• Delphi study
• chemical incidents

For accident and emergency (A&E) departments, many chemical incidents occur each year. However, surveillance suggests that few incidents occur in any one department each year as probably not more than about 10 events are reported for each A&E.¹ The problem of A&E departments failing to manage incidents effectively has been reported.²³ With little routine experience from any hazardous material incident or chemical incident, building the necessary skills to achieve the maximisation of patient care and the minimisation of harm to staff and hospital facilities has been difficult. Therefore, the need to prevent problems arising from a chemical incident, be it accidental or deliberate, for an A&E department has been a major concern.

Much activity has been undertaken in the United Kingdom over the past five years to tackle the issues of effective and safe chemical incident preparedness, response, and recovery for an A&E department.⁴ This work was accelerated by the terrible events in the United States on 11 September 2001, the succeeding concerns about anthrax in envelopes in the United States, white powders in the United Kingdom and elsewhere, and, most recently, the identification of toxic material in envelopes distributed in Belgium in June in 2003. In addition, the reporting of the high level of “terrorist threat” across the world has precipitated anxiety about preparedness for chemical, biological, radiological, and nuclear events for many emergency and healthcare professionals. Guidance on decontamination prepared by the Home Office is helping to take forward joint working and the concept that all agencies are required to save life.⁵

Before this, the work on an accelerated Delphi study into the planning for chemical incidents was undertaken between October 2000 and February 2001 and reported in this journal,⁶⁷ became essential as little evidence based medicine exists in this area. This may in part have been attributable to a paucity of healthcare professionals, such as toxicologists, who have regarded such issues as a priority. Thus this work has provided an elegant platform to develop consensus and agreement on developing the way forward to improved facilities, equipment, and processes. The issues investigated by the study included planning and preparedness, risk assessment, and training. Work was undertaken on the prehospital response covering command and control, scene management and safety, communications, roles, triage, decontamination, treatment, and transport. Within the hospital response, issues such as facilities layout, decontamination and lifesaving first aid, treatment, specialist advice, and transfer were considered. Personal protective clothing and decontamination issues were reviewed.

What is the outcome of this work? This study, along with other work, has helped to develop the current equipment now in use at all acute hospital and ambulance trusts in the United Kingdom. It has lead to the development of training programmes such as the structured approach to chemical casualties.⁸

Most significantly, the outcome of this and much else has been the development, on 1 April 2003, of the Health Protection Agency.⁹ This public health lead agency with the National Radiological Protection Board has six divisions and its functions¹⁰ are:

• to advise government on public health protection policies and programmes.

• to deliver services and to support the NHS and other agencies in protecting people from infections, poisons, chemical, and radiation hazards.

• to provide an impartial and authoritative source of information and advice to professionals and the public.

• to respond to new threats to public health and to provide a rapid response to health protection emergencies.

• to improve knowledge about health protection through research and development, education and training.

The future for improved response in collaboration with A&E departments is therefore brighter and continuing work with the Health Protection Agency and the Department of Health will take this process forward.