Economic Disaster Diverts Attention from Emergency Preparedness

John Commins, for HealthLeaders Media , April 23, 2009

The deep recession that is threatening a financial disaster for many of the nation's hospitals also may be distracting them from preparing for a mass-casualty event like a terrorist attack, an earthquake, or a hurricane.

"It would be fair to say there has been some attention diverted from this," says Rosylne Schulman, senior associate director of policy development at the American Hospital Association.

"Part of a hospital's mission is to be prepared for emergencies and disasters and to take care of their communities. However, this recent downturn has drawn some of that attention away to pure survival," Schulman says. "Hospitals are looking at the reality of their financial situation and comparing that to the relative unlikeliness of a catastrophic disaster. Their primary focus is on continuing to serve their communities as a financially viable institution."

Nearly eight years after 9/11, the nation's hospitals are still in danger of being overwhelmed by mass-casualty disasters and public health emergencies, a new HHS-sponsored study released this week shows.

However, the University of Pittsburgh Medical Center – Center for Biosecurity independent evaluation of the HHS Hospital Preparedness Program also found that hospitals have made significant strides to improve preparedness in the immediate five years after the terrorist attacks.

The Biosecurity Center was charged with conducting an independent evaluation of HHS' Hospital Preparedness Program and its impact on healthcare preparedness for mass casualty disasters. The program was established after 9/11 to improve hospitals' preparedness for all types of disasters.

The study, which evaluated HPP from 2002 to 2007, found that healthcare planning for catastrophic emergencies at individual hospitals is still rudimentary and that a large-scale emergency could "overwhelm the medical capabilities of communities, regions or the entire country and require drastic departures from customary healthcare practices."

While acknowledging that more needs to be done, Schulman says the approximately $3.4 billion in federal funding since HPP's inception has been critical to improvements in disaster preparedness. "It sounds like a lot of money, but if you divide it up among the 5,000 or so acute-care hospitals in the country, it turns out to be very little per hospital," Schulman says. "But it draws attention to the issues in hospitals. It helps to focus their internal assessments of what they have and what they need and how far they need to go."

Schulman says AHA is lobbying Congress and the Obama administration in the hopes of getting more HPP funding, or at least avoiding cuts.

The HHS study determined that the most useful indicators for measuring disaster preparedness include a hospital’s ability to surge to accommodate additional patients during disasters, how well hospitals do in training their staff for disasters and realistic exercises, and—of course—how well hospitals perform during actual disasters.

The evaluation found that hospital leaders are more supportive of disaster preparedness, that hospital disaster preparedness plans are more comprehensive and better coordinated with local emergency management agencies, and that overall disaster training has become more rigorous. In addition, hospitals have stockpiled emergency supplies and medicines, improved communication systems, and now conduct more frequent and higher quality disaster exercises.

Schulman says the hospital sector understands the importance of disaster preparedness. "This is competing with many other very important priorities and it's a hard job deciding where we are going to spend taxpayers’ dollars," she says.

The study’s findings are based on a year of research and analysis, including interviews with 133 people involved with hospital preparedness in every state and at local levels across the country. 

John Commins is a senior editor with HealthLeaders Media.

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