They also mention the successful use of protein adducts as biomarkers in the case of sulphur mustard, acrylamide, ethylene oxide, dichlorvos and acrylonitrile. Another example of the utility of biological monitoring was reported by Jones and

McCallum (2011). This involved a workplace ‘incident’ in which tunnelling workers were exposed to levels of benzene that exceeded exposure limits. Biological monitoring (urinary S-phenylmercapturic acid levels) revealed BTK inhibitors high internal exposures to benzene despite the use of personal protection equipment Investigation showed this was due a combination of environmental and human factors. Improvements in protective equipment, work practices and worker behaviour led to significant reductions in exposure. Selleckchem CHIR 99021 For first responders to major incidents with no ‘normal’ exposure to the substance

and relying on personal protective equipment for control of exposure the more appropriate guidance values may be those derived from background/population levels. If the equipment is working and being used correctly it might be expected that systemic exposure will be low. However, in these cases and also for those potentially exposed in the wider population, care should be taken interpreting the results. Although population studies are very helpful in assessing the overall exposure of the population they are more difficult to interpret for the individual. Samples are usually collected at times

that are not defined in relation to exposure (extent or frequency) and may show considerable intra-individual variation (Aylward et al., 2014). Since biological monitoring guidance values for both environmental and for occupational exposures have their limitations in the aftermath of a chemical incident, there is a need for biological guidance values specific for use in such incidents. Biological guidance values help assess systemic exposure but are related to external exposure dose metrics. Acute Exposure Reference Values Suplatast tosilate (AERVs) such as AEGLs (EPA, 2012) or Emergency Response Planning guidance Levels (ERPGs AIHA, 2013) are external exposure guidance values specifically derived for chemical incidents (Bos et al., 2013). This guidance can be used in support of the public health management of chemical incidents and should enable comparison of the public health impacts of the chemical exposure and of the possible emergency response measures such as shelter-in-place or evacuation. Such guidance values have at least three tiers (representing action levels) showing the following characteristics: 1. A threshold for discomfort or other minor, rapidly reversible health effects. The eldest programs for derivation of AERVs are the Emergency Response Planning Guidelines (ERPGs) and the Acute Exposure Guideline Levels (AEGLs), both initiated in the US.