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, When Trucks Stop, America Stops (HT: 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, 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 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.
Medicine & Health
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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."
Posted by: Ambitwistor | December 22, 2009 10:09 AM
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.
Posted by: k8 | December 22, 2009 4:28 PM