Email Enquiry

 

Medical Response to Anhydrous Ammonia Incidents

Initial Email Enquiry –

An interesting article on Anhydrous Ammonia recently released on the HAZMAT 101 News for June 2004. I know we have a particular interest having an Ammonia Plant on our Billingham complex.

The Albany medical Center (AMC) is an Academic Medical Center consisting of a 600 plus bed two hospital system and medical school located in the capital city of New York State. As the tertiary care facility for a population center of nearly one million people, AMC has a full decontamination and HazMat response team available to respond to contaminated patients and on site spills. As the surrounding communities range from manufacturing, urban and agricultural and are criss-crossed by rail and interstate highways. Anhydrous ammonia releases, either accidental or as a result of criminal activities, are medical emergencies for which the AMC HazMat team trains for and responds to.

Sources of Anhydrous Ammonia
Refrigeration: Anhydrous ammonia is a commercial refrigerant used in dairy and ice cream plants. In Albany, NY a deteriorating cold storage facility in the downtown business district prompted action by the State Attorney General’s office to stabilize and then to remove the ammonia refrigerant gas. In November of 2002, an anhydrous ammonia leak from a Perry’s Ice Cream plant in Akron, NY forced the evacuation of dozens of families before fire and HazMat teams discovered and then sealed a chemical leak on the roof of the building. Residents returned to their homes a few hours later. No casualties were reported.

Industry: In January of 2002, a freight train carrying anhydrous ammonia overturned near Minot, ND spilling thousands of gallons and killing one person and causing the evacuation of hundreds more.

Agriculture & Illegal Meth Labs: Anhydrous ammonia is widely used in agriculture as a nitrogen source for plant fertilization. It is stored in large compressed cylinders (similar to propane tanks) and injected into soils before planting. In May of 2004, a man and woman from Oak Ridge Tennessee were charged with theft of anhydrous ammonia, a component used in making meth, and criminal trespassing on federal land. The charges stem from an investigation into the theft of three 35-pound tanks of the ammonia from BOC Gas of Chattanooga on March 27. The two were reportedly caught when they allegedly returned to Chattanooga to retrieve the stolen tanks that they reportedly hid in a nearby field. "This is a trend we are seeing now with our local 'cookers' stealing from surrounding counties. We have even identified several locals stealing anhydrous from surrounding states such as Georgia and North Carolina. In Tonawanda, New York two men pled guilty in federal court in April of 2004 to theft of anhydrous ammonia from a Cayuga County farm. The defendants were arrested earlier this month following a vehicle stop in which deputies recovered two containers filled with five to seven gallons of anhydrous ammonia from the trunk of the vehicle. They intended to sell the stolen ammonia for the manufacture of methamphetamine.

ome Immediate Effects of Exposure to Anhydrous Ammonia

  • Coughing
  • Hoarseness
  • Upper airway obstruction
  • Fluid in the lungs
  • Chest pain
  • Runny nose
  • Tearing in the eyes
  • Impaired vision
  • Dizziness
  • Shortness of breath
  • Headache
  • Dizziness
  • Eye irritation
  • Headache
  • Burns
  • Skin irritation - redness, blisters
  • Nausea
  • Vomiting

Inhalation of anhydrous ammonia may result in human and wildlife fatalities: Minot, ND derailment, ILDH is 300 ppm, 1 human death, numerous wild and domestic animals (potential for economic damage). Anhydrous ammonia is a refrigerant gas, a powerful dessicant and removesw ater from living tissues (burns, mummification).

 

Emergency Medical Information
  • CAS # 7664-41-7; UN 1005 (anhydrous gas); Ammonia solutions: UN 2672 (12 to 44%), UN 2073 (>44%).
  • Ammonia as a gas presents no risk of secondary contamination outside the hot zone.
  • Liquid ammonium hydroxide can contaminate responders either directly or through off-gassing.
  • Odor and irritating properties: As its odor threshold is 5 ppm or 10 times lower than the OSHA PEL, it can warn of its presence before injury occurs.
  • Unfortunately, olfactory fatigue occurs rapidly and exposures can rapidly progress to fatal levels (IDLH at 300 ppm).
  • Ammonia has a vapor density LT 1 (0.59) so it should rise (lighter than air) BUT vapors of liquefied gas in an uncontrolled release are much more dense and this leads to puddling in low spots, and a great risk of asphyxia
  • Children are at greater risk due to relatively higher lung surface and minute volume to wt ratio and shorter stature.

Risk of emergency department contamination is low, predominantly from vomitus (ingestion), clothing, unwashed skin & hair. Usually seen are contact burns, airway obstruction, and compromised respiration (A & B of the ABC’s). There is no antidote and care is supportive, focused on ABC’s. ABC Reminders: quickly access for a patent airway, ensure adequate respiration and pulse. If trauma is suspected, maintain cervical immobilization manually and apply a cervical collar and a backboard when feasible.

The document "Medical Management Guidelines for Acute ChemicalE xposures" by ATSDR is an excellent emergency medical resource for ammonia and other chemical exposures . Also, public health and emergency personnel may contact the ATSDR Emergency Response Center 24 hours a day at1 -404-498-0120.

Pre-hospital Care:

  1. Responders should carefully observe the Hot Zone protocol: only thoset rained & properly attired should enter.
  2. Respiratory Protection: SCBA or supplied air.
  3. Skin Protection: no exposed skin (level A).
  4. Victim Removal: ambulatory patients should be lead to decontamination zone.
  5. Non-ambulatory patients should use backboards or gurneys to move to decontamination zone.
  6. Children may require special measures tor educe separation anxiety.

Decontamination

  • Remove clothing & personal effects - identify & double bag (security, wrist tag, patient label).
  • Provide privacy screens (media peeps) & blankets.
  • Flush skin/hair with water and mild soap at least 5 minutes.
  • Remove contacts (if possible) & irrigate eyes with water or saline at least 15 minutes, check and note eye pH.
  • DO NOT INDUCE EMESIS.
  • DO NOT GIVE CHARCOAL.
  • 4-8 oz of milk may be given if patient is conscious, able to swallow and has ingested ammonia.

Transport
  • transport for evaluation burn victims, ingestion exposures and those in respiratory distress or irritation.
  • Release those asymptomatic exposed to ammonia gas - not likely to develop complications.
  • Only decontaminated patients should be transported by ground ambulance.
  • FAA Rules prohibit air transport.
  • No use of "body bags"
  • Prepare for emesis (towels, bags) in transit.

Hospital Care
  • Verify Patient Decontamination.
  • ABC’s are VIP!
  • ET tube or surgical airway.
  • Bronchodialater drugs ok with ammonia.
  • Children with stridor: racemic epinephrine aerosol 0.25–0.75 ml of 2.25% x 20 min.
  • Ophthalmic anesthetic (0.5% tetracaine) for blepharospasm.
  • Use lid retractors for irrigation under the eyelid.
  • Patients who are comatose, hypotensive, having seizures or have cardiac arrhythmias should be treated in the conventional manner.
  • Observe patients carefully for 6 to 12 hours for signs of upper-airway obstruction. Patients who have had a severe exposure may develop noncardiogenic pulmonary edema.
  • Eye exposures: continue irrigation for at least 15 minutes or until the pH of the conjunctival fluid has returned to normal. Test visual acuity. Examine the eyes for corneal damage and treat appropriately. Immediately consult an ophthalmologist for patients who have severe corneal injuries.
  • Endoscopy to evaluate gastrointestinal-tract injury.
  • Endotracheal intubation or cricothyroidotomy if throat swelling.
  • No antidote. Corticosteroids to limit esophageal scarring is unproven and may be harmful. Hemodialysis is not effective.
  • No specific test. Routine laboratory tests - cbc, glucose, and electrolyte determinations. Chest radiography and pulse oximetry/ arterial blood gas.
  • Admit patients with respiratory distress, burns or ingestion for delayed effects.
  • Patients exposed by inhalation who are initially symptomatic should be observed carefully - pulmonary injury 18 to 24 hours.
  • Acute ocular exposure to ammonia may result in persistent intraocular pressure, cataract formation, and glaucoma with significant reduction in visual acuity.
  • Release asymptomatic patients and treated, mild exposures.
  • Advised to seek medical care promptly if symptoms recur or develop.
  • Advise no cigarette smoking for 72 hours after exposure.

 Patient Follow Up
  • Send copy to patient’s primary care physician
  • Reexamine in 24 hours patients with mild to moderate skin burns.
  • Reexamine patient’s eye injuries in 24 hours.

Reporting
  • To company personnel.
  • To state/local health department, If appropriate.
  • OSHA or NIOSH.

Conclusion
Hazmat professionals, first responders and emergency medical personnel can expect an increasing incidence of ammonia exposures, both from intensive agricultural operations and illegal activities. Anhydrous ammonia injuries are immediate (dessication, chemical burns) and present low risk of secondarye xposures. Treatment is supportive and the ABC's are essential. As illegal activity may be involved, responders to an anhydrous ammonia release need to be aware of the potential reluctance of individuals to seek immediate medical care.

More Information
NASD: Chemicals/Pesticides: Anhydrous Ammonia
Anhydrous Ammonia Properties
Toxicology Profile for Anhydrous Ammonia (PDF Doc.)
ATSDR Anhydrous Ammonia Facts
ATSDR Information Center: 1-888-422-8737
ATDSR Emergency Response Center: 1-404-498-0120


1st Response –

The attached article was very informative for emergency response personnel. What everyone must remember is that the anhydrous ammonia is also flammable and can explode if confined. It is not listed as flammable or combustible, but we have had a few incidents where it was released inside a building and exploded. Two Haz Mat fire fighters were killed in Shreeveport, Louisiana about 30 years ago when they were attempting to shut a valve and contain a leak in a refrigerated building. The gas cloud ignited and the resulting explosion killed both Fire Fighters. In Houston about 25 years ago at an ice cream factory, just as the Houston FD arrived on the scene, the building exploded and the front wall was blown off of a 4 story building.

Do not let your guard down, this stuff is not only dangerous if inhaled, it can cause bad burns, and can even be flammable.

It is carried in LPG trucks and railroad cars in the summer time. In the winter they change back to LPG.


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