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.