Chemical incidents - overview
Chemical incidents range from single‑patient workplace or household exposures to industrial fires, transport accidents, terrorist releases and chemical warfare.
Emergency departments must be prepared to receive contaminated or symptomatic patients, provide secondary‑care decontamination, recognise toxidromes and deliver immediate life‑saving care and antidotes where indicated.
The following presents a practical, exam‑relevant ED approach based on UK CBRN / UKHSA guidance and ED practice recommendations (UKHSA CBRN handbook; RCEM; Resuscitation Council UK).
Who will attend and who leads
- Expect symptomatic or contaminated casualties to self‑present to EDs.
- Secondary‑care decontamination is an NHS responsibility unless a large mass‑casualty decontamination is being run at scene; Fire & Rescue and ambulance services usually lead scene mass decontamination (UKHSA; gov.uk).
- Notify your hospital incident command, local toxicology/NPIS advice line and UKHSA/public‑health early.
Core hospital priorities
1. Keep staff safe by using appropriate PPE, restricting access and isolating suspected contaminated patients. 2. Triage and provide immediate life‑saving interventions; do not let decontamination delay resuscitation. 3. Contain spread within the ED by using designated areas and limiting patient movement. 4.
Disrobe and remove gross contamination, then perform secondary‑care decontamination if required. 5. Recognise toxidromes and give supportive or antidotal therapy. 6. Coordinate waste handling, environmental notifications and multi‑agency liaison. 7. Restore services safely and record exposures for follow‑up.