ABSTRACT
OBJECTIVE: To assess the level of preparedness of Australian hospitals, as perceived by senior emergency department physicians, for chemical, biological and radiological (CBR) incidents, as well as the resources and training available to their departments. METHODS: Detailed questionnaires were mailed to the directors of the 86 hospital emergency departments (EDs) in Australia accredited by the Australasian College for Emergency Medicine. Questions covered hospital planning, available resources and training, and perceived preparedness. RESULTS: Responses were received from 76 departments (88%): 73 reported that their ED had a disaster plan, with 60 (79%) having a contingency plan for chemical, 57 (75%) for biological, and 53 (70%) for radiological incidents. Specific staff training for managing patients from a conventional mass casualty incident was given in 83% of EDs, falling to 66% for a CBR incident. Forty-three per cent reported that their plan involved staff managing contaminated patients, but availability of personal protective equipment and decontamination facilities varied widely. Although 41% believed their ED could cope with a maximum of 20 patients in the first 2 hours after a conventional incident, this increased to 71% for a CBR incident. Staff training was considered the main funding priority (59%). CONCLUSIONS: This survey raises significant questions about the level of preparedness of Australian EDs for dealing with patients from both conventional and CBR incidents. Hospitals need to review their plans and functionality openly and objectively to ensure that their perceived preparedness is consistent with reality. In addition, they urgently require guidance as to reasonable expectations of their capacity. To that end, we recommend further development of national standards in hospital disaster planning and preparedness.
Subject(s)
Biological Warfare , Chemical Warfare , Disaster Planning , Emergency Service, Hospital/standards , Terrorism , Australia , Emergency Medical Service Communication Systems/standards , Humans , Surveys and QuestionnairesABSTRACT
Methaemoglobinaemia is an important perturbation to recognise, as untreated it may cause severe tissue hypoxia and cell death. We describe a case of methaemoglobinaemia acquired in an unusual manner, during an explosion at an explosives manufacturing plant.
Subject(s)
Accidents, Occupational , Blast Injuries/physiopathology , Methemoglobinemia/physiopathology , Adult , Blast Injuries/surgery , Blast Injuries/therapy , Explosive Agents/poisoning , Humans , Male , Methemoglobinemia/etiology , Methemoglobinemia/therapy , Trinitrotoluene/poisoningABSTRACT
In response to the increasing threat of a mass casualty incident involving chemical, biological or radiological agents, and concern over the preparedness of our hospital system to cope with patients from such an incident, we conducted the largest hospital-based field exercise involving contaminated patients that has been held in Australia. In the present paper, we outline the background to, and methodology of, Exercise Supreme Truth, and the efforts made to increase its realism. We focus our discussion on three issues highlighted by the exercise, which we believe have enormous implications for the development of hospital chemical, biological or radiological plans and the likelihood of their success--hospital security, crowd control and decontamination.
Subject(s)
Disaster Planning , Hospital Planning , Terrorism , Australia , Bioterrorism , Chemical Terrorism , Crowding , Decontamination , Disaster Planning/organization & administration , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/statistics & numerical data , Explosions , Hospitals, Urban/organization & administration , Hospitals, Urban/statistics & numerical data , Humans , Security MeasuresABSTRACT
We report the clinical and toxicological features of a case of fatal iodine ingestion, and summarize the physiology, clinical characteristics and management of iodine ingestion. Physicians are likely to have little experience in managing such patients, particularly with the advent of less toxic preparations, and therefore need ready access to management guidelines. This case also highlights the potential for substances to retain their toxicity over long periods of time.
Subject(s)
Betamethasone/analogs & derivatives , Iodine/poisoning , Administration, Oral , Aged , Betamethasone/poisoning , Corrosion , Emergency Medicine/methods , Fatal Outcome , Female , Gastrointestinal Tract/pathology , Humans , Poisoning/diagnosis , Poisoning/pathology , Poisoning/therapyABSTRACT
Para-methoxyamphetamine (PMA) is a substituted synthetic amphetamine used in the recreational drug scene. It is unusual because of the high incidence of significant morbidity and mortality in overdose. We report a case of PMA overdose in South Australia, and review our experience with the drug. We review the literature on PMA overdose and offer suggestions on the management of overdose with this dangerous drug.
Subject(s)
Amphetamines/poisoning , Poisoning/therapy , Acute Disease , Adult , Amphetamines/urine , Chromatography, Gas , Drug Overdose , Female , Glasgow Coma Scale , Humans , Hypnotics and Sedatives/therapeutic use , Hypnotics and Sedatives/urine , Male , Midazolam/therapeutic use , Midazolam/urine , Poisoning/drug therapy , South Australia/epidemiology , Substance-Related Disorders/urineABSTRACT
Recent world events have forced Australia to re-examine its role on the world stage and its susceptibility to terrorist attacks. The authors examine the brief historical exposure of Australia to the phenomenon of terrorism, and review the geopolitical climate and features that may render it more susceptible to attack in the future. Australia's emergency management structure is outlined, and its current state of medical preparedness for a terrorist incident is critically reviewed.
