Journal Article

Outbreak of lead poisoning from a civilian indoor firing range in the UK

Pucci, Mark Richard, Bradberry, Sally Marie, Khan, Aleha, Warsi, Aamna, Elamin, Muhammad Elamin Muhammad Osman

2024

Overview

IntroductionLead 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.MethodsA 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.ResultsEighty-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.DiscussionThis 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.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Abdomen / Antidotes / Asymptomatic / Availability / Blood levels / Chelating Agents - adverse effects / Chelation / Chelation therapy / Constipation / Dimercaptosuccinic acid / Disease Outbreaks / Emergency medical care / Employees / Ethylenediaminetetraacetic acids / Exposure / Firearms / Firing ranges / Headaches / Hospitals / Humans / Infant / Lead / Lead content / Lead poisoning / Lead Poisoning - epidemiology / Lead Poisoning - etiology / Legislation / Nausea / Occupational exposure / Occupational hazards / Occupational Health / Outbreaks / Pain / Patients / Poisoning / Poisons / Public health / Public Health Surveillance / Recreational facilities / Succimer - adverse effects / Toxicology / Trace elements / United Kingdom - epidemiology / Vigilance / Vomiting / Workplace