Managing Public Health Risks from Environmental Incidents. Guidance for Use in Wales

Managing public health risks from environmental incidents. Guidance for use in Wales Version 3.0

Version 1.0 March 2014

Version 2.0 January 2017

2 Authors:

Kristian James, Principal Environmental Public Health Specialist, Public Health Wales

Huw Brunt, Consultant in Environmental Health Protection, Public Health Wales

Andrew Kibble, Operational Manager, Public Health England CRCE-Wales

Kate Cameron, Natural Resources Wales

Chris Brereton, Chief Environmental Health Officer, Welsh Government

Acknowledgements

The authors would like to thank the following for their comments during the drafting this revised guidance.

Adrian Girvin, Aneurin Bevan University Health Board

Deanne Griffiths, Blaenau Gwent County Borough Council

Oliver Mathews, Carmarthenshire County Council

Sam Naylor, City & County of Swansea

Daniel Rixon, Public Health Wales

3 Preface

This guidance is intended to support the public health response to environmental incidents prior to formal command and control.

This guidance aims to strengthen and support collaborative structures being implemented to manage public health risks of environmental incidents in Wales by:-

. defining what constitutes an environmental incident; . outlining incident response process, notification and management procedures, . clarifying agency roles and responsibilities, and . describing available resources to inform action.

It sets out arrangements for the management of incidents that are minor or localised using an Incident Management Team (IMT) approach, through to the early stages of potentially major incidents when existing command and control arrangements may apply.

This guidance is in three parts:-

Part 1: Generic guidance on how environmental incidents in Wales should be managed.

Part 2: Key stages and practical actions (supported by checklists and templates) required to manage an incident.

Part 3: Supporting information for incidents affecting one or more environmental media.

This revised guidance acknowledges the need to apply the Joint Emergency Services Interoperability Programme (JESIP) doctrine of “working together-saving lives-reducing harm” and the Joint Decision Model¹. This is to ensure a consistent approach to incident risk communication, assessment and management and in turn, the fluid escalation of incidents when appropriate.

¹ http://www.jesip.org.uk/joint-decision-model

4 5 Abbreviations

AQC Air Quality Cell CO Carbon monoxide CRCE Centre for Radiation, Chemicals and other Environmental Hazards DPH Director of Public Health DWI Drinking Water Inspectorate FSA Food Standards Agency HB Health Board IMT Incident Management Team JESIP Joint Emergency Services Interoperability Programme LA Local Authority LRF Local Resilience Forum NRW Natural Resources Wales PHW Public Health Wales STAC Scientific and Technical Advice Cell WAQTA Wales Air Quality Technical Advisor

6 Part 1: Generic incident management guidance

7 1.1 What is an environmental incident? An environmental incident, in public health terms, can be described as

“Any event (usually acute) in which there is, or could be, public exposure(s) to chemical or other hazardous substances which causes, or has the potential to cause adverse health impacts”.

Excluded from this definition and from this guidance, are

 environmental incidents with no associated public health risks, (it is not always possible to determine that this is the case, especially in the early stages of an incident, and so a dynamic risk assessment is important)  occupational exposures with no public health risk,  incidents involving non-ionising radiation and  incidents involving drugs, other substances of abuse and single case poisonings, with the exception of carbon monoxide (CO) incidents which can pose risks to others.

Environmental incidents can vary in scale. Examples include a small chlorine-mixing accident at a swimming pool affecting few people, or a chemical spill affecting water supplies, or a smouldering waste fire with a plume adversely affecting local communities over a prolonged period.

Incidents may not be immediately obvious but may be identified through ongoing public health surveillance, complaints or community concerns raised.

1.2 Dealing with environmental incidents

The primary aim in the management of an environmental incident is to protect public health. The main objective is to break any source-pathway-receptor linkages to prevent further exposures. Secondary objectives are to improve incident surveillance and to identify learning points and actions to improve future incident management.

Organisations involved in incident management will need to communicate and share information and actions collaboratively as an Incident Management Team (IMT; table 1)

Table 1 Organisations involved in incident response

Core organisations Likely co-opted partner agencies, including: Local Authorities Emergency Services Public Health Wales Health and Safety Executive Public Health England (CRCE-Wales) Food Standards Agency Health Boards Drinking Water Inspectorate (DWI) and Water Companies Natural Resources Wales Maritime and Coastguard Agency

8 1.3 Declaring an environmental incident? Any organisation involved in dealing with a situation that they believe to meet the definition of an environmental incident can convene an IMT. An IMT should be convened immediately if an environmental incident has the following characteristics:-

 immediate and/or continuing health hazard;  one or more routes of exposure;  an at-risk population.

If necessary, a joint declaration of an incident will be made and an IMT convened (most likely as a virtual meeting). If an incident is declared, but not unanimously, all core partner organisations must participate in IMT meetings to formally explain their position and engage in the process unless it is clearly outside their remit.

1.4 Convening an Incident Management Team The responsibility for managing environmental incidents is shared by all members of the IMT. One member should assume the initial lead and coordinating role. The first decisions will be to confirm that an environmental incident is occuring, whether it is a major incident, if existing plans apply or that an IMT is required. Such decisions may need to be kept under review with further risk assessments based upon emerging infomation.

The IMT must:-

 appoint a Chair;  review membership;  commence a decision log;  agree meeting duration, frequency and anticipated life-span;  discuss and agree purpose, aspirations and outputs (with timescales);  take minutes to record decisions and actions;  review evidence and confirm the incident has actual/possible public health impacts;  identify the population at risk;  identify the source-pathway-receptor relationships and undertake dynamic public health risk assessment (using epidemiological and environmental health expertise);  consider if environmental, biological sampling and monitoring data are needed;  consider action to mitigate risks and protect population health (for example, clean- up, remediation, decontamination, counter measures);  agree messages and communication methods (e.g. any existing warning & informing strategies.  consider arrangements for recovery from incident;  ensure appropriate arrangements are in place for out of hours contact;  keep relevant local agencies, the general public and the media informed;  provide support, advice, and guidance to individuals/organisations directly involved;

9  regularly review the scale of the incident to determine appropriate level of response and, if necessary, request formal Civil Contingencies structures be established upon escalation;  evaluate the response provided in a written report (either a formal debrief or multiagency evaluation report).

The Chair will be appointed at the first meeting and is initially likely to be a Public Health representative. As an incident evolves, it may be appropriate for another core organisation member to become Chair. The Chair must ensure the IMT is managed in a professional manner.

A suggested IMT agenda is provided below (Figure 1).

Figure 1 IMT meeting agenda

10 While core members will have their own incident management responsibilities a commitment should be made by each to co-ordinate action through the IMT. Each core member representative must have sufficient seniority to make and implement decisions and to ensure adequate resources are available to undertake effective actions.

Core members are responsible for ensuring other relevant members are co-opted to the IMT. This includes providing sufficient financial and other resources (within remit and capacity) to bring the incident to a successful conclusion. Others can request to join the IMT if there is a case to do so, but the final decision on membership is with the core members.

Any IMT member, whether core or co-opted, should disclose any available information to inform incident investigation and management.

Where an incident affects people in other UK countries e.g. a chemical incident related plume blows across a national border, it is expected that relevant incident management partners in each area work together to perform the duties of the IMT.

1.5 Incident Management Team – members, roles and responsibilities Public Health Wales (PHW) is a Category 1 responder (providing a 24/7/365 health protection service) as set out in the Civil Contingencies Act 2004. It provides health protection advice and support to others to interpret, manage and communicate risks associated with such incidents. PHW will draw upon specialist expertise, particularly chemical and radiation and other hazardous substance-related toxicology, from and through Public Health England Centre for Radiation, Chemicals and Environmental Hazards in Wales (CRCE-Wales).

Health Boards (HBs) have a statutory responsibility to protect and improve local population health and wellbeing. In most incidents HBs are supported by Public Health Wales. The main link with HBs will be through the Director of Public health (DPH). Where incidents may impact on wider NHS services e.g. primary and secondary care, other HB staff such as Emergency Planners will be involved.

Local Authority (LA) responsibilities are often met through coordinated activity across a number of different departments. Civil Contingencies units ensure that LAs are adequately prepared for and able to respond to/recover from emergencies in line with the Civil Contingencies Act 2004. In an incident, LAs will coordinate their response and resources or support the Emergency Services and others as necessary. As the emphasis switches to recovery, LAs will lead community rehabilitation and the restoration of the environment. Environmental Health professionals have a significant contribution to make to incident response; while they do not have a statutory duty to directly investigate or manage environmental incidents, they often have considerable scientific expertise and capability to act to support incident exposure/risk assessments, management and recovery.

11 Natural Resources Wales (NRW) has responsibility to prevent or minimise pollution of the environment due to release of substances from prescribed (permitted) processes. It also has powers to prevent any poisonous, noxious or polluting or solid waste matter from entering controlled waters and powers to remove or dispose of the matter, mitigate the impacts and where reasonably practicable restore the waters. NRW is a Category 1 responder as set out in the Civil Contingencies Act 2004.

Non-core IMT members will come from a broad range of other organisations depending on the nature and scale of an incident.

1.6 Communication Effective communication should be established between IMT members at the outset and maintained throughout. Teleconference facilities will be made available.

The IMT Chair will ensure that minutes are taken at all meetings. The minute taker (as identified by the Chair) is accountable to the Chair for this function.

Communicating messages through partner agencies and the media is important. Each IMT member must support an agreed communications strategy by providing resources, support and advice as necessary. There shall be no communications from IMT members external to the agreed communications strategy, unless agreed by all members.

1.7 Major incidents - escalation beyond an IMT The IMT should follow the Joint Emergency Services Interoperability Programme (JESIP) doctrine of working together to save saving life and reduce harm (figure 2).

1.8 Working together A major incident may be declared by one or more emergency responder agencies.

In the event of a significant or ‘major’ incident occurring or where local existing incident plans prevail and the situation escalates beyond an IMT and this guidance, formal Civil Contingencies incident response structures will be implemented as agreed by the Local Resilience Forum (LRF).

A ‘major incident’ has been defined by the Cabinet Office Civil Contingencies Secretariat as “An event or situation, with a range of serious consequences, which requires special arrangements to be implemented by one or more emergency responder agencies”

Notes:

a) ‘emergency responder agencies’ describes all Category one and two responders as defined in the Civil Contingencies Act (2004) and associated guidance;

12 b) a major incident is beyond the scope of business-as-usual operations, and is likely to involve serious harm, damage, disruption or risk to human life or welfare, essential services, the environment or national security; c) a major incident may involve a single-agency response, although it is more likely to require a multi-agency response, which may be in the form of multi-agency support to a lead responder; d) the severity of consequences associated with a major incident are likely to constrain or complicate the ability of responders to resource and manage the incident, although a major incident is unlikely to affect all responders equally; e) the decision to declare a major incident will always be a judgement made in a specific local and operational context, and there are no precise and universal thresholds or triggers. Where LRFs and responders have explored these criteria in the local context and ahead of time, decision makers will be better informed and more confident in making that judgement.

Some LRF plans adopt a more flexible interpretation of when they are utilised and in most instances would not meet the major incident criteria as set out in this Cabinet Office definition. In some cases, Tactical Coordinating Group / Strategic Coordinating Group activation does not require the declaration of a major incident. Also, a Tactical Coordinating Group can be established without a Strategic Coordinating group by any LRF member who requires incident management structures above the operational level to be implemented.

13 Figure 2 JESIP Principles of Joint Working

Core organisations and partners may learn of an incident from a variety of sources. JESIP has developed a common information sharing model ‘METHANE’ (Figure 2) to encourage consistent and efficient information sharing between responders.

14 Figure 2 M/ETHANE notification

The JESIP Joint Decision Model informs and supports a consistent approach to incident risk assessment, management and the fluid escalation of incidents when appropriate (Figure 3).

Figure 3 JESIP Joint Decision Model

15 1.9 Evaluation Post incident the IMT response should be evaluated (table 2). Public Health Wales will co-ordinate this through an independent reviewer. The evaluation report must be completed within three months of the last IMT meeting and outline SMART recommendations approved by all IMT members.

Table 2 Sample evaluation form

Incident

Date of Incident

Date form completed

Completed by

Role in Incident

Organisation

After any incident or event it is accepted there will be some areas of improvement identified, but it is also important to note good practice to assist and guide others who may face a similar set of circumstances in the future. Your views and experience count.

Please detail the things that went well:

Please detail the things that did not go well:

What is the most valuable thing you have learned as a result of this incident?

Please provide any tips for people who may perform a similar role in the future:

16 Part 2: Environmental Incident Response: Practical Support & Resources

17 2.1 The incident response process

The key stages of incident response are outlined below (Figure 4).

Figure 4 Incident response

2.2 Logging Actions

From the initial notification of an actual or potential incident, a log of key actions and decisions should be kept (Table 3).

Table 3 Incident log sheet

Loggist’s Name Date Location

Conversation with Information Action Time (name and contact Organisation (including rationale) details) provided

18 2.3 Incident notification

A standard incident notification form should be used (Table 4).

Table 4 Notification form

Call taken by:

Date: Time:

Notifier Name: Organisation:

Telephone number: Email:

Major Incident declared? (Y/N) Yes: No: M Complete rest of form regardless of If yes, speak to CCDC /CEHP answer immediately

E Exact Location:

T Type of Incident:

H Hazard: (please specify)

A Access: any access information?

Number of people exposed:

Number of fatalities:

Number of people reporting symptoms: (give details below) N Symptoms reported:

Number of people seeking medical attention:

Other information:

E Emergency services present:

Details of affected individuals (if known) Name: Date of Birth: Address: Postcode: Contact Telephone Number: Gender: GP Details: Reported Symptoms and Onset: Test Results: Hospital Attended or GP Consulted? (Please specify) Details of affected individuals (if known) continued Name: Date of Birth: Address: Postcode: Contact Telephone Number: Gender: GP Details: Reported Symptoms and Onset: Test Results: Hospital Attended or GP Consulted? (Please specify) Details of affected individuals (if known) continued Name: Date of Birth: Address: Postcode: Contact Telephone Number: Gender: GP Details: Reported Symptoms and Onset: Test Results: Hospital Attended or GP Consulted? (Please specify) Details of affected individuals (if known) continued Name: Date of Birth: Address: Postcode: Contact Telephone Number: Gender: GP Details: Reported Symptoms and Onset: Test Results: Hospital Attended or GP Consulted? (Please specify) Details of affected individuals (if known) continued Name: Date of Birth: Address: Postcode: Contact Telephone Number: Gender: GP Details: Reported Symptoms and Onset: Test Results: Hospital Attended or GP Consulted? (Please specify)

20 2.4 Risk assessment Upon notification of an incident core IMT members must undertake an intitial public health risk assessment to inform immediate actions (figure 5, tables 6&7). Any and all decisions should be recorded and regularly reviewed with further risk assessments based upon emerging infomation.

Figure 5 Principles of risk assessment Table 6 Risk assessment checklist CONSIDERATIONS Accidental or deliberate? What chemicals and in what quantities? Public Health concerns? How contained is the fire / release? Other related events? Likely duration of incident? Water related incidents, also consider Incident Source (surface, ground, public, private) descriptors Water treatment in use, including temporary treatment Supply or distribution affected High risk properties or areas (hospitals, nursing homes, dialysis patients) Travel time of contaminants through the system Effect of remedial measures Air quality incidents, also consider Is there a plume? Is a CHEMET available / requested? Chemical(s) properties & characteristics known & Chemical understood? Public Health concerns clear? properties Toxicological impacts of chemical(s) available? Quick dispersion likely? Number potentially exposed? Population Sensitive populations in the vicinity? Presenting symptoms? Immediate health Exposure pathways? effects & impact Unusual symptoms reported to hospitals, GPs or NPIS? Gaps in this on health services Number actually exposed? section Sufficient capacity at A&E? should Initial PH risk assessment & changes over time? prompt Individuals or populations at risk now / in future? convening Public health follow-up? Register needed? of a STAC Secondary contamination likely? Treatment of contaminated / potentially contaminated people? General public Specific antidotes or counter measures? health Delayed symptoms possible? Close schools, businesses, other facilities? Advice to shelter or evacuate? Advice to wider community? Advice to GPs & hospitals? Advice to media? Current & forecast weather conditions? (Met office) Environmental Food chain contamination? (FSA) conditions Contain potentially contaminated run-off? (NRW) Other environmental media contaminated? Environmental / biological sampling & monitoring needed? Incident site Chemical reactions / new products likely? issues PPE required in hot / warm zones? Mobile decontamination at scene & or hospitals?

22 The information obtained should inform the risk assessment which then informs the public health response (table 7).

Table 7 Risk assessment form RISK ASSESSMENT NOTES Incident Description / Characteristics E.G. Fire, Spill, Plume Etc: Hazard(s) :

Name Of Substances:

Size Of Fire, Spill, Release Etc:

Affected Geographical Area: Vector Or Pathway Of Contamination: Air / Water / Land / Food Affected:

Number Of People Dead:

Taken To Hospital: Risk to Population e.g. direct contact, explosion, toxic fumes etc. Potential Health Effects Of Hazard Has Any Organization Declared A Major Yes: No: Incident? If yes, which: Tick Rationale No Public Health Risk No Incident Low Public Health Risk Minor Incident (Advice Only) Current Medium Public Health Risk Assessment: Risk Minor Incident (Advice & Further Actions) High Public Health Risk Major Incident List Any Assumptions Guiding The Risk Assessment: Actions Taken:

Summary Of Advice Provided: Communications Yes: No: Team Involved: Further Actions Required: 2.5 Reviewing risk assessment: medium & long term

Medium & long term considerations for the IMT are suggested below (Table 8).

Table 8: Medium and long term considerations Medium Term Psycho-social implications? Epidemiological investigation? General public health Clinical follow up? Biomarkers available? Site decontamination required? If so, how? Incident site issues Environmental sampling & monitoring undertaken? Temporary mortuary required? Health outcomes Should fatalities be decontaminated? Chemical environmentally persistent? Chemical properties Environmental decontamination required? Can evacuated residents return to their homes? Population Do evacuated residents need re-housing? management Re-open schools, businesses, and leisure, recreational & other facilities? Other Modelling available? Long Term Long term health consequences of exposure? Is the chemical(s) of concern carcinogenic? Is the chemical of concern teratogenic? General public health Measures to follow up casualties exposed & potentially exposed? Community burden of disease post incident? Research opportunities? Environment (including buildings) decontaminated? Incident site issues Business continuity in place? Lessons to be learned? Have these been disseminated? Learning Measures to prevent / reduce impact of such incidents in the future?

24 Part 3: Incident specific information 3.1 Incidents affecting air quality

Air Quality Cell

NRW in consultation with PHW and PHE CRCE, may activate an Air Quality Cell (AQC) if there is believed to be significant potential risk to public health or the environment from exposure to pollutants released to air. An AQC will not be formed for radioactive, nuclear or biological incidents.

The AQC facilitates the co-ordination, collection, collation and interpretation of air quality data to inform action to protect public health and the environment. The AQC will:-

 decide on the need for the deployment of the air quality monitoring teams;  decide whether the AQC needs to continue to meet to provide incident command and responders with advice in the event that deployment of monitoring teams is not or no longer necessary, or will not be able to provide air quality data;  agree a safe location for monitoring air quality with the monitoring teams, in conjunction with other appropriate agencies, for example, Fire and Rescue Services;  co-ordinate air quality monitoring and modelling and assess the uncertainties and limitations of the data.  gather, collate and interpret local air quality data and information from other sources to inform public health risk assessments and communications.  determine the environmental public health risks from exposure to pollutants and chemical contaminants in the air; and  agree appropriate and consistent messages for Public Health representatives to provide health protection advice.

The AQC will provide Sitreps (situation reports) to partner agencies, as appropriate (figure 6). PHW have primary responsibility on behalf of the AQC to deliver health protection advice to those who need it.

Where appropriate, other partners with particular expertise (for example LAs, Food Standards Agency (FSA) Wales or Health and Safety Laboratories) may be invited to join an AQC.

26 Figure 6 A typical air quality incident timeline.

Start 30 min – 2hr 2-6hr 6-12hr 12hr - days NRW Wales Air Quality NRW WAQTA NRW Chair: Technical Advisor 1 Discuss need for AQC with 1 Chair AQC (on cascade). (WAQTA): PHW and PHE. 2 Share real time air quality data with AQC. 1 Receives notification of 2 Convenes AQC. 3 Share, as appropriate, real time air quality data with the wider response community. incident that may involve air 3 Invites local authority to join 4 Ensure PHW, on behalf of AQC, provides Scientific and Technical Advice Cell (STAC)/multi- pollution potentially posing AQC agency group with AQC situation report, including health protection advice. a serious risk to public 4 Deploys monitoring teams. 5 Initiates handover to local recovery group. health, or 5 Estimates source term for Met 2 Receives request to set Office. up AQC e.g. from a multi- 6 Liaise with FSA and H&SL if agency group. needed.

Monitoring team Monitoring team Monitoring team Monitoring team Monitoring team 1 Travel to site. 1 Initial AQ 1 Real time AQ 1 Real time AQ monitoring. monitoring. monitoring. 2 Results to WAQTA 2 Provide air 2 Results to 3. Laboratory results sent to quality data to WAQTA. CRCE. WAQTA. 3 Samples sent to laboratories.

Met Office Met Office: Met Office: Met Office: Met Office: 1 Provide CHEMET. 1 Updated CHEMET or NAME 1 Revised NAME 1 Modelling refined 1 Modelling refined using 2 Supply meteorological dispersion modelling with dispersion using monitoring monitoring results. data for site. source term. modelling using results. updated source terms.

PHE (CRCE) PHE (CRCE) PHE (CRCE) 1 Receives notification of 1 Discuss need for AQC with 1 Collate and evaluate air quality data. incident that may involve air PHW and NRW. 2 Consider public health impact and potential for exposure. pollution potentially posing 2 Contribute to the air quality 3 Provide interpretation to PHW/AQC for public health assessment a serious risk to public risk assessment. 4 Contribute health protection advice to situation report. health 5 Liaise with key partners such as FSA, Met Office etc.

PHW PHW PHW 1 Receives notification of 1 Discuss need for AQC with 1 Contribute to evaluation of air quality data. incident that may involve air PHE CRCE and NRW. 2 Interpret data and assess risks associated with any likely or actual population exposure. pollution potentially posing 2 Contribute to the air quality 3 Contribute health protection advice to situation report. a serious risk to public risk assessment. 4 Provide public health advice as appropriate health 5 Liaise with others, including wider NHS partners. 3.2 Incidents affecting land quality

Contaminated land will only pose a potential risk to a person’s health if there is a route through which the substances can move from the land and enter the human body. Such routes are inhalation of gases, ingestion of soil (particularly in children), consumption of contaminated food or water or direct skin contact with the polluted material.

Many other factors however have to be considered when assessing the significance of health risks from contaminated land including site specific features

An overview of the public health links to land quality may be found at http://www.wales.nhs.uk/sitesplus/888/page/81977. A summary of relevant legislation is shown in table 5.

Table 5 Relevant legislation, contaminated land

Act Summary or relevant sections Notes & references Applies ‘polluter pays principle’ covering only the most serious https://www.gov.uk/government/p Environmental Damage cases. Requires business or other ‘operator’ identifying an ublications/environmental- (Prevention and imminent threat or actual damage and taking immediate action. damage-prevention-and- Remediation) Enforcing authorities must determine whether there is remediation-regulations-2009- Regulations 2009 environmental damage and decide on necessary remedial guidance-for-england-and-wales measures. Larger industrial installations subject to integrated controls upon Environmental significant emissions, resource efficiency, accidental emissions and Permitting (England and http://www.defra.gov.uk/industrial installation site restoration. Most regulated by NRW (Part A (1) Wales) Regulations -emissions/ activities) and Local authorities (Part A (2) activities). Smaller 2010 installations, are subject to controls on emissions to air and are regulated by local authorities (Part B activities) Local authority duty to detect and investigate statutory nuisances. a. any premises in such a state as to be prejudicial to health or a Where a statutory nuisance Environmental nuisance exists / likely to occur / recur, Protection Act 1990 b. any dust, steam, smell or other effluvia arising on industrial, trade must take action to abate. sections 79 & 80 or business premises and being prejudicial to health or a nuisance Usually, means serving an Statutory Nuisance Abatement Notice on the person, c. any accumulation or deposit which is prejudicial to health or a requiring works within a nuisance reasonable time. Failure to comply is a criminal offence.

Environmental http://wales.gov.uk/topics/environ Protection Act 1990 Defines “contaminated land”; the identification of, remediation of mentcountryside/epq/contaminat Part IIA Contaminated and liability. edland/documents/?lang=en Land 3.3 Incidents affecting controlled water

Controlled waters are:-

 coastal waters up to 3 nautical miles from the freshwater limit;  inland freshwaters including rivers, watercourses and on-line (connected to a river water course or ground water) ponds or lakes;  ground waters.

Core IMT organisations should co-opting experts from the following:-

 Water Companies  Maritime & Coastguard Agency  Food Standards Agency Wales  Animal Health and Veterinary Laboratories Agency  National Poisons Information Service.

Resources

Suggested No Adverse Response Levels (SNARLs) for abstractions. Provided by WRc through NRW Environmental Toxicity Advisory Service contract. http://www.wrcplc.co.uk/os-ukwir-tox-advisory-service

Blue Green Algae – Natural Resources Wales https://naturalresources.wales/media/678768/blue-green-leaflet-dl.pdf

Blue Green Algae - Public Health Wales http://www.wales.nhs.uk/sitesplus/888/page/53916/

Blue-green algae: advice for the public https://www.gov.uk/government/publications/blue-green-algae-advice-for-the-public

Public Health Wales, Communicating public health risks associated with the maritime transportation of hazardous substances http://www.arcopol.eu/?/=/section/resources/search/1/resource/148

29 3.4 Incidents affecting drinking water quality

To be read in conjunction with the Communicable Disease Outbreak Plan for Wales 3.5 Other useful resources Air Quality in Wales. A website with near-real time ambient air quality data http://www.welshairquality.co.uk/

Acute exposure guideline levels (AEGLs) representing threshold exposure limits for the general public applicable to emergency exposure periods ranging from 10 minutes to 8 hours. http://www.epa.gov/oppt/aegl/index.htm

Cardiovascular disease and air pollution (COMEAP, 2006): https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304668/COMEAP_card iovascular_disease_and_air_pollution.pdf

Chemical Incident Management http://webarchive.nationalarchives.gov.uk/20140722091854/http:/www.hpa.org.uk/ProductsServices/ ChemicalsPoisons/ChemicalRiskAssessment/ChemicalIncidentManagement/

Chemical hazards https://www.gov.uk/topic/health-protection/chemical-hazards

Daily Air Quality Index provides recommended actions & health advice relating to levels of air pollution http://uk-air.defra.gov.uk/air-pollution/daqi

Guidance: Responding to asbestos-related public health concerns Public Health Wales, 2013 http://howis.wales.nhs.uk/sitesplus/888/page/4946 1

Long-term exposure to air pollution: effect on mortality (COMEAP, 2009): https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304641/COMEAP_mort ality_effects_of_long_term_exposure.pdf

Managing Public Health Risks from Environmental Incidents: Guidance for Wales http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=73076

Mortality Effects of Long-Term Exposure to Particulate Air Pollution in the UK (COMEAP, 2010): https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304641/COMEAP_mort ality_effects_of_long_term_exposure.pdf

Public Health Wales. Communicating public health risks associated with the maritime transportation of hazardous substances http://www.arcopol.eu/?/=/section/resources/sub/r_successful_outputs/resource/148

Reports and statements from the Committee on the Medical Effects of Air Pollutants (COMEAP). https://www.gov.uk/government/collections/comeap-reports

Shelter or evacuation checklist: http://www.who.int/ipcs/emergencies/shelter_or_evacuation.pdf

Suggested No Adverse Response Levels (SNARLs) for abstractions. Provided by WRc through NRW Environmental Toxicity Advisory Service contract. http://www.wrcplc.co.uk/os-ukwir-tox-advisory-service

UK-Air provides data on air quality in the UK including details of standards and air quality forecasts http://uk-air.defra.gov.uk/

UK Recovery Handbook for Chemical Incidents https://www.gov.uk/government/publications/uk-recovery-handbook-for-chemical-incidents-and- associated-publications

31 Managing public health risks from environmental incidents. Guidance for use in Wales

Version 2.0 January 2017