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.

Keywords: benchmarks; emergency preparedness; evaluation; mass casualty incident; toxicological/chemical event.

Figure 1

Scores of emergency preparedness for toxicological/chemical events during the five evaluation cycles.

Figure 2

Overall scores of emergency preparedness for toxicological/chemical events in the first and fifth cycle of evaluation.

Figure 3

Changes in overall emergency preparedness for toxicological/chemical events by hospitals that are secluded or near other medical facilities. Interaction effect p = 0.005.

Figure 4

Changes in overall emergency preparedness for toxicological/chemical events by type of area (urban or periphery). Interaction effect p = 0.002.

Figure 5

Changes in overall emergency preparedness for toxicological/chemical events measures by geographical location. Interaction effect p = 0.056.