A new report found that U.S. hospitals would struggle to respond adequately to large-scale catastrophic events such as disasters and attacks, raising concerns about the nation’s capacity to handle bioterrorism or other mass-casualty events.
The two-year study from Johns Hopkins University Bloomberg School of Public Health’s Center for Health Security states that although the healthcare system is better prepared post-9/11, it’s still not par in terms of handling a catastrophic disaster — and “other segments of society that support or interact with the healthcare system and that are needed for creating disaster-resilient communities are not sufficiently prepared for disasters.”
Researchers put disaster prep into four categories: relatively small-scale mass injury/illness events like a tornado, shooting spree or small outbreaks; large-scale natural disasters such as significant hurricanes or earthquakes; complex mass casualty events such as the Las Vegas and Orlando mass shootings, the Boston Marathon bombing, the 2003 Station nightclub fire in Rhode Island, limited radiological and chemical events, and limited spread of deadly pathogens such as bioterrorism agents or Ebola; and catastrophic health events such as a major earthquake in a concentrated population center, a nuclear blast, or a large-scale pandemic or bioterror attack.
“We conducted a gap analysis for each type of disaster and concluded that the United States is fairly well prepared for relatively small-scale mass injury/illness events that happen more frequently, less well prepared for large-scale and complex disasters, and poorly prepared for catastrophic health events,” stated the authors, led by Eric Toner, MD.
One of the challenges is that preparing for one type of disaster “only partially prepares us for other types, and focusing solely on the common elements leaves gaps for specific actions or capabilities required for each type of event.”
“Different events require different mixes of skill sets, resources, and response capabilities when the principal goal is to reduce injury and illness and to save lives,” the report says. “…Non-English speakers and disabled people are at greater risk for all events, and individuals in inadequate housing may be more vulnerable to severe weather events and epidemics.”
In the catastrophic category, the study notes that “infrastructure may be damaged, the normal healthcare system may be degraded and therefore would be enhanced risk, many complex casualties can be anticipated, and the geographic extent of casualties would likely cover a large area.”
They cited a 2005 Department of Homeland Security report that laid out 15 catastrophic scenarios, including the detonation of a 10-kiloton nuclear device in Washington that would kill 9,000 people instantly and 36,000 more within 24 hours from trauma or radiation sickness, a wide-scale anthrax attack that would expose 328,000 people to the bacteria and potentially kill 13,000, and a magnitude 7.5 quake in a major city that could kill 1,400 people.
Researchers weighed the characteristics of each disaster category, the burden placed on the healthcare system, and the scope of the response.
Complex mass casualty events “can be expected to create a heavy but transient burden of trauma, critical care, and specialty care patients. Surge capacity at individual facilities may be temporarily overwhelmed, but overall local/regional healthcare system capacity is typically sufficient to meet the increased demand.”
“In a catastrophic health event, a markedly increased burden on local and regional health sectors can be expected that may overwhelm surge capacity, even if the infrastructure is fully intact (which it may not be, depending on the scenario). Many parts of the system may be damaged or degraded for prolonged periods. This includes hospitals and healthcare facilities, but also services like home care,” the report states. “Patients would include victims of the event as well as patients with chronic conditions who are displaced from their normal sources of care. The magnitude of the healthcare system burden may be affected by policy decisions or actions taken (or not), such as effective public messaging about sheltering.”
The study calls for fostering a “culture of resilience” that incorporates the grassroots and community leaders.
“Much of civil society and many parts of the health sector are not resilient and are not participating in preparedness activities, as was demonstrated in Hurricanes Katrina and Sandy. When disaster strikes and these entities fail, people suffer and the hospitals become overwhelmed, leading to cascading hardship and suffering. To address this, many more components of the health sector and civil society need to be more resilient and connected to formal preparedness and resilience activities in their communities.”
Researchers also called for creating a network of disaster resource hospitals as complex disasters “require expertise and resources that are not found in most hospitals,” yet major medical centers with the resources may “lack a dedicated focus on disaster preparedness and response.” Additionally, a national coordinator for catastrophic events would be responsible for keeping “sustained focus on catastrophic health events and integrating the work of the various initiatives without the distraction of needing to prepare for and respond to other types of common events.”
“The role of the office should be to create a strategy and concept of operations for how all national assets would work together to most effectively respond to a catastrophic health event and then to coordinate efforts to implement them,” the report recommended. “This office should also be charged with the implementation of a well-developed strategy for crisis standards of care.”