Emergency department disaster preparedness: Identifying the barriers

Study objectives: Recent world events have highlighted the necessity of emergency departments (ED) being prepared to respond to disasters. The Metropolitan Medical Response System is one form of targeted funding aimed at improving regional preparedness and disaster response. Significant progress has been made at the systems level, but it is unclear what impact these initiates have had on front-line ED providers. There is a perception among providers that they are not prepared, especially for nuclear, biological, or chemical (NBC) agents. We attempted to identify some of the factors that hinder ED provider preparedness. Methods: A 23-question survey was given to physicians, nurses, and administrators (safety officer/disaster team manager) at Level I and II trauma centers in St. Louis, Missouri. Respondents were asked to complete the survey according to their clinical experience. The survey tried to gauge the degree to which a number of factors (eg, personnel, training, funding) affect the provider's ED in being able to handle a mass casualty incident (MCI) using a 5-point Likert scale ("not a reason" to "critical reason"). Results: One hundred seventy surveys were returned (77 nurses, 65 physicians, 6 administrators, 22 who did not identify their position). Only a few ED providers (13%) agreed with the statement, "You can't plan for them, disasters just happen." About half (55%) of respondents thought that the events of September 11, 2001, spurred hospitals to make significant improvements in their level of disaster preparedness. Most providers are familiar with their hospital's disaster plan (59%) and believe that drills improve readiness (69%). Lack of commitment (13%) and financial support (15%) by the hospitals does not appear to be a hindrance to disaster preparedness. Few identified the lack of a disaster planning group (16%) or ED provider staff participation within that group (23%) as a major hurdle. Most providers thought that ED staff are familiar with existing MCI protocols (physicians 65%, nurses 60%), but non-ED staff were not (physicians 69%, nurses and technicians 67%). Respondents are split (56%) over whether the presence of rotating resident physicians affected ED preparedness. Most providers (68%) thought that physicians were knowledgeable about NBC issues; however, they were more ambivalent about nursing and ED technician staff knowledge (57%) of these agents. EDs do not appear to be lacking in terms of NBC reference material or basic supplies. Half of providers (49%) believed that they lacked specialized protective gear, and even more (60%) perceive the lack of familiarity with equipment and decontaminating techniques as a major issue. Most ED providers think that there are sufficient MCI drills but identified the lack of dedicated time for instruction and participation (61%) as a concern. Although the ED is often the first part of a hospital to be affected by a disaster, other clinical and ancillary services are inevitably involved in the response plan. Many ED providers think that lack of involvement by other services (clinical and ancillary) limits their overall ability to respond (45% to 47%). Conclusion: Many barriers exist that limit ED providers disaster preparedness. Internal ED issues include lack of specialized equipment and training in NBC events. External to the ED, providers are concerned about insufficient knowledge about MCI and lack of involvement by other hospital departments. Although funding and hospital commitment are minor issues, providing dedicated time for education appears to be the greatest barrier we must overcome.