interpretation of the FAST examination strongly influenced the precision of

emergency physician interpretation of the FAST examination. Only more

experienced pairs of emergency physicians uniformly achieved excellent or good k

values for 4 view FAST interpretations.

104 Computed Tomography Scan Use Is Rising Faster Than OtherInvestigational Modalities in the Emergency DepartmentEvaluation of Patients

Brown J, Shesser R/George Washington University, Washington, DC

Study objectives: Computed tomography (CT) scan use has become increasingly

common in US emergency departments (EDs). Knowledge of trends in CT scan use

has implications for ED design and patient flow. We undertake a study to investigate

the change in use of ED CT scan use and compare it with the change in use of other

tests, such as chest radiographs or blood tests. We also investigate the relationship

between CT scan use and changes in patient acuity.

Methods: Data were obtained from the 1996 to 2000 National Hospital

Ambulatory Medical Care Survey (NHAMCS), a national probability sample survey

conducted by the National Center for Health Statistics, Centers for Disease Control

and Prevention. All visits that resulted in a CT scan being obtained were identified.

Similar data were collected for the use of chest radiographs and blood tests.

Indicators of patient severity (triage category, hospital admission, and ICU

admission rates) were also collected, and demographic data were also obtained.

Continuous variables were summarized by mean and SDs. Proportions were

compared with a x2 test; an a priori significance level of P value less than .05 was

selected. Descriptive analyses were performed with statistical software (Microsoft

Excel 2000 version 9.0; Microsoft Corporation, Redmond, WA). The data used for

this study are openly accessible to the public and excluded all patient identifiers. The

study was therefore exempt from institutional board review approval.

Results: We analyzed 115,011 visits that represented 496.4 million visits to US

EDs during the 5-year study period. Data were weighted in accordance with

NHAMCS guidelines for statistical analysis. The total number of CT scans performed

increased from 2.9 million to 5.7 million (x2=99.2, P=.001). The percentage of ED

patients undergoing CT scanning in the study period increased from 3.2% to 5.3%.

The use of the CBC count also increased moderately from 25.8% to 26.1% (x2=8.1,

P=.01). The rate of chest radiographs remained constant throughout the study

period (16.5%, x2=0.23, P=NS). The hospital admission rate increased from 10.6%

(9,620,213 admissions in 1996) to 12.4% (13,364,017 admissions in 2000; x2=29.1,

P=.001). The percentage of patients admitted to the ICU (1.7% in 1996, 1.6% in

2000) decreased moderately but significantly (x2=9.4, P=.01). There was a decrease

in the triage acuity of patients presenting to the ED: the percentage categorized as

level 1 (to be seen within #15 minutes) decreased significantly from 21% to 15.7%

(x2=159, P=.001). Overall, the growth in CT scanning was higher than for the

growth in the use of a CBC count, chest radiographs, or hospital admission rate,

which suggests that despite a lack of increased patient acuity, the rate of CT scan use

is increasing. Projections based on 5 years of data suggest that by 2010, more than

10% of all ED patients will undergo a CT scan while in the ED.

Conclusion: The use of CT scanning is increasing at a faster rate than other

common tests. This increase cannot be explained by increasing patient acuity. These

trends need to be factored into ED design and may have implications for the training

of emergency medicine residents. These conclusions also suggest the need for the

investigation of the rational use of CT scanning in patient subpopulations.

Table, abstract 103.

Comparison MvL1/2Pairs, MoreExp. 1/2

Pairs, LessExp. 1/2

Pairs,All

All 4 views combined 0.63 0.74 0.51 0.63Pericardial 0.44 0.64 0.39 0.51Right upper quadrant 0.72 0.96 0.66 0.77Left upper quadrant 0.63 0.66 0.66 0.66Suprapubic 0.53 0.68 0.22 0.45

R E S E A R C H F O R U M A B S T R A C T S

O C T O B E R 2 0 0 4 4 4 : 4 A N N A L S O F E M E R G E N C Y M E D I C I N E

105 Hospital Disaster Preparedness in Los Angeles County,California

Kaji AH, Lewis RJ/Harbor-UCLA Medical Center, Torrance, CA

Study objectives: We characterize disaster preparedness among a cohort of

hospitals, focusing on practice variation, plan characteristics, and surge capacity.

Methods: This was a descriptive, cross-sectional study using an in-person hospital

survey and a 117-item questionnaire in Los Angeles County, CA. The study included

45 of the 81 designated 911 receiving hospitals, including private and tertiary care

facilities. Observations include a description of hospital disaster plans, modes of

intra- and interhospital communication, community and interagency involvement,

decontamination capability and training, drills, pharmaceutical stockpiles, and each

facility’s surge capacity (assessed by monthly emergency department [ED] diversion

status, number of available beds, ventilators, and negative pressure isolation rooms).

Additional measures of preparedness included whether hospitals had the following:

mutual aid agreements with other hospitals, long-term care facilities, and medical

vendors; protocols for canceling elective surgeries and early in-patient discharge;

surveillance systems; ongoing training with local emergency m edical services and

fire departments; communication with the public health department; volunteer

credentialing systems; and a protocol for mass fatality incidents.

Results: Ninety-five percent had adopted the Hospital Emergency Incident

Command System, and 100% used the ReddiNet, a radio-based communications

network. Ninety-five percent had memoranda of understanding with medical

suppliers. However, 67% never had joint training programs with local police and fire

agencies, and only 16%and 7%hadwrittenmutual aid agreementswith other hospitals

and long-term care facilities, respectively. Eighty-eight percent of hospitals had level B

and/or C personal protective equipment, and 44% had decontamination facilities

suitable in inclement weather. Ninety-six percent of respondents noted a nurse

shortage, 58%had amonthly EDdiversion rate of greater than 20%, and 69% estimated

a surge capacity of less than 20 beds. Fifty-eight percent of responding hospitals had

fewer than 10 negative pressure isolation rooms, only 36% had more than 10

ventilators, and 55% did not keep a stockpile of antibiotics or antidotes. Although 93%

and 98%, respectively, had protocols for canceling elective surgeries and early in-

patient discharge, only 64% had plans in place for a mass fatality incident.

Conclusion: There are no objective measures of ‘‘hospital preparedness’’ or

‘‘hospital surge capacity.’’ In addition to establishing such standards, focus must be

placed on enhancing interagency and interhospital communications. Current

numbers of available hospital beds, ventilators, isolation rooms, and

pharmaceuticals may be insufficient to effectively care for victims of large-scale

disasters and other public health emergencies.

106 Simple Triage and Rapid Treatment: Does It PredictTransportation and Referral Needs in Patients Evaluated byDisaster Medical Assistance Teams?

Richards ME, Nufer KE/University of New Mexico, Albuquerque, NM

Study objectives: Disaster preparedness and response has taken on a new urgency

because of recent world events. Aspects of a disaster response that have not been

fully evaluated or assessed for validity include triage and triage systems. A

commonly used system is the modified Simple Triage and Rapid Treatment

(START). In this system, patients are triaged to 1 of 4 categories: red, immediate

care; yellow, delayed care; green, ‘‘walking wounded’’; and black, unsalvageable. The

START triage system is frequently used by disaster medical assistance teams

(DMAT), and is the system used by the New Mexico DMAT (NMDMAT) during

deployments. However, this model has not been assessed previously to determine

whether it is a useful or appropriate tool in a DMAT deployment. Our goal is to

determine whether the START system commonly used by DMATs is a useful

predictor of patient referral and transportation needs in disasters. To our knowledge,

this is the first evaluation of this triage tool in DMAT deployments.

Methods: This is a retrospective cohort review of all patients treated by the

NMDMAT after Hurricane Andrew (Florida, August 1992), Hurricane Iniki (Hawaii,

September 1992), the Northridge Earthquake (California, January 1994), and the

Houston flood caused by Tropical Storm Allison (Texas, June 2001). Medical

records were reviewed for triage category, disposition, and mode of transportation.

Patients were assigned 1 of 4 triage categories according to urgency for medical care:

green, yellow, red, or black. Disposition was assigned to 1 of 2 categories: home or

referral to additional medical care. Transportation was also assigned to 1 of 2

S 3 3