edema, congestion on the membranes that surround the lungs, enlarged spleen, and aspiration of the gastrointestinal contents. We do not know if exposure to phosphine will result in birth defects or other developmental effects in people.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) sets a limit of 0.3 parts of phosphine per million parts of workroom air (0.3 ppm) for an 8-hour work shift, 40 hour work week.

How can families reduce the risk of exposure to phosphine?


Most families will not be exposed to significant levels of phosphine. However, consumption of food contaminated

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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WHITE PHOSPHORUS
CAS # 7723-14-0
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about white phosphorus. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: White phosphorus is a waxy solid which burns easily and is used in chemical manufacturing and smoke munitions. Exposure to white phosphorus may cause burns and irritation, liver, kidney, heart, lung, or bone damage, and death. White phosphorus has been found in at least 77 of the 1,416 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is white phosphorus? (Pronounced hwt fsfr-s)
White phosphorus is a colorless, white, or yellow waxy solid with a garlic-like odor. It does not occur naturally, but is manufactured from phosphate rocks. White phosphorus reacts rapidly with oxygen, easily catching fire at temperatures 10 to 15 degrees above room temperature. White phosphorus is used by the military in various types of ammunition, and to produce smoke for concealing troop movements and identifying targets. It is also used by industry to produce phosphoric acid and other chemicals for use in fertilizers, food additives, and cleaning compounds. Small amounts of white phosphorus were used in the past in pesticides and fireworks. G It can be found in the water and bottom sediment of rivers and lakes near facilities that make or use it. G In the air, white phosphorus reacts rapidly with oxygen to produce relatively harmless chemicals within minutes. G In water, white phosphorus reacts with oxygen within hours or days. G In water with low oxygen, white phosphorus may degrade to a highly toxic compound called phosphine, which eventually evaporates to the air and is changed to less harmful chemicals. G White phosphorus can build up slightly in the bodies of fish that live in contaminated lakes or streams. G In soil, white phosphorus may stick to particles and be changed within a few days to less harmful compounds. G In deep soil or sediments with little oxygen, white phosphorus may remain unchanged for many years.

How might I be exposed to white phosphorus?


G Breathing contaminated air near a facility that is using white phosphorus. G Eating contaminated fish or game birds from sites containing white phosphorus. G Drinking or swimming in water that has been contaminated with white phosphorus.

What happens to white phosphorus when it enters the environment?


G White phosphorus can enter the environment when it is made, used in manufacturing or by the military, or accidentally spilled during transport and storage.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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WHITE PHOSPHORUS CAS # 7723-14-0

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


G Touching soil contaminated with white phosphorus. G If you work in industries that use or manufacture white phosphorus or munitions containing white phosphorus. posed to white phosphorus. However, the above health effects may lead your doctor to suspect that you have been exposed, if you have a history of exposure.

How can white phosphorus affect my health?


Little information is available about the health effects that may be caused by white phosphorus. Most of what is known about the effects of breathing white phosphorus is from studies of workers. Most of what is known about the effects of eating white phosphorus is from reports of people eating rat poison or fireworks that contained it. Breathing white phosphorus for short periods may cause coughing and irritation of the throat and lungs. Breathing white phosphorus for long periods may cause a condition known as phossy jaw which involves poor wound healing of the mouth and breakdown of the jaw bone. Eating or drinking small amounts of white phosphorus may cause liver, heart, or kidney damage, vomiting, stomach cramps, drowsiness, or death. We do not know what the effects are from eating or drinking very small amounts of white phosphorus-containing substances over long periods of time. Skin contact with burning white phosphorus may burn skin or cause liver, heart, and kidney damage. We do not know whether or not white phosphorus can affect the ability to have children or cause birth defects in people.

Has the federal government made recommendations to protect human health?


The EPA has listed white phosphorus as a Hazardous Air Pollutant. The EPA requires that spills or accidental releases into the environment of 1 pound or more of white phosphorus be reported to the EPA. The National Institute for Occupational Safety and Health (NIOSH), the Occupational Safety and Health Administration (OSHA), and the American Conference of Governmental Industrial Hygienists (ACGIH) have all set the inhalation exposure limit for white phosphorus in the workplace during an 8-hour workday at 0.1 milligram of white phosphorus per cubic meter of air (0.1 mg/m3).

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or gas. Milligram (mg): One thousandth of a gram. Sediment: Mud and debris that have settled to the bottom of a body of water.

Source of Information
This ToxFAQs information is taken from the 1997 Toxicological Profile for White Phosphorous produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

How likely is white phosphorus to cause cancer?


The EPA has determined that white phosphorus is not classifiable as to its carcinogenicity in humans. There are no studies available in people or animals that suggest white phosphorus causes cancer.

Is there a medical test to show whether Ive been exposed to white phosphorus?
There is no medical test that shows if you have been ex-

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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PLUTONIUM
CAS # 7440-07-5
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about plutonium. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Plutonium is a radioactive material that does not occur naturally to any extent, but is produced in nuclear reactors. It has been found to cause lung, liver, and bone cancer in animals. This chemical has been found in at least 5 of the 1,177 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is plutonium? (Pronounced pl-tn-m)
Plutonium is a silvery white metal that exists as a solid under normal conditions. It is produced when uranium absorbs an atomic particle. Trace amounts of plutonium occur naturally, but large amounts have been produced in nuclear reactors. Trace levels of plutonium can be found in the environment, from past nuclear bomb tests, in several forms called isotopes. The most common plutonium isotopes are plutonium-238 and plutonium-239. Plutonium undergoes radioactive decay. In this decay process, energy is released and a new product is formed. The energy released is called radiation. When plutonium decays, it divides into two partsa small part that is called alpha radiation and a large part called a daughter. The daughter is also radioactive, and it, too, continues to decay until a nonradioactive daughter is formed. During these decay processes, three types of radiation are releasedalpha, beta, and gamma. Alpha particles can travel only a short distance and cannot travel through your skin. Beta particles can penetrate through your skin, but they cannot go all the way through your body. Gamma radiation can go all the way through your body.

What happens to plutonium when it enters the environment?


G Trace amounts of plutonium are found naturally in uranium-rich ores. Most is made in special nuclear reactors. G It may also enter the environment from releases from nuclear reactors, weapons production plants, and research facilities. G A major source of plutonium is releases from nuclear weapons testing. G Plutonium may enter surface water from accidental releases and disposal of radioactive wastes. G Soil may become contaminated with plutonium from fallout from nuclear weapons testing. G Plutonium can move slowly from soil into the groundwater. G Low levels may be absorbed by plants.

How might I be exposed to plutonium?


G Everyone is exposed to very low levels of plutonium in air. G Very low levels may be found in drinking water and food. G Exposure to higher levels could occur from an accidental release during its use, transport, or disposal.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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PLUTONIUM CAS # 7440-07-5

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


G Workers at nuclear facilities using plutonium may be exposed to higher levels of it. G People who live near facilities that use plutonium in their operations may be exposed to it from releases to the air. G It may also be found at radioactive waste disposal sites.

Has the federal government made recommendations to protect human health?


The EPA has set a drinking water limit of 15 picocuries per liter (15 pCi/L) for gross alpha particle activity. The EPA has also set a drinking water limit of 4 millirems per year (4 mrem/yr) for beta and gamma radiation. The Nuclear Regulatory Commission (NRC) has set a radiation dose limit for individual members of the public for all sources of radiation of 0.5 rem per year (0.5 rem/yr). The federal recommendations have been updated as of July 1999.

How can plutonium affect my health?


Plutonium has not been shown to cause adverse health effects in people. Animal studies have shown lung diseases from short-term exposure to high concentrations of plutonium. Animal studies have also shown effects on the blood, liver, bone, and immune system from plutonium exposure.

How likely is plutonium to cause cancer?


Studies in people have found no cancer from plutonium. Animal studies have reported an increase in lung, liver, and bone cancers from exposure to plutonium. The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified plutonium for carcinogenicity.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Millirem (mrem): A unit used to measure radiation dose (one thousandth of a rem). National Priorities List: A list of the nations worst hazardous waste sites. Picocurie (pCi): A unit used to measure the amount of radioactive material. rem: A unit used to measure radiation dose. Short-term: Lasting 14 days or less.

Is there a medical test to show whether Ive been exposed to plutonium?


There are tests available that can measure the amount of plutonium in a urine sample, even at very low levels. These measurements can be used to estimate the total amount of plutonium that is in the body. However, these measurements cannot be used to determine the levels to which the person was exposed or to predict the potential for health effects. There are also tests to measure plutonium in body organs, feces, bones, and milk. These tests require special equipment and cannot be routinely done in a doctors office.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1990. Toxicological profile for plutonium. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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POLYBROMINATED BIPHENYLS and POLYBROMINATED DIPHENYL ETHERS


Division of Toxicology ToxFAQsTM September 2002

This fact sheet answers the most frequently asked health questions (FAQs) about polybrominated biphenyls and polybrominated diphenyl ethers. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Polybrominated biphenyls (PBBs) and polybrominated diphenyl ethers (PBDEs) are manmade chemicals found in plastics used in a variety of consumer products to make them difficult to burn. Some people who ate food contaminated with PBBs in the 1970s had skin problems. Almost nothing is known about health effects of PBDEs in people. PBBs have been found in at least 9 of the 1,613 National Priorities List sites identified by the Environmental Protection Agency (EPA). PBDEs have not been identified in any of the 1,613 sites.
What are PBBs and PBDEs?
PBBs and PBDEs are manufactured chemicals found in plastics used in a variety of consumer products (computer monitors, televisions, textiles, plastic foams, etc.) to make them difficult to burn. Because they are mixed into plastics rather than bound to them, they can leave the plastic and find their way into the environment. PBBs and PBDEs are similar, but not identical compounds. Both are colorless to off-white solids. Both PBBs and PBDEs are mixtures of up to 209 individual component chemicals called congeners. The manufacture of PBBs was discontinued in the United States in 1976, while production of PBDEs has continued to the present. Trade names of some commercial PBB mixtures include FireMaster BP-6 and FireMaster FF-1. Trade names of some PBDE commercial mixtures include Bromkal 70-5DE, Tardex 50L , and Saytex 115 . ! Sunlight can degrade some PBDEs in air. ! PBDEs do not dissolve easily in water, but stick to particles and settle to the bottom of river or lakes. ! Some PBDEs in water can build up in fish.

How might I be exposed to PBBs and PBDEs?


! Exposure to PBBs by the general population will be mainly from past releases. ! Michigan residents who ate animal products contaminated with PBBs were exposed to these chemicals. ! Some people living in Michigans lower peninsula may still be experiencing exposure to PBBs. ! You can be exposed to PBBs in the air if you live near a waste site that contains PBBs. ! Low levels of PBDEs are found in air, sediments, animals, and food. ! Analyses of blood, breast milk, and body fat indicate that most people are exposed to low levels of PBDEs. ! Exposure to higher levels of PBDEs can occur in workers who produce or manufacture PBDE-containing products. ! Exposure to PBDEs can also occur if you work in a confined place where plastics and foam products are recycled, and computers are repaired.

What happens to PPBs and PBDEs when they enter the environment?
! PBBs entered the air, water and soil during their manufacture and use. ! PBBs entered the environment when animal feed was accidentally mixed with PBBs in lower Michigan in 1973. ! PBBs entered the environment during the disposal of contaminated animal feed and animal products, and during the disposal of plastic products containing PBBs in waste sites. ! Small amounts entered the environment from improper incineration of plastics containing PBBs. ! PBDEs entered air, water, and soil during their manufacture and use in consumer products. ! In air, PBDEs can be present as particles, but eventually settle to soil or water.

How can PBBs and PBDEs affect my health?


Most of what we know about the health effects of PPBs in people comes from studies of people in Michigan who ate PBBcontaminated animal products for several months. Some residents complained of nausea, abdominal pain, loss of appetite, joint pain, fatigue, and weakness. However, it could not be clearly established that PBBs were the cause of these health problems. There is stronger evidence that PBBs may have caused skin problems, such as acne, in some people who ate contaminated

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html How can families reduce the risk of exposure to PBBs and PBDEs?
! Since PBBs are no longer produced or used, the risk of exposure to these compounds is limited. ! Do not eat fish or wildlife caught in contaminated locations; always follow posted health warnings. ! Discourage children from playing in the dirt near waste sites. ! Discourage children from eating dirt, from putting their hands in their mouths or from doing other hand-to mouth activities. ! If you are exposed to PBDEs at work, you may carry PBDEs home on your skin, clothes, or tools. You can avoid this by showering, and changing clothing before leaving work, and your work clothes should be kept separate from other clothes and laundered separately.

food. Some workers exposed to PBBs by breathing and skin contact for days to months also developed acne. Studies in animals exposed to large amounts of PBBs for a short time or to smaller amounts for longer time show that PBBs can cause weight loss, skin disorders, nervous and immune system effects, and effects on the liver, kidneys, and thyroid gland. There is no definite information on health effects of PBDEs in people. Rats and mice that ate food with moderate amounts of PBDEs for a few days had effects on the thyroid gland. Those that ate smaller amounts for weeks or months had effects on the thyroid and the liver. Preliminary evidence suggests that PBDEs may cause neurobehavioral alterations and affect the immune system in animals.

How likely are PBBs and PBDEs to cause cancer?


We do not know whether PBBs can cause cancer in humans, but we know that they can cause liver cancer in rats and mice. Based on the findings in animals, the Department of Health and Human Services (DHHS) determined that PBBs may reasonably be anticipated to be carcinogens. The International Agency for Research on Cancer (IARC) has determined that PBBs are possibly carcinogenic to humans. We do not know whether PBDEs can cause cancer in humans. Rats and mice that ate food with decabromodiphenyl ether (one type of PBDEs) throughout their lives, developed liver tumors. Based on this evidence, the EPA has classified decabromodiphenyl ether as a possible human carcinogen.

Is there a medical test to show whether Ive been exposed PBBs and PBDEs?
There are tests that can detect PBBs and PBDEs in blood, body fat, and breast milk. These tests can tell whether you have been exposed to high levels of the chemicals, but cannot tell the exact amount or type of PBB or PBDE you were exposed to, or whether harmful effects will occur. Blood tests are the easiest and safest for detecting recent exposures to large amounts of PBBs or PBDEs. These tests are not routinely available at the doctors office, but samples can be sent to laboratories that have the appropriate equipment.

How can PBBs and PBDEs affect children?


Children are exposed to PBBs and PBDEs in generally the same way as adults, mainly by eating contaminated food. Because PBBs and PBDEs dissolve readily in fat, they can accumulate in breast milk fat and be transferred to babies and young children. They can also cross the placenta and reach the fetus. No specific health effects attributed to PBBs were found in children who ate contaminated food in the Michigan accident or in children born to mothers who ate the contaminated food. No studies are available of children exposed to PBDEs. Neurobehavioral alterations have been found in animals that were exposed to PBBs in the womb and by nursing. Such exposures also caused changes in thyroid hormone levels in the newborn animals and birth defects. Exposure to PBDEs in the womb and through nursing has also caused thyroid effects and neurobehavioral alterations in newborn animals, but not birth defects.

Has the federal government made recommendations to protect human health?


There are no federal guidelines or recommendations for protecting human health from exposure to PBBs. The EPA requires that companies that transport, store, or dispose p-bromodiphenyl ether (a particular PBDE compound) follow the rules and regulations of the federal hazardous waste management program. The EPA requires that industry tell the National Response Center each time 100 pounds or more of pbromodiphenyl ether are released to the environment.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2002. Toxicological Profile for Polybrominated Biphenyls and Polybrominated Biphenyl Ethers (Draft for Public Comment). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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POLYCHLORINATED BIPHENYLS
Division of Toxicology ToxFAQsTM February 2001
This fact sheet answers the most frequently asked health questions (FAQs) about polychlorinated biphenyls. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present. HIGHLIGHTS: Polychlorinated biphenyls (PCBs) are a mixture of individual chemicals which are no longer produced in the United States, but are still found in the environment. Health effects that have been associated with exposure to PCBs include acne-like skin conditions in adults and neurobehavioral and immunological changes in children. PCBs are known to cause cancer in animals. PCBs have been found in at least 500 of the 1,598 National Priorities List sites identified by the Environmental Protection Agency (EPA). What are polychlorinated biphenyls? Polychlorinated biphenyls are mixtures of up to 209 individual chlorinated compounds (known as congeners). There are no known natural sources of PCBs. PCBs are either oily liquids or solids that are colorless to light yellow. Some PCBs can exist as a vapor in air. PCBs have no known smell or taste. Many commercial PCB mixtures are known in the U.S. by the trade name Aroclor. PCBs have been used as coolants and lubricants in transformers, capacitors, and other electrical equipment because they dont burn easily and are good insulators. The manufacture of PCBs was stopped in the U.S. in 1977 because of evidence they build up in the environment and can cause harmful health effects. Products made before 1977 that may contain PCBs include old fluorescent lighting fixtures and electrical devices containing PCB capacitors, and old microscope and hydraulic oils. What happens to PCBs when they enter the environment? [ PCBs entered the air, water, and soil during their manufacture, use, and disposal; from accidental spills and leaks during their transport; and from leaks or fires in products containing PCBs. [ PCBs can still be released to the environment from hazardous waste sites; illegal or improper disposal of industrial wastes and consumer products; leaks from old electrical transformers containing PCBs; and burning of some wastes in incinerators. [ PCBs do not readily break down in the environment and thus may remain there for very long periods of time. PCBs can travel long distances in the air and be deposited in areas far away from where they were released. In water, a small amount of PCBs may remain dissolved, but most stick to organic particles and bottom sediments. PCBs also bind strongly to soil. [ PCBs are taken up by small organisms and fish in water. They are also taken up by other animals that eat these aquatic animals as food. PCBs accumulate in fish and marine mammals, reaching levels that may be many thousands of times higher than in water. How might I be exposed to PCBs? [ Using old fluorescent lighting fixtures and electrical devices and appliances, such as television sets and refrigerators, that were made 30 or more years ago. These items may leak small amounts of PCBs into the air when they get hot during operation, and could be a source of skin exposure. [ Eating contaminated food. The main dietary sources of PCBs are fish (especially sportfish caught in contaminated lakes or rivers), meat, and dairy products. [ Breathing air near hazardous waste sites and drinking contaminated well water. [ In the workplace during repair and maintenance of PCB transformers; accidents, fires or spills involving transformers, fluorescent lights, and other old electrical devices; and disposal of PCB materials. How can PCBs affect my health? The most commonly observed health effects in people exposed to large amounts of PCBs are skin conditions such as acne and rashes. Studies in exposed workers have shown changes in blood and urine that may indicate liver damage. PCB exposures in the general population are not likely to result in skin and liver effects. Most of the studies of health effects of PCBs in the general population examined children of mothers who were exposed to PCBs. Animals that ate food containing large amounts of PCBs for short periods of time had mild liver damage and some died. Animals that ate smaller amounts of PCBs in food over several weeks or months developed various kinds of health effects, including anemia; acne-like skin conditions; and liver, stomach, and thyroid gland injuries. Other effects

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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POLYCHLORINATED BIPHENYLS
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html
electrical equipment, or transformers, since they may contain PCBs. [ Children should be discouraged from playing in the dirt near hazardous waste sites and in areas where there was a transformer fire. Children should also be discouraged from eating dirt and putting dirty hands, toys or other objects in their mouths, and should wash hands frequently. [ If you are exposed to PCBs in the workplace it is possible to carry them home on your clothes, body, or tools. If this is the case, you should shower and change clothing before leaving work, and your work clothes should be kept separate from other clothes and laundered separately. Is there a medical test to show whether Ive been exposed to PCBs? Tests exist to measure levels of PCBs in your blood, body fat, and breast milk, but these are not routinely conducted. Most people normally have low levels of PCBs in their body because nearly everyone has been environmentally exposed to PCBs. The tests can show if your PCB levels are elevated, which would indicate past exposure to above-normal levels of PCBs, but cannot determine when or how long you were exposed or whether you will develop health effects. Has the federal government made recommendations to protect human health? The EPA has set a limit of 0.0005 milligrams of PCBs per liter of drinking water (0.0005 mg/L). Discharges, spills or accidental releases of 1 pound or more of PCBs into the environment must be reported to the EPA. The Food and Drug Administration (FDA) requires that infant foods, eggs, milk and other dairy products, fish and shellfish, poultry and red meat contain no more than 0.2-3 parts of PCBs per million parts (0.2-3 ppm) of food. Many states have established fish and wildlife consumption advisories for PCBs. Source of Information Agency for Toxic Substances and Disease Registry (ATSDR). 2000. Toxicological profile for polychlorinated biphenyls (PCBs). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

of PCBs in animals include changes in the immune system, behavioral alterations, and impaired reproduction. PCBs are not known to cause birth defects. How likely are PCBs to cause cancer? Few studies of workers indicate that PCBs were associated with certain kinds of cancer in humans, such as cancer of the liver and biliary tract. Rats that ate food containing high levels of PCBs for two years developed liver cancer. The Department of Health and Human Services (DHHS) has concluded that PCBs may reasonably be anticipated to be carcinogens. The EPA and the International Agency for Research on Cancer (IARC) have determined that PCBs are probably carcinogenic to humans. How can PCBs affect children? Women who were exposed to relatively high levels of PCBs in the workplace or ate large amounts of fish contaminated with PCBs had babies that weighed slightly less than babies from women who did not have these exposures. Babies born to women who ate PCBcontaminated fish also showed abnormal responses in tests of infant behavior. Some of these behaviors, such as problems with motor skills and a decrease in short-term memory, lasted for several years. Other studies suggest that the immune system was affected in children born to and nursed by mothers exposed to increased levels of PCBs. There are no reports of structural birth defects caused by exposure to PCBs or of health effects of PCBs in older children. The most likely way infants will be exposed to PCBs is from breast milk. Transplacental transfers of PCBs were also reported In most cases, the benefits of breastfeeding outweigh any risks from exposure to PCBs in mothers milk. How can families reduce the risk of exposure to PCBs? [ You and your children may be exposed to PCBs by eating fish or wildlife caught from contaminated locations. Certain states, Native American tribes, and U.S. territories have issued advisories to warn people about PCB-contaminated fish and fish-eating wildlife. You can reduce your familys exposure to PCBs by obeying these advisories. [ Children should be told not play with old appliances,

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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POLYCYCLIC AROMATIC HYDROCARBONS (PAHs)


Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about polycyclic aromatic hydrocarbons (PAHs). For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to polycyclic aromatic hydrocarbons usually occurs by breathing air contaminated by wild fires or coal tar, or by eating foods that have been grilled. PAHs have been found in at least 600 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are polycyclic aromatic hydrocarbons? (Pronounced pl-sklk r-mtk hdrkarbnz)
Polycyclic aromatic hydrocarbons (PAHs) are a group of over 100 different chemicals that are formed during the incomplete burning of coal, oil and gas, garbage, or other organic substances like tobacco or charbroiled meat. PAHs are usually found as a mixture containing two or more of these compounds, such as soot. Some PAHs are manufactured. These pure PAHs usually exist as colorless, white, or pale yellow-green solids. PAHs are found in coal tar, crude oil, creosote, and roofing tar, but a few are used in medicines or to make dyes, plastics, and pesticides. G PAHs enter water through discharges from industrial and wastewater treatment plants. G Most PAHs do not dissolve easily in water. They stick to solid particles and settle to the bottoms of lakes or rivers. G Microorganisms can break down PAHs in soil or water after a period of weeks to months. G In soils, PAHs are most likely to stick tightly to particles; certain PAHs move through soil to contaminate underground water. G PAH contents of plants and animals may be much higher than PAH contents of soil or water in which they live.

How might I be exposed to PAHs?


G Breathing air containing PAHs in the workplace of coking, coal-tar, and asphalt production plants; smokehouses; and municipal trash incineration facilities. G Breathing air containing PAHs from cigarette smoke, wood smoke, vehicle exhausts, asphalt roads, or agricultural burn smoke. G Coming in contact with air, water, or soil near hazardous waste sites. G Eating grilled or charred meats; contaminated cereals, flour, bread, vegetables, fruits, meats; and processed or pickled foods. G Drinking contaminated water or cows milk.

What happens to PAHs when they enter the environment?


G PAHs enter the air mostly as releases from volcanoes, forest fires, burning coal, and automobile exhaust. G PAHs can occur in air attached to dust particles. G Some PAH particles can readily evaporate into the air from soil or surface waters. G PAHs can break down by reacting with sunlight and other chemicals in the air, over a period of days to weeks.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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POLYCYCLIC AROMATIC HYDROCARBONS (PAHs)

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G Nursing infants of mothers living near hazardous waste sites may be exposed to PAHs through their mother's milk. health effects will occur or find out the extent or source of your exposure to the PAHs. The tests arent usually available in your doctors office because special equipment is needed to conduct them.

How can PAHs affect my health?


Mice that were fed high levels of one PAH during pregnancy had difficulty reproducing and so did their offspring. These offspring also had higher rates of birth defects and lower body weights. It is not known whether these effects occur in people. Animal studies have also shown that PAHs can cause harmful effects on the skin, body fluids, and ability to fight disease after both short- and long-term exposure. But these effects have not been seen in people.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) has set a limit of 0.2 milligrams of PAHs per cubic meter of air (0.2 mg/m3). The OSHA Permissible Exposure Limit (PEL) for mineral oil mist that contains PAHs is 5 mg/m3 averaged over an 8-hour exposure period. The National Institute for Occupational Safety and Health (NIOSH) recommends that the average workplace air levels for coal tar products not exceed 0.1 mg/m3 for a 10-hour workday, within a 40-hour workweek. There are other limits for workplace exposure for things that contain PAHs, such as coal, coal tar, and mineral oil.

How likely are PAHs to cause cancer?


The Department of Health and Human Services (DHHS) has determined that some PAHs may reasonably be expected to be carcinogens. Some people who have breathed or touched mixtures of PAHs and other chemicals for long periods of time have developed cancer. Some PAHs have caused cancer in laboratory animals when they breathed air containing them (lung cancer), ingested them in food (stomach cancer), or had them applied to their skin (skin cancer).

Glossary
Carcinogen: A substance that can cause cancer. Ingest: Take food or drink into your body.

References Is there a medical test to show whether Ive been exposed to PAHs?
In the body, PAHs are changed into chemicals that can attach to substances within the body. There are special tests that can detect PAHs attached to these substances in body tissues or blood. However, these tests cannot tell whether any Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for polycyclic aromatic hydrocarbons. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information?

For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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ETHYLENE GLYCOL and PROPYLENE GLYCOL


CAS # 107-21-1 and 57-55-6
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about ethylene glycol and propylene glycol. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Ethylene glycol and propylene glycol are clear liquids used in antifreeze and deicing solutions. Exposure to large amounts of ethylene glycol can damage the kidneys, heart, and nervous system. Propylene glycol is generally regarded as safe for use in food. Ethylene glycol has been found in at least 34, and propylene glycol in at least 5, of the 1,416 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are ethylene glycol and propylene glycol? (Pronounced th-ln and pr p-ln gl kl)
Both ethylene glycol and propylene glycol are clear, colorless, slightly syrupy liquids at room temperature. Either compound may exist in air in the vapor form, although propylene glycol must be heated or briskly shaken to produce a vapor. Ethylene glycol is odorless but has a sweet taste. Propylene glycol is practically odorless and tasteless. Both compounds are used to make antifreeze and deicing solutions for cars, airplanes, and boats; to make polyester compounds; and as solvents in the paint and plastics industries. Ethylene glycol is also an ingredient in photographic developing solutions, hydraulic brake fluids and in inks used in stamp pads, ballpoint pens, and print shops. The Food and Drug Administration (FDA) has classified propylene glycol as an additive that is generally recognized as safe for use in food. It is used to absorb extra water and maintain moisture in certain medicines, cosmetics, or food products. It is a solvent for food colors and flavors. Propylene glycol is also used to create artificial smoke or fog used in fire-fighting training and in theatrical productions.

What happens to ethylene glycol and propylene glycol when they enter the environment?
q Neither compound is likely to exist in large amounts in air. q About half of the compounds that enter the air will break down in 2450 hours. q Both compounds break down within several days to a week in water and soil.

How might I be exposed to ethylene glycol and propylene glycol?


q You can be exposed to ethylene glycol when you use antifreeze, photographic developing solutions, coolants, and brake fluid. q You can be exposed to propylene glycol by eating food products, using cosmetics, or taking medicine that contains it. q If you work in an industry that uses ethylene glycol or propylene glycol, you could be exposed by breathing or touching these substances.

How can ethylene glycol and propylene glycol affect my health?


Eating or drinking very large amounts of ethylene glycol can result in death, while large amounts can result in nausea,

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

convulsions, slurred speech, disorientation, and heart and kidney problems. Female animals that ate large amounts of ethylene glycol had babies with birth defects, while male animals had reduced sperm counts. However, these effects were seen at very high levels and would not be expected in people exposed to lower levels at hazardous waste sites. Ethylene glycol affects the body's chemistry by increasing the amount of acid, resulting in metabolic problems. Similar to ethylene glycol, propylene glycol increases the amount of acid in the body. However, larger amounts of propylene glycol are needed to cause this effect.

the body, they are very difficult to detect, even though symptoms may be present.

Has the federal government made recommendations to protect human health?


The EPA has set a drinking water guideline for ethylene glycol of 7,000 micrograms (7,000 mg/L) in a liter of water for an adult. The Food and Drug Administration (FDA) has classified propylene glycol as generally recognized as safe, which means that it is acceptable for use in flavorings, drugs, and cosmetics, and as a direct food additive. The American Conference of Governmental Industrial Hygienists (ACGIH) recommends a maximum level of 127 milligrams of ethylene glycol per cubic meter of air (127 mg/m3) for a 15-minute exposure.

How likely are ethylene and propylene glycol to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified ethylene glycol and propylene glycol for carcinogenicity. Studies with people who used ethylene glycol did not show carcinogenic effects. Animal studies also have not shown these chemicals to be carcinogens.

Glossary
Acid: A sour substance. Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Metabolic: Chemical changes in cells that provide energy to the body. Synthetic: Made by humans.

Is there a medical test to show whether Ive been exposed to ethylene or propylene glycol?
Tests are available to determine if you have been exposed to ethylene glycol. These tests are only used on people who are showing symptoms of ethylene glycol poisoning (but they could be used in other situations). The tests are most often used on people who have intentionally consumed, or who suspect they have consumed, large amounts of ethylene glycol. Propylene glycol is generally considered to be a safe chemical, and is not routinely tested for, unless specific exposure, such as to a medicine or cosmetic, can be linked with symptoms. Since both chemicals break down very quickly in

Source of Information
This ToxFAQs information is taken from the 1997 Toxicological Profile for Ethylene Glycol and Propylene Glycol produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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PYRETHRINS AND PYRETHROIDS


Division of Toxicology ToxFAQsTM September 2001
This fact sheet answers the most frequently asked health questions (FAQs) about pyrethrins and pyrethroids. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Pyrethrins and pyrethroids are insecticides that are applied to crops, garden plants, pets, and also directly to humans. High levels of pyrethrins or pyrethroids can cause dizziness, headache, nausea, muscle twitching, reduced energy, changes in awareness, convulsions and loss of consciousness. Pyrethrins have been found in at least 5 of the 1,585 current or former NPL sites identified by the Environmental Protection Agency (EPA), and permethrin (a pyrethroid compound) has been found in at least 2 of the sites. No other pyrethroids were detected at NPL sites.
What are pyrethrins and pyrethroids? (Pronounced pI-rE-thren; pI-rE-throid)
Pyrethrins are naturally-occurring compounds with insecticidal properties that are found in pyrethrum extract from certain chrysanthemum flowers. The pyrethrins are often used in household insecticides and products to control insects on pets or livestock. Pyrethroids are manufactured chemicals that are very similar in structure to the pyrethrins, but are often more toxic to insects as well as to mammals, and last longer in the environment than the pyrethrins. More than 1,000 synthetic pyrethroids have been developed, but less than a dozen of them are currently used in the United States. Permethrin is the most frequently used pyrethroid in the United States.

How might I be exposed to pyrethrins and pyrethroids?


Pyrethrins and pyrethroids usually enter the body when people eat foods contaminated by these chemicals. They may also enter your body when you breathe air that contains these compounds or when you get them on your skin. The use of products that contain pyrethrins and pyrethroids, such as household insecticides, pet sprays and shampoos, lice treatments that are applied directly to the head, and mosquito repellents that can be applied to clothing, may lead to exposure.

How can pyrethrins and pyrethroids affect my health?


Pyrethrins and pyrethroids interfere with the normal way that the nerves and brain function. Exposure to very high levels of these compounds for a short period in air, food, or water may cause dizziness, headache, nausea, muscle twitching, reduced energy, changes in awareness, convulsions and loss of consciousness. Changes in mental state may last several days after exposure to high levels of pyrethroids has ended. There is no evidence that pyrethrins or pyrethroids affect the ability of humans to produce children, but some animal studies have shown reduced fertility in males and females.

What happens to pyrethrins and pyrethroids when they enter the environment?
Pyrethroids enter the environment primarily due to their use as insecticides. In air, all six of the pyrethrins and many of the pyrethroids are broken down rapidly (12 days) by sunlight or other compounds found in the atmosphere. Pyrethrins and pyrethroids bind strongly to soil and are eventually degraded by microorganisms in soil and water; they generally do not move from the soil to groundwater.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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PYRETHRINS AND PYRETHROIDS


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Children should avoid playing in soils near uncontrolled hazardous waste sites where pyrethrins and pyrethroids may have been discarded.

How likely are pyrethrins and pyrethroids to cause cancer?


There is no evidence that pyrethrins or pyrethroids causes cancer in people or in animals. The International Agency for Research on Cancer (IARC) has determined that the carcinogenicity to humans for three pyrethroids (deltamethrin, fenvalerate, permethrin) is not classifiable.

Is there a medical test to show whether Ive been exposed to pyrethrins or pyrethroids?
Pyrethrins, pyrethroids, and their breakdown products can be detected in your blood and urine, but only within a few days after your last exposure. These tests are not usually available at your doctors office, but your doctor can send the samples to a laboratory that can perform the tests. None of these tests can predict whether you will experience any related health effects.

How can pyrethrins and pyrethroids affect children?


It is likely that health effects seen in children exposed to high levels of pyrethrins or pyrethroids will be similar to the effects seen in adults. We do not know whether children differ from adults in their susceptibility to these chemicals. Birth defects have not been observed in humans exposed to pyrethrins or pyrethroids. Offspring of animals that ingested pyrethrins or pyrethroids while pregnant showed signs of possible damage to the immune system. Some animals that were exposed to pyrethrins or pyrethroids right after birth showed altered behavior as adults.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) has set a limit of 5 milligrams of pyrethrins per cubic meter of workplace air (5 mg/m3) for 8-hour shifts and 40-hour work weeks. The EPA has recommended daily oral exposure limits for 10 different pyrethroids ranging from 0.005 to 0.05 mg per kilogram of body weight per day (0.005-0.05 mg/kg/day). The EPA has established tolerances for residues of pyrethrins and various pyrethroids that range from 0.01 to 75 parts per million parts (0.01-75 ppm) of a variety of foods.

How can families reduce the risk of exposure to pyrethrins and pyrethroids?
Exposure to pyrethrins and pyrethroids can be reduced by exercising care when using pesticides containing these compounds around the house, on pets, and on children and by storing them properly. Certain pyrethroids are sprayed to control mosquitos during the spring and summer; remaining indoors and closing your windows while your neighborhood is being sprayed will lessen your exposure. Additional ways to reduce possible exposure include thoroughly washing fruits and vegetables before eating them, ensuring that children wash their hands before eating, and discouraging young children from eating dirt.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for Pyrethrins and Pyrethroids (Draft for Public Comment) Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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PYRIDINE
CAS # 110-86-1
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about pyridine. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Everyone is exposed to very low levels of pyridine in air, water, and food. Workers who make or use the chemical may be exposed to higher levels of it. Studies in people and animals suggest that pyridine may damage the liver. This chemical has been found in at least 11 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is pyridine? (Pronounced pr-dn)
Pyridine is a colorless liquid with an unpleasant smell. It can be made from crude coal tar or from other chemicals. Pyridine is used to dissolve other substances. It is also used to make many different products such as medicines, vitamins, food flavorings, paints, dyes, rubber products, adhesives, insecticides, and herbicides. Pyridine can also be formed from the breakdown of many natural materials in the environment.

How might I be exposed to pyridine?


G Everyone is exposed to very low levels of pyridine in air, water, and food. G Workers may be exposed in industries that make pyridine or use it to make other products by breathing it in air or by touching it. G People may breathe pyridine when it is released into the air from burning cigarettes and from hot coffee. G People who live near hazardous waste sites or landfills where pyridine exists may be exposed to it by breathing contaminated air or by drinking contaminated water.

What happens to pyridine when it enters the environment?


G Pyridine is primarily released to the environment from industries that make and use this chemical. G Pyridine evaporates into the air very easily. G In the air, it may take several months or years until it breaks down into other compounds. G Pyridine is very soluble in water. G In water or soil, it may be broken down in a few days to a few months by microscopic organisms. G Pyridine sticks to soil particles. G Pyridine probably doesn't build up in plants or animals.

How can pyridine affect my health?


Very little information is available on the health effects of pyridine. Animal studies and some limited case reports in people have noted liver damage from exposure to pyridine. Two patients with epilepsy had damage to the liver and kidneys after ingesting some pyridine. We do not know if the pyridine caused these effects because the patients were taking several other medications at the same time. Harmful effects to the liver were also seen in rats and mice that were given pyridine for three months. Headaches, giddiness, a desire to sleep, quickening of the pulse, and rapid breathing occurred in adults who

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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PYRIDINE CAS # 110-86-1

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breathed an unknown amount of pyridine for an unknown length of time. Mild skin irritation and eye irritation were seen in rabbits when pyridine was placed on their skin or in their eyes. We do not know whether pyridine affects the ability of men and women to have children or whether it causes birth defects.

reported. The Food and Drug Administration (FDA) allows pyridine to be used as a flavoring agent in the preparation of foods. The Occupational Safety and Health Administration (OSHA) has set an occupational exposure limit of 5 parts of pyridine per million parts of workplace air (5 ppm) for an 8-hour workday over a 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) and the American Conference of Governmental and Industrial Hygienists (ACGIH) have established the same guidelines as OSHA for pyridine exposure levels in the workplace. NIOSH has recommended that 1,000 ppm be considered immediately dangerous to life and health. This is the exposure level of a chemical that is likely to cause permanent health problems or death.

How likely is pyridine to cause cancer?


The Department of Health and Human Services, the International Agency for Research on Cancer, and the Environmental Protection Agency (EPA) have not classified pyridine as to its human carcinogenicity. No studies are available in people or animals on the carcinogenic effects of pyridine.

Is there a medical test to show whether Ive been exposed to pyridine?


There are medical tests available to measure levels of pyridine in urine and blood. However, these tests are not usually performed in most doctors' offices because special equipment is needed to conduct them. These tests can't tell how much pyridine you were exposed to or if harmful health effects will occur from the exposure to pyridine.

Glossary
Carcinogenicity: Ability to cause cancer. Evaporate: To change into a vapor or a gas. Herbicide: A chemical that kills weeds and other plants. Ingesting: Taking food or drink into your body. Insecticide: A chemical used to kill insects. ppm: Parts per million.

Has the federal government made recommendations to protect human health?


The EPA requires that discharges or accidental spills into the environment of 1,000 pounds or more of pyridine be

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for pyridine. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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RADIUM
CAS # 7440-14-4
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about radium. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Radium is a radioactive substance formed from the breakdown of uranium and thorium. Exposure to high levels results in an increased risk of bone, liver, and breast cancer. This chemical has been found in at least 18 of the 1,177 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is radium? (Pronounced rd-m)
Radium is a naturally occurring silvery-white radioactive metal that can exist in several forms called isotopes. Radium is formed when uranium and thorium break down in the environment. Uranium and thorium are found in small amounts in most rocks and soil. Two of the main radium isotopes found in the environment are radium-226 and radium-228. Radium undergoes radioactive decay. It divides into two partsone part is called radiation and the other part is called a daughter. The daughter, like radium, is not stable, and it also divides into radiation and another daughter. The dividing of daughters continues until a stable, nonradioactive daughter is formed. During the decay process, alpha, beta, and gamma radiation are released. Alpha particles can travel only a short distance and cannot travel through your skin. Beta particles can penetrate through your skin, but they cannot go all the way through your body. Gamma radiation can go all the way through your body. Radium has been used as a radiation source for treating cancer, in radiography of metals, and combined with other metals as a neutron source for research and radiation instrument calibration. Until the 1960s, radium was a component of the luminous paints used for watch and clock dials, intrument panels in airplanes, military instruments, and compasses.

What happens to radium when it enters the environment?


G Radium is constantly being produced by the radioactive decay of uranium and thorium. G Radium is present at very low levels in rocks and soil and may strongly attach to those materials. G Radium may also be found in air. G High concentrations are found in water in some areas of the country. G Uranium mining results in higher levels of radium in water near uranium mines. G Radium in the soil may be absorbed by plants. G It may concentrate in fish and other aquatic organisms.

How might I be exposed to radium?


G Everyone is exposed to low levels of radium in the air, water, and food.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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RADIUM CAS # 7440-14-4

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G Higher levels may be found in the air near industries that burn coal or other fuels. G It may be found at higher levels in drinking water from wells. G Miners, particularly miners of uranium and hard rock, are exposed to higher levels of radium. G It may also be found at radioactive waste disposal sites.

Has the federal government made recommendations to protect human health?


The EPA has set a drinking water limit of 5 picocuries per liter (5 pCi/L) for radium-226 and radium-228 (combined). The EPA has set a soil concentration limit for radium-226 in uranium and thorium mill tailings of 5 picocuries per gram (5 pCi/g) in the first 15 centimeters of soil and 15 pCi/g in deeper soil. The federal recommendations have been updated as of July 1999.

How can radium affect my health?


Radium has been shown to cause effects on the blood (anemia) and eyes (cataracts). It also has been shown to affect the teeth, causing an increase in broken teeth and cavities. Patients who were injected with radium in Germany, from 1946 to 1950, for the treatment of certain diseases including tuberculosis were significantly shorter as adults than people who were not treated.

Glossary
Anemia: A decreased ability of the blood to transport oxygen. Carcinogen: A substance that can cause cancer. CAS: Chemical Abstracts Service. National Priorities List: A list of the nations worst hazardous waste sites. Picocurie (pCi): A unit used to measure the quantity of radioactive material. rem: A unit used to measure radiation dose.

How likely is radium to cause cancer?


Exposure to high levels of radium results in an increased incidence of bone, liver, and breast cancer. The EPA and the National Academy of Sciences, Committee on Biological Effects of Ionizing Radiation, has stated that radium is a known human carcinogen.

Is there a medical test to show whether Ive been exposed to radium?


Urine tests can determine if you have been exposed to radium. Another test measures the amount of radon (a breakdown product of radium) in exhaled air. Both types of tests require special equipment and cannot be done in a doctors office. These tests cannot tell how much radium you were exposed to, nor can they be used to predict whether you will develop harmful health effects.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1990. Toxicological profile for radium. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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RADON
CAS # 14859-67-7
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about radon. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Radon is an odorless, radioactive gas formed from the breakdown of uranium. Exposure to high levels results in an increased risk of lung cancer. This chemical has been found in at least 5 of the 1,177 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is radon? (Pronounced rdn)


Radon is a naturally occurring radioactive gas that is odorless and tasteless. It is formed from the radioactive decay of uranium. Uranium is found in small amounts in most rocks and soil. It slowly breaks down to other products such as radium, which breaks down to radon. Radon also undergoes radioactive decay. It divides into two partsone part is called radiation, and the other part is called a daughter. The daughter, like radon, is not stable, and it also divides into radiation and another daughter. The dividing of daughters continues until a stable, nonradioactive daughter is formed. During the decay process, alpha, beta, and gamma radiation are released. Alpha particles can travel only a short distance and cannot travel through your skin. Beta particles can penetrate through your skin, but they cannot go all the way through your body. Gamma radiation can go all the way through your body. Radon is no longer used in the treatment of various diseases including cancer, arthritis, diabetes, and ulcers. Radon is used to predict earthquakes, in the study of atmospheric transport, and in exploration for petroleum and uranium.

What happens to radon when it enters the environment?


G Radon enters the environment from the soil, from uranium and phosphate mines, and from coal combustion. G Radon has a radioactive half-life of about 4 days; this means that one-half of a given amount of radon will decay to other products every 4 days. G Some of the radon produced in the soil will move to the surface and enter the air. G Radon daughters attach to dust and other particles in the air. G Most of the radon will remain in the soil. G Radon also moves from the soil and enters the groundwater

How might I be exposed to radon?


G Radon is found at very low levels in outdoor air. G It is found at higher levels in indoor air in homes, schools, and office buildings. G Cracks in the basement or foundation of a home may allow higher levels of radon inside the home.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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RADON CAS # 14859-67-7

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G Indoor radon levels are affected by the radium and uranium levels in soil, the porosity of the soil, the composition and condition of the foundation materials, and the ventilation rate of the room. G Miners, particularly those who mine uranium and hard rock, are exposed to higher levels of radon. G Radon is found in drinking water and may be higher in well water.

Has the federal government made recommendations to protect human health?


The EPA has set a guideline for radon in air inside homes of 4 picocuries per liter (4 pCi/L) of air. The EPA has also set a standard of 20 picocuries per square meter per second (20 pCi/m2/sec) for emissions of radon-222 (a radon daughter) to the air from uranium mill tailings in non-operational piles. The federal recommendations have been updated as of July 1999.

How can radon affect my health?


Exposure to high levels of radon may result in an increased incidence of lung diseases, such as emphysema and pulmonary fibrosis. These diseases have been seen at a higher rate than normal among underground miners who were also exposed to arsenic, silica dust, diesel fumes, and cigarette smoke. Lung disease has been reported to increase with increasing exposure to radon and cigarette smoking. Effects on the lung have also been seen in animals exposed to radon.

Glossary
CAS: Chemical Abstracts Service. Emphysema: A lung disease. Millirem (mrem): A unit used to measure radiation dose. National Priorities List: A list of the nations worst hazardous waste sites. Picocurie (pCi): A unit used to measure the quantity of radioactive material. Pulmonary fibrosis: Formation of fibrous tissue in the lung.

How likely is radon to cause cancer?


People exposed to high levels of radon have an increased incidence of lung cancer.

Is there a medical test to show whether Ive been exposed to radon?


Radon in human tissues is not detectable by routine medical testing. However, several of its decay products can be detected in urine and in lung and bone tissue. These tests cannot tell how much radon you were exposed to, nor can they be used to predict whether you will develop harmful health effects.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1990. Toxicological profile for radon. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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RDX
CAS # 121-82-4
Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about RDX. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: RDX is an explosive. Few people will be exposed to RDX. Exposure to large amounts can cause seizures. RDX has been found in at least 16 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is RDX? (Pronounced RDX)


RDX stands for Royal Demolition eXplosive. It is also known as cyclonite or hexogen. The chemical name for RDX is 1,3,5-trinitro-1,3,5-triazine. It is a white powder and is very explosive. RDX is used as an explosive and is also used in combination with other ingredients in explosives. Its odor and taste are unknown. It is a synthetic product that does not occur naturally in the environment. It creates fumes when it is burned with other substances.

q It does not cling to soil very strongly and can move into the groundwater from soil. q RDX can be broken down in air and water in a few hours, but it breaks down more slowly in soil. q RDX does not build up in fish or in people.

How might I be exposed to RDX?


Few people will be exposed to RDX. Fewer than 500 people are known to work with RDX. These people can be exposed by: q Breathing dust with RDX in it. q Getting RDX on their skin. q Drinking contaminated water or touching contaminated soil near factories that produce RDX.

What happens to RDX when it enters the environment?


q Particles of RDX can enter the air when it is disposed of by burning. q RDX can enter the water from disposal of waste water from Army ammunitions plants, and it can enter water or soil from spills or leaks from improper disposal at these plants or at hazardous waste sites. q RDX dissolves very slowly in water, and it also evaporates very slowly from water.

How can RDX affect my health?


RDX can cause seizures (a problem of the nervous system) in humans and animals when large amounts are inhaled or eaten. The effects of long-term (365 days or longer), low-level exposure on the nervous system are not known. Nausea and

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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RDX CAS # 121-82-4

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vomiting have also been seen. No other significant health effects have been seen in humans. Rats and mice that ate RDX for 3 months or more had decreased body weights and slight liver and kidney damage. It is not known whether RDX causes birth defects in humans; it did not cause birth defects in rabbits, but it did result in smaller offspring in rats. It is not known whether RDX affects reproduction in people.

Has the federal government made recommendations to protect human health?


The Department of Transportation (DOT) has many regulations on the transportation of explosives. The EPA recommends a drinking water guideline of 2 micrograms (mg) RDX per liter for lifetime exposure for adults. The National Institute for Occupational Safety and Health (NIOSH) has recommended an exposure limit of 1.5 milligrams RDX per cubic meter of air (1.5 mg/m3) for a 10-hour workday, 40-hour workweek. The NIOSH short-term exposure limit, which is the highest level of RDX that they recommend workers be exposed to for 15 minutes, is 3 mg/m3. The American Conference of Governmental Industrial Hygienists (ACGIH) also recommends an exposure limit of 1.5 mg/m3 in workplace air for an 8-hour workday, 40-hour workweek.

How likely is RDX to cause cancer?


The EPA has determined hat RDX is a possible human carcinogen. In one study, RDX caused liver tumors in mice that were exposed to it in the food. However, carcinogenic effects were not noted in rat studies and no human data are available.

Is there a medical test to show whether Ive been exposed to RDX?


Medical tests are available that can measure RDX levels in your blood or urine. However, these tests can only be used if you have come in contact with RDX in the last few days. These tests can determine if you have been exposed to RDX, but they cannot be used to determine how much RDX entered your body. These tests arent available at most doctors offices, but can be done at special laboratories that have the right equipment. However, they cannot be used to determine long-term health effects from RDX. The usual immediate health effects (seizures, muscle twitching, or vomiting) from very high exposures would probably occur before you had the blood or urine test.

Glossary
Carcinogen: A substance that can cause cancer. CAS: Chemical Abstracts Service. Dissolve: To disappear gradually. Evaporate: To change into a vapor or a gas. Microgram (mg): One millionth of a gram. Milligram (mg): One thousandth of a gram. Tumor: An abnormal mass of tissue.

Reference
Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for RDX. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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SELENIUM
CAS #7782-49-2
Division of Toxicology ToxFAQsTM September 2001

This fact sheet answers the most frequently asked health questions (FAQs) about selenium. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: People may be exposed to low levels of selenium daily through food and water. Selenium functions as an antioxidant and is needed for good health, but exposure to high levels can result in neurological effects and brittle hair and deformed nails. Occupational inhalation exposure may cause dizziness, fatigue, irritation of mucous membranes, and respiratory effects. This substance has been found in at least 494 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is selenium?
Selenium is a naturally occurring mineral element that is distributed widely in nature in most rocks and soils. In its pure form, it exists as metallic gray to black hexagonal crystals, but in nature it is usually combined with sulfide minerals or with silver, copper, lead, and nickel minerals. Most processed selenium is used in the electronics industry, but it is also used: as a nutritional supplement; in the glass industry; as a component of pigments in plastics, paints, enamels, inks, and rubber; in the preparation of pharmaceuticals; as a nutritional feed additive for poultry and livestock; in pesticide formulations; in rubber production; as an ingredient in antidandruff shampoos; and as a constituent of fungicides. Radioactive selenium is used in diagnostic medicine. forms are very mobile and may enter surface water from soils. Selenium may accumulate up the food chain.

How might I be exposed to selenium?


The general population is exposed to very low levels of selenium in air, food, and water. People working in or living near industries where selenium is produced, processed, or converted into commercial products may be exposed to higher levels of selenium in the air. People living in the vicinity of hazardous waste sites or coal burning plants may also be exposed to higher levels of selenium.

How can selenium affect my health? What happens to selenium when it enters the environment?
Selenium occurs naturally in the environment and can be released by both natural and manufacturing processes. Selenium dust can enter the air from burning coal and oil. This selenium dust will eventually settle over the land and water. It also enters water from rocks and soil, and from agricultural and industrial waste. Some selenium compounds will dissolve in water, and some will settle to the bottom as particles. Insoluble forms of selenium will remain in soil, but soluble Selenium has both beneficial and harmful effects. Low doses of selenium are needed to maintain good health. However, exposure to high levels can cause adverse health effects. Short-term oral exposure to high concentrations of selenium may cause nausea, vomiting, and diarrhea. Chronic oral exposure to high concentrations of selenium compounds can produce a disease called selenosis. The major signs of selenosis are hair loss, nail brittleness, and neurological abnormalities (such as numbness and other odd sensations in the extremities). Brief exposures to high levels of elemental selenium or selenium dioxide in air can result in respiratory tract irritation,

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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SELENIUM
CAS #7782-49-2
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

bronchitis, difficulty breathing, and stomach pains. Longerterm exposure to either of these air-borne forms can cause respiratory irritation, bronchial spasms, and coughing. Levels of these forms of selenium that would be necessary to produce such effects are normally not seen outside of the workplace. Animal studies have shown that very high amounts of selenium can affect sperm production and the female reproductive cycle. We do not know if similar effects would occur in humans.

selenium; these should be used according to the manufacturers directions. Children living near selenium waste sites or coal burning plants should be encouraged to wash their hands before eating and to avoid putting their unwashed hands in their mouths.

Is there a medical test to show whether Ive been exposed to selenium?


Low levels of selenium are normally found in body tissues and urine. Blood and urine tests for selenium are most useful for people who have recently been exposed to high levels. Toenail clippings can be used to determine longerterm exposure. These tests are not usually available at your doctors office, but your doctor can send the samples to a laboratory that can perform the tests. None of these tests, however, can predict whether you will experience any health effects.

How likely is selenium to cause cancer?


Studies of laboratory animals and people show that most selenium compounds probably do not cause cancer. In fact, studies in humans suggest that lower-than-normal selenium levels in the diet might increase the risk of cancer. The International Agency for Research on Cancer (IARC) has determined that selenium and selenium compounds are not classifiable as to their carcinogenicity to humans. The EPA has determined that one specific form of selenium, selenium sulfide, is a probable human carcinogen. Selenium sulfide is not present in foods and is a very different chemical from the organic and inorganic selenium compounds found in foods and in the environment.

Has the federal government made recommendations to protect human health?


The EPA restricts the amount of selenium allowed in public water supplies to 50 parts total selenium per billion parts of water (50 ppb). The Occupational Safety and Health Administration (OSHA) sets a limit of 0.2 mg selenium/m3 of workroom air for an 8-hour work shift. ATSDR and the EPA have determined that 5 micrograms of selenium per kilogram of body weight taken daily would not be expected to cause any adverse health effects over a lifetime of such intake.

How can selenium affect children?


It is likely that the health effects seen in children exposed to selenium will be similar to the effects seen in adults. However, one study found that children may be less susceptible to the health effects of selenium than adults. Selenium compounds have not been shown to cause birth defects in humans or in other mammals.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for Selenium (Draft for Public Comment) Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

How can families reduce the risk of exposure to selenium?


Certain dietary supplements and shampoos contain

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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SELENIUM HEXAFLUORIDE
CAS #7783-79-1
Division of Toxicology ToxFAQsTM April 2002

This fact sheet answers the most frequently asked health questions (FAQs) about selenium hexafluoride. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Selenium hexafluoride is a corrosive gas. Significant exposure may occur only if you work with selenium hexafluoride. It is unlikely that the general population will be exposed to this substance. Exposure to selenium hexafluoride can cause irritation of the respiratory airway, skin and eyes. Exposure to high levels can cause severe skin and eye damage and accumulation of fluid in the lungs, and even death. Selenium hexafluoride has not been found in any of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is selenium hexafluoride?
Selenium hexafluoride is a corrosive, colorless gas at room temperature. Selenium hexafluoride is only slightly soluble in water. It does not occur naturally in the environment. Selenium hexafluoride is used as a gaseous electrical insulator. Selenium hexafluoride does not accumulate in the food chain.

How might I be exposed to selenium hexafluoride?


The general population is unlikely to be exposed to selenium hexafluoride. Workers that use selenium hexafluoride as a gaseous electric insulator or use selenium hexafluoride to produce other selenium containing compounds may be exposed to this gas.

What happens to selenium hexafluoride when it enters the environment?


When released to air, selenium hexafluoride will react with moisture, forming other compounds which are removed from the atmosphere by rainfall. Selenium hexafluoride is slightly soluble in water. It reacts slowly with water to form other compounds. It may also evaporate from water. Because it is a gas, it is rarely found in soil. If released to soil, selenium hexafluoride will react with moisture forming other compounds or evaporate from the soil.

How can selenium hexafluoride affect my health?


Exposure to low levels of selenium hexafluoride gas can cause irritation of the respiratory airway, skin, and eye. Exposure to high levels can lead to severe skin and eye damage, accumulation of fluid in the lungs, and eventually death.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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SELENIUM HEXAFLUORIDE
CAS #7783-79-1
ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html

Exposure to the liquified gas can cause severe skin injury or frostbite and also severe eye damage and blindness. Long-term exposure to low concentrations of selenium hexafluoride may cause effects similar to exposure to other selenium or fluoride compounds, such as pale appearance, nervousness, depression, gastrointestinal problems, lack of appetite, weight loss, and dental defects. There is no information on whether exposure to selenium hexafluoride may affect the reproductive system in humans or in animals.

We do not know if exposure to selenium hexafluoride will result in birth defects or other developmental effects in people. There are no developmental studies in laboratory animals.

How can families reduce the risk of exposure to selenium hexafluoride?


Most families will not be exposed to selenium hexafluoride.

Is there a medical test to show whether Ive been exposed to selenium hexafluoride?
There are no tests to determine whether you have been exposed to selenium hexafluoride. If you suspect exposure, a chest x-ray be an appropriate way to determine whether your lungs have been damaged.

How likely is selenium hexafluoride to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified selenium hexafluoride as to its carcinogenicity to humans. There are no studies of carcinogenity of selenium hexafluoride in animals.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) has set an exposure limit of 0.05 parts of selenium hexafluoride per million parts of workroom air (0.05 ppm) for an 8-hour work shift, 40 hour work week.

How can selenium hexafluoride affect children?


There are no studies on the health effects of children exposed to selenium hexafluoride. It is likely that the health effects seen in children exposed to this chemical will be similar to the effects seen in adults. In general, children may be more vulnerable to corrosive agents because of the smaller diameter of their airways.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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SILVER
CAS # 7440-22-4
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about silver. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Silver is an element found naturally in the environment. At very high levels, it may cause argyria, a blue-gray discoloration of the skin and other organs. This chemical has been found in at least 27 of the 1,177 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is silver? (Pronounced slvr)
Silver is a naturally occurring element. It is found in the environment combined with other elements such as sulfide, chloride, and nitrate. Pure silver is silver colored, but silver nitrate and silver chloride are powdery white and silver sulfide and silver oxide are dark-gray to black. Silver is often found as a by-product during the retrieval of copper, lead, zinc, and gold ores. Silver is used to make jewelry, silverware, electronic equipment, and dental fillings. It is also used to make photographs, in brazing alloys and solders, to disinfect drinking water and water in swimming pools, and as an antibacterial agent. Silver has also been used in lozenges and chewing gum to help people stop smoking.

G It may be released into water from photographic processing.

G Rain may wash silver out of soil into the groundwater. G Silver does not appear to concentrate to a significant
extent in aquatic animals.

How might I be exposed to silver? G Breathing low levels in air. G Swallowing it in food or drinking water. G Carrying out activities such as jewelry-making, soldering, and photography. ing it.

G Using anti-smoking lozenges or other medicines contain-

How can silver affect my health?


Exposure to high levels of silver for a long period of time may result in a condition called arygria, a blue-gray discoloration of the skin and other body tissues. Lower-level exposures to silver may also cause silver to be deposited in the skin and other parts of the body; however, this is not known to be harmful. Argyria is a permanent effect, but it appears to be a cosmetic problem that may not be otherwise harmful to health.

What happens to silver when is enters the environment? G Silver may be released into the air and water through
natural processes such as the weathering of rocks.

G Human activities such as the processing of ores, cement


manufacture, and the burning of fossil fuel may release silver into the air.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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SILVER CAS # 7440-22-4

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Exposure to high levels of silver in the air has resulted in breathing problems, lung and throat irritation, and stomach pains. Skin contact with silver can cause mild allergic reactions such as rash, swelling, and inflammation in some people. Animal studies have shown that swallowing silver results in the deposit of silver in the skin. One study in mice found that the animals exposed to silver in drinking water were less active than unexposed animals. No studies are available on whether silver affects reproduction or causes developmental problems in people. drinking water not exceed 0.10 milligrams per liter of water (0.10 mg/L) because of the skin discoloration that may occur. The EPA requires that spills or accidental releases of 1,000 pounds or more of silver be reported to the EPA. The Occupational Safety and Health Administration (OSHA) limits silver in workplace air to 0.01 milligrams per cubic meter (0.01 mg/m3) for an 8-hour workday, 40-hour workweek. The National Institute of Occupational Safety and Health (NIOSH) also recommends that workplace air contain no more that 0.01 mg/m3 silver. The American Conference of Governmental Industrial Hygienists (ACGIH) recommends that workplace air contain no more than 0.1 mg/m3 silver metal and 0.01 mg/m3 soluble silver compounds. The federal recommendations have been updated as of July 1999.

How likely is silver to cause cancer?


No studies are available on whether silver may cause cancer in people. The only available animal studies showed both positive and negative results when silver was implanted under the skin. The EPA has determined that silver is not classifiable as to human carcinogenicity.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemcial Abstracts Service. Milligram (mg): One thousandth of a gram. National Priorities List: A list of the nation's worst hazardous waste sites. Soluble: Capable of being dissolved in water.

Is there a medical test to show whether Ive been exposed to silver?


Silver can be measured in the blood, urine, feces, and body tissues of exposed people. Silver builds up in the body, and the best way to learn if past exposure has occurred is to look for silver in samples of skin. Tests for silver are not commonly done at a doctors office because they require special equipment. Although doctors can find out if a person has been exposed to silver by doing these tests, they cannot tell whether any health effects will occur.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1990. Toxicological profile for silver. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Has the federal government made recommendations to protect human health?


The EPA recommends that the concentration of silver in

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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SODIUM HYDROXIDE
CAS #1310-73-2
Division of Toxicology ToxFAQsTM April 2002

This fact sheet answers the most frequently asked health questions (FAQs) about sodium hydroxide. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Sodium hydroxide is a manufactured chemical. It is present in several domestic cleaning products. Very low levels can produce irritation of the skin and eyes. Exposure to the solid or concentrated liquid can cause severe burns in the eyes, skin, and gastrointestinal tract which may ultimately lead to death. This substance has been found in at least 49 of the 1,585 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is sodium hydroxide?
At room temperature, sodium hydroxide is a white crystalline odorless solid that absorbs moisture from the air. It is a manufactured substance. When dissolved in water or neutralized with acid it liberates substantial heat, which may be sufficient to ignite combustible materials. Sodium hydroxide is very corrosive. It is generally used as a solid or a 50% solution. Other common names include caustic soda and lye. Sodium hydroxide is used to manufacture soaps, rayon, paper, explosives, dyestuffs, and petroleum products. It is also used in processing cotton fabric, laundering and bleaching, metal cleaning and processing, oxide coating, electroplating, and electrolytic extracting. It is commonly present in commercial drain and oven cleaners. If released to soil, sodium hydroxide will separate into sodium cations and hydroxide anions when it comes into contact with moisture. Sodium hydroxide does not accumulate in the food chain.

How might I be exposed to sodium hydroxide?


Small amounts of sodium hydroxide are sometimes used in drain and oven cleaners. Using these products may expose you to sodium hydroxide. Workers employed in industries where sodium hydroxide is produced or used may be exposed to this compound.

How can sodium hydroxide affect my health?


Sodium hydroxide is very corrosive and can cause severe burns in all tissues that come in contact with it. Inhalation of low levels of sodium hydroxide as dusts, mists or aerosols may cause irritation of the nose, throat, and respiratory airways. Inhalation of higher levels can produce swelling or spasms of the upper airway leading to obstruction and loss of measurable pulse; inflammation of the lungs and accumulation of fluid in the lungs may also occur. Ingestion of solid or liquid sodium hydroxide can cause spontaneous vomiting, chest and abdominal pain, and difficulty swallowing. Corrosive injury to the mouth, throat, esophagus, and stomach is very rapid and may result in

What happens to sodium hydroxide when it enters the environment?


Sodium hydroxide released to the atmosphere breaks down readily by reacting with other chemicals. Sodium hydroxide separates in water to sodium cations (positively charged sodium atoms) and hydroxide anions (negatively charged oxygen and hydrogen atoms), which ultimately decrease the acidity of the water.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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perforation, hemorrhage, and narrowing of the gastrointestinal tract. Case reports indicate that death results from shock, infection of the corroded tissues, lung damage, or loss of measurable pulse. Skin contact with sodium hydroxide can cause severe burns with deep ulcerations. Pain and irritation are evident within 3 minutes, but contact with dilute solutions may not cause symptoms for several hours. Contact with the eye may produce pain and irritation, and in severe cases, clouding of the eye and blindness. Long-term exposure to sodium hydroxide in the air may lead to ulceration of the nasal passages and chronic skin irritation. We do not know if exposure to sodium hydroxide could affect reproduction in humans.

The cancer could have arisen during repair of the damaged tissue.

How can sodium hydroxide affect children?


There are no studies on the health effects of children exposed to sodium hydroxide. The effects seen in children accidently exposed to sodium hydroxide are similar to the effects observed in adults. We do not know if exposure to sodium hydroxide can result in birth defects or other developmental effects in people.

How can families reduce the risk of exposure to sodium hydroxide?


Products containing sodium hydroxide should be stored out of the reach of children. Cleaners containing sodium hydroxide should not be stored in containers that may appear attractive to children, such as soda bottles.

How likely is sodium hydroxide to cause cancer?


There have been reports of cancer of the esophagus 15 to 40 years after the formation of narrow points caused by corrosion induced by sodium hydroxide. However, these cancers were most likely the result of tissue destruction and scar formation rather than a direct carcinogenic action of sodium hydroxide itself. The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified sodium hydroxide for carcinogenicity in humans. Some reports indicate that cancer of the esophagus may develop many years after exposure to sodium hydroxide levels that are high enough to cause tissue damage. But this does not mean that sodium hydroxide itself is a cancer agent.

Is there a medical test to show whether Ive been exposed to sodium hydroxide?
There are no clinical tests that show that you have been exposed to sodium hydroxide.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) sets a limit of 2 milligrams of sodium hydroxide per cubic meter of air (2 mg/m3) in the workplace for an 8-hour work shift, 40-hour work week. The Food and Drug Administration (FDA) allows sodium hydroxide as a food additive in levels not to exceed 1%.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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STODDARD SOLVENT
CAS # 8052-41-3
Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about Stoddard solvent. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to Stoddard solvent occurs mainly in the workplace. People who breathe Stoddard solvent can experience headaches; dizziness; and eye, skin, or throat irritation. This substance has been found in at least 7 of the 1,430 National Priorities List Sites identified by the Environmental Protection Agency (EPA).
What is Stoddard solvent? (Pronounced stdrd slvnt)
Stoddard solvent is a colorless, flammable liquid that smells and tastes like kerosene. It will turn into a vapor at temperatures of 150200 C. Stoddard solvent is a petroleum mixture that is also known as dry cleaning safety solvent, petroleum solvent, and varnoline; its registered trade names are Texsolve S and Varsol 1. It is a chemical mixture that is similar to white spirits. Stoddard solvent is used as a paint thinner; in some types of photocopier toners, printing inks, and adhesives; as a dry cleaning solvent; and as a general cleaner and degreaser. Use of trade names is for identification only and does not imply endorsement by the Agency for Toxic Substances and Disease Registry (ATSDR) the Public Health Service, or the U.S. Department of Health and Human Services (DHHS). cals, these chemicals may react differently in the environment. Some of these chemicals can: q Be broken down by sunlight or other chemicals in the air; q Attach to particles in soil or water; q Sink down to the sediment in water; and q Be broken down by microorganisms in water, soil, or sediment. It is not known whether Stoddard solvent will build up in plants or animals living in contaminated soil or water, but some of the chemicals that make up Stoddard solvent might build up in these situations.

How might I be exposed to Stoddard solvent?


q Using products containing Stoddard solvent such as a paint or paint thinner, and breathing the vapors, or getting the vapors in your eyes. q Breathing contaminated air where Stoddard solvent is manufactured, used, or spilled. q Breathing contaminated air at or near hazardous waste sites. q Drinking or bathing in contaminated water. q Ingesting contaminated soil or water near waste sites containing Stoddard solvent.

What happens to Stoddard solvent when it enters the environment?


Because Stoddard solvent is a mixture of many chemi-

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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q Touching contaminated soil or water. is a mixture of many chemicals, some of these chemicals can be detected in your breath, blood, urine, and fat. However, the tests cannot tell you if you have been exposed to the specific mixture of chemicals found in Stoddard solvent. They also cannot tell whether you will suffer any health effects.

How can Stoddard solvent affect my health?


Most of the information on the health effects of Stoddard solvent comes from studies in which it is breathed; there are fewer studies of exposure to the eyes or skin. Exposure to Stoddard solvent in the air can affect your nervous system and cause dizziness, headaches, or a prolonged reaction time. It can also cause eye, skin, or throat irritation. Rats, cats, and dogs that breathed in large amounts of Stoddard solvent for several hours suffered seizures. Breathing Stoddard solvent has caused bronchitis in guinea pigs, but neither seizures nor bronchitis have been reported when humans breathed it. The effects of swallowing Stoddard solvent are not known. It is not known whether Stoddard solvent can cause birth defects or affect reproduction.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) has set a maximum exposure limit of 500 parts of Stoddard solvent per 1 million parts of air (500 ppm) for an 8hour workday, 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) recommends that the average workplace air levels not be more than 60 ppm in workplace air for a 10-hour workday, 40-hour workweek.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Ingesting: Taking food or drink into your body. ppm: Parts per million. Sediment: Mud and debris that have settled at the bottom of a body of water.

How likely is Stoddard solvent to cause cancer?


The International Agency for Research on Cancer (IARC) has determined that Stoddard solvent is not classifiable as to its carcinogenicity to humans. Very few studies have been located that study the carcinogenic effects of Stoddard solvent in humans or animals.

Reference Is there a medical test to show whether I've been exposed to Stoddard solvent?
There is no routinely used test to show whether you have been exposed to Stoddard solvent. Because Stoddard solvent Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for Stoddard solvent. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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STRONTIUM
CAS #7440-24-6
Division of Toxicology ToxFAQsTM July 2001

This fact sheet answers the most frequently asked health questions (FAQs) about strontium. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to stable or radioactive strontium occurs from ingesting contaminated food or drinking water or breathing contaminated air. In children, high levels of stable strontium can impair bone growth. High levels of radioactive strontium can cause anemia or cancer. Strontium has been found at 101 of the 1,585 National Priority List sites identified by the Environmental Protection Agency (EPA).
What is strontium?
Strontium is a naturally occurring element found in rocks, soil, dust, coal, and oil. Naturally occurring strontium is not radioactive and is referred to as stable strontium. Stable strontium in the environment exists in four stable isotopes, 84 Sr (read as strontium eighty-four), 86Sr, 87Sr, 88Sr. Strontium compounds are used in making ceramics and glass products, pyrotechnics, paint pigments, fluorescent lights, and medicines. Strontium can also exist as several radioactive isotopes, the most common is 90Sr. 90Sr is formed in nuclear reactors or during the explosion of nuclear weapons. Radioactive strontium generate beta particles as they decay. One of the radioactive properties of strontium is half-life, or the time it takes for half of the isotope to give off its radiation and change into another substance. The half-life of 90Sr is 29 years. Stable strontium in soil can dissolve in water and move deeper in the soil to underground water. Radioactive decay is the only way of decreasing the amount of 90Sr in the environment.

How might I be exposed to strontium?


You can be exposed to low levels of stable strontium and radioactive strontium by breathing air, eating food, or drinking water. Food and drinking water are the largest sources of exposure to strontium. You can be exposed to radioactive strontium if you eat food that was grown in contaminated soil. Living near uncontrolled radioactive waste sites containing strontium.

How can strontium affect my health?


Exposure to low levels of stable strontium has not been shown to affect adult health, but may harm children (see following section). Breathing or ingesting high levels of radioactive strontium can damage bone marrow and cause anemia and prevent the blood from clotting properly.

What happens to strontium when it enters the environment?


In air, stable strontium is present as dust which eventually settles over land and water. Stable strontium dissolves in water

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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STRONTIUM
CAS #7440-24-6
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How likely is strontium to cause cancer?


The only stable strontium compound that may cause cancer is strontium chromate, but this is due to chromium not strontium. Exposure to high levels of radioactive strontium may cause cancer. Leukemia has been seen in humans exposed to relatively large amounts of strontium. Leukemia and cancers of the bone, nose, lung, and skin have also been seen in laboratory animals. The International Agency for Research on Cancer (IARC) has determined that radioactive strontium is a human carcinogen.

Is there a medical test to show whether Ive been exposed to strontium?


All people have small amounts of stable strontium in their bodies. There are tests to measure the level of strontium in blood, hair, feces, and urine. These tests are most useful for people exposed to high levels. These tests cannot determine the exact levels of strontium you may have been exposed to or predict how the levels in your tissues will affect your health. If a person has been exposed to radioactive strontium, special tests can be used to measure levels of radiation in blood, feces, or urine. These tests are most useful when done soon after exposure, since radioactive strontium is quickly incorporated into bone and its release from bone occurs in very small amounts over a period of years.

How can strontium affect children?


We do not know if exposure to strontium will result in birth defects or other developmental effects in people. Birth defects have been observed in animals exposed to radioactive strontium. Exposure to high levels of stable strontium can result in impaired bone growth in children. Children may be more susceptible than adults to the harmful effects of radioactive strontium.

Has the federal government made recommendations to protect human health?


EPA has set a limit of 4000 g strontium per liter of drinking water (4000 g/L). EPA has set a limit of 8 picocuries 90Sr per liter of drinking water (8 pCi/L). The Nuclear Regulatory Commission (NRC) has set a limit of 20 Ci per year for on-the-job exposure to 90Sr in air.

How can families reduce the risk of exposure to strontium?


Having a balanced diet with sufficient amounts of vitamin D, calcium, and protein will reduce the amount of strontium that is absorbed.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2001. Toxicological Profile for Strontium (Draft for Public Comment). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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STYRENE
CAS # 100-42-5
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about styrene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to styrene is most likely to occur from breathing indoor air that
is contaminated with styrene vapors from building materials, tobacco smoke, and consumer products. People who work where styrene is used or manufactured are likely to be exposed by breathing workplace air. Breathing styrene is most likely to affect the nervous system. Styrene has been found in at least 213 of 1,416 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is styrene? (Pronounced strn)
Styrene is primarily a synthetic chemical. It is also known as vinylbenzene, ethenylbenzene, cinnamene, or phenylethylene. It's a colorless liquid that evaporates easily and has a sweet smell. It often contains other chemicals that give it a sharp, unpleasant smell. It dissolves in some liquids but doesnt dissolve easily in water. Billions of pounds are produced each year to make products such as rubber, plastic, insulation, fiberglass, pipes, automobile parts, food containers, and carpet backing. Most of these products contain styrene linked together in a long chain (polystyrene) as well as unlinked styrene. Low levels of styrene also occur naturally in a variety of foods such as fruits, vegetables, nuts, beverages, and meats. It evaporates from shallow soils and surface water. It doesnt stick easily to soils and sediments. It's broken down by bacteria in the soil and water. It's not expected to build up in animals. Styrene breaks down to half the amount within a few days in surface water; in groundwater, however, it takes between 6 weeks and 7.5 months.

How might I be exposed to styrene?


Breathing indoor air that is contaminated with styrene vapors from building materials, consumer products, and tobacco smoke. Breathing contaminated workplace air. Drinking contaminated water. Living near industrial facilities or hazardous waste sites. Smoking cigarettes or eating a lot of food packaged in polystyrene containers.

What happens to styrene when it enters the environment?


Styrene enters the environment during the manufacture, use, and disposal of styrene-based products. It can be found in air, water, and soil. It is quickly broken down in the air, usually within 1 to 2 days.

How can styrene affect my health?


If you breathe high levels of styrene for a short time, youre most likely to experience nervous system effects such as depression, concentration problems, muscle weakness, tiredness, and nausea, and possibly eye, nose, and throat irritation.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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When animals breathed styrene vapors in short-term studies, they damaged the lining of their noses. Long-term exposure damaged their livers, but there is no evidence that this will occur in people because there is no information on human health effects of breathing low levels for a long time. The test for styrene and its breakdown products require special equipment and are not usually available at your doctors office, but may be ordered by the doctor. Your doctor can take samples and send them to a testing laboratory.

There is also little information on human health effects from Has the federal government made eating or touching styrene. Animal studies show that ingestion of recommendations to protect human health? high levels of styrene over several weeks can cause damage to the The EPA has determined that 0.1 part of styrene per milliver, kidneys, brain, and lungs. When styrene was applied to the lion parts of water (0.1 ppm) is the maximum amount that may skin of rabbits, it caused irritation. be present in drinking water. The EPA also requires that spills There is no information as to whether breathing, ingesting, or accidental releases into the environment of 1,000 pounds or or touching styrene affects fetal development or human repromore of styrene be reported. duction. The Occupational Health and Safety Administration In animal studies, short-term exposure to very high levels (OSHA) has limited workers' exposure to an average of resulted in some reproductive and developmental effects. 100 ppm for an 8-hour workday, 40-hour workweek.

How likely is styrene to cause cancer?


The International Agency for Research on Cancer (IARC) has determined that styrene is possibly carcinogenic to humans. Several studies of workers have shown that breathing styrene may cause leukemia. There is no information on the carcinogenicity of styrene in people who swallow it or get it on their skin. Studies in animals that breathed or ate styrene suggest that it is weakly carcinogenic.

Glossary
Carcinogen: A substance that can cause cancer. CAS: Chemical Abstracts Service. Ingesting: Taking food or drink into your body. Leukemia: Cancer of the blood-forming tissues. Long-term: Lasting one year or longer. Polystyrene: A long chain of styrene molecules joined together. ppm: Parts per million. Short-term: Lasting 14 days or less.

Is there a medical test to show whether Ive been exposed to styrene?


Styrene and its breakdown products can be measured in your blood, urine, and body tissues. Styrene leaves your body quickly. If you are tested within one day, the actual amount of exposure can be estimated. However, it is difficult to predict if the exposure will affect your health.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for styrene. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information?

For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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SULFUR DIOXIDE
CAS # 7446-09-5
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about sulfur dioxide. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to sulfur dioxide occurs from breathing it in the air. It affects the lungs and at high levels may result in burning of the nose and throat, breathing difficulties, and severe airway obstructions. This chemical has been found in at least 16 of 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is sulfur dioxide? (Pronounced sl fr d k sd)


Sulfur dioxide is a colorless gas with a pungent odor. It is a liquid when under pressure, and it dissolves in water very easily. Sulfur dioxide in the air comes mainly from activities such as the burning of coal and oil at power plants or from copper smelting. In nature, sulfur dioxide can be released to the air from volcanic eruptions.

How might I be exposed to sulfur dioxide?


q Breathing air containing it or touching it. q Working in industries where it occurs as a by-product, such as copper smelting or power plants. q Working in the manufacture of sulfuric acid, paper, food preservatives, or fertilizers. q Living near heavily industrialized activities where sulfur dioxide occurs.

How can sulfur dioxide affect my health?


Exposure to very high levels of sulfur dioxide can be life threatening. Exposure to 100 parts of sulfur dioxide per million parts of air (100 ppm) is considered immediately dangerous to life and health. Burning of the nose and throat, breathing difficulties, and severe airway obstructions occurred in miners who breathed sulfur dioxide released as a result of an explosion in a copper mine. Long-term exposure to persistent levels of sulfur dioxide can affect your health. Lung function changes were seen in some workers exposed to low levels of sulfur dioxide for 20 years or more. However, these workers were also exposed to other chemicals, so their health effects may not have been from sulfur dioxide alone. Asthmatics have also been shown

What happens to sulfur dioxide when it enters the environment?


q When released into the environment, sulfur dioxide moves into the air. q In the air, it can be converted to sulfuric acid, sulfur trioxide, and sulfates. q Sulfur dioxide dissolves in water. q Once dissolved in water, sulfur dioxide can form sulfurous acid. q Sulfur dioxide can be absorbed into the soil, but we dont know if or how it moves in soil.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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to be sensitive to the respiratory effects of low concentrations of sulfur dioxide. Animal studies also show respiratory effects from breathing sulfur dioxide. Animals exposed to high concentrations of sulfur dioxide showed decreased respiration, inflammation of the airways, and destruction of areas of the lung.

How can families reduce the risk of exposure to sulfur dioxide?


Families living near heavily industrialized areas where sulfur dioxide occurs should limit their outdoor activities during times of high air pollution. By paying attention to news bulletins and air pollution advisories, families can control the amount of their exposure. People with respiratory difficulties should pay special attention to these warnings, and asthmatic childrens outdoor exercise should be limited when high levels of sulfur dioxide are present in air.

How likely is sulfur dioxide to cause cancer?


There are no studies that clearly show carcinogenic effects of sulfur dioxide in people or animals. Studies have investigated workers in the copper smelting and pulp and paper industries, but the results are inconclusive since the workers were also exposed to arsenic and other chemicals. The one available animal study suggests that sulfur dioxide may be a carcinogen in mice. The International Agency for Research on Cancer (IARC) has classified sulfur dioxide as Group 3, not classifiable as to human carcinogenicity.

Is there a medical test to show whether Ive been exposed to sulfur dioxide?
Sulfur dioxide in the body is changed into other sulfurcontaining chemicals in the body. These breakdown products can be measured in blood and urine, but this requires special equipment that is not routinely available in a doctors office. Furthermore, exposure to chemicals other than sulfur dioxide can also produce sulfate, so the presence of sulfate breakdown products in your body does not necessarily mean you have been exposed to sulfur dioxide.

How can sulfur dioxide affect children?


Children who live in or near heavily industrialized areas where sulfur dioxide occurs may experience difficulty breathing, changes in the ability to breathe deeply, and burning of the nose and throat. It is not known whether children are more vulnerable to these effects than adults. However, children may be exposed to more sulfur dioxide than adults because they breathe more air for their body weight than adults do. Long-term studies surveying large numbers of children indicate that children who have breathed sulfur dioxide pollution may develop more breathing problems as they get older, may make more emergency room visits for treatment of wheezing fits, and may get more respiratory illnesses than other children. Children with asthma may be especially sensitive even to low concentrations of sulfur dioxide, but it is not known whether asthmatic children are more sensitive than asthmatic adults.

Has the federal government made recommendations to protect human health?


EPA has set an air quality standard of 0.03 ppm for longterm, 1-year average concentrations of sulfur dioxide. Shortterm, 24-hour air concentrations should not exceed 0.14 ppm more than once a year. The Occupational Safety and Health Administration (OSHA) has set a limit of 2 ppm over an 8-hour workday, 40hour workweek.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1998. Toxicological profile for sulfur dioxide. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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SULFUR TRIOXIDE (SO3) and SULFURIC ACID


CAS # 7446-11-9 and 7664-93-9
Agency for Toxic Substances and Disease Registry ToxFAQs June 1999

This fact sheet answers the most frequently asked health questions (FAQs) about sulfur trioxide (SO3) and sulfuric acid. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Sulfur trioxide (SO3) is formed from sulfur dioxide; SO3 forms sulfuric acid when it comes in contact with water. Sulfuric acid can cause burns to the skin, eyes, lungs, and digestive tract. Severe exposure can result in death. This substance has been found in at least 47 of the 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).
G SO3 is formed when sulfur dioxide reacts with water in the What are sulfur trioxide and sulfuric acid? air. (Pronounced slfr tr ksd and sl-fyrk sd) Sulfur trioxide (SO3) is generally a colorless liquid. It can also exist as ice- or fiber-like crystals or as a gas. When SO3 is exposed to air, it rapidly takes up water and gives off white fumes. It can react with water to form sulfuric acid. SO3 is also called sulfuric oxide and sulfuric anhydride. It is used in the production of sulfuric acid and other chemicals, and explosives. Sulfuric acid is a clear, colorless, oily liquid that is very corrosive. It is also called sulphine acid, battery acid, and hydrogen sulfate. It is used in the manufacture of fertilizers, explosives, other acids, and glue; in the purifiction of petroleum; in the pickling of metal; and in lead-acid batteries (used in most vehicles). G Sulfuric acid dissolves in the water in air and can remain suspended in air for varying periods of time. G Sulfuric acid is removed from the air in rain. G Sulfuric acid contributes to the formation of acid rain.

How might I be exposed to sulfur trioxide and sulfuric acid?


G Working in the chemical or metal plating industry; producing detergents, soaps, fertilizers, or lead-acid batteries; or working in printing and publishing or photography shops. G Breathing outdoor air where coal, oil, or gas are burned. G Touching the material that forms on the outside of your car battery. G Breathing air near a hazardous waste site where SO3 is disposed of. G Coming in contact with toilet bowl cleaners mixed with water.

What happens to sulfur trioxide and sulfuric acid when they enter the environment?
G Much of the sulfuric acid in the air is formed from sulfur dioxide released when coal, oil, and gas are burned.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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SULFUR TRIOXIDE (SO3) AND SULFURIC ACID CAS # 7446-11-9 and 7664-93-9

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html How can sulfur trioxide and sulfuric acid affect my health?
Touching sulfuric acid will burn your skin, and breathing sulfuric acid can result in tooth erosion and respiratory tract irritation. Drinking sulfuric acid can burn your mouth, throat, and stomach; it can result in death. If you get sulfuric acid in your eyes, it will cause your eyes to water and will burn. breathe more air per kilogram of body weight than adults.

How can families reduce the risk of exposure to sulfur trioxide and sulfuric acid?
G Keep household products like drain and toilet bowl cleaners containing sulfuric acid out of the reach of children. G Wear protective gloves when using products that contain sulfuric acid. G Keep car batteries away from children.

How likely are sulfur trioxide and sulfuric acid to cause cancer?
People who have breathed large quantities of sulfuric acid at work have shown an increase in cancers of the larynx. However, most of the people were also smokers who were exposed to other chemicals and acids as well. The ability of sulfuric acid to cause cancer in laboratory animals has not been studied. The International Agency for Research on Cancer (IARC) has determined that occupational exposure to strong inorganic acid mists containing sulfuric acid is carcinogenic to humans. IARC has not classified pure sulfuric acid for its carcinogenic effects.

Is there a medical test to show whether Ive been exposed to sulfur trioxide and sulfuric acid?
There is no medical test to determine whether you have been exposed to sulfur trioxide or sulfuric acid. Breathing in acids, including sulfuric acid, will increase the acidity of your saliva. Measuring the acidity of saliva may determine whether you have been exposed to acid but cannot tell which acid.

Has the federal government made recommendations to protect human health?


EPA limits the amount of sulfur dioxide that can be released into the air. This limits the amount of sulfur trioxide and sulfuric acid that form from sulfur dioxide in the air. The Occupational Safety and Health Administration (OSHA) and the National Institute of Occupational Safety and Health (NIOSH) limit the amount of sulfuric acid in workroom air to 1 milligram per cubic meter of air (1 mg/m3).

How can sulfur trioxide and sulfuric acid affect children?


Children may be exposed in the same ways as adults; however, they may be more at risk due to accidental injuries and accidents in the home. Teenagers may have jobs (such as car repair) in which they have contact with sulfuric acid. Children may have increased sensitivity to sulfuric acid in air, due to their smaller airway diameters and the fact that they

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1998. Toxicological profile for sulfur trioxide (SO3) and sulfuric acid. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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SYNTHETIC VITREOUS FIBERS


Division of Toxicology ToxFAQsTM September 2002

This fact sheet answers the most frequently asked health questions (FAQs) about synthetic vitreous fibers. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. It is important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Synthetic vitreous fibers are manmade fibrous materials used for thermal and sound insulating purposes. Short-term exposure can cause reversible skin, eye, and lung irritation. Workers from factories making synthetic vitreous fibers used in home insulation showed no increased rates of lung problems. Some refractory ceramic fiber workers showed changes in their chest x-rays, but these changes are not associated with breathing problems. There is no clear association between exposure to synthetic vitreous fibers and cancer in humans. Synthetic vitreous fibers have not been detected in any of the 1,613 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are synthetic vitreous fibers?
Synthetic vitreous fibers are a group of fibrous, inorganic materials that contain aluminum or calcium silicates, and are made from rock or stone, clay, slag, or glass. They do not occur naturally in the environment, but are used widely for thermal and sound insulating purposes and to reinforce other materials. There are three categories of synthetic vitreous fibers: 1) glass fibers (fiberglass), including glass wool and continuous filament glass, 2) mineral wool, which contains stone wool and slag wool, and 3) refractory ceramic fibers. Insulation that is used in homes and buildings is composed of synthetic vitreous fibers. Refractory ceramic fibers are not widely used for building insulation. They are used to insulate furnaces, in replacement of asbestos. suspended and be carried some distance by wind before settling. ! Synthetic vitreous fibers do not move through soil.

How might I be exposed to synthetic vitreous fibers?


! When insulation materials containing synthetic vitreous fibers are disturbed, fibers can be suspended in the air and breathed in. ! When installing or removing home insulation, fibers can come in contact with the eyes and skin. ! Workers who install or remove insulation or who are involved in building maintenance or repair are expected to have the highest levels of exposure to synthetic vitreous fibers.

What happens to synthetic vitreous fibers when they enter the environment?
! Synthetic vitreous fibers can enter the air, water, and soil from the manufacture, use, and disposal of fiber-containing materials. ! They are generally not broken down to other compounds in the environment and remain virtually unchanged over long periods of time. They can eventually be broken down if the water or soil is very acidic or very alkaline. ! Most fibers suspended in air from insulation materials settle quickly, but some smaller diameter fibers may remain

How can synthetic vitreous fibers affect my health?


When synthetic vitreous fibers are suspended in air they can cause irritation of the eyes, the nose and throat, and parts of the lung. When these fibers contact the skin, they may also cause irritation. These effects are reversible and disappear shortly after exposure stops. Animal studies show that repeatedly breathing dusty air containing a lot of synthetic vitreous fibers can lead to inflammation and fibrosis of the lung. Pulmonary inflammation is part of a natural defense system to clear the lung of deposited particles. If exposure stops, most

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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SYNTHETIC VITREOUS FIBERS


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deposited fibers are eventually cleared, and pulmonary inflammation stops. However, if pulmonary inflammation continues over a long period of time, a slow build up of scar tissue may occur in the lungs and in the membrane encasing the lungs called the pleura. This effect is called pulmonary fibrosis or pleural fibrosis. Glass fibers commonly used in home insulation materials did not cause fibrosis in animals, but refractory ceramic fibers did. You are unlikely to develop long-term pulmonary inflammation or pulmonary fibrosis from synthetic vitreous fibers, unless you are exposed to very dusty conditions daily for many years. Studies of workers from factories that make synthetic vitreous fibers used in home insulation materials did not find abnormal numbers of cases of long-term pulmonary inflammation, breathing problems, or changes in chest x-rays. Some workers who made refractory ceramic fibers showed changes in chest x-rays that are called pleural plaques, but their ability to breathe was normal. Pleural plaques are small areas of very mildly scarred pleural tissue.

vitreous fibers for children. It is likely that children exposed to these types of fibers will experience the same effects as adults, such as eye, skin, and upper respiratory tract irritation. There are no studies that examined whether exposure to synthetic vitreous fibers affect the developments of the fetus, infants, or young children.

How can families reduce the risk of exposure to synthetic vitreous fibers?
! Insulating material in attics or walls is the most common source of synthetic vitreous fibers in a home. Avoid disturbing or contacting these materials. ! If you install your own insulation, wear protective clothing, respiratory protection, and eye protection, and follow recommendations provided by the manufacturer for installing this material. ! If you are exposed to these fibers at work, you may carry fibers home on your skin, clothes, or tools. You can avoid this by showering, and changing clothing before leaving work. Your work clothes should be kept separate from other clothes and laundered separately.

How likely are synthetic vitreous fibers to cause cancer?


You are unlikely to develop cancer from breathing in air with small amounts of synthetic vitreous fibers. Studies of workers from factories that make synthetic vitreous fibers have not found increased rates of lung cancer or cancer of the pleura, called mesothelioma. Animals exposed for life to air containing refractory ceramic fibers showed increased rates of lung cancer and mesothelioma, but animals exposed to insulation glass wools and stone wools did not. The International Agency for Research on Cancer (IARC) determined that insulation glass wool, stone wool, and slag wool, and continuous filament glass are not classifiable as to carcinogenicity to humans because of the inadequate evidence of carcinogenicity in humans and the relatively low biopersistence of these materials. IARC determined that refractory ceramic fibers are possibly carcinogenic to humans because of their relatively high biopersistence and the findings of cancer in animals that repeatedly breathed in high levels of refractory ceramic fibers. The EPA has classified refractory ceramic fibers as a probable human carcinogen.

Is there a medical test to show whether Ive been exposed to synthetic vitreous fibers?
There are currently no tests specific for synthetic vitreous fibers. A chest x-ray is a common method to determine if you have certain conditions, such as pleural plaques, lung or pleural fibrosis, or mesotheliomas.

Has the federal government made recommendations to protect human health?


The Occupational Safety and Health Administration (OSHA) has set a limit of 5 milligrams of synthetic vitreous fibers as inert or nuisance dust per cubic meter (5 mg/m3) of air for the respirable fraction and 15 mg/m3 for total dust. The voluntary limit for fiberglass and mineral wool is 1 fiber per cubic centimeter.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2002. Toxicological Profile for Synthetic Vitreous Fibers (Draft for Public Comment). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

How can synthetic vitreous fibers affect children?


There are no unique exposure pathways to synthetic

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-4228737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html. ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.
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1,1,2,2-TETRACHLOROETHANE
CAS # 79-34-5
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about 1,1,2,2-tetrachloroethane. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: 1,1,2,2-Tetrachloroethane is a manufactured chemical that is no longer used much in the United States. Breathing high levels of 1,1,2,2-tetrachloroethane can cause fatigue, vomiting, dizziness, and possibly unconsciousness. Breathing, drinking, or touching it for a long period of time can cause liver damage, stomachaches, or dizziness. 1,1,2,2-Tetrachloroethane has been found in at least 273 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is 1,1,2,2-tetrachloroethane? (Pronounced tt r-klr -thn)
1,1,2,2-Tetrachloroethane is a manufactured, colorless chemical that does not burn easily. It is volatile and has a sweet odor. In the past, it was used in large amounts to produce other chemicals and as a solvent, to clean and degrease metals, and in paints and pesticides. Commercial production of 1,1,2,2tetrachloroethane for these uses has stopped in the United States. It presently is used only as a chemical intermediate in the production of other chemicals. q 1,1,2,2-Tetrachloroethane does not build up significantly in the bodies of fish or other organisms.

How might I be exposed to 1,1,2,2-tetrachloroethane?


q 1,1,2,2-Tetrachloroethane can be found at low levels in both indoor and outdoor air. q It has rarely been found in public drinking water supplies, although in a few instances it has been found in private well water that may have been used for drinking. q It has not been reported in food or soil. q Since production of the chemical has stopped, most workers would not be exposed to it. q Limited exposure could occur from breathing in vapors or touching it due to spills or accidents in the workplace.

What happens to 1,1,2,2-tetrachloroethane when it enters the environment?


q 1,1,2,2-Tetrachloroethane eventually moves into the air or ground water. q It does not attach to soil particles when released to land. q When released to surface water, much of it will evaporate to the air while the rest may break down in the water. q Breakdown of the chemical is slow; it takes about 13 months for half of the chemical to disappear in ground water and 2 months in air.

How can 1,1,2,2-tetrachloroethane affect my health?


Breathing high levels of 1,1,2,2-tetrachloroethane in a closed room can cause fatigue, vomiting, dizziness, and possibly unconsciousness. However, most people recover from these effects once they are in fresh air. Breathing, drinking, or touching 1,1,2,2-tetrachloroethane can cause liver damage, stomach-

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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1,1,2,2-TETRACHLOROETHANE CAS # 79-34-5


ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

aches, or dizziness if you are exposed to large amounts for a long period of time. The health effects from long-term (365 days or longer) exposure to low levels of 1,1,2,2-tetrachloroethane are not known. It is also not known whether 1,1,2,2-tetrachloroethane will cause reproductive effects in people.

The Occupational Safety and Health Administration (OSHA) has set a permissible exposure limit of 5 parts of 1,1,2,2-tetrachloroethane per million parts of air (5 ppm) in the workplace during an 8-hour workday, 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) recommends a maximum level of 1 ppm 1,1,2,2-tetrachloroethane for a 10-hour workday, 40-hour workweek. The American Conference of Governmental Industrial Hygienists (ACGIH) recommends an exposure limit of 6.9 milligrams of 1,1,2,2-tetrachloroethane per cubic meter of air (6.9 mg/m3) for an 8-hour workday, 40-hour workweek.

How likely is 1,1,2,2-tetrachloroethane to cause cancer?


It is not known whether 1,1,2,2-tetrachloroethane causes cancer in people. In a long-term study, 1,1,2,2-tetrachloroethane caused an increase in liver tumors in mice, but not in rats. The International Agency for Research on Cancer (IARC) has determined that 1,1,2,2-tetrachloroethane cannot be classified as to its ability to cause cancer in humans, while the EPA has determined that it is a possible human carcinogen.

Glossary
Carcinogen: A substance with the ability to cause cancer. CAS: Chemical Abstracts Service. Ingest: To eat or drink something. Milligram (mg): One thousandth of a gram. Pesticide: A substance that kills pests. Solvent: A chemical that can dissolve other substances. Tumor: An abnormal mass of tissue. Volatile: Easily changes into a vapor or a gas.

Is there a medical test to show whether Ive been exposed to 1,1,2,2-tetrachloroethane?


There are no medical tests to determine if you have been exposed to 1,1,2,2-tetrachloroethane. The symptoms of 1,1,2,2-tetrachloroethane poisoning, such as stomachaches, fatigue, and dizziness are common to many diseases and are not useful to determine if you were exposed to this chemical. 1,1,2,2-Tetrachloroethane can affect the liver and there are medical tests to determine whether the liver is working properly. However, liver disease may have many causes and does not only indicate exposure to 1,1,2,2-tetrachloroethane.

Source of Information
This ToxFAQs information is taken from the 1996 Toxicological Profile for 1,1,2,2-Tetrachloroethane produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Has the federal government made recommendations to protect human health?


The EPA requires that spills or accidental releases into the environment of 100 pounds or more of 1,1,2,2-tetrachloroethane be reported to the EPA.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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TETRACHLOROETHYLENE
CAS # 127-18-4
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about tetrachloroethylene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Tetrachloroethylene is a manufactured chemical used for dry cleaning and metal degreasing. Exposure to very high concentrations of tetrachloroethylene can cause dizziness, headaches, sleepiness, confusion, nausea, difficulty in speaking and walking, unconsciousness, and death. Tetrachloroethylene has been found in at least 771 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is tetrachloroethylene? (Pronounced ttr-klr -th-ln)
Tetrachloroethylene is a manufactured chemical that is widely used for dry cleaning of fabrics and for metal-degreasing. It is also used to make other chemicals and is used in some consumer products. Other names for tetrachloroethylene include perchloroethylene, PCE, and tetrachloroethene. It is a nonflammable liquid at room temperature. It evaporates easily into the air and has a sharp, sweet odor. Most people can smell tetrachloroethylene when it is present in the air at a level of 1 part tetrachloroethylene per million parts of air (1 ppm) or more, although some can smell it at even lower levels.

How might I be exposed to tetrachloroethylene?


G When you bring clothes from the dry cleaners, they will release small amounts of tetrachloroethylene into the air. G When you drink water containing tetrachloroethylene, you are exposed to it.

How can tetrachloroethylene affect my health?


High concentrations of tetrachloroethylene (particularly in closed, poorly ventilated areas) can cause dizziness, headache, sleepiness, confusion, nausea, difficulty in speaking and walking, unconsciousness, and death. Irritation may result from repeated or extended skin contact with it. These symptoms occur almost entirely in work (or hobby) environments when people have been accidentally exposed to high concentrations or have intentionally used tetrachloroethylene to get a high. In industry, most workers are exposed to levels lower than those causing obvious nervous system effects. The health effects of breathing in air or drinking water with low levels of tetrachloroethylene are not known. Results from some studies suggest that women who work in dry cleaning industries where exposures to tetrachloroethyl-

What happens to tetrachloroethylene when it enters the environment?


G Much of the tetrachloroethylene that gets into water or soil evaporates into the air. G Microorganisms can break down some of the tetrachloroethylene in soil or underground water. G In the air, it is broken down by sunlight into other chemicals or brought back to the soil and water by rain. G It does not appear to collect in fish or other animals that live in water.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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TETRACHLOROETHYLENE CAS # 127-18-4

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ene can be quite high may have more menstrual problems and spontaneous abortions than women who are not exposed. However, it is not known if tetrachloroethylene was responsible for these problems because other possible causes were not considered. Results of animal studies, conducted with amounts much higher than those that most people are exposed to, show that tetrachloroethylene can cause liver and kidney damage. Exposure to very high levels of tetrachloroethylene can be toxic to the unborn pups of pregnant rats and mice. Changes in behavior were observed in the offspring of rats that breathed high levels of the chemical while they were pregnant. formed at special laboratories that have the right equipment. Because exposure to other chemicals can produce the same breakdown products in the urine and blood, the tests for breakdown products cannot determine if you have been exposed to tetrachloroethylene or the other chemicals.

Has the federal government made recommendations to protect human health?


The EPA maximum contaminant level for the amount of tetrachloroethylene that can be in drinking water is 0.005 milligrams tetrachloroethylene per liter of water (0.005 mg/L). The Occupational Safety and Health Administration (OSHA) has set a limit of 100 ppm for an 8-hour workday over a 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) recommends that tetrachloroethylene be handled as a potential carcinogen and recommends that levels in workplace air should be as low as possible.

How likely is tetrachloroethylene to cause cancer?


The Department of Health and Human Services (DHHS) has determined that tetrachloroethylene may reasonably be anticipated to be a carcinogen. Tetrachloroethylene has been shown to cause liver tumors in mice and kidney tumors in male rats.

Glossary
Carcinogen: A substance with the ability to cause cancer. CAS: Chemical Abstracts Service. Milligram (mg): One thousandth of a gram. Nonflammable: Will not burn.

Is there a medical test to show whether Ive been exposed to tetrachloroethylene?


One way of testing for tetrachloroethylene exposure is to measure the amount of the chemical in the breath, much the same way breath-alcohol measurements are used to determine the amount of alcohol in the blood. Because it is stored in the bodys fat and slowly released into the bloodstream, tetrachloroethylene can be detected in the breath for weeks following a heavy exposure. Tetrachloroethylene and trichloroacetic acid (TCA), a breakdown product of tetrachloroethylene, can be detected in the blood. These tests are relatively simple to perform. These tests aren't available at most doctors' offices, but can be per-

Source of Information
This ToxFAQs information is taken from the 1997 Toxicological Profile for Tetrachloroethylene (update) produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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TETRYL (2,4,6-TRINITROPHENYLn-METHYLNITRAMINE) CAS # 479-45-8


Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about tetryl. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to tetryl occurs around military installations where it was made, used, or stored. Workers who breathed tetryl-laden dust complained of coughs, fatigue, headaches, eye irritation, lack of appetite, nosebleeds, nausea, and vomiting. This substance has been found in at least 12 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).

What is tetryl? (Pronounced ttrl)


The chemical name for tetryl is 2,4,6-trinitrophenyl-nmethylnitramine. Some commonly used names are nitramine, tetralite, and tetril. Tetryl is an odorless, synthetic, yellow crystal-like solid that is not found naturally in the environment. Under certain conditions, tetryl can exist as dust in air. It dissolves slightly in water and in other liquids. Tetryl was used to make explosives, mostly during World Wars I and II. It is no longer manufactured or used in the United States. Stocks of tetryl are found in storage at military installations and are being destroyed by the Department of Defense (DOD).

G It is not likely to evaporate from water or soil. G It breaks down rapidly in sunlit rivers and lakes, but much more slowly in groundwater. G Tetryl does not move easily from soil to groundwater. G It is not known if tetryl builds up in fish, plants, or land animals.

How might I be exposed to tetryl?


Most people are not exposed to tetryl because contamination is around military installations where it was made, used, or stored. You may be exposed by: G Drinking contaminated well water near a military installation site. G Breathing contaminated dust near a military installation site. G Having skin contact with contaminated soil or water near a military installation site.

What happens to tetryl when it enters the environment?


G Tetryl may be released to the air, water, and soil when old stores of the explosive are destroyed by exploding or burning.

How can tetryl affect my health?


Workers at military facilities during World Wars I and II who breathed tetryl-laden dust complained of coughs, fatigue, headaches, eye irritation, lack of appetite, nosebleeds, nausea,

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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TETRYL (2,4,6-TRINITROPHENYLn-METHYLNITRAMINE) CAS # 479-45-8

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


and vomiting. Workers who routinely handled tetryl developed a distinct yellow staining of the hands, neck, and hair. Many workers who had skin contact with tetryl developed skin rashes. Some also developed allergies with asthma-like reactions (severe coughing and wheezing) after breathing tetryl. Rabbits fed high doses of tetryl every day for 69 months developed effects on the kidneys and liver. Decreased bloodclotting capability and changes in the spleen were also noted. We do not know if these effects would occur in humans exposed to similar doses of tetryl. We do not know if tetryl causes birth defects, or if it affects reproduction in humans or animals.

Has the federal government made recommendations to protect human health?


The Department of Transportation (DOT) has many regulations for the transportation of explosives including tetryl. The Occupational Safety and Health Administration (OSHA) set a maximum level of 1.5 milligrams of tetryl per cubic meter of workplace air (1.5 mg/m3) for an 8-hour workday, 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) and the American Conference of Governmental Industrial Hygienists (ACGIH) also recommend a maximum concentration of 1.5 mg/m3 in workplace air for an 8- to 10-hour workday, 40-hour workweek.

How likely is tetryl to cause cancer?


The International Agency for Research on Cancer (IARC), the Department of Health and Human Services (DHHS), and the EPA have not reviewed tetryl to determine whether it is likely to cause cancer. The carcinogenicity of tetryl in humans and animals has not been studied.

Glossary
Breakdown product: A substance that is formed when a chemical breaks down in the body. Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. Milligram (mg): One thousandth of a gram. Synthetic: Made by humans.

Is there a medical test to show whether Ive been exposed to tetryl?


There is no routine medical test to show if you have been exposed to tetryl. Breakdown products of tetryl have been measured in the urine of animals, and similar measurements of tetryl breakdown products in the urine of people could be completed.

Reference
Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for tetryl (update). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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THALLIUM
CAS # 7440-28-0
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about thallium. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to thallium occurs mainly from eating food. Exposure to higher levels of thallium may occur in the workplace. Breathing high levels of thallium may result in effects on the nervous system, while ingesting high levels of it results in vomiting, diarrhea, temporary hair loss, and other effects. This chemical has been found in at least 210 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is thallium? (Pronounced thl-m)
Pure thallium is a bluish-white metal that is found in trace amounts in the earths crust. In the past, thallium was obtained as a by-product from smelting other metals; however, it has not been produced in the United States since 1984. Currently, all the thallium is obtained from imports and from thallium reserves. In its pure form, thallium is odorless and tasteless. It can also be found combined with other substances such as bromine, chlorine, fluorine, and iodine. When it's combined, it appears colorless-to-white or yellow. Thallium is used mostly in manufacturing electronic devices, switches, and closures, primarily for the semiconductor industry. It also has limited use in the manufacture of special glass and for certain medical procedures. G Some thallium compounds are removed from the atmosphere in rain and snow. G It's absorbed by plants and enters the food chain. G It builds up in fish and shellfish.

How might I be exposed to thallium?


G Eating food contaminated with thallium may be a major source of exposure for most people. G Breathing workplace air in industries that use thallium G Smoking cigarettes. G Living near hazardous waste sites containing thallium (may result in higher than normal exposures). G Touching or, for children, eating soil contaminated with thallium. G Breathing low levels in air and water.

How can thallium affect my health?


Exposure to high levels of thallium can result in harmful health effects. A study on workers exposed on the job over several years reported nervous system effects, such as numbness of fingers and toes, from breathing thallium. Studies in people who ingested large amounts of thallium over a short time have reported vomiting, diarrhea, temporary hair loss, and effects on the nervous system, lungs, heart, liver,

What happens to thallium when it enters the environment?


G Thallium enters the environment primarily from coalburning and smelting, in which it is a trace contaminant of the raw materials. G It stays in the air, water, and soil for a long time and is not broken down.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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and kidneys. It has caused death. It is not known what the effects are from ingesting low levels of thallium over a long time. Birth defects were not reported in the children of mothers exposed to low levels from eating vegetables and fruits contaminated with thallium. Studies in rats, however, exposed to high levels of thallium, showed adverse developmental effects. It is not known if breathing or ingesting thallium affects human reproduction. Studies showed that rats that ingested thallium for several weeks had some adverse reproductive effects. Animal data suggest that the male reproductive system may be susceptible to damage by low levels of thallium. There is no information available on the health effects of skin contact with thallium in people or animals. These tests require special equipment that is not usually available in most doctors offices. In addition, these tests cannot determine if adverse health effects will occur from the exposure to thallium.

Has the federal government made recommendations to protect human health?


The EPA requires that discharges or accidental spills into the environment of 1,000 pounds or more of thallium be reported. The Occupational Safety and Health Administration (OSHA) has set an exposure limit of 0.1 milligrams per cubic meter (0.1 mg/m3) for thallium in workplace air. The American Conference of Governmental Industrial Hygienists (ACGIH) has established the same guidelines as OSHA for the workplace. The National Institute for Occupational Safety and Health (NIOSH) has recommended that 15 mg/m3 of thallium be considered immediately dangerous to life and health. This is the exposure level of a chemical that is likely to cause permanent health problems or death.

How likely is thallium to cause cancer?


The Department of Health and Human Services, the International Agency for Research on Cancer, and the Environmental Protection Agency (EPA) have not classified thallium as to its human carcinogenicity. No studies are available in people or animals on the carcinogenic effects of breathing, ingesting, or touching thallium.

Glossary
Carcinogenicity: Ability to cause cancer. Ingesting: Taking food or drink into your body. Milligram (mg): One thousandth of a gram.

Is there a medical test to show whether Ive been exposed to thallium?


There are medical tests available to measure levels of thallium in urine and hair. In addition, thallium can also be measured in blood; however, this is not a good indicator of exposure since thallium only stays in blood a very short time.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for thallium. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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THORIUM
CAS # 7440-29-1
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about thorium. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Thorium is a radioactive substance that occurs naturally in the environment. It has been shown to cause an increase in cancers of the lung, pancreas, and blood in workers exposed to high levels of it in the air. This chemical has been found in at least 16 of the 1,177 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is thorium? Pronounced (thr-m)
Thorium is a naturally occurring, radioactive substance. In the environment, thorium exists in combination with other minerals, such as silica. Small amounts of thorium are present in all rocks, soil, water, plants, and animals. Soil contains an average of about 6 parts of thorium per million parts of soil (6 ppm). More than 99% of natural thorium exists in the form of thorium-232. It breaks down into two partsa small part called alpha radiation and a large part called the decay product. The decay product is also not stable and continues to break down through a series of decay products until a stable product is formed. During these decay processes, radioactive substances are produced. These include radium and radon. These substances give off radiation, including alpha and beta particles, and gamma radiation. Some rocks in underground mines contain thorium in a more concentrated form. After these rocks are mined, thorium is usually concentrated and changed into thorium dioxide or other chemical forms. After most of the thorium is removed, the rocks are called depleted ore or tailings. Thorium is used to make ceramics, gas lantern mantles, and metals used in the aerospace industry and in nuclear reactions. Thorium can also be used as a fuel for generating nuclear energy.

What happens to thorium when it enters the environment?


q Thorium is a natural part of the environment. q Thorium changes extremely slowly into other radioactive substances. q It takes about 14 billion years for half of the thorium-232 to change into new forms. q As rocks are broken up by wind and water, the thorium and all other components of the rocks become part of the soil. q Thorium in soil can be washed into rivers and lakes. q Windblown dust and volcanic eruptions are natural sources of thorium in the air. q Burning coal may release small amounts of thorium into the air. q Mining thorium or making products that contain it may also release thorium into the environment.

How might I be exposed to thorium?


q Just by being alive, everyone is exposed to small amounts of thorium in air, water, and food.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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q Breathing air near facilities where uranium, phosphate, or tin ore is processed. q Living in homes built on soil with high levels of thorium. q Working in the uranium, thorium, tin, and phosphate mining, and gas mantle production industries may expose you to higher levels of thorium. q Living near radioactive waste disposal sites. These tests are only useful if done within several days to a week after exposure. The tests cannot tell you if your health will be affected by the exposure. They require special equipment and are probably not available at your local clinic or hospital.

How can thorium affect my health?


Studies on thorium workers have shown that breathing high levels of thorium dust results in an increased chance of getting lung disease. Liver diseases and effects on the blood were found in people injected with thorotrast, a thorium compound injected into the body as a radiographic contrast medium between the years 1928 and 1955. Animal studies have shown that breathing thorium may result in lung damage. Studies on exposed human populations have not reported any birth defects or effects on a person's ability to have children.

Has the federal government made recommendations to protect human health?


The EPA has set a drinking water limit of 15 picocuries per liter (15 pCi/L) of water for gross alpha particle activity and 4 millirems per year for beta particles and photon activity (for example, gamma radiation and x-rays). The federal recommendations have been updated as of July 1999.

Glossary
CAS: Chemical Abstracts Service. National Priorities List: A list of the nations worst hazardous waste sites. Millirem (mrem): A unit used to measure radiation dose. Picocurie (pCi): A unit used to measure the intensity of radiation. ppm: Parts per million.

How likely is thorium to cause cancer?


Workers who had high exposures to cigarette smoke, radon gas, and thorium had cancers of the lung, pancreas, and blood. People who had large amounts of thorium injected into their blood for special x-ray tests had more than the usual number of liver tumors, cancers of the blood, such as leukemia, and tumors of the bone, kidney, spleen, and pancreas.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1990. Toxicological profile for thorium. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Is there a medical test to show whether Ive been exposed to thorium?


Special tests that measure the level of radioactivity from thorium in your urine and feces, and radon gas in the air you exhale can determine if you have been exposed to thorium.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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TIN
CAS # 7440-31-5
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about tin. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to tin results mostly from eating food and breathing air that contains tin. Breathing or swallowing large amounts of some compounds that contain tin may cause stomachaches, anemia, and liver and kidney problems. Tin has been found in at least 202 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is tin? (Pronounced tn)
Tin is a natural element in the earths crust. It is a soft, white, silvery metal that doesn't dissolve in water. Tin is used to make cans. It is present in brass, bronze, pewter, and some soldering materials. Tin can be combined with other chemicals to form compounds. When combined with chemicals like chlorine, sulfur, or oxygen, it is called an inorganic tin compound. These are used in toothpaste, perfumes, soaps, coloring agents, and dyes. When tin is combined with materials that contain carbon, it is called an organotin compound and is used to make plastics, food packages, plastic pipes, pesticides, paints, and pest repellants. Tin metal, as well as inorganic and organic tin compounds, can be found in the air, water, and soil near places where they are naturally present in the rocks, or where they are mined, manufactured, or used. The time that each type of tin compound stays in the air, water, and soil differs for each compound. In the atmosphere, tin exists as gases and fumes, and attaches to dust particles. Some tin compounds dissolve in water. In water, tin attaches to the soil and sediments. Organotins build up in fish, other organisms, and plants.

How might I be exposed to tin?


Eating food or drinking juice or other liquids from tin containers. Breathing air that contains tin in the workplace or near hazardous waste sites. Touching substances that contain high levels of tin.

How can tin affect my health?


The inorganic tin compounds usually enter and leave your body rapidly when you breathe or eat them, so they usually do not cause harmful effects. Human and animal studies show that large amounts of these tin compounds can cause stomachaches, anemia, and liver and kidney problems.

What happens to tin when it enters the environment?


Tin is released into the environment by both natural processes and human activities such as mining, coal and oil combustion, and the production and use of tin products.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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Breathing or swallowing organotin compounds can cause breathing problems and eye irritation, and can interfere with the way your brain and nervous system work. In severe cases, it can cause death. Some of the organotin compounds seemed to weaken rats ability to protect themselves from disease. These effects have not been observed in people. Rats and mice exposed to organotin compounds had problems with reproduction and with the development of normal babies. We do not know if this would happen to people. Inorganic tin compounds do not affect reproduction or cause birth defects. There is very little information on the health effects caused by touching tin compounds. When the skin and eyes of people and animals were exposed to both organotin and inorganic tin compounds, their skin and eyes became irritated. your body. This test is only useful if you have been exposed to food and air concentrations that result in much higher than normal body levels. These tests are not routinely performed at your doctors office, but your doctor can take samples and send them to a testing laboratory.

Has the federal government made recommendations to protect human health?


The EPA has limited the use of certain organotin compounds in paints. The Occupational Safety and Health Administration (OSHA) has set a maximum concentration limit of 0.1 milligrams per cubic meter of air (0.1 mg/m3) for organotin compounds, and 2.0 mg/m3 for tin and inorganic tin compounds. The Food and Drug Administration (FDA) regulates the use of some organotin compounds in coating and plastic food packaging.

How likely is tin to cause cancer?


The Department of Health and Human Services, the International Agency for Research on Cancer and the Environmental Protection Agency (EPA) have not classified tin for carcinogenicity. There is no evidence that tin or tin compounds cause cancer in humans. Animal studies show that inorganic tin compounds do not cause cancer in rats and mice, but we do not know if organotin compounds cause cancer in animals.

Glossary
Anemia: A decreased ability of the blood to transport oxygen. Carcinogenicity: Ability to cause cancer. Milligram (mg): One thousandth of a gram. Organotin: Compound that contains both tin and carbon.

Is there a medical test to show whether Ive been exposed to tin?


Tin can be measured in your urine and feces. This can tell you how much tin is in your body. It cannot tell you when or how it got there because you always have some tin in

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for tin. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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TITANIUM TETRACHLORIDE
CAS # 7550-45-0
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about titanium tetrachloride. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Titanium tetrachloride is very irritating to the eyes, skin, mucous membranes, and the lungs. Breathing in large amounts can cause serious injury to the lungs. Contact with the liquid can burn the eyes and skin. The Environmental Protection Agency (EPA) has identified 1,416 hazardous waste sites on its National Priorities List (NPL) sites. Titanium tetrachloride has not been found in any of the sites on the NPL. However, the number of NPL sites evaluated for titanium tetrachloride is not known.
What is titanium tetrachloride? (Pronounced t-tn-m ttr klrd)
Titanium tetrachloride is a colorless to pale yellow liquid that has fumes with a strong odor. If it comes in contact with water, it rapidly forms hydrochloric acid, as well as titanium compounds. Titanium tetrachloride is not found naturally in the environment and is made from minerals that contain titanium. It is used to make titanium metal and other titanium-containing compounds, such as titanium dioxide, which is used as a white pigment in paints and other products and to produce other chemicals. q Some of the titanium compounds may settle out to soil or water. In water, they sink into the bottom sediments. q The titanium compounds may remain for a long time in the soil or sediments. q Some other titanium compounds, such as titanium dioxide, are also found in air and water.

How might I be exposed to titanium tetrachloride?


q You are not likely to be exposed to titanium tetrachloride in water, soil, food, or air. q Because titanium tetrachloride breaks down rapidly in air, you probably would not be exposed to it unless you worked in an industry that made or used it. q If you work in an industry that uses titanium tetrachloride, you could be exposed by breathing it or touching it. q If titanium tetrachloride spills, you could get it on your skin.

What happens to titanium tetrachloride when it enters the environment?


q Titanium tetrachloride enters the environment primarily in the air from factories that make or use it in various chemical processes, or as a result of spills. q If moisture is in the air, titanium tetrachloride reacts rapidly with it to form hydrochloric acid and other titanium compounds, such as titanium hydroxide and titanium oxychlorides.

How can titanium tetrachloride affect my health?


Titanium tetrachloride can be very irritating to the skin, eyes, mucous membranes, and the lungs. Breathing in large

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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amounts of titanium tetrachloride can injure the lungs seriously enough to cause death. If you breathe in lower levels of titanium tetrachloride, less serious respiratory system effects can include coughing and tightness in the chest. More severe effects including chemical bronchitis or pneumonia, and congestion of the mucous membranes of the upper respiratory tract can also occur. These effects can cause long-term effects such as the narrowing of the vocal cords, windpipe, and upper airways. Accidental exposure to liquid titanium tetrachloride can result in skin burns and can cause permanent damage to the eyes, if they are not protected. There is not enough information to determine if titanium tetrachloride causes birth defects or affects reproduction. for particles that contain titanium. This test is not specific for titanium tetrachloride exposure, but it does indicate exposure to some titanium-containing substances. Also, the test does not indicate whether you may have potential health effects resulting from such exposure or the amount of titanium compound to which you were exposed.

Has the federal government made recommendations to protect humanhealth?


Releases of more than 100 pounds of titanium tetrachloride have been proposed as the release levels that must be reported to the EPA. Maximum levels have not been established for titanium tetrachloride exposure in the workplace.

Glossary How likely is titanium tetrachloride to cause cancer?


The Department of Health and Human Services (DHHS), the International Agency for Research on Cancer (IARC), and the EPA have not classified titanium tetrachloride for carcinogenicity. Some laboratory animals that breathed titanium tetrachloride fumes for 2 years developed lung tumors of a special type. However, there is no evidence that long-term exposure to titanium tetrachloride causes cancer in people. Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Irritant: Abnormal reaction to a substance. Long-term: 365 days or longer. Sediment: Mud and debris that have settled to the bottom of a body of water. Tumor: An abnormal mass of tissue.

Source of Information
This ToxFAQs information is taken from the 1997 Toxicological Profile for Titanium Tetrachloride produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Is there a medical test to show whether Ive been exposed to titanium tetrachloride?
There is no medical test to indicate whether you have been exposed to titanium tetrachloride. However, you can be tested for the presence of titanium dioxide or titanium metal, which are breakdown products of titanium tetrachloride. This test uses electron microscopes to examine lung tissue

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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TOLUENE
CAS # 108-88-3
Division of Toxicology ToxFAQsTM February 2001

This fact sheet answers the most frequently asked health questions (FAQs) about toluene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to toluene occurs from breathing contaminated workplace air, in automobile exhaust, some consumer products paints, paint thinners, fingernail polish, lacquers, and adhesives. Toluene affects the nervous system. Toluene has been found at 959 of the 1,591 National Priority List sites identified by the Environmental Protection Agency

What is toluene?
Toluene is a clear, colorless liquid with a distinctive smell. Toluene occurs naturally in crude oil and in the tolu tree. It is also produced in the process of making gasoline and other fuels from crude oil and making coke from coal. Toluene is used in making paints, paint thinners, fingernail polish, lacquers, adhesives, and rubber and in some printing and leather tanning processes.

[ Toluene does not usually stay in the environment long. [ Toluene does not concentrate or buildup to high levels in animals.

How might I be exposed to toluene?


[ Breathing contaminated workplace air or automobile exhaust. [ Working with gasoline, kerosene, heating oil, paints, and lacquers. [ Drinking contaminated well-water. [ Living near uncontrolled hazardous waste sites containing toluene products.

What happens to toluene when it enters the environment?


[ Toluene enters the environment when you use materials that contain it. It can also enter surface water and groundwater from spills of solvents and petrolieum products as well as from leasking underground storage tanks at gasoline stations and other facilities. [ When toluene-containing products are placed in landfills or waste disposal sites, the toluene can enter the soil or water near the waste site.

How can toluene affect my health?


Toluene may affect the nervous system. Low to moderate levles can cause tiredness, confusion, weakness, drunkentype actions, memory loss, nausea, loss of appetite, and

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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TOLUENE
CAS # 108-88-3
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hearing and color vision loss. These symptoms usually disappear when exposure is stopped. Inhaling High levels of toluene in a short time can make you feel light-headed, dizzy, or sleepy. It can also cause unconsciousness, and even death. High levels of toluene may affect your kidneys.

[ When not in use, toluene-containing products should be tightly covered to prevent evaporation into the air.

Is there a medical test to show whether Ive been exposed to toluene?


There are tests to measure the level of toluene or its breakdown products in exhaled air, urine, and blood. To determine if you have been exposed to toluene, your urine or blood must be checked within 12 hours of exposure. Several other chemicals are also changed into the same breakdown products as toluene, so some of these tests are not specific for toluene.

How likely is toluene to cause cancer?


Studies in humans and animals generally indicate that toluene does not cause cancer. The EPA has determined that the carcinogenicity of toluene can not be classified.

Has the federal government made recommendations to protect human health?


EPA has set a limit of 1 milligram per liter of drinking water (1 mg/L). Discharges, releases, or spills of more than 1,000 pounds of toluene must be reported to the National Response Center. The Occupational Safety and Health Administration has set a limit of 200 parts toluene per million of workplace air (200 ppm).

How can toluene affect children?


It is likely that health effects seen in children exposed to toluene will be similar to the effects seen in adults. Some studies in animals suggest that babies may be more sensitive than adults. Breathing very high levels of toluene during pregnancy can result in children with birth defects and retard mental abilities, and growth. We do not know if toluene harms the unborn child if the mother is exposed to low levels of toluene during pregnancy.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 2000. Toxicological Profile for Toluene. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

How can families reduce the risk of exposure to toluene?


[ Use toluene-containing products in well-ventilated areas.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQsTM Internet address is http://www.atsdr.cdc.gov/toxfaq.html . ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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TOTAL PETROLEUM HYDROCARBONS (TPH)


Agency for Toxic Substances and Disease Registry ToxFAQs August 1999
This fact sheet answers the most frequently asked health questions (FAQs) about total petroleum hydrocarbons (TPH). For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: TPH is a mixture of many different compounds. Everyone is exposed to TPH from many sources, including gasoline pumps, spilled oil on pavement, and chemicals used at home or work. Some TPH compounds can affect your nervous system, causing headaches and dizziness. TPH has been found in at least 23 of the 1,467 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are total petroleum hydrocarbons? (Pronounced ttl p-trl-m hdr-krbnz)
Total petroleum hydrocarbons (TPH) is a term used to describe a large family of several hundred chemical compounds that originally come from crude oil. Crude oil is used to make petroleum products, which can contaminate the environment. Because there are so many different chemicals in crude oil and in other petroleum products, it is not practical to measure each one separately. However, it is useful to measure the total amount of TPH at a site. TPH is a mixture of chemicals, but they are all made mainly from hydrogen and carbon, called hydrocarbons. Scientists divide TPH into groups of petroleum hydrocarbons that act alike in soil or water. These groups are called petroleum hydrocarbon fractions. Each fraction contains many individual chemicals. Some chemicals that may be found in TPH are hexane, jet fuels, mineral oils, benzene, toluene, xylenes, naphthalene, and fluorene, as well as other petroleum products and gasoline components. However, it is likely that samples of TPH will contain only some, or a mixture, of these chemicals.

What happens to TPH when it enters the environment? G TPH may enter the environment through accidents, from G G G G G

industrial releases, or as byproducts from commercial or private uses. TPH may be released directly into water through spills or leaks. Some TPH fractions will float on the water and form surface films. Other TPH fractions will sink to the bottom sediments. Bacteria and microorganisms in the water may break down some of the TPH fractions. Some TPH fractions will move into the soil where they may stay for a long time.

How might I be exposed to TPH? G Everyone is exposed to TPH from many sources. G Breathing air at gasoline stations, using chemicals at
home or work, or using certain pesticides.

G Drinking water contaminated with TPH. G Working in occupations that use petroleum products. G Living in an area near a spill or leak of petroleum
products.

G Touching soil contaminated with TPH.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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TOTAL PETROLEUM HYDROCARBONS (TPH)

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html How can TPH affect my health?
Some of the TPH compounds can affect your central nervous system. One compound can cause headaches and dizziness at high levels in the air. Another compound can cause a nerve disorder called peripheral neuropathy, consisting of numbness in the feet and legs. Other TPH compounds can cause effects on the blood, immune system, lungs, skin, and eyes. Animal studies have shown effects on the lungs, central nervous system, liver, and kidney from exposure to TPH compounds. Some TPH compounds have also been shown to affect reproduction and the developing fetus in animals.

Has the federal government made recommendations to protect human health?


There are no regulations or advisories specific to TPH. The following are recommendations for some of the TPH fractions and compounds: The EPA requires that spills or accidental releases into the environment of 10 pounds or more of benzene be reported to the EPA. The Occupational Safety and Health Administration has set an exposure limit of 500 parts of petroleum distillates per million parts of air (500 ppm) for an 8-hour workday, 40-hour workweek.

How likely is TPH to cause cancer?


The International Agency for Research on Cancer (IARC) has determined that one TPH compound (benzene) is carcinogenic to humans. IARC has determined that other TPH compounds (benzo[a]pyrene and gasoline) are probably and possibly carcinogenic to humans. Most of the other TPH compounds are considered not to be classifiable by IARC.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Immune system: Body organs and cells that fight disease. Pesticides: Chemicals used to kill pests.

Is there a medical test to show whether Ive been exposed to TPH?


There is no medical test that shows if you have been exposed to TPH. However, there are methods to determine if you have been exposed to some TPH compounds. Exposure to kerosene can be determined by its smell on the breath or clothing. Benzene can be measured in exhaled air and a breakdown product of benzene can be measured in urine. Other TPH compounds can be measured in blood, urine, breath, and some body tissues.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1999. Toxicological profile for total petroleum hydrocarbons (TPH). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals, and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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TOXAPHENE
CAS # 8001-35-2
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about toxaphene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Toxaphene is an insecticide which is currently banned for all uses in the United States. Breathing, eating, or drinking high levels of toxaphene could damage the lungs, nervous system, and kidneys, and can even cause death. Toxaphene has been found in at least 58 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
q It does not dissolve well in water, so it is more likely to be found in air, soil, or sediment at the bottom of lakes or streams, than in surface water. q Toxaphene breaks down very slowly in the environment. q Toxaphene accumulates in fish and mammals.

What is toxaphene? (Pronounced tks-fn)


Toxaphene is an insecticide containing over 670 chemicals. It is usually found as a solid or gas, and in its original form it is a yellow to amber waxy solid that smells like turpentine. It does not burn and evaporates when in solid form or when mixed with liquids. Toxaphene is also known as camphechlor, chlorocamphene, polychlorocamphene, and chlorinated camphene. Toxaphene was one of the most heavily used insecticides in the United States until 1982, when it was canceled for most uses; all uses were banned in 1990. It was used primarily in the southern United States to control insect pests on cotton and other crops. It was also used to control insect pests on livestock and to kill unwanted fish in lakes.

How might I be exposed to toxaphene?


q People who breathe air near a hazardous waste site where toxaphene was disposed could be exposed to it. q Infants or toddlers could be exposed by eating contaminated soil. q People who eat large quantities of fish and shellfish which were contaminated with toxaphene could be exposed. q People who drink water from wells containing toxaphene could also be exposed.

How can toxaphene affect my health?


Breathing, eating, or drinking high levels of toxaphene could damage the lungs, nervous system, and kidneys, and can even cause death. However, since toxaphene is no longer used in the United States, most people would not be exposed to high levels of it. People could be exposed to low levels of it; however,

What happens to toxaphene when it enters the environment?


q Toxaphene may enter the environment from hazardous waste sites. q It may enter the air by evaporation.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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TOXAPHENE CAS # 8001-35-2


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there is no information on how low levels affect people. Studies show that animals which ate food or drank water containing toxaphene had effects on the liver, kidneys, adrenal glands, and immune system. It is not known whether toxaphene can affect reproduction or cause birth defects in people. Animal studies have reported that toxaphene affects the development of newborn animals when their mothers are exposed during pregnancy.

The EPA also requires spills or accidental releases into the environment of 1 pound or more of toxaphene be reported. The Occupational Safety and Health Administration (OSHA) has set a permissible exposure limit of 0.5 milligrams toxaphene per cubic meter of air (0.5 mg/m3) for an 8-hour workday, 40 hour workweek. The National Institute for Occupational Safety and Health (NIOSH) recommends that toxaphene levels should be as low as possible in the workplace due to its potential carcinogenicity. The American Conference of Governmental Industrial Hydienists (ACGIH) recommend 0.5 mg/m3 for an 8-hour workday, 40-hour workweek. They also recommend that 1 mg/m3 be considered a level that should not be exceeded in a 15-minute period.

How likely is toxaphene to cause cancer?


It is not known whether toxaphene causes cancer in people. An animal study reported that toxaphene caused cancer of the thyroid gland when the animals were exposed to high levels over their lifetimes. The Department of Health and Human Services (DHHS) has determined that toxaphene may reasonably be anticipated to be a carcinogen.

Glossary
Carcinogen: A substance with the ability to cause cancer. CAS: Chemical Abstracts Service. Insecticide: A substance that kills insects. Milligram (mg): One thousandth of a gram. Sediment: Mud and debris that have settled to the bottom of a body of water.

Is there a medical test to show whether Ive been exposed to toxaphene?


Toxaphene and its breakdown products can be detected in blood, urine, breast milk, and body tissues. Urine and blood tests are the most common tests used. These tests arent available at most doctors offices, but can be done at special laboratories that have the right equipment. However, these tests cannot determine how much toxaphene you have been exposed to, or whether you will experience any health effects.

Source of Information
This ToxFAQs information is taken from the 1996 Toxicological Profile for Toxaphene produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Has the federal government made recommendations to protect human health?


The EPA has set a drinking water standard of 0.003 milligrams of toxaphene per liter of drinking water (0.003 mg/L).

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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1,1,1-TRICHLOROETHANE
CAS # 71-55-6
Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about 1,1,1-trichloroethane. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to 1,1,1-trichloroethane usually occurs by breathing contaminated air. It is found in building materials, cleaning products, paints, and metal degreasing agents. It can cause unconsciousness and other effects if inhaled in large amounts, but usually the effects will disappear after exposure ends. This substance has been found in at least 696 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is 1,1,1-trichloroethane? (Pronounced tr-klr-thn)
1,1,1-Trichloroethane is a colorless liquid with a sharp, sweet odor. Even though it is usually found as a liquid, it evaporates quickly and becomes a vapor. It is also known as methyl chloroform, methyltrichloromethane, and trichloromethylmethane; its registered trade names are Chloroethene NU and Aerothene TT. Use of trade names is for identification only and does not imply endorsement by the Agency for Toxic Substances and Disease Registry, the Public Health Service, or the U.S. Department of Health and Human Services. 1,1,1-Trichloroethane does not occur naturally in the environment. It is found in many common products such as glue, paint, industrial degreasers, and aerosol sprays. By 1996, 1,1,1-trichloroethane will no longer be made in the United States due to its effects on the ozone layer. G Contaminated water from hazardous waste sites may also contaminate surrounding soil and nearby surface or groundwater. G From lakes and rivers, most of the 1,1,1-trichloroethane evaporates quickly into the air. G Water can carry 1,1,1-trichloroethane through the soil and into the groundwater where it can evaporate and pass through the soil as a gas, then be released to the air. G Organisms living in soil or water may also break down 1,1,1-trichloroethane. G It will not build up in plants or animals.

How might I be exposed to 1,1,1-trichloroethane?


G Breathing contaminated air; it is used in many building materials, so you are likely to be exposed to higher levels indoors than outdoors or near hazardous waste sites. G Breathing contaminated air in the workplace while using cleaning products, aerosol sprays, paint, and metal degreasing agents. G Ingesting contaminated drinking water and food. G Allowing liquids containing it to touch your skin.

What happens to 1,1,1-trichloroethane when it enters the environment?


G Most of the 1,1,1-trichloroethane released into the environment is evaporated into the air, where it may last for about 6 years. G It may travel to the ozone layer, where sunlight can break it down into chemicals that destroy the ozone layer.

How can 1,1,1-trichloroethane affect my health?


If you breathe air containing high levels of 1,1,1-trichloroethane for a short time you may become dizzy, lightheaded, and may lose your balance. These symptoms will dis-

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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1,1,1-TRICHLOROETHANE CAS # 71-55-6

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

appear if you stop breathing contaminated air. Breathing much higher levels may cause unconsciousness, low blood pressure, and loss of heartbeat. The effects of breathing 1,1,1-trichloroethane for a long time are not known. In animals such as rats and dogs, exposure to high levels damages the breathing passages, affects the nervous system, and causes mild effects on the liver. After pregnant rats or rabbits were exposed to 1,1,1-trichloroethane, effects on the offspring, such as delayed development and changes in the setting of the bone structure, were usually only seen at levels that were toxic to the mother. It isnt known whether this chemical affects human reproduction or development. There are no studies in people to tell whether harmful health effects occur from eating food or drinking water contaminated with 1,1,1-trichloroethane. Placing large amounts of it in an animals stomach has caused effects on the nervous system, mild liver damage, unconsciousness, and even death. If your skin comes into contact with 1,1,1-trichloroethane, you might feel some irritation. Studies in animals have shown that skin contact may affect the liver and very large amounts may cause death.

ethane. These tests can sometimes estimate how much 1,1,1-trichloroethane has entered your body. Blood and breath tests need to be taken within a few hours of exposure, and urine tests need to be taken within 12 days. These tests, however, cant tell whether your health will be affected as a result of your exposure. The exposure tests arent routinely available in hospitals and clinics because special equipment is required to perform them.

Has the federal government made recommendations to protect human health?


The EPA has set a limit of 0.2 parts of 1,1,1-trichloroethane per million parts of drinking water (0.2 ppm). EPA has recommended that the level of 1,1,1-trichloroethane in lakes and streams shouldnt exceed 18 ppm to prevent possible health effects from drinking water or eating contaminated fish. The Occupational Safety and Health Administration (OSHA) has set a workplace exposure limit of 350 ppm for an 8-hour workday, 40-hour workweek.

Glossary
Carcinogenicity: Ability of a substance to cause cancer. CAS: Chemical Abstracts Service. Long time: Lasting one year or longer. ppm: Parts per million. Short time: Lasting 14 days or less.

How likely is 1,1,1-trichloroethane to cause cancer?


No information is available to show that 1,1,1-trichloroethane causes cancer. The International Agency for Research on Cancer (IARC) has determined that 1,1,1-trichloroethane is not classifiable as to its human carcinogenicity.

References Is there a medical test to show whether Ive been exposed to 1,1,1-trichloroethane?
Breath, blood, and urine samples can be tested to determine if you have recently been exposed to 1,1,1-trichloroAgency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for 1,1,1-trichloroethane. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information?

For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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1,1,2-TRICHLOROETHANE
CAS # 79-00-5
Agency for Toxic Substances and Disease Registry ToxFAQs July 1999

This fact sheet answers the most frequently asked health questions (FAQs) about 1,1,2-trichloroethane. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: 1,1,2-Trichloroethane is primarily used as a solvent and a chemical intermediate in industry. Breathing high levels of it caused effects on the liver, kidney, and nervous system in animals. This chemical has been found in at least 45 of the 1,177 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is 1,1,2-trichloroethane? (Pronounced 1,1,2-tr-klr-thn)
1,1,2-Trichloroethane is a colorless, sweet-smelling liquid. It does not burn easily, can be dissolved in water, and evaporates easily. It is used as a solvent (a chemical that dissolves other substances) and as an intermediate in the production of the chemical, 1,1-dichloroethane. 1,1,2-Trichloroethane is sometimes present as an impurity in other chemicals, and it may be formed when another chemical breaks down in the environment under conditions where there is no air.

How might I be exposed to 1,1,2-trichloroethane?


G Breathing outdoor air that contains it from industrial releases. G Drinking contaminated water. G Breathing contaminated workplace air. G Touching it when used as a solvent in the workplace. G Breathing air near a hazardous waste site that contains 1,1,2-trichloroethane.

How can 1,1,2-trichloroethane affect my health? What happens to 1,1,2-trichloroethane when it enters the environment?
G Most 1,1,2-trichloroethane released into the environment will go into the air. G 1,1,2-Trichloroethane breaks down slowly in air; it takes approximately 49 days for half of it to break down. G 1,1,2-Trichloroethane may enter the groundwater by filtering through the soil. G It appears to stay in water for a long time; it takes years for it to break down. No information is available on how breathing or swallowing 1,1,2-trichloroethane may affect your health. Applying 1,1,2-trichloroethane to the skin of a person resulted in stinging and burning of the skin. When animals breathed high levels of 1,1,2-trichloroethane, it affected the liver and kidneys. Nervous system effects, such as excitation and sleepiness, were also seen. When animals swallowed food or water containing 1,1,2-trichloroethane, effects on the stomach, blood, liver, kidneys, and nervous system were seen.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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1,1,2-TRICHLOROETHANE CAS # 79-00-5

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


We do not know whether 1,1,2-trichloroethane can affect reproduction in people. Animal studies have not shown the chemical to affect normal reproduction and development. Discharges, spills, or accidental releases of 100 pounds or more of 1,1,2-trichloroethane must be reported to the EPA. The Occupational Safety and Health Administration (OSHA) has set a permissible exposure limit of 45 milligrams 1,1,2-trichloroethane per cubic meter of air (45 mg/m3) for an 8-hour workday in a 40-hour workweek. The American Conference of Governmental and Industrial Hygienists (ACGIH) and the National Institute for Occupational Safety and Health (NIOSH) also recommend an occupational exposure limit of 45 mg/m3 for 1,1,2-trichloroethane. The federal recommendations have been updated as of July 1999.

How likely is 1,1,2-trichloroethane to cause cancer?


No information is available on whether or not 1,1,2-trichloroethane will cause cancer in people. Only one study is available on the ability of 1,1,2-trichloroethane to cause cancer in animals. This study found an increase in liver cancer in mice, but not in rats, who were fed the chemical for their lifetime. The International Agency for Research on Cancer (IARC) has determined that 1,1,2-trichloroethane is not classifiable as to its carcinogenicity to humans.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Milligram (mg): One thousandth of a gram. National Priorities List: A list of the nations worst hazardous waste sites. Solvent: A substance that dissolves another substance.

Is there a medical test to show whether Ive been exposed to 1,1,2-trichloroethane?


Samples of your breath, blood, and urine can be tested to determine if you have been recently exposed to 1,1,2-trichloroethane. These tests must be done soon after the exposure occurred. These tests will not tell you whether your health will be affected by 1,1,2-trichloroethane and are not routinely available in hospitals and clinics because they require special equipment.

Source of Information
Agency for Toxic Substances and Disease Registry (ATSDR). 1989. Toxicological profile for 1,1,2-trichloroethane. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Has the federal government made recommendations to protect human health?


The EPA has set a limit of 0.005 milligrams of 1,1,2-trichloroethane per liter of drinking water (0.005 mg/L).

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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TRICHLOROETHYLENE
CAS # 79-01-6
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about trichloroethylene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Trichloroethylene is a colorless liquid which is used as a solvent for cleaning metal parts. Drinking or breathing high levels of trichloroethylene may cause nervous system effects, liver and lung damage, abnormal heartbeat, coma, and possibly death. Trichloroethylene has been found in at least 852 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is trichloroethylene? (Pronounced tr-klr-th-ln)
Trichloroethylene (TCE) is a nonflammable, colorless liquid with a somewhat sweet odor and a sweet, burning taste. It is used mainly as a solvent to remove grease from metal parts, but it is also an ingredient in adhesives, paint removers, typewriter correction fluids, and spot removers. Trichloroethylene is not thought to occur naturally in the environment. However, it has been found in underground water sources and many surface waters as a result of the manufacture, use, and disposal of the chemical.

How might I be exposed to trichloroethylene?


G Breathing air in and around the home which has been contaminated with trichloroethylene vapors from shower water or household products such as spot removers and typewriter correction fluid. G Drinking, swimming, or showering in water that has been contaminated with trichloroethylene. G Contact with soil contaminated with trichloroethylene, such as near a hazardous waste site. G Contact with the skin or breathing contaminated air while manufacturing trichloroethylene or using it at work to wash paint or grease from skin or equipment.

What happens to trichloroethylene when it enters the environment?


G Trichloroethylene dissolves a little in water, but it can remain in ground water for a long time. G Trichloroethylene quickly evaporates from surface water, so it is commonly found as a vapor in the air. G Trichloroethylene evaporates less easily from the soil than from surface water. It may stick to particles and remain for a long time. G Trichloroethylene may stick to particles in water, which will cause it to eventually settle to the bottom sediment. G Trichloroethylene does not build up significantly in plants and animals.

How can trichloroethylene affect my health?


Breathing small amounts may cause headaches, lung irritation, dizziness, poor coordination, and difficulty concentrating. Breathing large amounts of trichloroethylene may cause impaired heart function, unconsciousness, and death. Breathing it for long periods may cause nerve, kidney, and liver damage. Drinking large amounts of trichloroethylene may cause nausea, liver damage, unconsciousness, impaired heart function, or death.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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TRICHLOROETHYLENE CAS # 79-01-6


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Drinking small amounts of trichloroethylene for long periods may cause liver and kidney damage, impaired immune system function, and impaired fetal development in pregnant women, although the extent of some of these effects is not yet clear. Skin contact with trichloroethylene for short periods may cause skin rashes.

Has the federal government made recommendations to protect human health?


The EPA has set a maximum contaminant level for trichloroethylene in drinking water at 0.005 milligrams per liter (0.005 mg/L) or 5 parts of TCE per billion parts water. The EPA has also developed regulations for the handling and disposal of trichloroethylene. The Occupational Safety and Health Administration (OSHA) has set an exposure limit of 100 parts of trichloroethylene per million parts of air (100 ppm) for an 8-hour workday, 40-hour workweek.

How likely is trichloroethylene to cause cancer?


Some studies with mice and rats have suggested that high levels of trichloroethylene may cause liver or lung cancer. Some studies of people exposed over long periods to high levels of trichloroethylene in drinking water or in workplace air have found evidence of increased cancer. However, these results are inconclusive because the cancer could have been caused by other chemicals. The International Agency for Research on Cancer (IARC) has determined that trichloroethylene is not classifiable as to human carcinogenicity.

Glossary
Carcinogenicity: The ability of a substance to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or gas. Milligram (mg): One thousandth of a gram. Nonflammable: Will not burn. ppm: Parts per million. Sediment: Mud and debris that have settled to the bottom of a body of water. Solvent: A chemical that dissolves other substances.

Is there a medical test to show whether Ive been exposed to trichloroethylene?


If you have recently been exposed to trichloroethylene, it can be detected in your breath, blood, or urine. The breath test, if it is performed soon after exposure, can tell if you have been exposed to even a small amount of trichloroethylene. Exposure to larger amounts is assessed by blood and urine tests, which can detect trichloroethylene and many of its breakdown products for up to a week after exposure. However, exposure to other similar chemicals can produce the same breakdown products, so their detection is not absolute proof of exposure to trichloroethylene. This test isnt available at most doctors offices, but can be done at special laboratories that have the right equipment.

Source of Information
This ToxFAQs information is taken from the 1997 Toxicological Profile for Trichloroethylene (update) produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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1,2,3-TRICHLOROPROPANE
CAS # 96-18-4
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about 1,2,3-trichloropropane. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to 1,2,3-trichloropropane may occur from drinking water or from breathing air that is contaminated. This is most likely to occur near facilities that produce the chemical or near hazardous waste sites. People who are exposed to 1,2,3-trichloropropane can have eye and throat irritation. This chemical has been found in at least 20 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is 1,2,3-trichloropropane? (Pronounced 1,2,3-tr klr prpn)
1,2,3-Trichloropropane is a synthetic chemical that is also known as allyl trichloride, glycerol trichlorohydrin, and trichlorohydrin. It is a colorless, heavy liquid with a sweet but strong odor. It evaporates very quickly and small amounts dissolve in water. It is mainly used to make other chemicals. Some of it is also used as an industrial solvent, paint and varnish remover, and cleaning and degreasing agent. Very little information is available on the amounts manufactured and the specific uses. G There is very little evaporation from groundwater, so 1,2,3-trichloropropane can stay in groundwater for a long time. G Very little sticks to soil particles. G It is not expected to build up in fish or plants.

How might I be exposed to 1,2,3-trichloropropane?


G Breathing low levels in the air. G Drinking low levels in water. G Drinking contaminated well water from wells near hazardous waste sites. G Touching liquids or soil that contain 1,2,3-trichloropropane. G Working in a facility where 1,2,3-trichloropropane is used.

What happens to 1,2,3-trichloropropane when it enters the environment?


G It breaks down in the atmosphere when exposed to sunlight. G Every 15 days, half of the amount of 1,2,3-trichloropropane present in the air breaks down. G It evaporates from surface water and surface soil. G It leaches from deeper soil into the groundwater where it slowly breaks down.

How can 1,2,3-trichloropropane affect my health?


Exposure to high levels of 1,2,3-trichloropropane for a short time causes eye and throat irritation. People exposed to 100 parts of 1,2,3-trichloropropane per million parts of air (ppm) felt irritation, and some people exposed to 50 ppm for an 8-hour workday also had throat and eye irritation. We

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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1,2,3-TRICHLOROPROPANE CAS # 96-18-4

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html Is there a medical test to show whether Ive been exposed to 1,2,3-trichloropropane?
1,2,3-Trichloropropane can be measured in your blood, urine, and breath. However, it breaks down quickly and leaves your body in your breath, urine, and feces. The test cannot measure how much you have been exposed to or whether your health will be affected. The test requires special methods and equipment and is not usually available at your doctors office.

dont know what would happen to someone who breathed low levels for a long time. We also dont know what happens to people who swallow it or get it on their skin. Rats and mice died after breathing air containing 1,2,3-trichloropropane at levels higher than we have in the environment. When rats breathed it at levels lower than those that irritated humans, they developed eye, nose, and lung irritation, and liver and kidney disease. The main health effect in both animals and people is damage to the respiratory system. When rats swallowed 1,2,3-trichloropropane at high levels, they died from liver and kidney damage. When exposed to moderate levels that did not cause death, the rats had minor liver and kidney damage, blood disorders, and stomach irritation. When it was applied to the skin of rabbits, it caused severe irritation followed by injury to internal organs. This happened only when large amounts were applied to the skin. We do not know if 1,2,3-trichloropropane damages people's ability to reproduce or if it causes birth defects. When rats breathed low levels for several weeks or swallowed a large amount for a few days there were no effects on their ability to reproduce and there was no increase in birth defects.

Has the federal government made recommendations to protect human health?


The Environmental Protection Agency (EPA) recommends that no more than 2 parts of 1,2,3-trichloropropane per million parts (ppm) of water should be present in water that adults drink over a long period of time (7 years). For children, the recommended level is 0.6 ppm. The Occupational Health and Safety Administration (OSHA) has limited workers exposure to an average of 50 ppm in workplace air for an 8-hour workday, 40-hour workweek.

Glossary
Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Leach: To be removed or washed away by water. Solvent: A substance that dissolves another substance.

How likely is 1,2,3-trichloropropane to cause cancer?


The Department of Health and Human Services, the International Agency for Research on Cancer, and the Environmental Protection Agency (EPA) have not classified 1,2,3trichloropropane for carcinogenicity. We do not know whether 1,2,3-trichloropropane causes cancer in humans, but animals that swallowed low doses for most of their lives developed tumors in several organs.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for 1,2,3-trichloropropane. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/ toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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1,3-DINITROBENZENE and 1,3,5-TRINITROBENZENE


CAS # 99-65-0 and 99-35-4
Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about 1,3-dinitrobenzene and 1,3,5-trinitrobenzene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to 1,3-dinitrobenzene and 1,3,5-trinitrobenzene may occur from contaminated water, food, air, and soil near an Army ammunitions plant or other chemical manufacturer. High levels of 1,3-dinitrobenzene affect the ability of blood to carry oxygen. Effects of 1,3,5-trinitrobenzene are expected to be similar. These substances have been found in at least 19 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What are 1,3-dinitrobenzene and 1,3,5-trinitrobenzene? (Pronounced 1,3-d-ntr-bnzn and 1,3,5-trntr-bnzn)
1,3-Dinitrobenzene and 1,3,5-trinitrobenzene are synthetic substances that are used in explosives. Both substances are yellow crystal-like solids at room temperature. They may exist in air in very small amounts as dust or a vapor, and can dissolve in certain liquids. If either substance is put under very high heat, it will explode. They have have no odor or taste.

How might I be exposed to 1,3-dinitrobenzene and 1,3,5-trinitrobenzene?


If you live or work near an Army ammunitions plant or other chemical manufacturer, you may be exposed to these compounds by drinking contaminated water, eating contaminated food, breathing contaminated air, or touching or eating contaminated soil.

How can 1,3-dinitrobenzene and 1,3,5-trinitrobenzene affect my health?


Waste discharges from Army ammunitions plants or other chemical manufacturers are the primary sources for release of both compounds to air, water, and soil. 1,3-Dinitrobenzene and 1,3,5-trinitrobenzene are suspected to cause similar health effects. Exposure to high concentrations of 1,3-dinitrobenzene can reduce the ability of blood to carry oxygen and can cause your skin to become bluish in color. If you are exposed to 1,3-dinitrobenzene for a long time, you can develop a reduction (or loss) in the number of red blood cells (anemia). Other symptoms of 1,3-dinitrobenzene exposure include headache, nausea, and dizziness.

What happens to 1,3-dinitrobenzene and 1,3,5trinitrobenzene when they enter the environment?
q Both compounds are likely to break down in air, water, and soil very slowly. q Both compounds are slightly soluble in water. q 1,3-Dinitrobenzene evaporates slowly from water; 1,3,5trinitrobenzene does not evaporate from water. q Neither compound sticks to soil strongly, so they can move through soil into groundwater. q These compounds are not likely to build up in fish or people.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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1,3-DINITROBENZENE and 1,3,5-TRINITROBENZENE CAS # 99-65-0 and 99-35-4


ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html

We do not know if there are any long-term health effects from exposure to 1,3-dinitrobenzene or 1,3,5-trinitrobenzene. We also do not know if these chemicals cause birth defects in humans. Results of studies in animals show that effects of 1,3-dinitrobenzene and 1,3,5-trinitrobenzene on the blood are similar to the effects seen in people. Results from animal studies also show some other effects of 1,3-dinitrobenzene exposure, such as behavioral changes and male reproductive system damage. We do not know if these compounds can cause birth defects in animals. We do not know if the effects seen in animals could also occur in people.

The EPA requires that spills or accidental releases into the environment of 100 pounds or more of 1,3-dinitrobenzene, and 10 pounds or more of 1,3,5-trinitrobenzene, must be reported to the EPA. The Occupational Safety and Health Administration (OSHA) regulates levels of 1,3-dinitrobenzene in the workplace. The maximum allowable amount of 1,3-dinitrobenzene in workroom air during an 8-hour workday, 40-hour workweek, is 1 milligram per cubic meter (1 mg/m3). The National Institute for Occupational Safety and Health (NIOSH) and the American Conference of Governmental Industrial Hygienists (ACGIH) also recommend an exposure limit of 1 mg/m3 1,3-dinitrobenzene in workplace air over a 40-hour workweek.

How likely are 1,3-dinitrobenzene and 1,3,5trinitrobenzene to cause cancer?


The EPA has determined that these compounds are not classifiable as to their carcinogenicity in humans. This is because the ability of these compounds to produce cancer has not been studied in humans or animals.

Glossary
Anemia: A decreased ability of the blood to transport oxygen. Breakdown product: A substance that is formed when a chemical breaks down in the body. Carcinogenicity: Ability to cause cancer. CAS: Chemical Abstracts Service. Evaporate: To change into a vapor or a gas. Long-term: 365 days or longer. Milligram (mg): One thousandth of a gram.

Is there a medical test to show whether Ive been exposed to 1,3-dinitrobenzene or 1,3,5trinitrobenzene?
There is no routine medical test to show if you have been exposed to 1,3-dinitrobenzene or 1,3,5-trinitrobenzene. Tests have been used to detect 1,3-dinitrobenzene and its breakdown products in blood and urine of exposed animals, but these tests have not been used for people.

Reference
Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for 1,3-dinitrobenzene/1,3,5-trinitrobenzene (update). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Has the federal government made recommendations to protect human health?

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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2,4,6-TRINITROTOLUENE (TNT) CAS # 118-96-7


Agency for Toxic Substances and Disease Registry ToxFAQs September 1996
This fact sheet answers the most frequently asked health questions (FAQs) about 2,4,6-trinitrotoluene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to 2,4,6-trinitrotoluene occurs through eating, drinking, touching, or inhaling contaminated soil, water, food, or air. Health effects reported in people exposed to 2,4,6-trinitrotoluene include anemia, abnormal liver function, skin irritation, and cataracts. This substance has been found in at least 20 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency.
What is 2,4,6-trinitrotoluene? (Pronounced 2,4,6-tr ntr-tl y n)
2,4,6-Trinitrotoluene is a yellow, odorless solid that does not occur naturally in the environment. It is commonly known as TNT and is an explosive used in military shells, bombs, and grenades, in industrial uses, and in underwater blasting. 2,4,6-Trinitrotoluene production in the United States occurs solely at military arsenals.

How might I be exposed to 2,4,6-trinitrotoluene?


q Drinking contaminated water that has migrated from chemical waste disposal sites. q Breathing contaminated air. q Eating contaminated foods such as fruits and vegetables. q Eating contaminated soil.

How can 2,4,6-trinitrotoluene affect my health? What happens to 2,4,6-trinitrotoluene when it enters the environment?
q 2,4,6-Trinitrotoluene enters the environment in waste waters and solid wastes resulting from the manufacture of the compound, the processing and destruction of bombs and grenades, and the recycling of explosives. q It moves in surface water and through soils to groundwater. q In surface water, it is rapidly broken down into other chemical compounds by sunlight. q It is broken down more slowly by microorganisms in water and sediment. q Small amounts of it can accumulate in fish and plants. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry Workers involved in the production of explosives who were exposed to high concentrations of 2,4,6-trinitrotoluene in workplace air experienced several harmful health effects, including anemia and abnormal liver function. Similar blood and liver effects, as well as spleen enlargement and other harmful effects on the immune system, have been observed in animals that ate or breathed 2,4,6-trinitrotoluene. Other effects in humans include skin irritation after prolonged skin contact, and cataract development after long-term (365 days or longer) exposure.

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2,4,6-TRINITROTOLUENE (TNT) CAS # 118-96-7

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


It is not known whether 2,4,6-trinitrotoluene can cause birth defects in humans. However, male animals treated with high doses of 2,4,6-trinitrotoluene have developed serious reproductive system effects. The Department of Transportation (DOT) specifies that when 2,4,6-trinitrotoluene is shipped, it must be wet with at least 10% water (by weight) and it must be clearly labeled as a flammable solid. The Occupational Safety and Health Administration (OSHA) set a maximum level of 1.5 milligrams of 2,4,6-trinitrotoluene per cubic meter of workplace air (1.5 mg/m3) for an 8-hour workday for a 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) and the American Conference of Governmental Industrial Hygienists (ACGIH) recommend an exposure limit of 0.5 mg/m3 in workplace air for a 40-hour workweek.

How likely is 2,4,6-trinitrotoluene to cause cancer?


The EPA has determined that 2,4,6-trinitrotoluene is a possible human carcinogen. This assessment was based on a study in which rats that ate 2,4,6-trinitrotoluene for long periods developed tumors of the urinary bladder.

Is there a medical test to show whether Ive been exposed to 2,4,6-trinitrotoluene?


Laboratory tests can detect 2,4,6-trinitrotoluene or its breakdown products in blood or urine. Detection of its breakdown products in urine is a clear indication of exposure. This test isnt available at most doctors offices, but can be done at special laboratories that have the right equipment. A simpler, but less specific test of 2,4,6-trinitrotoluene exposure is a change in the color of urine to amber or deep red due to the presence of its breakdown products. However, none of these tests can predict whether a person will experience any health effects.

Glossary
Anemia: A decreased ability of the blood to transport oxygen. Breakdown product: A substance that is formed when a chemical breaks down in the body. Carcinogen: A substance that can cause cancer. CAS: Chemical Abstracts Service. Cataract: Clouding of the lens or capsule of the eye, causing partial or total blindness. Milligram (mg): One thousandth of a gram.

Reference
Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for 2,4,6-trinitrotoluene (update). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Has the federal government made recommendations to protect human health?


Since 2,4,6-trinitrotoluene is explosive, flammable, and toxic, EPA has designated it as a hazardous waste.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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URANIUM
CAS # 7440-61-1
Agency for Toxic Substances and Disease Registry ToxFAQs September 1999
This fact sheet answers the most frequently asked health questions (FAQs) about uranium. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Uranium is a naturally occurring chemical substance that is mildly radioactive. Everyone is exposed to low amounts of uranium through food, air, and water. Exposure to high levels of uranium can cause kidney disease. It is not known to cause cancer, but can decay into other radioactive materials that may. Uranium above background levels has been found in at least 54 of the 1,517 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is uranium? (Pronounced y-rn-m)
Uranium is a common naturally occurring and radioactive substance. It is a normal part of rocks, soil, air, and water, and it occurs in nature in the form of minerals - but never as a metal. Uranium metal is silver-colored with a gray surface and is nearly as strong as steel. Natural uranium is a mixture of three types or isotopes called U-234 (234U), U-235 (235U), and U-238 (238U). All three are the same chemical, but they have different radioactive properties. Typical concentrations in soil are a few parts per million (ppm). Some rocks contain high enough mineral concentrations of uranium to be mined. The rocks are taken to a chemical plant where the uranium is taken out and made into uranium chemicals or metal. The remaining sand is called mill tailings. Tailings are rich in the chemicals and radioactive materials that were not removed, such as radium and thorium. One of the radioactive properties of uranium is half-life, or the time it takes for half of the isotope to give off its radiation and change into another substance. The half-lives are very long (around 200,000 years for 234U, 700 million years for 235U, and 5 billion years for 238U. This is why uranium still exists in nature and has not all decayed away. The isotope 235U is useful as a fuel in power plants and weapons. To make fuel, natural uranium is separated into two portions. The fuel portion has more 235U than normal and is called enriched uranium. The leftover portion with less 235U than normal is called depleted uranium, or DU. Natural, depleted, and enriched uranium are chemically identical. DU is the least radioactive and enriched uranium is the most.

What happens to uranium when it enters the environment? q Uranium is already naturally present throughout the enviq q q q

ronment. Human activities, wind, streams, and volcanoes can move the uranium around and change the levels that you are exposed to. Uranium is found in soil where it may stay for billions of years. It exists as dust in the air and the dust settles onto surface water, soil, and plants. Uranium enters water by dissolving soil, eroding soil and rocks, or in releases from processing plants. Larger particles settle into the bottom of lakes, rivers, and ponds and join uranium that is there naturally. Some plants may absorb uranium or it may stick to the root surface.

How might I be exposed to uranium? q Breathing air or drinking water in a place that has higher

than background levels of uranium. q Eating food grown in areas with higher than background levels of uranium. q Working in factories that process uranium or with phosphate fertilizers, or living near any type of mine. q Living near a coal-fired power plant.

How can uranium affect my health?


All uranium mixtures (natural, depleted, and enriched) have the same chemical effect on your body. Large amounts of uranium can react with the tissues in your body and damage

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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URANIUM CAS # 7440-61-1


It is possible that higher-than-normal levels of uranium may be in the soil at a hazardous waste site. If you live near such a hazardous waste site, you should prevent your children from eating dirt and make sure that they wash their hands frequently and before eating. You should also wash fruits and vegetables grown in that soil well, and consider discarding the outside portion of root vegetables.

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


your kidneys. The radiation damage from exposure to high levels of natural or depleted uranium are not known to cause cancer (see next section).

How likely is uranium to cause cancer?


Humans and animals exposed to high levels of uranium did not have higher cancer rates. The Committee on the Biological Effects of Ionizing Radiation (BEIR IV) reported that eating food or drinking water that has normal amounts of uranium will most likely not cause cancer. Uranium can decay into other radioactive substances, such as radium, which can cause cancer if you are exposed to enough of them for a long enough period of time. Studies have reported lung and other cancers in uranium miners; however, the miners also smoked and were exposed to other substances that cause cancer, such as radon and silica dust.

Is there a medical test to show whether Ive been exposed to uranium?


Uranium is in your normal diet, so there will always be some level of uranium in all parts of your body. Uranium is normally measured in a sample of urine collected and sent to a laboratory. Blood, feces, and tissue samples are rarely used. Because most uranium leaves the body within a few days, higher than normal amounts in your urine shows whether you have been exposed to larger-than-normal amounts within the last week or so. Some highly sensitive radiation methods can measure uranium levels for a long time after you take in a large amount. Also, some radiation equipment can tell if uranium is on your skin.

How can uranium affect children?


Like adults, children are exposed to small amounts of uranium in air, food, and drinking water. If children were exposed to very large amounts of uranium, it is possible that they might have kidney damage like that seen in adults. We do not know whether children differ from adults in their susceptibility to the health effects of uranium exposure. It is not known if exposure to uranium can affect the developing human fetus. In laboratory animals, high doses of uranium in drinking water resulted in birth defects and an increase in fetal deaths. Measurements of uranium have not been made in pregnant women, so we do not know if uranium can cross the placenta and enter the fetus. In an experiment with pregnant animals, only a small amount of the injected uranium reached the fetus.

Has the federal government made recommendations to protect human health?


The EPA requires that spills or accidental releases of uranium waste into the environment containing 0.1 curies or more of radioactivity must be reported to the EPA. The EPA is currently working to develop an appropriate drinking water limit for uranium based on a broad range of human and animal health studies. The Occupational Safety and Health Administration has set occupational exposure limits for uranium in breathing air over an 8-hour workday, 40-hour workweek. The limits are 0.05 milligrams per cubic meter (0.05 mg/m3) for soluble uranium dust and 0.25 mg/m3 for insoluble uranium dust.

How can families reduce the risk of exposure to uranium?


If your doctor finds that you have been exposed to significant amounts of uranium, ask whether your children might also be exposed. Your doctor might need to ask your state health department to investigate.

Source of information
Agency for Toxic Substances and Disease Registry. 1999. Toxicological profile for uranium. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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VANADIUM
CAS # 7440-62-2
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about vanadium. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Everyone is exposed to low levels of vanadium in air, water, and food; however, most people are exposed mainly from food. Breathing high levels of vanadium may cause lung irritation, chest pain, coughing, and other effects. This chemical has been found in at least 385 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is vanadium? (Pronounced v-nd-m)
Vanadium is a compound that occurs in nature as a whiteto-gray metal, and is often found as crystals. Pure vanadium has no smell. It usually combines with other elements such as oxygen, sodium, sulfur, or chloride. Vanadium and vanadium compounds can be found in the earth's crust and in rocks, some iron ores, and crude petroleum deposits. Vanadium is mostly combined with other metals to make special metal mixtures called alloys. Vanadium in the form of vanadium oxide is a component in special kinds of steel that is used for automobile parts, springs, and ball bearings. Most of the vanadium used in the United States is used to make steel. Vanadium oxide is a yellow-orange powder, dark-gray flakes, or yellow crystals. Vanadium is also mixed with iron to make important parts for aircraft engines. Small amounts of vanadium are used in making rubber, plastics, ceramics, and other chemicals. It does not dissolve well in water. It combines with other elements and particles. It sticks to soil sediments. Low levels have been found in plants, but it is not likely to build up in the tissues of animals.

How might I be exposed to vanadium?


Exposure to very low levels in air, water, and food. Eating higher levels of it in certain foods. Breathing air near an industry that burns fuel oil or coal; these industries release vanadium oxide into the air. Working in industries that process it or make products containing it. Breathing contaminated air or drinking contaminated water near waste sites or landfills containing vanadium. Vanadium is not readily absorbed by the body from the stomach, gut, or contact with the skin.

How can vanadium affect my health? What happens to vanadium when it enters the environment?
Vanadium mainly enters the environment from natural sources and from the burning of fuel oils. It stays in the air, water, and soil for a long time. Exposure to high levels of vanadium can cause harmful health effects. The major effects from breathing high levels of vanadium are on the lungs, throat, and eyes. Workers who breathed it for short and long periods sometimes had lung irritation, coughing, wheezing, chest pain, runny nose, and a

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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VANADIUM CAS # 7440-62-2

ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html


sore throat. These effects stopped soon after they stopped breathing the contaminated air. Similar effects have been observed in animal studies. No other significant health effects of vanadium have been found in people. We do not know the health effects in people of ingesting vanadium. Animals that ingested very large doses have died. Lower, but still high levels of vanadium in the water of pregnant animals resulted in minor birth defects. Some animals that breathed or ingested vanadium over a long term had minor kidney and liver changes. The amounts of vanadium given in these animal studies that resulted in harmful effects are much higher than those likely to occur in the environment. Another indicator of high vanadium exposure in people is that their tongues may have a green color on top.

Has the federal government made recommendations to protect human health?


The EPA requires discharges or spills of 1,000 pounds or more of vanadium into the environment to be reported. The Occupational Safety and Health Administration (OSHA) has set an exposure limit of 0.05 milligrams per cubic meter (0.05 mg/m3) for vanadium pentoxide dust and 0.1 mg/m3 for vanadium pentoxide fumes in workplace air for an 8-hour workday, 40-hour workweek. The American Conference of Governmental Industrial Hygienists (ACGIH) has recommended an occupational exposure limit of 0.05 mg/m3 for vanadium pentoxide. The National Institute for Occupational Safety and Health (NIOSH) has recommended that 35 mg/m3 of vanadium be considered immediately dangerous to life and health. This is the exposure level of a chemical that is likely to cause permanent health problems or death.

How likely is vanadium to cause cancer?


The Department of Health and Human Services, the International Agency for Research on Cancer, and the Environmental Protection Agency (EPA) have not classified vanadium as to its human carcinogenicity. No human studies are available on the carcinogenicity of vanadium. No increase in tumors was noted in a long-term animal study where the animals were exposed to vanadium in the drinking water.

Glossary
Carcinogenicity: Ability to cause cancer. Ingesting: Taking food or drink into your body. Long-term: Lasting one year or longer. Milligram (mg): One thousandth of a gram.

Is there a medical test to show whether Ive been exposed to vanadium?


There are medical tests available to measure levels of vanadium in urine and blood. These tests are not routinely performed at doctors' offices because they require special equipment, but your doctor can take samples and send them to a testing laboratory. These tests can't determine if harmful health effects will occur from the exposure to vanadium.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for vanadium. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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VINYL ACETATE
CAS # 108-05-4
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions about vinyl acetate. For more information, you may call 404-639-6000. This fact sheet is one in a series of summaries about hazardous substances and their health effects. This information is important because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to vinyl acetate occurs mainly in the workplace. Breathing high levels of it for a short time may irritate your eyes, nose, and throat. This chemical has been found in at least 48 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is vinyl acetate? (Pronounced vnl s-tt)
Vinyl acetate is an industrial chemical that is produced in large amounts in the United States. It is a clear, colorless liquid with a sweet, fruity smell. It is very flammable and may be ignited by heat, sparks, or flames. Vinyl acetate is used to make other industrial chemicals. These chemicals are used mainly to make glues for the packaging and building industries. They are also used to make paints, textiles, and paper. Vinyl acetate is also used as a coating in plastic films for food packaging and as a modifier of food starch.

How might I be exposed to vinyl acetate?


Working in a factory that makes or uses it. Breathing air near a factory that makes or uses vinyl acetate. Breathing air near a hazardous waste site containing vinyl acetate. Drinking contaminated water. Touching products that were made with it, such as glues and paints.

How can vinyl acetate affect my health?


The major effects experienced from breathing high levels of vinyl acetate for a short time are irritated eyes, nose, and throat. We dont know what the effects are from breathing lower levels of vinyl acetate for a long time. We also don't know what happens if you ingest vinyl acetate. Long-term animal studies show a reduced ability of animals to fight infection when rats and mice ingested high levels of the chemical. Birth defects were not seen in the offspring of animals that were exposed to vinyl acetate in drinking water during their pregnancies.

What happens to vinyl acetate when it enters the environment?


Vinyl acetate enters the environment from industries that make, use, or process it. Vinyl acetate breaks down readily in the environment. It takes about 6 hours for one-half of the chemical to break down in the air. It takes about 7 days for one-half of it to break down in water. It is not known how long vinyl acetate stays in the soil.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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VINYL ACETATE CAS # 108-05-4

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Vinyl acetate has caused skin irritation and blisters in workers who accidentally spilled it on their skin. Eye irritation has also been seen when people were exposed to vinyl acetate in the air or through accidents when the chemical went into their eyes.

5,000 pounds or more of vinyl acetate be reported to the EPA. The Food and Drug Administration (FDA) has determined that vinyl acetate may be safely used as a coating or a part of a coating that is used in plastic films for food packaging, and as a modifier of food starch. The American Conference of Governmental Industrial Hygienists (ACGIH) has established an exposure limit of 10 parts of vinyl acetate per million parts of workplace air (10 ppm) for an 8-hour workday, 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) recommends that exposure to vinyl acetate in the workplace not exceed 4 ppm over a 15minute period.

How likely is vinyl acetate to cause cancer?


The International Agency for Research on Cancer has determined that vinyl acetate is not classifiable as to its carcinogenicity to humans. There are no human studies on the carcinogenicity of vinyl acetate. Animal studies have shown mixed results; one study showed an increase in tumors of the noses of rats who breathed vinyl acetate, while another study did not show an increase in tumors in rats who drank water containing the chemical.

Glossary
Carcinogenicity: Ability to cause cancer. Ingesting: Taking food or drink into your body. Long-term: Lasting one year or longer. ppm: Parts per million. Short-time: Lasting 14 days or less. Tumor: An abnormal mass of tissue.

Is there a medical test to show whether Ive been exposed to vinyl acetate?
No tests are available to measure vinyl acetate in the blood, urine, or body tissues. Vinyl acetate breaks down very quickly in the body to substances that are normally found in the body; thus, measurement of these break down products is not useful for determining whether you have been exposed to vinyl acetate.

Has the federal government made recommendations to protect human health?


The Environmental Protection Agency (EPA) requires that discharges or accidental spills into the environment of

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1992. Toxicological profile for vinyl acetate. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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VINYL CHLORIDE
CAS # 75-01-4
Agency for Toxic Substances and Disease Registry ToxFAQs September 1997

This fact sheet answers the most frequently asked health questions (FAQs) about vinyl chloride. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

HIGHLIGHTS: Exposure to vinyl chloride occurs mainly in the workplace. Breathing high levels of vinyl chloride for short periods of time can cause dizziness, sleepiness, unconsciousness, and at extremely high levels can cause death. Breathing vinyl chloride for long periods of time can result in permanent liver damage, immune reactions, nerve damage, and liver cancer. This substance has been found in at least 496 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is vinyl chloride? (Pronounced vnl klrd)
Vinyl chloride is a colorless, flammable gas at normal temperatures with a mild, sweet odor. It is a manufactured substance that is used to make polyvinyl chloride (PVC). PVC is used to make a variety of plastic products, including pipes, wire and cable coatings, and the furniture and automobile upholstery. Vinyl chloride also results from the breakdown of other substances, such as trichloroethane, trichloroethylene, and tetrachloroethylene. Vinyl chloride is also known as chloroethene, chloroethylene, and ethylene monochloride. G Vinyl chloride is unlikely to build up in plants or animals.

How might I be exposed to vinyl chloride?


G Breathing vinyl chloride that has been released from plastics industries, hazardous waste sites, and landfills. G Breathing vinyl chloride in air or during contact with your skin or eyes in the workplace. G Drinking water from contaminated wells.

How can vinyl chloride affect my health?


Breathing high levels of vinyl chloride can cause you to feel dizzy or sleepy. Breathing very high levels can cause you to pass out, and breathing extremely high levels can cause death. Most of the studies on long-term exposure (365 days or longer) to vinyl chloride are about workers that make or use vinyl chloride. They were exposed to much higher levels of vinyl chloride in the air than is the general population. People who breathe vinyl chloride for long periods of time can have changes to the structure of their livers. People who work with vinyl chloride have developed nerve damage and immune reactions. Other workers have

What happens to vinyl chloride when it enters the environment?


G Liquid vinyl chloride evaporates easily into the air. Vinyl chloride, if it is near the surface of soil or water, can also evaporate. G Vinyl chloride in the air can break down within a few days to other substances, some of which can be harmful. G Small amounts of vinyl chloride can dissolve in water. G Vinyl chloride formed from the breakdown of other chemicals can enter groundwater.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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VINYL CHLORIDE CAS # 75-01-4

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developed problems with the blood flow in their hands; the tips of their fingers turn white and hurt when they are in cold temperatures. Sometimes, the bones in the tips of their fingers have broken down. Animal studies have shown that long-term (365 days or longer) exposure to vinyl chloride can damage the sperm and testes. It has not been proven that vinyl chloride causes birth defects in humans, but animal studies have shown that breathing vinyl chloride can harm unborn offspring and may also cause increases in early miscarriages. The effects of drinking high levels of vinyl chloride are unknown. If you spill vinyl chloride on your skin, it will cause numbness, redness, and blisters. vinyl chloride, but this is not sensitive enough to determine the effects resulting from exposure. These tests are not available at most doctors' offices, but can be done at special laboratories that have the right equipment.

Has the federal government made recommendations to protect human health?


The EPA requires that the amount of vinyl chloride in drinking water not exceed 0.002 milligrams of vinyl chloride per liter of water (0.002 mg/L). The EPA requires that spills or accidental releases into the environment of 1 pound or more of vinyl chloride be reported to the EPA. The Occupational Safety and Health Administration (OSHA) has set the maximum allowable level of vinyl chloride in workroom air during an 8-hour workday in a 40-hour workweek at 1 part vinyl chloride per million parts of air (1 ppm).

How likely is vinyl chloride to cause cancer?


The Department of Health and Human Services (DHHS) has determined that vinyl chloride is a known human carcinogen. Vinyl chloride exposure results in liver cancer in people.

Glossary
Carcinogen: A substance with the ability to cause cancer. Immune reaction: Sensitizing response of the body to a chemical. Milligram (mg): One thousandth of a gram. Miscarriage: Pregnancy loss. ppm: Parts per million.

Is there a medical test to show whether Ive been exposed to vinyl chloride?
The results of several tests can sometimes show if youve been exposed to vinyl chloride. If breath samples are taken just after exposure, vinyl chloride can be measured, but this is not helpful for measuring very low levels of the chemical. Better information is gotten by measuring a breakdown product of vinyl chloride, thiodiglycolic acid, in the urine shortly after exposure. However, this test will not give information on the level of exposure. Exposure to other chemicals can produce the same breakdown product in the urine. The binding of vinyl chloride to genetic material in your blood or tissue can tell whether you have been exposed to

Source of Information
This ToxFAQs information is taken from the 1997 Toxicological Profile for Vinyl Chloride (update) produced by the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services, Public Health Service in Atlanta, GA. Animal testing is sometimes necessary to find out how toxic substances might harm people and how to treat people who have been exposed. Laws today protect the welfare of research animals and scientists must follow strict guidelines.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease
Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone: 1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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XYLENE
CAS # 1330-20-7
Agency for Toxic Substances and Disease Registry ToxFAQs September 1996

This fact sheet answers the most frequently asked health questions (FAQs) about xylene. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to xylene occurs in the workplace and when you use paint, gasoline, paint thinners and other products that contain it. People who breathe high levels may have dizziness, confusion, and a change in their sense of balance. This substance has been found in at least 658 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).
What is xylene? (Pronounced zln)
Xylene is a colorless, sweet-smelling liquid that catches on fire easily. It occurs naturally in petroleum and coal tar and is formed during forest fires. You can smell xylene in air at 0.083.7 parts of xylene per million parts of air (ppm) and begin to taste it in water at 0.531.8 ppm. Chemical industries produce xylene from petroleum. Its one of the top 30 chemicals produced in the United States in terms of volume. Xylene is used as a solvent and in the printing, rubber, and leather industries. It is also used as a cleaning agent, a thinner for paint, and in paints and varnishes. It is found in small amounts in airplane fuel and gasoline. G In the air, it is broken down by sunlight into other less harmful chemicals. G It is broken down by microorganisms in soil and water. G Only a small amount of it builds up in fish, shellfish, plants, and animals living in xylene-contaminated water.

How might I be exposed to xylene?


G Breathing xylene in workplace air or in automobile exhaust. G Breathing contaminated air. G Touching gasoline, paint, paint removers, varnish, shellac, and rust preventatives that contain it. G Breathing cigarette smoke that has small amounts of xylene in it. G Drinking contaminated water or breathing air near waste sites and landfills that contain xylene. G The amount of xylene in food is likely to be low.

What happens to xylene when it enters the environment?


G Xylene has been found in waste sites and landfills when discarded as used solvent, or in varnish, paint, or paint thinners. G It evaporates quickly from the soil and surface water into the air.

How can xylene affect my health?


Xylene affects the brain. High levels from exposure for short periods (14 days or less) or long periods (more than 1 year) can cause headaches, lack of muscle coordination, dizziness, confusion, and changes in ones sense of balance. Exposure of

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service Agency for Toxic Substances and Disease Registry

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XYLENE CAS # 1330-20-7

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people to high levels of xylene for short periods can also cause irritation of the skin, eyes, nose, and throat; difficulty in breathing; problems with the lungs; delayed reaction time; memory difficulties; stomach discomfort; and possibly changes in the liver and kidneys. It can cause unconsciousness and even death at very high levels. Studies of unborn animals indicate that high concentrations of xylene may cause increased numbers of deaths, and delayed growth and development. In many instances, these same concentrations also cause damage to the mothers. We do not know if xylene harms the unborn child if the mother is exposed to low levels of xylene during pregnancy.

Has the federal government made recommendations to protect human health?


The EPA has set a limit of 10 ppm of xylene in drinking water. The EPA requires that spills or accidental releases of xylenes into the environment of 1,000 pounds or more must be reported. The Occupational Safety and Health Administration (OSHA) has set a maximum level of 100 ppm xylene in workplace air for an 8-hour workday, 40-hour workweek. The National Institute for Occupational Safety and Health (NIOSH) and the American Conference of Governmental Industrial Hygienists (ACGIH) also recommend exposure limits of 100 ppm in workplace air. NIOSH has recommended that 900 ppm of xylene be considered immediately dangerous to life or health. This is the exposure level of a chemical that is likely to cause permanent health problems or death.

How likely is xylene to cause cancer?


The International Agency for Research on Cancer (IARC) has determined that xylene is not classifiable as to its carcinogenicity in humans. Human and animal studies have not shown xylene to be carcinogenic, but these studies are not conclusive and do not provide enough information to conclude that xylene does not cause cancer.

Glossary
Evaporate: To change from a liquid into a vapor or a gas. Carcinogenic: Having the ability to cause cancer. CAS: Chemical Abstracts Service. ppm: Parts per million. Solvent: A liquid that can dissolve other substances.

Is there a medical test to show whether Ive been exposed to xylene?


Laboratory tests can detect xylene or its breakdown products in exhaled air, blood, or urine. There is a high degree of agreement between the levels of exposure to xylene and the levels of xylene breakdown products in the urine. However, a urine sample must be provided very soon after exposure ends because xylene quickly leaves the body. These tests are not routinely available at your doctors office.

References
Agency for Toxic Substances and Disease Registry (ATSDR). 1995. Toxicological profile for xylenes (update). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and
Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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ZINC
CAS # 7440-66-6
Agency for Toxic Substances and Disease Registry ToxFAQs September 1995

This fact sheet answers the most frequently asked health questions (FAQs) about zinc. For more information, call the ATSDR Information Center at 1-888-422-8737. This fact sheet is one in a series of summaries about hazardous substances and their health effects. Its important you understand this information because this substance may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present.

SUMMARY: Exposure to high levels of zinc occurs mostly from eating food, drinking water, or breathing workplace air that is contaminated. Exposure to large amounts of zinc can be harmful. However, zinc is an essential element for our bodies, so too little zinc can also be harmful. This chemical has been found in at least 801 of 1,416 National Priorities List sites identified by the Environmental Protection Agency.
What is zinc? (Pronounced zngk)
Zinc is one of the most common elements in the earth's crust. It's found in air, soil, and water, and is present in all foods. Pure zinc is a bluish-white shiny metal. Zinc has many commercial uses as coatings to prevent rust, in dry cell batteries, and mixed with other metals to make alloys like brass and bronze. A zinc and copper alloy is used to make pennies in the United States. Zinc combines with other elements to form zinc compounds. Common zinc compounds found at hazardous waste sites include zinc chloride, zinc oxide, zinc sulfate, and zinc sulfide. Zinc compounds are widely used in industry to make paint, rubber, dye, wood preservatives, and ointments.

Zinc compounds can move into the groundwater and into lakes, streams, and rivers. Most of the zinc in soil stays bound to soil particles. It builds up in fish and other organisms, but it doesn't build up in plants.

How might I be exposed to zinc?


Ingesting small amounts present in your food and water. Drinking contaminated water near manufacturing or waste sites. Drinking contaminated water or a beverage that has been stored in metal containers or flows through pipes that have been coated with zinc to resist rust. Eating too many dietary supplements that contain zinc. Breathing zinc particles in the air at manufacturing sites.

What happens to zinc when it enters the environment?


Some is released into the environment by natural processes, but most comes from activities of people like mining, steel production, coal burning, and burning of waste. It attaches to soil, sediments, and dust particles in the air. Rain and snow remove zinc dust particles from the air.

How can zinc affect my health?


Zinc is an essential element in our diet. Too little zinc can cause health problems, but too much zinc is also harmful. The recommended dietary allowance (RDA) for zinc is 15 milligrams a day for men (15 mg/day); 12 mg/day for women; 10 mg/day for children; and 5 mg/day for infants. Not enough zinc in your diet can result in a loss of appetite, a decreased sense of taste and smell, slow wound healing and

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ZINC CAS # 7440-66-6

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skin sores, or a damaged immune system. Young men who don't get enough zinc may have poorly developed sex organs and slow growth. If a pregnant woman doesn't get enough zinc, her babies may have growth retardation. Too much zinc, however, can also be damaging to your health. Harmful health effects generally begin at levels from 10-15 times the RDA (in the 100 to 250 mg/day range). Eating large amounts of zinc, even for a short time, can cause stomach cramps, nausea, and vomiting. Taken longer, it can cause anemia, pancreas damage, and lower levels of high density lipoprotein cholesterol (the good form of cholesterol). Breathing large amounts of zinc (as dust or fumes) can cause a specific short-term disease called metal fume fever. This is believed to be an immune response affecting the lungs and body temperature. We do not know the long-term effects of breathing high levels of zinc. It is not known if high levels of zinc affect human reproduction or cause birth defects. Rats that were fed large amounts of zinc became infertile or had smaller babies. Irritation was also observed on the skin of rabbits, guinea pigs, and mice when exposed to some zinc compounds. Skin irritation will probably occur in people. also be measured in urine, saliva, and hair. The amount of zinc in your hair tells us something about long-term exposure, but the relationship between levels in your hair and the amount that you were exposed to is not clear. These tests are not routinely performed at doctors' offices, but your doctor can take samples and send them to a testing laboratory.

Has the federal government made recommendations to protect human health?


EPA recommends that there be no more than 5 parts of zinc in 1 million parts of drinking water (5 ppm) because of taste. EPA also requires that releases of more than 1,000 (or in some cases 5,000) pounds of zinc or its compounds into the environment be reported. The Occupational Safety and Health Administration (OSHA) has set a maximum concentration limit for zinc chloride fumes in workplace air of 1 milligram of zinc per cubic meter of air (1 mg/m3) for an 8-hour workday over a 40hour work week and 5 mg/m3 for zinc oxide fumes. The National Institute for Occupational Safety and Health (NIOSH) has set the same standards for up to a 10-hour workday over a 40-hour workweek.

How likely is zinc to cause cancer?


The Department of Health and Human Services, the International Agency for Research on Cancer, and the Environmental Protection Agency (EPA) have not classified zinc for carcinogenicity.

Glossary
Anemia: A decreased ability of the blood to transport oxygen. Carcinogenicity: Ability to cause cancer. Milligram (mg): One thousandth of a gram.

References Is there a medical test to show whether Ive been exposed to zinc?
Zinc can be measured in your blood or feces. This can tell you how much zinc you have been exposed to. Zinc can Agency for Toxic Substances and Disease Registry (ATSDR). 1994. Toxicological profile for zinc. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

Where can I get more information? For more information, contact the Agency for Toxic Substances and Disease Registry, Division of Toxicology, 1600 Clifton Road NE, Mailstop E-29, Atlanta, GA 30333. Phone:1-888-422-8737, FAX: 404-498-0093. ToxFAQs Internet address via WWW is http://www.atsdr.cdc.gov/toxfaq.html ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

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