By Russell F. Mankes, PhD
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.
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.
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| Fig. 1. Anhydrous ammonia is commonly transported in black rail tank cars or in tanker trucks. | |
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| Fig. 2. Agricultural and industrial users store anhydrous ammonia in tanks on site. | |
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| Fig. 3. Anhydrous ammonia valves are characteristic and identifiable. Hoses used for anhydrous ammonia transfer are nylon and identified by labeling on the hose showing hose type (nylon), working pressure (350 PSI MAX WP), date of manufacture (Year), and manufacturer’s ID number. | |
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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 removes water from living tissues (burns, mummification).
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| Fig. 4. Full thickness chemical burn. | Fig. 5. Chemical eye burns. |
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| Fig. 6. Minor chemical burn to first responder from ammonia exposure. | Fig. 7. Farm worker with burn on hand from attempting to close a leaking anhydrous ammonia tank valve. |
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 Chemical Exposures" 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 at 1-404-498-0120.
Pre-hospital Care
1. Responders should carefully observe the Hot Zone protocol: only those trained & 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 to reduce separation anxiety.
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| Fig. 8. Patient intubation. |
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| Fig. 9. Edema from anhydrous ammonia. | Fig. 10. Intubation of patient suffering from anhydrous ammonia burns. |
Decontamination
Transport
Hospital Care
Patient Follow Up
Reporting
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 secondary exposures. 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.
| About the Author |
| Russell F. Mankes, PhD is an Associate Professor and Chemical Hygiene Officer and Responsible Facility Official for the Department of Environmental Health & Safety Albany Medical Center, Albany Medical College, Albany, New York. |