Hospital preparadness to respond to maxi-emergencies in Italy. Preliminaray results

Background: In the last few years maxi-emergencies have increased. The response requires a strong link between territorial services and hospitals; In Italy the regulations require hospitals to provide the elaboration of plans for the simultaneous acceptance of a large number of patients (PEMAF – Emergency Plan for Massive Influx of Injured). These plans are dynamic, need regular updates and should include systematic education and training of all workers. Materials and Methods: The present prevalence study investigates the “state of the art” of hospitals’ PEMAF, using a questionnaire exploring the following areas: hospital characteristics; workers’ training; organization and procedures; in-field experiences. The questionnaire was submitted using the website of SIMEU - Society of Medical Emergency, which covers about 10% of hospitals throughout the country. The questionnaire was to be completed on a voluntary basis, anonymously, directly on the web site. Preliminary descriptive analyses are presented in order to plan future actions. Results: To date, 29 hospitals (30% of those in the network) responded to the survey, 13 of which (48%) were of high complexity (with ED of II level). Responders come from 15/20 Italian Regions, mainly located in the Northern section (52%). The PEMAFs appear to be consistent with many maxi-emergencies that can occur in the hospital’s areas of influence (great social events, air/rail accidents, pandemias, etc.) but less with environmental events (e.g. chemical industry risk), which are considered only in about 50% of cases. High complexity and largest hospitals are consistent in 100% of cases for all maxi-emergencies. Most of hospitals (60%) refer they train workers on PEMAF, but an annual refresher course is organized only by 21%, mainly in the largest ones (>80.000 accesses/year). In 34% of hospitals the PEMAF has been tested in field because of a maxi-emergency; in these hospitals the PEMAF was of better quality. Conclusions: These preliminary results, although obtained from a self-representative sample, show differences among hospitals in their ability to respond on time and correctly to a maxi-emergency. Further studies are needed to verify this results and to investigate on how to improve the hospital’s supply.