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What Should OEM Physicians Know About Ammonium Bifluoride?

Hinkamp, David L. MD, MPH; McCann, Michael PhD, CIH; Babin, Angela MS, LMeSW

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Journal of Occupational and Environmental Medicine: January 2020 - Volume 62 - Issue 1 - p e7
doi: 10.1097/JOM.0000000000001765
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We were deeply saddened to read the report of the tragic death of a child after exposure to an art material at home in the article, “What Should OEM Physicians Know About Ammonium Bifluoride?” by Downs et al.1 The authors’ discussion of this case expertly highlights the toxicity of ammonium bifluoride and hydrofluoric acid and the special risks for children.

Their description of the use of ammonium bifluoride in an art project also demonstrates the importance of an awareness of the hazards encountered by those involved in the arts, whether as professionals, students, hobbyists, or bystanders. We discussed these issues in a series of articles on Occupational Health (OH) and the visual and performing arts in JOEM September 2017.2–4

In those articles we describe examples of common art materials, tools, and working conditions that can have acute health effects (polyurethane resins, power tools, etc) and chronic effects (heavy metal pigments, n-hexane, etc) on artists and others. In one of these articles3 we discuss etching glass with hydrofluoric acid or ammonium bifluoride and the precautions that are recommended.

Working at home on art or craft projects with hazardous materials is extremely common.5 Visitors to those art work areas, including children, older adults, and those with underlying health conditions, can be at particular risk. Hazardous art materials are readily available, but users often lack the material safety information and training required to protect themselves and others.6,9

Occupational Health professionals are particularly well qualified to recognize and understand the significance of these art-related exposures. Our articles describe art activities and how the OH approach can help manage the health and safety challenges. This OH approach can be life or health saving, but these art exposures may be unfamiliar, so resources for further information are also included.6–9

Artists contribute a lot that makes our communities better places to live and work. We in OH have much to contribute that could help our artist neighbors live safer and more productive lives. The horrific accident described in this article demonstrates just how important these contributions can be.


1. Downs JW, Hoffman RM, Cumpston KL, Rosein SR. What should OEM physicians know about ammonium bifluoride? J Occup Environ Med 2019; 61:e394–e395.
2. Hinkamp D, McCann M, Babin AR. Occupational health the arts. J Occup Environ Med 2017; 59:835–842.
3. Hinkamp D, McCann M, Babin AR. Occupational health the visual arts: an introduction. J Occup Environ Med 2017; 59:859–866.
4. Hinkamp D, Morton J, Krasnow D, et al. Occupational health and the performing arts: an introduction. J Occup Environ Med 2017; 59:843–858.
5. Chouinard J. Work in Home Studios Among Attendees at a Stained Glass Convention; A Convenience Survey. Unpublished data of 97% use of lead at home.
6. McCann M. Artist Beware: The Hazards in Working with All Arts and Crafts Materials and the Precautions Every Artist and Craftsperson Should Take. 3rd ed.2005; Guilford: The Lyons Press, 329.
7. Rossol M. The Artist's Complete Health and Safety Guide. 3rd ed.New York: Allworth Press; 2001.
8. Sataloff RT, Brandfonbrener AG, Lederman RJ. Performing Arts Medicine. 3rd ed.Narberth, PA: Science and Medicine; 2010.
9. McCann M. Entertainment and the arts, Chapter 96. In: ILO Encyclopaedia of Occupational Health and Safety. Fourth ed. 1998. 96.2–96.54. Geneva, Switzerland.
Copyright © 2020 by the American College of Occupational and Environmental Medicine