Public Health and Safety Effectiveness of Emergency

Public Health and Safety

Effectiveness of Emergency Management and the Readiness of Trauma Centers

Since massive terrorist attacks of September 11, 2001 and the anthrax scares in Washington, D.C. shortly thereafter, the effectiveness of emergency management responders and the readiness of emergency trauma centers have become national security issues. Unfortunately, the system is overburdened and may not be up to the challenge, possibly compromising the original mission for emergency rooms to provide adequate trauma care to local communities.

The nation's emergency room system is inadequate to deal with a WMD or other massive attack in terms of both funding and equipment.

In this research proposal, we will examine the need for examining why this is and what the federal government can do to remedy the need. Additionally, we need to find out to what extent federal efforts are succeeding and how and/or deficits with the federal efforts.

Analysis/Literature Review-Crisis for Emergency Management in the Emergency Room

In an article in the journal BMC Emergency Medicine problems in the emergency management response system and emergency trauma centers are revealed. The Homeland Security Act (HSA) of 2002 laid the groundwork for designating a critical emergency protection program. This ultimately led to the identification of emergency services as a targeted critical infrastructure resource. This has led to the crisis in hospital-based emergency care delivered through the doors of emergency trauma centers. The exigencies of the terrorist threat have brought about federal and state mandates. Unfortunately, due to insufficient federal funding, these mandates have contributed to a long-standing erosion of emergency medical care. All of this has converged to worsen the situation for severely an already overburdened trauma system that exceeds emergency capacities on a regular basis. This constant acute overcrowding causes great risk to the nation. Federal funding largess has not prioritized the improvements sufficiently for the proper maintenance of the emergency care infrastructure network. At the present time, the nation is for this reason, it is critical to re prioritize federal funding strategies before tragedy strikes again (Cherry & Trainer, 2008, 1-6).

The big issue then is how to provide the American public with a comfort level as to the viability of the nation's trauma center. In an article in the journal Prehospital and Disaster Medicine a nationally representative sample of EMS providers in the United States was surveyed to ascertain as to whether or not they had received training in handling WMD crises and/or public health emergencies as a part of their initial training and as continuing medical education subjects. Providers were also surveyed as to whether or not primary EMS agencies had the required specialty equipment to respond to specific emergency events. Over half of the EMS providers had received some training in WMD response procedures. Just 18.1% of the providers surveyed said that their agencies possessed the required equipment to adequately respond to a WMD emergency. EMS providers that only received WMD training reported a higher comfort level than those with equipment but who had received no training (ibid., 298-300).

There may not be a completely adequate level of training and education as well as the lack of a complete supply of equipment to respond to WMD. Lessor training is obviously associated with decreased comfort among EM providers in responding to nuclear, biological or incidents. Those EMS providers with access to better training and/or access to the appropriate equipment increases provider comfort in their response to WMD incidents (ibid., 300-302).

A pessimistic assessment is also shared in a 2008 study in the journal of Disaster Medicine and Public Health Preparedness. In this study, by the request of the Centers for Disease Control and Prevention, researchers at the University of Alabama at Birmingham performed a series of tenfocus group studies (total participants number of participants, 77) with ED nurses and physicians at hospitals in 3 U.S. regions. The participants considered that the topic of a hypothetical "dirty bomb" scenario. They discussed their perceptions, concerns and views of the current available guidance and informational materials (Becker & Middleton, 2008, 175-176).

The participants regularly expressed the view that neither hospital facilities or ERs are adequately prepared for a terrorist event that involves radioactive materials. The key concerns were the possibility of the hospital being overwhelmed, staffing problems, safety, potential staffing, problems with readiness and contamination/self-protection issues. Participants expressed also a need for additional information. Also, they disagreed strongly with components of current response guidances. In some cases they indicated that they disobey current protocols. Needless to say, this would indicate widespread cynicism (ibid., 176-180)..

Research Methodology

This author proposes to do a case study on a local trauma center, querying medical and EMS providers in a questionnaire as to the adequacy of their training and equipment to deal with a WMD event. Case studies are useful, because they will highlight the problems that a typical trauma center would experience in an emergency. Historical data such as that provided by state audits could also be brought to bear as to analyze the center's past performance during massive emergencies. In this way, a historical continuum would exist for a comparison of preparedness levels over time.