Hospital and Health Care Preparedness Report Requires Heeding

Hospital Week a Good Time to Apply Lessons Learned

By Michael Barrick

National Hospital Week is next week, May 11-17. Though the valuable work of the millions of hospital clinicians, physicians, administrators and support staff is certainly worthy of celebration, it is also an opportunity to reflect upon the state of hospital and health care system preparedness for our ever-changing world.

This is not a question I raise. It was raised last week in numerous news reports. On May 5, numerous national news outlets reported that hospitals are simply not prepared to meet the demands of a pandemic or other potential risks such as catastrophic natural hazards or terrorist attacks. The sources of those reports were none other than doctors, researchers and academicians from the Department of Homeland Security, the Centers for Disease Control and Prevention, and the Department of Health and Human Services.

Recognizing that hospitals would be overwhelmed in certain scenarios, these health care leaders issued a wake up call to the public. In speaking with family members and friends as this news was being reported, it was clear that the message had been heard. As a result, people are concerned. That’s good. From concern is born a deeper awareness. That awareness could lead the public to demand that the federal government take a fresh look at disaster statutes like The Stafford Act and other revenue streams for local responders and receivers.

Meanwhile, with this group of health care leaders offering very specific – and startling – recommendations such as not providing care for people over 85 or with severe chronic disabilities should systems be overwhelmed – it is perhaps fitting that hospitals not only celebrate next week; it is also an opportunity to study history in order to defy the predictions of these leading health care experts.

One such way is to examine the sarin nerve gas attacks in Japan in 1995. While terrorist attacks obviously represent different threats than other hazards, this event so overwhelmed local hospitals that its lessons apply to multiple scenarios.

In March of that year, residents of Tokyo using the subway system were victimized by a sarin nerve gas terrorism attack. Perpetrated by the Aum Shinrikyo cult under the leadership of Chizuo Matsumoto (AKA Shoko Asathara), this attack offers the United States health care system numerous lessons to be learned in the event of an attack by terrorists using Weapons of Mass Destruction (WMDs) or other mass-casualty events.

Terrorists are willing to kill thousands, kill indiscriminately, and use WMDs. Only small amounts of WMDs are needed to cause mass casualties. Symptoms are difficult to recognize because medical staff are unfamiliar with them. And, health care institutions will be quickly overwhelmed because of the huge patient surge and because victims and the “worried-wounded” will self-transport. First responders and receivers may be contaminated, depleting valuable human resources. Also, a large percentage of “victims” may not actually be infected, but will, in a panic, respond to the nearest health care facility, making it difficult for caregivers to discern between those actually afflicted and those who are psychosomatic.

Consequently, there are a number of steps that communities must take to mitigate, prepare for and respond to mass casualty events caused by WMDs or other mass casualty events. Medical staff must be thoroughly trained to recognize symptoms of WMDs, including nerve agents, smallpox, anthrax and other potential weapons. Hospitals, health departments and first responders must dramatically improve cooperation, and, as U.S. Army Major James Hanlon has said in lectures delivered to students of the University of North Carolina, “We must begin planning for the most catastrophic events now…We need to develop and integrate detection and surveillance capabilities….Equipment such as decon apparatus and personal protective equipment must be addressed (and) issues such as heating ventilation and air conditioning systems and the ability to quarantine large sections or entire hospitals will have to be addressed.”

Again, while this is a terrorist attack from which we draw lessons, many of the structures developed in response to this lesson are also essential for planning for and responding to a pandemic, natural disasters or other man-made events such as mass shootings or infrastructure failings, such as the bridge collapse in Minnesota.

My sense is that hospitals are responding. With new stringent standards from the Joint Commission for hospital emergency management plans and other upcoming changes, along with the adoption of the National Incident Management System and Hospital Incident Command System, hospitals are planning for disasters as never before. Still, the wake-up call has been issued and the public stirred. In response, hospitals would be well-served to give notice to the public they serve that they, health departments and first responders are committed to working together to ensure interoperability and adequate preparedness through funding, ongoing training and other measures.

© The Barrick Report and Emergency Preparedness Today,  2009. Contact the author at mbarrick@charter.net.