SUBJECT: Management of Exposure to CS Incapacitant Spray PROCEDURE No: MANAGEMENT OF EXPOSURE TO CS INCAPACITANT SPRAY

Transcription

1 SECTION: 16 HEALTH & SAFETY PROCEDURE No: NATURE AND SCOPE: SUBJECT: PROCEDURE TRUSTWIDE MANAGEMENT OF EXPOSURE TO CS INCAPACITANT SPRAY This Procedure raises awareness of and outlines the management of patients, service users, staff and/or visitors exposed to CS Incapacitant Spray (CS) DATE OF LATEST RATIFICATION: MARCH 2017 RATIFIED BY: EXECUTIVE LEADERSHIP TEAM IMPLEMENTATION DATE: MARCH 2017 REVIEW DATE: FEBRUARY 2020 (USUAL RATIFYING COMMITTEE: HEALTH, SAFETY, SECURITY & EMERGENCY PREPAREDNESS COMMITTEE) ASSOCIATED TRUST POLICIES & PROCEDURES: NONE ISSUE 4 MARCH 2017

2 NOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST MANAGEMENT OF EXPOSURE TO CS INCAPACITANT SPRAY PROCEDURE CONTENTS 1.0 Introduction 2.0 Background 3.0 Discharge of CS on Trust Premises 4.0 The Effects of Exposure to CS 5.0 Signs and Symptoms of Exposure to CS 5.1 Primary Signs and Symptoms 5.2 Secondary Signs and Symptoms 6.0 Exposure to CS Prior to Admission 7.0 Aftercare of an Individual Exposed to CS 8.0 Aftercare of an Environment Exposed to CS 9.0 Is Medical Treatment Required After Exposure? 10.0 Personal Protective Clothing and Equipment 11.0 Reporting an Incident of Discharge of/exposure to CS 12.0 Target Audience 13.0 Consultation 14.0 Equality Impact Assessment 15.0 Monitoring Compliance 16.0 Champion and Expert Writer 17.0 Review Date Appendix 1 Appendix 2 Appendix 3 Appendix 4 The Known Short Term Effects of Direct Contact with CS CS Incapacitant Spray - Aftercare and Decontamination Procedures - Aide Memoire Equality Impact Assessment Screening Tool Record of Changes ISSUE 4 MARCH

3 NOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST MANAGEMENT OF EXPOSURE TO CS INCAPACITANT SPRAY PROCEDURE 1.0 INTRODUCTION 1.1 This procedure is to assist with the awareness and management of patients, staff and/or visitors exposed to CS Incapacitant Spray (CS). 2.0 BACKGROUND 2.1 Police issued CS spray, so named because it was first synthesised by American Chemists Corson and Stoughton1928, consists of 5% concentration of CS (Ortho- Clorobenzylendrene Malonitrile) in the solvent MIBK (Methyl Iso Butyl Ketone) with a Nitrogen Propellant. 2.2 CS spray is carried in canisters by operational Police Officers in the United Kingdom who have been properly trained. It is used to provide officers with a tactical advantage in a violent situation. It can be used against an individual or to incapacitate several persons at the same time using the spray in a sweeping movement. 2.3 The canisters contain three ingredients: the active chemical CS (which is one of a group of chemical compounds called lachrymator or tear producing agent) Methyl Iso Butyl Ketone (MIBK), a liquid solvent to dissolve and carry it Nitrogen, an inert gas to act as a propellant for the spray 3.0 DISCHARGE OF CS ON TRUST PREMISES 3.1 The Trust does not expect that staff, patients, service users or visitors will ordinarily be exposed to CS. The Trust would expect CS to be used on Trust premises only in exceptional circumstances. 3.2 However, the Trust recognises that despite some reservations about the use of CS, once the Police are requested to attend and safely manage an incident, it is their decision as to whether CS is the most appropriate means to deal with a hostile or potentially hostile subject. 3.3 In all situations, the Trust expects that, wherever possible, staff will work closely with the Police at these times to disclose and discuss information relevant to the situation about the individual(s) who is/are potentially liable to be sprayed with CS. 3.4 The dialogue should include information that may be helpful to defuse the situation and/or prevent the use of CS. This should include capacity to understand police instructions, the likely effects of CS spray (physical and/or psychological) and the reaction of the individual including ability to comply with first aid instructions. 3.5 The importance of discussion between Trust staff and the Police cannot be over emphasised. Such discussion will help to ensure that wherever CS is used, it represents the least risk, and is the most appropriate form of intervention available at the time. 3.6 Prior to the discharge of CS, anyone not involved must be removed from the immediate vicinity to reduce the likelihood of contamination. 4.0 THE EFFECTS OF EXPOSURE TO CS ISSUE 4 MARCH

4 4.1 The effects of CS on an individual can depend on where and how the spray has been used. Factors that will influence the effects upon an individual are: If the CS has been used out of doors or in a confined space Hot and moist conditions - which make CS more effective than cold dry conditions The accuracy of its delivery 4.2 The primary effects of CS on an individual usually occur within seconds but can take up to 20 minutes. However, there is variation between individuals and some are more susceptible to the effects of CS than others. 4.3 The effects are temporary and reversible and usually last for between 15 minutes and one hour after exposure for the individual, (see Appendix 1). They can last up to 45 minutes for the immediate environment. 4.4 CS is likely to affect other individuals who are in the immediate vicinity or have to make contact with the person who has been sprayed shortly after the use of CS and they may also experience similar effects. 4.5 Alternating staff dealing with the incident may help to reduce the risk and effects of exposure. Staff with a history of respiratory problems or skin complaints should avoid direct contact, where possible, with the contaminated person and area until the affects of the CS have diminished. 5.0 SIGNS AND SYMPTOMS OF EXPOSURE TO CS INCAPACITANT SPRAY 5.1 Primary Signs and Symptoms The primary signs and symptoms of exposure to CS include: Intense pain and redness in the eyes Excessive watering of the eye A burning sensation in the throat Constriction of the chest Choking, coughing, retching Excessive mucus production Irritation of the skin 5.2 Secondary Signs and Symptoms The secondary signs and symptoms of exposure to CS include: Possible reddening of skin which may cause flaking or blistering. This is usually caused by the solvent used with the CS to form the spray The secondary effects may last for up to one week after exposure. 5.3 The effects of the CS will vary depending on the individual exposed and their susceptibility to the spray. 6.0 EXPOSURE TO CS PRIOR TO ADMISSION ISSUE 4 MARCH

5 6.1 There may be times Trust staff will come into contact with an individual who has been sprayed with CS prior to admission. In this instance, it is important that the time lapse between exposure and arrival for admission is identified. This will give an indication as to what effects the individual may be suffering and the likely duration. 6.2 On arrival, the individual should be escorted to a quiet room away from other patients, staff and visitors. Where possible, access to fresh air or free flowing ventilation should be provided to expedite the recovery process. 6.3 It is very likely that the individual s clothing will have been contaminated creating the possibility of reactivation. Clothing should therefore be removed at the earliest opportunity and suitable temporary clothing provided. 7.0 AFTERCARE OF AN INDIVIDUAL EXPOSED TO CS 7.1 The aftercare of an individual who has been sprayed with CS and the aftercare needs of third parties are the same. Prompt intervention and advice will provide the most benefit and reassurance to the person(s) affected. 7.2 Staff should wear clinical gloves and protective clothing (such as disposable aprons) wherever possible when in contact with an individual exposed to CS. 7.3 When approaching the individual, consideration should be given to the possible need to use physical restraint and the risks of contamination that this might present. 7.4 The individual s hearing might be impaired by the use of CS, due to stress reactions brought on by pain and therefore communication should be established by using clear and loud instructions. 7.5 Reassurance that the effects are temporary and normal recovery is likely within 15 minutes should be given. 7.6 The individual should be advised to keep their hands away from their face and not to rub their eyes. They will want to rub their eyes but this will spread the area of contamination and raise the temperature of the skin which will increase the burning sensation. 7.7 Exposure to CS will make removal of contact lenses difficult due to the eyes watering and closing. The individual should be encouraged to allow their tears to naturally irrigate their eyes until they feel able to remove the lenses easily. 7.8 Rigid (hard) lenses should be thoroughly rinsed and then cleaned as usual. It is unlikely that the CS will cause damage or that crystals can become embedded into them. Nonrigid (soft) lenses are likely to allow CS to enter into and through the lens material. Repeated exposure to CS is likely to damage the soft lenses and therefore it is best to assume that they are damaged and the individual should be advised not to wear them again. 7.9 The individual should be encouraged to wash and dry their hands before removing the lenses If possible remove contaminated clothing and place in a sealed polythene/plastic bag to prevent off gassing. The bag should be labelled accordingly. Be aware of the possible release of CS crystals from the clothing as it is removed. Where possible, this should be conducted in a well ventilated room, not connected to any shared air conditioning system so as to minimise the cross contamination of CS. ISSUE 4 MARCH

6 7.11 The individual should be encouraged to sit upright and breathe normally. Staff must monitor the person s breathing, pulse and blood pressure keeping a record in the Nursing Notes DO NOT irrigate the affected areas or allow patients/staff to rub their eyes. This will rupture more crystals and make the problems worse Showering will re-activate the crystals and cause increased pain. The casualty s facial skin and hair are best decontaminated by washing in cool tap water over a sustained period of 3-5 minutes. No other solutions should be used to wash face or skin The individual should be advised to wash their hands thoroughly before using the toilet to avoid further contamination risks Where possible a contaminated person should be moved to an uncontaminated area that is well ventilated an area outside is ideal where the individual can stand in the open to let the wind and fresh air neutralise effects. Do not stand the individual in front of an open window as this could cause any remaining crystals to be blown back into the room and risk contaminating others who are present If staff have any concerns about an individual s health, or if the effects of exposure to CS persist over a longer timescale than anticipated, a medical assessment is required. Staff must request attendance by a doctor or convey the individual to an Emergency Department. 8.0 AFTERCARE OF THE ENVIRONMENT EXPOSED TO CS 8.1 Prevent others from coming into the area where CS has been used for about 45 minutes. 8.2 If a room in Trust premises is contaminated, the doors and windows should be left open to allow air to blow through. A well ventilated room should clear of CS in 45 minutes. 8.3 If this is not possible, all surfaces within the contaminated area should be washed down using hot soapy water or a detergent and then thoroughly rinsed to remove any CS residue. The cloth should be disposed of when the wash down is complete. It is safe for the dirty water to be disposed of down the drains. 8.4 The person carrying out the cleaning should be advised of the risks by the person in charge. 8.5 The person carrying out the cleaning should wear Personal Protective Equipment (PPE) such as rubber gloves, tight fitting glasses (safety goggles) and a face mask. Once the cleanse is complete, these items should be disposed of in a labelled sealed bag. An overall should also be worn which should be washed immediately after use or put in a labelled sealed plastic/polythene bag until this can be carried out. 8.6 Contaminated clothing should be pegged onto a washing line or similar to allow fresh air to blow the majority of CS crystals away. This should then be followed by a thorough wash. If there is access to a washing machine, a couple of cycles should ensure that any remaining CS is removed from the clothing. 9.0 IS MEDICAL TREATMENT REQUIRED AFTER EXPOSURE? 9.1 Symptoms generally improve without medical treatment. However, if there are special concerns about pre-existing medical conditions, severe symptoms that do not improve within the expected timeframe, or health problems continue to be experienced, medical attention should be sought. ISSUE 4 MARCH

7 9.2 The effects of CS are usually only temporary. Symptoms typically go away within an hour after exposure stops. Effects on skin may take longer to improve. 9.3 For most people, health effects improve quickly and no future health problems would be expected PERSONAL PROTECTIVE CLOTHING AND EQUIPMENT 10.1 Individual Directorates should consider making available a CS Incapacitant Spray Emergency Pack for managing the effects of CS. This could include: Arco suits (disposable paper jump suits) for use by patients and staff whose clothing is contaminated Disposable aprons Disposable Clinical gloves Safety goggles Disposable face masks Disposable cloths Polythene bags Labels 11.0 REPORTING AN INCIDENT OF DISCHARGE OF/ EXPOSURE TO CS 11.1 After any incident of discharge of/exposure to CS, the Serious Untoward Incident (SUI1and SUI 2) report forms must be completed and circulated as per Trust Policy TARGET AUDIENCE 12.1 All Trust employees CONSULTATION 13.1 Consultation has been via the Trust Health and Safety Committee (including Staffside), the Executive Leadership Council and the Public Order and Safety Training Department, Nottinghamshire Police EQUALITY IMPACT ASSESSMENT 14.1 This procedure has been assessed using the Trust Equality Impact Assessment Screening Tool. The assessment concluded that the procedure has no adverse impact on, or result in the positive discrimination of, any of the diverse groups detailed. These include the strands of disability, ethnicity, gender, gender identity, age, sexual orientation, religion/belief, social inclusion and community cohesion Two of the core Trust values are to respect individuals and deliver effective communication. The Trust will ensure that all staff embrace these values when working with service users and help make a difference to their lives. The Trust is committed to treating every individual fairly and will not discriminate against any individuals or groups of people because of their race, gender, disability, age, religion or belief, sexual orientation, gender identity, marriage/civil partnership status or pregnancy and maternity status 15.0 MONITORING COMPLIANCE ISSUE 4 MARCH

8 15.1 The effectiveness of the procedure will be assessed at the Trust Health & Safety Committee on reviewing incidents reports of patients, staff and visitors being exposed to CS Spray CHAMPION AND EXPERT WRITER 16.1 The Champion of this procedure is the Executive Director of Nursing. The Expert Writer is the Trust Head of Emergency Preparedness, Resilience & Response (EPRR) REVIEW DATE 17.1 This procedure will be reviewed every three years or on receipt of new guidance in the Management of Exposure to CS Incapacitant Spray. ISSUE 4 MARCH

9 APPENDIX 1 THE KNOWN SHORT TERM EFFECTS OF DIRECT CONTACT WITH CS INCAPACITANT SPRAY SYMPTOMS WHICH MEANS ONSET TIME TIME TO RELIEF Inflammation of conjunctiva Causes red, water and itchy eyes 0-10 secs mins Pain in eyes Pain in the eyes 0-10 secs mins Reduced visual acuity Blurred vision 0-10 secs mins Excess lachrymation Causes ongoing tears 0-10 secs 15 mins Blepharospasm Rhinorrhoea Involuntary contraction of one of the muscles that controls the eyelids, causing them to close Persistent watery mucus discharge from the nose 0-10 secs mins 0-10 secs mins Burning sensation Burning sensation 0-10 secs mins Coughing Coughing 0-10 secs 10 mins Photophobia Difficulty breathing Tightness / pain in chest Sensitivity to light (only 10% of subjects) Irregular breathing including breathlessness for short periods, wheezing Including breathlessness for short periods 0-10 secs 1 hour 0-10 secs 10 mins 0-10 secs 10 mins Apprehension Feelings of fear 0-10 secs Varies Stinging / burning sensation on skin Stinging / burning sensation on skin Few minutes 15 mins Erythema skin Inflammation and irritation of skin Few minutes hours Erythema eyelids Inflammation and irritation of eyelids Few minutes 1 hour ISSUE 4 MARCH

10 APPENDIX 2 CS INCAPACITANT SPRAY AFTERCARE & DECONTAMINATION PROCEDURES AIDE MEMOIRE CS will cause temporary discomfort to the eyes, throat and nasal passages, and a burning sensation on the skin. People exposed to CS may also experience temporary difficulty in breathing and tightness of the chest, accompanied by coughing, retching and sneezing. Anyone experiencing the effects of CS should be: Moved to an uncontaminated area Given verbal reassurance that symptoms will only be temporary Encouraged to breathe normally. Medical assistance should be sought if breathing has not returned to normal after minutes Exposed to cool fresh moving air, if practical Advised to keep their eyes closed, until it is comfortable to open them Advised not to rub their eyes or face NB: EYES SHOULD NOT BE IRRIGATED Hands must be thoroughly washed before: Removing contact lenses (using disposable gloves where available) Going to the toilet DECONTAMINATION CLOTHING Contaminated clothing should be decontaminated by exposure to fresh air before being dry cleaned or washed. Anyone handling the clothing must wear rubber gloves and apron. DECONTAMINATION PREMISES A well ventilated room should be clear of CS in 45 minutes. Fans can be used to assist with this. Surfaces should be washed with detergent or hot soapy water and thoroughly rinsed. Rubber gloves, an apron and face mask should be worn (goggles if available). Dirty water can be poured down drain. Dirty cloths should be disposed of. Buckets should be washed out. ISSUE 4 MARCH

11 EQUALITY IMPACT ASSESSMENT (EIA) SCREENING TOOL APPENDIX 3 Name of policy/procedure/strategy/plan/function etc being assessed: Brief description of policy/procedure/strategy/plan/ function etc and reason for EIA: Names and designations of EIA group members: List of key groups/organisations consulted Data, Intelligence and Evidence used to conduct the screening exercise MANAGEMENT OF EXPOSURE TO CS INCAPACITANT SPRAY 16.4 This Procedure raises awareness of and outlines the management of patients, service users, staff and/or visitors exposed to CS Incapacitant Spray (CS) Caroline Brookes, Trust Head of EPRR Julie Gardner, Associate Director for Safeguarding & Social Care Trust Health, Safety, Security & Emergency Preparedness Committee Leadership Council Public Order and Safety Training Department, Nottinghamshire Police. Human Rights Act 1998 Health & Safety at Work 1974 etc Act ISSUE 4 MARCH

12 Equality Strand Race Gender Incl. Transgender Disability Incl. Mental Health and LD Religion/Belief Sexual Orientation Age Does the proposed policy/procedure/ strategy/ plan/ function etc have a positive or negative (adverse) impact on people from these key equality groups? Please describe No adverse impact or positive discrimination identified. This is a Statutory policy to maintain the safety of all individuals whilst ensuring the continued delivery of Trust services. Are there any changes which could be made to the proposals which would minimise any adverse impact identified? What changes can be made to the proposals to ensure that a positive impact is achieved? Please describe No this is a Statutory policy and will be implemented to ensure the health, safety and welfare of all affected N/A Have any mitigating circumstances been identified? Please describe Areas for Review/Actions Taken (with timescales and name of responsible officer) Author to review in 3 years As Race As above As above Author to review in 3 years As Race As above As above Author to review in 3 years As Race As above As above Author to review in 3 years As Race As above As above Author to review in 3 years As Race As above As above Author to review in 3 years 1 As Race As above As above Author to review in 3 years As Race As above As above Author to review in 3 years Community Cohesion* 2 Human Rights * 3 As Race As above As above Author to review in 3 years ISSUE 4 MARCH

13 * 1 for Social Inclusion please consider any issues which contribute to or act as barriers, resulting in people being excluded from society e.g. homelessness, unemployment, poor educational outcomes, health inequalities, poverty etc * 2 Community Cohesion essentially means ensuring that people from different groups and communities interact with each other and do not exclusively live parallel lives. Actions which you may consider, where appropriate, could include ensuring that people with disabilities and non-disabled people interact, or that people from different areas of the City or County have the chance to meet, discuss issues and are given the opportunity to learn from and understand each other. * 3 The Human Rights Act 1998 prevents discrimination in the enjoyment of a set of fundamental human rights including: The right to a fair trial, Freedom of thought, conscience and Religion, Freedom of expression, Freedom of assembly and association and the right to education Conclusions and Further Action (including whether a full EIA is deemed necessary and agreed date for completion) Screening Tool Consultation End Date Name of Equality and Diversity (E&D) Group Approving EIA (i.e. Directorate E&D Group, Divisional E&D Forum or Trustwide E&D Steering Group) Name of Responsible Officer Name and Contact Details (tel. , postal) Following this EIA screening exercise, it has been concluded that a full EIA is not required. This procedure applies to all Trust employees, patients, clients, service users inclusive of diversity strands. February 2017 EIA Reviewed, no amendments required. Equality and Diversity Sub-Committee of the Board of Directors. Caroline Brookes, Trust Head of EPRR caroline.brookes@nottshc.nhs.uk (0115) ISSUE 4 MARCH

14 APPENDIX 4 Procedure for: Management of Exposure to CS Incapacitant Spray Issue: 04 Status: Author Name and Title: APPROVED Caroline Brookes Head of Emergency Preparedness, Resilience & response (EPRR) Issue Date: 02 MARCH 2017 Review Date: FEBRUARY 2020 Approved by: EXECUTIVE LEADERSHIP TEAM (01/03/2017) (USUAL RATIFYING COMMITTEE: HEALTH, SAFETY, SECURITY & EMERGENCY PREPAREDNESS COMMITTEE) Distribution/Access: Normal RECORD OF CHANGES DATE AUTHOR PROCEDURE DETAILS OF CHANGE Feb Small changes to terminology. Additional sections C Brookes as per Trust policy writing guidance Jan 2013 Brookes Reviewed and no changes other than titles of Champion and Expert Writer May 2016 Brookes Update to dates and NHS Foundation Trust and titles ISSUE 4 MARCH