Ricin: Control Measures Overview for Responders and Clinicians

Healthcare Facility

Be prepared for victim(s) who may present to an emergency department without prior warning.
Direct the emergency department ventilation exhaust away from the fresh air intake to limit re-entrainment of any airborne contaminant from victims who present to and enter the emergency department.
Comply with healthcare facility’s Emergency Response Plan.
Prepare for mass casualties by establishing patient triage, registration, decontamination, treatment, transportation, and stabilization zones/areas for hospital admission(s).
Perform hazard vulnerability analysis to determine if hospital can manage the anticipated number of victims.
Determine if lockdown (shelter-in-place) is necessary, and secure area to control access and contain contamination.

Prepare for public health surge capacity and cooperate with other healthcare facilities, local, state, and federal authorities when:
- It is determined that healthcare facility cannot manage anticipated number of victims.
- Services expand beyond normal from large scale event.

Even though ricin is sometimes referred to as a biological agent, it is a protein extracted from plant material and is not a living organism. There is no antidote for ricin poisoning. For more on ricin pathogenesis, see Epidemiological Overview for Clinicians.
Maintain heightened awareness for evidence of ricin-exposed patients and collaborate with clinicians and laboratory to ensure immediate notification of local and state public health department officials when ricin poising is suspected
Ensure that telephone numbers for notification of appropriate healthcare facility and public health agencies are current and distributed to the appropriate healthcare facility departments and personnel.
Communicate with the laboratories that receive specimens for testing.

Healthcare personnel or laboratory workers sustaining exposure via sharps injury, cuts, or abrasions should immediately wash the exposed site with a soap and water.
Potentially exposed healthcare personnel should be advised to remove all PPE carefully, wash hands thoroughly with soap and water, refrain from any hand-to-mouth activities, and shower.
When exposure to eyes occurs, flush eyes with copious amounts of water or eye wash solution for at least 15 minutes.
Follow standard facility policy regarding workplace exposure.

Emergency/First responders Guidance on personal protective equipment selection can be found at the following sources:
- NIOSH's Emergency Response Safety and Health Database page for Ricin: Biotoxin
- WISER Protective Equipment/Clothing page for Ricin
RAND and NIOSH provide recommendations for protecting emergency responders in the book Protecting Emergency Responders, Volume 3.
OSHA provides recommendations for protecting healthcare workers from exposures when a hospital receives contaminated patients in the document OSHA BEST PRACTICES for HOSPITAL-BASED FIRST RECEIVERS OF VICTIMS from Mass Casualty Incidents Involving the Release of Hazardous Substances

NIOSH provides recommendations for the decontamination of patients and first responders in the Emergency Response Safety and Health Database for Ricin: Biotoxin.
EPA provides recommendations for the decontamination of surfaces in the NRT Quick Reference Card for Ricin.