Referral: Maryn McKenna On Dangers Of Responding To Chemical Suicides

 

 

# 5828

 

Maryn McKenna writing on her Superbug Blog has information on a disturbing trend in suicides – the mixing of household chemicals to produce toxic gases – that poses a direct threat to first responders.

 

Maryn, who has spent a good deal of time in Emergency Rooms, has a good understanding of the risks run by rescue personnel.  Something she demonstrated last year in Putting their lives on the line: Meningitis in first responders.

 

Today she brings us a report based on an MMWR Bulletin released yesterday called Chemical Suicides in Automobiles --- Six States, 2006—2010.  Go read:

 

 

Dangerous and Sad: Rising Suicides by Chemical Fumes

 

 

Although I try not to do `war stories’ in the blog, it is worth noting that 1978 I had an elderly patient who drank a pint or more of an unidentified insecticide (probably parathion) in a suicide attempt. 

 

He vomited en route to the hospital in the back of my rig, exposing me to the chemical and its fumes.  In the ER – as we administered multiple doses of Atropine – he vomited again this time exposing a doctor and 2 ER nurses.

 

This was back before we had specialized HAZMAT crews or really any protocols for dealing with this sort of thing. 

 

The bottom line: All of us ended up sickened by the fumes and skin exposure to the chemical, and all of us required weeks to recover.

 

While the use of toxic chemicals to commit suicide was pretty rare 30 years ago, today it appears to be a growing trend. One that can endanger anyone who arrives on the scene: first responders, family members, and even members of the general public.

NIOSH: Disease Risks For Emergency Responders

 

 

 

# 5164

 

 

In mid November Maryn McKenna and I both ran blogs on infectious disease risks run by emergency responders and medical personnel.

 

Maryn wrote Putting their lives on the line: Meningitis in first responders, while I wrote Firefighters & Paramedics At Greater Risk Of MRSA.

 

It is a much more complicated (and dangerous) world for first responders today than when I was a paramedic.  HIV, XDR-TB, MRSA, and a variety of other blood borne and airborne pathogens all pose serious threats to the health of medical personnel, and their families.

 

NIOSH (National Institute for Occupational Safety & Health) and the CDC  are currently seeking public comment on notification procedures for EREs (Emergency Response Employees) when they are exposed to potentially serious infectious diseases.

 

Interested parties (Nurses, Doctors, EMTs, Paramedics, LEOs, Firefighters, etc.) have until February 11th, 2011 to submit written comments.

You can find details on how to do so, and background information, at the NIOSH site below (slightly reparagraphed for readability).   

 

NIOSH Docket Number 219

Implementation of Section 2695 of Public Law 111-87

The Ryan White HIV/AIDS Treatment Extension Act of 2009 (Pub.L. 111–87) addresses notification procedures for designated officers, medical facilities, and State and community public health officers regarding exposure of emergency response employees (EREs) to potentially life-threatening infectious diseases.

 

The secretary of Health and Human Services (Secretary) has delegated authority to the Director of the Centers for Disease Control and Prevention (CDC) to issue a list of potentially life-threatening infectious diseases, including emerging infectious diseases, to which EREs may be exposed in responding to emergencies (including a specification of those infectious diseases that are routinely transmitted through airborne or aerosolized means); guidelines describing circumstances in which employees may be exposed to these diseases; and guidelines describing the manner in which medical facilities should make determinations about exposures.

 

CDC is seeking comment on the list of diseases and guidelines contained in this notice.

 

All comments will be posted without change here, including any personal information provided.

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General Notice and Request for Comments:

General notice and request for comments; 75 FR 77642; 12/13/10 [PDF - 54 KB]

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Background Material:

Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf. Accessed September 23, 2010 [PDF - 3,894 KB]

 

Unofficial figures: Procedures for Notification of Possible Exposure to Infectious Diseases under the Ryan White HIV/AIDS Treatment Extension Act of 2009 [PDF - 1,142 KB]

 

Ryan White HIV/AIDS Treatment Extension Act of 2009 (Pub. L. 111-87, to be codified at 42 U.S.C. 300ff-131 et seq.) [PDF - 195 KB]

 

Baron P. Generation and Behavior of Airborne Particles (Aerosols). PowerPoint Presentation. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Applied Technology. http://www.cdc.gov/niosh/topics/aerosols/pdfs/Aerosol_101.pdf. Accessed September 23, 2010 [PDF - 347 KB]

Firefighters & Paramedics At Greater Risk Of MRSA

 

 

# 5073

 

 

Yesterday Maryn McKenna, writing on some of the infection risks run by first responders (see Putting their lives on the line: Meningitis in first responders), mentioned additional concerns many firefighters and paramedics have expressed about their exposure to MRSA.

 

In her report she referenced a University of Arizona study that looked for – and found – environmental MRSA contamination in Tucson Firehouses (UA Study, Training Keeps MRSA from Firefighting Communities)

 

We’ve another story on precisely the same topic – published yesterday on the University of Washington’s website – regarding a study of first responders who volunteered to be tested for staph colonization.

 

This research revealed that more than 20% of those first responders who agreed to be tested were colonized with MRSA, and an additional 10% carried S. Aureus in their nose.

 

To put this in perspective, here is what the CDC’s MRSA page has to say about the prevalence of these bacteria in the general population.

 

Definition of MRSA

Methicillin-resistant Staphylococcus Aureus (MRSA) is a type of staph bacteria that is resistant to certain antibiotics called beta-lactams. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin, and amoxicillin. In the community, most MRSA infections are skin infections. More severe or potentially life-threatening MRSA infections occur most frequently among patients in healthcare settings.

 

While 25% to 30% of people are colonized* in the nose with staph, less than 2% are colonized with MRSA (Gorwitz RJ et al. Journal of Infectious Diseases. 2008:197:1226-34.).

*Colonized:
When a person carries the organism/bacteria but shows no clinical signs or symptoms of infection. For Staph aureus the most common body site colonized is the nose.

 

 

Although today’s report is based on a small study, a finding of a ten-fold greater rate of MRSA colonization among these first responders is more than a little concerning.

 

Additionally, as in Tucson, environmental MRSA contamination was also detected on a small number of surfaces in their workplace. 

 

 

Follow the link to read the entire article.

 

 

MRSA exposure for fire fighters, medics greater than for general public: UW study

Elizabeth Sharpe

 esharpe@u.washington.edu

 

Firefighters and medics may be, perhaps not surprisingly, at a higher risk for carrying methicillin-resistant Staphylococcus aureus (MRSA) than the average person, according to results from a new study conducted by Marilyn Roberts, a University of Washington professor of environmental and occupational health sciences. Roberts, a microbiologist, recently conducted the first-ever environmental health study on MRSA in Northwest fire stations and on fire personnel to determine the extent of related contamination.

 

(Continue . . . )