W. Jacoby1, S. Agarwal1, H. Jung1, A. E. Liepert1, P. J. Mercier1, A. P. O’Rourke1 1University Of Wisconsin,Surgery,Madison, WI, USA
Introduction:
Resource allocation during disasters poses clinical, administrative and ethical challenges–overwhelming available healthcare resources and obviating the standard of care. The lack of evidence-based standards or consensus-based goals for health care resource allocation in a disaster setting leads to uncertainly for providers being asked to distribute resources. To this end, limited research has been conducted to ascertain the opinions of the health care professionals who will actually be providing care if a disaster strikes.
Methods:
Data was obtained from a brief IRB-approved survey conducted at a quaternary care, academic institution. Personal experiences with disaster planning and awareness, opinions of main goal of crisis care, understanding of possible important disaster resource allocation factors (age, life expectancy, DNR status),and knowledge of triggers for declaring crisis care were ascertained. The anonymous survey was electronically distributed to a random sample of faculty physicians and residents. Analysis of descriptive characteristics and for possible relationships between baseline awareness and patterns of allocation was performed.
Results:
Analysis of physician responses demonstrated a 39% response rate (yield from 1233 surveys distributed). Mean years in practice was 12 years. Thirty-five percent of physicians stated they had been involved in disaster planning, but only 21% knew the institutional disaster plan or where to find these plans. Eighteen percent felt they had received adequate training to receive a large surplus of patients. The majority of physicians said that scope of practice (89%) and legal standards (65%) change during disaster scenarios, and just over half (52%) said ethical norms changed. A minority (24%) of physicians had experience with disasters or resource allocation, and most (82%) do not feel they have received adequate training in this area.
Conclusion:
The majority of physicians at a large academic hospital are ill prepared to deal with resource allocation in disasters. This early single institution analysis provides the first reported insights into baseline physician attitudes and can be a basis for targeting institutional education initiatives and future surveys in disaster planning and management.