Chemical incident planning: a review of the literature

Chemical incidents cause problems for Accident and Emergency (A & E) departments which are different from those recognized in other major accidents. As well as possible trauma there is the added problem of contamination. A & E departments must be prepared for chemical disasters with a chemical incident plan, decontamination facilities and protective clothing for all staff involved. The plan should include how to protect the hospital from contamination and how to prevent its personnel from becoming secondary casualties. The results of a survey into the preparedness of inner London A & E departments were published in issue 6.2 of this journal, April 1998. On 20 March, 1995 a religious cult released a nerve gas (sarin) into the Tokyo subway system. More than 5500 people needed hospital treatment and 11 people died (Reuter News Service, 22 March, 1995). The hospitals were overwhelmed with casualties. Once chemical exposure of victims was suspected, clothing was removed and patients were showered. Stretcher patients were decontaminated by means of bed bathing and a change of bedclothes (Okumura et al 1996). Hospital contamination was a problem during this incident due to the delay in recognising chemical exposure. This resulted in staff contamination. Many lessons were learned from this disaster, including the need to be prepared for all eventualities. If a similar incident occurred in the London Underground system, it would be catastrophic. Underground staff, police, fire fighters, ambulance staff and the general public could all be contaminated before the chemical was identified. There could be mass casualties, including personnel in the emergency services. How would London A & E departments cope, faced with a chemical disaster such as this?