6.4
Sources of information: role of the NPIS and the Centre for Radiation, Chemical and Environmental Hazards of the Health Protection Agency
There are a number of sources of information for clinicians when faced with poisoned patients. Toxbase is an online information resource developed by the NPIS and widely used as the first source of information for acute clinicians. It is found at www.spib.axl.
co.uk and an institutional password is needed to access this site.
The NPIS, a service commissioned by the Health Protection Agency (HPA), runs a telephone advice service and is able to give advice about the clinical treatment of individual patients and other aspects of management when the chemical has been identified. Some of the individual poisons units that comprise the NPIS hold regional stocks of some antidotes and also have laboratories that can undertake certain toxicological analyses. Lists of accred-ited toxicological laboratories can also be found on the website www.assayfinder.com .
During an acute chemical incident, the Centre for Radiation, Chemical and Environmental Hazards (CRCE) of the HPA can provide information about the toxic effects of chemicals, but will also liaise with the local Health Protection Unit (HPU), assist the emergency services in identifying the chemical(s), and advise other agencies, such as the utilities and local authority. CRCE undertakes surveillance of acute chemical incidents and therefore should be informed of all such events. Both CRCE and the NPIS provide a 24-hour service.
6.5
Planning and preparation
All EDs should have developed a Chemical Incident Plan, which should be separate from, but dovetails into, the Major Incident Plan. This should use the above system but be adapt-ed to the specific facilities and geography. An assessment of the risks in the catchment area of the hospital should be made, including local industry, including Control of Major Accident Hazards (COMAH) sites (Control of Major Accident Hazards Regulations 2005 ), transport systems (motorways, railways, and airports), and possible terrorist targets.
The plan should include contact details of sources of information, which should include:
◆ NPIS
◆ CRCE
◆ local HPUs
◆ institutional password for Toxbase.
It is helpful if an individual or group of members of staff have responsibility for updat-ing the plan and organizupdat-ing appropriate trainupdat-ing. It is useful if that group establishes links with those responsible for chemical response in the blue light services and with the local health emergency planning advisors. The plan should be tested and specific aspects, such as setting up the decontamination equipment and donning PPE, should be practised regularly. In particular, each hospital should determine in advance who will be undertaking decontamination; there are pros and cons to using clinical and non-clinical staff.
6.6
Summary
Treatment of all types of poisoning is primarily symptomatic and supportive, with gut decontamination, enhanced elimination techniques, and antidotes only being suitable for relatively few cases.
In chemical incidents, risk of secondary contamination can be reduced by external decontamination of casualties and appropriate use of PPE by staff who come into contact with patients before and during decontamination.
Advice should be sought from the NPIS and CRCE should be informed.
Chemical incident plans should be developed by all EDs and these should be thoroughly tested and practised.
6.7
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