Abstract
The survivability of mass casualties exposed to a chemical attack is dependent on clinical knowledge, evidence-based practice, as well as protection and decontamination capabilities. The aim of this systematic review was to identify the knowledge gaps that relate to an efficient extraction and care of mass casualties caused by exposure to chemicals. This systematic review was conducted from November 2018 through September 2020 in compliance with Cochrane guidelines. Five databases were used (MEDLINE, Web of Science Core Collection, Embase, Cochrane, and CINAHL) to retrieve studies describing interventions performed to treat victims of chemical attacks (protection, decontamination, and treatment). The outcomes were patient's health condition leading to his/her stabilization (primary) and death (secondary) due to interventions applied (medical, protection, and decontamination). Of the 2,301 papers found through the search strategy, only four publications met the eligibility criteria. According to these studies, the confirmed chemical poisoning cases in acute settings resulting from the attacks in Matsumoto (1994), Tokyo (1995), and Damascus (2014) accounted for 1,333 casualties including 11 deaths. No study reported comprehensive prehospital clinical data in acute settings. No mention was made of the integration of specialized capabilities in medical interventions such as personal protective equipment (PPE) and decontamination to prevent a secondary exposure. Unfortunately, it was not possible to perform the planned meta-analysis. This study demonstrated gaps in clinical knowledge application regarding the medical extraction of casualties exposed during a chemical attack. Further research is required to optimize clinical practice integrating mixed capabilities (protection and decontamination) for the patient and medical staff.
Highlights
The survivability of mass casualties exposed to a chemical attack is dependent on clinical knowledge, evidence-based practice, as well as protection and decontamination capabilities
Paquette-Raynard, Noebert, et al Conclusions: This study demonstrated gaps in clinical knowledge application regarding the medical extraction of casualties exposed during a chemical attack
Gaps in prehospital care for patients exposed to a chemical attack - a systematic review
Summary
The survivability of mass casualties exposed to a chemical attack is dependent on clinical knowledge, evidence-based practice, as well as protection and decontamination capabilities. Results: Of the 2,301 papers found through the search strategy, only four publications met the eligibility criteria According to these studies, the confirmed chemical poisoning cases in acute settings resulting from the attacks in Matsumoto (1994), Tokyo (1995), and Damascus (2014) accounted for 1,333 casualties including 11 deaths. There is a lack of medical guidelines and protocols for prehospital management in conjunction with the integrated use of protection and decontamination capabilities for both the health care professionals and the patients in the event of a chemical attack or other types of exposure (eg, biological, radiological, and nuclear).[10,22–30]. Little is still known regarding the clinical impact of chemical exposures in humans These knowledge gaps expose any population to inappropriate clinical care in the eventuality of a chemical attack with (or without) mass casualties, and a higher risk of death or long-term disability.[31,32]
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