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

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

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

HIGHLY TOXIC chemical warfare agents: small drop on skin can be FATAL
Cause death by RESPIRATORY ARREST due to CNS depression and muscle paralysis by same mechanism as organophosphorus insecticides
Absorbed through skin (through clothing) and eyes, by inhalation, or by ingestion
RAPID DRY DECONTAMINATION is essential following SKIN EXPOSURE; secondary cases can follow exposure to inadequately decontaminated primary cases
Clinical effects depend on agent, on dose, duration and route of exposure
Local effects are immediate
SPECIFIC ANTIDOTES AVAILABLE AND CAN BE LIFE SAVING IF ADMINISTERED PROMPTLY
Seek Immediate expert advice/support from:
- ECOSA (Emergency Coordinated Scientific Advice System)
- NPIS (National Poisons Information Service)
Always treat as a deliberate release – Contact Police

PPE (gowns, visors and two pairs of nitrile gloves) is adequate
It is not necessary to invoke lock down procedures in this situation
Ideally care should be provided in a single person room – where clothing and clinical waste can be secured safely for later disposal
Primary decontamination of a patient is achieved by removal and double bagging of their clothing
When time allows decontamination using a careful wash of the patient’s skin using soap / detergent and water is desirable using standard NHS PPE (gowns, visors and two pairs of nitrile gloves)

P1 (Severe): Unconscious, convulsions, respiratory distress, respiratory paralysis / arrest, profound bradycardia (< 40), cyanosis.

P2 (Moderate): Not walking. Excessive secretions, confusion, not obeying commands, wheezing, incontinence.

Atropine dose in <12yrs (PHE recommendation) – 50 – 75 microgram/kg

The most important differential diagnosis is suspected opiate overdose, and a trial of naloxone should be given initially PHE recommend:

Naloxone 12 years or over:

Naloxone Under 12 years of age:

Initial dose of 100 micrograms/kg (0.1mg/kg) up to a maximum of 2mg,
No response after 60 seconds give another 100micrograms/kg (0.1mg/kg)
Repeat until a satisfactory response has been obtained or a maximum of 2mg has been given.