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America Unprepared for Disaster

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

It's been going on for a long time before supply catches up with demand. Bentley says hospitals are caught between two opposing forces. On one hand, government and private insurers are cutting down on how much they'll pay for hospital services. That means hospitals take in less money. In response, they become more efficient. This means cutting back on empty beds.

On the other hand, disaster preparedness asks hospitals to keep a lot of spare beds around. But hospitals can't afford to do this.

"For a decade we have been squeezing hospitals like crazy in terms of cutting costs, releasing unused facilities, reducing capacity, and at the same time we are seeing reimbursement rates slow and drop. Hospitals are in a horrible fiscal situation," Redlener says. "If part of preparedness is having hospital surge capacity, we have been working in the exact opposite direction for years. Now we are in trouble. We don't have the comfort zone in hospital budgets that we need for preparedness."

The numbers are stark. According to a 2002 Advancing Health in America survey, 62% of all hospital emergency departments now say they are at -- or over -- their capacity to treat patients. In the cities, it's even worse: Three out of four emergency departments are at or over capacity. One in eight urban hospitals actually turn away ambulances 20% of the time. And this is business as usual, not a national emergency.

It's a dilemma with national security implications. Yet, Rivers and Kellermann assert, it's being ignored.

"Most hospitals in the country aren't sure how to handle tonight's 911 calls, much less a drastic terrorist attack," Kellermann says. "I am frankly baffled as to why individuals trusted with national security and public health aren't engaged in addressing this issue. There hasn't even been a meeting of key players. There have been no discussions of how do we handle a major, mass casualty attack or mass epidemic or bioterror incident."

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