Lack of funding leaves communities vulnerable
Despite 9/11 and its anthrax aftermath, the majority of hospitals and their surrounding communities have slipped back into "complacency" and are dangerously unprepared for bioterrorism or other mass casualty events, according to the Joint Commission on Accreditation of Healthcare Organizations. A recently released report by a panel of experts convened by the Joint Commission warned of a "brewing cataclysm" of underfunding, inexperience, and unpreparedness of emergency response capabilities across America’s communities. This vulnerability, the report stressed, must be urgently addressed by local, state, and federal authorities.
"The events of Sept. 11 and the subsequent anthrax attacks provided a startling wake-up call about this country’s emergency prepared-ness shortcomings," Dennis O’Leary, MD, Joint Commission president, said at a press conference held to release the findings.
"But across the country, people today seem to be slipping into a comfortable complacency about emergency preparedness," he added. "In most of America’s communities, there has been no mobilization, nor have the funds and resources been provided by the federal and state governments truly at the local level to make this possible."
O’Leary was asked specifically by Bioterrorism Watch whether that "complacency" was evidenced in the reluctance of many hospitals to immunize workers against smallpox. "Complacency is probably too strong a term in this context," he replied. "But I do think if you are a caregiver — a doctor or nurse and you are looking at this issue — what you’re weighing in your head is what is the risk of vaccination vs. how real do I think this smallpox risk is. That’s human nature. I think that there is some feeling that this smallpox risk is not really that great. It kind of typifies the general feeling. It’s a hard commentary that until something else happens it’s hard to get peoples attention. One smallpox case; it’s a different story."
The report was prepared in consultation with a 28-member panel, which included representatives of various federal and state agencies, frontline emergency care providers, emergency preparedness planners, and public health and hospital community leaders. Noting that virtually all disasters, including intentional terrorist events, will be experienced at the local level, the report emphasizes that many communities will be on their own for the first 24 to 72 hours.
The response that must be mobilized will, at a minimum, require the active involvement of emergency medical services, fire, police, hospitals, public health agencies, and municipal and county leaders. This is no task for a single hospital or agency, the report said.
"Many of our large metropolitan areas, such as New York City and Washington, DC, are far better prepared to deal with terrorist attacks and other disasters than they were before Sept. 11," O’Leary said. "However, most of America’s communities are at the stage of waiting for someone to call the meeting."
The report urged community leaders to convene that meeting, calling together local emergency management agencies, public health agencies, hospitals, and municipal and county leaders. The report goes on to detail the critical elements of good emergency management programs, and goes so far as to urge the creation of a federal program to hold communities "accountable" for such plans.
"The potentially involved players today do not, in most communities, work with or even talk with each other on a regular basis," O’Leary said. "Most are lone rangers that are used to being simply in control." Beyond the lack of communication and cooperation, there is a problem getting adequate funding to individual communities. Securing promised federal funds at the local level has been an historic problem, but the fiscal barriers were supposed to be torn down after 9/11, he said. "The federal government needs to feel a little more pressure and heat about making this happen. We are advised that the money kind of moves to the state levels and it gets hung up there in the budget allocation processes."
Complacent or cash-strapped?
Panel member Mark Ackermann, senior vice president and chief corporate services officer of Saint Vincent’s Catholic Medical Centers in New York City, stressed just how expensive it is to prepare for bioterrorism and natural disasters.
"Of the preparedness we are doing in our health care system — which is seven acute care hospitals — we anticipate we are going to need to spend about $10 million," he said. "Our board has already committed $2.5 million of that, which has been spent. We have received a total of $40,000 thus far from the federal government. I think that gives you an example of the timing issues here and the magnitude of the money."
Given those kinds of dollars, the $500 million earmarked by the federal government for emergency preparedness next fiscal year is not going to go very far. Hospitals are particularly vulnerable because the system has shrunk capacity to remain viable over the past two decades, the report stated.
"This has translated into the closure of many hospitals and even more emergency departments, despite the escalating demands for services," the Joint Commission panel said. "In addition, many hospitals now are experiencing severe shortages of nurses and other essential health care personnel. This is further reducing the capacity of these hospitals to deliver care, including emergency care. Today’s hard reality is that hospital emergency departments across the country are overcrowded and, even absent any external disaster, likely to be diverting patients on any given day."
Exacerbating the situation are several other factors, including soaring liability insurance premiums for physicians, state reductions in the number of people on Medicaid rolls, threatened Medicare cuts, and increasing demands for care of the uninsured.
Health care and community planners can stretch dollars by overlapping disaster plans where appropriate, taking an "all-hazards" approach that covers both bioterrorism and natural disasters, says panel member Edward J. Gabriel, M.P.A., EMT-P, deputy commissioner for preparedness at the New York City Office of Emergency Management. "You can use any of the pieces of preparedness for any particular kind of attack," he said. "For example, if you are getting a large hurricane into a particular area, you are going to need evacuation routes. So you can use the same framework by which you do an all-hazards planning drill for most of the major pieces of a terrorism-related drill."
(For a complete copy of the report, see Health Care at the Crossroads: Strategies for Creating and Sustaining Communitywide Emergency Preparedness Systems, at http://www.jcaho.org.)
Despite 9/11 and its anthrax aftermath, the majority of hospitals and their surrounding communities have slipped back into complacency and are dangerously unprepared for bioterrorism or other mass casualty events, according to the Joint Commission on Accreditation of Healthcare Organizations.
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