Serious concerns over whether our health care delivery systems are ready to respond to bioterrorist attacks and other emergencies have been raised in the aftermath of events of September 11, 2001. Public funding to address health care concerns related to homeland security have increased considerably at federal, state, and local levels, and health care providers - including physicians and institutional providers - have become part of the dialogue on readiness for bioterrorist and terrorist attacks. The role of the hospital as a focal point in planning is receiving considerable attention. At the same time, special concerns and issues pertain to the rural hospital. Rural hospitals may certainly be expected to provide emergency care resorting from bioterrorist attacks and will likely serve as points from which patients would be transferred. At the same time, there are opportunity costs of defining, implementing, and maintaining rural hospital emergency preparedness. This cost will be very real to rural hospitals, which tend to be smaller in size and generate more limited revenues than urban hospitals.

The purpose of this study is to improve our understanding of rural Emergency Room (ER) capacity and the nature of constraints in expanding capacity in response to demand surge caused by emergencies, including acts of terrorism or bioterrorism. Specific research questions to be addressed include the following:

• What determines ER capacity in rural hospitals?
• What are current constraints on this capacity, e.g., staffing, financial, hospital size, availability of EMS support, supply shortages?
• Do current emergency preparedness plans of rural hospitals address how to meet demand surges, e.g., obtain additional staff, curtail discretionary procedures, provide increased patient transfers?
• Do emergency preparedness plans specifically address bioterrorism? Do these plans address training needs of the rural hospital staff?

The research questions above will be addressed using a comprehensive review of the literature, discussions with hospital administrators, and the convening of a panel of experts. Discussion will be guided by issues and research gaps identified by a comprehensive literature review on the roles of rural hospitals in meeting needs resulting from bioterrorist attacks and other large-scale emergencies.

Publications

• Perspectives of Rural Hospitals on Bioterrorism Preparedness Planning
  NORC Walsh Center for Rural Health Analysis
  Date: 04/2004
  Representatives from several rural hospitals met to discuss various aspects of bioterrorist preparedness in terms of workforce and training, physical capacity and supplies, communication, and coordination with other entities.
• Understanding the Role of the Rural Hospital Emergency Department in Responding to Bioterrorist Attacks and Other Emergencies: A Review of the Literature and Guide to the Issues
  NORC Walsh Center for Rural Health Analysis
  Date: 04/2004
  This report reviews issues affecting rural hospitals' levels of readiness for a bioterrorist attack. Issues examined include physical capacity, sufficiency of health personnel, preparedness plans, disease surveillance systems, and communication/coordination. Concerns about funding cut across all the issues of preparedness.