Although nearly all surveyed U.S. hospitals had plans for responding to mass-casualty events such as earthquakes and chemical spills, gaps and omissions were common, a CDC analysis found.
Many hospitals had no plans for certain types of disasters and the plans they did have frequently failed to address the particular needs of important subpopulations such as children, according to Dr. Richard W. Niska and Iris M. Shimizu, PhD, in a National Center for Health Statistics report.
Niska and Shimizu analyzed responses to the 2008 National Hospital Ambulatory Medical Care Survey, which included a supplement on emergency response preparedness completed by 294 hospitals. The supplement asked for details on plans for responding to six types of events: epidemic-pandemic disease outbreaks, bioterror attacks, chemical accidents and attacks, nuclear-radiological events, large explosions and fires, and major natural disasters.
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Only about 68 percent of hospitals had plans for dealing with all six types of events, the researchers found. Most often omitted were plans for explosive-incendiary and nuclear-radiological events, each missing in roughly 20 percent of hospitals.
On the other hand, more than 95 percent of hospitals had plans for natural disasters or chemical incidents.
Planning was also often deficient when it came to patient transfer arrangements with other hospitals in cases of large numbers of casualties.
Although 88 percent of respondents indicated they had written agreements from other hospitals to accept adult patients during overload situations, just over half (56.2 percent ) had similar arrangements regarding children.
More than 40 percent of hospitals had no agreements with burn centers to take casualties from explosions and fires, Niska and Shimizu also found.
In addition, about one-quarter of hospitals had made no plans to expand onsite capacity to cope with large numbers of casualties.
Those that did typically identified hallways, administrative space, and decommissioned ward units as locations where patients could be treated during emergencies.
Nearly 40 percent had no plan for expanding morgue capacity.
Perhaps the most important shortcoming, according to Niska and Shimizu, was a low rate of special planning for pediatric patients.
Fewer than half of hospitals' plans covered had a tracking system for accompanied and unaccompanied children and a procedure for reuniting children with families. Guidelines for expanding onsite treatment capacity for children and supplies to house healthy displaced children were also lacking.
About half of hospitals also had not delineated how they would manage special-needs populations, such as people with limited mobility, pregnant women, the blind, and those with mental health problems.
Some of these concerns were highlighted in Japan this month following the massive March 11 earthquake and tsunami. Healthcare providers there found that their biggest challenge was not in treating the direct casualties of these events, but rather in maintaining care for individuals with chronic diseases.
The large-scale homelessness and disruptions in electric power and transportation meant that patients with diabetes, renal disease, and similar illnesses lost access to medications and other treatments.
But the CDC report, "Hospital Preparedness for Emergency Response: United States, 2008," also found that hospitals did well in certain aspects of preparedness.
For example, large majorities of hospitals had included other local agencies such as health and fire departments in their planning; developed regional communication systems to track available beds in their communities; and made plans for continuity of operations or evacuations during emergencies directly affecting the hospitals themselves.