Pandemic influenza and major disease outbreak preparedness in US emergency departments: A survey of medical directors and department chairs
Keywords:pandemic influenza, avian influenza, disaster medicine
Study objectives: To quantify the readiness of individual academic emergency departments (EDs) in the United States for an outbreak of pandemic influenza.
Methods, design, and setting: Cross-sectional assessment of influenza pandemic preparedness level of EDs in the United States via survey of medical directors and department chairs from the 135 academic emergency medicine departments in the United States. Preparedness assessed using a novel score of 15 critical preparedness indicators. Data analysis consisted of summary statistics, χ2, and ANOVA.
Participants: ED medical directors and department chairs.
Results: One hundred and thirty academic emergency medicine departments contacted; 66 (50.4 percent) responded. Approximately half (56.0 percent) stated their ED had a written plan for pandemic influenza response. Mean preparedness score was 7.2 (SD = 4.0) out of 15 (48.0 percent); only one program (1.5 percent) achieved a perfect score. Respondents from programs with larger EDs (=30 beds) were more likely to have a higher preparedness score (p < 0.035), an ED pandemic preparedness plan (p = 0.004) and a hospital pandemic preparedness plan (p = 0.007). Respondents from programs with larger EDs were more likely to feel that their ED was prepared for a pandemic or other major disease outbreak (p = 0.01). Only onethird (34.0 percent) felt their ED was prepared for a major disease outbreak, and only 27 percent felt their hospital was prepared to respond to a major disease outbreak.
Conclusions: Significant deficits in preparedness for pandemic influenza and other disease outbreaks exist in US EDs, relative to HHS guidelines, which appear to be related in part to ED size. Further study should be undertaken to determine the barriers to appropriate pandemic preparedness, as well as to develop and validate preparedness metrics.
HHS Pandemic Influenza Plan, Appendix B. Available at www.hhs.gov/pandemicflu/plan/appendixb.html. Accessed March 3, 2009.
US Department of Health and Human Services: HHS Pandemic Influenza Plan, published November 2005. Available at www. hhs.gov/pandemicflu/plan/pdf/HHSPandemicInfluenzaPlan.pdf. Accessed January 22, 2007.
Institute of Medicine Report, Hospital-Based Emergency Care: At the Breaking Point, June 2006,Web site of the National Academy of Medicine.Available at http://books.nap.edu/openbook.php?record_ id=11621&page=14. Accessed January 24, 2007.
McDonald LC, Simor AE, Su IJ, et al.: SARS in healthcare facilities, Toronto and Taiwan. Emerg Infect Dis. 2004; 10(5): 777-781.
Irvin C, Cindrich L, Patterson W, et al.: Hospital personnel response during a hypothetical influenza pandemic:Will they come to work? Acad Emerg Med. 2007; 14 (Suppl 1): 13.
Ehrenstein BP, Hanses F, Salzberger B: Influenza pandemic and professional duty: Family or patients first? A survey of hospital employees. BMC Public Health. 2006; 6: 311.
Emergency Medical Service and Non-Emergent (Medical) Transport Organizations Pandemic Influenza Planning Checklist, US Department of Health and Human Services’ Pandemic Flu Web site. Available at www.pandemicflu.gov/plan/pdf/ems.pdf. Accessed January 22, 2007.
Medical Offices and Clinics Pandemic Influenza Planning Checklist, US Department of Health and Human Services’ Pandemic Flu Web site. Available at www.pandemicflu.gov/plan/ pdf/medofficesclinics.pdf. Accessed January 22, 2007.
Greenberg MI, Hendrickson RG: Report of the CIMERC/ Drexel University emergency department terrorism preparedness consensus panel. Acad Emerg Med. 2003; 10(7): 783-788.
Higgins W, Wainright C, Lu N, et al.: Assessing hospital preparedness using an instrument based on the Mass Casualty Disaster Plan Checklist: Results of a statewide survey. Am J Infect Control. 2004; 32(6): 327-332.
Christian MD, Hawryluck L,Wax RS, et al.: Development of a triage protocol for critical care during an influenza pandemic. CMAJ. 2006;175(11): 1377-1381.
Kick JL, O’Laughlin DT: Concept of operations for triage of mechanical ventialation in an epidemic. Acad Emerg Med. 2006; 13(2): 223-229.
Lurie N, Dausey DJ, Knighton T, et al.: Community planning for pandemic influenza: Lessons from the VA health care system. Disaster Med Public Health Prep. 2008; 2(4): 251-257.
Kaji AH, Lewis RJ: Hospital disaster preparedness in Los Angeles County. Acad Emerg Med. 2006; 13(11): 1198-1203.
Taylor JL, Roup BJ, Blythe D, et al.: Pandemic influenza preparedness in Maryland: Improving readiness through a tabletop exercise. Biosecur Bioterror. 2006; 3(1): 61-69.
McKenna VB, Gunn JE, Auerbach J, et al.: Local collaborations: development and implementation of Boston’s bioterrorism surveillance system. J Public Health Manag Pract. 2003; 9(5): 384-393.
Fleet-Green JM, Chen FM, House P: Identifying the gaps between biodefense researchers, public health, and clinical practice in a rural community. J Rural Health. 2008; 24(3): 326-329.
Kayman H, Ablorh-Odjidja A: Revisiting public health preparedness: Incorporating social justice principles into pandemic preparedness planning for influenza. J Public Health Manag Pract. 2006; 12(4): 373-380.
DeLorenzo RA: Financing hospital disaster preparedness. Prehosp Disast Med. 2007; (22)5: 436-439.
Copyright 2007-2023, Weston Medical Publishing, LLC
All Rights Reserved