FIRST AID KIT POLICY AND GUIDELINES FOR LABORATORIES
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FIRST AID KIT POLICY
AND GUIDELINES FOR LABORATORIES
Northwestern University v Vice President for Research v Chemical and Biological Safety Committee v Office of Research Safety
____________________________________________
UNIVERSITY SAFETY POLICY
OSHA medical service regulations mandate that the “employer shall ensure the ready availability” of medical personnel and
first aid supplies for matters of employee health. Medical care at the University is available through the University Health
Service, the workers’ compensation providers for each respective campus, and local hospitals (see Chemical and Biological
Safety in Laboratories, Medical Emergency Procedures). University safety policy, as established by the Chemical and
Biological Safety Committee (CBSC), also manages compliance with this law by requiring principal investigators or lab
supervisors to provide a first aid kit for each lab group.
First aid kits shall be readily accessible to laboratory staff at all times while they are at work. Lab workers shall be trained to
know the location of the kit. Hazard-specific first aid supplies shall be made available, as appropriate, when research work
involves particular chemicals such as cyanides or hydrofluoric acid. Exposures to these severely toxic agents warrant
immediate application of special remedies.
____________________________________________
GUIDELINES FOR PROVIDING ADEQUATE SUPPLIES
General Overview of First Aid Kit Contents
OSHA demands that a “consulting physician” approve first aid kits. In essence, this means that the contents of basic kits
purchased from safety and laboratory supply companies are expected to have been reviewed for appropriateness and
completeness by a physician. Any kit ordered through a
commercial distributor is likely to meet this stipulation since the
manufacturer will develop the standardized product based on
medical counsel (for liability reasons). If in doubt at the time of
purchase, request that the distributor enclose formal
documentation of the consulting physician’s endorsement.
An alternative option is for lab groups to “design” their own
kits. These kits would need to be approved by a physician as
well but, in this case, the kit preparers must identify the medical
advisor themselves and maintain individual records of official
approval.
Factors to consider in selecting a kit:
• the supplies should be consistent with the types of injuries anticipated in this research space (e.g., will there be
burns, cuts, fractures, contusions, or allergic reactions?)
• its size must be appropriate to the number of people who will be using the kit
• supplies should be provided in single-use or -dose unit-type packs with suitable wrapping to ensure sterility and
hygiene
• the case should be dust- and moisture-resistant with no sharp edges
• consider the most convenient storage method for easy access—wall-mounted or portable?
• the assortment choice shall have received final clearance from a qualified medical expert.
As a practical model, the American National Standards Institute’s Minimum Requirements for Workplace First Aid Kits
(ANSI Z308.1-1998) recommends that basic units should contain:
• 1 absorbent compress (32 sq. in. with no side smaller than 4 in.)
• 16 adhesive bandages (1 x 3 in.)
• adhesive tape (total of 5 yd.)
p. 1First Aid Kit Policy, Rev. 4-99
• 10 individual-use antiseptic applications (0.5 g each)
• 6 individual-use burn treatment applications (0.5 g each)
• 2 pairs of medical exam gloves
• 4 sterile pads (3 x 3 in.)
• 1 triangular bandage (40 x 40 x 56 in.)
Commercially available kits prepared to ANSI standards will be labeled to indicate this status.
ANSI, the Red Cross, and/or ORS propose these optional use items:
• bandage compresses of various pad sizes ranging from 2 x 2, 3 x 3, or 4 x 4 in.
• eye covering(s) with the ability to cover both eyes (an area of at least 2.9 sq. in. per eye)
• eyewash (a minimum of 30 ml of sterile, isotonic, buffered solution in individual-use 15-ml applications)
NOTE: Not intended to replace a plumbed eyewash fountain for proper flushing. Meant to be used for the purpose of
restoring pH balance.
• cold pack (4 x 5 in.)
• gauze roller bandage (2 in. wide, 6 yd. long)
• adhesive bandages of assorted sizes
• plastic bags
• scissors with rounded tips
• tweezers (forceps)
• a small flashlight with extra batteries
• a blanket
• eyewash cups or eye irrigator loops
• suction-type contact lens remover.
The listing of the materials included in the ORS first aid kits is available to those wishing to compare their prospective kits to
an existing example. Contact ORS for further guidance (CH 3-8300, EV 1-5581).
Eye Irrigation
When flushing the eye at an eyewash, it is important to hold the eyelids open and to roll the eyeballs so that water will flow
over the entire surface of the eye. A major problem in irrigation at a plumbed eyewash is the difficulty in keeping the eye
open due to possible pain or eyelid spasm. Most eyewashes irrigate the central portion of the cornea but may miss the
superior cul-de-sacs (recesses of the external surface of the eyeball). Materials trapped in this area could cause significant
damage and need to be removed quickly.
To solve this dilemma, use of a specialized eye irrigation
device is recommended to supplement flushing at the
eyewash. This type of product provides an irrigation
loop that is designed to slide up easily under the upper
eyelid without having to pry open or otherwise
traumatize the eye. Sterile saline is the irrigant.
Consider supplying an Eye Irrigator™ in your first aid
kit. They are available from American Health and Safety,
Inc., 6250 Nesbit Rd., PO Box 46340, Madison, WI, 53744,
phone 800-522-7554, for $19.95 (product # W2020).
Personal Protective Equipment for the First Aid Provider
Personal protective equipment (PPE) shall be available in each lab for persons providing first aid/CPR assistance. The PPE
shall be in close proximity to the kit location. PPE supplies may consist of latex or vinyl disposable gloves, safety glasses,
CPR protective shields, and a face shield. Selection will depend on the training of the first aid responders.
Training
Principal investigators and lab supervisors are responsible for training lab workers regarding the location of first aid kits and
PPE accessories. The CBSC and ORS both recommend that at least two members of each lab group receive first aid and CPR
training. PIs/supervisors must determine whether to arrange for and/or sponsor first aid and CPR training for their staffs.
p. 2First Aid Kit Policy, Rev. 4-99
If there are lab workers who have particular sensitivities or medical problems that could interfere with first aid procedures,
consider discussing this issue with the entire staff. Barring any confidentiality concerns, it is wise to prepare colleagues for
possible reactions or symptoms should an employee suffer from an illness that demands special care. An employee with a
given medical condition (e.g., asthma, heart disease) may require prescription drugs during a respiratory attack or illness
episode. Whenever possible, warn staff of the specific procedures needed to help a worker with a preexisting health
complication.
____________________________________________
MAINTENANCE OF FIRST AID SUPPLIES
University safety policy requires monthly inspections of first aid kits.
Inspection elements:
• is the kit at its assigned site?
• are the kit contents complete and have used or damaged items been replaced?
• what is the condition of the contents (are they dry, properly packaged, clean, etc.)?
• are there any signs of tampering or vandalism of the kit or its contents?
• are there extraneous, unnecessary items stored in the kit? (these should be removed)
• check expiration dates and replace any out-of-date contents
• is an instruction book or first aid manual available?
• is there a notice that warns staff that any injury requiring first aid application should be followed by professional
medical attention?
____________________________________________
FIRST AID PROCEDURE FOR RESPONDING TO SUSPECTED CYANIDE EXPOSURE
Preparation Measures for Research Work Involving Cyanides
Safe Practices to Prevent Injury
1. Maintain a current inventory of hazardous chemicals used or stored in the
lab. This inventory should include any cyanides present in the workspace.
2. Store the cyanides properly. Those not requiring refrigeration must be kept
in a locked cabinet accessible only to trained and authorized personnel.
3. Maintain a supply of amyl nitrite vaporoles for emergencies. These inhalants are an antidote to cyanide
poisoning. Ideally, the stock of vaporoles should be available in the area where the cyanides will be used or as
close by as is practicable. Immediate application of the antidote heightens the chances of the victim’s survival.
The use of the vaporoles cannot cause permanent harm to the victim; therefore, it is worth attempting this
treatment even if there has been a slight delay in recognizing that the person has been poisoned.
4. Since amyl nitrite may be attractive as a recreational drug, strict security measures are required to control misuse.
When not needed for potential first aid application, it must also be locked inside a cabinet or drawer to limit
access. Remove the drug from the drawer when working with cyanides and keep the ampoules nearby within
easy reach. Once finished with work for the day, return the ampoules to the locked drawer. Alternatively, to allow
immediate retrieval for emergencies while still ensuring security, break-off locks can be used on the first aid kit.
The locks are easily wrenched off when one needs to reach the antidote. If broken between inspections, there is
clear indication of theft or potential vandalism to the kit. Visit ORS to see some samples of such locks and to
obtain purchasing information.
5. Plan your cyanide-requiring experiment carefully. Inform a buddy in the lab area that you will be handling cyanide
for a certain period of time and ask that person to check in with you at given intervals.
6. Ensure that you have received first aid training for cyanide exposure procedures. Verify that your buddy has
been trained in emergency procedures involving the specifics of amyl nitrite vaporole administration. Do NOT
commence work with cyanides without a trained back-up person.
7. Work in a fume hood! Wear appropriate personal protective equipment!
Suspected Exposure
p. 3First Aid Kit Policy, Rev. 4-99
Assessing the Situation
1. Hydrogen cyanide has a characteristic odor of bitter almonds. You may detect a faint scent from the victim. Be
aware that not everyone can smell cyanide (it’s a genetically predetermined trait).
2. If cyanide exposure is known or suspected (whether ingestion, inhalation, skin absorption, or eye contact), you
may notice the following symptoms:
• weakness
• headache
• confusion
• dizziness
• nausea
• vomiting
• loss of consciousness
3. An early symptom is an initial increase in respiratory rate. Unless treated quickly, breathing becomes slow and
gasping.
4. In a worst case scenario, exposure to a high concentration of cyanide will result in instantaneous collapse and
cessation of breathing.
Immediate Response
A. Contact the local police at 911 in an emergency. Request paramedic assistance. If possible, have a colleague make the
call so you can help the victim as soon as possible. (University Police can be reached at 456 for non-emergencies, and
ORS can be reached for laboratory assistance at 1-5581 in Evanston and 3-8300 in Chicago.)
B. If you can do so without endangering yourself, remove the victim from the lab to a safe area. Wear PPE to handle the
victim, who may be contaminated.
C. Evacuate the lab and close all the doors.
D. Administer the amyl nitrite once you and the victim are in a safe location.
NOTE: ALWAYS REMEMBER TO PROTECT YOURSELF FIRST AND FOREMOST. CALL FOR HELP RATHER THAN
ENTERING A CONTAMINATED ZONE. DO NOT PUT EMERGENCY RESPONDERS IN THE POSITION OF
HAVING TO SAVE YOU AND THE FIRST VICTIM!
Administration Procedure
A. Break the vaporole.
B. Hold it under the victim’s nose for approximately 15 seconds.
C. Remove the vaporole and allow the victim to rest for 15 seconds.
D. Repeat steps B and C until the paramedics arrive.
NOTE: In case the victim has suffered respiratory arrest, administer the vaporole through the rescue breathing protective
device (perform rescue breathing only if you have had appropriate training). Again, ventilate for 15 seconds,
remove the vaporole and rest, and then continue to repeat this practice until help arrives. See attached illustration.
Post-Incident Restocking
Once the emergency situation has been resolved, replace the vaporoles taken from the first aid kit. There should be a supply
of 6 vaporoles available at all times. The vaporoles have a shelf-life of approximately 2 years (the expiration date must be
printed on the outer container). Do NOT keep vaporoles past their expiration date. Give expired vaporoles to ORS for
disposal.
FYI, ORS stocks amyl nitrite in its emergency medical packs and wasterooms on both campuses.
Procedures For Obtaining Amyl Nitrite Inhalants
A. Chicago Campus:
Chicago lab workers can obtain the vaporoles from an occupational physician of their choice. The prescribing physician
will need a letter of authorization from the principal investigator. Any local pharmacy can fill the prescription.
Alternatively, Chicago personnel can follow the Evanston campus procedure listed below.
p. 4First Aid Kit Policy, Rev. 4-99
B. Evanston Campus:
In Evanston, the amyl nitrite vaporoles can be purchased from the pharmacy at the University Health Service, Searle
Hall, 633 Emerson Street. Follow these procedures:
• Call the main line at the University Health Service (1-8100) and request an appointment with Dr. John Alexander.
Explain the nature of the visit (i.e., to obtain amyl nitrite vaporoles).
• Bring a letter of authorization from the supervising principal investigator to the scheduled appointment. The letter
should include information as to the research being performed and the general anticipated use of cyanide salts. The
principal investigator must sign the letter, signifying that the description of operations is accurate and the amyl
nitrite vaporoles are indeed necessary.
• Dr. Alexander will issue the prescription for the inhalants. The prescription can be filled at the Searle Pharmacy.
Come prepared with a CUFS number for prescription billing.
____________________________________________
PROCEDURE FOR USE OF AMYL NITRITE VAPOROLES IN A RESCUE
BREATHING DEVICE
Rescue Breathing
Disclaimer: Rescue breathing and CPR shall not be attempted by any person who has not been trained in first aid and CPR
procedures by the Red Cross or another reputable and qualified professional organization. Do NOT mistake these
pages as adequate or substitute training for performing first aid/CPR. This summary review is intended merely to spur
the memory of certified and experienced first aid/CPR providers who have participated in practice sessions under the
oversight of a qualified instructor. The basic steps are not described well enough to allow laypersons to effectively
assist victims.
1. Clear the airway. Tilt the victim’s head back and lift the chin. Sweep the mouth for obstructions.
2. Perform rescue breathing with the vaporole in place (see next page for application options). Continue rescue breathing
as long as a pulse is present but the person is not breathing. Mouth-to-mouth resuscitation is not advised without use
of an universal airway device or a protector sheet with a one-way valve. Mouth-to-mask resuscitation is the appropriate
method to avoid cyanide contamination of the rescue provider!
3. Maintain circulation. If there is no pulse, compress the chest with the heel of one hand placed above the notch on the
lower end of the victim’s breastbone (where the ribs meet the breastbone). Place your other hand over this hand.
Position your shoulders directly over your hands. Keep a smooth, even rhythm and don’t pause between
compressions.
p. 5First Aid Kit Policy, Rev. 4-99 p. 6
First Aid Kit Policy, Rev. 4-99
Vaporole Administration
NOTE: Do NOT place the vaporole directly in the mask or it could be forced down the airway, creating an obstruction to
breathing. There are 2 methods to avoid this problem. Do not use either method unless you have had training with
the resuscitation equipment.
Method 1: Apply the universal airway procedure and put the vaporole between the oxygen enrichment attachment and the
isolation valve.
Method 2: Use a plastic resusci-protector sheet with a one-way valve under the vaporole. Clasp the rescue breathing
protective device over the vaporole and the resusci-protector sheet.
____________________________________________
FIRST AID PROCEDURE FOR RESPONDING TO HYDROFLUORIC ACID BURNS
Introduction
Hydrofluoric acid is an extremely hazardous liquid. It can cause severe skin and eye irritation or deep-seated, slow-to-heal
burns. In certain cases, exposure can prove fatal. For any major exposure to HF, immediate paramedic assistance is
necessary.
HF’s mode of action is to bind calcium whenever contact occurs with skin or other body tissues. Unlike the action of other
acids, which are rapidly neutralized, tissue destruction and neutralization of HF may proceed for days. Because calcium is
necessary for cell life, its binding can bring about rapid cell death. If the exposure is extensive, exc essive amounts of calcium
may be inactivated and inadequate supplies of calcium may be available for vital bodily functions.
Inform the physician treating the HF injury the nature of the chemical involved in the exposure and deliver a Material Safety
Data Sheet (MSDS). Some medical providers may not commonly encounter HF. Offer as much information as possible
p. 7First Aid Kit Policy, Rev. 4-99
regarding the chemical and its effects. Encourage the physician to consult an occupational specialist for further information,
if needed.
Skin Contact
Skin contact with hydrofluoric acid may cause severe burns. At concentrations of less than 50% hydrofluoric acid, the burns
may not manifest immediately. Fluoride ions penetrate the skin easily and, thus, the burns may be deep and can cause
considerable damage. Use and application of the antidote gel should not be based on the visible observation of burns but
on the knowledge of dermal contact. Be cognizant that exposure may occur under fingernails, where antidote application is
especially challenging. Therefore, medical care is absolutely essential.
1. Remove the victim to a safe location. Use protective equipment when handling a contaminated victim.
2. Immediately flush the exposed skin with water for a maximum of 5 minutes. Flush well but briefly. It is critical to apply
antidote as soon as possible.
3. Remove contaminated clothing during washing. Cut away clothing, if necessary, to avoid injuring affected skin.
4. While someone is assisting the patient with rinsing of the exposed skin, another lab member shall contact the local
police at 911 in an emergency. Paramedics will be necessary for hospital transport. (University Police can be reached at
456 for non-emergencies, and ORS can be reached for laboratory assistance at 1-5581 in Evanston and 3-8300 in
Chicago.)
5. After adequate 5-minute rinsing, apply calcium gluconate gel to the skin gently and freely. Aggressively massage the
gel into the affected part (wearing gloves) and continue to reapply and massage until pain is entirely relieved. If medical
assistance is delayed, apply gel every 15 minutes until pain and/or redness disappear or until the emergency rescue
team arrives. If the exposure is to a hand, the gel may be placed in a latex glove and the glove placed over the hand to
maintain beneficial contact with the affected area.
• Use as many tubes of calcium gluconate gel as required by the directions but throw away all tubes that have been
opened during first aid treatment of the injury. Opened tubes should not be saved for later reuse. Fresh tubes are
sealed for sterility protection.
• Following an incident involving use of the gel, ensure that the supply of gel remains adequate. Replace the gel
when the expiration date is exceeded.
6. All hydrofluoric acid burns are to be evaluated by a physician, usually in the emergency room setting. This includes
burns to a very small area of the skin and those treated with gel. Further reapplication of antidote gel or other medical
procedures may be necessary at the emergency room in order to prevent reversion of the acid burn.
Eye contact
Hydrofluoric acid can cause severe eye burns, with destruction or opacification of the cornea. Blindness may result from
severe or untreated exposures. Immediate first aid is necessary.
1. Immediately flush eye(s) for at least 5 minutes.
2. Irrigate the eye repeatedly with 500-1000 ml of a 1% calcium gluconate solution applied through a syringe.
3. Call for prompt emergency room transport. Apply ice-water compresses during transport.
4. Send the patient to an eye specialist as soon as possible.
Inhalation
Concentrated solutions and anhydrous hydrofluoric acid produce pungent fumes on contact with air. These fumes can
cause nasal congestion and bronchitis, even in low concentrations. Burns that occur when the vapors or liquid contact the
oral mucosa or upper airway may cause severe swelling, to the point of airway obstruction.
1. Immediately move the victim to fresh air and seek medical attention. Trained medical responders will be necessary to
administer oxygen and nebulized calcium gluconate.
2. Keep the victim warm, quiet, and relatively comfortable.
3. If breathing has stopped, start artificial respiration at once.
____________________________________________
CALCIUM GLUCONATE GEL AS AN ANTIDOTE TO HYDROFLUORIC ACID
BURNS ON SKIN
1. Calcium Gluconate 2.5% Topical Gel can be purchased from
p. 8First Aid Kit Policy, Rev. 4-99
• Pharmascience Inc., 175 Rano St., Buffalo, NY, phone 1-800-207-4477. The cost per 25-gram tube is $27.55 but a
minimum order of 6 tubes is required. A reduced price of $22.05 per tube is attached to purchases of 12 or more
tubes. Pharmascience will add a 5% shipping and handling fee.
• Cameron Medical, 9430 Burtis Street, South Oak, CA, 90280, phone 1-800-777-3723, Item #751500. The price is
currently $33.11 per 25-gram tube. This does not include the cost for delivery.
• Attard’s Minerals, 5081 Field Street, San Diego, CA, 92110. Order attard@attminerals.com or phone 1-619-275-2016.
A 30-gram tube is $28 and a 60-gram tube is $46. There is no minimum to buy. Orders of 6 or more get a 10%
discount. Orders have a $5 flat rate S&H charge.
This gel is available without a prescription (although please be aware that it is not approved by the FDA). Prices are
current for April 1999.
FYI, ORS stocks two tubes on each campus: one in the first aid pack and one in the wasteroom. The philosophy behind
the stock distribution is to have the gel immediately available in any location where HF may be handled. Some lab
workers keep gel supplies ready-to-grab on the air foils (sills) of the fume hoods where they will be working with this
highly corrosive agent.
2. If the commercial gel product is not available, an emergency in-house version can be prepared for treatment of
hydrofluoric acid burns on skin. This homemade gel is composed of 3.5 grams of calcium gluconate powder mixed into 5
ounces of water-soluble lubricant such as K-Y Jelly or Surgilube.
Pre-made stock should be kept on-hand whenever HF is to be used. There is little time for deliberation and searching for
the tubes. HF users may want to run practice drills for possible HF incidents to guarantee that they can follow
appropriate procedures quickly and automatically.
3. A local pharmacy may also be available to prepare antidote gel. The pharmacist may choose to substitute magnesium
for calcium.
NOTE: The major action of either of these two gels, commercial or homemade, is to provide excess (or substitute) calcium
stores so that bone tissue does not act as the calcium supply. The calcium from the gel will function as a fluoride
scavenger to generate calcium fluoride, a product that may be excreted from the body. Removal of calcium from
blood and tissue by fluoride ion attack results in a serious, frequently life-threatening condition known as
hypocalcemia.
All HF burns require a medical evaluation, whether treated with gel or not.
____________________________________________
REFERENCES
Segal, Eileen B, “First Aid for a Unique Acid: HF,” Chemical Health and Safety, September/October 1998, Vol. 5, No. 5, p.25.
Bronstein, A. C. and Currance, P. L. “Emergency Care for Hazardous Materials Exposures.” Mosby Company, 1988.
p. 9First Aid Kit Policy, Rev. 4-99
____________________________________________
FIRST AID KIT MONTHLY INSPECTION RECORD
Procedure
1. Perform the inspection by visually evaluating each item in the first aid kit. Confirm that the contents are in agreement
with the list of contents approved by the consulting physician. Ensure that the items are present in sufficient quantity
and, if appropriate, in good working order.
2. Enter the date, your initials or name, and the outcome of the inspection. Record a “YES” if the condition is acceptable.
3. Note any observations and the date and nature of any remedial action. Note if any expiration dates have been exceeded
and arrange to replace these items immediately.
4. Maintain this record in the laboratory-specific Safety Desk Book or with the kit.
Condition
Date Inspection performed by: Notes
acceptable
Yes r No r
Yes r No r
Yes r No r
Yes r No r
Yes r No r
Yes r No r
Yes r No r
Yes r No r
Yes r No r
Yes r No r
Yes r No r
Yes r No r
Yes r No r
Yes r No r
Yes r No r
Yes r No r
Yes r No r
Yes r No r
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