Horby P, Murray V, Cummins A, Mackway-Jones K, Euripidou R
Public Health Laboratory Service, Communicable Disease Surveillance Centre, London.
J Accid Emerg Med. 2000 Sep;17(5):344-7. doi: 10.1136/emj.17.5.344.
To evaluate the capability of accident and emergency (A&E) departments in six health regions of England to safely decontaminate casualties exposed to hazardous chemicals.
In January 1999 a postal questionnaire was sent to the clinical director of all A&E departments in Trent, North and South Thames, South and West, North West and, Anglia and Oxford Health Regions. The questionnaire inquired about characteristics of the department, decontamination facilities and equipment, and staff training. Nonresponders were sent a second questionnaire and contacted by telephone if they failed to respond to the second mailing.
308 of 326 departments identified (94%) returned a questionnaire. There was no significant difference in response rate by region (p = 0.99). Analysis was restricted to 154 major departments seeing more than 20000 new attendances per year. Of these 154 departments, 109 (71%) had a written chemical incident plan but only 55 (36%) maintained a list of nearby industrial chemical sites. Fifty nine departments (38%) stated that members of staff had received training in the management of chemically contaminated casualties in the preceding year. Eighteen departments (12%) possessed the level of personal protective equipment (PPE) recommended for decontamination by the Ambulance Services Association. Ninety six departments (62%) had a designated decontamination room but only seven (7%) of them incorporated all the features generally considered necessary for safe decontamination. Forty one units (27%) had the capability to decontaminate casualties outside of the department either with warm water from a shower attachment or with a mobile decontamination unit. Thirty six departments (23%) had neither a decontamination room nor the ability to decontaminate casualties outside the department. Only 16 units (10%) had both adequate PPE and either a decontamination room or the capability to decontaminate outside the department.
This study has identified deficiencies in the current NHS capability to respond to chemical incidents. To resolve this, nationally recognised standards for decontamination facilities, equipment and training should be formulated, agreed and implemented.
评估英格兰六个卫生区域的事故与急救（A&E）部门对接触危险化学品的伤亡人员进行安全去污处理的能力。
1999年1月，向特伦特、泰晤士河北部和南部、南部和西部、西北部以及东安格利亚和牛津卫生区域的所有A&E部门的临床主任发送了一份邮政调查问卷。该问卷询问了部门的特点、去污设施和设备以及人员培训情况。未回复者会收到第二份问卷，如果他们未回复第二份邮件，则通过电话联系。
在326个被识别的部门中，有308个（94%）返回了问卷。各区域的回复率没有显著差异（p = 0.99）。分析仅限于每年接待超过20000名新患者的154个主要部门。在这154个部门中，109个（71%）有书面的化学事故预案，但只有55个（36%）保存了附近工业化学场所的清单。59个部门（38%）表示，工作人员在上一年接受了化学污染伤亡人员管理方面的培训。18个部门（12%）拥有救护服务协会推荐的用于去污的个人防护装备（PPE）水平。96个部门（62%）有指定的去污室，但其中只有7个（7%）具备安全去污通常认为必要的所有特征。41个单位（27%）有能力在部门外使用淋浴喷头的温水或移动去污装置对伤亡人员进行去污处理。36个部门（23%）既没有去污室，也没有在部门外对伤亡人员进行去污处理的能力。只有16个单位（10%）既有足够的PPE，又有去污室或在部门外进行去污处理的能力。
本研究发现了当前英国国民医疗服务体系（NHS）应对化学事故能力方面的不足。为解决这一问题，应制定、商定并实施国家认可的去污设施、设备和培训标准。
