Emergency Medicine

MAJOR INCIDENT

462 Administrative and Legal Issues

(c) symptoms include watering eyes, blepharospasm, skin

erythema, dyspnoea, cough and wheeze, with pneumonitis

and non-cardiogenic pulmonary oedema

(d) death may follow high concentrations with mass

displacement of air/oxygen

(e) treatment includes decontamination and supportive care

with inhaled bronchodilators and steroids, and if required,

mechanical ventilation until resolution of the acute lung injury.

Biological incident

Biological incidents take two distinct forms: natural phenomena such as an inf lu-

enza pandemic or dengue epidemic, and deliberate release or a ‘white powder’- type

incident.

1 Naturally occurring incidents are managed in accordance with current

infectious disease isolation and treatment procedures.

2 A range of biological pathogens could potentially be used in a deliberate

release incident. These include:

(i) Bacteria such as the plague, viruses such as smallpox, spores such

as anthrax, fungi such as Fusarium or toxins such as ricin

(a) some have also been genetically engineered to produce

resistance to usual recognized treatments.

3 As effects from contamination with a biological agent may take days or even

weeks to manifest, a major challenge in any deliberate release incident is to

recognize it and to initiate the appropriate systems response.

(i) ED staff must be alert to an unusual pattern of infectious disease

and should liaise closely with infectious disease and population

health specialists.

(ii) Patterns that may indicate possible deliberate release include:

(a) unusual illness, e.g. sudden unexplained febrile death, critical

illness or pneumonia death in a previously healthy young

adult

(b) unexpected number of patients with the same symptoms

(c) unusual illness for that time of year, e.g. influenza in summer

(d) unusual illness for the patient’s age group, e.g. chickenpox in

a middle-aged adult

(e) illness in an uncommon patient category, e.g. cutaneous

anthrax in a patient with no history of contact with animals,

animal hides or products

(f) illness acquired in a non-endemic area

(g) unusual clinical signs, e.g. mediastinal widening on chest

radiograph (CXR), sudden onset of symmetrical flaccid

paralysis

(h) atypical progression of an illness, e.g. lack of response to

usually effective antibiotics.