NH3: Not your Mom’s cleaning ammonia

HMN-On the heels of the Ammonia leak in Boston that resulted in the death of an industry worker, let’s review ammonia. Do you and your crew review the symptoms of exposure on scene and do the EMS responders get that information? Many resources are available to the first responder. Just a few examples of these would be the CDC website or smartphone apps like WISER® which are helpful resources on scene. For obvious reasons, household ammonia products usually contain between 5% and 10% true ammonia, where industrial or agricultural applications may be 100% pure NH3. Ammonia may be referred to as ammonia gas, anhydrous ammonia, and liquid or liquefied ammonia. Ammonia containing water solutions are referred to as aqueous ammonia, ammonia solution, and ammonium hydroxide.

There is no specific antidote for any ammonia poisoning. Following your local medical protocol is always the preferred method. Treatment often consists of supportive measures only. On scene EMS often includes Basic Life Support (BLS) administration of humidified oxygen (when available) and Advanced Life Support (ALS) bronchodilators and advanced airway management when needed; treatment of skin and eyes with copious irrigation remembering that adding water to ammonia makes ammonium hydroxide. Copious amounts of water will dilute the solution to a minimal concentration easing the . No matter if you are rural or industrial, preplan, train, repeat…

Symptom Review of Ammonia exposure:

1.Respiratory symptoms are the most commonly seen and treated in the prehospital setting. Factors that determine the injury extent include. The amount of time the victim is exposed, the depth and rate of inhalation by the victim, and the concentration of the ammonia gas exposed to the victims respiratory tract. Even fairly low concentrations (50 ppm or less) of ammonia produce rapid onset of eye, nose, and throat irritation; and narrowing of the lower airways inducing a cough and a distinct wheeze.
2.More severe clinical signs include immediate narrowing of the throat and swelling, causing upper airway obstruction and accumulation of fluid in the lungs. Mucosal burns to the tracheobronchial tree can also occur. Immediate onset of laryngospasm with respiratory arrest can occur prior to exposure of the IDLH (300ppm).

*Always refer to your local medical control or prehospital protocol for patient treatment procedures.

The Center for Disease Control provided the following facts:
Persons exposed only to ammonia gas do not pose significant risks of secondary contamination to personnel outside the Hot Zone.Persons whose clothing or skin is contaminated with liquid ammonium hydroxide can secondarily contaminate response personnel by direct contact or through off-gassing ammonia vapor.Ammonia dissolves readily in water to form ammonium hydroxide a corrosive, alkaline solution at high concentrations.Ammonia’s strong odor and irritating properties usually provide warning of its presence; however, olfactory fatigue can occur and continued inhalation can result in fatal exposure. If you have an exposure, you should call your local emergency number (such as 911) or the National Poison Control Center at 1-800-222-1222.WARNING: Never mix ammonia with bleach. This causes the release of toxic chlorine gas, which can be deadly.

 

More specific information can be found on the Agency for Toxic Substances and Disease Registry (ATSDR) page.

Check out blog:

Ammonia Release Incident – Plan of Action

HazMat Front_cover_final_4-8-14.indd

About The Author

Jason Rogers is the Emergency Management Director in Muncie/Delaware County, Indiana. Jason has served 20 years as a paramedic and currently holds a dual role as the Director of EMS. As a paramedic, he served as the MCI medical coordinator and later, the commander for the Indiana Department of Homeland Security District 6 Response Task Force. Jason currently serves as the County Hazmat Coordinator and is a hazardous materials technician. Delaware County EMS staffs a Variable Incident Pre-hospital Emergency Response (VIPER) Team which provides MCI, Hazmat, and SWAT medic services in East Central Indiana. In 2016, Jason was appointed by the Indiana Governor to the Board of Firefighting Personnel Standards and Education. Jason is married and has two teenagers who are multi sport athletes.

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