Chemical accidents occur often across the United States, endangering the health and safety of many people. The Super fund Amendments and Reauthorization Act of 1986 (SARA) requires that communities increase their planning for medical response to these accidents. So far, little evidence has come forth that supports the notion that environmental legislation, such as SARA, improves preparedness for such accidents.

A one-group pretest/post-test longitudinal design was used to survey the medical directors of emergency departments in all acute care hospitals in the State of New York. Data were collected by mail survey and telephone follow-up in 1986 before the passage of SARA (Timel), and in 1989 after its implementation (Time2).

Ninety-four percent of the directors responded at Timel and 72% at Time2. In New York State, hospital preparedness for chemical accidents improved significantly during the study interval. The longer a hospital had a plan for response to chemical accidents, the more elements of preparedness were in place. Further, as a group, the hospitals that were the least prepared were located in the areas at highest risk.

Environmental legislation can influence the manner by which health care organizations prepare for environmental emergencies.

Investigate Emergency Physicians' knowledge about the Superfund Amendments and Reauthorization Act (SARA) Title III legislation, passed by the United States Congress in 1986, and to determine the factors contributing to their level of preparedness in dealing with patients exposed to toxic chemicals.

A 115-item questionnaire was mailed to the medical directors of all emergency departments (EDs) in the State of New York. The results of the cross-sectional survey were analyzed using standard statistical methods.

One hundred and eighty-seven (72%) of the directors of EDs in New York State responded to the survey. Three years after SARA was enacted, only 33% of the directors had heard about this legislation. Only 18% had been invited to attend the meetings of the Local Emergency Planning Committees (LEPC). Sixty percent of the directors knew whether or not the LEPC had devised plans that defined a role for their EDs in responding to environmental emergencies. This knowledge about community planning mainly had an effect on preparedness of the EDs. Preparedness also was predicted by how recently the EDs had treated patients exposed to toxic chemicals, the perception that emergency physicians had a legitimate role in planning for and responding to chemical emergencies, and how often emergency physicians had attended continuing education courses about hazardous materials.

Despite the finding that some emergency physicians are involved in community preparations, two main problems persist in planning a medical response to environmental emergencies. First, the ED directors generally are unaware of the legislation that mandates these preparations and are not interacting with community planners. Second, there is not full involvement by the local EDs in the LEPC planning efforts.

A procedure is needed to disseminate information about legislation which affects emergency physicians, such as SARA, and about regional planning for environmental emergencies. Dissemination should include education about the professions' role in planning for and providing care for patients exposed to toxic chemicals.