The Notification of Injuries from Hazardous Substances Draft Guidelines and Reference Material for Public Health Services To be used to assist in a pilot study from July – December 2001 April 2001 Jeff Fowles, Ph.D. Prepared by the Institute of Environmental Science and Research, Limited Under contract by the New Zealand Ministry of Health DISCLAIMER This report or document ("the Report") is given by the Institute of Environmental Science and Research Limited ("ESR") solely for the benefit of the Ministry of Health, Public Health Service Providers and other Third Party Beneficiaries as defined in the Contract between ESR and the Ministry of Health, and is strictly subject to the conditions laid out in that Contract. Neither ESR nor any of its employees makes any warranty, express or implied, or assumes any legal liability or responsibility for use of the Report or its contents by any other person or organisation. Guidelines for the Notification of Injuries from Hazardous Substances April 2001 Acknowledgements The author wishes to thank Dr Michael Bates and Melissa Perks (ESR), Sally Gilbert and Helen Saba (Ministry of Health), Dr Donald Campbell (Midcentral Health), Dr Deborah Read (ERMANZ), and Dr Nerida Smith (National Poisons Centre) for useful contributions and helpful suggestions on the construction of these guidelines. Guidelines for the Notification of Injuries from Hazardous Substances April 2001 TABLE OF CONTENTS SUMMARY ........................................................................................................................1 1. INTRODUCTION.........................................................................................................3 1.1 Background ........................................................................................................................................ 3 1.2 Purpose of the Guidelines.................................................................................................................. 3 1.3 Purpose and Scope of the Surveillance System ............................................................................... 3 1.4 Scope .................................................................................................................................................. 4 1.4.1 Inclusions ................................................................................................................................. 4 1.4.2 Exclusions................................................................................................................................. 5 1.5 Statutory Requirements for Notification of Chemical Injuries .................................................... 5 1.5.1 Toxic Substances Act 1979 and Regulations ............................................................................ 5 1.5.2 Health Act 1956 ........................................................................................................................ 5 1.5.3 Hazardous Substances and New Organisms Act, 1996............................................................ 6 1.6 Other Relevant Legislation ............................................................................................................... 6 1.6.1 Health and Safety in Employment Act (1992) ......................................................................... 6 1.6.2 Accident Rehabilitation and Compensation Insurance Act 1992 (ACC Act) .......................... 7 1.7 Roles and Responsibilities Overview............................................................................................... 7 1.7.1 Hospital Emergency Department Staff .................................................................................... 7 1.7.2 Role of the health protection officer (HPO)............................................................................. 7 1.7.3 Coroners................................................................................................................................... 8 1.7.4 National Poisons Centre (NPC) ............................................................................................... 9 1.7.5 ESR .......................................................................................................................................... 9 1.7.6 Ministry of Health.................................................................................................................... 9 1.7.7 ERMA.................................................................................................................................... 10 1.7.8 Occupational Safety and Health............................................................................................. 10 1.7.9 Accident Rehabilitation and Compensation Insurance Corporation ...................................... 10 1.8 Flow of Data and Reporting........................................................................................................... 10 1.9 Information Technology Requirements ........................................................................................13 2. IDENTIFICATION OF HAZARDS .........................................................................13 2.1 Identifying the Substance................................................................................................................ 13 2.1.1 Therapeutic Substances........................................................................................................... 15 2.1.2 Agricultural Chemicals .......................................................................................................... 15 2.1.3 Substance list.......................................................................................................................... 15 2.2 Multiple Substances........................................................................................................................ 16 2.3 Corrosives........................................................................................................................................ 16 2.4 Identifying Other Sources of Hazard ............................................................................................. 19 2.4.1 Childhood Poisonings and Child-Resistant Packaging ........................................................... 19 Guidelines for the Notification of Injuries from Hazardous Substances April 2001 3. NOTIFICATION BY HOSPITALS..........................................................................21 3.1 What Types of Injuries Must be Notified?.................................................................................... 22 3.2 Relationship to ICD-Coding........................................................................................................... 23 3.3 Guidance on Specific Data Fields .................................................................................................. 24 3.3.1 Data Fields ............................................................................................................................. 25 3.4 Identifying the Substance Involved ............................................................................................... 31 4. SPECIFIC AREAS FOR ANALYSIS AND INVESTIGATION ...........................31 4.1 Investigating Chemical Injury Incidents ...................................................................................... 31 4.1.1 Harmonising with Current PHS Systems ............................................................................... 32 4.2 Intentional Injuries from Hazardous Substances ........................................................................ 32 4.3 Childhood poisonings....................................................................................................................... 33 4.4 Workplace injuries........................................................................................................................... 34 5. CORONERS’ REPORTS...........................................................................................34 5.1 Abstraction of Coronial Data.......................................................................................................... 35 6. REPORTING TO NATIONAL AND LOCAL AGENCIES ..................................35 7. GENERAL REFERENCE MATERIAL ON POISONING/CORROSIVE INJURIES:...................................................................................................................35 8. NATIONAL CONTACT LIST...................................................................................36 9. REFERENCES............................................................................................................37 APPENDIX A...................................................................................................................38 Guidelines for the Notification of Injuries from Hazardous Substances April 2001 Summary New Zealand has been without a national surveillance system on poisonings and other chemical injuries for about the last ten years. This goes against not only prudent public health objectives, but also existing and imminent legislation that mandates injuries resulting in hospitalisation from hazardous substances must be notified to the Minister of Health. Furthermore, although a variety of local surveillance systems exist in several local Public Health Services (PHS) for the monitoring of poisoning notifications from hospitals, these systems are not standardised, and do not feed into a national database. The Hazardous Substances and New Organisms