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Title: Hospital preparedness for toxico-medical response in case of a chemical incident in major urban agglomerations in Poland

Abstract:

Subsequent to the development of the chemical industry, incidents involving toxic chemicals have become a frequent occurrence. Such dangerous incidents include the use of chemical weapons of mass destruction in various international and internal conflicts, as well as by terrorist groups. A chemical incident, regardless of its character, is defined as an unforeseen, sudden occurrence leading, within a short time, to the release of a major amount of a chemical substance which has an immediate negative effect on people. Whatever the circumstances and character of the released chemicals, the primary task of the rescue personnel lies in limiting, to the largest possible extent, the number of human casualties. In order to achieve this, all rescue units, including medical units, must be with well prepared. In the case of chemical incidents, hospitals are a vital element of the response. Proper preparation of medical units to respond in such cases includes: familiarity with potential sources of chemical threats; knowledge of the chemicals possible effects and symptoms in people; logistic and professional preparedness. A hospital’s preparedness for toxico-medical response includes also the existence of an action plan in case of a chemical incident. The present dissertation is an attempt at assessing the levels of the above-described preparedness in three major urban aglomerations ; in Poland, namely Warsaw, Krakow and Gdańsk-Sopot-Gdynia. The assessment was conducted in twelve multi-profile public hospitals in the three urban agglomerations. A questionnaire was filled directly by 146 hospital employees, including hospital directors (or medical directors), heads of emergency units and admission room, heads of intensive care units, internal units and acute poisoning units, as well as by assistant doctors and nurses employed in these units. The questionnaire touched upon such issues as the participants’ knowledge of potential chemical incident sources within their respective urban areas; relevant training provided to the participants; existence of emergency response plans; hospitals’ logistic preparedness (decontamination units, individual protection, stockpiling of antidotes and other medicine) as well as professionalpreparedness of the hospital employees. Annexed to the present work is the questionnaire employed for hospital preparedness assessment. For the purposes of this work, the assessment of preparedness was conducted for each hospital as a whole, and not for specific units, wards or staff groups. The statistic analysis of results was aimed at establishing the existence or non-existence of a correlation between the hospital, the hospital’s location and the staff’s position (function), and selected parameters (elements) of preparedness. In assessi ; ng the preparedness of medical staff, a direct questionnaire was used. It was assumed that the information provided in the questionnaire by the heads of units was consistent with the factual state of matters. In most hospitals, no emergency response training had been provided; no hospital reported training on chemical incidents. Only one hospital reported that a joint simulation drill had been conducted with other emergency response services (Municipal Fire Service). Most assessed personnel were not familiar with their hospital’s role (80.1%) nor their personal role (66.5%) in case of emergency response to a chemical incident. A majority (62.6%) were not aware of existing chemical threats within their respective urban areas, while only a fraction (13.0%) were informed of such threats. Only one hospital had an action plan (secret plan) in case of emergency, while none had an action plan specifically in case of a chemical incident. As far as logistic preparedness is concerned, only one hospital had a stationary decontamination unit and a mobile decontamination unit; however, the stationary unit did not fulfill the relevant sanitary and technical requirements. None of the hospitals assessed was properly equipped for personal protection; anti-chemical protective clothing declared as available by some nursing staff was in fact anti-HIV protective clothing. Among antidotes, ful ; l availability was declared in the case of atropine; naloxone was available in 82.9%, inhalatory beta-adrenergics in 75.3%, and calcium gluconate (injection) in 74%. Oximes were available in a number of acute poisoning centres, while hydroxycobalamine was available in one such centre. When faced with a choice of potential sources of information on hazardous substances and weapons of mass destruction, the participants pointed mostly to Poison Information Centres (97.2%), fire services (80.2%) and the internet (31.1%). As far as professional preparation goes, non-familiarity with possible means of decontamination, poor knowledge of hazardous substances and the resulting toxidromes, as well as insufficient knowledge concerning antidote use, complete the image of a total lack of chemical emergency preparedness among the assessed hospitals. The statistic analysis focusing on the potential correlation between the hospital (random sample), the hospital’s location (agglomeration), the questioned staff member’s position (function) and the evaluation of selected factors did not provide any evidence of a correlation between the hospital and the evaluation of all above-mentioned factors (hospital/SEE<2). A correlation was found between the location and the evaluation of strategic issues, the familiarity with means of external decontamination and the antidote availability (p<0.05). A correl ; ation was also found between the position (function) and the evaluation of strategic issues, familiarity with means of external decontamination and evaluation of the probability of a chemical incident or a terrorist attack in the studied agglomerations (p<0,05). The highest level of familiarity with selected strategic, logistic and professional factors was found in the medical staff of the Krakow hospitals. A set of indirect conclusions were also drawn from the study results. These include: the need to undertake regional studies aimed at analysing the potential chemical threats and establishing the minimum levels of toxico-medical preparedness in the hospitals in Poland; and developing cooperation between clinical toxicologists and emergency medical services in order to draft procedures for hazmat incident response.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

toksykologia

Degree grantor:

Wydział Lekarski

Promoter:

Pach, Janusz

Date issued:

2007

Identifier:

oai:dl.cm-uj.krakow.pl:1131

Call number:

ZB-105568

Language:

pol

Access rights:

tylko w bibliotece

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Last modified:

Jul 19, 2022

In our library since:

Nov 21, 2012

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