INTERIM GUIDELINES FOR HEALTH PROFESSIONALS ON THE RESPONSE TO SUSPECTED RICIN EXPOSURE

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To:	NHS Trusts - Medical Directors (England) Primary Care Trusts - Medical Directors/Directors of Public Health
Cc (Groups):	Chairman - Professional Executive Committee of PCT Consultants in Communicable Disease DHSC - Directors of Public Health Public Health Link Strategic Health Authorities (England) - Directors of Public Health Territorial CMOs
Fax To:

From:	Dr Pat Troop - Deputy Chief Medical Officer - Department of Health
Date:	9 January 2003

Reference	CEM/CMO/2003/2
Category:	IMMEDIATE (cascade within 6 hours)

Title:	INTERIM GUIDELINES FOR HEALTH PROFESSIONALS ON THE RESPONSE TO SUSPECTED RICIN EXPOSURE

Broadcast Content:

PUBLIC HEALTH LINK

To: Directors of Public Health of PCTs to forward to:

- All GENERAL PRACTITIONERS - please ensure this message is seen by all practice nurses and non-principals working in your practice and retain a copy in your `locum information pack'.

- Deputising services

- NHS and private nursing homes
- Private hospitals and if possible private doctors
- Project manager/Nurse lead in Walk in Centres
- Lead nurses in PCTs
- Leads at nurse-led PMS Pilots

- PCT pharmaceutical advisers

Medical Directors of NHS Trusts

to forward to:

- Accident and Emergency Departments

- Intensive Care/Critical Care Units

- Occupational Health Depts

- Infectious Disease Specialists

- Nurse Executive Directors of NHS Trusts

- Private hospitals and if possible private doctors

- Trust chief pharmacists

Cc: - Regional Directors of Public Health
- Directors of Public Health of Strategic Health Authorities

- National Poison Units

- National Focus to forward to Regional Service Provider Units

- UK CMOs

- PHLS

- CCDCs

- HEPAs

- Chairmen of Professional Executive Committee

From: Dr Pat Troop, Deputy Chief Medical Officer, Department of Health

Date: 9th January 2003

Reference: CEM/CMO/2003/2

Category: **IMMEDIATE MESSAGE**

**PLEASE ACTIVATE THE CASCADE **

Dear health professional

The Public Health Link alert (Reference CEM/CMO/2003/1) issued on Tuesday 7 January 2003 related to ricin in the environment. This alert notice is to provide interim guidelines for health professionals on the response to suspected ricin exposure. These guidelines have been prepared in conjunction with specialist advisers from the National Focus for Chemical Incidents, the Regional Service Provider Units and the PHLS, as well as Consultants in Communicable Disease Control.

We have received a small number of reports that the previous message did not get through to individuals with the required urgency. Therefore we would like to take this opportunity to remind all NHS Trusts and Primary Care Trusts that they must have robust mechanisms for receiving and cascading public health link messages 24 hours a day/7 days a week. They should also be linked into the alert mechanism for receiving public health link messages. The alert is a broadcast page to a Pageone pager. Dr Pat Troop's letter of 6 September 2002 explained how to obtain one of these pagers. All messages are put on the CMO website at: http://www.doh.gov.uk/publichealthlink so if the email has not got through to you then you can obtain it from the website. NHS Trusts and PCTs must maintain contact details for all of the health professionals that they may need to communicate with in an emergency.

INTERIM GUIDELINES FOR HEALTH PROFESSIONALS ON THE RESPONSE TO SUSPECTED RICIN EXPOSURE

1. Clinical situations may arise in which ricin exposure may need to be considered.

2. Guidelines on actions to be taken in the event of a deliberate release of ricin are already available on the PHLS website at: http://www.phls.org.uk/topics_az/deliberate_release/pdf/ricin_guidelines.pdf

3. Guidance on suspect packages and materials is already available on the PHLS web site at: http://www.phls.org.uk/topics_az/deliberate_release/pdf/packages_materials.pdf

4. Guidance on the investigation of unknown illnesses is already available on the PHLS web site at: http://www.phls.co.uk/topics_az/deliberate_release/pdf/unusual_guidelines.pdf. The document on outbreaks and incidents of unusual illness contains specific advice on:
· Whether an incident may have been caused by a deliberate release (page 34 - checklist 2);
· Actions to be taken by specific groups dealing with cases of unusual illness: hospital clinicians (page 26 -flowchart 4); general practitioners (page 48; ambulance services (page 18); pathologists (page 53); local laboratories (page 58); and public health professionals (page 67);
· Initial classification of possible aetiology of unusual illness (page 12 - flowchart 2);
· Management of outbreak/ incident according to likely aetiology (page 69); and
· Sources of expert advice (page 81).

5. It is important to take expert advice early from:
· National Poisons Information Service
· Regional Service Provider Units (Chemical Incidents)
· Public Health Laboratory Service
· Consultants in Communicable Disease Control

6. It is important to inform early:
· Local Police
· Consultants in Communicable Disease Control (to inform Regional Epidemiologist and Regional Director of Public Health who will inform DH)

7. General Practitioners and Ambulance Services should initially obtain advice through their local Accident and Emergency Department and Consultant in Communicable Disease Control.

Please see the attachment which contains an algorithm for medical professionals: patients presenting with signs/symptoms suggestive of exposure to a chemical/biological substance (possibly ricin).

Additional Information: