Download Public Health Rapid Risk Assessment (RRA) for Chemical Events

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Public Health Rapid Risk Assessment (RRA) for Chemical Events
Document developed in support of Decision No: 1082/2013/EU on the Management of serious cross border threats to
health. Developed by ECHEMNET project [20121101] co-funded by European Commission and CARIMEC and CARRANET
service contracts Framework Service Contract No 2009 61 05 – Lot 2 Service Contract Agreement No 2010 61 22/21
Who is this document for?
1. EXPERT COMMITTEE/NETWORK OF EXPERTS: For the rapid risk assessment of chemical
events that satisfy criteria for a cross border response pursuant with Art 9.1 and 10.2 of
1082/2013/EU.
2. RISK MANAGER: Could be used by national public health risk managers/assessors to aid
decision making or strategic assessment.
3. CO-ORDINATOR: Could be used by the European Commission to request for further
information on a confirmed or suspected cross border health threat.
What is this document for?
1. To allow risk assessment and communication of information relating to cross border
chemical public health threats (where they are outside the remit of other organisations in an
open, transparent, timely and harmonised manner).
2. To aid in risk prioritisation and defensible decision making process for an emerging chemical
event.
3. To ensure relevant stakeholders are informed in a timely manner to aid risk mitigation.
4. To help identify where support may be required.
Overarching actions list
1. Read through the RRA before completing the template; linked descriptions provide more
information of the template fields.
2. Answer the critical questions in the time available
3. If further, more detailed, hazard specific technical information is required to conduct the
RRA, request a Chemical Emergency Risk Management Monograph from SANTE C3.
4. Enable document track changes to ensure that multiple updates are recorded within this
document.
5. Highlight important fields that are the focus of the assessment in yellow.
6. If Information is unknown at the time of completion clearly state ‘unknown at the time of
completion’. If fields are not required in the development of the RRA state ‘Not Applicable’
in the field.
7. YOU MUST enter summary information in the green fields this information should be used to
populate the RRA public summary. Other fields are added to support the assessment – you
do not necessarily need to fill in every box – use each filed as a guide
8. Do not include person or person identifiable information of those affected or potentially
affected in the incident in this document.
9. The output of the RRA is the summary section – make sure you have enough time to merge
(using the merge macro function) – top right circular arrows.
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Rapid Risk Assessment for Chemical Events
1.
2.
3.
4.
5.
6.
7.
8.
Event Control Data .......................................................................................................................... 3
Hazard Data..................................................................................................................................... 4
Exposure Data ................................................................................................................................. 5
Clinical Case Data ............................................................................................................................ 6
Public Health Factors ...................................................................................................................... 6
Cross-sectoral factors...................................................................................................................... 8
Societal factors ................................................................................................................................ 9
Overall Public Health Risk Characterisation .................................................................................... 9
1. Event Control Data
Date & time
incident
Click here to enter a date.
Country of event
Click here to enter text.
Reporting
organisation
Click here to enter text.
Reporting country
Click here to enter text.
Source of
information
Choose an item.
Other: Click here to
enter text.
Click here to enter text.
Unique RAS-CHEM
Identifier
Add link to post
Creation date and
time
Click here to enter a date.
Last saved update
28/07/2017 20:29:00
Created by
Click here to enter text.
Last saved by
Assessment
requested by
European Commission ☐ Health Security Committee ☐ World Health Organization ☐
Date requested
Click here to enter a date.
Time frame for risk
assessment
Click here to enter text.
Why was the RRA
requested?
Click here to enter text.
What are the critical
questions to inform
the assessment?
Click here to enter text.
Names of expert risk
assessors engaged
in the RRA
Click here to enter text.
Event summary
EU Member State
☐ Other organisation:
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2. Hazard Data
Event Involving
☐
☐
☐
☐
☐
☐
☐
☐
Chemical Release from industrial process or accident
Chemical contamination of water, air, soil, crops
Chemical release during transport
Chemical contamination of foodstuff
Chemical contamination of non-foodstuff consumer item
Medicines
Recreational or illegal drugs
Deliberate release of chemical(s)
Other:
RAS-CHEM Alert Level
☐
☐
☐
☐
☐
☐
1a Background information only
1b Unusual event or case, where there is a low level of suspicion about release of a toxic chemical
1c Unusual event - information for poison centres
1c Unusual event - Public health concern
2a Unusual features of poisoning - with no known cause
2b Suspected release of chemical(s) with potential for mass intoxication/significant public health
impact
2c Suspected mass intoxication
2d Confirmed mass intoxication
3 Unusual public health event of international concern (PHEIC)
☐
☐
Reason for Reporting
☐
☐
☐
☐
☐
☐
☐
☐
Public health impact serious
Event unusual or unexpected
Significant risk for international spread
Significant scope for international coordination/cooperation
Event relevant for health security activities
Significant risk for international trade and travel restriction
Civil unrest and disruption
May be of interest to poison centres or public health authorities
Hazard Identification
Chemical(s)
Click here to enter text.
CAS Number(s)
Click here to enter text.
EC Number(s)
Click here to enter text.
Synonyms
Click here to enter text.
Chemical group
Choose an item.
Where is the
chemical (exposure
pathway)?
Choose an item.
Further detail on
Click here to enter text.
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vehicle/exposure
pathway
Quantity of
Chemical
Click here to enter text.
Toxicological
properties
Click here to enter text.
Detection or
confirmation
method
Click here to enter text.
Further
information on
hazard (including
limitations)
Click here to enter text.
Hazard Assessment
Click here to enter text.
Certainty of hazard
assessment
3. Exposure Data
Exposure data
details
Click here to enter text.
Levels of exposure
Click here to enter text.
Duration of
exposure(s)
Click here to enter text.
Circumstances of
exposure
Route of exposure
Location(s) of
exposure
Location details
Evidence from
human biological
tests
Click here to enter text.
Evidence from
environmental
monitoring or
dispersion
modelling
Click here to enter text.
Evidence for cross
border spread (EU
or wider)
Click here to enter text.
Weather conditions
Click here to enter text.
Wider significant
Click here to enter text.
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receptors (nonhuman)
Exposure data
further details
(including
limitations)
Click here to enter text.
Exposure
Assessment
Click here to enter text.
Certainty of
exposure
assessment
4. Clinical Case Data
Clinical summary
affected person(s)
Click here to enter text.
Observed clinical
effects
Click here to enter text.
Source of clinical
effect data
Choose an item.
Poisoning severity
Choose an item.
Outcome
Click here to enter text.
Clinical data further
details (including
limitations)
Click here to enter text.
Clinical case data
assessment
Click here to enter text.
Other:
Click here to enter text.
Certainty of clinical
case data
5. Public Health Factors
Location
Click here to enter text.
Population density
Click here to enter text.
Map of population
density
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Schematics or plans
for affected
installation
Likely duration of
incident/release
Click here to enter text.
Vital statistics of
affected population
Click here to enter text.
Sensitive receptors
Click here to enter text.
Local health care
facilities and
provision
Click here to enter text.
Local
decontamination
arrangements
Click here to enter text.
Required antidotes
Click here to enter text.
Required medical
support
Click here to enter text.
Personal protective
equipment
Click here to enter text.
Shelter in place or
evacuation
requirement
Click here to enter text.
Handling of
deceased
Click here to enter text.
Epidemiological
study or contact
tracing required?
Click here to enter text.
Biomonitoring
required?
Click here to enter text.
Long term follow-up
or psycho-social care
required?
Click here to enter text.
Recovery and
environmental
decontamination
factors
Click here to enter text.
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Other
environmental
factors
Click here to enter text.
Similar past events
in country or
otherwise?
Click here to enter text.
Evidence for cross
border spread (EU or
wider)
Click here to enter text.
Public health data
assessment further
details (including
limitations)
Click here to enter text.
Public health data
assessment
Click here to enter text.
Certainty of public
health data
assessment
6. Cross-sectoral factors
Police, security,
military or forensic
factors
Click here to enter text.
Transport and
migration factors
Click here to enter text.
Control of sales
Click here to enter text.
Border control
factors
Click here to enter text.
Impact on water
resources
Click here to enter text.
Impact on food
supply chain
Click here to enter text.
Impact on animals
and agriculture
Click here to enter text.
Rehousing,
education and local
facilities
Click here to enter text.
Economic factors
Click here to enter text.
Cross-sectoral
factors further
details (including
limitations)
Click here to enter text.
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Cross-sectoral
assessment
Click here to enter text.
Certainty of crosssectoral assessment
7. Societal factors
Religious, cultural or
social impacts
Click here to enter text.
Policy or political
impact
Click here to enter text.
Media interest
Click here to enter text.
Other societal
factors further
details (including
limitations)
Click here to enter text.
Societal assessment
Click here to enter text.
Certainty of societal
assessment
8. Overall Public Health Risk Characterisation
Main risks identified from section 1-7 above
Click here to enter text.
Estimates of likelihood
Choose an item.
Estimates of consequences
Choose an item.
Level of overall risk
Choose an item.
Level of confidence in risk assessment
Choose an item.
Key aspects of assessment in estimating risks
List headings
Are there aspects likely to change significantly
Should a follow-up risk assessment be undertaken?
If ‘yes’ when should a follow-up risk assessment be
undertaken?
DISCLAIMER: This document is currently in draft format and will remain so until it has been finalised
and agreed. Neither the European Commission, ASHTIII or ECHEMNET group nor any person acting
on behalf of the EC, the ASHT or ECHEMNET group is responsible for the use which might be made of
this document. The authors of the assessment have carefully checked the fields proposed to form the
document to ensure that is complete and generally in accord with the standards accepted at the time
of update. However, in view of the possibility of human error or changes in medical sciences, neither
the authors nor the leader of the ASHTIII or ECHEMNET projects nor any other party who has been
involved in the preparation of this work warrants that the information contained herein is in every
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respect accurate or complete, and they disclaim all responsibility for the results obtained from use of
the information contained in this work. Users are advised to check the information included in
assessment to be certain that the information contained in the document is accurate and will provide
a robust and detailed assessment of cross border chemical health threats that are outside of the
remit of other organisations. They are also advised to consult regional Poison Control Centre or
National Public Health Authority for any additional information, if needed.
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Rapid Risk Assessment –Summary
Title:
Click here to enter text.
Date:
28/07/2017
Number of Update
Click here to enter
text.
Key updates in this document
Click here to enter text.
Key conclusions
Click here to enter text.
Summary risk assessment (from below)
Click here to enter text.
Requested by:
Date of request
Click here to enter text.
Click here to enter a date.
Why was the RRA requested, including critical questions?
Click here to enter text.
Rapid health risk assessment working group:
Click here to enter text.
Event summary
Click here to enter text.
Hazard assessment
Click here to enter text.
Exposure assessment
Click here to enter text.
Clinical case data assessment
Click here to enter text.
Public health data assessment
Click here to enter text.
Cross sectoral assessment.
Click here to enter text.
Societal assessment
Click here to enter text.
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Risk characterisation
Click here to enter text.
Conclusions
Click here to enter text.
DISCLAIMER: This document is currently in draft format and will remain so until it has been finalised
and agreed. Neither the European Commission, ASHTIII or ECHEMNET group nor any person acting
on behalf of the EC, the ASHT or ECHEMNET group is responsible for the use which might be made of
this document. The authors of the assessment have carefully checked the fields proposed to form the
document to ensure that is complete and generally in accord with the standards accepted at the time
of update. However, in view of the possibility of human error or changes in medical sciences, neither
the authors nor the leader of the ASHTIII or ECHEMNET projects nor any other party who has been
involved in the preparation of this work warrants that the information contained herein is in every
respect accurate or complete, and they disclaim all responsibility for the results obtained from use of
the information contained in this work. Users are advised to check the information included in
assessment to be certain that the information contained in the document is accurate and will provide
a robust and detailed assessment of cross border chemical health threats that are outside of the
remit of other organisations. They are also advised to consult regional Poison Control Centre or
National Public Health Authority for any additional information, if needed.
END PRINT PAGE HERE IF RISK ASSESSMENT IS COMPLETED AND REQUIRES PRINTING ON PAPER
OR SAVING AS PDF FOR DISTRIBUTION.
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Rapid Risk Assessment Field Descriptions
Linked
Descriptions
These are internal document links that provide additional information to the risk
assessor.
Event Control
Data
Much of this information should be available from the RASCHEM entry for the
event. If the event is not posted to RASCHEM this should be done immediately.
Date & time
incident
Select date of the incident from the calendar. If known add time of the event
using the 24 hour clock (e.g. 23:00)
Reporting
organisation
The organisation which posted the initial report on the incident.
Reporting
country
The country which posted the initial report on the incident
Country of event
The country or countries affected (or potentially affected) by the incident
Source of
information
Unique RASCHEM Identifier
Drop down list to select where event information has emerged from (e.g.
media). Free text field ‘Other’ for sources not listed. If there is more than one
source of information please add additional sources in the ‘other’ field
A free text summary of the event including key aspects (e.g. contamination of
children’s toy (Aquabeads) with 1,4-butanediol, several children with severe
poisoning in UK)
This is the unique event identifier which is generated when the event is posted
to RASCHEM. Copy this unique ID into this field.
Creation date
and time
Document control field. Automatically added to the document when the
document is first used.
Last saved
update
Document control field. Automatically added to the risk assessment when the
document is saved.
Created by
Document control field. Automatically added to the document when the risk
assessment is created.
Last saved by
Document control field. Automatically added to the document when the risk
assessment is saved.
Tick box. Select the organisation that have requested a rapid risk assessment
Event summary
Assessment
requested by
Date requested
Time frame for
risk assessment
Why was the RRA
requested?
What are the
critical
questions?
Select the date and enter the time using 24 hour clock (e.g. 23:00) of when the
rapid risk assessment was requested.
A clear indication of the timeframe requested should be added here; this should
be discussed and agreed with DG-SANCO Health Threats Unit and Scientific
Committee Member(s)
This information should have been provided by the organisation requesting the
risk assessment. The information may relate to the potential risk and hazard
involved. The nature of the request is important in determining the type of risk
assessor (e.g. clinical toxicologist or organic chemist)
The formulation of the risk questions is a key step in the RRA. It is likely that the
organisation requesting the RRA will have established the risk questions. If this
has not been done then the potential questions should be discussed and
confirmed with DG-SANCO Health Threats Unit and Scientific Committee
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Names of expert
risk assessors
engaged in the
RRA
Hazard Data
Hazard
Identification
Chemical(s)
CAS Number(s)
EC Number(s)
Synonyms
Chemical group
Member(s) involved.
For further information refer to pages 9-11 in the WHO Rapid risk Assessment to
Acute Chemical Events:
http://whqlibdoc.who.int/publications/2009/9789241598149_eng.pdf?ua=1
List the names of the expert risk assessors and Scientific Committee who were
engaged in developing the RRA. This is a critical step in the RRA and care should
be taken in selecting appropriate expertise and skills. Please refer to the risk
assessor database and risk assessor skills framework. An operating procedure
for selecting risk assessors for a given threat will be developed within the
ECHEMNET project
Hazard identification is the identification and description of a chemical or
chemicals causing the public health event. The first section consists of check
boxes in order to ascertain the nature and scale of the event; this information
should also be posted to the relevant RASCHEM entries
These fields try to capture essential information about the nature of the
hazards. This information should be made available in the RASCHEM entry or if
provided in the corresponding Chemical Emergency Risk Management
Monograph
Common name of chemical or substance
Chemical Abstracts Services Registry Number available here:
http://echa.europa.eu/web/guest/information-on-chemicals/cl-inventorydatabase
EC number, also known as EC No., EINECS No., and EC#, available here:
http://echa.europa.eu/web/guest/information-on-chemicals/cl-inventorydatabase
List alternative names for chemicals, where possible including systematic, street
and other languages
http://echa.europa.eu/web/guest/information-on-chemicals/cl-inventorydatabase
http://echa.europa.eu/information-on-chemicals/registered-substances
http://www.inchem.org/
Include chemical group if known e.g.
 Acutely toxic substances, such as carbon monoxide, hydrogen sulphide,
hydrogen cyanide, acrylonitrile
 Irritating/corrosive substances, such as chlorine, ammonia, sulphur
dioxide, hydrogen chloride (hydrochloric acid)
 Pulmonary (lung) toxicants, such as phosgene, oxides of nitrogen
 Sensitizing substances, such as acrylates, formaldehyde, toluene
diisocyanate (TDI)
 Carcinogenic and mutagenic substances, such as benzene, acrylamide,
butadiene
 Reprotoxic substances
 Metal fumes/vapours, such as mercury
 Combustion gases
 Chemical weapons, such as nerve gases, mustard gases, tear gases,
psychochemicals, opiates, fentanyl derivatives
 Organic solvents, such as methanol, toluene, xylene
 Nanoparticles and nanomaterials
 Pharmaceuticals and medicaments (e.g. analgesics, anti-coagulants and
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Where is the
chemical
(exposure
pathway)?





anti-inflammatories)
Industrial/agricultural (fertiliser/pesticide/biocide)
Consumer products
Toxins from a biological origin (such as venoms, botulism)
licit/illicit drugs of abuse
Drop down list of vehicle that embodies or contains the toxic substance
or chemical
Further detail on
vehicle/exposure
pathway

If possible add further free text information on the chemical vehicle (e.g.
trade names, product type).
Quantity and
concentration of
chemical

Toxicological
properties

Detection or
confirmation
method

If appropriate enter quantity of chemical involved in metric units
o Solids: mass (e.g. 42,000 Kg, 100mg).
o Liquids: volumes (e.g. 5 litres or 100mls) molar concentration (e.g.
17M or 1.23x10-2M)
o Gases: parts per millions (PPM)
o Aerosols or dusts: milligrams per metre cubed (mg/m-3)
Provide an indication on the key hazardous properties and inherent
toxicological properties using:
o The Globally Harmonised System terms and codes:
http://echa.europa.eu/web/guest/information-on-chemicals/clinventory-database
o Corresponding Chemical Emergency Risk Management Monograph
o IPCS INCHEM resources: http://inchem.org/
o Public Health England Chemical Compendia Entries:
http://www.hpa.org.uk/Topics/ChemicalsAndPoisons/ChemicalsPois
onsAZ/?packedargs=Letter%3DA
Include detection methods and investigating laboratory details. This
may be environmental sampling or direct/indirect human biological
tests .
Mention if laboratory or field test confirm a specific cause or are
consistent with a particular type of hazard.
Include other information in this field which may aid the hazard
identification process (e.g. odour, state at room temperature).
If there are potential new products or reactions of the release that may
cause harm.
Indicate where there are uncertainties, where assumptions have been
made or if further information is required.

Further
information on
the hazard
(including
limitations)
Hazard
assessment
Certainty of
hazard
assessment



This process reflects the identification and characterisation of the chemical
hazard. This might include reviewing key information and characteristics of the
chemical(s) or ranking hazards if more than chemical is involved.
Estimating the certainty of the hazard assessment will depend on the nature of
the information provided, how quickly the assessment is required and the
complexity of the event. This estimate is most likely subjective unless there have
been positive results of direct confirmation tests.
For more detailed information on qualitative risk assessments:
http://www.who.int/foodsafety/publications/micro/MRA17.pdf?ua=1
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Choose one item from the drop down list.
 Very certain - probability of 95% or more
 Highly certain - probability of between 70% and 94%
 Certain - probability of between 30% and 69%
 Uncertain - probability of between 5% and 29%
 Very uncertain - probability of less than 5%
Exposure
Assessment
Adapted from:
http://whqlibdoc.who.int/publications/2009/9789241598149_eng.pdf?ua=1
The Exposure assessment is the evaluation of individuals and populations to
hazard presented above.
Exposure Data
Exposure data
details
Levels of
exposure
Duration of
exposure(s)
Circumstances of
exposure
Route of
exposure
Location(s) of
exposure
Location details
Evidence from
environmental
monitoring or
dispersion
modelling
Number of exposed person(s), age of exposed person(s), sex of exposed
person(s), susceptible person(s) (e.g. pregnant, infants etc.). Do not include
person identifiable information in the assessment
Include information on the level of the exposure for the affected patient/
population. This may rely on indirect environmental monitoring data,
information from the incident command or health investigations (e.g.
questionnaires, medical consultation) where exposure levels are inferred or
estimated. Or by direct measurement of biological samples for the contaminant
or metabolite or for biomarkers of effect. The exposure may or may not lead to
symptoms of poisoning.
Include information of the likely duration of the exposure if this is relevant (e.g.
four days for a large chemical fire). Also if there is likely to be a continuous or
intermittent exposure. Indicate when the exposure might end.
Drop down list of terms describing how the exposure has occurred (e.g.
intentional). These controlled terms are from the World Health Organization
INTOX definitions list: http://www.who.int/ipcs/poisons/definitions_en.pdf
Drop down list of terms describing the way in which the chemical has entered
the body (e.g. inhalation). These controlled terms are from the WHO INTOX
definitions list: http://www.who.int/ipcs/poisons/definitions_en.pdf
Drop down list of terms giving a broad description of the environment where
the exposure has occurred (urban, rural). These controlled terms are from the
WHO INTOX definitions list:
http://www.who.int/ipcs/poisons/definitions_en.pdf . If is more than one
location and it benefits the assessment add this information to the additional
columns
Drop down list of terms describing the specific type of environment where the
exposure has occurred (e.g. school). These controlled terms are from the WHO
INTOX definitions list: http://www.who.int/ipcs/poisons/definitions_en.pdf . If is
more than one location and it benefits the assessment add this information to
the additional columns
This information constitutes the raw material for assessing and managing the
consequences in a specific incident. Translating this information into an
estimate of injury also requires knowledge of the safe levels of exposure.
Emergency exposure limits— Acute Exposure Guideline Levels (AEGLs),
Emergency Response Planning Guideline levels (ERPGs) and Temporary
Emergency Exposure Limits (TEELs)—are the key additional ingredients for
assessing the consequences of injury.
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


Acute Exposure Guideline Level (AEGL) values published by the U.S.
Environmental Protection Agency (EPA)
Emergency Response Planning Guideline (ERPG) values produced by the
American Industrial Hygiene Association (AIHA)
Temporary Emergency Exposure Limit (TEEL) values developed by SCAPA
For any particular chemical, US Department of Energy (DOE) established the
following sensible hierarchy of Protective Action Criteria (PAC) values for its
facilities and activities:
 Use AEGLs (including final or interim values) if they are available.
 If AEGLs are not available, use ERPGs.
 If neither AEGLs or ERPGs are available, use TEELs.
Describe plume modelling such as grounding, plume height, speed of plume,
likely progression over 24-48 hours
Acute Exposure Guideline Values:
http://www.epa.gov/oppt/aegl/pubs/chemlist.htm
Emergency Response Planning Guidelines: http://www.aiha.org/getinvolved/AIHAGuidelineFoundation/EmergencyResponsePlanningGuidelines/Do
cuments/2013ERPGValues.pdf
Temporary Emergency Exposure Limit
http://www.atlintl.com/DOE/teels/teel/search.html
Immediately Dangerous to Life and Health values:
http://www.cdc.gov/niosh/idlh/intridl4.html
Evidence from
human biological
tests
Describe any direct or indirect biological sample test results indicating if they
above or below emergency reference values or indicative threshold toxicity
levels described authoritative literature sources (e.g. UK Toxbase, Poison
information Monographs). This information should be made available in the
relevant CERM sheet if this has been made available
Chemical Safety Information from Intergovernmental Organisations:
http://inchem.org/
European Chemicals Agency Registered Substances Database:
http://echa.europa.eu/information-on-chemicals/registered-substances
Public Health England Chemical Compendia Entries:
http://www.hpa.org.uk/Topics/ChemicalsAndPoisons/ChemicalsPoisonsAZ/?pac
kedargs=Letter%3DA
Acute Exposure Guideline Values:
http://www.epa.gov/oppt/aegl/pubs/chemlist.htm
Emergency Response Planning Guidelines: http://www.aiha.org/getinvolved/AIHAGuidelineFoundation/EmergencyResponsePlanningGuidelines/Do
cuments/2013ERPGValues.pdf
Temporary Emergency Exposure Limit
http://www.atlintl.com/DOE/teels/teel/search.html
Immediately Dangerous to Life and Health values:
http://www.cdc.gov/niosh/idlh/intridl4.html
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Weather
conditions
Indicate if the immediate or predicted weather conditions will affect the
exposure (e.g. wind speed or direction, rain, air pressure, heat, cold)
Wider significant
receptors (nonhuman)
Global Disaster Alert and Coordination System, portal with links to
information/data on ongoing events worldwide, incl. Europe (online)
o http://www.gdacs.org/
EUMETNET Meteoalarm, weather alerts in EU (online)
o http://www.meteoalarm.eu/
Describe if animals or livestock have been exposed and any information from
this investigation. If there is veterinary information list this here along with
information on organisation involved.
Exposure data
further details
(including
limitations)
If relevant information is missing from fields above list here.
Indicate where assumptions have been made or further information is required.
Exposure
Assessment
This process reflects the identification and characterisation of the exposure
pathways and routes. This might include reviewing key information and
characteristics of potential or actual levels and duration of exposure and
population exposed or potentially exposed.
Certainty of
exposure
assessment
For more detailed guidance on Exposure assessment:
http://www.inchem.org/documents/ehc/ehc/ehc214.htm#SubSectionNumber:3
.5.2
Estimating the certainty of the exposure assessment will depend on the nature
of the information provided, how quickly the assessment is required and the
complexity of the event. This estimate is most likely subjective unless there have
been meteorological modelling, diagnostic tests or environmental monitoring
and sampling.
For more detailed information on qualitative risk assessments:
http://www.who.int/foodsafety/publications/micro/MRA17.pdf?ua=1
Choose one item from the drop down list.
 Very certain - probability of 95% or more
 Highly certain - probability of between 70% and 94%
 Certain - probability of between 30% and 69%
 Uncertain - probability of between 5% and 29%
 Very uncertain - probability of less than 5%
Clinical Case Data
Assessment
Clinical summary
affected
person(s)
Observed clinical
effects
Source of clinical
Adapted from:
http://whqlibdoc.who.int/publications/2009/9789241598149_eng.pdf?ua=1
The clinical case data assessment is the evaluation of the clinical features of
those intoxicated by the hazard and via the exposure pathway(s) and route(s)
described above
Include a short summary of the signs and symptoms associated with the
exposed/affected individuals; include number and indications of sensitive
populations.
Do not include person identifiable information in the assessment
Include a list of the observed clinical effects.
Drop down list of potential sources of clinical data. If the source is not listed use
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effect data
free text in the right hand box to describe the source of information.
Poisoning
severity
The severity of the poisoning should be marked according to the Poisoning
Severity Score (PSS) (Persson et al. J Clin Toxicol 1998; 36: 205-13) As stated by
Pearson et al "The severity grading takes into account only the observed clinical
symptoms and signs, rather than those that might be anticipated. It does not
estimate risks hazards on the basis of information such as amount ingested or
serum concentration of the toxic agent"
Include an explanation of likely outcome of the exposure such as: full recovery,
fatalities likely, health monitoring required, indicate therapies or treatment,
potential long term health effects (e.g. cancer) and risks to the unborn.
If there are unusual symptoms that may be recognised by healthcare providers
include description of this here.
Indicate where assumptions have been made or further information is required.
Outcome(s)
Clinical data
further details
(including
limitations)
Clinical data
assessment
Certainty of
clinical data
assessment
This process reflects the identification and characterisation of the clinical case
data of the affected population. This might include reviewing key information
and characteristics of the intoxications such as severity, number of people
presenting with features of poisoning and the actual or potential health
outcomes.
Estimating the certainty of the clinical case data will depend on the nature of
the information provided, how quickly the assessment is required and the
complexity of the event. This estimate is most likely subjective unless there have
been clinical review and diagnosis of patients by suitably qualified medical
professionals (e.g. clinical toxicologists)
For more detailed information on qualitative risk assessments:
http://www.who.int/foodsafety/publications/micro/MRA17.pdf?ua=1
Choose one item from the drop down list.
 Very certain - probability of 95% or more
 Highly certain - probability of between 70% and 94%
 Certain - probability of between 30% and 69%
 Uncertain - probability of between 5% and 29%
 Very uncertain - probability of less than 5%
Public Health
Factors
Location
Adapted from:
http://whqlibdoc.who.int/publications/2009/9789241598149_eng.pdf?ua=1
The public health assessment is the broader evaluation of the potential or actual
impacts of the event on the populous that may be affected by the hazard via the
exposure pathway(s) and route(s) described above.
Actual site or position of event and co-ordinates if available or appropriate
Local, Regional, National – Latitude & Longitude (either decimal or Degrees,
Minutes, Seconds): http://itouchmap.com/latlong.html
EC JRC Digital Atlas (online)
http://dma.jrc.it/map/
Provides links to Copernicus activations
EC Copernicus Emergency Management Service, rapid mapping service (online,
maps for events online and for download)
o http://emergency.copernicus.eu/
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European Environment Agency, data and maps (online and for download)
o http://www.eea.europa.eu/data-and-maps
Population
density
If relevant include population density in persons per square kilometre. Where
possible use National Census data.
Eurostat Population Information
http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Population_st
atistics_at_regional_level
EC Eurostat Statistical data (online and for download)
http://ec.europa.eu/eurostat/data/database
Map of
population
density
Schematics or
plans for affected
installation
Likely duration of
incident/release
Vital statistics of
affected
population
Sensitive
receptors
Local health care
facilities and
provision
Local
decontamination
arrangements
Insert picture of population density of the affected area(s)
Eurostat Population Information
http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Population_st
atistics_at_regional_level
Regional Level Atlas: http://ec.europa.eu/eurostat/statisticalatlas/gis/viewer/?year=2013&chapter=01
For Local Level use National Census Data (for UK):
http://www.ons.gov.uk/ons/interactive/census-map-2-1---popdensity/index.html
Insert picture of site or plant if the incident is of industrial or environmental
nature
If the start of the release/incident is known and the likely end of the incident is
known (based upon planned mitigation measures) include this here (e.g. Large
Industrial Fire in France, fire service estimates burn will last for 2 days)
If the vital statistics (e.g. populous by age & sex; birth rate; death rate) of the
exposed or potentially exposed population is known add this here.
If information about potential sensitive population exposed or potentially
exposed is known include here; this could include social deprived populations
(malnutrition, education), elderly residential properties, hospitals, schools,
nurseries, day care centres; migrant populations etc. This could take the form of
a GIS map of sensitive receptors.
Include information (name, location, capacity, operational status, contact
details) about the local health care provision such as Hospitals, Accident and
Emergency Centres, General Medical Centres or Clinics. Where possible include
information about specialist centres that may handle large scale incidents or
temporary measures as indicated in local crisis management and resilience
plans. If information is known from previous sections on the type and number of
casualties either known or predicted and the level of care required include this
here. Also indicate the likely health-seeking behaviour of the affected
population
As above if the incident requires personal decontamination measures and
information is known about the local arrangements include this here (e.g. mass
showering, dry disrobing). If the capacity of the local arrangements and timeline
to implement such control measures is known also include this here.
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Required
antidotes
If the incident requires emergency medical countermeasures such as antidotes
(e.g. atropine) include this here as well as an indication of the likely number of
units required based upon the exposure and clinical data assessments. If the
local access to such countermeasures is known in terms of units available and
timeline for deployment include this here.
Required medical If the incident requires emergency medical support (e.g. dialysis) include this
support
here as well as an indication of the likely requirement level based upon the
exposure and clinical data assessments. If the local access to such
countermeasures is known in terms of units available and timeline for
deployment include this here.
Personal
If the incident requires protective equipment for first responders, workers or
protective
the public (e.g. facemasks, respirators) include this here as well as an indication
equipment
of the likely requirement level based upon the exposure and clinical data
assessments. If the local access to such countermeasures is known in terms of
units available and timeline for deployment include this here.
Shelter in place
Based upon the information within the hazard assessment, exposure
or evacuation
assessment and local population information presented above describe the
requirement
sheltering in place or evacuation requirements for the incident (e.g. numbers of
houses, people to be evacuated). If local crisis management arrangements are
known include this here.
handling of
If the incident requires the safe management of the fatalities include this here
deceased
Include considerations such as religious and cultural beliefs, decontamination,
temporary mortuary arrangements.
Epidemiological
Based on the hazard assessment, exposures assessment, and clinical data
study or contact
assessment; include considerations of potential requirements for
tracing required? epidemiological studies, health register or contact tracing of the exposed
potential exposed population. Include information about why this should be
done and the time frame.
http://www.atsdr.cdc.gov/ntsip/ace_toolkit.html
Biomonitoring
Based on the hazard assessment, exposures assessment, clinical data
required?
assessment and public health data include considerations of potential
requirements for analytical chemistry of the chemical body burden of the
exposed potential exposed population. Include information about why this
should be done.
Long term follow- Consider potential effects on isolated individuals, restricted contact, impacts on
up or psycholifestyle (e.g. access to childcare arrangements), psychological considerations,
social care
social cohesion, acceptability and impact of control measures.
required?
Recovery and
environmental
decontamination
factors

Include consideration of factors related to recovery or remediation for
return to new normal (e.g. costs, upheaval, time required)
Other
environmental
factors

If there are other environmental factors that should be considered (e.g.
tidal factors, negative or other positive effects of control measures)
include this here.
Similar past
events in country
or otherwise?

If there have been associated or preceding events in the same of
neighbouring countries include this information here.
Evidence for

If there is evidence for cross border spread of the incident that has not
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cross border
spread (EU or
wider)
Public health
data further
details (including
limitations)
Public health
data assessment
Certainty of
public health
data assessment
been documented elsewhere include this information here.

If relevant information is missing from fields above list here such as
unintended consequences of control measures (e.g. removal of food
supply by culling of affected animals), privacy, use of untested control
measures, equity, duty to provide care, transparency.
 Indicate where assumptions have been made or further information is
required.
This process reflects the characterisation of the public health data of the
affected or potentially affected population. This might include reviewing key
information such as population density; potential control measures and public
acceptability and ranking these factors based upon their potential public health
impact of the event.
Estimating the certainty of the public health data will depend on the nature of
the information provided, how quickly the assessment is required and the
complexity of the event. This estimate is most likely subjective unless there have
been very similar events or comparable events in recent memory.
For more detailed information on qualitative risk assessments:
http://www.who.int/foodsafety/publications/micro/MRA17.pdf?ua=1
Choose one item from the drop down list.
 Very certain - probability of 95% or more
 Highly certain - probability of between 70% and 94%
 Certain - probability of between 30% and 69%
 Uncertain - probability of between 5% and 29%
 Very uncertain - probability of less than 5%
Cross-sectoral
Factors
Police, security,
military or
forensic factors
Transport and
migration factors
Control of sales
Adapted from:
http://whqlibdoc.who.int/hq/2012/WHO_HSE_GAR_ARO_2012.1_eng.pdf
The cross-sectoral factors section represents a broad and rapid evaluation of the
potential or actual impacts on different sectors of the incident in question which
may influence the overall assessment of the risks to public health and also
suggest where further cross-sectoral collaboration may be necessary.
The emphasis of the RRA should be public health, but consideration to the needs
of coordinating efforts with other sectors should be considered
 If the event is of a deliberate nature or large scale then there may be
additional factors related to civil protection of military to consider (e.g.
chain of custody of samples); include this information here.
 Also indicate the responsible authority (e.g. Europol) and if this
organisation is co-ordinating or collaborating in the crisis response
If there are factors related to the transport of people and potential disruption or
higher demand, include this here. This might include maritime events, disruption
of flights, closure of transport hubs etc.
Also indicate the responsible authority and if this organisation is co-ordinating
or collaborating in the crisis response
If the event results or could result in restriction of sales of products include this
here. If possible indicate how trading standard guidelines have been breached;
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Border control
factors
Impact of water
resources
Impact on food
chain supply
Impact on
animals and
agriculture
Rehousing,
education and
local facilities
Economic factors
Cross-sectoral
factors further
details (including
limitations)
Cross sectoral
assessment
how many products are to be recalled; issues related to product recalling
Also indicate the responsible authority and if this organisation is co-ordinating
or collaborating in the crisis response
If the event could or does impact of points of entry in EU MSs include this here.
This might include mass migration of affected individuals; receiving injured
nationals or non-nationals for treatment.
Also indicate the responsible authority and if this organisation is co-ordinating
or collaborating in the crisis response
If the event results in or could result in impacts on water resources for drinking,
washing, leisure include this information here. If possible indicate how water
safety guidelines values have been breached.
Also indicate the responsible authority and if this organisation is co-ordinating
or collaborating in the crisis response
If the event results in or could result in impacts on food supply chain include this
information here. If possible indicate how food safety guidelines values have
been breached; control measures to be implemented (e.g. removal from sale,
further food testing); if the product is processed into other products for
downstream resale.
Also indicate the responsible authority (e.g. European Food Safety Authority)
and if this organisation is co-ordinating or collaborating in the crisis response
If the event results in or could result in impacts on animals or agriculture include
this information here. This might include restrictions on local farming, testing of
livestock, culling of animals.
Also indicate the responsible authority (e.g. European Food Safety Authority,
DG-Environment) and if this organisation is co-ordinating or collaborating in the
crisis response
If the event results in or could result in impacts on housing, education or local
facilities include this information here. If possible indicate the likely or actual
disruption for the local population (e.g. 50 families rehoused for more than 3
months; 3 schools (ages 5-17) closed temporarily.
Also indicate the responsible authority (e.g. DG-HOME) and if this organisation
is co-ordinating or collaborating in the crisis response
 Include economic factors not described elsewhere, such as:
o associated with direct costs of the incident to the response agencies;
o associated with direct costs of the incident to the affected
individuals/families/communities;
o Indirect costs (ability to work/household income/community income
and ;
o effects on trade, travel, tourism.
 If relevant information on the cross-sectoral factors is missing from
fields above list here such as NGO involvement; international
agreements; disaster relief operations
 Indicate where assumptions have been made or further information is
required.
This process reflects the characterisation of the cross sectoral factors of the
affected or potentially affected population. This might include reviewing key
information such as effects on food or water supply and ranking the factors that
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Certainty of cross
sectoral
assessment
may influence the public health impact of the event.
Estimating the certainty of the public health data will depend on the nature of
the information provided, how quickly the assessment is required and the
complexity of the event. This estimate is most likely subjective unless there have
been very similar events or comparable events in recent memory.
For more detailed information on qualitative risk assessments:
http://www.who.int/foodsafety/publications/micro/MRA17.pdf?ua=1
Choose one item from the drop down list.
 Very certain - probability of 95% or more
 Highly certain - probability of between 70% and 94%
 Certain - probability of between 30% and 69%
 Uncertain - probability of between 5% and 29%
 Very uncertain - probability of less than 5%
Adapted from:
http://whqlibdoc.who.int/publications/2009/9789241598149_eng.pdf?ua=1
Societal factors
The societal factors section represents a broad evaluation of the potential or
actual impacts on society of the incident in question which may influence the
overall assessment of the risks to public health.
Religious, cultural If there are religious, cultural or social factors that should be considered include
or social impacts this here. This might include religious festivals where fasting is observed,
cancellation of planned civic ceremonies or events etc.
Policy or political If there is a high level or could be a high level of political interest (e.g. from
impact
political opponents) or there are other factors related to political events (e.g.
elections) include this here.
Also if there are policies in place that would render the affected population (e.g.
political oppression) more vulnerable include this here.
This might include regional, national or international dimensions
Media interest
If the event has caused or could cause a high degree of media interest; including
main streams media and social media describe this impact or potential impact
here.
Other societal
If there are other societal factors (e.g. pressure groups, racial tension, civil
factors further
unrest) that should be considered that are not listed above include this here.
details (including Indicate where there are uncertainties, where assumptions have been made or
limitations)
if further information is required.
Societal
assessment
Certainty of
societal
assessment
This process reflects the characterisation of the societal factors of the affected
or potentially affected population. This might include reviewing key information
such as political, religious or media aspects and ranking the factors that may
influence the public health impact of the event. If possible include a description
of the societal impact
Estimating the certainty of the public health data will depend on the nature of
the information provided, how quickly the assessment is required and the
complexity of the event. This estimate is most likely subjective unless there have
been very similar events or comparable events in recent memory.
For more detailed information on qualitative risk assessments:
http://www.who.int/foodsafety/publications/micro/MRA17.pdf?ua=1
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Choose one item from the drop down list.
 Very certain - probability of 95% or more
 Highly certain - probability of between 70% and 94%
 Certain - probability of between 30% and 69%
 Uncertain - probability of between 5% and 29%
 Very uncertain - probability of less than 5%
Risk
Characterisation
Adapted from:
http://whqlibdoc.who.int/publications/2009/9789241598149_eng.pdf?ua=1
Please refer to pages 19-25 of WHO Rapid risk assessment of acute public health
events
Main risks
identified from
section 1-5 above
In this section bring together the main elements of the sections above that are
ranked the most important in evaluating the risks to public health (these
sections should be highlighted yellow)
Estimates of
likelihood
In this section estimate the overall certainty of the event by evaluating the
certainty of main elements of the assessments described above.
Choose one item from the drop down list.
 Very certain - probability of 95% or more
 Highly certain - probability of between 70% and 94%
 Certain - probability of between 30% and 69%
 Uncertain - probability of between 5% and 29%
 Very uncertain - probability of less than 5%
Estimates of
consequences
In this section estimate of public health consequences of the event by evaluating
the certainty of main elements of the assessments described above.

Minimal
o Limited impact on the affected population
o Little disruption to normal activities and services
o Routine responses are adequate and there is no need to implement
additional control measures
o Few extra costs for authorities and stakeholders
 Minor
o Minor impact for a small population or at-risk group
o Limited disruption to normal activities and services
o A small number of additional control measures will be needed that
require
o minimal resources
o Some increase in costs for authorities and stakeholders.
 Moderate
o Moderate impact as a large population or at-risk group is affected
o Moderate disruption to normal activities and services
o Some additional control measures will be needed and some of these
require
o moderate resources to implement
o Moderate increase in costs for authorities and stakeholders
 Major
o Major impact for a small population or at-risk group
o Major disruption to normal activities and services
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o
A large number of additional control measures will be needed and
some of these
o require significant resources to implement
o Significant increase in costs for authorities and stakeholders
 Severe
o Severe impact for a large population or at-risk group
o Severe disruption to normal activities and services
o A large number of additional control measures will be needed and
most of these
o require significant resources to implement
o Serious increase in costs for authorities and stakeholders
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Level of overall
risk
Using the risk matrices developed for WHO Rapid risk assessment of acute
public health events indicates the level of overall risk.
Low risk - Managed according to standard response protocols, routine control
programmes and regulation
Moderate risk - Roles and responsibility for the response must be specified.
Specific monitoring or control measures required
High risk - Senior management attention needed: there may be a need to
establish command and control structures; a range of additional control
measures will be required some of which may have significant consequences
Very high - risk Immediate response required even if the event is reported out
of normal working hours. Immediate senior management attention needed (e.g.
the command and control structure should be established within hours); the
implementation of control measures with serious consequences is highly likely
Level of
confidence in risk
assessment
It is important to document the risk assessment team’s level of confidence in
the assessment and the reasons for any limitations. This will depend on the
reliability, completeness and quality of the information used, and the underlying
assumptions made with respect to the hazard, exposure and context.
The more evidence there is to inform the hazard, exposure and clinical, public
health, cross-sectoral and societal assessments, the greater confidence the team
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Key aspects of
assessment in
estimating risks
Are these aspects
likely to change
significantly
Should a followup risk
assessment be
undertaken?
If ‘yes’ when
should a followup risk
assessment be
undertaken?
Key updates in
this document
Key Conclusions
Summary risk
assessment (from
below)
can have in the results. The degree of confidence can be expressed using a
descriptive scale that ranges from very low to very high.
Indicate the key elements of the assessment that have been used to estimate
the overall risk (e.g. hazard identity, airborne concentration calculated from air
quality sampling, patients with symptoms, prevailing weather conditions and
downstream population)
If any aspect of the RRA is likely to change, particularly those that have
influenced the risk categorisation process, indicate this here as well as the
evidence for this change. This is likely to affect the period that the RRA is valid
for and should be clearly indicated
Based upon the information in the field above and the nature of the incident
indicate if a follow-up RRA or conventional Risk Assessment (RA) (e.g. longer
term, quantitative) should be undertaken.
Based upon evidence provided in the two fields above indicate when the next
RRA or RA should be undertaken.
Summary Section
Include key points that have changed (or important factors or variables that
have remained the same) since the previous assessment.
Recommend writing this section at the end e.g. after main sections of the
summary have been compiled
Include a short summary of the event and the key conclusions as an overview so
that risk managers can scan this section and be confident that they are aware of
the main important points.
Recommend writing this section at the end e.g. after main sections of the
summary have been compiled
Needs to explain – assumptions, certainties, uncertainties, limitations
Should include information from hazard characterisation section and also
include main limitations identified throughout the assessment
Conclusions
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Rapid Risk Assessment User Guide
Overarching actions list
1. Read the RRA user guide before completing the RRA; linked descriptions provide more
information of the template fields.
2. If further, more detailed, hazard specific technical information is required to conduct the
RRA, request a Chemical Emergency Risk Management Monograph from SANTE C3.
3. Enable document track changes to ensure that multiple updates are recorded within this
document.
4. Highlight important fields that are the focus of the assessment in yellow.
5. If Information is unknown at the time of completion clearly state ‘unknown at the time of
completion’. If fields are not required in the development of the RRA state ‘Not Applicable’
in the field.
6. YOU MUST enter summary information in the green fields this information should be used to
populate the RRA public summary
Do not include person or person identifiable information of those affected or potentially affected in
the incident in this document.
7. COORDINATOR/ASSESSORS: Work through each section of the Risk Assessment; if additional
experts are required use the expert database to identify and contact relevant experts.
8. Once the key questions, time frame and working group have been agreed then each
member should be assigned a task related to drafting and editing the RRA.
9. Tasks could include drafting a specific section of the RRA (e.g. public health assessment) or
reading and editing the main RRA document or reading and editing the summary RRA.
10. ONLY the summary section will be made available to external parties, the topmost sections
are purely designed as a working document to ensure that important aspects are
considered. IT is likely that some fields will be empty – in which case add N/A
11. If fields are missing but information related to the assessment is important add this to the
‘Further information’ field in the relevant section.
Further guidance on conducting RRAs
http://www.ecdc.europa.eu/en/publications/Publications/1108_TED_Risk_Assessment_Methodolog
y_Guidance.pdf
http://whqlibdoc.who.int/hq/2012/WHO_HSE_GAR_ARO_2012.1_eng.pdf
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Rapid Risk Assessment Characteristics










Has to be delivered in a short time (e.g. 24-36 hours)
There will be a limited opportunity to engage with experts outside of the core network of
experts and Scientific Committee
The RRA may require support for other European Institutions (e.g. ECDC, EFSA, EMCDDA,
EMA, ECHA) or International Organisations (e.g. WHO)
There will be a limited opportunity to generate new data
There will be a limited time to search for data
Often have greater uncertainty than classical risk assessment
The RRA has to be robust, reproducible and transparent.
The RRA has to use plain, understandable language that is easy for decision use to aid
decision making
The quality of the request needs to be clear and has to have a realistic time frame/
expectations statement
A Chemical Emergency Risk Management Monograph may be required to support a RRA.
Chemical Emergency Risk Management Sheet Template
If the assessment of an event require further technical information on an identified chemical hazard
this can be requested from DG-SANCO C3 as a Chemical Emergency Risk Management Monograph
Contact: [email protected]
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