Biomedical Engineering Reference
In-Depth Information
1 Recurring Pitfalls in Hospital
Preparedness and Response
JEFFREY N. RUBIN
Hospitals are an essential component of
community preparedness for terrorism and other
hazards, both natural and manmade. Despite
general preparedness requirements within the
industry, hospitals typically are a weak link with
respect to community disaster preparedness, partic-
ularly for those incidents involving contaminated
patients. Significant systemic constraints make
most hospitals reluctant partners in preparedness
and generate ineffective response; this condition
has been highlighted by the antiterrorism training
and preparedness programs in the past few years.
Results of numerous exercises and actual responses
across the United States indicate a predictable list
of pitfalls, most of them related to inherent system
limitations that continue to hinder effective disaster
operations in hospitals:
response plans, and considerable federal resources
have been expended toward the same end—albeit
with inconsistent results. With some exceptions,
community preparedness efforts have faltered at
a common, though not exclusive, point: hospitals.
Those involved in preparedness and response
recognize the quandary: hospitals are essential,
irreplaceable resources for planning, response, and
recovery associated with disasters, but they carry
a unique set of constraints that makes effective
participation in such efforts challenging at best.
1.2 Hospital Challenges and
Constraints
Barbera et al. [1] cogently discussed the constraints
and challenges facing hospitals, along with public
expectations. Hospitals as a whole face diffi-
cult financial times: approximately 30% of U.S.
hospitals are operating at a financial loss, with
many more teetering on the financial brink [2].
Hospitals face increasing operating costs coupled
with decreasing reimbursement rates. Emergency
departments (EDs) have become primary care
intake points for much of the public [3], regard-
less of their insurance status. Staffing shortages are
becoming the rule for most departments across a
wide range of skill levels and specialties [4]; loss
of experienced staff exacerbates the problem. High
staff turnover rates further burden the remaining
staff and add overtime and incentive costs to
already strained budgets [5].
Costs have not been the only increasing item.
Healthcare facilities are hardly exempt
Communications
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Hospital security
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Decontamination procedures, equipment, and
training
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Hospital staff management
•
Exercise realism, content, follow-up
1.1 Introduction
Recent events have focused attention on the ability
of communities to respond to acts of terrorism.
In addition to intentionally generated incidents,
most communities have been struggling with
preparedness against a range of natural and tech-
nological hazards. Public safety and emergency
management personnel have developed and tested
from
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