1. EM Congress Sitges 2003 The preparedness and respons to chemical disasters Two studies of general hospitals in the Netherlands

2. EM Congress Sitges 2003 Dr. Jacquo van Remmen, MD., MSc. l “Rijnstate” Hospital, Arnhem, Department for Emergency Medicine l PhD-programm at the University Hospital Utrecht, Departments for Emergency Medicine and Public Health

3. EM Congress Sitges 2003 Introduction l Prevention l Preparedness l Respons l Restoration

4. EM Congress Sitges 2003 Two studies l Preparedness: l The Hospital Disaster Plan (HDP) l Respons: l The Hospital Treatment Capacity (HTC)

5. EM Congress Sitges 2003 Study # 1. The status of the Hospital Disaster Plan in the Netherlands

6. EM Congress Sitges 2003 The Hospital Disaster Plan l 1987: Line of conduct issued by the government l 1992: Law demands an exercised HDP l 1997: Study inquires the status of the HDP among all general hospitals l 2000: Law demands the appointment of a Disaster Manager in the HDP l 2002: Study similar to the study 1997 and looking into the appointment of a Disaster Manager

7. EM Congress Sitges 2003 Materials and Methods l Similar questionnaire as in 1997 l Send to 110 Boards of Directors

8. EM Congress Sitges 2003 Questionnaire:

9. EM Congress Sitges 2003 Questionnaire: l Most important reason for score less than 5: Financial Time Organizational

10. EM Congress Sitges 2003 Questionnaire: l Is there a Disaster Manager appointed? l If so, does he/she have a medical background (physician or nurse)?

11. EM Congress Sitges 2003 Questionnaire: l Anonymously filled in l Free communication possible

12. EM Congress Sitges 2003 Materials and Methods l Responding hospitals were grouped after: l Number of beds l Province

13. EM Congress Sitges 2003 Materials and Methods l Average score of the status of the HDP: l addition of all scores l dividing the sum by the number of items

14. EM Congress Sitges 2003 Results (R=95%)

15. EM Congress Sitges 2003 Results

16. EM Congress Sitges 2003 According to # beds:

17. EM Congress Sitges 2003 According to province:

18. EM Congress Sitges 2003 Appointment Disaster Manager: (only in 2002)

19. EM Congress Sitges 2003 Discussion l Hospitals could freely score themselves: l These results reflect the hospital’s own opinion their HDP-status.

20. EM Congress Sitges 2003 Discussion l A hospital with a HDP but without regular drills and upgrading (score < 5) is not fully prepared to a disaster.

21. EM Congress Sitges 2003 Conclusion l 2002: 24% is fully prepared l in spite of the appointment of a disaster manager l 1997: 41% was fully prepared

22. EM Congress Sitges 2003 Conclusion 1 out of 4 general hospitals in the Netherlands is fully prepared

23. EM Congress Sitges 2003 Study # 2 The Hospital Treatment Capacity (HTC) for casualties exposed to irritant gasses

24. EM Congress Sitges 2003 Hospital Treatment Capacity (HTC): l The number of victims per hour per 100 beds l that can receive adequate treatment l with sufficient equipment l within an exercised HDP (Score=5)

25. EM Congress Sitges 2003 Irritant gases:

26. EM Congress Sitges 2003 Casualties exposed to irritant gases need: l Decontamination l Airway management l Intensive care bed l Mechanical ventilation

27. EM Congress Sitges 2003 Determination:

28. EM Congress Sitges 2003 Materials and Methods l Questionnaire for 110 hospitals l Table-top exercise for 110 hospitals l Visiting the National IC- internetsite of available ventilation beds during 3 months

29. EM Congress Sitges 2003 Questionnaire:

30. EM Congress Sitges 2003 Table-top exercise:

31. EM Congress Sitges 2003 Internet site: l July-September 2002 l Daily visit l Potential vacant V-beds l Representing 75% of the total V- beds. l Measuring daily respons of the IC’s (R=62%)

32. EM Congress Sitges 2003 Results Questionnaire: (R=95%)

33. EM Congress Sitges 2003 HTC Average Score: Methods + Personnel+ Materials 3,8+3,1+2,2=9,1 9,1/3= 3

34. EM Congress Sitges 2003 Results Decontamination: (R=45%)

35. EM Congress Sitges 2003 Results Decontamination: l Compared with UK-study: Netherlands 95 % unable UK 90 % unable

36. EM Congress Sitges 2003 Results Table-top exercise: (R=70%)

37. EM Congress Sitges 2003 Results Internet-site: (R=62%)

38. EM Congress Sitges 2003 Discussion l HTC average score = 3 l 95% has no complete decontamination equipment l During 24 hrs 1 victim per 300 beds can be treated if HDP = 5 l HTC for casualties exposed to irritant gases = 0,3 %

39. EM Congress Sitges 2003 Discussion l Average stay of IC-patient > 24 hrs l If total IC-beds in the Netherlands is 900 beds: after the first 1h the HTC can be remain 0% for > 24 hrs.

40. EM Congress Sitges 2003 Conclusion l Weakest elements of the HTC for casualties exposed to irritant gases are: Poor preparedness for decontamination Shortage of ventilationbeds

41. EM Congress Sitges 2003 Questions ?

42. EM Congress Sitges 2003 Thank you very much for your attention.