40_Smedley_Chap40.indd 823 1/2/2013 1:06:21 PM CHAPTER 40 Non-chemical emergencies 824 Psychiatric emergencies General points \200 Psychiatric emergencies are relatively common among people who have an established diagnosis of serious mental disorder, but unusual in the general workin g population A situation can be considered as an emergency when there is a serious and current risk to t he safety of the person and/or others. This danger may be: \200 a consequence of delibera te planning \200 or the risk can be unintentional. Immediate assessment of emergencies \200 Ensure the safety of the person \200 Try to sp eak with the person, recognizing that it is usually impractical to carry out a detailed psy chiatric assessment in these circumstances Ensure the safety of others (including yourself) while doing so 1 When there is an immediat e and serious risk of harm, there should be no delay in calling the police \200 If possib le, try to establish some dialog with the person. However, avoid confrontation and disagree ment. This may calm the situation, enable further evaluation of the problem, and perhaps gi ve an initial indication whether there is an underlying psychiatric disorder \200 A more detailed assessment of the person \200\231s mental state can be arranged thereafter in a more secure and specialist setting \200 When talking with the pe rson, it may be useful to ask about: what they are planning to do? \200 why they wish to harm themselves or others? \200 wha t, if anything, has happened very recently to them to prompt the crisis? whether they have had previous mental health problems? 1 Take any account of suicidal thoughts seriously. Particular concern is raised when a person makes clear statements of intent to kill themselves, particularly: \200 if they have made \201 rm plans of how to kill themselves \200 if they have curr ent signi \201 cant symptoms of depression and/or if they have experienced recent serious loss- Colleagues and management may have some knowledge, ask about: recent stress (whether or not work-related) \200 and any history of previous mental disor der. 2 A person whose behavior is considered dangerous as a result of a current mental disorder does not need to be detained using the Mental Health Act in order for them to be restrained in an emergency. This can be carried out under common law. Subsequent specialist assessmen t and treatment may require the person to be legally detained in hospital. 40_Smedley_Chap40.indd 824 1/2/2013 1:06:21 PM PSYCHIATRIC EMERGENCIES 825 Lower risk situations Some situations that cause alarm may not be regarded as medical emerg en- cies that require immediate and assertive intervention. However, they may make it impos sible for the person to continue working, and they would bene \201 t from early medical as sessment. Such situations may include: \200 Acts of self-harm without suicidal intent \200 Symptoms of mild or moderate mood disorder \200 Overwhelming symptoms of anxiety. I t will be useful to ensure the person agrees to be seen urgently by their GP, out-of-hours medical services or at the A&E department, and if neces- sary to make arrangements for them to be transported there. Particular psychiatric disorders \200 Behavior that is dangerous to self or others does n ot in itself indicate that a person is mentally ill. In many situations, such behavior aris es at times of crisis, and the person may well have behaved similarly in the past when face d with overwhelming dif \201 culties Current intoxication with alcohol and/or drugs may increase impulsivity and disinhibition In a minority of situations, current symptoms of an untreated serious mental disorder present a serious risk \200 people who have delirium may be disorientated , aroused, hallucinated, and irrational those who have acute schizophrenia may be violent as a result of command hallucinations, or because of their persecutory beliefs symptoms of acute mania may include irrational thinking and extreme excitement and irritability symptoms of severe depression may result in acts of serious self- harm It is very unlikely that a con \201 dent diagnosis can be made in the setting of an acute emergency. This will usually be possible only after further assessment and observation, phy sical examination and appropriate investigations, interviews with others who know the perso n, and knowledge of any previous psychiatric and medical history. 40_Smedley_Chap40.indd 825 1/2/2013 1:06:21 PM This page intentionally left blank 827 Chapter 41 Terrorism Terrorism (deliberate use of chemical, radiation or biological or nuclear weapons 828 Chemical weapons 829 Biological weapons 830 Radiation and nuclear weapo ns 832 41_Smedley_Chap41.indd 827 1/2/2013 1:07:04 PM CHAPTER 41 Terrorism 828 Terrorism (deliberate use of chemical or biological weapons, or radiation and nuclear weapo ns) Small groups of terrorists have the ability to cause massive damage and extensive human suffering with little or no warning. Emergency services must be able to respond rapidly an d appropriately to such scenarios. \200 Rescue and treatment of victims, and control and containment of \201 re or other hazards are complicated. Sites may be contaminated with n uclear, chemical, biological, or radiological substances The impact of weapons may stretch much further than the scene of disaster. Exposed personnel can spread contamination into other areas as they depart from t he scene As well as the physical injuries, there is major public fear over any use of such weapons, with the risk of signi \201 cant psychological casualties. Public reassurance and health r isk communication forms an essential part of the management of any incident Thorough contingency planning is necessary by all organizations likely to be involved. Routes of exposure \200 Radiation and chemical agents can enter the body by: inhalation \200 absorption through skin or eyes \200 injection by \202 ying glass or shrapnel \200 ingestion Biological agents are usually transmitted through inhalation. Other factors As well as the direct and indirect health effects from the terrorist agent, t he effect of risk controls on responding forces must be considered. Protective equipment li mits movement and carries risks of hyperthermia in its own right. Speci \201 c terrorist weapons Each main class of weapon is covered as a separate topic (s ee b p. 829, Chemical weapons; b p. 830, Biological weapons; b p. 832, Radiation and nuclea r weapons). Further information and guidance Guidance is available from the Health Protection Agency. A vailable at: M http://www.hpa.org.uk/ Topics/EmergencyResponse/CBRNAndDeliberateRelease/ 41_Smedley_Chap41.indd 828 1/2/2013 1:07:04 PM CHEMICAL WEAPONS 829 Chemical weapons Terrorists have used chemical weapons in the past, and it is likely to hap - pen again. There is the potential for large numbers of casualties. Numerous chemical agen ts exist, each with different symptoms and effects. Although some may require extensive lab oratory facilities to manufacture, others can be fabricated relatively simply. Much of the ef \201 cacy of such a weapon depends on its ability to disperse the material. Types of chemical weapons \200 Blood agent/cyanides: attack the capacity of the blood to hold and deliver oxygen, causing the victim to suffocate. Cyanide gasses and compounds are most common Nerve agents: affect the individual \200\231s nervous system. Most belong to the family of organophosphates, and have similarities to some pesticides Blister agents: also known as vesicants, they attack exposed skin, resulting in blisters an d skin burns e.g. mustard gas and lewisite Choking agents: attack lungs, causing pulmonary oedema, e.g. chlorine and phosgene Incapacitating agents: usually irritate skin, mucous membranes, eyes, nose, lips and mouth; causing vomiting or intolerable pain. Whilst this may lead to serious medical situations, it is not designed to kill or cause permanent harm. Used alone, the in tention is to temporarily incapacitate and force people to leave an area. However, these ag ents can be used in combination with other chemical weapons to force removal of protective equipment. Examples include pepper spray, Tear/CS gas and other riot control agents. Risks to emergency personnel Chemical contamination can offer a major and immediate hazard to responders who must be correctly trained and equipped. All agents have the potential for 2 contamination of ambulances, \201 re, and medical equipment, thereby affecting anyon e who comes in contact with them. Therefore, proper decontamination is necessary before cas ualties leave the area. Management of casualties \200 Decontamination: must take place rapidly often within minut es of exposure \200 Stabilization \200 Assess cause \200 Give antidotes/treat symptoms \200 Seek specialist advice. 41_Smedley_Chap41.indd 829 1/2/2013 1:07:05 PM CHAPTER 41 Terrorism 830 Biological weapons Bioterrorism presents serious challenges. Biological weapons can be easy to develop and have utility across the spectrum of con \202 icts and targets. \200 Thei r release may be: overt \200\224announced openly by the perpetrators \200 covert \200\224i.e. unannounced without a warning or indication of the organism Many organisms could be used deliberately and distributed through food, water, or air Depending on the organism, deliberate use may be indistinguishable from natural outbreaks, either through the use of naturally occurring pathogens or because symptoms are identical. Therefore, early recognition of outbreaks can only be achieved if clinicians are aware of t he possibility and take appropriate measures before a de \201 nite diagnosis is reached Agent used and mechanism of delivery will depend on whether terrorists are sponsored by a government. A state sponsored group with access to biotechnol ogy and laboratory infrastructure is much more likely to have the ability to cause casualti es on a large scale. However, an unsupported single operative involved in deliberate contam ination of food may still have devastating impact, albeit on a smaller scale These weapons may be much more effective when used against civilian populations. The latter comprise more vulnerable groups at the extremes of age, th e immune compromised and the un-vaccinated, rather than fast moving, relatively healthy mil itary organizations. There is a real risk that public panic will lead to swamping of medica l care. Types of biological weapons Pathogens \200 Disease-causing organisms that can reproduce a nd keep spreading long after the attack Potential for many thousands of casualties, but likely to be much less because of dif \201 culty in ef \201 ciently spreading material to reach large populations Plague, smallpox, anthrax, and haemorrhagic fever are known to be possible biological weapons. Toxins \200 Poisonous substances produced by living things \200 Many are lethal in smal l quantities and can kill very large numbers of people More like a chemical attack than a biological one \200 Include ricin, botulism toxin, and a \202 otoxin \200 Again the main problem for the terrorist is one of dispersion. Recognition of a bioterrorism incident Any case of smallpox, plague, pulmonary anthrax, gla nders, Venezuelan equine encephalitis, or viral haemorrhagic fever in the UK should be assu med to be the effect of a deliberate release unless proven otherwise. 41_Smedley_Chap41.indd 830 1/2/2013 1:07:05 PM BIOLOGICAL WEAPONS 831 Bioterrorist attack The following \201 ndings indicate the possibility of a bioterrorist attack: \200 Unusual illness \200 Unusual numbers of patients with same symptoms \200 Illness unusual for time of year \200 Illness unusual for patient age group \200 Illne ss in an unusual patient \200 Illness acquired in an unusual place \200 Unusual clinica l signs or disease progression. Prophylaxis and treatment \200 Prophylactic vaccination is possible for certain agents. O nce the threat is known, vaccination may be used to contain spread of a weapon used strateg ically. However, it will always involve risk \200\223bene \201 t assessments, and post-exp osure measurements may be more relevant unaware of hazard, and may be unprotected. The delay in detection means those handling initial casualties will be Management of biological exposures \200 Dependent on the pathogen: identi \201 cation of the agent is critical, and will facilitate measures to protect responders (such as vaccina tion) A suspected casualty should be isolated, and medical staff should wear full protective clothing Treatment of the condition depends on the speci \201 c agent and symptoms Specialist help should be sought. In the UK this is available from the Health Protection Agency Monitoring of others exposed and if appropriate post exposure prophylaxis/will be necessary. 41_Smedley_Chap41.indd 831 1/2/2013 1:07:05 PM CHAPTER 41 Terrorism 832 Radiation and nuclear weapons Although terrorist access to functional nuclear weapons canno t be ruled out, it is thought to be very unlikely. More probable scenarios include the use of conventional explosives to attack nuclear facilities, or to spread radioactive materials directly over a large area, and the targeted use of small quantities of radioactive materi al (e.g. Litvinenko polonium poisoning 2006). In most such cases, it is the fear of the unk nown effects of these weapons (rather than any short-term health risks) that is likely to b e the major problem. Radiation sources \200 Radiation can present an external or internal hazard \200 The te rrorist scenario can involve alpha, beta or a gamma radiation (but not neutrons which would only be released from operating nuclear reactors of nuclear weapon yields) External hazards, which are predominantly gamma and penetrating, are removed when the source is taken away However, contamination by radioactive dust will persist and can damage the skin (beta and gamma only) and internal \200\230target \200\231 organs from inh alation, ingestion, or skin penetration. In these circumstances (unless internal contaminat ion is very major), the main effects are likely to be long term, predominantly involving ex cess risk of malignancy. Monitoring \200 The presence of radiation in the environment is readily measurable. Many medical physics, nuclear medicine departments and front line services are able to measure b eta and gamma radiation, although alpha measurement requires more specialized equipment Quanti \201 cation of an individual \200\231s personal exposure is much more dif \201 cult. Risk controls \200 It is important that \201 rst responders use respiratory protection to avoid breathing in the radioactive dust, and full clothing to prevent contamination of s kin In the case of an incident involving radioactive iodine, there may be bene \201 t in early use of potassium iodide (KI) as a blocking agent for both responders and casualties. Management of casualties with radiation exposure \200 Provide respiratory protection \200 Remove from hazard area \200 Decontaminate externally by showering \200 Control m ovement to avoid spread of contamination 2 However, management of conventional injuries mus t take priority over radioactive contamination, as the latter will not present an immedi- a te threat to life for either casualty or medical personnel. 41_Smedley_Chap41.indd 832 1/2/2013 1:07:05 PM RADIATION AND NUCLEAR WEAPONS 833 Those who have been exposed to an external radiation hazard present no risk to responding forces once removed from radiation. In UK radiation casualtie s should be moved to an appropriate hospital designated by the Strategic Health Authority. Advice can be sought from the ambulance service. Further information and guidance Health Protection Agency. Available at: M http:www.hpa.org .uk, US Radiation Emergency Assistance Center/Training Center. Available at: M http://www.o rau.gov/ reacts 41_Smedley_Chap41.indd 833 1/2/2013 1:07:05 PM This page intentionally left blank Appendices 1 Hazard statements for \200\230health effects \200\231 used under classi \201 cation, labeling, and packaging of substances and mixtures regulations 837 839 841 867 875 877 2 Consent for occupational health assessment 3 List of prescribed diseases 4 List of RIDDOR reportable diseases 5 Informatics in occupational health 6 Lung volumes 7 Height and weigh t converter and body mass index (BMI) calculator 879 8 Agents classi \201 ed by the IARC monographs, volumes 1 \200\223106 885 42_Smedley_app01.indd 835 1/2/2013 3:22:12 PM This page intentionally left blank 837 Appendix 1 Hazard statements for \200\230health effects \200\231 used under classi \201 c ation, labeling, and packaging of substances and mixtures regulations H300: Fatal if swallowed H301: Toxic if swallowed H302: Harmful if swallowed H303: May be h armful if swallowed H304: May be fatal if swallowed and enters airways H305: May be harmful if swallowed and enters airways H310: Fatal in contact with skin H311: Toxic in contact wi th skin H312: Harmful in contact with skin H313: May be harmful in contact with skin H314: Causes severe skin burns and eye damage H315: Causes skin irritation H316: Causes mild skin irritation H317: May cause an allergic skin reaction H318: Causes serious eye damage H319: Causes serious eye irritation H320: Causes eye irritation H330: Fatal if inhaled H331: Tox ic if inhaled H332: Harmful if inhaled H333: May be harmful if inhaled H334: May cause alle rgy or asthma symptoms or breathing dif \201 culties if inhaled H335: May cause respirator y irritation H336: May cause drowsiness or dizziness H340: May cause genetic defects H341: Suspected of causing genetic defects H350: May cause cancer H351: Suspected of causing canc er H360: May damage fertility or the unborn child H361: Suspected of damaging fertility or the unborn child H362: May cause harm to breast-fed children 42_Smedley_app01.indd 837 1/2/2013 3:22:13 PM APPENDIX 1 Hazard statements for \200\230health effects \200\231 838 H370: Causes damage to organs H371: May cause damage to organs H372: Causes damage to organ s through prolonged or repeated exposure H373: May cause damage to organs through prolonged or repeated exposure 42_Smedley_app01.indd 838 1/2/2013 3:22:13 PM 839 Appendix 2 Consent for occupational health assessment Essential information about your assessment What is the purpose of an OH assessment? The pu rpose is to assess health problems that may be caused (or made worse) by work, or are havin g an effect on your ability to work. We aim to give fair and impartial advice to both you a nd your manager about: \200 Your \201 tness for your job \200 Any risks to your healt h that arise from your duties or your workplace. Unlike a normal doctor (or nurse) \200\223 patient encounter, an OH assessment does NOT aim to diagnose or treat disease. However, in some circum- stances we may just help to ensure that you are receiving the right medical te sts or treatment. When is an OH assessment needed? Depending on your circumstances, it might be needed: \200 When starting a new job \200 When returning to work after a period of time off work due to illness \200 If you have problems carrying out your job or are not performing as well as would be expected If you have a high level of absence from work due to sickness \200 If there is a concern that you might have a health problem that is caused or made worse by work. Who will carry out the assessment? Your appointment will be with an OH doctor or nurse. The OH doctors and nurses who carry out assessments have skills in assessing the relation- shi p between health and work. What will happen at my appointment? The doctor or nurse will ask you questions about your h ealth and your job, and may carry out a medical examination. \200 They will sometimes arr ange to visit your workplace and see your activities for themselves They may ask for your written permission to obtain further medical information from a GP or other doctor who has been treating you. If they ask to do this, the doctor or nurse will e xplain the reason for requesting a report, and what will happen to the information that you r doctor provides. What will happen after my assessment? At the end of the consultation we will usually send a report to the person who referred you (usually your manager or a personnel of \201 cer). 43_Smedley_app02.indd 839 1/2/2013 3:23:27 PM APPENDIX 2 Consent for assessment 840 If you referred yourself, we may or may not want to send a report to your manager, but this would depend on your own situation and wishes. What information will be sent to my manager? The sort of information that will be included in the manager \200\231s report depends on the reason for your referral, but would usually include practi- cal advice about \201 tness for work, e.g. \200 Whether you are \201 t for work \200 If not \201 t now, an estimate of how long it might be before you are \201 t \200 Whether adjustments or changes need to be made to your job in order to help you to return to work, or to protect your health. These changes may be short term (for rehabilitation) or longer term \200 The likelihood of further health problems l eading to absence from work in the future The report does not usually contain con \201 dential personal or medical information. Rare ly, it might be useful to include some medical details, but this is exceptional and is only done with your consent. Will I know what is being said about me in a report? Yes, you have open access to all infor mation that will pass from OH as a result of your assessment. At the end of your appointmen t, the doctor or nurse will tell you what they are going to say in the report and to whom i t will be sent. You will have an opportunity to discuss the report with the doctor or nurse . You can also have a copy of the report if you wish. You can choose to have a copy either before it is released or at the same time. Can I refuse to see the doctor or nurse, or refuse to have a report released to my manager? Yes, you are quite free to decline the assessment. You can also refuse to have a report rel eased at the end of the consultation. However, it is often not in your best interest to do so, as your employer will not be able to take your health problem into account properly. If you are worried about the OH consultation or report, please discuss with someone in the OH team. They will help you to understand the likely consequences of consenting or refusing i n your own particular case. Finally It is important to remember that the OH Professionals do not take sides with either an employee or their manager \200\224but aim to give careful advice to both. Please do not hesitate to ask for more information or explanation if you need it. Please sign below to indicate that you have read this information sheet and consent to your occupational health assessment. Name (in capitals): Signature Date: 43_Smedley_app02.indd 840 1/2/2013 3:23:27 PM 841 Appendix 3 List of prescribed diseases List of diseases that are covered and the kinds of jobs that are included. This is not a co mplete list of jobs, and you should not be put off claiming just because your job is not li sted. If in doubt, claim. 44_Smedley_app03.indd 841 1/2/2013 3:25:46 PM 4 4 _ S m e d l e y _ a p 8 4 2 p 0 3 . i n d d A P P E N D X 8 Disease no. Name of disease or injury Type of job 4 2 Conditions due to physical agents (physical cause) Any job involving I A1 Leukemia (other than chronic lymphatic leukemia) or cancer of the bone, female breast, test is or thyroid Exposure to electromagnetic radiations (other than radiant heat) or to ionizing particles w here the dose is suf \201 cient to double the risk of the occurrence of the condition, e.g . people working in the nuclear industry and hospital X-ray departments 3 L i s t o f A2 Cataract Frequent or prolonged exposure to radiation from red-hot or white-hot material, e.g. glass and metal workers, stokers p r e s c r i b e d A3 Dysbarism, including decompression sickness, barotrauma and osteonecrosis. For example, the bends Subjection to compressed or rare \201 ed air or other respirable gasses or gaseous mixture s, e.g. underwater or tunnel workers A4 Task-speci \201 c focal dystonia of the hand or forearm. For example, writer \200\231s cra mp Prolonged periods of handwriting, typing or other repetitive movements of the \201 ngers, hand or arm d i s e a s e s A5 Subcutaneous cellulitis of the hand Manual labor causing severe or prolonged friction or pressure on the hand, e.g. miners and road workers using picks and shovels A6 Bursitis or subcutaneous cellulitis arising at or about the knee due to severe or prolonged external friction or pressure at or about the knee, e.g. housemaid \200\231s knee Manual labor causing severe or prolonged external friction or pressure at or about the knee , e.g. workers who kneel a lot A7 Bursitis or subcutaneous cellulitis arising at or about the elbow due to severe or prolonge d external friction or pressure at or about the elbow Manual labor causing severe or prolonged external friction or pressure at or about the elbo w. For example, jobs involving continuous rubbing or pressure on the elbow 1 / 2 / 2 0 1 3 Disease Name of disease or injury Type of job 3 : 2 5 : 4 6 P M 4 4 _ S m e d l e y Disease no. Name of disease or injury Type of job _ a p p Conditions due to physical agents (physical cause) Any job involving 0 3 . i n d d 8 A8 Traumatic in \202 ammation of the tendons of the hand or forearm, or of the associated ten don sheaths. Tenosynovitis Manual labor, or frequent or repeated movements of the hand or wrist, e.g. routine assembly workers 4 3 A10 Occupational deafness. Sensorineural hearing loss amounting to at least 50dB in each ear, b eing the average of hearing losses at 1, 2 and 3kHz frequencies, and being due in the case of at least one ear to occupational noise The use of, or work wholly or mainly in the immediate vicinity of the use of, a: (a) Band saw, circular saw or cutting disc to cut metal in the metal founding or forging in dustries, circular saw to cut products in the manufacture of steel, powered (other than han d powered) grinding tool on metal (other than sheet metal or plate metal), pneumatic percus sive tool on metal, pressurized air arc tool to gouge metal, burner or torch to cut or dres s steel-based products, skid transfer bank, knock out and shake out grid in a foundry, mach ine (other than a power press machine) to forge metal including a machine used to drop stam p metal by means of closed or open dies or drop hammers, machine to cut or shape or clean m etal nails, or plasma spray gun to spray molten metal L I S T O F (b) Pneumatic percussive tool to drill rock in a quarry, on stone in a quarry works, underg round, for mining coal, for sinking a shaft, or for tunneling in civil engineering works P R E S C R (c) Vibrating metal molding box in the concrete products industry, or circular saw to cut c oncrete masonry blocks I (d) Machine in the manufacture of textiles for weaving man-made or natural \201 bres (inc luding mineral \201 bres), high speed false twisting of \201 bres, or the mechanical cl eaning of bobbins B E D D I S E A S E S (Cont \200\231d) 1 / 2 8 4 3 / 2 0 1 3 3 : 2 5 : 4 6 P M 4 4 _ S m e d l e y _ a p 8 4 4 p 0 3 . i n d d A P P E N D X 8 Disease no. Name of disease or injury Type of job 4 4 Conditions due to physical agents (physical cause) Any job involving I A10 (Cont \200\231d) (e) Multi-cutter molding machine on wood, planing machine on wood, automatic or semiautomat ic lathe on wood, multiple cross-cut machine on wood, automatic shaping machine on wood, do uble-end tenoning machine on wood, vertical spindle molding machine (including a high speed routing machine) on wood, edge banding machine on wood, bandsawing machine (with a blade w idth of not less than 75mm) on wood, circular sawing machine on wood including one operated by moving the blade towards the material being cut, or chain saw on wood 3 L i s t o f p r e s c r i b e d (f) Jet of water (or mixture of water and abrasive material) at a pressure above 680 bar, o r jet channeling process to burn stone in a quarry (g) Machine in a ship \200\231s engine room, or gas turbine for performance testing on a te st bed, installation testing of a replacement engine in an aircraft, or acceptance testing of an Armed Service \201 xed wing combat aircraft; d i s e a s e s (h) Machine in the manufacture of glass containers or hollow ware for automatic molding, au tomatic blow molding, or automatic glass pressing and forming (i) Spinning machine using compressed air to produce glass wool or mineral wool (j) Continuous glass toughening furnace (k) Firearm by a police \201 rearms training of \201 cer; or (l) Shot-blaster to carry abrasives in air for cleaning 1 / 2 / 2 0 1 3 Disease no Name of disease or injury Type of job 3 : 2 5 : 4 6 P M 4 4 _ S m e d l e y Disease no. Name of disease or injury Type of job _ a p p Conditions due to physical agents (physical cause) Any job involving 0 3 . i n d d A11 (a) Intense blanching of the skin, with a sharp demarcation line between affected and non-a ffected skin, where the blanching is cold-induced, episodic, occurs throughout the year and affects the skin of the distal with the middle and proximal phalanges, or distal with the middle phalanx (or in the case of a thumb the distal with the proximal phalanx), of: (a) The use of hand-held chain saws on wood; or 8 4 5 (b) The use of hand-held rotary tools in grinding or in the sanding or polishing of metal, or the holding of material being ground, or metal being sanded or polished, by rotary tools ; or (i) in the case of a person with 5 \201 ngers (including thumb) on one hand, any 3 of tho se \201 ngers, or (ii) in the case of a person with only 4 such \201 ngers, any 2 of those \201 ngers, or (c) The use of hand-held percussive metalworking tools, or the holding of metal being worke d upon by percussive tools, in riveting, caulking, chipping, hammering, fettling or swaging ; or (iii) In the case of a person with less than 4 such \201 ngers, any one of them or, as th e case may be, the one remaining \201 nger L Where none of the person \200\231s \201 ngers was subject to any degree of cold-induced, episodic blanching of the skin prior to the person \200\231s employment in an occupation de scribed in the third column in relation to this paragraph, or I S T O F P R E S C R (Cont \200\231d) I B E D D I S E A S E S 1 / 2 8 4 5 / 2 0 1 3 3 : 2 5 : 4 6 P M 4 4 _ S m e d l e y _ a p 8 4 6 p 0 3 . i n d d A P P E N D X 8 Disease no. Name of disease or injury Type of job 4 6 Conditions due to physical agents (physical cause) Any job involving I A11 (Cont \200\231d) (b) signi \201 cant, demonstrable reduction in both sensory perception and manipulative de xterity with continuous numbness or continuous tingling all present at the same time in the distal phalanx of any \201 nger (including thumb) where none of the person \200\231s \201 ngers was subject to any degree of reduction in sensory perception, manipulative dexte rity, numbness or tingling prior to the person \200\231s employment in an occupation descri bed in the second column in relation to this paragraph where the symptoms in paragraph (a) or paragraph (b) were caused by vibration (d) The use of hand-held powered percussive drills or hand-held powered percussive hammers in mining, quarrying, demolition, or on roads or footpaths, including road construction; or 3 L i s t o f p r e s c r i b e d (e) The holding of material being worked upon by pounding machines in shoe manufacture A12 Carpal tunnel syndrome (a) The use, at the time the symptoms \201 rst develop, of hand-held powered tools whose internal parts vibrate so as to transmit that vibration to the hand, but excluding those to ols which are solely powered by hand; or d i s e a s e s (b) Repeated palmar \202 exion and dorsi \202 exion of the wrist for at least 20h/ week for a period or periods amounting in aggregate to at least 12mths in the 24mths prior to th e onset of symptoms. We use \200\230repeated \200\231 to mean once or more often in every 30s A13 Osteoarthritis of the hip Work in agriculture as a farmer or farm worker for a period of, or periods which amount in aggregate to, 10yrs or more 1 / 2 / 2 0 1 3 Disease Name of disease or injury Type of job 3 : 2 5 : 4 6 P M 4 4 _ S m e d l e y Disease no. Name of disease or injury Type of job _ a p p Conditions due to physical agents (physical cause) Any job involving 0 3 . i n d d A14 Osteoarthritis of the knee Work underground in a coal mine for a period of, or periods which amount in aggregate to, a t least 10yrs in any one or more of the following occupations: 8 4 7 (a) before 1 January 1986 as a coal miner; or (b) on or after 1 January 1986 as a: (i) face worker working on a non-mechanized coal face (ii) development worker (iii) face salvage worker (iv) conveyor belt cleaner; or (v) conveyor belt attendant A \200\230non-mechanized coal face \200\231 means a coal face without either powered roof supports or a power loader machine which simultaneously cuts and loads the coal or without both L I S T O F Work wholly or mainly \201 tting or laying carpets or \202 oors, (other than concrete \202 oors) for a period of, or periods which amount in aggregate to, 20yrs or more P R E S C R (Cont \200\231d) I B E D D I S E A S E S 1 / 2 8 4 7 / 2 0 1 3 3 : 2 5 : 4 7 P M 4 4 _ S m e d l e y _ a p 8 4 8 p Disease no. Name of disease or injury Type of job 0 3 . i n Conditions due to physical agents (physical cause) Any job involving d d A P P E N D X Disease no. Name of disease or injury Type of job 8 4 8 Conditions due to biological agents (caused by animal, plant or other living organism) Any job involving I B1 Anthrax (a) Contact with anthrax spores, including contact with animals infected by anthrax; or (b) Handling, loading, unloading or transportation of animals of a type susceptible to infecti on with anthrax or of the products or residues of such animals 3 L i s t o f p r e s c r i b e d B2 Glanders Contact with equine animals or their carcasses, e.g. farm and slaughterhouse workers, and g rooms handling horses B3 Infection by leptospira. For example, swamp fever, swineherd \200\231s disease, and Weil \200\231s disease (a) Work in places which are, or are liable to be, infested by rats, \201 eld mice or vol es, or other small mammals; or (b) Work at dog kennels or the care or handling of dogs; or d i s e a s e s (c) Contact with bovine animals or their meat products or pigs or their meat products. For example, farm, veterinary, sewerage and slaughterhouse workers B4 Ankylostomiasis Contact with a source of ankylostomiasis B5 Tuberculosis. TB infection Contact with a source of tuberculous infection. For example, doctors, nurses, ambulance cre ws, pathology technicians and social workers B6 Extrinsic allergic alveolitis (including farmer \200\231s lung) Exposure to molds or fungal spores or heterologous proteins by reason of employment in: (a) Agriculture, horticulture, forestry, cultivation of edible fungi or malt- working; or 1 / 2 / 2 0 1 3 Disease no Name of disease or injury Type of job 3 : 2 5 : 4 7 P M 4 4 _ S m e d l e y Disease no. Name of disease or injury Type of job _ a p p Conditions due to physical agents (physical cause) Any job involving 0 3 . i n d d (b) Loading or unloading or handling in storage moldy vegetable matter or edible fungi; or 8 4 9 (c) Caring for or handling birds; or (d) Handling bagasse (e) Work involving exposure to metalworking \202 uids mists B7 Infection by organisms of the genus brucella, Brucellosis Contact with: (a) Animals infected by brucella, or their carcasses or parts thereof, or their untreated p roducts; or (b) Laboratory specimens or vaccines of, or containing, brucella. For example, farm, veteri nary, slaughterhouse, animal laboratory workers B8A Infection by hepatitis A virus Contact with raw sewage B8B Infection by hepatitis B or C virus Contact with: L I S T O F (a) Human blood or human blood products; or (b) Any other source of hepatitis B or C virus P R E S C R B9 Infection by Streptococcus suis . A very rare form of meningitis from exposure to infected pigs or pork products Contact with pigs infected by Streptococcus suis , or with the carcasses, products or resid ues of pigs so infected, e.g. pork butchers, pig breeders, slaughterhouse workers I B10(a) Avian chlamydiosis Contact with birds infected with Chlamydia psittaci , or with the remains or untreated prod ucts of such birds, e.g. duck farm workers, feather processing workers, abattoir workers, p oultry meat inspectors, pet shop owners and assistants B E D D I S E A S E S (Cont \200\231d) 1 / 2 8 4 9 / 2 0 1 3 3 : 2 5 : 4 7 P M 4 4 _ S m e d l e y _ a p 8 5 0 p 0 3 . i n d d A P P E N D X Disease Disease no. no. Name of disease or injury Name of disease or injury Conditions due to biological agents (ca used by Conditions due to physical agents (physical cause) animal, plant or other living or ganism) Type of job Type of job Any job involving Any job involving 8 5 0 I B10(b) Ovine chlamydiosis Contact with sheep infected with Chlamydia psittaci , or with the remains or untreated prod ucts of such sheep, e.g. sheep farm workers, veterinary surgeons 3 L i s t B11 Q fever Contact with animals, their remains or their untreated products, e.g. farm workers involved in the rearing of sheep, abattoir workers, veterinary surgeons o f p r e s c r i b e d B12 Orf Contact with sheep or goats, or with the carcasses of sheep or goats, e.g. farm workers, ab attoir workers, meat inspectors B13 Hydatidosis Contact with dogs, e.g. shepherds, veterinarians and people who care for dogs B14 Lyme disease Exposure to deer or other mammals of a type liable to harbor ticks harboring Borrelia bacte ria d i s e a s e s B15 Anaphylaxis Employment as a healthcare worker having contact with products made with natural rubber lat ex Disease no. Name of disease or injury Type of job Conditions due to chemical agents (chemical cause) Any job involving C1(a) Anemia with a hemoglobin concentration of 9g/dL or less, and a blood \201 lm showing punc tate basophilia The use or handling of, and exposure to the fumes, dust or vapor of, lead or a compound of lead, or a substance containing lead For example, plumbers, painters, enamellers, pottery g lazing workers C1(b) Peripheral neuropathy C1(c) CNS toxicity 1 / 2 / 2 0 1 3 Disease no Name of disease or injury Type of job 3 : 2 5 : 4 7 P M 4 4 _ S m e d l e Disease no. Name of disease or injury Type of job y _ a p Conditions due to physical agents (physical cause) Any job involving p 0 3 . i n d d C2 CNS toxicity characterized by parkinsonism