Pandemic influenza and major disease outbreak preparedness in US emergency departments: A selected survey of emergency health professionals

2019 ◽  
Vol 14 (4) ◽  
pp. 269-277
Author(s):  
Melinda J. Morton, MD, MPH ◽  
Edbert B. Hsu, MD, MPH ◽  
Sneha H. Shah, MD ◽  
Yu-Hsiang Hsieh, PhD ◽  
Thomas D. Kirsch, MD, MPH
Keyword(s):  
Infectious Disease ◽  
Pandemic Influenza ◽  
Health Professionals ◽  
Emergency Departments ◽  
Disaster Preparedness ◽  
The United States ◽  
Disease Outbreak ◽  
Free Text ◽  
Pandemic Preparedness ◽  
Personnel Staffing

Objective: To assess the level of pandemic preparedness at emergency departments (EDs) around the country and to better understand current barriers to preparedness in the United States represented by health professionals in the American College of Emergency Physician (ACEP) Disaster Medicine Section (DMS).Methods, design, and setting: A cross-sectional survey of ACEP DMS members was performed. A total of 300 members were surveyed both via e-mail and with paper surveys during the 2009 ACEP Scientific Assembly DMS Meeting. An optional comments section was included for section members’ perspectives on barriers to preparedness. A 15-item pandemic preparedness score was calculated for each respondent based on key preparedness indicators as defined by the authors. Results were analyzed with descriptive statistics, χ2 analysis, Cochran-Armitage trend test, and analysis of variance. Free text comments were coded and subjected to frequency-based analysis.Results: A total of 92 DMS members completed the survey with a response rate of 31 percent. Although 85 percent of those surveyed indicated that their hospital had a plan for pandemic influenza response and other infectious disease threats, only 68 percent indicated that their ED had a plan, and 52 percent indicated that their hospital or ED had conducted disaster preparedness drills. Only 57 percent indicated that there was a plan to augment ED staff in the event of a staffing shortage, and 63 percent indicated that there were adequate supplies of personal protective equipment. While 63 percent of respondents indicated that their ED had a plan for distribution of vaccines and antivirals, only 32 percent of EDs had a plan for allocation of ventilators. A total of 42 percent of respondents felt that their ED was prepared in the event of a pandemic influenza or other disease outbreak, and only 35 percent felt that their hospital was prepared. The average pandemic preparedness score among respondents was 8.30 of a total of 15. Larger EDs were more likely to have a higher preparedness score (p = 0.03) and more likely to have a pandemic preparedness plan (p = 0.037). Some major barriers to preparedness cited by section members included lack of local administration support, challenges in funding, need for dedicated disaster preparedness personnel, staffing shortages, and a lack of communication among disaster response agencies, particularly at the federal level.Conclusions: There appear to be significant gaps in pandemic influenza and other infectious disease outbreak planning among the hospitals where ACEP DMS members work. This may reflect a broader underlying inadequacy of preparedness measures. 

Pandemic influenza and major disease outbreak preparedness in US emergency departments: A selected survey of emergency health professionals

2011 ◽  
Vol 6 (3) ◽  
pp. 187-195 ◽  
Author(s):  
Melinda J. Morton, MD, MPH ◽  
Edbert B. Hsu, MD, MPH ◽  
Sneha H. Shah, MD ◽  
Yu-Hsiang Hsieh, PhD ◽  
Thomas D. Kirsch, MD, MPH
Keyword(s):  
Infectious Disease ◽  
Pandemic Influenza ◽  
Health Professionals ◽  
Emergency Departments ◽  
Disaster Preparedness ◽  
The United States ◽  
Disease Outbreak ◽  
Free Text ◽  
Pandemic Preparedness ◽  
Personnel Staffing

Objective: To assess the level of pandemic preparedness at emergency departments (EDs) around the country and to better understand current barriers to preparedness in the United States represented by health professionals in the American College of Emergency Physician (ACEP) Disaster Medicine Section (DMS).Methods, design, and setting: A cross-sectional survey of ACEP DMS members was performed. A total of 300 members were surveyed both via e-mail and with paper surveys during the 2009 ACEP Scientific Assembly DMS Meeting. An optional comments section was included for section members’ perspectives on barriers to preparedness. A 15-item pandemic preparedness score was calculated for each respondent based on key preparedness indicators as defined by the authors. Results were analyzed with descriptive statistics, ᵪ2 analysis, Cochran-Armitage trend test, and analysis of variance. Free text comments were coded and subjected to frequency-based analysis.Results: A total of 92 DMS members completed the survey with a response rate of 31 percent. Although 85 percent of those surveyed indicated that their hospital had a plan for pandemic influenza response and other infectious disease threats, only 68 percent indicated that their ED had a plan, and 52 percent indicated that their hospital or ED had conducted disaster preparedness drills. Only 57 percent indicated that there was a plan to augment ED staff in the event of a staffing shortage, and 63 percent indicated that there were adequate supplies of personal protective equipment.While 63 percent of respondents indicated that their ED had a plan for distribution of vaccines and antivirals, only 32 percent of EDs had a plan for allocation of ventilators.A total of 42 percent of respondents felt that their ED was prepared in the event of a pandemic influenza or other disease outbreak, and only 35 percent felt that their hospital was prepared. The average pandemic preparedness score among respondents was 8.30 of a total of 15. Larger EDs were more likely to have a higher preparedness score (p = 0.03) and more likely to have a pandemic preparedness plan (p = 0.037). Some major barriers to preparedness cited by section members included lack of local administration support, challenges in funding, need for dedicated disaster preparedness personnel, staffing shortages, and a lack of communication among disaster response agencies, particularly at the federal level.Conclusions: There appear to be significant gaps in pandemic influenza and other infectious disease outbreak planning among the hospitals where ACEP DMS members work.This may reflect a broader underlying inadequacy of preparedness measures.

Pandemic influenza and major disease outbreak preparedness in US emergency departments: A survey of medical directors and department chairs

2019 ◽  
Vol 14 (4) ◽  
pp. 279-286
Author(s):  
Melinda J. Morton, MD, MPH ◽  
Thomas D. Kirsch, MD, MPH ◽  
Richard E. Rothman, MD, PhD ◽  
Marielle M. Byerly, MD ◽  
Yu-Hsiang Hsieh, PhD ◽  
...  
Keyword(s):  
United States ◽  
Pandemic Influenza ◽  
Department Chairs ◽  
The United States ◽  
Disease Outbreak ◽  
Pandemic Preparedness ◽  
Preparedness Plan ◽  
Major Disease ◽  
Medical Directors ◽  
Pandemic Preparedness Plan

Study objectives: To quantify the readiness of individual academic emergency departments (EDs) in the United States for an outbreak of pandemic influenza.Methods, design, and setting: Cross-sectional assessment of influenza pandemic preparedness level of EDs in the United States via survey of medical directors and department chairs from the 135 academic emergency medicine departments in the United States. Preparedness assessed using a novel score of 15 critical preparedness indicators. Data analysis consisted of summary statistics, χ2, and ANOVA.Participants: ED medical directors and department chairs.Results: One hundred and thirty academic emergency medicine departments contacted; 66 (50.4 percent) responded. Approximately half (56.0 percent) stated their ED had a written plan for pandemic influenza response. Mean preparedness score was 7.2 (SD = 4.0) out of 15 (48.0 percent); only one program (1.5 percent) achieved a perfect score. Respondents from programs with larger EDs (=30 beds) were more likely to have a higher preparedness score (p 0.035), an ED pandemic preparedness plan (p = 0.004) and a hospital pandemic preparedness plan (p = 0.007). Respondents from programs with larger EDs were more likely to feel that their ED was prepared for a pandemic or other major disease outbreak (p = 0.01). Only one-third (34.0 percent) felt their ED was prepared for a major disease outbreak, and only 27 percent felt their hospital was prepared to respond to a major disease outbreak.Conclusions: Significant deficits in preparedness for pandemic influenza and other disease outbreaks exist in US EDs, relative to HHS guidelines, which appear to be related in part to ED size. Further study should be undertaken to determine the barriers to appropriate pandemic preparedness, as well as to develop and validate preparedness metrics.

Pandemic influenza and major disease outbreak preparedness in US emergency departments: A survey of medical directors and department chairs

2009 ◽  
Vol 4 (4) ◽  
pp. 199-206 ◽  
Author(s):  
Melinda J. Morton, MD, MPH ◽  
Thomas D. Kirsch, MD, MPH ◽  
Richard E. Rothman, MD, PhD ◽  
Marielle M. Byerly, MD ◽  
Yu-Hsiang Hsieh, PhD ◽  
...  
Keyword(s):  
United States ◽  
Pandemic Influenza ◽  
Department Chairs ◽  
The United States ◽  
Disease Outbreak ◽  
Pandemic Preparedness ◽  
Preparedness Plan ◽  
Major Disease ◽  
Medical Directors ◽  
Pandemic Preparedness Plan

Study objectives: To quantify the readiness of individual academic emergency departments (EDs) in the United States for an outbreak of pandemic influenza.Methods, design, and setting: Cross-sectional assessment of influenza pandemic preparedness level of EDs in the United States via survey of medical directors and department chairs from the 135 academic emergency medicine departments in the United States. Preparedness assessed using a novel score of 15 critical preparedness indicators. Data analysis consisted of summary statistics, χ2, and ANOVA.Participants: ED medical directors and department chairs.Results: One hundred and thirty academic emergency medicine departments contacted; 66 (50.4 percent) responded. Approximately half (56.0 percent) stated their ED had a written plan for pandemic influenza response. Mean preparedness score was 7.2 (SD = 4.0) out of 15 (48.0 percent); only one program (1.5 percent) achieved a perfect score. Respondents from programs with larger EDs (=30 beds) were more likely to have a higher preparedness score (p 0.035), an ED pandemic preparedness plan (p = 0.004) and a hospital pandemic preparedness plan (p = 0.007). Respondents from programs with larger EDs were more likely to feel that their ED was prepared for a pandemic or other major disease outbreak (p = 0.01). Only onethird (34.0 percent) felt their ED was prepared for a major disease outbreak, and only 27 percent felt their hospital was prepared to respond to a major disease outbreak.Conclusions: Significant deficits in preparedness for pandemic influenza and other disease outbreaks exist in US EDs, relative to HHS guidelines, which appear to be related in part to ED size. Further study should be undertaken to determine the barriers to appropriate pandemic preparedness, as well as to develop and validate preparedness metrics.

scholarly journals Epidemiology of Patients with Dance-Related Injuries Presenting to Emergency Departments in the United States, 2014-2018

2021 ◽  
pp. 194173812098411
Author(s):  
Joshua Honrado ◽  
R. Curt Bay ◽  
Kenneth C. Lam
Keyword(s):  
Incidence Rate ◽  
Emergency Departments ◽  
The United States ◽  
Incidence Rates ◽  
The Body ◽  
Free Text ◽  
Level Of Evidence ◽  
Injury Surveillance System ◽  
Female Patients ◽  
Almost All

Background: Updated rates and patterns associated with patients with dance-related injuries reporting to US emergency departments (EDs) is needed. Hypothesis: Between the years 2014 and 2018, there will be an observed rise of patients with dance-related injuries seen within US EDs. Study Design: Retrospective analysis. Level of Evidence: Level 4. Methods: Utilizing the National Electronic Injury Surveillance System (NEISS) database, data were abstracted for all structured dance-related injuries for all people who presented to a NEISS participating hospital from January 1, 2014, to December 31, 2018. Data were abstracted on age, sex, race, disposition, location on the body where the injury happened, and free text box regarding the mechanism and nature of the injury. Each patient case was associated with a weight to provide national incidence rate (per 100,000) estimates. Descriptive statistics were used to summarize counts, percentages, and rates across patient cases. Results: Between years 2014 and 2018, 4152 patients reported to the NEISS EDs with a dance-related injury. Most injuries occurred in female patients (83.3%; n = 3459) and among those who were 10 to 18 years old (76.2%; n = 3164). The most common injuries were ankle sprain/strain (12.7%; n = 527) and knee sprain/strain (10.4%; n = 431). Almost all patients were treated and released (97.1%; n = 4033). These data yielded population-weighted estimates of 125,618 injuries for the study period, with an increasing trend over time (19.2% increase over 5 years). Incidence rates were over 4 times higher for female (12.4) than for male patients (3.0) and highest in the 10- to 18-year-old age group (incidence rate = 46.4). Conclusion: Patients with dance-related injuries reporting to EDs increased over a 5-year period from 2014 to 2018. The majority of dancers in the study were female patients, between the ages of 10 and 18 years, nearly half of the patients reported to the ED with a sprain/strain, and almost all patients were treated and released. Clinical Relevance: An increase in access to proper injury prevention medical services and education should be provided to female dancers between the ages of 10 and 18 years. Strength of Recommendation Taxonomy: B.

scholarly journals Assessment of the Preparedness and Planning of Academic Emergency Departments in India during the COVID-19 Pandemic – A Multicentric Survey

2021 ◽  
pp. 1-13
Author(s):  
Vivek Gopinathan ◽  
Sanjan Asanar ◽  
Vimal Krishnan S ◽  
Freston Marc Sirur ◽  
Jayaraj Mymbilly Balakrishnan
Keyword(s):  
Emergency Medicine ◽  
Emergency Departments ◽  
Disaster Preparedness ◽  
Treatment Protocol ◽  
Descriptive Statistics ◽  
Emergency Physicians ◽  
Pandemic Preparedness ◽  
Cross Sectional ◽  
Planning Strategies ◽  
Training Exercises

ABSTRACT Objective: Emergency Medicine being a young specialty in India, we aimed to assess the level of disaster preparedness and planning strategies among various academic Emergency Departments (EDs) across India during the COVID-19 pandemic. Methods: A cross-sectional multicentric survey was developed and disseminated online to various academic EDs in India and followed up over a period of 8 weeks. All results were analysed using descriptive statistics. Results: 28 Academic Emergency Medicine Departments responded to the study. Compared to Pre-COVID period, COVID-19 pandemic has led to 90% of centres developing separate triage system with dedicated care areas for COVID suspect/infected in 78.6% centres with nearly 70% utilizing separate transportation pathways. Strategizing and executing the Institutional COVID-19 treatment protocol in 80% institutes were done by Emergency Physicians. Training exercises for airway management and PPE usage were seen in 93% and 80% centres respectively. Marked variation in recommended PPE usage were observed across EDs in India. Conclusions: Our study highlights the high variance in the level of preparedness response among various EDs across India during the pandemic. Preparedness for different EDs across India needs to be individually assessed and planned according to the needs and resources available.

Assessing Veterinary Practice and Practitioner Preparedness for Natural and Man-Made Disasters, Including COVID-19

2021 ◽  
pp. e20210066
Author(s):  
Lawrence N. Garcia ◽  
Candice Stefanou ◽  
Carla L. Huston ◽  
Sarah A. Bell
Keyword(s):  
Emergency Management ◽  
Disaster Preparedness ◽  
The United States ◽  
Economic Losses ◽  
Pandemic Preparedness ◽  
Preparedness Plan ◽  
Veterinary Practice ◽  
Practice Experience ◽  
Global Pandemic ◽  
Veterinary Curriculum

Natural and man-made disasters lead to hundreds of millions of dollars in economic losses annually worldwide. Veterinarians are most qualified to support local, state, national, and international efforts in emergency management. However, they may lack the knowledge and advanced training to most effectively plan, prepare, and respond. Currently, only two colleges offer training embedded in their core veterinary curriculum. In this study, a survey was conducted to gain an understanding of veterinary practice and practitioner preparedness for natural and man-made disasters in the United States and Canada, with questions assessing pandemic preparedness. The participants graduated from 28 American Veterinary Medical Association (AVMA)–accredited veterinary colleges globally and 2 non-accredited veterinary colleges, represent a diverse set of veterinary practice types, and have an average of 26 years’ practice experience. Overall, 63.5% of veterinary respondents had experienced a natural disaster, while only 9.6% had experienced a man-made disaster. Approximately 66% report having a practice disaster preparedness plan, while less than 20% of those actively maintain and update the plan. Furthermore, less than 50% of the practices and practitioners were ready to face the challenges of a global pandemic. Approximately 68% reported using some form of communication to educate clients about family and pet disaster readiness. Many felt that some advanced disaster readiness training would have been helpful in their veterinary curriculum. Our findings indicate that additional training in the veterinary curriculum, as well as continuing education, would help veterinarians and practices be better prepared for natural and man-made disasters.

Emergency preparedness, resilience and response to a biological outbreak

2020 ◽  
Vol 166 (1) ◽  
pp. 37-41 ◽  
Author(s):  
P Welby-Everard ◽  
O Quantick ◽  
A Green
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Pandemic Influenza ◽  
Emergency Preparedness ◽  
Disease Outbreaks ◽  
Disease Outbreak ◽  
Biological Agent ◽  
Medical Attention ◽  
The Public ◽  
Major Disease

Major disease outbreaks continue to be a significant risk to public health, with pandemic influenza or an emerging infectious disease outbreak at the top of the UK National Risk Register. The risk of deliberate release of a biological agent is lower but remains possible and may only be recognised after casualties seek medical attention. In this context the emergency preparedness, resilience and response (EPRR) process protects the public from high consequence infectious diseases, other infectious disease outbreaks and biological agent release. The core elements of the EPRR response are recognition of an outbreak, isolation of patients, appropriate personal protective equipment for medical staff and actions to minimise further disease spread. The paper discusses how high-threat agents may be recognised by clinicians, the initial actions to be taken on presentation and how the public health system is notified and responds. It draws on the national pandemic influenza plans to describe the wider response to a major disease outbreak and discusses training requirements and the potential role of the military.

scholarly journals 611. Infectious Disease Management of Homeless and Non-Homeless Populations in United States Emergency Departments

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S366-S366
Author(s):  
Jessica Barnes ◽  
Larry Segars ◽  
Jason Wasserman ◽  
Patrick Karabon ◽  
Tracey A Taylor
Keyword(s):  
Infectious Disease ◽  
United States ◽  
Emergency Department ◽  
Infectious Diseases ◽  
Emergency Departments ◽  
The United States ◽  
Homeless Persons ◽  
Prescribing Patterns ◽  
Significant Difference ◽  
Cohort Study Design

Abstract Background Studies have long documented the increased emergency department usage in the United States by homeless persons compared to their housed counterparts, as well as an increased overall prevalence of infectious diseases. However, there is a gap in knowledge on the treatment that homeless persons receive for these infectious diseases within United States emergency departments compared to their housed counterparts. This study seeks to understand this potential difference in treatment, including diagnostic services tested, procedures performed, and medications prescribed. Methods This study utilized a retrospective, cohort study design to analyze data from the 2007-2010 National Hospital Ambulatory Medical Care Survey (NHAMCS) database. Complex sample logistic regression analysis was used to compare variables, including diagnostic services, procedures, and medication classes prescribed between homeless and private residence individuals seeking emergency department treatment for infectious diseases. This provided an odds ratio to compare the two populations, which was then adjusted for confounding variables. Results Compared to private residence individuals, homeless persons were more likely (OR: 10.99, p< 0.05, CI: 1.08-111.40) to receive sutures or staples when presenting with an infectious disease in United States emergency departments. Compared to private residence persons, homeless individuals were less likely (OR: 0.29, p< 0.05, CI: 0.10-0.87) to be provided medications or immunizations when presenting with an infectious disease in United States emergency departments, and significant differences were detected in prescribing habits of multiple medication classes. Conclusion This study detected a significant difference in suturing/stapling and medication prescribing patterns for homeless persons with an infectious disease in United States emergency departments, compared to their housed counterparts. These results provide a platform for continual research. Disclosures All Authors: No reported disclosures

Suicidal Behavior and Non-Suicidal Self-Injury in Emergency Departments Underestimated by Administrative Claims Data

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 318-325 ◽  
Author(s):  
Barbara Stanley ◽  
Glenn W. Currier ◽  
Megan Chesin ◽  
Sadia Chaudhury ◽  
Shari Jager-Hyman ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Suicide Attempts ◽  
The United States ◽  
Administrative Claims ◽  
Suicide Attempters ◽  
Self Injury ◽  
Axis I ◽  
Ed Visits ◽  
External Causes ◽  
Severe Psychopathology

Abstract. Background: External causes of injury codes (E-codes) are used in administrative and claims databases for billing and often employed to estimate the number of self-injury visits to emergency departments (EDs). Aims: This study assessed the accuracy of E-codes using standardized, independently administered research assessments at the time of ED visits. Method: We recruited 254 patients at three psychiatric emergency departments in the United States between 2007 and 2011, who completed research assessments after presenting for suicide-related concerns and were classified as suicide attempters (50.4%, n = 128), nonsuicidal self-injurers (11.8%, n = 30), psychiatric controls (29.9%, n = 76), or interrupted suicide attempters (7.8%, n = 20). These classifications were compared with their E-code classifications. Results: Of the participants, 21.7% (55/254) received an E-code. In all, 36.7% of research-classified suicide attempters and 26.7% of research-classified nonsuicidal self-injurers received self-inflicted injury E-codes. Those who did not receive an E-code but should have based on the research assessments had more severe psychopathology, more Axis I diagnoses, more suicide attempts, and greater suicidal ideation. Limitations: The sample came from three large academic medical centers and these findings may not be generalizable to all EDs. Conclusion: The frequency of ED visits for self-inflicted injury is much greater than current figures indicate and should be increased threefold.

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