Injection, Injection injury, hydraulic, hydraulics, fluid injection, fluid injection injury, catastrophic, death, industrial safety, OSHA

1. Fluid Injection Injury Prevention Training
Contains public sector information licensed under the Open
Government License v3.0.
Chris Russell
U.S. Army Corps of Engineers
February, 2015

2. What You Will Learn
• The fundamentals of fluid injection injuries
• Sources of potential injuries
• How to identify fluid injection injuries
• Importance of immediate medical care
• Methods of protection/avoidance
• Sources of additional information

3. What is a fluid injection injury?
Injection injuries can be defined as the
puncturing of the epidermis by a jet of a fluid
under pressure. Hydraulic injection injury is the
term used to describe an injury sustained by an
individual following an injection of fluid,
usually while operating or inspecting
pressurized hydraulic equipment.

4. Basics of fluid injection injuries
Pressurized fluids such as those found in
hydraulic applications can travel at the speed of
a bullet and penetrate all known levels of
personal protective equipment.
Skin penetration can occur at pressures as low as
100psi and from 4 inches to the source.

5. Sources of fluid injection injuries
• Paint spray guns
• High pressure lube guns
• Hydraulic lines or fittings
• Pressure washers
• Fuel injection systems

6. Why this is important to know?
Hydraulic injection injuries are usually occupational
and sustained by workers, both skilled and
unskilled, with injuries mostly sustained to the
palm or pads of the digits of the hand. Most often a
lack of comprehension of the potential severity of
injuries of this type on the part of the injured party
and medical professionals is the main obstacle to
effective treatment. This appears to be largely due
to the apparent benign initial presentation of the
wound. If untreated, hydraulic injection injuries
can, and have, result(ed) in amputation or even
death.

7. Components required for injury
Pressure – Force of the fluid jet measured in Newtons
Proximity – How close your body part is to the jet
Jet size – Diameter of orifice where fluid is expelled
It is obvious that if one of these variables is absent or
diminished the chances of sustaining injury through
hydraulic injection are significantly reduced.

8. Severity factors for injury
Type of fluid
Amount of fluid
Pressure of fluid stream (depth of injection)
Toxin or bacteria in fluid
Degree of spread (directly affected by time)
Delay of treatment

9. Typical initial injury to the hand
The left hand of a 33 year old
industrial paint sprayer shortly after
sustaining an injection injury of oil
based paint to the base of the index
finger. Note the seemingly benign
nature of the puncture wound where
the paint has entered the hand.
picture by R Heirner

10. Typical initial injury to the hand
One of several incisions made during
the debridement process to remove
necrotic tissue and paint.
picture by R Heirner

11. Typical initial injury to the hand
The right hand of 25 year old male 36
hours after sustaining a hydraulic
injection of solvent into the pad of the
index finger. Due to the initial innocuous
presentation of a small puncture wound
on the finger, medical advice was not
sought upon sustaining the injury.
Necrosis of the tissue can already been
seen at the tip of the finger.
picture by ZH Dailiana

12. Typical initial injury to the hand
The patient after undergoing a
wide surgical debridement
and pressure relieving of the
compartments of the hand.
This procedure took place 56
hours after the initial injury.
picture by ZH Dailiana

13. Typical initial injury to the hand
After amputation of the index finger.
picture by ZH Dailiana

14. Typical initial injury to the hand
Another common injury site
is the palm of the hand,
commonly sustained when
using a piece of hydraulically
powered equipment at the
point at which a material or
component failure occurs.
picture by ZH Dailiana
Fuel oil injection to the palm

15. Typical initial injury to the hand
The same patient undergoing
surgical debridement in order to
relieve the pressure from the
inner compartments of the hand
and remove necrotic tissue.
picture by ZH Dailiana

16. Preparing for an injury
• Contact your local medical facility and ask them if they
are familiar with fluid injection injuries
• Determine the closest facility with the means to deal
with these emergencies
• Develop an EAP (Emergency Action Plan) and rehearse
• Educate all your team members on potential hazards of
fluid injection injuries, prevention and treatment
• Institute risk mitigation measures for injection injuries

17. What to do?
• Get a copy of the MSDS (Material Safety Data Sheet)
• Immediately transport the individual to a MTF (Medical
Treatment Facility)
• Notify hospital staff that you suspect a fluid injection
injury and give them the MSDS
• Lock-out, tag-out and deenergize suspected equipment

18. What not to do?
• Apply a tourniquet
• Underestimate the injury
• Attempt to clean the wound
• Allow the injured to eat or drink anything

19. Ways to prevent injuries
• Maintain 12” distance (stand-off) from sources
• Use a barrier to check for leaks (wood, cardboard, etc.)
• Ensure all hoses are protected from chafing
• Inspect components on routine basis
• Replace (never repair) worn hoses or components
• Wear all recommended PPE when working with, on,
or around hydraulic systems or components

20. Resources
• www.fluidpowersafety.com
• http://www.hse.gov.uk/safetybulleti
ns/hydraulic-injection-injury.htm
• http://www.ncbi.nlm.nih.gov/pmc/ar
ticles/PMC2532970/
• http://www.wikem.org/wiki/High-
Pressure_Injection_Injury
Where can I find
more information?

21. Remember
• The bottom line when dealing with any
suspected fluid injection injury is speedy
treatment.
• When in doubt, get a second, or even a third
opinion. Few people care as much about you
as you do.
• These injuries can be fatal and, even in the
best cases, are career ending, life altering
events that are completely preventable.

22. What You Have Learned
• The fundamentals of fluid injection injuries
• Sources of potential injuries
• How to identify fluid injection injuries
• Importance of immediate medical care
• Methods of protection/avoidance
• Sources of additional information

23. What are your questions?
This slide show is available for download from the
Hydropower Apprentice Program Sharepoint portal
located at
https://team.usace.army.mil/sites/NWW/Train/Hydro
Power%20Apprentice%20Program/Forms/AllItems.a
spx
If you have any questions, comments or suggestions please email
christopher.l.russell@usace.army.mil