Strengthening emergency department response to chemical, biological, radiological, and nuclear disasters: A scoping review.

IF 2.1 4区 医学 Q2 EMERGENCY MEDICINE Australasian Emergency Care Pub Date : 2024-10-01 DOI:10.1016/j.auec.2024.09.003
Jamie Ranse, Benjamin Mackie, Julia Crilly, David Heslop, Bridget Wilson, Marion Mitchell, Sarah Weber, Nathan Watkins, Joseph Sharpe, Michael Handy, Attila Hertelendy, Jane Currie, Karen Hammad
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Abstract

Introduction: Natural hazards resulting in disasters are increasing globally, impacting communities and disrupting industries. In addition to planning for these natural hazard disasters, emergency departments (EDs) should prepare for chemical, biological, radiological, and nuclear (CBRN) incidents that result in surges of patient presentations. Chemical, biological, radiological, and nuclear incidents differ in preparedness to natural hazards, requiring an understanding of patient management and health system-related challenges.

Methods: This scoping review used the Arksey and O'Malley five-step framework. Manuscripts were retrieved from four databases and search engines using keywords relating to impacts on the ED from real world CBRN event(s). Analysis focused on the characteristics of CBRN event, ED impact, and lessons learnt against four surge capacity domains that including staff, stuff, space, and systems.

Results: A total of 44 paper were included in this review. Most of the incidents were chemical in nature (n = 36/44, 81.8 %). The majority of CBRN incidents were accidental (n = 34/44, 77.3 %). Between 1 and 1470 people (Mdn=56, IQR: 18-228) presented to an ED from each event. Most patients were discharged from the ED, but this was variably reported. Some key lessons related to secondary exposure to ED staff, repurposing spaces, and coordination of CBRN incidents.

Conclusion: With the increasing number of CBRN incidents, strategies to strengthen EDs and limit the impact from a surge in patient presentations are paramount. An understanding of local CBRN risk to inform a top-hazards approach to CBRN preparedness, and the implementation of pre-emptive CBRN clinical pathways is recommended. Additionally, strategies should be implemented to protect staff from the risk of secondary exposure to a CBRN event. These strategies may include adequate education, training, and personal protective equipment for staff.

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加强急诊科应对化学、生物、放射和核灾难的能力:范围审查。
导言:在全球范围内,自然灾害导致的灾难日益增多,对社区造成了影响并扰乱了产业。除了为这些自然灾害制定计划外,急诊科(ED)还应为导致患者激增的化学、生物、放射和核(CBRN)事件做好准备。化学、生物、放射和核事故与自然灾害的准备工作不同,需要了解患者管理和医疗系统相关的挑战:本次范围界定审查采用了 Arksey 和 O'Malley 的五步框架。使用与真实世界 CBRN 事件对急诊室的影响相关的关键词,从四个数据库和搜索引擎中检索了相关稿件。分析的重点是 CBRN 事件的特征、急诊室受到的影响以及从人员、物资、空间和系统等四个激增能力领域吸取的经验教训:结果:共有 44 篇论文被纳入本综述。大多数事件属于化学事件(n = 36/44,81.8%)。大多数化学、生物、辐射和核事故是意外事故(n = 34/44,77.3%)。每次事件都有 1 到 1470 人(Mdn=56,IQR:18-228)被送往急诊室。大多数患者已从急诊室出院,但报告的情况各不相同。一些重要的经验教训与急诊室工作人员的二次接触、空间的重新利用以及化学、生物、辐射和核事件的协调有关:结论:随着化学、生物、辐射和核事件的不断增加,加强急诊室并限制患者激增造成的影响的策略至关重要。建议了解当地的化学、生物、辐射和核风险,为化学、生物、辐射和核防备工作的最高危害方法提供信息,并实施先发制人的化学、生物、辐射和核临床路径。此外,还应该实施一些战略,保护工作人员免受化学、生物、辐射和核事件的二次暴露风险。这些策略可包括对员工进行充分的教育、培训和个人防护设备。
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来源期刊
Australasian Emergency Care
Australasian Emergency Care Nursing-Emergency Nursing
CiteScore
3.30
自引率
5.60%
发文量
82
审稿时长
37 days
期刊介绍: Australasian Emergency Care is an international peer-reviewed journal dedicated to supporting emergency nurses, physicians, paramedics and other professionals in advancing the science and practice of emergency care, wherever it is delivered. As the official journal of the College of Emergency Nursing Australasia (CENA), Australasian Emergency Care is a conduit for clinical, applied, and theoretical research and knowledge that advances the science and practice of emergency care in original, innovative and challenging ways. The journal serves as a leading voice for the emergency care community, reflecting its inter-professional diversity, and the importance of collaboration and shared decision-making to achieve quality patient outcomes. It is strongly focussed on advancing the patient experience and quality of care across the emergency care continuum, spanning the pre-hospital, hospital and post-hospital settings within Australasia and beyond.
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