Ranse J. (2021). The impact of Chemical, Biological, Radiological, Nuclear and Explosive events on Emergency Departments: An integrative review; invited speaker for Qatar Health 2021, Doha, Qatar, 22nd January. [online]

1. Dr Jamie Ranse, RN PhD
Senior Research Fellow, Emergency Care | Menzies Health Institute Queensland, Griffith University
Founder, Mass Gathering Collaboration | Griffith University, Queensland
Visiting Research Fellow | Department of Emergency Medicine, Gold Coast Health
The Impact of Chemical, Biological, Radiological, and Nuclear events on
Emergency Departments: An integrative review

2. Jamie Ranse1,2; Benjamin Mackie3; David Heslop5; Jane Currie6;
Bridget Wilson2; Julia Crilly1,2; Marion Mitchell1,7; Sarah Weber4;
Nathan Watkins2; Joseph Sharpe8; Michael Handy9; Karen Hammad1
1. Menzies Health Institute Queensland, Griffith University, Queensland, Australia
2. Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
3. School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Queensland, Australia
4. Emergency Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
5. School of Population Health, University of New South Wales, Sydney, Australia
6. School of Nursing, Queensland University of Technology, Queensland, Australia
7. Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
8. Trauma Service, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
9. Townsville Trauma Service, Townsville Hospital and Health Service, Townsville, Queensland, Australia
RESEARCH TEAM

3. • Disasters occur globally
• Chemical, Biological, Radiological and Nuclear [CBRN] events
• Preparedness
• Education
• Resources
• Willingness
• Intersect with mass gathering events
INTRODUCTION

4. • What impact do CBRN events have on emergency departments?
QUESTION
• To identify papers relating to the impact of CBRN events on
Emergency Departments.
• To analyze these papers for lessons learnt to strengthen
emergency department preparedness.
AIMS

5. Design
• This systematic literature review was guided by the Preferred
Reporting Items of Systematic reviews and Meta-Analysis
(PRISMA) Guidelines.
Data Collection
• Healthcare databases
• Different combinations of Medical Subject Headings (MeSH) terms
and keywords
METHOD

6. Data Collection (cont.)
METHOD

7. Data Collection (cont.)
METHOD

8. Data Analysis
• Study characteristics, CBRN characteristics, and population
affected
METHOD

9. Data Analysis
• Patient presentation characteristics, Emergency Department
characteristics, resources used, outcomes
METHOD

10. Data Analysis
• Lessons learnt (thematic analysis)
METHOD

11. Included papers
RESULTS

12. Study characteristics, CBRN characteristics, and
population affected
• Most CBRN events published occurred in the United States of
America (n=22/44, 50%), followed by Turkey (n=4/44, 9.1%)
• Most of the events were chemical (n=36/44, 81.9%)
• Chlorine (n=9/36, 25%)
RESULTS

13. Patient presentation characteristics, Emergency
Department characteristics, resources used, outcomes
• The included papers reported between 1 and 5,500 people [M=54,
IQR: 22-253] people presented to EDs as a result of CBRN events
• Often to multiple EDs
• Imaging and pathology frequently used
• Decontamination often in the ED carpark
• Patient length of stay in the ED was inconsistently reported
• Most people discharged from the ED and not admitted to hospital
RESULTS

14. Lessons learnt
• Plans (early activation, how does decontamination work?)
• Incident command (move away from the ED)
• Communication (early miscommunication, back-ups needed)
• Personnel (field triage, separate decontamination team,
spontaneous volunteers)
• Resources (shortage of beds, oxygen)
RESULTS

15. • Contextualize to local environment, hazards and risks
• Testing of plans, multidisciplinary and multiagency
• Resources:
• Physical – specialist equipment
• Human – other / non-ED staff
• Discharge processes from the ED
• Enhance willingness
DISCUSSION