Understanding to the IDLH Environment Ricky Kue, MD, MPH, FACEP, FAEMS Associate Medical Director, Boston EMS Medical Team Manager, FEMA USAR MA-TF1 2017 NAEMSP Annual Meeting New Orleans, LA Disclosures/Conflicts of Interest Sadly, none I M A DOCTOR NOT A HAZMAT TECH!!! 1
What we will cover (I hope) Background and definition of IDLH Identifying an IDLH environment Basic identification and response to hazardous materials ERG Practical application of IDLH values Review of PPE selection Let s Define IDLH value Immediately Dangerous to Life and Health (IDLH) An atmospheric concentration of any toxic, corrosive or asphyxiant substance that poses an immediate threat to life or would cause irreversible or delayed adverse health effects or would interfere with an individual's ability to escape from a dangerous atmosphere. [29 CFR 1910.120] Thank you, OSHA and NIOSH! So what s an IDLH Condition? Any condition that poses an immediate or delayed threat to life or that would cause irreversible adverse health effects or that would interfere with an individual's ability to escape unaided from a permit space. [29 CFR 1910.146] Thanks again, OSHA and NIOSH! 2
Historical context The Occupational Safety and Health Act of 1970: OSHA Occupational Safety and Health Administration Within the Department of Labor CFR 1910.120 (Hazardous Waste Operations and Emergency Response HAZWOPER) Sets and enforces standards Enforcers NIOSH National Institute of Occupational Safety and Health Within the CDC/P Study risks and develop recommendations Researchers Background on the IDLH Concept Respiratory protection discussed as early as 1940 s 1974, NIOSH and OSHA jointly works on Standards Completion Program (SCP) 387 substances-specific guidelines were developed based on available published data BASIS of NIOSH Pocket Guide Provided technical info IDLH values developed as part of SCP for guidance on selection of respiratory protection Based on best available toxicity data available Updated IDLH values in 1994 based on new data 30-minute escape time was used as a safety margin, but workers are expected to EXIT IMMEDIATELY!!! Why define an IDLH level? To ensure a worker can escape from a given contaminated environment in the event of respiratory protective equipment failure Considered a maximum level above which only a highly reliable breathing apparatus providing maximum worker protection is permitted Key component to the NIOSH Respiratory Selection Logic for workers 3
An IDLH environment implies The need for PPE The need for monitoring The ability to respond to on-site injury/illness (Separate from any on-site rehab functions) The presence of a toxic hazard IDLH level and exposure limits if specific hazard is identified https://m.youtube.com/watch?v=znqwacoqffq 4
You respond to this Anatomy of a DOT Placard DOT Hazard Class Number Every Good FireFighter Ought To Receive Cash Money!!! 5
Ways to identify our hazard NIOSH Pocket Guide ERG (Emergency Response Guide) More practical for FR s Uses DOT Placard info Lookup based on UN/NA ID Lookup by name Lookup flow diagram for??? Using the ERG Search by name Search by UN/NA # Search by placard markings Orange section provides response guidance Green section provides isolation guidance ERG UN/NA ID# 1017 6
UN/NA #1017 Green Section Guide 124 1017 (Chlorine) Now what??? Hopefully, you recognized a potential IDLH environment early on Staged appropriately, donned PPE What level PPE? Does NIOSH IDLH values assist me in selecting appropriate respiratory protection in this scenario??? 7
DHHS (NIOSH) pub no. 2005-149 Respiratory Protection When the IDLH is not helpful Situations and conditions that might preclude the use of a health-based IDLH value include levels: Above the concentration that would result in oxygen deprivation (< 19.5%) Higher than a particulate concentration that generates significant hazards from reduced visibility Greater than 10% of the LEL concentration or the minimum concentration of gas or vapor (highly flammable) Greater than the time-weighted average (TWA) OEL multiplied by the assigned protection factor for the most protective respirator 8
Levels of PPE Level A Level B Level C Level D IDLH in emergency operations Remember, IDLH values set thresholds in determining respiratory protection level for workers IDLH condition means the threshold has been passed HAZMAT, Structural Firefighting When responding to a potential HAZMAT: We presume to be in IDLH environment Consider appropriate PPE (Respiratory Logic q.1-3) Highly reliable respirators in emergency operations such as full facemask SCBA or supplied air PD/PPm) Appropriate stand-by for rescue and intervention 9
Take home message: IDLH values help establish a respiratory standard but emergency operations typically occur in an IDLH environment Identify the hazard Establish control zones and stage accordingly PPE will typically include: SCBA APRs limited in oxygen deficient atmosphere 10