Hospital Preparedness: A Public Health Mandate Remains Under-Appreciated

Abstract

At the time of this writing, the scope of devastation of the 26 December 2004 magnitude 9.0 Banda Aceh earthquake and subsequent South Asia Tsunami has yet to be determined. Initial reports in the lay press indicate that all 569 medical facilities in Sri Lanka have been destroyed. In the Banda Aceh region, only 82 of the 400 provincial health department staff have been accounted for, and approximately 150 physicians remain listed as missing [1]. The scale of the catastrophe, and its impact on the health care infrastructure, is a bleak reminder of the random power of nature, and the need for an adequate, flexible hospital response. Events of the past decade have increased awareness regarding mass casualty events (Table 1). The 1995 sarin nerve agent release on the Tokyo subway system raised global awareness for the potential use of so-called “weapons of mass destruction” by terrorist organizations against noncombatants, and the need to prepare non-military forces to deal with such casualties [2,3]. The subsequent push in the United States for domestic preparedness, however, largely focused on pre-hospital preparedness and protection. Nerve agent preparedness conveniently dove-tailed into preexisting procedures for hazardous materials response, and provided an immediate threat to be managed in the prehospital arena. The thought of subsequent hospital-based patient management, and therefore preparedness, never approached the radar screens of government officials in charge of preparedness development and funding. Hospital capability was essentially assumed, and the burden of development and maintenance placed upon the health care industry. While individual institutions took the initiative to develop hospital-based preparedness plans, little cohesion existed at the national level. Figure 1 Table 1: Selected Recent Mass Casualty Disaster Events The State of Ohio Terrorism Preparedness conference held 5-6 June 2000 in Columbus, OH, highlighted governmental indifference towards hospital capability and needs. When an attempt was made to address short-comings in current hospital preparedness, the issue was immediately deemed irrelevant to the State’s global preparedness vision, and was the only item relegated to the discussion trash bin during the entire break-out session (Figure 1). The big picture, that the hospital is part of the continuum of patient care initiated in the pre-hospital arena, appeared lost to many in leadership