No pagers required..

On call was always interesting, you could guarantee at some point during a weekend of being on call that an unusual or difficult to resolve issue would arise. What’s more is that they always seemed to happen when I was in the middle of a run or a bike ride…but maybe that says more about me than the calls….My family quickly got used to having to stop and let me dissaper somewhere quiet and discrete to take a call (no pagers, just blackberries which back then seemed revolutionary!).

The rota for public health was designed in a way that meant we got to work alongside microbiologists, consultants in disease control and local directors of public health. We took calls, as first responders, from all over the country so it was often quite busy. The calls also had a seasonal nature. Summer and autumn were often food poisoning type queries as the BBQ season got underway, winter was predominantly respiratory illnesses such as influenza outbreak management and more often than not, dealing with a closed care home due to norovirus.

Around about this time of year, as spring is beginning, there were often a number of calls regarding bats.

Bats are incredibly clever creatures that can navigate using sonar to guide them away from and around objects but as they wake in early spring they can be a little “off” with their aim. So fallen, tired bats can be found near their nests on the floor, a little lost. The trouble with rescuing them is that unless your wearing good garden gloves or similar protection their razor sharp teeth can pierce your skin without you feeling it at the time.

Not many people know this but some species of bat found in the UK can carry lyssavirus, a virus that behaves very similar to rabies and as such anyone with potential exposure requires treatment as if they’d been bitten by a rabid animal.

Just like rabies, by the time the symptoms develop, treatment is unsuccessful so prompt risk assessment and treatment is essential.

In rural areas, like Dorset, bat bite queries are a common on call issue. We worked hard with the local acute Trusts to ensure stocks of immunoglobulin were available with easy access but on many occasions we had to send a taxi to Southampton Hospital as they held the regional stock.

Sharing the learning from call with the local bat protection league was a really important part of the job. Through there networks they were able to help us in sharing messages round glove wearing and seeking advice if a bite was suspected. Illness associated with bat encounter is incredibly rare but as catastrophic in it potential outcome we always advised a thorough risk assessment for every possible bite.

Another type of seasonally related call were those due to weather. Winter and summer storms often brought about a flurry of calls.

One very warm Thursday summers evening, as I cycled home, I took a call from one of my colleagues in the local environmental health team. It had just rained solid for 5 hours, the amount of rain which fell was unbelievable but as quickly as it fell it dried up. Well, in Ferndown it had but this was uphill from Bournemouth. Downhill, towards the rivers and streams that fed into the sea, a torrent of water had surged through the bourne valley and dumped all the debris that had washed off the streets and streams onto the Bournemouth lower gardens and beaches.

The next day was due to be the first day of the free air festival in Bournemouth. Hundreds of thousands of people were expected to attend and sit on the beaches and gardens to watch the displays which were currently either under 2 foot of water or covered in black debris! The question posed to me by my EHO colleague was, what were the potential risks to the public from all this pollution?

Within the next 12 hours, myself and my ever calm consultant lead, had to work out the threat possibilities and how to protect the public from them. So as the sun set we made some quick decisions based on other flooding events around the UK and internationally. In addition to what pollution could be seen we also knew that the storm drains had opened and that the sewer system had been overcome, so the usual blue beach quality water was not going to be present that day.

At 06:00 the next morning the gardens and beach were full of park and gardens staff, repairing plants and sweeping paths, as well as raking grass and sand. The standing water was drying up and the sun was already making the day warm. Whilst the usual green grass and tropical plants looked a little storm battered, unless you really knew what had happened you would not have known the extent to which it had been flooded.

Most of our concern was based around the fecal bacteria that would be on the areas where in a short time people would be sitting and eating picnics. With little facilities for hand washing we were concerned that a great many people could be exposed and potentially become ill. But was this any greater risk than normal given the wildlife that would frequent these areas?

There was a lot of research on line. Post flooding event articles were quite easy to get hold off but most of them covered issues related to contaminated water supplies. A few covered soil pollution and these formed the basis of our risk assessment and advice.

We knew that with the volume of water a dilution effect of any contamination would occur. We also knew that the impact of UV light would start to reduce the number of viable pathogens as well as the dedicating impact of the suns heat. We concluded that there would be a small amount of residual risk but over the course of the day this would rapidly decline to normal levels. The sea quality would also return to normal given the change in tides but we a divided for water sampling just to be sure.

As further preparations went on to return the gardens to their usual state I sat in the control centre and presented our advice…

Keep people off the gardens and out of the sea until the change of tides and continue to clear the areas of debris.

Whether it was the impact of UV light, the dilution effect from the huge volumes of water that washed through the town or just pure luck, there were no reported cases of illness linked to the hundreds of thousands of visitors who came to the town that day. We continued to carry out surveillance over the next few weeks but thankfully no illness.

Being on call taught me a great many skills, most of which I learnt from the consultants I had shared the in call duties with, I learnt where to look for answers and how to convert research into useable information. More importantly I learnt what were the best questions to ask and what questions I needed to prepare to answer. As an INFJ this was key, no time for dwelling when immediacy is required!

At the time this incident occurred I was deeply involved in the health protection planning for the Olympics. With lots of travel across the South West and back and forth to London this was a really busy time for me.

Now looking back it was the best part of being a nurse in the HPA…but more on that in the next blog.