Emergency department disaster preparedness: Are Regional efforts reaching local front lines?

Study objectives: Since the attacks of September 11, 2001, there has been heightened awareness for the possibility of a mass casualty incident (MCI). The Metropolitan Medical Response Systems (MMRS) are one form of targeted funding aimed at improving regional preparedness and response. Although significant progress has been made at the system level during the past 2 years, it is unclear whether these initiatives have filtered down to front-line providers. We choose to assess the impact of MMRS initiatives on emergency department (ED) provider familiarity with and perceptions about disaster preparedness. Methods: A 3-part survey with 30 questions 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. They were asked about disaster preparedness and drills and their institution's ability to handle a number of specific scenarios. Answers were either dichotomous or used a 5-point Likert scale (entirely false to entirely true or unprepared to very prepared). Results: One hundred seventy surveys were returned (50%). Participants included 77 nurses, 65 physicians, 6 administrators, and 22 who did not identify their position. Thirty-eight percent of respondents work in Level I hospitals and 31% in pediatric hospitals. The majority (84%) were aware that their hospital had a disaster or MCI committee. Most (78%) were aware of the existence of the St. Louis MMRS to which their hospitals belong. Fewer (53%) were aware of the mutual aid agreement (signed by all 41 area hospitals 2 years ago) indicating that hospitals will support one another during a disaster (including the sharing of equipment, supplies, and personnel). Of respondents, 43% affirmed that disaster preparedness was part of their employee orientation. Most noted that periodic disaster drills occurred, and 58% said they were familiar with their facility's plan and would be able to carry out their individual portion of it. Although the September 11, 2001, attacks have caused facilities to improve their level of disaster preparedness, less than half of providers thought that the disaster drills being held provided effective training to handle an MCI (41%). However, most believed that holding drills will improve readiness (69%). The vast majority (81%) did not have a working understanding about how MMRS operations would affect their institutions during a disaster. Most ED providers surveyed felt prepared to handle limited local disasters outside the hospital, such as a 4-car highway accident (74%) or "food poisoning" at a local restaurant (67%). If there were more than 25 patients of mixed acuity, such as tornado hitting nursing home (53%) or protest march (57%), most thought that hospitals would not be able to handle the influx. Most did not feel prepared to handle incidents involving the hospital, such as a fire in central supply (61%) or an earthquake damaging a portion of the building (50%). Despite the attention paid to bioterrorism recently, respondents felt least prepared to handle situations involving nuclear, biological, or chemical agents. Only 22% said they are prepared to deal with an anthrax scare at a local mall with 200 potential victims, and only 35% could handle a tanker derailment with leaking chlorine gas. However, the problem is not only overwhelming numbers of patients; less than 35% of providers felt ready to care for a single smallpox-infected patient. Conclusion: Many ED providers are aware of the heightened concern about disaster preparedness. However, our ability to respond effectively remains limited. Despite more than 2 years of intense work at the regional systems level, most providers, although familiar with MMRS, do not understand its role or likely impact on their institutions during a disaster, such as providing pharmacy caches, sharing supplies between local hospitals, and improving interhospital communication. Staff members are familiar with hospital disaster plans. Although most providers think that disaster drills can improve readiness, they disagree about the effectiveness of current drills to prepare them to handle an MCI.