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

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

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

EU co-funded best practise

Project Inventory Section

Optimisation through Research of Chemical Incident

Decontamination Systems (ORCHIDS [2007203]) Mass Casualty Decontamination

‘Public Health Response to Chemical Incident and

Emergencies Toolkit (CIE-Toolkit [2007205]) Public Health Management

MASs-casualties and Health-care following the release of

toxic chemicals or radioactive materials (MASH [2007209]) Medical Management

Alerting System for Chemical Health Threats (ASHTII

[2007210]) Clinical Effects & Chemical List

Development of an Alerting System for Chemical Health

Threats (ASHTI [2004212]) Chemical List

Development of Generic Scenarios, Alerting System and

Training Modules Relating to Release of Chemicals by

Terrorists (GCST)

Chemical List

CARIMEC

CARIMEC

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

State of play for EU coordination and international liaison and alerting

CARIMEC

State of play for EU coordination and international liaison and alerting

CARIMEC

• 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

Objectives

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

Chemical Emergency Risk Management (CERM) sheets

Delivery target: 12hrs

Rapid Alert System for Chemicals (RASCHEM)

RAPEX

UK CRCE

UK NPIS

Webcrawlers

Webcrawlers

Webcrawlers

Webcrawlers

Event Based Surveillance

Indicator Based Surveillance

Severity Route of exposure

Chemical

Indicator Based Surveillance

Rodenticides

PT14-Rodenticides (MG 3)

PT18-Insecticides (MG 3)

Insecticides and Acaricides

Mulluscicides PT16-Mulluscides (MG 3)

MG 3-Pest control

MG 1-Disinfectants

MG 2-Preservatives

MG 4-Other biocidal products

Fungicides and Bactericides

Herbicides

Plant grouth regulators

Other PPPs

http://ec.europa.eu/food/plant/pesticides/pesticides_database/index_en.htm

http://ec.europa.eu/environment/biocides/transition.htm

PLANT PROTECTION PRODUCTS

Soil sterilants

BIOCIDES

Indicator Based Surveillance

16

Table 1a. Biocidal Rodenticide exposures identified in 2007-2012 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 0,0

124-38-9 Carbon dioxide 2 0,7 0 0,0 0 0,0

045 Coumarins 268 99,3 479 54,6 677 42,8

56073-10-0 Brodifacum 47 17,4 94 10,7 28 1,8

28772-56-7 Bromadiolone 13 4,8 160 18,2 342 21,6

997* Bromadiolone and other coumarines 0 0,0 19 2,2 0 0,0

5836-29-3 Coumatetralyl 14 5,2 113 12,9 13 0,8

66-76-2 Dicoumarol 0 0,0 1 0,1 0 0,0

56073-07-5 Difenacoum 106 39,3 63 7,2 264 16,7

104653-34-1 Difethialone 35 13,0 19 2,2 2 0,1

90035-08-8 Flocoumafen 27 10,0 8 0,9 4 0,3

81-81-2 Warfarin 26 9,6 2 0,2 24 1,5

070 Glucosides 0 0,0 17 1,9 28 1,8

15879-93-3 Chloralose 0 0,0 17 1,9 28 1,8

079 Indandiones 2 0,7 49 5,6 2 0,1

3691-35-8 Chlorophacinone 2 0,7 48 5,5 2 0,1

27668-52-6 Diphacinone 0 0,0 1 0,1 0 0,0

185 Vitamin D compounds 0 0,0 1 0,1 25 1,6

67-97-0 Colecalciferol 0 0,0 1 0,1 25 1,6

998 Other chemical classes/unclassified 0 0,0 1 0,1 36 2,3

00-00-0 Corn cob, powdered 0 0,0 0 0,0 33 2,1

00-00-0 Calcium lignumsulfonate 0 0,0 1 0,1 0 0,0 57-24-9 Strychnine 0 0,0 0 0,0 9 0,6 999 Unknown 0 0,0 330 37,6 809 51,2 Total Rodenticides 270 100,0 877 100,0 1.580 100,0

*Combined exposure to active ingredients belonging to the same chemical class; **exposures occurred in 2007-2010

Indicator Based Surveillance

EU PC Data Processing

Indicator Based Surveillance

ASHT contribution to EU Legal Frameworks

• Aiding the Commission and MSs in providing ad-hoc surveillance, situational awareness and exchanging best practice both in the preparedness and response to serious cross border chemical incidents in support of the EU Decision for Serious Cross Border Health Threats (Art 4,6)

• Contributing to work at the European level related to the harmonisation

of dangerous chemicals as described in Article 45 of the CLP Directive; • Enabling MSs to fulfil their obligations in reporting exposures to biocides

and pesticides products as stipulated in Directive 2009/128/EC; Regulation (EC) n. 1107/2009 and Directive 98/8/EC; Regulation (EU) n. 528/2012 in a harmonised manner.

Lisbon Treaty – Article 168

1. A high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities. Union action, which shall complement national policies, shall be directed towards improving public health, preventing physical and mental illness and diseases, and obviating sources of danger to physical and mental health. Such action shall cover the fight against the major health scourges, by promoting research into their causes, their transmission and their prevention, as well as health information and education, and monitoring, early warning of and combating serious cross-border threats to health.

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.