JCAHO president calls for bioterror preparedness
The Joint Commission on Accreditation of Healthcare Organizations is urging Congress to act quickly to improve the nation’s bioterrorism response capacity by developing systemwide, integrated community approaches to emergency management, with support from the federal and state levels. The nationwide improvement may follow improvements that are already underway on a smaller scale at most hospitals across the country.
At bioterrorism hearings before the Subcom-mittee on Oversight and Investigations of the House Committee on Energy and Commerce, Dennis S. O’Leary, MD, president of the Joint Commission, said the health care system already has in place much of what is needed to respond to bioterrorism, but more work is needed.
"We as a nation are not unprepared to deal with bioterrorism, but this country’s public health and medical care systems could be better prepared than they are today," O’Leary said. "We need to start addressing the identified needs with all due haste."
O’Leary called for these improvements:
- Medical care workers must be trained to become familiar with pathogens that may be used in bioterrorism, aware of the symptoms they produce, knowledgeable about their routes of transmission, and alert to the possibility of their use.
- A single, integrated system of response must be created to effectively address a full range of diseases and rare events, whether of terrorist or natural origins.
- Community or statewide capacity analyses of preparedness that include available medical facilities and delivery sites must be carried out.
- A medical/public health surveillance system should be established to promptly detect naturally occurring epidemics as well as terrorist activity.
- Issues relating to precious national supplies (e.g., vaccines) and their disbursement need to be evaluated and resolved.
- National funding policies, which have progressively reduced the elasticity of the medical system to ramp up to a peak demand, must be re-evaluated.
"If the system capabilities are appropriately upgraded, the medical care and public health systems will be able to respond effectively to massive disasters," O’Leary added.
Cameron Bruce, CSP, PE, a health care consultant in Orinda, CA, says hospitals should review their emergency preparedness plans to ensure that they include the threat of bioterrorism. While most plans will have some mention of such a threat, plans written prior to Sept. 11 probably did not take the threat seriously enough, Bruce says.
"Now we know that just about anything could happen. The things we just barely touched on before now deserve another look," he says. "You probably won’t have to start from scratch, but you’ll probably have work to do."
The emergency preparedness plan should be designed with practicality in mind, Bruce advises. Think of actually using the plan and making it useful, rather than trying to just prepare something that will pass the Joint Commission’s review.
"The Joint Commission’s requirements aren’t all that strict, and if you just do it for them, you’re not going to have what you need if you have to respond to bioterrorism," he says. "Write it for yourself."
Bruce says he is encouraged by the response of hospital quality professionals so far. There was an immediate increase in interest after the Sept. 11 attacks, and Bruce says he believes many health care organizations will have greatly improved their emergency preparedness plans by the early part of 2002. (For more on how to revise an emergency preparedness plan for bioterrorism, see Hospital Peer Review, November 2001.)
Previous improvements serve current need
In his testimony to the subcommittee, O’Leary pointed out that some of the Joint Commission’s recent strengthening of its emergency preparedness requirements are paying off.
"Several years ago, in a move that now seems prescient, the Joint Commission decided to develop new standards that would broaden the ability of individual health care organizations to deal with rare events. At that time, we had become concerned that the medical system was inadequately prepared to deal with the rare threat of bioterrorism, and perhaps equally unprepared for the greater possibility of infectious outbreaks arising from an increasing global inventory of virulent infectious agents. Regardless of the source of the threat, readiness for managing biological events has certain common elements."
He went on to explain that the Joint Commis-sion’s accreditation standards were modified in three ways, all of which infused the concept of community involvement into the preparedness process. First, the Joint Commission shifted the focus of the standards from simple emergency preparedness to emergency management. Now health care organizations are expected to address four specific phases of disaster planning: mitigation, preparedness, response, and recovery.
"This means engaging in planning as to how an organization would lessen the impact to its services following an emergency; how organization operations might need to be altered during the heat of the crisis; and how to conduct consequency management to return the organization to normal functioning once a crisis has passed," he said.
The Joint Commission requires that when organizations are addressing each of the four phases of disaster planning, they must broaden their preparedness and their perspectives to take into account how the community around them may be affected during a rare event. The new standards, which were effective January 2001, also require accredited organizations to take an "all hazards approach" to planning.
"What this means is that organizations must develop emergency management plans that contain a chain of command approach that is common to all hazards deemed to be credible threats — an approach that also can be easily integrated into their community’s emergency response structure," O’Leary said. "Hospitals must start this aspect of planning by considering a wide variety of threats that could befall their community, including terrorism.
Hospitals, for example, are now required by these new standards to do a hazard vulnerability analysis that starts with an unconstrained list of extreme events, and then critically appraises their probability of occurrence, their risk to the organization and the capacity for responding to each potential threat."
O’Leary also made one point that may be especially important in light of the nation’s fears over anthrax and other threats that experts say are not likely to cause much damage. If the community fears such a threat, the hospital may have to develop a response, he says.
"Inherent in this analysis is having an understanding what the community itself, rather than just the health care organization, considers to be a realistic threat."
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