Gaps in Prehospital Care for Patients Exposed to a Chemical Attack - A Systematic Review

Stephane Bourassa; Emmanuelle Paquette-Raynard; Daniel Noebert; Marc Dauphin; Pelumi Samuel Akinola; Jason Marseilles; Philippe Jouvet; Jacinthe Leclerc

doi:10.1017/S1049023X22000401

Gaps in Prehospital Care for Patients Exposed to a Chemical Attack - A Systematic Review

Prehosp Disaster Med. 2022 Mar 11;37(2):1-10. doi: 10.1017/S1049023X22000401. Online ahead of print.

Authors

Stephane Bourassa^{1

2

3

4}, Emmanuelle Paquette-Raynard⁵, Daniel Noebert⁴, Marc Dauphin^{4

6}, Pelumi Samuel Akinola^{7

8}, Jason Marseilles⁷, Philippe Jouvet^{1

2}, Jacinthe Leclerc^{6

7

9}

Affiliations

¹ Sainte-Justine University Hospital Research Center, Montreal University, Montreal, Quebec, Canada.
² Faculty of Medicine, Montreal University, Montreal, Quebec, Canada.
³ Retired - Canadian Armed Forces Intelligence Service.
⁴ Medical Intelligence CBRNE Inc., Quebec City, Quebec, Canada.
⁵ Library Services, Laval University, Quebec City, Quebec, Canada.
⁶ Retired - Royal Canadian Medical Service.
⁷ Department of Nursing, University of Quebec at Trois-Rivières, Trois-Rivières, Quebec, Canada.
⁸ Department of Nursing, Faculty of Health Sciences, University of Pecs, Pecs, Hungary.
⁹ Research Center, Quebec Heart and Lung Institute - Laval University, Quebec City, Quebec, Canada.

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). The outcomes were patient's health condition leading to his/her stabilization (primary) and death (secondary) due to interventions applied (medical, protection, and decontamination).

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.

Keywords: acute settings; biological; chemical; chemical attack; decontamination; explosive (CBRNE); nuclear; prehospital settings; protection; radiological; respiratory insults; treatment.

Publication types

Review