Alaska has made great strides in improving its Disaster Preparedness, implementing policies and procedures that allow the state to respond to natural disasters and protect its citizens. Improvements, however, are still needed in the areas of Public Health and Injury Prevention, Access to Emergency Care, and Quality and Patient Safety Environment.
Alaska has made great improvements in its Disaster Preparedness, moving from 49th to 18th in this category since the 2009 Report Card. It ranks fourth in number of nurses registered in the Emergency System for Advanced Registration of Volunteer Health Professionals (ESARVHP; 853.1 per 1 million people) and 20th in number of physicians registered (31.4 per 1 million). Alaska RESPOND, the medical strike team, is also part of the national ESAR-VHP system, further enhancing medical response. Alaska plans to exercise the Patient Forward Movement in a statewide Alaska Shield 2014 Full-Scale Exercise to test additional medical teams, including out-of-state physicians. In addition, it has developed a statewide medical communication system with redundancy, and the state is in the process of procuring communications trailers and backpacks to provide additional layers of redundancy.
Alaska continues to have a strong Medical Liability Environment. Despite a relatively high average malpractice award payment ($405,000), Alaska has enacted such protections as mandatory pretrial screening panels, joint and several liability reform, and a $400,000 medical liability cap on non-economic damages. It also has the 16th lowest average medical liability insurance premiums for both primary care physicians ($9,203) and specialists ($39,853), as well as the second highest rate of insurers writing medial liability policies (31.8 per 1,000 physicians).
While Alaska fared poorly overall with regard to the Quality and Patient Safety Environment, the state has made some noteworthy improvements. It ranks among the best in the nation for the proportion of hospitals adopting electronic medical records and computerized practitioner order entry and has improved the proportion of patients with acute myocardial infarction who are given percutaneous coronary intervention within 90 minutes of arrival. Alaska has also allocated funding for quality improvement of the EMS system.
Alaska is a large, rural state with a very low population density compared to other states, and it faces unique challenges, particularly in the area of Access to Emergency Care. Although it has high numbers of board-certified emergency physicians (14.8 per 100,000 people) and emergency physicians (16.1 per 100,000), the state faces workforce shortages in several professions, including neurosurgeons (1.2 per 100,000), plastic surgeons (1.4 per 100,000), and registered nurses (754.3 per 100,000). Since about half the state's population lives in the Anchorage area, home to the state's only Level II trauma center, only 57.9% of Alaska's population is within 60 minutes of Level I or II trauma center care. The state also has low rates of adequate health insurance coverage, with 20.9% of its adults and 10.7% of its children having no health insurance at all.
Furthermore, Alaska ranks poorly in Public Health and Injury Prevention. It has the lowest rate of adults aged 65 and older who received an influenza vaccination in the past 12 months (51.8%) and has lower-than-average immunization rates among children aged 19ñ35 months (73.2%). Alaska has the highest rate of fatal occupational injuries in the nation (103.4 per 1 million workers) and among the highest rates of homicides and suicides and unintentional poisoning-related deaths, which includes drug overdoses. It also has relatively high proportions of adults who binge-drink (20.8%) and smoke (22.9%).
Alaska's high rates of preventable deaths and low vaccination rates point to the need for a stronger public health system. The state needs to fund and support activities related to vaccination and injury prevention in order to improve the well-being of its citizens. Alaska should consider funding injury prevention efforts to address its highest-in-the-nation rate of fatal occupational injuries. The state should also consider efforts to reduce binge drinking and drug use, which likely contribute to disproportionately high rates of homicide and suicide and poisoningrelated deaths.
The state also needs to continue to improve the Quality and Patient Safety Environment by implementing triage and destination policies for stroke and ST-elevation myocardial infarction patients and a uniform system for providing pre-arrival instructions, which provide a critical opportunity to provide life-saving care while waiting for first responders to arrive. Alaska's Quality and Patient Safety Environment will also be improved greatly when it incorporates the Centers for Disease Control and Prevention's Guidelines for Field Triage into its State Trauma System Plan, which ultimately will improve the care received by the state's emergency patients.