The capability of accident and emergency departments to safely decontaminate victims of chemical incidents

Objectives - To evaluate the capability of accident and emergency (A&E) dep artments in six health regions of England to safely decontaminate casualtie s exposed to hazardous chemicals. Methods - In January questionnaire was sent to the clinical director of all A&E departments in Trent, North and South Thames, South and West, North We st 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 co ntacted by telephone if they failed to respond to the second mailing. Results - 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 20 000 n ew attendances per year. Of these 154 departments, 109 (71%) had a written chemical incident plan but only 55 (36%) maintained a list of nearby indust rial chemical sites. Fifty nine departments (38%) stated that members of st aff had received training in the management of chemically contaminated casu alties in the preceding year. Eighteen departments (12%) possessed the leve l of personal protective equipment (PPE) recommended for decontamination by the Ambulance Services Association. Ninety six departments (62%) had a des ignated decontamination room but only seven (7%) of them incorporated all t he features generally considered necessary for safe decontamination. Forty one units (27%) had the capability to decontaminate casualties outside of t he department either with warm water from a shower attachment or with a mob ile decontamination unit. Thirty six departments (23%) had neither a decont amination room nor the ability to decontaminate casualties outside the depa rtment. Only 16 units (10%) had both adequate PPE and either a decontaminat ion room or the capability to decontaminate outside the department. Conclusions - This study has identified deficiencies in the current NHS cap ability to respond to chemical incidents. To resolve this, nationally recog nised standards for decontamination facilities, equipment and training shou ld be formulated, agreed and implemented.