	Background

The resources that hospitals and their emergency departments would  require for responding to a large-scale bioterrorist attack are far greater  than those needed for everyday performance. Hospitals Reported Planning for Bioterrorism Response but Do Not Have Certain Medical Capacities to Handle a Large Increase in Patient Load

Most hospitals in urban areas across the country reported participating in  basic planning and coordination activities for bioterrorism response. Although most hospitals reported providing at least some training to their  personnel on identification and diagnosis of disease caused by biological  agents considered likely to be used in a bioterrorist attack, only about half  report they have conducted drills or exercises simulating response to a  bioterrorist incident. Most Hospitals Have Emergency Response Plans Addressing Bioterrorism and Are Participating in Local, State, or Regional Planning and Coordination Activities

Our survey showed that hospitals have engaged in a variety of planning  and coordination activities, with most having prepared an emergency  response plan addressing bioterrorism; participated in a local, state, or  regional interagency disaster preparedness committee; and made  agreements with at least one other organization to share personnel or  equipment in the event of a bioterrorist or other mass casualty incident. Four out of five hospitals reported having a written emergency response  plan that specifically addresses bioterrorism (see fig. Hospitals Reported Insufficient Medical Equipment to Handle a Large Increase in Patients

The availability of medical equipment needed for bioterrorism response  varied greatly among hospitals, and hospitals reported that they did not  have the capacity to respond to the large increase in the number of  patients that would be likely to result from a bioterrorist incident with  mass casualties (see table 2). For example, if a large number of patients  were to arrive at a hospital with severe respiratory problems associated  with anthrax or botulism, a comparable number of ventilators would be  required to treat them. Comments from the American Hospital Association

Representatives from the American Hospital Association provided oral  comments on a draft of this report. The officials generally agreed with our  findings and stated that this was a good and useful report providing  helpful information on hospital preparedness. We also examined the relationships between the  extent of hospital bioterrorism preparedness and size of hospital as  indicated by the number of inpatient staffed beds. Questions in the survey focused on preparedness to respond to a  bioterrorist event. Infectious Disease Outbreaks: Bioterrorism Preparedness Efforts Have  Improved Public Health Response Capacity, but Gaps Remain.
Why GAO Did This Study

In the event of a large-scale infectious disease outbreak, as could be seen with a bioterrorist attack, hospitals and their emergency departments would be on the front line. Federal, state, and local officials are concerned, however, that hospitals may not have the capacity to accept and treat a sudden, large increase in the number of patients, as might be seen in a bioterrorist attack. In the Public Health Improvement Act that was passed in 2000, Congress directed GAO to examine preparedness for a bioterrorist attack. In this report GAO provides information on the extent of bioterrorism preparedness among hospitals in urban areas in the United States. To conduct this work, GAO surveyed over 2,000 urban hospitals and about 73 percent provided responses addressing emergency preparedness. The survey collected information on hospital preparedness for bioterrorism, such as data on planning activities, staff training, and capacity for response.

What GAO Found

While most urban hospitals across the country reported participating in basic planning and coordination activities for bioterrorism response, they did not have the medical equipment to handle the number of patients that would be likely to result from a bioterrorist incident. Four out of five hospitals reported having a written emergency response plan addressing bioterrorism, but many plans omitted some key contacts, such as other laboratories. Almost all hospitals reported participating in a local, state, or regional interagency disaster preparedness committee. In addition, most hospitals reported having provided at least some training to their personnel on identification and diagnosis of disease caused by biological agents considered likely to be used in a bioterrorist attack, such as anthrax or botulism. In contrast, fewer than half of hospitals have conducted drills or exercises simulating response to a bioterrorist incident. Hospitals also reported that they lacked the medical equipment necessary for a large influx of patients. For example, if a large number of patients with severe respiratory problems associated with anthrax or botulism were to arrive at a hospital, a comparable number of ventilators would be required to treat them. Yet half of hospitals reported having fewer than six ventilators per 100 staffed beds. In general, larger hospitals reported more planning and training activities than smaller hospitals. Representatives from the American Hospital Association provided oral comments on a draft of this report, which GAO incorporated as appropriate. They generally agreed with the findings.