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Challenge of Hospital Emergency Preparedness: Analysis and Recommendations

Published online by Cambridge University Press:  08 April 2013

Abstract

In the United States, recent large-scale emergencies and disasters display some element of organized medical emergency response, and hospitals have played prominent roles in many of these incidents. These and other well-publicized incidents have captured the attention of government authorities, regulators, and the public. Health care has assumed a more prominent role as an integral component of any community emergency response. This has resulted in increased funding for hospital preparedness, along with a plethora of new preparedness guidance.

Methods to objectively measure the results of these initiatives are only now being developed. It is clear that hospital readiness remains uneven across the United States. Without significant disaster experience, many hospitals remain unprepared for natural disasters. They may be even less ready to accept and care for patient surge from chemical or biological attacks, conventional or nuclear explosive detonations, unusual natural disasters, or novel infectious disease outbreaks.

This article explores potential reasons for inconsistent emergency preparedness across the hospital industry. It identifies and discusses potential motivational factors that encourage effective emergency management and the obstacles that may impede it. Strategies are proposed to promote consistent, reproducible, and objectively measured preparedness across the US health care industry. The article also identifies issues requiring research. (Disaster Med Public Health Preparedness. 2009;3(Suppl 1):S74–S82)

Type
Concepts in Disaster Medicine
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2009

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References

REFERENCES

1.Priest L. Attack on the US. We Need Blood. February 4, 2006. http://www.theglobeandmail.com/special/attack/pages/rescue_article02.html. Accessed March 16, 2009.Google Scholar
2.Kirschenbaum, L, Keene, A, O’Neill, P, et alThe experience at St. Vincent’s Hospital, Manhattan, on September 11, 2001: preparedness, response, and lessons learned. Crit Care Med. 2005;33 (Suppl 1):S48S52.CrossRefGoogle ScholarPubMed
3.Jurkovich, T.September 11th—the Pentagon disaster response and lessons learned. Crit Care Nurs Clin N Am. 2003;15:143148.Google Scholar
4.Marcozzi, D, Sanders, M, Vanderwagen, WC.A nation prepared: inspiration in the face of tragedy. Disaster Med Public Health Preparedness. 2007;1:S6S8.CrossRefGoogle ScholarPubMed
5.Maldin, B, Lam, C, Franco, C, et alRegional approaches to hospital preparedness. Biosecur Bioterror. 2007;5:4353.Google Scholar
6.Gray BH, Hebert K. After Katrina: Hospitals in Hurricane Katrina. Challenges Facing Custodial Institutions in a Disaster. Urban Institute Web site. July 2006. http://www.urban.org/UploadedPDF/411348_katrinahospitals.pdf. Accessed October 20, 2008.Google Scholar
7.Light PC. The Katrina Effect on American Preparedness. New York University Center for Catastrophe Preparedness and Response. 2006. http://www.nyu.edu/ccpr/katrina-effect.pdf. Accessed March 16, 2009.Google Scholar
8.VHA Capabilities Assessment Program. Veterans Health Administration Web site. 2008. http://www1.va.gov/EMSHG/page.cfm?pg=133. Accessed October 12, 2008.Google Scholar
9.Emergency Preparedness States Are Planning for Medical Surge, but Could Benefit from Shared Guidance for Allocating Scarce Medical Resources. GAO-08-668.Washington, DC: United States Government Accountability Office; 2008:2223.Google Scholar
10.Braun, BI, Wineman, NV, Finn, NL, et alIntegrating hospitals into community emergency preparedness planning. Ann Intern Med. 2006;144:799811.Google Scholar
11.Iglehart, JK.The American health care system. Community hospitals. N Engl J Med. 1993;329:372376.Google Scholar
12.Barbera JA, Macintyre AG, DeAtley CA. Ambulances to Nowhere: America’s Critical Shortfall in Medical Preparedness for Catastrophic Terrorism. John F. Kennedy School of Government Web site. October 2001. http://belfercenter.ksg.harvard.edu/publication/2788/ambulances_to_nowhere.html. Accessed September 29, 2008.Google Scholar
13.Pellegrino, ED.The commodification of medical and health care: the moral consequences of a paradigm shift from a professional to a market ethic. J Med Philos. 1999;24:243266.Google Scholar
14.Visits to US Emergency Departments at All-time High: Number of Departments Shrinking. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/od/oc/media/pressrel/r050526.htm. Accessed September 29, 2008.Google Scholar
15.Action Needed to Bolster Nation’s Emergency Care System; Lack of Funds, Coordination Lead to Overcrowding and Ambulance Diversions. The National Academies Web site. June 14, 2006. http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=06142006. Accessed October 12, 2008.Google Scholar
16.Kaji, AH, Koenig, KL, Lewis, RJ.Current hospital disaster preparedness [editorial]. JAMA. 2007;298:21882190.CrossRefGoogle ScholarPubMed
17.Hospital Preparedness Program. US Department of Health and Human Services Web site. http://www.hhs.gov/aspr/opeo/hpp. Accessed September 30, 2008.Google Scholar
18.Metropolitan Medical Response System, Federal Emergency Management Agency. http://www.fema.gov/mmrs. Accessed September 30, 2008.Google Scholar
19.Urban Areas Security Initiative Nonprofit Security Grant Program (UASI-NSGP). Federal Emergency Management Agency Web site. http://www.fema.gov/government/grant/uasi/index.shtm. Accessed September 30, 2008.Google Scholar
20.Auf der Heide E. Disaster Response: Principles of Preparation and Coordination. 1989. http://orgmail2.coe-dmha.org/dr/Images/Main.swf. Accessed October 12, 2008.Google Scholar
21.Cherry, RA, Trainer, M.The Current Crisis in Emergency Care and the Impact on Disaster Preparedness. BMC Emerg Med. 2008;8:7.Google Scholar
22.Brady D. Terrorism: put the money where the danger is. Business Week Web site. April 14, 2003. http://aol.businessweek.com/magazine/content/03_15/b3828618.htm. Accessed September 20, 2008.Google Scholar
23.Braun, BI, Darcy, L, Divi, C, et alHospital bioterrorism preparedness linkages with the community: improvements over time. Am J Infect Control. 2004;32:317326.Google Scholar
24.Medical Center Hazard and Vulnerability Analysis. http://www.njha.com/ep/pdf/627200834041PM.pdf. Accessed October 12, 2008.Google Scholar
25.Hazard Vulnerability Analysis. American Society for Healthcare Engineers Web site. 2000. http://www.ashe.org/ashe/products/pubs/hazvulanalysis.html. Accessed October 12, 2008.Google Scholar
26.National Planning Scenarios. Homeland Security Council and Department of Homeland Security. April 2005. http://media.washingtonpost.com/wp-srv/nation/nationalsecurity/earlywarning/NationalPlanningScenariosApril2005.pdf. Accessed September 30, 2008.Google Scholar
27.Kaji, AH, Lewis, RJ.Hospital disaster preparedness in Los Angeles County. Acad Emerg Med. 2006;13:11981203.Google Scholar
28.Auf der Heide, EA.The importance of evidence-based disaster planning. Ann Emerg Med. 2006;47:3449.Google Scholar
29.Niska, RW, Burt, CW.Bioterrorism and mass casualty preparedness in hospitals: United States, 2003. Adv Data. 2005;364:114.Google Scholar
30.Dara, SI, Ashton, RW, Farmer, JC.Engendering enthusiasm for sustainable disaster critical care response: why this is of consequence to critical care professionals. Crit Care. 2005;9:125127.Google Scholar
31.Torres GW. For Emergency’s Sake. Hospitals & Health Networks Web site. August 2, 2005. http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/PubsNewsArticle/data/050802HHN_Online_Torres&domain=HHNMAG. Accessed December 14, 2008.Google Scholar
32.Ransom, MM, Goodman, RA, Moulton, AD.Addressing gaps in health care sector legal preparedness for public health emergencies. Disaster Med Public Health Preparedness. 2008;2:5056.Google Scholar
33.Keim, ME, Pesik, N, Twum-Danso, N.Lack of hospital preparedness for chemical terrorism in a major US city: 1996–2000. Prehosp Disaster Med. 2003;18:193199.CrossRefGoogle Scholar
34.Greenberg, MI, Jurgens, SM, Gracely, EJ.Emergency department preparedness for the evaluation and treatment of victims of biological or chemical terrorist attack. J Emerg Med. 2002;22:273278.CrossRefGoogle ScholarPubMed
35.American Public Health Association. Resource Guide: Federal Assistance Programs for Terrorism Preparedness. http://www.apha.org/advocacy/priorities/issues/rebuilding/legislativebuildresourceguide.htm. Accessed October 12, 2008.Google Scholar
36.HHS Announces $25 Million Available for Health Care Partnership Emergency Care Competitive Grants Program. US Department of Health and Human Services Web site. August 10, 2007. http://www.hhs.gov/news/press/2007pres/08/pr20070810a.html. Accessed October 12, 2008.Google Scholar
37.HHS Awards Health Care Facilities Partnership Program Grants. US Department of Health and Human Services Web site. September 27, 2007. http://www.hhs.gov/news/press/2007pres/09/20070927c.html. Accessed October 12, 2008.Google Scholar
38.Statement by Michael O. Leavitt, Secretary, US Department of Health and Human Services, on HHS Leadership in Federal Emergency Preparedness Efforts Before House Committee on Oversight and Government Reform. May 07, 2008. http://www.hhs.gov/asl/testify/2008/05/t20080507a.html. Accessed October 12, 2008.Google Scholar
39.Smith C. Hospital Emergency Preparedness Funding Decreases. Healthcare Association of New York State Web site. June 11, 2008. http://www.hanys.org/news/index.cfm?storyid=359 Accessed October 12, 2008.Google Scholar
40.Pub L 107-188.Google Scholar
41.The Hospital Preparedness Program. Assistant Secretary for Preparedness and Response, Department of Health and Human Services Web site. http://www.hhs.gov/aspr/opeo/hpp. Accessed September 28, 2008.Google Scholar
42.Emergency Management Strategic Healthcare Group. US Department of Veterans Affairs Web site. http://www1.va.gov/emshg. Accessed September 30, 2008.Google Scholar
43.Joint Commission Standards Improvement Program. Hospital Accreditation Program—Accreditation Requirements, Emergency Management Chapter (Effective January 1, 2009). http://www.jointcommission.org/Standards/SII/sii_hap.htm. Accessed September 30, 2008.Google Scholar
44.Schultz, CH, Mothershead, JL, Field, M.Bioterrorism preparedness: I. The emergency department and hospital. Emerg Med Clin North Am. 2002;20:437455.Google Scholar
45.NFPA: National Fire Protection Association, With Relevant Standards That Include NFPA 1600 and NFPA 99. http://www.nfpa.org. Accessed March 16, 2009.Google Scholar
46.ASTM E2413-04 Standard Guide for Hospital Preparedness and Response. ASTM International Web site. http://www.astm.org. Accessed March 16, 2009.Google Scholar
47.New York State Department of Health “Dear CEO” Letter Sent to Hospital CEOs in New York City (November 22, 2005): Hospital Evacuation Plan Requirements and Templates. http://www.gnyha.org/182/Default.aspx. Accessed October 12, 2008.Google Scholar
48.Lanser, EG.America under attack: ACHE affiliates respond. Health Exec. 2002;2:1218.Google Scholar
49.Eastwood, GL.Academic health care centers and the war on terrorism. J Public Health Manag Pract. 2003;9:433436.Google Scholar
50.Broadway, RL.Anthrax threat intensifies focus on disaster preparedness—executive insights. Healthc Finance Manage. 2002;56:2831.Google Scholar
51.Berman, MA, Lazar, EJ.Hospital emergency preparedness—lessons learned since Northridge. N Engl J Med. 2003;348:13491355.Google Scholar
52.Healthcare Executives’ Role in Emergency Preparedness. Policy statement, American College of Healthcare Executives Web site. November 2006. http://www.ache.org/policy/emergency_preparedness.cfm. Accessed September 30, 2008.Google Scholar
53.Emergency Readiness. American Hospital Association Web site. http://www.aha.org/aha_app/issues/Emergency-Readiness/index.jsp. Accessed October 12, 2008.Google Scholar
54.Lurie N. Public health preparedness. An opportunity and a challenge. RAND Rev. 2006;Summer:26–29.Google Scholar
55.Case studies. Harvard Business Publishing for Educators Web site. http://www.hbsp.harvard.edu. Accessed October 12, 2008.Google Scholar
56.National Strategy for Homeland Security. Office of Homeland Security Web site. July 2002. http://www.whitehouse.gov/homeland/book. Accessed September 27, 2008.Google Scholar
57.National Strategy for Homeland Security. The White House Web site. October 2007. http://www.whitehouse.gov/infocus/homeland/nshs/2007/index.html. Accessed September 27, 2008.Google Scholar
58.Public Health and Hospital Emergency Preparedness Programs: Evolution of Performance Measurement Systems to Measure Progress. GAO-07-485R. March 23, 2007. http://markey.house.gov/docs/health/GAO%20-%20Mar%2023%20-%20Public%20Health%20Preparedness.pdf. Accessed September 28, 2008.Google Scholar
59.Interim National Preparedness Goal, Homeland Security Presidential Directive 8: National Preparedness. Department of Homeland Security Web site. March 31, 2005. http://www.ojp.usdoj.gov/odp/docs/InterimNationalPreparednessGoal_03-31-05_1.pdf. Accessed September 28, 2008.Google Scholar
60.De Lorenzo, RA.Financing hospital disaster preparedness. Prehospital Disast Med. 2007;22:436439.Google Scholar