Public Health Preparedness

Los Angeles County hospitals are limited in disaster preparedness and severely limited in surge capacity

Few Los Angeles County hospitals, including major trauma centers, can expand their capacity to handle a surge of more than 20 patients if a public health disaster strikes, according to a new study. This limited surge capacity and failure to integrate disaster training and planning with other agencies and medical facilities limits the ability of these hospitals to plan for public health disasters, conclude Amy H. Kaji, M.D., M.P.H., and Roger J. Lewis, M.D., Ph.D., of Harbor-University of California, Los Angeles Medical Center.

The researchers evaluated the hospital disaster plan structure, agreements, communications, supplies, drills and training, and surge capacity of 45 Los Angeles County hospitals that receive 911 calls. A total of 43 hospital plans were based on the Hospital Emergency Incident Command System. The majority had protocols for hospital lockdown (100 percent), canceling elective surgeries (93 percent), early discharge (98 percent), day care for children of staff (88 percent), designating victim overflow areas (96 percent), and predisaster "preferred" vendor agreements (96 percent).

Fewer hospitals involved law enforcement (56 percent) or had mutual aid agreements with other hospitals (20 percent) or long-term care facilities (7 percent). Although 96 percent conducted multiagency drills, only 16 percent actually involved other agencies in their disaster training. Less than one-third (29 percent) had a surge capacity of more than 20 beds. Less than half (42 percent) had 10 or more isolation rooms, and 60 percent had to divert ambulances to other hospitals more than 20 percent of the time. The hospitals had a generally high level of availability of equipment and supplies, yet less than half of hospitals had warm-water decontamination showers and an antibiotic stockpile, and less than one-third had immediate access to six or more ventilators. This suggests a significantly limited ability to respond to a biological or chemical event resulting in multiple victims with respiratory failure. The study was supported in part by the Agency for Healthcare Research and Quality (HS13985).

See "Hospital disaster preparedness in Los Angeles County", by Drs. Kaji and Lewis, in the November 2006 Academic Emergency Medicine 13(11), pp. 1198-1203.

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