Healthcare delivery in times of crisis - Disaster Management in Focus

Healthcare delivery in times of crisis - Disaster Management in FocusHealthcare Review, Nov 26, 2001 by Calvin Bruce

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Every facet of our society, government, and economy were affected by the unfolding story of terrorism striking the homeland. An important lesson to learn from these tragedies is the necessity to prepare for the "unthinkable."

From the standpoint of healthcare delivery, how prepared is the nation to handle additional crises of such a magnitude? Based on their public statements, many governmental and healthcare organizations are serious about their responsibility to contribute to our nation's responsiveness to any worst-case scenario.

Federal Government Responses

Since September 11, the federal government has worked feverishly to prepare for any widespread health threats. Secretary of Health and Human Services (HHS) Tommy Thompson has addressed the matter in numerous televised speeches. His reassurance is that the US has intensified its overall preparedness for any possible biochemical attack, although more needs to be done.

To minimize panic over the recent anthrax incidents, Thompson mentioned that the US has 400 tons of antibiotics to treat up to 12 million anthrax cases. He has asked Congress for another $1.5 billion--on top of the 2002 budget request of $345 million--in order to expand the nation's pharmaceutical stockpile, develop new tools to fight bioterrorism, increase local and state readiness, improve food safety, expand HHS response capabilities, and produce up to 300 million doses of smallpox vaccine to cover all Americans.

The Centers for Disease Control and Prevention (CDC), an HHS agency, is at the epicenter of the federal government's response to any national medical crisis (see www.bt.cdc.gov). Specifically, the CDC is linked to a network of 81 laboratories that continually monitor any suspicious threats to pubic health.

In July 2000, the CDC issued bioterrorism guidelines for communities to adopt as part of their overall disaster plans. Special emphasis was placed on the importance of hospital emergency rooms being prepared for major trauma cases. The guidelines stressed the benefits of hospital-wide planning, securing advice from terrorism experts, conducting worst-case scenario drills, and drawing upon community resources such as fire departments' hazardous materials teams.

The threat of smallpox contagion is even more alarming. In early November, the CDC announced immediate plans to inoculate medical teams with smallpox vaccine, along with providing them with special readiness training to respond to any possible outbreak (see www.cdc.gov/od/oc/media/pressrel/r011104p.htm).

Making this public announcement is reassuring in one sense. But it does raise concern among millions of American citizens who are increasingly nervous at the prospect of more insidious biochemical attacks occurring.

Organizational Responses

Other prominent organizations have addressed the importance of adequate preparation for any major threat to our nation's health.

The National Association of County and City Health Officials has implemented programs designed to help local municipalities prepare for and respond to any major health threats, such as bioterrorism, outbreaks of communicable disease, or major environmental health threats (see www.naccho.org/files/documents/explanatory.html).

The Center for the Study of Bioterrorism and Emerging Infections is affiliated with the Saint Louis School of Public Health. The Center's Web site includes timely articles and case studies on bioterrorism, related research projects, educational resources, and an extensive bibliography (see www.slu.edu/colleges/sph/bioterrorism/index.html).

At a 2000 interim meeting of The American Medical Association, its House of Delegates adopted recommendations contained in the report "Medical Preparedness for Terrorism and Other Disasters" (www.ama-assn.org/ama/pub/article/2036-4967.html). It recommended creation of a public-private entity that would coordinate community-wide medical responses to terrorist activity. This entity would bring together federal, military, and public health content experts with medical educators and representatives of medical societies. Their tasks would include preparing educational material discussing "disaster material" and appropriate medical and community responses to potential terrorism.

The American Hospital Association (AHA) is a partner in the National Bioterrorism Preparedness and Response Initiative. This organization offers physicians and other healthcare professionals updated information and insight on terrorism, weapons of mass destruction, and effective disaster preparedness.

The AHA's report "Hospital Preparedness for Mass Casualties" (www.ahapolicyforum.org/policyresources/Modisaster.asp) stresses a response that involves mobilization of all hospital personnel, access to community resources, and maximizing internal and external communication systems. The report addresses the myriad of policy, operational, and financial issues involved in a given hospital's rapid response to a mass influx of patients in a time of confusion and panic.

How Prepared Are Healthcare Facilities?

Being prepared theoretically and in actuality are two different things. On the Web site for the Center for Civilian Biodefense Studies (CCBS), several articles seriously question how prepared our US healthcare system is to handle massive medical emergencies (see www.hopkins-biodefense.org).

Particularly incisive is the online Congressional testimony of Tara O'Toole, MD, a Senior Fellow with the CCBS. In her assessment, the "US healthcare system is operationally fragile and inelastic.... Even small increases in demand are enough to bring hospitals to a point of crisis."

Hospitals and healthcare organizations of all sizes face the same problem, according to O'Toole. "The lack of surge capacity in American hospitals is such that few, if any, hospitals could handle a sudden influx of 100 patients needing advanced life-support care. No city in America, and no contiguous geographic region, could handle 1,000 patients suddenly needing advanced medical care," (see www.hopkins-biodefense.org/pages/library/fema.html).

It should provide some reassurance that many governmental and healthcare organizations--along with individual hospitals--are strengthening their overall readiness and responsiveness to any potential crisis. On the other hand, it's apparent that much more needs to be done throughout the US healthcare system to prepare for any worst-case scenario. One can only hope that should that occur, those who are entrusted with securing our health and safety will be up to the task.

Calvin Bruce serves as senior staff writer for J&C Nationwide in Atlanta, GA. He has published articles in publications such as Healthcare Business and Healthcare Review

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