8.3 Poisoning Symptoms, First Aid, and Heat Stress

Quick Answer: Rinse, strip clothing, call NJPIES (1-800-222-1222), take the label. Do not induce vomiting unless the label or a poison specialist says so. Cholinesterase poisoning (organophosphates and carbamates) shows pinpoint pupils, salivation, and twitching. Heat stress shows headache, nausea, and sweating without pinpoint pupils. N.J.A.C. 7:30-6.8(d) makes records immediately available to emergency medical personnel.

40 CFR 171.103(c)(2)(vii) and (viii) require commercial applicators to recognize symptoms of pesticide poisoning and to know first aid and other procedures after a mishap. New Jersey then names the phone numbers and the record rule that actually move a patient from a truck cab to a hospital with the right product identity.

Three pictures that are not the same disease

Cholinesterase inhibitors (organophosphates and carbamates)

Many insecticides inhibit cholinesterase, the enzyme that turns off nerve signals. The result is a cholinergic crisis. Memorize it as SLUDGE (salivation, lacrimation, urination, defecation, GI cramps, emesis) or DUMBELS (diarrhea, urination, miosis, bronchorrhea/bradycardia, emesis, lacrimation, salivation/sweating). Exam-visible signs:

• Pinpoint pupils (miosis) — the discriminator versus heat stress
• Muscle twitching or fasciculations, weakness, difficulty breathing
• Sweating, drooling, nausea, vomiting, diarrhea
• Headache, confusion, tightness in the chest
• In severe cases: seizures, unconsciousness, respiratory failure

Onset can be minutes (especially after inhalation or a concentrate splash) or delayed a few hours (dermal). Do not wait for a “full SLUDGE set” to decontaminate and call NJPIES. Carbamates often reverse faster than organophosphates, but you do not make that call in the field with a stopwatch. Medical staff may use atropine and, for some organophosphates, pralidoxime — those are hospital drugs, not truck-box experiments.

Irritants and corrosives

Herbicides, some fungicides, solvents in emulsifiable concentrates, and Category I eye/skin products injure where they touch. Signs stay local: burning, redness, blistering, corneal pain, cough from an inhaled irritant. You may see no pinpoint pupils and no systemic twitching. First aid is still remove the product — strip clothing, rinse 15–20 minutes — because a “just an irritant” splash can destroy an eye. Category I DANGER without POISON is often this pattern: corrosive, not a cholinesterase story.

Heat stress versus poisoning

New Jersey summers put Category 3B and 6A crews in impermeable PPE on asphalt. Heat exhaustion looks alarmingly like early pesticide illness: headache, nausea, dizziness, weakness, heavy sweating, rapid pulse, irritability. Heat stroke is a medical emergency: hot skin, confusion or collapse, and sweating that may stop. Discriminators:

If you cannot tell, do both tracks: get the person out of the heat and out of contaminated clothing, rinse exposed skin, and call 911 plus NJPIES. Never withhold cooling because you are “waiting to see if it’s OP,” and never skip decontamination because you decided it was “just heat.” Do not give atropine in the field as a diagnostic test.

First aid by route — follow the label, then the specialist

40 CFR 156.68 requires first-aid statements on products in Toxicity Categories I, II, and III. EPA’s standard language is what you should already have rehearsed before the job, not after the splash.

Skin or clothing. Take off contaminated clothing. Rinse skin immediately with plenty of water for 15–20 minutes. Call a poison center or doctor. Clothing itself is a continuing dermal dose — bag it, do not toss it in the truck cab on someone else’s seat. Wash before reuse or discard if the label says so.

Eyes. Hold the eye open and rinse slowly and gently with water for 15–20 minutes. Remove contact lenses after the first 5 minutes if present and easy to remove, then continue rinsing. Call NJPIES or a doctor. Do not add oils, drops, or neutralizing chemicals unless the label orders that specific step.

Inhalation. Move to fresh air. If the person is not breathing, call 911 and start CPR if you are trained. Call NJPIES. For fumigants and confined spaces, do not become the second victim — ventilate and use the labeled respirator before entry.

Swallowed. Call NJPIES or a doctor immediately for treatment advice. If the person can swallow, they may sip a glass of water. Do not induce vomiting unless told to do so by the label, NJPIES, or a doctor. Do not give anything by mouth to an unconscious person. Petroleum solvents and corrosives make vomiting especially dangerous (aspiration, re-burn of the esophagus). Syrup of ipecac in the spray truck is an outdated Core fail.

Then take the label — the container, the booklet, a photo of the full panel if that is all you can grab — and the SDS to medical personnel. Name, EPA Registration Number, and active ingredients beat “some insecticide from the shop.” N.J.A.C. 7:30-6.8(d) requires the application record immediately in an emergency; non-emergency medical requests go through NJDEP. WPS agricultural employers add the 40 CFR 170 emergency-assistance package (SDS, EPA number, how it was used, exposure circumstances).

Who you call in New Jersey

Consumer Information Notices must print NPIC, NJPIES, and the Program number so customers can call. Your crew still needs NJPIES memorized without looking at the notice.

Spills that become health emergencies — 9.8 and 9.17

If a fire, explosion, casualty, or other event puts pesticide where it might move into air, adjacent property, a drain, a sewer, drinking water, groundwater, or waters of the State, N.J.A.C. 7:30-9.8 requires you to immediately contain, cover, or remove it. Owner, person who brought the pesticide, and person who caused the upset are jointly and severally responsible, and each must notify NJDEP under 9.17. Disposal of the recovered pesticide needs a written plan within 10 work days, Department-approved — not a backyard burn pile.

7:30-9.17 reportable spills: call 1-877-WARNDEP immediately, then mail the written report within 10 days. Phone-in facts: applicator identity, business, property owner, location, product name and EPA number, estimated amount and dilution, corrective action. Reportable thresholds (7:30-1.2) include ≥1 pound active ingredient outdoors; indoors, >1 gallon liquid (pesticide and/or diluent) or dry mix with ≥1 pound active; specified indoor organochlorine termiticide stains; any heating-duct or heating-system contamination. Small drips still get contained and still get first aid if someone was exposed. Do not delay rinsing a splashed operator while you weigh whether the puddle is “reportable.”

N.J.A.C. 7:30-9.6(c) — never put pesticides in food, drink, or household containers — is a first-aid rule as much as a storage rule. NJPIES’s own pesticide page exists because people drink from those bottles. 40 CFR 171.103(c)(2)(ix) makes keeping children away from pesticides and containers a Core competency, not a slogan.

Worked New Jersey scenarios

Scenario G — vomiting. A 7A technician swallows a mouthful of emulsifiable concentrate. A coworker reaches for ipecac. Stop. Call NJPIES. Give water only if the person is conscious and the specialist or label says so. Do not induce vomiting unless told. Send the label with the ambulance.

Scenario H — heat versus OP. A 3B applicator in a chemical-resistant suit on a July Camden County job is nauseated, sweating, and dizzy. Pupils are normal. Strip the suit in the shade, cool with water, call 911 if mental status slips. Still rinse any contaminated skin and check the label, because heat and dermal exposure can coexist. Pinpoint pupils would have pushed you harder toward cholinesterase poisoning plus NJPIES.

Scenario I — record at the ER. A child at a treated apartment is drooling after finding a soda bottle in a garage. The 7A business must immediately give emergency medical personnel the 6.8 record for that account, plus the label and SDS. Call NJPIES. The soda bottle is already a 9.6(c) violation; do not add a 6.8(d) delay.

Scenario J — spill plus splash. A mix-load jug tips in a paved lot and runs toward a storm drain while it soaks an operator’s pants. 9.8 containment (dike, cover, keep it out of the drain) and strip-and-rinse the operator start together. If the quantity meets the reportable definition, 9.17 is an immediate 1-877-WARNDEP call — after the person is being decontaminated, not instead of it.

High-yield traps

• Do not induce vomiting unless the label or NJPIES says so.
• Pinpoint pupils point to cholinesterase poisoning, not heat.
• Rinse 15–20 minutes; clothing is still a dose until it is off.
• NJPIES 1-800-222-1222 is emergency; NPIC is general; WARNDEP is the spill hotline.
• Emergency medical staff get the record immediately; the 10-day letter is the spill follow-up, not the hospital clock.

Official resources

• 40 CFR 156.68 first-aid statements
• EPA Recognition and Management of Pesticide Poisonings
• NJPIES
• NJPIES pesticide/rodenticide page
• N.J.A.C. 7:30-9.8
• N.J.A.C. 7:30-9.17
• NJDEP 1-877-WARNDEP spill reporting