The New MS 17

The HSE Guidance note MS17 is issued to advise on the Medical Aspects of work-related exposures to organophosphate chemicals so that the reader knows how to comply with the law.
The guidance is not compulsory but illustrates good practice.

The first reading of the paper will leave the impression that at last the dangers of OP compounds have been recognised by the authorities but once again the Devil is in the detail.

The document is a further weakening of the 1980 version and yet the content has increased from 32 sections to 93 with a further 4 sections on reporting and investigation. Since few doctors have seen the original version it is unlikely that they will find the time to read this version - even if they have a copy, which is unlikely.

Criticisms have already been made of the document since its release early in the year 2000.

Doctors should be particularly wary of this document for it is clear that they are held responsible for the recognition, diagnosis and the management of Chronic Organophosphorus Poisoning. The paper makes that clear and adds that specialist opinion may only be needed in some cases.

This indicates that, although GPs are rarely trained in toxicology and the HSE has not released such documents to them in the past, GPs are to be held responsible for failing to diagnose and report the condition.

Despite the desperate need for proper monitoring of any adverse effects caused by these chemicals the advice given can be ignored even though OP poisoning is a notifiable disease.
Employers are warned of the need to assess the risks to health under the Control of Substances Hazardous the Health Acts. COSHH warns that exposure to substances known to be hazardous to health should be avoided and safer alternatives used instead. In theory this should require the use of non-OP pesticides as there is a known risk with OPs.

Health Surveillance is recommended but employers are advised not to include any details in the COSHH record despite the need to keep such records for 40 years.

It is admitted that OP compounds can cause long-term ill health but the paper adds to the confusion over the previously admitted dangers from repeated low dose exposures by claiming that the evidence for these dangerous effects is not clear. Strangely the risks posed by contaminated clothing which offer just such exposures are recognised and later the paper admits that repeated small doses can result in cumulative exposures which in turn can lead to poisoning.

The risk posed by spray drift and domestic use of pesticides is recognised as are the risks from inhalation and skin contact.

The importance of the solvent is again stressed and the part played by them in the causation of Central Nervous System toxicity is also recognised.

It is also noted that OPs can cause adverse effects other than those resulting from their anticholinesterase actions but although descriptions are given of the known OP induced illnesses the reporting of Chronic OP Poisoning is vague and the illness is simply said to need more study.
This is despite reference to the fact that Chronic OP Poisoning is a prescribed disease under the Industrial Injuries provisions of the Social Security Act of 1975. [Actually it should read 1958 - see below]

Interestingly the paper suggests that there is a group of seemingly unexposed individuals who are found to have low levels of OP metabolites in the urine. It is claimed, despite the claims that OPs break down rapidly, that they are ubiquitous in the environment and that the origin of these background levels is not known.
Perhaps the writer did not realise that OPs are added to our food.
What is strange is that they are able to find OP metabolites in such individuals but specialist laboratories often claim not to be able to find any trace in those who use such chemicals regularly and who have been poisoned by them.

The paper which gives details of poisoning symptoms and the testing, treatment, and reporting procedures is available from the HSE and is priced at 5.50 for just 8 pages.

Or as a download Here at http://www.hsl.gov.uk/media/586005/ms17.pdf

It reports that there is no recognised effective treatment for Chronic OP Poisoning.

Officials admit that the Industrial Injuries Act referred to in this paper became law in 1958 and not 1975 as is repeatedly quoted.

Dated 16/9/2000   Updated 1/8/2001

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