Thetford plastics fire, October 1991: the role of a preventive medical team in chemical incidents.

OBJECTIVES: To review the role of a medical team in the emergency management of a major polyvinyl chloride (PVC) fire in an urban area. METHODS: The district health authority's consultant in communicable disease control (CCDC) was requested to advise on the health impacts of a fire that consumed some 1000 tonnes of plastic, mainly PVC, over 72 hours and which emitted a large smoke plume that threatened the health of local residents and emergency workers alike, constituting one of the largest incidents the local emergency services had dealt with in recent years. A medical team was formed comprising the CCDC, a regional epidemiologist, an occupational physician, and a medical toxicologist. This paper is an account of this team's experience of advising on the medical management of the emergency without having any formally established role or previous training for the task. RESULTS: The main issues requiring the input of the medical team included: the possible products of combustion and their effects on health; the clinical management of those exposed; the alerting of local hospitals to the type of casualties to expect; the special health risks posed to emergency workers, especially the firemen; the need for evacuation of local residents; the risks of contamination of soil, water, and crops; the potential health impact of the plume; and the provision of expert and authoritative advice on the short and long term health implications to the public. Active surveillance systems, which included the local general practitioners and hospitals, were established and air monitoring instigated. The 46 casualties were restricted to emergency personnel who had inadvertently received exposure to the fire smoke: all recovered within 48 hours. Local residents were unharmed. CONCLUSION: The incident showed the need for preventive medical teams trained to fill a formal advisory and investigative role for chemical releases and fires, and which can play an integral part in emergency management.

Tempting fate: control of communicable disease in England.

Recent changes in the NHS have left many defects in the systems for the control of communicable diseases and infection and their surveillance and the management of outbreaks. Clear, explicit legislation is needed, placing the responsibilities on health authorities. New teams led by consultants need to be set up to investigate and manage outbreaks of communicable diseases of all types.

The epidemiology of snake bite presenting to British Military Hospital Dharan during 1989.

Fifty-eight cases of snake bite seen at the British Military Hospital, Dharan, Nepal during 1989 were studied prospectively. Data is presented on the epidemiology and outcome of snake bite in this area of lowland Nepal with details of the age and sex of patients, date and time of bite, delay in arrival at hospital, use of tourniquets, circumstances of the bite, and snake identification. Neurotoxicity due to envenomation was recorded in 11 patients. No case of coagulopathy was recorded. The overall case fatality was 5.2% but mortality amongst those exhibiting signs of neurotoxicity was 27.3%.

Scrub typhus in Hong Kong.

A retrospective analysis of cases of scrub typhus in military personnel in Hong Kong during the years 1979-1989 is presented. Fifty-nine cases were identified, most occurring during the hot humid season between May and October. Few civilian cases of scrub typhus are notified to the Hong Kong Medical and Health Department and possible reasons for the disparity in case numbers between military and civilian personnel are discussed. Reports from other areas of South-east Asia have documented a previously unrecognized high incidence of scrub typhus in the indigenous population. It is suggested that a prospective study utilizing specific serological diagnostic techniques would be of value in assessing the importance of scrub typhus as a cause of 'fever of undetermined origin' in the civilian population of Hong Kong.

Cerebral cysticercosis as a common cause of epilepsy in Gurkhas in Hong Kong.

A prospective study of Nepalese adults (Gurkhas) based in Hong Kong who presented with adult-onset epileptiform seizures determined that cerebral cysticercosis was causative in 7 out of 8 cases. The relative roles of specific cysticercal serology and computerised axial tomography in diagnosis are discussed. Serum IgE levels were found to be raised in all patients with cerebral cysticercosis in the absence of other parasitic infection and reverted to normal after the patients were treated with praziquantel. Evidence suggests that the Gurkhas acquired their cysticercal infections in Nepal.

Mycobacterium simiae as a cause of intra-abdominal disease: a case report.

A case of intra-abdominal disease caused by Mycobacterium simiae in a Nepalese adult female is reported. She was treated successfully with combination chemotherapy, despite multiple drug resistance in vitro.

Pulmonary tuberculosis in Gurkhas in Hong Kong in the period 1984-1987 and the role played by routine radiology in case detection.

A retrospective study of all cases of pulmonary tuberculosis in Gurkha soldiers and their dependants in Hong Kong in the years 1984-1987 inclusive was performed. In addition all chest X-rays requested for routine purposes and taken at the British Military Hospital, Hong Kong during 1986 were analysed. These studies showed that the current regulations requiring an annual chest X-ray for all Gurkha soldiers and their dependants were neither cost effective nor productive in screening for active pulmonary tuberculosis.

Malaria chemoprophylaxis with a proguanil-chloroquine-maloprim combination in Papua New Guinea.

Proguanil 200mg daily and chloroquine base 300mg weekly along with maloprim 1 tablet weekly was used as malaria chemoprophylaxis for 140 Hong Kong based soliders on a seven-week jungle exercise in a holoendemic malarial area of Papua New Guinea. On return from exercise all personnel were treated with primaquine 7.5mg three times daily for a two week period. One solider developed P. falciparum on the exercise whilst taking chemoprophylaxis and four subsequently developed P. vivax malaria after cessation of chemoprophylaxis.

Fatal disseminated strongyloidiasis in an immunocompromised former war prisoner of the Japanese.

An ex-Far East prisoner of war (FEPOW) treated with corticosteroids for severe polymyositis died from multisystem strongyloidiasis and pyogenic meningitis. At necropsy larvae were widely disseminated in the lungs, liver, heart and brain.

Mast cells and gastric secretion in the rat.

Gastric secretion of acid was measured in adult rats deprived of solid food for 48 hr. In control animals, values were obtained for the residual content of acid in the stomach, indicative of the rate of basal secretion, and for the quantities of acid secreted in 30 min following injections of histamine, pentagastrin, insulin and compound 48/80. The same measurements were made in groups of rats treated for 5 days with compound 48/80 (a regime which depleted the whole body of mast cells) and for 3 days with dexamethasone (which selectively depleted the gastric mucosa of mast cells). The content of residual acid was depressed to one third of the control value in the 48/80-treated rats, but the additional secretion due to histamine, pentagastrin or insulin was unaffected. A secretory response to a single injection of compound 48/80 could not be obtained in rats depleted of mast cells. In the dexamethasone-treated rats, the residual level of acid was increased to 1-5 times the control value, but the magnitudes of the responses to secretogogues were unchanged. It is concluded that basal secretion of acid into the stomach of the rat is stimulated by histamine derived from mast cells throughout the body, those of the gastric mucosa having no special significance in this respect. Mast cells are not involved in the mediation of the secretagogue actions of exogenous histamine, pentagastrin and insulin, but the present results do not preclude the participation of histamine from sources other than mast cells in the process of gastric secretion.