State-by-State Report on the Status of Emergency Medicine

As a nice complement to the "Ready or Not?" report released earlier this week, the American College of Emergency Physicians has published its annual "National Report Card on the State of Emergency Medicine," which examines emergency medicine on a state-by-state basis and concludes that:

The emergency care system in the United States remains in serious condition, with numerous states facing critical problems. That is the disturbing but unmistakable finding of the 2009 edition of "The National Report Card on the State of Emergency Medicine," a report designed to provide the American public with an objective assessment of the emergency care environment across the country.

Which is, of course, not a surprise. For years, hospital managers have applied "just-in-time" principles to their operations, in an attempt to hold down spiraling costs. They've trimmed as much fat as possible, leaving hospitals with little surge capacity.

Granted, we are stockpiling vaccines and other medications, which will help in the event of the inevitable health care crisis. (I'm less sanguine about our ability to deliver them in a timely, organized, effective manner; but that's another story.) Unless we re-build some excess capacity in our health care system, other necessities such as bed space, health care staff, respirators, etc., are simply not going to be there.

We pays our money, we takes our chances...

Worthwhile Reading: "Marrying Prevention and Resiliency"

There's some good food for thought in this occasional paper from RAND, which advocates a "hybrid" approach to prevention and mitigation:

Instead of seeing an either/or choice between traditional prevention and mitigation or resiliency measures, it is more productive to consider them together in an integrated way—as two complementary elements of a strategy aimed at lessening the consequences of successful terrorist attacks. Doing so essentially stretches the concept of prevention beyond the ideal of halting attacks before they happen to also include efforts to limit the human and economic costs of even successful attack operations.

It's not a terribly long read, and it's worth the time.

We still haven't found the right balance of prevention, mitigation, and response. The unfortunate political reality is: It's much too easy to allow preventive efforts to devolve into "security theater"; it's much to easy to give short-shrift to mitigation, despite the effectiveness of many mitigatory efforts, because mitigation almost always lacks sex appeal; and it's much too easy to overemphasize response, since everybody wants to take the credit for a successful response to the inevitable disasters and nobody wants to take the blame for an unsuccessful one.

Earthquakes in the Midwest: Who's Prepared?

Not good news:

Tennessee is the only one of eight states in the Central United States Earthquake Consortium to finish its revision to the Catastrophic Event Annex of our state's emergency-management plan.

Anyone in the Midwest who's unprepared for a major earthquake simply doesn't appreciate history. In 1811 and 1812, three enormous quakes in the New Madrid seismic zone devastated a wide area. Fortunately the population was very low at the time. But today? Memphis and St. Louis are both in the zone and could sustain major damage from a big quake.

Check out November's report by the Mid-America Earthquake Center, which said:

[T]he total economic impact of a series of New Madrid Seismic Zone (NMSZ) earthquakes is likely to constitute by far the highest economic loss due to a natural disaster in the USA.

An earthquake of magnitude 7, as has been predicted, or a recurrence of the 1811-1812 series could have devastating impacts on the region, with considerable national repercussions, as transportation routes, natural gas and oil transmission pipelines are broken and services are interrupted. Preliminary estimates, including those completed by the Mid-America Earthquake Center (MAEC), found that economic losses from a magnitude 7.7 (Mw7.7) event in the NMSZ could reach $50-$80 billion dollars in direct losses alone. Additionally, there could be thousands of fatalities, tens of thousands of injured victims, and even hundreds of thousands left without homes.

According to Hildenbrand et al. (1996), the chance of a magnitude 6 or 7 earthquake occurring within the next 50 years is roughly 90%.

1812 seems like a long time ago, but complacency is unforgivable.

Poughkeepsie Gets It

Good practice in Poughkeepsie:

When different police departments talk to each other, it's bad news for the bad guys.

The Field Intelligence Group is an unofficial association of about two dozen police officers, probation and parole officers and other law enforcement officials from the various departments in Dutchess and Ulster counties.

They meet weekly and stay in contact constantly, using text messaging and e-mail to alert each other of crimes and trends and work together on cases that cross jurisdictions.

Information they share include descriptions of suspects or crimes. These days it does not take long to distribute surveillance video to all the police agencies in the area.

"You'd be surprised how many times we get video of something and we send it out, and you'll get three or four calls within a few hours ... saying, 'Hey, I know him,' " said Detective Erik Lindmark, field intelligence officer for the Town of Poughkeepsie Police Department.

Dutchess' Field Intelligence Group was born out of tragedy. After Sept. 11, 2001, a lack of communication between different federal agencies was blamed for not preventing the attacks. A lack of communication between the New York City police and fire departments was blamed for further loss of life that day.

Deputy Sheriff Stephen Reverri, the field intelligence officer representing the Dutchess County Sheriff's Office, said Sept. 11 shed light on the importance of communication on the local level, as well.

"Information wasn't being shared, and we saw it on a local level dealing with common criminals," Reverri said.

Share information. Preserve civil liberties. Protect the public. It works. And ... it's free!

The group has no budget; it relies on individual agencies allowing their officers the time to participate.

Quickly Noted: Annual "Ready or Not?" Report Published

The Trust for America's Health has released its annual "Ready or Not?" report, analyzing the readiness of the U.S. public health system for a major biological disaster. The report includes state-by-state rankings and always makes for interesting, if somewhat depressing, reading.

Here's the press release and summary of key findings. Here's the full report (pdf, 2.6MB).

Lessons Learned: Only Our Own?

It's probably a universal human trait: We're very adept at changing our ways based on what's in the rear-view mirror. But only our own, not someone else's.

That's why it's so vital to share information and learn from others' experiences. For example:

CHARLESTON, W.Va. -- Kanawha County officials have changed an emergency response plan more than three months after a deadly explosion at the Bayer CropScience plant in Institute.

Depending upon the severity of an event, Emergency Services Director Dale Petry says the county will issue an automatic shelter-in place during a chemical emergency if officials can't get clear information about the incident within 10 minutes.

Emergency services officials have criticized Bayer CropScience for failing to provide timely information following the Aug. 28 incident in which two people died. The incident remains under federal, state and local investigation.

Has Kanawha County's experience caused any other local government officials, anywhere else in the United States, to re-consider their own emergency response plan?

There are 15,000 hazardous chemical facilities in the United States. 7000 of them could affect more than 1000 people in the local area in the event of an accident or intentional release. 123 of them could affect more than 1 million people (source). When is the last time the communities near those chemical facilities examined their emergency response plans?

LA Re-thinks Emergency Management

The Mayor's office in Los Angeles has released a new emergency management initiative.

This initiative ... involves several components to enhance the City’s planning and preparedness efforts, train city employees in disaster response, better prepare the community in disaster preparedness, and modernize the City’s antiquated emergency management structure.

Here's one thing I find interesting. To describe the current state of preparedness, the city uses measures such as staffing levels, training exercises, programs and strategies. For example:

[T]he City Council recently approved the Mayor’s request to add three new positions to EMD to work on planning and preparedness activities, emergency operations, and public information. In addition, through the leadership of General Manager Jim Featherstone, a former Captain in the LAFD’s Planning and Tactical Training Division, EMD is modernizing its operations, procedures, and principles to reflect a contemporary emergency management approach to the numerous dangers the City faces.

But that's not the best measure of preparedness. Real preparedness has to be measured in terms of capabilities. It's not just how many training exercises you have, the size of your staff, or the strategies and tactics you employ. Those are necessary, yes. But they're not sufficient. If you're going to assess your state of preparedness, you need to be able to declare with some confidence what your capabilities are.

Planning for a Pandemic? Meh.

In direct contrast to the immediately previous blog entry, and a week after the NYT's Freakonomics blog asked, "Why do voters reward poor disaster preparedness?" a story comes out of Georgia about some local elected officials who haven't even shown up to the meeting to prepare for a pandemic flu:

Jones County’s biggest problem with a pandemic flu occurrence may be the perceived apathy demonstrated in planning for the event by local elected officials.

Jones County’s pandemic flu preparedness committee met July 17 at the Emergency Management office and has the task of educating the public to the reality of having to be self-sufficient if the disease hits. In the case of a pandemic, communities cannot be dependent on federal or even state assistance.

City and county elected officials were conspicuous by their absence at the meeting with Probate Judge Mike Greene the sole representative.

They also didn't show up to a table-top exercise in February:

An after-action report by the North Central Health District Office about Jones County’s Feb. 20 table top exercise stated, “The fact that no elected officials or business leaders were present at the exercise lends itself to the belief that the leadership of Jones County does not seem to have bought into this concept.”

Any local official who isn't involved in this type of planning is doing their community a great disservice. A pandemic is not a question of if, but when. And every community will be affected.

I've bolded the key concept in red. Every local official needs to realize that in the event of a major pandemic, local communities are going to be largely on their own. Local planning is essential.

Preparation In the Absence of Press

The threat of pandemic flu has gotten a lot less press lately, mostly because the incidence of avian flu seems to have plateaued somewhat (though Indonesia is still being really tight-lipped about what's going on there, so who really knows?)

But even though the issue is getting less attention in the media, some communities are continuing to do the smart thing and developing plans to address a pandemic flu. It's worth remembering that there's no guarantee that the source of the next human pandemic will be avian flu. It could come from another source, and it could conceivably come out of nowhere and surprise us.

So it's good to see local communities, like these in South Dakota, working together to develop plans to deal with the threat, which in its severest instances (e.g., an event comparable to the 1918 Spanish Flu outbreak) could have more widespread impacts than almost any other catastrophic event:

After more than a year of work, the members of a local planning committee will present their pandemic influenza response plan to the public.

The 131-page plan was developed by committees from Aurora, Davison and Hanson counties and it provides guidelines on how to deal with a pandemic flu outbreak that many medical professionals believe is inevitable.

[The plan] provides action checklists to help schools, businesses and other community organizations develop a coping plan, in the event of a flu outbreak.

A family preparedness kit will ... demonstrate what items should be on hand in the event of an epidemic. Such preparedness will be important in the event of a flu outbreak.

While the Centers For Disease Control and the state Health Department will monitor and report on all flu outbreaks, said Assistant Mitchell Fire Chief Steve Willis, local jurisdictions will largely be on their own.

Apathy is the greatest danger when it comes to planning for a dangerous flu outbreak, says Jim Montgomery, Davison County Emergency Management director.

Mr. Montgomery is absolutely right - the best community-based plan will be useless unless individual citizens, businesses and other entities such as churches and community groups do their part to prepare.

In my humble opinion, the effort to create the plan ought to be dwarfed by the effort to distribute it, publicize it, and follow up to ensure that people are prepared. According to the Red Cross, more than 90 percent of Americans are not prepared for a major disaster. In Mitchell, only about 40 people (in a population of 15,000) showed up at the meeting to learn about the pandemic flu plan. But as the dedicated John Solomon regularly and diligently reminds us (because repetition makes a message stick) citizen preparedness is vital.

The Holy Grail of preparedness is getting more individuals to prepare on their own. Every citizen that's adequately prepared will help the system - not only by being better off themselves, but also by reducing the strain on community services, improving the situation for their neighbors as well.