Hospital Preparedness for Emergency Response

7/29/2019 Hospital Preparedness for Emergency Response

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Number37 n March24,2011

HospitalPreparednessforEmergencyResponse:UnitedStates,2008

RichardW.Niska,M.D.,M.P.H.;and IrisM.Shimizu,Ph.D.

AbstractObjectiveThisreportisasummaryofhospitalpreparednessforresponding

topublichealthemergencies, includingmasscasualtiesandepidemicsofnaturallyoccurringdiseasessuchasinfluenza.

MethodsDataarefromanemergencyresponsepreparednesssupplementtothe2008NationalHospitalAmbulatoryMedicalCareSurvey,whichusesanationalprobabilitysampleofnonfederalgeneralandshortstayhospitals intheUnitedStates.Sampledatawereweightedtoproducenationalestimates.Keyresults+Nearlyallhospitalshadresponseplansforchemicalreleases,naturaldisasters,epidemics,andbiological incidents.Preparednessforexplosiveor incendiaryincidentswaslessfrequentthanpreparednessforother typesofincidents.

+Whilemosthospitalshadplansforcancellationofelectiveproceduresandadmissions, twothirdshadplansforalternatecareareaswithbeds,staffing,andequipment.

+Onehalfofhospitalsplannedforalternatecareareasin inpatienthallwaysordecommissionedwardspace,orforconversionofinpatientunits toaugmentintensivecare.

+Onehalfofhospitalshadadjustedstandardsofcareforallocationofmechanicalventilatorsformasscasualties.

+Althoughoveronehalfofhospitalshadstagedepidemicdrills,onlyonethirdincludedmassvaccinationormedicationdistribution.

+Onehalfofhospitalsplannedforadvanceregistrationofhealthcareprofessionals.

+Whilemosthospitalshadmemorandaofunderstanding(MOUs)withotherhospitals totransferadultsduringanepidemic,fewerhospitalshadMOUsforpediatricsandburns.Lessthanonehalfofhospitalsaccommodated theneedsofchildrenandpersonswithdisabilitiesduringapublichealthemergency.

Keywords:Emergencypreparedness+hospitalpreparedness+masscasualty+pandemic

IntroductionFollowing theWorldTradeCenter

attackofSeptember2001and theanthraxterrorism incidentofOctober2001,therehasbeenaheightenedinterestinusingsurveystoassessourreadinessforvariousdisasters.Therefore,theU.S.DepartmentofHealthandHumanServices,OfficeoftheAssistantSecretaryforPlanningandEvaluation(ASPE),providedfunding totheNationalCenterforHealthStatistics(NCHS)tosurveyhospitalsaboutpreparednessfortreatingpatientsfrombioterrorismattacksormasscasualtyincidents.

Bioterrorism

and

Mass

CasualtyPreparednessSupplementswereaddedto the2003and2004NationalHospitalAmbulatoryMedicalCareSurveys(NHAMCS).Apreliminaryreportonhospitalpreparednessforbioterrorismorothermasscasualtiesshowed thathospitalswerepreparedin2003 inmostof theareasstudied(1).Othermorecomprehensivepublicationscoveringbothyearsfollowed(24).

Insubsequentyears, thenationalfocusshiftedfrombioterrorismtopreparationfornaturaldisasterssuchasHurricaneKatrinaandmajorinfluenzaoutbreaks.In2004,anoutbreakofH5N1avianinfluenzawasreported in

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics


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Page2 NationalHealthStatisticsReports n Number37 n March24,2011poultryinnineeasternAsiancountries,whichwasgeneticallyrelatedto52fatalhumancasesreportedbyearly2005(5).Bytheendof2008,H5N1avianinfluenzahadbeenresponsiblefor248humandeathsin15countries inAsiaandAfrica,andhadbeenreported inbothdomesticandwildbirds inEuropeaswell(6,7).AlthoughnoavianorhumanH5N1caseshavebeenreportedintheAmericas,there ispublicconcernthat thisvirusorotherscouldresult inoutbreaksorevenpandemicsin thefuture.Inresponse tothisconcern,ASPEprovidedfundsforNCHStosurveyhospitalsontheirpreparednessformasscasualtyeventsincludingpandemics.

Thisreportservesasadescriptivesummaryofhospitalpreparednessfordealingwithnaturallyoccurringdiseases,epidemicsandpandemicssuchasinfluenza,andotherpublichealthemergencies.Informationaboutemergencypreparedness inU.S.hospitals iscrucialfor thosewhoarechargedwithplanninghow topreventandtreatlargeoutbreaksof infectiousdiseaseandothermasscasualtyevents.Methods

NHAMCSis

anational

annual

surveyofambulatorymedicalcarevisitstononinstitutional,nonfederal,acutecare,andshortstayhospitals.Shortstayhospitalsare thosewithanaveragelengthofstayofless than30days,whereasacutecarehospitalsarethosewhosespecialtyisgeneral(medicalorsurgical)orchildrensgeneral.NHAMCSusesamultistageprobabilitysamplingdesign involvingsamplesofgeographicprimarysamplingunitsandhospitalswithemergencydepartments(ED)oroutpatientdepartmentswithinthoseunits.Thedataareweightedusingtheinverseprobabilitiesofhospitalselectionwithanadjustmentfornonresponse.Therefore,estimatesareconsideredrepresentativeofhospitalsthroughouttheUnitedStates.

In2008,emergencypreparednessitemswereaddedtoNHAMCSinaspecialsupplement.Manyof the itemsonthe20032004surveyswereretained,butthe2008instrumentwas

greatlyexpanded toincludenewquestionsarisingfromresearchfindingsaswellasthosesuggestedbyoutsideprofessionalorganizations. Thisreportfocusesonnewcontentadded tothe2008survey.Afuturereportwilldiscusstrendsbetween20032004and2008foritemsthatwereretainedfromtheearliersurveys.

NHAMCS isadministeredonsiteateachparticipatinghospitalbyfieldrepresentativesemployedby theU.S.CensusBureauunderaninteragencyagreementwithNCHS.Thepandemicsupplementwasaneightpageselfadministeredquestionnaireconsistingof112totaldata items.Itwascompletedforeachsamplehospitalby thepersonresponsiblefor thehospitalsemergencyresponseplan.Thesupplementwasreturned to theU.S.CensusBureausNationalProcessingCenter(NPC)withtheNHAMCScorematerials.NPCperformedthequalitycontroleditsanddataentry,andprovidedNCHSwithmonthlyupdatesandafinalcumulativeSASfile.

AdescriptiveanalysiswasconductedbyNCHSusingafirstorderTaylorseriesapproximationmethodasappliedinSUDAAN9.0.1toaccountforthecomplexsurveydesign(8).Becauseallcontinuousvariableshadpositivelyskeweddistributions, thecentral tendencywasreportedasthemedian.

Thedeterminationofstatisticalsignificancewasbasedon thetwotailedttest.TheBonferroni inequalitywasusedtoestablishthecriticalvalueforstatisticallysignificantdifferences(0.05levelofsignificance)basedon thenumberofpossiblecomparisonswithinaparticularvariable(orcombinationofvariables)ofinterest.Termsrelating todifferencessuchasmoreorfewerindicatethatthedifference isstatisticallysignificant.Termssuchasnotdifferentorsimilarindicatethat thedifferenceisnotstatisticallysignificant.Alackofcommentonaparticulardifferencedoesnotimplyanythingaboutstatisticalsignificance.Results

Ofthesampleof395 inscopehospitalsfromthe2008NHAMCS,294

hospitalsrespondedto thesupplement(responserateof74.4percentunweightedand78.1percentweighted),representingthenationalweighteduniverseof5,212hospitals.Emergencyresponseplans+Allhospitalshadanemergencyresponseplanforatleastoneof thesixhazardsstudied(epidemic-pandemic,biological,chemical,nuclearradiological,explosiveincendiary,andnaturalincidents)(Table1,Figure1).

+Nearlyallhospitals(99.0percent)hademergencyresponseplansthatspecificallyaddressedchemicalaccidentsorattacks,whichwerenotsignificantly

different

from

the

prevalenceofplansfornaturaldisasters(97.8percent),epidemicsorpandemics(94.1percent),andbiologicalaccidentsorattacks(93.2percent).

+ Significantlyfewerhospitals(81.3percent)hadplansfornuclearorradiologicalaccidentsorattacksthanforchemicalaccidentsorattacksandnaturaldisasters.

+ Significantlyfewerhospitals(79.6percent)hadplansforexplosiveorincendiaryaccidentsorattacksthanforchemicalaccidentsorattacks,naturaldisasters,epidemicsorpandemics,andbiologicalaccidentsorattacks.

+About67.9percentofhospitalshadplansforallsixhazards.

Cooperativeplanning+About99.6percentofhospitalsengaged incooperativeplanningwithat leastoneoftheeightentitiesstudied(Table2).

+About93.7percentofhospitalsengaged incooperativeplanning indevelopingorupdatinganemergencyresponseplanforpublichealthemergencieswith thestateorlocalofficeofemergencymanagement; thiswasnotsignificantlydifferentfromtheprevalencesforplanningwithotherhospitals(92.7percent),emergencymedicalservices(EMS)(89.0percent),stateorlocalpublic


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NationalHealthStatisticsReports n Number37 n March24,2011 Page3

Chemical Natural Epidemic Biological

P

ercent

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2008.

Incident type

NUCRAD is nuclear-radiological. Significantly different from chemical and natural incidents (bothp < 0.05).

95% confidence interval

0

20

40

60

80

100

NUCRAD EXPINC

EXPINC is explosive-incendiary. Significantly different from chemical, natural, epidemic, and biological incidents(allp < 0.05).

99.0 97.8 94.1 93.2

81.3 79.6

Figure1.Percentageofhospitalswithemergencyresponseplansforselectedtypesofincidents:UnitedStates,2008

healthdepartments(88.7percent),orfiredepartments(86.0percent).

+Significantlyfewerhospitals includedhazardousmaterials teams(64.3percent)or theFederalBureauofInvestigation(19.0percent)intheiremergencyresponseplanning than theothersixentities listedabove.

+About18.7percentofhospitalsincludedalleightentitiesintheiremergencyresponseplanning.

Plansforcomponentsofhospitalpreparedness

Table3summarizesresponses toaseriesofquestionsaboutwrittenemergencyresponseplansfor48componentsofpreparednessforhospitalovercrowdingincidentsorpublichealthemergencies,andwhethertheplanswere implementedinanactual incidentduring2007.Broadcategoriesofhospitalpreparednessincludedmemorandaofunderstanding(MOUs)withotherhospitals,regionalcommunicationsystems,mutualaidagreements,expansionofonsitesurgecapacity,prioritysettingforlimitedresources,expansionofonsitehealthcareworkforce,masscasualtymanagement,managementofpediatricandotherspecialpopulations,andcommunicationstrategies.

MOUswithotherhospitals+About87.8percentofhospitalshadMOUswithoneormorehospitalstoacceptadultpatients,butonly56.2percenthadMOUswithoneormorechildrenshospitals toacceptpediatricpatientsintransferfromtheirownEDwhennobedswereavailableat thehospital.

+Only8.6percentofhospitalshadimplementedadulttransferMOUs,and8.0percenthad implementedpediatrictransferMOUsduringactualincidentsin2007.

+OnlyaboutonehalfofhospitalshadMOUswithburncenterstoacceptexplosiveincendiarymasscasualties(56.9percent),orwithotheroutpatientfacilities toaugmentoutpatientservices(42.8percent).

Regionalcommunicationsystems+About85.3percentofhospitalshadregionalcommunicationsystemstotrackEDclosuresordiversions.About29.2percentimplementedthesesystemsduringanactualincidentin2007.

+About80.6percentofhospitalshadregionalcommunicationsystemstotrackavailableadultintensivecareunit(ICU)beds,70.1percent trackedpediatricICUbeds,and64.8percenttrackedneonatalICUbeds.About22.6percent implementedadultICU

trackingsystems,16.9percentimplementedpediatricICU trackingsystems,and14.1percentimplementedneonatalICU trackingsystemsduringanactualincident in2007.

+Mosthospitalshadregionalcommunicationsystems to trackavailableadult(89.7percent),pediatric(82.0percent),andneonatal(67.8percent)hospitalbeds.Aboutonequarter implementedadult(30.4percent),pediatric(23.7percent),orneonatal(18.9percent)bedtrackingsystemsduringanactual incidentin2007.

+Only51.9percentofhospitalshadregionalcommunicationsystemstotrackspecialtycoverage.About15.1percentimplemented thissystemin2007.

Mutualaidagreements+About84.1percentofhospitalshadmutualaidagreementswithotheragenciestosharesuppliesandequipment.About16.3percentimplemented theseagreements in2007.

Expansionofon-sitesurgecapacity+About90.5percentofhospitalshadplansforisolationofairbornediseasepatients innegativepressurerooms.About14.2percent implementedtheseplans in2007(Table3,Figure2).

+About86.3percentofhospitalshadplansforcancellationofelectiveproceduresandadmissions.About12.9percentimplemented theseplansin2007.

+About73.7percentofhospitalshadplansforsettingup temporaryfacilitieswhen thehospitalisunusable(e.g.,withoutpowerorflooded).

+Manyhospitalshadplansforestablishmentofalternatecareareaswithbeds,staffing,andequipment innonclinicalspace(68.7percent),inpatientunithallways(52.3percent),ordecommissionedwardspace(49.7percent).


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Page4 NationalHealthStatisticsReports n Number37 n March24,2011

P

ercent


Component


0

20

40

60

80

100

50.7 49.7

Electivecancellations

Nonclinicalspace

Inpatienthallways

Intensivecare

conversion

Decommissionedward space

52.368.786.3

Figure2.Percentageofhospitalswithplansforselectedcomponentsofonsitesurgecapacityexpansion:UnitedStates,2008

+Only50.7percentofhospitalshadplansforconversionofinpatientunitstoaugment intensivecarecapacity.

Prioritysettingforlimitedresources+About72.4percentofhospitalshadwritten triageprocessesfor limitedintensivecareresources(Table3).

+About64.0percentofhospitalshadplansforregionalcoordinationofadjustedstandardsofcareduringapandemicorothermasscasualtyincident.

+About43.2percentofhospitalshadplansforimplementingadjustedstandardsofcareforinitiationandwithdrawalofmechanicalventilation.

+About32.9percentofhospitalshadplansfordeliveryofpotassium iodideinresponsetoradioactiverelease.

Expandingon-sitehealthcareworkforce+About88.8percentofhospitalshadaplanforcontinuityofoperations intheeventofanemergency.About14.9percent implementedthisplanduringanactualincident in2007.

+About6of10hospitalshadmutualaidagreementswithotheragenciestosharehealthcareproviders(69.5percent),orplansforadvanceregistrationofvolunteerhealthprofessionals(55.9percent).

+About6of10hospitalshadplansforstaffabsenteeismdue topersonalorfamily impactfrom theemergency(66.9percent),oronsitechildcaretomaintainstaffatthehospital(63.1percent).

Masscasualtymanagement+About94.6percentofhospitalshadplansforhospitalevacuations.

+Mosthospitalshadplansfortransporting largenumbersofpatientswithinthehospital(83.9percent)orbetweenhospitals(77.0percent).

+Only62.6percentofhospitalshadplansforanonsitelargecapacitymorgue.

Pediatrics+About42.6percentofhospitalshadatrackingsystemforaccompaniedandunaccompaniedchildren.

+About34.0percentofhospitalshadplansforreunificationofchildrenwithfamilies,and31.1percentforprotocols to identifyandprotectdisplacedchildren.

+About32.4percentofhospitalshadguidelinesfor increasingpediatricsurgecapacity.

+About29.4percentofhospitalshadplansforacquiringsuppliestoshelterhealthydisplacedchildren.

Specialpopulations+About73.3percentofhospitalshadplansforcommunicatingwithnonEnglishspeakingpatients.About15.4percentimplemented thoseplansduringanactual incidentin2007.

+Onlyaboutonehalfofhospitalshadplansforcommunicatingwithdeaf(58.3percent)orblind(47.5percent)patients.

+About47.6percentofhospitalshadplansforshelteringmobilityimpairedpatients.

+About46.7percentofhospitalshadplansforshelteringpatientswithspecialhealthcareneeds.About42.0percent implementedtheseplansduringanactualincident in2007.

+Onlyaboutonethirdofhospitalshadplansforshelteringpregnantwomen(39.2percent),mentallychallenged(39.0percent),or technologydependent(33.7percent)patients.

Communications+About93.4percentofhospitalshadplansforreceivingnotificationofalertsfrom thestateorlocalhealthdepartment.About34.5percentimplementedtheseplansduringanactual incidentin2007.

+About79.4percentofhospitalshadplansforparticipatingwithlocalpublichealthdepartmentsinpubliceducationabout theimportanceofinfluenzavaccination.About29.5percent implementedtheseplansduringanactualincident in2007.

Internalmasscasualtydrills,simulations,orexercises+ Inthelastyear,onehalf(50.6percent)ofhospitalsconductedmore thanone internaldrill;31.9percentconductedonlyoneinternaldrill;11.1percentconductednointernaldrills;andthenumberofinternaldrillswasunknownfor6.4percent(Tables4and5).

+Forthosehospitals inwhich thenumberofdrillswasknown, themediannumberofinternalfullscalesimulationsconductedwasone.

+Themediannumberofadultvictimsutilized ineachhospitals largestinternaldrillwas15.


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NationalHealthStatisticsReports n Number37 n March24,2011 Page5

Severe epidemics Mass vaccinations

P

ercent


Scenario type

Significantly different from severe epidemic drill scenarios (bothp < 0.05).


Community mass0

10

20

30

40

50

60

70

medication

22.5

58.5

32.5

Figure3.Percentageofhospitalsparticipatinginselectedmasscasualtydrillscenariotypes:UnitedStates,2008

+Themedianlengthofeachhospitalslongestinternaldrillwas4.0hours.

+Themediannumberoftabletopexercisesconductedin thelastyearbyahospitalwasone.

Externalmasscasualtydrills,simulations,orexercises+ In thelastyear,28.4percentofhospitalsconductedmore thanoneexternaldrill(i.e., incollaborationwithotherorganizations);53.6percentconductedonlyoneexternaldrill;11.5percentconductednoexternaldrills;andthenumberofexternaldrillswasunknownfor6.5percentofhospitals(Tables4and5).

+For thosehospitals inwhich thenumberofdrillswasknown, themediannumberoffullscalesimulationsconducted incollaborationwithotherorganizations(lawenforcement,healthdepartment,emergencymanagement,firedepartment,EMS,hazardousmaterialsteams,ordecontaminationteams)wasone.

+Themediannumberofadultvictimsutilizedineachhospitals largestexternaldrillwas16.

+Themedianlengthofeachhospitalslongestexternaldrillwas4.0hours.

+Themediannumberoftabletopexerciseshospitalsconductedin

collaborationwithotherorganizationswas0.5.

Typesofscenariosinmasscasualtydrills+About88.2percentofhospitalsaddressedgeneraldisasterandemergencyresponseintheirdrills,significantlymore thananyother typeofscenariostudied(Table6).

+About thesamepercentagesofhospitalsaddresseddecontaminationprocedures(69.6percent),severeepidemicsorpandemics(58.5percent),andchemicalaccidentsorattacks(55.6percent)in theirdrills.

+Comparedwithhospitalsstagingdecontaminationscenarios,significantlyfewerhospitals(42.5percent)focusedonacutedecontaminationofaerosolexposuresfrombiologicalaccidentsorattacks.

+Comparedwithhospitalsstagingsevereepidemicscenarios,aboutthesamepercentage(39.1percent)focusedondelayeddiseaseoutbreakmanagementforbiologicalaccidentsorattacks.However,significantlyfewerhospitalsaddressedmassvaccinations(32.5percent),massmedicationdistributiontohospitalpersonnel(30.6percent),ormassmedicationdistributiontothecommunity(22.5percent)(Figure3).

+ Formassmedicationdistribution,statisticallysimilarpercentagesofhospitalsfocusedonhospitalpersonnelandthecommunity.

+ In theirdrillsonbiologicalaccidentsorattacks,statisticallysimilarpercentagesofhospitalsfocusedonacutedecontaminationofaerosolexposuresanddelayeddiseaseoutbreakmanagement.

+About32.4percentofhospitalsaddressedexplosiveorincendiaryaccidentsorattacksin theirdrills,significantlyfewer thanscenariosforgeneraldisasters,decontamination,epidemics,orchemicalattacks,butstatisticallysimilar toscenariosforacutedecontaminationofbiologicalaerosolexposuresanddelayeddiseaseoutbreakmanagementforbiologicalattacks.

+About18.7percentofhospitalsaddressednuclearorradiologicalaccidentsorattacksin theirdrills,significantlyfewer thanscenariosforgeneraldisasters,decontamination,epidemics,chemicalattacks,oracutedecontaminationofbiologicalaerosolexposures,butstatisticallysimilartoscenariosfordelayeddiseaseoutbreakmanagementforbiologicalattacksandexplosions.

+ Statisticallysimilarpercentagesofhospitalsaddressedchildren(44.6percent)andthefrailelderly(36.2percent)intheirdrills.Butonly17.1percentaddressedmentallychallengedindividuals in theirdrills,significantly lessthanchildrenor thefrailelderly.

Collaborationwithoutsideorganizationsonmasscasualtydrills+Statisticallysimilarpercentagesofhospitalsperformeddrills,simulations,orexerciseswithstateorlocalofficesofemergencymanagement(85.8percent),stateorlocal lawenforcement(81.5percent),stateorlocalpublichealthdepartments(81.3percent),firedepartments(79.7percent),andfiredepartmentbasedEMS(72.1percent)(Table7).


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Page6 NationalHealthStatisticsReports n Number37 n March24,2011+About69.7percentofhospitalsperformeddrillswithEMSnotbasedinafiredepartment,significantlyfewerthanwithofficesofemergencymanagement,butstatisticallysimilartofiredepartmentbasedEMS, lawenforcement,publichealthdepartments,andfiredepartments.

+ Statisticallysimilarpercentagesofhospitalsperformeddrillswithdecontamination teams(58.4percent)andhazardousmaterialsteams(50.9percent).

+ Statisticallysimilarpercentagesofhospitalsperformeddrillswithschoolsystems(30.6percent), industrialorcommercialorganizations(25.8percent),orlongtermcarefacilities(20.4percent).

Masscasualtyresources+Forpersonalprotection, themediannumberofN95masksperhospitalwas432,and themediannumberofpersonalprotectivesuitswithpoweredairpurifyingrespiratorsperhospitalwas10(Table8).

+Themediannumbersofpatients thatcouldbehandledbyhospitaldecontaminationshowersperhourwassevenforambulatorypatients,three

for

small

children

or

infants,

and threeforstretcherpatients.

+Themediannumbersofbedsperhospitalwas70forregularinpatientstaffedbeds,8forcriticalcarebeds,11forEDtreatmentspaces,and4fornegativepressureisolationrooms.

+Themediannumberofmechanicalventilatorsperhospitalwassix.

AmbulancediversionWhenEDsareatcapacity,

ambulancediversion isimplemented.Thus,thenumberofannualhours thatanED isonambulancediversion,orthatahospital isondiversionfor traumaorcriticalcarecases,reflects thehospitalscapacitytoacceptnewpatients,notonlyduringroutineoperations,butalsoduringamasscasualty incident(Table9).+ In2007, themajorityofhospitals(58.7percent)didnotreportbeingonEDambulancediversion.About

16.3percentofhospitalswereonambulancediversionfor220hoursorless(equivalent toabout9.2days),whichrepresentedthemeanforthe91.2percentofhospitalsforwhichdatawereavailable.About16.2percentofhospitalswereonambulancediversionformore than220hours.Ambulancediversioninformationwasunknownfor8.7percentofhospitals.

+ In2007,themajorityofhospitals(72.5percent)didnotreportbeingontraumadiversion.About7.1percentofhospitalswereontraumadiversionfor32hoursorless(equivalenttoabout1.3days),whichrepresentedthemeanforthe85.2percentofhospitalsforwhichdatawereavailable.Theestimatewasunreliableforhospitalsontraumadiversionformore than32hours.Traumadiversioninformationwasunknownfor14.8percentofhospitals.

+ In2007, themajorityofhospitals(66.4percent)didnotreportbeingoncriticalcarediversion.About10.6percentofhospitalswereoncriticalcarediversionfor72hoursorless(equivalent tothreedays),whichrepresentedthemeanforthe84.5percentofhospitalsforwhichdatawereavailable.About7.5percentofhospitalswereoncriticalcarediversionformore than72hours.Criticalcarediversion informationwasunknownfor15.5percentofhospitals.

Hospitalpreparednessfunding

Between2002and2007,aboutonequarterofhospitals(24.3percent)receivedmorethan$150,000infederalpreparednessfunding,19.2percentreceivedmorethan$75,000butlessthan$150,000,and24.2percentreceivedmorethanzerobut lessthan$75,000.About5.2percentreceivednofunding.Theamountoffundingwasunknownfor27.2percentofhospitals(Table10).Discussion

Thisemergencyresponsepreparednesssupplementcontains

valuableinformationforfederal,state,andlocalplannerswhoareresponsibleforhospitalsresponsetoinfectiousdiseaseepidemicsandothermasscasualty incidents.In thisreport,baselineshavebeenestablishedfornewdataelements.Futureresearchwill tracktrendsbetween20032004and2008fordataelementsthatareunchanged,andidentifyhospitalcharacteristicsthatareassociatedwithemergencypreparedness.Thereareseveralkey issuesthatarehighlightedby thissurvey.

Whilenearlyallhospitalshaveemergencyresponseplansforchemicalreleases,naturaldisasters,epidemicsorpandemics,andbiologicalaccidentsorattacks,preparednessforexplosiveorincendiaryincidentsissignificantly lessfrequent thanpreparednessforothertypesofmasscasualty incidents.Asimilar trendwasfoundwithrespecttoincludingexplosionscenariosinmasscasualtydrills.Explosiveterrorismisinfrequent intheUnitedStates,withnoincidentshavingoccurredsincethe2001airlineattacksat theWorldTradeCenter,Pentagon,andoverPennsylvania(9).However,incendiaryincidents(fires)aremorecommon.TheU.S.FireAdministrationreported thattherewereabout15,500fires inhighrisestructuresbetween

1996

and

1998.

While

hospital

preparednessforfiresmostofteninvolvesreceivingcasualtiesfromincidentsoccurringelsewhere,it isnoteworthythatabout6percentof thesehighrisestructurefiresoccurredinhospitals(10).

EDcrowdingcontinuestobeamajorpolicyissue.TheInstituteofMedicine(IOM)hasexpressedconcernthatmanyhospitalsnowoperatingatornearfullcapacitylacktheability tohandlesuddenincreasesinvolumeassociatedwithmasscasualties(11).TheAmericanCollegeofEmergencyPhysicians(ACEP)recommends thathospitalsdevelopinfluenzapreparednessplans toassureadequateinpatientsurgecapacitybysuchmeansasopeningunusedareas,doublingup inpatientrooms,cancelingelectiveadmissionsandprocedures,andusingalternateareasforextracriticalcarespace(12).Wefoundthatwhilemosthospitalshadplansforcancellationofelective


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NationalHealthStatisticsReports n Number37 n March24,2011 Page7proceduresandadmissions,onlyabouttwothirdshadplansforestablishmentofalternatecareareaswithbeds,staffing,andequipmentinnonclinicalspace.Onlyaboutonehalfhadplansforestablishingalternatecareareasininpatientunithallwaysordecommissionedwardspace,orforconversionof inpatientunitstoaugmentintensivecarecapacity.OnepracticethatmaybeusefulindecompressingEDs isestablishingalternatecareareas ininpatienthallwaysuntilregularbedsbecomeavailable.Becauseofconcernsabout thesafetytopatientsof thisapproach,oneacademicEDstudiedadverseeventsresultingfrom theirinstitutionalprotocolforadmittingEDboardedpatientsto inpatienthallwaybedsduringovercrowdingsituations.InhospitalmortalityandICUtransferswerebothsignificantly lowerforpatientsadmittedtohallwaybedsthanforthoseadmitted tostandardinpatientbeds.Theauthorsconcluded thathallwayboardingwasnotharmful topatients(13).

Whenresourcesforpatientcarebecomescarceindisastersituations,IOMrecommends thedevelopmentofconsistentstatecrisisstandardsofcare(14).Oneexampleofsucharesource ismechanical

ventilators

for

patients

in

respiratoryfailuredueto infectiousagents thathavecompromisedlungfunction.Wefoundthatonlyaboutonehalfofhospitalshadadvanceplansforadjustedstandardsofcareforallocationofmechanicalventilatorsduringmasscasualty incidentswhennormalcapacitiesmightbeoverwhelmed.Butmodelsdoexistfordevelopingsuchstandards.Inonetertiarymedicalcenter,atriagesystemwasdevelopedandtestedfor institutingorcontinuingmechanicalventilationbasedonobjectiveclinicalfactorsrelated tosurvivalpotentialandavailableresources.Thesystem,whichinvolvesachange in thestandardofcare,wouldbe implementedthrough thehealthdepartmentandsupportedbyadeclarationfrom thestategovernorwithprofessionalliabilityprotections inplace(15).

ACEPrecommendsthathospitalscreateandexecuteatrainingprogram

basedupontheiremergencyoperationsplans,developpandemic influenzaexerciseprograms,andexecuteanexerciseto testthevalidityof thetrainingandplans(12).Asevidencedbythe2009H1N1 influenzaepidemic,massvaccinationandmedicationdistributionarefrequentlykeycomponentsofepidemicresponse.Wefound thatalthoughmore thanonehalfofhospitalshadstagedepidemicdrills,onlyaboutonethirdhadincludedmassvaccinationorcommunitymedicationdistributionspecifically.Inasurveyofhealthcareepidemiologistsfollowingtheexperienceof the2009H1N1influenzaepidemic,only60percentfeltthattheirhospitalswerewellpreparedforapandemic,and31percentreportedshortagesofantiviralmedications.Theauthorsidentifiedpandemicinfluenzaplanrevisionsandconsiderationofmandatoryinfluenzavaccinationsforhealthcareworkersas importantpriorities(16).

TheEmergencySystemforAdvanceRegistrationofVolunteerHealthProfessionalsGrantProgramoftheU.S.Officeof theAssistantSecretaryforPreparednessandResponsehelpshealthprofessionalsvolunteerinpublichealthemergenciesby

providing

verifiable

information

abouttheiridentity,license,credentials,andclinicalprivilegestoparticipatingmedicalfacilities(17).Despite theexistenceofthisfederal initiative,wefoundthataboutonehalfofhospitalshadplansforadvanceregistrationofoutsidehealthcareprofessionals.

Planningforspecialpopulations,includingchildren,appearstobelesscommon thanplanningforadultpatients.Forexample,ACEPrecommendsthatwritten transferprotocolsand interfacilityagreementsshouldbe inplacewhenpatienttransferispartofaregionalplan toprovideoptimalspecializedcare(18).WhilemosthospitalshaveMOUswithotherhospitals toacceptadultpatients intransferduringanepidemic,fewerhospitalshaveMOUsforpediatricandburnpatients.Similarly, less thanonehalfofhospitalshadvariousprogramsinplacetoaccommodatetheneedsofchildrenandpersonswith

disabilitiesduringapublichealthemergency.References1. NiskaRW,BurtCW.Bioterrorism

andmasscasualtypreparednessinhospitals:

United

States,

2003.

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NationalHealthStatisticsReports n Number37 n March24,2011 Page9Table1.Hospitalswithemergencyresponseplansforselectedtypesof incidents:UnitedStates,2008

NumberofTypeof incident hospitals Percent SE 95%confidence interval

Chemical accidents or attacks . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,162 99.0 0.3 98.1 99.5 Natural disasters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,095 97.8 0.8 95.4 98.9 Epidemics or pandemics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,904 94.1 1.9 88.9 96.9 Biological accidents or attacks. . . . . . . . . . . . . . . . . . . . . . . . . . . 4,859 93.2 2.2 87.4 96.5 Nuclearorradiologicalaccidentsorattacks. . . . . . . . . . . . . . . . . . . 4,235 81.3 4.5 70.7 88.6 Explosiveor incendiaryaccidentsorattacks . . . . . . . . . . . . . . . . . . 4,147 79.6 4.1 70.3 86.5 All types of incidents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,540 67.9 4.7 58.0 76.4 NOTES:Unweightedsamplesizeis294,representingaweightednationalestimateof5,212hospitals.SEisstandarderrorofpercent.

Table2.Hospitalsengagedincooperativeplanning indevelopingorupdatingaresponseplanforpublichealthemergencies,bytypeofentityengaged:UnitedStates,2008

NumberofTypeofoutsideentityengaged hospitals Percent SE 95%confidence interval

Stateor localofficeofemergencymanagement. . . . . . . . . . . . . . . . 4,884 93.7 1.9 88.7 96.6 Other hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,832 92.7 2.7 85.2 96.6 Emergency medical services. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,640 89.0 3.3 80.7 94.0 State or local public health department . . . . . . . . . . . . . . . . . . . . . 4,622 88.7 3.1 80.9 93.6 State or local law enforcement. . . . . . . . . . . . . . . . . . . . . . . . . . . 4,492 86.2 2.9 79.4 91.0 Fire department. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,483 86.0 3.4 77.9 91.5 Hazardous materials teams. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,351 64.3 5.6 52.6 74.5 Federal Bureau of Investigation . . . . . . . . . . . . . . . . . . . . . . . . . . 992 19.0 3.2 13.6 26.0 All eight entit ies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 973 18.7 3.2 13.2 25.7 NOTES:Unweightedsamplesizeis294,representingaweightednationalestimateof5,212hospitals.SEisstandarderrorofpercent.


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11/15

Table3.Hospitalshavingcomponents inawrittenplanforuseduringanovercrowdingincidentorpublichealthemergency,bytypeofplan2008Con.

InemergencyresponseplanTypeofplancomponent Number Percent SE 95%confidence interval Number

PediatricGuidelineson increasingpediatricsurgecapacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,687 32.4 3.9 25.2 40.5 * Protocolto identifyandprotectdisplacedchildrenrapidly. . . . . . . . . . . . . . . . . . . . . . . . . 1,621 31.1 3.7 24.4 38.8 * Trackingsystemforchildren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,222 42.6 4.1 34.8 50.9 * Reunificationofchildrenwithfamilies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,774 34.0 3.8 27.1 41.8 * Suppliesforshelteringhealthydisplacedchildren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,531 29.4 4.1 22.0 38.0 *

SpecialpopulationsCommunication withdeafpatients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,036 58.3 5.0 48.2 67.6 * Communication with blind pa ti en ts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,476 47.5 4.9 38.1 57.1 * Communication withnon-English-speakingpatients . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,820 73.3 4.2 64.3 80.7 804 Shelteringmobility-impairedpatients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,481 47.6 4.4 39.2 56.2 * Shelteringtechnology-dependentpatients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,757 33.7 3.9 26.5 41.8 * Shelteringpregnantwomen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,042 39.2 3.9 31.7 47.2 * Shelteringpatientswithspecialhealthcareneeds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,433 46.7 4.0 39.0 54.5 2187Shelteringmentallychallengedpatients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,034 39.0 3.9 31.6 47.0 *

Communications Notification ofalertsfromyourhealthdepartment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,866 93.4 2.3 87.1 96.7 1800Participation inpubliceducationabout influenzavaccination. . . . . . . . . . . . . . . . . . . . . . . 4,140 79.4 3.0 73.0 84.7 1536*Figuredoesnotmeetstandardsofreliability(fewerthan30unweightedcases).NOTES:Unweightedsamplesize is294,representingaweightednationalestimateof5,212hospitals.SE isstandarderrorofpercent.MOU ismemorandaofunderstanding.ED isemergencydepartm


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Page12 NationalHealthStatisticsReports n Number37 n March24,2011Table4. Internalandexternalmasscasualtydrills(numberandpercentdistribution):UnitedStates,2008

Numberof internaldrillsNumberof

Internaldrills hospitals Percent SE 95%confidence intervalTotal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,212 100.0 . . . . . . . . .N o dril ls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 578 11.1 2.4 7.2 16.8 One drill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,661 31.9 4.3 24.0 40.9 More than one dri l l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,638 50.6 5.5 39.9 61.3 Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335 *6.4 2.8 2.6 14.8

Drills incollaborationwithotherorganizationsNumberof

Numberofexternaldrills hospitals Percent SE 95%confidence intervalTotal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,212 100.0 . . . . . . . . .No dril ls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 599 11.5 2.5 7.4 17.5 One drill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,794 53.6 3.9 45.9 61.2 More than one dri l l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,482 28.4 3.9 21.4 36.7 Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337 *6.5 2.1 3.3 12.2 . . . Categorynotapplicable.*Figuredoesnotmeetstandardsofprecision(relativestandarderrorgreater than30%).NOTES:Totalunweightedsamplesize is294,representingaweightednationalestimateof5,212hospitals.SE isstandarderrorofpercent.

Table5. Internalandexternalmasscasualtydrills(mediannumberofdrills,numberofvictims,and lengthof longestdrill):UnitedStates,2008

InternaldrillsNumberofhospitals Median SE Interquartilerange

Full-scale simulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,877 1.1 0.1528 0.4 1.9Numberofvictims in largestdrill

Adul t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,058 14.9 2.5 4.8 26.1 Pediatric . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,752 *1.4 0.6 ** 4.2

Length of longest drill (hours) . . . . . . . . . . . . . . . . . . . . . . . . . . 4,271 4.0 0.5 3.4 20.3 Table-top exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,373 0.7 0.1 0.1 1.5

Externaldrills(incollaborationwithotherorganizations)Numberofhospitals Median SE Interquartilerange

Full-scale simulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,875 0.7 0.1 0.2 1.3 Numberofvictims in largestdrill

Adul t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,006 15.6 2.2 6.0 24.9 Pediatric . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,681 1.2 ** ** 4.6

Length of longest drill (hours) . . . . . . . . . . . . . . . . . . . . . . . . . . 4,189 4.0 0.5 3.9 19.5 Table-top exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,436 0.5 0.1 ** 1.3 *Figuredoesnotmeetstandardsofprecision(relativestandarderrorgreater than30%).**Notpossibletoextrapolatedata tocomputevalue.NOTES:Totalunweightedsamplesize is294,representingaweightednationalestimateof5,212hospitals.Numberofhospitalsexcludes those forwhich thenumberofdrillsisunknown.SE isstandarderrorofmedian.


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NationalHealthStatisticsReports n Number37 n March24,2011 Page13Table6.Typeofdrillscenarioamonghospitalsparticipating inmasscasualtydrills:UnitedStates,2008

NumberofTypeofscenario hospitals Percent SE 95%confidence interval

General disaster and emergency response. . . . . . . . . . . . . . . . . . . . . . . . 4,599 88.2 3.2 80.2 93.3 Decontamination procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,627 69.6 4.2 60.8 77.1 Severe epidemic or pandemic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,051 58.5 4.3 49.9 66.7 Chemical accidents or attacks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,898 55.6 4.3 47.0 63.9 Biologic accidents or attacks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Decontamination of aerosol exposure. . . . . . . . . . . . . . . . . . . . . . . . . . 2,213 42.5 4.0 34.9 50.4

Delayed disease outbreak management . . . . . . . . . . . . . . . . . . . . . . . . 2,038 39.1 5.4 29.0 50.2 Mass vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,692 32.5 4.6 24.1 42.1 Explosive or incendiary accidents or attacks . . . . . . . . . . . . . . . . . . . . . . . 1,689 32.4 3.6 25.8 39.8 Massmedicationdistributiontohospitalpersonnel . . . . . . . . . . . . . . . . . . . 1,597 30.6 4.9 22.0 41.0 Mass medication distribution to community . . . . . . . . . . . . . . . . . . . . . . . . 1,174 22.5 4.3 15.2 32.0 Nuclear or radiological accidents or attacks . . . . . . . . . . . . . . . . . . . . . . . 972 18.7 2.8 13.8 24.8 Specialpopulations

Chi ldren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,324 44.6 3.9 37.0 52.4 Frail elderly. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,886 36.2 4.0 28.6 44.5 Mentally challenged. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 892 17.1 3.6 11.2 25.3

NOTES:Unweightedsamplesizeis294,representingaweightednationalestimateof5,212hospitals.SEisstandarderrorofpercent.

Table7.Typeoforganizationwithwhichhospitalscollaborate inexternalmasscasualtydrills:UnitedStates,2008Hospitalcollaboratingwithorganization

NumberofTypeofcollaboratingorganization hospitals Percent SE 95%confidence interval

Stateor localofficeofemergencymanagement. . . . . . . . . . . . . . . . . . . . . 4,471 85.8 2.5 80.0 90.1 State or local law enforcement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,248 81.5 2.7 75.5 86.3 State or local public health department . . . . . . . . . . . . . . . . . . . . . . . . . . 4,235 81.3 3.3 73.8 87.0 Fire department. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,155 79.7 3.0 73.1 85.0 EMS: fire department based . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,760 72.1 3.7 64.3 78.8 EMS: not based in fire department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,633 69.7 4.0 61.2 77.0 Decontamination teams. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,042 58.4 4.0 50.3 66.1 Hazardous materials teams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,652 50.9 4.8 41.6 60.1 School systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,595 30.6 4.2 23.0 39.5 Industrial or commercial organizations. . . . . . . . . . . . . . . . . . . . . . . . . . .

1,347

25.8

4.1

18.7

34.6

Long-term care facilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,061 20.4 3.4 14.5 27.8 NOTES:Unweightedsamplesizeis294,representingaweightednationalestimateof5,212hospitals.SEisstandarderrorofpercent.EMS isemergencymedicalservices.

Table8.Selectedemergencyresponseresourcesandcapabilitiesinhospitals:UnitedStates,2008Numberof

Typeofequipment hospitals Median SE InterquartilerangeMechanical ventilators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,814 5.7 0.9 2.0 19.4 N95 masks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,912 432.1 78.0 128.2 1,494.7Personal protective suits with PAPR . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,705 9.7 1.0 5.4 19.2 Emergency department treatment spaces. . . . . . . . . . . . . . . . . . . . . . . . . 4,953 10.5 1.1 5.1 21.6 Crit ical care beds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,807 8.5 1.0 3.7 26.3 Negative pressure isolation rooms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,020 4.1 0.4 1.0 10.0 Regular inpatient staffed beds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,817 70.4 15.5 24.6 158.6Decontaminationshowers

Ambulatory patients per hour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,863 7.0 1.1 1.4 19.8 Stretcher patients per hour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,776 3.0 0.4 0.8 7.9 Small children or infants per hour . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,429 3.4 0.9 0.6 13.4

NOTES:Unweightedsamplesizeis294,representingaweightednationalestimateof5,212hospitals.Numberofhospitalsexcludes those forwhich thenumberofselectedresourcesorcapabilities isunknown.SEisstandarderrorofmedian.PAPR ispoweredairpurifyingrespirator.


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Page 14 National Health Statistics Reports n Number 37 n March 24, 2011Table9.Annualhoursspentondiversionstatus,bytypeofdiversion:UnitedStates,2008

Number ofDiversion type hospitals Percent SE 95% confidence interval

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,212 100.0 . . . . . . . . .Ambulances to emergency department

N one. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,061 58.7 3.8 51.0 66.0 1 to 220 hours1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 850 16.3 2.8 11.5 22.6 More than 220 hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 846 16.2 2.8 11.4 22.5Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 8.7 1.8 5.8 13.0

TraumaN one. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,777 72.5 3.1 65.9 78.2 1 to 32 hours2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 370 7.1 1.9 4.2 11.7 More than 32 hours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295 *5.7 1.8 3.0 10.6 Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 770 14.8 2.0 11.2 19.3

Critical care casesN one. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,461 66.4 3.2 59.9 72.3 1 to 72 hours3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 551 10.6 2.3 6.9 16.0 More than 72 hours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393 7.5 1.7 4.8 11.6 Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 807 15.5 2.3 11.5 20.6

. . . Category not applicable. * Figure does not meet standards of precision (relative standard error greater than 30%). 1The mean was 220.4 hours. The median and mode were zero.2The mean was 31.6 hours. The median and mode were zero.3The mean was 72.1 hours. The median and mode were zero.NOTES: Unweighted sample size is 294, representing a weighted national estimate of 5,212 hospitals. SE is standard error.

Table10.Totalfundingreceivedperhospitalfromfederalhospitalpreparednessprograms:UnitedStates,20022007Funding Number ofhospitals Percent SE 95% confidence interval

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,212 100.0 . . . . . . . . .N one . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1-$75,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $75,001-$150,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . More than $150,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U nknow n. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

270 1,259 1,002 1,265 1,416

*5.2 24.2 19.2 24.3 27.2

1.7 5.4 4.8 2.7 4.4

2.7 15.1 11.5 19.4 19.4

9.9 36.3 30.5 29.9 36.6

. . . Category not applicable.* Figure does not meet standards of precision (relative standard error greater than 30%). NOTE: Unweighted sample size is 294, representing a weighted national estimate of 5,212 hospitals. SE is standard error of percent.


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Page16 NationalHealthStatisticsReports n Number37 n March24,2011

AcknowledgmentsThisreportwasprepared in theDivisionofHealthCareStatistics.VictorShigaev,RobertoValverde,andElizabethRechtsteiner in theTechnicalServicesBranchperformed thesampleweightingandedited thedataset.NancySonnenfeldcontributedto thediscussionsection.ThereportwaseditedandproducedbyCDC/OSELS/NCHS/OD/OfficeofInformationServices, InformationDesignandPublishingStaff:BetsyM.Finleyeditedthereport; typesettingwasdonebyAnnetteF.Holman;andgraphicswereproducedbyJohnJeter.

SuggestedcitationNiskaRW,ShimizuIM.Hospitalpreparednessforemergencyresponse:UnitedStates,2008.Nationalhealthstatisticsreports;no37.Hyattsville,MD:NationalCenterforHealthStatistics.2011.

CopyrightinformationAllmaterialappearing inthisreport is in thepublicdomainandmaybereproducedorcopiedwithoutpermission;citationas tosource,however, isappreciated.

NationalCenterforHealthStatisticsEdwardJ.Sondik,Ph.D.,Director

JenniferH.Madans,Ph.D.,AssociateDirectorforScience

DivisionofHealthCareStatisticsJaneE.Sisk,Ph.D,Director

U.S.DEPARTMENTOFHEALTH&HUMANSERVICESCenters forDiseaseControlandPreventionNationalCenter forHealthStatistics3311ToledoRoadHyattsville,MD20782

FIRSTCLASSPOSTAGE&FEESPAID

CDC/NCHSPERMITNO.G-284

OFFICIALBUSINESSPENALTYFORPRIVATEUSE,$300Toreceivethispublicationregularly,contacttheNationalCenterforHealthStatisticsbycalling18002324636E-mail:[email protected]:http://www.cdc.gov/nchsDHHSPublicationNo.(PHS)20111250CS220252

T38772(03/2011)
mailto:[email protected]://www.cdc.gov/nchsmailto:[email protected]://www.cdc.gov/nchs

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