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America Unprepared for Disaster

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

Disaster Waiting to Happen continued...

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."

Preparing for the Next 9/11

Redlener says that there's no scientific way to know exactly what hospitals should prepare for. So he's calling for a major, national effort to agree on what preparedness should look like.

"In my 30 years in health care, this is probably the most crucial, most critical agenda I have had the opportunity to work on," he says. "I am very, very worried. We don't have to be this unprepared. It is fixable. It is not as though we have a huge asteroid on a fixed path to hit the earth. We can prepare for disasters, whether it's terrorism or an industrial accident or a natural event. We now have an opportunity --- and an obligation -- to prepare."

Kellermann has worked out a detailed action plan. In a nutshell, the plan is to convene, reform, and re-engineer:

  • Convene: This calls for a high-profile meeting of federal and state officials and representatives of hospital and medical associations to identify what each player can do.
  • Reform: These are things that cost little to do. Most involve tweaking regulations and reimbursement formulas to give hospitals a financial incentive to prepare for disasters.
  • Re-engineer: This means targeted investments in emergency medicine and disaster preparedness. It also means training more emergency medicine doctors, nurses, and emergency medical technicians.

"My watch reads Sept. 4," Kellermann says. "In a week it will be Sept. 11. We don't have a lot of time left before something happens again, and wakes us up to these issues. But that is a hell of a way to run health policy in this country."

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Reviewed on September 05, 2003

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