Pandemic influenza and major disease outbreak preparedness in US emergency departments: A selected survey of emergency health professionals

Authors

  • Melinda J. Morton, MD, MPH
  • Edbert B. Hsu, MD, MPH
  • Sneha H. Shah, MD
  • Yu-Hsiang Hsieh, PhD
  • Thomas D. Kirsch, MD, MPH

DOI:

https://doi.org/10.5055/ajdm.2019.0340

Keywords:

disaster medicine, disaster preparedness, pandemic influenza, emergency department preparedness, pandemic preparedness

Abstract

Objective: To assess the level of pandemic preparedness at emergency departments (EDs) around the country and to better understand current barriers to preparedness in the United States represented by health professionals in the American College of Emergency Physician (ACEP) Disaster Medicine Section (DMS).

Methods, design, and setting: A cross-sectional survey of ACEP DMS members was performed. A total of 300 members were surveyed both via e-mail and with paper surveys during the 2009 ACEP Scientific Assembly DMS Meeting. An optional comments section was included for section members’ perspectives on barriers to preparedness. A 15-item pandemic preparedness score was calculated for each respondent based on key preparedness indicators as defined by the authors. Results were analyzed with descriptive statistics, χ2 analysis, Cochran-Armitage trend test, and analysis of variance. Free text comments were coded and subjected to frequency-based analysis.

Results: A total of 92 DMS members completed the survey with a response rate of 31 percent. Although 85 percent of those surveyed indicated that their hospital had a plan for pandemic influenza response and other infectious disease threats, only 68 percent indicated that their ED had a plan, and 52 percent indicated that their hospital or ED had conducted disaster preparedness drills. Only 57 percent indicated that there was a plan to augment ED staff in the event of a staffing shortage, and 63 percent indicated that there were adequate supplies of personal protective equipment. While 63 percent of respondents indicated that their ED had a plan for distribution of vaccines and antivirals, only 32 percent of EDs had a plan for allocation of ventilators. A total of 42 percent of respondents felt that their ED was prepared in the event of a pandemic influenza or other disease outbreak, and only 35 percent felt that their hospital was prepared. The average pandemic preparedness score among respondents was 8.30 of a total of 15. Larger EDs were more likely to have a higher preparedness score (p = 0.03) and more likely to have a pandemic preparedness plan (p = 0.037). Some major barriers to preparedness cited by section members included lack of local administration support, challenges in funding, need for dedicated disaster preparedness personnel, staffing shortages, and a lack of communication among disaster response agencies, particularly at the federal level.

Conclusions: There appear to be significant gaps in pandemic influenza and other infectious disease outbreak planning among the hospitals where ACEP DMS members work. This may reflect a broader underlying inadequacy of preparedness measures.

 

Author Biographies

Melinda J. Morton, MD, MPH

Captain, U.S. Army; Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Edbert B. Hsu, MD, MPH

Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

Sneha H. Shah, MD

Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

Yu-Hsiang Hsieh, PhD

Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

Thomas D. Kirsch, MD, MPH

Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

References

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.

Levin PJ, Gebbie EN, Qureshi K: Can the health care system meet the challenge of pandemic flu? Planning, ethical, and workforce considerations. Public Health Rep. 2007; 122(5): 573-578.

Cauchemez S, Donnelly CA, Reed C, et al.: Household transmission of 2009 pandemic influenza A (H1N1) virus in the United States. N Engl J Med. 2009; 361(27): 2619-2627.

Hanfling D, Hick JL: Hospitals and the novel H1N1 outbreak: The mouse that roared? Disaster Med Public Health Prep. 2009;3 (Suppl 2): s100-s106.

Shapiro JS, Genes N, Kuperman G, et al.: Health information exchange, biosurveillance efforts, and emergency department crowding during the spring 2009 H1N1 outbreak in New York City. Ann Emerg Med. 2010; 55(3): 274-279.

McKenna M: Pearls about swine: How emergency departments are coping with the surge of H1N1. Ann Emerg Med. 2010; 55(1): A19-A21.

Miroballi Y, Baird JS, Zackai S, et al.: Novel influenza A (H1N1) in a pediatric health care facility in New York City during the first wave of the 2009 pandemic. Arch Pediatr Adolesc Med. 2010; 164(1): 24-30.

Anonymous: Some EDs fell short in H1N1 outbreak. ED Manag. 2009; 21(9): 102-103.

Johnson MM, Bone EA, Predy GN: Taking care of the sick and scared: A local response in pandemic preparedness. Can J Public Health. 2005; 96(6): 412-414.

Burkle FM Jr: Do pandemic preparedness planning systems ignore critical community- and local-level operational challenges? Disaster Med Public Health Prep. 2010; 4(1): 24-29.

Hick JL, Christian MD, Sprung CL, et al.: Chapter 2. Surge capacity and infrastructure considerations for mass critical care. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Intensive Care Med. 2010; 36 (Suppl 1): S11-S20.

Joynt GM, Loo S, Taylor BL, et al.: Chapter 3. Coordination and collaboration with interface units. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Intensive Care Med. 2010; 36 (Suppl 1): S21-S31.

Sandrock C; European Society of Intensive Care Medicine’s Task Force for intensive care unit triage during an influenza epidemic or mass disaster. Chapter 4. Manpower. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Intensive Care Med. 2010; 36 (Suppl 1): S32-S37.

Sprung CL, Zimmerman JL, Christian MD, et al.: Recommendations for intensive care unit and hospital preparations for an influenza epidemic or mass disaster: Summary report of the European Society of Intensive Care Medicine’s Task Force for intensive care unit triage during an influenza epidemic or mass disaster. Intensive Care Med. 2010; 36(3): 428-443.

Christian MD, Joynt GM, Hick JL, et al.: Critical care triage. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Intensive Care Med. 2010; 36 (Suppl 1): S55-S64.

Morton MJ, Kirsch TD, Rothman RE, et al.: Pandemic influenza and major disease outbreak preparedness in US emergency departments: A survey of medical directors and department chairs. Am J Disaster Med. 2009; 4(4): 199-206.

American College of Emergency Physicians: Our Mission and Vision. Available at http://www.acep.org/aboutus.aspx?LinkIdentifier=id& id=22624&fid=1532&Mo=No&taxid=112437. Accessed November 22, 2010.

American College of Emergency Physicians: Disaster Medicine Section. Available at http://www.acep.org/acepmembership.aspx?id=24994. Accessed November 22, 2010.

World Health Organization: Pandemic Influenza Weekly Update 69. Available at http://www.who.int/csr/don/2009_10_09/en/index.html. Accessed November 23, 2010.

Balicer RD, Barnett DJ,Thompson CB, et al.: Characterizing hospital workers’ willingness to report to duty in an influenza pandemic through threat- and efficacy-based assessment. BMC Public Health. 2010; 10: 436.

Martin R, Conseil A, Longstaff A, et al.: Pandemic influenza control in Europe and the constraints resulting from incoherent public health laws. BMC Public Health. 2010; 10: 532.

Martin R: The role of law in pandemic influenza preparedness in Europe. Public Health. 2009; 123(3): 247-254.

Bennett B: Legal rights during pandemics: Federalism, rights and public health laws--A view from Australia. Public Health. 2009; 123(3): 232-236.

De Ville K: Legal preparation and pandemic influenza. J Public Health Manag Pract. 2007; 13(3): 314-317.

Published

10/01/2019

How to Cite

Morton, MD, MPH, M. J., E. B. Hsu, MD, MPH, S. H. Shah, MD, Y.-H. Hsieh, PhD, and T. D. Kirsch, MD, MPH. “Pandemic Influenza and Major Disease Outbreak Preparedness in US Emergency Departments: A Selected Survey of Emergency Health Professionals”. American Journal of Disaster Medicine, vol. 14, no. 4, Oct. 2019, pp. 269-77, doi:10.5055/ajdm.2019.0340.

Similar Articles

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)

<< < 1 2