Risk management for antidotes and emergency preparedness

Abstract

Antidote preparedness is a major challenge for both acute individual emergencies and mass casualties. Identification and management of risks is a crucial aspect in the development of risk management strategies to ensure no disruptions in the antidote supply chain. The aims of this study were to review the management of antidote preparedness in Malta and to develop local guidelines on emergency preparedness based on risk management principles. This study was divided into three phases. Phase one assessed local antidote availability and identified risks in emergency preparedness. Risk identification was performed through the performance of (i) vertical audits of eight chosen antidotes at Mater Dei Hospital (MDH), Gozo General Hospital (GGH), and at the Central Procurement and Suppliers Unit (CPSU), (ii) onsite observations at the Emergency Department at MDH, Pharmacy Department at GGH and at CPSU, and (iii) discussions with healthcare professionals in the field. Phase two involved the validation of the identified risks and risk assessment by an expert focus group, in relation to acute cases and mass health threats. Risk matrices were developed to aid in the prioritisation of validated risks. Phase three included the development of guidelines for enhanced local emergency preparedness. Twelve risk themes emerged from the thematic analysis of data collected from the vertical audits, onsite observations, and meetings with healthcare professionals in the field of antidotes. An additional risk was identified through the focus group discussions. All thirteen risk themes were validated by the nine-membered expert focus group. Thirteen risk matrices were developed highlighting the increased severity of identified risks in the event of a mass casualty as compared to an individual acute case. Three risk themes were prioritised by the expert focus group as being of major risks in local emergency preparedness: (1) Problematic sourcing, (2) Inadequate stocking of antidotes, and (3) Lack of a national strategy plan. Guidelines were developed, using flow charts, to address the top three risk themes for the optimisation of local emergency preparedness. Findings from this study indicate inadequate local preparedness for both individual acute poisoning and mass casualty events. This study highlights the need for national healthcare system optimisation to ensure antidote availability and accessibility in a timely manner. Risks associated with availability can be mitigated through the establishment of international cooperation agreements at European and global levels. Risks in antidote and emergency preparedness call for a better coordinated national strategy in the management of emergency preparedness.