Consider prehospital administration of activated charcoal as an aqueous slurry in patients with a potentially toxic ingestion who are awake and able to protect their airway. Activated charcoal is most effective when administered within one hour of ingestion. Administration in the prehospital setting has the potential to significantly decrease the time from toxin ingestion to activated charcoal administration, although it has not been shown to affect outcome (Alaspaa et al, 2005; Thakore & Murphy, 2002; Spiller & Rogers, 2002).

Use a minimum of 240 milliliters of water per 30 grams charcoal (FDA, 1985). Optimum dose not established; usual dose is 25 to 100 grams in adults and adolescents; 25 to 50 grams in children aged 1 to 12 years (or 0.5 to 1 gram/kilogram body weight) ; and 0.5 to 1 gram/kilogram in infants up to 1 year old (Chyka et al, 2005).

ADVERSE EFFECTS/CONTRAINDICATIONS

INHALATION: Move patient to fresh air. Monitor for respiratory distress. If cough or difficulty breathing develops, evaluate for respiratory tract irritation, bronchitis, or pneumonitis. Administer oxygen and assist ventilation as required. Treat bronchospasm with an inhaled beta2-adrenergic agonist. Consider systemic corticosteroids in patients with significant bronchospasm.

If bronchospasm and wheezing occur, consider treatment with inhaled sympathomimetic agents.

ACUTE LUNG INJURY: Maintain ventilation and oxygenation and evaluate with frequent arterial blood gases and/or pulse oximetry monitoring. Early use of PEEP and mechanical ventilation may be needed.

DECONTAMINATION: Remove contaminated clothing and jewelry and place them in plastic bags. Wash exposed areas with soap and water for 10 to 15 minutes with gentle sponging to avoid skin breakdown. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).

Treat dermal irritation or burns with standard topical therapy. Patients developing dermal hypersensitivity reactions may require treatment with systemic or topical corticosteroids or antihistamines.

DECONTAMINATION: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, the patient should be seen in a healthcare facility.

PREHOSPITAL ACTIVATED CHARCOAL ADMINISTRATION

ACTIVATED CHARCOAL: Administer charcoal as a slurry (240 mL water/30 g charcoal). Usual dose: 25 to 100 g in adults/adolescents, 25 to 50 g in children (1 to 12 years), and 1 g/kg in infants less than 1 year old.

1000 (454)

1000 (454)

Symbol(s): Not Listed

Hazard class or Division: 3

Identification Number: UN1264

Packing Group: III

Label(s) required (if not excepted): 3

Special Provisions: B1, IB3, T2, TP1

Packaging Authorizations (refer to 49 CFR 173.***):

Quantity Limitations:

Vessel Stowage Requirements:

Health Rating (Blue): 2

Flammability Rating (Red): 3

Instability Rating (Yellow): 1

Oxidizer/Water-Reactive Designation: Not Listed

(3) Flammable. Liquids and solids that can be ignited under almost all ambient temperature conditions. Including liquids with a flash point below 73 degrees F and a boiling point above 100 degrees F, solid materials which form coarse dusts that burn rapidly without becoming explosive, materials which burn rapidly by reason of self-contained oxygen (ie, organic peroxides), and materials which ignite spontaneously when exposed to air.

1: "Water may be ineffective" applies to a situation where materials with a flash point below 100 degrees F (37.8 degrees C) are burning. Water will only be effective if used by experienced fire fighters under favorable conditions. Even though water may not put the fire out, it can be used to protect equipment and structures.

5: Flammable liquid fires can be extinguished using carbon dioxide, dry chemical, foam, and vaporizing liquid extinguishers, as long as the fires are small to moderate in size and the flammable liquid reservoir is shallow. Use of foam to form a blanket over a flammable liquid is not effective when the liquid is water-soluble. Certain alcohol resistant foams are effective extinguishing agents for polar, non-polar, and water-soluble liquid fires. These foams are preferred for fighting flammable liquid fires except those that involve water reactive flammable liquids.

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TEEL-0: The threshold concentration below which most people will experience no adverse health effects.

TEEL-1: The airborne concentration (expressed as ppm [parts per million] or mg/m(3) [milligrams per cubic meter]) of a substance above which it is predicted that the general population, including susceptible individuals, could experience notable discomfort, irritation, or certain asymptomatic, nonsensory effects. However, these effects are not disabling and are transient and reversible upon cessation of exposure.

TEEL-2: The airborne concentration (expressed as ppm or mg/m(3)) of a substance above which it is predicted that the general population, including susceptible individuals, could experience irreversible or other serious, long-lasting, adverse health effects or an impaired ability to escape.

TEEL-3: The airborne concentration (expressed as ppm or mg/m(3)) of a substance above which it is predicted that the general population, including susceptible individuals, could experience life-threatening adverse health effects or death.