Tuesday, May 06, 2008

In Case of Terror Attack, Good Luck Getting in the Hospital

Not surprising: Emergency rooms in major cities may not be sufficiently prepared for an influx of patients that would result from a major terrorist attack.

There are certainly some politics being played here, but the basic fact that we've lost hospital capacity in general, and ER capacity in particular, is accurate:

[T]he House Committee on Oversight and Government Reform, chaired by Rep. Henry Waxman, D-Calif., conducted a survey of 34 hospitals on March 25 and found that not one was prepared at that moment on that day for a terror attack.

"The situation in Washington, D.C. and Los Angeles was particularly dire. There was no available space in the emergency rooms at the main trauma centers serving Washington, D.C. One emergency room was operating at over 200 percent of capacity: more than half the patients receiving emergency care in the hospital had been diverted to hallways and waiting rooms for treatment. And in Los Angeles, three of the five Level I trauma centers were so overcrowded that they went 'on diversion,' which means they closed their doors to new patients. If a terrorist attack had occurred in Washington, D.C. or Los Angeles on March 25 when we did our survey, the consequences could have been catastrophic. The emergency care systems were stretched to the breaking point and had no capacity to respond to a surge of victims."

In the interest of keeping costs down, hospitals have shed excess capacity, shortened hospital stays, kept fewer supplies on hand, etc. At the same time, the 47 million uninsured know the only place they can reliably get immediate medical care - emergency or not - is the ER.

So you've got a situation where many ERs are regularly maxed out. A surge in patients, whether it results from a major accident, terrorist attack, or naturally occurring disease, could very quickly overload the system.

It reminds me of an example Steve Flynn provided in The Edge of Disaster: After a 2003 nightclub fire in Warwick, Rhode Island, in which 96 people died and 215 were injured, the health care system in New England was fully taxed in trying to accommodate even that number of patients. Considering that the
concentration of hospitals is relatively more dense in New England than it is in most locations in the U.S., that ought to give public health professionals and emergency response planners something to think about.

Update 2008-05-09: HHS Secretary Michael Leavitt agreed that there's a lack of surge capacity:
"There are deficiencies in our surge capacity..." Leavitt testified.

Leavitt said HHS will report by the end of the year the results of a nationwide survey of surge plans and capabilities. He said a survey is underway of hospitals' ability to electronically track and report the number of available beds on one hour's notice.

"Surge capacity is about using existing assets to convert to a hospital capacity very quickly. It is not simply using the emergency room," Leavitt said.
It's not clear to me what reason - other than politicking - there is for just studying the scope of the problem rather than beginning to address it. If you know there's a lack of surge capacity, you could start mitigating it even as you study its scope.

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