Maintaining Preparedness to Severe Though Infrequent Threats—Can It Be Done?

Abstract

Background: A mass casualty incident (MCI) caused by toxicological/chemical materials constitutes a potential though uncommon risk that may cause great devastation. Presentation of casualties exposed to such materials in hospitals, if not immediately identified, may cause secondary contamination resulting in dysfunction of the emergency department. The study examined the impact of a longitudinal evaluation process on the ongoing emergency preparedness of hospitals for toxicological MCIs, over a decade. Methods: Emergency preparedness for toxicological incidents of all Israeli hospitals were periodically evaluated, over ten years. The evaluation was based on a structured tool developed to encourage ongoing preparedness of Standard Operating Procedures (SOPs), equipment and infrastructure, knowledge of personnel, and training and exercises. The benchmarks were distributed to all hospitals, to be used as a foundation to build and improve emergency preparedness. Scores were compared within and between hospitals. Results: Overall mean scores of emergency preparedness increased over the five measurements from 88 to 95. A significant increase between T1 (first evaluation) and T5 (last evaluation) occurred in SOPs (p = 0.006), training and exercises (p = 0.003), and in the overall score (p = 0.004). No significant changes were found concerning equipment and infrastructure and knowledge; their scores were consistently very high throughout the decade. An interaction effect was found between the cycles of evaluation and the hospitals’ geographical location (F (1,20) = 3.0, p = 0.056), proximity to other medical facilities (F (1,20) = 10.0 p = 0.005), and type of area (Urban vs. Periphery) (F (1,20) = 13.1, p = 0.002). At T5, all hospitals achieved similar high scores of emergency preparedness. Conclusions: Use of accessible benchmarks, which clearly delineate what needs to be continually implemented, facilitates an ongoing sustenance of effective levels of emergency preparedness. As this was demonstrated for a risk that does not frequently occur, it may be assumed that it is possible and practical to achieve and maintain emergency preparedness for other potential risks.

Review of the requirements for effective mass casualty preparedness for trauma systems. A disaster waiting to happen?

“…Centres are formally assessed every 2 yr by independent evaluators using an objective measurement tool of parameters and indicators of disaster preparedness. 36 After assessment, missed benchmarks are re-evaluated 3 months later and resulting modifications must be reported to the centre's board and the Ministry of Health. 36 Using this state-run monitoring system, disaster preparedness of Israeli trauma centres has increased.…”

“…36 After assessment, missed benchmarks are re-evaluated 3 months later and resulting modifications must be reported to the centre's board and the Ministry of Health. 36 Using this state-run monitoring system, disaster preparedness of Israeli trauma centres has increased. 36 Similar efforts in larger nations have not been replicated.…”

“…36 Using this state-run monitoring system, disaster preparedness of Israeli trauma centres has increased. 36 Similar efforts in larger nations have not been replicated. However, trauma centre verification by the American College of Surgeons and the Royal Australasian College of Surgeons includes questions about disaster preparedness.…”

Hospital Preparedness Assessment Instruments in Chemical Incidents: A systematic literature review

“…[19] To this end, diverse tools were designed to maintain hospital preparedness in relation to chemical incidents; however, there is still no consensus on which tools are benefi cial in preserving hospital preparedness in these events. [20] Therefore, evaluating the existing tools and extracting the effective factors in hospital preparedness has a crucial role for policymakers in this field. The present study systematically reviewed the instruments available in this field.…”

Exercising for mass casualty preparedness

“…5 Similar core standards are described in most countries, some with more concrete benchmarks. 6 The requirement to exercise and be prepared applies to every healthcare provider, not just those who usually deal with major trauma. The scale and nature of mass casualty incidents mean that hospitals of all sizes and specialties should expect to be involved in the management of these events, and plan accordingly.…”