Integrating Hospitals into Community Emergency Preparedness Planning

6 June 2006 | Volume 144 Issue 11 | Pages 799-811

Background: Strong community linkages are essential to a health care organization's overall preparedness for emergencies.

Objective: To assess community emergency preparedness linkages among hospitals, public health officials, and first responders and to investigate the influence of community hazards, previous preparation for an event requiring national security oversight, and experience responding to actual disasters.

Design: With expert advice from an advisory panel, a mailed questionnaire was used to assess linkage issues related to training and drills, equipment, surveillance, laboratory testing, surge capacity, incident management, and communication.

Setting: A simple random sample of 1750 U.S. medical–surgical hospitals.

Participants: Of 678 hospital representatives that agreed to participate, 575 (33%) completed the questionnaire in early 2004. Respondents were hospital personnel responsible for environmental safety, emergency management, infection control, administration, emergency services, and security.

Measurements: Prevalence and breadth of participation in community-wide planning; examination of 17 basic elements in a weighted analysis.

Results: In a weighted analysis, most hospitals (88.2% [95% CI, 84.1% to 92.3%]) engaged in community-wide drills and exercises, and most (82.2% [CI, 77.8% to 86.5%]) conducted a collaborative threat and vulnerability analysis with community responders. Of all respondents, 57.3% (CI, 52.1% to 62.5%) reported that their community plans addressed the hospital's need for additional supplies and equipment, and 73.0% (CI, 68.1% to 77.9%) reported that decontamination capacity needs were addressed. Fewer reported a direct link to the Health Alert Network (54.4% [CI, 49.3% to 59.5%]) and around-the-clock access to a live voice from a public health department (40.0% [CI, 35.0% to 45.0%]). Performance on many of 17 basic elements was better in large and urban hospitals and was associated with a high number of perceived hazards, previous national security event preparation, and experience in actual response.

Limitations: Responses reflect hospitals' self-perception of linkages. The quality of linkages and the extent of possible biases favoring positive responses were not assessed.

Conclusions: In this baseline assessment, most hospitals reported substantial integration. However, results suggest that relationships between hospitals, public health departments, and other critical response entities are not adequately robust. Suggestions for enhancing linkages are discussed.

Editors' Notes Context Recent natural disasters and terrorist attacks have underscored the necessity for health care facilities to integrate their activities with other community response teams. Contribution The investigators developed and administered a nationwide survey questionnaire to assess the existence and character of hospital–community services linkages that facilitated the response to local emergencies. Most responding hospitals conducted community drills; analyzed threat vulnerability; and planned for additional supplies, equipment, and decontamination facilities. Other linkages were less widespread. Cautions Hospital response rate to questionnaires was low, and answers were unverified. Implications Effective coordination of effort requires development of national standards for community preparedness. —The Editors

 

Author and Article Information

From Joint Commission on Accreditation of Healthcare Organizations, Oakbrook, Illinois, and George Washington University Institute for Crisis, Disaster and Risk Management, Washington, DC.

Acknowledgments: The authors thank the hospital staff who participated in the project and committed substantial time and effort to complete the questionnaire. The authors also thank the members of the technical expert panel for their assistance: Mark Ackermann, St. Vincent's Catholic Medical Center of New York; Christine Bradshaw, DO, MPH, Centers for Disease Control and Prevention, Public Health Practice Program Office; Ed Gabriel, EMT-P, New York City Office of Emergency Management; Darlene Isbell-Gidley, RN, MPH, Orange County California Health Care Agency; Jane Maffie-Lee, MSN, RN-CS, Manet Community Health Center, Quincy, Massachusetts; Ralph Morris, MD, MPH, Public Health Preparedness, Minnesota Department of Health, Bemidji, Minnesota; Sally Phillips, RN, PhD, Agency for Healthcare Research and Quality; Barbara Russell, RN, MPH, ACRN, CIC, Infection Control Services, Baptist Hospital of Miami, Miami, Florida; Tim Sashko, Fire Chief, Fire Department, Buffalo Grove, Illinois; and Steve Smith, MPH, USPHS, Bureau of Primary Health Care, Division of Clinical Quality, Health Resources and Services Administration, Rockville, Maryland. The authors also thank Dennis O'Leary, MD; Chandrika Divi, MPH; Scott Williams, PsyD; Mark Beezhold; Brette Tschurtz; and Tasha Mearday for their contributions.

Grant Support: In part by a grant from the Agency for Healthcare Research and Quality as part of its Partnerships for Quality Initiative (Cooperative Agreement Number 1U 18HS18808-01).

Potential Financial Conflicts of Interest: Consultancies: J.A. Barbera (Joint Commission on Accreditation of Healthcare Organizations); Grants received: B.I. Braun (Agency for Healthcare Research and Quality), N.V. Wineman (Agency for Healthcare Research and Quality), N.L. Finn (Agency for Healthcare Research and Quality), J.M. Loeb (Agency for Healthcare Research and Quality).

Requests for Single Reprints: Nicole V. Wineman, MA, MPH, MBA, Joint Commission on Accreditation of Healthcare Organizations, Division of Research, 1 Renaissance Boulevard, Oakbrook Terrace, IL 60181; e-mail, nwineman{at}jcaho.org.

Current Author Addresses: Dr. Braun, Ms. Wineman, Ms. Finn, and Drs. Schmaltz and Loeb: Joint Commission on Accreditation of Healthcare Organizations, Division of Research, 1 Renaissance Boulevard, Oakbrook Terrace, IL 60181.

Dr. Barbera: Institute for Crisis, Disaster and Risk Management, The George Washington University, 1776 G Street NW, Suite 110, Washington, DC 20052.

Author Contributions: Conception and design: B.I. Braun, J.A. Barbera, J.M. Loeb.

Analysis and interpretation of the data: B.I. Braun, N.V. Wineman, N.L. Finn, S.P. Schmaltz.

Drafting of the article: B.I. Braun, N.V. Wineman.

Critical revision of the article for important intellectual content: N.L. Finn, J.A. Barbera, J.M. Loeb.

Final approval of the article: J.M. Loeb.

Statistical expertise: S.P. Schmaltz.

Obtaining of funding: B.I. Braun, J.M. Loeb.

Administrative, technical, or logistic support: N.V. Wineman, N.L. Finn, J.M. Loeb.

Collection and assembly of data: B.I. Braun, N.V. Wineman, N.L. Finn.

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