title: Preparedness of Finnish Emergency Medical Services for Chemical Emergencies.
abstract: Introduction The preparedness level of Finnish Emergency Medical Services (EMS) for treating chemical emergencies is unknown. The aim of this study was to survey the preparedness level of EMS systems for managing and handling mass-casualty chemical incidents in the prehospital phase in Finland. Hypothesis The study hypothesis was that university hospital districts would have better clinical capability to treat patients than would central hospital districts in terms of the number of patients treated in the field within one hour after dispatching as well as patients transported to hospital within one hour or two hours after dispatching.
  
  
  METHODS
  This cross-sectional study was conducted as a Webropol (Wuppertal, Germany) survey. All hospital districts (n=20) in continental Finland were asked about their EMS preparedness level in terms of capability of treating and transporting chemically affected patients in the field. Their capability for decontamination of affected patients in the field was also inquired.
  
  
  RESULTS
  University hospital district-based EMS systems had at least 20% better absolute clinical capacity than central hospital-based EMS systems for treating chemically affected patients concerning all treatments inquired about, except the capacity for non-invasive ventilation (NIV)/continuous positive airway pressure (CPAP) treatment in the field. Overall, there was a good level of preparedness for treating chemical accident patients with supplemental oxygen, bronchodilators, and inhaled corticosteroids. Preparedness for providing antidote therapy in cases of cyanide gas exposure was, in general, low. The variation among the hospital districts was remarkable. Only nine of 15 central hospital district EMS had a mobile decontamination unit available, whereas four of five university hospital districts had one.
  
  
  CONCLUSIONS
  Emergency Medical Services capacity in Finland for treating chemically affected patients in the field needs to be improved, especially in terms of antidote therapy. Mobile decontamination units should be available in all hospital districts. Jama TJ , Kuisma MJ . Preparedness of Finnish Emergency Medical Services for chemical emergencies. Prehosp Disaster Med. 2016;31(4):392-396.
authors.affiliation: 1Centre for Prehospital Care and Emergency Medicine,Päijät-Häme Social and Healthcare Group,Lahti,Finland.
authors.forename: Timo J
authors.initials: TJ
authors.lastname: Jama
authors.affiliation: 2Emergency Medical Services,Department of Emergency Medicine,Helsinki University Hospital,Finland.
authors.forename: Markku J
authors.initials: MJ
authors.lastname: Kuisma
mesh_terms: D055884:Chemical Hazard Release; D002959:Civil Defense / Q000458:organization & administration / Q000592:standards*; D003430:Cross-Sectional Studies; D003666:Decontamination / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D004189:Disaster Planning / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D004632:Emergency Medical Services / Q000458:organization & administration / Q000592:standards*; D005387:Finland; D019538:Health Care Surveys; D006801:Humans; D054527:Mass Casualty Incidents; D020380:Needs Assessment; D000078329:Workforce
keywords: CBRN; CBRN chemical; CPAP continuous positive airway pressure; EMS; EMS Emergency Medical Services; HUS University Hospital District of Helsinki and Uusimaa; IV intravenous; NIV non-invasive ventilation; biological; chemical incidents; decontamination; nuclear; preparedness; radiological