HRSA Disaster Preparedness Cooperative SPECIAL REPORT ON THE EMERGENCY PREPAREDNESS OF THE HOSPITALS & HEALTH SYSTEMS IN PENNSYLVANIA

Transcription

1 HRSA Disaster Preparedness Cooperative SPECIAL REPORT ON THE EMERGENCY PREPAREDNESS OF THE HOSPITALS & HEALTH SYSTEMS IN PENNSYLVANIA A Report on the August, 2002 Joint DOH/HAP Emergency Preparedness Needs Assessment

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3 TABLE OF CONTENTS Introduction... 3 Methodology... 3 List of Figures... 4 Survey Results... 6 Emergency Preparedness Planning... 6 Collaboration & Cooperation Staff Resource Issues Equipment & Training Needs Physical Plant Assessment Emergency & Risk Communications Capacities Emergency Preparedness Priority Needs Emergency Preparedness Expenditures Conclusion Hospital Preparedness Activities... 41

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5 INTRODUCTION The federal Department of Health and Human Services, Health Resource Services Administration (HRSA) has awarded the Pennsylvania Department of Health (PADOH) a Cooperative Agreement to upgrade the preparedness of the Commonwealth s hospitals and collaborating entities to respond to acts of Bioterrorism. These activities will also allow the health care system to become more prepared to deal with non-terrorist epidemics of infectious diseases. Specific benchmarks are to: 1) develop detailed plans for receipt of materiel from the National Pharmaceutical Stockpile (NPS) and plans for the vaccination or distribution of antibiotics to the entire population of the Commonwealth within three to five days; 2) develop plans in each hospital region to accommodate a surge of 500 acutely ill patients; 3) support efforts by all hospitals to create isolation rooms in their emergency departments for any suspect smallpox case and for all febrile patients with rash who might possibly be developing the disease and could spread it to others. Every acute care general hospital with an emergency department in Pennsylvania completed and returned a needs assessment. METHODOLOGY To reach these goals PADOH contracted with the Hospital and Healthsystem Association of Pennsylvania (HAP) to distribute, collect and analyze a Hospital Emergency Preparedness Needs Assessment. The agreement tasked HAP with convening an ad hoc working group to develop the hospital preparedness survey instrument. The 22-page tool was distributed electronically to the chief executive officer of every Pennsylvania general acute care hospital with an emergency department, including Veterans Administration hospitals, and included recommendations for the assembly of a team of hospital staff members to review and assist in the completion of all the survey elements. One hundred percent (208) of the surveyed hospitals completed and returned the assessment tool. The responses were tabulated in MS Excel spreadsheets and contain a wealth of data that is currently being studied. Initial tabulations have been categorized and highlights are presented in sections below. Hospital Emergency Preparedness Needs Assessment - 3 -

6 LIST OF FIGURES FIGURE 1: Hospital Emergency Planning... 7 FIGURE 2: Designated Resources for Special Populations... 7 FIGURE 3: Poison Control Center...8 FIGURE 4: Hospital Emergency Planning... 8 FIGURE 5: Map of PA Regional Counter-Terrorism Task Force Regions FIGURE 6: Regional Attendance at RCTTFs FIGURE 7: Contingency Plan for Mutual Aid FIGURE 8: Mutual Aid with Bordering States FIGURE 9: Employee Vaccination Status FIGURE 10: Emergency Coordinator FIGURE 11: Bioterrorism Preparedness: Safety Education & Employee Orientation FIGURE 12: Personal Protective Equipment (PPE) FIGURE 13: Staff Trained in PPE FIGURE 14: Extreme Weather Drills & PPE FIGURE 15: Bioterrorism Preparedness: Early Recognition & Staff Training FIGURE 16: Real-Time Inventory FIGURE 17: Regional Syndromic Surveillance FIGURE 18: Decontamination Facilities FIGURE 19: Decontamination Capacity: Patients per Hour FIGURE 20: Decontamination Capacity: Hours (Duration) FIGURE 21: Decontamination Capacity: Gallons FIGURE 22: Reconfiguration of Hospital Space for Quarantine FIGURE 23: Emergency Power FIGURE 24: Lockdown Procedure FIGURE 25: Emergency Command Center FIGURE 26: Telephone Hotline FIGURE 27: Pre-Printed Public Material FIGURE 28: Non-English Speaking Public FIGURE 29: Video Conferencing Capability FIGURE 30: High Priority Needs: Technical/Training Assistance FIGURE 31: High Priority Needs: Financial Assistance FIGURE 32: Emergency Preparedness Cost Center FIGURE 33: Emergency Preparedness Spending Hospital Emergency Preparedness Needs Assessment - 4 -

7 Emergency Preparedness Planning Hospital Emergency Preparedness Needs Assessment - 5 -

8 Emergency Preparedness Planning Internal emergency preparedness planning issues the survey addressed included specifics of the hospitals plans. Results of primary concern included plans for quarantine, special populations needs and clinician protection. Forty-six percent of hospitals address quarantine in their emergency plan. Fifty-six percent of hospitals have not addressed special populations needs in emergency plans. More than 90% of hospitals have addressed a Poison Control Center as a 24/7 resource in their emergency plan. Fifty-three percent of hospitals address protection of clinicians in their plans. Hospital Emergency Preparedness Needs Assessment - 6 -

9 FIGURE 1 Hospital Emergency Planning % of acute care* hospitals addressing following topics in their emergency plans Preservation of Evidence 60.2% 121 Securing Patient Valuables 78.6% 158 Triage Stabilization & Treatment 99.0% 95.5% Transfer of Mass Casualties Decontamination 87.1% 90.5% Isolation 79.1% 159 Quarantine 46.3% 93 Contingency for Computer Failure 83.6% % 20.0% 40.0% 60.0% 80.0% 100.0% * Results reflect 201 acute care hospitals, 7 specialty hospitals excluded from analysis FIGURE 2 Many Pennsylvania acute care* hospitals have not addressed the need for designated resources for special populations in their emergency plans. % of acute care hospitals that have addressed the following needs of special populations: Not Addressed 55.7% 112 Disabled, including homebound 25.9% 52 Other Cultures & Languages 34.8% 70 Chronically Ill 29.4% 59 Remote Populations 17.4% 35 Homeless 23.4% 47 Elderly 33.3% 67 * Results reflect 201 acute care hospitals, 7 specialty hospitals excluded from analysis Children 29.4% % 15.0% 30.0% 45.0% 60.0% % of acute care hospitals Hospital Emergency Preparedness Needs Assessment - 7 -

10 FIGURE 3 Most Pennsylvania acute care* hospitals have addressed the use of their regional Poison Control Center (PCC) as a 24/7 reference in the hospital s emergency plan. Use of PCC addressed in plan 90.5% Use of PCC not addressed in plan 9.5% * Results reflect 201 acute care hospitals, 7 specialty hospitals excluded from analysis FIGURE 4 Hospital Emergency Planning % of acute care* hospitals addressing following topics in their emergency plans Use of Spokespersons 87.1% 175 News Conference Location Information Sharing with PIO 95.5% 94.5% Volunteer Clinical Help & Donated Items 29.4% 59 Credentialing New Clinicians 39.3% 79 Protection of Clinicians 52.7% 106 Patient Registration Process Personnel Augmentation 94.5% 92.0% Post-Emergency Facility Recovery 52.7% % 20.0% 40.0% 60.0% 80.0% 100.0% * Results reflect 201 acute care hospitals, 7 specialty hospitals excluded from analysis Hospital Emergency Preparedness Needs Assessment - 8 -

11 Collaboration and Cooperation Hospital Emergency Preparedness Needs Assessment - 9 -

12 Collaboration and Cooperation Hospitals were asked if they routinely attended meetings of their region s counter-terrorism task force. Plans or procedures for giving or receiving mutual aid from other hospitals, other community health providers and neighboring out-of-state cities were also queried. More than 80% have sent representatives to meetings of their region s counter-terrorism task force. Eighty-four percent have a contingency plan or procedures for giving/receiving mutual aid/support from other hospitals. With regard to other community health providers such as nursing homes, physicians offices, and primary care clinics, only 41.3% of hospitals have a contingency plan or procedures for giving/receiving mutual aid/support. Fewer than 5% of hospitals in border counties with other states have mutual aid/support agreements with those out of state hospitals. Hospital Emergency Preparedness Needs Assessment

13 FIGURE 5 Pennsylvania Counter-Terrorism Task Force Regions Counter-terrorism Regions Northwest South Central Southwest East Central NW Central Northeast North Central Southeast SC Mountain FIGURE 6 More than 80% of Pennsylvania s hospitals have sent a representative to meetings of their region s Counter- Terrorism Task Force. % of hospitals who have sent a representative to their RCTTF 120% 100% 80% 11/11 45/53 7/8 11/12 10/11 17/18 18/19 16/18 47/58 % of hospitals 60% 40% 20% 100.0% 84.9% 87.5% 91.7% 90.9% 94.4% 94.7% 88.9% 81.0% 0% Northwest Southwest NW Central North Central South Central Mtn. South Central East Central Northeast Southeast Hospital Emergency Preparedness Needs Assessment

14 FIGURE 7 More than 80% of Pennsylvania s hospitals have a contingency plan for giving or receiving mutual aid and/or support to/from other hospitals in their local area. % of hospitals indicating that they have a contingency plan for mutual aid with the following : Other Hospitals 84.1% 175 Other Community Health Providers 41.3% 86 0% 20% 40% 60% 80% 100% % of hospitals FIGURE 8 Of the Pennsylvania hospitals located in counties bordering surrounding states, fewer than 5% have an agreement for mutual aid/support with that bordering state. Hospital Has Contingency Plan for Mutual Aid 4.9% 5 98 No Contingency Plan for Mutual Aid 95.1% Hospital Emergency Preparedness Needs Assessment

15 Staff Resource Issues Hospital Emergency Preparedness Needs Assessment

16 Staff Resource Issues The survey s staff resource questions included specifics such as employee vaccine record keeping, general staff orientation, and safety knowledge issues. Leadership was addressed by asking hospitals if a staff member had been assigned to the role of commander or coordinator for emergencies. All but 5% of hospitals maintain employee vaccination records. Nine of ten hospitals have a designated coordinator of emergencies. Thirty-nine percent of hospitals have annual safety education in Bioterrorism to train staff. One of four hospitals have general orientation in Bioterrorism for new staff. Hospital Emergency Preparedness Needs Assessment

17 FIGURE 9 Greater than 90% of Pennsylvania hospitals maintain records on employee vaccination status. Hospital does not maintain records 4.8% Hospital maintains records 94.3% No response 0.5% 1 FIGURE 10 Nine out of 10 Pennsylvania hospitals have a designated staff member, on premises, who has been assigned the role of Coordinator or Commander for emergencies 24/7. Hospital has designated "Commander" 89.9% Hospital does not have a designated "Commander" 10.1% Hospital Emergency Preparedness Needs Assessment

18 FIGURE 11 Bioterrorism Preparedness % of acute care hospitals indicating that annual safety education for training staff and general orientation for new employees include the following topics: 60% % of acute care hospitals 45% 30% 15% % Bioterrorism WMD Chemical Contam. Infectious Disease Outbreak Radiologic Disaster Nuclear Disaster None of these Safety Ed 38.8% 21.9% 42.8% 46.3% 39.8% 26.4% 34.3% Orientation 24.4% 13.4% 29.4% 40.3% 25.9% 16.4% 47.8% Hospital Emergency Preparedness Needs Assessment

19 Equipment and Training Needs Hospital Emergency Preparedness Needs Assessment

20 Equipment and Training Needs Supplies of personal protective equipment (PPE) and staff training in the use of PPE were questioned and re-surfaced as both financial and technical/training assistance priorities in the section below titled Priority Needs. Additional issues identified included supply inventories and the need for training and hospital participation in syndromic surveillance activities. Sixty-nine percent of hospitals have some form of personal protective equipment. More than one-half of those with PPE had staff trained in the use of the equipment. Less than 11% of hospitals have drilled staff in full personal protective ensembles under extreme weather circumstances. Six of ten hospitals have trained staff in the care of patients contaminated by biological agents. Three-quarters of hospitals maintain real-time inventories for essential medical supplies, equipment and drugs. Seventy-six percent of hospitals do not participate in syndromic surveillance. Hospital Emergency Preparedness Needs Assessment

21 FIGURE 12 More than two-thirds of Pennsylvania s acute care* hospitals have some form of personal protective equipment (PPE). Hospital has some type of PPE 69.2% Hospital has no PPE 30.8% * Results reflect 201 acute care hospitals, 7 specialty hospitals excluded from analysis Type of PPE Full-Face Respirator Ensembles Hooded PAPRs Other: HEPA masks, Tyvex Suits, SCBA # Hospitals Reporting % of Total 63.3% 59.0% 20.9% FIGURE 13 Six out of ten Pennsylvania acute care* hospitals have staff trained in the use of personal protective equipment (PPE). Hospital has staff trained in the use of PPE 61.2% Hospital does not have staff trained in the use of PPE 40.7% * Results reflect 201 acute care hospitals, 7 specialty hospitals excluded from analysis Staff Trained in the Use of... Full-Face Respirator Ensembles Hooded PAPRs Other: HEPA masks, Tyvex Suits, SCBA # Hospitals Reporting % of Total 66.7% 54.5% 22.0% Hospital Emergency Preparedness Needs Assessment

22 FIGURE 14 Very few Pennsylvania acute care* hospitals have drilled staff in full PPE under extreme weather circumstances. 20% * Results reflect 201 acute care hospitals, 7 specialty hospitals excluded from analysis 16% % of acute care hospitals 12% 8% 4% % % 0% % hospitals that have had drills for Extreme Weather HazMat % hospitals that have had drills for Extreme Weather Decon FIGURE 15 Bioterrorism Preparedness % of acute care hospitals indicating that systems for the early recognition of exposed patients and the training of staff in the care of contaminated patients are in place for the following scenarios: 75% % of acute care hospitals 60% 45% 30% % 0% Biological Agents Chemical Agents Radiological Agents Nuclear Agents None of These Early Recognition 56.7% 51.7% 44.8% 36.3% 36.8% Staff Training 61.2% 63.2% 60.7% 49.3% 28.4% Hospital Emergency Preparedness Needs Assessment

23 FIGURE 16 More than 75% of Pennsylvania s hospitals maintain real-time inventories for essential medical supplies, equipment and drugs. % of hospitals indicating that inventories of the following are kept: Laboratory 77.9% 162 Pharmaceuticals 80.3% 167 Medical Equipment 79.8% 166 Medical Supplies 88.9% 185 0% 20% 40% 60% 80% 100% % of hospitals FIGURE 17 The majority of acute care* hospitals in Pennsylvania do not currently participate in a regional system for syndromic surveillance. Do participate in regional syndromic surveillance 24.4% Do not participate in regional syndromic surveillance 76.1% * Results reflect 201 acute care hospitals, 7 specialty hospitals excluded from analysis Hospital Emergency Preparedness Needs Assessment

24 Physical Plant Assessment Hospital Emergency Preparedness Needs Assessment

25 Physical Plant Assessment Hospitals were questioned on their decontamination ability including location and system capacities. Physical plant and operations support sections of the survey addressed emergency power and ventilation systems. Facility logistics including security, the ability to reconfigure hospital space for quarantine purposes and provision for a designated emergency command center were also surveyed. Eighty-four percent of hospitals have decontamination facilities. On average, hospitals could decontaminate 15 patients per hour for 7 ½ hours and contain an average of 308 gallons of water without environmental runoff. Most hospitals don t address the reconfiguration of hospital space for quarantine. Most hospitals have an emergency power supply of 1-5 days, on average. Eighty-one percent of hospitals have a procedure in place to lock down all external doors within 30 minutes. Ninety-seven percent of hospitals have an emergency command center. Hospital Emergency Preparedness Needs Assessment

26 FIGURE 18 Eight out of ten Pennsylvania acute care* hospitals have decontamination facilities. Hospital has Decon Facility 84.1% Hospital does not have Decon Facility 15.9% * Results reflect 201 acute care hospitals, 7 specialty hospitals excluded from analysis Location of Decon Facility Indoors Outdoors with Heat Outdoors without Heat # Hospitals Reporting % of Total 60.3% 17.2% 49.7% FIGURE 19 Pennsylvania acute care* hospitals could decontaminate, on average, 15 patients per hour with the equipment and staff currently available. % of acute care hospitals indicating decontamination capability: 86 % of acute care hospitals 50% 40% 30% 20% 10% 0% 3 1.8% % 50.9% % * Results reflect 201 acute care hospitals, 7 specialty hospitals excluded from analysis 6 3.6% 1 0.6% None 1 to 5 patients per hour 6 to 20 patients per hour 21 to 50 patients per hour > 50 patients per hour No response Hospital Emergency Preparedness Needs Assessment

27 FIGURE 20 Pennsylvania acute care* hospitals could continue decontamination for, on average, 7½ hours without outside help or re-supply. % of acute care hospitals indicating length of decontamination time: 40% 63 % of acute care hospitals 30% 20% 10% 0% 8 4.7% 37.3% % % * Results reflect 201 acute care hospitals, 7 specialty hospitals excluded from analysis % 4 2.4% None 1 to 3 hours 4 to 8 hours 9 to 23 hours > 24 hours No response FIGURE 21 Pennsylvania acute care* hospitals could contain, on average, 308 gallons of water used for decontamination without environmental runoff. % of acute care hospitals indicating decontamination capacity: 30% * Results reflect 201 acute care hospitals, 7 specialty hospitals excluded from analysis % of acute care hospitals 20% 10% % 22.5% 23.7% % % 9 5.3% 0% None gallons gallons gallons > 1,000 gallons No response Hospital Emergency Preparedness Needs Assessment

28 FIGURE 22 Most acute care* hospitals in Pennsylvania do not address the reconfiguration of hospital space, for quarantine of communicable diseases and treatment of infectious disease epidemics, in their emergency plan. Emergency plan addresses reconfiguation of space 38.3% Emergency plan does not address reconfiguration of space 61.7% * Results reflect 201 acute care hospitals, 7 specialty hospitals excluded from analysis FIGURE 23 Most Pennsylvania hospitals could supply emergency power for 1 to 5 days. % of hospitals indicating the duration of emergency power available. 1 month or longer 27.9% days 9.6% days 8.7% days 25.0% days 26.4% 55 Less than 24 hours 2.4% 5 0% 5% 10% 15% 20% 25% 30% 35% 40% % of hospitals Hospital Emergency Preparedness Needs Assessment

29 FIGURE 24 Most hospitals in Pennsylvania have a procedure to lock down all exterior doors within 30 minutes, without requiring outside personnel. Hospital has a 30-min. lockdown procedure 80.8% Hospital does not have a 30- min. lockdown procedure 19.2% FIGURE 25 Nearly all Pennsylvania hospitals have a designated emergency command center (EOC). Hospital has designated EOC 96.6% Hospital does not have designated EOC 3.9% Hospital Emergency Preparedness Needs Assessment

30 Emergency & Risk Communications Capacities Hospital Emergency Preparedness Needs Assessment

31 Emergency and Risk Communications Capacities The vital and diverse element of communications for emergency preparedness was addressed in the survey s sections on emergency plan, warnings, notifications and communications sections, public information, and distance learning. Public access via phone hotlines, preprinted materials and videoconferencing were among the primary communications modalities. Nearly one-third of hospitals have an established telephone hotline for public information. A majority of hospitals do not have pre-printed public materials on exposure to biological agents. Less than 10% of respondents have pre-printed public materials available in languages other than English. Half of all hospitals have videoconferencing capacity. Hospital Emergency Preparedness Needs Assessment

32 FIGURE 26 Fewer than 1 in 3 Pennsylvania hospitals has an established telephone hotline that can be using for public information during an emergency. 50% % of hospitals indicating "yes" 40% 30% 20% 10% % % % 0% % of hospitals that have an established hotline that can be used in large-scale emergencies to take public inquiries. % of hospitals whose hotline can accommodate non-english speaking persons. % of hospitals that can disseminate information quickly (within 2 hours) to the non-english speaking public in its service area. FIGURE 27 Most Pennsylvania hospitals do not have pre-printed public materials available to victims on the signs, symptoms, and treatment after exposure. % of hospitals who have pre-printed material available for the following incidents: 90% 75% 134 % of hospitals 60% 45% 30% 15% 0% % % % 8.0% 8 4.0% 66.7% Biological Incident Chemical Incident Radiological Incident Nuclear Incident Explosive Incident None of These Hospital Emergency Preparedness Needs Assessment

33 FIGURE 28 Less than 10% of Pennsylvania hospitals have preprinted public information available in languages other than English. Material not available in other languages 36.3% Material available in other languages 6.5% 13 No response 57.2% FIGURE 29 Half of the hospitals in Pennsylvania have video conferencing capability. Hospital does not have videoconferencing ability 50.0% Hospital has videoconferencing ability 50.0% Hospital Emergency Preparedness Needs Assessment

34 Emergency Preparedness Priority Needs Hospital Emergency Preparedness Needs Assessment

35 Emergency Preparedness Priority Needs The final section of the survey asked respondents to rate 26 separate preparedness items/areas in terms of priority need. Each item was ranked by priority need (range of 1 denoting most needed to 5 denoting least needed) for both technical/training assistance and financial assistance. More than two-thirds of PA s hospitals identified the seven highest priority needs for technical/training assistance as: Training staff in Emergency Procedures [85.6%] Upgrading Decontamination Facilities [80.4%] Treatment & Diagnosis of Victims: Biological [79.9%] Purchasing Personal Protective Equipment [79.9%] Treatment & Diagnosis of Victims: Chemical [77.0%] Treatment & Diagnosis of Victims: Radiological [67.5%] Conducting/Participating in Emergency Exercises [67.0%] Treatment & Diagnosis of Victims: Nuclear [66.3%] More than two-thirds of PA s hospitals identified the five highest priority needs for financial assistance as: Upgrading Decontamination Facilities [82.8%] Purchasing Personal Protective Equipment [81.8%] Upgrading Communications Equipment [76.6%] Training Staff in Emergency Procedures [71.3%] Upgrading Security Arrangements [67.9%] Hospital Emergency Preparedness Needs Assessment

36 FIGURE 30 More than two-thirds of Pennsylvania s hospitals identified the following 8 needs as their highest priorities for technical/training assistance RANK Preparedness Category N Technical Score 1 Training Staff in Emergency Procedures % 2 Upgrading Decontamination Facilities % 3 Treatment & Diagnosis of Victims: Biological % 3 Purchasing Personal Protective Equipment (PPE) % 4 Treatment & Diagnosis of Victims: Chemical % 5 Treatment & Diagnosis of Victims: Radiological % 6 Conducting/Participating in Emergency Exercises % 7 Treatment & Diagnosis of Victims: Nuclear % FIGURE 31 More than two-thirds of Pennsylvania s hospitals identified the following 5 needs as their highest priority for financial assistance: RANK Preparedness Category N Financial Score 1 Upgrading Decontamination Facilities % 2 Purchasing Personal Protective Equipment (PPE) % 3 Upgrading Communications Equipment % 4 Training Staff in Emergency Procedures % 5 Upgrading Security Arrangements % Hospital Emergency Preparedness Needs Assessment

37 Emergency Preparedness Expenditures Hospital Emergency Preparedness Needs Assessment

38 Emergency Preparedness Expenditures Hospitals were asked to estimate both prior expenditures (over the past 12 months) in preparation for a disaster or mass casualty incident and future expenditures (over the next 12 months). Checklists of 12 specific activities for which hospitals had incurred expenditures and planned to incur future expenditures was offered to determine the spending increases for each activity. Over the past 12 months [ ], hospitals spent $8.3 million. Over the next 12 months [ ], hospitals planned to spend $24.6 million. Average projected spending per hospital reflects a 200% increase from $42k in to $125k in Eighty-six percent of hospitals do not have a specific emergency preparedness cost center. Twenty-nine percent more hospitals plan to spend money on upgrading communications equipment in the next year than the previous year. Hospital Emergency Preparedness Needs Assessment

39 FIGURE 32 Most Pennsylvania hospitals do not have a dedicated Emergency Preparedness cost center in their annual budgets. Hospital has EP cost center 13.9% Hospital does not have EP cost center 86.1% FIGURE 33 Where Is the Money Going? Emergency Preparedness Activity Upgraded Communications Physical Plant Changes Inter-institutional Arrangements Equipment Purchases Housekeeping & Other Stocks Upgraded MIS Staffing Reorganization Training & Disaster Exercises Protocols & Plans Increased Pharmaceuticals Enhanced Security % of Hospitals Who... Spent in last 12 months 41.8% 45.2% 27.9% 70.7% 24.0% 36.5% 17.3% 89.9% 74.5% 51.4% 59.6% Plan to spend in next 12 months 71.2% 69.7% 45.7% 88.0% 39.9% 48.6% 23.6% 95.7% 79.8% 56.3% 63.5% % of Hospitals Increasing Spending 29.4% 24.5% 17.8% 17.3% 15.9% 12.1% 6.3% 5.8% 5.3% 4.9% 3.9% Hospital Emergency Preparedness Needs Assessment

40 CONCLUSION The Hospital Emergency Preparedness Assessment results confirmed and quantified key issues facing Pennsylvania acute care general hospitals. It provided for the first time a comprehensive statewide assessment of hospital preparedness, an indication of the current commitment by Commonwealth hospitals to prepare for a terrorist event, acknowledgement that much more effort is required and a priorities list of additional preparedness needs. Hospitals reported that next year s expenditures by hospitals represent a threefold increase from the past year and expected spending across the Commonwealth exceeds the total HRSA Cooperative Agreement distribution of $3.3 million by seven times. The assessment tool also provides a common pathway for future regional planning and mutual aid. Survey results are already being used in the development of educational programs to meet the training needs identified. The agreement by the statewide Hospital Bioterrorism Preparedness Planning Committee on minimum equipment levels for hospital first responders to ensure uniformity in purchases was based in part on needs expressed in the survey responses. Most importantly, the final section of the survey instrument gave each hospital an opportunity to self-identify emergency preparedness priority needs. This compiled information will be widely distributed among both statewide advisory planning groups and the nine Regional Counterterrorism Task Forces to enable them to focus their efforts on those areas most frequently cited for improvement. Hospital Emergency Preparedness Needs Assessment

41 HOSPITAL PREPAREDNESS ACTIVITIES The Hospital Emergency Preparedness Needs Assessment was one in a sequence of tasks that have now been completed. Also completed at this time are the agreements between PADOH and the Hospital and Healthsystem Association of PA (HAP) and HAP s agreement with each general acute care hospital with an Emergency Department. Of note is that there has been one hundred percent compliance in the submission of both the assessment instrument and the agreement with HAP by the hospitals. Both of these documents will be posted to the PADOH website Emergency Preparedness section shortly. Under the Pennsylvania HRSA Cooperative Agreement $3.3 million was directed to acute care general hospitals with emergency departments. The allocation formula adopted by PADOH utilized emergency department volume as a proxy for the percent of the service area that, in an emergency situation, would naturally gravitate to that hospital. The money was allocated giving each hospital $5000 plus $.50 for each emergency department visit as reported to the PADOH in its 2000/2001 Annual Hospital Survey. This formula assured that even small volume rural hospitals would receive a meaningful amount toward addressing identified priorities and that trauma centers with large volumes would receive amounts reflective of their larger patient populations. In addition, each hospital was required to sign a memorandum of agreement committing the hospital to: Participating in its regional counter-terrorism task force; Working toward the development of mutual aid agreements to give mutual aid to and receive mutual aid from other health care facilities in the region in the event of a disaster or other infectious disease outbreak; Initiating and maintaining Internet connectivity for use in reporting diseases electronically through Pennsylvania s electronic disease reporting system (PA-NEDSS) to PADOH and for receipt of health alerts from PADOH; Enrolling appropriate persons representing administration, laboratory, pharmacy, medical command, medical staff, nursing, and infection control staff in the Learning Management System (LMS) online educational service for disaster preparedness training; and Utilizing the funding distributed by HAP in accordance with PADOH allocations for approved purposes only. The approved funding purposes costs associated with the items listed above, enhancement of isolation capacity, acquiring personal protective equipment, alteration of the facility s ventilation systems to isolate the emergency department or a portion thereof, establishment or enhancement of decontamination capacity, staff education on potential agents of bioterrorism, and medications and vaccines were identified as priorities through the needs assessment survey process. The funding has been distributed to each acute care general hospital with an emergency department in the Commonwealth. Hospital Emergency Preparedness Needs Assessment

42 Next steps are: Compilation of the aggregate assessment data into the nine Regional Counter-Terrorism Task Force (RCTTF) groupings and five Hospital Planning Regions so that each region will have an indication of the variance between hospitals in each respective region. Distribution of the aggregate regional data to each RCTTF. Site visits between representatives from the Emergency Medical Services (EMS) Office, Office of Public Health Preparedness (OPHP), Bureau of Community Health Systems and the Pennsylvania Emergency Management Agency (PEMA) with each of the nine RCTTFs to integrate the Regional and Statewide NPS plans. These meetings should be concluded before January 31, Schedule of tabletop and Regional field exercises for each RCTTF will be implemented, concluding by August 31, The development and distribution of a model mutual aid agreement to create collaborative agreements between hospitals and their regional neighbors as well as those hospitals in bordering states. Complete Regional Hospital Plans including increasing hospital staffed bed capacity, personnel augmentation, providing isolation and quarantine, addressing hospital overcrowding and diversion, linkages to expert consultation and referral centers, movement of hospital equipment, meeting the special needs of children, pregnant women, the elderly and other special needs groups, hospital security, disposal of medical waste, enhancing networking and collaboration among health care facilities, Emergency Medical Services agencies, and the Emergency Management System, and the receipt and distribution of essential goods and services, such as food, water, shelter and electricity by July, Funds have been identified from the HRSA Cooperative Agreement to next complete similar assessments with Federally Qualified Health Centers (FQHC) and FQHC look-alikes. Hospital Emergency Preparedness Needs Assessment