title: A survey assessment of the level of preparedness for domestic terrorism and mass casualty incidents among Eastern Association for the Surgery of Trauma members.
abstract: OBJECTIVE
  The goal of this survey was to establish a benchmark for trauma surgeons' level of operational understanding of the command structure for a pre-hospital incident, a mass casualty incident (MCI), and weapons of mass destruction (WMD). The survey was distributed before the World Trade Center destruction on September 11, 2001.
  
  
  METHODS
  The survey was developed by the authors and reviewed by a statistician for clarity and performance. The survey was sent to the membership of the 2000 Eastern Association for the Surgery of Trauma spring mailing, with two subsequent mailings and a final sampling at the Eastern Association for the Surgery of Trauma 2001 meeting. Of 723 surveys mailed, 243 were returned and statistically analyzed (significance indicated by p < 0.05).
  
  
  RESULTS
  No statistical difference existed between level of designation of a trauma center (state or American College of Surgeons) and a facility's level of pre-paredness for MCIs or WMD. Physicians in communities with chemical plants, railways, and waterway traffic were statistically more likely to work at facilities with internal disaster plans addressing chemical and biological threats. Across all variables, physicians with military training were significantly better prepared for response to catastrophic events. With the exception of cyanide (50%), less than 30% of the membership was prepared to manage exposure to a nerve agent, less than 50% was prepared to manage illness from intentional biological exposure, and only 73% understood and were prepared to manage blast injury. Mobile medical response teams were present in 46% of the respondents' facilities, but only 30% of those teams deployed a trauma surgeon. Approximately 70% of the membership had been involved in an MCI, although only 60% understood the command structure for a prehospital incident. Only 33% of the membership had training regarding hazardous materials. Of interest, 76% and 65%, respectively, felt that education about MCIs and WMD should be included in residency training.
  
  
  CONCLUSIONS
  A facility's level of pre-paredness for MCIs or WMD was not related to level of designation as a trauma center, but may be positively influenced by local physicians with prior military background. Benchmark information from this survey will provide the architecture for the development and implementation of further training in these areas for trauma surgeons.
authors.affiliation: Department of Surgery, University of Tennessee College of Medicine-Chattanooga Unit, Chattanooga, Tennessee, USA. cirauldl@erlanger.org
authors.forename: David L
authors.initials: DL
authors.lastname: Ciraulo
authors.forename: Eric R
authors.initials: ER
authors.lastname: Frykberg
authors.forename: David V
authors.initials: DV
authors.lastname: Feliciano
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Knuth
authors.forename: Charles M
authors.initials: CM
authors.lastname: Richart
authors.forename: Christy D
authors.initials: CD
authors.lastname: Westmoreland
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Williams
mesh_terms: D001291:Attitude of Health Personnel; D019985:Benchmarking / Q000458:organization & administration; D002983:Clinical Competence / Q000592:standards*; D004189:Disaster Planning / Q000592:standards*; D004502:Education, Medical, Continuing / Q000592:standards; D004522:Educational Status; D004632:Emergency Medical Services / Q000592:standards; D013502:General Surgery / Q000193:education / Q000592:standards; D015386:Hazardous Substances / Q000506:poisoning; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020380:Needs Assessment / Q000458:organization & administration; D009511:New England; D009689:Nuclear Warfare / Q000517:prevention & control*; D010819:Physician's Role; D012955:Societies, Medical; D015144:Southeastern United States; D011795:Surveys and Questionnaires; D023481:Terrorism / Q000517:prevention & control*; D014193:Trauma Centers; D014194:Traumatology / Q000193:education / Q000592:standards
chemical_list: D015386:Hazardous Substances