To develop a tool that assesses disaster-planning strategies used by Home Health Agencies (HHAs) throughout Nebraska.

A survey of HHAs in Nebraska was created, distributed, and analyzed to assess and gain information about their written disaster plans. Part 1 of this 2-part survey identified agencies with written disaster plans and collected basic information about plan and structure. Part 2 identified detailed characteristics of the HHA and their pandemic influenza plans. Also, pandemic influenza preparedness of HHAs was assessed and compared to other health care institutions.

More than 90% of the HHAs that responded to the survey reported that they have written disaster plans; almost half of the plans address strategies for surge capacity. The majority of HHAs with plans also have disaster-specific plans for pandemic influenza preparedness. Our findings suggest that Nebraska HHAs have taken substantial steps toward preparedness, although individual plans may vary considerably.

This survey provides a first step at evaluating HHA disaster preparedness plans. It also demonstrates that Nebraska HHAs have taken substantial steps toward being prepared, although individual plans vary widely. (Disaster Med Public Health Preparedness. 2013;0:1–9)

Currently, there is no widely available method to evaluate an emergency department disaster plan. Creation of a standardized patient data- base and the use of a virtual, live exercise may lead to a standardized and reproducible method that can be used to evaluate a disaster plan.

A virtual, live exercise was designed with the primary objective of evaluating a hospital's emergency department disaster plan. Education and training of participants was a secondary goal.

A database (disastermed.ca) of histories, physical examination findings, and laboratory results for 136 simulated patients was created using information derived from actual patient encounters.The patient database was used to perform a virtual, live exercise using a training version of the emergency department's information system software.

Several solutions to increase patient flow were demonstrated during the exercise. Conducting the exercise helped identify several faults in the hospital disaster plan, including outlining the important rate-limiting step. In addition, a significant degree of under-triage was demonstrated. Estimates of multiple markers of patient flow were identified and compared to Canadian guidelines. Most participants reported that the exercise was a valuable learning experience.

A virtual, live exercise using the disastermed.ca patient database was an inexpensive method to evaluate the emergency department disaster plan. This included discovery of new approaches to managing patients, delineating the rate-limiting steps, and evaluating triage accuracy. Use of the patient timestamps has potential as a standardized international benchmark of hospital disaster plan efficacy. Participant satisfaction was high.

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.

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.

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 bio-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.

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.

The pivotal role of anesthesiologists in the implementation of disaster plans is not widely appreciated.

To describe the role of anesthesiologists as managers in the operating room (OR) especially during hospital disaster management.

On 25 February 1991, King Fahd Hospital of the University in Eastern Saudi Arabia, was alerted, received, triaged, and treated the victims of a Scud missile attack on a United States military barracks which killed 28 and injured more than 100 service personnel.

There were 47 males and 15 females admitted to the hospital. Their initial triage categories of injuries were: 1) red, 23; 2) yellow, 27; and 3) green, 7. The flow of patients through the main operating rooms occurred in two peaks: 1) treated within nine hours (60%); and 2) during the next 11 hours (40%). A total 101 units of blood and blood products were consumed.

The role of the Chief of Anesthesiology was vital in the dynamics of the situation regarding appropriate deployment of staff and ensuring an orderly throughput of victims in the operating room. He also was required to keep track of resources and supply levels in the operating room, so that he could advise the hospital administration appropriately.

The successful management of a large multi-casualty incident, which involved use of the operating rooms, depended upon the efficient coordination of clearly defined functions with the Chief of Anesthesiology Service as the team leader.