Things we may not think about until we need them: hospital preparedness

One of the disturbing aspects of the recent E. coli outbreak in Germany was the apparent lack of sufficient hospital surge capacity to handle a sudden influx of seriously ill patients. Der Spiegel reported:

On Monday, hospitals all over northern Germany struggled to treat thousands of patients suffering from the effects of the bacteria. More than one-third of the people infected with E. coli have also come down with a life-threatening complication known as hemolytic-uremic syndrome (HUS) which attacks the blood, kidneys and brain, and has left doctors racing to save lives. Ambulances have reportedly raced between cities to get desperately needed dialysis treatments for victims' failing kidneys as demand for machines became unmanageable. Meanwhile, clinics have cancelled routine operations in order to focus on emergency rooms filled with people infected by the bacteria, which causes watery or bloody diarrhea.

Hospitals face competing demands. On the one hand, we want them to keep their costs down, which often means paring back staffing, equipment, and space to what's essential (among other measures). On the other hand, we want them to be ready to respond when disaster strikes - whether it's a fire in a crowded nightclub, an outbreak of SARS, a wildfire, or a foodborne illness that leaves hundreds of people at risk of organ damage.

One solution is for federal or state governments to fund hospitals' preparation for public health disasters. Last week, the Department of Health and Human Services announced that it was awarding $352 million in grants to hospitals and healthcare systems to support preparedness activities, including medical surge capabilities, as part of the Hospital Preparedness Program. An HHS press release describes some of the uses of the funds:

Grant recipients use the HPP funds to employ experts who have developed and maintained preparedness plans and to purchase equipment, including mobile medical units and equipment to communicate with local emergency responders. HPP funds have been used to train and educate staff on disaster response, including the National Incident Management System, which provides a standardized management structure for disaster response. Grant recipients are required to test this capability through disaster exercises.

Using HPP funds, grant recipients put systems in place to track the number of hospital beds available which helps hospitals handle a surge of patients after disasters, as well as systems to register volunteers. The funds also support planning, training and exercises for evacuating facilities, for sheltering patients and staff in place, and for managing mass fatalities. In addition, HPP funds may be used to purchase pharmaceutical caches for use during an emergency response.

HPP encourages grant recipients to develop health care coalitions with other hospitals and health care systems, community businesses and non-government organizations which can support a facility in caring for patients.

These kinds of investments may not have many impacts that are visible to patients, local communities, investors, or board members in the short term. They won't pay off unless - until - disaster strikes. But when outbreaks and natural disasters occurs, the preparedness payoff can be counted in terms of lives saved.

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