Testing emergency medical personnel response to patients with suspected infectious disease.
OBJECTIVE
In the United States (US), hospitals are required to have disaster plans and stage drills to test these plans in order to satisfy the Joint Accreditation Commission of Healthcare Organizations. The focus of this drill was to test if emergency response personnel, both prehospital and hospital, would identify a patient with a potentially communicable infectious disease, and activate their respective disaster plan.


METHODS
Twelve urban/suburban emergency departments (ED) received patients via car and ambulance. Patients were moulaged to imitate a smallpox infection. Observers with checklists recorded what happened. The drill's endpoints were: (1) predetermined end time; (2) identification of the patient and hospital "lock-down"; and (3) breach of drill protocol.


RESULTS
None of the ambulance personnel correctly identified their patients. Of the total 13 mock patients assessed in the ED, seven (54%) were identified by the ED staff as possibly being infected with a highly contagious agent and, in turn, the hospital's biological agent protocol was initiated. Of the correctly identified patients, five (71%) were placed in isolation, and the remaining two (29%), although not isolated, were identified prior to their ED discharge and the appropriate protocol was activated. The six remaining mock patients (46%) were incorrectly diagnosed and discharged. Of the hospitals that had correctly identified their "infected" patients, only two (29%) followed their notification protocol and contacted the local health department.


CONCLUSIONS
This drill was successful in identifying this area's shortcomings, highlighted positive reactions, and raised some interesting questions about the ability to detect a patient with a possibly highly contagious disease.
Klein
Kelly R
KR
Department of Emergency Medicine, Wayne State University, 4160 John R, Suite 616, Detroit, MI 48201, USA. KleinKR@mindsring.com
Atas
Jenny G
JG
Collins
Jerry
J
D000293:Adolescent; D000328:Adult; D023482:Bioterrorism; D002648:Child; D002983:Clinical Competence; D003140:Communicable Disease Control / Q000592:standards*; D004189:Disaster Planning; D004632:Emergency Medical Services / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D007318:Inservice Training; D008875:Middle Aged; D016544:Patient Simulation; D012189:Retrospective Studies; D012899:Smallpox / Q000175:diagnosis / Q000517:prevention & control; D014218:Triage; D014481:United States