Survey

Form Approved
OMB No. 0920-XXX
Exp Date:

Survey of Hospital Preparedness in a Mass Casualty Event
Public Reporting burden of this collection of information is estimated at 120 minutes per response, including the time for reviewing
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Atlanta, GA 30333; Attn: PRA (0920-XXXX).

Welcome to the Survey of Hospital Preparedness in a Mass Casualty Event. Please enter your survey ID and
password to begin.
Survey ID
_______________________________________

Password
_______________________________________

1

Subject Information and Consent Form
Name of Research Study:

Evaluation of Hospital Preparedness in a Mass Casualty Event (MCE)

Protocol #:

200-2009-28540

Sponsor:

Centers for Disease Control and Prevention

Principal Investigator Name: Russ Foushee, PhD
Research Site Address:

100 Capitola Drive, Suite 106, Durham, NC 27713

Daytime Telephone Number: 919-354-5272
24-hour Contact Number:

919-354-5272

The U.S. healthcare system and its civilian healthcare providers have relatively limited experience in treating patients
with explosion-related injuries. Deficiencies in response capability could result in an increased number of injuries and
deaths, in addition to increased fear in the general public that hospitals may not be fully prepared for terrorist attacks
or Mass Casualty Incidents (MCIs), or large scale natural disasters.
After an explosion or a MCI (to include large scale natural disasters), the surge of patients admitted to nearby hospitals
typically occurs within minutes of the event and can quickly overwhelm hospital resources. The U.S. recently
experienced two catastrophes involving major explosions: the tragic terrorist bombing attack of the Boston Marathon
and the fertilizer plant explosion in the town of West, Texas. Both incidents caused many deaths and casualties and an
immediate surge of patients that strained the capacity of local Emergency Medical Service systems, hospitals and
other health care facilities to care for those critically injured.

2

The CDC’s National Center for Injury Prevention and Control is conducting this public health preparedness and
response project with SciMetrika, LLC to ascertain the hospital and healthcare facilities’ The CDC’s National Center for
Injury Prevention and Control is conducting this public health preparedness and response project with SciMetrika, LLC
to ascertain the hospital and healthcare facilities level of preparedness for MCIs related to bombings, non-bombing
explosions and natural disasters. To achieve this objective, this extensive questionnaire consisting of 133 questions
was designed to assess the hospitals’ general emergency preparedness and response capacities as well as the
capacity of the major hospital functional areas that are of particular importance to MCI-related preparedness and
response. Considering the extensiveness of the survey, it may be necessary to complete the various sections with the
assistance of several staff members from the appropriate hospital departments.
The results will identify current capacity and preparedness gaps for bombings and other MCIs. In addition to this initial
study, additional waves of the survey may be implemented to follow up and compare results over a period of time. This
information may be particularly useful to federal and state agencies working on hospital preparedness efforts and can
potentially assist in identifying areas where additional preparedness resources are needed at a national level.
We want to hear from you! The CDC would like your facility to participate in this survey which includes questions on
current resources, critical preparedness elements, emergency management planning, risk communication, logistics,
and training. The CDC will use the results from this survey to identify areas of strengths and weaknesses in current
hospital capacity and preparedness efforts at the national level to handle bombings and MCIs to increase overall
preparedness levels. In addition to this initial study, additional waves of the survey may be implemented to follow up
and compare results over a period of time. This information may be particularly useful to federal and state agencies
working on hospital preparedness efforts and can potentially assist in identifying areas where additional preparedness
resources are needed at a national level.
We are focusing on questions about responses to bombings, non-bombing explosions, and any type of natural
disasters resulting in a large surge in injured patients. Other type of events where infectious, chemical, and
radiological contaminants are involved in the incident will not be considered. This will be a retrospective analysis with
period of reference from January 1 to July 31, 2014.
For the purpose of this survey an MCI is defined as: “An event which generates more patients at one time than locally
available resources can manage using routine procedures. It requires exceptional emergency arrangements and
additional or extraordinary assistance.”

3

Also, with regards to trauma-level designation, it is important to note that a single facility may have multiple traumalevel designations (from comprehensive trauma service to limited care) for various types of services (e.g. adult vs.
pediatric). A trauma-level ranking is typically designated by state or local authorities or verified by the American
College of Surgeons. If you are a designated trauma hospital, when responding to the questionnaire, please indicate
your facility’s highest trauma-level designation (e.g. Level I - adult vs. Level II - pediatric hospital).
The reports prepared as a result of this survey will summarize findings across the practices and facilities and will not
associate responses with a specific individual, practice, or facility. We will not provide information that identifies you
or your practice or facility to anyone outside the study team, except as required by law. At no time will your individual
information be seen.
The survey is divided into sections that address different aspects of hospital preparedness. Considering the
extensiveness of this questionnaire, if you need assistance to evaluate certain services, please contact the appropriate
person(s) from the indicated departments to obtain the needed information. Thank you in advance for taking the time
to complete our Assessment Tool for the Evaluation of Hospital Preparedness in a Mass Casualty Event (MCE). We
know that your time is valuable and greatly appreciate your willingness to participate in this research. If you have any
questions or concerns, please call Lisa Garbarino at 770-XXX-XXXX or email at [email protected].
Please note that your participation in this research is voluntary and you will not be penalized if you refuse to
participate or decide to stop.
A copy of this consent form is available on the study web site.
Please choose ACCEPT to continue with the survey or DECLINE if you choose to not participate.
 ACCEPT

 DECLINE

4

If you need to stop the survey and return at a later time to complete, you may simply close the browser window and
return to the website at your convenience. Your information is automatically saved. When you return to the website and
enter your SurveyID and Password you will be automatically taken to the point where you left off.
Q1

Q2

Q3

Please complete the following information about your facility.
Hospital Name:

_____________________________________________________________________________

Address:

_____________________________________________________________________________

City:

_____________________________________________________________________________

State:

_____________________________________________________________________________

Zip Code:

_____________________________________________________________________________

Please complete the following information about yourself.
Name

_____________________________________________________________________________

Title

_____________________________________________________________________________

Department

_____________________________________________________________________________

Office Phone Number

_____________________________________________________________________________

Office E-mail Address

_____________________________________________________________________________

Is your hospital a designated trauma center by the American College of Surgeons or the State?
 Yes
 No

Q4

What is your hospital’s trauma level designation?
Adult

Level 1

Level 2

Level 3

Level 4

Level 5

Other













5

Please describe your hospital’s adult trauma level designation?
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
_______________________________________________
Pediatrics













Please describe your hospital’s pediatrics trauma level designation?
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
_______________________________________________

Q5

Does your hospital have a separate pediatric emergency department (ED) or designated rooms for pediatric
patients?
 Yes
 No

Q6

If no separate or dedicated pediatric ED is available, does your facility have an agreement with Emergency
Medical Services (EMS) and nearby pediatric ED(s) to divert and/or transfer incoming pediatric patients
(excluding walk-ins)?





Q7

Agreement with EMS
Agreement with nearby ED(s)
Both
None

Please indicate your facility’s staffing total capacity (both employed and privileged; part-time and as needed)
with regard to the following hospital personnel. Please enter the TOTAL NUMBER for each type.
Total Clinical Staff

_______________

Emergency Medicine Physicians (board certified)

_______________

Neurosurgeons

_______________

Orthopedic Surgeons

_______________

Critical Care Physicians

_______________
6

Q8

Pediatric Emergency Medicine Physicians

_______________

Pediatric Surgeons

_______________

Pediatric Clinical Care Physicians

_______________

Anesthesiologists

_______________

Certified Nurse Anesthetists (CRNAs)

_______________

Total Critical Care and Emergency Nurses

_______________

Certified Critical Care and Emergency Nurses

_______________

Please indicate your facility’s patient care capacity for the following resources. Please enter the AVERAGE
NUMBER of staffed beds for each area.
Burn Beds

_______________

Emergency Department (ED)

_______________

Emergency Department (PEDS)

_______________

Intensive Care (Medical)

_______________

Intensive Care (Surgical)

_______________

Intensive Care (Neonatal)

_______________

Intensive Care (PEDS)

_______________

Medical-Surgical Beds (Adult)

_______________

Medical-Surgical Beds (PEDS)

_______________

Obstetrics Beds

_______________

Step Down

_______________
7

Q9

Operating Room

_______________

Post Anesthesia Care

_______________

Is your facility responsible for the direct provision of EMS (e.g., 911 responses through a hospital based EMS
system) to your community?
 Yes
 No
 Don't Know

Q10

Please estimate the number of vehicles leased, owned, or contracted for.






Q11

Q12

1 to 5
6 to 10
11 to 15
16 or more
Don't Know

What is the total staffing level of these ambulances. Please enter NUMBER OF AVAILABLE STAFF.
Advanced Life Support (ALS)

_______________

Basic Life Support (BLS)

_______________

Both ALS and BLS

_______________

Does your facility utilize (receive or transport) air medical resources, such as helicopters?
 Yes
 No
 Don't Know

8

Q13

Does your facility have a morgue?
 Yes
 No

What is the capacity of your facility’s morgue including both actual morgue and temporary morgue units?
Please enter NUMBER OF UNITS.
_______________
Q15

Please indicate your facility’s resource total capacity for the following medical equipment and devices. Please
enter the TOTAL NUMBER for each one.
Portable cardiac monitors

_______________

Portable X-ray machines

_______________

Portable ultrasound machines

_______________

Portable ventilators

_______________

Pediatric capable ventilators

_______________

Computed Tomography scanners (CT scanners)

_______________

Magnetic Resonance Imaging Devices (MRIs)

_______________

Q16

Does your facility have a security force with full-time security responsibilities?

Q17

What are your facility’s security arrangements?

 Yes
 No
 Don't Know





Part-time Security
Agreement with Local Police
Don't Know
Other

9

Q18

Does your facility have a plan (written or otherwise) for security force supplemental staffing in the event that a
bombing, non-bombing explosion or a natural disaster MCI occurs resulting in surge of injured patients?
 Yes
 No
 Don't Know

Q19

Can your facility implement perimeter-restricted access or lockdown (preventing access; not egress) within 10
minutes of notification of an MCI or patient surge event?
 Yes
 No
 Don't Know

Q20

Does your facility have procedures to ensure appropriate screening and directed access for personnel,
equipment and supplies, emergency transport vehicles, and family during a lockdown?
 Yes
 No
 Don't Know

Q21

Do security procedures in place provide screening of incoming mail, packages and deliveries to the facility
during response to an MCI?
 Yes
 No
 Don't Know

Q22

Has an Emergency Traffic Control plan (written or otherwise) been created and shared with local law
enforcement and first responders in the community?
 Yes
 No
 Don't Know

Q23

Do you have a plan (written or otherwise) for the proper identification, collection and protection of possible
evidence from patients being treated in the MCI?
 Yes
 No
 Don't Know

10

Q24

Do you have a protocol (written or otherwise) for chain of custody procedures?
 Yes
 No
 Don't Know

Q25

In the event of a loss of central power due to an MCI, does your facility’s secondary/emergency power plan
account not only for the requirements of daily operations, but also the increased resource needs and demand
(e.g., imaging) that will occur in an MCI?
 Yes
 No
 Don't Know

Q26

Do you have secondary water source(s) necessary for consumption, clinical care, and non-clinical operations?
 Yes
 No
 Don't Know

Q27

Does your facility have medical gases that can last for 72 hours without re-supply?

Q28

Does your facility have procedures in place to acquire additional medical gas resources if required?

 Yes
 No
 Don't Know
 Yes
 No
 Don't Know

Q29

Does your facility have procedures in place for the management of increased volume and disposal of
contaminated wastes, goods, and fluids that will occur in an MCI?
 Yes
 No
 Don't Know

11

Q30

Does your facility have a plan to make adequate network bandwidth available for the increased use of
electronic medical records, imaging, and electronic communications that may occur in an MCI?
 Yes
 No
 Don't Know

Q31

Do your facility’s main information and data storage systems have offsite backups and/or recovery
capabilities?
 Yes
 No
 Don't Know

Q32

If your facility has implemented an Electronic Health Record (EHR), is there a backup plan and materials for
patient management and tracking in the event of an EHR system loss?





Q33

Yes
No
Don't Know
Have Not Implemented EHR

Does your facility have an Emergency Operations Plan (EOP) that addresses the four phases of emergency
management: preparedness, response, mitigation, and recovery?
 Yes
 No
 Don't Know

Q34

Is this plan integrated into local/county/state emergency planning and operations?
 Yes
 No
 Don't Know

Q35

Does your facility’s plan include preparedness for bombings, natural disasters, or other events that will result
in a large number of injured patients in your community?
 Yes
 No
 Don't Know

12

Q36

Does your plan address the needs of people with functional and access needs (e.g. visual impairments, lack of
transportation) in mass casualty events?
 Yes
 No
 Don't Know

Q37

Does the plan address emergency credentialing of qualified volunteer practitioners for a disaster response?
 Yes
 No
 Don't Know

Q38

Does your facility participate in the Emergency System for Advance Registration of Volunteer Health
Professionals (ESAR-VHP) program?
 Yes
 No
 Don't Know

What triggers the activation of your hospital’s disaster plan (e.g. nature of event, number of patients, etc.)?
Please describe in the following box. The remaining number of characters allowed for this response is: left.
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
_______________________________________________________________________

Q40

Does your hospital’s EOP include standing up an Incident Command System (ICS) or Hospital Incident
Command System (HICS)?
 Yes
 No
 Don't Know

Q41

Is your hospital’s administrative leadership (e.g. CEO, president, etc.) actively involved in the ICS?
 Yes
 No
 Don't Know

13

Q42

Do new staff members receive training in the hospital’s ICS?
 Yes
 No
 Don't Know

Q43

Does your hospital’s EOP include specific plans that can be activated in response to an MCI related to a
bombing, non-bombing explosion, or natural disaster for the following departments?
Yes

No

Not Applicable

Emergency Medical Services System







Emergency Department







Surgical Department







Intensive Care Unit







Radiology







Blood Bank







Hospital Medicine







Administration







Pharmacy







Nursing Care







Security







Pediatrics/Neonatal







Laboratory Services







Pathology







14

Q44

Mental Health







Respiratory Care







Engineering/Maintenance







Central Supply







Communication







Information Technology







Was your hospital's EOP for the following depatments exercised in past 12 months?
Yes

No

Don't Know

Emergency Medical Services System







Emergency Department







Surgical Department







Intensive Care Unit







Radiology







Blood Bank







Hospital Medicine







Administration







Pharmacy







Nursing Care







Security







Pediatrics/Neonatal







15

Laboratory Services







Pathology







Mental Health







Respiratory Care







Engineering/Maintenance







Central Supply







Communication







Information Technology







Q45

Does your facility have a hospital emergency management/disaster preparedness coordinator/director?

Q46

Does he/she work at a full time or part time capacity in that role?

 Yes
 No
 Don't Know
 Full-time
 Part-time
 Don't Know

Q47

Does your facility have a Continuity of Operations Plan (COOP) or Business Continuity Plan (BCP)?

Q48

Which of the following departments are actively involved in your hospital’s preparedness and response
planning efforts?

 Yes
 No
 Don't Know

Emergency Medical Services System
Emergency Department

Yes

No

Not Applicable













16

Q49

Surgical Department







Intensive Care Unit







Radiology







Blood Bank







Hospital Medicine







Administration







Pharmacy







Nursing Care







Security







Pediatrics/Neonatal







Laboratory Services







Pathology







Mental Health







Respiratory Care







Does your facility have current mutual aid Memorandums of Understanding (MOUs), agreements in place
and/or working relationships with the following entities:
Yes

No

Don't Know

Law enforcement







Fire







Emergency Medical Services







17

Military Installations







Other local and regulated health care facilities







Burn center







Red Cross







Metropolitan Medical Response System
(MMRS)







Community Emergency Response Teams
(CERT)







Pharmacies







Supply Chain Distributors







Other







Please specify the other agencies for which you have an MOU in place. The remaining number of characters
allowed for this response is: left.
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
_______________________________________________________________________

Q50

Does your facility have current mutual aid MOUs or agreements in place for the following medical
equipment/resources:
Yes

No

Don't Know

Ventilators







Portable MRIs







Portable CT







Portable Dialysis







Power Generators







18

Q51

Has all of your staff (e.g. clinical and administrative staff) received a formal presentation or orientation to gain
understanding on your facility’s EOP?
 Yes
 No
 Don't Know

Q52

Does all of your clinical staff receive annual training for management of adult and pediatric injured patients
due to bombings, explosions, and natural disaster-related MCIs that may result in a large number of injured
patients?






Q53

Yes
No
Just Adults
Just Pediatrics
Don't Know

Please provide the best estimate of the percentage of total staff that has taken any National Incident
Management System (NIMS) course. Please enter your best estimate from 0 to 100 PERCENT.
_______________

Q54

Q55

Please provide your best estimate of the percentage of your clinical staff (physicians, nurses, physician’s
assistants, nurse practitioners, others) that have received any of the following training and education in
disaster preparedness and response, as it pertains to caring for a large number of injured adult and pediatric
patients from mass casualty event. Please enter your best estimate from 0 to 100 PERCENT.
Formal education or fellowship programs

_______________

Disaster training courses

_______________

Lectures, grand rounds, seminars

_______________

Is there a mechanism in place at your facility to provide just in time training to clinicians in the event of an MCI
involving large numbers of injured patients?
 Yes
 No
 Don't Know

19

Q56

Has your facility exercised (full-scale or functional) its EOP in the last 12 months?
 Yes
 No
 Don't Know

Q57

Has your facility conducted drills or exercises for MCI scenarios specifically related to response to bombings,
non-bombing explosions, or natural disasters that result in a large number of injured patients?
 Yes
 No
 Don't Know

Q58

During drills and exercises, has your facility accounted for MCI scenarios, such as loss of power, water, or
injury of staff?
 Yes
 No
 Don't Know

Q59

Does your facility conduct unannounced or surprise drills?

Q60

Have your departments had actual or true-life experience with increased surge due to an MCI related to a
bombing, non-bombing explosion, or natural disasters?

 Yes
 No
 Don't Know

 Yes
 No
 Don't Know

Q61

Which of the following elements were most challenging to manage at your facility during an MCI surge
response. Please select up to five (5) options that were the most challenging.
5 Most Challenging Elements

Ambulatory care capacity (e.g. ambulatory care centers, surge tents, clinics, etc)



Ancillary and support services (e.g. laboratory services, including communication & reporting
to & from regional public health; imaging services; other ancillary & diagnostic services)



20

Burn needs



Communication systems (primary & back up internal & external communication systems,
assigned frequencies & uses, maintenance & equipment locations, internet, telephone, cell,
walkie-talkie, radio, notification systems, etc)



Continuity of hospital operations



Documentation and patient tracking



Fatalities



Implementing the disaster plan and incident command structure



Management of families and crowds



Media communications



Medical waste



Mental health needs



Patient holding areas



Personnel (staff and volunteers)



Security (e.g. lockdown, screening)



Services not normally provided by your facility



Supplies, pharmaceuticals and equipment



Treatment areas - ED, operating rooms, ICU, medical and surgical floors



Triage



Other


21

Please describe the other elements were most challenging to manage at your facility during an MCI surge
response. The remaining number of characters allowed for this response is: left.
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
_______________________________________________________________________

Q62

Does your facility develop an after action report following surge events?
 Yes
 No
 Don't Know

Q63

Q64

Does your facility have a designated disaster supply for use during a response to an MCI, including a cache of
emergency drugs, supplies, and equipment, ready for immediate distribution to and from the ED?
Yes

No

Don't Know

Emergency drugs







Supplies







Equipment







In the event of a response to an MCI, have you designated an in-hospital alternate treatment area that can
accommodate a surge of injured patients?
 Yes
 No
 Don't Know

Q65

Does your community have designated alternate care site(s) (external to your facility) identified to
accommodate casualty surge during response to an MCI?
 Yes
 No
 Don't Know

22

Q66

Is your hospital responsible for supplying staffing, logistical support, supplies, or equipment to these sites
during an MCI?
 Yes
 No
 Don't Know

Q67

Does your EOP include provisions for transferring patients to external alternate care sites?
 Yes
 No
 Don't Know

Q68

Does your facility have a plan for tracking patients (location and condition) during a response to an MCI?

Q69

Is the plan for tracking patients during a response to an MCI electronic or manual?

 Yes
 No
 Don't Know
 Electronic
 Manual
 Don't Know

Q70

Is there a backup manual system to the electronic system?

Q71

Can your facility’s plan track patients who are transferred to another local facility or out of the community?

 Yes
 No
 Don't Know
 Yes
 No
 Don't Know

23

Q72

Was your facility’s EOP developed with collaboration and input from local EMS services?
 Yes
 No
 Don't Know

Q73

Is the local EMS a part of your drills and exercises?

Q74

Does your EOP include provisions to mobilize EMS resources (e.g., for evacuation) to your facility if needed or
required?

 Yes
 No
 Don't Know

 Yes
 No
 Don't Know

Q75

Does your facility use a disaster triage system that is consistent with the system used by local EMS?
 Yes
 No
 Don't Know

Q76

Has your Emergency Department (ED) and hospital leadership identified additional areas in the institution that
could be converted to patient care areas if needed to manage a surge of injured patients?
 Yes
 No
 Don't Know

Q77

Has your ED established a procedure to facilitate the early discharge of patients in the ED to increase bed
capacity to manage a surge of injured patients?
 Yes
 No
 Don't Know

24

Q78

Has your ED identified patient care supplies that would be needed in an event involving a large number of
injured patients (e.g., IV access, gowns, gloves, dressings, airway supplies, etc)?
 Yes
 No
 Don't Know

Q79

Does your facility have access to additional supplies during a surge event?
 Yes
 No
 Don't Know

Q80

Has your ED developed a call down list for all staff?

Q81

Has the list been exercised in the past 12 months?

 Yes
 No
 Don't Know
 Yes
 No
 Don't Know

Q82

Has your ED developed a collaborative plan with radiology to facilitate the rapid imaging (including
transportation, utilization and triage of available imaging resources, and interpretation of studies) that will be
required with a surge of injured patients?
 Yes
 No
 Don't Know

Q83

Does your facility have an Intensive Care Unit (ICU)? This includes Adult or Pediatric ICU.
 Yes
 No
 Don't know

25

Q84

Does your facility have a plan to identify ICU overflow sites for patients who cannot be admitted to an existing
ICU and ensure that adequate staff support and monitoring can be provided?
 Yes
 No
 Don't Know

Q85

Q86

Has your facility identified any of the following for the ICU?
Yes

No

Don't Know

Resources needed for communicating within the
organization and community? (e.g., portable
communication devices, satellite phones)







Transportation resources (e.g. vehicles, personnel)
for patients with severe burns if transfer is needed?







A plan to acquire additional ventilators, adult and
pediatric, and personnel to staff them if required?







Protocols that govern admissions to the ICU and
application of ICU resources in an MCI?







Does your hospital have a surgical unit? This includes Adult or Pediatric surgical units.
 Yes
 No
 Don't Know

Q87

Does your hospital have a plan (personnel, supplies, medications, equipment) to be able to conduct emergent
surgical procedures for up to 96 hours?
 Yes
 No
 Don't Know

Q88

Has your hospital established a flexible response so that unused operating space can readily be mobilized?
 Yes
 No
 Don't Know

26

Q89

Has your facility specified the authority, process, and responsibilities of the Operating Room (OR) key staff?
 Yes
 No
 Don't Know

Q90

Is there a plan to ensure safe and rapid transfer of patients from the ED to the OR?

Q91

Is there a plan to ensure safe and rapid transfer to another facility if required?

 Yes
 No
 Don't Know
 Yes
 No
 Don't Know

Q92

Does your facility have a pediatric unit?

Q93

Do you have a detailed pediatric-specific disaster plan?

 Yes
 No

 Yes
 No
 Don't Know

Q94

Does the plan address the management of surge capacity in the event of mass traumatic injuries involving
children and/or infants?
 Yes
 No
 Don't Know

27

Q95

Has that plan been jointly developed by all relevant pediatric disciplines (e.g., pediatrics, pediatric critical care,
pediatric surgeons)?
 Yes
 No
 Don't Know

Q96

Were community resources, such as first responders, included in the plan’s development?
 Yes
 No
 Don't Know

Q97

Q98

If your facility is a pediatric hospital only, can you manage adult patients during response to an MCI?





Yes
No
Don't Know
Not a Pediatric Only Hospital

Has your facility developed a radiology management plan for use during an MCI to ensure effective and timely
patient throughput?
 Yes
 No
 Don't Know

Q99

Is there a plan in place to support the utilization of ultrasound by radiologists, ultrasound technicians,
emergency physicians, and surgeons in an event involving a large number of injured patients?
 Yes
 No
 Don't Know

Q100

Has your facility conducted an imaging equipment survey and calculated the capacity (patients/hour) of each
of your imaging devices in your facility?
 Yes
 No
 Don't Know
28

Q101

Does your facility have a plan for rapid communication of results of imaging studies during a MCI that does
not rely on an EHR?
 Yes
 No
 Don't Know

Q102

Is there a plan in place to ensure timely availability of equipment and readings?
 Yes
 No
 Don't Know

Q103

Is there a plan in place to obtain specialized studies and interventions (e.g., interventional procedures,
MRI/MRA) at your facility or another institution?
 Yes
 No
 Don't Know

Q104

Is there a plan in place to ensure that each study is formally read and discrepancies with any initial readings
are reported in a timely fashion?
 Yes
 No
 Don't Know

Q105

Has your hospital’s laboratory developed a collaborative plan with the ED to facilitate the management of
increased volumes of specimens that will be required with a surge of injured patients?
 Yes
 No
 Don't Know

Q106

Does your facility have MOUs or agreements in place to re-supply media, reagents and other critical supplies?
 Yes
 No
 Don't Know

29

Q107

Does your facility have an alternate/backup plan in place for specimen tracking if required?
 Yes
 No
 Don't Know

Q108

Does your facility have an alternate/backup plan in place for specimen transportation if required?

Q109

Does your facility have an arrangement in place to transfer workload if your laboratory is overwhelmed?

 Yes
 No
 Don't Know
 Yes
 No
 Don't Know

Q110

Does your facility have a blood bank?

Q111

Does your blood bank have plans in place to handle an increased influx of patients that require blood products
in an event that results in a large number of injured patients?

 Yes
 No
 Don't Know

 Yes
 No
 Don't Know

Q112

Are your blood bank personnel trained on handling surge activities generated by response to an MCI?
 Yes
 No
 Don't Know

30

Q113

Does your facility have an MOU or agreement in place with community blood suppliers for emergency delivery
of blood products?
 Yes
 No
 Don't Know

Q114

If immediate requests for a specific blood component exceed your supply, does your facility have a procedure
for triaging blood orders before more such components can be obtained?
 Yes
 No
 Don't Know

Q115

Does your facility have a plan to notify and update your community blood supplier with the expected or actual
volume of blood needed during an MCI?
 Yes
 No
 Don't Know

Q116

Has your facility developed procedures or protocols (including staffing, responsibilities) to enable hospitalists
to rapidly transfer or discharge suitable patients in order to open beds in the hospital?
 Yes
 No
 Don't Know

Q117

Have the hospitalists in your facility been trained on their potential responsibilities in an MCI involving large
numbers of injured patients?
 Yes
 No
 Don't Know

Q118

Does your facility have adequate plans (including training of staff, additional space, MOUs or agreements with
other facilities) in place for management of a large volume of fatalities during response to an MCI?
 Yes
 No
 Don't Know
31

Q119

Does your facility’s EOP include participation in a community mass fatality plan?
 Yes
 No
 Don't Know

Q120

Does your facility have policies and procedures in place to ensure chain of custody and facilitate the
disposition of contaminated remains, including explosives, chemical, and/or infectious remains in
coordination with local, regional, and national law enforcement and homeland security agencies?
 Yes
 No
 Don't Know

Q121

Does your the facility have adult and pediatric mental health personnel to assist with response to an MCI?






Q122

Yes, both
No, both
Yes, Adults only
Yes, Pediatrics only
Don't Know

Does your facility have a plan in place to assess the physical and psychological well being of hospital
personnel during and after response to an MCI?
 Yes
 No
 Don't Know

Q123

Does your pharmacy department have a designated inventory of medicines that would be readily retrievable
during response managing a large number of injuries in an MCI?
 Yes
 No
 Don't Know

32

Q124

Q125

Are the following medications and supplies included in your pharmacy department's designated inventory?
Yes

No

Don't Know

Analgesics







Anxiolytics







Antipsychotics







Antibiotics







Intravenous fluids







Drugs for airway management







Burn care agents







Ears, nose, and throat (ENT) medications for tympanic membrane perforation







Ocular







Vaccines







Has your hospital performed an assessment of medications available in the community and identified potential
sources of drugs?
 Yes
 No
 Don't Know

Q126

Does your facility have plan in place to ensure rapid delivery (from supplier, mutual aid, pharmacy, other
institutions) of necessary medications during response to an MCI?
 Yes
 No
 Don't Know

33

Q127

Does your facility have an MOU or agreement in place for community-wide (e.g. other hospitals, pharmacies,
EMS) sharing of pharmaceuticals in the event of the occurrence of an MCI?
 Yes
 No
 Don't Know

Q128

Does your facility participate in the Centers for Disease Control and Prevention’s (CDC) CHEMPACK program?
 Yes
 No
 Don't Know

Q129

Is your hospital’s administrative leadership (e.g. CEO, president, etc.) actively involved in the following areas
pertaining to preparedness?
Yes

No

Don't Know

Preparedness leadership for the organization







Communication and relationships in preparedness (e.g. EMS, emergency management,
other healthcare facilities, etc)







Logistics and supplies







Alternate care sites







Patient tracking







Community resources and support







Ethics in disaster preparedness







Security







Clinical services







Ancillary services







34

Q130

Has your hospital’s administration identified secondary vendors for key equipment and supplies?
 Yes
 No
 Don't Know

Q131

Has your facility developed a mechanism for rapid call back and expansion of nursing staff in the event of an
MCI with a large number of injured patients?
 Yes
 No
 Don't Know

Q132

Has your facility developed a centralized database that houses staff competency skills, in order to rapidly
identify nurses who are able to care for critically injured patients?
 Yes
 No
 Don't Know

Q133

Has your facility developed a mechanism to rapidly deploy nurses with pediatric expertise to appropriate care
areas?
 Yes
 No
 Don't Know

Q134

Has your facility developed a mechanism to incorporate nursing staff into the rapid identification of patient’s
who may eligible for discharge or transfer?
 Yes
 No
 Don't Know

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