Gas & Oil Pakistan Limited

Doc. # GO-OPS-MHK-006
Revision #: 00
First Aid Box Date: November 1, 2019
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First Aid Box

REVISION NO.: 00

REV. DATE: 30.11.2019

Prepared By Reviewed By Approved By

Nouman Ameer M. Hanif Sultan M. Fasihuddin
Name & Signatures
____________ ____________ _____________

Installation Manager
Designation DGM Operations Head of Operations
MHK Terminal

Date 30.11.2019 30.11.2019 30.11.2019

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DOCUMENT CHANGE RECORDS

PAGES
REV. NO DATE OF REV. BRIEF DESCRIPTION OF CHANGES
EFFECTED

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PURPOSE
The purpose of this procedure is to provide brief and clear instructions for first aid
personnel and others who have to deal with casualties.

SCOPE
This procedure describes the immediate methods to be used to deal with casualties,
predominantly after exposure to chemicals.

RESPONSIBILITY
The employee discovering a casualty is responsible for this procedure being followed.
Competent persons trained in First Aid are responsible for immediate first aid attention.
The Admin / HR are responsible for ensuring adequate resources are provided for first aid
both in terms of trained personnel and equipment.

PROCEDURE
This procedure provides guidance on the immediate first aid to be administered after
various types of injuries or contact Emergency Responses Team.
Always use barriers, such as latex gloves, masks and CPR shields, to prevent the
transmission of diseases.

CHEMICAL CONTACT FIRST AID

The chemical the victim has been in contact with shall be identified and the requirements
for immediate first aid should be checked on the Material Safety Data Sheet. The person
administering first aid should ensure that they are protected from contact with the
chemical by using the appropriate PPE specified.
The routes by which chemicals cause adverse health effects:
 Touches the skin - Skin Contact or Skin Absorption
 Gets in the eye - Eye Contact
 Is swallowed – Ingestion
 Is breathed in – Inhalation
 Penetrates the skin – Injection (either by high pressure or through an open wound)

If the specific first aid requirements are not known a general guide is as follows:
The majority of accidents and incidents involving chemicals do not result in the
development of severe symptoms. However, it is important to be able to identify the
substance involved and be aware of its potential effects, check the label, MSDS or
Chemical Information Tag.
Note that some chemicals may cause delayed effects.

SKIN CONTACT
Chemical spillage onto the skin is very common and may cause irritation with redness,
pain or itching (dermatitis), or chemical burns and blistering with corrosive chemicals.
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Chemical burns can occur after contact with solids, liquids or fumes. Some chemicals can
be absorbed through the skin causing generalized symptoms of poisoning, such as
nausea, vomiting, and difficulty in breathing or unconsciousness. A corrosive chemical
causes redness and pain at the site of contact with rapid blistering and destruction of the
skin in severe cases. Allergic or injection injuries can cause whole body (systemic) effect;
immediate medical attention must be obtained. Delay can turn a minor accident into a
major poisoning. The immediate first aid action described below should be followed.

Immediate First Aid:

 Remove all chemically contaminated clothing and shoes immediately, unless stuck
to the skin.
 Drench the affected area with running water for at least 10 minutes; repeat if the
chemicals are still present.
 Check for burns and general symptoms of poisoning and arrange for transport to
hospital or medical facility if required.

EYE CONTACT
The eye is very delicate. Poisonous or corrosive chemicals can damage it very quickly
causing temporary or permanent blindness. Speed is essential.
Emergency treatment must be performed at once to prevent permanent damage. Alkaline
materials such as caustic materials and lime are particularly hazardous to eyes,
immediate first aid is essential to prevent the potential of permanent eye damage

Immediate First Aid:

 Wash the chemical out of the eye, while holding the eyelids open, for at least 10
minutes. If the Chemical is an alkaline material, continue to rinse until medical
attention is available.
 Transfer to hospital for detailed eye examination.

INGESTION
When dangerous chemicals are swallowed, they may be absorbed into the bloodstream
through the stomach, causing symptoms throughout the body. Alternatively, they may be
corrosive, causing local burns to the mouth, gullet and stomach. Many chemicals are both
poisonous and corrosive; the following treatment should be used. Products containing
solvents may be aspirated into the lungs if vomiting occurs check the MSDS for specific
requirements.

Immediate First Aid:

 Do NOT make the casualty vomit.
 If unconscious:
 Do not give anything by mouth.

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 Check for breathing, pulse and heartbeat - give artificial ventilation/ chest
compression if required.
 If breathing and pulse are normal, place in recovery position.
 If conscious:
 Give 0.5 Liters of water to drink immediately.
 If the chemical is corrosive, give repeated drinks of water at a rate of a cupful every
10 minutes.
 Transfer the casualty to a hospital or medical facility as soon as possible.

INHALATION
This is a very common and can be a serious form of poisoning because the lungs quickly
absorb hazardous gases, vapors or fumes into the bloodstream causing symptoms
elsewhere in the body.

Immediate First Aid:

 Remove casualty from area of exposure (Wear protective clothing and breathing
apparatus if required).
 If unconscious:
 Do not give anything by mouth.
 Check for breathing, pulse and heartbeat - give artificial ventilation/ chest
compression if required.
 If breathing and pulse are normal, place in recovery position.
 If conscious make the casualty lie or sit down quietly. If the breathing becomes
rapid and bubbly, place in the sitting up position and give oxygen if available.
 Transfer to a hospital or medical facility as soon as possible.

COMBUSTION FUMES
The burning or heating of many chemicals may produce harmful fumes. Often these
fumes contain Carbon Monoxide and Carbon Dioxide and/or are corrosive. If fumes
containing these toxic breakdown products are inhaled, nausea, vomiting, shortness of
breath and unconsciousness may occur. Emergency treatment as for inhalation should be
given. The casualty should be taken to a hospital or medical facility as soon as possible
for observation and treatment.

Welding Fumes
Welding fumes may give rise to symptoms of poisoning particularly in confined spaces or
if adequate precautions are not taken. The most dangerous fumes are nitrogen oxides
(NOx) causing symptoms including coughing and shortness of breath. Some metal alloys
can cause” metal fume fever”; nausea, fever, shivering, headache, muscle pains, and a
dry cough 6-12 hours after exposure. Zinc fumes are particularly hazardous and may

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produce a sudden shortness of breath followed by unconsciousness; the casualty must be

transferred to a hospital or medical facility immediately.

Welder’s Flash (Arc Eye)

An uncovered flash from a welding torch may develop welder’s flash (arc eye) in a welder
or passer-by due to damage to the cornea of the eye. Symptoms usually develop a few
hours after a welding flash with a feeling of intense pain in the eyes. The eyes may feel as
if they are full of sand or pepper and they will appear red and swollen and very watery.
The casualty should be taken to hospital for further treatment with a note of any drugs
given.

Inert Gases
These gases are not harmful in themselves but may cause asphyxia by displacing oxygen
from the atmosphere. Problems most commonly arise when there is a slow leak of gas
into an enclosed area, particularly if the gas is unscented and, therefore, undetectable. If
the gas is heavier than air, e.g. carbon dioxide, it may form a pool in a basement or
trench. Therefore, a casualty found lying unconscious below ground level should not be
approached until the rescuer has put on self-contained breathing apparatus. Emergency
treatment as per inhalation.

GENERAL FIRST AID

Shock
The term shock is used to describe a condition of general bodily weakness caused by a
lack of blood or fluid in the body. Loss of blood may be due to internal or external bleeding
and loss of fluid may be due to major burns, severe vomiting or diarrhea, or illness such
as heart attack. The symptoms are:
o Weakness, faintness and giddiness.
o Extreme pallor, with cold, sweaty skin.
o Rapid, weak pulse and shallow breathing.
o Confusion and restlessness.
o Slow development of unconsciousness.

Immediate First Aid:

 Loosen any tight clothing and insulate the casualty from cold, both above and
below, with a coat or blanket.
 Do not give any drinks or food. If the casualty is thirsty, moisten lips with water.
 If the casualty is conscious, lie him flat on his back. Do NOT sit upright.
 If the casualty becomes unconscious, or if he vomits, place in the recovery position.

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Bleeding
Bleeding may be internal or external. External bleeding occurs from a visible wound and
internal bleeding from blood loss into an internal organ such as the lungs or intestines. In
internal bleeding the blood loss is hidden unless the casualty vomits, coughs up blood or
passes blood. Chemicals, particularly if they are corrosive, may cause internal bleeding,
while external bleeding usually results from cuts or abrasions. An adult can lose up to a
pint of blood without any ill effects. More than this and they will slowly develop the
symptoms of shock. Shock occurring from internal or external bleeding is a serious sign
and the casualty must be taken immediately to a hospital or medical facility.

Immediate First Aid for External Bleeding

 The principle of controlling bleeding is to restrict the blood flow to the wound and
therefore encourage blood clotting. To stop bleeding, the wound should be pressed
with the fingers or the palm of the hand, preferably over a sterile pad or dressing.
 The injured area should be raised and supported above the level of the casualty’s
heart. It may help if the casualty lies down. A sterile pad should be placed on top of
the original pad and bandaged firmly enough to control the bleeding without
impeding the circulation.
 Further padding and bandages should be applied on top of the original dressings if
bleeding continues. Reassure the casualty, call for medical assistance or an
ambulance and closely observe their pulse and respiration.

Immediate First Aid for Internal Bleeding

 Arrange for the casualty to be transported immediately to a hospital, as it is not
usually possible for a rescuer to stop internal bleeding.
 If possible, lie the casualty down and raise the legs slightly. Reassure them and
keep the breathing and pulse under close observation.
 Prepare to give artificial ventilation and chest compression, if necessary. If the
casualty is conscious and breathing normally, place in the recovery position. If the
casualty vomits or passes anything, a sample should be taken and sent to the
hospital with the casualty.

Burns
Dry Burns and Scalds
These are commoner than chemical burns. Flames, cigarettes and hot machinery all
cause dry burns, while steam and hot liquids cause scalds.

Immediate First Aid for Dry Burns and Scalds:

 Drench the affected area of skin with running water for at least 10 minutes.
 Gently remove anything restrictive (ring, watch etc.) and any burned clothing that is
NOT stuck to the skin.
 Do NOT apply any lotion or ointment.
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 Cover the burned area with a clean, dry, non-fluffy material such as a sterile
dressing, plastic kitchen film or clean cloth.
 If there are deep burns, blistering over any area larger than the size of the
casualty’s hand, or any other burn that interferes with breathing, transfer the
casualty to hospital as soon as possible.

Immediate First Aid for Dry Burns and Scalds:

 Chemical burns may require drenching with running water for at least 20 minutes.
 Some chemicals are not removed by water alone; oil chemicals require washing
with mild detergent and water.
 Emergency treatment should be given for skin contact.
 Chemicals may be absorbed by burns on the skin; some are than absorbed into the
blood, causing symptoms of poisoning elsewhere in the body.

Burns to the Mouth and Throat

Burns to the mouth and throat may occur from drinking very hot liquid, swallowing
corrosive chemical or inhaling hot air or fumes.
The casualty will complain of severe pain in the mouth and throat and may have burns on
the lips and face. The main danger is that swelling may occur in the tissues of the throat
and upper airway, causing difficulty in breathing.
The rescuer should reassure the casualty and keep him under close observation
loosening any tight clothing or jewelry around the neck while waiting for medical
assistance.

Immediate First Aid for Burns to the Mouth and Throat:

 If the fumes are still present, remove the casualty from the area of exposure. Take
great care that the rescuers do not become victims (use appropriate PPE). It is
advised to have a rescuer outside the contaminated area to call for help.
 Check whether casualty is conscious or unconscious.
 If unconscious:
 Do NOT give anything by mouth.
 Check breathing and pulse, give artificial ventilation and chest compression, if
required.
 Place in the recovery position.
 If conscious:
 Give sips of cold water or milk at frequent intervals.
 Do NOT induce vomiting.
 Transfer the casualty to a hospital as soon as possible.

Cold Burns

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A cold burn, which is a form of frostbite, is caused by contact with a refrigerated or

compressed gas such as liquid oxygen.
The casualty will complain of prickling of the affected skin followed by numbness, and the
skin will appear blue or white and will feel hard and waxy.
The cold burn may spread to involve deeper tissues therefore treatment should be given
early to limit the damage.

Immediate First Aid for Cold Burns:

 The affected area may swell rapidly, so remove any rings, watches, shoes or other
restrictions.
 Place the injured part in warm (40oC) water if available or use your own body heat
to warm the area.
 Elevate the affected area and cover with soft dressings.
 Do NOT warm in front of a fire or over a radiator.
 Do NOT rub or massage the area or break any blisters.
 Considerable pain will be experienced on re-warming so reassure the casualty and
take to a hospital as soon as possible.

Allergic Reactions
A number of chemicals may cause damage by provoking allergic reactions. People who
have existing allergic diseases such as eczema, hay fever, or allergic asthma are more
likely to develop allergic reactions to chemicals. It is important that working procedures
should be laid down to prevent such people from working with chemicals known to cause
allergies.
First exposure to the chemical is usually uneventful, harmful effects occur on subsequent
exposure so that with each exposure the body becomes increasingly sensitized to the
chemical, causing increasingly severe allergic reactions. There are three main forms of
chemical induced reactions:

Sensitivity Dermatitis
A wide variety of chemicals can cause sensitivity dermatitis on skin contact. The affected
area of skin becomes red and itchy, with small blisters, which often break down and leak
clear fluid, making the skin appears moist. The most important treatment is to avoid all
future contact with the chemical. Local treatment can be given to the affected skin; obtain
medical advice.

Allergic asthma
Inhalation of certain chemical fumes and dusts can cause severe shortness of breath due
to an acute asthmatic attack in which spasms of the small airways and the lungs causes
them to be severely narrowed. The casualty feels his chest is tight and his breathing
becomes very wheezy. The treatment is to immediately relieve the spasm. If a Salbutamol
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(Ventolin) inhaler is available give the casualty two puffs, following the manufacturer’s
instructions on the packet. The casualty should be transferred to a hospital for further
treatment. It is essential that all future contact with the chemical is avoided.

Anaphylactic shock
This is a very severe form of allergic reaction, which can occur when a person with a well-
established allergy comes into contact with a sensitizing chemical. However, a similar
reaction can also occur in people who have shown no previous allergic tendency. There is
usually a rapid onset of severe wheezing accompanied by a blotchy, itchy rash followed
by swelling of the mouth and throat, which may obstruct the airway. There may be rapid
development of shock/ unconsciousness. Breathing may stop.

TRAINING
Selected personnel will be trained in First Aid/CPR. The location and identity of these
personnel is brought to the attention of all employees through safety meetings, training
and information posted on notice-boards.

REFERENCES
Training Records
Accident Records

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