Are trauma surgeons prepared? A survey of trauma surgeons' disaster preparedness before and during the COVID-19 pandemic

Jay Doucet; David V Shatz; Lewis J Kaplan; Eileen M Bulger; Jeannette Capella; Deborah A Kuhls; Mary Fallat; Kyle N Remick; Christopher Newton; Adam Fox; Randeep Jawa; John A Harvin; David P Blake; Marko Bukur; Jonathan Gates; James Ficke; Mark L Gestring; American Association for Surgery of Trauma Disaster Committee

doi:10.1136/tsaco-2022-001073

Are trauma surgeons prepared? A survey of trauma surgeons' disaster preparedness before and during the COVID-19 pandemic

Trauma Surg Acute Care Open. 2023 Jun 28;8(1):e001073. doi: 10.1136/tsaco-2022-001073. eCollection 2023.

Authors

Jay Doucet¹, David V Shatz², Lewis J Kaplan³, Eileen M Bulger⁴, Jeannette Capella⁵, Deborah A Kuhls⁶, Mary Fallat⁷, Kyle N Remick⁸, Christopher Newton⁹, Adam Fox¹⁰, Randeep Jawa¹¹, John A Harvin¹², David P Blake¹³, Marko Bukur¹⁴, Jonathan Gates¹⁵, James Ficke¹⁶, Mark L Gestring¹⁷; American Association for Surgery of Trauma Disaster Committee

Collaborators

American Association for Surgery of Trauma Disaster Committee:
Joanelle Bailey, Avi Bhavaraju, Alfredo Cesar Cordova, Eleanor Curtis, Michael Kenneth Dalton, Bradley Dennis, Alexander Laurance Eastman, Lee David Faucher, Peter Fischer, Galina A Glinik, Jane Josephine Keating, Katherine Kelley, Alison A Smith, Nicole Toscano, Robert D Winfield, Nicole Toscano

Affiliations

¹ Department of Surgery, University of California San Diego Health System, San Diego, California, USA.
² Department of General Surgery, UC Davis Medical Center, Sacramento, California, USA.
³ Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ Department of Surgery, University of Washington, Seattle, Washington, USA.
⁵ Department of Surgery, The Iowa Clinic, Des Moines, Iowa, USA.
⁶ Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA.
⁷ Department of Surgery, University of Louisville, Louisville, Kentucky, USA.
⁸ Department of Surgery, Uniformed Services University School of Medicine, Bethesda, Maryland, USA.
⁹ UCSF Benioff Children's Hospital, San Francisco, California, USA.
¹⁰ Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
¹¹ Department of Surgery, Stony Brook University, Stony Brook, New York, USA.
¹² Department of Surgery, UT Health, Houston, Texas, USA.
¹³ Division of Acute Care Surgery, Inova Health System, Falls Church, Virginia, USA.
¹⁴ Bellevue Hospital Center, New York, New York, USA.
¹⁵ Department of Surgery, Hartford Hospital, Hartford, Connecticut, USA.
¹⁶ Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.
¹⁷ Department of Surgery, University of Rochester, Rochester, New York, USA.

Abstract

Objective: US trauma centers (TCs) must remain prepared for mass casualty incidents (MCIs). However, trauma surgeons may lack formal MCI training. The recent COVID-19 pandemic drove multiple patient surges, overloaded Emergency Medical Services (EMS) agencies, and stressed TCs. This survey assessed trauma surgeons' MCI training, experience, and system and personal preparedness before the pandemic compared with the pandemic's third year.

Methods: Survey invitations were emailed to all 1544 members of the American Association for the Surgery of Trauma in 2019, and then resent in 2022 to 1575 members with additional questions regarding the pandemic. Questions assessed practice type, TC characteristics, training, experience, beliefs about personal and hospital preparedness, likelihood of MCI scenarios, interventions desired from membership organizations, and pandemic experiences.

Results: The response rate was 16.7% in 2019 and 12% in 2022. In 2022, surgeons felt better prepared than their hospitals for pandemic care, mass shootings, and active shooters, but remained feeling less well prepared for cyberattack and hazardous material events, compared with 2019. Only 35% of the respondents had unintentional MCI response experience in 2019 or 2022, and even fewer had experience with intentional MCI. 78% had completed a Stop the Bleed (STB) course and 63% own an STB kit. 57% had engaged in family preparedness activities; less than 40% had a family action plan if they could not come home during an MCI. 100% of the respondents witnessed pandemic-related adverse events, including colleague and coworker illness, patient surges, and resource limitations, and 17% faced colleague or coworker death.

Conclusions: Trauma surgeons thought that they became better at pandemic care and rated themselves as better prepared than their hospitals for MCI care, which is an opportunity for them to take greater leadership roles. Opportunities remain to improve surgeons' family and personal MCI preparedness. Surgeons' most desired professional organization interventions include advocacy, national standards for TC preparedness, and online training.

Level of evidence: VII, survey of expert opinion.

Keywords: COVID-19; Disasters; Mass Casualty Incidents.