Activating physicians within a hospital emergency plan: A concept whose time has come?

Background: Clinicians are an essential component of the medical response to an emergency in which there are actual or suspected injuries. However, little is known about the institutional notification methods for clinicians during emergencies, particularly for off-site staff. Further, there is little knowledge regarding clinicians’ level of awareness of the emergency plans at hospitals with which they are affiliated, or of their knowledge regarding the notification protocols involved in plan activation during an emergency. If physicians are unaware of how to respond to an actual or threatened emergency, the effectiveness of any hospital emergency plan is severely limited. Objective: This study sought to examine hospital emergency plans, institutional clinician notification, and recall procedures, as well as clinicians’ level of knowledge regarding the emergency notification and recall protocol(s) at the hospital(s) with which they are affiliated. Methods: Written surveys were sent to hospital emergency coordinators, chiefs of service, and individ-ual clinicians employed by a large, multihospital healthcare system in a major urban area. Results: We found that 64 percent of respondents’ hospitals had a recall protocol; of those, 53 percent required that the hospital contact clinicians, with 17 percent of those hospitals using a central operator to make the calls. Of the chiefs of services who participat-ed, 56 percent claimed to be very familiar with their facility’s emergency plan, and 53 percent knew that it had been activated at least once in the past year. Conclusions: Hospital emergency responders are not sufficiently knowledgeable of their institutions’ emergency plans. In order to ensure sufficient surge capacity and timely response, a tiered activation sys-tem, intimately familiar to potential responders, should be developed, taught, and drilled by hospitals to formalize physician call-up.

A Hospital Emergency Plan

By definition, hospitals should be among the places with the highest safety index (1). But often, on these premises, we have occasional accidents which may be dangerous and which illustrate the way hospitals are exposed to various and often undervalued risks.The incidences of unforeseen, dangerous situations involving sudden accidents, of uncontrollable emergency conditions and also of larger catastrophes are awful. Recent accidents proved inadequate safety inside hospitals. In Parma (2) escaping gas was followed by an explosion that destroyed a division of the hospital and resulted in wounded and dead. In Mondovi, an explosion in the central heating system of the hospital caused the death of an employee. A fire that broke out in an old people's home in Southern Italy brought about the death of three persons. The first shocks of the earthquake in 1980 caused the death of many patients and staff (including six physicians) in the so called “safe” hospital of San Angelo Dei Lombardi. In the earthquake in 1976 many patients and some personnel of the hospital staff in Gemona, Friuli lost their lives (3)Apparently these facts are not closely linked together. Some were caused by human error, others by inadequacy of buildings, age of structures, even where the disaster was due to natural causes. However all these events show the presence of the common denominator of “high risk,” typical of hospital structures (4,5). The principle dangerous situations are: (a) risks coming from the structures of the premises (no earthquake-proof principles of modular structure); and (b) risks connected with the working activities (6,7).