Occupational Health Services Medical and surgical management in every case of industrial injury or disease should aim to restore the disabled worker to his former earning power and occupation as com pletely as possible and without unnecessary delay Concise, dependable medical re ports that are promptly submitted to those agencies entitled to them are a part of this obligation In the same way, equitable ad ministration of workmen's compensation rests on medical testimony which adheres closely to reasonable scientific deductions regarding the injury or its possible conse quences The industrial physician is responsible for maintenance and completeness of medical records Records and reports are a necessary part of an occupational medical program Comprehensive records must be kept and re ports rendered m order that management be guided in their continuing responsibility for health and safety, and the employees kept in formed of the degree of success of the safety program afforded by their cooperation Rec ords and reports are necessary to direct and evaluate preventive medical and safety engi neering techniques They are necessary to chart progress in the reduction of accidents The physician is also responsible for prop erly instructing nurses and other paramedical personnel (such as first-aiders) and directing their activities Their duties, therefore, should be described in clear, concisely writ ten directives, a copy of which should be posted in the medical department There must be no delegation of services requiring expert medical attention The industrial physician, nurse, and safety director should concur with management to plan for emergency handling of large num bers of seriously injured employees in the event of disaster, such as explosion, fire, or other catastrophe These plans should be coordinated with community plans for such events See "Planning for Emergencies," Chapter 37 Procedures should include selecting, train ing, and supervising auxiliary personnel, and should provide for 1 Selecting and training auxiliary nursing personnel 2 Selecting and training first aid workers 3 Transporting and canng for the injured 4 Transferring seriously injured to hospitals (where operating rooms and blood trans fusions are available, donors could be arranged for) 5 Coordinating these plans with the safety department, guards, police, road patrols, fire departments, and other interested community groups Duties of the occupational health nurse Occupational health nursing is a special ized branch of the nursing profession The position requires a registered professional nurse, who is licensed in the state where employed In addition, it is desirable that the occupational health nurse have some knowledge of workmen's compensation laws, insurance, health and safety laws, occupa tional diseases, sanitation, first aid, and rec ord keeping The occupational health nurse contributes the most when she works with the company physician who provides her with written di rectives that have been discussed between them, so they are mutually agreed upon and understood Working with the physician, the occupa tional health nurse can provide a variety of nursing services, such as initial care for in juries or illnesses, counseling, health educa tion, consultation about sanitary standards, and referral to community health agencies She also can participate in programs to eval uate employee health, such as health exam inations, or to prevent disease, such as im munizations When the physician is only located at the plant part time, the nurse is responsible to him on professional matters, and to a mem ber of management on administrative matters In this case, the nurse works with the safety director m planning and conducting accident prevention programs The occupational health nurse must main tain a confidential professional relationship with the employees m conformity with legal and ethical codes She may not divulge in formation contained in individual employee health records unless the employee gives his signed permission, the medical files are only accessible to medical personnel It must be clear that establishment of medi cal diagnosis and definition of treatment are 1226

1313 Substance *' Heptane (n-heptane) Hexachloroethane--Skin * Hexachloronaphthalene-Skin Hexane (n*hexane) 2-Hexanone Hexone sec-Hexyl acetate Hydrazine--Skin Hydrogen bromide C Hydrogen chloride Hydrogen cyanide --Skin Hydrogen ftuonde Hydrogen peroxide 90% Hydrogen selemde Hydrogen sulfide Hydroqumone C Iodine Iron oxide fume Isomyl acetate Isoamyi alcohol Isobutyl acetate * Isobutyl alcohol Isophorone Isopropyl acetate Isopropyl alcohol Isopropylamine Isopropylether isopropyl giycidy!

Elements of Industrial Toxicology the eyes, nose, throat, and lungs Dichloromethane --see Methylene chlo ride.

or into the pores of a concrete floor, the con tamination may become so great as to necessi tate replacement or sealing of the floor before the plant or laboratory can be safely used again Although it cannot be removed, mer cury can be sealed into such floors by cover ing them completely with an asphalt mastic, preferably after the vapor pressure of the mercury has been reduced by flooding the whole area with a lime sulfur spray To prevent such inconvenience, metallic mercury should be handled over impervious tables or containers with the surfaces de pressed and arranged to drain to a central point Spilled mercury can then be collected and returned to stock A number of volatile mercury compounds are used in seed disinfection Examples are ethyl mercury chloride and phosphate and the corresponding phenyl mercury com pounds These materials are highly toxic When used without adequate enclosure and dust control, they can rapidly produce severe mercurial intoxication These seed-treating compounds are also strong primary skin irri tants and will cause itching, burning, and blistering on direct contact Such irritations heal slowly The type of mercurv intoxication common to industry is characterized by a tremor of the hands, irritation of the mucous membranes of the mouth, excessive flow of saliva, and changes in the personality Poisoning by one of the volatile compounds may be more rapid so that personality changes are not so likely to be seen Inhalation of mercury vapor, usually in very high concentrations, mav produce metal fume fever, which may disappear with no other apparent symptoms, or may be followed by a pneumonitis or other symptoms of mercunalism The ordinary toxic dust respirator does not protect against intoxication by metallic mer cury or by the volatile seed-treating com pounds, since they are in the form of vapor rather than dust A gas mask offers some pro tection, but if enclosure and local exhaust are not possible, the only effective protection is a supplied air respirator See Industrial Data Sheet 203 and Hygtemc Gutde Mesityl oxide is a high-boiling, unsaturated ketone which is thought to be somewhat more toxic than the ketones of lower molecular weights Metal hydrides (primary types) are com pounds of hydrogen and the alkali metals sodium, potassium, lithium, magnesium, cal cium, and strontium Information on the health hazards of metal hydrides is limited Since they react with water to form caustic hydroxides, they are irritating to the eves, skin, and mucous membranes They also re lease a large amount of heat on reaction with the moisture of the skin See Industrial Data Sheet 462 and Hygienic Gutde Methanol (methyl alcohol) poisoning is usually produced bv swallowing the liquid or inhaling high concentrations of vapor in an enclosed place such as a tank The signs of poisoning include headache, nausea, vomit ing, violent abdominal pains, aimless and erratic movements, dilated pupils, sometimes delinum, and such eye symptoms as pain, tenderness on pressure, and occasionally blindness Direct action of the liquid or the vapor on the skin and mucous membranes may pro duce an irritation and inflammation One of the peculiarities of methanol poi soning is its exceptionally severe action on the optic nerve About one-half of all the serious cases of methanol poisoning result in some impairment of vision, which is usually permanent and may vary from dimness or blind spots scattered through the visual field to total blindness See Industrial Data Sheet 407 and Hygienic Guide Methoxychlor (2,2-di [ p-methoxypheny1 ] 1,1,1-tnchloroethane) is a synthetic insecti cide which is closely related to DDT m its action It is, however, about '/ to `/io as toxic as DDT Consequently, the hazard from in halation of the dust or mist of sprays of this insecticide is remote Methoxychlor is not absorbed through the intact skin in significant amounts, and does not seem to have any effect on the central nervous system In animal experiments, con tinued feeding of diets containing methoxy chlor m toxic concentration leads to loss of weight in the animals by their voluntary re striction of food intake and also to fatty m- 1357

Ionizing Radiation TABLE 44-D MAXIMUM PERMISSIBLE FLUX FOR OCCUPATIONAL EXPOSURE TO VARIOUS TYPES OF IONIZING RADIATIONS* Type of Radiation QF` Average Exposure Rate\ (mradlwk) Approximate Flux to Give a Maximum Permissible Exposure in an 8-hr Dayt X and gamma rays Beta rays and electrons Thermal neutrons Fast neutrons Alpha particles Protons Heavy ions 1 1 25 10 10 10 20 100 100 40 10 10 10 5 1 '4g00 photons/sq cm/sec in free air at 0 deg C (error < 13 per cent for E = 0 07 to 2 Mev) 4 3 x 10* "(QF)P e,ectrons or 1)6,3 rays/sq cm/sec incident on tissue ( = 23 electrons or 15 /8/sq cm/sec of 1 Mev energy) 700 thermal neutrons/sq cm/sec incident on tissue 19 neutrons of 2-Mev energy/sq cm/sec incident on tissue 4 ~3|qxf)1pflT alpha particles/sq cm/sec incident on tissue ( = 0 005 alpha of 5 Mev/sq cm/sec) 43|qXpj1p07 protons/sq cm/sec incident on tissue ( = 0 06 protons of 5 Mev/sq cm/sec) 4 3 x 107 heavy lons/sq cm/sec ( = 0 0002 oxygen ions of 5 Mev/sq cm/sec) NOTES `Values of flux corresponding to dose values as recommended in 1959 by the National Committee on Radiation Protec tion and by the International Commission on Radiological Protection " Quality factor formerly relative biological effectiveness (R6E) tAverage occupational exposure rate permissible to blood-forming organs (essentially total body exposure), gonads, and eyes of persons of age 18 or over These values may be averaged over a year, provided the dose equivalent in any thirteen weeks does not exceed 3 rem (rem = QF x rad) All values in columns 3 and 4 may be increased by a factor of 3 if the exposure is limited to organs other than blood-forming organs, gonads, or eyes t Maximum permissible exposure rate based on a 20-mrem dose equivalent delivered to tissue in an 8-hr day (= 2 5/QF mrad/hr) and assuming IV = 35 for alpha and 34 for beta and secondary electrons The rad in soft tissue is considered to correspond to an energy absorption of 100 ergs/gm The P is the stopping power in units of electron volts/gm/sq cm of soft tissue From A H Snell Nuclear Instruments and Their Uses, New York, N Y , John Wiley b Sons Inc , 1962 exposures of nonemployees in uncontrolled areas be regulated so as to make it improbable that any individual will receive a whole body dose of more than 0 5 rem (500 millirems) during any one year ' Internal emitters Guide levels of dosage from internal emitters are calculated with care and should be applied as a guide for evaluating operations They are essentially opinions (based on the best available informa tion at the time of publication) or interpre tations of experimental animal data together with some human data relating exposure dose to biological effects which are likely to occur within the lifetime of the human being The 1462

installation should be used In some instances (e g , where large pieces must be handled), a radiography room is not practical An area within the plant must be roped off and posted with warning signs or otherwise barricaded to prevent unauthorized personnel from entering the area Sometimes it has been found that segregating the opera tion with respect to time is the only solution to this problem, that is, to perform radiog raphy at night or other times when there are no other workmen m that part of the plant Others have solved the problem by fencing off an open area outside the buildings m such a manner that unauthorized persons cannot enter the high radiation zones Similar measures must be taken to restrict areas where radiography is performed in the field Radiation safety problems in field radi ography can be complicated by the curiosity of bystanders, the presence of other unin formed workers on the project and possible temporary misplacement of a "free" gamma source In such field applications as radiog raphing welds on pipelines, pressure tanks, refineries and other construction projects, there should be a thoroughly trained radia tion safety supervisor in charge of the work He is responsible for maintaining adequate precautionary measures to prevent unneces sary exposure of personnel Radiation warning signs should be posted and restrictive barriers erected to control traffic in the vicinity of an exposed source The warning sign should include (a) DangerRadiation, Keep Away (Do Not Loiter) and (b) the radiation symbol, Fig 44-15 Radiation safety rules should be explained to the workers and their cooperation enlisted m maintaining a safe standard of operation Where a project may be delayed by restricting the area to other workers, here again, con sideration should be given to making radiog raphs at odd hours when few or no other per sons are around The contractor should be made aware of the safe limits of radiation ex posure so that unreasonable production sched ules are not requested Generally speaking, the most important item with regard to field radiography is to make sure that the restricted site is always under surviellance by the per son in charge so that unauthorized workers, bystanders, or curiosity seekers do not enter An appropriate survey instrument should 3R FlC 44-15 --The American Standards Institute recommends this symbol for radiation warning signs Symbol should be reddish-purple, displayed against a yellow background and should be accom panied by the word "RADIATION" in yellow let ters on reddish-purple panel Radiation signs should be proportioned the same as "danger" signs and sized according to the area to be marked See ASI Standard N2 1 "Radiation Symbol " be immediately available at each field in stallation Radiation surveys of the radiog raphic setup for the purpose of establishing working times within the area should be a routine procedure m the field A survey gives the operator a quick means of determining dose rates around the site and determining where restrictive barriers should be placed Personnel monitoring, such as film badges, s also essential for those workers engaged m routine radiographic work Although misplacement ofradiation sources is not to be tolerated, it is possible for them to be accidentally dropped behind equipment and in locations where the capsule is not vis ible Small sources should therefore be tagged or labeled Where a source is mis placed, every effort should be made to re cover the source immediately without over exposure to personnel Without the use of a survey instrument, such as a geiger or scin tillation counter, it would be difficult, if not 1471

Ionizing Radiation References "Decontamination'' literature Huff, John B "Decontamination Techniques for Small Equipment" Nucleonics, 11 151-153 (Nov 1961) Sachs, F Skm Decontamination Washington, D C , Atomic Energy Commission Research Report Y-914, Oct 22, 1952 "Radioecology" literature Bernard, S R "Maximum Permissible Amounts of Natural Uranium in the Body, Air and Drink ing Water Based on Human Experimental Data " Health Physics, 1 288-305 (Dec 1958) Blat7, H Radiation Hygiene Handbook New York, N Y , McGraw-Hill Book Co , 1959 1CRP Committee "II Report on Permissible Dose foi Internal Radiation (1959) " Health Physics (June 1960) Mannelli, L D , and others `The Quantitative Determination of Camma-Ray Emitting Elements in Living Persons " American Journal of Roentgenology, Radium Therapy and Nuclear Medicine, 73 661-671, 1955 Miller, C E , and L D Mannelli "Low Intensity Spectrometry of the Gamma Radiation Emitted by Human Beings " Second U N International Conference on Peaceful Uses of Atomic Energy New York, United Nations, Department of Public Information Paper A/Conf 15/p/762, 1958 Morgan, K Z "Current Status of the Internal Dose Problem " Health Physics, 1 125-135 (Sept 1958) Schultz, Vincent, and Alfred W Klement, eds Radioecology American Institute of Biological Sciences New York, N Y , Reinhold Publishing Corp , 1963 "Experience of atomic energy industry" literature Atomic Energy Commission, Office of Technical Services, Washington, DC A Summary of Incidents Involving Radioactive Material in Atomic Energy Activities, Jan -Dec 1956 Research Report TID-5360 and Supplement, Aug 1957 A Summary of Incidents Involving USAEC Shipments of Radioactive Material, 1957-1961 Research Report TID-16764 and Supplement, 1962 Journals and periodicals On English) AMA Archives of Industrial Health American Medical Association, 535 North Dearborn St, Chicago, III 60610 American Industrial Hygiene Association American Industrial Hygiene Association, 1014 Broadway, Cincinnati, Ohio Health Physics Oak Ridge National Laboratories, Oak Ridge, Tenn International Journal of Applied Radiation and Isotopes Pergamon Press, 122 East 55th St, New York, N Y Nuclear Instruments and Methods North Holland Publishing Co , Box 103, Amsterdam, The Netherlands Nuclear Safety U S Government Printing Office, Washington, D C 20402 Nuclear Science Abstracts Atomic Energy Commission Available U S Government Print ing Office, Washington, D C 20402 Nuclear Science and Engineering American Nuclear Society Available Academic Press, Inc , 111 Fifth Ave , New York, N Y Nucleonics McGraw-Hill Inc , 330 West 42nd St, New York, N Y 10036 1504

Type of dust Ignition temp of dust cloud (degC) Win spark energy required for ignition of dust thud (mithjoules) Min ex plosive concen tration (oz per 1 000 cuft) Max explosion pressure <pst) Vinyl butyral resin Vinyl chlonde-acrylonitnie polymer Vinyl copolymer resin Agricultural products Alfalfa Cellucotton Cinnamon Citrus peel dehydrated Clover seed Cocoa Corncob meal Cotton seed Furfural residue Grain dust Lycopodium Nut shells Omon dehydrated Pea dehydrated Potato starch Pyrethrum Soybean Tung Wheat dust Wheat flour Yeast Miscellaneous Adipic acid Aluminum stearate Asptnn Bark dust (Douglas-fr) Beryllium acetate Calcium lignin sulfonic acid Carbon activated Casein rennet Cellulose Charcoal (pine wood) Coal low volatile Coal medium volatile Coat high volatile (Pgh seam) Coal, subbitummous Diazoaminobenzine Dmitro-ortho-cresol Diphenyl Gi Isolate Hexamethylenetetramine Lactalbumin Lignite Uver protein Napalm Paraformaldehyde Peat sphagnum Pentaerythntol Phenothiazme Phthalic anhydride Phytosterol 450 390 530 500 460 440 440 490 470 420 410 400 380 470 400 440 430 500 460 420 410 560 420 440 460 440 520 350 440 470 380 520 550 400 660 540 620 590 660 520 460 620 635 605 610 455 470 550 440 650 560 410 570 440 520 450 410 460 450 540 650 330 BO 10 15 60 320 60 40 45 80 100 160 60 30 80 40 40 30 60 40 SO 40 35 25 60 40 50 30 240 50 50 SO 70 15 25 40 100 100 80 80 120 60 60 45 20 80 60 25 10 SO 60 45 40 20 50 10 15 10 70 85 20 601 35 85 100 40 100 65 50 100 40 115 60 100 60 60 45 62* 85 50 30 120 40 110 55 90 40 105 40 105 55 95 40 105 25 85 30 105 130 60* 50 100 75 110 45 95 too 80 45 95 35 100 35 90 70 110 70 105 50 95 so 105 35 75 15 95 35 85 30 90 60 60 160 60 40* 45 65 55 100 40* 45 120 60 55 85 45 95 35 100 15 90 25 55* 35 55 20 90 15 100 40 90 45 90 45 60 20 85 40 100 45 85 30 90 15 80 15 70 25 75 Rates of pressure nse (psi per sec) Avg Max Limiting oxygen percentage to prevent ignition of dutt cloud by electric sparks 800 500 1 700 200 500 900 1 400 1 200 400 550 150 1 200 2.200 800 1 800 1 400 t 000 1 400 2 300 1 900 400 2100 1 600 2 300 GOO 1 000 1 200 1 600 1 400 1,500 1 200 1 000 1 200 1 200 2000 2900 600 600 200 400 1 100 200 300 300 600 1,200 2 000 2900 1300 400 1200 2400 900 600 BOO 1 000 2 500 900 1700 1.400 1 300 1 500 2 000 1 000 4 500 500 1 000 3000 4 000 3 000 1 000 1200 250 3 750 6 750 2500 7 000 4 000 2 750 4 750 7 000 4 000 1250 6 000 8 000 8000 1 500 2 750 3250 5 000 3500 3,500 3 750 2500 2 750 4 750 10 000+ 9500 2000 2 000 300 1 000 2 750 250 600 600 2250 3 000 5500 10 000+ 2250 1 500 3750 10000-12 750 2750 2250 3000 10000+ 2250 9 500 4 250 4250 8000 17 14 15 13 to 15 13 15 17 17 13 18 16 15 14 13 15 12 14 16 14 I 1611

MetalStamping--Chairmati--Ahvma B, Auerhaan, Corp.

j. 1970 National Safety Congress . , , Eastern Safety Equipment Co., Inc., 19-79 Stcihway St, New York; N.

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f) The requirements or subsection (b) shall only apply to hulk gasoline plants: 1) That-have an annual gasoline throughput greater than or equal to 1.000.OOP gallons, as averaged over the preceding three calendar years: and 2) That either- distribute gasoline td gasoline dispensing facilities subject to the requirements of Section 215.583(a)(2) or that are located In the following counties: Boone.

20 O' That asbestos brake linings (friction material) may be used In a brake system when the friction material operates In cither a dry or oil-wetted environment in a totally enclosed brake compartment which prevents the emission of brake wear products into the ambient air. 2.

and some had left these areas of exposure as young children.

would have to sell its short fibers.