Three new reports reinforce what emergency public health preparedness authorities have been sounding alarms about for the last half-decade. And that is emergency care and individual preparedness for emergencies has continued to worsen - despite the billions that have been spent on preparedness and efforts to emphasize individual disaster readiness.

Exacerbating matters today is the nation and states’ fiscal crisis.

Meanwhile, the Department of Homeland Security's (DHS) Homeland Security Threat Assessment for the years 2008-2013, which, though marked "for official use only" was leaked to the media the week of Dec. 22,  predicts that in the next five years, terrorists will try to carry out a catastrophic biological attack that could overwhelm health care systems.

In a Dec. 18 speech, DHS Secretary Michael Chertoff said the threat posed by weapons of mass destruction remains "the highest priority at the federal level." 

Other recent assessments on the potential for terrorist attacks also predicted that the greatest threat from terrorists in the coming years is a biological attack.

While the new DHS assessment stated that biological and other WMD attacks remain difficult for Al Qaeda and other terrorist organizations to carry out because it's not as easy to acquire the materials needed to conduct such an attack, experts told HSToday.us that the materials and expertise to launch a bio-attack have proliferated so extensively that it would in fact be quite easy to carry out a biological attack.

Federal, state and private sector public health authorities meanwhile have been warning that the nation's emergency health care system is unprepared for such a mass casualty attack.

The American College of Emergency Physicians (ACEP) 2009 Report Card on the State of Emergency Medicine concluded that “the emergency care system in the United States is in serious condition, with numerous states facing critical problems.”

The group stated that its “overall grade for the nation is C-, with 90 percent of the states earning mediocre or near-failing grades.”

“We’ve been saying for years that trauma and EDs [Emergency Departments] are in a worsening crisis,” said National Foundation for Trauma Care (NFTC) Executive Director Connie Potter.

HSToday first reported on the crisis in trauma care in its nationally recognized investigative report, The Trauma in America’s Trauma Care. HSToday.us followed up last May with a two-part series, The Crisis in Trauma, ER Care, and, Crisis in Mass Casualty Medical Care.

ACEP’s annual report card is the most comprehensive assessment of the emergency care environment across the country. For the last several years, the scores it’s given states and the federal government have steadily declined.

“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,” declared ACEP about its objective assessment of emergency care in the United States.

“The results of the 2009 report card present a picture of an emergency care system fraught with significant challenges and under more stress than ever before,” the association’s report stated. “The overall grade for the nation across all five categories is a C-.

“This low grade is particularly reflective of the poor score in access to emergency care (D-). Because of its direct impact on emergency services and capacity for patient care, this category of indicators accounts for 30 percent of the report card grade, so the poor score is especially relevant. This category also incorporates many of the issues that states have identified as their top areas of concern,” which are:

• Boarding of patients in emergency departments and hospital crowding;
• Lack of adequate access to on-call specialists;
• Limited access to primary care services;
• Shortages of emergency physicians and nurses;
• Ambulance diversion;
• Inadequate reimbursement from public and private insurers, and;
• High rates of uninsured individuals

Meanwhile, on December 9 the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) released the sixth annual Ready or Not? Protecting the Public's Health from Diseases, Disasters, and Bioterrorism report, which found “that progress made to better protect the country from disease outbreaks, natural disasters and bioterrorism is now at risk, due to budget cuts and the economic crisis.”

The report concluded that major gaps remain in many critical areas of preparedness, including hospital surge capacity for mass casualty and catastrophic crises, rapid disease detection and food safety.

The surge capacity of the nation’s hospitals is vital to being able to care for mass casualties from a catastrophic terrorist attack or major natural disaster. However, as the July 2008 HSToday report, Seeking to Surge, detailed, national hospital surge capacity is below par, with a great many hospitals already operating at full capacity incapable of adequately coping with a sudden influx of patients. HSToday earlier explored the problems in emergency care preparedness in the report, Emergency Response: Intensive Care Needed.

“The average state’s daily hospital occupancy rate is reported to be 67 per 100 staffed beds, but that number goes as high as 85 per 100 in some states. Moreover, the time of day when hospital patients are counted may vary, and may not reflect times of peak occupancy,” stated ACEP’s report. “In addition, a lack of specialty beds (e.g., ICU, burn unit, psychiatric) contributes to hospital crowding and emergency department boarding as patients must wait hours or even days to transfer to appropriate units or facilities.”

Tim Stephens, an emergency public health preparedness authority, has told HSToday.us that these problems will contribute to the chaos many hospitals will face during a mass casualty event.

More than three years ago, former Department of Health and Human Services Secretary Thomas “Tommy” Thompson stressed that hospital surge capacity is the “single most important” emergency response problem facing the nation. In the event of a catastrophic terror attack, hospitals would “be overwhelmed.”

Every public health preparedness authority HSToday.us has talked to in recent years agrees.

"If Southern California's hospitals can't handle patient inflow even during the course of a normal day, I have grave doubts about how the region would do in a disaster scenario," Jim Lott, executive director of the Hospital Association of Southern California, recently told the Daily Breeze. "Any increase in demand would stretch the system beyond what it could handle."

In June, the Government Accountability Office (GAO) released the report of its audit of states' preparations for widespread surge. Congress’ investigative arm concluded from its 20-state review that the states “faced challenges relating to all four key components in preparing for medical surge.”