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Response to Letter to the Editor Re: “What Should OEM Physicians Know About Ammonium Bifluoride?”

Downs, John W. MD, MPH; Hoffman, Rebecka M. MD; Cumpston, Kirk L. DO; Rose, S. Rutherfoord PharmD

Author Information
Journal of Occupational and Environmental Medicine: January 2020 - Volume 62 - Issue 1 - p e8
doi: 10.1097/JOM.0000000000001764
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We are grateful for Hinkamp's et al1–3 letter, and their work to bring more light to occupational hazards associated with the performing and visual arts. We read with interest their prior reviews of occupational hazards in the arts, and agree that education of artists and crafts persons is imperative to their safety. As suggested in their review of occupational health and safety in the arts, too often these workers are under informed, or may be pressed to perform dangerous duties without appropriate personal protective equipment.

We agree that ammonium bifluoride is an underappreciated hazard by OEM physicians, and felt compelled to bring to light this rare and tragic case with the hope it will prevent future injury or death. Furthermore, we recognize that artisans frequently do work within their own home, and this may lead some physicians to disregard the potential magnitude of toxicity with avocations. Hinkamp et al1–3 point out that hazards may be more present in unregulated home workspaces. Occupational health professionals are uniquely qualified to help these workers understand the risks of visual arts work. Visual artists may not receive sufficient health and safety education prior to starting work, and may be unaware of appropriate personal protective equipment for various job tasks.

We appreciate the work Hinkamp et al1–3 are doing to provide a safe and healthy working environment for workers in the visual and performing arts. It is our hope that the misfortune in our case will be used as warning to prevent potential morbidity and mortality associated with chemical hazards in this industry.


1. Hinkamp D, McCann M, Babin AR. Occupational health and the arts. J Occup Environ Med 2017; 59:835–842.
2. Hinkamp D, McCann M, Babin AR. Occupational health and the visual arts: an introduction. J Occup Environ Med 2017; 59:859–866.
3. Hinkamp D, Morton J, Krasnow D, et al. Occupational health and the performing arts: an introduction. J Occup Environ Med 2017; 59:843–858.
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