In 2005, hurricanes were the “outside” factor that had the greatest and most lasting effect on emergency planning in healthcare. The 2005 devastation of the Gulf States by Hurricanes Rita and Katrina led to major changes, in 2006, in emergency planning for healthcare institutions throughout the country. The need for better evacuation planning spurred numerous multiple initiatives as hospitals and nursing homes used a considerable share of their scarce resources gearing up for future evacuations of uncertain magnitude and at uncertain times.
In much the same way, the international as well as national warnings earlier in 2009 about the H1N1 (Swine Flu) virus had healthcare institutions re-tooling their emergency plans so they could respond to a potentially much greater health threat from this disease, predicted to hit during the flu season of 2009/2010. In December 2009, on the eve of the second decade of the 21st century, emergency planners at hospital and healthcare institutions will have to decide what they must do to better prepare for this still looming disease, and other major threats, in 2010 and beyond.
The Next Wave: Other Infectious Diseases?
Perhaps the most obvious place that healthcare will be focused at the start of the next decade will be viruses such as H1N1. The challenges of monitoring for index cases, using limited vaccine supplies as judiciously as possible, accelerating vaccine deliveries (including extra supplies for those segments of the population requiring multiple doses), studying the potential vaccine side effects, and preparing for an increase in emergency-room visits are issues that already have frustrated, and will continue to be major concerns of, emergency planners.
The newly emerging diseases will create planning initiatives for healthcare whether or not a virus becomes pandemic in size. A deadly infectious disease will continue to create challenges in the areas of supply chain issues, staffing problems (due to sick employees or staff family members), stockpile concerns (anti-viral medications, breathing masks and personal protective equipment, respirators, and other equipment, and a host of other supplies), and, most important of all, the hospital surges that such diseases produce.
Emerging new diseases will most probably be the single most significant challenge facing the nation’s healthcare community throughout the next decade. A recent review by the New York State Department of Health on how hospitals reacted to the H1N1 flu surge, both in New York City and on Long Island, revealed that the U.S. healthcare system is still not adequately prepared to deal with such events. Seasonal flu, the H1N1 virus, avian flu, and the newly emerging diseases will, therefore, continue to be major problems for healthcare planners to contend with for many years to come.
Surge Capacity, Hospital Security, and Related Factors
After two relatively quiet storm seasons, U.S. hospitals and nursing homes are still faced with the challenge of deciding: (a) when to shelter in place – i.e., decide not to evacuate anyone; (b) when to partially evacuate patients who are not at serious risk to be moved; and (c) when to actually start a full evacuation of their institutions. Future hurricanes will probably continue to be the major catalyst for such planning, but other hazards – fire, for example, or a loss of power, a terrorist incident, extreme wind damage, or similar disasters – can force healthcare leaders, ready or not, to make evacuation decisions without always having all of the facts needed to make the best possible choice.
Because of the now well-documented 2005 experiences from Gulf Coast hospitals and nursing homes, however, most institutions have planned ahead of time for sudden evacuations than ever before in the nation’s history. With predictions of climate change resulting in even more major storms, this hazard also will continue to be high on emergency-planning HVA (hazard and vulnerability analyses) lists.
Hospital surge caused by other than flu – the shooting massacres at Virginia Tech in 2007, for example, and Fort Hood, Texas, in 2009 – will challenge planners for the next decade as well. Since the 2001 World Trade Center terrorist attacks, the United States has been relatively free of manmade mass-casualty incidents (MCIs) such as suicide bombings and CBRNE (chemical-biological-radiological-nuclear-explosives) incidents – accidental as well as intentional – but healthcare planners logically realize they may well see an increase in these over the next decade as well. Planners must, therefore, also focus on the fact that healthcare institutions themselves have become targets. If healthcare planning at every level of government does not include the protection of healthcare institutions themselves, the nation could quickly lose many of these facilities and, without them, the ability to care for the most seriously sick and injured who have the greatest need for such care.
Planning efforts to make hospitals both more secure and more adaptable to a major as well as unexpected patient surges are vital in the coming decade. However, because surge incidents are usually few and far between, it will be difficult for hospital administrators to continue to justify major financial commitments for what seem to be “unlikely” scenarios. In the area of surge and security for hospitals, such planning may actually decrease, therefore, unless new incidents refocus institutions on this specialized area of planning and funding.
A New Focus on Overall Healthcare Preparedness
Over the next decade, healthcare institutions also must learn to use their preparedness resources in ways that can affect, and improve, daily operating efficiencies so that the costs involved can be justified by the institutional decision makers. Without sustainable funding, hospital emergency-preparedness capabilities will be much more difficult to maintain.
One possible way to at least partially resolve this problem would be through the concept of continuous institutional awareness or readiness. This type of sustainable program can be used by institutions to react to day-to-day issues, not just emergencies. The routine availability of a hospital command center or HICS (Hospital Incident Command System) unit can help alleviate numerous problems ranging from a Friday night surge in the emergency department to the repair of a broken water pipe that floods an operating room to the rapid institutional reaction to a loss of computer/communication services.
In other words, if a hospital uses the emergency-management structure it has developed to react to disasters of an everyday nature, it can save money while increasing efficiency at the same time. This will or should be sufficient to justify a sustained budget for emergency management in the hospital setting. It also would permit hospitals to use the HICS training and infrastructure developed during the first decade of the 21st century to sustain and perhaps even improve hospital emergency planning during the century’s second decade.
Theodore (Ted) Tully, AEMT-P, is President of STAT Healthcare, an Emergency Management consulting group. He previously served as Administrative Director for Emergency Preparedness at the Mount Sinai Medical Center in New York City, as Vice President for Emergency Services at the Westchester Medical Center (WMC), as Westchester County EMS (emergency medical services) Coordinator, and as a police paramedic/detective in Greenburgh, N.Y. He also helped create the WMC Center for Emergency Services, which is responsible for coordinating the emergency plans of 32 hospitals in the lower part of New York State.