Hospital Preparedness for Chemical Accidents: The Effect of Environmental Legislation on Health Care Services

Abstract

Background:Chemical accidents occur often across the United States, endangering the health and safety of many people. The Super fund Amendments and Reauthorization Act of 1986 (SARA) requires that communities increase their planning for medical response to these accidents. So far, little evidence has come forth that supports the notion that environmental legislation, such as SARA, improves preparedness for such accidents.Methods:A one-group pretest/post-test longitudinal design was used to survey the medical directors of emergency departments in all acute care hospitals in the State of New York. Data were collected by mail survey and telephone follow-up in 1986 before the passage of SARA (Timel), and in 1989 after its implementation (Time2).Results:Ninety-four percent of the directors responded at Timel and 72% at Time2. In New York State, hospital preparedness for chemical accidents improved significantly during the study interval. The longer a hospital had a plan for response to chemical accidents, the more elements of preparedness were in place. Further, as a group, the hospitals that were the least prepared were located in the areas at highest risk.Conclusion:Environmental legislation can influence the manner by which health care organizations prepare for environmental emergencies.

An Investigation of Hospital Disaster Preparedness in Turkey

“…In an attempt to prepare the data collection questionnaire to be used in the study, the relevant literature (Landesman et al, 1994;PAHO/WHO, 2000;Tsai et al, 2004;Bulut et al, 2005;Kaji et al, 2007;Remmen, 2006;Lök et al, 2009;Yi et al, 2010) were examined, and the contents of the hospital disaster plans were studied. A total of 32 descriptive questions were posed in the questionnaire.…”

Hospital Disaster Preparedness in Los Angeles County

“…Questionnaire items included a description of the structure of the hospital disaster plan, modes of intrahospital and interhospital communication, decontamination capability and training, characteristics of drills, pharmaceutical stockpiles, and each facility's surge capacity (assessed by monthly ED diversion status and number of available beds, ventilators, and negative pressure isolation rooms). Because a survey performed in 1994 demonstrated that hospitals were better prepared when the medical directors of the ED participated in community planning, 32 we also assessed whether each hospital participated in the local disaster planning committee. Additional survey items examined mutual aid agreements with other hospitals and with long-term care facilities, predisaster ''preferred'' agreements with medical vendors, protocols for canceling elective surgeries and early inpatient discharge, the ability to provide day care for dependents of hospital staff, syndromic surveillance systems, ongoing training with local EMS and fire agencies, communication with the public health department, a volunteer credentialing system, a system for hospital lockdown, and a protocol for mass fatality incidents.…”

Hospital Preparedness Plans for Chemical Incidents and Threats: A Systematic Review

“…30 One important issues that usually is neglected is water supply for washing and drinking in this situation. 30,31 Prerequisites for chemical plan development include assessment of risk and vulnerability, resources and capabilities and staff competency; the definitions of chemical disasters, events, catastrophes; features of a hospital emergency management plan, 25,31,32 plan activation notification (early warning system) communication, personal identification, chain of command, hospital command center, support staff, reporting center, traffic flow, triage, decontamination, treatment areas, patient caretransportation-tracking, logistics and supplies; specialized areas for family, volunteer, media, morgue, evacuation; establishment of alternate care sites; education and training; testing and evaluating plans, including ambulatory sites; and recovery. 25…”

“…30 Some of the prioritized educational topics for chemical disasters include nuclear/biological/chemical (NBC) agent and terrorism awareness, early recognition of chemical emergencies, incident command system, triage of massive numbers of victims, proper use of PPE, decontamination procedures for chemically exposed patients, use of backup communication systems, and methods for preparing backup supplies. 31,32 Training programs and levels are different for the staff in emergency departments. 25 Training and education should be based on the duties of staff and their roles.…”

“…[25][26][27][28] Furthermore, many roles are mixed, and some of team members may perform the duty of other staff, leading to agitation and anarchy, and slower service to the victims. 30,32 The use of a hanging necklace that includes information about each person's job description, can solve this problem. 25,31,33 Communication Effective communication is the biggest challenge for hospitals during chemical incidents and disasters.…”