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7/29/2019 Hospital Preparedness for Emergency Response
1/15
Number37 n March24,2011
HospitalPreparednessforEmergencyResponse:UnitedStates,2008
RichardW.Niska,M.D.,M.P.H.;and IrisM.Shimizu,Ph.D.
AbstractObjectiveThisreportisasummaryofhospitalpreparednessforresponding
topublichealthemergencies, includingmasscasualtiesandepidemicsofnaturallyoccurringdiseasessuchasinfluenza.
MethodsDataarefromanemergencyresponsepreparednesssupplementtothe2008NationalHospitalAmbulatoryMedicalCareSurvey,whichusesanationalprobabilitysampleofnonfederalgeneralandshortstayhospitals intheUnitedStates.Sampledatawereweightedtoproducenationalestimates.Keyresults+Nearlyallhospitalshadresponseplansforchemicalreleases,naturaldisasters,epidemics,andbiological incidents.Preparednessforexplosiveor incendiaryincidentswaslessfrequentthanpreparednessforother typesofincidents.
+Whilemosthospitalshadplansforcancellationofelectiveproceduresandadmissions, twothirdshadplansforalternatecareareaswithbeds,staffing,andequipment.
+Onehalfofhospitalsplannedforalternatecareareasin inpatienthallwaysordecommissionedwardspace,orforconversionofinpatientunits toaugmentintensivecare.
+Onehalfofhospitalshadadjustedstandardsofcareforallocationofmechanicalventilatorsformasscasualties.
+Althoughoveronehalfofhospitalshadstagedepidemicdrills,onlyonethirdincludedmassvaccinationormedicationdistribution.
+Onehalfofhospitalsplannedforadvanceregistrationofhealthcareprofessionals.
+Whilemosthospitalshadmemorandaofunderstanding(MOUs)withotherhospitals totransferadultsduringanepidemic,fewerhospitalshadMOUsforpediatricsandburns.Lessthanonehalfofhospitalsaccommodated theneedsofchildrenandpersonswithdisabilitiesduringapublichealthemergency.
Keywords:Emergencypreparedness+hospitalpreparedness+masscasualty+pandemic
IntroductionFollowing theWorldTradeCenter
attackofSeptember2001and theanthraxterrorism incidentofOctober2001,therehasbeenaheightenedinterestinusingsurveystoassessourreadinessforvariousdisasters.Therefore,theU.S.DepartmentofHealthandHumanServices,OfficeoftheAssistantSecretaryforPlanningandEvaluation(ASPE),providedfunding totheNationalCenterforHealthStatistics(NCHS)tosurveyhospitalsaboutpreparednessfortreatingpatientsfrombioterrorismattacksormasscasualtyincidents.
Bioterrorism
and
Mass
CasualtyPreparednessSupplementswereaddedto the2003and2004NationalHospitalAmbulatoryMedicalCareSurveys(NHAMCS).Apreliminaryreportonhospitalpreparednessforbioterrorismorothermasscasualtiesshowed thathospitalswerepreparedin2003 inmostof theareasstudied(1).Othermorecomprehensivepublicationscoveringbothyearsfollowed(24).
Insubsequentyears, thenationalfocusshiftedfrombioterrorismtopreparationfornaturaldisasterssuchasHurricaneKatrinaandmajorinfluenzaoutbreaks.In2004,anoutbreakofH5N1avianinfluenzawasreported in
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
7/29/2019 Hospital Preparedness for Emergency Response
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Page2 NationalHealthStatisticsReports n Number37 n March24,2011poultryinnineeasternAsiancountries,whichwasgeneticallyrelatedto52fatalhumancasesreportedbyearly2005(5).Bytheendof2008,H5N1avianinfluenzahadbeenresponsiblefor248humandeathsin15countries inAsiaandAfrica,andhadbeenreported inbothdomesticandwildbirds inEuropeaswell(6,7).AlthoughnoavianorhumanH5N1caseshavebeenreportedintheAmericas,there ispublicconcernthat thisvirusorotherscouldresult inoutbreaksorevenpandemicsin thefuture.Inresponse tothisconcern,ASPEprovidedfundsforNCHStosurveyhospitalsontheirpreparednessformasscasualtyeventsincludingpandemics.
Thisreportservesasadescriptivesummaryofhospitalpreparednessfordealingwithnaturallyoccurringdiseases,epidemicsandpandemicssuchasinfluenza,andotherpublichealthemergencies.Informationaboutemergencypreparedness inU.S.hospitals iscrucialfor thosewhoarechargedwithplanninghow topreventandtreatlargeoutbreaksof infectiousdiseaseandothermasscasualtyevents.Methods
NHAMCSis
anational
annual
surveyofambulatorymedicalcarevisitstononinstitutional,nonfederal,acutecare,andshortstayhospitals.Shortstayhospitalsare thosewithanaveragelengthofstayofless than30days,whereasacutecarehospitalsarethosewhosespecialtyisgeneral(medicalorsurgical)orchildrensgeneral.NHAMCSusesamultistageprobabilitysamplingdesign involvingsamplesofgeographicprimarysamplingunitsandhospitalswithemergencydepartments(ED)oroutpatientdepartmentswithinthoseunits.Thedataareweightedusingtheinverseprobabilitiesofhospitalselectionwithanadjustmentfornonresponse.Therefore,estimatesareconsideredrepresentativeofhospitalsthroughouttheUnitedStates.
In2008,emergencypreparednessitemswereaddedtoNHAMCSinaspecialsupplement.Manyof the itemsonthe20032004surveyswereretained,butthe2008instrumentwas
greatlyexpanded toincludenewquestionsarisingfromresearchfindingsaswellasthosesuggestedbyoutsideprofessionalorganizations. Thisreportfocusesonnewcontentadded tothe2008survey.Afuturereportwilldiscusstrendsbetween20032004and2008foritemsthatwereretainedfromtheearliersurveys.
NHAMCS isadministeredonsiteateachparticipatinghospitalbyfieldrepresentativesemployedby theU.S.CensusBureauunderaninteragencyagreementwithNCHS.Thepandemicsupplementwasaneightpageselfadministeredquestionnaireconsistingof112totaldata items.Itwascompletedforeachsamplehospitalby thepersonresponsiblefor thehospitalsemergencyresponseplan.Thesupplementwasreturned to theU.S.CensusBureausNationalProcessingCenter(NPC)withtheNHAMCScorematerials.NPCperformedthequalitycontroleditsanddataentry,andprovidedNCHSwithmonthlyupdatesandafinalcumulativeSASfile.
AdescriptiveanalysiswasconductedbyNCHSusingafirstorderTaylorseriesapproximationmethodasappliedinSUDAAN9.0.1toaccountforthecomplexsurveydesign(8).Becauseallcontinuousvariableshadpositivelyskeweddistributions, thecentral tendencywasreportedasthemedian.
Thedeterminationofstatisticalsignificancewasbasedon thetwotailedttest.TheBonferroni inequalitywasusedtoestablishthecriticalvalueforstatisticallysignificantdifferences(0.05levelofsignificance)basedon thenumberofpossiblecomparisonswithinaparticularvariable(orcombinationofvariables)ofinterest.Termsrelating todifferencessuchasmoreorfewerindicatethatthedifference isstatisticallysignificant.Termssuchasnotdifferentorsimilarindicatethat thedifferenceisnotstatisticallysignificant.Alackofcommentonaparticulardifferencedoesnotimplyanythingaboutstatisticalsignificance.Results
Ofthesampleof395 inscopehospitalsfromthe2008NHAMCS,294
hospitalsrespondedto thesupplement(responserateof74.4percentunweightedand78.1percentweighted),representingthenationalweighteduniverseof5,212hospitals.Emergencyresponseplans+Allhospitalshadanemergencyresponseplanforatleastoneof thesixhazardsstudied(epidemic-pandemic,biological,chemical,nuclearradiological,explosiveincendiary,andnaturalincidents)(Table1,Figure1).
+Nearlyallhospitals(99.0percent)hademergencyresponseplansthatspecificallyaddressedchemicalaccidentsorattacks,whichwerenotsignificantly
different
from
the
prevalenceofplansfornaturaldisasters(97.8percent),epidemicsorpandemics(94.1percent),andbiologicalaccidentsorattacks(93.2percent).
+ Significantlyfewerhospitals(81.3percent)hadplansfornuclearorradiologicalaccidentsorattacksthanforchemicalaccidentsorattacksandnaturaldisasters.
+ Significantlyfewerhospitals(79.6percent)hadplansforexplosiveorincendiaryaccidentsorattacksthanforchemicalaccidentsorattacks,naturaldisasters,epidemicsorpandemics,andbiologicalaccidentsorattacks.
+About67.9percentofhospitalshadplansforallsixhazards.
Cooperativeplanning+About99.6percentofhospitalsengaged incooperativeplanningwithat leastoneoftheeightentitiesstudied(Table2).
+About93.7percentofhospitalsengaged incooperativeplanning indevelopingorupdatinganemergencyresponseplanforpublichealthemergencieswith thestateorlocalofficeofemergencymanagement; thiswasnotsignificantlydifferentfromtheprevalencesforplanningwithotherhospitals(92.7percent),emergencymedicalservices(EMS)(89.0percent),stateorlocalpublic
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NationalHealthStatisticsReports n Number37 n March24,2011 Page3
Chemical Natural Epidemic Biological
P
ercent
SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2008.
Incident type
NUCRAD is nuclear-radiological. Significantly different from chemical and natural incidents (bothp < 0.05).
95% confidence interval
0
20
40
60
80
100
NUCRAD EXPINC
EXPINC is explosive-incendiary. Significantly different from chemical, natural, epidemic, and biological incidents(allp < 0.05).
99.0 97.8 94.1 93.2
81.3 79.6
Figure1.Percentageofhospitalswithemergencyresponseplansforselectedtypesofincidents:UnitedStates,2008
healthdepartments(88.7percent),orfiredepartments(86.0percent).
+Significantlyfewerhospitals includedhazardousmaterials teams(64.3percent)or theFederalBureauofInvestigation(19.0percent)intheiremergencyresponseplanning than theothersixentities listedabove.
+About18.7percentofhospitalsincludedalleightentitiesintheiremergencyresponseplanning.
Plansforcomponentsofhospitalpreparedness
Table3summarizesresponses toaseriesofquestionsaboutwrittenemergencyresponseplansfor48componentsofpreparednessforhospitalovercrowdingincidentsorpublichealthemergencies,andwhethertheplanswere implementedinanactual incidentduring2007.Broadcategoriesofhospitalpreparednessincludedmemorandaofunderstanding(MOUs)withotherhospitals,regionalcommunicationsystems,mutualaidagreements,expansionofonsitesurgecapacity,prioritysettingforlimitedresources,expansionofonsitehealthcareworkforce,masscasualtymanagement,managementofpediatricandotherspecialpopulations,andcommunicationstrategies.
MOUswithotherhospitals+About87.8percentofhospitalshadMOUswithoneormorehospitalstoacceptadultpatients,butonly56.2percenthadMOUswithoneormorechildrenshospitals toacceptpediatricpatientsintransferfromtheirownEDwhennobedswereavailableat thehospital.
+Only8.6percentofhospitalshadimplementedadulttransferMOUs,and8.0percenthad implementedpediatrictransferMOUsduringactualincidentsin2007.
+OnlyaboutonehalfofhospitalshadMOUswithburncenterstoacceptexplosiveincendiarymasscasualties(56.9percent),orwithotheroutpatientfacilities toaugmentoutpatientservices(42.8percent).
Regionalcommunicationsystems+About85.3percentofhospitalshadregionalcommunicationsystemstotrackEDclosuresordiversions.About29.2percentimplementedthesesystemsduringanactualincidentin2007.
+About80.6percentofhospitalshadregionalcommunicationsystemstotrackavailableadultintensivecareunit(ICU)beds,70.1percent trackedpediatricICUbeds,and64.8percenttrackedneonatalICUbeds.About22.6percent implementedadultICU
trackingsystems,16.9percentimplementedpediatricICU trackingsystems,and14.1percentimplementedneonatalICU trackingsystemsduringanactualincident in2007.
+Mosthospitalshadregionalcommunicationsystems to trackavailableadult(89.7percent),pediatric(82.0percent),andneonatal(67.8percent)hospitalbeds.Aboutonequarter implementedadult(30.4percent),pediatric(23.7percent),orneonatal(18.9percent)bedtrackingsystemsduringanactual incidentin2007.
+Only51.9percentofhospitalshadregionalcommunicationsystemstotrackspecialtycoverage.About15.1percentimplemented thissystemin2007.
Mutualaidagreements+About84.1percentofhospitalshadmutualaidagreementswithotheragenciestosharesuppliesandequipment.About16.3percentimplemented theseagreements in2007.
Expansionofon-sitesurgecapacity+About90.5percentofhospitalshadplansforisolationofairbornediseasepatients innegativepressurerooms.About14.2percent implementedtheseplans in2007(Table3,Figure2).
+About86.3percentofhospitalshadplansforcancellationofelectiveproceduresandadmissions.About12.9percentimplemented theseplansin2007.
+About73.7percentofhospitalshadplansforsettingup temporaryfacilitieswhen thehospitalisunusable(e.g.,withoutpowerorflooded).
+Manyhospitalshadplansforestablishmentofalternatecareareaswithbeds,staffing,andequipment innonclinicalspace(68.7percent),inpatientunithallways(52.3percent),ordecommissionedwardspace(49.7percent).
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Page4 NationalHealthStatisticsReports n Number37 n March24,2011
P
ercent
SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2008.
Component
95% confidence interval
0
20
40
60
80
100
50.7 49.7
Electivecancellations
Nonclinicalspace
Inpatienthallways
Intensivecare
conversion
Decommissionedward space
52.368.786.3
Figure2.Percentageofhospitalswithplansforselectedcomponentsofonsitesurgecapacityexpansion:UnitedStates,2008
+Only50.7percentofhospitalshadplansforconversionofinpatientunitstoaugment intensivecarecapacity.
Prioritysettingforlimitedresources+About72.4percentofhospitalshadwritten triageprocessesfor limitedintensivecareresources(Table3).
+About64.0percentofhospitalshadplansforregionalcoordinationofadjustedstandardsofcareduringapandemicorothermasscasualtyincident.
+About43.2percentofhospitalshadplansforimplementingadjustedstandardsofcareforinitiationandwithdrawalofmechanicalventilation.
+About32.9percentofhospitalshadplansfordeliveryofpotassium iodideinresponsetoradioactiverelease.
Expandingon-sitehealthcareworkforce+About88.8percentofhospitalshadaplanforcontinuityofoperations intheeventofanemergency.About14.9percent implementedthisplanduringanactualincident in2007.
+About6of10hospitalshadmutualaidagreementswithotheragenciestosharehealthcareproviders(69.5percent),orplansforadvanceregistrationofvolunteerhealthprofessionals(55.9percent).
+About6of10hospitalshadplansforstaffabsenteeismdue topersonalorfamily impactfrom theemergency(66.9percent),oronsitechildcaretomaintainstaffatthehospital(63.1percent).
Masscasualtymanagement+About94.6percentofhospitalshadplansforhospitalevacuations.
+Mosthospitalshadplansfortransporting largenumbersofpatientswithinthehospital(83.9percent)orbetweenhospitals(77.0percent).
+Only62.6percentofhospitalshadplansforanonsitelargecapacitymorgue.
Pediatrics+About42.6percentofhospitalshadatrackingsystemforaccompaniedandunaccompaniedchildren.
+About34.0percentofhospitalshadplansforreunificationofchildrenwithfamilies,and31.1percentforprotocols to identifyandprotectdisplacedchildren.
+About32.4percentofhospitalshadguidelinesfor increasingpediatricsurgecapacity.
+About29.4percentofhospitalshadplansforacquiringsuppliestoshelterhealthydisplacedchildren.
Specialpopulations+About73.3percentofhospitalshadplansforcommunicatingwithnonEnglishspeakingpatients.About15.4percentimplemented thoseplansduringanactual incidentin2007.
+Onlyaboutonehalfofhospitalshadplansforcommunicatingwithdeaf(58.3percent)orblind(47.5percent)patients.
+About47.6percentofhospitalshadplansforshelteringmobilityimpairedpatients.
+About46.7percentofhospitalshadplansforshelteringpatientswithspecialhealthcareneeds.About42.0percent implementedtheseplansduringanactualincident in2007.
+Onlyaboutonethirdofhospitalshadplansforshelteringpregnantwomen(39.2percent),mentallychallenged(39.0percent),or technologydependent(33.7percent)patients.
Communications+About93.4percentofhospitalshadplansforreceivingnotificationofalertsfrom thestateorlocalhealthdepartment.About34.5percentimplementedtheseplansduringanactual incidentin2007.
+About79.4percentofhospitalshadplansforparticipatingwithlocalpublichealthdepartmentsinpubliceducationabout theimportanceofinfluenzavaccination.About29.5percent implementedtheseplansduringanactualincident in2007.
Internalmasscasualtydrills,simulations,orexercises+ Inthelastyear,onehalf(50.6percent)ofhospitalsconductedmore thanone internaldrill;31.9percentconductedonlyoneinternaldrill;11.1percentconductednointernaldrills;andthenumberofinternaldrillswasunknownfor6.4percent(Tables4and5).
+Forthosehospitals inwhich thenumberofdrillswasknown, themediannumberofinternalfullscalesimulationsconductedwasone.
+Themediannumberofadultvictimsutilized ineachhospitals largestinternaldrillwas15.
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NationalHealthStatisticsReports n Number37 n March24,2011 Page5
Severe epidemics Mass vaccinations
P
ercent
SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2008.
Scenario type
Significantly different from severe epidemic drill scenarios (bothp < 0.05).
95% confidence interval
Community mass0
10
20
30
40
50
60
70
medication
22.5
58.5
32.5
Figure3.Percentageofhospitalsparticipatinginselectedmasscasualtydrillscenariotypes:UnitedStates,2008
+Themedianlengthofeachhospitalslongestinternaldrillwas4.0hours.
+Themediannumberoftabletopexercisesconductedin thelastyearbyahospitalwasone.
Externalmasscasualtydrills,simulations,orexercises+ In thelastyear,28.4percentofhospitalsconductedmore thanoneexternaldrill(i.e., incollaborationwithotherorganizations);53.6percentconductedonlyoneexternaldrill;11.5percentconductednoexternaldrills;andthenumberofexternaldrillswasunknownfor6.5percentofhospitals(Tables4and5).
+For thosehospitals inwhich thenumberofdrillswasknown, themediannumberoffullscalesimulationsconducted incollaborationwithotherorganizations(lawenforcement,healthdepartment,emergencymanagement,firedepartment,EMS,hazardousmaterialsteams,ordecontaminationteams)wasone.
+Themediannumberofadultvictimsutilizedineachhospitals largestexternaldrillwas16.
+Themedianlengthofeachhospitalslongestexternaldrillwas4.0hours.
+Themediannumberoftabletopexerciseshospitalsconductedin
collaborationwithotherorganizationswas0.5.
Typesofscenariosinmasscasualtydrills+About88.2percentofhospitalsaddressedgeneraldisasterandemergencyresponseintheirdrills,significantlymore thananyother typeofscenariostudied(Table6).
+About thesamepercentagesofhospitalsaddresseddecontaminationprocedures(69.6percent),severeepidemicsorpandemics(58.5percent),andchemicalaccidentsorattacks(55.6percent)in theirdrills.
+Comparedwithhospitalsstagingdecontaminationscenarios,significantlyfewerhospitals(42.5percent)focusedonacutedecontaminationofaerosolexposuresfrombiologicalaccidentsorattacks.
+Comparedwithhospitalsstagingsevereepidemicscenarios,aboutthesamepercentage(39.1percent)focusedondelayeddiseaseoutbreakmanagementforbiologicalaccidentsorattacks.However,significantlyfewerhospitalsaddressedmassvaccinations(32.5percent),massmedicationdistributiontohospitalpersonnel(30.6percent),ormassmedicationdistributiontothecommunity(22.5percent)(Figure3).
+ Formassmedicationdistribution,statisticallysimilarpercentagesofhospitalsfocusedonhospitalpersonnelandthecommunity.
+ In theirdrillsonbiologicalaccidentsorattacks,statisticallysimilarpercentagesofhospitalsfocusedonacutedecontaminationofaerosolexposuresanddelayeddiseaseoutbreakmanagement.
+About32.4percentofhospitalsaddressedexplosiveorincendiaryaccidentsorattacksin theirdrills,significantlyfewer thanscenariosforgeneraldisasters,decontamination,epidemics,orchemicalattacks,butstatisticallysimilar toscenariosforacutedecontaminationofbiologicalaerosolexposuresanddelayeddiseaseoutbreakmanagementforbiologicalattacks.
+About18.7percentofhospitalsaddressednuclearorradiologicalaccidentsorattacksin theirdrills,significantlyfewer thanscenariosforgeneraldisasters,decontamination,epidemics,chemicalattacks,oracutedecontaminationofbiologicalaerosolexposures,butstatisticallysimilartoscenariosfordelayeddiseaseoutbreakmanagementforbiologicalattacksandexplosions.
+ Statisticallysimilarpercentagesofhospitalsaddressedchildren(44.6percent)andthefrailelderly(36.2percent)intheirdrills.Butonly17.1percentaddressedmentallychallengedindividuals in theirdrills,significantly lessthanchildrenor thefrailelderly.
Collaborationwithoutsideorganizationsonmasscasualtydrills+Statisticallysimilarpercentagesofhospitalsperformeddrills,simulations,orexerciseswithstateorlocalofficesofemergencymanagement(85.8percent),stateorlocal lawenforcement(81.5percent),stateorlocalpublichealthdepartments(81.3percent),firedepartments(79.7percent),andfiredepartmentbasedEMS(72.1percent)(Table7).
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Page6 NationalHealthStatisticsReports n Number37 n March24,2011+About69.7percentofhospitalsperformeddrillswithEMSnotbasedinafiredepartment,significantlyfewerthanwithofficesofemergencymanagement,butstatisticallysimilartofiredepartmentbasedEMS, lawenforcement,publichealthdepartments,andfiredepartments.
+ Statisticallysimilarpercentagesofhospitalsperformeddrillswithdecontamination teams(58.4percent)andhazardousmaterialsteams(50.9percent).
+ Statisticallysimilarpercentagesofhospitalsperformeddrillswithschoolsystems(30.6percent), industrialorcommercialorganizations(25.8percent),orlongtermcarefacilities(20.4percent).
Masscasualtyresources+Forpersonalprotection, themediannumberofN95masksperhospitalwas432,and themediannumberofpersonalprotectivesuitswithpoweredairpurifyingrespiratorsperhospitalwas10(Table8).
+Themediannumbersofpatients thatcouldbehandledbyhospitaldecontaminationshowersperhourwassevenforambulatorypatients,three
for
small
children
or
infants,
and threeforstretcherpatients.
+Themediannumbersofbedsperhospitalwas70forregularinpatientstaffedbeds,8forcriticalcarebeds,11forEDtreatmentspaces,and4fornegativepressureisolationrooms.
+Themediannumberofmechanicalventilatorsperhospitalwassix.
AmbulancediversionWhenEDsareatcapacity,
ambulancediversion isimplemented.Thus,thenumberofannualhours thatanED isonambulancediversion,orthatahospital isondiversionfor traumaorcriticalcarecases,reflects thehospitalscapacitytoacceptnewpatients,notonlyduringroutineoperations,butalsoduringamasscasualty incident(Table9).+ In2007, themajorityofhospitals(58.7percent)didnotreportbeingonEDambulancediversion.About
16.3percentofhospitalswereonambulancediversionfor220hoursorless(equivalent toabout9.2days),whichrepresentedthemeanforthe91.2percentofhospitalsforwhichdatawereavailable.About16.2percentofhospitalswereonambulancediversionformore than220hours.Ambulancediversioninformationwasunknownfor8.7percentofhospitals.
+ In2007,themajorityofhospitals(72.5percent)didnotreportbeingontraumadiversion.About7.1percentofhospitalswereontraumadiversionfor32hoursorless(equivalenttoabout1.3days),whichrepresentedthemeanforthe85.2percentofhospitalsforwhichdatawereavailable.Theestimatewasunreliableforhospitalsontraumadiversionformore than32hours.Traumadiversioninformationwasunknownfor14.8percentofhospitals.
+ In2007, themajorityofhospitals(66.4percent)didnotreportbeingoncriticalcarediversion.About10.6percentofhospitalswereoncriticalcarediversionfor72hoursorless(equivalent tothreedays),whichrepresentedthemeanforthe84.5percentofhospitalsforwhichdatawereavailable.About7.5percentofhospitalswereoncriticalcarediversionformore than72hours.Criticalcarediversion informationwasunknownfor15.5percentofhospitals.
Hospitalpreparednessfunding
Between2002and2007,aboutonequarterofhospitals(24.3percent)receivedmorethan$150,000infederalpreparednessfunding,19.2percentreceivedmorethan$75,000butlessthan$150,000,and24.2percentreceivedmorethanzerobut lessthan$75,000.About5.2percentreceivednofunding.Theamountoffundingwasunknownfor27.2percentofhospitals(Table10).Discussion
Thisemergencyresponsepreparednesssupplementcontains
valuableinformationforfederal,state,andlocalplannerswhoareresponsibleforhospitalsresponsetoinfectiousdiseaseepidemicsandothermasscasualty incidents.In thisreport,baselineshavebeenestablishedfornewdataelements.Futureresearchwill tracktrendsbetween20032004and2008fordataelementsthatareunchanged,andidentifyhospitalcharacteristicsthatareassociatedwithemergencypreparedness.Thereareseveralkey issuesthatarehighlightedby thissurvey.
Whilenearlyallhospitalshaveemergencyresponseplansforchemicalreleases,naturaldisasters,epidemicsorpandemics,andbiologicalaccidentsorattacks,preparednessforexplosiveorincendiaryincidentsissignificantly lessfrequent thanpreparednessforothertypesofmasscasualty incidents.Asimilar trendwasfoundwithrespecttoincludingexplosionscenariosinmasscasualtydrills.Explosiveterrorismisinfrequent intheUnitedStates,withnoincidentshavingoccurredsincethe2001airlineattacksat theWorldTradeCenter,Pentagon,andoverPennsylvania(9).However,incendiaryincidents(fires)aremorecommon.TheU.S.FireAdministrationreported thattherewereabout15,500fires inhighrisestructuresbetween
1996
and
1998.
While
hospital
preparednessforfiresmostofteninvolvesreceivingcasualtiesfromincidentsoccurringelsewhere,it isnoteworthythatabout6percentof thesehighrisestructurefiresoccurredinhospitals(10).
EDcrowdingcontinuestobeamajorpolicyissue.TheInstituteofMedicine(IOM)hasexpressedconcernthatmanyhospitalsnowoperatingatornearfullcapacitylacktheability tohandlesuddenincreasesinvolumeassociatedwithmasscasualties(11).TheAmericanCollegeofEmergencyPhysicians(ACEP)recommends thathospitalsdevelopinfluenzapreparednessplans toassureadequateinpatientsurgecapacitybysuchmeansasopeningunusedareas,doublingup inpatientrooms,cancelingelectiveadmissionsandprocedures,andusingalternateareasforextracriticalcarespace(12).Wefoundthatwhilemosthospitalshadplansforcancellationofelective
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NationalHealthStatisticsReports n Number37 n March24,2011 Page7proceduresandadmissions,onlyabouttwothirdshadplansforestablishmentofalternatecareareaswithbeds,staffing,andequipmentinnonclinicalspace.Onlyaboutonehalfhadplansforestablishingalternatecareareasininpatientunithallwaysordecommissionedwardspace,orforconversionof inpatientunitstoaugmentintensivecarecapacity.OnepracticethatmaybeusefulindecompressingEDs isestablishingalternatecareareas ininpatienthallwaysuntilregularbedsbecomeavailable.Becauseofconcernsabout thesafetytopatientsof thisapproach,oneacademicEDstudiedadverseeventsresultingfrom theirinstitutionalprotocolforadmittingEDboardedpatientsto inpatienthallwaybedsduringovercrowdingsituations.InhospitalmortalityandICUtransferswerebothsignificantly lowerforpatientsadmittedtohallwaybedsthanforthoseadmitted tostandardinpatientbeds.Theauthorsconcluded thathallwayboardingwasnotharmful topatients(13).
Whenresourcesforpatientcarebecomescarceindisastersituations,IOMrecommends thedevelopmentofconsistentstatecrisisstandardsofcare(14).Oneexampleofsucharesource ismechanical
ventilators
for
patients
in
respiratoryfailuredueto infectiousagents thathavecompromisedlungfunction.Wefoundthatonlyaboutonehalfofhospitalshadadvanceplansforadjustedstandardsofcareforallocationofmechanicalventilatorsduringmasscasualty incidentswhennormalcapacitiesmightbeoverwhelmed.Butmodelsdoexistfordevelopingsuchstandards.Inonetertiarymedicalcenter,atriagesystemwasdevelopedandtestedfor institutingorcontinuingmechanicalventilationbasedonobjectiveclinicalfactorsrelated tosurvivalpotentialandavailableresources.Thesystem,whichinvolvesachange in thestandardofcare,wouldbe implementedthrough thehealthdepartmentandsupportedbyadeclarationfrom thestategovernorwithprofessionalliabilityprotections inplace(15).
ACEPrecommendsthathospitalscreateandexecuteatrainingprogram
basedupontheiremergencyoperationsplans,developpandemic influenzaexerciseprograms,andexecuteanexerciseto testthevalidityof thetrainingandplans(12).Asevidencedbythe2009H1N1 influenzaepidemic,massvaccinationandmedicationdistributionarefrequentlykeycomponentsofepidemicresponse.Wefound thatalthoughmore thanonehalfofhospitalshadstagedepidemicdrills,onlyaboutonethirdhadincludedmassvaccinationorcommunitymedicationdistributionspecifically.Inasurveyofhealthcareepidemiologistsfollowingtheexperienceof the2009H1N1influenzaepidemic,only60percentfeltthattheirhospitalswerewellpreparedforapandemic,and31percentreportedshortagesofantiviralmedications.Theauthorsidentifiedpandemicinfluenzaplanrevisionsandconsiderationofmandatoryinfluenzavaccinationsforhealthcareworkersas importantpriorities(16).
TheEmergencySystemforAdvanceRegistrationofVolunteerHealthProfessionalsGrantProgramoftheU.S.Officeof theAssistantSecretaryforPreparednessandResponsehelpshealthprofessionalsvolunteerinpublichealthemergenciesby
providing
verifiable
information
abouttheiridentity,license,credentials,andclinicalprivilegestoparticipatingmedicalfacilities(17).Despite theexistenceofthisfederal initiative,wefoundthataboutonehalfofhospitalshadplansforadvanceregistrationofoutsidehealthcareprofessionals.
Planningforspecialpopulations,includingchildren,appearstobelesscommon thanplanningforadultpatients.Forexample,ACEPrecommendsthatwritten transferprotocolsand interfacilityagreementsshouldbe inplacewhenpatienttransferispartofaregionalplan toprovideoptimalspecializedcare(18).WhilemosthospitalshaveMOUswithotherhospitals toacceptadultpatients intransferduringanepidemic,fewerhospitalshaveMOUsforpediatricandburnpatients.Similarly, less thanonehalfofhospitalshadvariousprogramsinplacetoaccommodatetheneedsofchildrenandpersonswith
disabilitiesduringapublichealthemergency.References1. NiskaRW,BurtCW.Bioterrorism
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11.InstituteofMedicineoftheNationalAcademies.Improvingtheefficiencyofhospitalbasedemergencycare.Chapter4in:Futureofemergencycare:Hospitalbasedemergencycareatthebreakingpoint.Washington,DC:NationalAcademiesPress12964.2007.
12.AmericanCollegeofEmergencyPhysicians.NationalstrategicplanforemergencydepartmentmanagementofoutbreaksofnovelH1N1influenza.Availablefrom:http://www.acep.org/assets/0/16/898/904/908/99911/b51b7c76e1e34123-
91a35416055544b5.pdf.13.ViccellioA,SantoraC,SingerAJ,
ThodeHCJr,HenryMC.Theassociation
between
transfer
of
emergencydepartmentboarderstoinpatienthallwaysandmortality:A4yearexperience.AnnEmergMed54(4):5113.2009.
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15.HickJL,OLaughlinDT.Conceptof
operationsfortriageofmechanicalventilationinanepidemic.AcadEmergMed13(2):2239.2006.
16.LautenbachE,SaintS,HendersonDK,HarrisAD.InitialresponseofhealthcareinstitutionstoemergenceofH1N1influenza:experiences,obstacles,andperceivedfutureneeds.ClinInfectDis50(4):52830.2010.
17.AssistantSecretaryforPreparednessandResponse.Emergencysystemforadvanceregistrationofvolunteerhealthprofessionalsgrantprogram.Availablefrom:http://www07.grants.gov/search/search.do?&mode=VIEW&oppId=54485.
18.AmericanCollegeofEmergencyPhysicians.Appropriateinterhospitalpatienttransfer.AnnEmergMed54(1):141.2009.
http://www.usfa.dhs.gov/downloads/pdf/tfrs/v2i18-508.pdfhttp://www.usfa.dhs.gov/downloads/pdf/tfrs/v2i18-508.pdfhttp://www.usfa.dhs.gov/downloads/pdf/tfrs/v2i18-508.pdfhttp://www.usfa.dhs.gov/downloads/pdf/tfrs/v2i18-508.pdfhttp://www.usfa.dhs.gov/downloads/pdf/tfrs/v2i18-508.pdfhttp://www.acep.org/assets/0/16/898/904/908/99911/b51b7c76-e1e3-4123-91a3-5416055544b5.pdfhttp://www.acep.org/assets/0/16/898/904/908/99911/b51b7c76-e1e3-4123-91a3-5416055544b5.pdfhttp://www.acep.org/assets/0/16/898/904/908/99911/b51b7c76-e1e3-4123-91a3-5416055544b5.pdfhttp://www.acep.org/assets/0/16/898/904/908/99911/b51b7c76-e1e3-4123-91a3-5416055544b5.pdfhttp://www.acep.org/assets/0/16/898/904/908/99911/b51b7c76-e1e3-4123-91a3-5416055544b5.pdfhttp://www.acep.org/assets/0/16/898/904/908/99911/b51b7c76-e1e3-4123-91a3-5416055544b5.pdfhttp://www.acep.org/assets/0/16/898/904/908/99911/b51b7c76-e1e3-4123-91a3-5416055544b5.pdfhttp://www.iom.edu/~/media/Files/Report%20Files/2009/DisasterCareStandards/Standards%20of%20Care%20report%20brief%20FINAL.pdfhttp://www.iom.edu/~/media/Files/Report%20Files/2009/DisasterCareStandards/Standards%20of%20Care%20report%20brief%20FINAL.pdfhttp://www.iom.edu/~/media/Files/Report%20Files/2009/DisasterCareStandards/Standards%20of%20Care%20report%20brief%20FINAL.pdfhttp://www.iom.edu/~/media/Files/Report%20Files/2009/DisasterCareStandards/Standards%20of%20Care%20report%20brief%20FINAL.pdfhttp://www.iom.edu/~/media/Files/Report%20Files/2009/DisasterCareStandards/Standards%20of%20Care%20report%20brief%20FINAL.pdfhttp://www.iom.edu/~/media/Files/Report%20Files/2009/DisasterCareStandards/Standards%20of%20Care%20report%20brief%20FINAL.pdfhttp://www.iom.edu/~/media/Files/Report%20Files/2009/DisasterCareStandards/Standards%20of%20Care%20report%20brief%20FINAL.pdfhttp://www.iom.edu/~/media/Files/Report%20Files/2009/DisasterCareStandards/Standards%20of%20Care%20report%20brief%20FINAL.pdfhttp://www.iom.edu/~/media/Files/Report%20Files/2009/DisasterCareStandards/Standards%20of%20Care%20report%20brief%20FINAL.pdfhttp://www.iom.edu/~/media/Files/Report%20Files/2009/DisasterCareStandards/Standards%20of%20Care%20report%20brief%20FINAL.pdfhttp://www.iom.edu/~/media/Files/Report%20Files/2009/DisasterCareStandards/Standards%20of%20Care%20report%20brief%20FINAL.pdfhttp://www.iom.edu/~/media/Files/Report%20Files/2009/DisasterCareStandards/Standards%20of%20Care%20report%20brief%20FINAL.pdfhttp://www.iom.edu/~/media/Files/Report%20Files/2009/DisasterCareStandards/Standards%20of%20Care%20report%20brief%20FINAL.pdfhttp://www07.grants.gov/search/search.do?&mode=VIEW&oppId=54485http://www07.grants.gov/search/search.do?&mode=VIEW&oppId=54485http://www07.grants.gov/search/search.do?&mode=VIEW&oppId=54485http://www07.grants.gov/search/search.do?&mode=VIEW&oppId=54485http://www07.grants.gov/search/search.do?&mode=VIEW&oppId=54485http://www07.grants.gov/search/search.do?&mode=VIEW&oppId=54485http://www07.grants.gov/search/search.do?&mode=VIEW&oppId=54485http://www07.grants.gov/search/search.do?&mode=VIEW&oppId=54485http://www07.grants.gov/search/search.do?&mode=VIEW&oppId=54485http://www07.grants.gov/search/search.do?&mode=VIEW&oppId=54485http://www07.grants.gov/search/search.do?&mode=VIEW&oppId=54485http://www07.grants.gov/search/search.do?&mode=VIEW&oppId=54485http://www.iom.edu/~/media/Files/Report%20Files/2009/DisasterCareStandards/Standards%20of%20Care%20report%20brief%20FINAL.pdfhttp://www.acep.org/assets/0/16/898/904/908/99911/b51b7c76-e1e3-4123-91a3-5416055544b5.pdfhttp://www.usfa.dhs.gov/downloads/pdf/tfrs/v2i18-508.pdf7/29/2019 Hospital Preparedness for Emergency Response
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NationalHealthStatisticsReports n Number37 n March24,2011 Page9Table1.Hospitalswithemergencyresponseplansforselectedtypesof incidents:UnitedStates,2008
NumberofTypeof incident hospitals Percent SE 95%confidence interval
Chemical accidents or attacks . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,162 99.0 0.3 98.1 99.5 Natural disasters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,095 97.8 0.8 95.4 98.9 Epidemics or pandemics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,904 94.1 1.9 88.9 96.9 Biological accidents or attacks. . . . . . . . . . . . . . . . . . . . . . . . . . . 4,859 93.2 2.2 87.4 96.5 Nuclearorradiologicalaccidentsorattacks. . . . . . . . . . . . . . . . . . . 4,235 81.3 4.5 70.7 88.6 Explosiveor incendiaryaccidentsorattacks . . . . . . . . . . . . . . . . . . 4,147 79.6 4.1 70.3 86.5 All types of incidents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,540 67.9 4.7 58.0 76.4 NOTES:Unweightedsamplesizeis294,representingaweightednationalestimateof5,212hospitals.SEisstandarderrorofpercent.
Table2.Hospitalsengagedincooperativeplanning indevelopingorupdatingaresponseplanforpublichealthemergencies,bytypeofentityengaged:UnitedStates,2008
NumberofTypeofoutsideentityengaged hospitals Percent SE 95%confidence interval
Stateor localofficeofemergencymanagement. . . . . . . . . . . . . . . . 4,884 93.7 1.9 88.7 96.6 Other hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,832 92.7 2.7 85.2 96.6 Emergency medical services. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,640 89.0 3.3 80.7 94.0 State or local public health department . . . . . . . . . . . . . . . . . . . . . 4,622 88.7 3.1 80.9 93.6 State or local law enforcement. . . . . . . . . . . . . . . . . . . . . . . . . . . 4,492 86.2 2.9 79.4 91.0 Fire department. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,483 86.0 3.4 77.9 91.5 Hazardous materials teams. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,351 64.3 5.6 52.6 74.5 Federal Bureau of Investigation . . . . . . . . . . . . . . . . . . . . . . . . . . 992 19.0 3.2 13.6 26.0 All eight entit ies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 973 18.7 3.2 13.2 25.7 NOTES:Unweightedsamplesizeis294,representingaweightednationalestimateof5,212hospitals.SEisstandarderrorofpercent.
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Table3.Hospitalshavingcomponents inawrittenplanforuseduringanovercrowdingincidentorpublichealthemergency,bytypeofplan2008Con.
InemergencyresponseplanTypeofplancomponent Number Percent SE 95%confidence interval Number
PediatricGuidelineson increasingpediatricsurgecapacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,687 32.4 3.9 25.2 40.5 * Protocolto identifyandprotectdisplacedchildrenrapidly. . . . . . . . . . . . . . . . . . . . . . . . . 1,621 31.1 3.7 24.4 38.8 * Trackingsystemforchildren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,222 42.6 4.1 34.8 50.9 * Reunificationofchildrenwithfamilies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,774 34.0 3.8 27.1 41.8 * Suppliesforshelteringhealthydisplacedchildren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,531 29.4 4.1 22.0 38.0 *
SpecialpopulationsCommunication withdeafpatients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,036 58.3 5.0 48.2 67.6 * Communication with blind pa ti en ts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,476 47.5 4.9 38.1 57.1 * Communication withnon-English-speakingpatients . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,820 73.3 4.2 64.3 80.7 804 Shelteringmobility-impairedpatients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,481 47.6 4.4 39.2 56.2 * Shelteringtechnology-dependentpatients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,757 33.7 3.9 26.5 41.8 * Shelteringpregnantwomen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,042 39.2 3.9 31.7 47.2 * Shelteringpatientswithspecialhealthcareneeds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,433 46.7 4.0 39.0 54.5 2187Shelteringmentallychallengedpatients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,034 39.0 3.9 31.6 47.0 *
Communications Notification ofalertsfromyourhealthdepartment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,866 93.4 2.3 87.1 96.7 1800Participation inpubliceducationabout influenzavaccination. . . . . . . . . . . . . . . . . . . . . . . 4,140 79.4 3.0 73.0 84.7 1536*Figuredoesnotmeetstandardsofreliability(fewerthan30unweightedcases).NOTES:Unweightedsamplesize is294,representingaweightednationalestimateof5,212hospitals.SE isstandarderrorofpercent.MOU ismemorandaofunderstanding.ED isemergencydepartm
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Page12 NationalHealthStatisticsReports n Number37 n March24,2011Table4. Internalandexternalmasscasualtydrills(numberandpercentdistribution):UnitedStates,2008
Numberof internaldrillsNumberof
Internaldrills hospitals Percent SE 95%confidence intervalTotal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,212 100.0 . . . . . . . . .N o dril ls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 578 11.1 2.4 7.2 16.8 One drill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,661 31.9 4.3 24.0 40.9 More than one dri l l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,638 50.6 5.5 39.9 61.3 Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335 *6.4 2.8 2.6 14.8
Drills incollaborationwithotherorganizationsNumberof
Numberofexternaldrills hospitals Percent SE 95%confidence intervalTotal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,212 100.0 . . . . . . . . .No dril ls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 599 11.5 2.5 7.4 17.5 One drill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,794 53.6 3.9 45.9 61.2 More than one dri l l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,482 28.4 3.9 21.4 36.7 Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337 *6.5 2.1 3.3 12.2 . . . Categorynotapplicable.*Figuredoesnotmeetstandardsofprecision(relativestandarderrorgreater than30%).NOTES:Totalunweightedsamplesize is294,representingaweightednationalestimateof5,212hospitals.SE isstandarderrorofpercent.
Table5. Internalandexternalmasscasualtydrills(mediannumberofdrills,numberofvictims,and lengthof longestdrill):UnitedStates,2008
InternaldrillsNumberofhospitals Median SE Interquartilerange
Full-scale simulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,877 1.1 0.1528 0.4 1.9Numberofvictims in largestdrill
Adul t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,058 14.9 2.5 4.8 26.1 Pediatric . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,752 *1.4 0.6 ** 4.2
Length of longest drill (hours) . . . . . . . . . . . . . . . . . . . . . . . . . . 4,271 4.0 0.5 3.4 20.3 Table-top exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,373 0.7 0.1 0.1 1.5
Externaldrills(incollaborationwithotherorganizations)Numberofhospitals Median SE Interquartilerange
Full-scale simulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,875 0.7 0.1 0.2 1.3 Numberofvictims in largestdrill
Adul t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,006 15.6 2.2 6.0 24.9 Pediatric . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,681 1.2 ** ** 4.6
Length of longest drill (hours) . . . . . . . . . . . . . . . . . . . . . . . . . . 4,189 4.0 0.5 3.9 19.5 Table-top exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,436 0.5 0.1 ** 1.3 *Figuredoesnotmeetstandardsofprecision(relativestandarderrorgreater than30%).**Notpossibletoextrapolatedata tocomputevalue.NOTES:Totalunweightedsamplesize is294,representingaweightednationalestimateof5,212hospitals.Numberofhospitalsexcludes those forwhich thenumberofdrillsisunknown.SE isstandarderrorofmedian.
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NationalHealthStatisticsReports n Number37 n March24,2011 Page13Table6.Typeofdrillscenarioamonghospitalsparticipating inmasscasualtydrills:UnitedStates,2008
NumberofTypeofscenario hospitals Percent SE 95%confidence interval
General disaster and emergency response. . . . . . . . . . . . . . . . . . . . . . . . 4,599 88.2 3.2 80.2 93.3 Decontamination procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,627 69.6 4.2 60.8 77.1 Severe epidemic or pandemic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,051 58.5 4.3 49.9 66.7 Chemical accidents or attacks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,898 55.6 4.3 47.0 63.9 Biologic accidents or attacks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Decontamination of aerosol exposure. . . . . . . . . . . . . . . . . . . . . . . . . . 2,213 42.5 4.0 34.9 50.4
Delayed disease outbreak management . . . . . . . . . . . . . . . . . . . . . . . . 2,038 39.1 5.4 29.0 50.2 Mass vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,692 32.5 4.6 24.1 42.1 Explosive or incendiary accidents or attacks . . . . . . . . . . . . . . . . . . . . . . . 1,689 32.4 3.6 25.8 39.8 Massmedicationdistributiontohospitalpersonnel . . . . . . . . . . . . . . . . . . . 1,597 30.6 4.9 22.0 41.0 Mass medication distribution to community . . . . . . . . . . . . . . . . . . . . . . . . 1,174 22.5 4.3 15.2 32.0 Nuclear or radiological accidents or attacks . . . . . . . . . . . . . . . . . . . . . . . 972 18.7 2.8 13.8 24.8 Specialpopulations
Chi ldren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,324 44.6 3.9 37.0 52.4 Frail elderly. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,886 36.2 4.0 28.6 44.5 Mentally challenged. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 892 17.1 3.6 11.2 25.3
NOTES:Unweightedsamplesizeis294,representingaweightednationalestimateof5,212hospitals.SEisstandarderrorofpercent.
Table7.Typeoforganizationwithwhichhospitalscollaborate inexternalmasscasualtydrills:UnitedStates,2008Hospitalcollaboratingwithorganization
NumberofTypeofcollaboratingorganization hospitals Percent SE 95%confidence interval
Stateor localofficeofemergencymanagement. . . . . . . . . . . . . . . . . . . . . 4,471 85.8 2.5 80.0 90.1 State or local law enforcement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,248 81.5 2.7 75.5 86.3 State or local public health department . . . . . . . . . . . . . . . . . . . . . . . . . . 4,235 81.3 3.3 73.8 87.0 Fire department. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,155 79.7 3.0 73.1 85.0 EMS: fire department based . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,760 72.1 3.7 64.3 78.8 EMS: not based in fire department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,633 69.7 4.0 61.2 77.0 Decontamination teams. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,042 58.4 4.0 50.3 66.1 Hazardous materials teams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,652 50.9 4.8 41.6 60.1 School systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,595 30.6 4.2 23.0 39.5 Industrial or commercial organizations. . . . . . . . . . . . . . . . . . . . . . . . . . .
1,347
25.8
4.1
18.7
34.6
Long-term care facilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,061 20.4 3.4 14.5 27.8 NOTES:Unweightedsamplesizeis294,representingaweightednationalestimateof5,212hospitals.SEisstandarderrorofpercent.EMS isemergencymedicalservices.
Table8.Selectedemergencyresponseresourcesandcapabilitiesinhospitals:UnitedStates,2008Numberof
Typeofequipment hospitals Median SE InterquartilerangeMechanical ventilators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,814 5.7 0.9 2.0 19.4 N95 masks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,912 432.1 78.0 128.2 1,494.7Personal protective suits with PAPR . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,705 9.7 1.0 5.4 19.2 Emergency department treatment spaces. . . . . . . . . . . . . . . . . . . . . . . . . 4,953 10.5 1.1 5.1 21.6 Crit ical care beds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,807 8.5 1.0 3.7 26.3 Negative pressure isolation rooms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,020 4.1 0.4 1.0 10.0 Regular inpatient staffed beds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,817 70.4 15.5 24.6 158.6Decontaminationshowers
Ambulatory patients per hour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,863 7.0 1.1 1.4 19.8 Stretcher patients per hour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,776 3.0 0.4 0.8 7.9 Small children or infants per hour . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,429 3.4 0.9 0.6 13.4
NOTES:Unweightedsamplesizeis294,representingaweightednationalestimateof5,212hospitals.Numberofhospitalsexcludes those forwhich thenumberofselectedresourcesorcapabilities isunknown.SEisstandarderrorofmedian.PAPR ispoweredairpurifyingrespirator.
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Page 14 National Health Statistics Reports n Number 37 n March 24, 2011Table9.Annualhoursspentondiversionstatus,bytypeofdiversion:UnitedStates,2008
Number ofDiversion type hospitals Percent SE 95% confidence interval
Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,212 100.0 . . . . . . . . .Ambulances to emergency department
N one. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,061 58.7 3.8 51.0 66.0 1 to 220 hours1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 850 16.3 2.8 11.5 22.6 More than 220 hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 846 16.2 2.8 11.4 22.5Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 8.7 1.8 5.8 13.0
TraumaN one. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,777 72.5 3.1 65.9 78.2 1 to 32 hours2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 370 7.1 1.9 4.2 11.7 More than 32 hours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295 *5.7 1.8 3.0 10.6 Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 770 14.8 2.0 11.2 19.3
Critical care casesN one. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,461 66.4 3.2 59.9 72.3 1 to 72 hours3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 551 10.6 2.3 6.9 16.0 More than 72 hours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393 7.5 1.7 4.8 11.6 Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 807 15.5 2.3 11.5 20.6
. . . Category not applicable. * Figure does not meet standards of precision (relative standard error greater than 30%). 1The mean was 220.4 hours. The median and mode were zero.2The mean was 31.6 hours. The median and mode were zero.3The mean was 72.1 hours. The median and mode were zero.NOTES: Unweighted sample size is 294, representing a weighted national estimate of 5,212 hospitals. SE is standard error.
Table10.Totalfundingreceivedperhospitalfromfederalhospitalpreparednessprograms:UnitedStates,20022007Funding Number ofhospitals Percent SE 95% confidence interval
Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,212 100.0 . . . . . . . . .N one . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1-$75,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $75,001-$150,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . More than $150,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U nknow n. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
270 1,259 1,002 1,265 1,416
*5.2 24.2 19.2 24.3 27.2
1.7 5.4 4.8 2.7 4.4
2.7 15.1 11.5 19.4 19.4
9.9 36.3 30.5 29.9 36.6
. . . Category not applicable.* Figure does not meet standards of precision (relative standard error greater than 30%). NOTE: Unweighted sample size is 294, representing a weighted national estimate of 5,212 hospitals. SE is standard error of percent.
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Page16 NationalHealthStatisticsReports n Number37 n March24,2011
AcknowledgmentsThisreportwasprepared in theDivisionofHealthCareStatistics.VictorShigaev,RobertoValverde,andElizabethRechtsteiner in theTechnicalServicesBranchperformed thesampleweightingandedited thedataset.NancySonnenfeldcontributedto thediscussionsection.ThereportwaseditedandproducedbyCDC/OSELS/NCHS/OD/OfficeofInformationServices, InformationDesignandPublishingStaff:BetsyM.Finleyeditedthereport; typesettingwasdonebyAnnetteF.Holman;andgraphicswereproducedbyJohnJeter.
SuggestedcitationNiskaRW,ShimizuIM.Hospitalpreparednessforemergencyresponse:UnitedStates,2008.Nationalhealthstatisticsreports;no37.Hyattsville,MD:NationalCenterforHealthStatistics.2011.
CopyrightinformationAllmaterialappearing inthisreport is in thepublicdomainandmaybereproducedorcopiedwithoutpermission;citationas tosource,however, isappreciated.
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