Abstract
BackgroundA number of significant chemical incidents occur in the UK each year and may require Emergency Departments (EDs) to receive and manage contaminated casualties. Previously UK EDs have been found to be under-prepared for this, but since October 2005 acute hospital Trusts have had a statutory responsibility to maintain decontamination capacity. We aimed to evaluate the level of preparedness of Emergency Departments in North West England for managing chemical incidents.MethodsA face-to-face semi-structured interview was carried out with the Nurse Manager or a nominated deputy in all 18 Emergency Departments in the Region.Results16/18 departments had a written chemical incident plan but only 7 had the plan available at interview. All had a designated decontamination area but only 11 felt that they were adequately equipped. 12/18 had a current training programme for chemical incident management and 3 had no staff trained in decontamination. 13/18 could contain contaminated water from casualty decontamination and 6 could provide shelter for casualties before decontamination.ConclusionWe have identified major inconsistencies in the preparedness of North West Emergency Departments for managing chemical incidents. Nationally recognized standards on incident planning, facilities, equipment and procedures need to be agreed and implemented with adequate resources. Issues of environmental safety and patient dignity and comfort should also be addressed.
Highlights
A number of significant chemical incidents occur in the UK each year and may require Emergency Departments (EDs) to receive and manage contaminated casualties
This pattern of patient behaviour was not substantiated by experience in Japan, where 85% of patients following the Tokyo subway sarin attacks in March 1995 self-transported to hospital [3], or in the United States, where between 1995 and 2001 15 Emergency Department (ED) personnel were injured as a result of contaminated casualties in 6 different incidents with agents including hydrofluoric acid, acetone, hydrochloric acid and chlorine [4]
Planning and training 16 of the 18 departments had a formal written incident plan for the management of chemical incidents, but only 7 of these had it accessible at the time of interview. 12 respondents were confident in their ability to wash down a patient, but only 5 were sure of the time required for decontamination. 16 interviewees felt they knew which agencies to contact in the event of a chemical incident, of which 9 had the appropriate telephone numbers immediately to hand
Summary
A number of significant chemical incidents occur in the UK each year and may require Emergency Departments (EDs) to receive and manage contaminated casualties. It might have been hoped that the events of September 11th 2001 and the subsequent raising of awareness of chemical threats might have improved the situation This has not been substantiated by the National Audit Office [8] or a more recent study which found that only 82% of UK EDs had trained staff in the use of Personal Protective Equipment (PPE). The same study identified a number of problems with the PPE currently in use, notably leaks around the foot area and problems with sizing [9]
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