Collaborative hospital strategies for metropolitan disaster medical preparedness and response (California, Florida, Illinois, Louisiana, Missouri)

Since the events of September 11th, JCAHO, public health and hospital trade associations have called for community inter-organizational collaboration to prepare for and respond to mass casualty events, bioterrorism, and other public health emergencies. The context for these calls is a fragmented public health system and highly competitive hospital markets. This research asks how hospitals, public health and EMS agencies are working together to develop coordinated mass casualty inter-organizational responses, in relatively collaborative and well-prepared communities. To answer this question, expert key informants are interviewed for state and community case studies to understand their perceptions.; A purposive sample of five disaster states, with different natural catastrophe histories, was selected from publicly available state CDC public health and HRSA hospital preparedness cooperative agreement program grant applications to represent major U.S. regions. These states include: California, Florida, Illinois, Louisiana, and Missouri. A comparison state without a history of natural disasters, Oregon, was also selected. State level key informants, expert in current state preparedness activities, were selected by position title from state bioterrorism advisory committee membership lists to represent perceptions of hospital, public health, and EMS stakeholders. One key informant from each stakeholder group was interviewed from each sample state. These informants recommended relatively well-prepared "exemplary" communities in their states where hospitals, public health and EMS agencies are collaborating to develop inter-organizational surge capacity.; Case study communities include the Orange County, CA, Portland, OR, Miami, FL, Rockford, IL, and St. Louis, MO metropolitan areas, and two rural communities---Corvallis, OR and Shreveport, LA. At least three key informants were interviewed by phone from each metropolitan or rural region: a hospital disaster coordinator, a public health official, and an EMS officer. Informants were also interviewed from the St. Louis MMRS and two additional hospital systems in Portland. The project conducted group interviews with hospital informants during site visits to Orange County, Corvallis, Miami, Portland, and Rockford.; Key informants describe several planning and response models being used in case study communities. Planning models include technical/rational plans prepared by professional planners, a political influence planning model in one community, and evidence of collaborative planning models in four communities. (Abstract shortened by UMI.)...