So a patient comes to ED after white powder thrown is at them what do you do? Your initial response can help them and everyone in the department!

1. Ask them to leave the department
   • Going to garage was useful
   • Inform Nurse in Charge and Consultant
2. Dynamic risk assessment
   • Performed by nursing/medical staff while outside
3. Decontaminate
   • Non-caustic chemicals: Dry decontamination
   • Caustic, Biological, Radiological: Wet decontamination
   • Retain clothing and wipes,  double bagged as evidence/disposal
   • Patient Disrobing Instruction Card
4. Return to ED

If you haven’t seen the Initial Operational Response (IOR) training video please watch it.

The patient can then be thoroughly assesses, to identify the substance involved (this may involve witnesses, police info and symptomatology), and treated appropriately.

• Public Health England are a useful source of advice.
• Organophophate/Nerve agent – PHE

Police should be informed of the incident for several reasons: 1. Public safety, 2. To collect the evidence and possible find out what it was for you. (if this is not a criminal act Public health England can advise on return/disposal of personal effects)

Inform Manager On-Call of incident as it may disrupt the functioning of ED and can provide support.

 

Patient symptom-free and substance unknown

In our recent case Public Health England advised

• 4-6hr observation
• Discharge with advice:
  • “if developing symptoms to return to the ED via ambulance but the patient must be aware that they must inform 999 of the original exposure.”

Resourses

• Public Health England (PHE) Advice – Lines
• PDF: PHE – Organophosphate – Inc. signs/symps and management of organophosphate poisoning & chain of evidence form
• Action Card – mobile patients
• NHS England (HAZMAT/CBRN) – inc. national stocks
• Home Offices (2015)
  • Disrobing – pg 20
  • DRY decontamination – pg 21
  • WET decontamination – pg 22

NHS England, Public Health England and the Health Protection Agency have produced several very useful resources for us to use – BUT First.

Remove – Remove – Remove

Basics

• Disrobing guide
• Wet – Decon (improvised)
• Dry – Decon (improvised)

Contacts

• Health Protection Agency Teams – HERE
  • West Yorkshire
    • In hours: 0113 386 0300
    • Out of hours: 114 304 9843

• ECOSA (Emergency Coordinated Scientific Advice System) – 0300 3033 493

• UK NPIS – 0344 892 0111

Guides

• PHE: CBRNe Guide – covers from initial contact to specific threats
• HPA: New Disease New Threats – images and info to aid identification
• PHE: Suspected Novichock in ED – guide to management
• NHS England: Guide to Major Incident and Mass Casualty – covers most MAJAX issues inc. ballistics, explosive, chemical
• Local: Ram-Gene – External Radioactive Contamination
• PHE: Radiation (internal only) – we have Rotem Ram-Gene

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