title: Full-scale regional exercises: closing the gaps in disaster preparedness.
abstract: BACKGROUND
  Man-made (9/11) and natural (Hurricane Katrina) disasters have enlightened the medical community regarding the importance of disaster preparedness. In response to Joint Commission requirements, medical centers should have established protocols in place to respond to such events. We examined a full-scale regional exercise (FSRE) to identify gaps in logistics and operations during a simulated mass casualty incident.
  
  
  METHODS
  A multiagency, multijurisdictional, multidisciplinary exercise (FSRE) included 16 area hospitals and one American College of Surgeons-verified Level I trauma center (TC). The scenario simulated a train derailment and chemical spill 20 miles from the TC using 281 moulaged volunteers. Third-party contracted evaluators assessed each hospital in five areas: communications, command structure, decontamination, staffing, and patient tracking. Further analysis examined logistic and operational deficiencies.
  
  
  RESULTS
  None of the 16 hospitals were compliant in all five areas. Mean hospital compliance was 1.9 (± 0.9 SD) areas. One hospital, unable to participate because of an air conditioner outage, was deemed 0% compliant. The most common deficiency was communications (15 of 16 hospitals [94%]; State Medical Asset Resource Tracking Tool system deficiencies, lack of working knowledge of Voice Interoperability Plan for Emergency Responders radio system) followed by deficient decontamination in 12 (75%). Other deficiencies included inadequate staffing based on predetermined protocols in 10 hospitals (63%), suboptimal command structure in 9 (56%), and patient tracking deficiencies in 5 (31%). An additional 11 operational and 5 logistic failures were identified. The TC showed an appropriate command structure but was deficient in four of five categories, with understaffing and a decontamination leak into the emergency department, which required diversion of 70 patients.
  
  
  CONCLUSIONS
  Communication remains a significant gap in the mass casualty scenario 10 years after 9/11. Our findings demonstrate that tabletop exercises are inadequate to expose operational and logistic gaps in disaster response. FSREs should be routinely performed to adequately prepare for catastrophic events.
authors.affiliation: FH Sammy Ross, Jr, Trauma Center, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Klima
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Seiler
authors.forename: Jeff B
authors.initials: JB
authors.lastname: Peterson
authors.forename: A Britton
authors.initials: AB
authors.lastname: Christmas
authors.forename: John M
authors.initials: JM
authors.lastname: Green
authors.forename: Greg
authors.initials: G
authors.lastname: Fleming
authors.forename: Michael H
authors.initials: MH
authors.lastname: Thomason
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Sing
mesh_terms: D004189:Disaster Planning / Q000458:organization & administration*; D004190:Disasters; D004631:Emergency Medical Service Communication Systems / Q000458:organization & administration*; D060731:Emergency Responders / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D054527:Mass Casualty Incidents / Q000706:statistics & numerical data; D020380:Needs Assessment; D016544:Patient Simulation; D018570:Risk Assessment; D016019:Survival Analysis; D023481:Terrorism; D014481:United States