UNITED NATIONS ENVIRONMENT PROGRAMME
INTERNATIONAL LABOUR ORGANISATION
WORLD HEALTH ORGANIZATION
INTERNATIONAL PROGRAMME ON CHEMICAL SAFETY
MANAGEMENT OF POISONING
A handbook for health care workers
The issue of this document does not constitute formal publication.
It should not be reviewed, abstracted, or quoted without the written
permission of the Manager, International Programme on Chemical Safety,
WHO, Geneva, Switzerland.
This report contains the collective views of an international group of
experts and does not necessarily represent the decisions or the stated
policy of the United Nations Environment Programme, the International
Labour Organisation, or the World Health Organization.
Management of Poisoning
First draft prepared at the National Institute of Health Sciences,
Tokyo, Japan, and the Institute of Terrestrial Ecology, Monk's Wood,
United Kingdom
Published under the joint sponsorship of the United Nations
Environment Programme, the International Labour Organisation, and the
World Health Organization
World Health Organization
Geneva, 1997
The International Programme on Chemical Safety (IPCS) is a joint
venture of the United Nations Environment Programme, the International
Labour Organisation, and the World Health Organization. The main
objective of the IPCS is to carry out and disseminate evaluations of
the effects of chemicals on human health and the quality of the
environment. Supporting activities include the development of
epidemiological, experimental laboratory, and risk-assessment methods
that could produce internationally comparable results, and the
development of manpower in the field of toxicology. Other activities
carried out by the IPCS include the development of know-how for coping
with chemical accidents, coordination of laboratory testing and
epidemiological studies, and promotion of research on the mechanisms
of the biological action of chemicals.
WHO Library Cataloguing in Publication Data
Henry J.A.
Management of poisoning: a handbook for health care workers /
J.A. Henry Wiseman.
1.Toxicology - handbooks 2.Poisons - handbooks 3.Poisoning -
prevention & control I.Wiseman, H.M. II.International Programme on
Chemical Safety III.Title
3. I.Series
ISBN 92 4 154481 3 (NLM Classification: QV 600)
ISSN 0250-863X
The World Health Organization welcomes requests for permission to
reproduce or translate its publications, in part or in full.
Applications and enquiries should be addressed to the Office of
Publications, World Health Organization, Geneva, Switzerland, which
will be glad to provide the latest information on any changes made to
the text, plans for new editions, and reprints and translations
already available.
(c) World Health Organization 1997
Publications of the World Health Organization enjoy copyright
protection in accordance with the provisions of Protocol 2 of the
Universal Copyright Convention. All rights reserved. The designations
employed and the presentation of the material in this publication do
not imply the expression of any opinion whatsoever on the part of the
Secretariat of the World Health Organization concerning the legal
status of any country, territory, city or area or of its authorities,
or concerning the delimitation of its frontiers or boundaries. The
mention of specific companies or of certain manufacturers' products
does not imply that they are endorsed or recommended by the World
Health Organization in preference to others of a similar nature that
are not mentioned. Errors and omissions excepted, the names of
proprietary products are distinguished by initial capital letters.
Contents
Preface
Acknowledgements
Introduction
How to use this book
Poisons centres and poison control programmes
Part 1. General information on poisons and poisoning
1. Poisons and poisoning
Objectives
What is a poison?
Exposure to a poison
How poison gets into the body
What happens when poison is inside the body The effects of
poison
When systemic effects happen
2. How poisoning happens
Objectives
Accidental poisoning
Self-poisoning
Using poison to harm other people
Poison in food or drink
Medical poisoning
Abuse of drugs, chemicals or plants
The benefits and dangers of using chemicals
3. How to prevent poisoning
Objectives
How you can help people make their homes,
workplaces, and the community safer
What can be done to prevent poisoning?
How to make homes safe
How to prevent poisoning with pesticides
What employers can do to prevent poisoning at work
How to avoid snake bites
How to prevent insect, spider and scorpion stings
and bites
How to avoid eating poisonous plants, mushrooms
and fish
How to avoid infection from food contaminated
with germs
4. What to do in an emergency
Objectives
The dangers to look out for
What to do in an emergency
5. First aid
Objectives
Give first aid at once
First aid for poisoning
Using traditional medicines to treat
poisonous bites and stings
6. Getting medical help
Objectives
If you can get to a hospital in less than two hours
If you are a long way from a hospital
If you cannot get medical help quickly
Taking the patient to hospital
What to do after you have read this chapter
7. Examining the patient Objectives Symptoms and signs
What the examination cannot tell you
When the patient does not have any symptoms or signs
How to examine a patient and find out the symptoms
and signs
Patterns of symptoms and signs
8. Finding out what happened
Objectives
Talking to people
Look for the poison or other things that show you
what happened
What to do next
9. How to look after a poisoned patient outside hospital
Objectives
What to do when the patient has swallowed poison
How to stop poison getting into the blood after it
has been swallowed
Making the patient vomit
Giving activated charcoal
Giving a laxative
How to look after a very sick patient
10. Medicines and equipment
How to care for medicines and first aid equipment
Medicines
First aid equipment
Part 2. Information on specific poisons
Introduction
The information in each section
Pesticides
Aluminium phosphide and zinc phosphide
Arsenic and arsenic-containing chemicals
Chlorophenoxyacetate weedkillers
Dinitro-o-cresol (DNOC), dinitrophenol, dinoseb and
pentachlorophenol
Insect repellent
Metaldehyde
Organochlorine pesticides
Organophosphorus and carbamate insecticides
Paraquat
Phenol and related substances
Pyrethrins and pyrethroid insecticides
Rat poisons
Sodium chlorate
Strychnine
Thallium
Warfarin and other pesticides that stop blood clotting
Chemicals and chemical products used in the home and the
workplace
Aerosol sprays
Air-fresheners, deodorant blocks and moth-balls
Benzene, tetrachloroethylene, toluene, trichloroethane,
trichloroethylene and xylene
Borax, boric acid and sodium perborate
Button batteries
Carbon monoxide
Carbon tetrachloride
Caustic and corrosive chemicals
Cosmetics and toiletties
Cyanide
Disinfectants and antiseptics
Ethanol and isopropanol
Ethylene glycol and methanol
Glue
Lead
Petroleum distillates
Phosgene
Soap and detergents
Tobacco products
Volatile oils
Products that are not usually harmful
Medicines
Acetylsalicylic acid, choline salicylate, methyl salicylate,
salicylic acid
Amfetamine-like medicines, atropine-like medicines,
antihistamines, cocaine, ephedrine, and pseudoephedrine
Aminophylline and theophylline
Amitriptyline-like medicines, chloroquine,
quinidine and quinine
Barbiturates, chlorpromazine-like medicines, diazepam-
like medicines and meprobamate
Carbamazepine, phenytoin and valproic acid
Chlorpropamide-like medicines and insulin
Colchicine
Dapsone
Digitalis, digitoxin and digoxin
Glyceryl trinitrate, hydralazine, and propranolol-like
medicines
Ibuprofen
Iron-containing medicines
Isocarboxazid, phenelzine and tranylcypromine
Isoniazid
Lithium carbonate
Magnesium hydroxide, magnesium sulfate,
phenolphthalein, and senna
Opiates
Oral contraceptives
Paracetamol
Penicillin and tetracycline antibiotics
Proguanil
Rifampicin
Salbutamol
Plants, animals and natural toxins
Plants that contain atropine
Cannabis
Irritant plants
Oleanders
Ornamental beans
Mushrooms
Snakes
Spiders
Venomous fish
Poisoning from eating seafood
Word list
Index
Preface
This handbook has two main aims: to give people living in rural
places, far from medical help, information on what to do when someone
is poisoned; and to suggest ways of preventing poisoning in the
community.
It is written for people with little or no medical training who
are likely to be the first to come into contact with someone who has
been poisoned, such as community health workers (CHWs), first-aiders,
or professionals in other sectors working in rural communities. Some
information has also been included for health workers with a knowledge
of clinical medicine and diagnostic procedures, working in rural
health stations and health centres where there may be some medical
equipment and medicines available.
The handbook is meant to be used as a practical reference book in
an emergency. It can also be used by people who teach community health
workers and others practical skills, such as mouth-to-mouth
respiration and heart massage, that can only be learnt by practising
under trained supervision. It may also be useful as a teaching aid for
student doctors, nurses, and paramedical personnel.
The book will be most useful if it is translated into local
languages and adapted to local conditions, which may vary in terms of:
the tasks authorized for CHWs, such as giving injections; the
functions assigned to CHWs; the functions assigned to local health
centres and doctors at rural hospitals; the availability of medicines;
and the particular problems prevalent in the area.
Only a small amount of information is given about chronic
poisoning, which is often caused by using chemicals at work. Readers
who wish to know more about chronic poisoning should find a book that
deals with the health of people at work (occupational health).
The intended readership
Community health workers. CHWs can generally read, write, and do
simple arithmetic, and have basic training in:
- first aid,
- taking body temperature,
- counting the pulse,
- dispensing medicines.
CHWs may also be trained to give intramuscular and subcutaneous
injections.
First-aiders. First-aiders are trained to rescue people from danger,
and to give immediate help to the victims of accidents until a trained
health care worker can take charge. People who are likely to be the
first on the scene of an accident, such as workers in factories or
offices, firefighters, or policemen, are often trained in first aid.
Professionals with no medical training. Many highly educated
professional workers, such as teachers, agricultural advisors,
pharmacists, scientists and technologists, know about the use and
effects of chemicals. In communities where there are no doctors, they
may be the only people who know about chemicals and poisons. They may
be first on the scene of an accident or they may be called upon to
help someone who is thought to have been poisoned. They need to know
the first aid for poisoning due to pesticides, medicines, household
products, and other substances. They should also be able to advise
people on how to prevent poisoning.
In some countries professional people with no medical training
may attend courses run by poisons centres to learn basic first aid
skills.
Nurses, medical students and paramedical staff. The book may be
useful as a handbook and training manual.
Doctors. Some information has been included specifically for doctors
working in rural health stations and health centres where there may be
some medical equipment and medicines available. This information has
been separated from the main text. It does not include details of
medical treatment that can be given only in a hospital.
Acknowledgements
This handbook has been prepared on the recommendation of a group
of experts convened by the International Programme on Chemical Safety
(IPCS)1 in February 1987. A draft text was prepared by Dr J.A. Henry
and Ms H.M. Wiseman, and commented on by a number of experts, in
particular Dr E. Fogel de Korc (Montevideo, Uruguay), Dr G.R.
Gardiner, Dr J. Jackson and Mr W. Tardoir (Brussels, Belgium), and
colleagues from UNEP's International Register of Potentially Toxic
Chemicals (IRPTC) and the Occupational Safety and Health Branch of
ILO. An editorial group, convened by the IPCS to review the text,
consisted of Dr J.-C. Berger (Luxembourg), Dr N. Besbelli (Ankara,
Turkey), Professor M. Ellenhorn (Los Angeles, USA), Professor B. Fahim
(Cairo, Egypt), Dr Sming Kaojarern (Bangkok, Thailand), Professor A.
Furtado Rahde (Porto Alegre, Brazil), Dr N.N. Sabapathy (Fernhurst,
England), Professor A.N.P. van Heijst (Utrecht, Netherlands), and Dr
A. David (ILO). The text was tested at an IPCS Workshop, held in
Harare, Zimbabwe, from 28 January to 1 February 1991, and subsequently
in two training workshops in Zimbabwe. Parts of the text were also
reviewed at an IPCS Workshop held in Dakar, Senegal, 24-27 January
1995. For the IPCS, Dr J. Pronczuk de Garbino provided the editorial
inputs and Dr J.A. Haines coordinated the work.
The first aid manual of the Joint Voluntary Aid Societies in the
United Kingdom, and publications of the Global Crop Protection
Federation, were particularly useful as source materials for the first
draft. The United Kingdom Department of Health, through its financial
support to the IPCS, provided the resources for the drafting of the
text and for the editorial group to meet. The illustrations were
prepared by Picthall & Gunzi, London.
__________
1 The IPCS is a cooperative venture of the World Health
Organization (WHO), the International Labour Organisation (ILO)
and the United Nations Environment Programme (UNEP). WHO is the
executing agency for the programme, which aims to provide the
internationally evaluated scientific data basis for countries to
develop their own chemical safety measures, and to strengthen
national capabilities to prevent and treat harmful effects of
chemicals and to manage chemical emergencies.
Introduction
How to use this book
This book is in two parts. Part 1 gives general information on
poisons and poisonings, how poisonings happen and how you can prevent
them. It also gives guidance on how to deal with poisoning
emergencies. Part 2 gives specific information on the effects of
poisoning with various pesticides, medicines, household chemical
products, and poisonous plants and animals, and guidance on what to do
when you think someone has been poisoned. A word list and an index are
also provided.
To be ready for emergencies
1. Keep a first aid kit, like the one recommended in Chapter 10, in
the house, in the community, or at work.
2. Study this book before it is needed, especially Part 1, Chapters
4-9, which tell you what to do when someone is poisoned.
3. Practise some of the first aid, so that you know what to do in an
emergency.
To look up a chemical, plant or animal
Use Part 2 when you see someone who is poisoned. Look in the
index at the end of the book to find the medicine, chemical, plant or
animal you think may have caused the poisoning.
Information for doctors
In Chapter 5, "First aid", and Chapter 9, "How to look after a
poisoned patient outside hospital", and in Part 2, parts of the text
are separated off by horizontal lines. This information is meant for
doctors.
If you do not understand the meaning of some of
the words in this book
Look for the word in the word list (medical words used in the
boxes of information for doctors are not explained in the word list).
Poisons centres and poison control programmes
In many countries there are poisons centres which give advice
about the treatment and prevention of poisoning. They have information
about medicines, pesticides, poisonous plants, venomous animals, and
household products, and chemicals used at work. The doctor in the
poisons centre can tell you what to do when someone has swallowed or
breathed in a chemical, spilt it on the skin, or splashed it in the
eyes.
Most poisons centres can be contacted at any time of day or night
by telephone or, in some countries, by radio. They may have supplies
of special antidotes (for example snake or spider antivenoms). Some
poisons centres have hospital wards where they can treat poisoned
patients.
In many countries, other organizations work with poisons centres
in a national poisons control programme to improve the treatment and
prevention of poisoning. These organizations include:
- hospitals and other places where poisoned patients are treated;
- organizations that collect information on poisoning;
- organizations that make or use substances which might cause
poisoning;
- government authorities that control the use of chemicals within
the country;
- universities and colleges where doctors and other people are
taught about poisoning.
There is space in the back of this book where you can write the
addresses of organizations in your country that might help you deal
with cases of poisoning or give advice on how to prevent poisoning.
PART 1
General information on poison and poisoning
CHAPTER 1
Poisons and poisoning
Objectives
After studying this chapter you should:
1. Know what a poison is.
2. Understand what is meant by local poisoning and systemic
poisoning. Understand all the ways poison can get into the body,
and be able to recognize circumstances where poisoning might
happen.
3. Understand what is meant by acute poisoning and chronic
poisoning, and be able to explain to people that continued
exposure to small amounts of poison for several days, weeks or
months can be harmful, even if they do not immediately feel
unwell.
4. Be able to explain to people that taking too much medicine may be
dangerous.
5. Be able to explain to people why it is important to take care
when handling dangerous chemicals and why it is important to wash
chemicals off the skin as soon as possible.
6. Be able to explain how petroleum distillates, such as kerosene,
cause harm if they are swallowed.
7. Understand why people who have swallowed poison may be helped if
they are made to vomit or given activated charcoal.
8. Recognize that people are more likely to be harmed by poison if
they are very old, very young or in poor health.
9. Know why a person who has been exposed to poison may appear to be
unaffected by it, and why it is often a good plan to watch a
person for 12-24 hours after they have been exposed to poison,
even if they seem well.
What is a poison?
A poison is any substance that causes harm if it gets into the
body. Harm can be mild (for example, headache or nausea) or severe
(for example, fits or very high fever), and severely poisoned people
may die.
Almost any chemical can be a poison if there is enough in the
body. Some chemicals are poisonous in very small amounts (for example,
a spoonful by mouth or a tiny amount injected by a snakebite); others
are only poisonous if a large amount is taken (several cupfuls, for
example).
The amount of a chemical substance that gets into the body at one
time is called the dose. A dose that causes poisoning is a poisonous
dose or toxic dose. The smallest amount that causes harm is the
threshold dose. If the amount of a chemical substance that gets into
the body is less than the threshold dose, the chemical will not cause
poisoning and may even have good effects. For example, medicines have
good effects if people take the right doses, but some can be poisonous
if people take too much.
Exposure to a poison
When people are in contact with a poison they are said to be
exposed to it. The effect of exposure depends partly on how long the
contact lasts and how much poison gets into the body, and partly on
how much poison the body can get rid of during this time.
Exposure may happen only once or many times.
Acute exposure is a single contact that lasts for seconds,
minutes or hours, or several exposures over about a day or less.
Chronic exposure is contact that lasts for many days, months or
years. It may be continuous or broken by periods when there is no
contact. Exposure that happens only at work, for example, is not
continuous.
Chronic exposure to small amounts of poison may not cause any
signs or symptoms of poisoning at first. It may be many days or months
before there is enough chemical inside the body to cause poisoning.
For example, a person may use pesticide every day. Each day the person
is exposed to only a small amount of pesticide, but the amount of
pesticide in the body gradually builds up, until eventually, after
many days, it adds up to a poisonous dose. Only then does the person
begin to feel unwell.
How poison gets into the body
The way poison gets into the body is called the route of
exposure or the route of absorption. The amount of poison that
gets into the blood during a given time depends on the route.
Through the mouth by swallowing (ingestion)
Most poisoning happens this way. Small children often swallow
poison accidentally, and adults who want to poison themselves may
swallow poison. If people eat, drink or smoke after they have been
handling poisons, without first washing their hands, they may
accidentally swallow some of the poison. This is a common cause of
pesticide poisoning.
When poisons are swallowed they go to the stomach (Fig. 1). Some
poisons can pass through the gut walls and into the blood vessels. The
longer a poison stays in the gut the more will get into the blood and
the worse the poisoning will be.
If a person vomits soon after swallowing a poison, it may be
expelled from the body before a poisonous dose gets into the blood.
So, if the person does not vomit straight away, it is sometimes useful
to make the person vomit. There are two other ways to stop poisons
passing from the gut into the blood: (1) give activated charcoal
because this binds some poisons so that they cannot pass through the
gut walls; or (2) give laxatives to make the poison move through the
gut and out of the body more quickly. The circumstances when it is
useful to make a patient vomit or to give activated charcoal or
laxatives, and the circumstances when these procedures may be
dangerous, are described in Chapter 9.
Poisons that do not pass through the gut walls do not get into
the blood and so cannot affect other parts of the body. They move
along the gut and leave the body in the faeces. For example, mercury
metal cannot pass through the gut walls; if mercury from a thermometer
is swallowed, it passes out of the body in the faeces and does not
cause poisoning.
Through the lungs by breathing into the mouth or nose (inhalation)
Poisons in the form of gas, vapour, dust, fumes, smoke or fine
spray droplets may be breathed into the mouth and nose and go down the
air passages into the lungs (Fig. 2). Only particles that are too
small to be seen can pass into the lungs. Larger particles are trapped
in the mouth, throat and nose and may be swallowed. A person may
breathe in poison when working with a poisonous substance inside a
building without fresh air, or when spraying pesticide without wearing
adequate protection. Oil or gas heaters, cookers, and fires give off
poisonous fumes which may reach dangerous concentrations if the smoke
cannot get outside or if the room does not have a good supply of fresh
air.
Poison that gets into the lungs passes into the blood vessels
very quickly because the air passages in the lungs have thin walls and
a good blood supply.
Through the skin by contact with liquids, sprays or mists
People working with chemicals such as pesticides may be poisoned
if the chemical is sprayed or splashed onto the skin, or if they wear
clothes soaked with chemical.
The skin is a barrier that protects the body from poisons.
However, some poisons can pass through the skin (Fig. 3). They pass
through warm, wet, sweaty skin more quickly than through cold, dry
skin, and they pass through skin damaged by scratches or burns more
quickly than through undamaged skin. A poison that damages the skin
will pass through more quickly than one that does not damage the skin.
It may be possible to wash poison off the skin before a poisonous dose
gets into the body.
By injection through the skin
Poisons can be injected through the skin from a syringe, or a
pressure gun, or during tattooing, or by the bite or sting of a
poisonous animal, insect, fish or snake. The injection may go directly
into the blood vessels, or under the skin into muscle or fatty
tissues. Poison injected into the blood has a very quick effect.
Poison injected under the skin or into muscle has to pass through
several layers of tissue before reaching the blood vessels, so it acts
more slowly.
What happens when poison is inside the body
How poison is carried round the body
Once a poison gets into the blood it is carried to the whole body
as the blood is pumped round the body by the heart (Fig. 4).
How poison is broken down by the body
Some poisons are changed by the body into other chemicals. These
are called metabolites, and may be less poisonous or more poisonous
than the original substance. The metabolites are more easily passed
out of the body than the original chemicals. These changes take place
mostly in the liver.
How poison leaves the body
Unchanged poisons or their metabolites usually leave the body in
the urine, faeces or sweat, or in the air that a person breathes out.
The movement of poison from the blood into urine takes place in the
kidneys, and the movement of poison from blood into breathed-out air
takes place in the lungs. Poison in the faeces may have passed down
the gut without being absorbed into the blood or it may have been
absorbed into the blood and then passed out into the gut again. Some
poisons, like DDT, pass into body tissues and organs where they may
stay for a long time.
The effects of poison
The effects of a chemical substance on the body may be described
as either local or systemic.
A local effect is limited to the part of the body in contact with
the chemical: the skin, the eyes, the air passages or the gut.
Examples of local effects are skin rashes, skin burns, watery eyes,
and irritation of the throat causing coughing. Many poisons cause
local effects, but there are also many poisons that do not. Further
details about local effects are given below.
A systemic effect is a more general effect that occurs when a
poison is absorbed into the body.
Some poisons cause both local effects and systemic effects. If
someone has local effects from exposure to a chemical it is important
to check whether they also have signs or symptoms of systemic
poisoning.
Local effects
On the skin
Chemicals that damage the skin cause reddening or a rash, pain,
swelling, blisters or serious burns. The burns are like the burns
caused by fire.
An irritant chemical causes itching, a burning feeling, or pain
when it first touches the skin, but does not cause burns if washed off
straight away. However, if it is in contact with the skin for a long
time, for example when people wear contaminated clothes for several
hours, it might cause burns.
Some irritant chemicals have no effect the first few times they
touch the skin, but with continued contact they cause reddening or a
rash. This might happen with repeated use of a household cleaner.
Sometimes people become sensitive to a chemical after they have
used it many times. They may have no effects at first but after a few
weeks or months they get a rash every time they use it.
A corrosive or caustic chemical very quickly causes painful
burns and destroys the skin. There may be blisters and the skin may
turn grey-white or brown.
On the eyes
Irritant or corrosive chemicals can cause severe pain if they get
into the eyes. They may very quickly burn the surface of the eye and
cause scars or even blindness. The eyes will look red and watery. The
person may not want to open the eyes and bright light will hurt.
Inside the gut
Irritant or corrosive chemicals may damage the mouth and throat
or the inside of the gut. The person will have belly pain, vomiting
and diarrhoea, and the vomit and faeces may contain blood. If the
throat is burnt it may swell very quickly, so that the person cannot
breathe.
Inside the air passages and lungs
Some gases and vapours can irritate the nose, throat and upper
air passages and cause coughing and choking.
Some gases and vapours damage the lungs in a way that causes them
to fill with water. This may happen very soon after a person breathes
in the substance, or it may happen up to 48 hours afterwards. A person
with water in the lungs cannot breathe properly and may drown. He or
she must be taken to a hospital as quickly as possible. Water in the
lungs is called lung oedema.
Some of the gases that cause lung oedema also irritate the nose,
throat and upper air passages, and make people cough and choke. When
people start to cough and choke, they will quickly move away from the
gas into fresh air, if possible. This often means that they are not
exposed to the gas for long enough to get poisoned.
Some poisonous gases, such as carbon monoxide, have no effect on
the nose and throat. Poisonous gases that do not cause coughing and
choking are very dangerous because people may not know they are
breathing poison.
Petroleum distillate liquids, such as kerosene, may cause lung
oedema when swallowed. When people swallow any liquid or solid, the
air passage closes and keeps most of it out of the lung but small
amounts of liquid may still get in. With most liquids this does not
harm the lungs because the amount is too small, but even very small
amounts of petroleum distillates can cause lung oedema.
More importantly, when people are unconscious the air passage
does not close, so there is nothing to stop food, drink or vomit
getting into the lungs and blocking the air passages or causing lung
oedema. That is why it is very dangerous to try to give any food,
drink or medicine to unconscious people.
At injection sites
Irritant poisons that are injected into the skin, such as poisons
from insect stings and snake bites, may cause pain and swelling where
they are injected. People who accidentally inject themselves with
veterinary products, when giving injections to animals or birds, may
get local effects.
Systemic effects
There are many ways in which poisons can cause harm:
* By damaging organs such as the brain, nerves, heart, liver,
lungs, kidneys, or skin. Most poisons have a greater effect on
one or two organs than on other parts of the body. The organs
that are most affected are called the target organs.
* By blocking messages between nerves.
* By stopping the body working properly, for example, by blocking
energy supply or oxygen supply.
Effects on unborn babies
Some poisons can harm a baby inside the womb. This is most likely
during the first three months of pregnancy when the nervous system and
all the major organs begin to form. The parts of the baby usually
affected are the bones, eyes, ears, mouth and brain. If the damage is
very bad the baby will stop growing and die. Some poisonous chemicals
may harm a baby in the womb without harming the mother. This is
serious because there is nothing to warn the mother that her baby is
in danger.
If a mother drinks alcohol or smokes during pregnancy it may harm
her baby. Medicines may also harm a baby in the womb. Pregnant women
should never take medicines unless they are prescribed by a doctor.
When systemic effects happen
Systemic effects only happen when the amount of poison in the
body is greater than the amount the body can get rid of, and the
poison builds up and reaches the threshold level.
Usually, when contact with a poison lasts only a short time
(acute exposure), the effects happen soon after exposure and do not
last very long. But, in some cases, the effects of a poison are not
seen for several hours or even days after an acute exposure. When
people have been exposed to a poison for a long time (chronic
exposure), the effects may last for a long time.
Sometimes a person may be exposed to a poison yet not seem to
have any ill effects. This may be because the person has not been
exposed for long enough to absorb a toxic dose. Or it may be that the
person has absorbed a toxic dose but appears well because it is too
soon to see any effects of poisoning.
Sometimes it can be hard to know whether a person who has been
exposed to a poison is going to develop any ill effects. Before you
send a person home always check:
- how long ago the exposure to poison happened;
- how long it usually takes before the effects of the poison
can be seen (check in Part 2 of this book or contact a
poisons centre).
When you suspect someone has been poisoned it is often a good
idea to watch the person for 12-24 hours to see if any ill effects
develop. In some cases you may need to watch them even longer than
that.
Exposure to a chemical does not affect everyone in exactly the
same way. Some people may be more sensitive than others. For example,
young children and old people are more likely to be severely poisoned
than young adults; and people who are sick because they are not eating
well, or because they drink a lot of alcohol or have a disease, are
more likely to be severely poisoned than healthy people.
CHAPTER 2
How poisoning happens
Objectives
After studying this chapter you should be able to:
1. Recognize when there is a danger of poisoning from chemical
products, medicines, carbon monoxide, pesticides, or contaminated
food, at home or at work.
2. Explain to other people how poisoning happens so that they are
aware of the dangers.
3. Warn people about the danger of taking a chemical product out of
its original container and putting it in another one.
4. Explain to people why it is important to use a product in the way
the manufacturers mean it to be used.
5. Explain to people why it is dangerous to abuse drugs.
6. Discuss with people the usefulness and dangers of using
chemicals.
Some poisonings happen by accident but some happen when people
try deliberately to harm themselves (self-poisoning) or others. There
are other circumstances that may result in poisoning:
- eating food containing poison;
- taking, or being given, the wrong kind of medicine or the wrong
dose;
- taking drugs because they change mood or behaviour, or using
plants or chemical products for this purpose.
Accidental poisoning
Accidental poisoning may happen when:
- young children or old people handle poisons not knowing what
they are;
- people mistake poison for food or drink because it is not in
its original container;
- people misuse chemical products or medicines;
- people use or misuse pesticides;
- people work with chemicals;
- people are exposed to carbon monoxide, usually at home.
Poisoning in childhood
Many poisoning accidents in the home happen to small children
aged between 1 and 4 years. At this age children want to explore. They
can crawl or walk round the house on their own and by the age of 2
they can probably climb onto a chair to reach a high shelf. They can
open drawers and cupboards, and they may be able to open screw-top
bottles.
They like to put things in their mouths but they are not old
enough to understand that some things might be harmful. They seem to
have a different sense of taste from adults, and often like to swallow
things that to adults taste strange or bitter. They may swallow
medicines that look like sweets or motor oil that looks like syrup. If
they are thirsty they may swallow a liquid, such as a household
cleaner, that looks like a soft drink or fruit juice.
The chemical products most often swallowed by children are:
- household cleaners such as bleach, detergent and disinfectant;
- paraffin and kerosene used as household fuels;
- cosmetics;
- medicines;
- paint and products for household repairs;
- household pesticides.
These chemicals are often used around the home. They are often
kept in places where a small child can see and reach them, for
example, on shelves or tables, or on the ground.
Many accidents happen when people looking after young children
are too busy to watch them all the time. They may be looking after a
large family with several young children, or doing housework. If an
open container is left within easy reach, it may take only a few
seconds for a child to grab it and swallow the contents.
It is especially dangerous if a child is left alone, or in the
care of slightly older brothers or sisters, for several hours at a
time.
Poisoning in old age
Old people may poison themselves accidentally. If they cannot see
very well, they may pick up the wrong bottle and swallow a household
cleaner, for example, instead of a drink or a medicine. Old people
tend to be forgetful and confused. They may forget to take their
medicine, or they may take too much and poison themselves because they
cannot remember how much to take or when they took the last dose.
Taking products out of their own containers
Accidents can happen when someone takes a chemical product out of
its container and puts it in another one. The new container does not
have the right label so nobody else will know what is inside. Even the
person who did it may forget. It is specially dangerous to pour any
chemical or medicine into a drinking cup, or drink bottle, or any
container where it might be mistaken for food or drink. Young children
cannot tell the difference between harmful chemicals and food or
drink, and even adults may drink from bottles without checking to see
what is inside.
That is why it is dangerous for shopkeepers to take chemicals
from large containers and then sell them in smaller containers.
Poisoning from misuse of chemical products or medicines
Poisoning accidents can happen when safety warnings are ignored
and chemicals are used in the wrong way. For example, there is usually
a warning on a bleach container that bleach should not be mixed with
any other cleaner. If people ignore the warning and use bleach with
another household cleaner, they may be poisoned by the gases given
off. Another example of misuse of a product is when insecticides that
are meant to be used on plants or buildings are used to kill insects
living on people, in their hair or on their bodies.
Sometimes people poison themselves by misusing medicines. They
may take more than the doctor prescribed because they think, wrongly,
that a larger dose will make them better more quickly. Taking someone
else's medicine is also a kind of misuse. People who take someone
else's medicine may be harmed if they take the wrong dose or take a
medicine that is not meant for treating their condition. Women who
take medicine to try to end a pregnancy are misusing the medicine, and
may poison themselves.
Pesticide poisoning
Pesticides are chemicals made to poison insects, weeds or other
pests. Most pesticides are also poisonous or harmful to humans if they
get on the skin, or if they are breathed into the lungs in the form of
gases, fumes, dust or fine spray droplets, or if they are swallowed.
These are some of the ways people may be poisoned:
- if they use pesticides in the wrong way; for example,
children may be poisoned if pesticides are sprayed on their bed-
clothes;
- if they do not use protective equipment; for example, they may
splash pesticide on their clothes or skin, or may breathe in
pesticide;
- if they eat, drink or smoke after working with pesticides, and
have the chemicals on their hands - they should wash their hands
first;
- if empty pesticide containers are used to store food or drink -
it is impossible to wash all the pesticide out of an empty can,
and some pesticide will get into the food or drink;
- if food containers or drink bottles are used to store pesticides
- someone may mistake the contents for food or drink.
Poisoning at work
Many chemicals that are made, used, or stored in workplaces are
poisonous. People who work with these chemicals need to know how to
handle them safely to avoid being poisoned.
Sometimes workers may not know that they are handling a poisonous
chemical, or they may know that the chemical is poisonous but not have
been told or shown how to handle it safely. They may not have read the
label or the safety information. Sometimes they may know the dangers
but be too lazy or careless to use safe methods.
Accidents, fires or explosions at work may result in chemicals
spilling or leaking out of their containers onto roads or into rivers,
or vapours and gases being released into the air. Sometimes chemicals
spread over a large area and poison many people.
Chemical waste and empty chemical containers may be serious
safety hazards if they are not dealt with in the right way.
Carbon monoxide poisoning
When oil, gas, wood, coal or other fuels burn they give off a gas
called carbon monoxide, which can cause serious poisoning and often
causes death. This can happen when fires, stoves, heaters, or ovens
are used in rooms, huts or tents where there is no open window or
chimney to let fresh air in and carbon monoxide out. Petrol engines
also give off carbon monoxide, and people may be poisoned if they run
a car engine inside a garage when the doors are shut.
Self-poisoning
People may try to harm themselves by deliberately taking poison -
this is called self-poisoning. In some countries people take medicines
to poison themselves, but people living in rural communities are more
likely to take pesticides.
People suffering from depression, serious illness, or alcohol
dependence may try to kill themselves by taking poison. They may
swallow large amounts of medicine, pesticide or other poisons. If they
recover they might try to poison themselves again unless they receive
appropriate treatment.
Many young people who try to poison themselves are unhappy
because of problems they do not know how to deal with, such as unhappy
love affairs or arguments with boyfriends or girlfriends.
Using poison to harm other people
Sometimes people use poison to harm others. They may do it as a
joke or they may want to frighten or even kill a person. If you have
evidence that this is happening or has happened, tell the police.
Poison in food or drink
Food or drink can be contaminated by poison from microscopic
organisms such as bacteria, viruses, or mould, or by chemical poisons.
Some plants, mushrooms, animals or sea-creatures contain poisonous
chemicals. Poisons made by plants, animals or microorganisms are
called toxins.
Poisons made by microscopic organisms
Food may be contaminated by bacteria before or after cooking,
during preparation or storage, by contact with hands that have not
been thoroughly washed, or with contaminated surfaces, containers or
kitchen utensils. It may also be contaminated by animals or insects,
particularly flies. Heating food thoroughly destroys most - but not
all - bacteria and bacterial toxins. However, if cooked food is kept
warm or at room temperature for any length of time, any bacteria
present will multiply and may cause disease.
Moulds grow on foods that are damp or damaged by insects, and
some moulds produce poisons. Moulds growing on nuts or grain that has
been gathered and stored before it is dry may cause serious poisoning.
Some ways of drying and preserving food do not stop moulds growing on
the food.
People can catch diseases from eating food infected with worms or
other organisms, but this is not poisoning and is not dealt with in
this book.
Chemical poisons
There are many ways chemical poisons can get into food and drink,
for example:
- when people working with chemicals eat in the workplace or do not
wash their hands before eating;
- when chemicals spill onto food as it is being moved from place to
place, or when it is in a storeroom;
- when food or drink is stored or cooked in containers that are
contaminated with chemicals;
- when people make flour from grain that has been treated with
pesticide because it was meant to be used for seed or bait, not
for food;
- when people brew their own alcoholic drinks and produce poisonous
alcohols, such as methanol;
- when water supplies are polluted by accidental spills of
chemicals, or by chemical waste from factories or waste dumps
near watercourses.
Poisonous plants, mushrooms, animals and sea-creatures
Some plants, mushrooms, animals and sea-creatures contain toxins.
Sometimes it is very hard to tell the difference between plants or
fish that are good to eat and those that are poisonous.
Medical poisoning
Sometimes people are poisoned by medicines given to them by a
doctor or another health care worker. They may be given the wrong
medicine or be given the wrong dose of the right medicine. There are
many reasons why this can happen. The doctor may not know the patient
is allergic to a medicine, or may give the wrong dose because of a
mistake in measuring it.
Abuse of drugs, chemicals or plants
People may take drugs to change their mood or behaviour, to feel
relaxed, or to get more energy. This is called drug abuse because it
is not a medical use of the drug. Some people abuse drugs such as
heroin, cocaine or barbiturates. Drinking too much alcohol is an
important kind of drug abuse.
Other substances may produce some of the same effects. Some
people breathe in chemicals such as glue, paint, nail varnish remover,
cigarette lighter gas, petrol or dry-cleaning fluid. This is sometimes
called solvent sniffing or solvent abuse. People may breathe fumes
from a cloth soaked in liquid or put chemicals or glue into a plastic
bag and breathe deeply from the bag.
In many societies people use plants or fungi for their
hallucinogenic, stimulant or relaxing effects. Some plants may be
eaten raw, others are cooked, made into drinks, or smoked. Two plants
commonly used in this way are tobacco and cannabis.
Many of the drugs, chemicals and plants that are abused are
poisonous if people take too much at one time or use them for many
months or years. For example, alcohol causes liver damage, smoking
causes lung cancer and cannabis can affect people's memory.
The benefits and dangers of using chemicals
All countries use a large number of different chemicals in
agriculture, in industry, in medicines and in the home. There are many
good reasons for using them. Pesticides and fertilizers have helped
farmers grow more crops. Medicines can cure or prevent disease, and
they can give people longer and more comfortable lives. Cleaning
products have made household tasks easier.
Useful chemicals can also be dangerous. People may have to use
amounts that could be poisonous if they got into the body. Some
chemicals can also cause harm if they get into the air people breathe,
into the soil where people work or grow food and animals live, and
into the rivers and streams that supply water for drinking, washing,
or irrigating crops. The danger can be made smaller if chemicals are
used safely, and efforts are made to prevent accidents, but the danger
will never completely go away.
Communities must decide whether the benefit of using the
chemicals is large enough and the danger small enough for them to live
with. There are many things to think about:
* How useful is the chemical?
* What kind of harm can the chemical cause?
* Will the chemical affect the environment?
* Can the chemical be handled safely?
* How many people will use the chemical, and how many people might
be exposed to it because they work or live near the place it is
made or used?
* Can a less poisonous chemical be used instead?
* How much money could be saved by using the chemical and how much
would it cost to stop using it?
CHAPTER 3
How to prevent poisoning
Objectives
After studying this chapter you should be able to:
1. Discuss with people how to prevent poisoning.
2. Help people make their homes, their workplaces, and the community
safer.
It is better, safer and cheaper to prevent poisoning than to cure
it. Most poisonings can be prevented.
Everyone - children, parents, farmers, schoolteachers, factory
workers and health care workers - can do things to make their homes,
their workplaces, and the community safer.
How you can help people make their homes, workplaces, and
the community safer
There are three steps you should take:
1. First of all, find out about the poisonings that have happened in
your community in the last few years. Find out how they happened,
where they happened and what the poisons were. Think about why
the poisonings happened.
2. Think about how poisonings that have happened in your community
could have been prevented. This chapter lists many ways to
prevent poisoning. Talk to your poisons centre about the
poisonings in your community. The poisons centre may be able to
suggest ways to prevent them.
3. Discuss with people how poisonings can be prevented. Share what
you know with others and help them understand why poisonings
happen and what can be done to stop them happening again.
* Talk with families and mother-and-child health groups about
preventing poisoning at home. Talk about how to teach
children, even at an early age, not to touch, eat or play
with medicines or household chemicals.
* Talk to schoolteachers about how to teach children about the
dangers of poisoning in their homes and the dangers from
poisonous snakes, plants and animals. For example, teachers
could ask the children to find out about accidents that have
happened in the community and to suggest ways to prevent
such accidents.
* Talk to community leaders or committees about the accidents
that have happened. Discuss with them and the people what
you think can be done to make your community safe.
* Make friendly visits to homes and workplaces from time to
time, not to find fault, but to help people to see where
there are dangers and how to make them safe.
This chapter gives some "dos" and "do nots" to help you when you
talk to people about how to prevent poisoning.
The first time you read this chapter you may think "It is
impossible for people in my community to do that. How can I tell
people to wear boots to protect themselves from snake bites, when they
cannot even afford shoes? How can I tell them to keep medicines in a
locked cupboard, when we do not have cupboards in our homes?"
The community should know the best ways of preventing poisoning
and aim to use them. But when you talk to people about how to prevent
poisoning, discuss how to adapt the advice to your local situation.
There may be other ways that will work just as well. For example,
people may tell you that there are other places in their homes that
are as safe as locked cupboards. There may be a local carpenter who
could make boxes or cupboards that lock, if the community wants them.
Work towards your target in stages. For example, if people cannot
afford boots, start by encouraging them to wear simple, locally made
shoes or sandals.
What can be done to prevent poisoning?
It is important to handle all chemicals safely, not just the ones
you know are poisons. Many chemicals that you might not think are
poisonous could make someone ill or cause burns.
It is very important to protect children, because they cannot
protect themselves and they do not understand that some things can be
poisonous.
Many poisonings could be prevented if chemicals were kept safely,
used safely and got rid of safely.
Keep chemicals safely
* Do keep medicines, cleaners and pesticides where children cannot
see or reach them (Fig. 5).
* Do not keep chemicals you no longer need.
* Do not put chemicals in containers that once contained food or
drink; people may eat or drink the chemicals by mistake.
Use chemicals safely
* Do use medicines, cleaners, pesticides and other chemicals in the
right way, and use the right amount (not more or less). Read the
label and follow carefully the instructions for use (Fig. 6). A
person who cannot read it should find someone who can. It may be
dangerous to use chemicals from unlabelled containers. Ask the
supplier for another container with a label.
Get rid of left-over chemicals and empty containers safely
* Do find out whether it is better to bury or burn the
chemicals you want to get rid of. Choose a place to bury or burn
chemical waste where there will be as little danger as possible
to the people living nearby or to the environment (Fig. 7).
* Do find out from environmental health officers or community
leaders the local arrangements for getting rid of chemical waste.
Seek professional advice about how to get rid of large amounts of
unwanted chemicals.
* Do not use empty bottles, cans or other containers that have
been used for storing chemicals to store or cook food or drink.
Do not give them to children to play with.
* Do not leave left-over chemicals or empty containers where
children might find them.
* Do not throw left-over chemicals or empty containers near a
river, pond or spring. Chemicals might get into the water and
poison fish, or poison people or animals that drink the water or
wash in it. This may also happen if chemical waste is poured into
drains that empty into waterways.
The rest of this chapter gives more detailed guidelines on how to
prevent the different types of poisoning described in Chapter 2.
How to make homes safe
How to keep chemicals safely
* Do keep all household chemicals where children cannot see
them or reach them. Keep medicines, insecticides, weedkillers and
rat poison in a locked cupboard or locked suitcase or in a high
cupboard.
* Do keep household products, pesticides and medicines in their
own containers.
* Do keep caps and tops on bottles and keep them properly closed
(Fig. 8). Keep boxes closed. A child who finds an open container
may swallow the contents before anyone can stop him or her. A
child may try to open a closed container, but this may take time
and a young child will often find it difficult. An adult may see
what is happening and stop the child before he or she can open
the container.
* Do not keep household cleaners on the floor, under the
kitchen sink, or in low cupboards that a child can easily open
(Fig. 9).
* Do not keep medicines, pesticides or household products
next to food or drink. A child may think they are something to
eat or drink. Even an adult may swallow the contents of some
containers without first checking what is inside. A chemical may
spill onto food, and someone may be poisoned by eating the
contaminated food.
* Do not keep medicines, pesticides or household products in
drink bottles, cups or containers normally used for food or
drink.
* Do not keep chemicals or empty containers you no longer need. For
drink guidelines for getting rid of them safely, see chapter 3.
How to use medicines and household products safely
Medicines
* Do be sure to take or give the right dose of medicine. Find out
the right dose by reading the label or asking a health care
worker. Be very careful not to take or give too much. Too large a
dose of medicine may make a person very sick. It is a mistake to
think that if you take all the medicine at once you will get
better more quickly.
* Do put the medicine away safely as soon as you have given the
dose.
* Do not take medicine or give medicine to others without taking
advice from a doctor or health worker.
* Do not give children medicine that was not prescribed for them.
* Do not pretend to children that medicines are sweets. They cannot
tell the difference and might later poison themselves if they
think medicines are sweets.
Household chemicals, such as cleaners or pesticides
* Do read the label. Make sure you know how to use the product and
how much to use, and look for advice about how to use the product
safely.
* Do hold on to a product while you are working with it. If you put
it down, leave it where you can see it all the time. A child can
quickly grab an open bottle and swallow the liquid, or spill it
onto the skin or into the eyes.
* Do wipe up any of the chemical that gets spilt, and make sure the
outside of the bottle or container is clean and dry.
* Do put chemicals away as soon as you have finished using them.
While they are out of their usual storage place, children may get
hold of them.
* Do not spray household pesticides over food or children's toys.
* Do not mix different cleaners or other products together.
* If the product has to be added to water before it is used, do not
mix it in a container that is used for food and drink.
Get rid of household products safely
* Do put lids on household rubbish bins so that children cannot
take things out.
* Do use the local arrangements for getting rid of household
rubbish. Do not leave rubbish lying around the house or dump it
anywhere else.
* Do not puncture, heat or burn pressurized containers. If the
community burns household rubbish, do not put pressurized
containers into the fire. They should be buried instead.
Other ways to prevent poisoning in the home
* Do keep the floors and walls clean. Fill holes or cracks so that
there is nowhere for insects to live and no way snakes can get
into the house.
* Do keep gas or liquid fuel heaters, stoves and ovens in good
working order so that they do not produce dangerous amounts of
carbon monoxide gas.
* Do keep chimneys or flues clear and open to the outside air so
that fumes containing carbon monoxide gas from fires and stoves
do not stay inside the house.
* Do not use heaters, stoves or ovens in rooms with no chimney,
flue or open window to let in fresh air and let out the fumes
containing carbon monoxide gas.
How to prevent poisoning with pesticides
Pesticides are very widely used and in some countries many people
get sick or die because of poisoning with pesticides. Poisoning can be
prevented if pesticides are used safely and proper precautions are
taken.
People working where pesticides are used or stored - on
plantations, on farms, in factories or in shops - should know how to
handle and use pesticides safely. Every member of the community needs
to know about the hazards of using pesticides and how to avoid them.
Most of these guidelines can be applied wherever chemicals of any
kind are stored or used. If you want to know more about safety at work
ask someone with expert knowledge about health problems at work.
Store pesticides safely
* Do keep pesticides in their original containers. It is dangerous
to transfer pesticide from one container to another. The
pesticide may be mistaken for food or drink.
* Do keep pesticides in a safe and secure store. Seek advice from
agricultural advisers on where to site the store and how to build
it. It should be marked with warning signs and have locked doors
and barred windows, to keep out unauthorized people, especially
children.
* Do make a list of all products in the store and update it
regularly. Do not keep the list in the store but keep it in a
safe place where it will be accessible in the event of a fire. In
the store, keep chemical safety data sheets and emergency
telephone numbers.
* Do keep pesticides, particularly rodenticide baits and pesticide
treated seeds, away from foodstuffs so they are not mistaken for
food.
* Do not keep agricultural pesticides in living areas. Keep them in
a separate shelter. The only pesticides that should be kept at
home are those for killing household pests.
* Do not keep pesticides in drink bottles or other containers
normally used for food or drink.
Use pesticides safely
Everyone who applies pesticide should first have training in the
method of application, the operation, cleaning and maintenance of the
equipment and the safety precautions to be taken.
A pesticide, or any other chemical product, should have a label
saying what it is, who made it and how to use it safely and
effectively. There should also be information about possible hazards,
safety precautions, first aid instructions and advice to health
workers. If the container is small, this information may be given in a
leaflet attached to the container. There may also be a product
information leaflet and a chemical safety data sheet.
* Do read the label and any other product information you have been
given, before you use the product. If you do not understand the
information, ask someone who knows, such as your employer or the
person who supplied the product. Never use a product until you
have read and understood the label. If the product does not have
a label ask the supplier to give you a labelled container. Make
sure you know:
- what the contents are,
- how much pesticide to use and how to dilute it,
- how to use the product safely, and what equipment and
clothing to use,
- the hazards associated with its use, and the first aid to
give if there is an accident,
- when the pesticide should be used and how often.
If you cannot find this information on the label ask the
supplier, another user, a community leader, or an agricultural
extension worker to give you the information.
* Do warn your neighbours before you spray pesticides.
* Do make sure machinery and equipment are in good working order
and regularly checked.
* Do wear lightweight work clothes that cover as much of your skin
as possible when you mix or apply pesticide, when you clean
equipment and empty containers, and when you get rid of left-over
pesticide. Wear boots or shoes to cover your feet. Gloves and
goggles will give extra protection from splashes. Do have a clean
change of clothing.
* Do wear protective clothing and use protective equipment if the
label tells you to. If the label tells you to use protective
clothing or equipment it is because the product could harm or
even kill you if you do not have that protection. Make sure all
protective clothing and equipment are properly checked,
maintained and stored.
* Do mix only the amount of chemical that can be used in one day.
Then you will not need to get rid of left-over pesticide or leave
it overnight.
* Do have plenty of soap and water available for washing.
* Do wash gloves before you take them off.
* Do wash your hands thoroughly with soap and water after handling
or using pesticides. Wash your hands with soap and water before
you eat, drink, chew tobacco, smoke, rub your eyes or touch your
mouth.
* Do make sure that you are never alone when you are mixing or
using very poisonous pesticides.
Stop work immediately if you are using a chemical and you get a
rash or feel sick, if your eyesight troubles you, or you begin to
sweat more than usual or feel unusually thirsty, or even if you
have a headache or cold or flu symptoms. Tell your employer and
go to a doctor at once. Show the product label, information
leaflet or data sheet to the doctor.
* Do find out when it is safe to harvest and eat food that has been
sprayed with pesticide.
* Do bury or burn food that has been contaminated by pesticide.
* Do not use dirty or damaged protective equipment, or dirty or
torn protective clothes, or leaking gloves or boots. They may be
more dangerous than using nothing.
* Do not use bare hands to scoop powder out of packs, or dip bare
arms or hands into liquids to stir mixtures. Use measures and
mixing vessels for making up solutions (Fig. 10). Do not use
these for anything except pesticides.
* Do not measure out or mix pesticides in or near houses, or where
animals are kept.
* Do not blow through or suck spray nozzles to clear blockages.
Clean the nozzle with water or a grass stem.
* Do not spray pesticide when a strong wind is blowing because it
may drift over you, or nearby animals or houses.
* Do not leave pesticides unattended while they are out of the
store.
* Do not let anyone go into fields when pesticides are being
sprayed.
* Do not let children drink or play near spray equipment or near
places where pesticides are mixed, or near a field that is being
sprayed.
* Do not let children use pesticides.
Get rid of empty containers and left-over pesticide safely
* Do ask agricultural advisers about the safest way to get rid of
stocks of unwanted pesticide and empty pesticide containers. Most
waste can be buried but this is not safe for all chemicals and
may not be allowed in some areas. It is very important to choose
both the method used and the place where waste is burnt or buried
so as not to cause danger to people or to the environment. Do not
get rid of pesticides or pesticide-contaminated waste in
community waste pits used for household rubbish. More specific
recommendations for getting rid of chemical waste are outside the
scope of this book.
* Do use all the pesticide in a sprayer if possible, to avoid
having to get rid of unused pesticide. If that is not possible,
empty all unused pesticide out of spray tanks and get rid of
small amounts of left-over diluted pesticide by tipping it into a
hole in the ground away from dwellings, wells, waterways and
crops. Ask professional advice about where to dig the hole, and
check how much waste can be put in it and how often it can be
used. Put a fence round the hole to keep children away, and put a
sign on the gate showing that poisons have been buried there.
* Do wash all equipment after use and put it back in the store.
Collect the washing water in an empty container and pour it into
the hole used for small amounts of left-over diluted pesticide.
* Do wash out empty containers three times with water. Usually you
empty containers when you are mixing pesticides for use. If you
wash out the containers straight away you can get rid of the
washings by adding them to the spray tank. Washings which cannot
be reused should be collected and got rid of in the hole used for
small amounts of diluted pesticide. After they have been cleaned,
store empty containers in the pesticide store until they can be
got rid of safely.
* Do wash yourself thoroughly after work, and put on clean clothes.
* Do wash all work clothes well every day. Wash work clothes
separately from other clothes. Never wear work clothes at home,
or leave dirty clothes in the house.
* Do not take home left-over chemicals. Put them back in the store.
* Do not use empty containers to cook food or to store food or
drinking-water for humans or animals, as it is impossible to
clean out all the pesticide and to make the containers safe.
Plastic containers should be washed as described above and holes
punched in the base or sides so that they cannot be used again
(Fig. 11). Treat steel drums and small tin containers in the same
way (but do not make holes in pressurized containers).
What employers can do to prevent poisoning at work
General measures
Employers should protect workers from the dangers of using
chemicals. There are several things they can do to protect them.
* Comply with local and national health and safety regulations.
* Choose the least dangerous chemicals. If there are several
different chemicals that do the same job, choose the least
poisonous one.
* Choose safe equipment and safe ways of using it.
* Make sure workers are exposed to chemicals as little as possible.
For example, where appropriate, use mechanical ventilators in
buildings where chemicals are used or stored.
* Provide workers with equipment and clothing, where appropriate,
to protect them from exposure to chemicals. Maintain clothing and
equipment in good condition.
* Use safety signs and notices.
Employers should also:
- tell workers if they are using dangerous chemicals;
- teach workers about the dangers and make sure that they
understand fully;
- train and encourage workers to use safety equipment and
clothing and to use chemicals safely;
- check from time to time to see if the workers are using the
safety equipment and clothing and are using chemicals
safely. Warn those who are not doing so about the dangers.
Checking the health of workers and their exposure to chemicals
Workers should not be exposed to amounts of chemicals that might
make them ill or damage their health. In the workplace the amount of
chemicals in the air should be measured and recorded. Workers should
be offered regular medical checks if appropriate, to see if they are
being harmed by chemicals at work and to see whether measures need to
be taken to prevent exposure.
First aid and emergencies
* First aid should be available at every workplace.
* Training in first aid should always be a part of work training.
In every workplace the possible dangers from the use of poisonous
substances should be assessed, and workers should be given the
training, first aid equipment, and supplies they need to deal with the
dangers, as well as some means of communication and transport in case
of an accident.
Training
Employers should train all workers in what to do after any kind
of accident, emergency or injury. They should teach workers how to
give first aid. From time to time they should check that workers still
remember what to do.
In every workplace there should be one or more trained first
aiders always on the site, to give first aid in an emergency, such as
poisoning, injury or sudden sickness. In many countries, national
labour regulations say that there must be a person trained in first
aid in each workforce of a certain size, but trained first aiders are
needed even in smaller organizations not covered by regulations. Even
a person working alone should know first aid and know if the work is
dangerous. The number of people who should be trained in first aid
depends on the size of the danger. These people may be workers or
supervisors or, if a person works at home, other adults in the family.
Equipment
First aid equipment should always be kept in workplaces where
there are dangerous chemicals. For example, where there are corrosive
liquids, an eye-wash fountain or a plastic bottle with an eye-wash may
be needed. If there is a danger that the corrosive liquid could be
spilt on the skin, an emergency shower may be needed. Emergency
breathing equipment should be kept where irritant or poisonous gases,
such as chlorine or carbon dioxide, are used, so that workers can
escape or rescue others if there is a gas leak. In some cases special
equipment may be needed to rescue people after an accident.
Supplies
Antidotes may need to be added to first aid kits in workplaces
where very quick-acting poisonous chemicals are used. For example,
amyl nitrite capsules should be kept in places where cyanide is used.
Getting help and taking people to hospital
The easiest way to get help when there is an accident at work is
to shout to a fellow-worker or, for those working at home, a member of
the family or a neighbour.
Employers should know what to do and who to contact if there is
an accident or emergency with dangerous chemicals.
Where appropriate, there should be posters with clear
instructions about what to do and who to contact if there is an
accident or emergency with dangerous chemicals. The posters should
give telephone numbers of the nearest emergency service, health
service, or poisons centre, or instructions about how to contact them.
They should also have pictures and instructions on how to give first
aid and how to get medical help after first aid has been given.
Employers should check from time to time that these procedures still
work, and find out, for example, whether the people to contact have
changed.
Cooperation between employers and workers
Employers, workers and their representatives should cooperate
closely to apply these safety measures. Workers should take care of
their own health and safety by following training and instructions
given by their employers, by using protective equipment and clothing
properly and by reporting at once to their supervisor any situation
that could be dangerous.
Workers should be given information about the dangers of using
chemicals in their work, and be trained in ways of working that will
protect them from those dangers.
How to avoid snake bites
When a person and a snake meet, the snake will usually try to get
away if given the chance. Snakes usually bite only when they are
surprised by a sudden movement and cannot get away.
* Do wear shoes when walking outdoors. Tall leather boots give the
best protection for walking in long grass or undergrowth. Wear
them with long trousers hanging outside the boots (Fig. 12).
* Do learn about the poisonous snakes in your area. Learn what they
look like and where they live. Most snakes live on the ground but
some live in trees or bushes. Find out if there are any snakes
that spit venom and how they attack.
* Do take care at night because that is when many snakes are
active. Tell children to wear shoes and use a torch when walking
around at night. Teach them to leave snakes alone.
* Do not go near snakes. Run away if you can. If you cannot run
away, do not make sudden movements.
* Do not touch a snake even if it looks dead. Some snakes pretend
to be dead to avoid attack.
* Do not turn over stones or logs, or put your hand or foot into a
hole in the ground. Before stepping over a log look for snakes on
the other side.
* Do not sleep on the ground. You might roll over onto a snake
while asleep, or a snake may move next to you to get warm.
How to prevent insect, spider and scorpion stings and bites
* Do find out about the poisonous insects, caterpillars, spiders,
and scorpions in your area. Learn what they look like and where
they live.
* To protect yourself from bee stings when working among flowers or
fruits, do wear long trousers, long-sleeved shirts and gloves,
and cover your head and face as much as possible (Fig. 13). Avoid
wearing things that attract bees, such as bright flowery
clothing, bright shiny jewellery, buttons or buckles, or using
scented perfume, soap or shampoo.
* Do not walk outdoors in bare feet or open shoes.
* Do not touch insects, caterpillars, spiders, scorpions, or
centipedes.
* Do not put your hands in leaf litter, rotten tree trunks or holes
where insects, caterpillars, spiders, scorpions or centipedes
might live.
How to avoid eating poisonous plants, mushrooms and fish
* Do find out which plants and mushrooms in your community are
poisonous and what they look like. Make sure you can recognize
them - some edible plants, mushrooms and fish are very hard to
distinguish from poisonous ones.
* Do learn how to prepare foods correctly. Some plants (like
cassava) are poisonous if not properly prepared or cooked, and
some plants and fish have poisonous parts that must not be eaten.
* If you are preparing tropical fish, do separate the flesh from
the head, skin and gut as soon as possible, because these may
contain large amounts of poison.
* Do not buy mushrooms from people who are selling them by the
roadside.
* Do not eat fish that is not fresh. Some fish are good to eat when
they are fresh, but become poisonous when they have been dead for
some time.
How to avoid infection from food contaminated with germs
* Do keep kitchens clean. Keep tables and other surfaces on which
food is prepared clean, and keep kitchen utensils clean.
* Do protect food by keeping it covered or in boxes or cupboards
with wire screens (Fig. 14).
* Do wash your hands well with clean soap and water before touching
or preparing food. Cuts or sores on fingers should be covered
with a clean dressing.
* Do boil plates and eating utensils used by sick people before
anyone else uses them.
* Do not keep food for a long time in a warm place. Do not keep
left-over cooked food if you cannot keep it cool or keep it in a
refrigerator.
* Do not let flies, other insects, worms, rats or other animals
touch or crawl on food. They carry germs and spread disease.
* Do not let dust get on food or let people touch food.
* Do not leave food scraps or dirty dishes lying around, as these
attract flies and let germs breed.
* Do not leave clean utensils lying on the ground.
* Do not eat raw or undercooked meat. Cook it right through.
* Do not eat food that is old or smells bad.
* Do not eat food from cans that are swollen or that squirt out
when opened. Be especially careful with canned fish.
CHAPTER 4
What to do in an emergency
Objectives
After studying this chapter, you should be able to:
1. Decide quickly and calmly what to do in an emergency.
2. Check for danger at the scene of an accident, fire or explosion,
and warn other people.
3. Decide quickly when to get help to rescue a person who is
overcome by poisonous gas, or trapped inside a burning building.
A poisoned person may suddenly become very sick and need
immediate first aid. When you help someone who has been poisoned or
injured in a chemical accident, fire or explosion, or by carbon
monoxide, you should be aware of the dangers, so that you can protect
yourself and warn others.
The dangers to look out for
There may be a danger of poisoning:
- inside a room or building where there is a heater or cooker
burning wood, oil or gas, where there is not enough fresh air;
- inside a garage where a car engine is running;
- inside an empty chemical storage tank;
- inside a grain store or silo;
- near a chemical fire or explosion, or a spill or leak of gases,
solids or liquids, especially in a pit, trench or cellar;
- inside a burning building. Fires give off smoke and hot air,
which may damage the lungs if breathed in, and poisonous gases,
especially if chemicals or plastics are burning. The poisonous
gases quickly build up in a closed space;
- from contact with skin or clothes of people who have been
contaminated by very poisonous chemicals, such as cyanide or
organo-phosphorus pesticides.
There may also be a danger of injury at the scene of a chemical
accident. For example, there may be a danger from traffic if the
accident happened on the road, or a danger from collapsing buildings
at the scene of a fire or explosion.
What to do in an emergency
When there is an emergency:
* Keep calm.
* Make sure you are safe.
* Raise the alarm and call for help.
* Move the victims away from danger.
* Give first aid.
Keep calm
Try to calm yourself before you approach a victim or an incident.
Most people are frightened if they are injured or suddenly taken ill.
By remaining calm you will help to relieve their fear. Act quickly and
quietly.
Make sure you are safe
Before you do anything else, make sure that you are safe. If
there is danger, you must protect yourself. If you become another
victim there may be no one to help you.
Quickly check that there is no danger from:
- poisonous gas, smoke or fumes,
- poisonous liquids,
- fire and collapsing buildings,
- traffic.
Check which way the wind is blowing and keep out of areas where
smoke or fumes from leaks or spills might blow over you.
Raise the alarm and call for help
If you are the first person on the scene, shout to others in the
area to warn them of any danger and to call for help.
If there is more than one victim always shout for help before you
do anything else.
If there is a nurse, doctor, health worker or first aider living
or working nearby, send someone to get help.
Move the victim away from danger, if it is safe for you to do so
If someone is unconscious in a room or building that might be
full of poisonous gas:
* Open the door and open or break the windows from the outside, to
let in fresh air. Wait until the room is full of clean air before
you go in.
* Do not switch on an electric light and do not let anyone go into
the room with a lighted cigarette or naked flame. These may cause
an explosion.
If someone is trapped inside a burning building:
* Do not go in unless you are wearing proper breathing equipment
that you have been trained to use. If you go into a burning
building with nothing to protect you from breathing poisonous gas
and smoke, you may become unconscious and not be able to get out.
A wet rag over the mouth and nose will not protect you.
If someone is unconscious inside an empty storage tank:
* Use an air compressor to blow fresh air into the tank. Wait until
the tank is full of clean air before you go in.
* If the storage tank cannot be cleared with a compressor, do not,
go in unless you are wearing proper breathing equipment that you
have been trained to use. If you go into an empty storage tank
with nothing to protect you from breathing poisonous gas, you may
become unconscious and not be able to get out.
Protect yourself from being poisoned by contact with the victim.
Put on gloves before you touch people who have been poisoned with
cyanide, crowd-control gases, or organophosphorus pesticides. Poison
on their skin or clothes could poison you.
Give first aid
Give first aid before you move the victim, unless it is dangerous
to stay there (see Chapter 5).
If there will be a delay in getting the victim to a doctor or to
hospital, you may need to do more to help him or her (see Chapter 9).
CHAPTER 5
First aid
Objectives
After studying this chapter, you should be able to:
1. Tell when a person:
- is unconscious,
- is not breathing,
- has no heartbeat.
2. Decide what to do and give first aid in each case.
3. Give first aid when a person:
- has fits (convulsions),
- has chemical in the eyes,
- has chemical on the skin,
- has been bitten or stung by a poisonous or venomous animal.
First aid is the help a person gives straight away in a medical
emergency.
This chapter can help you learn first aid, but you also need
someone to teach you first aid, and check that you are doing it
correctly. It is important to have someone show you the right way to
do mouth-to-mouth respiration and heart massage. You should practise
on a special training manikin (a life-size model). Never practise
heart massage on another person, only on a manikin.
It is dangerous to use heart massage if you have not had proper
training.
People who are poisoned may:
- be unconscious,
- stop breathing,
- have no heartbeat,
- have fits (convulsions).
They need immediate first aid to help them to breathe and to
start the heart beating.
When people get chemical in the eyes or on the skin, it may cause
burns. These people need immediate first aid to wash the chemicals out
of the eyes and off the skin. The chemical may also get into the body
and cause poisoning.
People who have been bitten or stung by a poisonous or venomous
animal need first aid:
- to remove stings, spines or tentacles,
- to clean the wound and stop infection,
- to slow the spread of poison through the body.
Give first aid at once
Immediate first aid may stop serious poisoning and may save life.
If breathing and the heart stop, the person will die within a few
minutes unless you give first aid at once.
First aid for poisoning
Here is an action list. Each step is explained in more detail
below the list. Start with the first step and follow each step in the
order given. Act as quickly as you can, but stay calm.
1. Check if the patient is conscious.
2. Open the airway and make sure the tongue is not blocking the
throat.
3. Check if the patient is breathing.
4. Clean out the mouth and clear the throat.
5. Give mouth-to-mouth respiration.
6. Check if the heart is beating.
7. If the heart is beating, but the patient is still not breathing,
carry on with mouth-to-mouth respiration.
8. If the heart is not beating, give heart massage.
9. If the patient is breathing but is unconscious, turn him or her
onto one side, into the recovery position.
10. Give first aid for fits if necessary.
11. Wash any chemical out of the eyes.
12. Remove contaminated clothing and wash any chemical off the skin
and hair.
13. Give first aid for poisonous bites and stings.
Check if the patient is conscious
Try to make the patient wake up. Shout "Are you all right?" and
gently shake the shoulders, but take care not to make any injuries
worse (Fig. 15). Pinch the skin on the neck and watch the face. A
patient who is just sleeping will wake up, but an unconscious patient
will not.
Open the airway
The airway is the tube through which air passes from the mouth
and nose to the lungs. If it is blocked the patient cannot breathe and
air cannot get into or out of the lungs. A patient who cannot breathe
will die within four minutes.
In an unconscious patient the tongue may block the throat and the
airway. Make sure the airway is open and air can get down the throat
(Fig. 16):
* Place the patient on his or her back.
* Tilt the head back and lift the chin up with the finger and thumb
of one hand on the bony part of the chin, while pressing the
forehead back with the other hand (Fig. 17). This will open the
airway and stop the tongue blocking the throat.
Check whether the patient is breathing
After opening the airway, quickly check whether the patient is
breathing (Fig. 18):
* Look for the belly or the chest moving up and down.
* Feel the chest moving up and down.
* Feel the patient's breath on your cheek.
* Listen for breath sounds. Put your ear close to the patient's
mouth.
Use all four checks. Remember that the chest may move up and down
even when the throat is completely blocked and air cannot get to the
lungs.
A person may stop breathing because:
* Something is stuck in the throat.
* The throat is blocked by the tongue, or by blood, spit, vomit,
food, or false teeth. (If you have tilted the head back, the
tongue will not block the throat.)
* The throat is blocked because the patient has swallowed poison
which has burnt the throat and made it swell.
* The patient has been poisoned.
* The patient has been hit on the head or chest.
* The patient has had a heart attack.
* The patient has nearly drowned.
Clean out the mouth and clear the throat
If the patient is not breathing after you have tilted the head
back, something may be blocking the throat.
Turn the head to one side. With one or two fingers (and
preferably wearing gloves) scoop deeply round the mouth and throat to
clear any blockage such as vomit (see Fig. 19). Take out the patient's
false teeth.
If the patient starts breathing turn him or her onto one side,
into the recovery position. Check breathing and pulse frequently.
Whatever the cause, if the patient does not start breathing you
must act immediately to help the patient to breathe.
Give mouth-to-mouth respiration
You can help the patient to breathe by blowing air from your
lungs into his or her lungs through the patient's mouth (mouth to
mouth) or nose (mouth to nose). This is called mouth-to-mouth (or
mouth-to-nose) respiration.
* Do not give mouth-to-mouth respiration if the patient is still
breathing.
If there is poison on the patient's lips, or if corrosive
chemicals have burnt the lips and chin, wipe the chemical off, cover
the mouth with a cloth to protect yourself from getting poison on your
lips or hands, and give mouth-to-nose respiration. Breathe into the
patient's nose (see Fig. 20).
How to give mouth-to-mouth respiration or mouth-to-nose respiration
to an adult
1. With the patient lying flat on his or her back, clear any
blockage from the mouth. Kneel beside the patient's head.
2. Tilt the head back.
3. Pinch the nose with one hand. With the other hand pull the mouth
open (Fig. 21). Do not press on the neck. For mouth-to-nose
respiration, close the patient's mouth with your thumb.
4. Breathe in deeply. Cover the patient's mouth completely with your
own mouth and breathe out steadily and smoothly so that all your
breath goes into the patient's mouth. Breathe out strongly to
fill the chest (see Fig. 22). Look for the patient's chest
rising. For mouth-to-nose respiration put your mouth around the
patient's nose.
5. Lift your mouth away so that the patient can breathe out and you
can take another breath of air. Turn your head, look for the
chest falling, feel the breathed-out air on your cheek, and
listen for the sound of the patient breathing out (see Fig. 23).
For mouth-to-nose respiration you may have to open the patient's
mouth to let air out.
6. Take another breath of air. Once the chest has fallen, blow into
the patient's mouth (or nose) again. Watch the patient breathe
out again. Then check that the heart is beating.
If the chest does not rise with each breath, and you cannot feel
or hear the patient breathing out, then either the airway is blocked
or some of your breath is not going into the patient's chest. Check
that the head is held well back and clear the airway again. Make sure
there is no air escaping when you breathe into the patient's mouth (or
nose).
How to give mouth-to-mouth respiration to a child or a baby
Open the airway in a child or baby in the same way as for an
adult, but do not tilt the head too far back or the soft airway may
kink.
If you can see something blocking the throat carefully remove it,
but do not sweep your finger inside a baby's mouth if you cannot see
anything there. If the throat is swollen because of an infection, you
might make the swelling worse.
Do not pinch the nose. Put your lips over both the nose and the
mouth (Fig. 24). Breathe gently, just enough to move the chest. For a
very small baby only small puffs are needed. Do not blow hard or you
may harm the baby's chest. Blow into the chest every 3 seconds.
Check if the heart is beating
Feel for the pulse in the neck, in the hollow between the voice
box and the muscle. Place two fingers on the voice box (Adam's apple)
and slide your fingers into the groove under the jaw (Fig. 25). Keep
your fingers there for at least five seconds to feel if there is a
pulse.
If you cannot feel a pulse, the heart has stopped. This is called
cardiac arrest. The patient will be unconscious and will probably have
large pupils. If the patient has white skin it will probably have a
blue-grey colour. If the patient has black or brown skin look for a
blue colour to the nails, lips and the inside of the lower eyelids. If
the heart stops, breathing will also stop and the patient will need
both heart massage and mouth-to-mouth respiration.
If the heart is beating, but the patient is still not breathing,
carry on with mouth-to-mouth respiration
Take a deep breath and blow once every 5 seconds, until the
patient starts to breathe without help. You may have to do this for
more than one hour.
If the patient has breathed in an irritant gas, the mouth and
throat may be full of froth. You cannot remove this froth by wiping,
so do not waste time trying to remove it. As this froth is air
bubbles, all you have to do to move air in and out of the lungs is to
blow the froth into the lungs. So blow as usual.
When the patient starts to breathe, turn him or her onto one side
into the recovery position. The patient may vomit when breathing
starts again but the vomit will not block the throat if the patient is
lying on one side. Let the vomit come out and clear it out of the
mouth with your finger.
Watch carefully in case the patient stops breathing again. If
breathing stops turn the patient onto his or her back and start mouth-
to-mouth respiration again.
If the heart is not beating give heart massage
If you cannot feel a pulse in the neck, you should try to start
the heart beating again by giving heart massage (see below).
Heart massage (or chest compression) means pressing down on the
heart to push blood out of it and round the body. This may start the
heart beating again. It will only be effective if the patient is lying
on a hard surface.
If there is no heartbeat, the patient will have stopped
breathing. Always start mouth-to-mouth respiration before heart
massage.
Do not give heart massage if the heart is beating, even faintly.
Stop as soon as you feel a pulse in the neck, but carry on with mouth-
to-mouth respiration if the patient is still not breathing.
How to give heart massage to an adult
1. Check that there is no heartbeat.
2. Lay the patient on his or her back on a firm surface. Kneel
beside the patient's chest.
3. Find the right place to put your hands. Find the lower edge of
the ribs. Follow the edge of the ribs to where they meet the
breastbone. Place your middle finger on the base of the
breastbone, and the index finger next to it (Fig. 26), then place
the heel of your other hand next to these two fingers, on the
breastbone in the midline of the chest (Fig. 27).
4. Now cover this hand with the heel of your other hand, lock your
fingers together, keeping them off the chest (Fig. 28). Put your
shoulders above the patient's chest and keep your arms straight.
5. Press down on the lower half of the breastbone 4-5 centimetres,
keeping your arms straight. Then stop pushing. While counting
"one and two and three and...", press 15 times, in time with the
numbers (80 presses a minute). Presses should be regular and
smooth, not jerky and jabbing.
6. Remember that both mouth-to-mouth respiration and heart massage
are needed. After 15 presses tilt the head back again so that air
can get down the throat, put your mouth round the patient's mouth
and give two breaths.
7. Continue with 15 presses followed by two full breaths. After one
minute check the heartbeat, then after 3 minutes or every 12
cycles check the heartbeat again. As soon as the heartbeat
returns stop heart massage immediately. You may see the patient's
colour become more normal and the pupils return to normal size.
8. Continue mouth-to-mouth respiration at 12 breaths a minute, until
the patient breathes without help. It may be some time before
breathing starts again, even after the heart has started beating.
When breathing starts again put the patient onto his or her side
in the recovery position.
If another person is with you, get him or her to do the breathing
while you do the heart massage (Fig. 29). The other person should
kneel by the patient's head while you kneel by the middle of the
chest. The other person should give two breaths and check the
heartbeat. If there is no heartbeat you should give five presses on
the chest. Continue with the other person giving one breath and you
giving five presses on the chest. Check the heartbeat after one minute
then after every three minutes or 12 cycles.
How to give heart massage to a child or a baby
The best place to feel the pulse in a small child or a baby is on
the inside of the upper arm. With your thumb on the outside of the arm
press your first and middle fingers into the groove below the muscle.
When giving heart massage to a child or baby, press with less
force but slightly faster than you would for an adult.
For a child use one hand only and press lightly on the chest
(Fig. 30). Press down 2.5-3.5 cm.
For a small child or a baby press on the chest with just two
fingers. Press down 1.5-2.5 cm (Fig. 31).
Keep your hand or fingers below the level of the nipples.
Press down at a rate of 100 presses a minute giving 15
compressions followed by two breaths.
If the patient is breathing but is unconscious, turn him or her onto
one side, into the recovery position
An unconscious patient should be turned to lie on one side to
stop the tongue blocking the throat and to allow fluid to come out of
the mouth. This is called the recovery position.
Before you turn the patient over:
* If breathing is noisy, sweep your finger round the mouth to
remove anything blocking the airway, and take out the patient's
false teeth if they are loose.
* Empty the patient's pockets of anything that would be
uncomfortable to lie on.
* Take off the patient's spectacles in case they injure the eyes.
* Look for injury to the head or neck, and feel with your fingers
to see whether the back of the neck or the backbone is bent or
swollen.
* Get help if the patient has an injury to the head or neck. Three
people should roll the patient keeping the head, neck and body in
a straight line. Do not let the patient sit up when he or she
wakes up.
The patient should be turned onto one side with:
- the head, neck and body in a straight line,
- the head placed so that the tongue will not block the throat, and
vomit or saliva can come out of the mouth;
- the arms and legs placed so that the patient stays in the same
position.
One way of turning a patient
1. Kneel beside the patient, turn the patient's face towards you,
and tilt it back, with the jaw jutting forward so the airway
stays open. Place the arm nearest you above the head. Place the
patient's other arm across the chest. Raise the patient's far leg
under the knee, to bend it (Fig. 32).
2. Protect the patient's face with one hand. With your other hand,
grasp the patient's clothes at the hip and pull the patient
towards you until he or she is resting on one side, against your
knees (Fig. 33). The patient's head should be resting on the
lower arm. Check that the airway is still open.
3. Take the patient's upper arm and place the hand under the face
(Fig. 34). This will help to keep the head tilted back and the
airway open. Now position the upper leg so that the bent knee
rests on the ground and supports the patient's body.
If the patient is too heavy for you, get help. Someone else can
support the patient's head while you do the turning, or can push the
patient towards you as you pull.
Give first aid for fits (convulsions) if necessary
1. If the patient has a fit, make him or her lie down in a safe
place. Make sure there are no hard or sharp objects nearby and
protect the patient from injury.
2. Turn the patient to lie on one side so that the tongue comes to
the front of the mouth and froth can come out of the mouth
easily.
3. Put a folded cloth under the patient's head, or hold the head so
that it does not bang on hard things.
4. Do not try to stop the shaking movements.
5. Loosen any tight clothing.
6. Do not put anything in the patient's mouth or try to open it.
7. After the fit, let the patient rest in the recovery position.
Wash any chemical out of the eyes
Wash chemicals out of the eyes at once, with plenty of cool,
clean water, before you wash the skin. Even a delay of a few seconds
can make the injury worse.
1. Immediately gently brush or wipe any liquid or powdered chemical
off the face. Let the patient sit or lie down with the head
tilted back and turned towards the worst affected side. Gently
open the eyelids of the affected eye or eyes and run cold water
over from a tap or pour water from a jug. Make sure the water
drains away from the face and does not go into the unaffected
eye. Wash out the eye or eyes in this way for 15-20 minutes,
timed with a watch if possible.
The patient may be in great pain and may want to keep his or her
eyes closed, but you must wash the chemical out of the eyes in
order to prevent permanent damage. Gently pull the eyelids wide
open, and keep them apart (Fig. 35).
2. While you are rinsing the eyes check that the inside of the
eyelids has been well washed. Check that there are no solid
pieces of chemical in the folds of skin round the eyes, or on the
eyelashes or eyebrows. If you are not sure whether all the
chemical has been removed, wash out the eyes for 10 more minutes.
3. Do not let the patient rub the eyes.
4. The patient's eyes should be examined by a doctor even if there
is no pain, because damage may be delayed.
5. If light hurts the patient's eyes, cover them with a sterile eye
pad, a dry gauze pad, or a pad of clean cloth. Bandage the pad in
place securely, but not too tightly. This will protect the eyes
and help them to heal.
6. If the patient is in pain, give aspirin or paracetamol every four
hours.
Medical treatment of chemical contamination of the eye
* If the pain is severe the patient may need an intramuscular
injection of morphine.
* Look for burns. Put drops of fluorescein in the eye. Burns will
stain yellow.
* Prevent infection. If there are yellow stains with fluorescein,
put chloramphenicol 1% eye ointment in the eye. Put more ointment
into the eye every two hours. Continue until the eye is no longer
red and the sclera is white, and then for another 24 hours.
Remove contaminated clothing and wash any chemical off the skin
and hair
1. Take the patient immediately to the nearest shower or source of
clean water. If there is no water nearby dab or gently wipe the
skin and hair with cloths or paper. Do not rub or scrub the skin.
2. Immediately wash the affected part of the body under cold or
lukewarm running water, using soap if you have some. If there is
no running water use buckets of water. Do it quickly and use a
lot of water (Fig. 36). Wear gloves and an apron if needed, to
protect yourself from splashes of chemical. Some chemicals give
off vapour: be careful not to breathe it in.
3. At the same time quickly remove any of the patient's clothes
contaminated with chemical or vomit, as well as shoes and wrist
watch if necessary. Speed is important - cut the clothes off if
the chemicals are very poisonous or corrosive.
4. If large areas of the body are contaminated with chemical, wash
the patient under a shower or a hose. Remember to clean the hair
and under the fingernails, in the groin and behind the ears, if
necessary.
5. Continue to pour water over the patient for 10 minutes, or longer
if you can still see chemicals on the skin. If the skin feels
sticky or soapy, wash it until the feeling disappears. This may
take an hour or more.
6. Make sure the water drains away freely and safely as it will have
chemical in it.
7. Dry the skin gently with a clean, soft towel. If clothing stays
stuck to the skin even after water has been poured over it, do
not remove it.
8. Remember that many chemicals can pass through the skin very
quickly. Look for signs of poisoning (see Chapter 7).
9. Put contaminated clothes in a separate sealed container and do
not use them again until they have been washed. Throw away shoes
contaminated with chemical. If you have used cloths or paper to
wipe the skin, put these in a container and burn them.
If the patient has burns, and there is no doctor:
1. Do not break open blisters or remove skin. Where the skin is red
and painful or raw, cover it and the skin round it with a
sterile, dry dressing and bandage. Keep the bandage loose. This
will protect the burn and speed up healing.
2. Dress the patient in clean clothes or cover with a sheet.
3. Replace fluid loss: if a large area is burnt give the patient
half a cup of water every 10 minutes until the patient reaches
hospital.
4. Treat pain: give aspirin every four hours until the pain is
better.
5. Get the patient to a doctor or hospital as soon as possible.
Give first aid for poisonous bites and stings
This section gives general advice first, followed by specific
advice for dealing with:
- snake bites,
- stings or bites by bees, wasps, hornets, fire ants, scorpions,
spiders or ticks,
- stings by jellyfish,
- stings by venomous fish.
General advice
1. People often panic if they have been bitten or stung. You should
tell the patient that many snakes, spiders, insects and sea
creatures are harmless and that even the bites and stings of
dangerous animals often do not cause poisoning.
2. Keep the patient calm and still. Moving the bitten or stung limb
speeds up the spread of venom to the rest of the body. Fear and
excitement also make the patient worse. The patient should be
told not to use the limb and to keep it still and below the level
of the heart. The limb may swell after a while, so take off the
patient's rings, watch, bracelets, anklets and shoes as soon as
possible. A splint and a sling may help to keep the limb still.
3. The following measures should not be used. They may cause
infection, or make the effects of the venom worse.
- Do not cut into the wound or cut it out.
- Do not suck venom out of the wound.
- Do not use a tourniquet or tight bandage.
- Do not put chemicals or medicines on the wound or inject them
into the wound (potassium permanganate crystals for example).
- Do not put ice packs on the wound.
- Do not use proprietary snake bite kits.
Time spent giving traditional remedies and herbal medicines would
be better spent getting the patient quickly to hospital. Such
"remedies" are often of no use and may be dangerous or even life-
threatening.
4. The patient should lie on one side in the recovery position so
that the airway is clear, in case or vomiting or fainting.
5. Do not give the patient anything by mouth - no food, alcohol,
medicines or drinks. However, if it is likely to be a long time
before the patient gets medical care, give the patient water to
drink to stop dehydration.
6. Try to identify the animal, but do not try to catch it or keep it
if this will put you, the patient or others at risk. If the
animal is dead take it to hospital with the patient, but handle
it very carefully, because even dead animals can sometimes inject
venom.
7. As soon as possible, take the patient to a hospital, medical
dispensary, or clinic where medical care can be given. The
patient should not walk but should keep as still as possible. If
there is no ambulance or car, carry the patient on a stretcher or
trestle, or on the crossbar of a bicycle.
8. Antivenom should only be given in a hospital or medical centre
where resuscitation can be given, because the patient may have an
allergic reaction. If available, antivenom should be used if
there is evidence of severe poisoning. It should not be used when
there are no signs of poisoning.
Using traditional medicines to treat poisonous bites and stings
No home remedy or traditional cure for poisonous bites or stings
(from snakes, scorpions, spiders or other poisonous animals) has any
effect beyond that of the healing power of belief.
Anyone who says that a traditional medicine kept a snake's venom
from harming him or her was probably bitten by a snake that did not
inject poison.
Some traditional medicines may do some good. If a person believes
in them he or she will feel less afraid, the pulse will slow down, the
person will move and tremble less, and as a result, the poison will
spread through the body more slowly. So there is less danger.
But the benefit of these traditional medicines is very limited.
Even when they are given traditional medicines, many people still
become very ill or die from snake bite. Using traditional medicine may
delay more effective treatment. It is better to use hospital
treatment.
Do not use traditional remedies that contain animal or human
waste or that involve eating animals not usually used as food. They do
not help at all. They are often dangerous and