Dr Rob Orford Public Health England

Transcription

1 CARIMEC Chemical & Radiological Inventory for Medical Emergency Countermeasures ASHT III - Alerting, Reporting and Surveillance System for Chemical Health Threats, Phase III. Dr Rob Orford Public Health England

2 Acknowledgements Alerting System for Chemical Health Threats, Phase III (ASHTIII) Group Rob Orford, Charlotte Hague, Monique Mathieu-Nolf, Laura Settimi, Herbert Desel, Martin Ebbecke, Daniela Pelclova, Sergey Zakharov, Gabija Dragelyte, Robertas Badaras, Erik Andrew Richard Adams, Gillian Jackson, Franca Davanzo, Fabrizio Sesana, Al Bronstein, Raquel Duarte-Davidson

3 CARIMEC Identify and consolidate an inventory of public health measures and medical countermeasures for appropriate response following toxic industrial chemicals or radio nuclear incidents, to include: Immediate actions after an incident Decontamination procedures Monitoring for people/ patient assessment purposes Public health response State of play for EU coordination and international liaison and alerting Case studies

4 EU co-funded best practise Project Optimisation through Research of Chemical Incident Decontamination Systems (ORCHIDS [ ]) Inventory Section Mass Casualty Decontamination Public Health Response to Chemical Incident and Emergencies Toolkit (CIE-Toolkit [ ]) Public Health Management MASs-casualties and Health-care following the release of toxic chemicals or radioactive materials (MASH [ ]) Alerting System for Chemical Health Threats (ASHTII [ ]) Development of an Alerting System for Chemical Health Threats (ASHTI [ ]) Development of Generic Scenarios, Alerting System and Training Modules Relating to Release of Chemicals by Terrorists (GCST) Medical Management Clinical Effects & Chemical List Chemical List Chemical List CARIMEC

5 CARIMEC

6 CARIMEC monographs for 47 Agents 1. Acetone 2. Acetylene 3. Acrylonitrile 4. Aluminium 5. Aluminium phosphide 6. Ammonia 7. Aniline 8. Arsenic 9. Arsine 10. Asbestos 11. Benzene 12. Bromine 13. Cadmium 14. Carbon disulphide 15. Carbon monoxide 16. Chlorine 17. Chloroform 18. Cyclohexane 19. Diesel 20. Dioxin 21. Ethanol 22. Ethylene glycol 23. Ethylene oxide 24. Formaldehyde 25. Hydrogen chloride 26. Hydrogen cyanide 27. Hydrogen peroxide 28. Hydrogen sulphide 29. Kerosine 30. Lead 31. Mercury 32. Methanol 33. Napthalene 34. Nitric acid 35. Petrol 36. Phenol 37. Phosgene 38. Phosphorous white/ yellow 39. Potassium cyanide 40. Sodium hydroxide 41. Sodium hypochlorite 42. Styrene 43. Sulphuric acid 44. Sulphur mustard 45. Trichlorethylene 46. Xylene 47. VX CARIMEC

7 State of play for EU coordination and international liaison and alerting CARIMEC

8 State of play for EU coordination and international liaison and alerting CARIMEC

9 Objectives Development of EU standardized Chemical Emergency Risk Management (CERMs). Evaluation of automated EU Poison Control Centre exposure case data processing for surveillance. Development of a Toxidrome IT tool to enhance RASCHEM functionality. Feasibility study of using RASCHEM for reporting human pesticide exposures (to meet EU Directives 1998/8/EC and 2009/128/EC) Feasibility of establishing a network of toxicological experts to monitor toxicological data reported to RASCHEM & improve global health awareness

10 Chemical Emergency Risk Management (CERM) sheets 1 Acetone 26 Chloropicrin 51 Lambda cyhalthorin 76 Silicon tetrachloride 2 Acetylene 27 Coal tar 52 Lead 77 Sodium azide 3 Acrylonitrile 28 cyanogen chloride 53 Lewisite 78 Sodium hydroxide 4 Adamsite 29 Cyclohexane 54 Malathion 79 Sodium hypochlorite 5 Agent CS 30 Deltamethrin 55 Melamine 80 Soman 6 Alkalis 31 Dichlorvos 56 Mercury 81 Strychnine 7 Aluminium 32 Diesel 57 Metaldehyde 82 Styrene 8 Aluminium phosphide 33 Diflubenzuron 58 Methacrylonitrile 83 Sulfur mustard 9 Aluminium sulphate 34 Dioxin 59 Methanol 84 Sulfuric acid 10 Aminotadalafil 35 Diquot 60 Methyl Mercaptan 85 Sulphur 11 Ammonia 36 Epichlorohydrin 61 Methylisocyanate 86 Sulphur dichloride 12 Aniline 37 Ethanol 62 Napthalene 87 Sulphur trioxide 13 Arsenic 38 Ethylene glycol 63 Nitric acid 88 Sulphuryl fluoride 14 Arsine 39 Ethylene oxide 64 Nitrogen mustard 89 Tabun 15 Asbestos 40 Fentanyl 65 OP Nerve Agents 90 Terbufos 16 Benzene 41 Fluorine 66 Paraquat 91 Thallium 17 Botulinum toxin 42 Formaldehyde 67 Permethrin 92 Thallium (I) chloride 18 Bromine 43 Hydrochloric acid 68 Petrol 93 Thionyl chloride 19 Cadmium 44 Hydrogen chloride 69 Phenol 94 Toluene-2-4-diisocyanate 20 Camphor 45 Hydrogen cyanide 70 Phosgene 95 Trichlorethylene 21 Carbon disulphide 46 Hydrogen fluoride 71 Phosphorous oxychloride 96 Triphenyl phosphate 22 Carbon monoxide 47 Hydrogen peroxide 72 Phosphorous white/ yellow 97 Vanadium 23 Chlorine 48 Hydrogen sulphide 73 Potassium cyanide 98 VX 24 Chloroacetic acid 49 Iodine 74 Ricin 99 Xylene 25 Chloroform 50 Kerosine 75 Sarin

11 Delivery target: 12hrs

12 Rapid Alert System for Chemicals (RASCHEM) RAPEX Webcrawlers Webcrawlers UK NPIS Webcrawlers UK CRCE Webcrawlers Event Based Surveillance

13 Indicator Based Surveillance

14 Chemical Severity Route of exposure Indicator Based Surveillance

15 PLANT PROTECTION PRODUCTS BIOCIDES Other PPPs Herbicides Fungicides and Bactericides Rodenticides Insecticides and Acaricides Soil sterilants Mulluscicides Plant grouth regulators MG 3-Pest control PT14-Rodenticides (MG 3) PT18-Insecticides (MG 3) PT16-Mulluscides (MG 3) MG 2-Preservatives MG 1-Disinfectants MG 4-Other biocidal products es/pesticides_database/index_en.htm Indicator Based Surveillance ides/transition.htm

16 Table 1a. Biocidal Rodenticide exposures identified in in Germany, Italy, and the United Kingdom Chemical class Code Chemical class Biocides (code: B14) Active ingredient code (CAS No.) Active ingredient denomination D ^IT UK n. % n. % n. % 099 Acidic oxides 2 0,7 0 0,0 0 0, Carbon dioxide 2 0,7 0 0,0 0 0,0 045 Coumarins , , , Brodifacum 47 17, ,7 28 1, Bromadiolone 13 4, , ,6 997* Bromadiolone and other coumarines 0 0,0 19 2,2 0 0, Coumatetralyl 14 5, ,9 13 0, Dicoumarol 0 0,0 1 0,1 0 0, Difenacoum ,3 63 7, , Difethialone 35 13,0 19 2,2 2 0, Flocoumafen 27 10,0 8 0,9 4 0, Warfarin 26 9,6 2 0,2 24 1,5 070 Glucosides 0 0,0 17 1,9 28 1, Chloralose 0 0,0 17 1,9 28 1,8 079 Indandiones 2 0,7 49 5,6 2 0, Chlorophacinone 2 0,7 48 5,5 2 0, Diphacinone 0 0,0 1 0,1 0 0,0 185 Vitamin D compounds 0 0,0 1 0,1 25 1, Colecalciferol 0 0,0 1 0,1 25 1,6 998 Other chemical classes/unclassified 0 0,0 1 0,1 36 2, Corn cob, powdered 0 0,0 0 0,0 33 2, Calcium lignumsulfonate 0 0,0 1 0,1 0 0, Strychnine 0 0,0 0 0,0 9 0,6 999 Unknown 0 0, , ,2 Total Rodenticides , , ,0 *Combined exposure to active ingredients belonging to the same chemical class; **exposures occurred in Indicator Based Surveillance 16

17 EU PC Data Processing Indicator Based Surveillance

18 ASHT contribution to EU Legal Frameworks Aiding the Commission and MSs in providing ad-hoc surveillance, situational awareness Lisbon and exchanging Treaty best Article practice 168 both in the preparedness and response to serious cross border chemical incidents in 1. A high support level of human of the EU health Decision protection for Serious shall Cross be ensured Border in Health the definition Threats and (Art implementation 4,6) of all Union policies and activities. Union action, which shall complement national policies, shall be directed towards improving Contributing public health, to work preventing at the physical European and level mental related illness to the and harmonisation diseases, and obviating sources of of danger dangerous to physical chemicals and as mental described health. in Article Such action 45 of the shall CLP cover Directive; the fight against the major health scourges, by promoting research into their causes, their transmission and their prevention, Enabling as MSs well to as fulfil health their information obligations and in reporting education, exposures and monitoring, biocides early warning of and and pesticides combating products serious as cross-border stipulated in threats Directive to 2009/128/EC; health. Regulation (EC) n. 1107/2009 and Directive 98/8/EC; Regulation (EU) n. 528/2012 in a harmonised manner.

19 There is a need to find a mechanism for: I. Full roll-out and training on RASCHEM. II. Training and support for assessing risks at national level from emerging chemical threats. III. Maintenance of Event & Indicator Based Surveillance and RASCHEM moderation. IV.Development of resources for EU MSs and EC. V. Development and maintenance of codes and terms that are used to record exposures. VI.Development of enhanced cross-sectoral operation and exchange for chemical health threats.