Data Sources
All population-based rates use U.S. Census Bureau data from the corresponding year (2005-2007). U.S. Census Bureau “Annual Population Estimates 2000 to 2007.” [online] May 1, 2008. http://www.census.gov/popest/states/NST-ann-est.html, accessed 02/20/2008.
ACCESS TO EMERGENCY CARE
Board-certified emergency physicians per 100,000 population
American Board of Emergency Medicine, 2008. Unpublished data.
American Osteopathic Board of Emergency Medicine, 2008. Unpublished data.
Neurosurgeons; Orthopedists and hand surgeons; Plastic surgeons; ENTs; and Emergency physicians per 100,000 population
AMA PHYSICIAN PROFESSIONAL DATA © 2008 by the American Medical Association.
Includes only “active” physicians (working at least 20 hours per week).
Neurosurgeons include physicians reporting a self-designated subspecialty of neurological surgery or pediatric neurological surgery.
Orthopedists and hand surgeons include physicians reporting a self-designated subspecialty of hand surgery, hand surgery/orthopedic surgery, orthopedic surgery of spine, orthopedic adult reconstructive surgery, orthopedic musculo-oncology, orthopedic pediatric surgery, orthopedic sports medicine, orthopedic surgery, orthopedic surgery, orthopedic surgery - trauma, or orthopedics (foot and ankle).
Plastic surgeons include physicians reporting a self-designated subspecialty of plastic surgery, plastic surgery - head and neck, and facial plastic surgery.
ENTs include physicians reporting a self-designated subspecialty of otolaryngology.
Emergency physicians include the following self-designated specialties: Emergency medicine, Internal Medicine/Emergency Medicine/Critical Care, Internal Medicine - Emergency Medicine, Pediatric Emergency Medicine, Pediatric Emergency Medicine-EM, Pediatrics - Emergency Medicine.
Registered nurses per 100,000 population
U.S. Department of Labor, Bureau of Labor Statistics. Occupational Employment Statistics, May 2007. http://www.bls.gov/oes/, accessed 07/24/08.
Additional primary care FTEs needed; Additional mental health FTEs needed
U.S. Department of Health and Human Services, Health Resources and Services Administration. Geospatial Data Warehouse, Health Professional Shortage Area (HPSA) data. http://datawarehouse.hrsa.gov/HPSADownload.aspx, accessed 04/01/08.
Level I or II trauma centers per 1 million population
2008 data provided by the American Trauma Society and available online at: http://www.amtrauma.org/tiep/reports/TCPopulation.html.
This measue only includes adult Level I or II trauma centers within a state. Level I and II trauma centers that only treat children are not included; trauma centers that treat children and adults are included. Likewise, this measure only includes trauma centers that are located within a state. It does not include trauma centers that may be designated by a state, but located in a neighboring state.
Percent of population within 60 minutes of a Level I or II trauma center
American Trauma Society. “Map Tool to Assess Timely Access to Trauma Centers” [online] 2008 http://tramah.cml.upenn.edu/CML.TraumaCenters.Web/Default.aspx, accessed 10/17/08.
This percentage also includes access to Level I or II trauma centers in neighboring states.
Accredited chest pain centers per 1 million population
Society of Chest Pain Centers. “Accredited Chest Pain Centers” [online]. http://www.scpcp.org/accreditation/accreditedlist.html, accessed 07/22/08.
This rate includes only those centers accredited by the Society of Chest Pain Centers.
Percent of population with an unmet need for substance abuse treatment
Substance Abuse and Mental Health Services Administration, Office of Applied Studies, National Survey on Drug Use and Health, 2004 and 2005. Treatment data by State: State treatment gap. [online] December 2007. http://www.oas.samhsa.gov/statesTX.htm#Gap, accessed 03/18/08.
Needing But Not Receiving Treatment refers to respondents classified as needing treatment for alcohol or illegal substances, but not receiving treatment for an alcohol or illegal substance problem at a specialty facility (i.e., drug and alcohol rehabilitation facilities [inpatient or outpatient], hospitals [inpatient only], and mental health centers).
Physicians accepting Medicare per 100 beneficiaries
Number of physicians accepting Medicare from CMS/ORDI/CBC (Medicare Physician Registry) 2008; Number of beneficiaries from Kaiser Family Foundation. Total Number of Medicare Beneficiaries, 2008. [online] January 2008. http://www.statehealthfacts.org/, accessed 03/18/08.
Data presented are for “Medicare physicians and other medical professionals” including active medical doctors, limited licensed practitioners, and non-physicians. Medicare physicians and other medical professionals from American Samoa and Palau are included in California; Guam included in Hawaii; Virgin Islands included in Puerto Rico.
Medicaid fee levels for office visits as a percent of the national average; Percent change in Medicaid fees for office visits levels 2004-05 to 2007
2007 Medicaid feel levels are from American Academy of Family Physicians (http://www.aafp.org/online/etc/medialib/aafp_org/documents/policy/state/medicaid/evalmgmtcodes.Par.0001.File.tmp/statemedicaidencountercodes.pdf, accessed 07/10/08). 2004-05 data are from the American Academy of Pediatrics (http://www.aap.org/research/medreim0405state.htm), accessed 07/10/08.
The rates used for both analyses were 99203 (new patient, low complexity); 99204 (new patient, moderate complexity); 99205 (new patient, high complexity); 99213 (established patient, low complexity; and 99214 (established patient, moderate complexity). These five codes were chosen because they were the ones for which relatively recent information were available about their relative contribution to overall Medicaid physician charges. The five primary codes were weighted based on their relative contribution as identified in a previous study (Zuckerman S, McFeeters J, Cunningham P, Nichols L. Changes in Medicaid Physician Fees, 1998-2003: Implications for physician participation. [online] June 2004), resulting in the following composite rate: 99203 (6.6%); 99204 (5.7%); 99205 (3.2%); 99213 (61.4%); 99214 (23.1%).
2004-05 rates were not available for 4 states (Alaska, Delaware, Indiana, and Michigan) that did not respond to the survey and one state (Tennessee) that did not have a fee-for-service Medicaid program for children.
To assure that rates were comparable for the two time periods, the AAP’s convention of using the highest non-facility rates provided by the states was followed. In four cases (California, Connecticut, Florida, and Virginia), this resulted in a different set of 2007 rates being used for this indicator than for the previous indicator (comparing each state’s rates to the national average).
Percent of adults with no health insurance; Percent of children with no health insurance; Percent of adults with Medicaid
U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2007. Current Population Survey Table Creator [online]. http://www.census.gov/hhes/www/cpstc/cps_table_creator.html, accessed 03/18/08.
Pediatric specialty centers per 1 million population; Emergency departments per 1 million population; Hospital closures in 2006; Staffed inpatient beds per 100,000 population; Hospital occupancy rate per 100 staffed beds; and Psychiatric care beds per 100,000 population
American Hospital Association, AHA Annual Survey, FY 2006.
Pediatric specialty centers include hospitals with more than one neonatal intensive care unit or pediatric intensive care unit. Hospital occupancy rate is an estimate of the percentage of beds occupied on an average day.
State collects data on diversion
ACEP Survey of State Health Officials, 2008.
QUALITY & PATIENT SAFETY ENVIRONMENT
Funding for quality improvement within the EMS system; Funded state EMS medical director; Uniform system for providing pre-arrival instructions; State has or is working on a stroke system of care; State has or is working on a PCI network or a STEMI system of care; Statewide trauma registry
ACEP Survey of State Health Officials, 2008.
Emergency medicine residents per 1 million population
Accreditation Council for Graduate Medical Education. “Resident Physician Population by Specialty and State Academic Year 2006-2007” [online]. http://www.acgme.org/acWebsite/CMS/cms_index.asp, accessed 03/18/08; American Osteopathic Association. Emergency Residents by State 2007, Unpublished data.
Adverse event reporting requirement
National Academy for State Health Policy. Quality and Patient Safety: State adverse event reporting rules and statutes, [online] December 2005. http://www.nashp.org/_docdisp_page.cfm?LID=2A789909-5310-11D6-BCF000A0CC558925, accessed 03/20/08.
Oregon has a voluntary adverse event reporting system.
Hospital-based infection reporting requirement
Kaiser Family Foundation. “Hospital-Based Infections Reporting Requirements, 2008.” State Health Facts [online]. 2008 February. http://www.statehealthfacts.org/comparetable.jsp?ind=407&cat=8, accessed 07/12/08.
Mandatory quality reporting requirement
Kaiser Family Foundation. “Mandatory Quality Reporting Requirement, 2008.” State Health Facts [online]. 2008 February. http://www.statehealthfacts.org/comparetable.jsp?ind=406&cat=8, accessed 07/12/08.
Percent of counties with Enhanced 911 capability;
National Emergency Number Association, DDTI. Wireless Deployment Reports & Maps: Report 2. Percentage of counties that are E9-1-1 Capable. [online] 2008. http://nena.ddti.net/NationalReport.aspx, accessed 07/12/08.
Percent of hospitals with computerized practitioner order entry; Percent of hospitals with electronic medical records
HIMSS AnalyticsTM Database (Derived from the Dorenfest IHDS+ DatabaseTM), 2007.
Percent of patients with acute myocardial infarction given PCI within 90 minutes of arrival
Centers for Medicare & Medicaid Services. Hospital Quality Initiatives, Hospital Compare Downloadable Database September 2007 (1st through 4th Q 2006) [online]. http://www.cms.hhs.gov/HospitalQualityInits/25_HospitalCompare.asp, accessed 03/26/08.
Number of Joint Commission reviewed sentinel events per 1 million (1995-2006)
The Joint Commission. Sentinel Event Statistics - December 31, 2007, Additional Statistics: Reviewed events per million population [online]. http://www.jointcommission.org/SentinelEvents/Statistics/, accessed 03/24/08.
MEDICAL LIABILITY ENVIRONMENT
Lawyers per 10,000 population; Lawyers per physician; Lawyers per emergency physician
Data for lawyers are from Bureau of Labor Statistics, U.S. Department of Labor, Occupational Employment Statistics [online] May 2008. http://www.bls.gov/oes/, accessed 07/24/08.
Data for physicians and emergency physicians are from AMA PHYSICIAN PROFESSIONAL DATA © 2008 by the American Medical Association. Includes only “active” (working at least 20 hours per week) physicians.
ATRA judicial hellholes (Range 0 to –7)
American Tort Reform Association. Judicial Hellholes 2007 [online]. Washington, D.C.: American Tort Reform Association, 2007. http://www.atra.org/reports/hellholes/, accessed 02/28/08.
ATRA assigns both positive and negative designations to specific counties or other jurisdictions within the states. 1 point was given for having a designated “point of light,” 0 points for not being mentioned, -1 point for having a “dishonorable mention,” –2 points for having a jurisdiction on the “watch list,” and –3 points for the presence of a “judicial hellhole.” Negative points therefore represent problem areas. Several states appear in multiple categories. The total scores received by the states ranged from -7 to 0.
Malpractice payments per 100,000 population; Average malpractice award payments; Databank reports per 1,000 physicians
National Practitioner Data Bank Public Use Data File, September 30, 2007, U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, Office of Workforce Analysis and Quality Assurance, Practitioner Data Banks Branch.”
Malpractice payments include the number of payments made by insurer, self-insured organization, and state compensation fund as primary insurer.
The Average malpractice award payments was calculated by summing all of the malpractice payments and dividing by the number of payments made by an insurer, self-insured organization, and the state compensation fund as primary insurer.
The number of Databank reports includes those for Physicians (MD), Physician Intern/Resident (MD), Osteopathic Physician (DO), and Osteopathic Physician Intern/Resident (DO).
Patient compensation fund
National Conference of State Legislatures. “State Medical Liability Laws, 2007” [online]. http://www.ncsl.org/standcomm/sclaw/StateMedliablitylaws2007.htm, accessed 01/30/08; American Tort Reform Association. “State and Federal Civil Justice Reforms,” [online] 2008. http://www.atra.org/reforms, accessed 04/06/08.
Although Colorado, Florida, Oregon, and Wyoming have passed legislation to create a patient compensation fund, these states did not receive credit because provisions have not been implemented.
Health court pilot project grant
Common Good “Legislative Activity on Health Courts,” [online] Feb 2008. http://commongood.org/f-healthcourtslegislation.html, accessed 02/20/08; Common Good “Common Good launches new state action project with Robert Wood Johnson Foundation support,” [online]. http://commongood.org/f-stateaction.html, accessed 02/20/08.
Number of insurers writing malpractice policies per 1,000 physicians
National Association of Insurance Commissioners. “Countrywide Survey of Medical Malpractice Insurance 1991-2007.” [online] May 2008. http://www.naic.org/documents/research_stats_medical_malpractice.pdf, accessed 07/22/08.
Average medical liability insurance premium for primary care physicians, Average medical liability insurance premiums for specialists
Medical Liability Monitor. Rate Survey Issue. October 2007, 32 (10): 38pp
Averages are based on unweighted averages of rates for regions within states and companies providing rates, as listed in the 2007 Medical Liability Monitor. Primary care physicians are represented by rates for Internal Medicine, and specialists are represented by rates for OB-GYN and General Surgery.
Pretrial screening panels / Findings admissible as evidence; Periodic payments; Medical liability cap on non-economic damages; Joint and several liability abolished
American Medical Association. “State Laws Chart 1: Liability Reforms” February 2008; American Tort Reform Association. “State and Federal Civil Justice Reforms,” [online] 2008. http://www.atra.org/reforms, accessed 04/06/08.
Maine and Connecticut did not receive credit for pretrial screening panels’ findings admissible as evidence because findings are only admissible if the decision is unanimous.
Additional liability protections for EMTALA-mandated emergency care
American Tort Reform Association. “State and Federal Civil Justice Reforms,” [online] 2008. http://www.atra.org/reforms, accessed 04/06/08.
State provides for case certification; Expert witness required to be of the same specialty as the defendant; Expert witness must be licensed to practice medicine in the state
American Medical Association. “State Laws Chart 2: Liability Reforms” February 2008; American Tort Reform Association. “State and Federal Civil Justice Reforms,” [online] 2008. http://www.atra.org/reforms, accessed 04/06/08.
Case certification includes affidavits/certificates of merit and any other certification by an expert witness that the case has merit.
PUBLIC HEALTH & INJURY PREVENTION
Traffic fatalities per 100,000 population:
Percent of traffic fatalities alcohol related
National Highway Traffic Safety Administration. Fatal Accident Reporting System 2002-2005 Final and 2006 ARF. [online] http://www-nrd.nhtsa.dot.gov/departments/nrd-30/ncsa/STSI/USA%20WEB%20REPORT.HTM, accessed 02/28/08.
This measure includes traffic fatalities where the Blood Alcohol Content (BAC) was .01+ g/dL.
Front occupant restraint use (%)
National Highway Traffic Safety Administration. Traffic Safety Facts: Seat Belt Use in 2007 - Use Rates in the States and Territories. [online] Jan 2008. http://www-nrd.nhtsa.dot.gov/Pubs/810949.PDF, accessed 06/24/08.
Helmet use required for all motorcycle riders
Insurance Institute for Highway Safety, Highway Loss Data Institute. “Current US motorcycle and bicycle helmet laws.” [online] March 2008. http://www.iihs.org/laws/HelmetUseCurrent.aspx, accessed 03/18/08; National Conference of State Legislatures. “NCSL Transportation Reviews: Motorcycle Safety.” [online] December 2007. http://www.ncsl.org/programs/transportation/motorcycletranrev07.htm, accessed 03/11/08.
Data for Puerto Rico are from the National Conference of State Legislatures; all other data are from the Insurance Institute for Highway Safety.
Child safety seat/seat belt legislation (Score out of possible 10 points)
Insurance Institute for Highway Safety, Highway Loss Data Institute. “Safety Belt Use Laws.” [online] March 2008. http://www.iihs.org/laws/safetybeltuse.aspx, accessed 07/22/08.
Insurance Institute for Highway Safety, Highway Loss Data Institute. “Child restraint laws” [online] March 2008. http://www.iihs.org/laws/childrestraint.aspx, accessed 07/22/08.
States received:
5 points: Primary enforcement / all seats, all ages / fines of at least $25 / at least one point on license for failure to comply.
4 points: Primary enforcement / all seats, all ages / any fine / no points on license.
3 points: Limited primary enforcement / all ages in front seats / any fine / no points on license.
2 points: Secondary enforcement / all seats, all ages / any fine / no points on license.
1 point: Limited secondary enforcement / all ages in front seats / any fine / no points on license.
0 points: Very limited enforcement / no adult law.
An additional point was given for every year of age over age 3 children are required to use a child restraint/booster seat for a possible additional 5 points.
One point was subtracted for secondary enforcement of child safety seat laws.
Percent of children immunized (aged 19-35 months)
Centers for Disease Control and Prevention, National Immunization Program. National Immunization Survey, Jan – Dec 2006. http://www.cdc.gov/vaccines/stats-surv/imz-coverage.htm#nis, viewed 07/22/08.
Percent of adults aged 65+ who received flu vaccine in the last 12 months; Percent of adults aged 65+ who ever received pneumococcal vaccine; Percent of adults with BMI > 30; Current smokers, percent of adults; Binge alcohol drinkers, percent of adults
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Behavioral Risk Factor Surveillance System, 2006. [online] April 2007. http://apps.nccd.cdc.gov/brfss/page.asp?cat=OB&yr=2006&state=All#OB, accessed 02/28/08.
Fatal occupational injuries per 1 million workers
U.S. Department of Labor, Bureau of Labor Statistics. Census of Fatal Occupational Injuries 2005-2006, Customized Tables [online]. Feb 2008. http://www.bls.gov/iif/oshcfoi1.htm#charts, accessed 03/12/08.
The denominator consisted of 2005 and 2006 population data from the U.S. Census Bureau.
Homicides and suicides (non-motor vehicle) per 100,000 population; Unintentional fall-related fatal injuries per 100,000 population; Unintentional fire/burn-related fatal injuries per 100,000 population; Unintentional firearm-related fatal injuries per 100,000 population
Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999-2005. CDC WONDER On-line Database, compiled from Compressed Mortality File 1999-2005 Series 20 No. 2K, 2008. http://wonder.cdc.gov/cmf-icd10.html, accessed 03/13/08.
Intentional non-MV fatal injuries and unintentional fall-related fatal injuries are from 2005.
Unintentional fire/burn-related injures are from 2003-2005. The data presented for Hawaii and Wyoming should be interpreted with caution because the rate is based on fewer than 20 cases.
Unintentional firearm-related fatal injuries are from 1999-2005. These data should be interpreted with caution because the number of deaths used to calculate the rate was less than 20 in 11 states - Alaska, Delaware, DC, Hawaii, Maine, Massachusetts, New Hampshire, North Dakota, Rhode Island, Utah, and Vermont.
Gun-purchasing legislation (score out of 8 possible points)
Brady Campaign. “State Gun Laws: Brady State Scorecard 2007” [online]. March 2008. http://www.stategunlaws.org, accessed 03/11/08; Department of Justice, Bureau of Alcohol, Tobacco, Firearms and Explosives. “ATF P 5300.5 State Laws and Published Ordinances - Firearms (2005 - 26th Edition)” [online] August 2005. http://www.atf.gov/firearms/statelaws/26thedition/, accessed 03/11/08; U.S. Department of Justice, Federal Bureau of Investigation. National Instant Criminal Background Check System (NICS) Program, Operations Report 2005 [online]. January 2006. http://www.fbi.gov/hq/cjisd/nics/index.htm, accessed 03/17/08.
Data for DC and Puerto Rico are from ATF, 2005; all other state data are from the Brady Campaign, 2008 and the U.S. Department of Justice, 2006.
One point was awarded for each of the following indicators (partial credit was given) – Firearm owners are required to report all lost or stolen guns to law enforcement; Background checks are required on all gun sales; Safety training/testing required to receive a permit; Childproof handguns: only authorized users are able to operate handguns; State requires locking devices be sold with guns; Gun owners are held accountable for leaving guns accessible to kids; It is illegal to sell handguns to anyone under 21 years of age; State participation in the NICS.
Percent of tobacco settlement funds spent on health-related services and programs
Kaiser Family Foundation. State Allocation of Tobacco Settlement Funds, Distribution of Current Annual Appropriation, SFY2005. [online] http://www.statehealthfacts.org/comparebar.jsp?ind=282&cat=5, accessed 02/07/08.
Includes tobacco use prevention, health services, long-term care, and health research.
Total injury prevention funds per 1,000 population; Unintentional injury prevention funds per 1,000 population; Intentional injury prevention funds per 1,000 population; Fall injury prevention funds per 1,000 population
The STIPDA 2007 State of the States Report. Atlanta (GA): State and Territorial Injury Prevention Directors Association; 2008. www.stipda.org.
Infant mortality rate (per 1,000 live births)
Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: Final data for 2005. National vital statistics reports; vol. 56 no 10. Hyattsville, MD: National Center for Health Statistics. 2008.
DISASTER PREPAREDNESS
Per capita federal disaster preparedness funds
Trust for America’s Health. Shortchanging America’s Health 2008: A State-by-State Look at How Federal Public Health Dollars Are Spent. Washington, DC; Department of Homeland Security. “FY2007 Homeland Security Grant Program.” DHS web site, http://www.dhs.gov/xlibrary/assets/grants_st-local_fy07.pdf, accessed 04/22/08.
Includes CDC funding for pandemic influenza and terrorism preparedness and emergency response; OASPR Hospital Preparedness Program funding; and funding from Department of Homeland Security: State Homeland Security Grant Program, Urban Areas Security Initiative, Law Enforcement Terrorism Prevention Program Awards, Metropolitan Medical Response System Awards, Citizen Corps Grant Program.
Disaster preparedness funds used specifically for health care-related preparedness are tracked; All hazards medical response plan or ESF-8 plan; Plan shared with all EMS and essential hospital personnel; Public health and emergency physician input into the state planning process; Public health and emergency physician input into the daily operations of the SEOC; Written plan for the coordination of the SEOC or local EMAs to provide security to hospitals in case of emergency events; Written plan specifically for special needs patients; Written plan to supply medications for chronic conditions; Written plan to supply dialysis for patients; Real-time notification system in place to notify identified health care providers of an event; “Just-in-time” training systems in place; Statewide medical communication system with one layer of redundancy; Statewide patient tracking system; Statewide victim tracking system; Statewide real-time or near real-time syndromic surveillance system; Real-time surveillance system in place for common ED presentations; State or regional strike teams or medical assistance teams; Disaster management, bioterrorism, and chemical terrorism training required for essential hospital personnel, EMS personnel; State requires EMS and essential ED personnel to be NIMS compliant; State able to verify credentials and assign volunteer health professionals to four ESAR-VHP levels
ACEP Survey of State Health Officials, 2008.
Number of drills and exercises conducted involving hospital personnel, equipment, or facilities; Bed surge capacity per 1 million population; Nurses registered in ESAR-VHP per 1 million population; Physicians registered in ESAR-VHP per 1 million population
ACEP Survey of State Health Officials, 2008.
The states were asked to provide this information based on their annual ASPR year-end reports.
Ohio declined to respond because they calculate bed surge capacity by bed category and there is the possibility of duplication in simply adding the numbers together, which would overestimate bed surge capacity in the state.
Accredited by the Emergency Management Accreditation Program
Emergency Management Accreditation Program. Accredited Programs [online]. http://www.emaponline.org/?109, accessed 04/24/08.
Burn unit beds per 1 million population
American Burn Association. “Burn Care Facilities, United States” [online] March 2008. http://www.ameriburn.org/FinalPubPage.pdf, accessed 04/08/08.
Data for Puerto Rico are from the American Hospital Association, AHA Annual Survey, FY 2006.
Verified burn centers per 1 million population
American Burn Association. “Burn Center Verification” [online]. http://www.ameriburn.org/verification_verifiedcenters.php?PHPSESSID=e9431affc4f503c05e8820ca991f2092, accessed 08/11/08.
Data for Puerto Rico are from the American Hospital Association, AHA Annual Survey, FY 2006.
ICU beds per 1 million population
American Hospital Association, AHA Annual Survey, FY 2006.
Includes medical/surgical, cardiac, neonatal, pediatric, and other ICU beds.
Additional liability protections for health care workers during a disaster
Trust for America’s Health. State by State Comparison Table - Healthcare Volunteer Liability Protection [online]. October 2007. http://healthyamericans.org/reports/bioterror07/, accessed 05/13/08.
Liability protections are identified in the Report Card as “clearly defined” based on the TFAH report.
Percent of RNs that received any emergency training
U.S. Department of Health and Human Services, Health Resources and Services Administration. National Sample Survey of Registered Nurses 2004. [Public use data files available online] http://datawarehouse.hrsa.gov/nursingsurvey.htm, accessed 03/26/08.
Includes training for biological attack, chemical attack, nuclear radiation attack, and/or natural disaster.