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The Next Challenge in Healthcare Preparedness: Catastrophic Health Events

By Eric Toner, MD, and Mary Beth Hansen, March 5, 2010

In 2007, the Office of the Assistant Secretary for Preparedness and Response (ASPR) in the U.S. Department of Health and Human Services (HHS) contracted with the Center for Biosecurity to conduct a 2-year, comprehensive assessment of the HHS Hospital Preparedness Program (HPP), from the time of its establishment in 2002 through mid-2007, and to develop recommendations for improving and evaluating future hospital preparedness efforts.

The Center’s new report, The Next Challenge in Healthcare Preparedness: Catastrophic Health Events,1 proposes key elements of a national strategy for healthcare preparedness and response. The Preparedness Report follows the Center’s report, Hospitals Rising to the Challenge: The First Five Years of the U.S. Hospital Preparedness Program and Priorities Going Forward (March 2009),2 a key finding of which was that, while much progress has been made in healthcare preparedness for common medical disasters, the U.S. healthcare system is not yet prepared for catastrophic health events (CHE).*

Major Challenges to Catastrophic Health Event Response

The Center’s analysis of the current system for a national response to CHEs revealed several major challenges, among them: the lack of robust systems to support information and resource sharing among hospitals and neighboring healthcare coalitions and the lack of capacity to triage, treat, and transport the numbers of patients that will be affected in a CHE. The nation’s healthcare system is also in need of guidance on crisis standards of care and a national plan that outlines healthcare roles, responsibilities, and actions during a CHE. Perhaps the biggest challenge, however, is that many of the nation’s hospitals and other healthcare organizations do not yet participate in fully functional healthcare coalitions, which the Center has identified as essential to disaster response.

Definition and Vision of a Healthcare System Prepared for Events of All Sizes

Challenges notwithstanding, the Center proposes that CHE preparedness can be achieved, building upon the foundation that has been laid through the HPP program. To that end, the Center puts forth a definition of a well-prepared healthcare system, a vision of success, and a set of concrete recommendations (see Overview, below).

Definition: A well-prepared healthcare system is able to effectively manage the medical consequences of common disasters and is able to respond quickly and with agility to harness all useful public and private national resources to cope with a CHE.

Vision: During a disaster, a well-prepared healthcare system will be able to function under a variety of adverse circumstances that may include: an immediate surge of patients in need of acute care, a prolonged surge of patients, a contaminated or contagious environment, loss of infrastructure that necessitates triage and treatment outside of healthcare institutions, poor situational awareness, and disruption of incident management chains of command.

Overview of Recommendations

  • Every U.S. hospital should participate in a healthcare coalition that prepares and responds collaboratively to common disasters and CHEs.

  • Links should be established among neighboring healthcare coalitions to enable regional exchange of healthcare information and assets during a CHE.

  • Out-of-hospital triage sites should be established and healthcare responders should be trained in CHE triage.

  • A patient transport system that harnesses alternative, private sector resources should be created.

  • Development of crisis standards of care should be expanded, and they should be consistently implemented within and across states.

  • A national framework for healthcare response to CHEs should be developed to guide states, jurisdictions, and local entities in developing plans for medical and public health activities.

Conclusion

The progress that has been made in healthcare preparedness since 2002 has made most communities better prepared for the kinds of disasters that occur most frequently. However, more needs to be done to ready the nation for a CHE.The recommendations made by the Center are feasible, and the path to success is clear, but concrete progress toward the goal of CHE preparedness will take time, sufficient funding, and sustained effort at the federal, state, and community levels for a number of years. Read the full report (PDF).

References

  1. Center for Biosecurity of UPMC. The Next Challenge in Healthcare Preparedness: Catastrophic Health Events. Prepared for the U.S. Department of Health and Human Services under Contract No. HHSO100200700038C. 2009. http://www.upmc-biosecurity.org/website/resources/publications/2010/pdf/2010-01-29-prepreport.pdf. Accessed March 3, 2010.
  2. Center for Biosecurity of UPMC. Hospitals Rising to the Challenge: The First Five Years of the U.S. Hospital Preparedness Program and Priorities Going Forward. Prepared for the U.S. Department of Health and Human Services under Contract No. HHSO100200700038C. 2009. http://www.upmc-biosecurity.org/website/resources/publications/2009/pdf/2009-04-16-hppreport.pdf. Accessed March 3, 2010.

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* A “catastrophic health event,” as defined in Homeland Security Presidential Directive 21 (HSPD-21) is an event that could result in tens or hundreds of thousands of sick or injured individuals who would require access to healthcare resources. The White House. Homeland Security Presidential Directive 21: Public Health and Medical Preparedness. October 18, 2007. http://www.dhs.gov/xabout/laws/gc_1219263961449.shtm#1. Accessed March 3, 2010.