A Study On The Emergency Response Capability To Pubic Health Events Among Medical Institutes In Guangdong Province

Objects and implicationsEmergent public health events occurred frequently all over the world in therecent years, such as the hepatitis the outbreak in Shanghai in 1988, the 9.11 terrorismand anthrax crisis in the United States, the 'mad cow' disease (BSE) in England, theglobal SARS epidemic in 2003, the avian influenza epidemic in Southern East Asia in2004, and etc. Due to the characteristics of emergency, population based, chain-reacting, seriousness, and requiring comprehensive and systematic response, the emergent public health events not only threaten to human's survival and health, but also have great negative impacts on economic development, social stabilization, and nation's security. According to the requirements of Department of Health inGuangdong, the medical institutes in various levels started the building of emergencyresponse system in Guangdong. The study is to investigate the emergency responsecapability to emergent public health events in medical institutes in Guangdong inorder to understand the situation of emergency response system building in medicalinstitutes in Guangdong and provide scientific basis and policy-making suggestionsfor the strategic developments of emergency response in medical institutes inGuangdong. MethodsThe study objects include hospitals in the emergency medical center network inGuangdong province. Target sampling method was used to sample 209 hospitals inthe 120 emergency medical center network in Guangzhou and Shenzhen, andprefecture-level and county-level hospitals in the other 19 prefectures. Questionnairewas used to collect the information.Study process and contentsThe study is to construct the evaluation indicators to evaluate the capability inemergency response to public health events in medical institutes in Guangdongprovince based on the literature review. Two-round expert consultations in the filed ofepidemiology and emergency response were held by the office of emergency responsein the department of health in Guangdong to collect the suggestions and comments onthe elementary evaluation indicators. Modifications were made according to therecommendations of the experts. Four medical institutes in Guangzhou andZhongshan were investigated to pretest the investigation way and questionnaires.Modified questionnaires were used to investigate the 209 medical institutes on theemergency response capability to the public health events.The study contents included five aspects:1. The rules, the framework, and staff on emergency response.2. Surveillance and forecast on emergency response.3. Field dispose and medical treatment.4. The logistic guarantee system.5. Public propaganda and media communication.Results1. The preliminary emergency response network and system have been built inmedical institutes in Guangdong About 68% of the sampled medical institutes have dependent emergencyresponse offices. Among 95% of the studied medical institutes, the directors wereresponsible for the emergency response work and had specific assignments. OnlyGuangzhou and Shenzhen had constructed the uniform prefecture-level emergencyresponse network based on the 120 medical systems. Effective command andpolicy-making system on emergency response is to be constructed in Guangdongprovince.Rules on emergency response including emergency response coordination, emergency on-duty, emergent public health events report, emergent medical treatment, infectious disease registration and report, infectious disease preliminary diagnosis andseparate dispose, infectious disease disinfection and quarantine had been constructedamong 90% of the medical institutes. 85% of the medical institutes have built rules onlaboratory procedure and management, and logistics preparing for emergencyresponse. 80% of the institutes have built rules on laboratory testing. The proportionsof having built financing preparing system were less than 60% in all the districts andin all the levels.2. The human resources building in emergency response were good at quantitybut not enough at qualityThere were 1082 staffs working on emergency response management in themedical institutes, 74.0% of whom are undergraduates and staffs from technologicalacademy and 50.7% of whom were seniors. The education background and the titledistribution were better in the three-star hospitals than that in the two-star hospitals, were better in the Pearl River Delta than that in the east and west, were better in theeast and west than that in the north. As for the education background, staff withbachelors accounted 40% of all the staff in the pearl river delta, 15% in the east andwest, 25% in the north. There were totally 99 doctors and 417 masters (may overlapped in the departments). However, there were only one doctor and 18 mastersin the east and west. There was no doctor or master in the north. It should be noticedthat the education background was worst in the department of laboratory. The staffwith education lower than technological academy accounted 71.93% in thedepartment of laboratory. It was more serious in the east and west, and in the northerndistricts. The staff with education higher than bachelor accounted only 12.0% in theeast and west, and only 23.5% in the north. As for the title distribution, seniorsaccounted 10.82% to 32.32% in the pearl river delta. This proportion was about 1/2 ofthat in the east and west, and 1/5 to 1/2 of that in the north.3. The capability of surveillance, forecast and field response is low.All the institutes had rules on infectious disease registration and report, out-patient log, and had full-time or part-time staffs responsible for the emergencyreport. 90% of the medical institutes could detect and report unknown pneumonia andabnormal fever timely. 80% of the institutes could detect and report abnormal deathand influenza-like-illness. However, this proportion was only 33.3% to 46.2% for thesapremia and infection shock. Since the medical instituted in Guangdong had startedsurveillance on related information in the recent two years, they had not startedroutine analysis and forecast rules due to the scarce of data.The average period from receiving the emergency, call to arrival of medical staffswas 4.8 minutes. It was 3.6 minutes in pearl river delta districts, 6.7 minutes in theeast and west, and 7.6 minutes in the north.The proportion of having expert committees in the medical institutes varied invarious departments. It was over 96% in the department of infectious disease, over80% in the department of emerging infectious disease and unknown epidemic, population abnormal reaction for the immunization, and disasters, 72.7% in thedepartment of occupational poisoning, and less than 60% in the department of food borne disease epidemic, nosocomial infection, bio- and chemical terrorism. Therewere no significant differences in the different districts and different levels.4. The emergency response training and practice had been started among themedical staffsOver 90% of the medical institutes had started training on emergency responseamong the staffs and 80% of them had periodic assessments on the training. The maincontents of training were diagnosis and treatment of the infectious diseases, SARS, and avian influenza. 77.5% of the medial institutes had started or participated practiceon the emergency response. This proportion was 83.12% in the pearl river delta, was69.4% in the east and west, and was 64.7% in the north. The practice programsincluded 120 emergency treatment, protection from SARS and avian influenza, medical treatment on emergent public health events, fire protection, and populationevacuation. There was no program on cooperation between hospitals orcoordination among diverse departments.5. There were some reserved resources on emergency response. However, thelogistic guarantee system was to be strengthened.The hospitals paid high attention to emergency response preparing on infectiousdiseases. 85% of the hospitals had prepared emergency response program oninfectious diseases. However, this proportion was only 47.9% to 66.7% as for thepopulation abnormal reactions to immunizations.The detection and surveillance capabilities were weak in the hospital labs. Therewas no provincial lab network in Guangdong.The cooperation and coordination system ran well among the hospitals, department of health, and CDCs. However, there was no coordination systembetween hospitals and other departments.The routine hospital beds were 81000 in Guangdong province and the reserved hospital beds were 21000, 10744 of them were infectious or serious diseases relatedwhich accounted 51.2% of all the reserved hospital beds. The differences weresignificant in different districts and different levels. The hospitals had prepared someresources for emergency response. However, there was no evaluation system on theclassifications, the quantities, and reasonableness of the resource preparing.6. The role of hospitals on the public propaganda in emergency response was tobe strengthened.The roles of hospitals on the public propaganda in emergency response were notenough. Only 38.3% of the hospitals had schemes or rules on public propaganda andmedia communication in emergency response. 56.9% of the hospitals had specificdepartments dealing with public propaganda in emergency response for public healthevents.In total, the emergency response systems had been constructed in medicalinstitutes in Guangdong province. There were response capabilities in surveillance, information report, preparing, training and practice on emergency response, resourcesreservation, and field treatment. The capabilities in emergency response were not inbalanced development in different districts. The capabilities were higher in pearl riverdelta than in the east and west, and were worst in the north. The capabilities werehigher in the three-star hospitals than that in two-star hospitals.InnovationThis was the first program to study the emergency response capability to publichealth events in medical institutes in Guangdong province. It studied the wholeresponse capability to public health events in medical institutes in Guangdong and thedifferences between different level hospitals. It explored the capability building onthe response to public health events and provided scientific bases for the policymaking.