Agency for Toxic Substances and Disease Registry 
Case Studies in Environmental Medicine (CSEM) 

Taking an Exposure History
Other Resources

Learning Objectives

Upon completion of this section, you will be able to

• describe reference sources available that help identify toxicants

Introduction

Identifying the hazard, controlling the exposure, and arresting or reversing the progression of the patient’s illness are the goals of taking an exposure history.

Often, patients do not know the chemicals to which they have been exposed although they may know the trade names or slang terms for the chemicals.

Likewise, household products used by patients may have labeling that is inadequate for proper identification.

A variety of printed reference sources, including books, journals, and Material Safety Data Sheets (MSDSs), usually provide the quick access to medical and toxicological information for health practitioners. Information can also be obtained from sources such as, poison control centers, government agencies, employers, manufacturers, and unions (Bresnitz, Rest et al. 1985).

Material Safety Data Sheet (MSDS)

The objective of the MSDS is to concisely inform you about the hazards of the materials you work with so that you can protect yourself and respond to emergency situations. The law states that you must have access to MSDSs and be taught to read and understand them.

The Occupational Safety and Health Administration (OSHA) has developed a right-to-know regulation covering three basic areas

• the generation and distribution of information about chemical hazards
• requirements for the labeling of chemicals used in the workplace
• programs for training employees in the safe use of these chemicals

Many state and local right-to-know laws, however, are more comprehensive than the federal regulation.

The MSDS is a component of the right-to-know law. Manufacturers and importers are required to provide an MSDS for each hazardous chemical in a shipment. Users of the chemicals must keep copies of MSDSs and make them available to workers, clinicians, and others.

MSDSs contain information on the chemical properties of the substance, handling precautions, known health effects, and conditions that might worsen with exposure. The information on human health effects, however, can be vague and may have limited clinical value. The MSDS may not provide information on the synergistic effects of multiple chemical exposures. Clinical decisions should not be made solely from information obtained from MSDSs (sample MSDS, see Appendix II).

Additional Toxicological Information

Books and journals provide the most accessible information on toxicologic issues. Some sources of information that the clinician can use to identify thechemicals, processes, and hazards of toxic substances are described in the following list.

Daugaard J. Symptoms and signs in occupational disease: a practical guide.  Chicago: Year Book Medical Publishers, 1978. A classification of occupational and environmental diseases according to associated clinical signs and symptoms.

Etzel RA, editor. Pediatric Environmental Health. 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003.

Fay BA, Billings CE, editors. Index of signs and symptoms of industrial diseases. Atlanta: US Department of Health and Human Services, 1981. A guide to occupational and environmental diseases listed by associated clinical signs and symptoms.

Gosselin RE, Smith RP, Hodge HC, editors. Clinical toxicology of commercial products. Baltimore: Williams & Wilkins, 1984. A classification of products and the chemicals they contain, including the adverse health effects produced by exposure.

Hathaway G, Proctor NH, Hughes JP, editors. Proctor and Hughes’chemical hazards of the workplace. 4th ed. New York: Van Nostrand Reinhold, 1996. A short text summarizing the most important occupational chemical hazards.

LaDou J. Occupational and environmental medicine. Stamford (CT):  Appleton & Lange, 1997. Aids in the diagnosis, treatment, and remedial measures of occupational injuries and illnesses.

Maxcy KF, Rosenau MJ, Last J, Wallace RB, editors. Maxcy-Rosenau-  Last public health and preventive medicine. 14th ed. Stamford (CT):  Appleton & Lange, 1998. Although communicable diseases continue to be the main focus of this book, increased emphasis has been placed on environmental and behavioral factors that can influence health.

Rosenstock L, Cullen M, editors. Textbook of clinical occupational and environmental medicine. Philadelphia: WB Saunders, 1994. Complete coverage of the clinical aspects of occupational medicine.

Sullivan JB Jr, Krieger GR, editors. Hazardous materials toxicology: clinical principles of environmental health. Baltimore: Williams & Wilkins, 1992.  A complete reference including epidemiology, principles of management and evaluation of toxic exposures, toxic hazards of specific industries and sites, and economic implications of medical and legal issues.

Poison Control Centers

The regional poison control centers can act as valuable resources in providing information about the toxicity and health effects of hazardous exposures involved in poisonings. The main emergency number across the country is 1-800-222-1222, although some states have other contact numbers as well as a number for the hearing impaired. For more information, contact the American Association of Poison Control Centers at www.aapcc.org.

Key Points

• A variety of printed reference sources are available to the clinician, including books, journals, and Material Safety Data Sheets (MSDSs).

Progress Check