title: Bioterrorism and mass casualty preparedness in hospitals: United States, 2003.
abstract: OBJECTIVE
  This study examined the content of hospital terrorism preparedness emergency response plans; whether those plans had been updated since September 11, 2001; collaboration of hospitals with outside organizations; clinician training in the management of biological, chemical, explosive, and nuclear exposures; drills on the response plans; and equipment and bed capacity.
  
  
  METHODS
  The National Hospital Ambulatory Medical Care Survey (NHAMCS) is an annual survey of a probability sample of approximately 500 non-Federal general and short-stay hospitals in the United States. A Bioterrorism and Mass Casualty Supplement was included in the 2003 survey and provided the data for this analysis.
  
  
  RESULTS
  Almost all hospitals have plans for responding to natural disasters (97.3 percent). Most have plans for responding to chemical (85.5 percent), biological (84.8 percent), nuclear or radiological (77.2 percent), and explosive incidents (76.9 percent). About three-quarters of hospitals were integrated into community-wide disaster plans (76.4 percent), and 75.9 percent specifically reported a cooperative planning process with other local health care facilities. Despite these plans, only 46.1 percent reported written memoranda of understanding with these facilities to accept inpatients during a declared disaster. Hospitals varied widely in their plans for re-arranging schedules and space in the event of a disaster. Training for hospital incident command and smallpox, anthrax, chemical, and radiological exposures was ahead of training for other infectious diseases. The percentage of hospitals training their staff in any exposure varied from 92.1 percent for nurses to 49.2 percent for medical residents. Drills for natural disasters occurred more often than those for chemical, biological, explosive, nuclear, and epidemic incidents. More hospitals staged drills for biological attacks than for severe epidemics. Despite explosions being the most common form of terrorism, drills for these were staged by only one-fifth of hospitals. Hospitals collaborated on drills most often with emergency medical services, fire departments, and law enforcement agencies.
authors.affiliation: Division of Health Care Statistics, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, USA.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Niska
authors.forename: Catharine W
authors.initials: CW
authors.lastname: Burt
mesh_terms: D023482:Bioterrorism; D004189:Disaster Planning / Q000458:organization & administration* / Q000706:statistics & numerical data; D004190:Disasters; D004631:Emergency Medical Service Communication Systems; D004632:Emergency Medical Services / Q000458:organization & administration*; D004864:Equipment and Supplies; D019538:Health Care Surveys; D006752:Hospital Planning / Q000706:statistics & numerical data*; D006801:Humans; D007318:Inservice Training / Q000706:statistics & numerical data; D007373:Interinstitutional Relations; D008505:Medical Staff, Hospital / Q000193:education; D016134:Organizational Policy; D014481:United States