Toxicology in remote consultations with mining sites

Dr Will Ibbotson1

1Royal Flying Doctor Service South East, Dubbo, NSW, Australia


The RFDS provides medical services to a number of mining sites in NSW. These sites are geographically isolated, and utilise many hazardous substances.
We surveyed all mining sites in our area to assess which hazardous substances are used, and how exposure to these may present to our service.

An survey was sent to all mining sites listed by NSW Mining, assessing substances mined and chemicals recorded as hazardous to health.

There are 73 registered sites in NSW(1) mining silver, gold, lead, cobalt, zinc, zircon, copper, titanium and coal.
Registered substances hazardous to health include sulphuric acid, nitric acid, cyanide, mercury and ammonia. No hazardous chemicals were reported to be used in the mining of silver, zircon, titanium or coal.

A variety of presentations may be seen from exposure to these substances. Acids such as sulphuric and nitric acid, and bases such as ammonia, commonly present with burns, either through direct contact or inhalation(2). These are treated by flushing with water, then transfer to hospital.
Cyanide toxicity typically presents with dizziness, nausea and vomiting, headaches and weakness, before seizures, apnoea and cardiac arrest. A cherry red colouration of the skin may also be seen(3). Death can occur rapidly, especially from inhalation. Following diagnosis, treatment is with decontamination, followed by thiosulphate, hydroxocobalamin or dicobalt edetate.

Recognising the presentation of exposure to toxic substances is important when conducting remote consultations to mining sites.
Prompt recognition of the toxin with early decontamination and treatment is key to reducing mortality and morbidity.

1. Mines in NSW Sydney, NSW 2015 [Available from:
2. Flammiger A, Maibach H. Sulfuric acid burns (corrosion and acute irritation): evidence-based overview to management. Cutan Ocul Toxicol. 2006;25(1):55-61.
3. Parker-Cote JL, Rizer J, Vakkalanka JP, Rege SV, Holstege CP. Challenges in the diagnosis of acute cyanide poisoning. Clinical Toxicology. 2018;56(7):609-17.


Dr. Will Ibbotson is a Medical Officer for the Royal Flying Doctors Service South East (RFDSSE) Section and an Anaesthetist at Dubbo Base Hospital, NSW, Australia.

In his role he is responsible for undertaking telemedicine and remote consultations across rural NSW and conducting emergency aeromedical retrievals from prehospital, clinic and hospital settings across the state.

He has interests in education and the applications of technology in improving patient care and safety.

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