Despite the more than $8 billion that’s been spent on hospital and public health preparedness between 2001 and 2008, the nation’s hospital surge capacity remains inadequate for disasters like large-scale terrorist bombings, wrote two doctors in a commentary in the August 5 issue of the Journal of the American Medical Association (JAMA).

“Disturbing signs show that [hospital] surge capacity has diminished … despite assurances from governmental and nongovernmental officials that hospitals can quickly ramp up in response to a mass casualty event,” wrote Dr. Kobi Peleg of the National Center for Trauma & Emergency Medicine Research, and Dr. Arthur Kellermann of the Department of Emergency Medicine, Emory School of Medicine.

The two noted in their JAMA commentary, "Enhancing Hospital Surge Capacity for Mass Casualty Events," that the 2006 Institute of Medicine’s three-volume report on the future of emergency medical care in the United States that identified many problems, including extensive ER crowding, widespread boarding of admitted patients in ER hallways, frequent episodes of patient diversion and even the dwindling numbers of specialists willing to take on on-call trauma and ER jobs.

“All of these problems have eroded hospital surge capacity,” Peleg and Kellermann wrote.

HSToday.us has regularly reported on the growing problem of hospital surge capacity and what it means in terms of being able to manage mass casualty events. A year ago HSToday.us examined in a two-part follow-up to earlier reporting on the crisis in mass casualty medical preparedness.

“In spring 2008,” the authors of the JAMA commentary wrote, “the House Committee on Oversight and Government Reform conducted a point-in-time survey of level 1 trauma centers in seven US cities considered at high risk of terrorist attack. On the day of the survey, responding hospitals were so overcrowded with patients, it is unlikely that they could handle an incident of the scale of the Madrid train bombings, which produced 2,000 casualties in a matter of minutes.”

The crisis in the nation’s trauma care system that Homeland Security Today first reported on in the spring of 2004 has only worsened, said Connie Potter, executive director of the National Foundation for Trauma Care, whose members include doctors, nurses, administrators and others from many of the nation’s busiest trauma and ER departments.

Peleg and Kellermann suggest in their commentary that the US look to Israel, for example, for how to establish a robust mass casualty medical response capability.

This reporter was in Israel not all that long ago and visited doctors and officials of a hospital in Jerusalem who demonstrated just how well prepared they are to handle a sudden surge of at least 100 patients – as are other hospitals through Israel.

“Israel’s experience in preparedness and response shows that it is possible to maintain surge capacity for sudden mass casualty events without compromising a hospital’s daily operations,” Peleg and Kellermann concluded. “Certain practices, such as promptly transferring emergency admissions to inpatient units, improve efficiency and promote patient safety. Measures like these may work equally well in the United States.”