Download Health and Safety Communiqué Immediate Attention to All

Health and Safety Communiqué
Immediate Attention to All Paramedic Services
August 6/13
This communiqué is designed to inform Emergency Medical Service Providers, supervisors and
workers, of an expanding treatment plan and the potential hazards in the field. It is not to be construed
as a ‘Policy and Procedure’ that is to be followed but rather should cause an immediate dialogue among
personnel. This will assist in ensuring that workers are informed of the hazards in the workplace, as per
the Occupational Health and Safety Act (OHSA).
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Antineoplastic’s are cytotoxic cancer medications that target rapidly dividing cells, inhibiting their growth.
This is not restricted to cancer cells, but any rapidly dividing cells.
New technologies now allow more freedom of mobility and improved lifestyle options during the
treatment process for patients. Increasing numbers of patients are now receiving chemotherapy at home,
over a 3-7 day treatment plan.
2 diseases commonly treated with antineoplastic home chemotherapy today are colorectal and breast
cancer. Expansion to these and other treatment programs is being developed.
With increased patient numbers comes increased risk of worker exposure as they may have minimal
familiarity with this drug or the delivery apparatus. They may unknowingly expose themselves needlessly.
Even a small amount of this medication can be quite toxic to the worker.
Health Risks to workers include; reproductive effects, fetal malformations, organ damage, cancer or
changes in genetic material. Pregnant or nursing paramedics are at increased.
Exposures can occur with direct contact with the medications (absorption), with an inadvertent touch of
contaminated surfaces in the patient environment (absorption) or with atomized medication (inhalation).
Contact with bodily fluids such as urine, vomit or fecal matter from any chemotherapy patient can also be
toxic for up to 48 hours post treatment, whether home or hospital therapy.
EMS may encounter these patients anywhere as they may be fully mobile in the community.
Universal precautions with full PPE (gown, double nitrile gloves, N-95, goggles and face shield) and
immediately adopting early Q & A amendments into your History Taking routine are imperative.
Spills require specialized procedures and equipment not provided within EMS.
The apparatus most often utilised for drug delivery is an Elastomeric pump. A body heat activated balloon
reservoir within a bottle strapped to the patients’ side. Looks similar to a baby bottle in a pouch. (See
sample at; http://www.capca.ca/wp-content/uploads/Baxter-Elastomeric-Pumps-Clinician-Guide11.pdf)
For more information regarding antineoplastics or other hazardous drugs go to;
https://www.irsst.qc.ca/media/documents/PubIRSST/CG-002.pdf
There is currently no approved ‘best practice model’ adopted in Ontario for EMS interactions with these
or other dangerous drugs. The Ontario Emergency Medical Services Section 21 Sub Committee is currently
and actively seeking assistance in producing a sector wide Policy and Procedure Guidance Note for this
segment of our patient population. Details to follow.
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by Wayne Markell AEMCA; ACP
Resources:
Public Services Health and Safety Association (PSHSA)
Cancer Care Ontario –Evidence-based Series - Safe Handling of Cytotoxics
https://www.cancercare.on.ca/toolbox/qualityguidelines/other-reports/collaborative-pr-ebs/
ASSTSAS/IRSST Prevention Guide http://www.asstsas.qc.ca/publications/publications-specialisees/guides-deprevention/prevention-guide-safe-handling-of-hazardous-drugs.html
NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings 2012
NIOSH Alert: Preventing Occupational Exposures to Antineoplastic and other Hazardous Drugs in Healthcare
Settings DHHS (NIOSH) Publication No. 2004-165 (2004)
Personal Protective Equipment for Health Care Workers Who Work with Hazardous Drugs
DHHS (NIOSH) Publication No. 2009-106 (2008)
Prevention Guide, Safe Handling of Hazardous Drugs https://www.irsst.qc.ca/media/documents/PubIRSST/CG002.pdf
Baxter Medical, Elastomeric Pump
http://www.capca.ca/wp-content/uploads/Baxter-Elastomeric-Pumps-Clinician-Guide11.pdf
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by Wayne Markell AEMCA; ACP