ED Disaster Preparedness

Frontline Hospitals Role

There are countless factors that are paramount in the handling of disasters in EDs. The recent unspeakable tragedies at the World Trade Center, the Pentagon, and in Pennsylvania illustrate, once again, that horrible, unpredictable disasters can and do occur. It becomes quite clear that hospital emergency departments must be equipped with proven disaster relief systems ready to be activated at a moment's notice. After all, not even the most effective emergency and fire rescue efforts will be successful if hospitals are unprepared to deal with large volumes of patients under various degrees of distressed circumstances.

• EDs must have clear, predefined processes and scenarios in place that can immediately be activated based on the event.
• These events could include hazardous materials (HAZMAT) attacks, or biological terrorism incidents, which have broad geographical reach.
• Therefore, all hospital EDs, large or small, urban or rural, must be prepared to meet with the internal and external challenges associated with terrorist attacks.
• The readiness system must be customized to the facility, internalized, tested, and optimized; it cannot simply rely on the mandates or actions of external bodies or be developed as the events occur.

Achieving disaster readiness is now a national matter; it will take training, time, and funding to develop a solid, integrated approach. The recent successes of the triage system in NYC must be applied to all hospitals and optimized to address the uncertainty of our world. Now is the time, more than ever, for hospitals to install disaster readiness systems, as recent history has shown us that the unthinkable can reoccur.

Current ED Preparedness

Our hospitals and their staff are simply not ready to handle large-scale disasters. They lack the necessary components of preparedness, which include planning, purchase of adequate equipment and supplies, training, and simulated disaster preparedness drills. According to an August, 2000 final report titled, "Hospital Preparedness for Mass Casualties", that was prepared by the American Hospital Association, other components of preparedness include community-wide preparedness, staffing issues, communications issues, and public policy.

• American hospitals, especially small and rural hospitals, are woefully unprepared to handle the major influx of trauma patients that would result from a chemical or nuclear terrorism attack or a large-scale natural disaster.
• In an exposed population of 100,000 people, a theoretical bioterrorist attack releasing Bacillus anthracis spores into prevailing winds could cause up to 50,000 anthrax cases, with more than 32,000 deaths.
• Massive numbers of infected patients would need to be diagnosed and treated.
• Anticipated injuries from a large-scale natural disaster or nuclear attack might include high velocity wounds, crush injuries, shrapnel wounds, and thermal or chemical burns.

Our hospitals should be prepared for, and have the competency to respond to, the unique nature of biological, chemical, and nuclear disasters. They should also have the ability to adequately evacuate patients to downstream care facilities. Unfortunately, even major metropolitan hospitals lack adequate preparedness. Rural or small community frontline hospitals--those hospitals to which the first casualties of a mass disaster might be taken--are even more unprepared. While the task of readying our nation's hospitals to cope with large-scale terrorist attacks is formidable, the consequences of a lack of preparedness would be disastrous.

• A recent study showed that fewer than 20% of hospitals surveyed had plans for biological or chemical weapons incidents.
• Less than half had appropriate decontamination units, only 12% had appropriately isolated sources of air, and only 6% had appropriate resources for treating a chemical incident such as a sarin attack.
• While 64% of responding hospitals had antibiotics sufficient to treat 50 anthrax patients, only 29% were prepared to treat 50 sarin victims with atropine, and no hospitals had adequate supplies of pralidoxime.

Small community and rural hospitals attract the least attention from the healthcare industry because there is little return on investment in focusing on them. This is true despite the fact that proportionally smaller EDs see more emergency care than larger facilities. It is interesting to note that a small rural hospital is more likely to have an ED than the same size hospital in an urban area.

Unfortunately, the ignored and ill-prepared frontline hospitals will be forced to deal with the consequences and fear of biological, chemical, and nuclear terrorism in their communities.

Emergency Medical Response Grid Solution

One of the recommendations of the CDC Report on Biological and Chemical Terrorism is that "a cadre of well-trained health-care and public health workers will be available in every state. Their terrorism-related activities will be coordinated through a rapid and efficient communication system that links U.S. public health agencies and their partners."

To address the problem of lack of preparedness for major disasters, CEHI will establish an interactive collaborative network of frontline and small EDs, leading re-engineering experts, and key collaborators--an Emergency Medical Response Grid (EMRG). We believe that implementation of this program will greatly improve hospital response capabilities, not only during large-scale disasters such as a terrorist attack, but during day-to-day operation of frontline hospital EDs.

• Optimal Readiness and Response: Frontline and small community hospitals do not have the resources to provide disaster readiness services to address mass casualties of biological, chemical, and nuclear weapons of mass destruction. By collaborating and sharing the responsibilities for such special services with other hospitals in overlapping service areas, and by using a common web-based Knowledge Management System, our hospital leaders can develop optimal readiness and response capabilities.
• Effective Communication: One of the features of the EMRG, will be improved communications between medical personnel and members of the press and public. This is needed to reduce panic during a major terrorist attack. Communication is one of five major areas targeted for improvement in the CDC Report on Bioterrorism. According to this report, "effective communication with the public through the news media will also be essential to limit terrorists' ability to induce public panic and disrupt daily life."
• Early Warning System: With improved diagnostic capabilities and enhanced communication abilities, an EMRG could provide an "early warning system" in the event of a biological terrorist attack or outbreak of new infectious diseases.
• Development of a Grid: Collaboration and shared resources and capabilities will provide an important interface for all parties involved. While the 30-team program proposed here is not going to constitute flipping a switch that turns on a national EMRG, it is an important first step to the development of such a grid.
  
  Click here or on graphic below for EMRG animation.