North Dakota ranked among the top 10 states in the nation in the Disaster Preparedness and Access to Emergency Care categories, but a renewed focus on injury prevention efforts and a strong emphasis on quality and safety initiatives are still needed.
Strengths. North Dakota has taken significant strides to incorporate important Disaster Preparedness planning into state operations and to implement policies that enhance its ability to respond to a disaster. North Dakota has an all-hazards medical response or ESF-8 plan that is shared will all EMS and essential hospital personnel. Likewise, the state has written plans specifically for special needs patients and for supplying medications for chronic conditions in the event of a disaster. Additionally, the state has a plan for the coordination of the State Emergency Operations Center or local emergency management agencies to provide security to hospitals during an emergency event. North Dakota also has a real-time notification system in place to notify identified health care providers of an event, as well as statewide “just-in-time” training systems, and a medical communication system with one layer of redundancy. The state also ranks among the top six with regard to nurses and physicians registered in the state-based Emergency System for Advance Registration of Volunteer Health Professionals (636.2 and 73.5 per 1 million people, respectively) and ranks second for the number of ICU beds (434.5 per 1 million). These successes may be due in part to receipt of the fourth highest rate of federal funding for disaster preparedness ($21.51 per capita).
Another high note for North Dakota is the Medical Liability Environment. Contributing to success in this area are factors such as the exceptionally high rate of insurers writing medical liability policies within the state (26.6 per 1,000 physicians), the abolition of joint and several liability, and the provision for case certification by an expert witness. The state also has among the 10 lowest average medical liability premiums for specialists ($35,922).
North Dakota’s above average grade for Access to Emergency Care is influenced by high per capita rates of Level I or II trauma centers, pediatric specialty centers, emergency departments, staffed inpatient beds, psychiatric care beds, and registered nurses. For each of these indicators, the state ranks among the top five. The state also has the sixth highest rate of physicians accepting Medicare with 4.1 physicians per 100 beneficiaries.
Challenges. The Quality and Patient Safety Environment grade for North Dakota suffers because the state does not have a funded EMS medical director or reporting requirements for adverse events or hospital-based infections. Furthermore, North Dakota does not have any emergency medicine residents and has the third lowest percentage of hospitals using computerized practitioner order entry or electronic medical records (4.9 and 18.0 percent, respectively).
North Dakota faces many challenges regarding Public Health and Injury Prevention indicators. The lack of a helmet requirement for all motorcycle riders and the relatively high percentage of binge alcohol drinkers (21.2 percent versus 15.4 percent nationally) contribute to the state’s poor performance. The state also has a high proportion of traffic fatalities that are alcohol-related (45.0 percent) and ranks 45th for its high rates of unintentional fall-related fatal injuries (11.8 per 100,000 people) and fatal occupational injuries (75.8 per 1 million workers).
Recommendations. North Dakota should focus on improving the Quality and Patient Safety Environment through such mechanisms as requiring reporting of adverse events and hospital-based infections. The state should also work with hospitals and universities in the region to establish an emergency medicine residency program, which could result in attracting and maintaining needed emergency physicians.
Likewise, passing and enforcing a helmet law for all motorcycle riders and focusing health promotion efforts on binge alcohol drinking, driving under the influence of alcohol, and safety in the workplace would improve North Dakota’s Public Health and Injury Prevention outcomes.