Published in: Prehospital and Disaster Medicine, 37(2), 230–239. Cambridge University Press.
DOI: 10.1017/s1049023x22000401
Full text: Cambridge Core
Open Access: CC BY 4.0
Abstract
Introduction: The survivability of mass casualties exposed to a chemical attack is dependent on clinical knowledge, evidence-based practice, as well as protection and decontamination capabilities. The aim of this systematic review was to identify the knowledge gaps that relate to an efficient extraction and care of mass casualties caused by exposure to chemicals.
Methods: This systematic review was conducted from November 2018 through September 2020 in compliance with Cochrane guidelines. Five databases were used (MEDLINE, Web of Science Core Collection, Embase, Cochrane, and CINAHL) to retrieve studies describing interventions performed to treat victims of chemical attacks (protection, decontamination, and treatment).
Results: Of the 2,301 papers found through the search strategy, only four publications met the eligibility criteria. According to these studies, the confirmed chemical poisoning cases in acute settings resulting from the attacks in Matsumoto (1994), Tokyo (1995), and Damascus (2014) accounted for 1,333 casualties including 11 deaths. No study reported comprehensive prehospital clinical data in acute settings. No mention was made of the integration of specialized capabilities in medical interventions such as personal protective equipment (PPE) and decontamination to prevent a secondary exposure. Unfortunately, it was not possible to perform the planned meta-analysis.
Conclusions: This study demonstrated gaps in clinical knowledge application regarding the medical extraction of casualties exposed during a chemical attack. Further research is required to optimize clinical practice integrating mixed capabilities (protection and decontamination) for the patient and medical staff.
Key Findings
- Of 2,301 papers screened, only 4 met eligibility criteria
- 1,333 casualties and 11 deaths documented across the Matsumoto, Tokyo, and Damascus chemical attacks
- No comprehensive prehospital clinical data were found in any study
- No documentation of integrated PPE and decontamination during medical interventions
- Secondary exposures of health care professionals occurred due to lack of protection
- No study used a dedicated medical algorithm for chemical attack response
Citation (APA)
Bourassa, S., Paquette-Raynard, E., Noebert, D., Dauphin, M., Akinola, P. S., Marseilles, J., … Leclerc, J. (2022). Gaps in prehospital care for patients exposed to a chemical attack – A systematic review. Prehospital and Disaster Medicine, 37(2), 230–239. https://doi.org/10.1017/s1049023x22000401