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# OAR Box 1818 Prepped byOllie Stewart



# Document

Number: 

# 75 ) IV-A- 4 Docket Number: 

# A-87-1 1

Printed 11/6/2008 3:12:46

PM Sheet 75of 79P. 2



## DRAFT FINA

L REPORT

o n

INCIDENCE OF SIPHONING-RELATE DGASOLIN

E INGESTIO

N t o Offic e o f Mobil e Source s U.S . Environmenta l Protectio n Agency
An n Arbor , Michiga n

b y

Michae l J . Murph

y

Marc h198 9

BATTELL E 50 5 King Avenu e Columbus , O H 4320 1P. 3



## TABLE O F CONTENT S

Pag e

INTRODUCTIO

N1 SIPHONIN

G AND GASOLIN

E INGESTIO

N2 Cause s o f Siphoning Accident s 2 Effect s o f Gasolin e Ingestio n 4 FREQUENCY O F SIPHONING-RELATE D GASOLIN E INGESTIO

N4 NEIS S Dat a o n Gasolin e Ingestio n . 5 Origi n o f NEIS S Dat a 5 Analysi s o f NEIS S Dat a o n Gasoline-Siphoning Incident s 6 Poiso n Contro l Cente r Dat a o n Siphoning-relate d Gasolin e Ingestio n 8 Origi n o f AAPC C Dat a 8

Analysi s o f AAPC C Dat a 9 DISCUSSIO

N1 2 Compariso n o f AAPC C an d NEIS S DAT

A1 2 Choic e o f Ag e Limi t 1 4 SUMMAR Y 1 4 REFERENCE S 1 7

l lP. 4



## INCIDENCE O

F SIPHONING-RELATE

DGASOLIN

E INGESTIO

N

INTRODUCTIO

N Siphoning accident s ar e th e majo r caus e o f gasolin e ingestio n b yadults . Change s i n th e configuratio n o f automobil e ga s tan k fille r tube s ar e no wpropose d a s par t o f an on-boar d systemt o reduc e emission s o f gasolin e vapors . Some o f thes e design approache s mayals o mak e siphoning o f gasolin e fro mautomobil e tank s mor e difficul t an d therefor e les s frequent . Th e following analysi s estimate s th e incidenc e o f siphoning-relate d gasolin e ingestio n an

d henc e th e potentia l fo r automobil e fue l syste m modification s t o reduc e th e numbe r o f injurie s du e t o gasolin e ingestio n accidents .

Thi s analysi s expand s o n informatio n uncovere d during previou s wor k assignmen t 3-1 4 o f contrac t 68-02-424 6 tha t suggeste d man yincident s o f gasolin e ingestio n ar e cause d b ygasolin e siphoning . An assessmen t o f propose d on-board systemhardwar e design s suggeste d tha t som e approache s coul d effectivel yprohibi t siphoning an

d thu s potentiall yreduc e the numbe r o f injurie s an d death s resulting fro mingestio n o f gasolin e during siphoning mishaps . Two source s o f dat a o n th e numbe r an d frequencyo f injurie s an

d death s relate d t o gasolin e siphoning wer e identifie d an d examined : the Nationa l Electroni c Injur ySurveillanc e System (NEISS) , operate d b ythe Consume r Product s Safet yCommissio n (CPSC) , an

d the American Associatio n o f Poiso n Contro l Center s (AAPCC ) databas e o f exposur e reports .P. 5



## SIPHONIN

GAN DGASOLIN

E INGESTIO

N
Peopl e sipho n gasolin e fro mautomobil e tank s fo r a variet yo f reasons . Some siphoning i s performe d t o remov e gasolin e fro ma n automobil e fue l tan k fo r us e i n a law n mowe r o r othe r implemen t wit ha smal l gasolin e engine . Othe r siphoning ma yb e performe d t o transfe r fue l fro

mon e automobil e tan k t o another , eithe r b ythe vehicl e owne r o r clandestinel yb yothers .

Cause s o f Siphoning Accident s Gasolin e siphoning accident s ar e generall ycause d b ythe circumstance s an

d condition s associate d wit hsiphoning , rathe r than b ycomponen t o r hardwar e failures . Some o f thes e circumstance s ar e discusse d below . Siphoning i s frequentl yan unplanne d activit yusing an y availabl e hos e o r tube . Ofte n suc hhose s o r tube s ar e opaque , making i t impossibl e t o monito r th e progres s o f th e liquid . Th e heigh t o f th e sipho n als o contribute s t o mishaps . T o sipho n fro

m an automobil e tank , sufficien t suctio n mus t b e applie d t o rais e th e gasolin e t o the leve l o f the fille r nec k opening . Thi s distanc e i s abou t 0. 5 m an d require s a negativ e pressur e o f 3.5-4. 0 kPa . Thus , considerabl e effor t i s require d t o star t the siphon , sometime s leadin g t o lac k o f adequat e contro l afte r the liqui d start s flowing . Substantia l exposur e t o gasolin e vapo r ma yals o occu r during siphoning , causing a lac k o f menta l alertnes s an d thereb

yP. 6



## increasing the likelihoo d o f an accident . Rapi d an d competen t starting o f a sipho n woul d lea d t o a flowo f air , the n liqui d gasolin e i n th e sipho n tub e an d henc e minima l exposur e t o gasolin e vapor . However , th e sipho n tub e maynot , initially , b e belowthe surfac e o f th e liqui d i n th e automobil e tank . Aconsiderabl e amoun t o f vapo r migh t the n b e ingeste d befor e th e siphone r realize s th e tub e need s t o b e repositioned . Or , gasolin e ma yb e sucked par t wayup th e tub e an

d the n allowe d t o return t o th e tan k befor e the siphoning i s finall yinitiated . Thi s actio n woul d we t a considerabl e lengt ho f the insid e o f the sipho n tub e wit hgasoline , increasing th e exposur e t o gasolin e vapo r whe n th e sipho n i s finall yestablished . Th e equilibriu mconcentratio n o f gasolin e vapo r ove r liqui d gasolin e i s abou t 300,00 0 ppm. ' ' An exposur e whic heve n approache s thi s severit yca n caus e lac k o f menta l alertnes s veryquickly. ' ' Finally , eve n successfu l siphoning o f gasolin e b yadult s may indirectl ylea

d t o ingestio n o f gasolin e b ychildren . Young childre n wh o observ e adult s siphoning gasolin e ma yconfus e siphoning wit hdrinking . Somewha t olde r childre n ma ysimpl y attemp t t o imitat e an adul t activity . Th e fundamenta l reaso n fo r gasolin e siphoning i s th e apparen t attractivenes s an

d convenienc e o f th e technique . Whil e the above discussio n shoul d mak e clea r tha t whil e siphoning gasolin e fro man automobil e fue l tan k i s far fro

mtrivial , i t mayappea r easy . Thus , change s t o th e automobil e fue l syste mwhic hmak e siphoning mor e difficul t bot hi n fac t an d i n appearanc e ar e likel yt o reduc e the incidenc e o f siphoning an d henc e siphoning-relate d accidents .P. 7



## Effect s o f Gasolin e Ingestio n Th e healt heffect s o f gasolin e ingestio n ca n b e serious ( K Generally , i f gasolin e i s take n int o th e mouth , bu t no t swallowed , th e result s ar e unpleasant ( ' , bu t no t permanen t o r life

threatening . However , i f actua l swallowing o f gasolin e occurs , serious , potentiall yletha l toxi c effect s ca n result . ^ 5 

## H 5 

## ' Aletha l dos e o f 90-13 5 g ha s bee n reporte d a s a "reasonabl e estimat e fo r an averag e adult." ( ' Moreover , chemica l pneumoni a an d pulmonary edem a cause d b

yaspiratio n o f gasolin e afte r belching o r vomiting mayoccur . Thi s ca n b e a life-threatening condition, ' ) an d make s medica l treatmen t problematica l sinc e action s take n t o remove the stomac hcontent s entai l a ris k o f vomiting wit hsubsequen t aspiration , whil e drug s t o curtai l vomiting ten d t o exacerbat e the depressio n o f th e centra l nervou s syste m cause d b

yth e exposur e t o gasolin e hydrocarbons .

FREQUENC

YO F SIPHONING-RELATE

DGASOLIN

E INGESTIO

N

Ther e ar e two primarysource s o f informatio n regarding the frequencyo f siphoning-relate d gasolin e ingestion . Th e firs t sourc e i s a computerize d record o f visit s t o hospita l emergenc y rooms , know

n a s th e Nationa l Electroni c Injur ySurveillanc e System (NEISS) . Th e secon

d sourc e i s a record o f call s t o poiso n contro l centers . Informatio n availabl e fro meac hsourc e regarding the incidenc e o f siphoning-relate d gasolin e ingestio n i s discusse d below . Acompute r literatur e searc ho f majo r bibliographi c databases , including th e Nationa l Technica l Informatio n Servic e (NTIS) , IndexP. 8



## Medicus , Chemica l Abstracts , ToxLine , an d Engineering Index , di d no t disclos e an

ysignifican t source s o f additiona l dat a concerning the incidenc e o f siphoning-relate d gasolin e ingestion .

NEIS S Dat a o

nGasolin

e Ingestio

n Origi no f NEIS S Dat a T o gathe r dat a o n th e incidenc e o f injurie s associate d wit h variou s consume r products , the Consume r Product s Safet yCommissio n (CPSC ) operate s th e Nationa l Electroni c Injur ySurveillanc e System (NEISS) , a databas e o f report s fro mhospita l emergenc yrooms . Althoughhospita l emergencyroom s se e a broad spectru mo f injuries , i t i s fel t tha t thi s dat a collectio n strateg yi s especiall y effectiv e fo r capturing dat a o n th e mor e sever e injuries . Th e NEIS S i s base d o n a rando mprobabilit ysampl e o f al l hospital s wit hemergencycenter s throughou t th e U.S . an d it s territories . I n th e design o f NEIS S b yCPSC , hospital s wit h emergencyroom s wer e stratifie d b ysiz e an

d location , an

d a simpl e random sampl e o f primaryan d alternat e hospital s wa s selecte d fro m eac hstratum . Th e curren t NEIS S sampl e consist s o f 6 2 hospital s whic hrepresen t al l th e hospital s wit hemergencydepartment s i n the U.S . Fo r eac hcas e i n th e sample , th e NEIS S staf f have calculate d a weighting facto r t o represen t th e numbe r o f case s i n th e entir e populatio n associate d wit han occurrenc e a t tha t particula r hospital . Th e NEIS S staf f take s variou s measures , suc ha s dat a audit s an d telephon e callback s t o patient s an d witnesses , t o maintai n the qualit yo f th e dat a an d t o reduc e inpu t errors . Theyals o mak eP. 9



## on-sit e visit s t o emergencydepartment s i n th e NEIS S t o determin e whethe r al l in-scop e case s ar e being captured . Analysi s o f NEIS S Dat a o n Gasoline-Siphoning Incident s Exposur e Incidence . Compute r printout s wer e obtaine d fro m CPS C o f al l reporte d injurie s associate d wit hth e us e o f gasolin e fo r calenda r yea r 198 7 an d fo r calenda r yea r 1988 . Thes e printout s ar e include d i n thi s repor t a s Appendice s Aan d B , respectively . Eac hentryo n th e printout s wa s manuall yscanne d fo r bot han indicatio n o f gasolin e ingestio n i n th e inciden t descriptio n an d a patien t ag e o f 6 o r greater . Atota l o f 3 3 suc hincident s wer e identified . O f thes e 3 3 incidents , 2 0 mentione d siphoning specifically ; 5 othe r incident s wer e identifie d whos e description s suggeste d siphoning-relate d ingestio n o f gasolin e althoughth e wor d siphoning wa s no t mentione d specifically . Appendi xC list s al l the identifie d incident s o f gasolin e ingestio n along wit hth e associate d weighting factors . Eac ho f th e 3 3 incident s o f gasolin e ingestio n wa s multiplie d b yit s associate d weighting factor , an d th e product s wer e the n totale d t o giv e expecte d nationa l incidenc e fo r th e 24-mont h period . Th e resul t wa s a tota l o f 2,60 1 case s o f gasolin e ingestion . Similarly , fo r siphoning-relate d gasolin e ingestion , ther e wer e 2 0 incident s tha t listed siphoning a s a caus e o f ingestio n yielding an expecte d nationa l tota l o f 1,57 0 case s ove r th e 24

- mont hperiod . An additiona l 5 incident s wher e siphoning wa s suspecte d yielde d an additiona l 33 5 cases , fo r a n expecte d nationa l tota l o f 1,90 5 cases . Not e tha t siphoning wa s eithe r know n o rP.1 0



## suspecte d i n 1,905/2,601 , o r 7 3 percent , o f the case s o f gasolin e ingestio n b

yperson s ag e 6 o r older . Althoughth e NEIS S dat a i s derive d fro ma statistica l sampl e o f hospita l emergenc yrooms , tha t sampl e i s relativel ysmall : onl y 6 2 ou t o f a tota l o f 5,34 9 hospita l emergencyroom s i n the U.S . ar e i n th e sample . Give n the numbe r o f reporte d siphoning-relate d gasolin e ingestion s during 1987-198 8 time perio d (1,905) , the coefficien t o f variatio n associate d wit hthi s estimate d numbe r o f injurie s ma yb e obtaine d b yinterpolating fro mth e tabl e o f generalize d standard error s an d coefficient s o f variatio n presente d i n a CPS C analysi s o f th e NEIS S data.( 9 

## ) Suc ha n interpolatio n lead s t o an estimate d coefficien t o f variatio n o f 0.22 . Thus , fo r a 9 5 percen t confidenc e level , th e estimate d numbe r o f case s i s 190 5 + ( 2 x0.2 2 x1905) , o r 1,070-2,740 . Thes e dat a ma yb e normalize d t o an annua l basis , yielding a n estimate d 95 3 case s pe r yea r involving siphoning-relate d gasolin e ingestion , wit ha 9 5 percen t confidenc e rang e o f 530-1,370 . Th e weighte d averag e ag e o f patient s treate d fo r siphoning-relate d gasolin e ingestio n wa s 20. 7 years . Figur e 1 show s th e ag e distributio n o f thes e cases . Exposur e Severity . Th e NEIS S databas e als o ha s informatio n o n th e severit yo f injurie s associate d wit ha particula r case . However , th e NEIS S databas e i s concerne d onl ywit hth e conditio n o f th e patien t upo n arriva l a t th e hospita l an d i n th e emergenc y room . Thus , th e NEIS S databas e woul d showa deat honl yi f th e patien t wa s dead o n arriva l o r die d i n th e emergenc yroom . Patient s wh o di e i n othe r part s o f the hospital , e.g . i n a n intensive car e unit , woul d no t b e recorde d a s death s i n the NEIS S statistics . CPS C doe s no t routinel yreceive deat hcertificat e dat a fo r adults .P.1 1



## Th e NEIS S dat a showtha t o f th e 1,90 5 case s o f siphoning

relate d gasolin e ingestion , 27 7 wer e seriou s enought o requir e hospitalizatio n o f th e patient . Annualizing thi s dat a yield s 13 9 peopl e eac hyea r wh o ar e hospitalize d becaus e o f siphoning-relate d gasolin e ingestion . Th e weighte d averag e ag e o f victim s o f siphoning-relate d gasolin e ingestio n requirin g hospitalizatio n wa s 29 . •40-4 9



## FIGURE 1 . Ag e Distributio n fo r Case s o f Siphoning-Relate d Gasolin e Ingestio n Reporte d t o NEIS S i n 1987

- 1988 .

I t i s likel ytha t nearl yal l o f the injurie s associate d wit h siphoning gasolin e involve d siphoning t o o r fro man automobil e tank . Informatio n fro mth e medi a o n gasolin e ingestion , fo r exampl e (10)(U ) a s wel l a s th e experienc e o f th e America n Associatio n o f Poiso n Contro l Center s discusse d below , certainl y support s thi s view .
Poiso n Contro l Cente r Dat a o n Siphoning-relate d Gasolin e Ingestio n Origi n o f AAPC C Dat a Th e America n Associatio n o f Poiso n Contro l Center s (AAPCC ) receive s report s o f human poisoning fro m 6 3 participating poiso n contro l centers , serving a combine d populatio n o f 137. 5 million ,

Thi s averag e i s base d o n report s fro monl yfive hospitals . 8P.1 2



## o r 5 7 percen t o f the U.S . population . Th e AAPC C receive d 1,166,94 0 report s o f human exposur e case s i n 1987 . Whil e th e AAPC C databas e i s no t represente d t o be a statistica l sampl e o f the U.S . population , th e larg e fraction o f th e populatio n covere d (5 7 percent ) togethe r wit hth e ubiquitou s presenc e o f gasolin e an d automobile s i n th e U.S . probabl yserve s t o minimiz e sampling errors . Analysi s o f AAPC C Dat a Exposur e Incidence . O f th e 1,166,94 0 report s o f human exposur e t o potentiall ytoxi c substance s receive d b yth e AAPC C i n 1987 , 12,73 9 involve d gasolin e only . An additiona l 28 9 exposure s wer e reporte d whic hinvolve d gasolin e plu s anothe r substance . Becaus e siphoning fro mvehicl e fue l tank s i s likel yt o involve onl y gasoline , suc hcombinatio n exposure s wer e excluded . O f th e 12,73 9 gasoline-onl yexposures , 8,56 5 (6 7 percent ) involve d ingestion . Thes e dat a concerning gasoline-relate d exposur e report s fro mpoiso n contro l center s have bee n summarize d b yLitovitz. ^ ) O f th e 8,56 5 case s o f gasolin e ingestion , 5 9 percen t involve d person s age d 6 o r older . I f w e assume tha t 9 2 percen t o f the gasolin e ingestion s b yperson s ag e 6 o r olde r wer e associate d wit h siphoning (se e Nationa l Capita l Poiso n Cente r data , below) , the n w e hav e 856 5 x0.5 9 x0.9 2 = 464 9 reporte d case s o f gasoline-relate d siphoning ingestio n involving person s age d 6 o r older .P.1 3



## Sinc e th e AAPC C databas e receive s informatio n fro mpoiso n contro l center s serving 5 7 percen t o f th e U.S . population , i f the gasolin e exposure s wer e uniforml ydistributed , 22,33 2 case s o f gasolin e exposur e an d 8,15 6 case s o f siphoning-relate d gasolin e ingestio n woul d b e estimate d fo r th e entir e U.S . populatio n ag e 6 o r olde r i n 1987 . Th e numbe r o f case s o f gasolin e exposur e migh t b e furthe r extrapolate d t o includ e under-reporting i n th e geographi c area s whic har e serve d b

ypoiso n contro l center s reporting t o th e AAPCC . Typically , a multiplie r o f 4. 0 i s use d t o cove r bot hnon-reporting an d under-reporting. 1 

## * ' However , i t i s likel ytha t man yo f th e under-reporte d case s wer e no t reporte d becaus e th e person s involve d considere d themto o mino r t o warran t seeking medica l advice . Moreover , littl e dat a i s availabl e t o suppor t th e estimat e o f the proportio n o f under-reporte d cases , an d i n an ycase , th e estimat e i s fo r al l type s o f poiso n exposure s an d i s no t specifi c t o gasolin e exposures . Becaus e thes e uncertaintie s coul d confus e the analysis , an extrapolatio n t o under-reporte d case s ha s no t bee n applie d t o th e dat a use d i n thi s report . Litovit z ha s als o mad e a detaile d analysi s o f gasolin e exposur e case s reporte d t o th e Nationa l Capita l Poiso n Center, ( ' whic hserve s 3,000,00 0 peopl e i n the Washington , D.C . area . Thi s dat a i s a subse t o f the AAPC C data . O f th e 8 0 gasolin e ingestion s reporte d t o th e Nationa l Capita l Poiso n Cente r involving person s 6 year s o f ag e o r older , ther e wer e 6 7 event s reporte d t o b e siphoning-relate d an d 6 reporte d t o b e non-siphoning related . Th e remaining 7 event s ar e o f unknow n cause . I f thes e 7 unknow n event s ar e allocate d i n th e sam e proportio n a s th e event s o f know n cause , the n 6. 4 o f themwoul d be expecte d t o b e associate d wit hsiphoning . Considering thes e 6.4 , plu s th e 6 7 know

n siphoning events , lead s t o th e conclusio n tha t

1 0

### P. M



## 9 2 percen t o f th e gasolin e ingestion s reporte d t o the Nationa l Capita l Poiso n Cente r ar e siphoning-related . Thi s same percentag e wa s use d i n ou r analysi s o f the nationwid e AAPC C data , above . Exposur e Severity . Th e AAPC C dat a offe r two measure s o f gasolin e exposur e severity : th e rat e o f utilizatio n o f healt hcar e facilitie s an

d an assessmen t o f medica l outcome . Fo r bot ho f thes e measures , th e availabl e dat a o n gasolin e ingestion s cove r al l ag e groups . Thus , using thi s dat a require s making th e assumptio n tha t th e distributio n o f exposur e severitie s among th e populatio n 6 year s o f ag e o r greate r i s th e sam e a s fo r th e entir e population . A s note d previously , gasolin e ingestion s b yperson s age d 6 o r olde r constitut e 5 9 percen t o f th e tota l numbe r o f gasolin e ingestio n cases . Th e AAPC C dat a showtha t o f th e 8,56 5 reporte d case s o f gasolin e ingestion , 3,41 1 wer e reporte d t o hav e n o medica l effec t an d tha t fo r a n additiona l 75 5 case s o f unknow n outcome n o toxi c effec t woul d b e expected. ( ' Mino r medica l effect s wer e reporte d fo r 3,60 8 case s an

d moderat e o r majo r (life-threatening ) effect s wer e reporte d fo r 13 8 cases . I n addition , 53 8 potentiall ytoxi c case s wer e reporte d wher e th e medica l outcome wa s no t known . I f th e proportio n o f mino r an d o f moderat e o r majo r effect s wa s the sam e fo r thes e case s a s fo r thos e case s wit hknow n effects , 51 8 additiona l case s wit ha mino r effec t an d 1 8 additiona l case s wit h a moderat e o r majo r effec t woul d b e expected . Asmal l numbe r o f case s fo r whic hth e medica l effec t reporte d wa s no t relate d t o the exposure , o r fo r whic hth e exposur e wa s unknown , wer e neglected . Applying th e sam

e analysi s previousl yapplie d t o al l case s o f gasolin e ingestio n t o the case s o f gasolin e ingestio n wit hmino r medica l effect s lead s t o a n estimat e of : ( (360 8 + 518 ) x0.5 9 x0.9 2 ) / 0.5 7 = 392 9

1 1P.1 5



## reporte d case s o f siphoning/relate d gasolin e ingestio n wit hmino r medica l effect s fo r the entir e natio n i n 1987 . Likewise , fo r siphoning-relate d gasolin e ingestio n wit hmoderat e o r majo r medica l effects : ( (13 8 + 18 ) x0.5 9 x0.9 2 ) / 0.5 9 = 14 9

case s ar e estimate d fo r th e entir e natio n i n 1987 . Th e AAPC C dat a als o showtha t 16. 4 percen t o f al l reporte d gasolin e ingestions , including ingestion s wit ha concomitan t exposur e t o anothe r substance , resulte d i n th e utilizatio n o f a healt hcar e facility. ' ' Assuming tha t thi s percentag e applie s equall yt o the case s o f gasoline-onl yexposure , an d recalling tha t an annua l tota l o f 8,15 6 siphoning-relate d gasolin e ingestion s ag e 6 o r ove r wer e estimate d fro m th e AAPC C data , thi s implie s tha t eac hyea r 1,33 8 suc hcase s utilize d a healt hcar e facility . DISCUSSIO

N
Compariso n o f AAPC C an d NEIS S DAT

A Sinc e ther e i s a substantia l differenc e i n th e estimate d overal l incidenc e o f gasolin e ingestio n a s derive d fro mth e NEIS S dat a an d fro m th e AAPC C data , a discussio n o f th e criteri a fo r inclusio n i n th e respectiv e database s i s relevant . Fo r a cas e t o b e include d i n th e NEIS S database , th e injure d perso n mus t actuall y visi t an

d b e treate d i n the emergencyroo mo f a hospital . Thus , visit s o r call s t o privat e physicians , visit s t o urgen t car e clinics , o r case s o f self-treatmen t ar e no t included . Th e AAPC C databas e include s al l inquirie s t o poiso n contro l centers . Thes e

1 2P.1 6



## inquirie s ma yb e mad e b ytelephone , an

d maycome fro

mhospitals , physicians , o r othe r individuals . Barring an

yevidenc e o f significan t fictitiou s o r duplicative reporting t o poiso n contro l centers , th e AAPC C dat a mayb e take n a s mor e representative o f the actua l tota l incidenc e o f siphoning

relate d gasolin e ingestion . I n fact , anecdota l evidenc e base d o n discussion s wit htechnica l staf f a t Battell e an d wit hother s indicate s tha t ther e ar e a fairl ylarg e numbe r o f case s i n whic h gasolin e wa s take n int o th e mout hduring siphoning , bu t no t swallowed , tha t ar e neve r reporte d a t all . Th e NEIS S data , o n th e othe r hand , emphasiz e seriou s cases , thos e requiring medica l treatment . Fo r thes e mor e seriou s cases , th e agreemen t betwee n th e two database s i s quit e good . Th e AAPC C dat a yiel d an estimat e o f 1,33 8 utilization s o f a healt hcar e facility . Thi s compare s wel l wit h th e NEIS S database ; whic hshow s 95 3 visit s t o hospita l emergency room s alon e annuall yfo r siphoning-relate d gasolin e ingestion . Moreover , th e estimat e derive d fro mth e AAPC C dat a o f 14 9 case s o f siphoning-relate d gasolin e ingestio n wit hmoderat e o r majo r medica l effect s agree s wel l wit hth e 13 9 NEIS S case s liste d a s resulting i n hospitalization . I n summary , th e NEIS S dat a i s indicative o f th e numbe r o f gasolin e exposur e case s sever e enoug ht o warran t a visi t t o a hospita l emergencyroom , whil e th e AAPC C dat a i s indicative o f the tota l numbe r o f event s significan t enoug ht o caus e an adul t t o seek professiona l medica l advice .

1 3P.1 7



## Choic e o f Ag e Limi t Th e ag e o f 6 wa s chose n a s th e lowe r ag e limi t fo r considering ingestio n case s becaus e the exposur e scenario s listed i n NEIS S databas e an

d i n th e Nationa l Capita l Poiso n Cente r (NCPC ) dat a show tha t al l victim s o f siphoning-relate d gasolin e ingestio n wer e ag e 6 o r older. * Moreover , Litovitz' s tabulatio n o f NCP C data, 1 

## * 17 

## ) show s a strongl ybimoda l ag e distributio n o f gasolin e ingestio n cases , wit ha minimu ma t age s 5-9 . Suc han ag e distributio n suggest s tha t differen t mechanism s predominat e fo r ingestio n above an d belo wabou t ag e 6 . Abov e tha t age , i t i s clea r tha t siphoning i s the predominan t caus e o f gasolin e ingestion .

SUMMAR Y Siphoning-relate d gasolin e ingestio n i s a common , ye t potentiall yseriou s injury . Informatio n fro mth e America n Associatio n o f Poiso n Contro l Center s give s a n estimat e o f 8,15 6 suchcase s reporte d eac hyear , 14 9 o f whic hinvolve d moderat e o r majo r medica l effects , whil e informatio n fro mth e Nationa l Electroni c Injur

ySurveillanc e System , covering a randomsampl e o f hospita l emergenc yroom s give s an estimat e o f 95 3 case s eac hyea r seriou s enoughfo r treatmen t i n a hospita l emergenc yroom , 13 9 o f whomwer e hospitalized . Thes e dat a ar e summarize d i n Tabl e 1 . Inasmuc ha s th e populatio n o f th e U.S . i n 198 6 wa s abou t 24 0 million , approximatel y9 1 percen t o f whomwer e 6 o r older, ' ' the AAPC C dat a implie s tha t eac hyea r approximatel y1 ou t o f ever y 27,00 0 American s ag e 6 o r olde r ingest s gasolin e becaus e o f a siphoning accident .

Two case s i n the NCP C iata , aged 3 an d 4 , wh o imitate d siphoning b

yolde r person s ar e no t included . 1 4P.1 8



## Th e mos t importan t fundamenta l caus e o f gasolin e siphoning i s th e apparen t attractivenes s an d convenienc e o f th e technique . Thus , change s t o th e automobil e fue l syste mtha t mak e siphoning mor e difficul t bot hi n fac t an d i n appearanc e ar e ap t t o reduc e the overal l incidenc e o f siphoning an d henc e th e numbe r o f siphoning accidents .

1 5P.1 9



## Tabl e 1 . Summar

yo f Estimate d Incidenc e o f Siphoning-Relate d Gasolin e Ingestion . (Al l entrie s ar e o n an annua l basis. )

Numbe r o f gasoline-siphoning s unknow n Numbe r o f siphoning-relate d gasolin e ingestion s seriou s enought o see k medica l advice^ 3 

## ' 8,15 6 Numbe r o f siphoning-relate d gasolin e ingestion s wit hmino r medica l effects( a 

## ) 3,92 9 Numbe r o f siphoning-relate d gasolin e ingestion s resulting i n utilizatio n o f a healt hcar e facility* 3 

## ' 1/33 8 Numbe r o f siphoning-relate d gasolin e ingestion s seriou s enought o g o t o a hospita l emergenc yroon- p ' 95 3 Numbe r o f siphoning-relate d gasolin e ingestion s resulting i n moderat e o r majo r medica l effects' 3 

## ' 14 9 Numbe r o f siphoning-relate d gasolin e ingestion s resulting i n hospitalization ^ ' 13 9 Numbe r o f gasoline-siphoning-relate d deaths' 3 

## ' ' .. . non e reporte d (a ) Base d o n AAPC C data . (b ) Base d o n NEIS S data .

1 6P.2 0



## REFERENCE S
(1 ) Gasolin e wit ha Rei d vapo r pressur e o f 7 0 kP a ha s an estimate d equilibriu mconcentratio n o f gasolin e vapo r ove r liqui d gasolin e a t 2 0 C o f abou t 300,00 0 ppm . (2 ) Patty' s Industria l Hygien e an d Toxicology , Third Revise d Edition , Georg e D . Clayto n an d Floranc e E . Clayton , editors , (1981) . p . 3374 . I n on e human trial , an exposur e t o 10,00 0 pp m o f gasolin e wa s reporte d t o caus e dizzines s i n 4 minutes . (3 ) "Flammabilityan d Toxicit yTradeoff s wit hMethano l Fuels, " Pau l A . Machiele , SA E Pape r 872064 , (1987) . p . 7 . (4 ) "Siphon Burns, " Omni , Jun e 1980 . p . 37 . (5 ) Patty' s Industria l Hygien e an d Toxicology , Third Revise d Edition , Georg e D . Clayto n an d Floranc e E . Clayton , editors , (1981) . p . 3384ff . (6 ) "Accidenta l Deat hb yGasolin e Ingestion, " A . Carnevale , M . Chiarotti , an

d N . D e Giovanni , America n Journa l o f Forensi c Medicin e an

d Pathology , £ , 15 3 (1983) . (7 ) Clinica l Toxicolog yo f Commercia l Products , 5t hEdition , R.E . Gosselin , R.P . Smith , H . C . Hodge , an d J.E . Braddock , (1984) . p . III-220 . (8 ) Clinica l Toxicolog yo f Commercia l Products , 5t hEdition , R.E . Gosselin , R.P . Smith , H . C . Hodge , an d J.E . Braddock , (1984) . p . 11-154 , III-220ff . (9 ) "Th

e NEIS S Sampl e (Desig n an d Implementation) " Repor t b y the Divisio n o f Hazard an d Injur yDat a Systems , U.S . Consume r Produc t Safet yCommission , Marc h1986 , las t revise d Jul y1988 . p . 39 . (10 ) "Siphon Warning, " Newsweek , 1 7 Decembe r 1973 . p . 94 . (11 ) "It' s 'Fill'e r Up ' Agai n a s Car s Crow d Station s Afte r Drought, " Ne wYor k Times , 4 De c 83 . p . 1:7 . (12 ) "Acut e Exposur e t o Methano l i n Fuels : APredictio n o f Ingestio n Incidenc e an d Toxicity, " Tob

yLitovitz , Pape r submitte d t o Methano l Healt han d Safet yWorkshop , Lo s Angeles , CA , 1- 2 Novembe r 1988 , sponsore d b ythe Sout hCoas t Ai r Qualit y Managemen t District . 1 7P.2 1



## (13 ) America n Associatio n o f Poiso n Contro l Center s 198 7 Annua l Report . (14 ) "Acut e Exposur e t o Methano l i n Fuels : APredictio n o f Ingestio n Incidenc e an d Toxicity, " Tob

yLitovitz , Pape r submitte d t o Methano l Healt han d Safet yWorkshop , Lo s Angeles , CA , 1- 2 Novembe r 1988 , sponsore d b ythe Sout hCoas t Ai r Qualit y Managemen t District , p . 14-15 . (15 ) "Acut e Exposur e t o Methano l i n Fuels : APredictio n o f Ingestio n Incidenc e an d Toxicity, " Tob

yLitovitz , Pape r submitte d t o Methano l Healt han d Safet yWorkshop , Lo s Angeles , CA , 1- 2 Novembe r 1988 , sponsore d b yth e Sout hCoas t Ai r Qualit y Managemen t District , p . 21 , Tabl e 8 . (16 ) "Acut e Exposur e t o Methano l i n Fuels : APredictio n o f Ingestio n Incidenc e an d Toxicity, " Tob

yLitovitz , Pape r submitte d t o Methano l Healt han d Safet yWorkshop , Lo s Angeles , CA , 1- 2 Novembe r 1988 , sponsore d b ythe Sout hCoas t Ai r Qualit y Managemen t District , p . 20 , Tabl e 7 . (17 ) "Acut e Exposur e t o Methano l i n Fuels : APredictio n o f Ingestio n Incidenc e an d Toxicity, " Tob

yLitovitz , Pape r submitte d t o Methano l Healt han d Safet yWorkshop , Lo s Angeles , CA , 1- 2 Novembe r 1988 , sponsore d b ythe Sout hCoas t Ai r Qualit y Managemen t District , p . 15 , Tabl e 10 . (18 ) Statistica l Abstrac t o f th e Unite d States , 108t hEdition , U.S . Departmen t o f Commerce , (1988) . p . 17 .

1 8P.2 2



## APPENDI XA

NEIS S Data : Incident s Associate dwit hGasolin e

1 Ja n8 7 - 3 1 De c 8 7U.S . CONSUME RPRODUC T SAFET YCOMMISSION I S JI i t TUESDAY . INIIIk YIN( - 1 DENT' S TKFAIF DI

N NEIS S EMERGENC YDEPARTMENT S INVOLVIN

GGASOLINE : lANIUR YI MX 7 T O TH E PRESEN T

. . I-I O Jl •III ' I . (ltd / CO AI U KWOO D UUKNIN G STO\E S DA I I : VICTI M . . ACCIDEN T. . . PRODUCTS . .. . INJUR Y TRLA' I .ni l IIOsp l IAI . CAS E AG E Sl.' XLOCAL E FIR E OC C 1S T2N D 3R D DlA G BDYP TDIS P SlVT V H / M 1 2 K7III. I I|'ii.l4tl3: > UIIHJV7V 2 02' / M HOM E FIR E N (ll o 7 (I VII I 3-PRO D BKN- T2 5 - S » •TR/RE L SI X •||-liiMlMU 2 I42 XFIR E I N GARAGE . P TWO KKIN O O N WOO D BURNER . PU TCA S i£ l iu.HH / II P I N FACE , BURN S O N FACE . BOT H HAND S ABAC KD X1S Ti 2N D DEGRE E BURN S UFP A

« . I'KODUCI* . uj« yl.A S O KL P IILATERS . NO I ELstWIILK E CLAiSI F DAT E VICTI M ACCIDENT . . . . PRODUCTS . .. . INJUR Y TREA TCO I I IIOSPIIA I CAS E AG E SE XLOCAL E FIR E OC C 1S T2N D 3R D DlA G BDYP TD l S P SEVT Y K7U-IJ H K7( i S > | IA I I >o.- i * 00 2 7 2 09 4 04 4 P HOM E FIR E N OJS' J 091 0 NO/ ? BRN- TFING R TR/RE L TW O WlUill l 10 2 142 s LIGHTIN G PILO TLIGH TO N L P OA S IIFATER.GA S BURS TINT O FLAM E AN D UUKNL D VICTIM S FINUk'k S AN D HAN D

. . I'loiliil i | I I t-i -i MKoslN I U Ktil l HEATER S D AI E VICTI M . . .ACCIDEN T. PRODUCTS . INJUR Y IfcLA TCOI L Hos p I IA I CAS E AG E SE XLOCAL E FIR E OC C I s T2N D 3R D DlA G BDYP TDIS P SEVT Y h / I

_ ' I « SII';:

»Y)4lu4 3 oooovsa o III' / M HOM E NO/ ? N u3V ¥ U9I 0 3-PRO D URN- TL/AR M TR/RE L FIV E W l Kill l jil.tiuoi i KEROSEN E HEATE R STARTE D BURNIN G FIERCELY . P I STATE S H E ACCIDENTL Y FILLE DHEATE RWIT HGASOLIN E THA T WA S STORE DI

N A KEROSEN E CAN .

. . PRODUCT . 0 4 ti h COOKWARE . NO TSPECIFIE D DAT E VICTI M .. . ACCIDENT . . . . PRODUCTS . . . INJUR Y TK l A l CUL L HOSPITA L CAs E AG E SE XLOCAL E FIR E OC C 1S T2N D 3R D DlA G BDYP TD l s P SEVT Y h •'•i n I n H/oi.2- 1 .IN'/I.' u 2 2 IIIIOIMIVJ- I ill ? M UN KNO/ ? N H4<n i ti'/l u 3 PRO D URN- THAN D TR/RE L FIV E W l Kil l I 2 7 . S|U S WEN TT O REMOV E AI'A N I Ro M CULLMA N STOV E HA D GA S O N HAN D FLAME S IG N I TED S

••PRODUCT . 0t>7« i RUG S O R CARPETS . NO TSPECI F I I' D DAI E . \ICTI M ...ACCIDENT.. . . . PRODUCTS.. . . INJUR Y IKIA I COL L HOSPITA L CASL " AGI . SI XLOCAL E FIR E OC C 1S T2N D 3R D DlA G BDYP TDIS P SEVT Y SSi.tj l .SStilJ I IKSI2M2 2 S.- . I .->•»•»-n i -iii i I - UN KFIR E N ni.7i . OHI O J PRO D URN- T2i-i O TR/RE L SI X MFH.HT - II I >SS / MIIRNINi . CARPE TPIECE S WIT H GASO L INE . F l AME S IGNITE D WHE N MATC H WASTHKOW N ONT O GA S SAIUKATE D MATERIAL.BURNE D R.SID E O F FACE.NECK.RIGH TALEF TLEG SI I s CoNsliMI KPRODU C I s.AI I I VCOMMISSIO N I ) J I S TUESDAY . IDL Y2 ii. I'/n. S INIIIK YIN l HUNT S IRIATI D I N N l I S S I MiRGENC YDTPAK I MENT S IN\O I \ INl . GASO l IN I IANIIAK YI' J .1 7 T O Til l PRESEN T

. . IWIM U I . U h i I MlKKMIlll * COMPOUND S O KCIIIMIfAI S DATE ' VICTI M . ACCIDEN TPKOIUICT S . . INJUR Y TR I A TCOI L llosl'IIA I CAS F AG E SI XI I M A l E FIR E OC C 1S T2N D »R D DlA G BDYP TDIs P SLVT V XX0/I 2 KS l

> 7 I M -.('-12302 2 0* 1 I' J )'/ 2 I 02 ) M HOM E NO/ ? YO S * I O'/l o NO/ ? URN- C HAN D TR/RE L FIV E WEIGHT * 3 H 2X5 7 CHEMICA L Usl D T o COA l BLACKTO P O N ADRIVEWA YSPLASHE D O N BOT H HANDS . USE D GASOLIN E I O IK YT O REMOV E

•» PKOl.illC'T . O-JI O l.ASll l INI . DAT E VICTI M . ACCIDEN TPRODUCT S INJUR Y TREA TCOI L llosl'IIA I CAS E AG E SI XI. U AL E FIR E OC C 1S T2N D 3R D DlA G BDYP TDIS P SEVT Y S /t i I I I I s/H I o- l ili m .'H-.- I HU227-I2 0 ti.' i M IIOM l No/ ? N ii/l o IIIIIII I NO/ ? POIS N AL L IR/RE L TW O W l Hill l HI 2 I Ii n POINSlONIN G CIU M 1 1 Al . PAITLN I INIIA I ID / SWALLOWE D OASO L I N E H E WA S SIPHO N IN G s*. . I.I . :

s / / H'.ii , > n •- . >III)|2SM S III.I I M I'UIILI C NO/ ? YIIMI O ouo n No/ ? UK N THAN D TR/RE L FIV E W l I < .11 1 Iii 2 II2. S GASOLIN E EXP I oDF D I N HAN D Will i E A TWOR K

. s /nln- / h/ull l 1A. 1 1102 2 33US404 3 02 0 M STREE TA« P Yuvl u mm o NO/ ? BRN- TL/LE G TR/RE L FIV E W l U.ll l iti

.2,1) / GO TOA S O N LL u WHIL E IR I IN G l o S I A R I TRUC KAN D I T(LEG ) CAUGH TFIR E S VoU.- : .17 0 11 0 »A. s 11.12 2 l M l 2 7 So n 0/ 2 I UN KNO/ ? N OMI d ooo o NO/ ? URN- C FAC E TR/RE L FIV E WFTGIII' - I S 2XS / SP I ASIIF D (iASO l IN E INT O FAC F h/oli l K/ull l HiiDiij i u2l)4lli. l o M M INDs l NO/ ? Yi l vI i i ooo o NO/ ? BRN- C U/LE G TR/RE L FIV E W l U.ll l I02.I42 KBUR N O F LL G GASOLIN L EXPLODE D A TWOR K .-./..M l M'/OII ) l\. i I H o . IIOIIOMI2 4 o 2 S M UN KFIR E N U'/ll l OM7 2 3 - PROl' i URN - S HAN D TR/RE L FIV E W l K.H I - 10 2 I 42 K2N D OIGKI L UIIKN S K TPA I M AN D R TKNEE . GASOLIN E FRO M APOWE R SA WIGNITE D AN D CAUGH TPANT S O N FIR E •s/oll ! M 7t l I l o IS-/4202 2 oi./7S'J) 5 o I • / M PUBLI C NO/ ? YO'/l u ooo o NO/ ? CT/A B EY E TR/RE L TW O ( WllGIII - 4) . 2)0 0 OA S SlAlIO N AT l LNDA N TGO TGASO L I N E I N EYE . CORNEA L ABRASION . • K/nll s H/UI2 U «S'i»2ti2 2 iiuo n IKS ) oi l M HOM E NO/ ? N ii'/l u oooi i NO/ ? POIS N AL L TR/RE L TW O WEIGHT - 4 ) 25o o GASOI.IN I INGESTIO N INGESTE D UNKNOW N AMOUN T h/ulo l «/oin- / iVilloi- i I ;•/).! / ill s M HOM E NO/ ? N O'/l o ooo o NO/ ? BRN- THAN D TR/RE L FIV E WKIull l K l OOOI I UURN I l. l I I HAN D O N G ASO t IN l . 2N D DEGRE E BUR N LE TI HAND . TB S l/4 »U s CONSUME RPRODUC T SAF E T V (DM M I SS ION

I ) JI XTUESDAY . JU l V 21 . . I'/.I

X INJUR YINCIDENT S TREATE DI N NEIS S EMERGENC YDEPARTMENT' S INVOLVIN GGASOLINE : JANUAR Yl'J.1 7 T O TH E PRESEN T

• • I'KOI'l* . I . o'/lo GASOI.IN L MAT E VICTI M . ACCIDENT . PRODUCT S INJUR Y •tKIA T CO M

HOsl'ITU . CAS E AG E SE XLOCAL E FIR E OC C 1S T 2N D3R DDlA GBDYP T DIS P SEVT Y X/012 1 «/0l2' / IAI.S2O.I 4 ooll7)'/ V 02 3 M

INDs T NO/ ? Yoyl o ooo o NO/ ? URN- C FAC E TR/RE L FIV E WhIGIII - 0X.o2) O BURN S T O FAC E FRO M GA S X/0121 . X70I2- JH.)/Jtll 5 O74I703 3 03 o M INDST . NO/ ? YO'/IO tl'/Mt l NO/ ? POIS N AL L TR/RE L TW O WEIGHT - XI 000 0 P T INSID E STORAG E TAN KAN DINHALE DSOM E TYP E O F GA S FUME S 87012 1 x7ol2* 4 IPX 2 102 2 002XXy/ 4 01 9 M HOM E NO/ ? N • 0-41 0 000 0 NO/ ? POIS N AL L TR/RE L TW O WEIGHT - 3X2X) 7 INVOLUNTAR YINGESTIO N O F 2 O Z O F GASOLIN E S/iilii> X/ii-l. . •« . I c. x2 v i il( . I M

UN KNo/ ? N ovl o ooo o No/ ? URN- T HAN D'TR/RE L FIV E h i K.M . ' - GO I GA S O N HAN DIIIA

I I MM.Il l TIKI ' ...i- i K.... . IIIII I-/X7 I o« . - I M l-

l Mi l I C TIK E N

0-/I 0 000 0 NO/ ? BRN- T 25) 0 TR/RE L SI X h i K.ill M. . i . WA S A l GA S SlAlIO N WHI N GAS O INE THA I WA S SPILLE DO N GROUN DCAUGH T HKE - BURNIN GP I IHA T WA S STANDIN GI O CLOS E T O AREA.lFIR E NO T ATTENDE DBV Fl K hV. ui u*.'II.'. . • i.\.-M|U 2 2 MK.X87S 7 02 2 M HOM E Nil/ ? N U'/I O32I XNO/ ? UR N T FAC E HOS P SI X W l I • .II I I S Js< ; IGNITIN GGRI M . SOMEON E HA DTHROW N GA S O N

I T AN DI T FLAKE DU P x'/u2o » X/U2H- . )ASHo2 2 u/)l224 4 o2 JM UN KNO/ ? N U4 1 l

l ooo o No/ ? BRN- T FAC E TR/RE L FIV E WEIGHT - J

X.2.S) 7 FLAS HBAC KFRO M GASOLIN E FIR E ,s7n2u l X7020I . 112)211) ) tiooo)ii3 l iij v F HOM E FIR E N u'/ll

i ooo o No/ ? URN- T FAC E TK/RE L FIV E W l IGH I 10 2 142 s TKVIG N I O STAR T I IR

T WIT HGASOLINE.FLAME S FLARE DUl * BURNIN GHE RFAC E

. - /o2o xX/02I O IS-/I202 2 oiSli.'/l l oi l M HOM E NO/ ? N 0*41 0 OOO O NO/ ? BRN- T 2 5-il l HOS P SEVE N WLIGlll - -I ) .2)o o GASOLIN L CA N EXPLODE DI N

FACE . SHIR T CAUGH T O N FIR E - 27 * BURN S T O FAC E 

### »trx+KtrMTTii: s "AND"BSCIC : 

### ._.. . .1/1.211 /

X/02 M IS/2IOI I OII|II/I,3 I n2« * M UN KNO/ ? N o'/l o ooo o NO/ ? UKN- S HAN D TR/RE L FIV E W l IO N I Udi> n flKKNII " HAN D O N SOM E GASOLIN E TOOAY/D XJ BUR N WOUN D LEF THAN D
X/H2I I X/021 2 ll'iiilii) ) IUIOOII/4 2 im i M I'UH I I C AUT O N n'/lt i oyX I NO/ ? OTHE R EA R TR/RE L ZER O WFIGIII-10 2 142* 1 GA s CA N Fil l OF F TRUC KSTRIKIN G SID E O F HEAD . GA S WEN TINT O EA R CAUSIN G CHEMICA L OTITI S MEDI A .1/II.I J S/02I - tl'ui . I n t.a nii 2 2ii.il.- ' I I .'i i M I'UIILI C NO/ ? Yir/I O ooo o NO/ ? URN- C EY E TR/RE L SI X w l I',II I ni 2 I I.- , WAS sl'KA l INI , G.-xso l IN E O N MACHIN E T o KI.MO\ E TA R WHIL E O N HI E JO B AN D IIIWINT O 11 1 s 

# JI I S CONSUME R PRODUC TSAFET YCOMMISSIO N INJUR YINCIDENT S TREATE D I N NEIS S EMERGENC YDEPARTMENT S INVOLVIN G GASOLINE : JANUAR Y198 7 T O TH E PRESEN T 15:1 8 TUESDAY . JUL Y2o . I'/X X

. . PRODUC TJ O'/l o GASOLIN E DAT E TREA TCOI L VICTI M HOSPITA L CAS E AG E SE X .. . ACCIDENT.. . LOCAL E FIR E OC C ... . PRODUCT S 1S T 2N D3R D INJUR Y DlA GBDYP T DIS P SEVT Y «702l< > 870 2 I

X WEIGIll - 5 1 . 304 / 3Nu22U) 5 000440) ) 03 ) M UN KNO/ ? N 091 0 000 0 NO/ ? BRN- C 25-5 0 TR/RE L SI X WHIL E PUTTIN GGASOLIN E IN CAKBOKAIO KTH E GA S SHO T BAC KA T HI M CAUSIN G BURN S T O FACE . NECK . AN DL . HAN D H7U2I hX702I X WEIGHT - X I 000 0 1110104 ) 0(111504X2 01 2 M HOM E NO/ ? N (191( 1 OOO O NO/ ? SPLASHE DST P GA S TREATMEN T IN BOT HEYE S DRMA T EY E TR/RE L TW O

X/02I X8/1)2 2 1 WEIGHT - 38.28) / JPX2302 2 (1029227 4 02 4 M PUBLI C NO/ ? Y PT . SPLASHE DGASOLIN E I N RT . EY E 091 0 ooo o NO/ ? BRN- C EY E TR/RE L SI X

X7 u2 2 I X7 U 2 2 i . W l 11.11 1 I X2X 1 / IP.1 2 102 2 oo>930X 2 o2 2 M PUULI C FIR E YO'/l o ooo o NO/ ? BUR N T O R T HAN DDUE . T O IGNITE DGASOLIN E BRN- T HAN DHOS P SI X

X70lu 9 t

i 7(1- 1 I 3 WEIGIII - 45.2)0 0 IS922U2 2 009608(1 0 00 2 M HOM E NO/ ? N INGESTE DDIESELFUE L UNKNOW N AMOUN T 0 9 1 0 000 0 NO/ ? POIS N AL L TR/RE L TW O

X/ o II I I tt 7I

I 10 3 WEIGHT - X I 110(1 0 I 31.-.1.204 ) H44X450 7 (10 2 M HOM E NO/ ? N (I9I O 09X 1 NO/ ? POIS N AL L TR/RE L TW O CHIL DDRAN KUNKNOW N AMOUN T O F GASOLIN E OU T O F CAN . EMPT YCA N WA S FOUN D OUTSID E O F HOUS E DGASOLIN E INGESTIO N X7 0 llll . X7030 9 WEIGHT-102.142 8 3T2(.4(l) ) 0X92034 0 oi> 3 M PUBLI C NO/ ? N 091 0 09X 0 NO/ ? CT/A B EY E GASOLIN E FRO M

PUM P SgUIKTE DIN E1E-COKNEA L ABRASIO N TR/RE L TW O

X7 I I I i l 4 X7 0 1 0 5 WEIGHT - OX . 0 2 S o 3N«.i.2ii M oo l b l 29 4 0 1' / M INDST . NO/ ? V 091 0 173 1 NO/ ? BR N T L/AR M

TR/RE L FIV E WA S A T WOR KAN DHA DGASOLIN E O N ARM LI T AMATC HAN DGOTUUKN T X/Olli o K7( 1 3 M

l WEIGHT - 0 8 02) 0 IH(.)20I 4 X 7 107X5 2 o2 XM INDs T AUT O Y(191 0 220 0 NO/ ? POIS N AL L TR/RE L TW O GASOLIN E INGESTIO N - SWALLOWE DMOUTHFU L O F GASOLIN E WHIL E SIPHONIN GI T FRO M A TRUC KA T WOR K X/ o l o / x'/ u3 I o WEIGHT-10 2 I42 X isJ/liii ) ooo24/(> 4 o2 o M PUBLI C NO/ ? Yo'/lo uuu uNO/ ? URN- C EY E TR/RE L SI X 2 o I ROL DSPI I I I DGASOLIN E IN BOT HEYE S WHIL E PUMPIN GGASOLINE . DX ; CHEMICA L BURN S T O BOT HEYES . 8/031 2 8703 1 . WEIGHT-10 2 142 8 ID342H) ) ouoiii i J5< i o|- / M

HOM E FIR E N 091 0 000 0 NO/ ? BRN- T HAN DTR/RE L FIV E 2N DAN D3R DDEGRE E BURN S O N LEF T HAN DWORKIN GWIT HGASOLIN E AN DI T IGNITtD. . .NO I FIR E DEPARTMEN T ATTENDED . x/u) l 1 9/011 / W l IGlll XI IP ) I t uI ) oi.x'JIll / u'i . M INDST . NO/ ? Yo'/lo uuu uNO/ ? DRMA T EY E TR/RE L TW O SP I ASH I DGASOI.IN L IN LLI T LY E A

T WOR KTODAY . CHE M I CA L IRRITATIO N T O LM - T I V

I .I I s CONSUME RPRODUC T SAFET YCOMMISSIO N INJUR YINCIDENT S TREATE DI N NEIS S EMERGENC YDEPARTMENT S INVOLVIN GGASOLINE . JANUAR YI9S 7 T O TH E PRESEN T IS : I XTUESDAY . Jil

l V 2< . . I'/X

X

, . I'KoliUCT . (1

9 1 0 GASO I IN

L DAT E TREA T COL L

**- > 7 O3 I OX/ O3 I a WEIGHT - 45.2)0 0 I HOSPITA L 3 S • * 4 2 0 2 2 VICTI M

CAS E AG E SE X .ACCIDENT . LOCAL E FIR E OC C PRODUCT S 1S T 2N D3R D 02*4487X 3 03 ) M I ND S I . FIR E Y091 0 Ooo o NO/ ? MECHANI C SUsTAINR DIGN I TE DGASOLIN E BURN S T O HANDS . D I A G URN- T . INJUR Y

BDYP T DIS P SEVT Y HAN D HOS P SI X

X7 0 11 9fcEIGHTr X7031 9 WEIGIl l - H X/l l 1 1 7 W l l l il l 1

X / u 1 2 2 WLlGll l -
X7i l 1 2 2 WEIGHf XVI I 121 1

X I 000 0

X7 0 3 2 0 xi.ooo o

X7 o 12 " 2 7 i 1o s ,l/ol2 1 X1.OOO O

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JP) I 104 ) 0D'/oll40 XOi l M HOM E NO/ ? N O'/IO 141 4 3-PRO DPOIS N AL L WHIL E SIPHONIN GGASOI.IN F WIT HA HOS E FRO M

TRACTOR . PATIEN T SWALLOWE D MOUTHFU L O F GASOLINE / HYDROCARBO N INGESTIO N TR/RE L TW O

(K..S9997 5 ()l ) M SCHOO L FIR E N 091 0 oou o NO/ ? BRN- T L/LE GTR/RE L FIV E SPILLE DGASOLIN E WHIC HIGNITE DO N RIGH T LOWE RLE GA T SCHOO L WHIL E BURN INGBUSHES.1S T AN D2N DDLGRL E UUKN S LOWE RLEG/FIR E DEPARTMEN T NO T THER E IN-I12.I2 2 nn2G . I I • ) ol' ) I PUI HI C NO/ ? N O'/lo 111 4 No/ ?

. i .' u»2 U U-poon- / HOsF " BROI L GA S INT O EYF s A T GA S STATIO N FRN/ UEY E

3M))I04 ) 0O2X9I0 X04 7 M HOM E FIR E N 091 0 004 8 3-PRU DURN- T HAN D POURIN GGASOLIN E DOW N A DRAI N AN DNEARB YPILO T LIGH T IGNITE DGASOLIN E UNKNOW N

WHETHL RFIR E DEP T WA S O N SCENE/BURNE DHAN D IC I 3 UD ) OOX7442 7 2 2 uM HOM E NO/ ? N O'/IO (10(1 0 NO/ ? POIS N AL L SWALA I OWE DGASOLIN E N O ON E WITNESSE DTH E INCIDEN T TOXI XINGESTIO N TR/RE L TW O

TR/RE L FIV E

TR/RE L TW O

XHI 12 / 8 7 o 13 0 WLlGll l - 10 2 I42 X 3W 3 1IO) ) 0000371 2 oo o M PUBLI C FIR E N 091 0 000 0 NO/ ? TRAC T 2)-) UTN/HS P SEVE N H E WA S PLAMN GA l IM S FRIEND S AN DWA S CAUGH T O N FIR E B YA

GASOLIN E FIRE . (N O ON E KNOW S DETAIL S J2ND/3K DDEGRE E BURN S T O BODY.T O BUR N CTR . X /l l 12 HX /II J 1 I W l II.II T - X IOOO O I* . IV)4I0I ) om./'//•/• / (1 2 2 M HOM E A» F N (1

9 1 0 oou o NO/ ? BRN- T 2 ) 5( 1 TN/HS P SEVE N WORKIN GO N

CAR . GASO I IN I EXPLOSIO N PATIENT S FACE . CHES T A BOTI I ARM S A HAND S CAUGH T FIRE . 2N Da 3R DDEGRE E BURNS . NO T STATE DI F FD A 8 In I i o X704 O I WEIGHT - 38 . 28) / IA. 1 1102 2 82) 8 3X4 ) mi xM UN K SPLASHE DGA S I N

LIE S NO/ ? N 0 9 1 0 000 0 NO/ ? BRN- C EY E TR/RE L SI X

X7I I io 1 X7U-l n o WEIGHT ' 3 X2X 5 7 I . X/OHI O X/04 O I WEIGHT-10 2 . 142 X JKSI202 2 X4X7i.77 o uv i M STREE T AUT O N 09I O oou o NO/ ? BRN- T 25-5 0 HOS P SEVE N TRIE DT O STAR T CAR.POU RINGGA S I N CAKBORATOR.ENGIN E BAC KFIRE DAN DEX PLODE DIN

FACE.CA RFIRE.2N DDEGRE E BURN S FACE.CHEST.HANDS.YE S FIR E DEP T 31274(D ) 0X11213 / 111* . M HOM E AUT O N 091( 1 OOO O NO/ ? SUFFERE DBURN S T o AR M WHIL E POURIN GGA S I N CARBURETO R BRN- C L/AR M TR/RE L FIV E

X/U4u 4 X/u-

l i l / W l I GU T 1 0 2 1-12*

1 IWIIHD ) ouooii-i.1, 1 u| 2 M PUBLI C NO/ ? N ii'/l

o u'/X I NO/ ? BRN- T L/AR M TR/RL' L FIV E H F WA S I'l.A

V IN GWIT HA

FIR E AN DPOURE DGASO I IN E O N TH E FIRE . TII E FIR E FLARE D2N DDEG . BIRN S T O ARMS.(L ) EAR.FIREME N CALLE DT O SCENE .I I s CONSUME RPRODUC T SAFET YCOMMISSIO N 15:1. 1 TUESDAY , lll l Y2o . I9XX INJUR YIN

l HUNT S TREATE DIN NEIS S EMERGENC YDEPARTMENT S INVOLVIN GGASOLINL . JANUAR YIVX 7 T O TH E PRESEN T

*» . PRODUCT : 0 9 1 0 GASO I INF DAT E VICTI M . . ACCIDEN T . . . . . PRODUCTS . .. . INJUR Y TKLA I COL L llosl'IIAI . CAS E AG L SL XLOCAL E FIR E OC C 1S T 2N D3R DDIA UBDYP T DIs P SEVT 1 8/040 1 S70I0 / JWIJUD ) UUOOUIX' / 04 4 M HOM E NO/ ? N O'/IO 100 4 NO/ ? PRAC T HAN DTR/RE L THRE E WEIGH T 10 2 II2 XH E WA S BURNIN GGREAS E FRO M A OI L CAP , POURE DGASOLIN E ONT O FIRE,FIR E FLAKRE DAN DBURNE DHI S (R ) HAND . X70 4 I I X704I 4 IAXU02 2 071)2)9 2 21 2 F HOM E NO/ ? N 091 0 oooi i NO/ ? POIS N AL L TR/RE L TW O WEIGHT - 18.2X5 7 INGESTE DUNKNOW N AMOUN T O F GASOLIN E X/H4I 1 8/041 4 3VO-I30) ) ooouX4l o oJ ) M IIOM

L Aal - N

U'/lo ouu o NO/ ? URN- T 2)-) UTR/RE L SI X WEIGHT - IU 2 . 142. 1 1 4 * * 1S T AN D2N DDEGKL L BURNS . AR M BACK . AN DFACE . WA S POURIN GGA S INT O CARBORATO RAN DI T BA C K l I RED.(All s INGEXPLOSIO N O F FLAME S . BUR N INGP T •I7ii4ii xX70I M

IN ) 1202. ' 002009) 7 III I M HOM E FIR E N 0 9 I

n17) 1 3 PRO DBRN- T FAC E TR/RE L FIV E W l IGHI - 27.510.- . CHIL DWA S OUTSID E HI S HOUS E POURE DGASOLIN E O N TOYIRUC KLI T A MATC HW l C HIGNITE DTH E GASOLIN E FIR E DE P WA S CALLE D x/.i-ll- l X/04H . iN)Olo4 ) oooolUO X00 2 M HOM E NO/ ? N uvl u1.1/ 0 NO/ ? OTHE RAL L TR/RE L ZER O rti K.Ill - XI oiio o PT . CAM E INT O HOUS E CRYIN GW/ODO Kul - GA S AROUN DMOUTH . I D l AG . -EXPOSUR E T O GASOLINE I X/OI2 H 87042 1 ISlMiD ) OtiOIVc . 1 7 Uo l M SPORT S NO/ ? N 09I O 120 4 NO/ ? BRN- C U/LE G TN/RE L FIV E WlIGHT'102.I42 XPATIEN TGO TGASOLIN E INSID E AWE TSUI TSUSTAININ G CHEMICA L BURN S TO LEG . X.u-1 2 1 X/042 2 3AX3IH2 2 l4noX*-/iil lll l 2 M HOM E NO/ ? N O'/I

UOOO O NO/ ? I'OlSN AL L TR/RE L TW O W l K.II T SA.iAmt/

DRAN KUNKNOW N gUANTIT YOF " GA S X/042 0 X7042 i IN' ) 1202 2 (10207X2 2 21 0 M UN KNO/ ? N 091 0 OIIO O NO/ ? POIS N AL L HOS P SI X WlIGIIT * 2 7 5I0 XMO M STATF S CHIL DINGESTE DA MOUTHFU L O F GASOLIN E .s/u-12 1 1 X/u-12 / Jl'ui.30) ) UU22IX/. 1 o4 2 M HOM E NO/ ? N uvl uOoo o NO/ ? URN- T FAC E IR/RE L FIV E WEIGHT-IU2 . I42 XPOURE DGASOLIN E O N A BRUS HFIR E AN DFIR E FLASHE DUAC KBURNIN GPT . X/o-12 0 X7U42 XIV'l«.2o) i II 7 M 3 12-f t I l l I 7 M

UN KFIR E N 091 0 (loo dNO/ ? FRAC T 2S-S 0 TR/RE L SI X WEIGHT - 10 2 . 142. 1 ATEMPTE DT O STAR T BONFIR E WIT HGAOLIN E FIR E BURN T ABDOMINA L ARE A AN D BOH I THIGII/2N DDEGRE E BURNS / K/U42 9 X/O-ll o SNMI3U-I ) ooulul'/ Xo2 l M UN KFIR E N 091 0 000 0 NO/ ? BRN- S AL L TN/HS P SEVE N W l K.IIT - XI . limn . PT . W/UUKNI DIN A FLASHBAC KFIR E FRO M GASOLINE . BURNE DHANDS . HEAD . FAC E .CHEST.ARM S I UNKNOW N WHER E HAPPENE DO RI F PT . W/A T WOR KJ X/O10 2 X/oiii i U7 1 | 0 14 07)11X1 1 mi xM HOM E FIR E N Ilil

uOoo o NO/ ? BRN- T 25-5 0 TR/RE L SI X Will.Ill - 08.02) 0 UIIRNE DWIT HGASOLIN E 2 IIRS . AiHJ . 2ND . DEGRE E BUR N RIGH T WRIS T A

RIGH T / THIG HI I FD A 

# LU S CONSUME RPRODUC T SAFET YCOMMISSIO N INJUR YINCIDENT S TREATE DIN NEIS S EMERGENC YDEPARTMENT S INVOLVIN GGASOLINE . IANUAR Yi9x / T O TH E PRESEN T I ) : I XTUESDAY . JUL Y2u

. I'/X X

I k PRODUCT

. O'/I O GASO I IN L DAT E

. . 1RIA TCOL L I I H 7( 1 3(1' I X7USII 5 WEIGHT - 2 7.510 8 VICTIM . HOSPITA L CAS E AG E SE X . .ACCIDENT.. . LOCAL E FIR E OC C .. . PRODUCT' S 1S T 2N D3R D INJUR Y DlA GBDYP T DIS P SEVT Y IN / 1202 2 (I02)0|2 XOIK , F UN KNO/ ? N (191 0 OOOI I NO/ ? DRMA T EY E TR/RE L TW O GASOLIN E SPLASHE DINT O PT S EY E AMOUN T O F GASOLIN E NO T KNOW N EPISOD E WA S UNWITNESSE D 870)0 8 870)0' / W t K.IIT - 8 I .UUUU JP)2I04 ) 0000203 4 oil. ' M HOM E NO/ ? N 09l o oou o NO/ ? FRN/ B EY E P T HA DGA S O N

HAND S (HOW

UNKNOW N

I AN DRUBBE DI I INT O EVE S TR/RE L TW O

X7 l l i o 9 X70 5 I I WEIGHT- - o X02i o (Ai. X> u1 4 oliiixxo2- l oi l M HOM E NO/ ? N o')l o ooo o NO/ ? BURNE DAR M

WH1 1 F I IGHTIN GFIRE . BUR N FRO M GASOLIN E BRN- T L/AR M TR/RE L FIV E

X70.i nXX/ll ) M WEIGIl l 102 . 112.- . ll'iii . lu ) ) 0022217 4 OO O I ' HOM E NO/ ? N 091 0 141 4 NO/ ? POIS N AL L CHIL DSWALLOWE DMOUT HFUL L O F GASOLIN E - WA S SUCKIN GGA S OU T O F HOS E FRO M A CA R TR/RE L TWO

x/ni M X/ o i I 2 WI T Gi l I XI Oi

l O o l|'-. 2 im i OUO02XJ 7 i.n 2 M HOM E NO/ ? N SPILLE DGASOLIN E I N BOT HEYE S ns . I i l ooo o NO/ ? UR N C EY E TR/RE L SI X X/0)| o X705I 2 W l Kill I - XI . OOU O 3M)5I04 ) (I02/X07 7 02 3 F HOM E NO/ ? N 0*

7 1 0 000( 1 NO/ ? SPLASHE DGASOLIN E I N EYES/CHEMICA L IRRITATIO N DRMA T EY E TR/RE L TWO

X'/O I I ) X7 0 5 I •

/ WEIGHT - I

X2X5 / ll'S2 11.22 O03O3XX I 1142 M HOM E NO/ ? N O'/I

O 000 0 NO/ ? P T SP I ASHE DGASOLIN E INT O BOT HEYE S ACCIDENTALL Y BRN- C EY E TR/RE L SI X

X/O) 2 I X70) 2 8 WEIG HI - XI .000 0 3L)(»I04 ) 0 0 19207 4 2 1 8 M HOM E NO/ ? N 091 0 000 0 NO/ ? PT . INGESTE DUNKNOW N LIQUI D- POSSIBL E GA S POIS N AL L TR/RE L TW O

X7II52 7 X701J O WEIGHT - 10 2 I I2 X tpm . luS S 0112227) 2 Oi l I - PUBLI C NO/ ? N O'/IO OOO O NO/ ? ST/S P WRIS T TR/RE L ON E TRIPPE DAN DFEL L PUTTIN GGASOLIN E I N CA RA T GA S STATOOP M

X/(I ) I I X/OO O I WLlGlll - 10 2 . 142 8 «K 2 12(D ) 0009499 / 110 9 M PUBLI C AUT O N 091 0 000 0 NO/ ? DRMA T FAC E TR/RE L TW O • PUTTIN GGA S IN

TH E CA RA T 7 ELEVE N AN DSPLASHE DGA S I N FACE .
X7(D2 I X70(. o I WEIGIll - OX.02S O i.v..'/i o ) i 003O2XXI . mi xI - HOM E NO/ ? N INGESTIO N

O F GASOLIN E O'/IO ooo o NO/ ? POIS N AL L TR/RE L TW O

8 7I DII I X7 0 0 0 I WF K.IIT 10 2 I I2h JI il l ill)- i 024)0401 1 0/ 0 M HOM E NO/ ? N 091 0 000 0 NO/ ? AR M AN DWRIs T UUKN S USIN GGASOLIN E T o BUR N BRUS H BRN- T L/AR M TR/RE L FIVEI I s CONSUME RPRODUC T SAFET YCOMMISSIO N I):I XTUESDAY . JUL Y20 . 19X 8 INJUR * INCIDENT S TKL.VIL DI N NLTS S LMLKGCNC YDEPARTMENT S INVOLVIN GGASOLINL . JANUAR Y198 7 T O TH E PRESEN T

. . PRODUCT . 0 9 I I I GASO I INI : IMI L VICTI M . . .ACCIDENT . . . .. . PRODUCTS . .. . INJUR Y IKLA I CUL L Hos p I I A L CAS E AGf c SE XLOCAL E FIR E OC C 1S T2N D 3R D DlA G BDVP TDIs P SEVT Y 87ii)2i , X'/ucu i 3A.1.1I02 2 271.2)49 1 02 u M HOM E NO/ ? N O9I 0 OOO O NO/ ? URN- C EY E TR/RE L SI X WIIGII I J X2X5 / WORKIN G UNDE R Ill s CA R AN D GA S DRIPPE D INT O EY E
X7U52 7 X/lloli I IA X1102 2 l'JXOo8X n u2 o F PUBLI C AUT O N (1 9 1 0 000( 1 NO/ ? BRN- C EY E TR/RE L SI X WEIGIll - 3 8 28) 7 PUTTIN G GA S I N CAR . SPLASHE D INT O EYE S .1/ID2 9 li/uuo l ipiu.3u) J ou222/'/ | uu 4 M IIOM L No/ ? N 091 0 uoo u NO/ ? TRN/ B EY E TR/RE L TW O WLlGll l 10 2 142. 1 GASO I IN I SPI I I I D O N P TW I II I G E I TI N G INT O EV E x/III.II. ' X7OI.II - , . O40-I4 I ill. ' M I AR M TIK I N O'/l u 114 1 ) PRO D UR N TL/AR M TR/RE L FIV E WIIGII I iu 2 i . I. I I* • •Ki t I IVI D JN D DIoKI I IIIIRN S T O l-OKI.ARM . ABDOME N HOLDIN G CIGARETT E T O CHEC K

WAll KI.IVI I I N DRUM.GA S WAS I N DRU M WHIC H IGNITE D GA S FLAME S FLARE D U P i .mini . M l ni l M TAR M FIR E N u'/l o Mi l NO/ ? UR N TFAC E TR/RE L FIV E rti I..I U i. . . U U p . i.n i * BINDIN G OVTR T O CHEC KW AT l " k MAL I I N DRU M WIT H CIGARETT E NO TKNOW N I N G GA S WAS I N IHiU M sil l P I RI D TTIEKMA I UUKN S T O FAC E h /III. O i .-,/..<..1 1 IS94202 2 U(lXX94) 4 0) 4 M UN KFIR E ? O'/I O oilii o No/ ? BRN- T25-5( 1 HOS P SEVE N WIIGII I 4 i 2l.u i POURIN G GASOLINE . I TCAUGH TO N FIRE . 40 * BURNS . X7oi.i i I x/III.II. ) I D l- l 3ii) i u 10433) 5 U U I HOM E AUT O N 0 9 l u UUU U NO/ ? BKN- C EY E TN/RE L SI X rti. K. KI IU 2 142. 1 VICTI M WAS HELPIN G IIL R 11Kb BAN D FIN D AGASOLIN E LEA KUNDE R TH E TRUC KAN D GASOLIN E SPILLE D INT O BOT H EYE S AN D TH E RIGH TEAR . X/IK.III . X7000 XIT297U) ) O0O2540 I U2 9 M HOM E NO/ ? N o9|( l I2I H NO/ ? BRN- THAN D TR/RE L FIV E WIIGII I 10 2 I42 XVICT M WAS ATTLMPTOIN G T O RELIGH TTH E CHARCOA L I N IH S GRIL L B YPOURIN G G Asol . IN E ONT O IH E llo s COAL S 3R D UEG . T O HAN D 2ND- I ST . T O FOREAR M X/ono /

x/lli.o xipo o loi ) I.II22)07 ) oo. i M HOM E NO/ ? N (191 0 ooo o NO/ ? POIS N AL L TR/RE L TW O WIIGII I Iii 2 I 12.1 (TOL D DRAN KSOM E GASOLIN E - AMOUN TUNKNOW N
S/000 9 87001 0 3A X1102 2 4942I9I. Xoi l M HOM E NO/ ? N 091( 1 OOO O NO/ ? POIS N AL L TR/RE L TW O WEIGHT - 3X2.15 / INHALE S GA S FUME' S
X/ui.1 2 «/in . 1 4 lA.illo.'. ' l)Xo/77 u ol / M HUM ! NO/ ? N O'/l o 321. 1 NO/ ? URN- TFAC E TR/RE L FIV E WEIGHT - 3 X2X) 7 PU TGASO I IN L T O GRIL L T O STAR TI TAN D I TFLAME D U P I N FAC E X/oi.1 2 x/di.l i iN-iulo- M 0110/-1X1. I 114 ) M HOM E FIR E N II VI o uoo u NO/ ? BRN- TFAC E TR/RE L FIV E W l Kil l I X I IIIIIII I P I I IT E BRUS H FIR E W/GASDIIN E a VAPOR S FLASHE D BACK : BURNIN G FACE . N O MENTIO N O F FIR E DEP TI N ATTENDANC EU s CONSUME RPRODUC T SAFET YCOMMISSION I):I XTUESDAY . JULY2 o 19X 8 INJUR YINCIDENT S TREATE DI N NEIS S EMERGENC YDEPARTMENT S INVOLVIN

GGASOLINE : JANUAR Y19X 7 T O TH E PRESEN T

. . PRODI uT j O'/I

O (iA.sol . INF . DAT E VICTI M .. . ACCIDENT . . ... . PRODUCT S INJUR Y TREA T COM . HOSPITAL CAS E AG E SEXLOCAL E FIR E OC C 1S T 2ND3R DDlA GBDYP T DIS P SEVT Y a/IK , I ) .1/1) 0 1 / 3S3(.2ll) ) 000)219 / u) UM HOM E NO/ ? N uvl uOOU

O NO/ ? BRN- C EA RIK/KE L TW O WLlGll l I02.I42 XIIUK T EA RGO I GASOLIN E INT O EA RWHIL E WORKINGON GA S LINE DX : BUR N T O E A R X700I 2 X70OI 7 3N9I202 2 007(lll)) 4 01 2 M UN KNO/ ? N 0 9 1( 1 000 0 NO/ ? BRN- C FAC E TR/RE L FIV E WEIGHT " 2 7 510 8 CiO TGASOLIN E SPLASHE D I N FAC E 8/001 5 .1/001 7 )S942o2 2 8iio48)9 2 u 21 . M PUBLI C NO/ ? N •U VI u ooo o NO/ ? S I /.S P ANKL E TR/RE L ON E WLlGll l I).2)O U SLIPPE D I N GA S O N TLoG R Ol GA S STATION . SPRAINE D ANKL E
X7oi.l i S/.II.I / 112/101 1 OX12X2I Xoi l M f l lll l H AUT O N o9 1 o 190 9 No/ ? BRN- TI /LE G TR/RE L FIV E W l K.ll l |0 » 142. 1 PUTTIN G GA S INT O CA R WIT H (TGAKI-'TT E I N MoUTH.PUIIF D GA S HO F OU TSPILL - IN G GAS . Sil l FIRE D 2 - 1 BURN S T O LE G .1/1102 1 ,1/uoJ I 11/1103 4 0/4044I XOI 4 M HOM E Aa l ? o •/ I l l UUU U NO/ ? URN- C L/LE G TR/RE L FIV E M L K.ll l o. i 02) 0 GASOLIN E EXPLODE D FRO M MOTURCVCL E . IKIE D IU PU I FIR E OU TWIT H HANDS . U FDA . MULTIPL E BURN S T O L LE G AN D PAL M X7IK.2 I X7IU.2 4 (AKIIU2 2 I|i.ii92l 7 u) 2 M HOM E AUT O N 119 1 o oou o NO/ ? BRN- C EA R TR/RE L TW O WEIGHT - I X2X) 7 WORKIN G UNDE R CAR-GASO I IN E SPILLE D INT O EA R x/ot.2 2 X/oo2 ) 4VU.20) ) (I/X4X29 I 0 1 2 M UN KAa p N 0 9 II I UOO U NO/ ? BRN- TL/AR M TR/RE L FIV E rti K.H I I..2.I42 XH L WAS TRYIN G I O P KI M L ACARUIIRATL R WIT H GA S WHE N I TCAUGH TO N FIR E SPREADIN G T O ARM S AN D HANDS/BURN S TO AR M AN D HANDS / x7.ii.2 l X/ilo2 ) I S l.'lol i iiiiii i 39 2 ) 222 I HOM E NO/ ? N O'/l u 111 2 NO-CR C POIS N AL L TR/RE L TW O WEIGHT - IU2 . M' X2 2 M O O l D INGESTE D UNLEADE D GA S I N A N OPE N COFFE E CA N SUSTAININ G GASOLIN E INGESTION . R/UPPE R LOB E PNEUMONI A x/(ii,2 4 D/002 ) 3M I /)(!) ) U(iu2)0X ) uu 3 M UN KNO/ ? N 091 0 OOO O NO/ ? POIS N AL L TR/RE L TW O WLlGlll-102.I42 XINGESTE D GASOLIN E JUS TPRIO R T O ARRIVAL . QUESTIO N AMOUNT . X7002 I .17002 5 IS922U2 2 0(l22XX*9 o 2| I M HOM E NO/ ? N O'/I O 000 0 NO/ ? POIS N AL L TR/RE L TW O WEIGHT - 4 5 250 0 POSSIBL E GASOLIN E INGESTIO N FOUN D WIT H GASOLIN E C A X/ui.2 ) x/oo.' o IMI9I0. D OOO0234 9 01 9 I UN KNO/ ? N (19 1 o OUII O NO/ ? DRMA TEY E TR/RE L TW O WIIGII I 10 2 I42 Xsl' l ASIII- D GASOI.IN I INT O RIGH TEY E CHEMICA L CONJUNCTIV I T l S RIGH TEY E X/nc.2 5 X7III.2 O IMI'iUD ) IHIIIU 2 li u O M M PUBLI C AUT O N uvl u UUU U NO/ ? DRMA TCYt " TR/RE L TW O • W l K.ll l Hi- ' 142 8 GA S NO/./L F POPPE D OU TO F CA R GA S LAN KAN D SPLASHE D GA S INT O BOT H EYES iTIIMIC M CONJUNCTIVITI S BOT H IVE SI I S . CONSUME RPRODUC T SAFET YCOMMISSIO N INJUR V INCIDINT S TREATE DIN NEIS S EMERGENC YDEPARTMENT S INVOLVIN GGASOLINE : JANUAR Y19 8 7 T O TH E PRESEN T IS : I XTUESDAY . Jil

l V 2o . I9XX

. . I-|.'< i l ilil' T. 11 9 I l i I. A Sil l INI DAT E TRE AI COI L HOSPITA L V I i. T I M . CAS E AG E SE X .ACC I DEN T . . LOCAL E FIR E OC C . .PRODUCT S 1S T 2N D3R D INJUR Y DlA GBDYP T DIS P SEVT Y 8/1102 / 8 7002 9 WLlGll l 38.285 7 3AX3I02 2 1802212 8 02 0 M PUBLI C NO/ ? N 1191 0 OOU O NO/ ? SPILLE DGASOLIN E O N HAND S AN DCAUGH T FIR E BRN- T HAN DTR/RE L FIV E

X7 0 0 2 / X7 Ofi 2 9 WEK.H I 18.285 7 I. A X. I 111 2 2 i9|5ol) 9 l i 2 7 M

UN KNO/ ? N 091 0 000( 1 NO/ ? SPILLE DGASO I IN E O N HAND S AN DCAUGH T FIR E BRN- T HAN DTR/RE L FIV E

X7002 ) X 7 0 0 2 9 WEIGIl l 10 2 . I42 X IM I 7)0) ) 00(12233 0 oo xM HOM E FIR E N O'/lo Ooo o NO/ ? BRN- T FAC E TR/RE L FIV E IHKL W GASOLIN L O N

A FIR L a TIK E FLARE DU P a FUKNL DFACE . FIR E DEPT . AT I ENHANC E UNKNOWN . K'/ill . 2 l, K/III , 2 ' • WI- Kill ! S II nI INn.'.'n. i mi l 1419 ) oo l M H i IM I No/ ? N O9I 0 ooo o NO/ ? POIS N AL L TR/RE L TW O DRAN KGASO I IN I A THOME . FXAC TAMOUNT ' UNKNOWN . EYE S KO I LT D B.A l KAN D AMB U I.ATO KPROBLE M X/u o 2 .

i . 1 'o o 2 '

/ W T I i.l I

I ) I i o I / iNo.'.'o.i ) uu i 349U ) oo. l M HOM E NO/ ? N 0 9 II I 12.1. 1 NI)/ ? SPLASHE DGASO I IN L I N IH S EV E WHIL E TIM.IN GMINIUIK E BRN- C EY E TR/RE L SI X

X/III . 2 1 .1 /II O 2 9 W l K.lll I0 2 I42 X llll l I J. i . i on. * C , 0.1. 1 U2. . M HOM E FIR E N o'/I

UOoo o NO/ ? URN- T HAN DTR/RE L FIV E BUR N HAN D- TRYIN GT O PU T OU T GASOLIN E FIRE - N O MENTIO N OF " FIR E DEP T ATTENDANC E O N

E RREPOR T X70 0 2 / 8 707U I WLlGll l 10 2 142. 1 (AI020) ) 0(i0407li . 00 2 M HOM E NO/ ? N 091 0 114 1 NO/ ? POIS N AL L TR/RE L TW O

. INGESTE DA

N UNKNOW N

AMOUN T Ol GA S FOUN DA GALLO N

CONTAINE RI N

TRAS HCA N WITHOU T A

LI DO N

CONTAINE R X/i l 7l i I X7II/0 2 WEIGH T 10 2 I42 X IHIIHD i UUOOU7I 7 U 2 2 I - HOM E NO/ ? N O'/lo ooo o NO/ ? URN- T FAC E TR/RE L FIV E BURNIN GWFFD s A T HOMF . PIL E O F DEA DWEEDS . I I T MATC HDI DNO T BURN . POU R GASOLIN L ONT O Pill" . I T ARI DUP . BURN S RIGH T SID E FACE . L I P . EAR . ANKL E X7 0 7 0 1 8/ 0 7 0 3 WIIGIII - 3 8 28.1 / 1PX2402 2 0029329 ) 21 ) I HOM E NO/ ? N 091 0 OOO O NO/ ? POIS N AL L TR/RE L TW O PT . INO I MI DA

SMAL L AMOUN T O F GASOLINE . X/. i 7 n i X7t l 7 t l / W l K.ll l I 11 2 I - I 2 s IMI'.iiu i * > UUUU2.IX 7 ul. . M lloM L NO/ ? N 09i o K.4 ) No/ ? URN- TU/l.E G TR/RE L FIV E

SPII.LI D i.A s O N PANT S PANT S IGNITE D WHIL E WORKIN G UNDE R HO TMACHIN E
X/u'/ii o XIII

III I W l K.ll l ) X28) 7 IAXIIU2 2 492)79l o 02 2 M HOM E AUT O N 0911 1 WORKIN G UNDE R CA R AN D GA S GO TINT O R EY E 000 0 NO/ ? URN- C EY E TR/RE L SI X

XIn In . . 1 / n /n S W l K.ll l *

> I lu- l / IN..- ' 2 U .* > i •ni l M.lr.- 1 mi l M PUBLI C NO/ ? N il'il u uoo u NC)/ ?

Illlll i DRAN KAGASO I IN I ADD I I I VT : ATARI ABOA TMARIN A POIS N AL L TR/RE L TW OI I s (ONsllMIRPKODUC T SAFET YCOMMISSION 15:1 8 TUESDAY . JULY20 . I9X XI I INJUR YINCIDINT S TREATE DI N NlIS S EMERGENC YDEPARTMENT S INVOLVIN

GGASOLIN E JANUAR Y19X 7 T O TH E PRESEN T

••PKODI U I : (191 0 GASO I IN L HAI L . . VICTI M .. . ACCIDENT' . . . . PRODUCTS . . . INJUR Y TREA TCOL L IIOsPIIAl . CAS E AG E SI XLOCAL E FIR E OC C 1S T2N D IR D DlA G BDYP TDIS P SEVT Y 87(17(1 0 X7II70 9 IpoMili l OillliXllf . IHI > M HOM E NO/ ? N 091 0 (IIIIII I NO/ ? POIS N Al l TR/RE L TW O WIIGIII- I 0 2 I 42 8 MOTHE R STATE S P TSWA I I OWE D A N UNKNOW N AMOUN TO F GASOLIN E D XPOSSIBL E GASOLIN E INGESTIO N 8/07U O X/0/0 9 3P.123U2 2 uo3M4l o 01 2 M UN KNO/ ? N 09l o 000 0 NO/ ? URN- C U/LE G TK/RE L FIV E WLIGIIT - 3X285 / UUKN S l o LIT . HUG H WHE N S p ILLE D GASO L I N E O N HIMSEL F X/O/o xX/o/n i IMi)lii H iiiliil|)5 l oi l M HOM E FIR E N O9I 0 173 1 3-PRO D BRN- THAN D TR/RE L FIV E WEIGHT - X I llllii o PlAVINl i WIT H MATCHE S AN D GASO I IN F AN D TH E CA N O F GASOLIN E EXPLODE D BURNIN G ID S HAN D N O TIKI : DEPARTMEN TI N ATTENDANCE ' x/u/| u .l/o/l i i.l.iilik*. ' 22.10004 / oi l M HOM E No/ ? N o'/l o 140 1 NO/ ? OTHE R EV E 'TR/RE L ZER O WIIGII I J.i.2i > . . .. . / I IIJlpii.li.. . I.LI Tl.'V I I KR I TA M O N GASOLIN E SPLASHE D I N EY E WHE N POURIN G I TINT O LAWNMOIVI. K .1/1./0 2 x/u/l- l KIlKi.i i UX7IU24 ) uu ] M UN KNO/ ? N 0 9 II I OOU O NO/ ? OTHE R EV E TR/RE L ZER O WEIGHT-102 . I42 XGASOLIN E SPLASHE D INT O TH E EY E THERMA L EXPOSUR E T O GASOLIN E ft/u/M 8/071 ) 3CI34U.I ) UX71U73. 1 UO ) TUN KNO/ ? N 09I U UUU U NO/ ? BRN- C HEA D TR/RE L FIV E WI.IGIII-IU2.I42 XGASOLIN L WAS SPILLE D O N FAC E AN D UAC K THERMA L MEXPOSUR E T O GASOLIN E X/U7I I X/u/l i IS94202 2 lll/lool ) 02 ) M HOM E FIR E N 091 0 oi l 0 0 NO/ ? BRN- TFAC E HOS P SI X WEIGHT - 4 ) 2500 - ? GASOLIN E CAUSE D FIRE . 2 AN D 3 DEGRE E BURN S T O FAC E AN D NECK . CHAR T DOE S NO TGIV E DETAIL S O F ACCIDEN TO R FIR E DEPT . RESPONS E x/u/1 3 87071 ) )S'/42U2 2 /UX877X O uu 3 M HOM E NO/ ? N U9I U 000 0 NO/ ? DRMA TEY E TR/RE L TW O WEIGHT - 4).2)0 0 GASOLIN E SPLASHE D INT O EYE . CONJUNCTIVITI S •s/o/l l X707I O ir.")7iii 5 OII0257I 9 oi l M HOM E NO/ ? N 091 0 llll l NO/ ? BRN- C FAC E TR/RE L FIV E WEIGHT ; HI2. . 14 2 8 X7u 7 I oHEPUOo I GASOLIN E SP I ASHE D O N FAC E WHIL E FOLLOWIN G ALAW N MOWER . DX ; CHEMICA L BUR N FAC E AN D EYES . X/o/1 4 X/O'/l o 1S9I2H2 2 10788)1 0 u 2 I M HOM E NO/ ? N 091 0 000 0 NO/ ? POIS N AL L TR/RE L TW O WEIGIll - 45.250 0 SWAI.LOWL D MOUTHFU L O F GA S WHIL E SIPHONIN G X70/I- I X70/U . IPX2IU2 2 II01IJ12 U oi l M PUBLI C NO/ ? N U9I 0 OOO O NO/ ? BRN- C ll/TR KTR/RE L FIV E * WFK.UT - I X2x5 7 GFTTTN G GA S A TTH E STATIO N AN D SPLASHE D TII E GA S O N CHES TAN D ARM S 8/(i/l l ft/o/l/ (NU 2 2U). ) UUU4/ID 4 oi. i M HOM E FIR E N U9I U UUU U NO/ ? BRN- C FAC E HOS P SI X W l K.lll - ) l lul / Will i F I.IGIIMN G AGRAS S FIR E WIT H GASO I IN E IH E FIR E FOLLOWE D U P TH E STR E A M ol - GA S AN D RECU-VE D AFLAS H UUR N TO TH E FACE : N O MENTIO N O F F.DEPT . 

# LU. 1 CONSUME RPRODUC T 5AIEI V COMMISSIO N INJUK V IN l ll/FNI S IRbAIE DI N NEIS S tMERGENC V DEPAKIMENT S INVOLVIN GGASOLINE . JANUAR Y19.1 7 T O TH E PRESEN T I):I XlUbSDAV . JUL Y20 . I9XX1 2

i t PRODUC T 0 9 II

I GASO I IN E

.. . DAT E TREA T COL L VICTI M HOsPMA L CAS E AG E SE X . . ACCIDENT. . LOCAL E FIR E OC C f . ,' o , * I J ,1/0/1 7 .IN*/J2tu 2 oo'/u3l2 7 ui ) TUN K WEIGIll - 27.510 8 X'.'07 | 7BEPO0O 9 GASOLIN L I N LEF TLY E NO/ ? N . . .PRODUCTS . . . INJUR Y 1S T 2N D3R DDlA GBDYP T DIs P SEVT Y U9I U1 4 3V

NO/ ? TKN/ UEY E TR/RE L TW O

8 7( 1 7 l l 8 70 7 1 7 WEIGHT - 2/510 8 JN93202 2 0000280 0 II 2 o M LIN

K GASOLIN E IN

EY E NO/ ? N 0 9 1 0 ooo o NO/ ? DRMA T EY E TR/RE L TW O

X/ u7 I 2 X7o7 I 7 WEIGH T 2 7 5 I O X IN'/ 3 2 (1

2 2 0000 2 9 9 I ol' / M UN KNO/ ? N GA S SPLASHE DINT O CVC S ovI uooo o NO/ ? FRN/ B EY E TR/RE L TW O

X7l i 7 I2 U'l

i\ I I I W T Kil l I2 /

* ) 10. 1 IN' ) I2U 2 . OOO0299 ) ou > M UN K GA S INT O BOT HEYE S NO/ ? N 09l o ooo o NO/ ? CT/A B EY E TR/RE L TW O

.- . / I . / I . 1 / II . 2 l . W l lul l I I U 2 I I 2 H .ll' " Ini) ) iniumJu S u)- / I HoM L I-IKL N uvl uulJ l No/ ? ANO XAL L 1N/KE L SI X STATE S SMOK E INHALATIO N WHE N GASOLIN E IGNITE DUYGA S HO T WATE RHEATE R D XSMOKE " INHALATIO N FIR E DEP T ATTENDE D X'/O/l i X7U72 I WEIG HI 5 1 30 4 7 IN02201 ) 0013)84 ) 04 0 M HOM E NO/ ? N 0 9 11

1 000 0 NO/ ? ACCIDENT!. V

SPLASHE DGASOLIN E INT O HI S EY E BRN- C EY E TR/RE L SI X

X/ o / I .

S X/ o 7 2 I W L I Gi l I O Xo 2)1 1
8/li 7 2 o 8 707 2 2 W l K.ll l 10 2 142 8

.1 HI I 2 ( . X /l l 11 I W l IGII IIU J . I4 2 8 X7(i72i . X70/2 X WEIGIll - 4 5 2 50 0 lUi.)20) 4 )ool3)9 ) 0) 2 M SPORT S FIR E N 091 0 uuu uNO/ ? URN- T 2)-) 0 TR/RE L SI X SPR I -'ICIA

L ISI . 2N DDG RURN S LI T LW KLEG,FOO T BAK UEC UI NG . BURNE DW / GAS . ICAMPFIKE ) IWIiliD ) 0(100757 1 oo o F PIIIII..I C FIR E N

09| u000( 1 NO/ ? BRN- T 25-S o TN/HS P SEVE N SH E AN DOTHE RKID S WER E PLAYIN GAN DSH E WA S CAUGH T O N FIR E B YGASOLIN E 3R DAN D2N DDE GBURN S T O TRUNK.ARMS.FAC E O F BODY.T I U.O F UTAH.UN KFDAT T IPIII . ini ) OU22444 I ol. l I HOM E NO/ ? N 091 0 lo'/ 0 NO/ ? FRN/ B EY E TR/RE L TW O PUTTIN GGASOLIN L I N CA RAN DGA S SPLASHE DI N EY E AN DPT . WEAR S CONTAC T LEN S HA DT O REMOV E LEN S IS942U2 2 7o.19)X4 o 03 1 M HOM E FIR E N 091 0 000 0 NO/ 7 BRN- T FOO T TR/RE L FIV E BURNE DFOO T WIT HGASOLIN E FLAMES . N O RECOR DO F FIR E DEPT . RESPONS E

. 1 / u / 2 I X7 o 7 2 . 1 h i IGII I I l l J . I 42 X

.1 lull I X7 0 /2 X W l IGII I 10 2 I42 X .1* . 1 7 HD ) ooo22)o ) 2 1 2 M HOM E NO/ ? N U'/l u UOO U NO/ ? POIS N AL L TR/RE L TW O I V R O l D MAL L INGESTE D GASOLIN E D ; TKEAIED . OBSERVE D AN D RELEASE D WIT H INSTRUCTION S T O PARENTS . DX ; INGESTIO N O F GASOLINE . 4C2- I lil n OOOI922 I OI O M HOM E NO/ ? N u'/l u o'/X I NO/ ? POIS N AL L TR/RE L TW O IRVINi i l o SIPIUI N REGULA R (iA S FRO M (iASCAN . OVERFLOWE D INT O MOUT H SWALLO W I D Mul l IHII U O F GA SU S CONSUME RPRODUC T SAFET' V COMMISSIO N INJUR YINCIDENT S TREATE DIN NEIS S EMERGENC YDEPARTMENT S INVOLVIN GGASOLINE . JANUAR Y19X 7 T O TH E PRESEN T I):I XTUESDAY . JUL Y20 . 19X 8 1 3

• t PRODUCT : 0 9 1 0 GASOIIN h

. . I i AI L

. TREA TCOL L VICTI M I lo s I' l TA LCASE ' AG E SL X . . ACCIDENT.. . LOCAL E LIR E OC C . .PRODUCT S 1S T 2N D3R D INJUK V DlA GBDYP T DIS P SEVT Y X70/2 7 X7072 X WEIGHT - 1(1

2 I42 X IWtilOi i 0O0O771 9 01 7 M PUH I I C NO/ ? N 09I O OOO O Ni./ ? ANO XAL L H E WA S A T A

(iA S STATIO N

WATC HI Nt" . TH E ATTENDEN T PU T INT O TH E CAR . TH E AT T INDEN T TURNE DAROUN DAN DACC I DENTL YDOUSE DHI M WIT HTH E GA S TR/RE L SI X

X/0/2 ) 8/0/3 0 WLlGll l - ) I . 3u 4 / 3N0220) ) OOI40I0 3 (D o I HOM E No/ ? N 09l o uuu uNO/ ? BRN- T 2)-) 0 HOS P SEVE N BURNIN GOU T BE L HIVE S WIT HGASOLIN E AN DFLAMIN GGASOLIN E TRAVELE DT O H E RHAND . ToKEARM . AN DTHIGH ; N O F.D . MENTIONE D X7072 7 X70 7 l

u WEIGHT-10 2 I42 X iT'iJiii i oou(i59i l uI i M HOM F FIR F N IM ) | I

I OOU ONO/ ? UR N T FING RTR/RE L TW O BURNE DAll . FIV E FINGFRTIPS . R T HAN DA T FATHER' S HOUS E BURNIN GGRAS S IN FENC E RO W

WIT HGASO I INE GO T O N HAN Da CAUGH T FIR E UN KI F F DATTENDE D X7 o I 2 liX III

I iI W l IGII I X I I .mi-

. uom/XXi i 21 9 M I IU M I NO/ ? N ii9| u ooo o NO/ ? POIS N AL L P AI I E N I AIIII-CilDI V INGl'.slF. D IMA M AMOUN I O F GASOLINE

. I' l COUGHE D AN D SPII.LL D GASOLIN LO N HIMSLLI * TR/RE L TW O

h i n.I I I I... . /.. I /. i II.'. . M SIRM I TIR E N H 9 I uI oo- l 3-PRO DURN- T 2 ) )i i TR/RE L SI X SIPHONE DGAS . I I T CIGA RI'TT E I IGIDT RT O SF F HO W Fil l I . CA N WAS . HA DGA S O N CLOTHE S WHIC HIGNITFD . 12* * BUR N T O AR M

AN DCHES T - N O FIR E DEP T RES P X7( i / l i

. i In

i n I W l K. I I I - I 0 2 I 1 2

. 1 U n l li».i ) 000121) 9 21 ) M HOM E NO/ ? N 091 0 111 2 3-PRO D POIS N AL L ACUT E IOXI C INGEsllO N O l CiASOLINL , REACHE D U P O N COUNTE R TOP

. FOUN D SOD ACA N WIT H GASOLIN LI N II

. LOO KUlJE S ITONAUL E DRINK

. TR/RE LTW O

X7n 7 IIX7 0 X. l 1 W l Kill ! - 2 7 5 IO X IN*

. 12112 2 oo/olli l 02' ) M UN KFIR E N GASOLIN E BURN S T O HAND S N O FIR E DEPARTMEN TATTENDANC E 0 9 1 0 0 0 0 0 NO/ ? BRN- THAN D TR/RE LFIV E

X/IIXU I8/0X0 4 W L IGII I- 2 7 . 5 IO X 1N93202 2 0000480 0 02 / M UN KNO/ ? N GASO LIN LI N BOT H EYE' S 091 0 000 0 NO/ ? CT/A B EY E TR/RE L TW O

XIn X u I X7l l Xi i i Wl - Kil l I XI

. OOO O IP ) 2 I o I ) o nm l 7 9 n o u2 ( , M HOM E Aa F N 0 9 1 0 OOO O NO/ ? GASOLIN E BURN S I T LE GP T TAKIN GOF F FUE L PUM P FRO M CA R BRN- T L/LE GTR/RE L FIV E

8 /l l X u ) X70X0 0 WEIGHT- - 3X2X5 7 IA X1102 2 O209I47 ) 02 o M UN KNO/ ? N 091 0 000 0 NO/ ? ACCIDENTALL YSWALLOWE D8 O Z O F GASOLIN E POIS N AL L TR/RE L TW O

X/OXO XX70 XI o W l Kill ! - IU 2 I M X IM I /Mil ) OOII2-K.7 7 oo n M HOM E NO/ ? N GO TGASO I IN E I N I YE S 091 0 ooo o NO/ ? BRN- C EY E TR/RE LSI X

X/IIX O /

X/O XI I WLlGll l 10 2 I I2 X »K2)2(D ) mi l lli.n l Oi o M PUBLI C NO/ ? N 0911 1 141 4 NO/ ? URN- U EY E TR/RE LSI X, GASOLIN E NolZ I k " GO TAWA YFRO M HI M WHE N FILLIN G HI S CA R AN D SHO TINT O H I S EVES

.U S CONSUME RPRODUC T SAFET YCOMMISSIO N INJUR YINCIDINT S TREATE DIN NEIS S EMERGENC YDEPARTMENT S INVOLVIN GGASOLINE . JANUAR Y198 7 T O TH E PRESEN T 15:1 8 TUESDAY . JUL Y2o . I98 XI

• PRODUCT : 091 0 GASO I IN T DAT E TREA TCOL L VICTI M HOSPITA L CAS E AG E SI X ACCIDEN T . LOCAL E FIR E OC C PRODUCT S 1S T2N D 3R D INJUR Y DlA GBDYP T DIS P SEVT Y X/oxl o X70Xl l WLlGll l - 8 1 . 000 0 IVillol ) (10(18149 1 01 4 M HOM E NO/ ? N 091 0 OUo O NO/ ? BRN- T L/LE GTR/RE L FIV E BURNE DRIGH T LOWE RLE GWHE N GASOLIN E EXPLODE DDWHIL E ATTEMPTIN GT O 1.1 IT I T X70XO X870X1 2 WEIGHT - 3 8 2X5 7 WIXOHI2 2 U0021O2 ) oi l M PUBLI C FIR E N 091 0 113 5 3-PRO DBRN- T HAN DTR/RE L FIV E HA DGASO I IN E I N EMPT YBOTTL E AN DLI T IT . I T BLE W U P AN DBURNEDHAN D N O FIR E ATTENDENCE.AI.TII O CHIL DRAN INT O FIR E STATIO N 87(181 2 8/U8I 4 WEIGHI - 45.250 0 3S9 4 20 2 2 - 50)8012 0 oo. l F HOM E NO/ ? N 091 0 OOO O NO/ ? SIPHONNIN GAN DACCIDENIALL V SWALLOWL DGASOLINE . GASOLIN L INGEsllON . POIS N AL L HOS P SI X

. 1 /ll. l I i s /U S I i . W T K.ll l I

X2X 1 / I A I 11.1 2 2 ioXxllI Xoo o M UN KNO/ ? N G O T GASO I IN E sP I ASHE DI N BOT HEYE S 0 9 I o ooo o NO/ ? URN- C EY E TR/RE L SI X

. " /o. i I I X/O XI 0 h i K.ll l 4 ) . 2)0( i IN'/)2o2 2 (iM)(i)) l o.' o M UN KNO/ ? N 0 9 1 0 ooo o NO/ ? GASOLIN E SECON DDEGRE E UUR N O N LET T ANKL E URN- C ANKL E TR/RE L FIV E

. 1 'ni l I X70XI 7 1N 9 12.12 2 O07(l)3o 7 0 1.1 M UN KNO/ ? N H9| o 14) 9 NO/ ? DRMA T EY E TR/RE L TW O WIIGII I 27.SIO XX7OXI7BEP00O 4 SPLASHE DGASO L I N E FRO M A I.AWNMOWERI N

EYE S X/OXI I X/0XI 7 WI-IGHI - 0 8 .025( 1 )N(.o2o3 l 001/898 9 02 2 M HOM E GO T GASOLIN E I N EV E NO/ 7 N (191 0 ooo o NO/ ? FRN/ B EY E TR/RE L TW O

X/U8 I i X70 XI X W l 1 1 il l I - 4 5 .2)0 0 1S94202 2 (.11.1) 2 11 5 03 7 M HOM E NO/ ? N U'/I

UUUU UNO/ ? GASOLIN E EXPLODE DBURN S T O ABDOME N AN DARM S BRN- T 2 5-5 0 HOS P SEVE N

X70 S I I 87 0 8 I 8 WblGH I - 102 . 142 8 31)0)0) ) (12210)8 ) 21' / M HOM E NO/ ? N 091 0 111 2 NO/ ? POIS N AL L TR/RE L TW O PAMEN I ALLEGED!. * DRAN KGASOLIN E FRO M A CA N WHIL E UNSUPERVISED - INGEST ! O N O F GASOLIN E 8 7 081 7 X/O

XI X WEIGHT-1 0 2 I 4 2 X H' 2 i.-l»)- > OX9/IIX 7 ol S I UN KAUT O N 0 9 II

I OOU O NO/ ? POIS N AL L SPIILE DI ClipGA S IN TRUN KO F CAR . EXPOSE DFO RI HOU RWIT HHEADACHE . NAUSEA . DIZZINES S GASOLIN E FUM E INHALATIO N TR/RE L TW O

X/OX I / X/O

XI 9 WEIGHT-102.142 8 )MI /)(!) ) OOU202I 9 nl 2 M FAR M

NO/ ? N INGI.SIE DSOM E GASOLIN E 091 0 UOO UNO/ ? POIS N AL L TR/RE L TWO

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I INF IANUAR Y19X 7 T O TH E PRESEN T 15:1 8 TUESDAY , JUL Y2o . I9XXI )

* . PRODI HI : 0 9 1 0 GASOLIN E D A IT : .. . TKLA T COL L I lo s I' l TA L V II T I M CAS L AG L SL X . . .ACCIDENT . . . LOCAL L TIR E OC C ... . PRODUC TS 1S T2N D 3R D INJUR Y DlA G BDYP TDIS P SEVT Y 8711X2 0 X7082 I WEIGHT- - 2 7 SHI S IN 9 1202 2 O n 7 0 I S X Xu2i l M UN K *SPIASHF D GA S I N EYE S NO / ? N (191 0 ooo o NO/ 7 BRN- C EY E TR/RE L SI X

8/0X2 0 87082 1 WEIGH!-102.142 8 3I204U) ) 0.197)21 ) OO / M HOM E NO/ ? N U9I 0 OUU O NO/ ? DRAN KUNKNOW N

AMOUN T O F GASOLINE-GASOLIN E INGESTIO N POIS N AL L HOS P SI X

K7(I X2 I X7IIX2- I WEIGHT - 2 7 5 10 8 IN' ) 12(12 2 oo'/ooilni mi l M UN KNO/ ? N CHIL E SWAI.. I OWE DGASOLIN E 0 9 1 0 000 0 NO/ ? POIS N AL L TR/RE L TW O

8/0X 2 1 X/0X 2 i W l IGII I XI IIIIIII . IM55I04 ) 0029)10 / 02 4 M HOM E FIR E N 091 0 09X 1 NO/ ? URN- TNEC K TR/RE L FIV E IRVIN G l o BUR N WORM S FRO M TRL t AN D GASOLIN L CA N CAUGH TFIRE . UNKNOW N I I I IRI : DEPARTMLN I I N ATTENDANC E X/ I I . 1 2 i . 1 III

X 2 / W l IGII I - 10 2 112 1 il-iii . IIII I O022532 0 ol d M HOM E NO/ ? N 091 0 ooo o NO/ ? WAS STARTIN G EIR E WIT H GASO I IN E AN D BURNE D I E G URN- T I./LE G TR/RE L FIV E

X/O X2 0 X7 0X 2 7 M l K.ll l - 10 2 . 142 8 3T2041D ) UX9/72X ) UI 3 F HOM E NO/ ? N 0 9 1 0 324 9 NO/ ? BRN- T25-5( 1 TR/RE L SI X POURE D GASOLIN L ONT O GRIL L FLAS H UAC KO F FIR E INI O FAC E AN D ARMS-BUR N FACE . AR M AN D FINGER S X/ll'll l I X/090 2 W l K.lll . 10 2 I 42 8 lAI.'.'oi ) oooox/i o oi o I HOM E NO/ ? N O'Ji o 190 9 NO/ ? URN- T AL L RAKIN GI LAVE S PU T GA S O N LEAVE S THE N

THRE W

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LEAVE S FLAME S FLARE DU P CAUSIN GTHERMA L BURN S T O AP B HOS P SEVE N

8/ 0 90 5 8 709 0 8 WEIGIll - 3 8 .28) 7 IAX3I02 2 0049480 9 00 2 I HOM E NO/ ? N 091 0 000 0 NO/ ? PLAVIN GIN

GARAG E O F HOUS E GO ! GASOLIN E IN MOUT H POIS N AL L TR/RE L TW O

. 1 / 11 9 O XX/

I I 9 ll' / WEIGHT - O

X02) 0 IAI.X20I I ooo o 7)5 4 02 7 THOM E NO/ ? N INHA ! IT l GASOLIN E (1 9 II I 000 0 NO/ ? POIS N AL L TR/RE L TW O

X/09II 8 8/0911 9 WEIGHT - 68.025 U IN(.o20) 4 OOI8I59 7 II I I M STREE TNO/ ? N SVP I IONIN G GA S SWALLOWE D SOM E 0 9 1 0 OOOI I NO/ ? POIS N AL L TR/RE L TW O

X7 I I 9 I I I . X70 9 I I WEIGHT-10 2 142 8 IMIXUD ) oo o IUX2. 1 ol / M UN KNO/ ? N 091( 1 ooo o NO/ ? BRN- T FAC E TR/RE L FIV E I KilTTINi i GAKUAG E WIT HGA S O N I T AN DGO T BURNED . R T SID E O F FACE . 1S T A N D2N DDEGRE E BURN S 8/(1 9 I 3 X/0 9 1 4 WLlGlll - 08.025 0 )A«X20) 4 0000/I4 O o) 9 I HOM E NO/ ? N u'/l

uUUU UNO/ ? GASOLIN E SPLASHE DI N EYE . CORNEA L ABRASIO N CT/A B EY E TR/RE L TW OI I s CONSUME RPRODUC T SAFET YCOMMISSIO N I5JI XTUESDAY . JUL Y2o . I9X XI r . INIIIK YINCIDENT S TREATE DIN NFTS S FM

I RGENC YDEPARTMENT S INVOLVIN GGASOLINE : JANUAR Y198 7 T O TH E PRESEN T

. . Ckonili'C . o 9I » GAM. I IN l D A IF " VICTIM . ACCIDEN TPRODUCT S INJUR Y TRIA L CO I I HusplTA I CAS E AG F SI XI OCAL E FIR E OC C 1S T2N D 3R D DlA G BDYP TDIS P SEVT Y K/U9I 2 87091 5 3K.M20) ) 000/17 2 1 02 2 M HOM E NO/ ? N 091 0 000 0 NO/ ? FKN/ B EY E TR/RE L TW O WLlGll l -10 2 .142. 1 WHIL E WORKIN G O N HI S JEE P GASOLIN E SPLASHE D I N BOT H EYES . a/ovi i K/u9l o IA.ill.i2 2 nx- l 2 7 32 ) m i 2 M 1*111) 1 KNO/ ? N U'/l u Uoo u NO/ ? URN- C EY E TR/RE L il X # WEIGHT - I S 2X5 / A TGA S STATIO N WIT H DAT ' GASO I IN L SPLASHE D I N EV E
8/U9 D x/091 7 1S94202 2 8090297 8 02 9 M HOM E TIK I N 091 0 1 8 3( 1 NO/ ? BRN- T25-5( 1 HOS P SEVE N WLK.III - 4).2)0( 1 GA S EXPLOSIO N I N OPE N GARAGE , SECON D DEGRE E BURN S FACE . TRUN KAN D HAND S N O TIK E DE P I . INVUI.YEMEN I . X/.i'M o .i.'ii'. i ll'ii'iii n oiiiiul/4 ) (il l I HuM l I IR I N o'/l o IIIIIII I NO/ ? BKN-' TL/LE G TR/RE L FIV E IV I Hil l Tin. ' 112 - FIS TAN D sTcONl i DI'GKri. ' BURN S o l I n > II I MI TAN D LEG S TURl' WGASOLIN L O N BURNIN G I IK I LIK I DIP TNO T(AMI D x/o'H I .1/nil. i IS-/2202 2 00909X9 0 iiii ) F Pllll l I C NO/ ? N 091 0 ooo o NO/ ? FKN/ B EV E TR/RE L TW O •("*_ , W l K.ll l 43.2)ii o GASOLIN E T O EVE' S SPRA VE D GASO L IN E FRO M GA S PUM P X/(iv l I .1/0)1. 1 3P.U)u2 2 UU32I03 H U M M PUULI C Al l T O N O'/l o ooo o NO/ ? URN- C EV E TR/RE L SI X ¥ WIIGII I I X2XS / GASOLIN E SPLASHE D I N EYE S Will i E A TTH E EXXO N GA S STATIO N (IH S FATHE R WA S PUMPIN GGA S INT O TH E CA RI x/091 1 X709I XIPX. ' lo2 2 illl)2lol 7 04 2 M Pllll

l I C AUT O N

091( 1 000 0 NO/ ? URN- C EY E TR/RE L SI X• WEIGH T I

X2X5 7 GASOLIN E SPLASHE DIN Ill s LYE S A S H E WA S PUMPIN GGASOLIN E INT O HI S CA RA I TH E EXXO N SlAlIO N X/H92 I .17092 2 1129/0) 1 ouo2o49 2 oo o M UN KAUT O N 091 0 ooo o NO/ ? BKN- UHAN DTR/RE L FIV E W l Kill ! IU 2 112 1 1S T DE GBUR N T O R T HAND . BURNE DWIT HGASOLIN E WHE N PRIMIN GCARBURETO R O N CAR(N O FURTHE RINFORMATIO N O N RECORD ) X/II92 I X/092 2 IDI-l Io n010X14X 4 21 2 M HOM E NO/ ? N 091 0 09X 1 NO/ ? POIS N AL L HOS P SI X WEIGIl l - 10 2 . 142. 1 POS S INGESTIO N O F GASOLINE . MOTHE RFOUN DHI M WIT HOPE N

CONTAINE RO F GASOLIN E IN

GARAG E (CONNECTE DT O HOUSE) . ODO RO F GASOLIN E O N BREATH . X7092 I .1/092 ) )Sv42u2 2 20X91)0 / o.) 9 M HOM E NO/ ? N U'/l

u32-1 9 NO/ ? URN- T L/LE GTR/KE L FIV E W l IGIII i).2)o o BUR N T O LL GFRO M

GASOLIN E WHIL E BAKBEQUING . X/U'/.' l .1/092 ) IS922o2 2 OU2I904 / 21 1 F HOM E NO/ ? N 091 0 000 0 NO/ ? POIS N AL L TR/RE L TW O WEIGIll - 41.250 0 GASOLINL ' INGESTIO N li/i>92i i ft/i.921 ip o 1 lo . i mi ni.-

l 9.1.1 oi l M

HOM E FIR E N O'/IO lo) XNO/ ? BRN- T .2 ) 5 o IK/KL L SI X W l K.lll H' 2 1-12 8 l- l WA S UUKNIN GIKASI I A l UoM L I N GAKDIN . USIN GGASOLINE . CLOTHIN GCAUGH T I - I K l D XPAR I IA

I THICKNES S HIIR N AUDoM L N / BU T I'lK'K S . RIGH T AR M

UFD AU s CONSUME RPRODUC T SAFET YCOMMISSIO N I):I XTUESDAY . JUL Y2o . 198 8 1 7 INJUR ) INCIDI.NI S IRLAIL DIN NLIS S LMLKGENC YDEPAKIMENT S INVOLVIN GGASOLINE : JANUAR Y19X 7 T O TH E PRESEN T

. . PRODUCT : 09ll l GASO I IN E

. DAIL* . VICTI M . . ACCIDENT . . . .. . PRODUCTS . . . INJUR Y IRL.V I CUL L IIUSPMA L CAS E AG E sb. \ LOCAL E FIR E OC C 1S T 2N D3R DDlA GBD V P T DIs P SEVT Y X/092 5 X7092 8 ll.'o-IO) ) 0X9X949 4 2I XF HOM E NO/ ? N U9I UOOO O NO/ ? POIS N AL L TR/RE L TW O WEIGIll-102 . 142 8 INGESTE DUNKNOW N QUANTIT YO F GASOLINE-POSSIB l E GASOLIN E INGESTIO N
X7092 8 87093 0 3CI3405 ) 08/1529 0 oo ) M HOM E NO/ ? N 091 0 000 0 NO/ ? POIS N AL L HOS P SI X WEIGIll - 102 . I42 XDRANKL DGASOLIN E DISCLOKATIO N O F SKI N

ASPIRATIO N X/U92 9 8/100 0 1MI-)Hi:i. ) oouo.'!./ ) oo ) M PUBLI C NO/ ? N ii9| o O'/X uNO/ ? DRMA T FAC E TR/RE L TW O . wT-iGii T1(12 . M2 xGASOLIN E I N EVES , GO TSPLASHE S I N TAC THANDL E O N GA S PUM P STUC K x/luo l 8/HIO , i ... . . ii. i ooii))iio 4 02 2 M UN KFIR E N O9| o ooo o NO/ ? BKN- TFAC E IK/RE L FIV E W TIGII I 1X 7 PAI N I O FAC E WHI N GASOLIN E IGNITE D N O OTHE R DEIAII. S AVAILABLE . DX . I * BUR N O l RIGI D SID E O F l-A c E . _UNKNOW N I F I 1K b DEP TA I TENDED .

. ..oi l .."21121. 1 21 / I IIOM L NO/ ? N "I9I O uuu u NO/ ? POIS N AL L TR/RE L TW O M I I . i n IKANsFll-I O IRO M MvKIVAI l IIOS P OKAN D O XO Z GASO I IN L D XACUT E HYDROCARBO N ASPIRATIO N x/lo.- i X'I.I.'' . IA X110 2 2 44X04)0 2 Ol d F PUBLI C NO/ ? N 091 0 00(1 0 NO/ ? POIS N AL L TR/RE L TW O W t K.ll l >

x2X3 /

INHALE D GASOLIN E FUME S
X/IU2 . X/iu.' / 1A)IUI4 ) OOOX97I 4 ti ) 7 M UN KFIR E N 09 1 u ooo o No/ ? BRN- TFAC E TR/RE L FIV E rti IGII I X I OOO O I 2 ) Kll.K M UUKN S FAC E THRE WGASOLIN E O N FIR E N O MENTIO N O F FIR E DEP T X/|(i2 o X/I02 7 1M)5I04 ) 0029/3/ 9 0 2 1 M HOM E FIR E N 091 0 o3o / 3-PRO D BRN- TU/TR KTN/HS P SI X WLlGlll - 4 5 4 2 3 o PU TGASOLIN E O N NEWSPAPE R T O LIGH TWOO D STOV E AN D SHIR TCAUGH TO N FIRE . SUSTAINE D BURN S T O CHEsT . TRANSFERRE D T O U WBUR N UNIT . UNKNG WIF " F D h/iu.i l X/MU 2 ilio.ijol l Jiiolol/ ) ul ) M I ND S I* . NO/ ? N O'/l u 104 ) 3 PRO D UR N TL/LE G TR/RE L FIV E WIIGII I 08.i.2) U 1. 2 Do KUUKN S I.W KLL G / FILLIN G MACHIN E W / GASO L I NE . S P I LLE D I TO N PANT S / SPAR KIGNITE DI T X/llil l 8/llu- l (||ii)2- u1 4 I00202I 7 22 1 M HOM E NO/ ? N 091 0 H9I 3 NO/ ? POIS N AL L TR/RE L TW O WEIGHT - OX.025( 1 INGESTIO N PT DRAN KABOU T A MOUTHFU L O F GASOLIN E a OI L (GIVE N MIL K PE RPOISO N

CONTROL ) x/llo l X/MO ) lpol4(i) 5 IIIIIII I 19- DOI 9 M

UN KNO/ ? N 09l o 141 4 NO/ ? POIS N AL L TR/RE L TW O WEIGHT - 111

2 . 142 8 PI " SWALLOWE DMOUTHFU L O F GASOLINL . WA S SYPHONIN GGASOLIN E D XINGESTIO N O F sMAI I AMOUN T O F GASO I IN E x/lll l x/lll o Ipoiloi ) iiiiiiol l 1 1 ui, , M

HOME ' NO/ ? N li'/l

o Ioo 2 NO/ ? POIS N AL L TR/HE L TW O WLlGlll - 10 2 142. 1 I' l SWAI. I OWI DGASOLIN E WHIL E TRYINl i I O SIPHE N FRO M TRACTO RU S CONSUME R PRODUC TSAFET YCOMMISSIO N 15 : I XTUESDAY . JUL Y2o . 19X 8 i s INJUR YINCIDINT S TREATE D I N NEIS S EMERGENC YDEPARTMENT S INVOLVIN G GASOLINE : JANUAR Y198 / T O TH E PRESEN T

. . PRODUCT . U9I O GAio l IN I DAT E . VICTI M ACCIDENT . . PRODUCT S .. . INJUR Y I k F. A I COL L HOSPITA L CAS E AG E SI XLOCAL E FIR E OC C 1S T2N D 3R D DlA G BDYP TDIS P SEVT Y X7III 3 X/II2 U 3N 9 1202 2 OO0I2.H. O oo o M UN KAUT O N 091 0 OOU O NO/ ? POIS N AL L HOS P SI X WEIGHT - 27.510 8 P TMOTHE R SI S CHIL D WAS SPYPONIN G GA S FRO M CA R AN D SWALLOWE D SOM E GAS . 87112 2 87112 5 1K2320) ) 0000 1 lu o u2 i M HOM E NO/ ? N 0 9 1( 1 ooo o NO/ ? BRN- C EA R TR/RE L TW O WEKiHT-10 2 I42 XWA S SIPHONIN G GA S AN D SOMEHO WGO TSOM E I N FA R CAUSIN G BURNIN G
87112 ) X/M2 9 1.A.1.H02 2 32944/8 0 04 1 F PUBLI C NO/ ? N 091 0 UUU U NO/ 7 BRN- C EA R IR/KLl . TW O WIIGII I 3. 1 2.15 / SPLASHE D GA S INI O R LA R x/|2o i X/1.10 2 (\.ii|o2 2 iui04i7 5 o5 2 M I IN K AUK ) N u'/l u ii')/ XNO/ ? BRN- C EY E TR/RE L SI X WIIGII I I X2X1 - GO TGA S AN D CAkliUR-VTO KC l EANE R SPLASHE D I N EYE S
ft/Mm x/12.1 2 )l/o|ol 4 01)1255 4 (Mi l F UN KNO/ ? N 0'/ I u 098 1 No/ ? CT/A B EY E TR/RE L TW O W l K.ll l 0 8 0211 1 WHIL E POURIN G GA S OIJ I O F AGA S CAN . I I SPLASIIL D I N EVL S 8/I2. H X/l2oi . iA.ill.i2 2 4729i,4'i | o.' i M UN KNO/ ? N il'H U ooo o NO/ ? URN- TFAC E TR/RE L FIV E WEIGH TI X2X5 / DROPPE D GASOI . IN E INT O FIR E AN D I TFLASHE D BAC KINI O FAC E 8/120 4 x/120 7 ls)o2ti5 ) uuoo39) 4 oi o M HOM E FIR E N u9l u ooo o NO/ ? BRN- T25-5 u TN/HS P SEVE N W l IGII I 10 2 I 42 8 SUSIAINL D BURN S I O 20 * O l BOD YIRU M GASOLIN L FIR L DX : BUR N T O BOD Y FIR L D l P L PRESEN T x/l.'o XX/I2U 9 IA.1IHI2 2 2M12i.ii / o2 o M PUBLIC * AUT O N U'/l u ooo o NO/ ? DRMA TEY E TR/RE L TW O . f^W w WlIGUT - IX.2X5 7 PUTTIN G GA S I N CA R AN D FUMF S IRRITATE D EYE S X/l2o /

X/I2I I IM I 9 1 ii> ) o(loo2X) l u l I M UN KNO/ ? N 0 9 1 0 UUU U NO/ ? BRN- THAN D TR/RE L FIV E WEIGIl l < MI2 . Mi xSPII.I.L D GASOLIN L O N LEF THAN D GASOLIN E WA S ACCIDENTL YIG N I TE D C'AU S IN G X/I.'i o X/I2I I ISU.2U) ) uuu. ) ) I I 2 o 1 7 I HOM E NO/ ? N o'/l o ouo o NO/ ? DRMA TEY E TR/RE L TW O WIIGII I Hi ) CM XIIUK TEYE ' G o I GA S SPLASHE D INT O EY E D XJ CHEMICA L CON J UNCT I VITU S
X/ I 2 I 1 X/I2I 4 INioinl ) UOU3/U3 4 oi l M HOM E FIR E N 091 0 000 0 NO/ ? URN- THAN D TR/RE L FIV E W i K.ll l 81 . Ooo o p | HA D GA S O N HAND S a FUME S IGNITED . I UNKNOW N I F FIR E DEPT . W/I N ATT - ENDANCE ) 8/l.'| i X/

I 2 I o i.Vlo.'in i IIIIII I xi.o j o.' | M UN KNO/ ? N O9| o uoo u NO/ ? OTHE R EA R TR/RL L ZER O W l K.ll l I •

•2 I I2 K

GASO I IN I Ai l IDINIAM VWEN TINT O HI S EAR . SHAR P PAI N I./EA R OX ; PAI N I N TAR . IVMPANI C MIMURAN I N O OTHE R D l T A1 1 S AV A1 1 ABI EI I s CONSUME RPRODUC T SAFET YCOMMISSIO N INJUR ) INCIDENT S IKE A TE DI N

NEIS S EMERGENC YDEPA RI ME N I S INVOLVIN GGASOLINE : JANUAR Y19X 7 T O TH E PRESEN T 15:1 8 TUESDA Y. JU L Y2 o . I • / 8 X1 9

••PROD I IC I

. 0 9 1 i l GASO I IN I D A IF . TREA T COL L VICTI M HOSPITA L CAS E AG E SE X ACCIDEN T LOCAL E FIR E OC C PRODUCT S INJUR Y 1S T 2N D3R DDlA GBDYP T DIs P SEVT Y 8/122 0 6/122 1 WLlGll l - 102 . 14 2 8 I S 1 7 10) 5 00112)4) 0 uu ) M HOM E NO/ ? N (191 0 UUU UNO/ ? BRN- C L/LE GTR/RE L FIV E P T SI'ILLL DGASOLIN E O N SEL F RtSULTIN GI N LARG E BLISTERE DARE A O N MID - CAL F O F LEG . DX : 2N DDEGRE E CHEMICA L UUR N 8 7 I 2 I XX7 I 2 2 I WEIGHT - 45.250 0

XXl ) I O I XX O I II O W L K.ll l I (1

5 .23X 1 IS942U2 2 70X24O2' / Oi l M UN KNO/ ? N 091 0 000 0 NO/ ? DRMA T EY E TR/RE L TW O ACCIDENTALL YSPLASHE DGASOLIN E I N EYE S - CHEMICA L CONJUNCTIVITI S IVI(.2(D ) OXX0094 0 oo. l M UN KNO/ ? N 091 0 112 3 NO/ ? POIS N AL L TR/RE L TW O TEENAG E HOV s SA W HI M DRIN KG.Vso l IN L OUTO I RE DPLASTI C CA N UNKNOW N AMOUN T CHIL DI s R l 'T'AKDI'O/GAsOI . INL ' INGESTION . 1 .11 1 I I I Moll. ' Wl K.ll l X I min i

7 . 1 .I nM / hX O I I 9 rt I K.ll l 10) 2 I . 1 I

XXo I 2 I XXO I 2 2 Wl IGII I - ) X2X5 / i | .o.'. i l i I.I/9I.U1. 1 oil' ) M HoM I No/ ? o il' ) I i l ooo o NO/ ? POIS N All . (TIII DHA S BI T N INHA I INl . I I ADT DGASo l IN F FO Rl o DAY S BECAUS E U E STATE S •I I MAD E HI M

FLI T WEIRD " I ) LEA DINHALATIO N TR/RE LTW O

ll.'oiiD ) U90)u7l o IDI I F Pllll l I C NO/ ? N O'/I O ooo o NO/ ? SPRAYE D GASOLIN E I N I AC LAN D EYE S CORNEA LUUR N LV L
IAX1IH2 2 IX2X7IO O 04 9 M UN KNO/ ? N (HEMICA I IRRITATIO N FRO M GASO LINI " O'/I O OOO O NO/ ? URN- C EY E TR/RE L SI X

DRMA THAN D TR/RE LON E

8X1 1 | 2 1 XX O I2 / W L K.ll l - 8 1 . OUtl o 11)0104 ) 0004/01 0 (ll o M (IN KNO/ ? N GASOLIN E I N LA R I AN D O N CLOTULS I (191 U OOU O NO/ ? BRN- C EA R TR/RE L TW O

xXu2 o / XX02H 9 WEIGHT - 3 X2X) 7 1PX 2 102 2 00) 4 117 ) nl nM PUBLI C NO/ ? N U9I 0 (19X 0 NO/ ? BRN- C AL L A GASOLIN E HUM: * I XP I ODE DWHI M PT . WA S PUMPINl i GA S A T TH E GA S STATIO N A N DGA S SI'ILLL DAl l OVE RI' T . WEN T HOM E a SHOWERED . NO W RAS HW/PAI N TR/RE L SI X

ft Xo2 I I XXO 2 I 2 WI : IGII I - 3 8 2.1 ) / IA XI 102. ' 37/8)0( 0 oi l M PUBLI C AUT O N 091 0 000 0 NO/ ? SPLASHE DGASOLIN L I N LYE S WHIL E FILLIN GCA R DRMAT ' EY E TR/RE L TW O

X.In. ' I I X8( 1 2 I o WIIGII I X I Ollll u IA ) I I.i l i ooO'/tii'/

O u 2 7 I

- UN KNO/ ? N 0 9 1 0 UUU UNO/ ? HA DGASO I INI : SOAKE DHAI RGO T SOM E I N EYE S DRMA T FAC E TR/RE L TW O

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RETARDE DPT . DRAN KGASOLIN E FRO M A PEP S I BOTTL E HOS P SI X

XX. . 2 2 . ' .1X0 2 2 1 W l IGII IIH i 2 1X 1 i|'u

. !..•>

. IIIIIII I | / 2 vu G

. | - PUBLI C NO/ ? N o9| o iluo o NO/ ? BKN- C I'V E I' TGO I GASO I INI : O N HANDS

. Will i I : PUMPIN G A T(iA S STATION

. RUBBE D EYE S TR/RE LSI XP.4 2



## APPENDI XB

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UNKNOW N

I F FIR F CrPT . ATTENOF O CH , HYPLOSTP N .BU^B S T O FAC r AN P AR- S A N I F FIR E PfP T 4TfCUi£ 0 I THICKNES S 1UR N P T A9M . HVOR P TH E RA " V . RECCR D DI P NO I INDICAT E M(l g CA S GO T IN CXPOSURr . AT P (V

E DX : ABRASIO N T O EV F A B V POURIN GGA S INT O CARBURETOR , GA S E R " S , LI T IT , MIN T OUT , PPURF O MORE , THE N f WII H GASLIN ' UHF N GASOLIN F CONTAINt R APM . ING E ST f0 SOM E GASOLIN E A THOH F » 0 T M E R SIGNE O OU TAN A SMt n OU TINT O EYES ' 5C C r ' GASOLIN E MHIC H MA S I N A MAR T KHOUT H 1 0 OAY S AGO . HA S INSOMNIA , I P AFPETITl . PjPOSS . LSA O POISONING .

POSSIPL F GASOLIN E RFLAT' D CAS= S 19f » lATfiNA L ELECTRONI C INJUR VSUSVflLLANC F SVS1E H CNFISS )

H.S . fONSI'Mr p PRODUC TSAFET » COMBTSSIP N NATIONA L I'lJUR YIN^PPPA TIP XCL'ARIMGliniS r• 17:0 ? FRIPAT , FIBPUAR T17 , 198 9P.5 1



## APPENDI X C Incident s reporte d t o NEIS S i n 1987-198 8 Involving Gasolin e Ingestio n• — 1 3 t aest mm. o 3 Cr )

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# JP.5 3



## APPENDI X D
Copyo f Paper : "Acut e Exposur e t o Methano l i n Fuels : a Predictio n o f Ingestio n Incidenc e an d Toxicity "P.5 4



# ACUT E EXPOSUR E T O METHANO L IN FUELS : APREDICTIO N O F INGESTIO N INCIDENC E AN D TOXICIT Y

Date submitted: Octobe r31 , 198 8

Submitted

by: TobyLitovitz , M.D . Director , Nationa l Capita l Poiso n Cente r Georgetow n Universit

yHospita l 380 0 Reservoi rRoad , N W Washington , D C 2000 7 202-784-208 8

PAG E 1P.5 5



### TABL E O F CONTENT S ABSTRAC T3 ACUT E HEALT H EFFECT S O F METHANOL : REVIE WO F TH E UTERATUR E 4 Epidemiolog yo

fMethano l Poisonin g 4 Clinica l Manifestation s ofMethano l Poisonin g 5 Diagnosi s ofMethano l Toxicity7 Dose/Respons e Dat a 8 Treatmen t ofMethano l Poisonin g 9 Othe rExposure Routes : Ocular , Dermal , Inhalatio n 1 0 METHANO L A S AFUE L PREDICTIV E INCIDENC E MODE L FO R ACUT E EXPOSURE S 1 1 Summaryof198 7 AAPC C Gasolin e Exposure Dat a 1 1 Revie wofSelecte d Gasolin e Exposure Case s t o Determin e Exposure Scenario s .. . 1 4 Predicte d Incidence , Toxicity , an d Healt h Effect s of Acut e Exposure t o Methanol-base d Fuel s 1 6 RECOMMENDATION S 1 8 REFERENCE S 2 7

PAG E 2



### _P.5 6



### ABSTRAC

T Arevie wcfou rcurren t understandin g o fth e epidemiology , clinica l manifestations , diagnosis , dose/response , an d treatmen t dat a fo racute methano l poisonin g i s presente d wit h a focu s o n methano l ingestions

. 13,02 8 acut e gasolin e exposur e case s reporte d t o th e America n Associatio n o fPoiso n Contro l Center

s i n 1987 are analyzed , followe d bya mor e detaile d analysi s of23 0 ofthes e reports t o gai n insigh t int o th e circumstance s surroundin g acut e gasolin e exposures . Thes e dat a allo wroug h projection s o

fth e incidence o

fmethano l poisoning , morbidity , an d mortality , followin g th e propose d widespread us e o

fmethano l fuels

. Th e analysi s o

f23 0 ingestio n scenario s reveale d severa l patterns
. Teenag e an d youn g adul t males (1 5 t o 2 9 year

s old ) were involve d i n 38.8 % o fingestio n cases , nearl yalway s as a resul t o

fsiphoning

. Accidenta l ingestion s i n childre n unde rsi xyear s accounte d fo r36.2 % o

freporte d ingestions

. I n mos t o fth e pediatri ccases , fue l can s o rcontaine rtransfer s wer e implicated

. Extrapolatio n of198 7 dat a reporte d by6 3 U.S

. poiso n center s t o th e America n Associatio n o fPoiso n Contro l Center

s provide s curren t annua l incidence estimate s of640 0 methano l exposures 0 

### , 52,000 gasolin e exposures , an d 35,00 0 gasolin e ingestions

. Widespread applicatio n o fmethano l fuel s woul d shif t th e clinica l focu s fo rthes e 35,00 0 annua l ingestio n cases . Methanol , i n contrast t o gasoline , pose s a hig h ris k

ofsystemi ctoxicity , wit h a misleadin g dela yi n th e appearance oftoxi cmanifestations , an d sever s clinica l outcome s suc h as death , permanen t blindness , an d neurologi cimpairmen t followin g failure t o obtai n appropriat e treatmen t promptly

. Furthermore , th e ingeste d dos e whic h require s invasiv e treatmen t (hemodialysis ) i s jus t 0. 4 ml/kg , a mer e teaspoonfu l ( 5 mi ) ofa n 85 % methano l fue l i n a 1 0 k g one-year-ol d child , an d jus t 7 m l i n a 1 5 kg three-year-old

. Wherea s a 70 k g adul t woul d nee d t o ingest 2 8 m i (les s tha n on e ounce ) t o obtai n a leve l whic h require s hemodialysis , thi s amoun t coul d easil yb e swallowe d i n a siphonin g acciden t bya youn g adul t male

. Simila rextrapolation s fro m th e oft cite d potentiall yletha l methano l dos e o f1 ml/kg i s equivalen t t o jus t 1 2 m l (les s tha n a tablespoonful ) o fa n 85 % methano l fue l i n a 1 0 k g 1-year-old , an d jus t 1 8 m l i n a 1 5 k g 3-year-old

. Base d o n th s reporte d 0.375% methano l mortalit yrats , th s widesprea d us ® ofmethano l fuel s coul d increas e th s numbe rofmethano l fatalitie s b y195/year , u p fro m th s curren t (extrapolated ) 24/year)

. Similarly , a dramati cincreas e i n th e occurrence o fblindnes s an d permanen t neurologi cimpairmen t i s predicted , thoug h th s absolut e numbe ro fcase s cannot b s estimate d as curren t statistics ar e unavailable

. Excluding

th e cost s o

fextende d hospitalization s fo rcomplication s o fmethano l poisoning , chroni ccars an d rehabilitatio n fo rsever s permanen t blindnes s o rneurologi cimpairment , an d loss o f life , th e increase d acute

healt h care expenditur

e alon e exceed s 5 0 t o 100 millio n dollar s annually

. Fro m a publi chealt h vantage , th e acut e hazar d pose d byconversio n t o methano l fuel s i s unacceptabl e du e t o th s predicte d increase s i n fatalities , blindness , an d permanen t neurologi cdisabilit ysecondar

y t o mor s frequen t ingestions

. Prio rt o conversio n t o a predominantl ymethano l fleet , innovative closure s an d packagin g technique s must b e develope d whic h preven t siphonin g an d limi t acces s bysmal l children

. Extensiv

e publi can d healt h professiona l educatio n wil l b s required , focusin g o n th e letha l consequence s an d permanen t sequelae whic h followmethano l poisoning , th e nee d t o preven t accidenta l ingestion , an d th e urgenc ywit h whic h treatmen t mus t b e undertake n despit e th e absence

0 

### Th e term s exposure

an d poisoning

ar e use d interchangeabl yherei n t o indicat e contac t byany rout e (ingestion , dermal , inhalation , parenteral , ocula ro rother ) t o a potentiall ypoisonou s substance i n a n amoun t o rmanne rsufficien t t o generate concer n abou t subsequen t manifestation s o ftoxicit yb yth e victi m o rcaretaker

. Typically , thes e ar e cases whic h woul d prompt a cal l t o a poiso n center
. Ahig h degre e o fvariabilit yi n th e anticipate d toxicit yo fthes e exposures i s evident , wit h som e bein g minimall y toxi co rnontoxic , an d other s posin g a severe , potentiall yletha l hazard

. PAG E 3P.5 7



### o fclinica l manifestation s o ftoxicity

. Containe rtransfe rshoul d b e discourage d an d clear , emphati c warnin g label s prominentl ydisplayed o n al l fue l containers an d aroun d th e fue l tan k orific e o feac h vehicle . Thes e warning s shoul d clearl yan d emphaticall ystate that deat h o rblindnes s i s likel yi feve n smal l amounts ar e swallowed .

ACUT E HEALT H EFFECT S O F METHANOL : REVIE WO F TH E UTERATUR E

Epidemiolog yo

fMethano l Poisonin g O f1,166,94 0 huma n exposure case s reporte d t o th e America n Associatio n o fPoiso n Contro l Centers (AAPCC) Nationa l Dat a Collectio n Syste m i n 1987 , methano l wa s implicate d i n 1,60 1 cases. 1 

### O fthese , 75 7 involved automotiv e products . Th e followin g tabl e compare s th e ag e distribution , reaso n fo r exposure , nee d fo rtreatmen t i n a health-care facility , an d medica l outcom e o fth e methano l exposur e case s wit h al l othe rpoisoning s reporte d t o thi s database : Tabl e 1 . Characterizatio n o fAcut e Methano l Exposures , 198 7 AAPC C Nationa l Dat a Numbe ro

fCase s % o

fCase s % o

fAl l Poisoning s

43.2 62. 3 8. 7 9. 8 47.2 26. 8 Ag e (years) * < 6 6-1 7 > 1 7 Reason * Accidenta l Intentiona l Treate d i n a health care facilit

y Medica l outcome * N o effect Mino reffec

t Moderat e effec

t Majo reffec

t Deat h 69 2

13 9 75 6 1,476 10 6 85 2 75 7 46 1 6 5 1 7 6 92. 2 88. 9

6. 6 9. 0 53. 2 23. 0 47. 3 28. 8 4. 1 1. 1 0.37 5 45. 9

24. 1 2.7 0. 3 0.03 4 'Unknow n dat a elements accoun t fo rcategor ytotal s less tha n 1,60 1 o r100% . Th e dat a i n Tabl e 1 indicate a disproportionat e involvement o fadults , more tha n two-fol d greate r requiremen t o

ftreatmen t i n a health-car e facility , an d mor e tha n ten-fol d greate rdeat h rate fo rmethano l exposures compare d t o reporte d exposure s t o othe rsubstances . Thes e dat a indicate a greate rtoxicit y o fmethano l an d nee d fo rmor e aggressiv e medica l evaluatio n an d intervention

. Th e 1,60 1 methano l poisonin g case s reporte d t o th e AAPC C Nationa l Dat a Collectio n Syste m i n 198 7 represen t onl ya subse t o fal l metr-.T--.ci pcisonmg s whic h occurre d i n th e Unite d State s durin g tha t year . Sixty-thre e participatin g poiso n cc-r*:o'* s servin g a tota l populatio n o f137. 5 millio n reporte d data

. Thu s th e dat a represen t a n estimate d 57 % •— e huma n poiso n exposure s whic h precipitate d poiso n cente r

PAG E 4

### contacts i n th e Unite d State s i n 1987

. Additionally , th e averag e participatin g cente rpenetrance " o fth e regio n serve d was 8. 5 exposure s pe rthousan d population , wit h a rang e o f3. 3 t o 18.7/1000 population

. Since th s mea n penetrance i s jus t unde rhal fth e maximum , i t ca n b e estimate d that o n th e average , poiso n center

s receive reports o

fabou t hal fth e exposure s whic h occu rwithi n thei rregion

. Thus , a rough approximation

o fth e actua l annua l U.S

. incidence o fmethano l poisonin g woul d b e fou rtime s greate rtha n th e dat a presente d above , o rabou t 6400 cases . Th e occurrence o

flarg e number

s o fmethano l poisonin g cases reflects it s presence i n manyproducts , including : canne d heat , de-icers , duplicato rfluid , gas-lin e antifreeze , pain t strippers an d removers , mode l airplan e fuels , pip e sweeteners , an d windshiel d washin g solutions

. Pediatri cpoisoning s hav e occurre d i n a chil d as youn g as 1 0 week s o fag e wher

e methano l was mistake n fo rdistille d wate ran d mixed i n th e child' s formula. 3 

### Crud e methano l has a disagreeabl e tast e an d odor , limitin g palatability

. Wit h furthe rdistillation , methano l becomes nearl yodorless

. Adulterate d bootlegge d whiskey , has bee n a recurren t sourc e o

fclustere d methano l poisonings

. Th e largest reporte d "epidemic 0 

### t o dat e occurre d i n Atlant a i n Octobe r195 1 a t whic h tim e 9 0 gallon s o fbootle g whiskeycontainin g 35-40 % methano l wer e distributed

. Forty-on e fatalitie s followe d poisoning s i n 32 3 patients. 3 

### I n th e mid-1960s , 1 8 poisoning s wit h 8 death s occurre d i n Lexington , Kentuck ywhe n th e bran d o

fshella cthinne ruse d t o mak e a n illici t alcoholi cbeverag e was changed. 4 

### I n Ma y1979 , 4 6 poisoning s wit h 3 death s wer e reporte d whe n methano l fro m duplicatin g machines was distribute d a s homemad e spirit s i n a Michiga n prison. 9 

### Multipl e episode s hav e bee n hav

e occurre d i n India , wit h mor e tha n 30 0 death s reporte d i n on e o fthes e "epidemics". 3 

### Cllnleal l ManlfQaSatlemi o et ? Methano l Peloonln g Methano l i s rapidl yabsorbe d fro m th e gastrointestina l tract ; pea k level s develo p i n 3 0 f o 6 0 minutes

. Methano l distribute s i n tota l bod ywater
. Eliminatio n i s predominantl ythroug h hepati cmetabolism ; pulmonar yclearance i s low(abou t 6 ml/min). 7 

### Anima l dat a o n methano l toxicityi s limite d t o primates , as rats an d othe rcommo n laborator yanimal s d o not accumulate formi caci d o rmanifes t typica l metaboli cacidosi s an d blindnes s unless rendere d folat e deficien t o rgive n nitrou s oxid e t o inhibi t methionin e synthetas e an d regeneratio n o ftetrahydrofolate. 0 

### I n th e absence ofa histor yo fmethano l ingestion , th e initia l diagnosi s i s difficult , as reflecte d b yth e multitud e ofdiagnose s assigne d t o methanol-intoxicate d patients a t th s tim e ofthsi rinitia l presentation

. Suc h divers

® initia l diagnose s as cholera , diabeti cketoacidosis , pancreatitis , meningitis , subarachnoi d hemorrhage , an d nephrolithiasi s hav e bee n implicated

. Th e delaye d onset ofsymptom s i s deceptive , frequentl yleadin g f o delaye d initiatio n o ftherapy

. Althoug h classicall ydescribe d as a 1 2 f o 2 4 hou r latency, 3, 8 

### thi s interva l varie s considerably , an d i s generall yshorte rwit h larg e ingestions

. Concomitan t ethano l us e furthe rdelay s th e onset o

fsymptoms , a dela

yo f9 0 hour s havin g bee n reporte d i n 2 patients wh o continue d t o consum e ethano l fo rtw o days afte ra methano l ingestion.' 0 

### Th e singl e most helpfu l diagnosti cclu e i s th e presence o fvisua l changes , bu t thes e ar e not uniforml y noted

. Cloudy , blurred , mist yo rindistinc

t visio n (whic h i s describe d as simila rt o "steppin g ou t int o a snow-field 0

### )' 1 

### i s th e mos

t frequen t complaint

. Yello wspots an d centra l scotomata ma yb e note d as well

. Permanent complet e blindnes s ma ydevelop , o rirreversibl e bu t less sever e visua l abnormalitie s ma yb e note d wit h complet e resolution

. I fvisua l functio n returns , i t generall ydoe s s o i n th e first si xdays. 1 3 

### Initially , opti cdis chyperemi a an d peripapillar yedema , clinicall yindistinguishabl e fro m that cause d b y increase d intracrania l pressure , ar e noted

. Whe n symptom s persist an d scotomas o rcomplete blindnes s develop , opti cdis cpallo ran d attenuatio n o farteriole s ar

e noted

. Adecrease d pupillar y

" Penetrance i s define d a s th e numbe ro

fhuma n poiso n exposur

e cases reporte d t o a cente rpe r thousan d populatio n serve d b ythat center
. PAG E 5

### respons e t o ligh t has prognosti csignificance

. N o patien t wit h normall yreactive pupil s has suffere d

permanen t visua l loss. 1 3 

### However , th e decrease d pupillar yreactio n ma

yoccu ri n patents wit h complete recovery . Th e mechanis m o fselective involvemen t o fth e opti cnerv

e i n methano l toxicityremain s unknown ; howeve rformi cacidosi s has bee n implicated ; an d clinicall yi t has bee n observe d that th e visio n ca n improve i fth e acidosi s i s corrected

. Correctio n o fth e acidosi s cause s a large rproportio n o fdissociate d formi caci d an d therefor e less CN S entr

yo fformi cacid

. Ocula rtoxicityma yb e du e t o formats inhibitio n o

fcytochrom e oxidas e i n th e opti cnerv e wit h inhibitio n o

fATP formatio n an d disruptio n ofopti cnerv

e function.' 3 

### Asever s anio n ga p metaboli cacidosi s cause d predominantl ybyformi cacid , a methano l metabolite , i s a hallmark

o fsignifican t methano l poisoning

. Lactate accumulatio n ma yals o b s see n du e f o th e increase d intracellula rNADU/NAD * rati o whic h stimulate s anaerobi cglycolysi s an d lactat e production.' 4 

### I n addition , i n sever

e format e acidosi s aerobi cmetabolis m i s compromise d secondar yf o formate inhibitio n o

fmitochondria l respiratio n a t cytochrom e as 3 

### . Sine s format s accounts fo r45 t o 120% (mean , 90% ) o fth e decreas e i n bicarbonat e concentratio n an d 8 0 t o 200% (mean , 120% ) observe d i n 1 0 methano l poisone d patients,' 0 

### i t i s ofte n assume d that formats i s th e major , i fnot th s onl yunmeasure d anion

. Howeve rlactat e assay s hav e onl ybee n performe d i n a smal l numbe ro fcase s reporte d i n th e medica l literature , an d i n severa l o fthese , lactate concentration s wer e considerabl yincrease d (i n th e absence o

fcardiovascula rinstability)." 1 

### ' 1 9 

### Methanol-induce d hypotensio n o rconvulsion s ma yals o contribut e t o th e productio n o fa lacti cacidosis

. Th e rate limitin g ste p i n methano l metabolis m i s its conversio n byalcoho l dehydrogenas e t o formaldehyde

. Formaldehyd e i s rapidl yconverte d f o formi c acid , an d the n metabolize d bya folafe-dependen fproces s f o carbo n dioxid e an d water
. Formaldehyd e i s highl yreactive an d 3 3 time s mor e toxi ctha n methanol ; formi caci d i s si xtime s mor e toxic

. However , th s half-life offormaldehyd e eliminatio n i s a mer e 1 t o 2 minutes ; thu s n o accumulatio n i s detectable

. Althoug h formaldehyd e was once believe d t o b s th s caus e o fmsthano i toxicity , i t i s no wgenerall y believe d that formi caci d i s th e majo rproblem

. Formi caci d accumulate s t o level s whic h correlat e wit h th s degre e o

facidosi s an d magnitud e o fth e anio n gap.' 1 3 

### Clinically , mortalit yrate s an d severit

yo f visua l symptom s correlat e wit h th e degre s o facidosis

. O

f32 3 poisone d patients reporte d i n th e Atlanta epidemic, 3 

### th e overal l mortalit yrat e was 6.2%

. Howeve ri n 11 5 patients wit h seru m bicarbonat e level s belo w2 0 meq/l , th s mortalit

yrat s incrsass d t o 19%

. Afurths rincreas e i n mortalit yt o 50 % was note d i n 3 0 patients wit h seru m bicarbonat e level s belo w1 0 meq/l. 3 

### Seru m format e concentration s ma y correlat e bette rwit h th e patients clinica l conditio n (acidosi s an d ocula rfindings ) tha n seru m methano l levels. 1 7 

### Othe rmanifestation s o

fmethano l toxicityar

e less specific

. Headache , dizziness , nausea , vomiting , epigastri cpai n an d weakness ar e ofte n th

® first symptom s noted

. CN S depressio n wit h com a confusion , slurre d speec h an d possibl e seizure s ar e seen , bu t ar

e delaye d i n onset unti l metabolite s accumulate (unles s concomitan t ethano l ingestio n i s present)

. Hyperpne a develop s as th e metaboli c acidosi s become s sever

e an d th e patien t attempts t o compensate
. Bradycardia , myocardia l depressio n an d shoc k

ma yb e see n i n sever

e intoxications

. Nucha l rigidityan d othe rmeningea l sign s hav e bee n reported

. Post-morte m finding s includ e cerebra l hemorrhag e an d edem a Symmetri cnecroti careas o fth e putame n wer

e describe d i n 4 1 o

f12 4 patients i n on e series. 1 0 

### Opti cnerv e demyelinatio n ma

yb e observed. 1 8 

### Radiolucen t lesion s correspondin g t o infarcte d region s o fth e putame n an d lenficulocapsula rregion s hav e als o bee n note d o n C To rMR I scan s i n survivors , an d ma ycorrelate wit h th e reduce d initiative , rigidity , bradykinesia , spasticity , cogwheeling , an d sensorimoto r polyneuropath y(includin g flacci d paralysi s o fth e extremities) 20 

### that hav e bee n reporte d afte rmethano l overdose. 21 

### *

28 

### , 23 

### * 24 

### * 2 3 

### Althoug h thes e permanen t neurologi csequelae ar e infrequen t theyar

e no w appearin g i n th e literature wit h greate rregularity , perhap s becaus e patients wit h poisoning s s o sever e that a fata l outcom e woul d hav e bee n expecte d ar

e no wsurvivin g du e t o advance s i n medica l care . Improvemen t wit h L-dop a administratio n has bee n described. 2 3 

### I n on e serie s o f372 acute methano l

PAG E 6P.6 0



### poisonings , 4 patients ha d residua l neurologi csigns. 2 7 

### O f4 5 methano l intoxicate d patients treate d i n on e ICU , brai n hemorrhag e was documente d i n 13.5% b yC Tscan. 2 8 

### Th e incidence o fthi s complicatio n i s possibl yenhance d b

yheparinizatio n durin g hemodialysis

. Othe rpathologi cfinding s note d o n autopsyhav e include d pancreati cnecrosis , fattyinfiltratio n o fth e live ran d kidneys , an d nonspecifi ccardia can d pulmonar ydamage

. Pancreati cnecrosis , ofte n hemorrhagic , ha s bee n reporte d i n variou s autops yserie s wit h a n incidence o f1 3 o f1 7 case s 2S 

### , 1 1 o f1 1 case s 30 

### , an d 1 o

f6 cases31



### . Amylase determination s i n 1 4 patients wit h acidosi s an d visua l disturbance s fro m acut e methano l poisonin g (Atlanta epidemic) demonstrate d elevation s i n 1 0 cases . Pancreatiti s ma

yb e a facto ri n th e uppe rabdomina l pai n frequentl ynote d i n methano l poisonings

. Eve n severel ypoisone d methanol-intoxicate d patients ca n b e expecte d t o survive i ftheypresen t withi n a fewhour

s o fth e ingestio n an d are treate d aggressively

. Physicia n failure t o recogniz e sever e poisonin g despit e th e laten t period , failure t o diagnos e methano l toxicitya t all , an d delaye d patien t presentatio n are th e majo rcause s o fpresen t da

ymethano l fatalities

. Diagnosi s ofMethano l Toxicit y Unfortunately , th e diagnosi s o fmethano l poisonin g i s ofte n quit e difficult

. Patients ma ypresen t late du e t o th e delaye d onset o fsymptoms , ma

yb e unawar

e o fa methano l adulterant , o rma yb e unabl e t o communicate secondar yt o CN S depression

. Specifi cmanifestation s o ftoxicityd o not appea runti l 1 2 t o 2 4 hour

s afte rth e ingestion , includin g classi cvisua l symptom s an d sign s o fhyperventilation

. Therefore , i n contrast t o mos t othe rpoisonings , prompt an d accurat e analyti claborator yassistance i s essentia l t o th e prope rmanagement o fthes e patients

. Ideall yever yemergenc

ydepartmen t shoul d hav e th e abilit

yt o obtai n methano l bloo d level s i n less tha n a n hour

. I n fata l methano l poisonings , methano l level s ar e generall ygreate rtha n 100 mg/dl

. Apatien t wit h a methano l leve l as hig h as 92 0 mg/d l survive d withou t sequela e followin g early , aggressive therapy , includin g prolonge d hemodialysis. 3 2 

### Prio rt o thi s report , th e highest documente d leve l i n a survivo rwas 570 mg/dl , an d th e highest leve l note d withou t visua l impairmen t was 36 0 mg/dl

. Hemodialysi s i s recommende d bymos

t author s i n patients wit h a methano l leve l greate rtha n o requa l t o 5 0 mg/dl , o r wit h significan t metaboli cacidosi s o rvisua l symptoms
. Wher e methano l level s cannot b e obtaine d promptly , laborator yaid s t o th e diagnosi s o fmethano l poisonin g includ e measuremen t o fseru m osmolalit

y(an d calculatio n o

fosmola l gap ) an d anio n ga p determination

. Methano l poisone d patients presen t wit h a n eari yosmola l ga p whic h graduall yresolves as methano l level s decrease , metabolite s form , an d a n anio n ga p metaboli cacidosi s develops

. Th e osmola l ga p i s determine d bysubtractin g th e calculate d fro m th e measure d osmolality

. Norma l osmolalit yi s 28 6 + 4 mOsm/k

g H 2 

### 0 , an d th e norma l osmola l ga p i s les s tha n o requa l t o 1 0 mOsm/k g H 2 

### 0

. A n osmola l ga p shoul d b e sough t onl yi ffreezin g poin t osmometr yi s utilized ; vapo rpressur e osmometr yma ynot detec

t volatil e solutes. 33 

### I n on e serie s o fpatients , mea n corpuscula rre d cel l volume s were significantl yincrease d i n moderate t o severelymethanol-poisone d patients. 9 

### Sever e metaboli cacidosi s distinguishe s methano l an d ethylen e glyco l fro m isopropano l an d ethanol

. Althoug h metaboli cacidosi s ma yoccu rwit h th e latte rtwo alcohols , i t i s not o fth e magnitud e o

fthat see n wit h methano l an d ethylen e glycol

. Al l fou ralcohol s ma yproduce a n anio n gap , althoug h that o f methano l an d ethylen e glyco l ma ynot b e presen t initially , it s appearance delaye d unti l metabolite s form

. Whe n comparabl e amounts ar e ingested , th e magnitud e o fth e anio n ga p i s generall ysmalles t wit h isopropano l (secondar yt o lacti caci d accumulatio n i n hypotensive poisone d patients) , moderate wit h ethanol , an d greatest wit h methano l an d ethylen e glycol

. Acetonemia , especiall ywhe n profound , suggests isopropano l toxicity

. Indee d th e findin g o fketosi s withou t acidosi s shoul d immediatel ypoin t t o isopropano l toxicity

. Th e ketonemi a o fethano l toxicity , i.e

. starvatio n ketosis , mor e likel yrepresents
PAG E 7P.6 1



# 1

increase d level s o

facetoacetate an d beta-hydroxybutyrate

. A n osmola l ga p i s note d wit h al l fou ralcohols

. Its magnitud e i s proportiona l t o th e amoun t ingeste d an d inversel yproportiona l t o th e molecula rweigh t o fth e alcohol

. Approximat e seru m level s o feac h alcoho l ca n b e predicte d fro m osmolalit ymeasurement

s usin g th e followin g formulas : Predicte d seru m concentration 34 

### (mg/dL ) = (osmola l ga p xmolecula rweight)/1 0 Osmola l ga p = measure d osmolalit y- calculate d osmolalit

y Calculate d osmolalit

y= 2 (Na

) + glucose/1 8 + BUN/2. 8 Her e osmolalit

yi s expresse d i n mOsm/k g H 2 

### 0 , sodiu m i n meq/liter , an d glucos e an d BU N i n mg/dl

. I fth e ure a an d glucos e ar e provide d i n S I units , th e formul a becomes : Calculate d osmolalit

y= (1.86 xN a + ure a + glucose)/0.9 3 Methanol' s lowmolecula rweigh t an d larg e amount s presen t i n th e intoxicate d patient' s bloo d caus e a profoun d effec

t o n th e seru m osmolality , o feve n greate rmagnitud e tha n ethanol , isopropanol , an d ethylen e glyco l a

t comparabl e seru m alcoho l levels

. Laborator ydifferentiatio n o

fth e alcohol s shoul d b e performe d wit h gas chromatography

. Olde rmethod s o fenzymati coxidatio n wit h alcoho l dehydrogenas e are not specific , an d fai l t o detec t non-ethano l alcohols

. Notin g th e nee d fo ra specifi cantidot e i n methano l an d ethylen e glyco l poisonin g i n contrast t o th e predominantl ysupportive car e rendere d fo rethano l an d isopropano l toxicity , failure t o specificall y identif yth e alcoho l involve d coul d hav e disastrou s clinica l consequences . Compariso n o fth e observe d osmola l ga p wit h that expecte d fro m th e measured ethano l leve l (0.21 7 time s th e ethano l level ) ma y serv e as a usefu l clinica l clu e t o th e presence o fothe ralcohols. 34

### *3 8 

### Formate level s are generall yavailabl e fo rresearc h purpose s only , bu t ar e valuabl e clinica l determinants o ftoxicity

. Com a ma

yoccu rearl yi n a clinica l cours e wit h hig h methano l level s withou t formi cacidosis , bu t ma yreflec t concomitan t ethano l ingestion

. Retina l toxicit yi s associate d wit h formi cacidosi s an d ma yb e see n i n th e aler

t patien t wit h onl ymoderate methano l levels

. Decrease d RB C folat e ma

y compoun d acidosi s an d worse n toxicity. 3 

### * Dose/Respons e Dat

a A n enormou s variabilit

yi s reporte d i n th e dos e require d fo racidosis , blindness , o rdeath

. Th e variatio n ma yresul t fro m a genuin e difference i n susceptibilitie s o findividuals , inabilit

yt o accuratel yestimate th e amoun t consumed , o rvariation s i n th e concomitan t ingestio n o fethanol

. Nutritiona l difference s amon g individual s ma

ylea d t o varyin g rate s o

fformate metabolis m du e t o differin g folat e levels

. Th e smallest amoun t o

fmethano l reporte d t o caus e deat h i s 1 5 m l ofa 40 % methano l solution 3 

### , o rjust 6 m l o fabsolute methanol

. Ye t surviva l has followe d th e ingestio n o f50 0 t o 60 0 ml

. Th e generall y accepte d potentiall yletha l dos e i s 3 0 ml

. Fou rmilliliter s i s th e lowes

t recorde d toxi cdose

. Th e literature cite s letha l methano l dose s o f3 0 t o 240 ml

. Th e generall yaccepte d potentiall yletha l dos e i s 1 ml/kg. 3 7 

### Abloo d leve l > . 5 0 mg/d l require s dialysis ; a leve l

. > 8 0 mg/d l i s potentiall ylethal. 37 

### Th e followin g excerpts fro m th e medica l literature indicat e th e tremendou s variabilit yo fth e methano l dose/response :

Enormou s variability , typifie d b yindividual s wh o consum e a s muc h as 4 liter s o f40 % msthano i withou t sequelae , whil e blindness develop s i n other s followin g a

s littl e a s 4 t o 1 0 ml . Seru m methano l level s greate rtha n orequa l t o 15. 6 m M are frequentl yassociated wit h blindness an d death. 3 0 On e ma n dran k

1 pin t o f10 % mixtur

e (5 0 ml) dail ywithou t producin g il l effects . Asingl e 4 m l dose was a toxi c dose i n anothe rinstance , it i s recorded ths t 1 0 cc , 3 0 t

o 6 0 ml , an d 18 0 to 24 0 m l repeatedl ycaused death . O n th e othe r
PAGE SP.6 2

hand , muc h larg e amounts hav e bee n take n without causin g temporar yo rpermanen t injury.* 3 0 Kseem s reasonabl e t o regard 1 g/k g a s th e approximat

e minima l letha l dose i n man.*-0Th e minimu m letha l dose o f methano l I n th e rhesu s monke ywas 3 g/kg . Deat h followe d ingestio n o f1 2 ounces (144 t o 21 6 m l absolut e methanol ) an d sever

e toxicit yfollowed ingestio n o

f2 , 4 , an d 6 ounces (2 4 t o 3 6 ml , 4 8 to 7 2 ml , an d 7 2 to 10 8 m l absolut e methanol ) o

fa 4 0 t o 60 % methano l duplicatin g flui d b ypriso n inmates. 4 ' Th e ingestio n o

f10 0 m l i s assumed b ymos t investigator

s t o b e fatal. 4 2 Th e ingestio n o

fapproximatel ySO

O m l wit h a resultin g pea k seru m methano l leve l o f92 0 mg/dl ) waa treate d wit h early , prolonge d hemodialysi s an d followed b yrecover

ywithou t sequelae. 3 2 Two adul t patients wit h acidosi s an d transien t visua l symptom s survived followin g th e ingestio n o f10 0 m l methanol. 43 Th e ingestio n o

fabou t 2 ounces o

fpain t thinne rb

ya n adul t mal e resulted i n metaboli c acidosi s an d severe , permanen t Impairmen t o

fvision . Of2 8 methano l intoxicated patients wh o attende d a drinkin g part yi n Papu a NewGuinea i n 1977, 4 died , 8 survived wit h sequelae o

fblindness o rpseudobulba rpals y(12 0 t o 60 0 m l ingested , mea n 36 0 ml) , an d 1 6 experience d complet e recover y(6 0 t o 50 0 m l Ingested , mea n 24 0 mi) . Hemodialysi s an d ethano l therapies were no t used i n these patients. 44 

### Treatmen t ofMethano l Poisonin g Followin g appropriat e respirator yan d cardiovascula rsupport , gastri cdecontaminatio n shoul d b e performed

. Sodiu m bicarbonat e mus t b e administere d promptl yt o correc t sever e acidosis

. Specifi c therapyi s directe d toward s slowin g metaboli cdegradatio n o fmethano l t o it s toxi cmetabolites

. Thi s i s accomplishe d b yadministerin g ethano l wit h its nine-fol d greate raffinit yfo ralcoho l dehydrogenas e compare d t o methanol

. Aseru m ethano l ieve l o f100 mg/d l wil l full yinhibi t alcoho l dehydrogenas e functio n an d formi caci d production

. Ethano l level s o f5 0 mg/d l wil l produce approximatel y80 % enzym e inhibition

. Ethano l ma

yb e give n intravenousl yo rorally

. Ethano l bloo d level s shoul d b e maintaine d jus t ove r100 mg/dl

. Aloadin g dos e o f7. 6 t o 10. 0 ml/kg 10

% ethano l i n D,W(o r0. 8 t o 1. 0 ml/kg 95 % ethano l dilute d i n orang e juic e PO

) shoul d b e administered

. Maintenanc e dose s o

f1.4 ml/kg/h r(continuou s drip ) o f 10% ethano l i n D S 

### War e give n I V(o r0.1 5 ml/kg/h r95% ethano l dilute d i n orang e juic e PO)

. Maintenance dose s mus t b e increase d durin g dialysis

. Thi s i s mos t easil yaccomplishe d byaddin g ethano l t o th e diaJysat

e t o obtai n a concentratio n o f100 mg/d l ethano l withi n th e dialysate

. Thi s o rany ethano l dosin g schem e wil l onl yapproximate a n individua l patient' s ethano l needs , wit h chroni cdrinker s requirin g considerabl ymore , an d nondrinker s possibl yless

. Seru m ethano l level s must b e continuousl y monitore d an d use d as a guid e fo rsubsequen t ethano l dosing

. I f10% ethano l i n D,Wi s unavailabl e fo rintravenou s administration , thi s solutio n ma yb e prepare d byremovin g 100 m l fro m a lite ro fD,W an d replacin g i t wit h 100 m l (tax-free , bulk ) absolute alcohol , afte rpassin g th e alcoho l throug h a .22 micro n filte rt o limi t particulat e matter
. Thi s i s not a n approve d parentera l alcoho l formulation , bu t absolut e alcoho l intende d fo rinjectio n woul d requir e 100 ampule s pe rlite ra t a cost o fapproximatel y $300 , compare d wit h a cost o fonl yon e dolla rfo rth e alcoho l i ftax-fre e bul k alcoho l wer

e utilize d instead

. Hemodialysi s i n additio n t o ethano l blockin g i s indicate d fo ral l patients wit h methano l level s i n excess o f5 0 mg/dl

. Level s belo

w5 0 mg/d l ar

e adequatel ytreate d wit h ethano l blockin g alon e unless severe , resistan t acidosi s o rvisua l involvemen t i s noted

. Peritonea l dialysi s has n o place i n th e management o fthes e patients as i t i s onl y1,8 a s efficien t a

s hemodialysis

. A

t lo wdoses , methano l metabolis m appear s t o b e firs t orde r(zer

o or-v r» retic s pertai n a t highe rdoses)

. Methanol' s eigh t hou rhalf-life observe d a

t lowdose s i s markec

y: '-.on^e d (t

o 30 t o 46. 5 hours' 3 

### ) wit h ethano l blocking

. Dialysi s decrease s thi s half-life t o 2. 5 hours , ----ociaiysi s effectivel yclear s plasm a formate a

s well. 48 

### Patient

s wit h ver yhig h methano l level s hav e bee n treate d wit h ethano l blockin g alon e (withou t hemodialysis) an d

PAG E 9

### hav e recovered

. However , thes e patients hav e require d extensive

an d vigilant

intensive car

e lastin g u p t o two weeks

. I n ou rexperience , continuou s an d accurat e contro l o fethano l levels , eve n i n th e intensiv e care settin g i s raref

yachieved , especiall yove rlength ytim e periods

. Hemodialysi s dramaticall y shorten s th e patient' s hospita l sta ytherebydecreasin g th e risks attendan t t o prolonge d coma , intubatio n an d ethano l therapyas wel l as decreasin g tota l healt h care costs
. Folate administratio n has als o bee n advocate d as a n adjunc t t o th e treatmen t o

fth e methanol-poisone d patient

. Th e oxidatio n o

fformi caci d t o carbo n dioxid e occur s vi a a folat e dependen t system
. Anima l experiments hav

e demonstrate d that rats ar e abl e t o oxidiz e methano l withou t formate accumulation

. However , rats rendere d folat e deficien t manifes t typica l methanol-induce d metaboli cacidosi s an d formats accumulation. 4947 

### Furthermore , folate supplementatio n i n monkey s decrease s formate accumulation. 47 

### Currentl yrecommende d folat e dose s i n human s ar e 1 mg/kg (u p f o 5 0 mg/dose ) IV ever yfou rhour

s fo ra tota l o

fsi xdoses

. I n symptomati cpatients , leucovori n ma yb e administere d as th e firs t dos s (i n th e sam e amount) i n place o ffoli cacid

. A n alternate inhibito ro

falcoho l dehydrogenase , 4-methyipyrazole , has bee n propose d fo rus e i n th e treatmen t o

fhuma n methano l poisoning s bu t i s not currentl yavailabl e i n th e Unite d State s fo rclinica l use . Studie s i n monkey

s demonstrate d that 4-methylpyrazol e abolishe d methano l toxicit yan d prevente d formi caci d accumulatio n i n monkey s receivin g letha l dose s o fmethanol. 40

### *4

9 

### Th e us e o

f4 - methylpyrazol s has th e therapeuti cadvantage s ove rethano l therapyo fa longe rduratio n o

factio n an d absence o

fCN S depressan t activity

.

Q.hm Exposus

- 

### ® Fteuteo : Ocular , Doraa! , InfialaSiam i Althoug h r

t i s generall yaccepte d that methano l poisoning s ma yals o occu rfollowin g derma l absorptio n o rinhalation , poisoning s bythes e route s are reporte d infrequently , poorl ydocumented , an d on e i s generall yunabl e t o determin e th e relativ e contributio n t o toxicit

yo feac h route
. Severa l case s are reporte d as derma l exposures , althoug h concomitan t inhalatio n cannot b s excluded

. A n 8-month-ol d i n Brussel s die d fro m methano l toxicit yafte rtreatmen t o

fa commo n col d b

yrubbin g th e chest wit h olivs oi l the n applyin g warm methano l compresses. 90 

### APolis h painte rwh o accidentall y poure d methano l o n hi s clothin g an d faile d t o remov e th e wet clothe s develope d methanol-induce d blindnes s withi n a fewdays. 9 1 

### Th e applicatio n o fmethanol-soake d cloth s unde rth e rubbe rpants o f babie s f o relieve abdomina l pai n was one s a commo n practice i n Argentin a Th s occlusive natur e o f th s applicatio n prevente d rapi d evaporatio n an d allowe d prolonge d derma l contact Th e apparen t beneficia l effec

t (pai n reliefan d slee p induction ) wer e likel ymanifestation s ofsystemi cmethano l poisonin g instead

. Twsnty-on s case s o fpercutaneou s methano l absorptio n resultin g fro m thi s practice wer e reporte d I n childre n ag e 1.5 month s t o 4 year s (mea n 1 1 months). 33 

### Thirtee n patients ha d sever e respirator ydepression , 1 4 wer

e comatose , 1 1 ha d seizures , an d 7 ha d anuri a o rsever e oliguri a Th e mea n admissio n p H was 6.93

. Methano l level s wer e obtaine d i n 1 1 childre n an d range d fro m 5 7 t o 1130 mg/d l (mea n 46 1 mg/dl)

. Twelv e childre n died

. I n additio n t o systemi ctoxicity , prolonge d ski n contac t cause s dermatitis , erythem a an d scaling

. Anima l dat a assessin g percutaneou s absorptio n o fmethano l ar

e limited

. Illnes s an d deat h wa s observe d i n monkey

s followin g th e derma l applicatio n o f0. 5 ml/kg , bu t i t i s no

fclea ri finhalatio n wa

s prevente d i n thes e studies

. Anothe rinvestigato rdrenche d th e entire bodie s o funshave n dog s fo r severa l hour

s i n a wa ythat preclude d inhalation

. Th e resultin g bloo d methano l level s indicate d that , a fleast i n th e do g model , th e degre e o fderma l methano l absorptio n was limited , an d certainl ymuc h less tha n that followin g inhalation. " Documente d systemi ctoxicit yfollowin g inhalatio n exposur e i s rare . Mos

t recorde d cases ar

e logge d fro m th e earl y1900's , an d mus t hav e involve d exposures t o extremel yhig h concentrations

. Th e

PAG E 1 0

### America n Counci l o fGovernmenta l Industria l Hygienists has set th e TL Vfo rmethano l vapo ra

t 20 0 pp m an d TLV-STE La

t 25 0 ppm . Limite d anima l data i s availabl e o n chroni co rsubacut e inhalatio n exposure s t o methanol

. Repeate d dail yexposur e t o methano l vapor

s i n concentration s u p t o 5000 pp m cause d onl ynasa l discharg e i n rats , an d n o effec t i n monkeys. 3

4 

### Ahuma n inhalatio n exposur e f o level s o f1200 t o 830 0 pp m produce d visua l impairment. 9 4 

### Experiment

s i n th e earl y1900' s demonstrate d deat h an d blindnes s i n a variet yo fanima l model s followin g methano l inhalatio n i n poorl yventilated , confine d spaces. 9 9 

### Th e author s o fthi s stud yrefe rt o "abou t on e hundre d case s o famblyopi a an d deat h fro m inhalatio n o

fwoo d alcoho l recorde d i n th e literatur e t o 1912°

. Amor

e recen t stud yfaile d t o demonstrate pulmonar

ytoxicit yi n rats expose d t o methano l vapo ra t concentration s u p t o 10,000 pp m fo ru p f o si xweeks. 3 3 

### Arevie

wo fth e mor e recen t methano l exposur e literature indicate s that th e commo n systemi cmanifestation s o fora l methano l exposur

e are extremel yrar

e followin g inhalation. 37 

### Teachers ' aide s i n Washingto n stat s utilizin g spiri t duplicator s manifeste d headache , nausea , blurre d vision , an d dizziness. 39 

### Thes e wer e combine d inhalatio n an d derma l exposure s (handlin g th e °wet ° papers)

. Concentration s o fairborn e methano l range d fro m 36 5 t o 308 0 ppm . A n estimate ofth e methano l bod yburde n an d pea k bloo d leve l ca n b e mad e fo ra work exposur e a t th e 20 0 pp m (26 1 mg/m 3 

### ) ACGI H TLV

. Assumin g 100% absorptio n o fmethano l vapor

s an d a 1 0 m 3 

### respirator yvolum e i n a n eight-hou rwork day , the n th e tota l bod yburde n is : bod yburde n =-

< 26 1 mg/m 3 

### x1 0 rrt 3 

### x1. 0 = 261 0 m g Assumin g complet e absorptio n o fthi s entir e amoun t i n th e first fewminute s o fth e workshif

t b ya 70 kg adul t an d methano l distributio n i n tota l bod ywater , a maximu m estimate o fth e pea k

bloo d leve l is : pea k bloo d leve l = 261 0 mg/4 9 lite r= 5. 3 mg/d l Obviously , thi s i s a worst-cas e calculation , bu t th e results indicate that significan t methano l toxicit ywil l not occu rfollowin g methano l inhalatio n a t level s withi n th s ACGI H TLV. 3 9 

### Ocula rexposure (methano l splashe d i n th e eye) produce s a mild , local , reversibl e reactio n i n rabbits

. N o systemi ctoxicityo reffects o n th e retin a o ropti cnerv e ar e observe d afte rmethano l splashe s i n th e eys . Comsa i opacitie s followin g externa l methano l contac t wit h th e eye hav

e bee n reported , bu t mus t b e rare. 60 

### METHANO LAS AFUEL : PREDICTIV E INCIDENC E MODE LFO R ACUT E INGESTION S

Summar yot f1*98 7 AAPC C Gaeolln

® Exposure s Data O f1,166,940 huma n exposur e cases reporte d f o th e America n Associatio n o fPoiso n Contro l Center

s (AAPCC ) Nationa l Data Collectio n Syste m i n 1987 , gasolin e was implicate d i n 13,02 8 exposures . (These dat a diffe rslightl yfro m that reporte d i n th s AAPC C Annua l Repor

t du e t o th e us e o

fspecifi c dat a edit s t o improve th e substance codin g accurac yutilize d fo rthi s project. ) Th e dat a collectio n syste m receive d reports fro m 63 participatin g poiso n center s i n 1987 , servin g a combine d populatio n o f137. 5 million , o r57% o fth e populatio n o

fth e Unite d States

. Extrapolatio n o fthes e data t o non reportin g region s an d unreporte d poisoning s allow s a n estimate o

factua l poisonin g incidence a t leas t 4 time s greate rtha n th e numbe rreported

. Thu s 52,000 gasolin e exposure s ar e estimate d t o hav

e occurre d i n th e Unite d State s i n 1987

. Mos t o fth e gasolin e exposures i n thi s databas e wer e acute (99.2%

) an d accidenta l (96.7%)

. Th e reaso n fo rth e exposur

e i s outline d i n th e tabl e below , wit h a compariso n provide d t o 1987 Nationa l Statistics fo ral l poiso n exposures . Compare d t o othe rtype s o fpoisoning s (Tabl e 2) , gasolin e exposure s occurre d mor

e frequentl ybecaus e o

faccidents o rintentiona l abuse , an d less frequentl yfo r
PAG E 1 1P.6 5



### suicida l reasons . Tabl e 2 . Distributio n ofreaso n fo rexposur e fo rgasolin e exposure s compare d t o al l poiso n exposure s Reaso n Gasolin e Exposure s Al l Poiso n Exposure s No . % % Accidenta l Occupationa l Non-occupationa l Tota l Accidenta l Intentiona l Suicida l Abus e Other/unknow n Tota l Intentiona l Other/unknow n 19 2 12,41 2 1Z60 4 4 6 22 3 12 7 39 6 2 8 1. 5 95. 3 96. 7 0. 4 1. 7 1. 0 3. 0 0. 2 1. 8

87. 1 88. 9 5. 8 1. 1 2. 2 9. 0 ZO Th e ag e an d sexdistributio n o fgasolin e exposures differ s markedl yfro m that see n i n othe rtypes o f poisoning . Astrikin g mal e predominance i s observed i n gasolin e exposures an d ingestion s (Tabl e 3) . I n addition , pediatri c gasolin e exposures are les s commo n an d adul t gasolin e exposures mor e commo n compare d t o non-gasolin e poisonings . Tabl e 3 . Ag e an d se xdistributio n fo rgasolin e exposure s an d gasolin e Ingestion s compare d t o othe rpoiso n exposures . AG E Al l Gasolin e Exposure s (years)

< 1

1 - --- • 

## 2 3 ; _ 4 

## 5 " ' 6-1 2 13-17 7 >1 7 Gasolin e Ingestion s NON-Gasolln e Ingestion s

Mal e Femal e % 0. 6 

# „w r 9. 1 

## '„4. e 2. 7 

### " 11. 0 7. 2 

## 739: 6 s 

### %

0. 2 

# v:a i 3. 2 

### "TMt7 " 0. 8 2'G.S' 1. 3 M J I Tota l

% 0. 8 ;10. 5 12. 4 6. 3 3. 5 2A 8. 5 

## to. * 35. 8 7. 8 43. 7 

## Unknow n,1 , 0.5 ' ,022 1,0 Tola * * ; - '' „ 79. 2 % 

## 20. 1 100, 0 Mal e Femal e % % 0. 5 0. 3 laM *mlAB

- 11. 1 3. 9 

# r^airt r Z 3 0. 7 ""1. 4 "0. 3 5. 1 0. 8 9, 5 * 1. 1 36. 9 4. 9 0. 4 „ 0, 1 Tota l

% 0. 9 13. 7 15. 1 6. 5 2. 9 1. 7 5. 9 

## io. e 42. 0 0. 7 Mal e Femal e

% % 4. 2 3. 7

••• AW' , *.W^WWM' WV* H S "T**** " „ 

### 10. 8 9. 1 2. 2 1. 7 

# '\„*"?u; \

0. 9 3. 1 2. 2



## „ ; ; \i.8~~T2- s * 11. 5 15. 0 

## ' s 

## "0. 3 " 0. 3 s 

### Tota l

% 8. 0 

# r,i w 20. 1 

# ::>t 3. 9



# ~ zt 5. 4 ?~4: 4 26. 8 

## " h 

### ;T» 3 $1. 6 17. 8 100. 0 sar;"4SJ S ,100. 0 Atabulatio n o

freaso n fo rexposur

e b yag e fo ral l gasolin e exposures demonstrates a surprisingl yhig h incidence o

faccidenta l adul t exposures compare d t o othe rtypes o fpoisonin g (Tabl e 4) .

PAG E 1 2P.6 6



### Tabl e 4

. Ag e an d reaso n distributio n fo rgasolin e exposure s compare d t o othe rtype s o f poiso n exposure .

< 6 6-1 2 13-1 7 > 1 7 Accidenta l

Gasolin e % 40. 7 5. 8 10. 3 41. 0 Othe r

% 62. 1 5. 0 2. 2 19. 0 Intentiona l

Gasolin e Othe r % % 0. 2 0. 3 0. 1 0. 3 0. 4 Z 1 0. 8 6. 3 

### Two percen t o

fgasolin e exposur

e case s involve d exposur e t o mor e tha n on e substance (gasolin e plu s som e othe rchemical , product , o rdrug)

. O fth e 13,02 8 gasolin e exposure s reporte d herein , 12,739 occurre d withou t a concomitan t exposur e (singl e substance)

. Th e multipl e exposur e case s are include d i n ai l analyse s herein , except fo rth e analysi s o fmedica l outcome , sympto m assessment , an d managemen t site

. Exposures occurre d a

t a residence i n 90.6% o fcases . Th e rout e o

fexposur e was mos

t frequentl y ingestio n (59.3%) followe d byocula r(19.5%) , derma l (11.4%) , an d inhalatio n (8.3%)

. (These data includ e case s wit h multipl e exposur e routes. ) Ahig h incidence o fpatients wit h relate d symptom s was observe d (58.7%)

. Th e distributio n o fsympto m occurrence byexposur e rout e i s presente d i n Tabl e 5

. Althoug h bot h adul t an d pediatri cgasolin e exposures wer e predominantl yaccidental , adul t gasolin e exposure s wer

e twic e as likel yt o hav

e relate d symptom s compare d t o childre n unde rsi x(Tabl e 6)

. Tabl e S. Occurrenc e ofrelate d symptom s I n gasolin e exposure case s

Ag e (years )

< 6 6-1 2 13-1 7 > 1 7 % wit h

relate d symptom s 41. 2 71. 3 68. 5 68. 3 

### Management sit e an d patien t dispositio n ar e outline d i n Tabl e 7 fo ral l gasolin e exposures . Wher e al l gasolin e exposure s ar

e considered , onl y15.6% o fgasolin e exposure s an d 16.4% o fgasolin e ingestion s wer e manage d i n a healt h care facility

. Th e medica l outcom e byexposur e route i s presente d i n Tabl e 8 fo reac h gasolin e exposur e wher e gasolin e was th e onl ysubstance implicated

. Only2 % o fgasolin e exposure s experience d a moderate o rmajo r(life-threatening ) medica l outcome
. Tw o death s occurred , bot h followin g inhalatio n o fgasolin e b yteenagers
. (Th e possibilit yo fingestio n wa

s no t exclude d i n cas e 2. ) Th e remainin g cases ha d n o effec t o ra mino reffec

t suc h a s nausea , self-limite d vomitin g o rmino rcough

. Brie fabstracts o

fthes e fatalitie s follow : Cas e 1 : A15-year-ol d mal e wa s foun d apnei can d unconscious , lyin g nex t t o hi s car . Th e patien t ha d apparentl ybee n inhalin g gasolin e fumes

. Hi s father , a paramedic , initiate d cardiopulmonar y resuscitatio n immediately

. H e wa s transporte d t o a healt h car e facility , an d foun d t o b e asystolic , PAG E 1 3P.67

.



### wit h dilate d pupils . Resuscitatio n effort s were unsuccessful . Ahistor yo frecreationa l inhalatio n o f gasolin e o n previou s occasion s wa s obtained . Cas e 2 : A14-year-ol d mal e wa s foun d i n cardiorespirator yarres t i n a she d i n a sittin g positio n wit h a n ope n containe ro

fgasolin e b

yhi s side . Resuscitatio n effort s durin g helicopte rtranspor t include d CPR , I Vfluids , endotrachea l intubation , MASTtrousers , epinephrine , atropine , lidocaine , an d defibrillation . Electromechanica l dissociatio n progresse d t o ventricula rfibrillation . Th e patien t wa s pronounce d dea d shortlyafte rarriva l a t a medica l center . Th e parents state d that th e victi m ha d attempte d t o sipho n gasolin e t o fil l hi s go-can . Since n o autops ywa s performed , it coul d no t b e determine d i

fth e patien t succumbe d t o asphyxiatio n du e t o inhalatio n o fth e gasolin e vapors o ri fingestio n wit h subsequen t aspiratio n occurred . Acompariso n o

fmethano l an d gasolin e fatalit yrate s (AAPC C 198 7 data ) reveal s a 25-fol d greate r fatalit yrate fo rmethanol , a reflectio n o fits profoundl ygreate rsystemi c toxicity . Deat h occurre d i n 6 o f 1,60 1 methano l exposures (0.375%) compare d t o 2 o f13,02 8 gasolin e exposures (0.015%) . Revie wo

fSelecte d Gasolin e Exposure Case s t o Determin e Exposure Scenario s Th e Nationa l Capita l Poiso n cente rreceives reports o fpoiso n exposures fro m th e approximatel y3 millio n peopl e o

fth e Washingto n D C metropolita n are a Thes e reports ar e generate d a t th e tim e a consultatio n i s requeste d o fth e cente reithe rb

yth e genera l publi c o rb ya healt h care professiona l involved i n th e care o

fa poisoned patient . Atota l o f30,31 8 huma n poiso n exposures were reporte d t o thi s cente ri n 1987 . Aretrospectiv

e revie wo fal l gasolin e exposures reporte d t o th e Nationa l Capita l Poiso n Cente ri n 198 7 wa s conducte d i n a n effor t t o obtai n som e insight into th e circumstances surroundin g eac h exposure . Thes e case s ar e als o include d i n th e AAPC C Nationa l Databas e describe d above . There wer e considerabl e limitation s o n th e informatio n that coul d b e gleane d fro m suc h a revie wdu e t o it

s retrospectiv

e nature , despite attempts t o contac t eac h patien t (bytelephone) t o obtai n missin g dat a o n th e amoun t ingeste d an d circumstances surroundin g th e exposure . O f24 1 gasolin e exposures include d i n th e Nationa l Capita l Poiso n Center' s 198 7 database , 23 0 are include d herei n fo rfurthe ranalysis . Eleve n were excluded , includin g 6 cat exposures , 1 do g exposure , an d fou rcodin g errors , predominantl yrelatin g t o othe rhydrocarbons . Thes e 23 0 gasolin e exposures were predominantl yingestion s (Tabl e 9) . Tabl e 9 . Exposur e rout e fo rgasolin e exposure s reporte d t o th e Nationa l Capita l Poiso n Cente rI n 198 7 Rout e No . %

7.8

Aclose rloo k

a t th e ingestio n G.; M *».*--ai s severa l distinc t ag e patterns , includin g th e typica l toddle r pea k fo raccidenta l poisonings , bu t * .•-> a ver yatypica l secon d pea k i n teenagers an d youn g adult s (Tabl e 10) . Childre n unde rsixacccu * t 'o r4 2 (36.2%) o fth e reporte d ingestions . Fiftee n t o 2 9 yea r PAG E 1 4 

### Ingestio n Ocula r Multipl e routes Ingestion

- > other Derma l Inhalatio n Oti c 11 6 4 6 3 9 78 1 8 8 3 50. 4

20. 0 17. 0 7. 8 3. 5 1. 3P.6 8



### ol d teenagers an d youn g adults accoun t fo ranothe r4 5 (38.8% ) o fth e ingestio n exposures . Tabl e 10 . Distributio n o fIngestio n Route s byAg e fo rCase s Reporte d t o th e Nationa l Capita l Poiso n Cente r Ag e 

## Ingestio n

Mi&"i\ ff. <?y- 

### < 1 t . „ \ 2 

## 3 \V 4 

## 5- 9 ;: : 10-1 4 

## 15-1 9 20-2 4 30-3 4 

## 3&3^22S2rSS

' * W W*****M{VA«Aw<»n « sw. v jfa 

### 40-4 4 4 1* . NVyjk'AWAV\W<1> ' VW,V^SS,VAV -.V . / 

### >5 0 unknow n adul t 

# uaknoyfti . •ff

AV^V^M V

. ^frWV k

Vfffffty 

### 12 * 1 5 

## \ « . 7 

## : 3 2 1 9 1 7 „ ^ - 

### 2 1 0 

# ro~~ 1 8 

### a r

0 

### 1 3 4 1 

### 7 1 1 

### 0 4 

### "0 - 3 

# ;< r 0 

## c r * 0 1 - 9 

### 2" ' Multipl e Route s 0 

### 6 5 4 4 4 2 t 0 

# ; r 1 

### '' g 3
, < ; 

### ~ ; 

### ~ r 

### 1 0 ' 0 ~ 3 

# uuo . 4 5 .39 ; Derma l 

### 0 

## * 2 1

, 1 2 0 1 3 1 

# \ r 

# o Zf. o ;;;;o ~ 0 4 

## ;; : o Aura l Inhalatio n

0 

## cr. o 

# P . o ^ 0 , 

## o ' 0 0

~ f 

## o 0 

# ZS 0

0 

## o 1 0 1 0 A-W l SWAT { V\ 

### 1 s

# o 1

..V^* •.i" . S \f. 

### 1 ' ' 

# X U Tota l

0 :;2 t 2 4 

# U * 1 4 

# "\- H 1 7 2 2 : ; i s 7 . ^ 7 4 

### 1 2 3 6 U 3 % 

### :;23o * Tabl e 1 1 demonstrate s th e predominan t rol e o fsiphonin g i n ingestion s occurrin g i n victim s wh o are 1 4 years o fag e o rolder . Of7 2 ingestion s i n teenagers an d adults ( > 1 4 years) , at least 6 2 (86.1%) ingeste d gasolin e becaus e o fa siphonin g acciden t Ofth e remainin g 1 0 teenag e an d adul t ingestions , 7 ingestio n scenario s were unknown , 2 involved accidenta l ingestio n followin g containe rtransfe r(e.g . gasolin e store d i n a Peps i bottle , an d consume d a s a beverage) , an d 1 wa s a suicid e attempt . Th e amoun t ingeste d i n th e siphonin g accidents wa s usuall ylisted a s ' a mouthful ' bu t range d a s hig h as " a coupl e o

fmouthfuls , severa l bi g mouthfuls , an d a bi g gulp' . Du e t o th e retrospectiv e nature o

fthi s study , th e reason s fo rsiphonin g were availabl e i n onl y1 5 o fth e 6 2 siphonin g incidents . O fthes e 1 5 cases , state d reason s fo rsiphonin g are listed i n Tabl e 12 . Tabl e 12 . State d reason s fo rsiphonin g I n selecte d accidenta l gasolin e Ingestions . Siphonin g fro m ca rfo rlaw n mowe r Siphonin g fro m law n mowe rfo rca r Siphonin g betwee n vehicles Siphonin g fo rvehicl e repai r 2 2 7 4 

### O fth e 4 2 ingestion s i n childre n unde rsixyears o fage , two recurrin g ingestio n scenarios were observed . Twenty-on e childre n dran k fro m a fue l ca n ( 7 o

fthes e can s hel d ga s intende d fo ruse i n a law n mower ; i n th e othe r1 4 th e intende d use was unknown o rothe rtha n a law n mower) . Containe r transfe rwa s involved i n 7 accidenta l pediatri c ingestions , includin g 4 cases o ftransfe ro

fgasolin e t

o a sod a bottl e o rsod a can . Onl yon e chil d ingeste d gasolin e directl yfro m th e ga s tan k o fa vehicle . PAG E 1 5P.6 9



### Predicte d Ineldenee , Toxicity , an d Healt h Effect s o f Aeut Q Ingestio n ofMethsnol-basisd * Fuel s To determin e th e potentia l fo rtoxicityfro m th e siphonin g accidents reported , we attempte d t o approximate th e maximu m volum e o fa mouthfu l i n eigh t youn g adul t males

. Eac h medica l studen t was aske d t o fil l hi s mout h t o capacit ywit h wate rfro m a containe ro fknow n volum e usin g a stra wthe n a piece o fplasti ctubin g (9 0 c m length , 6 m m interna l diameter , 8 m m externa l diameter ) simulatin g a siphon

. Th e mea n volum e o fa mouthfu l obtaine d wit h th e stra wwas 81. 3 m l (rang e 55 t o 11 0 ml)

. Whe n th s large rdiameter , longe rplasti ctubin g wa s used , th e mea n volum e decrease d t o 4 9 m l (rang e 2 9 t o 7 5 ml)

. Th e mea n ag e o

fth e stud ypopulatio n was 26. 6 year s (rang e 2 4 t o 3 1 years) , an d th e mea n weigh t was 79. 7 kg

. Thi s stud ydesig n shoul d not b s construe d as a n estimate o fth e actua l volume s obtaine d i n siphonin g accidents , bu t rathe ras a n estimate o fth s maximu m volum e o fa mouthfu l i n a populatio n o fth e approximate ag e an d se xo fsiphonin g acciden t victims

. Since many siphonin g acciden t victim s estimate d th e volum e ingeste d as °a mouthful 0 

### , thes e dat a indicat e that th e amoun t ingeste d coul d b e as muc h as 11 0 ml , o rnearl yfou rounces . I fswallowin g occur s i n th e less controlle d accidenta l setting , the n eve n mor e tha n thi s volum e coul d b e ingeste d i n a siphonin g accident

. Notin g th s wid e rang e o fpotentia l toxi can d letha l dose s cite d i n th e medica l literature , a critica l determinatio n o

fthes e dose s i s difficul t t o substantiate

. Ther e f s however , genera l agreemen t amon g healt h professional s regardin g th e 5 0 mg/d l methano l bloo d leve l whic h shoul d b s treate d wit h hemodialysis

. Notin g th e distributio n o fmsthano i i n tota l bod ywate r(V d 

### 0. 7 ml/kg ) an d rapi d ora l absorptio n ofmethanol , thi s correspond s approximatel yt o a n ingeste d dos s o f0. 4 ml/kg

. Thu s a patien t wh o has ingeste d 0. 4 ml/kg , whic h i s jus t 5 m l ( a teaspoonful ) o fa n 85 % methano l fue l i n a 1 0 kg one-year-ol d chil d an d jus t 7 m t i n a 1 5 kg three-year-ol d child , i s likel yt o require invasiv e treatmen t fo rth e ingestion

. Wit h th e recognitio n o fth e potentia l toxicit

yo fthes e smal l volumes , i t becomes immediatel yeviden t that virtuall yal l pediatri caccidenta l ingestion s ofmethano l fuel s wil l require healt h cars facilityevaluatio n an d laborator yassessmen t Furthermore , a substantia l proportio n o fthes e childre n wil l require hemodialysis

. Just as th e volum e ofmethano l whic h require s invasiv e therapeuti cactio n i s ver ysmall , th e potentiall y letha l dose s are not muc h greater
. Th s ofte n cite d potentiall yletha l methano l dos e o f1 ml/kg corresponds , whe n adjuste d fo rth e 85% concentratio n i n fuels , t o a n ingestio n o fjus t 1 2 m l (less tha n a fablespoonful ) o

fa methano l fue l i n a 1 0 kg 1-year-ol d child , an d jus t 1 8 m l i n a 1 5 kg 3-year-ol d child

. Analysi s ofcurren t acut e accidenta l gasolin e ingestio n dat a allow s a predictio n o

fth e nationwid e incidence o

fingestio n o

fmethano l fuel s Ifal l fuel s wer e change d t o methano l (M85 o rM100)

. Th e 8,746 gasolin e ingestion s (includin g ingestion s involvin g mor e tha n on e substance ) ca n b s extrapolate d t o a n approximate annua l incidence o f35,00 0 gasolin e (o rfuture methanol ) ingestions

. Notin g th e lo w dose s o fmethano l require d fo rtoxicit yan d th e larg e amounts potentiall yingeste d byadults i n siphonin g accidents , nearl yal l o fthes e exposure s woul d require emergenc ydepartmen t evaluatio n t o detennin e th e degre e o

fth e exposur

e (obtai n methano l level , seru m electrolytes , an d arteria l bloo d gases ; assess clinica l status)

. Oniy16.4 % o fgasolin e exposure s ar

e treated/evaluate d i n a healt h car e facilit ycurrently , thu s there woul d b e a considerabl e excess healt h car e burde n o

fapproximatel y29,000 patients/year

. A n analysi s o fth e potentia l excess morbidity , mortality , an d acut e healt h car e cos t follows

. Base d o n th e 0.375% methano l fatalit yrate reporte d i n 1987 , 19 5 additiona l methano l death s (u p fro m
PAG E 1 6P.7 0



### a n extrapolate d 2 4 methano l deaths ) woul d b e anticipate d annuall yi fmethanol/gasolin e blend s completel yreplace d gasoline

. Thi s numbe ri s highl yspeculative , a s multipl e assumption s mus t b e made , includin g similarit yo famount s ingeste d o fth e mixtur e wit h curren t methano l ingestions , n o chang e i n physicia n an d victi m awarenes s o fth e seriousnes s o fmethano l poisoning , n o chang e i n accessibilit yo fmethano l fuel s compare d wit h gasolin e fuels , etc
. Th e increase d occurrenc e o f blindnes s an d permanen t neurologi cimpairmen t followin g methano l poisonin g canno t b e estimate d fro m th e availabl e data , bu t woul d b e expecte d t o increas e b yapproximatel ya facto ro ffiv e ove runknow n curren t levels

. Th e increase d healt h car e cos t include s th e exces s emergenc ydepartmen t visits t o exclud e significan t methano l poisoning

. I n contras t t o methanol , wit h it s delaye d onse t o fsymptoms , ingestion s o f gasoline-base d fuel s ca n generall yb e evaluate d b ypoiso n center s ove rth e phon e du e t o th e occurrenc e o fearly , highl yprognosti csymptom s i n patient s wh o requir e healt h car e intervention

. Waitin g fo rsuc h symptom s t o occu rfollowin g methano l poisonin g woul d surel ylea d t o mor e fata l an d disable d victims

. Th e averag e cos t o fa n emergencydepartmen t evaluatio n t o exclud e methano l toxicit y (includin g hospita l fee , physicia n fe e an d laboratoryanalyses ) i s approximatel y$35 0 pe rpatient

. Thi s correspond s t o a tota l cos t o f$12,250,00 0 fo remergencydepartmen t visit s fo ral l methano l fue l ingestions , whic h i s a n exces s o f$10,150,00 0 ove rcurren t emergencydepartmen t cost s fo revaluatio n ofgasolin e ingestions

. Estimate s ofth e cost s o fsubsequen t treatmen t fo rthos e patient s identifie d i n th e emergenc ydepartmen t a s significantl ypoisone d depen d o n th e amoun t ingeste d an d result s o f emergenc ydepartmen t laboratoryassessments
. Apatien t wit h a toxi cmethano l leve l require s hospita l admission

. Th e cos t o fa n uncomplicated admissio n fo rmethano l poisonin g i s approximatel y$5,00 0 includin g IC U monitorin g fo ra t leas t tw o days , 2 additiona l day s o fhospitalization , hemodialysi s (at leas t once) , frequen t la b analysi s an d nephrologis t consultation

. Mode l I : 50 % o fmethano l ingestions requir e hospitalization ; 50 % ar e treate d i n th e emergenc y departmen t the n release d Cos t (million s o fdollars ) Hospitalizatio n (uncomplicate d course , n o sequelae ) 87. 5 Emergencydepartmen t visits (al l patients ) 12. 3 Chroni ccar e fo rdisabilit y(los s o fsight , neurologi cimpairment ) ?? ? TOTA Lfo rMode l I i s wel l ove r10 0 millio n dollar s pe ryear . Mode l II : 25 % o fmethano l ingestions requir e hospitalization ; 75 % ar e treate d i n th e emergency departmen t the n release d Cos t (million s o fdollars ) Hospitalizatio n (uncomplicate d course , n o sequelae ) 43. 8 Emergenc ydepartmen t visits (al l patients ) 12. 3 Chroni ccar e fo rdisabilit y(los s o fsight , neurologi cimpairment ) ?? ? TOTA Lfo rMode l I I i s wel l ove r5 6 millio n dollar s pe ryear .

PAG E 1 7P.7 1



### Not e tha t th e dolla ramount s i n Model s I an d I I ar e minimu m estimates

. Th e followin g extremel ycostl y item s ar e no fincluded : complicate d hospitalizations ; chroni ccar e an d rehabilitatio n fo rsevere , permanen t sequela e (blindnes s o rneurologi cimpairment) ; les s o flife

. I n contras t t o thes e methano l fue l healt h car s cost s estimates , onl y16.4 % o fgasolin e ingestion s ar e evaluate d i n emergency departments , an d onl y2.2 % admitte d fo rmedica l care . Thu s curren t acut e healt h car e cost s fo r gasolin e ingestio n ar e estimate d a t belo w$ 6 millio n annually

. Th e prediction s o fmorbidity , mortalit yan d healt h car e expenditure s presente d abov e require d numerou s assumption s regardin g th e similarit yo fcurren t gasolin e ingestio n scenario s wit h futur e methano l fue l ingestions

. Th e impac t o fman yfactor s canno t b e estimated , suc h a s difference s i n payabilit yaffectin g ingeste d dos s (especiall ywit h 100 % methano l vs . fuel s containin g som e gasoline) , whethe rmethanol bass d fuel s wil l b s utilize d i n law n mowers a s wel l (thu s encouragin g o rdiscouragin g siphoning) , an d dissimila rmiles/tan k

o fmethano l base d fue l possibl yleadin g t o mor e frequen t incident s o fconsumer s neglectin g t o replac e fue l a t appropriat e interval s durin g th e transitio n perio d fro m on s fue l typ e t o another

. Notin g th e multitud e assumption s require d t o develo p thi s model , th e predicte d morbidity , mortalit yan d healt h car e cos t shoul d b s interprete d a s estimates

. RECOMMENDATION S Fro m a publi chealt h vantage , th e acut e hazar d pose d b yconversio n f o methanol-base d fuel s i s unacceptabl e du e t o th e predicte d increase s i n fatalities , blindness , an d permanen t neurologi cdisabilit y secondaryt o mor e frequen t ingestions

. Prio rt o conversio n t o a predominantl ymethano l fleet , innovativ e engineerin g effort s mus t focu s o n th e developmen t o fclosure s fo rfue l can s an d vehicula r fue l tank s whic h wil l prohibi t accidenta l ingestion , eithe rdirectl yo rb ysiphon

. A s a start , a fe wclearly insufficient

preventio n measure s ar e outline d below

. Othe rapproache s urgentl ynee d t o b s developed

. Method s t o preven t siphonin g o fmsthano i fuel s mus t b s dsvslopsd

. On s possibilit yi s th s installatio n o fa meta l grats/scree n nea rth e openin g o feac h ga s tan k an d fue l ca n t o preven t th e insertio n o f siphons

. Law n mower s an d othe rgasolin s powere d equipmen t shoul d no t b s constructe d i n a wa ytha t the ywil l functio n o n methano l fuel s (s o tha t siphonin g wil l b s les s o fa temptation)

. Publi can d healt h professiona l educatio n i s essentia l an d shoul d focu s o n th s letha l consequence s an d permanen t sequela

® whic h follo wmethano l poisoning...thereb ypreventin g accidents , o rteachin g victim s t o see k promp t treatmen t despit e th e absenc e o fclinica l symptoms
. Becaus e methano l toxi c manifestation s ar e delaye d 1 2 o rmor s hours , asymptomati cpatient s an d uninforme d physician s may falsel yassum e tha t significan t poisonin g ha s no t occurred

. Additionally , th e publi cshoul d b s carefull y educate d i n th e importanc e o favoidin g containe rtransfe r(e.g

. storag e o fmethano l fuel s i n sod a bottles , ga s cans , etc ) an d siphoning

. Consideratio n shoul d b e give n t o additive s suc h a s a distinctiv e colo rt o allo wrapi d identificatio n o fth e substanc e ingested

. Wherea s M8 5 fuel s wil l contai n sufficien t gasolin s t o decreas e payabilit yan d limi t abus e (assumin g distillatio n i s no t attempte d wit h it s combustio n hazards) , M10 0 fuel s maynee d t o hav e a bitte rsubstanc e adde d t o serv e a s a marke ran d dete rabuse

. Th e propose d additio n o f emetic s t o M8 5 i s ill-advise d du e t o th e risk o fchemica l pneumoniti s followin g vomitin g an d subsequen t aspiratio n o fth e gasolin e component
. Althoug h th s risk o fpneumoniti s i s no t significan t wit h M10 0 fuels , thes e ma yb e abuse d wit h ethano l o rothe rdepressants , leadin g t o significan t earl yCN S depression , renderin g emeti cus e unsaf e i n thi s settin g a s well

. (A s a genera l rule , emetic s ar e neve r administere d f o patient s tha t ar e comatos e o rlikel yf o becom e comatos e rapidl ydu e t o th e patient' s inabilit yt o protec t th e airwayan d hig h ris k o faspiration. ) Warning s shoul d b e prominentl yplace d aroun d th e fue l tan k orific e o feac h vehicl e an d o n fue l can s
PAG E 1 8P.7 2 

# r

an d shoul d indicat e th e hazard s o fsiphonin g and/o ringestion

. Thes e warning s shoul d clearl yan d emphaticall ystate that deat h o rblindnes s i s likel yi feve n smal l amounts ar e swallowed

. Finally , a prospective stud yshoul d b e performe d wit h divers e geographi crepresentatio n t o verif yth e finding s presente d herei n an d see k additiona l exposur

e circumstance s an d preventio n options

. Thi s investigatio n shoul d includ e detaile d data gatherin g o n severa l hundre d gasolin e ingestion s a t a minimum

.

PAG E 1 9



### _

### Tabl e 5

. Sympto m assessmen t I n reporte d gasolin e exposure s fo rpatient s expose d t o gasolin e onl y(AAPC C Data , n o concomitan t

exposure)

. SYMPTO M ASSESSMEN T Asymptomatic " 

### Symptomatic , r

e We d l o exposure* ! Symptomatic , unrelate d Symptomatic , unknow n i frelate d Unknow n i fsymptomati c Tota l AL LEXPOSURE S No

. % 4,67 4 36. 7

_7,48 2 , 58. 7 , . 8 0 0. 6



### „ , 2# > 2. 3 , , 21 4 1. 7 

### ,12,73 8 J0P. 0 , . INGESTION S No

. % 4.04 3 47. 2 ,» . <?«*>'*<TM^>,/w* l , - \ 

### 5 7 0. 7

. , ,15 3 „ „ , 1, 0 10 3 1. 2

„ . §,56 5 100. 0 OCULA R No

. 35 5 2,38 2 3

. 1 3 8 7 2,84 0 %

12. 5 33 J 0. 1 0. 5 3. 1 10P. 0 DERMA L

No

. 54 6 1,00 5 1 1 3 d 2 2 1,62 2 %

33. 7 62. 0 0. 7 2. 3 1. 4 100, 0 INHALATIO N

No

. % 17 0 14. 6 84 8 ?Z.$ 1 6 1. 4 

### 11 0 0, 4 2 4 2. 1 1,16 8 10& O 'Exclude s case s code d a s asymptomati cinitiall ywhic h develope d symptom s afte rth e initial consultation

. * "Include s case s code d a s symptomati c(related ) a t th e tim e o fth e initia l poiso n cente rconsultatio n an d case s code d a s developin g symptom s afte rth e initial consultation

.

Tabl e 7

. Utilizatio n o fhealt h exposures)

. MANAGEMEN TSIT E

Non-healt h car e facilit y Healt h car e facilit y Other/unknow n Tota l car e facilitie s I n reporte d gasolin e exposure s fo rpatient s expose d

AL L EXPOSURE S No

. % 10.73 7 82. 4 

### 0,03 7 J5. 6 f J- TF i r T; f J % ^fs

f jwff • " 

### 25 4 1. 9 13,02 0 100. 0 _; , INGESTION S OCULA R No

. % No

. % 7,15 2 81. 8 2,54 9 88. 6

„ 1,437, , , 16. 4 „ . , 28 5 , 9. 9 , , 15 7 1. 8 4 2 1. 5 

# Km.m_.mQ'..-:

zm 100. 0 t o gasolin e

DERMA L No

. % 1,47 0 2 3 ,1,69 0 87. 0 

## 11- 7 1. 4 100. 0 (AAPC C data , al l

INHALATIO N No

. % 82 1 67. 1 36 6 29. 9 3 7 3. 0 1,22 4 , 100. 0

PAG E 2 0

### Tabl e 8 . Medica l outcom e o freporte d gasolin e exposure s fo rpatient s expose d t o gasolin e onl y(AAPC C data , n o concomitan t exposure) . MEDICA L OUTCOM E N o effec t Mino reffec

t Moderate effec

t Majo reffec

t Unknow n outcom e nontoxi c exposur

e potentiall ytoxi c exposur e 

### unknow n i ftoxi cexposur e Unrelate d effec

t Deat h Tota l AL L EXPOSURE S No . % 4,13 2 32. 4
, $34 7 49.f i , 22 5 1. 8 1 0 0. 1 1,11 1 , . 8. 7 , 73 7 5. 8 2 7 0 2 , 14 8 1. 2 2 . 0, 0 „ , 12,73 9 100. 0 INGESTION S No . % 3,41 1 39. 8

, .„&* * A>i



### 42. 1 13 1 1. 5 f . 0. 1 75 5 8. 8 53 8 6. 3 ..Z'S , , Q.2 9 4 1. 1

. A

### ., . . 0, „ 0.0 „ 8,56 5 %

### 100. 0 OCULA R No . 47 4 2,02 1 3 0 1 19 8 105 4 7 0 2,84 0 %

16. 7 71. 2 1. 1 0. 0 7. 0 3. 7 0 1 0. 2 0 0 100. 0 DERMA L

No . 50 2 06 5 2 6 1 14 9 5 6 3 2 0 0 1,62 2 %

30. 9 53. 3 1. 6 0. 1 9. 2 3. 5 0. 2 1. 2 0. 0 100. 0 INHALATIO N

No . 17 3 70 2 6 0 5 8 5 9 8 2 4 1 2 1,16 8 %

14. 8 60. 1 5. 1 0. 4 7. 3 8. 4 0. 2 3. 5 0. 2 100. 0

PAG E 2 1P.7 5



### Tabl e 11 . Gasolin e Exposure Scenarios , 198 7 Nationa l Capita l Poiso n Cente rDat a

453574 7 602417 4 602387 0 602224 8 602407 4 602414 8 603645 7 602792 5

602781 6 602651 0 602313 2 603437 7 614620 9 602927 3 603033 2 603283 1 602751 2 602743 6 453601 4 602020 9 602041 8 602140 0 602217 2 602226 0 602232 6 602420 1 602446 2 602637 3 602217 3 602097 0

602390 8 602390 9 602955 7 

### 602707 6 602898 5 1 2 mo M

1 6 mo F 1 7 mo M 1 8 mo F 1 8 mo M 1 8 mo M 1 8 mo M 1 8 mo F
1 8 mo F 1 9 mo M 2 1 mo M 2 2 mo M 2 y rM 2 y rM 2 y rF 2 y rF 2 y r 2 y r 2 y r F M M M M M F M M M M M M M
3 y r 3 y r 3 y r F M M 4 y rF
4 y rM taste

1 2 ounces taste dro p maybe non e taste littl e i fan y si p o rtwo probabl ynon e

taste unknown/smal l

si p smal l amoun t taste dro p o rtwo unknow n

dro p o rtwo littl e ifan y littl e i fan y smal l amoun t smal l amoun t ma yhav e taste d maybe a taste littl e i fan y

unknown i

fan y unknown i

fan y maybe a taste unknown mouthfu l Ingestio n

chil d dran k

fro m ca n witnessed-pu t mout h o n spou t o f5 gallo n ga s tan k dran k fro m a Peps i bottl e foun d wit h ca n t o mouth ; ga s i n standard ca n intende d fo ruse i n law n mowe r sucke d o n spou t o

fempt yca n ma yhav e pu t mout h o n spou t ma yhav e gotte n o n hands/pu t hand s t o mout h fathe rsa whe rspittin g it out ; wa s drainin g ga s fro m auxiliar ytan k o fpicku p truc k

into container ; turne d bac k an d chil d dippe d cu p into containe r got fro m a constructio n site nea rhom e foun d wit h ga s can , use d t o fil l law n mowe r sucke d ca p of

fga s ca n ga s ca n intende d fo rus e i n law n mowe r fro m botto m o

fa bottl e ha d mout h t o to p o

fga s ca n use d t o fil l law n mower ; store d i n garag e ga s statio n pum p malfunctioned ; chil d spraye d wit h gasolin e sucke d fro m ga s tan k

o fca r chil d dran k

fro m gallo n containe rwhil e mothe rtalkin g o n phon e brough t a n 'empty* ca n u p t o lips foun d ca n wit h to p off ; non e smelle d o n breat h foun d playin g wit h can ; denie d ingestio n ga s wa s i n a cu p mo m right there ga s i n ca n intende d fo rus e i n law n mowe r foun d playin g wit h can ; denie d ingestio n siphone d ou t o

fsipho n o n ga s can ; 1 2 y.o . siblin g ha d take n ga s ca n ou t o

fshe d t o fil l law n mowe ran d lef t it o n bac k

porc h 2 childre n foun d nea rga s ca n 2 childre n foun d nea rga s ca n ga s transferre d t o a sod a ca n jus t prio rt o fillin g law n mower ; chil d picke d u p ca n fro m drivewa y pu t sipho n hose whic h wa s i n ga s ca n into mout h an d sucked ; ha d watche d fathe rsipho n t o fil l law n mowe r (chil d ha s spin a bifida) dran k it fro m a Cok

e bottl e PAG E 2 2P.7 6



### 603210 7 602717 8 601928 1

601990 0 602141 0 603195 4 602971 7 602140 1 602138 2 614481 1 453393 2 601663 9 453331 8 603268 6 601531 0 602524 2 453335 3 603006 0 601781 6 602114 0 602155 0 602203 5 602261 0 453399 1 601772 5 602336 2 602523 1 601598 1 603131 1 602438 9 602954 9 602474 9 603180 2 603505 7 453529 8 614394 1 603336 8 453545 8 601516 2 453379 4 601626 6 601560 5 4 y r

4 y r 4 y r
4y r 4y r 5y r Sy r 9y r 1 2 y r 1 4 y r 1 5 y r 1 5 y r 1 6 y r 1 6 y r 1 6 y r 1 6 y r 1 7 y r 1 7 y r 1 7 y r 1 7 y r 1 7 y r 1 7 y r 1 7 y r 1 8 y r 1 8 y r 1 8 y r 1 8 y r 1 9 y r 1 9 y r 2 0 y r 2 0 y r 2 0 y r 2 0 y r 2 1 y r 2 1 y r 2 2 y r 2 2 y r 2 2 y r 2 2 y r 2 2 y r 2 2 y r 2 3 y r M F F

M M M M M M M M M M M M M M M M M M M M M M M M si p

taste/swallo

w

u p t o 3 ounces 1- 2 tablespoon s smal l amount mouthfu l unknow n mouthfu l mouthfu l taste mouthfu l mouthfu l
taste mouthfu l mouthfu l mouthfu l mouthfu l mouthfu l mouthfu l mouthfu l mouthful s M severa l bi g mouthful s M F M M M M M M M M M M M M abou t 2 tablespoon s

mouthfu l 4 gulps ver ylittl e mouthfu l "1- 2 ounces ' mouthfu l mouthfu l pu t stra

winto law n mowe ran d sippe d ga s unwitnessed ; fathe rpoure d ga s into a cu p prio rt o pourin g into carbureto ro flaw n mower ; olde rsiblin g though t it woul d b e funn yi fhi s siste rswallowed gas , an d gave it t o he r olde rsiblin g sa

wchil d drin k

fro m containe r chil d foun d nea rlaw n mower ; smel l o n hand s an d breat h siblin g pu t into orang e juic e containe r fathe rpu t ga s i n a Mountai n De wbottl e drippe d ga s fro m self-serv e pum p into drin k sucke d fro m hos e an d spi t ou t siphonin g ga s ou t o

fca rt o fil l law n mowe r youngste rwa s a t work ; siphoned , presumabl yfro m vehicl e siphonin g siphonin g siphonin g siphonin g siphonin g fro m leakin g ga s tan k o fca rprio rt o repairin g leak ; ha d severa l smal l sip s totallin g abou t a mouthfu l siphonin g fro m truc k siphonin g siphonin g fro m ca rt o fil l law n mowe r siphonin g siphonin g siphonin g siphonin g fro m on e ca rt o anothe r siphonin g siphonin g siphonin g fro m ca rt o motorcycl e siphonin g siphonin g fro m ca r siphonin g siphonin g siphonin g fro m on e vehicl e t o anothe r siphonin g fro m ca r siphonin g siphonin g fro m on e vehicl e t o anothe ra t wor k siphonin g siphonin g siphoning ; attemptin g t o sipho n wate rou t o fleakin g ga s tank ; use d opaqu e tub e almos t th e size o

fgarde n hose siphonin g siphoning ; t o pu t ga s i n carbureto rafte rca rbrok e dow n
PAG E 2 3P.7 7



### 601629 2 614417 3 602958 2 601947 7 602929 4 601905 6 453584 6 602235 5 615575 9 601647 7 603319 9 602689 6 601767 5 453343 3 602083 2 453528 8 602299 1 602785 9 603623 8 602942 3 602851 8 603088 9 603103 0 603108 2 603127 5 603198 5 603627 2 614461 5 614579 0 615592 2 601541 4 601601 7 601667 0 602206 9 602282 9 602422 6 603148 2 601995 9 602918 2 2 3 y rM

2 4 y rM 2 4 y rM 2 4 y rM 2 5 y rM 2 5 y rM 2 6 y rM 2 6 y rM 2 6 y rM 2 7 y rM 2 8 y rM 2 9 y rM 2 9 y rM 3 0 y rM 3 3 y rM 3 5 y rM 3 9 y rM 3 9 y rM 4 4 y rM 4 5 y rF 4 5 y rM AM AM AM AF A A A

A A A A A A A A A A M M M M F M M M M M M M M ver

ylittl e mouthfu l 4 ounce s mouthfu l mouthfu l swi g som e bi g gul p mouthfu l 5 c c mouthfu l littl e bi t drop s mouthfu l

mouthful s 1/ 4 cu p mouthfu l abou t 1 teaspoo n

mouthfu l mouthfu l mouthfu l coupl e mouthful s mouthfu l 1/ 3 cu p smal l amoun t mouthfu l mouthfu l mouthfu l siphonin g

swallowe d a s a suicid e attemp t siphonin g fro m on e ca rt o another ; tub e 1/2* i n diamete r siphonin g (interstat e truc k driver) siphonin g siphonin g ga s i n unmarke d bottl e siphonin g siphonin g siphonin g fro m on e vehicl e int o another ; unsur e wha t wa s use d siphonin g siphonin g siphonin g siphonin g siphonin g siphonin g siphonin g siphonin g siphonin g dran k fro m Peps i bottl e siphonin g ga s fro m law n mowe rt o car ; use d blac k rubberhos e abou t th e siz e ofmiddl e finge r siphonin g siphonin g siphonin g fro m on e vehicl e t o anothe rwhe n ra n ou t o fga s o n th e highwa y siphonin g ga s fro m law n mowe rt o vehicl e t o hel p strande d motorist ; unsur e wha t typ e hos e use d siphonin g siphoning ; do g jumpe d o n he r siphonin g siphonin g siphoning ; ha d pu t wron g ga s i n tractor ; wor k exposur e siphonin g siphonin g siphonin g siphonin g siphonin g

602184 2 614680 9 601548 4 1 2 y rM

1 5 y rM 2 5 y rM Inhalatio n deliberat e abus e (twice ) deliberat e abus e fume s fro m law n mowe r PAG E 2 4P.7 8



### 453337 3 602471 0 602408 7 602218 6 603261 4 3 1 y

r 3 5 y r 4 5 y r 

## A un k M M M
F fue l injecto rleaked , breathe d vapo rwhil e pluggin g occupational ; cleanin g massiv e spil l workin g o n law n mower/leakin g ga s ga s dumpe d outsid e building ; fumes circulatin g throug h th e ai rconditionin g syste m ga s fumes an d smok

e fro m ca r

615563 9 602681 0 603058 8 603214 6 602551 7 602358 4 603648 4 603573 4 601516 5 453360 6 602701 7 603364 9 601624 0 603499 4 602062 7 602111 6 602054 2 602175 4 603387 0 602445 7 603067 4 602764 1 602226 8 602655 0 602655 0 614355 3 603308 4 601531 9 602838 5 603284 2 603317 9 602074 7 603279 3 603409 2 602280 4 602351 1 613898 3 603329 9 603060 3 453410 6 453562 0 601571 9 1 8 mo M

2 y rF 2 y rF 2 y rF 3 y rM 3 y rM 3 y rM 3 y rF 4 y rM 5 y rF 5 y rM 5 y rM 6 y rM 6 y rM 7 y rM 8 y rM 1 0 y rM 1 2 y rM 1 2 y rF 1 3 y rM 1 3 y rF 1 3 y rM 1 3 y rF 1 4 y rM 1 4 y rM 1 4 y rM 1 4 y rM 2 0 y rM 2 1 y rM 2 3 y rF 2 3 y rM 3 3 y r 3 3 y r 3 3 y r A A A A A A A A M M M M M M F M M M F 

### Ocular splashe d i n eye s splashe d i n ey e splashe d i n eye s mo m spilled ga s i n child' s eye s splashe d i n eye splashe d i n ey e ha d o n hands ; rubbe d eye s splashe d i n eyes splashe d i n eye splashe d i n eye splashe d i n eye s fro m ga s pum p mo m pumpin g gas ; splashe d i n child' s eye splashe d i n eye splashe d i n eye splashe d i n ey e splashe d i n eye splashe d i n eyes splashe d i n eye s splashe d i n eye s splashe d whil e fillin g mowe r splashe d i n eye splashe d i n ey e spraye d i n ey e splashe d i n ey e splashe d i n eye splashe d i n eyes splashe d i n eye s splashe d i n eye splashe d i n eye splashe d i n eye s splashe d i n eye splashe d i n eye s whil e puttin g i n lawnmowe r ' splashe d i n eyes splashe d i n eye splas h fro m law n mowe r fro m law n mowe r splashe d i n eye splashe d i n eye s workin g o n car ; splashe d i n eye splashed i n eye splashe d i n eye a t wor k splashed i n eye PAG E 2 5 

# JP.7 9



### 602610 0 614387 6 602478 7 613936 8

602847 8 602014 4 602761 6 602268 9 602098 4 603262 3 602516 7 602531 7 602827 6 453316 6 601557 7 602948 5 613997 9 602835 3 602297 7 601459 6 602169 3 603262 4 

### A

chil d 

## un k un k M M M unknow n



## 1 7 mo M 18 mo M 2 3 4 4 1 0 1 6 1 8 1 9 2 0 2 5 3 8 A A A A chil d 

### V y r V V y r y r y y r y r y y r 

## M M M Mu. 

## M M M M M M F F M M M splashe d i n eye o n hands ; rubbe d ey

e splashe d i n eye s splashe d i n ey

e Derma l o n bac k o fle g foun d wit h ga s can ; ga s o n ski n spraye d o n hands , pu t o n fac e spraye d al l ove rsel f spraye d i n face a

t ga s statio n o n hand s an d arm s spraye d o n ski n a

t ga s statio n ga s o n finger ; rubbe d eyeli d use d t o remov

e pain t fro m leg s an d arm s ga s lin e broke whil e repairin g car , splashe d i n face gasolin e 'shower

* o n bac k splas h o n ar m splashe d o n ar m whil e pumpin g ga s spille d i n groi n are a ga s splashe d i n face spille d o n le g o n hand s an d anu s Oti c
603327 3 601704 0 601810 5 

### 2 9 y r

4 5 y r A M M M smal l amoun t i n ea r squirted/splashe d i n ea r unknow n Multipl e Route s 6032133 1 5 mo M 602714 7 602851 4 602414 4 602433 1 602610 5 603449 0 602701 4 602986 8 603121 8 602241 6 601756 7 1 6 mo M

1 8 mo M 1 8 mo M 1 8 mo M 1 8 mo M 2 y r F 2 y r M 2 y r M 2 y r F 2 y r F 3 y r M 

### ingestion/dermal ; foun d wit h bottl e t o mouth/bottl e pushe d awa

y ingestion/dermal ; foun d wit h ope n ca n possibl e ingestion/dermal ; knocke d ove rgas ca n i n yard ca n smel l o n mout h an d head ; tippe d ove rgas ca n i n garag e splashe d o n skin ; slept wit h gas-soake d washclot h i n roo m spille d o n face an d eyes splashe d o n face an d eyes possibl e ingestion/dermal ; 2 sibling s ma yhav e spille d ingeste d mouthful ; dermal ; ocula r derma l and/o ringestio n covere d wit h gas ; ingest and/o rderma l splashe d i n face an d eyes
PAG E 2 6 

# JP.8 0



### 6145268 3 y rM 602446 9 602232 9 602701 2 602449 1 614758 9 602683 1 602227 2 614425 3 602549 5 603318 5 602172 0 602896 4 603319 4 603435 9 601930 0 02132 4 602570 3 602845 2 603185 9 601849 7 602961 0 601816 7 602361 8 601598 3 602150 7 602928 1 3 y r

3 y r 4 y r 4 y r 4 y r 4 y r 

## sy r 7y r 7y r 8 y r 1 0 y r 1 3 y r 1 7 y r 2 7 y r 2 8 y r 2 8 y r 3 1 y r 3 7 y r 3 8 y r 4 1 y r 4 1 y r 4 3 y r 6 7 y r A A A M M M M M F M M M M M M M M M M M F M F M M F M M M 

### som e ocular/dermal/possibl e ingestion ; got mixtur e o foi l an d ga s fro m wee d trimme r ocular/dermal ; splashe d o n face foun d wit h gas al l ove rself ; ma yhav e ingeste d som e 2 sibling s ma

yhav e spille d splashe d o n face an d eye s ingestion/dermal/ocular ; olde rsiblin g sa whi m ingest smel l o fga s aroun d face an d insid e mouth , thoug h insists sh e jus t sniffe d th e fume s splashe d o n fac e an d eye s ocular/dermal ; disconnecte d nozzl e fro m tan k a t gas station-gas o n arms , legs , eye s a t ga s station ; splashe d o n ski n an d eye s ocular/dermal ; splashe d o n face splashe d o n fac e an d eye s afte rfillin g law n mowe r ocular/dermal ; splashe d o n face ingestion/inhalation ; siphoning ; foun d unresponsive dermal/aura l splashe d o n face an d eyes inhaiation/ingestio n whil e siphonin g dermal/inhalation ; drenche d wit h gas whil e workin g o n ca r tin yarm i n mout h an d o n ski n whil e siphonin g dermal/ocula r pumpin g gas ; i t spraye d al l ove rhe r dermal/ocular ; fillin g law n mowe ran d ga s splashe d i n fac e splashe d o n fac e an d eyes o n ski n an d i n mout h siphoning ; int o eye an d swallowe d splashe d int o fac e an d eyes denmal/ingestion ; blewint o tan k t o se e i fi t was clogged ; gas blewou t int o mout h an d face Exclude d Case s 453374 7 453497 0 601568 5 601834 1 601578 2 602559 9 602681 6 603165 5 614403 2 602417 7 603115 5 2 6 y r

1 7 y r CAT CAT 1 8 y r DO G CAT CAT CAT CAT A F M F

F 

### expose d t o fumes fro m truc k (not gasoline ) sniffin g butane ; ignite d ca t exposur e (dermal ) ca t exposur e (ingestio n an d dermal ) Sleepino l an d butan e rolle d i n leakin g ga s spille d o n cat spille d o n fu ran d licke d of f walke d throug h trayofgas an d licke d paw s knocke d ove rga s ca n ate shrimp/taste d like gasolin e o rkerosen e

PAG E 2 7



### _P.8 1



### ACKNOWLEDGEMENT S Significan t contribution s t o thi s wor k were mad e b

yRose An n Soloway , R.N. , M.S.Ed , (compilin g an d investigatin g gasolin e exposur e scenarios) an d b

yLisa Horton , M.D . an d Yoland a Haywood , M.D . (conductin g th e volum e o fa mouthfu l study) .

REFERENCE S
1 . Litovit

zTL , SchmitzBF , Matyunas N , Marti n TG : 198 7 Annua l Repor t o fth e America n Associatio n o fPoiso n Contro l Centers Nationa l Dat a Collectio n System . A m J Emer g Me d 1988;6:479-515 . 2 . Wenz l JE , Mill s SD , McCal l JT : Methano l poisonin g i n a n infant : Successfu l treatmen t wit h peritonea l dialysis . A m J Di s Chil d 1965;116:445-447 . 3 . Bennet

t IL , Car yFH , Mitchel l G L Acute methy l alcoho l poisoning : Revie wbase d o n experience s i n outbrea k o f32 3 cases . Medicin e (Baltimore ) 1953;32:431-463 . 4 . Kan e RL , Talber

t W , Harla n J , et al : Amethano l poisonin g outbrea k i n Kentucky : Aclinica l epidemiologi c study . Arc h Enviro n Healt h 1968;17:119-129 . 5 . SwartzRD , Millma n RP , Bill i J E e t al : Epidemi c methano l poisoning : Clinica l an d biochemica l analysi s o fa recen t episode . Medicin e 1981;60:373-38 2 6 . Ravichandra n R , Dudan i RA , Almeid a A F e t al : Methy l alcoho l poisoning : Experience o fa n outbrea k i n Bombay . J Postgraduate Me d 1984;30:69-74 . 7 . Jacobse n D , Ovreb o S , Arnese n E et al : Pulmonar yexcretio n o

fmethano l i n man . Sca n J Cli n La b Inves t 1983;43:377-379 . 8 . Eel s JT , Maka rAB , Noke rP E e t al : Methano l poisonin g an d formate oxidatio n i n nitrou s oxid e treate d rats . J Pharmaco l Ex p The r1981;217:57-61 . 9 . Ro e O : Th e metabolis m an d toxicit yo fmethanol . Pharmaco l Re v1955;7:399-41 2 10 . Jacobse n D , Janse n H , Wiik-Larse n E e t al : Studie s o n methano l poisoning . Acta Medic a Scandinavic a 1982;212:5-10 . 11 . Becke rCE : Acute methano l poisoning : Th e blin d drunk* . Medica l Staf fConference , Universit yo f California , Sa n Francisco . West J Me d 1981 ; 135 : 122-128 . 1 2 Bento n CD , Calhou n FP : Th e ocula reffect s o fmethy l alcoho l poisoning : Repor t o fa catastroph e involvin g 32 0 persons . A m J Opht h 1952;36:1677-1685 . 13 . Jacobse n D , McMarti n KE : Methano l an d ethylen e glyco l poisonings : Mechanis m o ftoxicity , clinica l course , diagnosi s an d treatment . Medica l Toxicology1986;1:309-334 . 14 . Shahangia n S , As h KO : Formi c an d lacti c acidosi s i n a fata l cas e o fmethano l intoxication . Cli n Che m 1986;32:395-397 .

PAG E 2 8P.8 2



### 15 . Smit h SR , Smit h SJM , Buckle yBM : Combine d formate an d lactate acidosi s i n methano l poisonin g (letter) . Lance

t 198 1 ;ii : 1295-6 . 16 . Sejerste d OM , Jacobse n D , Ovreb o S e t al : Formate concentration s i n plasm a fro m patients poisone d wit h methanol . Act a Me d Scan d 1983;213:105-110 . 17 . Osterio h JD , Pon d SM , Grad yS e t al : Seru m formate concentration s i n methano l intoxicatio n a s a criterio n fo rhemodialysis . An n Inter n Me d 1986;104:200-203 . 18 . Gond a A , Gaul t H , Churchil l D , Hollomb yD : Hemodialysi s fo rmethano l intoxication . A m J Me d 1978;64:749-758 . 19 . Pappa s SC , Silverma n M : Treatmen t o fmethano l poisonin g wit h ethano l an d hemodialysis . CM A J 1982;126:1391-94 . 20 . Tsa i WJ , Yan g GY , Ge rJ et al : Sensorimoto rneuropath yafte rmethano l poisoning . (Abstract ) Vet Hu m Toxico l 1988;30:357 . 21 . McLea n DR , Jacob s H , Mieik e BW : Methano l poisoning : Aclinica l an d pathologica l study . An n Neuro l 1980;8:161-167 . 22. Le yCO , Gal i FG : Parkinsonia n syndrom e afte rmethano l intoxication . Eu rNeuro l 1983;22:405-409 . 23 . Koopman s RA , U DKB , Pat yDW : Basa l ganli a lesion s i n methano l poisoning : M R appearance . J Compute rAssisted Tomograph y1988;12:168-170 . 24 . Aquiloniu s SM , Bergstrs m K , Enoksso n P et ai : Cerebra l compute d tomograph yi n methano l intoxication . J Compute rAssisted Tomograph y1980;4:425-428 . 25 . Bourra

t C , Riboullard L, Flocard F e t ai : Intoxicatio n volontair e pare l e methano l enciphaiopathi e S4v«r e e t regressive ave c anomalies a u scanne rX . RevNeuro l 1986;142:530-534 . 26 . Guggenhei m MA , Couc h JR , Weinber g W : Moto rdysfunctio n a s a permanen t complicatio n o f methano l ingestion . Arch s Neuro l 1971;24:550-554 . 27 . Scrimgeou rEM : Outbrea k o fmethano l an d isopropano l poisonin g i n NewBritain , Papu a Ne w Guine a Me d J Aus

t 1980;2:36-38 . 28 . Phan g PT , Passerin i L , Mieik e B e t al : Brai n hemorrhag e associate d wit h methano l poisoning . Cri t Care Me d 1988;16:137-140 . 29 . Bennet

t IL , Natio n TC , Olle

yJF : Pancreatiti s i n methy l alcoho l poisoning . J La b Cli n Me d 1952;40:405-409 . 30 . Burhan s EC : Methy l alcoho l poisonin g ( Aclinica l an d pathologica l studyo f1 1 fata l cases) . Illinoi s Me d J 1930;57:260-263 . 31 . Keene

yAH , Mellinkof

fSM : Metr-y i i coho l poisoning . An n Int Me d 1951;34:331-338 . 32 . Marten s J , Westhoven s R, Verbercumoes R: Recover ywithout sequelae fro m sever e methano l intoxication . Postgraduate Medica l J ? 532:58:454-456 .

PAG E 2 9P.8 3



### 33 . Walke rJA , Schwartzbard A , Krauss EA, e t al : Th e missin g gap : Apitfal l i n th e diagnosi s o falcoho l intoxicatio n byosmometry . Arc h Inter n Me d 1986;146:1843-1844 . 34 . Pappa s AA , Gadsde n RH , Taylo rH : Seru m osmolalit yi n acute intoxication : Aprospectiv e clinica l study . A m J Cli n Patho l 1985;84:74-79 . 35 . Pappa s AA , Gadsde n RH , Gadsde n R H e t al : Computerize d calculatio n o fosmolalit

yan d it s automati c compariso n wit h observed seru m ethano l concentration . A m J Cli n Patho l 1982;77:449-451 . 36 . Morto n DH , Lovejo yFJ , Freidma n P : Methano l intoxication : Coma , retina l toxicity , an d formi c acidosis . (Abstract

) Vet Hu m Toxico l 1983,25:281 . 37 . Becke rCE : Th e alcoholi c patien t a s a toxi c emergency . Emergenc yMe d Clinics o

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