Unintenonal Occupaonal Irritant and Asphyxiant Gas Exposures Margaret Cook-Shimanek, MD, MPH1, Sahaphume Srisuma, MD2,3, and Christopher Hoyte, MD1,2 1University of Colorado, Denver, CO 2Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, Colorado 3Ramathibodi Poison Center, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Introducon Results, connued Conclusions Figure 1: Call Frequency by Reported Gas Exposure, 2000-2014 • Occupaonal exposures to irritant and asphyxiant • Need for addional workplace controls to Carbon Monoxide Chlorine Gas Hydrogen Sulfide (Sewer Gas) Methane and Natural Gas Simple Asphyxiants hazardous gases are common. 600 prevent hazardous gas exposures 562 • Improper chemical mixing pracces and • Some gases are known to result in morbidity and 534 514 500 inadequate venlaon are contribung mortality, therefore characterizing these 486 460 factors to hazardous gas exposure unintenonal exposures may direct efforts for 450 428 workplace controls. 431 432 • Most exposures resulted in mild health 400 396 383 366 effects manageable with minimal 343 343 361 Research Objecves 353 342 348 335 intervenon, but serious health effects can 317 319 309 300 307 occur, including death • Describe characteriscs of occupaonal irritant 278 252 and asphyxiant gas exposures. 244 Limitaons 222 223 231 226 213 201 217 200 168 • Idenfy gases of greatest concern to direct hazard 180 178 • No access to case notes for specific cause NUMBER OF CALLS BY GAS EXPOSURE TYPE 167 163 145 156 148 prevenon and reducon efforts. 157 121 142 150 or follow up informaon 136 134 128 123 112 116 125 147 127 100 108 111 118 94 119 118 104 • Not all exposures confirmed with 96 96 75 Methods 67 76 biological tesng 62 76 59 53 64 61 64 66 56 • Passive surveillance underesmaon • Design: Retrospecve cohort analysis 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 • Data source: Naonal Poison Data System (NPDS) YEAR Discussion & Public Health Implicaons • Study period: 01/01/2000 through 10/31/2014 • NPDS captures health exposures • Populaon: Unintenonal occupaonal exposures managed on-site & at healthcare facilies Clinical effect (n=47,002) Level of care required (n=15,133) to irritant or asphyxiant gases reported to the NPDS • Informs several levels of exposure • Headache: 6,997 (14.9%) • Evaluate/treat & release: 11,888 (78.6%) prevenon efforts & clinical care Results • Nausea: 4,982 (10.6%) • Non-crical care: 1,055 (7.0%) • Average number of gas calls per year: 1,357 Dizziness: 4,641 (9.9%) • Crical care: 656 (4.3%) Eliminaon of gas-powered heang devices Demographics • Cough or choke: 4,457 (9.5%) Treatment (n=31,735) Substuon of cleaning chemicals • Males: 14,177 (69.6%) (n=20,357) Scenario (n=2,053) • Fresh air: 11,064 (34.9%) • Poor venlaon: 747 (36.4%) • Oxygen: 7,365 (23.2%) Engineering controls to • 20-49 years of age: 16,826 (82.7%) (n=20,357) improve venlaon • Mixing products: 489 (23.8%) Medical Outcome (n=20,357) Route of exposure (n=21,704) Administrave controls to detect gas • Management site (n=20,357) • Minor effect: 12,401 (60.9%) Inhalaon or nasal: 17,994 (82.9%) Training on • Healthcare facility: 15,133 (74.3%) • Moderate effect: 6,078 (29.9%) monitor • Dermal: 1,640 (7.6%) response • • On-site: 4,923 (24.2%) • Death: 61 (0.3%), 35 resulng from Ocular: 1,057 (4.9%) PPE hydrogen sulfide (H2S) exposure