By Linda Carroll

(Reuters Health) – More than half of key hospital doctors in England who would likely be involved in responding to a major incident, such as a bombing or massive fire, are ill prepared for it, a new report suggests.

Worse, the new survey finds them to be less prepared than peers were in 2006, the last time similar doctors were questioned, according to the study published in Emergency Medicine Journal.

The survey was designed to determine whether these trainee specialists – the equivalent to medical residents in the U.S. – in key positions were familiar with the details of their hospital’s major incident plan, a document all hospitals in England are required to keep by law.

The plans describe how to respond to an incident involving a large number of casualties and cover the strategic, tactical, and operational management that would be required; the plans also list key members of the response team, which would include specialists in anesthesiology, intensive care, emergency medicine, general surgery, trauma and orthopedics.

“Half of the respondents said they had read either the whole major incident plan or the section relating to them,” said the study’s lead author, Dr. Jamie Mawhinney, now academic foundation doctor at Guy’s and Thomas’ NHS Foundation Trust, but at the University of Oxford when the study was done. “Just under half were confident they knew where they could find it and only just over a third were confident in the role they would play if a major incident plan came into effect whilst they were on-call. This compares to over half in 2006.”

The researchers were “surprised that this was the case, especially given recent high-profile emergencies in the UK, such as the Grenfell Tower disaster and the London Bridge and Westminster Terror Attacks,” Mawhinney said in an email.

A recent report that detailed results from a survey of U.S. nursing school administrators found that more than three-fourths of the schools offered no training or less than one hour of training on nuclear emergency preparedness.

To get a sense of how well prepared is the latest crop of resident doctors in England, Mawhinney and his colleagues contacted 296 specialist residents in emergency medicine, trauma, orthopedics, anesthesia, and general surgery who worked at 74 hospitals busy enough to have dealt with 30,000 patients during the first three months of 2017.

Nearly two-thirds of the doctors (63%) responded, with more coming from trauma and orthopedics (73%) than other specialties. The specialty that was least represented was emergency medicine (50%).

Half of the doctors surveyed said they hadn’t read the plan at all, while one in four had read just part of it. Fewer than half (47%) knew where to find a copy of the plan. Few (36%) knew what they would be required to do if a major incident occurred. More than a third (37%) weren’t sure what they would be doing and more than one in four (27%) had no idea what their role would be.

Mawhinney and his colleagues would like to see those numbers improve. For that to happen, “I believe it would be necessary to increase training,” he said. “Specifically, we believe all doctors should receive education on their hospital’s major incident plan.”

The new findings are “a reminder that we have a lot of work to do,” said Dr. Irwin Redlener, a professor of health policy and management at the Columbia University’s Mailman School of Public Health and director of the National Center for Disaster Preparedness at Columbia in New York City. “I think you would find the same situation in the U.S. and in other countries.”

“I think it’s a big problem,” Redlener added. “And I think it comes down to this priority balancing act. How much time do we have to spend (getting ready) for a wide range of serious situations?”

While U.S. hospitals may be prepared to deal with certain types of tragedies, such as the shootings in El Paso and Dayton, they are unlikely to be as ready for incidents like “anthrax attacks, pandemics, or high level radiation disasters,” Redlener said.

SOURCE: Emergency Medical Journal, online August 12, 2019.