TAP CBRN Preparedness: Knowledge, Training and Networks

Preparedness of Finnish Emergency Medical Services for Chemical Emergencies

Introduction The preparedness level of Finnish Emergency Medical Services (EMS) for treating chemical emergencies is unknown. The aim of this study was to survey the preparedness level of EMS systems for managing and handling mass-casualty chemical incidents in the prehospital phase in Finland. Hypothesis The study hypothesis was that university hospital districts would have better clinical capability to treat patients than would central hospital districts in terms of the number of patients treated in the field within one hour after dispatching as well as patients transported to hospital within one hour or two hours after dispatching.

METHODS

This cross-sectional study was conducted as a Webropol (Wuppertal, Germany) survey. All hospital districts (n=20) in continental Finland were asked about their EMS preparedness level in terms of capability of treating and transporting chemically affected patients in the field. Their capability for decontamination of affected patients in the field was also inquired.

RESULTS

University hospital district-based EMS systems had at least 20% better absolute clinical capacity than central hospital-based EMS systems for treating chemically affected patients concerning all treatments inquired about, except the capacity for non-invasive ventilation (NIV)/continuous positive airway pressure (CPAP) treatment in the field. Overall, there was a good level of preparedness for treating chemical accident patients with supplemental oxygen, bronchodilators, and inhaled corticosteroids. Preparedness for providing antidote therapy in cases of cyanide gas exposure was, in general, low. The variation among the hospital districts was remarkable. Only nine of 15 central hospital district EMS had a mobile decontamination unit available, whereas four of five university hospital districts had one.

CONCLUSION

Emergency Medical Services capacity in Finland for treating chemically affected patients in the field needs to be improved, especially in terms of antidote therapy. Mobile decontamination units should be available in all hospital districts. Jama TJ , Kuisma MJ . Preparedness of Finnish Emergency Medical Services for chemical emergencies. Prehosp Disaster Med. 2016;31(4):392-396.

Triage, monitoring, and treatment of mass casualty events involving chemical, biological, radiological, or nuclear agents

In a mass casualty situation due to chemical, biological, radiological, or nuclear (CBRN) event, triage is absolutely required for categorizing the casualties in accordance with medical care priorities. Dealing with a CBRN event always starts at the local level. Even before the detection and analysis of agents can be undertaken, zoning, triage, decontamination, and treatment should be initiated promptly. While applying the triage system, the available medical resources and maximal utilization of medical assets should be taken into consideration by experienced triage officers who are most familiar with the natural course of the injury presented and have detailed information on medical assets. There are several triage systems that can be applied to CBRN casualties. With no one standardized system globally or nationally available, it is important for deploying a triage and decontamination system which is easy to follow and flexible to the available medical resources, casualty number, and severity of injury.

Targeted agenda program: an innovative approach to facilitate progress in disaster health

The Targeted Agenda Program (TAP) has been introduced for the first time during the 15th World Congress on Disaster and Emergency Medicine (15WCDEM) in Amsterdam in 2007 to stimulate interaction between the participants before, during and after the congress. A TAP process consists of 11 steps, starting with defining a relevant issue and ending with the publication of a TAP report based on expert opinions. Seven TAP groups participated during the 15WCDEM. The TAP issues referred to: (1) the need for health impact assessment of disasters; (2) the golden standard for preparedness for a chemical, biological, radiological and nuclear disasters; (3) the role of acute psychosocial first aid; (4) the 10 most important issues for policymakers to minimize health effects of floods; (5) the search for a golden standard in the treatment of wounded combatants; (6) the preparedness of health organizations for consequences of extreme weather conditions; and (7) the health problems of high-vulnerability groups during disasters. This article describes the motivation and operational aspects of the TAP and advocates that this concept can play an important facilitating role in focus, networking and enhancement of knowledge in the field of disaster health.