PREPAREDNESS OF HOSPITALS EMERGENCY DEPARTMENTS IN MALAYSIA FOR MANAGING ACUTE POISONING CASES
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Date
2010-03
Authors
AL SOHAIM, SULAIMAN IBRAHIM ALI
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Abstract
This study was undertaken to examine the level of preparedness of accident
and emergency departments across all regions in Malaysia with respect to poisoning
investigational and management facilities, availability and use of treatment
guidelines and other toxicological sources, training of staff and the extent by which
essential treatment facilities outside the accident and emergency department are
made accessible.
A self-administered semi-structured questionnaire was validated and sent to
all government accident and emergency departments in Malaysia and university
hospitals. to comprise of 4 main sections; (a) epidemiology data, (b) availability of
diagnostic and monitoring equipments, (c) treatment facilities available at the
accident and emergency department and (d) toxicological information and training of
staff. Collected data was analysed in SPSS version 16 using descriptive and
comparative analyses.
Seventy-seven accident and emergency departments of government hospitals
answered and completed the questionnaire (response rate 60.15%). Of those, seventy
six accident and emergency departments were included in the analysis. This study
found that paracetamol was the most common toxic agents reported; followed by
snake bite, beelhornet sting, and Clorox. Beside these, organophosphate, paraquat
and kerosene were also frequently reported.
Basic facilities required for poisoning identification and treatment were
available in accident and emergency departments of most hospitals including district
hospitals. This include,'stabilization facilities (with some exceptions); gastric lavage
and activated charcoal; monitoring facilities such as X-ray, ECG, pulse oximeter, and
ultrasound; laboratory investigations such as blood glucose, electrolytes, full blood
count (FBC), blood urea nitrogen, blood clotting, leukocyte count, liver function test,
renal function test, and urine full examination; and most of the essential drugs and
many of the antidotes.
When there were significant differences between hospitals, accident and
emergency departments of general hospitals were the best followed by accident and
emergency departments of district hospitals with specialists. This difference include
the average number of beds and ambulances; the availability of special services;
haemodialysis and peritoneal dialysis; breathing support facilities like mechanical
ventilators; !aboratof'j investigations such as acid-base balance, methaemoglobin, '
carboxyhaemoglobin, cholinesterase activity, and plasma osmolality; the antidotes
such as pralidoxime, N-acetyicysteine, deferoxamine and flumazenil; and
toxicology-related training
Generally, less than 50% of the hospitals conduct training both in terms of the
types of training provided and in terms of the proportion of staff trained. However,
the majority of the accident and emergency departments have plans for training.
Textbooks followed consultations with colleagues were the most important sources
of information on poisoning management used by the staff. The poison center came
at third place used by about two thirds of hospitals. Our data showed that more than
half of accident and emergency departments throughout Malaysia were using
treatment protocols.
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Keywords
HOSPITALS , POISONING