Number 391 + August 20, 2007

Emergency Response Planning in Hospitals,

United States: 2003–2004

Richard W. Niska, M.D., M.P.H., and Catharine W. Burt, Ed.D., Division of Health Care Statistics

Abstract

Objective—This study presents baseline data to determine which hospital

characteristics are associated with preparedness for terrorism and natural disaster in

the areas of emergency response planning and availability of equipment and

specialized care units.

Methods—Information from the Bioterrorism and Mass Casualty Preparedness

Supplements to the 2003 and 2004 National Hospital Ambulatory Medical Care

Surveys was used to provide national estimates of variations in hospital emergency

response plans and resources by residency and medical school affiliation, hospital

size, ownership, metropolitan statistical area status, and Joint Commission

accreditation. Of 874 sampled hospitals with emergency or outpatient departments,

739 responded for an 84.6 percent response rate. Estimates are presented with

95 percent confidence intervals.

Results—About 92 percent of hospitals had revised their emergency response

plans since September 11, 2001, but only about 63 percent had addressed natural

disasters and biological, chemical, radiological, and explosive terrorism in those

plans. Only about 9 percent of hospitals had provided for all 10 of the response plan

components studied. Hospitals had a mean of about 14 personal protective suits, 21

critical care beds, 12 mechanical ventilators, 7 negative pressure isolation rooms,

and 2 decontamination showers each. Hospital bed capacity was the factor most

consistently associated with emergency response planning and availability of

resources.

Keywords: bioterrorism c terrorism c emergency preparedness c hospital

preparedness

Introduction

The 2003 and 2004 National

Hospital Ambulatory Medical Care

Survey (NHAMCS) included a

Bioterrorism and Mass Casualty

Preparedness Supplement to assess a

nationally representative sample of

hospitals for their ability to respond to

mass casualties. A separate report on

clinician training for various terrorismrelated exposures has been published

(1). This paper reports on preparedness

in terms of planning for emergency

response and having appropriate

equipment and intensive care capacity,

as functions of residency and medical

school affiliation, hospital size,

ownership, metropolitan statistical area

(MSA) status, and accreditation by the

Joint Commission on Accreditation of

Healthcare Organizations (JCAHO).

The recent history of hospital

preparedness funding has been discussed

briefly elsewhere (2). The information

gained from a nationally representative

survey about strengths and limitations of

hospital disaster preparedness is crucial

for planning how future funding should

be used to improve hospital emergency

medical care.

The objective of this study is to

provide a baseline assessment of

hospital characteristics associated with

better disaster preparedness, because

these surveys were fielded at a time

when federal funding was not yet well

established at the hospital level.

Methods

The NHAMCS is conducted by the

Centers for Disease Control and

Prevention’s (CDC) National Center for

Health Statistics (NCHS) with yearly

review and approval by the NCHS

Ethics Review Board. The Bioterrorism

and Mass Casualty Supplement,

conducted in 2003 and 2004, was

funded by the U.S. Department of

Health and Human Services, Office of

the Assistant Secretary for Planning and

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 
2 Advance Data No. 391 + August 20, 2007

Evaluation. The multistage survey

design involving geographic primary

sampling units and hospitals within

those units has been described

previously (2). Because the data were

weighted according to the inverse

probability of hospital selection,

estimates are considered representative

of similar hospitals over the entire

Nation. Survey information is available

from http://www.cdc.gov/nchs/about/

major/ahcd/nhamcsds.htm.

The NHAMCS annually surveys

nonfederal general and short-stay

hospitals with emergency and outpatient

departments supervised by physicians.

The sample frame was taken from the

Verispan (formerly SMG) Hospital

Database, whose universe includes

hospitals from the 50 states and the

District of Columbia. Of 1,110 hospitals

sampled in 2003 and 2004, 874 were

within this scope. Data were received

from 739 hospitals, for an unweighted

response rate of 84.6 percent.

The preparedness supplement was a

self-reported written questionnaire that

was given to the hospital administrator

during an induction interview by a U.S.

Census Bureau interviewer. Completion

of the survey instrument was by the

staff person responsible for the

hospital’s emergency response plan for

bioterrorism or mass casualties. The

completed instrument was then collected

by the interviewer. A copy of the

supplement is available from http://

www.cdc.gov/nhamcs/data/NHAMCS905.pdf. It included questions about

updates of the hospital’s emergency

response plan since September 11, 2001;

whether that plan addressed biological,

chemical, nuclear-radiological,

explosive-incendiary, and natural

disaster incidents; and key plan elements

in the areas of collaboration with

outside organizations, expanding patient

care capacity, and obtaining supplies.

Hospitals were asked about the content

of their emergency response plans,

including these 10 components:

integration into community-wide

planning, cooperative planning with

other health care facilities, memoranda

of understanding with outlying hospitals

to accept inpatients during a disaster,

alternate care sites, cancellation of

elective procedures and admissions,

conversion of post-anesthesia unit to

augment intensive care, activation of

decommissioned wards, utilization of

nonclinical space for medical purposes,

antibiotic and supply stockpiles, and

coordinated supply-chain management

of pharmaceuticals and other supplies.

Survey respondents were asked to

provide total numbers of mechanical

ventilators, personal protective

(hazardous materials) suits, negative

pressure isolation rooms, critical care

unit beds (including intensive, pediatric

intensive, coronary, and post-anesthesia

care), and decontamination showers in

each hospital that would be useful in a

mass casualty incident.

Dichotomous categorical and

continuous dependent variables were

cross-tabulated to determine their

associations with selected hospital

characteristics: residency and medical

school affiliation, hospital size (fewer

than 100, 100–199, 200–299, or 300 or

more beds), ownership (state or local

government, proprietary, or nonprofit),

location in MSAs (urban or rural), and

accreditation by JCAHO.

Missing values (0.3 to 2.0 percent)

were recoded into unknown or negative

responses as appropriate. Chi-square

tests for categorical variables and t-tests

for continuous variables were performed

using SAS-callable SUDAAN–9.0.1 to

adjust for the complex sample design

(3). Results with nonoverlapping

95 percent confidence intervals were

considered significant.

Results

Emergency response plans for

specific types of incidents

About 91.9 percent of hospitals

reported revising their emergency

response plans since September 11,

2001. Nearly all hospitals affiliated with

medical schools (99.1 percent) had

revised their plans. Other characteristics

associated with revised plans included

having a residency program, bed

capacity, and ownership (Table 1).

About 63.2 percent of hospitals

addressed natural disasters as well as all

four types of terrorism incidents

(biological, chemical, nuclearradiological, and explosive-incendiary)

in their plans. Proprietary and nonprofit

hospitals addressed all hazards more

frequently than state or local

government hospitals. Other associated

characteristics included JCAHO

accreditation, bed capacity, and urban

location (Table 1).

Hospitals with residency programs

addressed biological, chemical, and

explosive incidents more frequently than

those without residencies. Hospitals

affiliated with medical schools

addressed chemical exposures more

often than unaffiliated hospitals

(Table 1).

Hospital bed capacity was

associated with addressing biological,

chemical, radiological, and explosive

incidents in the hospital emergency

response plan. Hospitals with fewer than

100 beds addressed biological,

radiological, and explosive incidents less

frequently than hospitals with 100 or

more beds and addressed chemical

incidents less frequently than hospitals

with 200 or more beds (Table 1).

Hospital ownership was associated

with addressing each of the biological,

chemical, radiological, and explosive

incidents in their response plans. State

and local government hospitals

addressed biological, chemical,

radiological, and explosive incidents less

frequently than proprietary and nonprofit

hospitals. Nonprofit hospitals addressed

biological exposures less frequently than

proprietary hospitals (Table 1).

Urban hospitals addressed

biological, chemical, radiological, and

explosive incidents more frequently than

rural hospitals. JCAHO-accredited

hospitals addressed natural disaster,

biological, chemical, radiological, and

explosive incidents more frequently than

nonaccredited hospitals (Table 1).

Content of emergency

response plans

Few hospitals (8.8 percent) had

provided for all 10 content elements

studied in their emergency response

plans. Hospitals in urban areas provided

for all 10 elements more frequently than

their counterparts. Hospitals with 300 or

more beds provided for all 10 more

frequently than those with fewer than

100 beds (Table 2).
Advance Data No. 391 + August 20, 2007 3

Hospitals provided for a mean of

Urban Rural 5.8 of the 10 components in their 50 49.9 

response plans. JCAHO-accredited

hospitals included more components 45 

than nonaccredited hospitals. Urban

40 hospitals included more components

than rural hospitals. Hospitals with 35 33.2 

25 22.7 

Convert post-anethesia care unit Activate decommissioned wards 

fewer than 100 beds included fewer

components than hospitals with 200 or

more beds (Table 3).

More than three-quarters of

hospitals (78.8 percent) reported

defining their role in community-wide Percent of hospitals 30 

20 18.7 

planning, and where appropriate, being

integrated into this planning; and

77.6 percent engaged in cooperative

planning with other local health care

facilities. Only 52.1 percent had entered

into memoranda of understanding that

allowed transfer of inpatients during a

disaster. JCAHO-accredited hospitals

provided for all three of these elements

more frequently than nonaccredited

hospitals. Hospitals with 300 or more

beds planned with other health facilities

more frequently than those with fewer

than 100 beds. State and local

government hospitals were integrated

into community plans less frequently

than nonprofit hospitals and planned

with other health facilities less

frequently than both nonprofit and

proprietary hospitals (Table 2).

As to expansion of capacity during

an emergency, 73.1 percent of hospitals

had planned for cancellation of elective

procedures and admissions, 65.5 percent

had plans to establish an alternate care

site, 59.8 percent had plans to make

medical use of nonclinical space,

39.9 percent planned to convert their

post-anesthesia care unit to

accommodate intensive care needs, and

27.9 percent planned to activate

decommissioned wards (Table 2). One

of these (utilization of nonclinical space)

showed no significant differences by

any hospital characteristics. JCAHOaccredited hospitals were more likely to

provide for all the rest of these elements

than nonaccredited hospitals. Urban

hospitals were more likely than rural

hospitals to convert their post-anesthesia

unit and activate decommissioned wards

space (Figure 1). Nonprofit hospitals

were more likely to cancel elective

procedures and admissions than state

and local government hospitals.

15 

10 

5 

0 

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey. 

Figure 1. Percent of hospitals with selected surge capacity plans by urban or rural status:

United States, 2003–2004

Hospitals with fewer than 100 beds

were less likely to convert their

post-anesthesia units or activate unused

ward space than hospitals with 200 or

more beds and less likely to cancel

elective procedures and admissions than

hospitals with 200–299 beds (Table 2).

As to medical supplies, 58.9 percent

of hospitals provided for coordinated

supply-chain management of critical

supplies and medications, and

45.3 percent provided for stockpiles of

antibiotics and supplies. JCAHOaccredited hospitals were more likely to

provide for both elements than their

counterparts. Hospitals with fewer than

100 beds were less likely to provide for

either of these elements than those with

200 or more beds (Table 2).

Mass casualty resources

On average, there were 12.0

mechanical ventilators, 14.1 personal

protective suits, 6.6 negative pressure

isolation rooms, 20.5 critical care beds,

and 1.7 decontamination showers per

hospital. Urban hospitals had more of

each resource than rural hospitals

(Figure 2). Larger hospitals, hospitals

with residencies or medical school

affiliations, and JCAHO-accredited

hospitals also had more of each resource

than their counterparts. Nonprofit

hospitals had more of each resource,

except for decontamination showers,

than government hospitals (Table 4).

Because the sample of hospitals was

nationally representative, estimates were

made of the total supply of these

resources within nonfederal general

short-stay hospitals. There were about

97,600 critical care beds, about 54,400

mechanical ventilators, about 31,200

negative pressure isolation rooms, about

64,500 personal protective suits, and

about 8,200 decontamination showers

available in hospitals nationwide during

2003 and 2004. Allocation of this

supply to urban and rural hospitals is

shown in Figure 3. Using U.S. Census

2003–2004 population figures, Figure 4

shows estimated numbers of each

resource available per 10,000 people,

with allocation to urban and rural areas.

Discussion

Emergency response plans

Preparedness planning in urban

hospitals may have improved somewhat

in recent years. The U.S. General

Accounting Office (GAO, now the

Government Accountability Office)

studied urban hospitals across the

country in mid-2002. They found that
4 Advance Data No. 391 + August 20, 2007

81 percent of urban hospitals had an

30 Urban 28.9 Rural	 emergency response plan addressing

biological terrorism. The current study

covering the next 2 years showed an

increase to 88 percent for biological 25 

terrorism plans, with 95 percent

confidence intervals that excluded the

GAO percentage. The finding that

Mean number per hospital 20 19.5 

17.7 

15 

10 

8.8 

6.2 

5 4.6

2.8 2.5 2.1 

1.1 

0 

Critical care Ventilators Isolation Personal Decontamibeds rooms protective nation showers 

suits 

hospitals with 100 or more beds planned

for biological terrorism more frequently

than smaller hospitals replicates the

GAO observation that hospitals that had

such plans were about 15 percent larger

than those that did not (4).

This study found that urban

hospitals were ahead of rural hospitals

in planning for explosive attacks. This is

not surprising, given recent historical

experience with explosions in urban

areas (the World Trade Center, the

Pentagon, and Oklahoma City). Urban

and rural hospitals did not differ in

planning for natural disasters.

Cooperative planning

This study found that although

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.	 79 percent of hospitals engaged in

cooperative planning with other

Figure 2. Mean number per hospital of resources available to hospitals: United States, facilities, only 52 percent had actual 2003–2004 written agreements to be able to transfer

patients during a disaster. This is

consistent with other recent literature. In 90,000 Urban Rural 86,733 a pre–September 11 study of 30

hospitals in the mid-Atlantic states, 80,000 

National totals of mass casualty resources

50,179 

50,000


40,000


30,000
 26,180 

20,000 

10,850 

10,000 7,666 6,318 4,177 4,984

1,841 

0 

70,000 

60,000 56,787 

Critical care 

beds 

Ventilators Isolation 

rooms 

Personal 

protective 

suits 

Decontamination showers 

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey. 

Treat et al. found that 97 percent had

plans to deal with seasonal increases in

patient census by transferring patients to

other facilities, but that no hospitals had

such agreements with respect to mass

casualty disaster management (5). In

2002, the GAO found that about

69 percent of urban hospitals had

agreements with other hospitals to share

resources during a bioterrorism attack

(4). However, this study found that only

about 57 percent of urban hospitals had

memoranda of understanding with other

facilities for transfer of inpatients.

Stockpiles

McIntyre et al. pointed out that

treating large numbers of patients with

antidotes, vaccinations, antibiotics, or

other equipment, such as ventilators,

Figure 3. National totals of mass casualty resources available to hospitals: United States, would result in depletion of existing

2003–2004
Advance Data No. 391 + August 20, 2007 5

Number of resources per 10,000 persons 

4.0 

3.5 

3.0 

2.5 

2.0 

1.5 

1.0 

0.5 

0 

Urban Rural 

3.6 

2.4 

2.1 

0.9 

1.1 1.1 

2.4 

1.7 

0.3 

0.4 

Critical care 

beds 

Ventilators Isolation Personal Decontamirooms protective nation showers 

suits 

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey. 

Figure 4. Selected mass casualty resources available in hospitals per 10,000 population:

United States, 2003–2004

supplies in short order (6). Treat et al.

found that 3 percent (one hospital)

stockpiled ciprofloxacin for anthrax, and

that no hospitals stockpiled vaccines

other than tetanus (5). This post–

September 11 study found that about

45 percent of hospitals had plans to

stockpile antibiotics and supplies. The

situation is better in urban hospitals. The

GAO found, in a nonrepresentative

national sample in 2002, that about

87 percent had descriptions in their

emergency response plans of how to

obtain additional pharmaceuticals for

surge capacity (4). This finding was not

replicated in the current study, however.

Only about 50 percent of a nationally

representative sample of urban hospitals

had response plans that provided for

stockpiling of antibiotics and supplies. It

is possible that greater awareness of

anthrax exposure from the October 2001

outbreak, along with specific federal

hospital preparedness funding targeted

to issues such as stockpiles, is partly

responsible for this increase (7).

Mechanical ventilators

This study reveals that hospitals

nationwide have available an average of

only 12 mechanical ventilators each.

Hick and O’Laughlin underscored the

difficulties that intensive care settings

would experience in an epidemic

involving a disease likely to cause

respiratory failure (8). In a hypothetical

pneumonic plague epidemic involving

400 patients, the regional 27–hospital

system in the Minneapolis area rapidly

experienced a major shortage of

ventilators. Although 480 intensive care

beds were available in that system, one

would presume that many of these were

already in use. The drill also revealed

little potential for backup, with only 16

ventilators available for purchase from

regional vendors. The authors therefore

proposed a three-stage triage system for

either instituting or continuing

mechanical ventilation, based on

objective clinical factors related to

survival potential and available

resources, but not on patient age or

subjective value judgments. The system,

which would involve a change in the

standard of care, would be implemented

through the health department and

supported by a declaration from the

state governor with professional liability

protections (8). The CDC Strategic

National Stockpile is designed to

augment local capacity and has

ventilators in its managed inventory (9).

But the Hick discussion is interesting as

a prototype for practical guidelines on

ethical dilemmas that would arise when

managing large numbers of sick patients

in a natural or bioterrorist-related

epidemic.

Decontamination and personal

protective equipment

McIntyre et al. published

recommendations on a concept of

operations for decontamination that

illustrated the complexity and potential

expense of such a system for a hospital

dealing with rare events without

supplemental support (6). Health care

providers involved in chemical

decontamination, as well as nonmedical

staff such as security personnel who

would participate in triage of potentially

contaminated patients, would need to be

outfitted with personal protective

equipment. The consensus at the time

was that, in most cases, Level C

personal protective equipment would be

appropriate. This would include

chemically resistant suits with gloves

and boots and full face masks with

filtration canisters. Decontamination

facilities would need to accommodate

large numbers of patients, as the authors

pointed out instances where otherwise

full-service emergency departments had

to shut down to deal with one or two

contaminated patients. The complexity

increases when one considers the

authors’ recommendation for a fourstage washdown, especially when

additional staff resources are needed to

wash incapacitated patients who cannot

shower on their own (6).

We found that urban hospitals had

about twice the decontamination

capacity of rural hospitals, similar to

previous literature. Treat et al. found

that 73 percent envisioned a

decontamination procedure whereby just

one patient would be handled at a time

in a single-room facility (5). Reanalysis

of their results showed that one-half of

their urban hospitals had single-stage

decontamination stations and one-half

had multistage (10–15 patients at a

time) mobile decontamination stations.

In contrast, 82 percent of their rural

hospitals had single-stage facilities, and
6 Advance Data No. 391 + August 20, 2007

the remaining 18 percent had no

decontamination capability at all (5).

Hospital ownership

State and local government

hospitals were behind nonprofit and

proprietary hospitals in planning for

biological, chemical, nuclear, and

explosive attacks, and behind nonprofit

hospitals in levels of all types of

disaster preparedness resources except

decontamination showers. Government

hospitals, by virtue of their mandate to

see patients regardless of their ability to

pay for their care, may see the brunt of

epidemic infectious diseases or chemical

exposures.

Limitations

Because this survey was designed to

generate nationally representative

estimates of nonfederal hospitals with

emergency or outpatient departments,

the findings are not applicable to federal

and military hospitals, or those without

emergency or outpatient departments.

Hospitals located in the five U.S.

territories were also excluded from the

sample. Although hospitals were

surveyed at different times throughout

the year and only during one 4-week

period, the results are presented as

average over the year. This approach

could have contributed to

underestimation of preparedness at the

end of the year or overestimation if a

hospital discontinued a program started

earlier. Finally, the accuracy of the

responses depended upon the knowledge

and motivation of the hospital personnel

filling out the survey.

Conclusions

This study presents baseline data on

emergency response planning and the

resources available to hospitals in

responding to natural disasters and

biological, chemical, radiological, and

explosive incidents. The findings may

inform hospitals and health care

professionals involved in future planning

efforts.

References

1.Niska RW, Burt CW. Training for

terrorism-related conditions in

hospitals: United States, 2003–2004.

Advance data from vital and health

statistics; no 380. Hyattsville, MD:

National Center for Health Statistics.

2006.

2.Niska RW, Burt CW. Bioterrorism

and mass casualty preparedness in

hospitals: United States, 2003.

Advance data from vital and health

statistics; no 364. Hyattsville, MD:

National Center for Health Statistics.

2005.

3.Research Triangle Institute.

SUDAAN (Release 9.0.1) [Computer

Software]. Research Triangle Park,

NC: Research Triangle Institute.

2005.

4.Crosse M, Bogart G, Cohen J,

Copeland R, Lawes S, Miller D,

Price R. Hospital preparedness: Most

urban hospitals have emergency

plans but lack certain capacities for

bioterrorism response. GAO–03–924.

Washington, D.C.: U.S. General

Accounting Office. 2003.

5.Treat KN, Williams JM, Furbee PM,

Manley WG, Russell FK, Stamper

CD Jr. Hospital preparedness for

weapons of mass destruction

incidents: An initial assessment. Ann

Emerg Med. 38:562–5. 2001.

6.Macintyre AG, Christopher GW,

Eitzen E, Gum R, Weir S, DeAtley

C, et al. Weapons of mass

destruction events with contaminated

casualties: Effective planning for

health care facilities. JAMA;

283(2):242–9. 2000.

7.Niska R, Argabrite A, Austin B,

Kosyak A, Alvarez W, Bossler S,

Gooding S. National bioterrorism

hospital preparedness program

cooperative agreement guidance.

Rockville, MD: Health Resources

and Services Administration. 2003.

8.Hick JL, O’Laughlin DT. Concept of

operations for triage of mechanical

ventilation in an epidemic. Acad

Emerg Med; 13:223–9. 2006.

9.CDC. About the strategic national

stockpile. Available from: http://intraapps.cdc.gov/od/otper/dsns/about.asp.

Accessed October 24, 2006.
7

ng revised emergency response plans since September 11, 2001, and having plans for all and selected incidents, by hospital characteristics:

Revised All incidents Biological Chemical

Number of 95% confidence 95% confidence 95% confidence 95% confidence

hospitals Percent interval Percent interval Percent interval Percent interval

5,014 91.9 87.7–94.7 63.2 57.7–68.5 83.6 79.6–86.9 85.2 80.9–88.7

1,062 97.9 95.1–99.1 71.5 60.0–80.8 93.9 87.6–97.1 95.2 92.1–97.2

3,952 90.2 85.0–93.8 61.0 54.5–67.1 80.8 75.9–84.9 82.6 77.2–86.9

1,469 99.1 97.2–99.7 69.4 57.3–79.3 91.3 82.8–95.8 94.9 90.4–97.3

3,545 88.9 83.2–92.8 60.7 54.1–66.9 80.4 74.7–85.1 81.2 75.7–85.8

2,941 88.0 81.3–92.6 53.8 45.7–61.7 76.0 69.5–81.5 79.6 72.7–85.1

980 96.1 90.9–98.4 76.1 67.5–83.0 94.6 87.7–97.8 91.6 83.8–95.8530 98.9 95.3–99.7 80.0 70.6–86.9 94.8 86.7–98.1 93.0 86.7–96.5

563 98.0 93.8–99.4 74.3 66.1–81.0 93.6 86.0–97.2 96.2 92.1–98.2

3,286 95.4 92.2–97.3 69.2 62.8–74.9 87.0 82.0–90.8 90.7 86.6–93.6

1,247 81.3 69.1–89.5 42.9 31.1–55.6 69.7 56.9–80.1 67.4 54.8–77.8

481 95.1 87.5–98.2 75.2 63.3–84.1 96.0 92.5–97.9 94.6 87.8–97.7

3,166 91.6 86.1–95.1 70.2 64.0–75.7 88.0 82.7–91.9 89.9 84.7–93.41,848 92.3 85.1–96.2 51.3 41.5–61.1 76.0 68.1–82.5 77.3 68.3–84.3

4,072 94.2 90.8–96.4 68.9 62.9–74.3 87.8 83.3–91.3 90.7 86.9–93.4

943 81.6 66.0–91.1 38.9 28.0–51.1 65.3 50.7–77.5 61.8 47.6–74.3

Advance Data No. 391+ August 20, 2007
8

ng revised emergency response plans since September 11, 2001, and having plans for all and selected incidents, by hospital

2004—Con.

Nuclear-radiological Explosive-incendiary Natural disaster

95% confidence 95% confidence 95% confidence

Percent interval Percent interval Percent interval

................. 74.8 69.0–79.9 77.9 72.2–82.6 96.2 93.9–97.6

................. 83.1 69.3–91.5 88.8 82.7–92.9 97.4 94.0–98.9

................. 72.6 65.7–78.6 75.0 68.1–80.8 95.8 93.0–97.6

................. 86.1 75.7–92.5 82.8 70.6–90.6 98.0 95.6–99.1

................. 70.2 63.0–76.4 75.8 68.9–81.7 95.4 92.2–97.3

................. 65.5 56.7–73.4 69.8 61.2–77.2 94.8 90.9–97.1

................. 83.9 76.0–89.5 90.6 85.1–94.2 98.8 95.9–99.6

................. 93.6 86.3–97.1 91.4 83.4–95.8 96.2 89.6–98.7

................. 90.0 83.2–94.2 85.2 78.1–90.2 98.9 96.1–99.7

................. 81.4 75.2–86.4 85.2 80.3–89.1 97.6 94.5–98.9

................. 51.3 39.0–63.5 56.0 41.7–69.4 92.4 83.8–96.7

................. 90.8 81.9–95.5 84.2 72.8–91.4 96.4 84.8–99.2

area

................. 81.7 75.6–86.6 86.1 81.6–89.6 96.3 93.4–97.9

................. 63.0 51.2–73.4 63.8 52.5–73.7 96.0 89.5–98.6

................. 82.7 77.6–86.9 83.1 77.8–87.4 97.9 95.9–98.9

................. 40.8 29.3–53.4 55.2 41.3–68.4 88.9 78.0–94.7

Advance Data No. 391+ August 20, 2007
9

ng emergency response plans providing for selected elements, by hospital characteristics: United States, 2003–2004

All 10 Community role Cooperative plans Inpatient transfer Alternate site

95% 95% 95% 95% 95%

of confidence confidence confidence confidence confidence

s Percent interval Percent interval Percent interval Percent interval Percent interval

8.8 6.5–11.9 77.6 72.3–82.1 78.8 73.2–83.6 52.1 45.3–58.7 65.5 60.7–70.0

13.3 8.8–19.8 85.6 78.4–90.7 86.5 78.9–91.7 63.0 52.1–72.7 66.8 58.8–73.9

7.6 5.0–11.4 75.4 69.1–80.8 76.8 69.8–82.5 49.1 41.6–56.7 65.1 59.6–70.3

13.4 8.7–20.1 80.3 69.8–87.8 85.2 73.3–92.3 58.5 47.4–68.8 73.7 66.2–80.0

6.9 4.5–10.6 76.5 70.4–81.6 76.2 69.5–81.8 49.4 41.7–57.1 62.1 56.3–67.6

6.9 4.0–11.7 73.3 65.0–80.3 72.8 63.6–80.3 45.2 36.0–54.7 64.9 57.8–71.4

8.6 4.8–14.9 81.9 72.5–88.6 86.1 77.3–91.9 65.0 54.0–74.5 58.2 48.3–67.5

10.9 6.5–17.6 83.7 74.6–90.0 84.9 75.9–90.9 59.1 48.1–69.2 73.2 63.8–80.9

17.4 12.8–23.2 86.3 78.6–91.6 92.2 86.2–95.7 59.0 47.9–69.2 74.0 66.8–80.1

9.0 6.7–12.1 81.6 76.2–85.9 84.5 79.9–88.2 54.8 47.5–61.9 65.6 59.4–71.4

*10.7 5.0–21.2 63.4 49.5–75.4 59.2 44.5–72.4 41.9 29.5–55.4 68.3 57.3–77.6

*2.8 0.7–10.3 87.1 75.1–93.8 91.0 76.8–96.8 59.6 44.7–72.9 57.1 44.4–68.8

12.6 9.1–17.1 79.7 74.0–84.5 82.5 77.0–87.0 57.2 49.5–64.6 64.9 59.0–70.4

*2.4 1.2– 4.8 73.9 63.2–82.3 72.5 60.3–82.1 43.3 32.6–54.6 66.5 57.3–74.5

10.3 7.6–13.7 81.5 76.2– 5.8 84.3 79.2–88.3 56.4 49.3–63.3 70.0 65.1–74.4

*2.7 0.4–16.8 60.8 46.5–73.4 55.3 38.5–71.0 33.2 22.7–45.6 46.2 33.0–59.9

Advance Data No. 391+ August 20, 2007
10

ng emergency response plans providing for selected elements, by hospital characteristics: United States, 2003–2004—Con.

cel electives Post-anesthesia Ward activation Nonclinical space Stockpiles Supply chain

95% 95% 95% 95% 95% 95%

confidence confidence confidence confidence confidence confidence

interval Percent interval Percent interval Percent interval Percent interval Percent interval

67.4–78.2 39.9 34.5–45.6 27.9 24.0–32.1 59.8 54.8–64.7 45.3 39.9–50.7 58.9 53.3–64.2

65.9–82.5 47.8 37.1–58.6 31.8 24.3–40.4 62.1 53.5–70.0 44.6 34.8–54.9 60.9 49.8–71.1

65.8–78.5 37.8 31.5–44.5 26.8 22.3–31.8 59.2 53.2–65.0 45.5 39.4–51.7 58.3 51.8–64.562.4–81.8 50.4 40.0–60.8 29.8 22.7–38.0 61.1 51.0–70.4 52.6 42.8–62.1 60.7 49.4–70.9

66.6–78.8 35.5 29.4–42.2 27.1 22.3–32.4 59.3 53.3–65.1 42.3 35.7–49.1 58.1 51.3–64.6

60.9–77.2 29.5 22.2–38.0 22.4 17.2–28.6 54.9 47.2–62.3 39.5 32.3–47.2 49.6 41.4–57.8

61.7–80.4 47.2 37.6–57.0 31.0 23.1–40.1 63.9 55.0–71.9 46.0 36.0–56.3 65.0 56.1–72.8

79.6–92.5 64.2 53.1–73.9 41.9 32.6–51.8 68.8 58.0–77.8 60.0 47.6–71.3 80.2 72.5–86.1

67.3–88.7 58.5 47.3–69.0 37.9 30.5–46.0 70.3 60.1–78.9 60.4 48.3–71.3 76.5 68.0–83.3

72.2–83.3 44.3 37.9–51.0 26.8 22.1–32.0 62.7 56.2–68.7 45.7 38.9–52.6 61.3 53.8–68.2

45.5–71.4 26.7 16.2–40.7 27.3 18.2–38.8 53.9 40.7–66.5 43.8 32.0–56.4 48.4 36.5–60.5

59.4–85.7 43.8 29.4–59.2 36.5 25.8–48.8 56.0 44.9–66.6 46.5 35.2–58.1 69.4 57.4–79.3

68.6–79.7 49.9 43.8–56.1 33.2 28.4–38.4 63.2 57.6–68.4 49.7 43.3–56.0 63.8 58.2–69.0

58.8–80.4 22.7 14.4–33.8 18.7 12.9–26.3 54.2 44.5–63.6 37.7 28.6–47.9 50.4 39.2–61.5

74.2–84.2 46.3 40.5–52.1 31.4 26.9–36.4 62.6 57.1–67.8 49.6 43.1–56.0 63.5 56.8–69.7

29.9–61.1 *12.5 5.7–25.2 *12.5 6.2–23.5 47.9 33.3–62.8 26.7 17.2–39.1 38.8 27.6–51.3

sion (relative standard error greater than 30%).

Advance Data No. 391+ August 20, 2007
Advance Data No. 391 + August 20, 2007 11

Table 3. Mean number of terrorism preparedness elements provided for in emergency response plans, by hospital characteristics:

United States, 2003–2004

Number of 95% confidence

Characteristic hospitals Mean interval

All hospitals .................................... 5,014 5.8 5.5–6.1

Residency

Yes ......................................... 1,062 6.2 5.7–6.8

No.......................................... 3,952 5.7 5.3–6.0

Medical school

Yes ......................................... 1,469 6.3 5.6–6.9

No.......................................... 3,545 5.6 5.3–5.9

Bed capacity

Less than 100 .................................. 2,941 5.2 4.8–5.6

100–199 ...................................... 980 6.2 5.6–6.7

200–299 ...................................... 530 7.0 6.5–7.6

More than 300 .................................. 563 7.0 6.3–7.6

Ownership

Nonprofit...................................... 3,286 6.1 5.7–6.4

State or local government ........................... 1,247 4.9 4.1–5.7

Proprietary .................................... 481 6.2 5.6–6.9

Metropolitan statistical area

Urban........................................ 3,166 6.2 5.8–6.5

Rural ........................................ 1,848 5.1 4.6–5.6

Joint Commission

Accredited ..................................... 4,071 6.3 6.0–6.5

Not accredited .................................. 942 3.8 3.0–4.5
12

ass casualty equipment items per responding hospital, by hospital characteristics: United States, 2003–2004

Mechanical ventilators Personal protective suits Negative pressure isolation rooms

95% 95% 95%

Number of confidence Number of confidence Number of confidence

hospitals1 Mean interval hospitals2 Mean interval hospitals3 Mean interval

........ 4,511 12.0 10.1–14.0 4,583 14.1 11.9–16.3 4,732 6.6 5.7– 7.5

........ 916 30.7 22.4–38.9 963 26.9 19.8–34.1 952 13.8 11.3–16.3........ 3,595 7.3 6.1– 8.5 3,619 10.6 8.6–12.7 3,780 4.8 3.9– 5.6........ 1,293 23.5 19.2–27.7 1,371 24.4 18.5–30.3 1,356 11.2 9.3–13.2........ 3,218 7.5 5.3– 9.7 3,212 9.7 7.7–11.6 3,376 4.7 3.8– 5.7

........ 2,676 3.6 2.6– 4.6 2,696 5.9 4.4– 7.5 2,807 2.5 2.0– 2.9

........ 914 12.2 10.4–14.1 907 14.7 11.2–18.1 927 8.4 6.2–10.6........ 445 22.5 19.6–25.5 483 26.0 19.9–32.1 481 12.2 10.4–14.1

........ 476 49.5 37.2–61.8 497 45.6 33.7–57.5 516 20.5 17.6–23.5

........ 2,983 13.7 11.0–16.5 3,041 16.2 13.3–19.1 3,134 7.5 6.3– 8.8

........ 1,094 7.5 4.4–10.5 1,091 9.5 6.0–13.0 1,140 3.9 2.5– 5.2

........ 434 12.0 7.7–16.2 450 10.6 6.1–15.0 458 6.7 4.8– 8.7

........ 2,832 17.7 14.5–20.9 2,910 19.5 16.0–23.0 2,983 8.8 7.5–10.0

........ 1,679 2.5 1.9– 3.0 1,672 4.6 3.3– 5.9 1,749 2.8 1.4– 4.3

........ 3,702 14.1 11.8–16.5 3,754 16.0 13.4–18.6 3,891 7.7 6.5– 8.8

........ 809 2.5 1.2– 3.8 829 5.4 3.1– 7.7 841 1.6 0.9– 2.3

Advance Data No. 391+ August 20, 2007
13

ass casualty equipment items per responding hospital, by hospital characteristics: United States, 2003–2004—Con.

Critical care beds Decontamination showers

95% 95%

Number of confidence Number of confidence

hospitals4 Mean interval hospitals5 Mean interval

........ 4,751 20.5 18.2–22.9 4,689 1.7 1.5–1.9

........ 976 42.0 35.4–48.5 959 2.5 2.0–3.1

........ 3,775 15.0 12.9–17.0 3,729 1.5 1.3–1.7

........ 1,378 36.2 30.6–41.8 1,368 2.4 1.8–2.9

........ 3,373 14.1 12.0–16.3 3,321 1.5 1.3–1.7

........ 2,794 7.5 6.0– 8.9 2,744 1.1 0.9–1.4

........ 943 24.9 20.9–28.9 921 1.8 1.6–2.1........ 490 39.3 35.0–43.5 497 2.7 2.2–3.1

........ 524 64.8 56.9–72.7 525 3.8 3.0–4.6

........ 3,095 23.7 20.9–26.6 3,094 1.8 1.6–2.1

........ 1,198 12.2 7.7–16.8 1,132 1.5 1.1–2.0

........ 458 20.8 16.4–25.2 463 1.7 1.2–2.2

........ 2,996 28.9 25.5–32.4 2,954 2.1 1.8–2.4

........ 1,755 6.2 4.5– 7.9 1,735 1.1 0.8–1.3

........ 3,878 23.8 21.4–26.3 3,830 1.9 1.7–2.2

........ 873 6.0 2.8– 9.2 858.5 0.9 0.7–1.1

of 5,014 hospitals.of 5,014 hospitals.of 5,014 hospitals.of 5,014 hospitals.of 5,014 hospitals.

Advance Data No. 391+ August 20, 2007
16 Advance Data No. 391 + August 20, 2007

Suggested citation

Niska RW, Burt CW. Emergency response

planning in hospitals, United States: 2003–

2004. Advance data from vital and health

statistics; no 391. Hyattsville, MD: National

Center for Health Statistics. 2007.

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