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Short report
Outbreak of lead poisoning from a civilian indoor firing range in the UK
  1. Aamna Warsi1,
  2. Mark Richard Pucci2,
  3. Sally Marie Bradberry2,
  4. Aleha Khan3,
  5. Muhammad Elamin Muhammad Osman Elamin2
  1. 1 Royal Air Force Medical Services, High Wycombe, UK
  2. 2 West Midlands Poisons Unit, Birmingham, UK
  3. 3 Trace Elements Laboratory, Black Country Pathology Services, Sandwell, UK
  1. Correspondence to Dr Aamna Warsi, Royal Air Force, High Wycombe, UK; aamna.warsi{at}nhs.net

Abstract

Introduction Lead exposure from discharged lead dust is a recognised risk at firing ranges. We report a lead poisoning outbreak among staff and their close contacts at a UK civilian indoor 24 m firing range.

Methods A retrospective review was undertaken of data collected on all patients at risk of lead poisoning identified either by direct referral to the Clinical Toxicology clinicians at the West Midlands Poisons Unit, or via the Trace Elements Supra-Regional Assay Service Laboratory at Sandwell hospital.

Results Eighty-seven patients were identified as having possible lead exposure, either at the firing range or via close contacts. Of these, 63 patients aged between 6 months and 78 years attended for blood lead concentration (BLC) testing. The highest BLC at presentation was 11.7 µmol/L (242 µg/dL). Only nine patients reported any symptoms at presentation. Fifteen patients received lead chelation therapy with oral dimercaptosuccinic acid (or succimer) 30 mg/kg/day or intravenous sodium calcium edetate (EDTA) 75 mg/kg/day, dependent on stock availability.

Discussion This report highlights the need for vigilance of lead poisoning as an occupational hazard in the UK, including at recreational facilities such as indoor firing ranges. It emphasises the importance of regulation of lead exposure in the workplace, particularly given the vague symptoms of lead poisoning, and proposes re-appraisal of UK legislation. This report also highlights potential issues surrounding stock availability of rarely used antidotes for uncommon presentations in the event of an outbreak of poisoning.

  • Lead
  • Occupational Health
  • Public health
  • Toxicology
  • Public Health Surveillance

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Twitter @aamnawarsi

  • Contributors MEMOE, SMB and MRP encouraged AW to write up this short report. AW and AK collected and analysed data on patients reviewed by MEMOE, SMB, MRP and AW. MEMOE consented patients. AW conducted a literature review and drafted the paper with the input of all authors. MEMOE supervised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.