Cone D C, Davidson S J
Department of Emergency Medicine, Allegheny University of the Health Sciences, Philadelphia, PA 19129, USA.
Prehosp Emerg Care. 1997 Apr-Jun;1(2):85-90. doi: 10.1080/10903129708958794.
This study was conducted to examine the preparedness of emergency departments (EDs) to safely receive, decontaminate, and treat chemically contaminated patients.
The safety officers of all 58 acute-care hospitals in the five-county philadelphia metropolitan region were surveyed by mail, with a repeat mailing to nonresponders followed by telephone contact. The 16 survey questions addressed the ability of EDs to safely decontaminate and treat chemically contaminated patients.
Thirty-eight of 58 hospitals (66%) returned usable surveys. Of these, 24 (63%) have a written plan for decontamination and treatment of chemically contaminated patients in the ED, and 19 (50%) have a hospital-wide disaster plan that includes contingencies for decontamination and treatment of one or more chemically contaminated patients. Thirteen hospitals (34%) conducted a drill of either of these plans in 1994. Twenty (53%) EDs have a specific treatment area for chemically contaminated patients. A stock of supplies for protecting the ED from secondary contamination is maintained by 16 (42%). While 24 (63%) store personal protective equipment, most of these involve only gowns, gloves, and surgical masks; only 13 provide any type of respiratory protection. Nine respondents were certain that patients brought in by local EMS would have been adequately decontaminated in the field, eight stated that they believed or felt decontamination would be adequate, and 12 were concerned that field decontamination might not be adequate. Eighteen hospitals (47%) reported treating one or more chemically contaminated patients in 1994. The authors believe the return rate reflects reluctance to commit hospital policies to paper. This was confirmed during telephone follow-up of nonrespondents when, for example, one safety officer discussed hazardous materials (hazmat) principles for 40 minutes, but refused to complete the survey.
Hospital hazmat preparedness in this area varies tremendously. A significant proportion of hospitals lack a written plan and equipment to allow the ED to safely and effectively handle the chemically contaminated patient. There is reluctance to discuss this topic.
本研究旨在调查急诊科安全接收、去污和治疗化学污染患者的准备情况。
通过邮件对费城五县大都市地区的58家急症护理医院的安全官员进行了调查，对未回复者再次邮寄问卷，随后进行电话联系。16个调查问题涉及急诊科安全去污和治疗化学污染患者的能力。
58家医院中有38家（66%）返回了可用的调查问卷。其中，24家（63%）有针对急诊科化学污染患者去污和治疗的书面计划，19家（50%）有全院范围的灾难计划，其中包括对一名或多名化学污染患者去污和治疗的应急措施。1994年，13家医院（34%）对上述任何一个计划进行了演练。20家（53%）急诊科有专门用于化学污染患者的治疗区域。16家（42%）医院储备了用于保护急诊科免受二次污染的物资。虽然24家（63%）医院储存了个人防护装备，但其中大多数仅包括隔离衣、手套和外科口罩；只有13家提供任何类型的呼吸防护。9名受访者确定当地紧急医疗服务机构送来的患者在现场已得到充分去污，8名表示他们认为或感觉去污会是充分的，12名则担心现场去污可能不充分。18家医院（47%）报告在1994年治疗了一名或多名化学污染患者。作者认为回复率反映了医院不愿将政策书面化。在对未回复者的电话随访中得到了证实，例如，一名安全官员讨论危险材料原则长达40分钟，但拒绝完成调查。
该地区医院在危险材料准备方面差异巨大。很大一部分医院缺乏书面计划和设备，无法让急诊科安全有效地处理化学污染患者。人们不愿讨论这个话题。
