Chapter 6
Medical Management Guidelines for Hydrogen Sulfide
If the use of the various control options does not provide the required
control of an inhalation hazard, respirators should be considered.
Typically respirators are used:
Synonyms include dihydrogen sulfide, sulfur hydride, sulfurated
hydrogen, hydrosulfuric acid, "sewer gas," "swamp gas," hepatic acid,
sour gas, and "stink damp."
Persons exposed to hydrogen sulfide pose no serious risks of secondary
contamination to personnel outside the Hot Zone. However, fatalities
have occurred to rescuers entering the hot zone.
Hydrogen sulfide is a colorless, highly flammable and explosive gas
produced naturally by decaying organic matter and by certain industrial
processes. Hydrogen sulfide has a characteristic rotten-egg odor;
however, olfactory fatigue may occur and consequently it may not
provide adequate warning of hazardous concentrations.
Hydrogen sulfide is well absorbed through the lungs; cutaneous
absorption is minimal. Exposure by any route can cause systemic
effects.
General Information
Description
Hydrogen sulfide is a colorless, flammable, highly toxic gas. It is shipped
as a liquefied, compressed gas. It has a characteristic rotten-egg odor
that is detectable at concentrations as low as 0.5 ppb.
Routes of Exposure
TSTC Ch. 6 H2S
Inhalation
Inhalation is the major route of hydrogen sulfide exposure. The gas is
rapidly absorbed by the lungs. The odor threshold (0.5 ppb) is much
lower than the OSHA ceiling (20 ppm). However, although its strong odor
is readily identified, olfactory fatigue occurs at high concentrations and at
continuous low concentrations. For this reason, odor is not a reliable
indicator of hydrogen sulfide's presence and may not provide adequate
warning of hazardous concentrations. Hydrogen sulfide is slightly heavier
than air and may accumulate in enclosed, poorly ventilated, and low-
lying areas.
Children exposed to the same levels of hydrogen sulfide as adults may
receive larger doses because they have greater lung surface area:body
weight ratios and increased minute volumes:weight ratios. In addition,
they may be exposed to higher levels than adults in the same location
because of their short stature and the higher levels of hydrogen sulfide
found nearer to the ground. Children may be more vulnerable to
corrosive agents than adults because of the relatively smaller diameter of
their airways.
Skin/Eye Contact
Prolonged exposure to hydrogen sulfide, even at relatively low levels,
may result in painful dermatitis and burning eyes. Direct contact with the
liquefied gas can cause frostbite. Absorption through intact skin is
minimal.
Ingestion
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Because hydrogen sulfide is a gas at room temperature, ingestion is
unlikely to occur.
Sources/Uses
Hydrogen sulfide is produced naturally by decaying organic matter and is
released from sewage sludge, liquid manure, sulfur hot springs, and
natural gas. It is a by-product of many industrial processes including
petroleum refining, tanning, mining, wood- pulp processing, rayon
manufacturing, sugar-beet processing, and hot-asphalt paving. Hydrogen
sulfide is used to produce elemental sulfur, sulfuric acid, and heavy
water for nuclear reactors.
Standards and Guidelines
OSHA ceiling = 20 ppm
OSHA maximum peak = 50 ppm (10 minutes, once, no other exposure)
NIOSH IDLH (immediately dangerous to life or health) = 100 ppm
AIHA ERPC-2 (emergency response planning guideline) (maximum
airborne concentration below which it is believed that nearly all
individuals could be exposed for up to 1 hour without experiencing or
developing irreversible or other serious health effects or symptoms which
could impair an individual's ability to take protective action) = 30 ppm.
Physical Properties
Description: Colorless gas with odor of rotten eggs
TSTC Ch. 6 H2S
Warning properties: Not dependable; characteristic rotten-egg odor
detectable at about 0.5 ppb, but olfactory nerve fatigue occurs in 2 to 15
minutes at concentrations over 100 ppm
Molecular weight: 34.1 daltons
Boiling point (760 mm Hg): -77°F (-60.3°C)
Vapor pressure: >760 mm Hg at 68°F (20°C)
Gas density: 1.2 (air = 1)
Water solubility: Slightly water soluble (0.4% at 68°F [20°C])
Flammability: Highly flammable and explosive between 4% and 45%
(concentration in air); may travel to a source of ignition and flash back.
Burns to produce a toxic gas, sulfur dioxide.
Incompatibilities
Hydrogen sulfide reacts with strong oxidizers, strong nitric acid, and
metals.
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Health Effects
Hydrogen sulfide is a mucous membrane and respiratory tract irritant;
pulmonary edema, which may be immediate or delayed, can occur after
exposure to high concentrations.
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Symptoms of acute exposure include nausea, headaches, delirium,
disturbed equilibrium, tremors, convulsions, and skin and eye irritation.
Inhalation of high concentrations of hydrogen sulfide can produce
extremely rapid unconsciousness and death. Exposure to the liquified
gas can cause frostbite injury.
Acute Exposure
Hydrogen sulfide's can cause inhibition of the cytochrome oxidase
enzyme system resulting in lack of oxygen use in the cells. Anaerobic
metabolism causes accumulation of lactic acid leading to an acid-base
imbalance. The nervous system and cardiac tissues are particularly
vulnerable to the disruption of oxidative metabolism and death is often
the result of respiratory arrest. Hydrogen sulfide also irritates skin, eyes,
mucous membranes, and the respiratory tract. Pulmonary effects may
not be apparent for up to 72 hours after exposure.
Children do not always respond to chemicals in the same way that adults
do. Different protocols for managing their care may be needed.
CNS
CNS injury is immediate and significant after exposure to hydrogen
sulfide. At high concentrations, only a few breaths can lead to immediate
loss of consciousness, coma, respiratory paralysis, seizures, and death.
CNS stimulation may precede CNS depression. Stimulation manifests as
excitation, rapid breathing, and headache; depression manifests as
impaired gait, dizziness, and coma, possibly progressing to respiratory
paralysis and death. In addition, decreased ability to smell hydrogen
sulfide occurs at concentrations greater than 100 ppm.
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Respiratory
Inhaled hydrogen sulfide initially affects the nose and throat. Low
concentrations (50 ppm) can rapidly produce irritation of the nose, throat,
and lower respiratory tract. Pulmonary manifestations include cough,
shortness of breath, and bronchial or lung hemorrhage. Higher
concentrations can provoke bronchitis and cause accumulation of fluid in
the lungs, which may be immediate or delayed for up to 72 hours. Lack
of oxygen may result in blue skin color.
Children may be more vulnerable to corrosive agents than adults
because of the relatively smaller diameter of their airways. Children may
also be more vulnerable to gas exposure because of increased minute
ventilation per kg and failure to evacuate an area promptly when
exposed.
Cardiovascular
High-dose exposures may cause insufficient cardiac output, irregular
heartbeat, and conduction abnormalities.
Renal
Transient renal effects include blood, casts, and protein in the urine.
Renal failure as a direct result of hydrogen sulfide toxicity has not been
described, although it may occur secondary to cardiovascular
compromise.
Gastrointestinal
Symptoms may include nausea and vomiting.
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Dermal
Prolonged or massive exposure may cause burning, itching, redness,
and painful inflammation of the skin. Exposure to the liquified gas can
cause frostbite injury.
Ocular
Eye irritation may result in inflammation (i.e., keratoconjunctivitis) and
clouding of the eye surface. Symptoms include blurred vision, sensitivity
to light, and spasmodic blinking or involuntary closing of the eyelid.
Potential Sequelae
Inflammation of the bronchi can be a late development. Survivors of
severe exposure may develop psychological disturbances and
permanent damage to the brain and heart. The cornea may be
permanently scarred.
Chronic Exposure
Hydrogen sulfide does not accumulate in the body. Nevertheless,
repeated or prolonged exposure has been reported to cause low blood
pressure, headache, nausea, loss of appetite, weight loss, ataxia, eye-
membrane inflammation, and chronic cough. Neurologic symptoms,
including psychological disorders, have been associated with chronic
exposure. Chronic exposure may be more serious for children because
of their potential longer latency period.
Carcinogenicity
Hydrogen sulfide has not been classified for carcinogenic effects.
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Reproductive and Developmental Effects
There is some evidence to suggest that exposure to hydrogen
Developmental Effects sulfide may be associated with an increased risk
of spontaneous abortion. No information was located pertaining to
placental transfer of hydrogen sulfide or to excretion of hydrogen sulfide
in breast milk. There are no studies of developmental effects in humans
exposed to hydrogen sulfide. However, results from animal studies
suggest that hydrogen sulfide may be a developmental neurotoxicant.
Hydrogen sulfide is not listed in TERIS or in Shepard's Catalog of
Teratogenic Agents. It is also not included in Reproductive and
Developmental Toxicants, a 1991 report published by the U.S. General
Accounting Office (GAO) that lists 30 chemicals of concern because of
widely acknowledged reproductive and developmental consequences.
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Prehospital Management
Victims exposed only to hydrogen sulfide gas do not pose substantial
risks of secondary contamination to personnel outside the Hot Zone.
However, personnel could be secondarily contaminated by contacting or
breathing vapors from clothing heavily soaked with hydrogen sulfide-
containing solution.
Hydrogen sulfide is a highly toxic gas that can produce extremely rapid
CNS and respiratory depression. It is also an irritant affecting skin and
mucous membranes.
There is no proven antidote for hydrogen sulfide poisoning. Treatment
generally consists of support of respiratory and cardiovascular functions.
Hot Zone
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Rescuers should be trained and appropriately attired before entering the
Hot Zone. If the proper equipment is not available, or if prehospital staff
have not been trained in its use, assistance should be obtained from a
local or regional HAZMAT team or other properly equipped response
organization.
Rescuer Protection
Hydrogen sulfide is an extremely rapidly acting, highly toxic gas.
Fatalities have occurred to rescuers entering the hot zone.
Respiratory Protection: Positive-pressure, self-contained breathing
apparatus (SCBA) is recommended in response situations that involve
exposure to potentially unsafe levels of hydrogen sulfide.
Skin Protection: Chemical-protective clothing is not generally required
because hydrogen sulfide gas is not absorbed through the skin, and skin
irritation is rare. Direct contact with the liquefied gas can cause frostbite.
Rescuers should have a safety line during rescue operations because of
the extremely rapid toxic action of hydrogen sulfide.
ABC Reminders
Quickly access for a patent airway, ensure adequate respiration and
pulse. If trauma is suspected, maintain cervical immobilization manually
and apply a cervical collar and a backboard when feasible.
Victim Removal
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If victims can walk, lead them out of the Hot Zone to the
Decontamination Zone. Victims who are unable to walk may be removed
on backboards or gurneys; if these are not available, carefully carry or
drag victims to safety.
Consider appropriate management of chemically contaminated children,
such as measures to reduce separation anxiety if a child is separated
from a parent or other adult.
Decontamination Zone
Patients exposed only to hydrogen sulfide gas who have no skin or eye
irritation do not need decontamination. They may be transferred
immediately to the Support Zone. Other patients will require
decontamination as described below.
Rescuer Protection
If exposure levels are determined to be safe, decontamination may be
conducted by personnel wearing a lower level of protection than that
worn in the Hot Zone (described above).
ABC Reminders
Quickly access for a patent airway, ensure adequate respiration and
pulse. Stabilize the cervical spine with a collar and a backboard if trauma
is suspected. Administer supplemental oxygen as required. Assist
ventilation with a bag-valve-mask device if necessary.
Basic Decontamination
TSTC Ch. 6 H2S
Victims who are able may assist with their own decontamination.
Remove and double-bag contaminated clothing.
Handle frostbitten skin and eyes with caution. Wrap the affected part
gently in blankets. Let the circulation reestablish itself naturally.
Encourage the victim to exercise the affected part while it is being
warmed.
Flush exposed skin and hair with water for 3 to 5 minutes. Use caution to
avoid hypothermia when decontaminating children or the elderly. Use
blankets or warmers when appropriate.
Do not irrigate frostbitten eyes. Otherwise, irrigate exposed or irritated
eyes with plain water or saline for at least 5 minutes. Eye irrigation may
be carried out simultaneously with other basic care and transport.
Remove contact lenses if easily removable without additional trauma to
the eye. If a corrosive material is suspected or if pain or injury is evident,
continue irrigation while transferring the victim to the support zone.
Consider appropriate management of chemically contaminated children,
such as measures to reduce separation anxiety if a child is separated
from a parent or other adult. If possible, seek assistance from a child
separation expert.
Transfer to Support Zone
As soon as basic decontamination is complete, move the victim to the
Support Zone.
TSTC Ch. 6 H2S
Support Zone
Be certain that victims have been properly decontaminated (see
Decontamination Zone above). Victims who have undergone
decontamination or who have been exposed only to hydrogen sulfide gas
pose no serious risks of secondary contamination. In such cases,
Support Zone personnel require no specialized protective gear.
ABC Reminders
Quickly access for a patent airway. If trauma is suspected, maintain
cervical immobilization manually and apply a cervical collar and a
backboard when feasible. Ensure adequate respiration and pulse.
Administer supplemental oxygen as required and establish intravenous
access if necessary. Place on a cardiac monitor.
Additional Decontamination
Continue irrigating exposed skin and eyes, as appropriate.
Advanced Treatment
In cases of respiratory compromise secure airway and respiration via
endotracheal intubation. If not possible, perform cricothyroidotomy if
equipped and trained to do so.
Treat patients who have bronchospasm with aerosolized bronchodilators.
The use of bronchial sensitizing agents in situations of multiple chemical
exposures may pose additional risks. Consider the health of the
myocardium before choosing which type of bronchodilator should be
administered. Cardiac sensitizing agents may be appropriate; however,
the use of cardiac sensitizing agents after exposure to certain chemicals
TSTC Ch. 6 H2S
may pose enhanced risk of cardiac arrhythmias (especially in the
elderly). Hydrogen sulfide poisoning is not known to pose additional risk
during the use of bronchial or cardiac sensitizing agents.
Consider racemic epinephrine aerosol for children who develop stridor.
Dose 0.25-0.75 mL of 2.25% racemic epinephrine solution in 2.5 cc
water, repeat every 20 minutes as needed, cautioning for myocardial
variability.
Patients who are comatose, hypotensive, or are having seizures or
cardiac arrhythmias should be treated according to advanced life support
(ALS) protocols.
If frostbite is present, treat by rewarming in a water bath at a temperature
of 102 to 108°F (40 to 42°C) for 20 to 30 minutes and continue until a
flush has returned to the affected area.
Nitrite therapy (found in the cyanide antidote kit) has been suggested as
a therapy for hydrogen sulfide exposure. Amyl nitrite is given by
inhalation (for 30 seconds every minute until an intravenous line is
established) followed by intravenous sodium nitrite (300 mg over
absolutely no less than 5 minutes). This may aid recovery by forming
sulfmethemoglobin, thus removing sulfide from combination in tissue. It
is not necessary to use the sodium thiosulfate component of the cyanide
antidote kit. The antidotal efficacy of nitrite therapy is controversial, but is
currently recommended if it can be started shortly after exposure.
However, there is only anecdotal evidence that nitrite therapy is effective,
and victims of hydrogen sulfide poisoning have survived without
sequelae after supportive care alone. The usefulness of nitrite therapy
TSTC Ch. 6 H2S
given beyond the first few minutes after exposure is questionable. Nitrite
therapy should not be allowed to interfere with the establishment of
adequate ventilation and oxygenation.
Transport to Medical Facility
Only decontaminated patients or patients not requiring decontamination
should be transported to a medical facility. "Body bags" are not
recommended.
Report to the base station and the receiving medical facility the condition
of the patient, treatment given, and estimated time of arrival at the
medical facility.
Multi-Casualty Triage
Consult with the base station physician or regional poison control center
for further advice regarding triage of multiple [Link] with
evidence of significant exposure (e.g., breathing difficulties,
unconsciousness, seizures, or collapse) should be transported to a
medical facility for evaluation. Patients who have minor or transient
irritation of the eyes or throat may be discharged from the scene after
their names, addresses, and telephone numbers are recorded. They
should be advised to seek medical care promptly if symptoms develop or
recur (see Patient Information Sheet below).
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Emergency Department Management
Hospital personnel away from the scene are not at risk of secondary
contamination from patients exposed only to hydrogen sulfide gas;
TSTC Ch. 6 H2S
however, personnel can be secondarily contaminated by contacting or
breathing vapors from clothing heavily soaked with hydrogen sulfide-
containing solution.
Hydrogen sulfide is a very rapidly acting, highly toxic gas that can
produce rapid CNS and respiratory depression. It is also an irritant
affecting skin and mucous membranes.
There is no proven antidote for hydrogen sulfide poisoning. Treatment
generally consists of support of respiratory and cardiovascular functions.
Decontamination Area
Patients who have been decontaminated previously and patients
exposed only to hydrogen sulfide gas who have no skin or eye irritation
may be transferred immediately to the Critical Care Area. Other patients
require decontamination as described below.
Be aware that use of protective equipment by the provider may cause
fear in children, resulting in decreased compliance with further
management efforts.
ABC Reminders
Evaluate and support airway, breathing, and circulation. Children may be
more vulnerable to corrosive agents than adults because of the smaller
diameter of their airways. In cases of respiratory compromise secure
airway and respiration via endotracheal intubation. If not possible,
surgically create an airway.
Treat patients who have bronchospasm with aerosolized bronchodilators.
The use of bronchial sensitizing agents in situations of multiple chemical
exposures may pose additional risks. Consider the health of the
TSTC Ch. 6 H2S
myocardium before choosing which type of bronchodilator should be
administered. Cardiac sensitizing agents may be appropriate; however,
the use of cardiac sensitizing agents after exposure to certain chemicals
may pose enhanced risk of cardiac arrhythmias (especially in the
elderly). Hydrogen sulfide poisoning is not known to pose additional risk
during the use of bronchial or cardiac sensitizing agents.
Consider racemic epinephrine aerosol for children who develop stridor.
Dose 0.25-0.75 mL of 2.25% racemic epinephrine solution in 2.5 cc
water, repeat every 20 minutes as needed, cautioning for myocardial
variability.
Patients who are comatose, hypotensive, or have seizures or ventricular
arrhythmias should be treated in the conventional manner.
Nitrite therapy (found in the cyanide antidote kit) has been suggested as
a therapy for hydrogen sulfide exposure. Amyl nitrite is given by
inhalation (for 30 seconds every minute until an intravenous line is
established) followed by intravenous sodium nitrite (300 mg over
absolutely no less than 5 minutes). This may aid recovery by forming
sulfmethemoglobin, thus removing sulfide from combination in tissue. It
is not necessary to use the sodium thiosulfate component of the cyanide
antidote kit. The antidotal efficacy of nitrite therapy is controversial, but is
currently recommended if it can be started shortly after exposure. The
usefulness of nitrite therapy given beyond the first few minutes after
exposure is questionable. There is only anecdotal evidence that nitrite
therapy is effective, and victims of hydrogen sulfide poisoning have
survived without sequelae after supportive care alone. Nitrite therapy
TSTC Ch. 6 H2S
should not be allowed to interfere with the establishment of adequate
ventilation and oxygenation.
Basic Decontamination
Patients who are able may assist with their own decontamination.
Remove and double-bag contaminated clothing and personal
belongings.
Handle frostbitten skin and eyes with caution. Place frostbitten skin in
warm water, about 108°F (42°C). Let the circulation reestablish itself
naturally. Encourage the victim to exercise the affected part while it is
being warmed.
Flush exposed skin and hair with plain water for 5 minutes, preferably
under a shower. Use caution to avoid hypothermia when
decontaminating children or the elderly. Use blankets or warmers when
appropriate.
Do not irrigate frostbitten eyes. Otherwise, irrigate exposed eyes for at
least 5 minutes. Remove contact lenses if easily removable without
additional trauma to the eye. An ophthalmic anesthetic may be
necessary to alleviate blepharospasm, and lid retractors may be required
to allow adequate irrigation under the eyelids. Continue irrigation while
transporting the patient to the Critical Care Area.
Critical Care Area
Be certain that appropriate decontamination has been carried out (see
Decontamination Area above).
TSTC Ch. 6 H2S
ABC Reminders
Evaluate and support airway, breathing, and circulation as in ABC
Reminders above. Children may be more vulnerable to corrosive agents
than adults because of the smaller diameter of their airways. Establish
intravenous access in seriously symptomatic patients. Continuously
monitor cardiac rhythm.
Patients who are comatose, hypotensive, or have seizures or cardiac
arrhythmias should be treated in the conventional manner.
Inhalation Exposure
Administer supplemental oxygen by mask to patients who have
respiratory symptoms. Treat patients who have bronchospasm with
aerosolized bronchodilators. The use of bronchial sensitizing agents in
situations of multiple chemical exposures may pose additional risks.
Consider the health of the myocardium before choosing which type of
bronchodilator should be administered. Cardiac sensitizing agents may
be appropriate; however, the use of cardiac sensitizing agents after
exposure to certain chemicals may pose enhanced risk of cardiac
arrhythmias (especially in the elderly). Hydrogen sulfide poisoning is not
known to pose additional risk during the use of bronchial or cardiac
sensitizing agents.
Consider racemic epinephrine aerosol for children who develop stridor.
Dose 0.25-0.75 mL of 2.25% racemic epinephrine solution in 2.5 cc
water, repeat every 20 minutes as needed, cautioning for myocardial
variability.
TSTC Ch. 6 H2S
Observe patients for 24 hours, repeating appropriate tests and chest
examinations as needed. Follow-up as clinically indicated.
Skin Exposure
If concentrated hydrogen sulfide was in contact with the skin, chemical
burns may result; treat as thermal burns. If the liquefied compressed gas
is released and contacts the skin, frostbite may result. If a victim has
frostbite, treat by rewarming affected areas in a water bath at a
temperature of 102 to 108°F (40 to 42°C) for 20 to 30 minutes and
continue until a flush has returned to the affected area.
Eye Exposure
Continue irrigation for at least 5 minutes. Test visual acuity. Examine the
eyes for corneal damage and treat appropriately. Immediately consult an
ophthalmologist for patients who have severe corneal injuries.
Antidotes and Other Treatments
Nitrite therapy (found in the cyanide antidote kit) has been Other
Treatments suggested as a therapy for hydrogen sulfide exposure. Amyl
nitrite is given by inhalation (for 30 seconds every minute until an
intravenous line is established) followed by intravenous sodium nitrite
(300 mg over absolutely no less than 5 minutes). This may aid recovery
by forming sulfmethemoglobin, thus removing sulfide from combination in
tissue. It is not necessary to use the sodium thiosulfate component of the
cyanide antidote kit. The antidotal efficacy of nitrite therapy is
controversial, but is currently recommended if it can be started shortly
after exposure. The usefulness of nitrite therapy given beyond the first
TSTC Ch. 6 H2S
few minutes after exposure is questionable. There is only anecdotal
evidence that nitrite therapy is effective, and victims of hydrogen sulfide
poisoning have survived without sequelae after supportive care alone.
Nitrite therapy should not be allowed to interfere with the establishment
of adequate ventilation and oxygenation.
Hyperbaric oxygen therapy is controversial and based on anecdotal
evidence. It may be effective for patients with persistent coma in whom
other treatments are unsuccessful.
Laboratory Tests
Routine laboratory studies for all symptomatic exposed patients include
CBC, blood glucose, and electrolyte determinations. Additional studies
for patients exposed to hydrogen sulfide include ECG monitoring and
renal-function tests. Chest radiography and pulse oximetry (or ABG
measurements) may be helpful in cases of inhalation exposure. If nitrites
are used, check methemoglobin levels.
Disposition and Follow-up
Consider hospitalizing patients who have evidence of systemic toxicity
from any route of exposure.
Delayed Effects
Patients who are unconscious or hypotensive should be observed
closely for complications including post-hypoxic encephalopathy.
Because pulmonary edema may be delayed in onset, patients seriously
exposed by inhalation should be monitored for 24 hours. If pulmonary
edema is suspected, admit patients to an intensive care unit.
TSTC Ch. 6 H2S
Patient Release
Asymptomatic patients who have no evidence of pulmonary edema or
CNS or respiratory compromise and no signs of eye irritation may be
discharged after 4 to 6 hours of observation with instructions to seek
medical care promptly if symptoms develop (see the Hydrogen Sulfide-
Patient Information Sheet below).
Follow-up
Obtain the name of the patient's primary care physician so that the
hospital can send a copy of the ED visit to the patient's doctor.
Patients exposed to hydrogen sulfide should be monitored for heart and
brain injuries, including evaluation for neurologic deficits.
Patients who have skin or corneal injury should be re-examined within 24
hours.
Reporting
If a work-related incident has occurred, you may be legally required to
file a report; contact your state or local health department.
Other persons may still be at risk in the setting where this incident
occurred. If the incident occurred in the workplace, discussing it with
company personnel may prevent future incidents. If a public health risk
exists, notify your state or local health department or other responsible
public agency. When appropriate, inform patients that they may request
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an evaluation of their workplace from OSHA or NIOSH. See Appendices
III and IV for a list of agencies that may be of assistance.
TSTC Ch. 6 H2S