Availability of treatment resources for the management of acute toxic exposures and poisonings in emergency departments among various types of hospitals in Palestine: a cross-sectional study

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Availability of treatment resources for the management of acute toxic exposures and poisonings in emergency departments among various types of hospitals in Palestine: a cross-sectional study Sa'ed H Zyoud 0 1 2 Samah W Al-Jabi 4 Yara I Bali 3 Afnan M Al-Sayed 3 Waleed M Sweileh 0 Rahmat Awang 2 0 Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University , Nablus, Palestine 1 Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University , Nablus, Palestine 2 WHO Collaborating Centre for Drug Information, National Poison Centre , Universiti Sains Malaysia (USM), Penang , Malaysia 3 PharmD Program, College of Medicine and Health Sciences, An-Najah National University , Nablus, Palestine 4 Department of Clinical and Comunity Pharmacy, College of Medicine and Health Sciences, An-Najah National University , Nablus, Palestine Background: Poisoning exposures continue to be a significant cause of morbidity and mortality worldwide. The lack of facilities, treatment resources, and antidotes in hospitals may affect the treatments provided and outcomes. This study aimed to determine the availability of gastrointestinal (GI) decontamination, stabilisation, elimination enhancement resources, and antidotes for the management of acute toxic exposures and poisonings in emergency departments (EDs) among various types of governmental and private hospitals in Palestine. Methods: A cross-sectional study using semi-structured questionnaire was performed. Data were collected based on hospital resources; GI decontamination, stabilisation, elimination enhancement resources and antidotes from Palestinian hospitals. Results: Eighteen hospitals (94.7%) have responded. Among them, paracetamol poisoning was the most frequently reported cases by EDs (mean frequency score = 7.6 2.1), followed by bee stings (mean = 6.9 2.7) and organophosphate poisoning (mean = 6.7 2.7). The availabilities of most resources related to GI decontamination items varied substantially with hospital type, but these differences were not statistical significant. The availability of stabilisation resources was not significantly different between hospitals types. For the availability of techniques used to enhance the elimination of toxic substances, there were variations between the hospitals types. However, these differences were not statistical significant, except for haemodialysis (p = 0.003) which was more available in governmental hospitals. For the availability of antidotes, none of the hospitals had sufficient stock of all antidotes listed. In relation to hospital type, there was variability in the availability of antidotes, but this did not reach statistical significance, except for deferoxamine (p < 0.001), which was available in all governmental hospitals but none of the private hospitals. Conclusions: The availability of treatment resources and antidotes in Palestinian hospitals was not adequate except for stabilisation resources. The availability of such resources acts as a marker for the level of readiness of hospital EDs in Palestine for the management of acute toxic exposure and poisoning. The implementation of a minimum list of antidotes and treatment resources would be useful to increase the level of resources. Coordination between Palestinian poison control and drug information centre and hospitals is also important. Availability; Treatment resources; Emergency departments; Poisoning; Hospitals; Palestine - Introduction With the availability of a vast number of chemicals and drugs, acute poisoning is a medical emergency [1,2] and is considered one of the most common reasons for visiting emergency departments (EDs). Poisoning exposures continue to be a significant cause of morbidity and mortality worldwide [3]. The National Vital Statistics Reports showed that poisoning was the fifth leading cause of injury and death in the United States of America in 2010 [4], while the exact incidence of this problem in Palestine remains uncertain and information available is limited due to under-diagnosis and underreporting. The growing incidence of poisoning has highlighted the importance for countries to have special programs for poison control and, in particular, the facilities for diagnosis, treatment, and prevention of poisoning [5]. If a poisoning is recognised early and appropriate supportive care is initiated rapidly, the majority of patient outcomes will be good [6]. An example of this is the treatment of patients diagnosed with paracetamol poisoning with N-acetylcysteine within 8 hours [7]. In addition, the treatment of poisoning cases in the ED begins with stabilising the patient and assessing the vital signs, starting with ABC (airway, breathing and circulation), which is sometimes followed by gastrointestinal (GI) decontamination or the immediate use of an antidote [6,8]. Supportive measures include the use of commonly stocked medicines such as adrenaline and sodium bicarbonate [9]. Furthermore, since the timely use of antidotes prevents death and shortens the length of hospitalisation, as well as reducing the patients pain and suffering, maintaining a sufficient stock of antidotes is the responsibility of any hospital that provides emergency health care [10]. If a poisoned patient needs a certain antidote that is not available in a particular hospital, then the treatment options include supportive measures, borrowing antidotes from another hospital or transferring the patient to the other hospital [9]. To the best of our knowledge, there is a worldwide lack of studies evaluating the preparedness and the availability of the necessary resources to treat poisoning cases. Published research in this area has concentrated mainly on the investigation of antidote availability and preparedness for disaster management. Over the past years, several studies have shown that the unavailability of antidotes is common in health care facilities and sufficient stocking of antidotes remains a problem worldwide [9,11-19]. Also, there are no studies to date that have addressed the level of preparedness of hospital EDs in Palestine for the management of acute toxic exposure and poisonings. Furthermore, only one attempt has been made to identify the availability of antidotes in one district in Palestine [20]. Since poisoning remains a serious problem in Palestine [3,21], and since various facilities are frequently not available, we initiated a countrywide survey to describe the availability of current facilities and the anticipated requirements in Palestine. The purpose of this study was to determine the availability of treatment resources for the management of acute toxic exposures and poisonings in EDs among various types of hospitals in Palestine, and to compare the availability of such facilities among various types of hospitals. Palest (...truncated)