TEMS Chemical Emergency Response Training

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TEMS Chemical Emergency Response Training

• For Members of Tulane Emergency Medical Services
  (TEMS)
• August 2008

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Objectives

• To learn how to identify chemicals
• To learn how chemicals can enter the body and the
  types of effects they may have
• To learn how to protect yourself from chemicals
• To learn some of the chemical classifications and
  where different types of chemicals can be found
  on Tulanes Uptown campus

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Objectives (cont.)

• To learn the proper response for a TEMS member
  when encountering a chemical incident
• To understand the role of Tulanes Office of
  Environmental Health Safety in emergency
  response incidents
• To know your role in hazardous materials spill
  response

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Information About Chemicals

• Information about a chemical can be found on the
  label and the Material Safety Data Sheet (MSDS)
• The OEHS website www.som.tulane.edu/oehs has a
  link where MSDSs can be obtained, or call OEHS at
  988-5486, then press 1
• Most laboratory doors at Tulane have signs
  showing types of chemicals within the lab and
  emergency contact information

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Chemical Routes of Entry

• Inhalation
• Ingestion
• Skin Contact/Absorption
• Injection

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Types of Effects

• Acute effect characterized by sudden and severe
  exposure and rapid absorption of the substance.
  Adverse health effects are often reversible.
  (Example carbon monoxide poisoning)
• Chronic effect characterized by prolonged or
  repeated exposures of a duration measured in
  days, months, or years. Symptoms may not be
  immediately apparent. Health effects are often
  irreversible. (Example mercury poisoning)

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Types of Effects

• Local effect an adverse health effect that
  takes place at the point or area of contact.
  Absorption does not necessarily occur. (Example
  strong acid)
• Systemic effect an adverse health effect that
  takes place at a location distant from the bodys
  initial point of contact and presupposes
  absorption has taken place. (Example benzene
  affects bone marrow)

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Types of Effects

• Cumulative poisons characterized by materials
  that tend to build up in the body as a result of
  numerous chronic exposures. Effects are not seen
  until a critical body burden is reached.
  (Example heavy metals)

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Types of Effects

• Synergistic effect When two or more hazardous
  materials are present at the same time, the
  resulting effect can be greater than the effect
  predicted based on the additive effect of the
  individual substances. (Example smoking and
  asbestos)

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Other Factors Affecting Exposure

• Rate of entry, chemical dose
• Age, lifestyle, state of health, and genetic
  disposition of individual exposed
• Previous exposures (can lead to tolerance or
  increased sensitivity)
• Environmental factors temperature and pressure

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Chemical Classifications/Possible Locations
(Uptown Campus TU)

• Carcinogens Chemicals which can cause or are
  suspected of causing cancer
• Examples Benzene, Chloroform, Formaldehyde,
  Carbon Tetrachloride, Dichloromethane
• Possible Locations Stern Hall, Israel (ESB)
  Building, Boggs Building
• Cancer is a chronic effect it takes a long time
  to develop.

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Chemical Classifications/Possible Locations
(Uptown Campus TU)

• Compressed Gases Gases which are stored in a
  container (cylinder, lecture bottle) under
  pressure
• Examples Argon, Nitrogen, Chlorine, Carbon
  Dioxide, Oxygen, Acetylene
• Possible Locations Stern Hall, Israel (ESB)
  Building, Boggs Building, Art, Facilities
  Services
• Exhaust Ventilation is needed when using
  compressed gases to prevent asphyxiation.
• Cylinders must be chained and have protective
  caps in place. If valve is damaged, cylinder can
  act as a missile.

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Chemical Classifications/Possible Locations
(Uptown Campus TU)

• Corrosives Chemicals which can cause
  irreversible alterations/chemical burns to human
  tissue (Acids/Caustics)
• Examples Sulfuric Acid, Nitric Acid,
  Hydrofluoric Acid, Ammonia Gas, Hydrochloric Acid
• Possible Locations Stern Hall, Israel (ESB)
  Building, Boggs Building, Art, Facilities
  Services, Blessey
• Hydrofluoric Acid - will attack glass use
  benzalkonium chloride solution or calcium
  gluconate gel for first aid treatment.
• For other acids or caustics, get victim to
  emergency shower or eyewash and wash for at least
  15 minutes.

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Chemical Classifications/Possible Locations
(Uptown Campus TU)

• Cryogenic Liquids/Gases Liquefied gases used at
  very low temperatures (below -200C)
• Examples Liquid Nitrogen, Liquid Oxygen
• Possible Locations Stern Hall, Israel (ESB)
  Building, Boggs Building
• Heavy gloves, face shield, and eye protection are
  needed when handling cryogenic liquids/gases

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Chemical Classifications/Possible Locations
(Uptown Campus TU)

• Explosives Chemicals which can release
  pressure, gas, and heat when subjected to shock,
  pressure, or high temperature
• Examples Nitroglycerin, TNT, Picric Acid,
  Sodium Azide
• Possible Locations Stern Hall, Israel (ESB)
  Building, Boggs Building

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Chemical Classifications/Possible Locations
(Uptown Campus TU)

• Flammables Chemicals which can ignite easily
  and burn rapidly, either spontaneously
  (pyrophoric) or from exposure to a
  high-temperature environment (autoignition), or a
  spark or open flame
• Examples Solvents, Ether, Hexane, Mineral
  Spirits, Diesel Fuel, Gasoline
• Possible Locations Stern Hall, Israel (ESB)
  Building, Boggs Building, Art, Facilities
  Services
• Fire triangle Ignition source oxygen fuel

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Chemical Classifications/Possible Locations
(Uptown Campus TU)

• Flammable Gases Gases which can form flammable
  mixtures with air
• Examples Hydrogen, Acetylene
• Possible Locations Stern Hall, Boggs Building,
  Art, Facilities Services
• Flammable gases are extremely dangerous fire
  hazards and require precisely regulated storage
  conditions.

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Chemical Classifications/Possible Locations
(Uptown Campus TU)

• Irritants Chemicals which can cause reversible
  inflammatory reactions (watery eyes, itchy skin)
• Examples Formaldehyde, Ammonia, Hydrogen
  Sulfide
• Possible Locations Stern Hall, Israel (ESB)
  Building, Boggs Building, Chemical Engineering
• Some irritants have distinctive odors.
• Get exposed person to fresh air.

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Chemical Classifications/Possible Locations
(Uptown Campus TU)

• Oxidizers Chemicals which promote combustion
• Examples Oxygen, Perchloric Acid, Nitric Acid
• Possible Locations Stern Hall, Israel (ESB)
  Building, Boggs Building, Art
• Keep oxidizers away from flammables.

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Chemical Classifications/Possible Locations
(Uptown Campus TU)

• Sensitizers Chemicals which can cause allergic
  reactions in normal tissue after repeated
  exposure to the chemical
• Examples Chromium compounds, Nickel compounds,
  Toluene Diisocyanate
• Possible Locations Stern Hall, Israel (ESB)
  Building, Boggs Building, Art
• Not everyone reacts to chemicals in the same way.
• Reaction may be as mild as a rash or as serious
  as anaphylactic shock.

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Chemical Classifications/Possible Locations
(Uptown Campus TU)

• Toxic The ability of a chemical to produce a
  health effect or injury once it reaches a
  susceptible site in or on the body
• Examples Lead and its salts, Arsenic, Dimethyl
  Mercury, Silica Dust, Cyanides, Hydrogen Bromide
• Possible Locations Stern Hall, Israel (ESB)
  Building, Boggs Building, Art
• All chemicals will exhibit a toxic effect if
  given a large enough dose.

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Chemical Classifications/Possible Locations
(Uptown Campus TU)

• Water Reactives Chemicals that react with water
• Examples Sodium metal, Potassium
• Possible Locations Stern Hall, Israel (ESB)
  Building
• Combustible metals need special type fire
  extinguishers (Class D).

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Chemicals May Have More Than One Property

• Example Acetic Acid flammable and corrosive
  Possible locations Stern Hall, Israel (ESB)
  Building, Boggs
• Example Pyridine flammable and toxic (bad
  odor) Possible locations Stern Hall, Israel
  (ESB) Building
• Example Nitric Acid oxidizer and corrosive
  Possible locations Stern Hall, Israel (ESB)
  Building, Boggs Building, Art

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Summary

• There are many types of chemicals at this
  university.
• The potential effect a chemical can have on a
  body depends on many factors. Not everyone
  reacts the same to chemical exposures.
• The dose and route of entry of a chemical affects
  the bodys response.
• Many chemicals have more than one property.
• Information about chemicals can be found on the
  label and the MSDS.
• Chemical effects are not always additive.

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Best Practices for First Responders of victims
from mass casualty incidents involving the
release of hazardous substances
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Best Practices for First Responders(EMS) -
Where did it come from?

• FEMA/OSHA Summit December 2002 Federal
  Disaster Response, Personnel Safety and Personal
  Protective Equipment
• Confusion on what PPE to buy
• What training is necessary for first receivers

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Who is a First Responder?

• First Responders respond to the site or point of
  release

• Includes Fire Fighters, Public Safety, HAZMAT
  teams, Emergency Medical Technicians

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First Responder Job Functions

• Secure the area of hazardous materials spill
  incident
• Protect lives and environment
• Give medical treatment

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State the Problem
First Responders have different training and
personal protective equipment needs than workers
in the Hot Zone.
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Emergency Medical Services Mission

• Care for sick and injured people
• Transport injured person to appropriate medical
  facility
• Protect emergency responders and first receivers

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Unique Challenges

• Work environment
• Life and death mission
• Significant negative consequences for mistakes
• External focus on health
• Issue of PPE for First Responders not previously
  addressed
• Limited scientific literature

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Hazard Transmission to First Responders

• Secondary Exposures from hair, skin and clothing
  of victims
• Influenced by
• Inherent characteristics of the toxin
• Concentration of release
• Contact time with victim
• Less than the site of release

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Response to a Major Chemical Incident

• Role of Supervisor
• Role of Tulane Dept. of Public Safety
• Role of OEHS
• Role of TEMS

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Role of Supervisor

• Attend to injured or contaminated persons.
  Remove them from further exposure.
• As needed, immediately flush the eyes with water
  using the eyewash fountain or use the safety
  shower for body exposure. Flush for at least 15
  minutes.
• Alert others in area to evacuate.
• Turn off or remove sources of ignition in the
  vicinity of the spill.

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Role of Supervisor (Cont.)

• Confine the spill (e.g., upright container, close
  doors, pull down sash of hood)
• Evacuate the area
• Close doors to affected area
• Notify OEHS (988-5486, ext. 1), and Tulane
  Police/TUDPS
• Standby to assist emergency personnel in
  uncontaminated area

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Role of Tulane Dept. of Public Safety

• Secure the scene of the incident
• Prevent all unauthorized personnel from entering
  the chemical spill area
• Provide necessary support for transportation,
  traffic control, and security

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Role of OEHS

• Secure spill area
• Help facilitate clean up activities
• Act as a Liaison between Tulane and outside
  response agencies
• Ensure that all Tulane personnel and injured
  persons are properly decontaminated if medical
  treatment is necessary

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Role of TEMS

• Know there is a high probability of exposure to
  chemicals
• Look for signs of chemicals on
• Clothing
• Skin
• Shoes
• Hair
• Face

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Role of TEMS (cont.)

• Do not enter chemical spill area without Public
  Safety and/or OEHS knowledge
• Contact OEHS for instructions/advice
• Cautiously provide medical care and transport for
  injured persons DO NOT rush in to contaminated
  area
• Protect yourself by wearing appropriate PPE

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Role of TEMS (cont.)

• Decontaminate victim when possible before
  transport by using eyewash, emergency showers
• Remove contaminated clothing at the incident site
  for removal by OEHS

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Training

• Workers assisting on the decontamination team,
  giving medical attention to victims, or providing
  security
• Trained to the first responder operations level
  or objectively demonstrate competency in the
  subject areas
• Workers performing immediate emergency support
  work
• Skilled support personnel
• Need an initial briefing at the time of response

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Training Summary

• TEMS is adequately trained to recognize the need
  to decontaminate injured personnel before
  transporting to a medical facility
• Proper Personal Protective Equipment is issued
  and worn
• Role of Tulane First Responders

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Summary

• Emergency response to a chemical incident is a
  team effort. The supervisor, Public Safety,
  TEMS, and OEHS each have a distinctive role.
• Never rush in when chemicals are involved.
• Seek and follow advice from OEHS 988-5486.

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Personal Protective Equipment (PPEs) - Basics

• For TEMS Employees of Tulane University
• August 2008

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Objectives

• To know how to assess the area for PPE needs
• To understand the importance of providing
  adequate amounts and various sizes of personal
  protective equipment
• To understand why potentially contaminated PPE
  should not be worn outside the work area
• To know how to properly select, use, and store
  PPE

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PPE/Hazard Assessment

• Assess each task and/or area when any of the
  following may apply
• Hazardous materials may be present
• Potentially infectious substances may be present
• Equipment that can pinch, compress, or radiate
  intensive heat or light may be used

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Proper Dress

• Dress appropriately for your job
• Usually best to wear closed-toe shoes and
  appropriate clothing (no shorts, sandals, flip
  flops)
• Wear PPE as needed

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Control of Workplace Hazards

• Engineering controls
• Administrative and work practice controls
• PPE is to be used when work practices and/or
  engineering controls do not lessen or eliminate
  the hazards, and in emergency situations. It is
  important to select and use PPE properly to
  reduce and/or eliminate exposure to the hazard.

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PPE/Hazard Assessment

• Assessment for personal protective equipment
  application must be done per hazard (physical and
  chemical)
• - Chemical - Impact
• - Biological - Penetration
• - Radiological - Compression
• - Noise - Heat/Cold
• - Vibration - Harmful Dust
• - Light radiation

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PPE/Hazard Assessment

• Things to look for include
• Sources of motion
• Temperature extremes (hot/cold)
• Chemical exposures
• Dust
• Light radiation (welding, brazing, cutting,
  furnaces, high intensity lights)
• Falling objects
• Sharp objects
• Rolling , pinching
• Electrical hazards

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PPE/Hazard Assessment

• Assessment must include the following areas of
  the body which may be affected
• Head eyes, ears, face, respiratory
• Hand wrist, fingers and palms
• Body torso and legs
• Foot shins and feet

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PPE/Hazard Assessment

• Proper PPE must be provided for each worker that
  the hazard affects.
• PPE must be made available in adequate amounts
  and different sizes.
• PPE must be stored as per manufacturer
  recommendations to prevent damage, distortion or
  contamination.
• Bag respirators dont hang from straps
• Rinse reusable gloves
• Dont leave in sunlight

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Use of PPE

• All who wear PPE must be trained on its uses,
  limitations and proper decontamination/storage.
• Those who wear PPE must not wear it outside their
  work area.
• If PPE is reusable, it must be properly cleaned
  and decontaminated after use.
• All PPE must be stored in a clean and safe manner.

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Eye Protection

• Safety glasses (with side shields and brow guard)
  impact hazards
• Safety goggles liquid chemicals
• Face shield used with eye protection
• - For impact protection, face shields alone do
  not offer eye protection. They must be used
  with approved safety glasses or goggles.
• The proper prescription safety glasses may be
  worn for impact protection with the approval of
  the supervisor.
• Notes
• The American Chemical Society advises that
  contact lenses may be worn around hazardous
  materials as long as the appropriate type of eye
  protection is used. Contact lenses do not
  provide adequate eye protection.

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Eye Protection

• When working with cryogenic materials, one must
  wear the proper gloves, eye protection, and a
  face shield.
• Proper eye protection must be used when working
  with UV light or when welding. Eye protection
  may also be required with some lasers.
• Contact OEHS for further assistance on the
  selection of appropriate eye wear.

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Protective Clothing

• Aprons
• Clean if contaminated with hazardous materials.
• Replace if torn, ripped or tattered .
• Laboratory Coats
• Must be worn only inside the work area
• Must be removed before leaving work area for
  breaks, lunch and end of the work day.
• Must be cleaned by a professional cleaning
  service. DO NOT TAKE CONTAMINATED CLOTHING HOME
  FOR WASHING.

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Protective Clothing

• When working with bloodborne pathogens,
  disposable clothing and/or laboratory coats may
  not be adequate protection for the employee.
• Such clothing must be resistant to blood and body
  fluid splashes.

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Hand Protection

• Latex Gloves
• Supervisors must supply adequate supplies and
  sizes.
• Worker and supervisor should be aware of latex
  allergies and must supply the appropriate
  substitute PPE as needed.
• Rubber Gloves
• Must be worn when working with highly corrosive
  or toxic materials
• Must be cleaned, decontaminated and properly
  stored after each use
• Temperature Resistant Gloves (non-asbestos)
• Leather

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Hand Protection

• Gloves must be inspected before each use for
  tears, holes, cracks, and deterioration.
• If gloves are defective or badly soiled, they
  must be discarded.
• Disposable gloves must not be reused.
• Contact OEHS for information on latex allergies
  and glove use.

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Hand Protection - Chemical

• For information as to the type of glove that
  should be used to protect yourself from a
  particular chemical, consult the glove
  manufacturers chemical compatibility chart.
• Contact OEHS for further assistance.

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Foot Protection

• Rubber Booties
• Chemical Resistant Shoes/Boots
• Steel-toe Shoes
• Paper booties

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Types of Respiratory Protection

• Air Purifying
• - TB Respirators (N-95)
• - Cartridge Respirators
• - Dust/Mist/Particulate Respirators
• - Positive Air-Purifying Respirators (PAPRs)
• Air Supplied
• - Self-Contained Breathing Apparatus (SCBAs)

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Respiratory Protection

• Respiratory protective equipment is needed when
  work practices and engineering controls cannot
  eliminate the inhalation hazard.
• The selection and type of respirator is based on
  the air contaminant and other factors (such as
  the concentration of the contaminant, oxygen
  deficient atmosphere, etc.).

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Respiratory Protection

• In order to wear a respirator, the following must
  be done
• The employee must receive a copy of the OSHA
  Respiratory Protection Standard and the Tulane
  University Respiratory Protection Program.
• The employee must be clean shaven.
• The employee must have a medical evaluation to
  determine their ability to wear a respirator.
• The employee must be fit-tested by OEHS on an
  annual basis or when the employees facial
  features have changed dramatically.
• Contact OEHS for more details on the Respiratory
  Protection Program.

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PPE Summary

• A PPE hazard assessment must be done when
  responding to an incident.
• PPE must be adequate for the job and available to
  the employee in different sizes and styles.
• PPE must not be brought home for laundering.
• PPE must be stored properly so that it will not
  be damaged.

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Tulane University Office of Environmental Health
Safety (OEHS) www.som.tulane.edu/oehs Pam
Fatland - Manager, Chemical Safety(504)
988-2800, pfatlan_at_tulane.edu Bruce McClue -
Supervisor, Hazardous Waste(504) 988-2865,
bmcclue_at_tulane.eduIf unable to proceed to quiz,
type the link below into your browserhttp//auror
a.tcs.tulane.edu/ehs/enterssn.cfm?testnum34
Proceed to Quiz