National Policing Ebola Virus Infection Guidelines: A Go to Guide for Police Officers and Staff

Transcription

1 National Policing Ebola Virus Infection Guidelines: A Go to Guide for Police Officers and Staff The Association of Chief Police Officers has agreed to these guidelines being circulated to, and adopted by, Police Forces in England, Wales & Northern Ireland. It is NOT PROTECTIVELY MARKED under the Government Protective Marking Scheme and any referrals for advice and rationale in relation to Freedom of Information Act disclosure, should be made to the ACPO Central Referral Unit at acpo.request@foi.pnn.police.uk ACPO

2 2 NOT PROTECTIVELY MARKED National Policing Ebola Virus Infection Guidelines: A Go to Guide for Police Officers and Staff (December 2014) Document information Protective marking NOT PROTECTIVELY MARKED Author ACC Paul Netherton Force/Organisation Devon and Cornwall Constabulary National Policing Business Area Uniformed Operations Contact details Lindy Woodage Review date July 2015 Version 1.0 These guidelines have been produced and approved by the National Policing Uniformed Operations Business Area on the 18 th December Guidelines produced by ACPO should be used by chief officers to shape police responses to ensure that the general public experience consistent levels of service. The implementation of all guidance will require operational choices to be made at local level in order to achieve the appropriate police response. ACPO has worked with Public Health England (PHE) to produce these guidelines on the Ebola Virus and signposts to the evidence base behind the guidance. It will be updated and republished as necessary. Any queries relating to this document should be directed to either the author detailed above or the ACPO Programme Support Office on /8958.

3 3 NOT PROTECTIVELY MARKED National Policing Ebola Virus Infection Guidelines: A Go to Guide for Police Officers and Staff (December 2014) Contents Section Page 1 Introduction 4 2 Managing People Who May have been Exposed to Ebola Virus 4 3 Risk Assessment of People who have Returned from West Africa 4 4 Use of Personal Protective Equipment (PPE) 5 5 What to do if you have been Contaminated by Blood or Body Fluids and Think You may have been Exposed to Ebola Virus 6 6 Advice to Custody Staff 7 7 Managing Non-Compliant, Asymptomatic People 7 8 Exemplar Case Studies 7 9 Reference Documents 8 Appendix A Ebola Contact Only Advice for Individuals and Line Managers (Page 9) Appendix B Custody Toolkit for Suspected Ebola Patient (Page 10) Appendix C Police Powers to Limit the Spread of Ebola Summary (Page 11)

4 4 NOT PROTECTIVELY MARKED National Policing Ebola Virus Infection Guidelines: A Go to Guide for Police Officers and Staff (December 2014) 1. SECTION 1 INTRODUCTION 1.1 Ebola virus is the cause of an illness which is very rare in Europe called viral hemorrhagic fever. The illness usually begins abruptly with fever, headache, joint and muscle pain, sore throat and intense weakness. Stomach pains, diarrhoea and vomiting may occur. Some individuals may develop a rash, red eyes, hiccups, and internal or external bleeding. In severe cases patients develop failure of the liver and kidneys. The incubation period for Ebola is usually 5-7 days, but can range from 2 to 21 days. 1.2 Infection occurs from direct contact (through broken skin or mucous membranes) with the blood, or other body fluids (stool, urine, saliva, semen) of infected people. 1.3 Ebola virus is not spread through routine, social contact (such as shaking hands) with asymptomatic individuals. The likelihood of contracting Ebola is considered very low unless there has been a specific exposure, such as direct contact with body fluids (e.g. blood, saliva, urine) of symptomatic infected persons or objects that have been contaminated with body fluids. 1.4 A fever in persons who have travelled to Ebola transmission areas is more likely to be caused by a common infection, such as malaria or typhoid fever. 1.5 The Association of Chief Police Officers (ACPO) and Public Health England (PHE) have produced guidance on Ebola virus. 1.6 This guide pulls together the existing guidance for police officers and staff and signposts to the evidence base behind the guide. 2. SECTION 2 MANAGING PEOPLE WHO MAY HAVE BEEN EXPOSED TO EBOLA VIRUS 2.1 The Chief Medical Officer has recommended enhanced screening arrangements at the UK s main ports of entry for people travelling from the affected regions - Liberia, Sierra Leone and Guinea. This will offer an additional level of protection to the United Kingdom (UK). 2.2 Screening is currently in place at London Heathrow, London Gatwick, Birmingham and Manchester airports, and at London St Pancras station for Eurostar. It involves assessing passengers recent travel history, who they have been in contact with and where they are going next, as well as a possible medical assessment. Medical assessments will be carried out by trained medical staff rather than Border Force staff. Passengers will also be given advice on what to do should they develop symptoms later. 2.3 People in the community who have returned from the affected regions of Africa are likely to be humanitarian aid workers. PHE has produced guidance for such people and the Agencies for whom they work. 3. SECTION 3 RISK ASSESSMENT OF PEOPLE WHO HAVE RETURNED FROM WEST AFRICA 3.1 Health/public health and social care workers returning from an affected area will be assessed before they can return to work involving patient contact in the UK. This assessment will look at the type of work that was carried out in West Africa and whether there were any issues around the use of PPE during this period. This will determine the degree of follow up required and the work activities they can resume in the following 21 days. People are not considered infectious whilst asymptomatic but to maintain high standards of patient safety within the NHS, some healthcare activities may be restricted until returning staff are past the incubation period for Ebola (21 days).

5 5 NOT PROTECTIVELY MARKED National Policing Ebola Virus Infection Guidelines: A Go to Guide for Police Officers and Staff (December 2014) 3.2 The following risk assessment will be carried out: Category 1: This person visited an Ebola affected area, but had no direct contact with an Ebola case (or body fluids) while they were there; this includes people who have had casual contact e.g. visited a home without direct contact with the Ebola patient or body fluids of the patient. Category 2: This person had direct (close) contact with Ebola cases (or body fluids) while they were in the affected area, but wore appropriate protective equipment/clothing (PPE), and had no known breaches in PPE. Category 3: This person had direct (close) contact with Ebola cases (or body fluids) while they were in the affected area, wore appropriate protective equipment/clothing (PPE), but are concerned that they may had a breach in these protective measures or have had direct contact with an Ebola patient s blood, urine or secretions without being protected. 3.3 The follow up required for each category of returning healthcare worker is: Category 1: There are no restrictions on the activities of a person in this category you can return to usual activities. There is no monitoring or reporting requirement. Category 2: You can return to live in your own/usual home with ordinary family and social contact, return to work with some restrictions (only certain types of clinical work if a healthcare worker), travel by public transport and carry out other daily activities. You are required to check your temperature (over 37.5 C) or other suspicious symptoms to a named monitoring team at PHE. Category 3: You can return to live in your own/usual home with ordinary family and social contact, attend office-based work only (not patient care areas), and can take agreed UK transport (as discussed with your monitoring team at PHE). You are required to check your temperature twice daily for 21 days after return, and to REPORT DAILY) to a named monitoring team at PHE, even if you don t have a raised temperature (over 38 C) or other suspicious symptoms. 3.4 People in category 2 and 3 will have been given a specific number to ring in the event of a raised temperature or the occurrence of symptoms. In the absence of this, the advice is to attend A&E, or call for an ambulance if the symptoms are severe. 3.5 If an officer or member of police staff is concerned about the assessment of risk when dealing with a member of the public recently returned from the relevant West African countries (Liberia, Sierra Leone and Guinea) they should contact the Force incident Manager (FIM). 3.6 If an officer or member of police staff comes into contact with someone recently returned from the relevant West African countries and who is symptomatic (a combination of being feverish, flu-like symptoms, diarrhoea and vomiting) they should inform the FIM who will inform the duty GOLD to consider a multi-agency response. 4. SECTION 4 USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE) 4.1 In most cases, it should not be necessary for police officers or staff to have to wear PPE in relation to a risk assessment of Ebola infection because Ebola virus infection is unknown in the UK and will not occur following social contact with asymptomatic potential contacts with Ebola virus. 4.2 How do I best protect myself from Ebola virus whilst policing? 4.3 Follow the universal precautions for infection control.

6 6 NOT PROTECTIVELY MARKED National Policing Ebola Virus Infection Guidelines: A Go to Guide for Police Officers and Staff (December 2014) 4.4 Continue with good hygiene and infection-prevention practices, i.e. through hand washing and use of sanitizing gel where available, during the course of your duties and use PPE where appropriate as you normally would. Ebola is not transmitted through the air. 4.5 Keep any open wounds cuts/scratches covered with a waterproof dressing, keep this clean and change dressing regularly. 4.6 If required to administer First Aid to someone with cuts, abrasions or blood loss, or who has vomited or defecated, a dynamic assessment of risk must be undertaken. 4.7 Always double glove prior to touching the person and assess the risk of blood, vomit or faecal spatter before approaching to administer treatment. The face shield can be used for resuscitation, but compression-only resuscitation is also acceptable. 4.8 PHE has produced a list indicating what PPE may be indicated and when. 4.9 Low possibility of Ebola (e.g. fever only): Non-Physical Contact (e.g. Interviewing people): No PPE required. Physical Contact (no splash of body fluids): Standard precautions apply: Hand hygiene, gloves, plastic apron. Physical Contact (splash of body fluids): Standard precautions apply: Hand hygiene, gloves, plastic apron PLUS Fluid repellent surgical facemask, eye protection High possibility of Ebola (e.g. fever, diarrhoea, vomiting, bleeding): Physical Contact: Standard precautions apply: Hand hygiene, double gloves, PLUS Fluid repellent disposable gown/suit, eye protection AND FFP3 respirator (as standard fluid repellent mask)* *Fit testing of the FFP3 mask is NOT required as Ebola is not transmitted through the air. The mask is simply used to prevent splash incidents by protecting nose and mouth Ensure your staff is made aware of where the above items can be located within your force area. 5. SECTION 5 WHAT TO DO IF YOU HAVE BEEN CONTAMINATED BY BLOOD OR BODY FLUIDS AND THINK YOU MAY HAVE BEEN EXPOSED TO EBOLA VIRUS 5.1 If you have been contaminated by blood or body fluids wash the area immediately and if you think there is a risk of Ebola call NHS England 111, who assess the Ebola risk. 5.2 PHE will in some cases maintain contact with individuals that are well but may have been exposed to ensure they do not become symptomatic. If necessary you may be referred to a specialist hospital. 5.3 If assessed as no Ebola risk you should follow the normal practice for such exposure and follow guidance relating to possible exposure to blood-borne viruses. 5.4 Contact the occupational health service for any other advice on infection control issues around blood or body fluid contamination. 5.5 Advice to individual officers and staff about work attendance and on-going support in the event of an exposure, or possible exposure, to Ebola virus may be found in Annex A.

7 7 NOT PROTECTIVELY MARKED National Policing Ebola Virus Infection Guidelines: A Go to Guide for Police Officers and Staff (December 2014) 6. SECTION 6 ADVICE TO CUSTODY STAFF 6.1 Generic guidance for custody suites is available see Annex B. 7. SECTION 7 MANAGING NON-COMPLIANT, ASYMPTOMATIC PEOPLE 7.1 Guidance on police powers to address this are contained in Annex C. 8. SECTION 8 EXEMPLAR CASE STUDIES 8.1 Police officer attends the home of member of public and discovers that someone from West Africa is there has just returned from work as an aid worker. 8.2 Actions: Ask whether the visit included working in Guinea, Liberia or Sierra Leone: - If Yes, ask whether this was within the last 21 days. - If No, continue as normal. If the person has visited Guinea, Liberia or Sierra Leone within the last 21 days, ask whether they are being monitored by PHE: - If Yes, this is normal procedure. - If No, inform FIM. The local PHE monitoring team will be informed and will provide further guidance. If the person has visited Guinea, Liberia or Sierra Leone you should ascertain whether they have any of the following symptoms: fever, headache, joint and muscle pain, sore throat and intense weakness, stomach pains, diarrhoea and vomiting or bleeding/bruising: - If No, PPE is not required. Continue as normal. - If Yes, obtain appropriate PPE according to dynamic risk assessment. Consult with FIM. 8.3 A member of the public presents themselves at the front desk of the police station requesting assistance. He is asking if you can call an ambulance as he is in a lot of pain. He informs you he is suffering from headaches, bleeding from the ears and nose and has a fever. The person is sick in the receptions area as he is giving you these details. 8.4 Actions: Request an ambulance using the 999 number. Try to ascertain further details such as recent travel undertaken has he visited Africa in the last 21 days in particular Guinea, Liberia or Sierra Leone: - If No, to the above continue as normal. - If Yes, consider where possible isolating the person away from the public area. Do not attempt to clean-up any body fluids without wearing appropriate PPE, and seek medical advice reference disposal (see PPE section for details). Inform supervisors and or the Force Incident Manager. Inform the ambulance service of his recent travel history on their arrival, prior to them entering the station and await further instructions.

8 8 NOT PROTECTIVELY MARKED National Policing Ebola Virus Infection Guidelines: A Go to Guide for Police Officers and Staff (December 2014) 8.5 A member of your staff has called-in to inform you they are taking a few days off sick. They inform you they have not been to see a doctor yet but are suffering from a temperature and severe diarrhoea. You are aware this person has recently been away travelling on holiday, but are unsure of the details. 8.6 Actions: Ascertain where they travelled during their holiday and when they returned. Did they visit Africa, in particular Guinea, Liberia or Sierra Leone? - If No, offer support following normal force procedures. - If Yes, advise the member of staff to call 111 urgently and for them to give as much detail as possible around their travel arrangements and physical symptoms. Inform senior line management. Ensure a follow-up call is made to the member of staff, informing line management of the outcome. See Annex A for guidance on returning to work in the event that the illness was not due to Ebola virus infection. 9. SECTION 9 REFERENCE DOCUMENTS 9.1 Reference documents which should be held consideration in support of these guidelines, as follows: Ebola virus briefing sheet. Association of Chief Police Officers (16/10/14). Ebola infection prevention and control guidance for primary care. Public Health England (20/11/14). Information for humanitarian aid workers working in Ebola-affected countries in West Africa. Public Health England (26/9/14). Information for families and friends of humanitarian aid workers working in West Africa as part of the Ebola response. Public Health England (September 2014). Ebola: Guidance to Police Forces on Use of Personal Protective Equipment (PPE). Public Health England, version 3.1 (28/11/14).

9 Ebola Contact Only Advice for Individuals and Line Managers Annex A Individual wishes to attend work as usual during the incubation period while symptom free Individual wishes to stay at home during the incubation period while symptom free Individual suffers with anxiety as a result of the potential contact Colleagues are unwilling to work with an individual who has had potential contact Individual Continue self monitoring as per PHE instructions Line Manager Provide welfare support Provide Counselling numbers Reassure colleagues using latest guidance available on the intranet Follow PHE advice if symptoms appear Individual Continue self monitoring as per PHE instructions Update Line Mgr regularly Line Manager Update HR to show individual on Special Leave (Paid) Maintain welfare contact Provide Counselling numbers Individual Report sick via the HR Advisory Centre. Do not use the automated service, please speak to an Advisor Continue self monitoring as per PHE instructions Engage with OH Update Line Mgr regularly Line Manager Provide welfare support Complete OH Referral Manage individual as per normal through the Attendance Management Policy Line Manager Reassure colleagues using the latest guidance available on the intranet Contact OH to attend a meeting for colleagues if required in order to answer their concerns from a medical perspective Consider alternative working arrangements for either the individual or colleagues. Note: This should not include lone working for the individual. Contact HR for further advice Follow PHE advice if symptoms appear Note: All of the advice on this page will differ slightly according to individual circumstances. Please contact HR to discuss further

10 Custody Toolkit for Suspected Ebola Patient Annex B This toolkit is specifically for detainees presenting in custody with suspected Ebola. The risk is still regarded as a very low risk and it is anticipated that only those with mild symptoms will present to custody. Anyone who is very unwell should be taken straight to hospital. There is greater likelihood that the person is suffering from common illness such as flu or malaria. Has this person arrived from Guinea, Liberia or Sierra Leone or spent time in these countries within the past 21 days? If yes, ask these questions While in that country, has this person: Come into contact with a person known/suspected to have Ebola? Cared for anyone with a severe illness, or who has died of an unknown cause? Attended any funerals or had any contact with any dead bodies? Visited any traditional healers or been admitted to hospital? Hunted or consumed bushmeat? If no, follow existing guidance on handing unwell members of public If no, follow existing guidance on handling unwell members of public If yes, ask these questions Does this person appear unwell? Symptoms to look out for include: fever (eg pale skin, sweating or shivering); weakness (eg unable to stand unsupported); chills, muscle aches, rash, bruising; vomiting, diarrhoea If no, continue as normal. Review regularly If yes, record above responses in the custody record Isolate the detainee in a cell Limit physical contact with detainee and consider appropriate PPE Call Public Health England urgently on 111 so a clinical risk assessment can be organised. Remember infection control, strict hygiene Custody lock down. Limit staff entering suite No new detainees to custody Normal consideration regarding the continued detention of the individual apply Non-physical contact - No PPE. Physical contact standard infection control. Good hand hygiene and double glove. Detainee requiring first aid good hand hygiene, double gloves, fluid repellent mask Await screening result Ebola - Negative Return to normal function Ebola - Confirmed Follow Public Health England advice and identify staff who had physical contact with the detainee

11 11 NOT PROTECTIVELY MARKED National Policing Ebola Virus Infection Guidelines: A Go to Guide for Police Officers and Staff (December 2014) Police Powers to Limit the Spread of Ebola Summary Annex C The police have restricted powers to limit the spread of an infectious disease. There is no provision in Police and Criminal Evidence Act (PACE) 1984 which would allow for the police to lawfully take steps to detain an individual or group of individuals on the basis that they are suspected or known to be carrying the Ebola virus. However, whilst it has not been specifically tested in court, it is considered likely that police powers to impose a containment cordon in order to prevent violent disorder [as provided by the case of Austin v Metropolitan Police Commissioner (2008)] would extend to circumstances in which the police are looking to contain a contagious disease of this nature. Article 5 of the ECHR lends weight to this position, as it contains the following exemption: No one shall be deprived of his liberty save in the following cases and in accordance with a procedure prescribed by law... the lawful detention of persons for the prevention of spreading infectious diseases.... Upon those suffering from Ebola being contained, there is no further power available to police in order to force those contained into quarantine, however, there is a power for the local authority to obtain an order from the magistrates pursuant to Section 45G Public Health (Control of Disease) Act 1984 which provides that a Justice of the Peace (JP) may make an order in relation to a person if the justice if satisfied that: (a) (b) (c) (d) Person (P) is or may be infected or contaminated, The infection or contamination is one which presents or could present significant harm to human health, There is a risk that P might infect or contaminate others, and It is necessary to make the order in order to remove or reduce that risk. The section specifies that the application must be made by a local authority, and must be supported by a number of items of evidence, as stipulated within the Health Protection (Part 2A Orders) Regulations 2010 to enable to magistrates to consider the application. The variety of orders available to the magistrates in these circumstances is wide and can relate to an individual, to objects and to groups of individuals.