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Emergency Rooms Not Ready for 'Major Event'

Catastrophe like 9/11 would not have been handled well, experts say

THURSDAY, Dec. 6, 2001 (HealthDayNews) -- Minutes after the Sep. 11 attack on the World Trade Center and the Pentagon, scores of nearby hospitals activated a recently approved emergency medical response program that was designed to handle large numbers of casualties.

But its effectiveness was never evaluated: The vast majority of the thousands of victims were killed instantly.

Now some experts are saying that the number of victims, had they lived, would have overwhelmed the response program.

Few hospitals or health agencies are ready to handle mass casualties or provide thousands of doses of antibiotics if local attacks occur, according to Russell Coile Jr., a security expert who spoke at the sixth annual Healthcare Internet and Technology conference in Las Vegas in October.

"America's worst public health nightmare has arrived," says Coile, a national strategy advisor from Southfield, Mich.

Emergency needs have changed, he adds, citing a recent disaster readiness checklist from the American Hospital Association (AHA). The AHA recommends that urban hospitals have enough on-site supplies to treat 1,000 individuals, and that rural hospitals have supplies available for at least 200 patients.

In addition to upgrading facilities and supplies, Coile notes the challenges hospitals face in mustering specific workers to deal with large-scale attacks. There are about 125,000 nursing vacancies nationwide, Coile says, and this acute nursing shortage severely limits hospitals' ability to respond to mass casualties.

Taking Things Seriously

Although comments like Coile's might once have been viewed as alarmist, the massive terrorism attacks in September provided a bold-face exclamation point to research that had already indicated the United States' emergency medical care system would have trouble handling a major catastrophe.

A study released at the annual meeting of the American College of Emergency Physicians in October indicated that only one in 30 hospitals had stockpiled medications for a bioterrorism attack.

None of the surveyed hospitals was prepared to manage a biological attack, and about 87 percent said they could handle only 10 to 15 casualties at once, the study said.

"Every hospital needs to change its thinking about disaster readiness. We're moving into an area where disasters are intentional and can create many casualties," says James Bentley, senior vice president for strategic policy planning for the AHA.

The Chicago-based AHA, which represents 86 percent of the America's 4,900 acute care hospitals, estimated this month that about $11.3 billion in federal aid is needed for hospitals to sustain services for 24 to 48 hours during a large-scale mass casualty event, until government resources arrive to support local operations.

Bentley cites coordination and communication as key areas that can make or break a disaster response.

Few hospitals have a well-defined plan that coordinates multiple emergency agencies for a mass casualty event. Even fewer have non-telephone-based communication systems, such as radio or the Internet. "You need backups to backups -- even if it's bicycle messengers," Bentley says. "Over the last 20 to 25 years, the push has been for hospitals to keep costs down and have a just-in-time inventory."

There is also the continuing problem of financing. With two-thirds of the nation's hospitals losing money on patient care, hospitals are trying to squeeze funding for disaster preparedness by deferring maintenance projects and equipment purchases, Bentley maintains.

Hospitals are trying to address the issue. The University of Nebraska Medical Center and Nebraska Health System, for example, are in the process of fine-tuning efforts for a mass casualty event. Communication with the public is considered important, and a single spokesperson for all emergencies and agencies has been named.

But that doesn't address the most important issue: having the supplies and necessary training to respond to chemical and biological weapon attacks.

John Hauser, safety officer for the partnership of the Nebraska Health System and University of Nebraska Medical Center in Omaha, says he hopes to secure antidotes for chemical agents and additional decontamination equipment and also provide training by the end of the year. Hauser considers his institutions to be far ahead of most other hospitals.

What To Do

For an update on how well a hospital in in your region is doing with its emergency medical procedures, go to this AHA site

And the Centers for Disease Control and Prevention offers this information.

This educational site gives you the latest information on dealing with terrorism.

SOURCES: Interviews with Russell Coile Jr., national strategy advisor, Superior Consultants, Southfield, Mich.; James Bentley, senior vice president for strategic policy planning, American Hospital Association, Chicago; John Hauser, safety officer, Nebraska Health System and University of Nebraska Medical Center, Omaha; Annals of Emergency Medicine, Journal of the American College of Emergency Physicians, Nov. 2001
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