Hospital preparedness for chemical accidents: the effect of environmental legislation on health care services.
BACKGROUND
Chemical accidents occur often across the United States, endangering the health and safety of many people. The Superfund Amendments and Reauthorization Act of 1986 (SARA) requires that communities increase their planning for medical response to these accidents. So far, little evidence has come forth that supports the notion that environmental legislation, such as SARA, improves preparedness for such accidents.


METHODS
A one-group pretest/post-test longitudinal design was used to survey the medical directors of emergency departments in all acute care hospitals in the State of New York. Data were collected by mail survey and telephone follow-up in 1986 before the passage of SARA (Time1), and in 1989 after its implementation (Time2).


RESULTS
Ninety-four percent of the directors responded at Time1 and 72% at Time2. In New York State, hospital preparedness for chemical accidents improved significantly during the study interval. The longer a hospital had a plan for response to chemical accidents, the more elements of preparedness were in place. Further, as a group, the hospitals that were the least prepared were located in the areas at highest risk.


CONCLUSIONS
Environmental legislation can influence the manner by which health care organizations prepare for environmental emergencies.
Landesman
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Albert Einstein College of Medicine Department of Pediatrics, Bronx, NY 10461, USA.
Markowitz
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Rosenberg
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D000063:Accidents, Traffic; D004189:Disaster Planning / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D004782:Environmental Health / Q000331:legislation & jurisprudence*; D015386:Hazardous Substances; D006302:Health Services Research; D006801:Humans; D008137:Longitudinal Studies; D009518:New York; D008486:Physician Executives; D011787:Quality of Health Care; D011795:Surveys and Questionnaires