WS/T 679-2020Technical specifications for health emergency response to sudden poisoning incidents (English PDF)

5.2 Principles for determining the cause

5.2.1 Etiology determination with complete evidence

The epidemiological investigation of an incident showed that there was a clear history of toxicant exposure and the basis for the clinical characteristics of poisoning, and the toxicant detection and identification results supported the epidemiological investigation.

5.2.2 Etiology determination with evidence deficiency

The epidemiological investigation of an incident showed that there was a clearly related history of toxicant exposure and the basis for the clinical characteristics of poisoning, but no toxicant test could be carried out Identification, or identification results of toxicant detection and epidemiological investigations cannot be fully confirmed.

6.1 Personal protection of health emergency personnel

See WS/T 680-2020 Appendix B requirements.

6.2 On-site emergency decontamination

6.2.1 When the poisoning emergency professionals are evacuating from the poison-contaminated area on the spot, they should first spray their personal protective equipment in the decontamination area.

Rinse, remove the protective equipment after cleaning, put it in a special container and properly seal it for storage.

6.2.2 All equipment and equipment that may be contaminated by toxic substances when entering the scene should be uniformly disposed of in the decontamination area. Can use water or decontaminate Equipment and equipment for preliminary decontamination of liquid, such as sampling tanks, sampling bags, etc., should be decontaminated first, and then use clean materials for outer packaging.

Keep and handover properly. Equipment that cannot be decontaminated on site, such as precision instruments, electronic equipment, etc., should be sealed and stored in a special container.

6.2.3 The waste liquid generated from on-site decontamination should be collected uniformly and handed over to relevant departments for harmless treatment after the on-site emergency work is over.

6.2.4 The items sealed and kept on site should be registered by a special person, and record the next whereabouts of the items and complete the handover work.

7.1 Investigation of relevant places

7.1.1 The investigation content of poisoning incidents through the respiratory tract and skin route includes the morphology and characteristics of the suspected poison, the storage and storage methods, and the poisoning scene Environmental conditions, meteorological conditions, ventilation measures, production process, protective conditions, contacts, etc.

7.1.2 The investigation object of the poisoning incident by oral route is the whole process from the production, processing and consumption of the suspicious poison or food involved in the poisoning incident the investigation content includes suspicious poisons or food processing (including raw materials and ingredients, seasonings, food containers, and tools used), Suspicious poison or food packaging, storage conditions, etc.

7.2 Investigation of related personnel

The subjects of investigation include poisoned patients, other affected persons, witnesses and other related personnel. The content of the investigation includes understanding the Life history, the time, location, route and type of substance of poisoned patients and other affected persons, number of poisoned persons, names, sex, Type of work, main symptoms of poisoning, progress of poisoning incident, emergency measures that have been taken, etc. At the same time, it should also go to the clinical treatment unit One-step understanding of relevant information (such as rescue process, clinical treatment data, laboratory test results, etc.).

7.3 Other

7.3.1 For similar poisoning incidents that occur repeatedly in the same area within a period of time, the investigation content should also include residents' production, living habits, environmental the life habits and deaths of animals and plants in China, as well as the relationship of the affected persons.

7.3.2 Similar poisoning incidents occurred in multiple areas within a period of time, and the investigation content should focus on poisons that can circulate in a larger area in a short time Links, such as food raw materials, stereotyped packaging products, etc. At the same time, attention should be paid to the abuse of poisons and deliberate crimes.

7.3.3 Make a record of the on-site investigation materials, take on-site photographs, audio recordings, etc. The evidence collection materials must have the signature of the person under investigation.

8.1 Selection of emergency samples for poisoning

Human biological samples such as vomit, stomach contents, blood and urine of poisoned patients are the preferred samples for emergency detection of poisoning.

The closely related air, water, food, etc. are also required samples. In addition, it should be further determined based on the on-site investigation results of the poisoning incident.

Other types of samples collected.

8.2 Methods of collecting emergency samples for poisoning

8.2.1 Collection of air and aerosol samples

When the type of poison is unknown or the content of poison in the air is high, direct sampling should be carried out with air bags or vacuum bottles (cans). Air poison when the category is clear and the content of airborne toxicants is low, absorption liquid, filter media or solid adsorbent should be used for concentrated sampling. Direct sampling the amount should be more than 5L, and the sampling amount of the concentrated sampling method should be determined according to the sampling instructions of the specific poison.

8.2.2 Collection of liquid samples

8.2.2.1 Homogeneous and stable liquid samples (such as water, wine, beverages, oil, dairy products, organic solvents, etc.) should be selected with good airtightness.

Collection in plastic or glass containers. Liquid samples that cannot be mixed stably should be collected as a whole in a large airtight container. If the sample volume is too large, the siphon method can be used for layered sampling, and they can be put into different sampling containers.

8.2.2.2 The skin of the poisoned patient should be cleaned before collecting blood samples. Blood samples should be placed in test tubes with stoppers. Reason not Blood samples in a poisoning incident should be collected in two ways. anticoagulated whole blood and plasma. When a poisoned patient takes a urine sample by himself, Poisoned patients wash their hands, and urine samples should be stored in inert plastic or glass containers with stoppers.

8.2.2.3 The sampling volume of homogeneous and stable liquid samples should be more than.200 mL, and the sampling volume of liquid samples that cannot be stably mixed should be 500 mL.

Above, the sampling volume of blood samples should be more than 5 mL, and the sampling volume of urine samples should be more than 50 mL.

8.2.3 Collection of solid and semi-liquid samples

8.2.3.1 Solid and semi-liquid samples should be collected in inert plastic or glass containers with good airtightness.

8.2.3.2 The sampling volume of solid and semi-liquid samples should be more than 100 g.

8.2.3.3 The vomit and feces of poisoned patients should be collected as much as possible.

8.2.4 Other

8.2.4.1 For samples with shaped packaging, in addition to the remaining samples that have been opened, the original packaging products of the same batch of the same manufacturer should also be collected.

8.2.4.2 Among the autopsy samples, blood, urine and other body cavity fluids should be collected in inert plastic or glass containers with good airtightness.

The collection volume should be more than 50 mL; the liver, kidney, brain and other organs and tissues should be collected in inert plastic or glass containers with good airtightness, and the collection volume should be more than 50 g.

8.2.4.3 When the residual quantity of the emergency samples of poisoning at the scene does not meet the minimum requirements for sampling, try to collect all the residual samples at the scene.

8.3 Storage and transportation of emergency samples for poisoning

All emergency samples of poisoning should be stored and transported under suitable conditions immediately after collection. Biological samples such as blood and urine should be kept at 4°C Store and transport under refrigeration. All samples after emergency testing should be kept for at least one week without changing the nature of the toxicants in the samples for laboratory review.

9.2 Laboratory testing and identification of emergency samples of poisoning

9.2.1 The emergency samples of poisoning should be tested and identified in the laboratory within 24 hours after collection.

9.2.2 The testing and appraisal of poisoning emergency laboratories should be carried out by using national standards/industry standard methods. If there is no country for testing and identification Standard/industry standard methods can be selected from the laboratory self-built testing and identification methods approved by experts organized by the health emergency command and coordination department.

9.2.3 The emergency detection and identification of poisoning shall have strict quality control assurance measures, and the original experimental records and maps shall be kept for at least 2 year. If there are storage conditions, the remaining poisoned samples should be stored for at least 2 years.

9.2.4 When two or more laboratories conduct emergency detection and identification of poisoning at the same time, if the detection and identification results are inconsistent, relevant laboratories should be organized Conduct an internal review. When the results still fail to match, the health emergency command and coordination department can select a third-party laboratory for parallel testing and identification.

9.3 Evaluation of the results of emergency detection and identification of poisoning

Decisions for emergency response to poisoning incidents should be made in conjunction with the results of epidemiological investigations and comprehensive evaluation of the results of emergency detection and identification of poisonings.

The test and identification results are only one of the basis.

10.3.1 Stop the poison and continue to absorb and remove the poison

10.3.1.1 Poisoning via respiratory exposure

Poisoned patients should immediately move away from the scene of the poisoning incident to a place with fresh air, keep the respiratory tract unobstructed, keep warm, and give oxygen treatment if necessary.

10.3.1.2 Exposure to poisoning through the mucocutaneous route

10.3.1.2.1 Before the poisoned patient is removed from the scene to start the next step of medical treatment, the on-site emergency decontamination should be carried out first.

10.3.1.2.2 Should assist in decontamination of poisoned patients who cannot walk independently.

10.3.1.2.3 Before decontaminating, remove contaminated clothing and accessories worn on the body, and pay special attention to the decontamination of hair and skin folds.

Eyes and contaminated wounds should be decontaminated with special decontamination equipment. Poisoned patients with unstable vital signs should be decontaminated first under close supervision.

10.3.1.2.4 The poisoned clothing and valuables of poisoned patients shall be put into waterproof and sealed packaging and sealed for storage after marking.

10.3.1.2.5 After the initial decontamination, there are still parts contaminated by toxic substances found during the treatment (special attention should be paid to the hair, eyes, perineum and Skin folds such as armpits) should be cleaned with plenty of water or saline in time.

10.3.1.3 Poisoning by oral exposure

Poisoning patients with clear consciousness and no contraindications should induce vomiting immediately; for those with consciousness disorders, gastric lavage can be performed when conditions permit.

10.3.2 Vital signs support

Closely monitor the vital signs of critically ill poisoned patients, establish venous access as soon as possible, keep the airway unobstructed, and take various symptomatic support measures in time.

10.3.3 Use special antidote

For methemoglobin forming agents (such as nitrite, aniline, etc.), cyanide, organophosphate insecticides, anticoagulant rodenticides Patients with poisoning such as drugs, opioid alkaloids, etc., should be given corresponding specific antidote in time.

10.4 On-site transfer and handover

10.4.1 Transfer and handover of poisoned patients

10.4.1.1 After the poisoned patient is medically treated at the scene and the condition is relatively stable, he shall be transferred to the designated medical institution under unified command, and the transfer and handover shall be reported in time.

10.4.1.2 In the process of transferring patients, the on-site transfer personnel should pay attention to the transfer of treatment measures with relevant medical rescue personnel, and closely observe the condition of the poisoned patient changes, to ensure that the necessary treatment measures are continued, and the corresponding medical records are kept.

10.4.2 Transfer and follow-up of other affected persons

10.4.2.1 After the on-site medical observation and treatment of other persons affected by the poisoning incident, the health emergency command department shall uniformly organize the transportation and follow-up observation.

10.4.2.2 The public health personnel at the grassroots level where the incident occurred is responsible for the follow-up and observation of other affected persons, and the follow-up time is until the incident related toxins the 2 long...