Urban hospitals may have better emergency response planning than rural

October 2007

Large urban hospitals have had more comprehensive revised emergency response plans than smaller rural hospitals since the Sept. 11 terrorist attacks, according to results published in Advance Data.

“Nearly all hospitals revised their emergency response plans after the events of Sept. 11, 2001, but only two-thirds addressed all five preparedness areas: natural disasters and biological, chemical, radiological and explosive terrorism,” Richard Niska, MD, MPH, medical epidemiologist for the ambulatory care statistics branch of the CDC/National Center for Health Statistics, told Infectious Disease News.“ Comprehensive plans that addressed all 10 of the response plan components were completed in only a small minority of hospitals. Larger hospitals did better than smaller ones in developing comprehensive response plans.”

Niska and colleague Catharine W. Burt, EdD, conducted a study using information from the Bioterrorism and Mass Casualty Preparedness Supplements to the 2003 and 2004 National Hospital Ambulatory Medical Care Surveys.

Conducted yearly by the CDC and the National Center for Health Statistics, the surveys are sent to nonfederal general and short-stay hospitals with emergency and outpatient departments under the supervision of physicians, according to the researchers. The organizations use the results to provide national estimates of variations in hospital emergency response plans and resources by residency and medical school affiliation, hospital size, ownership, metropolitan statistical area status and Joint Commission on Accreditation of Healthcare Organizations accreditation.

The researchers’ objective for this study was to provide a baseline assessment of hospital characteristics associated with better disaster preparedness.

Of the 874 hospitals sampled in 2003 and 2004 that met the participation requirements, administrators from 739 of the hospitals responded to the survey.

Survey questions addressed topics regarding emergency response plans within the hospitals, including 10 specific components:

• Integration into community-wide planning.
• Cooperative planning with other health care facilities.
• Memoranda of understanding with outlying hospitals to accept inpatients during a disaster.
• Alternate care sites.
• Cancellation of elective procedures and admissions.
• Conversion of post-anesthesia unit to augment intensive care.
• Activation of decommissioned wards.
• Use of nonclinical space for medical purposes.
• Antibiotic and supply stockpiles.
• Coordinated supply-chain management of pharmaceuticals and other supplies.

According to the researchers, about 91.9% of the hospitals surveyed reported revising their emergency response plans since Sept. 11.

“Nearly all hospitals affiliated with medical schools (99.1%) had revised their plans,” the researchers wrote.

Among the other characteristics that were associated with revised plans were having a residency program, bed capacity and ownership, according to the researchers.

“Few hospitals (8.8%) had provided for all 10 content elements studied in their emergency response plans,” the researchers wrote. “Hospitals with 300 or more beds provided for all 10 more frequently than those with fewer than 100 beds.”

On average, the hospitals surveyed provided for 5.8 of the 10 components; urban hospitals included more components than rural hospitals, according to the researchers.

Niska and Burt also found that more than 78.8% of the hospitals reported defining their role in community-wide planning and, when appropriate, being integrated into that planning. Additionally, 77.6% of the hospitals engaged in cooperative planning with other local health care facilities.

However, “only 52.1% had entered into memoranda of understanding that allowed transfer of inpatients during a disaster,” the researchers wrote.

Regarding expansion capacity during an emergency, the researchers found that 73.1% of the hospitals surveyed had planned for cancellation of elective procedures and admissions, 65.5% had plans to establish an alternate care site, and 59.8% had plans to use nonclinical space for medical purposes. Furthermore, 39.9% of the hospitals planned to convert their post-anesthesia units to augment intensive care, and 27.9% had plans to activate decommissioned wards.

According to the researchers, 58.9% of the hospitals provided for coordinated supply-chain management of critical supplies and medications, and 45.3% provided for stockpiles of antibiotics and supplies.

Survey data showed an average of 12 mechanical ventilators, 14.1 personal protective suits, 6.6 negative pressure isolations rooms, 20.5 critical care beds and 1.7 decontamination showers reported per hospital; according to the researchers, urban hospitals had more of each of these resources than did rural hospitals (see chart).

Of the hospitals surveyed, 63.2% reported that they had addressed natural disasters as well as each of the four terrorism types.

Preparation for incidents

The researchers found that hospitals with residency programs addressed biological, chemical and explosive incidents more frequently than those without residencies, and those with medical school affiliations addressed chemical incidents more frequently than those without affiliations.

Hospitals with fewer than 100 beds addressed biological, radiological and explosive incidents less often than did those with more than 100 beds. Hospitals with fewer than 100 beds addressed chemical exposure less frequently than hospitals with 200 beds or more, according to the researchers.

Additionally, “urban hospitals addressed biological, chemical, radiological and explosive incidents more frequently than rural hospitals,” the researchers wrote.

Urban hospitals also had two times the decontamination capacity of rural hospitals.

Overall, the results were not surprising, according to Niska, because the data were collected at a time when hospital preparedness funding had not been fully disseminated.

To increase the number of hospitals with comprehensive emergency response plans, change must occur at all levels.

“Change would start with hospital leaders, who should identify gaps in their plans, especially as they pertain to preparedness for epidemics, natural disasters and explosions,” Niska said. “Hospital staff and health care workers should participate in the development of these plans as their expertise allows.”

For more information:

• Niska RW, Burt CW. Emergency response planning in hospitals, United States: 2003-2004. Adv Data. 2007;391:1-13.