Hospital disaster preparedness in Los Angeles County

Hospital preparedness assessment for road traffic accidents with mass casualties: a cross-sectional study in Kurdistan Province, Iran

BACKGROUND

Road traffic accidents (RTAs) are predicted to become the world's seventh leading cause of death by 2030. Given the significant impact of RTAs on public health, effective hospital preparedness plays a pivotal role in managing and mitigating associated health and life-threatening issues. This study aims to meticulously evaluate the preparedness of selected hospitals in western Iran to handle road traffic accidents with mass casualties (RTAs-MC).

METHODS

The study employed a descriptive-analytical approach, utilizing a reliable and valid questionnaire to measure hospitals' preparedness levels. Descriptive statistics (frequency distribution and mean) were utilized to provide an overview of the data, followed by analytical statistics (Spearman correlation test) to examine the relationship between hospital preparedness and its dimensions with the hospital profile. Data analysis, performed using SPSS software, categorized preparedness levels as weak, moderate, or high.

RESULTS

The study found that hospitals in Kurdistan province had a favorable preparedness level (70.30) to respond to RTAs-MC. The cooperation and coordination domain had the highest preparedness level (98.75), while the human resource management (59.44) and training and exercise (54.00) domains had the lowest preparedness levels. The analysis revealed a significant relationship between hospital preparedness and hospital profile, including factors such as hospital specialty, number of beds, ambulances, staff, and specialized personnel, such as emergency medicine specialists.

CONCLUSION

Enhancing preparedness for RTAs-MC necessitates developing response plans to improve hospital profile, considering the region's geographic and topographic features, utilizing past experiences and lessons learned, implementing of Hospital Incident Command System (HICS), providing medical infrastructure and equipment, establishing communication channels, promoting cooperation and coordination, and creating training and exercise programs.

Exploring hospitals' functional preparedness effective factors in response to disasters: a qualitative study in a lower middle-income country

BACKGROUND

Medical services are among the most urgent needs of the disaster-affected population. Consequently, hospital preparedness -as the main health services provider- is one of the vital factors in effective response to disasters. The present study aims to explore the perspectives of study participants about the influential factors of hospital functional preparedness in a lower middle-income country.

METHODS

In this qualitative study, data were collected through 17 semi-structured interviews with disaster management authorities selected by purposive sampling. Content-Analysis was used to analyze the data.

RESULTS

138 codes were developed and categorized into ten categories and 34 subcategories. The main categories were: 1- leadership, command, and coordination (4 subcategories); 2- risk assessment (3 subcategories); 3- legislating and developing protocols, guidelines, and programs (3 subcategories); 4- estimating and storing the necessary supplies and equipment (3 subcategories); 5- human resource management (4 subcategories); 6- education, training, and development of staff (6 subcategories); 7- vital routes and facilities (3 subcategories); 8- communication (3 subcategories); 9- security, safety and locating of safe zones (3 subcategories); 10- underlying disaster risk factors (2 subcategories).

CONCLUSION

According to the participants of this study, ten categories of factors can affect hospitals' functional preparedness; hospital managers and decision-makers can consider these factors to ensure the proper provision of medical services during disasters.

The Impact of Exposure to Previous Disasters on Hospital Disaster Surge Capacity Preparedness in Finland: Hospital disaster surge capacity preparedness

OBJECTIVE

As disasters are rare and high-impact events, it is important that the learnings from disasters are maximized. The aim of this study was to explore the effect of exposure to a past disaster or mass casualty incident (MCI) on local hospital surge capacity planning.

METHODS

The current hospital preparedness plans of hospitals receiving surgical emergency patients in Finland were collected (n = 28) and analyzed using the World Health Organization (WHO) hospital emergency checklist tool. The surge capacity score was compared between the hospitals that had been exposed to a disaster or MCI with those who had not.

RESULTS

The overall median score of all key components on the WHO checklist was 76% (range 24%). The median surge capacity score was 65% (range 39%). There was no statistical difference between the surge capacity score of the hospitals with history of a disaster or MCI compared to those without (65% for both, P = 0.735).

CONCLUSION

Exposure to a past disaster or MCI did not appear to be associated with an increased local hospital disaster surge capacity score. The study suggests that disaster planning should include structured post-action processes for enabling meaningful improvement after an experienced disaster or MCI.

Hospital disaster preparedness in sub-Saharan Africa: a systematic review of English literature

BACKGROUND

Disasters are increasing worldwide, with Sub-Saharan Africa (SSA) being one of the most prone regions. Hospitals play a key role in disasters. This study provides a systematic review of the evidence on disaster preparedness by hospitals in SSA countries based on English literature.

METHODS

A systematic literature review was conducted of articles published between January 2012 and July 2022. We searched PubMed, Elsevier, Science Direct, Google Scholar, the WHO depository library and CDC sites for English language publications. The key inclusion criteria were: publications should have been published in the above period, deal with hospital disaster preparedness in SSA, the full paper should have been available, and studies should have presented a comparison between hospitals and/or a single hospital.

RESULTS

Results indicate improvements in disaster preparedness over time. However, health systems in SSA are generally considered vulnerable, and they find it difficult to adapt to changing health conditions. Inadequately skilled healthcare professionals, underfunding, poor knowledge, the absence of governance and leadership, lack of transparency and bureaucracy are the main preparedness barriers. Some countries are in an infancy stage of their health system development, while others are among the least developed health system in the world. Finally, a major barrier to disaster preparedness in SSA countries is the inability to collaborate in disaster response.

CONCLUSIONS

Hospital disaster preparedness is vulnerable in SSA countries. Thus, improvement of hospital disaster preparedness is highly needed.

Comparison of the Level of Disaster Preparedness Between Private and Government Hospitals in Saudi Arabia: A Cross-Sectional Study

OBJECTIVE

The objective of this study was to describe and compare almost all the components of disaster preparedness between private and government hospitals in the Eastern Province of the Kingdom of Saudi Arabia, using the World Health Organization's (WHO) checklist.

METHODS

We assessed and compared the disaster preparedness between government and private hospitals in Province, using the 10-key component WHO checklist in a descriptive cross-sectional study. Of 72 hospitals in the region, 63 responded to the survey.

RESULTS

All 63 hospitals had an HDP plan and reported having a multidisciplinary HDP committee. In all responding hospitals, HDP was acceptable in most indicators of preparedness; however, some hospitals to some extent fell short of preparedness in surge capacity, equipment and logistic services, and post-disaster recovery. Government and private hospitals were generally comparable in disaster preparedness. However, government hospitals were more likely to have HDP plans that cover WHO's "all-hazard" approach, both internal and external disasters, compared to private hospitals.

CONCLUSION

HDP was acceptable, however, preparedness in surge capacity, equipment and logistic services, and post-disaster recovery fell short. Government and private hospitals were comparable in preparedness with regards to all indicators except surge capacity, post-disaster recovery, and availability of some equipment.

Factors Influencing Hospitals' Disaster Preparedness in the Eastern Province of Saudi Arabia

OBJECTIVE

The study aimed to identify the factors that influence the disaster preparedness of hospitals and validate an evaluation framework to assess hospital disaster preparedness (HDP) capability in the Eastern Province of Saudi Arabia.

METHODS

A cross-sectional survey of all hospitals (n = 72) in the Eastern Region of Saudi Arabia was conducted. A factor analysis method was used to identify common factors and validate the evaluation framework to assess HDP capacity.

RESULTS

Sixty-three (63) hospitals responded to the survey. A 3-factor structure was identified as key predicators of HDP capacity. The first factor was the most highly weighted factor, which included education and training (0.849), monitoring and assessing HDP (0.723), disaster planning (0.721), and command and control (0.713). The second factor included surge capacity (0.708), triage system (0.844), post-disaster recovery (0.809), and communication (0.678). The third factor represented safety and security (0.638) as well as logistics, equipment, and supplies (0.766).

CONCLUSION

The identified 3-factor structure provides an innovative approach to assist the operationalization of the concept of HDP capacity building and service improvement, as well as serve as a groundwork to further develop instrument for assessing HDP in future studies.

[Hospital disaster planning in south-western Germany. A survey of 214 clinics]

Background

Due to legal regulations in Germany, public acute and emergency (A&E) hospitals-along with responsible authorities, emergency medical services, and other institutions such as the state medical associations-are committed to participate in civil protection. This participation includes the need to create and update emergency plans for external and internal crises and to take part in disaster drills. In fact, so far there is only little literature to prove whether and to what extent hospitals fulfill their obligations on this topic.

Objectives

Using a standardized survey, the state of emergency planning in hospitals in Baden-Wuerttemberg was evaluated.

Materials and methods

Based on a listing provided by the Hospital Society of Baden-Wuerttemberg (BWKG), all 214 hospitals in Baden-Wuerttemberg were identified. The standardized questionnaire inquired about specific characteristics of the emergency plan, the availability and knowledge of this plan by the hospital workforce and other local institutions that take part in civil protection and, finally, participation in disaster drills were queried.

Results

Of the 214 hospitals in Baden-Wuerttemberg, 135 (63%) provided information using the questionnaire. Except for one hospital, all other clinics indicated having a special emergency plan ready. In most cases (79.3%), both external (e.g., mass casualty incidents) and internal (e.g., fire, failure of technical equipment) crises are covered. In the vast majority of cases (94%), the hospitals also indicated that they regularly update their emergency plan, whereby the frequency of updates varied markedly. Three quarters of the hospitals said that they also regularly simulate the use of the emergency plan in disaster drills. In two thirds of the cases, external forces such as emergency medical services or the fire department also take part in these drills along with the hospitals themselves. In some cases, knowledge gained from the drills was incorporated into the emergency plan or led to improvements in staff training.

Conclusions

The willingness of public hospitals to establish comprehensive disaster planning and to take part in related drills seems to have improved noticeably in recent years. However, there is still the need for improvement in keeping the concepts up to date at some hospitals. Especially smaller hospitals showed deficits in emergency planning, particularly concerning preparedness for internal crises, resulting from failure of technical equipment. More regular drills should be used to test existing concepts and to familiarize employees with the processes on a routine basis.

Disaster medical support plan as an element of the hospital disaster resilience

Abstract.

Hospitals Disaster Preparedness and Management in the Eastern Province of the Kingdom of Saudi Arabia: A Cross-sectional study

OBJECTIVE

The current study was conducted to assess disaster preparedness of hospitals in the Eastern region of Saudi Arabia.

METHODS

A descriptive cross-sectional study of all hospitals in the Eastern Region of KSA was conducted between July 2017 and July 2018. The included hospitals were selected using convenience sampling. The questionnaire was distributed together with an official letter providing information about the aim and objectives of the study as well as ethical issues guiding their participation in the exercise.

RESULTS

All the included hospitals had a disaster plan that was completely accessible by all staff members. About 70% of the included hospitals established an educational program on disaster preparedness once per year. Assessment of hospital disaster preparedness was conducted using disaster drills in 62 (n= 98%) of the hospitals. However, only 9.5% of the hospitals had post-disaster recovery assistance programs like counseling and support services.

CONCLUSION

Most hospitals involved in this study had sufficient resources for disaster management; however, the overall effectiveness of hospitals' disaster preparedness was slight to moderate. Some recommendations to improve hospitals' disaster preparedness should be proposed, including improved staff training and testing, better communications and safety procedures, and adoption of a holistic approach for disaster management.

Analysis of Hospital’s Emergency and Disaster Preparedness Using Hospital Safety Index in Indonesia

Indonesia is country with abundant high-risk areas for various disasters that can affect both the structural and non-structural safety of various vital establishments, particularly hospitals. This present study aims to examine the level of the hospital safety index in nine hospitals in four provinces based on the guidelines from the WHO/PAHO (World Health Organization/Pan American Health Organization). The Hospital Safety Index (HSI) guidelines consist of four parameters that include the types of hazards, structural safety, non-structural safety, disasters and emergency managements. This study was a cross-sectional study on data obtained through interviews, focus group discussions (FGDs), observations, and document reviews to assess the parameters of the HSI. Data were calculated for the HSI score, and descriptive statistics and multiple correspondence analysis (MCA) were carried out. The SPSS software version 25.0 was used for the statistical analysis. Results show that the overall safety index was 0.673 (Level A), meaning that it is likely the hospital will maintain functionality in emergencies and disasters. By province, the level A index was identified in DKI Jakarta (0.76), Yogyakarta (0.709), and West Java (0.673), showing that hospitals in these provinces will maintain functionality in emergency and disaster situations; however, in North Sumatera, the index was categorized in B category (0.507), demonstrating that the hospital’s ability to function during and after emergencies and disasters is potentially at risk. The multiple correspondence analysis shows that the hospitals in the provinces of Yogyakarta and West Java tend to achieve similar categories in almost all assessment modules; therefore, control measures of preparedness should be considered, such as improvements in equipment and facilities; hospital emergency and disaster response and recovery planning; communication and information management; training; and relevant stakeholders awareness.

The Policy Gap and Inefficiency in Public Volunteers' Response to Assist the Hospitals After Natural Disasters in Iran: A Grounded Theory Methodology

OBJECTIVE

This study aims to explore a public volunteer's hospital response model in natural disasters in Iran.

METHODS

This study employed grounded theory using the Strauss and Corbin 2008 method and data analysis was carried out in three steps, namely open, axial, and selective coding. The present qualitative study was done using semi-structured interviews with 36 participants who were on two levels and with different experiences in responding to emergencies and disasters as "public volunteers" and "experts". National and local experts were comprised of professors in the field of disaster management, hospital managers, Red Crescent experts, staff and managers of Iran Ministry of Health and Medical Education.

RESULTS

The main concept of the paradigm model was "policy gap and inefficiency" in the management of public volunteers, which was rooted in political factions, ethnicity, regulations, and elites. The policy gap and inefficiency led to chaos and "crises over crises." Overcoming the policy gap will result in hospital disaster resilience. Meanwhile, the model covered the causal, contextual, and intervening conditions, strategies, and consequences in relation to the public volunteers' hospital response phase.

CONCLUSIONS

The current public volunteers' hospital in Iran suffered from the lack of a coherent, comprehensive, and forward-looking plan for their response. The most important beneficiaries of this paradigm model will be for health policy-makers, to clarify the main culprits of creating policy gap and inefficiency in Iran and other countries with a similar context. It can guide the decision-makings in upstream documents on the public volunteers. Further research should carried out to improve the understanding of the supportive legal framework, building the culture of volunteering, and enhancing volunteers' retention rate.

The Application of Hospital Safety Index for Analyzing Primary Healthcare Center (PHC) Disaster and Emergency Preparedness

The World Health Organization (WHO) defines the primary healthcare center (PHC) as a whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people’s needs as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation, and palliative care, and as close as feasibly possible to people’s everyday environment. PHCs are expected to remain operational when disasters occur. This study aimed to assess the PHC disaster preparedness level in Indonesia using The Hospital Safety Index (HSI) from WHO/PAHO. Eleven PHCs located in four provinces in Indonesia, i.e., Jakarta, Yogyakarta, North Sumatera, and West Java, were selected. Data were collected through interviews, focus-group discussions (FGDs), observations, and document reviews. The parameters assessed were all types of hazards, structural or construction safety, nonstructural safety, and functional attributes. The results show that the overall score of HSI for PHCs in Jakarta (0.674) and North Sumatera (0.752) fell into the “A” category, meaning that these PHCs would likely remain operational in the case of disasters. Meanwhile, the overall HSI scores for PHCs in West Java (0.601) and Yogyakarta (0.602) were between 0.36 and 0.65, or in “B” category, meaning that these PHCs would be able to recover during disasters but several services would be exposed to danger. The results suggested that there are several gaps that need urgent interventions to be applied for the structural safety of buildings, water supply systems, fuel storage, disaster committee organization, furniture and fittings, offices and storage equipment, as well as increasing the capacity of workers through a structured and systematic training framework for disaster readiness. The results from this study can be used for prioritizing budgets and resource allocation, cost planning, providing specific solutions for local and national government, and efforts to achieve disaster risk reduction.

Registered nurses' experience as disaster preparedness coordinators during a major incident: A qualitative study

Aims

To explore registered nurses’ experiences as disaster preparedness coordinators of hospital incident command groups’ during a major incident.

Design

A qualitative descriptive design using semi‐structured interview.

Methods

This was a qualitative study based on one focus group discussion and six individual follow‐up interviews. Participants were registered nurses in their capacity as disaster preparedness coordinators with experience from Major Incident simulations and a real‐life Major Incident. The interviews were transcribed verbatim and analysed using content analysis. The COREQ checklist was used for reporting the findings.

Results

The analysis of data generated the main category: Expectations, previous experience and uncertainty affect hospital incident command group response during a Major Incident and three categories, (I) Gaining situational awareness (containing two subcategories), (II) Transitioning to management (containing three subcategories) and (III) Actions taken during uncertainty (containing two subcategories).

Trauma, Teams, and Telemedicine: Evaluating Telemedicine and Teamwork in a Mass Casualty Simulation

INTRODUCTION

Mass casualty events (MASCAL) are on the rise globally. Although natural disasters are often unavoidable, the preparation to respond to unique patient demands in MASCAL can be improved. Utilizing telemedicine can allow for a better response to such disasters by providing access to a virtual team member with necessary specialized expertise. The purpose of this study was to examine the positive and/or negative impacts of telemedicine on teamwork in teams responding to MASCAL events.

METHODS

We introduced a telemedical device (DiMobile Care) to Forward Surgical Teams during a MASCAL simulated training event. We assessed teamwork-related attitudes, behaviors, and cognitions during the MASCAL scenario through pre-post surveys and observations of use. Analyses compare users and nonusers of telemedicine and pre-post training differences in teamwork.

RESULTS

We received 50 complete responses to our surveys. Overall, clinicians have positive reactions toward the potential benefits of telemedicine; further, participants report a significant decrease in psychological safety after training, with users rating psychological safety as significantly higher than non-telemedicine users. Neither training nor telemedicine use produced significant changes in cognitive and behavioral-based teamwork. Nonetheless, participants reported perceiving that telemedicine improved leadership and adaptive care plans.

CONCLUSIONS

Telemedicine shows promise in connecting Forward Surgical Teams with nuanced surgical expertise without harming quality of care metrics (i.e., teamwork). However, we advise future iterations of DiMobile Care and other telemedical devices to consider contextual features of information flow to ensure favorable use by teams in time-intensive, high-stakes environments, such as MASCAL.

Text messages by wireless mesh network vs voice by two-way radio in disaster simulations: A crossover randomized-controlled trial

BACKGROUND

Communication failures secondary to damaged infrastructure have caused difficulties in coordinating disaster responses. Two-way radios commonly serve as backup communication for hospitals. However, text messaging has become widely adopted in daily life and new technologies such as wireless mesh network (WMN) devices allow for text messaging independent of cellular towers, Wi-Fi networks, and electrical grids.

OBJECTIVE

To examine the accuracy of communication using text-based messaging transmitted over WMN devices (TEXT-WMN) compared to voice transmitted over two-way radios (VOICE-TWR) in disaster simulations. Secondary outcomes were patient triage accuracy, perceived workload, and device preference.

METHODS

2 × 2 Latin square crossover design: 2 simulations (each involving 15 min of simulated hospital-wide disaster communication) by 2 modalities (TEXT-WMN and VOICE-TWR). Physicians were randomized to one of two sequences: VOICE-TWR first and TEXT-WMN second; or TEXT-WMN first and VOICE-TWR second. Analyses were conducted using linear mixed effects modeling.

RESULTS

On average, communication accuracy significantly improved with TEXT-WMN compared to VOICE-TWR. Communication accuracy also significantly improved, on average, during the second simulation compared to the first. There was no significant change in triage accuracy with either TEXT-WMN or VOICE-TWR; however, triage accuracy significantly improved, on average, during the second simulation compared to the first. On average, perceived workload was significantly lower with TEXT-WMN compared to VOICE-TWR, and was also significantly lower during the second simulation compared to the first. Most participants preferred TEXT-WMN to VOICE-TWR.

CONCLUSION

TEXT-WMN technology may be more effective and less burdensome than VOICE-TWR in facilitating accurate communication during disasters.

Cognition and Implementation of Disaster Preparedness among Japanese Dialysis Facilities

Introduction

Few quantitative studies have explored disaster preparedness in dialysis facilities worldwide. This study examined the levels of disaster preparedness and their related factors in dialysis facilities in Japan.

Methods

We conducted a mail survey using a self-administered questionnaire for key persons responsible for disaster preparedness in dialysis facilities (N = 904) associated with the Japanese Association of Dialysis Physicians. Levels of disaster preparedness were evaluated by the implementation rates of four domains: (1) patient, (2) administration, (3) network, and (4) safety. Additionally, we focused on cognitive factors related to disaster preparedness, such as risk perception, outcome expectancy, self-efficacy, self-responsibility, and support from the surroundings.

Results

A total of 517 participants answered the survey (response rate: 57.2%). Implementation rates differed according to the domains of disaster preparedness. While the average implementation rate of the safety domain was 81.8%, each average implementation rate was 57.9%, 48.3%, and 38.4% for the administration, network, and patient domains, respectively. The study found that self-efficacy and support from the surroundings of the participants were significantly associated with the four domains of disaster preparedness. Alternatively, risk perception and support from surroundings were significantly associated with one particular domain each.

Conclusion

Our results suggest that boosting self-efficacy and support from surroundings among key persons of disaster preparedness in dialysis facilities may contribute to the advancement of the different domains of disaster preparedness.

Cohort research analysis of disaster experience, preparedness, and competency-based training among nurses

Introduction

It is expected that in unforeseen situations, nurses will provide appropriate medical interventions, using their expertise and skills to reduce the risks associated with the consequences of disasters. Consequently, it is crucial that they are properly prepared to respond to such difficult circumstances. This study aimed to identify the factors influencing the basic competences of nurses in disasters.

Materials and methods

The survey was directed to 468 nurses from all medical centres in Lublin. IBM SPSS Statistics version 23 was used for statistical analyses, frequency analysis, basic descriptive statistics and logistic regression analysis. The classical statistical significance level was adopted as α = 0.05.

Results

Based on the logistic regression analysis, it was found that work experience, workplace preparedness, as well as training and experience in disaster response are important predictors of preparedness.

Conclusions

These findings indicate that the nurses' core competencies for these incidents can be improved through education and training programmes which increase their preparedness for disasters. Nurses are among the most important groups of healthcare professionals facing a disaster and should be involved in all phases of disaster management, such as risk assessment and pre-disaster planning, response during crisis situations and risks’ mitigation throughout the reconstruction period.

Disaster Preparedness in Selected Hospitals of Western Ethiopia and Risk Perceptions of Their Authorities

Purpose

Despite the fact that hospitals are always at a high risk of disasters, the preparedness status in many of the Ethiopian hospitals is not well recognized. It is with this research gap in mind that this study motivated the authors to assess disaster preparedness level in selected hospitals of the western part of Ethiopia and their authorities’ risk perceptions.

Methods

This was a facility-based study conducted by using mixed qualitative and quantitative research designs among selected hospitals of western Ethiopia. While disaster and emergency readiness was evaluated using a modified World Health Organization observation check list. The key informant interview method was used to assess the disaster risk perception of the hospitals’ authorities in the study area.

Results

The overall level of emergency and disaster preparedness in the selected hospitals was weak with an average calculated preparedness score of 45.6%. The score of readiness in terms of disaster response and recovery planning was 33.3%. Moreover, we have not got a documented disaster plan in all of the hospitals and the hazard-specific response sub plans were also not consistently in place. Of prime concerns, this study has revealed that there was no patient evacuation plan in all of the selected hospitals. The human resource preparations of the hospitals were relatively better with an average readiness score of 60%. The study has found that no committee was responsible for emergency readiness at all of the sampled hospitals. The hospital authorities’ disaster risk perception was found to vary according to the type of calamities and this was from moderate to high level.

Conclusion

This study concludes that although their authorities’ risk perception of disasters was high, the selected hospitals were ill-prepared for the potential disaster strikes in this study area.

Quality Assurance Sampling Plans in US Stockpiles for Personal Protective Equipment: A Computer Simulation to Examine Degradation Rates

Medical countermeasure stockpiles in the United States are designed to support healthcare workers and the public during public health emergencies; they include supplies of personal protective equipment (PPE). As part of typical PPE manufacturing processes, appropriate test methods are used to ensure that the devices provide adequate protective performance. At the time of manufacture, performance is often measured and weighed against an objective standard of quality, resulting in a pass or fail attribute being assigned to individual PPE items and thence to production lots. Incorporating periodic performance testing for stockpiled PPE can ensure that they maintain their protective qualities and integrity over time while in storage. There is an absence of guidance regarding how to design quality assurance programs for stockpiled PPE. The applicability of the Lot Quality Assurance Sampling (LQAS) approach to stockpiled PPE was examined in a previous study that compared and contrasted different sample sizes in recovering the true percentage of defective units in large lots in the LQAS framework. The current study carries this line of inquiry forward by integrating PPE degradation over time and comparing different sampling time intervals in recovering the true underlying degradation rate. The results suggest that product degradation is more easily detected when tested at shorter time intervals and for higher degradation rates. They further suggest that sampling interval groupings can be made based on the proficiency with which they recover the true underlying degradation rate.

Emergency and Disaster Preparedness at a Tertiary Medical City

OBJECTIVE

The aim of this study was to evaluate the readiness of a tertiary medical city's response to a disaster by assessing the hospital resources and knowledge, attitudes, practices, and familiarity of health care providers toward disaster and emergency preparedness.

METHODS

All KFMC (King Fahad Medical City) staff with > 1 year of clinical experience were eligible to participate in a cross-sectional study. Participants responded to the Emergency Preparedness Information Questionnaire (EPIQ), knowledge and practice questionnaires, and a disaster planning attitude checklist. Data about resources were collected using the hospital disaster preparedness self-assessment tool.

RESULTS

The overall mean knowledge score for disaster and emergency preparedness was 4.4 ± 1.1, and the mean overall familiarity score was 3.43 ± 0.97. Most participants knew that disaster drills (90.2%) and training (74.6%) are ongoing. Sixty-six (21.0%) agreed that KFMC is unlikely to experience a disaster. The highest and lowest EPIQ familiarity scores were for decontamination (83.0%) and accessing critical resources and reporting (64.3%), respectively. Most participants (99.4%) have access to work computers; however, only 53.0% used the Internet to access information on bioterrorism and/or emergency preparedness. The hospital is ready to respond in case of a disaster according to the used tool.

CONCLUSIONS

The participants' levels of knowledge, practices, and overall familiarity toward emergency and disaster preparedness were satisfactory; however, participant attitudes and familiarity with where and how to access critical resources in the event of an emergency or disaster situations require reinforcement.

Emergency and Disaster Preparedness of European Hospital Pharmacists: A Survey

OBJECTIVE

This study was focused on reviewing the emergency and disaster preparedness of European hospital pharmacists.

METHODS

An online survey based on International Pharmaceutical Federation (FIP) guidelines for natural disasters was sent to European hospital pharmacies, with the support of the European Association of Hospital Pharmacists. Additional questions were added about the characteristics of respondents, as well as preparedness and experience of manmade disasters. Descriptive statistics were used to analyze the results.

RESULTS

Hospital pharmacists in France (20%) and Spain (19%) returned most of the 306 questionnaires completed in 27 countries. Half of the respondents had analyzed their regional disaster risk, but 65% had never practiced emergency drills. Fifteen percent of respondents had experienced at least 1 major emergency or disaster event in the last 5 years. Fifty-six percent of those respondents who experienced a disaster subsequently created and promoted internal standard operating procedures (SOPs) for future emergencies, versus 23% for those who had not experienced disasters. Among pharmacists having experienced disasters, 40% organized a post-disaster debriefing to improve their future response.

CONCLUSIONS

Results highlighted that most European hospital pharmacists were not fully compliant with FIP guidelines. However, respondents who had experienced disasters were more likely to create and promote SOPs for future disasters. Further worldwide analysis and benchmarking are necessary, and FIP guidelines should be more strongly promoted.

Quality Assurance Sampling Plans in US Stockpiles for Personal Protective Equipment

Personal protective equipment (PPE) stockpiles in the United States were established to facilitate rapid deployment of medical assets to sites affected by public health emergencies. Large quantities of PPE were introduced into US stockpiles because of the need to protect healthcare and other professionals during these events. Because most stockpiled PPE was acquired during, or immediately following, large-scale public health events, such as pandemic influenza planning (2005-20080), SARS (2003), H1N1 (2009-10), and Ebola (2014-15), aging PPE poses a significant problem. PPE such as N95 filtering face piece respirators were not designed to be stored for long periods, and much of the currently stored PPE has exceeded its manufacturer-assigned shelf life. Given the significant investment in the procurement and storage of PPE, along with projections of consumption during public health emergencies, discarding large quantities of potentially viable PPE is not an attractive option. Although shelf-life extension programs exist for other stockpiled medical assets, no such option is currently available for stockpiled PPE. This article posits stockpile quality assurance sampling plans as a mechanism through which shelf-life extension programs for stockpiled PPE may be achieved. We discuss some of the nuances that should be considered when developing a plan tailored to stockpiles and provide basic decision tools that may be used in the context of a quality assurance program tailored to stockpiled PPE. We also explore basic information by comparing and contrasting different sample size options.

Flood disaster preparedness experiences of hospital personnel in Thailand: A qualitative study

BACKGROUND

Nurses, as well as other health personnel and health systems, worldwide need to be adequately prepared for disasters because it is often difficult to predict where and when disasters strike. The 2011 Thailand flood disaster caused significant damage, including to hospitals. The purpose of this study was to investigate the experiences of hospital personnel regarding flood disaster preparedness in the central region of Thailand.

METHODS

This qualitative study was conducted using content analysis. Purposive sampling was used to select the participants. Semi-structured interviews were conducted with 15 participants who were doctors, nurses, and persons involved in flood disaster preparedness. Content analysis was used for data analysis.

FINDINGS

Two themes and ten subthemes were extracted with regard to flood disaster preparedness. The two themes were maintaining the function of care provision and struggle with preparedness. Personnel realized that preparation levels of their hospital were inadequate and identified the challenges in providing care during and after floods.

CONCLUSIONS

The finding identified several areas to improve the current state of preparedness of all hospitals that experienced service disruption due to flood disasters. This can help healthcare personnel, hospitals, and healthcare system to enhance flood disaster preparedness so that they can be better prepared.

Current Status of Disaster Preparedness of Pharmacies and Differences in Disaster Awareness Based on Pharmacy Size

Objective

The prevention of deaths caused indirectly by disasters is important, especially for evacuees requiring medication. Pharmacies play a major role in providing medication to disaster victims. Therefore, this study evaluated the current status of disaster preparedness among pharmacies, the extent of disaster awareness and knowledge of disaster mitigation measures, and any associations of these with the characteristics of pharmacies.

Methods

Questionnaires about disaster preparedness were sent to 337 pharmacies in Japan, in a region at high risk of major earthquakes. Tabulation analyses were carried out to examine the characteristics of pharmacies and then a logistic regression analysis was performed to examine the relationship between disaster awareness and the level of preparedness of pharmacies. Furthermore, to examine in detail any differences associated with pharmacy size, subgroup analyses were performed.

Results

High disaster awareness was significantly correlated with adequate disaster preparedness. However, in the subgroup analyses, no significant differences were observed among large pharmacies. In contrast, disaster awareness was significantly related to the disaster preparedness of small pharmacies.

Conclusion

The findings suggest that the disaster preparedness of pharmacies is related to the level of disaster awareness, highlighting the importance of disaster awareness activities in ordinary times before a disaster. (Disaster Med Public Health Preparedness. 2019;13:753–757)

Evaluation of disaster preparedness for mass casualty incidents in private hospitals in Central Saudi Arabia

Objectives:

To identify and describe the hospital disaster preparedness (HDP) in major private hospitals in Riyadh, Saudi Arabia.

Methods:

This is an observational cross-sectional survey study performed in Riyadh city, Saudi Arabia between December 2015 and April 2016. Thirteen major private hospitals in Riyadh with more than 100 beds capacity were included in this investigation.

Results:

The 13 hospitals had HDP plan and reported to have an HDP committee. In 12 (92.3%) hospitals, the HDP covered both internal and external disasters and HDP was available in every department of the hospital. There were agreements with other hospitals to accept patients during disasters in 9 facilities (69.2%) while 4 (30.8%) did not have such agreement. None of the hospitals conducted any unannounced exercises in previous year.

Conclusion:

Most of the weaknesses were apparent particularly in the education, training and monitoring of the hospital staff to the preparedness for disaster emergency occasion. Few hospitals had conducted an exercise with casualties, few had drilled evacuation of staff and patients in the last 12 months, and none had any unannounced exercise in the last year.

Disappearing everyday materials: The displacement of medical resources following disaster in Fukushima, Japan

This study draws upon interviews of medical staff working in the city of Minamisoma, Japan, following the 2011 Triple Disaster. It investigates staff responses to the disruption of material resources as a consequence of the disaster and its management. The disruption of spaces, and the loss of oxygen supplies, food, and medications impacted upon staff experience and the ability of institutions to care for patients. This resulted in a restructuring of spaces and materials as workers made efforts to reconfigure and reestablish healthcare functions. This is one of the few qualitative studies which draws upon the experience and perspectives of health workers in understanding material disruption following disaster. This is particularly important since this case did not involve the breakdown of lifeline infrastructure, but rather, brought to attention the way everyday material objects shape social experience. In highlighting these effects, the paper makes the case for the social scientific investigation of the impact of disasters on healthcare, shedding light on an area of research currently dominated by disaster medicine.

[Impact assessment of inadequate hospital disaster management : Reflection based on a risk model]

BACKGROUND

According to legal regulations alarm and emergency plans have to be developed and kept current in hospitals. However, often neither the hospital administration, nor the medical employees and nursing staff pay the necessary attention to these alarm and evacuation plans. In particular, risks and consequences - including financial ones - due to insufficient planning, are not adequately considered.

OBJECTIVES

Risks in hospitals are assessed based on a risk analysis. The risk assessment evaluates, whether the risk is acceptable, critical or unacceptable. Parameters for the risk analysis are the magnitude of damage and number of affected people. The intention of this paper is to evaluate whether there is a connection between estimated risk, quality of risk planning, and financial damage.

MATERIALS AND METHODS

We visualized the risk analysis as a two-dimensional matrix. In addition, we introduced disaster planning quality as a third dimension and calculated the dependency between risk and planning quality and also between the resulting damage level and the planning quality.

RESULTS

We showed that a poor disaster planning quality increases the unacceptable risk exponentially. Risk assessment can also draw conclusions about the extent of financial damage caused, for example fires, terrorist attacks or infrastructure failure. The amount of damage can be described as a function depending on the planning deficit of emergency planning. The worse the planning quality, the higher the amount of damages for non-tolerable risks can be.

CONCLUSIONS

Risk management means recognizing risks, assessing risks and managing risks. In hospitals, this mostly means using a critical incident reporting system (CIRS), however risk management in the sense of disaster planning is largely unknown. With a three-dimensional risk matrix, we showed a clear correlation between the quality of disaster planning and relative risk or financial damage. To substantiate the presented theoretical considerations, however, further research must be designed and implemented.

Tools and Checklists Used for the Evaluation of Hospital Disaster Preparedness: A Systematic Review

Hospitals need to be fully operative during disasters. It is therefore essential to be able to evaluate hospital preparedness. However, there is no consensus of a standardized, comprehensive and reliable tool with which to measure hospital preparedness. The aim of the current study was to perform a systematic review of evaluation tools for hospital disaster preparedness. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words "crisis," "disaster," "disaster medicine," "emergency," "mass casualty," "hospital preparedness," "hospital readiness," "hospital assessment," "hospital evaluation," "hospital appraisal," "planning," "checklist," and "medical facility" were used in combination with the Boolean operators "OR" and "AND." PubMed (National Library of Medicine, Bethesda, MD), ISI Web of Science (Thomson Reuters, New York, NY), and Scopus (Elsevier, New York, NY) were searched. A total of 51,809 publications were screened. The following themes were required for relevance: logistics, planning, human resources, triage, communication, command and control, structural and nonstructural preparedness, training, evacuation, recovery after disaster, coordination, transportation, surge capacity, and safety. The results from 15 publications are presented. Fifteen articles fulfilled the criteria of relevance and considered at least 1 of the 14 predetermined themes. None of the evaluated checklists and tools included all dimensions required for an appropriate hospital preparedness evaluation. The results of the current systematic review could be used as a basis for designing an evaluation tool for hospital disaster preparedness. (Disaster Med Public Health Preparedness. 2016;page 1 of 8).

System-level planning, coordination, and communication: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement

BACKGROUND

System-level planning involves uniting hospitals and health systems, local/regional government agencies, emergency medical services, and other health-care entities involved in coordinating and enabling care in a major disaster. We reviewed the literature and sought expert opinions concerning system-level planning and engagement for mass critical care due to disasters or pandemics and offer suggestions for system-planning, coordination, communication, and response. The suggestions in this chapter are important for all of those involved in a pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials.

METHODS

The American College of Chest Physicians (CHEST) consensus statement development process was followed in developing suggestions. Task Force members met in person to develop nine key questions believed to be most relevant for system-planning, coordination, and communication. A systematic literature review was then performed for relevant articles and documents, reports, and other publications reported since 1993. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process.

RESULTS

Suggestions were developed and grouped according to the following thematic elements: (1) national government support of health-care coalitions/regional health authorities (HC/RHAs), (2) teamwork within HC/RHAs, (3) system-level communication, (4) system-level surge capacity and capability, (5) pediatric patients and special populations, (6) HC/RHAs and networks, (7) models of advanced regional care systems, and (8) the use of simulation for preparedness and planning.

CONCLUSIONS

System-level planning is essential to provide care for large numbers of critically ill patients because of disaster or pandemic. It also entails a departure from the routine, independent system and involves all levels from health-care institutions to regional health authorities. National government support is critical, as are robust communication systems and advanced planning supported by realistic exercises.

Capacity indicators for disaster preparedness in hospitals within Nairobi County, Kenya

The goal of this study was to assess hospital capacity for disaster preparedness within Nairobi County. This information would be valuable to institutional strategists to resolve weaknesses and reinforce strengths in hospital capacity hence ensure efficient and effective service delivery during disasters. Analytical cross-sectional research design was used. Indicator variables for capacity were hospital equipment, hospital infrastructure, surrounding hospital environment, training, drills, staff knowledge and staff capabilities. Thirty two hospitals were studied of which nine of them were public hospitals. Data analysis was done using SPSS and presented in the form of frequency tables at p < 0.05. Study results indicated that hospital capacity to disaster preparedness in Nairobi County existed in 22 (68.88%) hospitals, in 6 (64.95%) public hospitals and 16 (69.64%) private hospitals. The difference in capacity between public and private hospitals within the County was less than 5%. This showed that both public and private hospitals were relatively at par, with regard to the capacity to handle disaster cases. Study findings also revealed that the surrounding hospital environment was the most highly rated indicator while inter hospital training and drills were the least rated. Although existent in hospitals within Nairobi County, for maximum hospital capacity and disaster preparedness within Nairobi County to be achieved, the existent gap in inter hospital training and inter hospital drills, both of which fall under the finance health systems pillar, required addressing.

Primary healthcare system capacities for responding to storm and flood-related health problems: a case study from a rural district in central Vietnam

BACKGROUND

As a tropical depression in the East Sea, Vietnam is greatly affected by climate change and natural disasters. Knowledge of the current capacity of the primary healthcare system in Vietnam to respond to health issues associated with storms and floods is very important for policy making in the country. However, there has been little scientific research in this area.

OBJECTIVE

This research was to assess primary healthcare system capacities in a rural district in central Vietnam to respond to such health issues.

DESIGN

This was a cross-sectional descriptive study using quantitative and qualitative approaches. Quantitative methods used self-administered questionnaires. Qualitative methods (in-depth interviews and focus groups discussions) were used to broaden understanding of the quantitative material and to get additional information on actions taken.

RESULTS

1) Service delivery: Medical emergency services, especially surgical operations and referral systems, were not always available during the storm and flood seasons. 2) Governance: District emergency plans focus largely on disaster response rather than prevention. The plans did not clearly define the role of primary healthcare and had no clear information on the coordination mechanism among different sectors and organizations. 3) Financing: The budget for prevention and control of flood and storm activities was limited and had no specific items for healthcare activities. Only a little additional funding was available, but the procedures to get this funding were usually time-consuming. 4) Human resources: Medical rescue teams were established, but there were no epidemiologists or environmental health specialists to take care of epidemiological issues. Training on prevention and control of climate change and disaster-related health issues did not meet actual needs. 5) Information and research: Data that can be used for planning and management (including population and epidemiological data) were largely lacking. The district lacked a disease early-warning system. 6) Medical products and technology: Emergency treatment protocols were not available in every studied health facility.

CONCLUSIONS

The primary care system capacity in rural Vietnam is inadequate for responding to storm and flood-related health problems in terms of preventive and treatment healthcare. Developing clear facility preparedness plans, which detail standard operating procedures during floods and identify specific job descriptions, would strengthen responses to future floods. Health facilities should have contingency funds available for emergency response in the event of storms and floods. Health facilities should ensure that standard protocols exist in order to improve responses in the event of floods. Introduction of a computerized health information system would accelerate information and data processing. National and local policies need to be strengthened and developed in a way that transfers into action in local rural communities.

Progress and challenges of disaster health management in China: a scoping review

Background

Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries.

Objective

This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity.

Design

A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims.

Results

The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue.

Conclusions

One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level).

Validation of a framework for measuring hospital disaster resilience using factor analysis

Hospital disaster resilience can be defined as "the ability of hospitals to resist, absorb, and respond to the shock of disasters while maintaining and surging essential health services, and then to recover to its original state or adapt to a new one." This article aims to provide a framework which can be used to comprehensively measure hospital disaster resilience. An evaluation framework for assessing hospital resilience was initially proposed through a systematic literature review and Modified-Delphi consultation. Eight key domains were identified: hospital safety, command, communication and cooperation system, disaster plan, resource stockpile, staff capability, disaster training and drills, emergency services and surge capability, and recovery and adaptation. The data for this study were collected from 41 tertiary hospitals in Shandong Province in China, using a specially designed questionnaire. Factor analysis was conducted to determine the underpinning structure of the framework. It identified a four-factor structure of hospital resilience, namely, emergency medical response capability (F1), disaster management mechanisms (F2), hospital infrastructural safety (F3), and disaster resources (F4). These factors displayed good internal consistency. The overall level of hospital disaster resilience (F) was calculated using the scoring model: F = 0.615F1 + 0.202F2 + 0.103F3 + 0.080F4. This validated framework provides a new way to operationalise the concept of hospital resilience, and it is also a foundation for the further development of the measurement instrument in future studies.

Hospital Disaster Preparedness as Measured by Functional Capacity: a Comparison between Iran and Sweden

Introduction

Hospitals are expected to continue to provide medical care during disasters. However, they often fail to function under these circumstances. Vulnerability to disasters has been shown to be related to the socioeconomic level of a country. This study compares hospital preparedness, as measured by functional capacity, between Iran and Sweden.

Methods

Hospital affiliation and size, and type of hazards, were compared between Iran and Sweden. The functional capacity was evaluated and calculated using the Hospital Safety Index (HSI) from the World Health Organization. The level and value of each element was determined, in consensus, by a group of evaluators. The sum of the elements for each sub-module led to a total sum, in turn, categorizing the functional capacity into one of three categories: A) functional; B) at risk; or C) inadequate.

Results

The Swedish hospitals (n = 4) were all level A, while the Iranian hospitals (n = 5) were all categorized as level B, with respect to functional capacity. A lack of contingency plans and the availability of resources were weaknesses of hospital preparedness. There was no association between the level of hospital preparedness and hospital affiliation or size for either country.

Conclusion

The results suggest that the level of hospital preparedness, as measured by functional capacity, is related to the socioeconomic level of the country. The challenge is therefore to enhance hospital preparedness in countries with a weaker economy, since all hospitals need to be prepared for a disaster. There is also room for improvement in more affluent countries.

DjalaliA, CastrenM, KhankehH, GrythD, RadestadM, OhlenG, KurlandL. Hospital disaster preparedness as measured by functional capacity: a comparison between Iran and Sweden. Prehosp Disaster Med.2013;28(5):1-8.

Assessing hospital preparedness: comparison of an on-site survey with a self-reported, internet-based, long-distance tabletop drill

BACKGROUND

Methods of defining hospital disaster preparedness are poorly defined in the literature, leaving wide discrepancies between a hospital's self-reported preparedness and that assessed by an objective reviewer.

OBJECTIVES

This study compared self-reported surge capacity data from individual hospitals, obtained from a previously reported long-distance tabletop drill (LDTT) prior to the 2010 FIFA World Cup tournament in Cape Town, South Africa, with surge capacity data assessed by an on-site survey inspection team.

METHODS

In this prospective, observational study, contact persons used in the prior LDTT assessing hospital disaster preparedness in the lead-up to the 2010 FIFA World Cup made surge capacity assessments (licensed bed capacity plus surge capacity beds) for the respiratory intensive care unit (RICU), neonatal intensive care unit (NICU), medical intensive care unit (MICU), and general medical/surgical beds in each hospital. Following the 2010 World Cup, this data was then re-evaluated by an on-site survey team consisting of two of the authors.

RESULTS

The contact persons for the individual hospitals from the LDTT underreported their individual hospital's surge capacity in 86% (95% CI, 46%-99%) of RICU beds; 100% (95% CI, 63%-100%) of MICU beds; 75% (95% CI, 40%-94%) of NICU beds; and 71% (95% CI, 35%-92%) of medical/surgical beds compared with the on-site inspection team.

CONCLUSIONS

The contact persons for the LDTT overwhelmingly underreported surge capacity beds compared with the surge capacity determined by the on-site inspection team.

Health systems' "surge capacity": state of the art and priorities for future research

CONTEXT

Over the past decade, a number of high-impact natural hazard events, together with the increased recognition of pandemic risks, have intensified interest in health systems' ability to prepare for, and cope with, "surges" (sudden large-scale escalations) in treatment needs. In this article, we identify key concepts and components associated with this emerging research theme. We consider the requirements for a standardized conceptual framework for future research capable of informing policy to reduce the morbidity and mortality impacts of such incidents. Here our objective is to appraise the consistency and utility of existing conceptualizations of health systems' surge capacity and their components, with a view to standardizing concepts and measurements to enable future research to generate a cumulative knowledge base for policy and practice.

METHODS

A systematic review of the literature on concepts of health systems' surge capacity, with a narrative summary of key concepts relevant to public health.

FINDINGS

The academic literature on surge capacity demonstrates considerable variation in its conceptualization, terms, definitions, and applications. This, together with an absence of detailed and comparable data, has hampered efforts to develop standardized conceptual models, measurements, and metrics. Some degree of consensus is evident for the components of surge capacity, but more work is needed to integrate them. The overwhelming concentration in the United States complicates the generalizability of existing approaches and findings.

CONCLUSIONS

The concept of surge capacity is a useful addition to the study of health systems' disaster and/or pandemic planning, mitigation, and response, and it has far-reaching policy implications. Even though research in this area has grown quickly, it has yet to fulfill its potential to generate knowledge to inform policy. Work is needed to generate robust conceptual and analytical frameworks, along with innovations in data collection and methodological approaches that enhance health systems' readiness for, and response to, unpredictable high-consequence surges in demand.

Secondary surge capacity: a framework for understanding long-term access to primary care for medically vulnerable populations in disaster recovery

Disasters create a secondary surge in casualties because of the sudden increased need for long-term health care. Surging demands for medical care after a disaster place excess strain on an overtaxed health care system operating at maximum or reduced capacity. We have applied a health services use model to identify areas of vulnerability that perpetuate health disparities for at-risk populations seeking care after a disaster. We have proposed a framework to understand the role of the medical system in modifying the health impact of the secondary surge on vulnerable populations. Baseline assessment of existing needs and the anticipation of ballooning chronic health care needs following the acute response for at-risk populations are overlooked vulnerability gaps in national surge capacity plans.

Cost-effectiveness comparison of response strategies to a large-scale anthrax attack on the chicago metropolitan area: impact of timing and surge capacity

Rapid public health response to a large-scale anthrax attack would reduce overall morbidity and mortality. However, there is uncertainty about the optimal cost-effective response strategy based on timing of intervention, public health resources, and critical care facilities. We conducted a decision analytic study to compare response strategies to a theoretical large-scale anthrax attack on the Chicago metropolitan area beginning either Day 2 or Day 5 after the attack. These strategies correspond to the policy options set forth by the Anthrax Modeling Working Group for population-wide responses to a large-scale anthrax attack: (1) postattack antibiotic prophylaxis, (2) postattack antibiotic prophylaxis and vaccination, (3) preattack vaccination with postattack antibiotic prophylaxis, and (4) preattack vaccination with postattack antibiotic prophylaxis and vaccination. Outcomes were measured in costs, lives saved, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). We estimated that postattack antibiotic prophylaxis of all 1,390,000 anthrax-exposed people beginning on Day 2 after attack would result in 205,835 infected victims, 35,049 fulminant victims, and 28,612 deaths. Only 6,437 (18.5%) of the fulminant victims could be saved with the existing critical care facilities in the Chicago metropolitan area. Mortality would increase to 69,136 if the response strategy began on Day 5. Including postattack vaccination with antibiotic prophylaxis of all exposed people reduces mortality and is cost-effective for both Day 2 (ICER=$182/QALY) and Day 5 (ICER=$1,088/QALY) response strategies. Increasing ICU bed availability significantly reduces mortality for all response strategies. We conclude that postattack antibiotic prophylaxis and vaccination of all exposed people is the optimal cost-effective response strategy for a large-scale anthrax attack. Our findings support the US government's plan to provide antibiotic prophylaxis and vaccination for all exposed people within 48 hours of the recognition of a large-scale anthrax attack. Future policies should consider expanding critical care capacity to allow for the rescue of more victims.

Medical Society's Blueprint for a Successful Community Response to Emergency Preparedness

It is clear from disaster evaluations that communities must be prepared to act independently before government agencies can cope with the early ramifications of disasters. In response to devastation to the borough of Staten Island, New York in the wake of 11 September 2001, the Richmond County Medical Society established a structure to incorporate community needs and institutions to work together for the common good. A program that brings together two hospital systems, nursing homes, emergency medical services, and the Office of Emergency Management physician leadership in a meaningful way now is in place. This approach has improved the disaster preparedness of Staten Island and demonstrated how the Medical Society can provide leadership in disaster preparedness and serve as a conduit for communication amongst entities that normally do not communicate.

[Are we prepared for a disaster? Spanish multicentre study]

INTRODUCTION

Paediatric Emergency Departments (PED) should have written disaster plans, to ensure a rapid and efficient response.

OBJECTIVES

1) to determine if Spanish PED have written disaster plans, 2) to describe the characteristics of these plans, and 3) if paediatric victims were included in them.

MATERIAL AND METHODS

Descriptive multicentre study based on questionnaires sent to physicians in charge of different Spanish PED. The structured survey included questions about external emergency plans (EEP) and internal emergency plans (IEP).

RESULTS

Twenty-five out of 44 surveys were replied. Eighteen PED had an EEP, most of them had been written 10 years ago and were reviewed every 3 years or more. In 11/18 PED, the EEP was well-known by health care providers. Drills were never performed in 13/18 PED. Twenty-one PED had an IEP, most of them had been written 8 years ago and were reviewed every 3 years or more. In 13/21 PED, IEP was well-known by health care providers but drills were never performed in 12/21 PED. IEP included evacuation plans (22), fire emergency plans (19), bomb threat plan (13) and flood plans (9). Nine PED have paediatric-specific disaster plans and in 7 PED, disaster plans included adult and paediatric victims. Children were not included In 1 EEP and in 5 IEP.

CONCLUSIONS

Most of PED have written disaster plans, but these plans are old, unknown by health care providers and almost half of them do not include paediatric victims. It is necessary to improve disaster planning in Spanish PED.

Hospital Incident Command System (HICS) performance in Iran; decision making during disasters

Background

Hospitals are cornerstones for health care in a community and must continue to function in the face of a disaster. The Hospital Incident Command System (HICS) is a method by which the hospital operates when an emergency is declared. Hospitals are often ill equipped to evaluate the strengths and vulnerabilities of their own management systems before the occurrence of an actual disaster. The main objective of this study was to measure the decision making performance according to HICS job actions sheets using tabletop exercises.

Methods

This observational study was conducted between May 1st 2008 and August 31st 2009. Twenty three Iranian hospitals were included. A tabletop exercise was developed for each hospital which in turn was based on the highest probable risk. The job action sheets of the HICS were used as measurements of performance. Each indicator was considered as 1, 2 or 3 in accordance with the HICS. Fair performance was determined as < 40%; intermediate as 41-70%; high as 71-100% of the maximum score of 192. Descriptive statistics, T-test, and Univariate Analysis of Variance were used.

Results

None of the participating hospitals had a hospital disaster management plan. The performance according to HICS was intermediate for 83% (n = 19) of the participating hospitals. No hospital had a high level of performance. The performance level for the individual sections was intermediate or fair, except for the logistic and finance sections which demonstrated a higher level of performance. The public hospitals had overall higher performances than university hospitals (P = 0.04).

Conclusions

The decision making performance in the Iranian hospitals, as measured during table top exercises and using the indicators proposed by HICS was intermediate to poor. In addition, this study demonstrates that the HICS job action sheets can be used as a template for measuring the hospital response. Simulations can be used to assess preparedness, but the correlation with outcome remains to be studied.

Assessment of Hospital Disaster Preparedness for the 2010 FIFA World Cup Using an Internet-Based, Long-Distance Tabletop Drill

Introduction: The State University of New York at Downstate (SUNY) conducted a web-based long-distance tabletop drill (LDTT) designed to identify vulnerabilities in safety, security, communications, supplies, incident management, and surge capacity for a number of hospitals preceding the 2010 FIFA World Cup. The tabletop drill simulated a stampede and crush-type disaster at the Green Point Stadium in Cape Town, South Africa in anticipation of 2010 FIFA World Cup. The LDTT, entitled “Western Cape-Abilities”, was conducted between May and September 2009, and encompassed nine hospitals in the Western Cape of South Africa. The main purpose of this drill was to identify strengths and weaknesses in disaster preparedness among nine state and private hospitals in Cape Town, South Africa. These hospitals were tasked to respond to the ill and injured during the 2010 World Cup.

Methods: This LDTT utilized e-mail to conduct a 10-week, scenario-based drill. Questions focused on areas of disaster preparedness previously identified as standards from the literature. After each scenario stimulus was sent, each hospital had three days to collect answers and submit responses to drill controllers via e-mail.

Results: Data collected from the nine participating hospitals met 72% (95%CI = 69%–75%) of the overall criteria examined. The highest scores were attained in areas such as equipment, with 78% (95%CI = 66%–86%) positive responses, and development of a major incident plan with 85% (95% CI = 77%–91%) of criteria met. The lowest scores appeared in the areas of public relations/risk communications; 64% positive responses (95% CI = 56%–72%), and safety, supplies, fire and security meeting also meeting 64% of the assessed criteria (95% CI = 57%–70%). Surge capacity and surge capacity revisited both met 76% (95% CI = 68%–83% and 68%–82%, respectively).

Conclusions: This assessment of disaster preparedness indicated an overall good performance in categories such as hospital equipment and development of major incident plans, but improvement is needed in hospital security, public relations, and communications ahead of the 2010 FIFA World Cup.

A survey of emergency department 2009 pandemic influenza A (H1N1) surge preparedness--Atlanta, Georgia, July-October 2009

During August through September 2009, a surge in emergency department (ED) visits for 2009 pandemic influenza A (pH1N1) illness occurred in Georgia, particularly among children. To understand surge preparedness and capacity, we obtained influenza-like illness (ILI) ED visit data from the Georgia State Electronic Notifiable Disease Surveillance System (SendSS) and conducted a retrospective, Internet-based survey among all 26 metro Atlanta ED managers with reference to the period 1 July-1 October 2009. SendSS detected a marked and progressive increase in mean monthly ILI visits from 1 July-1 October 2009, which more than tripled (from 399 to 2196) for the 2 participating EDs that cared for pediatric patients during this time. ED managers reported patient volume surges, resulting in space and supply limitations, especially at pediatric EDs. Most (92%) of the facilities had current pandemic influenza plans. Pandemic planning can help to ensure preparedness for natural and man-made disasters and for future influenza pandemics.

[Disaster situations. What must we know and do?]

Disasters are situations or events that overwhelm local capacity and can cause great damage and human suffering. Disasters are uncommon but their consequences may be extremely serious; that is why it is absolutely necessary that health care providers become fully prepared. The paediatric population is especially vulnerable to disasters effects, and so paediatricians have to play an essential role, not only during the disaster but also previously, during disaster planning. This review aims to provide an overview of the different types of disaster, the role of paediatricians in disaster preparedness, the stages of disaster managing and finally, hospital preparedness.

Pandemic influenza: implications for preparation and delivery of critical care services

In a 5-week span during the 1918 influenza A pandemic, more than 2000 patients were admitted to Cook County Hospital in Chicago, with a diagnosis of either influenza or pneumonia; 642 patients, approximately 31% of those admitted, died, with deaths occurring predominantly in patients of age 25 to 30 years. This review summarizes basic information on the biology, epidemiology, control, treatment and prevention of influenza overall, and then addresses the potential impact of pandemic influenza in an intensive care unit setting. Issues that require consideration include workforce staffing and safety, resource management, alternate sites of care surge of patients, altered standards of care, and crisis communication.

Improved trauma system multicasualty incident response: comparison of two train crash disasters

BACKGROUND

Two train crash multicasualty incidents (MCI) occurred in 2005 and 2008 in Los Angeles. A postcrash analysis of the first MCI determined that most victims went to local community hospitals (CHs) with underutilization of trauma centers (TCs), resulting in changes to our disaster plan. To determine whether our trauma system MCI response improved, we analyzed the distribution of patients from the scene to TCs and CHs in the two MCIs.

METHODS

Data from the emergency medical services and TC records were interrogated to compare patients triage status, type of transport, and the destination in the 2008 MCI to the 2005 MCI. Clinical data from the 2008 MCI were tabulated to evaluate severity of injuries, need for immediate and delayed operation, need for intensive care unit, and need for specialty surgical services, and appropriate distribution of patients.

RESULTS

In 2005, 14 (56%) of the 25 severely injured patients and 75 (71%) of the 106 total patients were transported to four CHs. In 2008, 53 (93%) of 57 of the severely injured patients were transported to TCs and only 34 (35%) of 98 of total patients were transported to nine CHs. In 2008, more TCs were used (8 vs. 5) and more patients were transported by air (34 vs. 2). In 2008, the most severely injured victims were transported to four level I TCs (median injury severity score, 16; range, 1-43; 10 emergent operations) and four level II TCs (median injury severity score, 10; range, 1-22; 4 emergent operations). Only 11 patients were admitted to CHs, and no operations were required.

CONCLUSIONS

A trauma system performance improvement program allowed us to significantly improve our response to MCIs with improved utilization of TCs and improved distribution of victims according to injury severity and needs.