Disaster preparedness of emergency departments in Hong Kong

January 2022 HKJEM Editorial

Emergency departments (EDs) around the world have been responding to the COVID-19 pandemic since it started 2 years ago. The number of cases worldwide is over 243 million worldwide ¹ at the time of writing, and the emergency care system has been key in this fight to protect the health of both individuals and society. ² Here in Hong Kong, the healthcare system responded quickly to the increased threat and EDs have adapted new measures including testing and isolation since the onset of the pandemic. ³ As the pandemic continues, our ability to respond to novel COVID-19 variants and other emergencies will continue to be challenged.

Disaster medicine has long been recognised as an integral component of emergency medicine. ⁴ An extensive review of the disaster preparedness of Hong Kong EDs was conducted in 2015. ⁵ The survey identified gaps in preparedness, despite measures to strengthen our health system against disasters over the past 15 years – including the establishment of emergency command structures, multi-agency planning, drills and training, and information technology advancements. Lam et al. ⁵ recommended competency based training targeting areas of weakness including low probability, high impact disasters such as pandemic infectious disease. In fact, our 2008 survey examining emergency physicians’ preparedness for CBRNE incidents in Hong Kong also found low confidence in managing these incidents and recommended enhanced training. ⁶

Recent developments in Health Emergency and Disaster Risk Management have recommended a risk based, all hazard approach to disaster preparedness, ⁷ and the 2015 survey has found that ED doctors and nurses correctly identified infectious disease outbreaks, typhoons (cyclones), civil unrest and major fires as the most likely hazards over the next 5 years. ⁵ Apart from the direct and indirect impact of COVID-19 pandemic^7,8 we are experiencing, Hong Kong has faced Super Typhoon Mangkhut in 2018, ⁹ the social unrest after the 2019 extradition bill, ¹⁰ and the 2017 subway fire ¹¹ raising concerns around the preparedness of our transportation system. EDs in Hong Kong should develop competency based training that better reflect the risks and the emerging threats that we currently face.

Experience from around the world provides us with important lessons in preparedness. In this issue, studies include the use of a checklist for mass casualty hospital preparedness in road traffic crashes, ¹² factors for patient survival in a dust explosion incident from Taiwan, ¹³ the use of instant messaging technology to improve prehospital triage in high altitude mountain train disasters, ¹⁴ and a scoping review on the prehospital emergency response to terrorist attacks. ¹⁵ There is much for us to learn.

Kevin KC Hung, Emily YY Chan and Colin A GrahamThe Chinese University of Hong Kong, Hong Kong