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.