Heal of Southern Arizona MCS Pages
First Do No Harm,
The Challenge of Patients with
Multiple Chemical Sensitivities (MCS)
By: Ann McCampbell, M.D.
Santa Fe, New México
This article was written for Emergency Medical Service
personnel in New Mexico. It was published in Focus,
October 1996, and is reprinted with permission.
Prior to 1988, I was a healthy, athletic physician who
played drums in a rock band. A year later, I was
severely disabled with what is known as Multiple
Chemical Sensitivities (MCS). The onset was subtle,
with slowly worsening food intolerances, progressing to
the point I could only eat three green vegetables. By
then I was also having severe reactions to inhaled
substances and had developed headaches, fatigue, heart
palpitations. abdominal pains, nausea and severe
diarrhea. Like so many others with MCS, I could no
longer tolerate where I lived and was forced to live
outside in my yard, the car, or a makeshift shelter.
Despite some improvements since the late 1980’s, I still
face food intolerances, malnutrition, and adverse
reactions to a wide array of chemicals commonly found
in the air, foods, and water of our everyday
environment. I go to few places outside my home in
order to avoid exposures to cigarette smoke, pesticides,
perfume, vehicle exhaust, cleaning products. and other
toxic fumes which make me sicker. I still do not know
what caused my MCS although I do know that I am sick
now and that my illness is real and has been devastating.
WHAT IS MCS?
Persons who have Multiple Chemical Sensitivities
(MCS) experience adverse health reactions following
exposure to a wide spectrum of certain chemicals at
levels which ordinarily do not affect others. The
stimulating agents are found everywhere in our modern
world: pesticides, new building materials, new carpets
and furniture, glue and solvents. paint. perfume. many
personal care products (detergents, fabric softeners,
shampoos, hair sprays, mousse, soaps, lotions, and
deodorants). tar and asphalt fumes. smoke, cleaning
products, disinfectants, vehicular and industrial exhaust
fumes, fresh ink, new plastics, and synthetic clothing.
Symptoms can be provoked by even minute amounts of
substances being inhaled, ingested, or absorbed through
the skin. Many with MCS react to mold dust, pollen
and animals, and there are significant overlaps between
MCS and the syndromes of Chronic Dysfunction and
Fibromvalgia, a condition of joint and muscle pain.
MCS occurs in people of all ages, races, and socio-
economic conditions. Women are affected more
frequently than men. Although the exact prevalence of
this disorder has not yet been clearly defined, a 1995
randomized study in California found that 16% of the
population reported some degree of chemical
sensitivities and 7% said they had been diagnosed with
MCS. Three physicians in northern New Mexico who
treat patients with MCS estimate that collectively, they
have diagnosed 1500 new patients in our area over the
past two years.
The severity of this illness varies greatly, from those
with only minimal symptoms (like skin rashes from
wearing latex gloves) to a severe and disabling chronic
illness which forces people to alter every aspect of their
lives. People with MCS often lose their jobs, homes,
careers, family and friends because their lives change so
drastically. They are unable to go into most buildings
and some become imprisoned in their homes where they
can establish a safe environment free of the chemicals
that cause their worst reactions. The isolation imposed
by these chemical barriers and the lack of understanding
about MCS contribute significantly to the devastating
nature of the illness.
Although the medical community has generally been
slow to understand or accept MCS as a ‘real” illness,
there are some physicians who understand and treat the
condition. It has also been recognized as a potentially
disabling condition by the federal Social Security
Administration, Department of Housing and
Development (HUD), Environmental Protection Agency
(EPA), and the National Academy of Sciences. The
newly-built medical facility in Taos — Holy Cross
Hospital — was constructed with rooms designed to
accommodate chemically sensitive patients by not only
utilizing less-toxic building materials, but also
establishing guidelines for staff to refrain from wearing
scented personal care products and utilizing less-toxic
CAUSES OF MCS
MCS is thought to result from exposures to toxic
chemicals, although the exact etiology of MCS is
unproven and the mechanism of the illness is unknown.
Some develop MCS after a single major exposure while
Others seem to develop symptoms slowly following
cumulative events. Many of those with MCS report the
onset of their illness after moving into a new home or
working in recently remodeled offices. Many members
of the health care profession have developed this
disorder, seemingly after chronic exposure to
disinfectants and other chemicals found in hospital and
other health care settings.
THE SYMPTOMS OF MCS
The symptoms of MCS vary greatly and are unique to
each person. but the unifying factor is that chemically
sensitive people experience the onset and/or
exacerbation of the symptoms following exposure to
chemicals. The diversity of symptoms and the lack of a
clear causative agent has contributed to the
bewilderment of medical professionals who, all too
often., throw up their hands in frustration and attribute
the symptoms to a pure psychiatric problem.
The symptoms of MCS run the gamut of all the body
systems: headache, fatigue, sleep disturbances,
dizziness, heart palpitations, respiratory difficulties,
swollen lymph nodes, abnormal taste sensations,
impaired circulation, gastrointestinal problems, joint and
muscle pain, weakness, loss of coordination, nerve
irritations, and even seizures. Many cerebral symptoms
can also appear, such as clouded thinking, difficulty in
concentration and communicating, memory loss, and
feelings of intoxication. Emotional symptoms may
occur as well, such as depression. panic attacks, and
emotional outbursts. Finally, persons with MCS may
have typical symptoms associated with allergies such as
itchy eyes, nasal congestion, sinusitis, asthma, hives and
other rashes, and even anaphylactic reactions.
The onset and severity of symptoms following in an
exposure vanes from person to person based on their
general state of health, recent cumulative exposures, and
other unknown factors. Symptom onset may be delayed
by hours or even days from exposure. The duration of an
individual’s reaction can also vary from seconds to a
few weeks or months.
DIAGNOSIS AND TREATMENT OF MCS
The diagnosis of MCS is often easy to make but difficult
to prove, since there are no agreed upon diagnostic
criteria for this disorder. Like other conditions with
limited physical and laboratory findings — e.g.
headaches — the physician must often rely primarily on
reports of the patient’s array of symptoms resulting from
environmental exposures. Various tests such as brain
scans, immunological studies. enzyme functioning, and
neuropsvchological tests have shown abnormalities in
many people with MCS, pointing to possible damage to
the immunological and central nervous systems.
There is no known cure for MCS. but a variety of
treatments can help reduce the reactions and improve
the overall health of people with the disorder. Avoiding
exposure to stimulating chemicals is of prime
importance, but not always possible in the environment
of modern society. Treatments that have been found to
be helpful include nutritional supplements,
detoxification techniques, allergy desensitization and
correction of hormonal imbalances. Complementary
medical techniques such as acupuncture and homeo-
pathic medicines have also been found to be effective.
Although some people seem to fully recover from MCS,
most unfortunately demonstrate a chronic relapsing
course characterized by spurts of improvement
countered with distressing setbacks. MCS is rarely fatal
in itself, but deaths have been known to occur as a result
of severe bronchospasm, heart irregularities, and
malnutrition. Tragically, suicide is also a factor of
morbidity for those with MCS who find their worlds
overwhelmingly intolerable due to the pain, isolation,
and helplessness associated with this illness.
MCS AND EMS
What does all this have to do with EMS? Like all
people, those with MCS occasionally find the need to
access emergency care, perhaps at even a greater rate
than others because of their precarious health. But many
with MCS have a deep fear of calling for help. Probably
the biggest reason for not calling for help is the fear of
having a serious, even life-threatening, reaction to an
administered drug. They also do not want to worsen
their condition by being exposed to ambulance exhaust
(especially diesel), perfume, cologne, scented laundry
products and cigarette smoke residue emanating from
the EMTs and various emergency equipment such as
plastic oxygen masks, intravenous fluids in plastic bags
and latex gloves. People with MCS also worry about
being transported to a hospital against their will.
Another element of concern has more to do with the
sometimes insensitive approach of health care providers
when faced with an MCS patient. Although many EMTs
have been reported to be kind, courteous and respectful
of MCS patients, others have been rude and ready to
assume the person they are treating is “crazy”. These
fears within the MCS community have unfortunately led
patients to prolong calling for help through 911 until
their condition has deteriorated drastically.
Knowing how to provide emergency treatment to a
chemically sensitive person who is in active distress is
admittedly difficult and presents a great challenge to the
EMT. The most important thing for an EMT to do is
to listen to the patient, accept what they are saying,
and respect their limits. This, of course, has to be
balanced with providing life-saving measures as taught
in EMT training and authorized through treatment
protocols. Bear in mind, too, that MCS patients may
have difficulty communicating verbally if they have
been, or continue to be, chemically exposed.
The following are the important issues for the
emergency treatment of MCS patients who access EMS:
• Listen to the patient — reassure patients that you
understand they are chemically sensitive and that
you will work with them in providing care.
Continually communicate with them regarding their
environment, the treatments you plan, and respect
the patient’s limitations in possibly refusing some
• Because vehicle exhaust fumes are so toxic, use
all methods to minimize exposure to patient —
ideally avoid idling of the ambulance at the scene of
an emergency response. At least turn off the motor
when loading and unloading a patient, and close the
windows to reduce fumes entering the vehicle
during transport. This should be a practice with all
• Refrain from wearing perfumes, cologne, or
other strongly fragrant products while on duty
in the closed space of an ambulance
compartment, the over-powering scent of fragrance
can be extremely hazardous to an MCS patient.
• Refrain from smoking while on duty or wearing
clothes that have smoke residue. (If you must
smoke please do it in an open area so that residue
does not accumulate.)
• Remove patients from hostile environments — as
with hazmat protocols, remove the patient from the
source of danger by moving them out of offices.
stores~ theaters. etc., and into fresh air whenever
possible. Quickly remove patients from areas of
gasoline spills or leaks, smoke, and exhaust fumes~
This measure alone, which is good practice will all
patients. may improve the patients ability to
communicate with you.
Use the patient’s own medical equipment
whenever possible — some patients with severe
MCS have their own air filters, oxygen tubing.
ceramic face masks, and toxic-free sheets/towels
which should be used in lieu of similar equipment
on the ambulance, with the patient’s permission. If
the patient desires to take his/her own medicine —
such as vitamins sublingual antigens or homeo-
pathic medicines, contact medical control for advice
and concurrence to allow the patient to self-
administer those agents.
• Intravenous fluids in plastic bags may be
harmful ideally, those with MCS should receive
i.v. solutions from glass bottles, but since these are
not standard on ambulance vehicles because of
safety concerns, consider that an i.v. may not be best
for the patient unless critically life-threatening
conditions exist. Also, avoid glucose solutions if
possible and use isotonic solutions.
• Avoid the use of drugs if possible — there needs
to be a balance between what is life-saving and what
may potentially harm a patient. MCS sufferers are
often sensitive to many drugs and preservatives.
Listen to the patient’s concerns, history of reactions
to medicines, and contact medical control for advice
on administration of any medication.
• Avoid use of latex gloves whenever possible — it
is understood that universal precautions are of great
importance to EMT care, but if alternatives to latex
gloves are available, these should be used.
There are scores of other suggestions that may improve
the EMS environment in treating MCS patients. such as
cautious use of disinfectants in the vehicle, hypo-
allergenic tapes and dressings, and the cleaning
practices for linens and towels. Details on these factors
can be obtained by contacting Barak Wolff, MPH.,
(505) 827-2389, or Ann McCampbell, M.D., (505) 466-
It is unfortunate that most MCS patients do not wear
identification bracelets that would notify the EMT of
their condition, but many MCS patients are unable to
wear metal bracelets due to allergies and sensitivities.
Hopefully, a standardized method of identification can
be developed in the future that will be helpful for
emergency providers and patients alike.
In summary. MCS is a serous and complex illness that
is poorly understood by most health care providers
People with MCS may have to access emergency
services because of an exacerbation of their MCS
symptoms or from an unexpected accident. In either
case, it is important for EMTs to be familiar with MCS
so that care can be balanced between what is life-saving
and appropriate versus what can actually produce more
harm to the patient. Listening to the patient, keeping an
open mind, and being flexible within guidelines goes a
long way towards making it a positive experience for all
involved. Utilizing direct medical control when conflicts
arise between standard emergency practices and the
wishes of an MCS patient arc of utmost importance.
As more is discovered in the future about this
complicated disease EMS will undoubtedly adjust its
protocols to provide better procedures and treatments for
MCS patients, while continuing to strive to “do no
THE STORIES OF MCS
Those who have MCS often face complex
challenges that the populace at large will never
experience. In the stories of chemically Sensitive people
in my community, their tales begin to show the faces of
When K.T. developed MCS, neither she nor her doctor
understood what was going on. She experienced a
frightening series of events when she was admitted to a
hospital to readjust the level of medications she ~
taking to deal with the anxiety and insomnia associated
with her MCS. The hospital environment, especially the
perfume and cigarette smoke, produced more serious
reactions and an evaluation by a staff psychiatrist
interpreted her behavior of trying to avoid them as “anti-
social tendencies” Against her wishes, she was
transferred to a county psychiatric facility, but by the
time she arrived there, her thinking had cleared so
completely that she was considered not appropriate for
admission. However, problems developed with the legal
processing of her discharge and she was forcibly
detained for three days until her brother could manage
her release. She describes this experience as “a total
When roller-skating, S.S. accidentally fell and fractured
her wrist. She told the responding EMTs about her
severe MCS and instructed them not to give her any
medicines, but she was not reassured that they would
comply. In the hospital’s ER. she attempted to
communicate the same history to the doctor but was
treated as if she was paranoid, or hysterical. In addition,
the emergency doctor refused to call her private
physician (who was familiar with her chemical
sensitivities) to get advice on how to treat her.
When R.T. accidentally ingested concentrated
hydrogen peroxide, a call to the Poison Control Center
initiated a 911 response. When the medics arrived. R.T.
was vomiting repeatedly and unable to clearly describe
her history and her fear of reactions if she was exposed
to harmful chemicals in the ambulance and hospital
Luckily, a neighbor, who was also chemically sensitive.
was available and advocated for RT.. including advice
that the EMTs not use the plastic oxygen mask and try
to limit R.T.’s exposure to vehicle exhaust and their
cologne. She had a less harmful transport to the hospital
after this information was shared and accepted.
A 43 year old woman, J.C., became ill after working
in an office that was undergoing major remodeling. The
installation of a new carpet produced extreme fatigue.
dizziness, trouble thinking, and difficulty in speaking.
Since then, she has been disabled and unable to work.
She now needs to use air filters in her home and car, and
frequently must wear an industrial respirator when she
goes out. If she catches a whiff of perfume, she feels
like “someone hit me across the head with a baseball
A 44 year old man, C.L., has been forced to move
numerous times in the past three years in an effort to
find living accommodations that are free of
formaldehyde-containing building material. This agent
is commonly found in particle board, plywood, and
carpeting. Exposure to formaldehyde produces foggy
thinking and memory loss so severe in C.L. that he is
unable to balance a checkbook or read a book. He also
suffers from fatigue, depression and severe digestive
problems. The physicians he has gone to for care have
not helped with either a diagnosis or effective treatment
of his illness.
Dr. McCampbell can be contacted at (505) 466-3622 or
In summary, MCS is a serious and complex
illness that is poorly understood by most
health care providers.
Guidelines to prepare for planned or emergency medical care.
Dr. Mc Campbell, who is a medical adviser for HEAL of Southern Arizona, has these suggestions to supplement the advice in the HEAL of S AZ Hospital packet.
. You should have an emergency packet that includes glass IV bottles containing normal saline or half normal saline. These are available from Merritt Pharmaceutical and are good for a couple of years.
• Use any drug in a small dose and go slowly. If you have tolerated a drug before, it’s probably OK.
In an emergency, if the patient is unconscious, you will have to depend on the usual medical treatments.
• If possible, have someone with you to advocate for you a family member or a chemically sensitive friend.
• If you need hospitalization, talk to a physician with whom you have a good rapport. Ask him/her what procedures and medications will be used. If possible, also consult a physician who specializes in environmental medicine.
• Since individual tolerances vary, medications that might be used should be tested using an electro-diagnostic machine, pendulum, muscle testing, etc.
• Most emergency Rooms have an isolation room (or an infection room) that has its own air handling system. Ask to be put in this room, if possible.
• When you are sick or have an emergency, you’ll do the best you can and it will probably be OK.
Copyright 2001-2010, HEAL of Southern Arizona. All rights reserved. Last updated: 1/12/2010