Hospitals must improve infrastructure, surge capacity, officials say

Whether the next major catastrophe to strike the nation is a hurricane, earthquake, pandemic, or terrorist attack, any community that fails to prepare and expects the federal government to come to its rescue is “tragically wrong,” said Health and Human Services Secretary Michael O. Leavitt.

“There is no way that you can respond to every hometown in America at the same time,” he told an audience on April 18 at the National Press Club in Washington, D.C.

One of the greatest lessons learned from the devastating hurricanes that struck the Gulf Coast last fall, Leavitt maintained, was that “what you do in advance” of a disaster “is more important than what you do after.”

Ben DeBoisblanc, medical director of the intensive care unit at Charity Hospital in New Orleans, said that when his facility lost power, including the emergency generators, water, and sewage services, and the only person practitioners could get on the phone was Wolf Blizter from CNN, “it crystallized in everyone’s mind that . . . we’re waiting around to be rescued. We’re waiting for somebody to help us. What a bad idea that is.”

Medical staff soon realized, he said, that it was up to them to “take care of ourselves.”

While the federal government has been busy working on national disaster strategies and response plans, said Homeland Security Secretary Michael Chertoff, “Traditionally, constitutionally, and by virtue of expertise and proximity, local and state governments are always at the first point of the spear when it comes to dealing with emergencies.”

Chertoff and Leavitt urged hospitals to improve their infrastructures and surge capacities.

But, said W. Frank Peacock, chairman of emergency preparedness at the Cleveland Clinic in Ohio, U.S. hospitals work on a “just-in-time, deliver-it-now” system.

“The problem is, we are just good enough for what happens now,” he said.

Hospitals each year are preparing for disasters, whether they recognize it or not, Peacock said.

“It’s called February,” he proclaimed, explaining that hospitals are in a state of emergency every February because of the sudden increase in patients with seasonal influenza.

Peacock criticized federal officials for expecting local communities and hospitals to assume the majority of the financial burden for disaster preparedness.

While every emergency is local, he declared, the federal government needs to step up and develop a comprehensive plan for improving the nation’s hospital infrastructure.

Many communities are losing hospitals because of revenue problems, Peacock contended, adding that Cleveland has lost three hospitals in the past decade.

“To ask any industry to double its productive capability with no funding is really [difficult], even if you were a wealthy industry, and the hospital industry is not wealthy,” he argued.

C. Ronald Kahn, president and director of the Joslin Diabetes Center in Boston, said that one of the major problems health care workers confronted during the Katrina response was a lack of medications.

He said he was worried that people with chronic conditions, such as diabetes mellitus, hypertension, and asthma, are at a greater risk of not surviving any disaster.

“We have a health care system that doesn’t really give enough attention to how we deal with them,” Kahn said.

Much of the nation’s attention lately, Leavitt noted, has focused on the possibility of an outbreak of pandemic influenza.

However, he said, preparing the nation for a pandemic, whether it comes in the form of the H5N1 virus or something else, is difficult “because anything you say in advance feels alarmist.”

“But anything we have done once a pandemic starts seems inadequate,” Leavitt said.

There is no “guarantee” that a disaster like a pandemic or another Hurricane Katrina or a 9/11 will strike the United States, Chertoff said.

But, he said, “there’s no guarantee that they won’t come.”