第一線反應人員與急診醫護人員對於TMAH的認知現況

Recognition of and Knowledge about Tetramethylammonium Hydroxide among First Responders and Emergency Department Staff

高翔(Hsiang Kao) ； 洪東榮(Dong-Zong Hung) ； 張群岳(Chun-Yueh Chang) ； 楊明達(Ming-Ta Yang) ； 林鎮宇(Cheng-Yu Lin) ； 李長興(Chang-Hsing Lee)

《中華民國急救加護醫學會雜誌》 20卷4期 (2009/12) Pp. 178-182

https://doi.org/10.30018/JECCM.200912.0002

摘要

氫氧化四甲銨(Tetramethylammonium Hydroxide, TMAH)是半導體與液晶工業常用的鹼性腐蝕性化學物質。在物質安全資料表裡並未標示TMAH會引起嚴重的全身性反應。在近幾年來，台灣發生了三起TMAH中毒意外而致死的案例，引起科技及急診醫學界的重視。中毒案例雖然經過某種程度的除污程序，仍然併發嚴重的呼吸與循環衰竭。而在疑似中毒致死的案例裡，未預期的呼吸與循環衰竭，是有可能得到及時的救護進而避免死亡的。本研究團隊藉著針對TMAH的毒性舉辦教育訓練時，探討第一線急救反應人員與急診醫護人員對於TMAH的認知狀況。我們發現，急救處置鏈中較弱的環節為廠區工安與急救人員，以及救護技術員；經由簡單的教育訓練課程，確可以迅速達到知識推廣目的。不過，急救人員和醫護人員分開訓練可能較為適當。MSDS與毒物諮詢中心是一般查詢的管道，但對於新興毒物傷害的資訊，網路搜尋正確的資料可能會較有幫助。

關鍵字

除污 ； 急診 ； 緊急醫療救護系統 ； 物質安全資料表 ； 中毒 ； 氫氧化四甲銨

並列摘要

Tetramethylammonium hydroxide (TMAH, (CH3)4 NOH, CAS No. 75-59-2) is widely used in various micro-electro-mechanical industries, especially in the manufacture of semiconductors and liquid crystal displays. It has been considered to have a relatively low level of toxicity, but there is little available toxicological information. In the past few years, three workers have quickly succumbed after significant TMAH contamination.
Methods: We arranged a training course focusing on the toxicology and emergency management of TMAH contamination for first responders and emergency department staff. Before and after the course, we tested the students with questions about TMAH and tried to identify differences in recognition between first responders and emergency department staff.
Results: In total, there were 210 of students who attended the course and these were made up of 98 were emergency responders and 112 medical staff members. We found that the training course was helpful to both groups of students. However, as expected, the first responders did less well in terms of emergency management than the medical staff even after the course. There were also differences between the two groups in terms of the reference media used when confronting the hazard. The first responders favored checking the material safety data sheet (MSDS) chemical file, while the emergency staff consulted the Poison Center or the Internet.
Conclusions: Advanced teaching courses seem to benefit all emergency responders, but we conclude that it might be better to hold courses separately.

並列關鍵字

decontamination ； emergency department ED ； emergency medical service EMS ； Material Safety and Data Sheet MSDS ； poisoning ； tetramethylammonium hydroxide TMAH