Hospital Preparedness for Emergency Response: United States, 2008

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Hospital Preparedness for Emergency Response: United States, 2008. Richard Niska, MD, MPH, FACEP Captain, USPHS Iris M. Shimizu, PhD National Center for Health Statistics 22 June 2011. Objective. Summary of hospital preparedness for responding to public health emergencies: Mass casualties - PowerPoint PPT Presentation

Transcript of Hospital Preparedness for Emergency Response: United States, 2008

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Hospital Preparedness for Emergency Response:United States, 2008Richard Niska, MD, MPH, FACEPCaptain, USPHS

Iris M. Shimizu, PhD

National Center for Health Statistics

22 June 2011ObjectiveSummary of hospital preparedness for responding to public health emergencies:Mass casualties Epidemics of naturally occurring diseasesPrior workBioterrorism and Mass Casualty Preparedness Supplement2003-2004National Hospital Ambulatory Medical Care Survey (NHAMCS)Funded by Office of the Assistant Secretary for Planning and Evaluation (OASPE)Publications from 2003-2004 supplementHospital collaboration with public safety organizations on bioterrorism response. Prehospital Emergency Care; 2008; 12:12-17.

Emergency response planning in hospitals, US: 2003-04. Advance Data from Vital and Health Statistics; 2007; 391. www.cdc.gov/nchs/data/ad/ad391.pdf

Percentage of hospitals with staff members trained to respond to selected terrorism-related diseases or exposures NHAMCS, US, 2003-04. MMWR. 2007; 56(16):401. www.cdc.gov/mmwr/preview/mmwrhtml/mm5616a6.htm

Training for terrorism-related conditions in hospitals: US, 2003-04. Advance Data from Vital and Health Statistics, 2006; 380. www.cdc.gov/nchs/data/ad/ad380.pdf

Percent of hospitals having plans or holding drills for attacks by explosion or fire. MMWR, 2005; 54(42). www2c.cdc.gov/podcasts/download.asp?f=1096061&af=h&t=1

Bioterrorism and mass casualty preparedness in hospitals: US, 2003. Advance Data from Vital and Health Statistics, 2005; 364. www.cdc.gov/nchs/data/ad/ad364.pdfCurrent workPandemic Emergency Response Preparedness Supplement 2008Parent survey: NHAMCSAgain funded by OASPEMethods:NHAMCSNHAMCS uses a national probability sample:U.S. nonfederal general and short-stay hospitalsData weighted to produce national estimates

Collects facility & visit level hospital characteristicsFacility level: emergency response supplementVisit level: emergency and outpatient department records

Methods:Emergency response supplementEight-page survey instrument

Delivered on site to hospital administrator by U.S. Census Bureau field representative

Self-administered by hospital staff member deemed appropriate by administrator

Collected later by Census field representative

Emergency response plansScenarios:Hospital overcrowdingDisastersMass casualtiesDisease outbreaksTerrorism

Choices:in emergency response planimplemented in actual incident during 2007not in emergency response plan

Percent95% confidence intervalsPercent of hospitals with emergency response plans for selected types of incidents:United States, 2008NUC-RAD = Nuclear-radiological. (2) EXP-INC = Explosive-incendiarySOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2008 9Collaboration with outside entitiesMemorandum of understanding (MOU) with other hospitals to accept patients in transfer from the emergency department when no beds are available:adultspediatric patients to childrens hospitals

MOU with regional burn center to accept transfers in the aftermath of an explosive or incendiary incident

MOU with other outpatient facilities to augment outpatient services

Regional communication systems to track:emergency department closures or diversionsavailable intensive care unit beds (adult, pediatric, neonatal)available hospital beds (adult, pediatric, neonatal)specialty coverage

Mutual aid agreements with other agencies to share supplies and equipment

Percent95% confidence intervalsPercent of hospitals having memorandum of understanding to accept emergency department transfers during overcrowding incidents or public health emergencies, by receiving hospital type:United States, 2008SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 200811Expansion of on-site surge capacityCancellation of elective procedures and admissions

Isolation of airborne disease patients in negative pressure areas

Conversion of inpatient units to augment intensive care unit (ICU) capacity

Alternate care areas with beds, staffing and equipmentinpatient unit hallwaysdecommissioned ward spacenon-clinical space

Setting up temporary facilities when the hospital is unusable (without power, flooded, etc.)

Percent95% confidence intervalsPercent of hospitals with plans for selected components of on-site surge capacity expansion: United States, 2008SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 200813Priority setting for limited resourcesDelivery of potassium iodide in response to radioactive release

Adjusted standards of care for initiation and withdrawal of mechanical ventilation

Triage processes for limited intensive care resources

Regional coordination of standards of care during a pandemic or other mass casualty incident

Percent of hospitals having written plan for adjusted standards of care for mechanical ventilators during a public health emergency:United States, 2008SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 200815Expanding on-site health care work forceContinuity of operations

Mutual aid agreements to share health care providers

Advance registration of volunteer health professionals

Staff absenteeism due to personal impact from the emergency

On-site child care to maintain staff in hospital

Percent of hospitals having written plan for advance registration of volunteer health professionals during a public health emergency:United States, 2008SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 200817Mass casualty managementWithin-hospital transport of large patient numbers

Inter-hospital transport of large patient numbers

Hospital evacuations

Establishing an on-site large capacity morgue

Percent95% confidence intervalsPercent of hospitals with plans for selected components of mass casualty management:United States, 2008SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 200819PediatricGuidelines on increasing pediatric surge capacity

Protocol to identify and protect displaced children rapidly

Tracking accompanied and unaccompanied children

Reunification of children with families

Supplies for sheltering healthy displaced childrenPercent95% confidence intervalsPercent of hospitals with plans for selected components related to pediatrics:United States, 2008

21Special populationsCommunication with:deaf patientsblind patientsnon-English-speaking patients

Sheltering of:mobility-impaired patientstechnology-dependent patientspregnant womenpatients with special health care needsmentally challenged patientsPercent95% confidence intervalsPercent of hospitals with plans for selected components of communication with special populations: United States, 2008

23Percent95% confidence intervalsPercent of hospitals with plans for selected components of sheltering special populations patients:United States, 2008

24CommunicationsNotification of alerts from health departments

Participation with local public health departments in education on influenza vaccination

Mass casualty drillsIn how many drills has your hospital participated in the last year?

Internal drills

Drills in collaboration with other organizationslaw enforcement, health department, emergency management, fire department, emergency medical services, hazardous materials teams, decontamination teams

Full scale simulationsHow many victims (adult, pediatric, elderly)?How long did the drill last?

Table-top exercisesDrill scenariosGeneral disaster and emergency responseBiologic accidents or attacksacute decontamination of aerosol exposuredelayed disease outbreak managementSevere epidemic or pandemicMass vaccinationsMass medication distribution to:hospital personnelcommunityChemical accidents or attacksNuclear or radiological accidents or attacksDecontamination proceduresExplosive or incendiary accidents or attacks

Percent95% confidence intervalsPercent of hospitals participating in selected mass casualty drill scenario types:United States, 2008SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 200828Ambulance diversionTotal number of hours in 2007 that:Emergency department (ED) was on ambulance diversionHospital was on trauma diversionHospital was on diversion for critical care casesPercent95% confidence intervalsPercent of hospitals on ambulance diversion status, by number of hours spent on diversion: United States, 2008Cut point based on mean of 220.4 hours spent on diversion. Distribution highly skewed with median and mode both equal to zero (no diversion hours).SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2008

30Key points:Explosions and firesPreparedness for explosions and fires less frequent than for other mass casualtiesExplosive terrorism infrequent in U.S.No incidents since 2001More common internationallyFires more common15,500 fires in high-rises (1996-1998)6% of these were in hospitalsU.S. Fire Administration. High-rise fires. Topical Fire Research Series 2(18):1-7. 2002.

Key points:Emergency department crowdingACEP recommends that hospitals develop adequate inpatient surge capacity by:canceling elective admissions and procedures83.6% of hospitals have plans for thisopening unused areas52.3% have plans to use inpatient hallwaysusing alternate areas for extra critical care space50.7% of hospitals have thisAmerican College of Emergency Physicians (ACEP). National strategic plan for emergency department management of outbreaks of novel H1N1 influenza.

Key points:Emergency department crowdingStudy of adverse events from admitting ED-boarded patients to inpatient hallway beds during ov