Importance of residency applicant factors based on specialty and demographics: a national survey of program directors.

BACKGROUND: With the transition away from traditional numerical grades/scores, residency applicant factors such as service, research, leadership, and extra-curricular activities may become more critical in the application process. OBJECTIVE: To assess the importance of residency application factors reported by program directors (PDs), stratified by director demographics and specialty. METHOD: A questionnaire was electronically distributed to 4241 residency PDs in 23 specialties during spring 2022 and included questions on PD demographics and 22 residency applicant factors, including demographics, academic history, research involvement, and extracurricular activities. Responses were measured using a Likert scale for importance. Descriptive statistics and Chi-square and Fisher exact test analysis were performed. RESULTS: 767 questionnaires were completed (19% response rate). Across all specialties, the factor considered most important was the interview (99.5%). When stratified by specialty, surgical PDs were more likely to characterize class rank, letters of recommendation, research, presenting scholarly work, and involvement in collegiate sports as extremely important/very important (all p < 0.0001). In contrast, primary care PDs favored the proximity of the candidate's hometown (p = 0.0002) and community service (p = 0.03). Mean importance of applicant factors also differed by PD age, gender, and ethnicity. CONCLUSION: We have identified several residency application factors considered important by PDs, stratified by their specialty, demographics, and previous experiences. With the transition away from numerical grades/scores, medical students should be aware of the factors PDs consider important based on their chosen specialty. Our analysis may assist medical students in understanding the application and match process across various specialties.

Referrals for Pediatric Appendicitis to a Tertiary Care Children's Hospital.

OBJECTIVES: This study aimed to analyze pediatric referrals for definite or possible appendicitis, to compare clinical predictors and laboratory values between patients with and without a final diagnosis of appendicitis, and to determine the accuracy of prereferral diagnostic interpretations of computed tomography scans, ultrasound, and magnetic resonance imaging modalities. METHODS: We conducted a retrospective analysis of pediatric patients referred from 2015 to 2019 to a tertiary care children's emergency department with definitive or possible appendicitis. Data abstracted included patient demographics, clinical symptoms, physical examination findings, laboratory results, and diagnostic imaging findings (by the referring center and the pediatric radiologist at the accepting center). An Alvarado and Appendicitis Inflammatory Response (AIR) score was calculated for each patient. RESULTS: Analysis was performed on 381 patients; 226 (59%) had a final diagnosis of appendicitis. Patients with appendicitis were more likely to have symptoms of nausea ( P < 0.0001) and vomiting ( P < 0.0001), have a higher mean temperature ( P = 0.025), right lower quadrant abdominal pain to palpation ( P = <0.0001), rebound tenderness ( P < 0.0001), a higher mean Alvarado score [5.35 vs 3.45 ( P < 0.0001)], and a higher mean AIR score [4.02 vs 2.17 ( P < 0.0001)]. Of the 97 diagnostic images initially interpreted as appendicitis by the referring center, 10 (10.3%) were read as no evidence of appendicitis. Of the 62 diagnostic images initially interpreted as "possible appendicitis" by the referring center, 34 (54.8%) were read as no evidence of appendicitis. Of those diagnostic images initially interpreted as "appendicitis" or "possible appendicitis" by the referring center, 24/89 (27.0%) of computed tomography scans, 17/62 (27.4%) of ultrasounds, and 3/8 (37.5%) of magnetic resonance imaging results were read as no evidence of appendicitis. CONCLUSIONS: Usage of established scoring algorithms, such as Alvarado and AIR, may decrease the unnecessary cost of diagnostic imaging and transfer to tertiary care. Virtual radiology consultations may be 1 potential solution to improve the referral process for pediatric appendicitis if initial interpretation is uncertain.

Management of Acute Injury and Illness in Pediatric Athletes by Athletic Trainers: Compliance With Emergency Medicine and Athletic Trainer Evidence-Based Guidelines.

OBJECTIVE: This study aimed to determine athletic trainer compliance with emergency medicine and athletic training evidence-based guidelines for the on-the-field management of common pediatric sports-related injury and illness. METHODS: A questionnaire was distributed electronically to selected members of the National Athletic Trainer Association. The questionnaire included 10 clinical scenarios describing common sports-related injury/illness (closed head injury, cervical spine injury, blunt chest injury, blunt abdominal injury, ankle injury, knee injury with laceration, heat-related illness). On-the-field management decisions for each scenario were compared with selected emergency medicine and athletic training guidelines. RESULTS: Analysis was performed on 564 completed questionnaires (9% response rate). Responders were compliant with practice guidelines for both emergency medicine and athletic training except for blunt chest trauma with tachycardia, closed head injury with loss of consciousness, closed head injury with repetitive speech, closed head injury with a fall higher than 5 feet, cervical spine injury with paresthesias, and heat-related illness with persistent symptoms. Discrepancies between emergency medicine and athletic training guidelines included closed head injury with repetitive speech, closed head injury and height of fall, closed head injury and unequal pupils, and cervical spine injury with neck pain and paresthesias. CONCLUSIONS: Based on our sample, athletic trainers were compliant with many guidelines supported by both emergency medicine and athletic training. We identified several deficiencies in the availability of evidence-based guidelines and discrepancies between these guidelines and athletic trainer responses. To provide optimal care to pediatric athletes who sustain injury or illness, emergency medicine and athletic training organizations should collaborate to improve these discrepancies.

Patterns in emergency department unscheduled return visits during the COVID-19 pandemic.

INTRODUCTION: Fear surrounding nosocomial infections, expanded telehealth, and decreases in ED (emergency department) utilization altered the way patients sought emergency care during the COVID pandemic. This study aims to evaluate COVID-19's impact on the frequency and characteristics of unscheduled return visits (URVs) to the adult and pediatric ED. METHODS: In this retrospective cohort study, the electronic medical record was used to identify ≤9-day URVs at a tertiary adult and pediatric ED from 4/16/19-2/29/20 (control) and 4/16/20-2/28/21 (COVID). The primary outcome, proportion of total ED visits made up by URVs, and secondary outcomes, patient characteristics (age), illness acuity (emergency severity index (ESI)), disposition, and mortality were compared between the cohorts. Pediatric and adult data were analyzed separately. A sub-analysis was performed to exclude patients with suspected respiratory infections. RESULTS: For adults, n = 4265, there was no significant difference between the proportion of ED census made up by URVs (4.56% (control) vs 4.76% (COVID), p = 0.17), mean patient age (46.33 (control) vs 46.18 (COVID), p = 0.80), ESI acuity (2.95 (control) vs 2.95 (COVID), p = 0.83), disposition (admission 0.32% (control) vs 0.39% (COVID), p = 0.69), and mortality (0.23% (control) and 0.49% (COVID), p = 0.15). When excluding possible respiratory infections comparisons remained insignificant. For pediatrics, n = 1214, there was a significant difference in the proportion of ED census made up by URVs (4.83% (control) to 3.55% (COVID), p < 0.01), age (5.52 (control) vs 6.43 (COVID), p = 0.01), and ESI acuity (3.31 (control) vs 3.17 (COVID), p < 0.01). There was no difference in disposition (admission 0.12% (control) vs 0% (COVID), p = 1). When excluding possible respiratory infections acuity (p = 0.03) remained significant. CONCLUSION: In the adult population, COVID did not significantly alter any of our outcomes. For pediatric patients, a decrease in the proportion of URVs and increase in acuity during COVID suggests that patients may have had other means of accessing care, avoided the ED, received more adequate care at initial presentation, or represented when more acutely ill.

Pediatric Urgent Care Center Management of Traumatic Injuries in Infants and Children: Adherence to Evidence-Based Practice Guidelines.

OBJECTIVES: To determine pediatric urgent care (PUC) clinician adherence to evidence-based practice guidelines in the management of pediatric trauma and to evaluate PUC emergency preparedness for conditions such as severe hemorrhage. METHODS: A questionnaire covering acute management of 15 pediatric traumatic injuries, awareness of the Stop the Bleed initiative, and presence of emergency equipment and medications was electronically distributed to members of the Society for Pediatric Urgent Care. Clinician management decisions were evaluated against evidence-based practice guidelines. RESULTS: Eighty-three completed questionnaires were returned (25% response rate). Fifty-three physician and 25 advanced practice provider (APP) questionnaires were analyzed. Most respondents were adherent to evidence-based practice guidelines in the following scenarios: cervical spine injury; head injury without neurologic symptoms; blunt abdominal injury; laceration without bleeding, foreign body, or signs of infection; first-degree burn; second-degree burn with less than 10% total body surface area; animal bite with and without probable tenosynovitis; and orthopedic fractures. Fever respondents were adherent in the following scenarios: head injury with altered mental status (adherence: physicians, 64%; APPs, 44%) and laceration with foreign body and persistent hemorrhage (adherence: physicians, 52%; APPs, 41%). Most respondents (56%) were unaware of Stop the Bleed and only 48% reported having a bleeding control kit/tourniquet at their urgent care. CONCLUSIONS: Providers in our sample demonstrated adherence with pediatric trauma evidence-based practice guidelines. Increased PUC provider trauma care certification, PUC incorporation of Stop the Bleed education, and PUC presence of equipment and medications would further improve emergency preparedness.

Publishing trends in the field of urgent care medicine from 2000 to 2020: A bibliometric analysis.

BACKGROUND: With a steady rise in the number of urgent care centers in the United States and the establishment of urgent care medicine as a specialty, research in the field is likely to emerge. OBJECTIVES: To perform a bibliometric analysis of published studies in the field of urgent care medicine over the past two decades. METHODS: A comprehensive literature review was conducted, including original and review articles pertaining to urgent care medicine published 2000-2020. Data abstracted from each article included publication year, journal, research study design, study population, clinical relevance (clinical or non-clinical), and study topics. RESULTS: A total of 144 publications from 94 peer-reviewed journals were analyzed. There has been a steady increase in the annual number of publications from 2010 to 2019. The most common study designs were retrospective (55.5%), study specific (24.3%), prospective (15.3%), and quality improvement (4.9%). Adults were the most frequently identified study population (33.3%), followed by pediatrics (18%), and both adults and pediatrics (16.7%). Publications were categorized as clinical (48.6%) and non-clinical (51.4%). The most common research topics were urgent care utilization [n = 34, 23.6%; especially effectiveness (n = 9) and disease based (n = 7)], diagnostic testing [(n = 20, 13.9%; especially HIV (n = 7) and sexually transmitted infections (n = 6)], and antibiotic stewardship (n = 17, 11.8%). CONCLUSION: Based on our sample, published research in the field of urgent care medicine has evolved. By describing current trends, we hope that clinicians and researchers continue to advance the field by developing high quality research, including prospective, multi-institutional/center studies involving both clinical and non-clinical topics.

Saliva microRNA Biomarkers of Cumulative Concussion.

Recurrent concussions increase risk for persistent post-concussion symptoms, and may lead to chronic neurocognitive deficits. Little is known about the molecular pathways that contribute to persistent concussion symptoms. We hypothesized that salivary measurement of microribonucleic acids (miRNAs), a class of epitranscriptional molecules implicated in concussion pathophysiology, would provide insights about the molecular cascade resulting from recurrent concussions. This hypothesis was tested in a case-control study involving 13 former professional football athletes with a history of recurrent concussion, and 18 age/sex-matched peers. Molecules of interest were further validated in a cross-sectional study of 310 younger individuals with a history of no concussion (n = 230), a single concussion (n = 56), or recurrent concussions (n = 24). There was no difference in neurocognitive performance between the former professional athletes and their peers, or among younger individuals with varying concussion exposures. However, younger individuals without prior concussion outperformed peers with prior concussion on three balance assessments. Twenty salivary miRNAs differed (adj. p < 0.05) between former professional athletes and their peers. Two of these (miR-28-3p and miR-339-3p) demonstrated relationships (p < 0.05) with the number of prior concussions reported by younger individuals. miR-28-3p and miR-339-5p may play a role in the pathophysiologic mechanism involved in cumulative concussion effects.

Etiology and disposition associated with radiology discrepancies on emergency department patients.

BACKGROUND: Diagnostic errors made by radiology resident physicians may lead to significant morbidity/mortality and patient dissatisfaction. OBJECTIVE: To determine the etiology and disposition associated with radiology discrepancies on emergency department (ED) patients. METHODS: We conducted a retrospective electronic chart review of patients presenting to our ED during "off hours" at the Penn State Hershey Medical Center during October 2013-November 2014 and had a radiology discrepancy, defined as a patient discharged from the ED with a diagnostic interpretation disagreement between the initial radiology resident physician read and final radiology attending physician read. RESULTS: 81,201 images were performed during "off hours", with 174 radiology discrepancies (0.214%) identified. Most discrepancies were associated with CT scans (62%). The most common final diagnostic interpretations associated with discrepancies were missed fracture (10.9%), incidental findings of mass or cyst (10.3%), gastrointestinal inflammation (6.3%), and pneumonia (5.7%). 10% of radiology discrepancies were instructed to emergently return to the ED. The most common modality associated with ED follow-up was CT scan of the abdomen/pelvis (50%). Of the 17 patients that returned to the ED, 10 had additional diagnostic imaging, 9 received a subspecialist consult, 5 required surgical treatment, 5 required additional medications, and 1 required a medical hospitalization. CONCLUSIONS: Based on our sample, discrepancies were a small percentage of images performed during "off hours", and were associated with CT scans, missed fractures, and non-emergent outpatient follow-up. We suggest that ED and radiology departments work collaboratively to monitor their own rates of discrepancies, and subsequent morbidities and mortalities, to improve patient care.

Adult emergency department referrals from urgent care centers.

BACKGROUND: Although urgent care centers (UCCs) can often evaluate and treat minor injuries/illnesses, patients may present with life threatening conditions that require immediate recognition, stabilization, and transfer to a higher level of care, beyond the capabilities of most UCCs. OBJECTIVE: To describe adult ED referrals from UCCs and to determine the percentage of referrals considered critical, complex, and simple. METHODS: A prospective study was conducted between 8/2016-8/2017 on patients >18 years referred directly to our ED from surrounding UCCs. Referrals were categorized based on investigations/procedures performed or medications/consultations received in the ED. RESULTS: We analyzed 317 patient encounters; 23 (7.3%) considered critical, 254 (80.1%) complex, and 40 (12.6%) simple. The most common chief complaints for all ED referrals were abdominal pain (62 encounters), chest pain (28), shortness of breath (16), eye pain/injury (16), and leg pain/swelling (15). 68% of patients received laboratory diagnostic investigations and 69% received radiologic investigations. 37% of patients required consultation from a subspecialist. 78% of patients were discharged home. The most common primary diagnoses for all ED referrals were nonspecific abdominal pain (27 encounters), laceration (22), fracture (20), nonspecific chest pain (12), cellulitis (12), and pneumonia (12). The most common primary diagnoses for critical referrals were appendicitis (7) and fracture (3). CONCLUSION: Many adult ED referrals in our sample were considered complex and few were considered critical. Individual UCCs should evaluate their current states of ED referrals, and develop educational and preparedness strategies based on the epidemiology of adult emergencies that may occur.

Pediatric Referrals to an Emergency Department From Urgent Care Centers.

OBJECTIVE: The aims of this study were to describe pediatric emergency department (ED) referrals from urgent care centers and to determine the percentage of referrals considered essential and serious. METHODS: A prospective study was conducted between April 2013 and April 2015 on patients younger than 21 years referred directly to an ED in central Pennsylvania from surrounding urgent care centers. Referrals were considered essential or serious based on investigations/procedures performed or medications/consultations received in the ED. RESULTS: Analysis was performed on 455 patient encounters (mean age, 8.7 y), with 347 (76%) considered essential and 40 (9%) considered serious. The most common chief complaints were abdominal pain (83 encounters), extremity injury (76), fever (39), cough/cold (29), and head/neck injury (29). Thirty-three percent of the patients received laboratory diagnostic investigations (74% serum, 56% urine), and 52% received radiologic investigations (67% x-ray, 17% computed tomography scan, 13% ultrasound, 11% magnetic resonance imaging). Forty-four percent of the patients received a procedure, with the most common being intravenous (IV) placement (66%); reduction, casting, or splinting of extremity fracture/dislocation (18%); and laceration repair (14%). The most common medications administered were IV fluids (33%), oral analgesics (30%), and IV analgesics (26%). Eighty-three percent of the patients were discharged home, 12% were hospitalized, and 4% had emergent surgical intervention. The most common primary diagnoses were closed extremity fracture (60 encounters), gastroenteritis (42), brain concussion (28), upper respiratory infection (24), and nonsurgical, unspecified abdominal pain (24). CONCLUSIONS: Many ED referrals directed from urgent care centers in our sample were considered essential, and few were considered serious. Urgent care centers should develop educational and preparedness strategies based on the epidemiology of emergencies that may occur.

Predictors of Intrathoracic Injury after Blunt Torso Trauma in Children Presenting to an Emergency Department as Trauma Activations.

BACKGROUND: Thoracic injuries are a major cause of death associated with blunt trauma in children. Screening for injury with chest x-ray study, compared with chest computed tomography (CT) scan, has been controversial, weighing the benefits of specificity with the detriment of radiation exposure. OBJECTIVE: To identify predictors of thoracic injury in children presenting as trauma activations to a Level I trauma center after blunt torso trauma, and to compare these predictors with those previously reported in the literature. METHODS: We performed a retrospective chart review of pediatric patients (<18 years of age) who presented to the Emergency Department of a Level I trauma center between June 2010 and June 2013 as a trauma activation after sustaining a blunt torso trauma and who received diagnostic imaging of the chest as part of their initial evaluation. RESULTS: Data analysis was performed on 166 patients. There were 33 patients (20%) with 45 abnormalities detected on diagnostic imaging of the chest, with the most common abnormalities being lung contusion (36%), pneumothorax (22%), and rib fracture (13%). Statistically significant predictors of abnormal diagnostic imaging of the chest included Glasgow Coma Scale score (GCS) < 15 (27% with abnormality vs. 13% without abnormality), hypoxia (22% vs. 5%), syncope/loss of consciousness (55% vs. 35%), cervical spine tenderness (12% vs. 3%), thoraco-lumbar-sacral spine tenderness (41% vs. 17%), and abdominal/pelvic tenderness (12% vs. 3%). CONCLUSIONS: Based on our data, predictors of thoracic injury in children after blunt torso trauma include GCS < 15, hypoxia, syncope/dizziness, cervical spine tenderness, thoraco-lumbar-sacral spine tenderness, and abdominal/pelvic tenderness.

Emergency and Disaster Preparedness of School Transportation Staff and School Buses in the United States: Compliance With Recommendations for School Transportation Safety.

OBJECTIVE: The aim of the study was to determine the compliance of school transportation staff and school buses with recommendations for the safe transportation of children to and from school and school-related activities. METHODS: An electronic questionnaire was distributed to school transportation staff represented by the International Brotherhood of Teamsters during the 2013-2014 academic year. RESULTS: Analysis was performed on 558 completed questionnaires (13% usable response rate). Responders had previous training in first aid (89%), basic life support (28%), and cardiopulmonary resuscitation (52%). Seventy-eight percent of school buses in our sample had restraint devices and 87% had seat belt cutters. Responders reported the immediate availability of the following on their bus: communication devices (81%), first aid kits (97%), fire extinguishers (89%), automated external defibrillators (1%), and epinephrine autoinjectors (2%). Thirty percent of responders have had no previous training in the management of emergencies such as trouble breathing, severe allergic reaction, seizures, cardiac arrest or unresponsiveness, and head, neck, or extremity trauma. Thirteen percent of responders are unfamiliar with or have had no previous training on protocols regarding emergency shelters and community evacuation plans in the event of a disaster. CONCLUSIONS: Variability exists in the compliance of school transportation staff and school buses with recommendations for the safe transportation of children. Areas for improvement were identified, such as educating school transportation staff in the recognition and initial management of pediatric emergencies, ensuring the presence of restraint devices, increasing the immediate availability of certain emergency medications and equipment, and familiarizing school transportation staff with designated emergency shelters and community evacuation plans.

Return to Learning After a Concussion and Compliance With Recommendations for Cognitive Rest.

OBJECTIVE: To determine the compliance of schools and school nurses in the United States with national recommendations for cognitive rest in students who sustain a concussion. DESIGN: Cross-sectional questionnaire based. PARTICIPANTS: Members of the National Association of School Nurses working at the high school level. INTERVENTION: A questionnaire, developed by the authors and based on recommendations for cognitive rest, was electronically distributed 3 times during the 2012 to 2013 academic year. MAIN OUTCOME MEASURES: Self-reported responses were collected regarding demographics and compliance of schools and school nurses with recommendations for the management of the postconcussion student, including the presence of specific guidelines for individualized care and the responsibility of the nurse for the prevention, detection, and management of concussions. RESULTS: Analysis was performed on 1033 completed questionnaires (36% usable response rate). Fifty-three percent of schools have guidelines to assist students when returning to school after a concussion. These guidelines include extension of assignment deadlines (87%), rest periods during the school day (84%), postponement or staggering of tests (75%), reduced workload (73%), and accommodation for light or noise sensitivity (64%). Sixty-six percent of nurses in our sample have had special training in the recognition and management of concussions. Nurses reported involvement in the following roles: identifying suspected concussions (80%), providing emotional support for recovering students dealing with concussion-related depression (59%), and guiding the student's postconcussion graduated academic and activity re-entry process (58%). CONCLUSIONS: We detected a wide variability in compliance of schools and school nurses with national recommendations for cognitive rest. CLINICAL RELEVANCE: Ensuring that schools have policies established for a student's return to learning, having specific guidelines to provide an individualized approach to return to learning based on postconcussion signs/symptoms, training school nurses in the recognition and management of concussions, and involving school nurses in the re-entry process are identified areas for improvement. Schools in the United States should be aware of these recommendations to guide a student's postconcussion graduated academic re-entry process.

EMS Activations for School-Aged Children From Public Buildings, Places of Recreation or Sport, and Health Care Facilities in Pennsylvania.

OBJECTIVES: To determine the etiology of emergency medical services (EMS) activations in 2011 to public buildings, places of recreation or sport, and health care facilities involving children aged 5 to 18 years in Pennsylvania. METHODS: Electronic records documenting 2011 EMS activations as provided by the Pennsylvania Department of Health's Bureau of EMS were reviewed. Data elements (demographics, dispatch complaint, mechanism of injury, primary assessment) from patients aged 5 to 18 years involved in an EMS response call originating from either a public building, a place of recreation and sport, or health care facility were analyzed. RESULTS: A total of 12,289 records were available for analysis. The most common primary assessments from public buildings were traumatic injury, behavioral/psychiatric disorder, syncope/fainting, seizure, and poisoning. The most common primary assessments from places of recreation or sport were traumatic injury, syncope/fainting, altered level of consciousness, respiratory distress, and abdominal pain. The most common primary assessments from health care facilities were behavioral/psychiatric disorder, traumatic injury, abdominal pain, respiratory distress, and syncope/fainting. When examining the mechanism of injury for trauma-related primary assessments, falls were the most common mechanism at all 3 locations, followed by being struck by an object. Of the 1335 serious-incident calls (11% of the total EMS activations meeting inclusion criteria), 61.2% were from public buildings, 14.1% from places of recreation or sport, and 24.7% from health care facilities. CONCLUSIONS: Our identification of common EMS dispatch complaints, mechanisms of injury, and primary assessments can be used in the education of staff and preparation of facilities for medical emergencies and injuries where children spend time.

Pediatric Care Provided at Urgent Care Centers in the United States: Compliance With Recommendations for Emergency Preparedness.

OBJECTIVES: To describe the compliance of urgent care centers in the United States with pediatric care recommendations for emergency preparedness as set forth by the American Academy of Pediatrics. METHODS: An electronic questionnaire was distributed to urgent care center administrators as identified by the American Academy of Urgent Care Medicine directory. RESULTS: A total of 122 questionnaires of the 872 distributed were available for analysis (14% usable response rate). The most common diagnoses reported for pediatric patients included otitis media (72%), upper respiratory illness (69%), strep pharyngitis (61%), bronchiolitis (30%), and extremity sprain/strain (28%). Seventy-one percent of centers have contacted community emergency medical services (EMS) to transport a critically ill or injured child to their local emergency department in the past year. Sixty-two percent of centers reported having an established written protocol with community EMS and 54% with their local emergency department or hospital. Centers reported the availability of the following essential medications and equipment: oxygen source (75%), nebulized/inhaled ß-agonist (95%), intravenous epinephrine (88%), oxygen masks/nasal cannula (89%), bag-valve-mask resuscitator (81%), suctioning device (60%), and automated external defibrillator (80%). Centers reported the presence of the following written emergency plans: respiratory distress (40%), seizures (67%), dehydration/shock (69%), head injury (59%), neck injury (67%), significant fracture (69%), and blunt chest or abdominal injury (81%). Forty-seven percent of centers conduct formal reviews of emergent or difficult cases in a quality improvement format. CONCLUSIONS: Areas for improvement in urgent care center preparedness were identified, such as increasing the availability of essential medications and equipment, establishing transfer and transport agreements with local hospitals and community EMS, and ensuring a structured quality improvement program.

Low Compliance of Urgent Care Centers in the United States With Recommendations for Office-Based Disaster Preparedness.

OBJECTIVES: The aim of the study was to determine the compliance of urgent care centers in the United States with published recommendations for office-based disaster preparedness. METHODS: An electronic questionnaire was distributed to urgent care center administrators as identified by the American Academy of Urgent Care Medicine directory. RESULTS: One hundred twenty-two questionnaires of the 872 distributed were available for analysis (14% usable response rate). Twenty-seven percent of centers have an established disaster plan for events that involve their establishment and surrounding community; 49% practice the plan at least once a year, 19% less frequent than once a year, and 32% never practice. Forty-seven percent of centers are familiar with designated emergency shelters and community evacuation plans. Seventeen percent of centers function as part of a surveillance system to provide early detection of any biologic/chemical/nuclear agents. Twenty-two percent of centers take part in local community and hospital disaster planning, exercises, and drills through emergency medical services and public health systems. Five percent of centers aid schools, child care centers, camps, and other child congregate facilities in disaster planning. Twenty-eight percent of centers have an assembled emergency/disaster kit, containing such items as water, first aid supplies, radios, flashlights, batteries, heavy-duty gloves, food, and sanitation supplies. CONCLUSIONS: Areas for improvement in urgent care center disaster preparedness were identified, such as developing an office disaster plan that is practiced at least yearly, becoming familiar with designated emergency shelters and community evacuation plans, providing surveillance to detect potential acts of terrorism, assisting community organizations (hospitals, schools, child care centers, etc) in disaster planning, and assembling office emergency/disaster kits.