Are We Ready?
A large-scale disaster like a pandemic flu or terrorist attack could overwhelm the nation's healthcare providers
Brian O'Neill is paid to worry. As vice president of emergency services for the North Shore-Long Island Jewish Health System, he is charged with making sure his organization's 15 hospitals are prepared for a nightmarish list of naturally occurring and man-made threats. What would happen if there were a repeat of the Long Island Express, the 1938 hurricane with 121-mph winds that destroyed 4,500 homes and killed 700 people? What if healthcare workers battling infectious disease in protective gear got overheated and exhausted? What if staffers were stranded in their homes by the weather? If any of these situations became a reality, the system's emergency preparedness center, located in an inconspicuous, low-slung building in the Long Island town of Syosset, would spring to life. Emergency workers would don the reflective vests now draped over chairs, consult binders filled with contingency plans, and examine chain-of-command charts. "We plan for everything," O'Neill says, "and hope for the best."
Some hospitals in big cities and high-risk areas are well prepared to cope with individual disasters like, say, a plane crash. But overall, the nation's healthcare system is not yet ready to handle a large-scale emergency like pandemic flu or another major hurricane. That was the consensus of experts assembled at last week's U.S.News & World Report Health Summit on emergency preparedness. "The problem is, we are just good enough for what happens now," said panelist W. Frank Peacock, chairman of emergency preparedness for the Cleveland Clinic. "We have trouble now managing flu in February across the country." Added summit panelist Arthur Kellerman, chairman of emergency medicine at Emory University Hospital in Atlanta: "Our trauma and emergency care system in this country is absolutely stretched like a piano wire."
Contingency plans. In fact, the Trust for America's Health, a nonprofit group focused on public health and disease prevention, recently gave the federal government a D+ for emergency preparedness. Almost 60 percent of states failed to meet more than half of the group's requirements, which include things like having the lab capacity to quickly test thousands of samples for anthrax or smallpox. Meanwhile, hospitals nationwide say U.S. funding woes and lack of guidance make it hard to enact contingency plans. Over the past few years, Johns Hopkins Medicine has spent $10 million on emergency preparedness, said summit panelist CEO Edward Miller. "And it comes out of other programs we are not funding," says Miller. "This is not a sustainable business plan."
The best preparedness approach, most experts say, is to plan for "all hazards," concentrating on the common elements shared by most disasters, rather than planning separately for an individual event. It doesn't matter whether it's a hurricane, terrorist attack, or pandemic. "You have a certain number of trauma patients, a certain number of infections, a certain number of respirator requirements," says James James, director of disaster preparedness for the American Medical Association. And all catastrophes require sufficient surge capacity--enough staff, supplies, and space to treat patients--and a coordinated response by healthcare providers in monitoring potential outbreaks and managing the influx of injured.
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