Are We Ready?
A large-scale disaster like a pandemic flu or terrorist attack could overwhelm the nation's healthcare providers
Surge capacity is the biggest concern. Hospitals can handle some overflow within their walls. Rooms can be reconfigured, elective surgeries canceled, and extra staff called in. But most hospitals simply can't absorb the huge influx of patients that might result from a pandemic or biological attack. So hospitals must plan to use other facilities, such as healthcare clinics or dialysis centers, or malls, stadiums, and schools. Thanks to preplanning by the Louisiana Department of Health and Hospitals, the Pete Maravich arena at Louisiana State University in Baton Rouge, for example, was quickly turned into a field hospital during Hurricane Katrina. The Trust for America's Health says hospitals in almost a third of states haven't sufficiently prepared to handle a surge.
Arranging for temporary space is just the beginning, as field hospitals must be manned. A study released last week found that nearly half of local public-health department staffers would not report to work if there were a pandemic. "When people are worried about their families, they'll put family before work," says Richard Bradley, an emergency medicine physician at the University of Texas Health Science Center in Houston, who noted that a number of his staffers were no-shows two days before Hurricane Rita's projected landfall last year. That's why Kaiser Permanente's Walnut Creek Medical Center, for example, is urging its staffers to make personal preparedness plans--like arranging meeting areas--for their own families, in the hopes they'll breathe easier and report to work if they know their kids are safe. Other hospitals are considering whether to provide child care or offer incentives, like vaccinations that may be in short supply, for employees and their families. And it's not just physicians and nurses who need attention; a hospital can't run without kitchen staff, janitors, and other support workers.
Volunteers. Hospitals also need to ramp up employee preparedness training. "The average physician is very familiar with his or her role as a clinician, but not in terms of his or her role in a public-health response," says James of the AMA, which has developed a standardized curriculum for disaster preparedness training. An example: how to decontaminate a patient exposed to a biological agent.
Conscripting other hands should also be part of any disaster plan. Some experts recommend more active recruitment of volunteer medical personnel for the federal disaster response system (box, Page 62). States and localities need to develop their own volunteer registries, too. Veterinarians, dentists, and out-of-state physicians could be on standby, as well as patients who have recovered from the flu and could perform basic tasks like organizing supplies. One obstacle that emerged during Katrina: finding a way to quickly credential out-of-state medical professionals.
In addition to staff and space, surge capacity includes having enough supplies--from protective masks to medications to disinfectants--to handle a disaster. The Centers for Disease Control and Prevention's Strategic National Stockpile plans to deliver to communities "push packages" of essential drugs and supplies within 12 hours in case local supplies run low, but hospitals and communities still need to be prepared to sustain themselves. That's expensive. It also takes precious space: Kaiser's Walnut Creek facility is exploring whether it can position containers outside; in an area already short on parking, it's hard to find the room. Supplies become more crucial the longer the disaster persists. If a hurricane wipes out access for days--as Katrina did--hospitals need to worry about food, water, and generator capacity.