ISPUB.COM The Internet Journal of Rescue and Disaster Medicine Volume 4 Number 2 1 of 6 Hospital Disaster Preparedness in the United States: New issues, New Challenges M Krajewski, M Sztajnkrycer, A Báez Citation M Krajewski, M Sztajnkrycer, A Báez. Hospital Disaster Preparedness in the United States: New issues, New Challenges. The Internet Journal of Rescue and Disaster Medicine. 2004 Volume 4 Number 2. Abstract Disasters are typically viewed as low probability yet high impact events. Although various definitions have been used, a disaster is frequently viewed as a situation in which the number of patients presenting to the medical facility within a given time period exceed the ability of the hospital to provide care without external assistance. As such, the definition is institution specific, and therefore preparedness must be likewise institution specific. The same event may represent a disaster for a 30 bed hospital and simply tax the capacity of an 1800 bed institution. INTRODUCTION Disasters are typically viewed as low probability yet high impact events. Although various definitions have been used, a disaster is frequently viewed as a situation in which the number of patients presenting to the medical facility within a given time period exceed the ability of the hospital to provide care without external assistance. As such, the definition is institution specific, and therefore preparedness must be likewise institution specific. The same event may represent a disaster for a 30 bed hospital and simply tax the capacity of an 1800 bed institution. The term “hospital preparedness” is a catch-all phrase, covering a multitude of inter-related areas of medical and non-medical disaster management. Although the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) mandates specific standards for hospital preparedness, in many institutions these standards never extend beyond the written page [ 1 ]. Prior to September 11 2001, hospital preparedness focused on either natural or unintentional man-made mass casualty events accidents, including earthquakes, tornadoes, commercial building collapse, airline and school bus accidents. In contrast to Israel and European countries, and despite such events as the 1993 World Trade Center bombing and the 1995 Oklahoma City bombing, the spectre of terrorism was remote from hospital disaster planning. Since September 11, 2001, the reality of U.S. vulnerability to domestic terrorism has translated into an increased sense of urgency to prepare for potential terrorist acts. While each institution is mandated by JCAHO to develop a specific and unique disaster plan, certain elements of the plan are universally applicable. The purpose of the current paper is to review selected specific aspects of hospital disaster preparedness in the new era of United States terrorism awareness. 1. HOSPITAL STAFFING One of the principal concerns in hospital preparedness is the determination of adequate staffing capabilities. The current health care situation is marked by lack of surge capacity and general nursing shortages, all of which are expected to worsen over the next decade [ 2 , 3 , 4 , 5 , 6 ]. Inter-hospital cooperation in hindered in part by fears of “poaching” of scarce nursing resources. Nursing shift “call-offs” are a routine event at many institutions, with the subsequent result of under-staffing during daily operations. Concern exists at many levels regarding staffing patterns during times of disaster hospital operations. The Canadian experience with SARS provides some insight into management during a biological disaster. Ontario Ministry of Health Guidelines to manage and mitigate the outbreak commented specifically on adequate hospital staffing [ 7 ]. The Ontario Health Coalition report submitted to the SARS commission specifically noted inadequate hospital capacity and understaffed facilities [ 8 ]. The SARS epidemic resulted in significant psychological stress for hospital staff, as noted by a survey of the hospital staff of a tertiary care facility [ 9 ]. Two thirds of respondents expressed concern