There are a number of important health issues that you need to be aware of and take responsibility for
Hepatitis B Prevention & Vaccination Policy (April 2023)
During a rescue we periodically become exposed to body fluids that could be infected e.g. with Hepatitis B Virus. This not only means blood, but also saliva and possibly other fluids (e.g. vomit). Therefore, all team members who go out on rescues and have close contact with a casualty should really be immunised. I have attached an information sheet that was drawn up by Paula Cook, GP and former team member .
Members of MR teams especially those people with a current Casualty Care certificate are potentially at risk as they are more likely to be in close contact with the casualty.
Even if you think you are already fully aware of the issues in relation to Hepatitis B, please can you read the following information carefully and respond accordingly. It is entirely your own choice whether you choose to be vaccinated for Hepatitis B or not. We recommend that all team members are vaccinated, and especially those who are Casualty Care Certificate holders.
What is Hepatitis B?
Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV).
How is it spread?
Hepatitis B virus (HBV) is a blood-borne virus so it is spread by direct contact with blood products (e.g. needle stick injuries), through sexual transmission or from a mother to child during childbirth. The virus may also be present in some body secretions such as saliva.
What does the infection do to you?
Most people who contract the disease will experience symptoms of nausea, reduced appetite, right upper abdominal pain, a mild fever, and malaise. In more serious cases people can become jaundiced, and 5 - 10% develop cirrhosis of their liver, experience liver failure or a have long term reduction in their liver’s effectiveness. Many individuals with chronic (long-term) HBV are unaware that they have the infection until it results in a complication.
How can we protect ourselves from becoming infected by the virus?
For those people undertaking what are known as ‘exposure-prone procedures’ e.g. inserting a cannula, using needles, injecting medications, inserting an airway device, there are two main ways to prevent becoming infected by hepatitis.
Practising safe clinical procedures at all times i.e. wearing gloves, handling sharps safely, clearing up body fluids appropriately.
Immunisation. NB Immunisation does not remove the responsibility of practising safely.
Who requires immunisation?
Anybody who undertakes exposure-prone procedures with a casualty, is deemed to have an increased (although still small) risk of coming into contact with the virus and should therefore be vaccinated. To put it in perspective, to prevent contracting this potentially serious disease, the NHS requires all healthcare workers to be immunised against HBV.
How does vaccination work?
Vaccination is obtained from your GP and is usually a course of three intramuscular injections (placed in your upper arm or thigh) spaced at 0, 1 and 2 month intervals.
All hepatitis B vaccines are inactivated, do not contain live organisms and therefore cannot cause the disease itself.
A few people (around 10-15%) do not respond to the course of three injections. For this reason, it is recommended (but is your own choice) that you have a blood test taken at around 4 months after your vaccination course ends. This blood test checks for the levels of specific antibodies and will give you confirmation that you are protected. For the minority of people for whom the primary vaccination course is insufficient, either one or three extra doses will be required.
Do I need any booster injections?
Yes.
Currently it is not known whether the vaccination provides lifelong immunity. Although this maybe the case, everyone is required to have one booster injection 5 years after their original vaccinations to ensure they are fully protected. After that booster, no further boosters are required.
I have already been vaccinated and had a 5-year booster; do I need to do anything?
Yes.
To ensure we are following best practice for anybody who is exposed to the risk of contacting hepatitis virus because they undertake exposure-prone procedures, we need to keep a register of the dates of your primary vaccination and subsequent 5-year booster. Please can you send this information to Roger as Team Medical Officer, who will hold it confidentially.
I need to have a booster, what do I do?
Make an appointment with your GP practice for the nurse to administer your booster injection. Send Roger the dates of your primary vaccination course and 5-year booster. This data will then be held confidentially.
I don’t know whether I have been vaccinated against Hepatitis B; what should I do?
Make a telephone appointment with your GP/practice nurse, who will be able to review your records and advise you.
I have not had a primary course of vaccination; what do I do?
Make an appointment with your GP practice for the nurse to administer your primary course of 3 injections. Ensure you advise them that you have occupational exposure through LAMRT and state whether you would like a blood test/serology testing at 4 months to ensure the vaccine has been sufficient to offer you protection. Send Roger the dates of your primary vaccination course. This data will then be held confidentially.
Who pays for the course of inoculations?
Some GP practices will be happy to provide this service free-of-charge to members of MREW teams. However, if this is not the case, the Team will refund any costs you incur. Please provide a receipt and send it to the Treasurer.
My GP/practice nurse says a blood test/serology testing at 4 months is not required; what do I do?
Initially you should show them this explanatory email, confirming to them that you are a member of LAMRT deemed to have occupational exposure and therefore are entitled to a blood test/serology testing to check your antibody levels. If you still encounter problems please speak to Roger who will attempt to resolve the issue for you.
What do I do if I have been exposed to blood and body fluids from a casualty known to be Hepatitis B positive and I have not been vaccinated?
Hepatitis B vaccine can also be highly effective at preventing infection if given shortly after exposure. Ideally it needs to be given within 48 hours of exposure, but it can still be effective given up to 7 days post exposure. In particularly high risk situations or for a team member who is known not to have responded to vaccine courses a Hepatitis B immunoglobulin may also be given with the vaccine. This helps to provide temporary protection whilst the vaccine becomes effective. Even if infection has already occurred at the time of immunisation, use of the Hepatitis B immunoglobulin reduces the symptoms of infection and most importantly can still prevent you becoming a carrier for Hepatitis B.
If you have concerns about exposure and risk after any rescue please speak to either Roger or Les as soon as you return to base. If neither were present on the rescue; you should ensure you speak to one of them urgently by telephone.
Roger Barton
April 2023
Ticks
· Ticks can carry a number of diseases, the most well-known being Lyme Disease (1200 cases in the UK in 2009). If these diseases become established, you can be blighted for years, so it pays to take this seriously.
· Risk is highest in rural forested areas and heathland such as the Highlands, Lake District and the New Forest.
· Prevention is best. Tick bite risk can be minimised by wearing clothing with sensible coverage such as long sleeved shirts and trousers tucked into socks. Insect repellents containing DEET are effective. [Ref 1]
· Transmission of Lyme Disease is unlikely if ticks are attached for <24 hours and not engorged.
· Check yourself each day e.g. when you get into the shower. The sites where ticks are attached are shown in the diagram [Ref 2].
· Carry tick forceps or fine-tipped tweezers and make sure you know how to use them correctly. Do NOT use your fingers to pull it out as you will expel the tick contents including the bugs into the wound. Noxious substances such as alcohol, petrol, volatile oils or lighted cigarette butts or matches should not be applied to the tick because of the risk of skin damage. A copy of a very useful page about tick removal from the BADA website is attached
· As ticks can carry a number of diseases, Once removed, you could keep the tick as it may help a future diagnosis.
· If you are bitten, look at the bite mark for the appearance over days-weeks of a red 'halo' discolouration around the bite, see photo (Ref 3). This occurs in 90% of infected cases, but not in every case so do not rely on this. If you see it, seek medical intervention. Specific antibiotics will be needed and are effective.
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Many people are bitten and show no symptoms so no action is needed. Not all ticks carry disease. In this situation, you don’t need a blood test nor prophylactic antibiotics.
If you have any symptoms, you must see a doctor. If you have flu-like symptoms seek medical advice and report that you have had a tick bite. If you do need treatment with antibiotics, you’ll need a two-week course.
Sun exposure, vitamin D and sunburn
You need some repeated sun exposure in the summer to build up vitamin D levels to last over the winter. However, on a very sunny day, this might only need to be about 15 minutes exposure. People with darker skin will need to spend longer in the sun to produce the same amount of vitamin D. [NHS Advice: Ref 4] Note that prolonged sun exposure does not cause your vitamin D levels to increase further, but does increase your risk of burning and skin cancer. Vitamin D production plateau’s at doses well below that required to cause sunburn [Ref 5]. Make every effort to avoid sunburn, particularly if you are fair-skinned.
Tetanus immunisation
People born after 1961 will have had a course of injections during childhood so should have long-lasting immunity. Hopefully, those of us born before then will have had a course of three injections at some time to provide immunity. Tetanus can be transmitted through any cut, particularly if the wound is deep or gets contaminated with soil or manure. [Ref 6].
The current advice from Public Health England is that people with any “dirty’ wounds should be given a booster dose In all cases if you have not had one within the last 10 years. Discuss with your GP.
Any questions about these issues discuss with the Team Doctor
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Safe disposal of sharps and clinical waste
The equipment room stores boxes for the disposal of dirty sharp equipment and clinical waste from rescues and training. These have to be managed in a particular way, guided by health and safety legislation. You will have a training session on how to keep all team members safe. Posters in both the equipment and medical training room show you what to do if you have an injury. For a more detailed explanation of our team policy go to the section on ‘Sharps Injury and Clinical Waste Management’ in the Cas Care Section of the website.
The major concern with sharps injuries is the risk of blood born infection. The three most common infections in the UK are HIV, Hepatitis B and Hepatitis C viruses.
‘Sharps’ are needles, intravenous cannulae and medical instruments, that could cause an injury by cutting or pricking the skin. A sharps injury is an incident, which causes a needle or other medical instrument to penetrate the skin. A ‘safer sharp’ means a medical sharp that is designed and constructed to incorporate a feature or mechanism which prevents or minimises the risk of accidental injury from cutting or piercing the skin if used correctly.
Anyone who comes into contact with a sharp instrument previously used on another person is at risk. In mountain rescue, team members and support staff can be put at risk of injury in two ways: those who directly handle sharps and those who may inadvertently be put at risk when sharps are not handled, stored, or disposed of correctly.
Risks arise from sharps during casualty care and following administration of drugs by intramuscular injection and intravenous cannulation, in the equipment room and medical training room. The risk occurs in the following ways:-
during use on a rescue
after use, before disposal
between steps in procedures
during disposal
whilst re-sheathing or recapping a needle.
sharps storage boxes kept in the equipment and medical training rooms and medical sacs
Injuries
If you are unfortunate enough to sustain an injury during team activities, on a call-out or in training (or even a social event!), you may be eligible for assistance with physiotherapy to get you back to health. Register your incident in the Accident Book, and contact the Medical Officer for details. The Team have engaged physiotherapy services locally. See the Injury Rehabilitation section, accessed from the Home page, for details.
Mental Wellbeing
Similarly, if you have been adversely affected by an incident in the course of your volunteering, the Team have a wellbeing lead, Jim Evans, to chat to confidentially. Alternatively, just talk to any other team member about your concerns. This could be your mentor, team leader, deputy leader, doctor or paramedic - anyone. The Team have also engaged confidential psychological support services to assist team members in this regard. Just ask. For details, see Mental Health Help, accessed from the Home page.
References
1. British Infection Association. The epidemiology, prevention, investigation and treatment of Lyme borreliosis in United Kingdom patients: A position statement by the British Infection Association. J Infection 2011;http://dx.doi.org/10.1016/j.jinf.2011.03.006
2. Gunduz A, et al. Tick attachment sites. Wild Environ Med 2008;19:4-6
3. Duncan CJA, et al. Tick bite and early Lyme borreliosis. Brit Med J 2012;344:e3124 doi: 10.1136/bmj.e3124
4. http://www.nhs.uk/Livewell/Summerhealth/Pages/vitamin-D-sunlight.aspx
5. Gilchrest BA. Sun exposure and vitamin D sufficiency. Am J Clin Nutr 2008;88:570S-7S
6. http://www.nhs.uk/chq/pages/1316.aspx?categoryid=67&subcategoryid=150