Realities of disaster preparedness in rural hospitals.

Disaster preparedness has always been an area of major concern for the medical community, but recent world events have prompted an increased interest. The health care system must respond to disasters of all types, whether the incidents occur in urban or rural settings. Although the barriers and challenges are different in the rural setting, common areas of preparedness must be explored. This study examines the experiences of rural hospital emergency departments with threat preparedness. Data were gathered through a nationwide survey to describe emergency department experience with specific incidents, as well as the frequency of occurrence of these events. Expanding surge capacity of hospitals and developing a community-wide response to natural or human-made incidents is crucial in mitigating long-term effects on the health care system. Analysis of preparedness activities will help identify common themes to better prioritize preparedness activities and maximize a hospital's response capabilities.

Realities of rural emergency medical services disaster preparedness.

INTRODUCTION: Disaster preparedness is an area of major concern for the medical community that has been reinforced by recent world events. The emergency healthcare system must respond to all types of disasters, whether the incidents occur in urban or rural settings. Although the barriers and challenges are different in the rural setting, common areas of preparedness must be explored. PROBLEM: This study sought to answer several questions, including: (1) What are rural emergency medical services (EMS) organizations training for, compared to what they actually have seen during the last two years?; (2) What scale and types of events do they believe they are prepared to cope with?; and (3) What do they feel are priority areas for training and preparedness? METHODS: Data were gathered through a multi-region survey of 1801 EMS organizations in the US to describe EMS response experiences during specific incidents as well as the frequency with which these events occur. Respondents were asked a number of questions about local priorities. RESULTS: A total of 768 completed surveys were returned (43%). Over the past few years, training for commonly occurring types of crises and emergencies has declined in favor of terrorism preparedness. Many rural EMS organizations reported that events with 10 or fewer victims would overload them. Low priority was placed on interacting with other non-EMS disaster response agencies, and high priority was placed on basic staff training and retention. CONCLUSION: Maintaining viable, rural, emergency response capabilities and developing a community-wide response to natural or man-made events is crucial to mitigate long-term effects of disasters on a local healthcare system. The assessment of preparedness activities accomplished in this study will help to identify common themes to better prioritize preparedness activities and maximize the response capabilities of an EMS organization.

Feasibility of screening and intervention for alcohol problems among young adults in the ED.

This study evaluates the feasibility of screening and brief intervention (SBI) for alcohol problems among young adults (18-39 years) in a rural, university ED. Research staff screened a convenience sample of patients waiting for medical treatment with the Alcohol Use Disorders Identification Test (AUDIT), used motivational interviewing techniques to counsel screen-positive patients (AUDIT >/= 6) during the ED visit, and referred patients to off-site alcohol treatment as appropriate. Patients were interviewed again at 3 months. Eighty-seven percent of age-eligible drinkers (2,067 of 2,371) consented to participate. Forty-three percent (894 of 2,067) screened positive, of which 94% were counseled. Forty percent of those counseled set a goal to decrease or stop drinking and 4% were referred for further treatment. Median times for obtaining consent, screening, and intervention were 4, 4, and 14 minutes, respectively. Project staff reported that 3% of patients screened or counseled were uncooperative. Seventy percent of 519 patients who participated in follow-up interviews agreed the ED is a good place to help patients with alcohol problems. High rates of informed consent and acceptance of counseling confirmed this protocol's acceptability to patients and indicated patients were comfortable divulging alcohol-related risk behavior. The modest times required for the process enhanced acceptability to patients as well as ED staff. The high prevalence of alcohol problems and the broad acceptance of SBI in this sample provide evidence of the ED's promise as a venue for this clinical preventive service.

Screening and brief intervention for alcohol problems among college students treated in a university hospital emergency department.

The authors evaluated a protocol to screen and provide brief interventions for alcohol problems to college students treated at a university hospital emergency department (ED). Of 2,372 drinkers they approached, 87% gave informed consent. Of those, 54% screened positive for alcohol problems (Alcohol Use Disorders Identification Test score < or = 6). One half to two thirds of the students who screened positive drank 2 to 3 times a week, drank 7 or more drinks per typical drinking day, or had experienced alcohol dependence symptoms within the past year. Ninety-six percent of screen-positive students accepted counseling during their ED visit. Three quarters of those questioned at 3-month follow-up reported that counseling had been helpful and that they had decreased their alcohol consumption. The prevalence of alcohol problems, high rates of informed consent and acceptance of counseling, and improved outcomes suggest that the ED is an appropriate venue for engaging students at high risk for alcohol problems.

Alcohol problems among young adult emergency department patients: making predictions using routine sociodemographic information.

OBJECTIVES: The study aims were to explore the process of identifying young adult Emergency Department (ED) patients at risk for alcohol problems, examine the sociodemographic predictors of patient alcohol problems, and determine differences between patients who screened positive and those who screened negative for alcohol problems. Implications for ED practice are discussed. METHOD: As part of a larger study, the Alcohol Use Disorders Identification Test was administered to consenting patients ages 18 to 29. A score of greater than 5 (out of 40) was considered a positive screen for alcohol problems. Sociodemographic information was collected from a generic Individual Information Form. RESULTS: Approximately 48% (1855 of 3890) of patients screened positive for alcohol problems. Among screen-positive patients, 91% (1689) had scores that corresponded to mild to moderate alcohol problems. Compared with screen-negative patients, screen-positive patients were almost 3 times more likely to be men (odds ratio [OR] = 2.70); 2.5 times more likely to use tobacco (OR = 2.43); 2 times more likely to be single (OR = 2.03); and 1.5 times more likely to have some college education (OR = 1.41), be an 18- to 20-year-old adult (OR = 1.61), be a college student (OR = 1.60), be unemployed (OR = 1.39), and cohabitate with friends (OR = 1.19). Screen-positive patients also were more likely to have made at least one past attempt to change their drinking behavior (OR = 3.21). CONCLUSION: Routine patient information presented an accurate risk profile for alcohol problems among patients in this study. If ED-based health care professionals routinely screened patients for alcohol problems or could predict potential alcohol problems by using routinely collected information, then intervention or referral for additional services may increase.