1. INTRODUCTION Since the terror attacks of September 11 th 2001, Emergency Department staff across North America have become more aware of the need to be prepared to deal with events involving chemical, biological, nuclear or radioactive contaminants either in mass casualty scenarios or involving smaller numbers of victims. Such an occurrence could be due to a terrorist event or an accidental release of toxic chemicals, radioactive substances or biological agents unrelated to terrorist activity. The purpose of this Hospital Emergency Readiness Overview or HERO study is to assess the readiness of Emergency Departments (EDs) in Canada for such events. In the last quarter of 2001, a study was performed to review the risks and characteristics of these events and to assess the preparedness of Canadian emergency departments to respond. At that time preparedness was assessed by means of a survey, which demonstrated significant deficiencies - most notably in the availability of appropriate equipment, antidotal therapy and decontamination capability. There were also deficiencies in the ability to respond to a major biologic or nuclear event. Since then, the Canadian Federal and Provincial governments have invested time, money and effort to remedy these deficiencies in preparedness for such events. In 2007, The Center for Excellence in Emergency Preparedness and the Disaster Committee of the Canadian Association of Emergency Physicians decided to repeat the earlier study to see if any progress has been made. The original questionnaire was modified with input from Federal and Provincial authorities as well as experienced emergency physicians and keeping in mind the limitations of the first study. METHODS The present survey incorporated the questions from the original study, as well as new questions suggested by representatives from the Ministry of Health and Long Term Care of Ontario Emergency Management Unit, the Public Health Agency of Canada and emergency physicians with experience in disaster management. The Canadian Association of Emergency Physicians e-mailed the survey to 315 EDs across Canada using their email list of Chiefs of Emergency or key contact persons. The ED chief or physician designate was asked to complete the survey and was instructed to ask other hospital personnel for assistance with information when needed. Results were pooled for confidentiality such that data element responses could not be ascribed to an individual hospital. Postal code identifiers were used to ensure that no duplicate entries were analyzed and to determine the distribution of responses by province. Results were collected on line and analyzed using the Survey Monkey © software. 20012008 Plan reviewed within 3 years 81%80% Simulation within 3 years40% (paper trial)65% (tabletop) Exercise within 3 years4%30% Protocol for bio-events37%88% PPE in the ED6%38% Decontamination plan18%62% Antidotes on site13-34%100% N95 availabilityNot in original survey100% HEPA filtered roomNot in original survey74% RESULTS The new survey collated results from 38 hospitals across Canada. Less than a quarter of hospitals had performed a risk analysis at all and, of those, more than half had not revisited this within five years. About half the responders also coordinated with other organisations. Between the two surveys there was improvement in the recency of table top (65% vs. 40% in 2001) or full deployment exercises (30% vs. 4%). 88% of facilities had a reporting protocol for bio events such as a sentinel case of smallpox, (37% in 2001). This is a dramatic improvement that occurred post SARS. Only 38% of hospitals stocked PPE (6% in 2001) in the ED, 40% of those who stocked the equipment had not trained within the past year and 62% had a chemical decontamination plan or team (18% in 2001). The prompt availability of chemical antidotes improved from 13-34% in 2001 to 100% today. 100% of respondents made N95 masks available and about half of the staff had been fit tested within the past year, 88% had access to supplies in an emergency and 74% had HEPA filtered rooms installed in their Emergency Departments. CONCLUSIONS The results of the HERO study suggest that, despite improvements, there remain significant gaps in Canadian health care facility disaster readiness. This study was approved by the Research Ethics Board of McMaster University and sponsored by the Centre for Excellence in Emergency Preparedness (www.ceep.ca) Dr. Daniel Kollek, MD, CCFP (EM) & Dr A. Adam Cwinn, MD, FRCPC Are Canadian Hospitals ready for disaster?