Ranse Jamie, Mackie Benjamin, Crilly Julia, Heslop David, Wilson Bridget, Mitchell Marion, Weber Sarah, Watkins Nathan, Sharpe Joseph, Handy Michael, Hertelendy Attila, Currie Jane, Hammad Karen
School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.
School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; 2nd Health Battalion, Australian Army, Australia.
Australas Emerg Care. 2025 Mar;28(1):37-47. doi: 10.1016/j.auec.2024.09.003. Epub 2024 Oct 2.
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.
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.
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.
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.
导致灾害的自然灾害在全球范围内不断增加，影响着社区并扰乱了各行业。除了为这些自然灾害灾难制定计划外，急诊科还应做好应对化学、生物、放射和核（CBRN）事件的准备，这些事件会导致患者就诊量激增。化学、生物、放射和核事件在应对自然灾害的准备方面有所不同，需要了解患者管理以及与卫生系统相关的挑战。
本范围综述采用了阿克西和奥马利的五步框架。使用与现实世界中CBRN事件对急诊科的影响相关的关键词，从四个数据库和搜索引擎中检索手稿。分析聚焦于CBRN事件的特征、急诊科的影响以及针对人员、物资、空间和系统这四个应急能力领域吸取的经验教训。
本综述共纳入44篇论文。大多数事件本质上是化学事件（n = 36/44，81.8%）。大多数CBRN事件是意外事件（n = 34/44，77.3%）。每次事件有1至1470人（中位数 = 56，四分位间距：18 - 228）前往急诊科就诊。大多数患者从急诊科出院，但报告情况各不相同。一些关键经验教训涉及急诊科工作人员的二次暴露、空间重新利用以及CBRN事件的协调。
随着CBRN事件数量的增加，加强急诊科并限制患者就诊量激增所带来影响的策略至关重要。建议了解当地CBRN风险，以采用针对CBRN准备的最高风险方法，并实施先发制人的CBRN临床路径。此外，应实施策略以保护工作人员免受CBRN事件二次暴露的风险。这些策略可能包括为工作人员提供充分的教育、培训和个人防护装备。
