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America Unprepared for Disaster

2 Years After 9/11, Lack of Preparedness "A National Crisis"
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WebMD Feature

It couldn't happen here. Before 9/11, that's what we used to think. We've known better for two years. Yet America remains unprepared to deal with disaster, experts say.

A big part of the problem is that hospital emergency departments already run at -- and over -- full capacity. Even a relatively modest disaster would overwhelm most cities' public health systems. This problem started before 9/11 -- and is getting worse, not better.

Why aren't things going according to plan? Because there is no plan, says Irwin Redlener, MD, director of the newly-created National Center for Disaster Preparedness at Columbia University's Mailman School of Public Health.

"This is a national crisis," Redlener tells WebMD. "I am very dismayed about where things stand at this time. We are telling the health-care system to get ready for bioterror, for example. But we are not telling them exactly what that means. And we are not giving them sufficient money or guidance. ... It is absurd to the point of lunacy."

A Chorus of Concern

Redlener isn't the only expert raising the alarm. Here's Arthur Kellermann, MD, MPH, chair of Emory University's emergency medicine department, a member of the board of the American College of Emergency Physicians, and a member of the National Institute of Medicine.

"This is a nationwide crisis and nobody wants deal with it," Kellermann tells WebMD. "Nothing has been done to address the problem of emergency room overcrowding and too little hospital capacity. Nothing -- capital N-O-T-H-I-N-G -- is being done on a national level."

And meet Emanuel Rivers, MD, MPH, director of emergency medicine research at Detroit's Henry Ford Hospital.

"Without a doubt we are going in the wrong direction," Rivers tells WebMD. "Increasing emergency room overcrowding is a very significant weakness in our ability to respond to any crisis. Look at the general deterioration of capacity in hospitals around the country. If we had a national crisis, we would have a much worse problem today than we would have had in 2001."

James Bentley, PhD, is the American Hospital Association's senior vice president for strategic policy planning. He says individual and regional hospitals have made huge improvements in disaster preparedness since 9/11. But he, too, says the lack of a national strategy creates problems.

"There is a lot of frustration in whatever state you look at, because the federal government is unwilling to say, 'OK, here is what we plan for,'" Bentley tells WebMD. "So Georgia could plan for one thing, and South Carolina and Alabama plan for something quite different."

Disaster Waiting to Happen

In a recent article in Emergency Medicine Journal, Rivers and co-author Stephen Trzeciak, MD, note that hospital emergency departments are America's safety net. But that net is dangerously frayed.

"The number of emergency room visits have gone up by 10 million to more than 100 million per year -- yet there has been a 20% decrease in number of emergency departments," Rivers says. "That translates into overcrowding. And a number of hospitals are downsizing, so fewer beds are available. With less money coming in, hospitals have lowered their capacity. Supply and demand have disassociated."

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