Morton Melinda J, Hsu Edbert B, Shah Sneha H, Hsieh Yu-Hsiang, Kirsch Thomas D
Captain, U.S. Army; Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Am J Disaster Med. 2020;14(4):269-277. doi: 10.5055/ajdm.2019.0340.
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, χ analysis, Cochran-Armitage trend test, and analysis of variance. Free text comments were coded and subjected to frequency-based analysis.
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.
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.
评估美国各地急诊科针对大流行的准备水平，并更好地了解美国急诊医师学会（ACEP）灾难医学分会（DMS）的卫生专业人员所代表的当前准备工作障碍。方法、设计与背景：对ACEP DMS成员进行了横断面调查。在2009年ACEP科学大会DMS会议期间，通过电子邮件和纸质调查问卷对总共300名成员进行了调查。问卷中设有一个可选的意见栏，用于收集分会成员对准备工作障碍的看法。根据作者定义的关键准备指标，为每位受访者计算了一个包含15项内容的大流行准备分数。使用描述性统计、χ分析、 Cochr an - Armitage趋势检验和方差分析对结果进行分析。对自由文本评论进行编码并进行基于频率的分析。
共有92名DMS成员完成了调查，回复率为31%。尽管85%的受访者表示其医院有针对大流行性流感应对及其他传染病威胁的计划，但只有68%的受访者表示其急诊科有计划，52%的受访者表示其医院或急诊科进行了灾难准备演练。只有57%的受访者表示在人员短缺时有增加急诊科工作人员的计划，63%的受访者表示有充足的个人防护装备供应。虽然63%的受访者表示其急诊科有疫苗和抗病毒药物分发计划，但只有32%的急诊科有呼吸机分配计划。共有42%的受访者认为其急诊科在发生大流行性流感或其他疾病爆发时有准备，只有35%的受访者认为其医院有准备。受访者的平均大流行准备分数在满分15分中为8.30分。规模较大的急诊科更有可能获得较高的准备分数（p = 0.03），也更有可能有大流行准备计划（p = 0.037）。分会成员提到的一些主要准备障碍包括缺乏地方行政支持、资金方面的挑战、需要专门的灾难准备人员、人员短缺以及灾难应对机构之间缺乏沟通，尤其是在联邦层面。
在ACEP DMS成员工作的医院中，大流行性流感和其他传染病爆发规划方面似乎存在重大差距。这可能反映出准备措施在更广泛层面上存在潜在不足。
