An assessment of Chemical, Biological, Radiologic, Nuclear, and Explosive preparedness among emergency department healthcare providers in an inner city emergency department

Joseph G. Kotora, DO, MPH

doi:10.5055/jem.2015.0253

Authors

Joseph G. Kotora, DO, MPH

DOI:

https://doi.org/10.5055/jem.2015.0253

Keywords:

disaster management, CBRNE, terrorism, decontamination

Abstract

Introduction: Emergency healthcare providers are required to care for victims of Chemical, Biological, Radiologic, Nuclear, and Explosive (CBRNE) agents. However, US emergency departments are often ill prepared to manage CBRNE casualties. Most providers lack adequate knowledge or experience in the areas of patient decontamination, hospital-specific disaster protocols, interagency familiarization, and available supply of necessary medical equipment and medications. This study evaluated the CBRNE preparedness of physicians, nurses, and midlevel providers in an urban tertiary care emergency department.

Methods: This retrospective observational survey study used a previously constructed questionnaire instrument. A total of 205 e-mail invitations were sent to 191 eligible providers through an online survey distribution tool (Survey Monkey®). Respondents were enrolled from February 1, 2014 to March 15, 2014. Simple frequencies of correct answers were used to determine the level of preparedness of each group. Cronbach’s coefficient á was used to validate the precision of the study instrument. Finally, validity coefficients and analysis of variance ANOVA were used to determine the strength of correlation between demographic variables, as well as the variation between

individual responses.

Results: Fifty-nine providers responded to the questionnaire (31.14 percent response rate). The overall frequency of correct answers was 66.26 percent, indicating a relatively poor level of CBRNE preparedness. The study instrument lacked precision and reliability (coefficient á 0.4050). Significant correlations were found between the frequency of correct answers and the respondents’ gender, practice experience, and previous experience with a CBRNE incident. Significant variance exists between how providers believe casualties should be decontaminated, which drugs should be administered, and the interpretation of facility-specific protocols.

Conclusions: Emergency care providers are inadequately prepared to manage CBRNE incidents. Furthermore, a valid and precise instrument capable of measuring preparedness needs to be developed. Standardized educational curriculums that consider healthcare providers’ genders, occupations, and experience levels may assist in closing the knowledge gaps between providers and reinforce emergency departments’ CBRNE preparedness.

Author Biography

Joseph G. Kotora, DO, MPH

Primary Investigator, Fellow, EMS and Disaster Medicine, Newark Beth Israel Medical Center, Newark, New Jersey

References

Okumura T, Takasu N, Ishimatsu S, et al.: Report on 640 victims of the Tokyo subway sarin attack. Ann Emerg Med. 1996; 28: 129-135.

Okumura T, Hisaoka T, Yamada A, et al.: The Tokyo subway sarin attack—Lessons learned. Toxicol Appl Pharm. 2005; 207: 471-476.

Williams J, Walter D, Challen K: Preparedness of emergency departments in northwest England for managing chemical incidents: A structured interview survey. BMC Emerg Med. 2007; 7: 20.

Mortelmans LJ, Van Boxstael S, De Cauwer HG, et al.: Preparedness of Belgian civil hospitals for chemical, biological, radiation, and nuclear incidents: Are we there yet? Eur J Emerg Med. 2014; 21: 296-300.

Kollek D, Wanger K, Welsford M: Chemical, biological, radiological and nuclear preparedness training for emergency medical services provider. Can J Emerg Med. 2009; 11: 337-342.

Report Card Task Force Members, ACEP Staff: America’s emergency care environment, a state-by-state Report Card: 2014 edition. Ann Emerg Med. 2014; 63: 97-242.

Berger E: Bad report card: Nation’s emergency care environment nears a failing grade. Ann Emerg Med. 2014; 63: 11A-13A.

Bennett RL: Chemical or biological terrorist attacks: An analysis of the preparedness of hospitals for managing victims affected by chemical or biological weapons of mass destruction. Int J Environ Res Public Health. 2006; 3: 67-75.

Higgins W, Wainright C, Lu N, et al.: Assessing hospital preparedness using an instrument based on the Mass Casualty Disaster Plan Checklist: Results of a statewide survey. Am J Infect Control. 2004; 32: 327-332.

Greenberg MI, Jurgens SM, Gracely EJ: Emergency department preparedness for the evaluation and treatment of victims of biological or chemical terrorist attack. J Emerg Med. 2002; 22: 273-278.

Greenberg MI, Hendrickson RG: Report of the CIMERC/Drexel University Emergency Department Terrorism Preparedness Consensus Panel. Acad Emerg Med. 2003; 10: 783-788.

Madsen JM, Greenberg MI: Preparedness for the evaluation and management of mass casualty incidents involving anticholinesterase compounds: A survey of emergency department directors in the 12 largest cities in the United States. Am J Disaster Med. 2010; 5: 333-351.

McInerney JE, Richter A: Strengthening hospital preparedness for chemical, biological, radiological, nuclear, and explosive events: Clinicians’ opinions regarding physician/physician assistant response and training. Am J Disaster Med. 2011; 6: 73-87.

Niska RW, Burt CW: Training for terrorism-related conditions in hospitals: United States, 2003-04. Adv Data. 2006: 1-8.

Roberts JS, Coale JG, Redman RR: A history of the Joint Commission on Accreditation of Hospitals. JAMA. 1987; 258: 936-940.

Adams LM, Canclini SB, Frable PJ: “Skip the infection, get the injection”: A case study IN emergency preparedness education. Nurse Educ Pract. 2015 (in press).

Considine J, Mitchell B: Chemical, biological and radiological incidents: Preparedness and perceptions of emergency nurses. Disasters. 2009; 33: 482-497.

Hsu CE, Mas FS, Jacobson H, et al.: Assessing the readiness and training needs of non-urban physicians in public health emergency and response. Disaster Manag Response. 2005; 3: 106-111.

Ciraulo DL, Frykberg ER, Feliciano DV, et al.: A survey assessment of the level of preparedness for domestic terrorism and mass casualty incidents among Eastern Association for the Surgery of Trauma members. J Trauma. 2004; 56: 1033-1039; discussion 9-41.

Niska RW, Burt CW: Terrorism preparedness: Have office-based physicians been trained? Family Med. 2007; 39: 357-365.

Cannard K: The acute treatment of nerve agent exposure. J Neurol Sci. 2006; 249: 86-94.

Bailey AM, Baker SN, Baum RA, et al.: Being prepared: Emergency treatment following a nerve agent release. Adv Emerg Nurs J. 2014; 36: 22-33; quiz 4-5.

Smith LA: Botulism and vaccines for its prevention. Vaccine. 2009; 27(suppl 4): D33-D39.

Perina DG, Beeson MS, Char DM, et al.: The 2007 Model of the Clinical Practice of Emergency Medicine: The 2009 update 2009 EM Model Review Task Force. Ann Emerg Med. 2011; 57: e1-e15.

Mitchell CS, Doyle ML, Moran JB, et al.: Worker training for new threats: A proposed framework. Am J Ind Med. 2004; 46: 423-431.

Mitchell CJ, Kernohan WG, Higginson R: Are emergency care nurses prepared for chemical, biological, radiological, nuclear or explosive incidents? Int Emerg Nurs. 2012; 20: 151-161.