OPTIMAL PREPAREDNESS OF THE HEALTHCARE SECTOR

Many chapters of this book outline an approach to preparedness and planning for a terrorist event involving WME in more detail; however, three overarching principles for optimal preparedness of the healthcare sector cannot be overemphasized: integration, testing, and resources.

Integration

Planning and preparedness for any disaster cannot be done in isolation, nor can hospitals develop plans based on untested assumptions of what other response agencies (fire services, law enforcement, etc.) will or will not do in a disaster response. Similar agencies must plan as a unit. In the event of a large-scale catastrophe, all hospitals will be involved, and thus area facilities must plan as though they are part of a regional network.

The healthcare sector encompasses much more than hospitals. Primary care clinics and private physicians, emergency medical services, private ambulance companies, community and state public health agencies, pharmacies, veterinary clinics, urgent care centers, long-term-care facilities and hospices, funeral homes, medical vendors and warehouses, and many other business concerns have both potential roles and a stake in the success of response operations. These potential sources of staffing and material resources must be included in planning and preparation. Integration and interoperability are discussed in further detail in other chapters of this book.

Testing

Modeling and simulation for terrorist events have historically been based on large-scale events that would rapidly overwhelm the local response system’s capacity, requiring the utilization of state and federal resources. Although this may be a valid test of vertical integration (the ability to incorporate regional, state, and federal resources into local disaster operations), another rarely used approach is to determine the system’s actual time-phased functional capability and capacity.

This methodology seeks to determine the resources actually required from all response sectors at a given period of time after the incident and may be of particular value because it could be used to establish the trigger required to activate and release these higher-level resources. Prospective determination of a system’s capacity allows a “high-water line” with which to compare an actual event as it unfolds, allowing more accurate needs assessments and requests for assistance that drive the state and federal responses.

Resources

It is unreasonable to expect the healthcare sector to expend resources they do not have or to amass large quantities of excess expirable supplies based on a low-probability event. Unlike the majority of emergency response organizations, the healthcare sector has historically received little or no funding from the public coffers for disaster preparedness and mitigation. The December 2003 Homeland Security Presidential Directive/HSPD-8 includes “clinical care” among its defined “first responders,” and healthcare is a first-responder discipline listed in budgets for fiscal year 2004 Office of Domestic Preparedness grant monies. This will allow the healthcare sector to use the grant money for planning, organizing, equipping, training, and exercising (The White House 2003).

Recent legislation has allotted some funding to improvements in state and community public health agencies, and a small percentage of this funding is designated for traditional healthcare operations. Businesses involved with healthcare operations should gain the support of local and state governments for a share of disaster preparedness funding if the communities can reasonably expect full participation in planning for these events.

Weapons of mass effect pose a challenge that the healthcare sector has not seen in the history of this country. Federal resources are necessary; however, these events would be first and foremost local calamities, and the local healthcare system will be part of the vanguard of response. Mitigation, planning, resource procurement, education, and training are required if this critical partner in response is to be prepared for these events.