SARA Three Years Later: Emergency Physician's Knowledge, Beliefs, and Actions

Abstract

Objective:Investigate Emergency Physicians' knowledge about the Superfund Amendments and Reauthorization Act (SARA) Title III legislation, passed by the United States Congress in 1986, and to determine the factors contributing to their level of preparedness in dealing with patients exposed to toxic chemicals.Methods:A 115-item questionnaire was mailed to the medical directors of all emergency departments (EDs) in the State of New York. The results of the cross-sectional survey were analyzed using standard statistical methods.Results:One hundred and eighty-seven (72%) of the directors of EDs in New York State responded to the survey. Three years after SARA was enacted, only 33% of the directors had heard about this legislation. Only 18% had been invited to attend the meetings of the Local Emergency Planning Committees (LEPC). Sixty percent of the directors knew whether or not the LEPC had devised plans that defined a role for their EDs in responding to environmental emergencies. This knowledge about community planning mainly had an effect on preparedness of the EDs. Preparedness also was predicted by how recently the EDs had treated patients exposed to toxic chemicals, the perception that emergency physicians had a legitimate role in planning for and responding to chemical emergencies, and how often emergency physicians had attended continuing education courses about hazardous materials.Conclusion:Despite the finding that some emergency physicians are involved in community preparations, two main problems persist in planning a medical response to environmental emergencies. First, the ED directors generally are unaware of the legislation that mandates these preparations and are not interacting with community planners. Second, there is not full involvement by the local EDs in the LEPC planning efforts.Recommendations:A procedure is needed to disseminate information about legislation which affects emergency physicians, such as SARA, and about regional planning for environmental emergencies. Dissemination should include education about the professions' role in planning for and providing care for patients exposed to toxic chemicals.

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

“…The implementation of SARA required that communities increase planning for medical responses to chemical accidents and that the healthcare sector be involved in preparing for these emergencies. 8 ' 10 To date, there is little evidence that this legislation has affected preparedness for such accidents.…”

Editorial Comments

“…The implementation of SARA required that communities increase planning for medical responses to chemical accidents and that the healthcare sector be involved in preparing for these emergencies. 8 ' 10 To date, there is little evidence that this legislation has affected preparedness for such accidents.…”

Hospital preparedness for victims of chemical or biological terrorism

“…10 Surveys of hospital emergency departments (EDs) have found broadly prevalent deficiencies in knowledge, plans, or resources for responding to hazardous materials or radiation incidents. [11][12][13][14] Even relatively small-scale hazardous materials incidents have overwhelmed the response capacities at some hospitals, producing symptoms in secondarily exposed ED staff or necessitating ED evacuations. [15][16][17] However, although the state of preparedness for hazardous materials incidents provides some indication of the level of preparedness for chemical weapons inciHospital Preparedness for Victims of Chemical or Biological Terrorism dents, the hazardous materials model may have limited applicability to the potential types and scale of problems associated with a chemical weapons incident, and it probably has little or no relevance for biological weapons incidents.…”