The Impact of Chemical, Biological, Radiological, Nuclear and Explosive Events on Emergency Departments: An Integrative Review

Abstract

Introduction:Disasters occur globally and can impact emergency department (ED) services. Chemical, biological, radiological, and nuclear (CBRN) events have different characteristics in terms of onset and duration when compared to other disasters, such as wildfires, floods, and hurricanes. It is important to have an understanding of the impact of CBRN events on EDs to inform disaster preparedness. The purpose of this paper is to identify peer-reviewed published literature that describes the impact on EDs from CBRN events.Method:An integrative literature methodology was used, guided by the Preferred Reporting Items of Systematic reviews and Meta-Analysis (PRISMA) Guidelines. MEDLINE, PsycINFO, CINAHL, Pubmed, and Scopus were searched using terms relating to CBRN events and EDs. Papers were included if they focused on the impact of real-world CBRN event(s). Information from each included paper was extracted into a table, including author(s), CBRN event characteristics, ED response characteristics, patient presentation characteristics, and outcome characteristics.Results:Of the 15,982 studies that were identified from the database searches, 4,012 were duplicates and 11,696 were irrelevant at the title and abstract screening stage. Therefore, 274 were screened at the full-text stage resulting in 44 studies for inclusion. Included papers were mostly from the United States of America (n=22/44, 50%), followed by Turkey (n=4/44, 9.1%). Most of the events were chemical (n=36/44, 81.9%), with Chlorine (n=9/36, 25%) being the most frequently reported chemical agent. Between 1 and 5,500 people [M=54, IQR: 22-253] presented to EDs because of CBRN events.Conclusion:Emergency departments assess and manage patients who present following CBRN events. Of these patients, the majority do not require hospital admission, suggesting that the ED is integral in the health response to CBRN events. As such, EDs should be adequately prepared, from a resource and process perspective to assess, manage and discharge large numbers of CBRN-related patients.