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
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
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."