Lott on Healthcare
James Lott is Executive Vice President of the Hospital Association of Southern California
Urgent Rehab Needed For Bioterrorism and Disaster Preparedness in California (Mar 17, 2008, 12:46 PM PDT)
Urgent Rehab Needed For Bioterrorism and Disaster Preparedness in California
According to a recent report by PriceWaterhouseCoopers, few regions in the United States have the appropriate hospital surge capacity to cope with a major disaster. Funding on the national level has been relatively low: "The federal government spends less than $5 per person annually to pay for health systems and agencies to be prepared for a disaster. More money is now spent to stockpile drugs and supplies than to hire and train health providers to treat disaster victims," the report states.
The study further notes that California received far more federal disaster preparedness funding than any other state - $143.2 million in 2007. Yet that works out to $3.93 per capita, significantly below the nationwide average of $4.30. By contrast, rural - and far less populated - states such as North Dakota, Alaska and Wyoming received $11.24, $10.73 and $13.40 per capita, respectively.
According to PriceWaterhouseCoopers, Los Angeles County has nearly 1,500 excess beds in case of a disaster. However, bed availability does not equal preparedness for a mass emergency. Special equipment - such as isolation rooms and decontamination equipment - would play a key role. According to a 2006 survey of hospital disaster preparedness in Los Angeles County, more than half of responding hospitals "had fewer than 10 designated isolation rooms…or warm-water decontamination showers and an antibiotic stockpile...less than one-third of hospitals had immediate access to six or more ventilators, suggesting a significantly limited ability to respond to a biological or chemical event resulting in multiple victims with respiratory failure."
In a contrast to the PriceWaterhouseCoopers conclusion, the Los Angeles County survey notes that "more than half (of surveyed hospitals) were on ambulance diversion more than 20% of the time, and less than one-third claimed to have a surge capacity of more than 20 beds."
If Southern California's hospitals can't handle patient inflow even during the course of a normal day, I have grave doubts about how the region would do in a disaster scenario. EMS experts are certain that Southern California's emergency rooms would be almost immediately overwhelmed in the wake of a major terror strike or some other incident with a large number of casualties, particularly if initial television news reports are overhyped. Some predict a surge as high as 1:1,000, or 1,000 patients seeking treatment for every patient that is hospitalized.
Moreover, there are significant concerns about what would happen at hospitals in response to a bioterror incident. There are questions as to whether essential medical staff would report for work, or leave the area with their families. According to the Trust for America's Health, only 43% of hospitals surveyed say they have any incentives to ensure staff reports during an emergency. In a scenario suggested by some, they would report for duty, but insist on keeping their families on the hospital campus for protection. This would likely creating logistical logjams, divide the attention of staff and perhaps even expose more people to a mass contagion.
Patients hospitalized prior to any incident may also be particularly vulnerable to whatever virus might be circulating. "Although hospitals are the first places that or smallpox or plague patients would likely turn to, they are actually the last places where public health personnel should want them to go," according to a 2005 UCLA School of Public Affairs report on improving bioterror response in L.A. County. "Smallpox and plague prey upon groups with special needs - especially patients with cancer, HIV…and pregnant women…smallpox, in particular, finds a hospital a good environment for spreading.
Given these conditions, coordination among the region's hospitals would be absolutely crucial in the wake of an attack. Yet only 23% of the community hospitals in Los Angeles County surveyed had mutual aid agreements with other critical care facilities. None of the public hospitals had such agreements in place.
According to the PriceWaterhouseCoopers study, funding for the federal Hospital Preparedness Program has been in decline since 2004, when it reached $516 million. It was only $415 million in 2007. Of that, up to 25% can go to non-hospital providers such as EMS and outpatient clinics.
In such an environment, the likelihood of innovation continuing in great strides seems remote. Although the emergency drug supply has been built up - federal spending on the Strategic National Stockpile has more than doubled since 2003 - there are doubts about the ability to swiftly and effectively distribute these crucial pharmaceuticals, as funding for staff, systems and training to manage the SNS has been in decline. Moreover, fewer than 10% of health professionals believe that primary care physicians are properly trained to respond to a disaster, even though they are likely to be on the front lines of any sort of bioterror incident.
Did You Know?
Front-line healthcare workers in California would be quickly overwhelmed in a disaster or terrorism event producing mass casualties. Reimagining the way our initial response system and capabilities are configured is urgently needed.
