Roman hospital management of a potential CBRNE event

Background: Rome hosts 6 advanced Emergency Departments (EDs) and 7 basic ones are the first line of defense of the city, and should provide healthcare assistance in case of maxi-emergencies. Rome hosts 5 warehouses of National Stockpile Antidotes (SNA), in case of a CBRN event, stockpiles are activated with a long-time call to be charged and delivered through specific trucks. Methods: The present study analyzes the PEIMAFs (State of emergency plans for massive influx of injures) of advanced EDs in Rome and their adequacy in case of a CBRNe attack. We hypothesized a chemical attack at Saint Peter’s Square during the General Assembly, on Wednesday (at 12.00).Subsequently, with a table-top simulation we evaluated the efficacy and the effectiveness of the SNA, and the travel times between the SNA warehouse and EDs. Findings: Being EDs chronically undermanned during the ordinary working conditions there will be serious issues in suddenly hosting a very large number of critical patients. In addition not all the hospitals inform their workers about PEIMAF or consider CBRNe emergencies in their PEIMAF, and simulations are not always performed. Moreover, the communication between the different institution involved is not optimal, presenting a major risk of contamination in case of CBRNe attacks. Conclusions: Our data highlight that despite an overall good organization there is room of improvement in shorting the times of travelling. In addition we believe is mandatory to develop in all the major roman hospitals the PEIMAF, which should be followed strictly by an organized training plan involving both theorical teaching, indoor and outdoor simulation, in order to train the hospital personnel and to evaluate weaknesses and vulnerabilities of the single PEIMAFs. Concluding, a smart call system can reduce the activation time of SNA, as well as well a better organization between the major hospitals in Rome, which can help reducing delivering time.