The Corpus Callosum

When Trucks Stop, Hospitals Stop

One of the more enlightening and worrisome articles I read recently was
href="http://www.newyorker.com/talk/financial/2008/11/24/081124ta_talk_surowiecki">The
Perils of Efficiency
, by James Surowiecki.  The article
was a discussion of the practical effects of the mathematical concept,
that you can only optimize one variable in an complex system.  So
if you optimize for lowest cost per unit of production, you have to
sacrifice something else.  One of the things you sacrifice, is
resilience. 

Most managers of systems with a supply chain have adopted what is
called just-in-time supply.  That is, they only stock enough stuff
to last until the next shipment is supposed to arrive.  This
lowers the cost of maintaining inventory.  But it leaves the
system vulnerable to disruptions of the supply chain.

The American Trucking Associations released a report a while back, href="http://www.truckline.com/Newsroom/Trucks%20Are/When%20Trucks%20Stop%20America%20Stops.pdf">When
Trucks Stop, America Stops
(HT: href="http://thesurvivalmom.com/2009/12/18/just-in-time-shipping-and-your-familys-survival/">The
Survival Mom).  I understand that this is a promotional
piece.  The Trucking Associations want us to be on their side, in
whatever lobbying and promotional efforts they may undertake.  But
it does highlight some serious concerns.

This matter was nearly tested a couple of years ago, when hurricanes
significantly reduced the refining capacity in the Gulf of
Mexico.  We still had a lot of oil sitting around, but with a
reduction in the ability to turn oil into diesel fuel and gasoline,
shortages developed.  It was not catastrophic, but a small
deviation in the course of one of the hurricanes could have led to
serious problems.

Without truck transportation, patient care within the truck
stoppage zone will be immediately jeopardized. According to Cook [Al
Cook, former president of the Materials Management Association], many
hospitals have moved to a just-in-time inventory system. In fact, some
work from a low-unit-of-measure system. This means that essential basic
supplies, such as syringes and catheters, are not ordered until the
supplies are depleted. These systems depend on trucks to deliver
needed supplies within hours of order placement
. [emphasis added]
Internal redistribution of supplies in hospitals could forestall a
crisis for a short time; however, in a matter of hours, hospitals
would be unable to supply critical patient care.
Hospitals and
nursing homes will exhaust food supplies in as little as 24
hours…Pharmacy stocks of prescription drugs will be depleted quickly.

I checked at the hospital where I work.  The dietitian says that
we have about four days of food at a normal capacity, more if we adopt
emergency rationing.  Being a psychiatric hospital, we don’t have
a lot of need for supplies that would be susceptible to
life-threatening shortages.  But the prescription drug situation
worries me.  That is a problem that is difficult to solve, because
many of the drugs are expensive, require specific storage temperatures,
and have limited shelf-life. 

For acute care hospitals, the problem is obvious.  A pandemic
could lead to disruption in the supply chain, just at the time that
critical-care supplies are being depleted most rapidly.  In that
situation, it would not be the trucking system that would be the
problem, href="http://spectrum.ieee.org/biomedical/ethics/pandemic-flu-could-clog-us-rail-lines">it
would be the rail system.  It would take longer for the
problem to develop, but it would be a very difficult problem to solve.

Individuals can (and should) store food and medicine, although it is
difficult to get extra supplies of prescription drugs.  Those
things are kind of obvious.  What may be less obvious is the
potential problem with water:

According to the Chlorine Institute, most water treatment
facilities receive chlorine in cylinders (150 pounds and one ton
cylinders) that are delivered by motor carriers. On average, trucks
deliver purification chemicals to water supply plants every seven to 14
days. Without these chemicals, water cannot be purified and made safe
for drinking. Without truck deliveries of purification chemicals,
water supply plants will run out of drinkable water in 14 to 28 days.

[emphasis added]

Households can maintain water purification supplies, although there is
significant expense involved in keeping large supplies.  With food
storage, the food can be rotated, so it is not wasted.  Water
purification supplies might never be used, so it is a bit of a dilemma
as to whether it is worth having.  But the situation is even more
difficult for large institutions. A household can get something like a href="http://www.berkeywater.com/Big_Berkey.html">Berkey water
purification system for a few hundred dollars, but that would be
nearly useless in a hospital. 

Of course, you can’t prepare for ever possible disaster.  However,
it would make sense for individuals to think about emergency
preparedness in light of these vulnerabilities.  Physicians should
prepare, at least mentally, for such disruptions.

Comments

  1. #1 Ambitwistor
    December 22, 2009

    This idea is one of the themes of the science fiction novel A Deepness in the Sky by Vernor Vinge. In the novel Vinge postulates that human civilizations have a finite lifetime before they inevitably collapse, and one of the reasons for the collapse of high civilizations is the optimization-resiliency tradeoff:

    “The flexibility of the governance is its life and depth. They’ve accepted optimizing pressures for centuries now. Genius and freedom and knowledge of the past have kept them safe, but finally the optimizations have taken them to the point of fragility. [...] Every decade the flexibility of the governance responded to the pressures of resource allocation, and the margins of safety shrank. [...] If you avoided all the other threats, the complexity of your own successes would eventually get you.”

  2. #2 k8
    December 22, 2009

    I checked with the hospital I work at regarding their emergency preparedness because frankly? I’m just a tad bit obsessed with disasters and diseases. And they are nowhere near prepared for any sort of disaster or pandemic, and even less prepared should shipping sources dry up. But to hear them tell it, they’re “just fine.” It frightens me, actually.