Chemical Incident Preparedness Among Emergency Medical Service Personnel A Qualitative Study
Main Article Content
Abstract
Background: Hazardous chemicals are essential for modern society but the use and transportation of them bears the risk of major incidents. Past incidents have revealed the importance of preparation and training of emergency medical service (EMS) personnel when responding to these incidents. However, studies have shown the level of preparedness to be insufficient. There is a lack of knowledge as to how EMS personnel perceive their preparedness and response when facing chemical incidents.
Aim: The aim of this study was to qualitative investigate working procedures regarding chemical incidents among a cohort of EMS personnel.
Method: Seventeen ambulance nurses from rural and urban areas were individually interviewed using four different realistic scenarios (vignettes). The transcribed text from the interviews was analyzed using qualitative content analysis.
Result: The results were derived into two categories with underlying sub-categories: a struggle to organize the onsite work situation (insufficient managerial support, limited resources, trust in rescue services, difficult decision making, stressful responsibilities); and decontamination—a demanding and risky situation (risk management, work in protective gear, aggravating circumstances). Participants often lack real life experience in facing a chemical incident and training that improves preparedness and the ability to respond adequately.
Conclusion: Chemical incidents pose many challenges for EMS personnel, but with proper training efforts many of these challenges could be solved. This study has shown the need for more accessible chemical incident training targeting EMS personnel: especially focusing on risk assessment; managerial support; resource management; equipment; and decontamination, including stress management and decision-making. Research in the area of chemical incidents is sparse and there remains much to understand concerning work procedures during chemical incidents.
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References
Barelli, A., Biondi, I., Soave, M., Tafani, C., & Bononi, F. (2008). The comprehensive medical preparedness in chemical emergencies:‘the chain of chemical survival’. European journal of emergency medicine, 15(2), 110-118. https://doi.org/10.1097/MEJ.0b013e3280bef902
Chilcott, R. P. (2014). Managing mass casualties and decontamination. Environment international, 72, 37-45. https://doi.org/10.1016/j.envint.2014.02.006
Davidsson, M. (2010). Ammonia harmed 16 persons [Downloaded 23-08-22]. https://www.arbetarskydd.se/ammoniak-skadade-16-personer/1549422
Davidson, R. K., Magalini, S., Brattekås, K., Bertrand, C., Brancaleoni, R., Rafalowski, C., & Nakstad, E. R. (2019). Preparedness for chemical crisis situations: experiences from European medical response exercises. https://doi.org/10.26355/eurrev_201902_17017
Eckerman I. Bhopal Gas Catastrophe 1984: Causes and Consequences (2011). In: Nriagu JO, editor. Encyclopedia of Environmental Health. Burlington: Elsevier;. p. 302–16. https://doi.org/10.1016/B978-0-444-52272-6.00359-7
Eiche, C., Birkholz, T., Jobst, E., Gall, C., & Prottengeier, J. (2019). Well-being and PTSD in German emergency medical services–A nationwide cross-sectional survey. PLoS One, 14(7), e0220154. https://doi.org/10.1371/journal.pone.0220154
Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse education today, 24(2), 105-112. https://doi.org/10.1016/j.nedt.2003.10.001
Graneheim, U. H., Lindgren, B. M., & Lundman, B. (2017). Methodological challenges in qualitative content analysis: A discussion paper. Nurse education today, 56, 29-34. https://doi.org/10.1016/j.nedt.2017.06.002
Haslam, J. D., Russell, P., Hill, S., Emmett, S. R., & Blain, P. G. (2022). Chemical, biological, radiological, and nuclear mass casualty medicine: a review of lessons from the Salisbury and Amesbury Novichok nerve agent incidents. British journal of anaesthesia, 128(2), e200-e205. https://doi.org/10.1016/j.bja.2021.10.008
Hruska, B., & Barduhn, M. S. (2021). Dynamic psychosocial risk and protective factors associated with mental health in Emergency Medical Service (EMS) personnel. Journal of affective disorders, 282, 9-17. https://doi.org/10.1016/j.jad.2020.12.130
Ingrassia, P. L., Foletti, M., Djalali, A., Scarone, P., Ragazzoni, L., Della Corte, F., ... & Fisher, P. (2014). Education and training initiatives for crisis management in the European Union: a web-based analysis of available programs. Prehospital and disaster medicine, 29(2), 115-126. https://doi.org/10.1017/S1049023X14000235
International efforts for industrial and chemical accidents prevention, preparedness and response [Downloaded 23-08-22.] https://www.oecd.org/chemicalsafety/chemical-accidents/Brochure%20chemical%20accidents%20prevention,%20preparedness%20and%20response.pdf
Jama, T. J., & Kuisma, M. J. (2016). Preparedness of Finnish emergency medical services for chemical emergencies. Prehospital and disaster medicine, 31(4), 392-396. https://doi.org/10.1017/S1049023X16000546
Jarman, M. P., Hashmi, Z., Zerhouni, Y., Udyavar, R., Newgard, C., Salim, A., & Haider, A. H. (2019). Quantifying geographic barriers to trauma care: Urban-rural variation in prehospital mortality. Journal of trauma and acute care surgery, 87(1), 173-180. https://doi.org/10.1097/TA.0000000000002335
Keeves, J., Ekegren, C. L., Beck, B., & Gabbe, B. J. (2019). The relationship between geographic location and outcomes following injury: A scoping review. Injury, 50(11), 1826-1838. https://doi.org/10.1016/j.injury.2019.07.013
Kenar, L., & Karayilanoglu, T. (2004). Prehospital management and medical intervention after a chemical attack. Emergency medicine journal, 21(1), 84-88. https://doi.org/10.1136/emj.2003.005488
Khajehaminian, M. R., Ardalan, A., Keshtkar, A., Boroujeni, S. M. H., Nejati, A., & Foroushani, A. R. (2018). A systematic literature review of criteria and models for casualty distribution in trauma related mass casualty incidents. Injury, 49(11), 1959-1968 https://doi.org/10.1016/j.injury.2018.09.005
Kirk, M. A., & Deaton, M. L. (2007). Bringing order out of chaos: effective strategies for medical response to mass chemical exposure. Emergency medicine clinics of North America, 25(2), 527-548. https://doi.org/10.1016/j.emc.2007.02.005
Koenig, K. L., & Schultz, C. H. (Eds.). (2010). Koenig and Schultz's disaster medicine: comprehensive principles and practices. Cambridge University Press. https://doi-org.proxy.ub.umu.se/10.1111/acem.13208
Lindgren, B. M., Lundman, B., & Graneheim, U. H. (2020). Abstraction and interpretation during the qualitative content analysis process. International journal of nursing studies, 108, 103632. https://doi.org/10.1016/j.ijnurstu.2020.103632
Liu, J., Xu, N., Shi, Y., Barnett, T., & Jones, S. (2023). Are first responders prepared for electric vehicle fires? A national survey. Accident Analysis & Prevention, 179, 106903. https://doi.org/10.1016/j.aap.2022.106903
Mackway-Jones K. MIMMS—på svenska (In Swedish) (2014) : Major Iincident Medical Management and Support :. Lund: Studentlitteratur. ISBN 9789144088174
Maguire, B. J., Dean, S., Bissell, R. A., Walz, B. J., & Bumbak, A. K. (2007). Epidemic and bioterrorism preparation among emergency medical services systems. Prehospital and disaster medicine, 22(3), 237-242. https://doi.org/10.1017/S1049023X0000474X
McGrath, C., Palmgren, P. J., & Liljedahl, M. (2019). Twelve tips for conducting qualitative research interviews. Medical teacher, 41(9), 1002-1006. https://doi.org/10.1080/0142159X.2018.1497149
Monteith, R. G., & Pearce, L. D. (2015). Self-care decontamination within a chemical exposure mass-casualty incident. Prehospital and disaster medicine, 30(3), 288-296. https://doi.org/10.1017/S1049023X15004677
Phelps, S. (2007). Mission failure: emergency medical services response to chemical, biological, radiological, nuclear, and explosive events. Prehospital and disaster medicine, 22(4), 293-296. https://doi.org/10.1017/S1049023X00004891
Regehr, C., & LeBlanc, V. R. (2017). PTSD, acute stress, performance and decision-making in emergency service workers. J Am Acad Psychiatry Law, 45(2), 184-192. https://jaapl.org/content/45/2/184
Rüter A, Nilsson H, Vikström T (2006). Medical management in the event of an accident and disaster : from the place of injury to the place of care. Lund: Studentlitteratur. ISBN 9789144039053
Schoenberg, N. E., & Ravdal, H. (2000). Using vignettes in awareness and attitudinal research. International journal of social research methodology, 3(1), 63-74. https://doi.org/10.1080/136455700294932
The National Board of Health and Welfare (1996:11) The smoke grenade accident in Uppsala on August 25, 1993, and the Chlorgas accident at the Vanadis bath on August 2, 1993—KAMEDO report no. 65. https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/1996-3-11.pdf
Thermaenius, F., Björnstig, U., Svensson, J., & Westman, A. (2022). Fatalities in Swedish fire-related car crashes from a toxicologic perspective. Traffic injury prevention, 1-5. https://doi.org/10.1080/15389588.2022.2148831
Thompson, J., Rehn, M., Lossius, H. M., & Lockey, D. (2014). Risks to emergency medical responders at terrorist incidents: a narrative review of the medical literature. Critical Care, 18, 1-10. https://doi.org/10.1186/s13054-014-0521-1
Thornton, R., Court, B., Meara, J., Murray, V., Palmer, I., Scott, R., ... & Wright, D. (2004). Chemical, biological, radiological and nuclear terrorism: an introduction for occupational physicians. Occupational medicine, 54(2), 101-109. https://doi.org/10.1093/occmed/kqh025
Westman, A., Saveman, B. I., Björnstig, U., Hylander, J., & Gyllencreutz, L. (2021). Mobilisation of emergency services for chemical incidents in Sweden-a multi-agency focus group study. Scandinavian journal of trauma, resuscitation and emergency medicine, 29(1), 1-8. https://doi.org/10.1186/s13049-021-00910-5
Wiyor, H. D., Coburn, J. C., & Siegel, K. L. (2020). Impact of clinician personal protective equipment on medical device use during public health emergency: A review. Disaster Medicine and Public Health Preparedness, 14(2), 273-283. https://doi.org/10.1017/dmp.2019.52
World Health Organization (2009). Manual for the Public Health Management of chemical incidents. https://www.who.int/publications/i/item/9789241598149
World Health Organization (2017). Hazadous Chemicals—Fact sheets on sustainable development: health targets. https://apps.who.int/iris/handle/10665/340828
World Medical Association. (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Jama, 310(20), 2191-2194. https://doi.org/10.1001/jama.2013.281053