Ricin: Control Measures Overview for Responders and Clinicians

Healthcare Facility

Emergency Preparedness

• Be prepared for victim(s) who may present to an emergency department without prior warning.
• Direct the emergency department ventilation exhaust away from the fresh air intake to limit re-entrainment of any airborne contaminant from victims who present to and enter the emergency department.
• Comply with healthcare facility’s Emergency Response Plan.
• Prepare for mass casualties by establishing patient triage, registration, decontamination, treatment, transportation, and stabilization zones/areas for hospital admission(s).
• Perform hazard vulnerability analysis to determine if hospital can manage the anticipated number of victims.
• Determine if lockdown (shelter-in-place) is necessary, and secure area to control access and contain contamination.

Surge Capacity

• Prepare for public health surge capacity and cooperate with other healthcare facilities, local, state, and federal authorities when:
  • It is determined that healthcare facility cannot manage anticipated number of victims.
  • Services expand beyond normal from large scale event.

Infection Control Practitioner

• Even though ricin is sometimes referred to as a biological agent, it is a protein extracted from plant material and is not a living organism. There is no antidote for ricin poisoning. For more on ricin pathogenesis, see Epidemiological Overview for Clinicians.
• Maintain heightened awareness for evidence of ricin-exposed patients and collaborate with clinicians and laboratory to ensure immediate notification of local and state public health department officials when ricin poising is suspected
• Ensure that telephone numbers for notification of appropriate healthcare facility and public health agencies are current and distributed to the appropriate healthcare facility departments and personnel.
• Communicate with the laboratories that receive specimens for testing.

Exposure Follow-up

• Healthcare personnel or laboratory workers sustaining exposure via sharps injury, cuts, or abrasions should immediately wash the exposed site with a soap and water.
• Potentially exposed healthcare personnel should be advised to remove all PPE carefully, wash hands thoroughly with soap and water, refrain from any hand-to-mouth activities, and shower.
• When exposure to eyes occurs, flush eyes with copious amounts of water or eye wash solution for at least 15 minutes.
• Follow standard facility policy regarding workplace exposure.

Patient Education

• Public Health Training Network
• Chemical Agents: Facts About Sheltering in Place
• Chemical Agents: Facts About Personal Cleaning and Disposal of Contaminated Clothing
• Chemical Agents: Facts about Evacuation

Incident Site

Protecting Emergency/First Responders

• Emergency/First responders Guidance on personal protective equipment selection can be found at the following sources:
  • NIOSH’s Emergency Response Safety and Health Database page for Ricin: Biotoxin
  • WISER Protective Equipment/Clothing page for Ricinexternal icon
• RAND and NIOSH provide recommendations for protecting emergency responders in the book Protecting Emergency Responders, Volume 3.
• OSHA provides recommendations for protecting healthcare workers from exposures when a hospital receives contaminated patients in the document OSHA BEST PRACTICES for HOSPITAL-BASED FIRST RECEIVERS OF VICTIMS from Mass Casualty Incidents Involving the Release of Hazardous Substancespdf iconexternal icon

Decontamination

• NIOSH provides recommendations for the decontamination of patients and first responders in the Emergency Response Safety and Health Database for Ricin: Biotoxin.
• EPA provides recommendations for the decontamination of surfaces in the NRT Quick Reference Card for Ricinpdf iconexternal icon.

Emergency Response Resources

• Emergency Response Resources for Emergency and First Responders
• NIOSH Emergency Response Safety and Health Database — RICIN: Biotoxin
• OSHA Standards for Personal Protective Equipment (PPE)external icon
• OSHA/NIOSH Interim Guidance for CBRN Response, PPE for Emergency Respondersexternal icon
• OSHA BEST PRACTICES for HOSPITAL-BASED FIRST RECEIVERS OF VICTIMS from Mass Casualty Incidents Involving the Release of Hazardous Substancespdf iconexternal icon