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Health and safety (HS) standard

Rationale
A PMC-SI service requires the highest level of safety for staff and others. The risks associated with PMC-SI must be adequately managed to assure that staff and other personnel are protected from radiation, disease, physical injury and emotional distress.

HS1  Ionising radiation protection/occupational risk and hazard notices
HS2  Minimise exposure to EMF fields and hazard notices
HS3 Infection risk
HS4  Hazardous materials
HS5  Moving and handling
HS6  Psychological risks

HS1  Ionising radiation protection/occupational risk and hazard notices

Rationale:
Managing exposure to radiation provides a key element of safe working practices in PMC-SI.

Criteria:
a. A PMC-SI service implements and monitors systems to manage risks associated with ionising radiation in accordance with all relevant legislation and local rules ,
b. Systems are in place to ensure that staff working with ionising radiation receive appropriate training in radiation safety and have access to any required protective equipment,
c. All areas where ionising radiation is used must be designated and monitored in accordance with regulations,
d. Hazard notices regarding the risks from ionising radiation must be clearly displayed within the service.

Commentary:
Radiographers, as part of their education and training, are fully conversant with the requirements of legislation related to ionising radiation protection. Roles and responsibilities are mandated in legislation with regard to adequate expert physics support and monitoring of the environment and personnel.

HS2  Minimise exposure to EMF fields and hazard notices

Rationale:
There are significant risks associated with working in high strength magnetic fields. Safe working practices are essential for this technology to be used safely.

Criteria:
a. A PMC-SI  service implements and monitors systems to manage risks associated with magnetic resonance imaging,
b. Systems in place to ensure that appropriate procedures and checks are undertaken prior to the examination,
c. Systems in place to ensure safe exposure to the EMF field for accompanying personnel. Screening should be applied to all including the cadaver and staff involved in the examination.

Commentary:
Post-mortem magnetic resonance imaging (PMMR) should be carried out only by specialist MR radiographers (Rutty et al 2012). MR Radiographers, as part of their education and training, are fully conversant with the requirements of all appropriate legislation related to MRI protection although may require further training related to the risks of MRI for post mortem examinations eg knowledge of implanted devices in the cadaver; systems to ensure no loose ferrous objects are within the body bag; body bags that are MRI safe.

The SCoR contends that HCPC registered radiographers have the most appropriate qualification to undertake CT as well as MR post-mortem imaging and that forensic imaging is within the scope of practice for radiographers who have completed the appropriate postgraduate level training in forensic procedures.

HS3  Infection risk

Rationale:
Risks associated with post-mortem imaging vary from the risks associated with imaging the living. Protection of personnel, visitors and other patients is essential.

Criteria:
a. A PMC-SI service implements and monitors systems to manage risks from infections,
b. Systems in place to ensure that staff are trained in the processes required to protect themselves and other facility users from any infection risk posed by the deceased.

Commentary:
A full risk assessment of likely contamination and control of the risks should be performed. Audit against the standards should take place to ensure effectiveness and compliance. Registered radiographers are trained in infection control and audit processes but will require up to date training and education with regard to procedures relating to the deceased. Access to expert infection control advice and training may need to be considered in the service specification. Access to occupational health expertise may also need to be considered should there be inadvertent exposure to an infection risk eg  needlestick injury or skin abrasion.

HS4  Hazardous materials

Rationale:
Deceased bodies may have been exposed to harmful substances and contamination either pre or post- mortem. The normal channels of communication may not be available and therefore safe working practices must be developed.

Criteria:
a.
A PMC-SI service implements and monitors systems to manage risks associated with hazardous substances and materials,
b. Systems and processes in place to protect staff and other facility users from risk associated with hazardous substances and materials.

Commentary:
A full risk assessment of likely hazardous substances and materials with control of the risks should be performed (Burnett 2004). Audit against the standards should take place to ensure effectiveness and compliance.  Access to expert advice and training may need to be considered in the service specification. Access to occupational health expertise may also need to be considered should there be inadvertent exposure to a hazardous substance or material. Registered radiographers, as part of their undergraduate education, are conversant with the appropriate legislative requirements in the handling of a range of hazardous substances and materials, but will need extra training in those factors related to post-mortem practices.

HS5  Moving and handling

Rationale:
The movement of a deceased body carries significant risks for manual handling and attention must be paid to safe working practices for staff and accompanying personnel.

Criteria:
a. A PMC-SI service implements and monitors systems to manage safe moving and handling,
b. Staff should be trained in systems, processes or equipment required for safe manual handling.

Commentary:
A full risk assessment of likely manual handling associated with PMC-SI should be performed. Audit against the standards should take place to ensure effectiveness and compliance. Suitable equipment must be provided. Registered radiographers are trained in manual handling techniques. Access to expert advice and training may need to be considered in the service specification. Access to occupational health expertise may also need to be considered.

HS6  Psychological risks

Rationale:
Employers should pay particular regard to the potentially distressing nature of some aspects of forensic practice which could lead to post traumatic stress disorder (PTSD) in the individual undertaking the examination. https://www.sor.org/learning/document-library/guidance-radiographers-pro...

Criteria:
A PMC-SI service implements and monitors systems to address any psychological or emotional factors which may affect staff,
Systems are in place that ensure staff have access to appropriate support.

Commentary:
There is a potential risk associated with the sensitive nature of post-mortem examinations that may result in radiographers suffering from emotional or psychological problems.  Radiographers and associated staff should have access to emotional and psychological support. This should be reflected in appropriate risk assessments and governance processes. Support may be through in-house processes such as occupational health services or via an external Health and Wellbeing service. Radiographers should be able to access immediate and ongoing support as required without need for formal referral through a managerial system. The guidance provided in the overarching forensic document should be followed.

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