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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HOSPITALS , POISONING
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