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Hospitals, You Are On Your Own

By Eric Toner, M.D., May 4, 2006

The Federal government released its National Strategy for Pandemic Influenza: Implementation Plan  today. Unfortunately, despite the assertion that, “protecting human health is the crux of pandemic preparedness,” which is accompanied by very clear predictions of the effects of a pandemic, the plan includes no indication that hospitals will be provided aid or assistance with their efforts to become better prepared. Furthermore, the plan makes explicitly clear that the federal government is limited in its ability to respond to a pandemic once it has started: “Local communities will have to address the medical and non medical impacts of the pandemic with available resources.” This is consistent with Secretary Leavitt’s oft-repeated admonition that, “Any community that fails to prepare with the idea that somehow, in the end, the federal government will be able to rescue them, will be tragically wrong.”

The need to prepare hospitals is being overlooked entirely by the federal government: In December, $350 million was appropriated for state and local pandemic preparedness, but no funding is specifically targeted to hospitals. As we have pointed out in a previous CBN Report (12/01/05), a pandemic will have catastrophic consequences for hospitals, which can reasonably expect huge influxes of very sick patients, high employee absenteeism, and shortages of medications, supplies, and equipment such as mechanical ventilators. At the same time, there will not be enough vaccine or antivirals to cover most people, which is reiterated in this new plan.

Therefore, the message to hospitals is eminently clear: You are on your own.

Given the marked decrease in surge capacity of the past few decades, ongoing personnel shortages, and “just in time” supply chains, U.S. hospitals are poorly prepared for even a mild pandemic, such as the last one, of 1968. Whereas a pandemic is almost certain, the same cannot be said of the other types of disasters for which hospitals routinely prepare. If your institution is ill-prepared to handle the predictably substantial and sustained increases in patient volume and the other demands of a pandemic, whether mild or severe, then you had better start doing what you can to help your hospital get ready.

It is estimated that one third of U.S. hospitals currently are losing money and that most of the others are just scraping by with operating margins averaging 1.9% [1]. Thus, few if any, have disposable income available to spend on programs such as disaster preparedness which do not generate any income. And without doubt, the costs of realistic and adequate hospital preparation will be great, but the costs of failing to prepare will be greater. Since substantial federal aid to hospitals, above and beyond current HRSA bioterrorism funding, is not likely to be forthcoming any time soon, spending by hospitals on pandemic preparedness would seem to be a prudent investment. In addition, it is vitally important that every hospital work actively with its local health department and neighboring hospitals to plan collaboratively.


American Hospital Association. Taking the Pulse 2005: The State of America’s Hospitals. Available at: Accessed May 4, 2006