Hazard vulnerability analysis and disaster preparedness in Puerto Rico hospital emergency departments

Background/Purpose: A Hazard Vulnerability Analysis (HVA) is useful to identify potential disasters that could affect the demand for hospital emergency services and the ability to provide them. Since each hazard is different, risks associated with it can be analyzed to prioritize preparedness, mitigation, response and recovery activities. Mass casualty incidents (MCI) have the potential to paralyze emergency department (ED) services due to a significant patient surge. Knowing the hospital vulnerabilities in advance will allow a rapid and efficient disaster response. Objective: To examine the HVA and disaster preparedness and response capability to a MCI at emergency departments in Puerto Rico. Methods: A survey was conducted to characterize ED level of preparedness and response to a MCI. Thirty-nine hospitals of a sample of 44 participated in the study. The questionnaire explored: general hospital characteristics; emergency plans; ED capacity and volume; equipment and infrastructure; collaborative agreements; personnel trainings; emergency communications; laboratory facilities; treatment protocols; security; and, epidemiologic surveillance. Results: Only 51.6% of the hospitals have conducted an HVA. Reasons reported for not having a HVA are: absence of personnel trained in HVAs; cost associated with the implementation of an HVA; and the lack of knowledge of where to receive trainings. Hospitals that conducted the HVA reported earthquakes and hurricanes as the higher risk vulnerabilities, and have these included in their emergency plan. Conclusion: Absence of an HVA is most commonly associated with not having trained staff, the costs of conducting an HVA, and the HVA not being a priority for the institution.