Biomedical Engineering Reference
In-Depth Information
was the first large-scale federal program to focus
on improving the ability of healthcare systems to
detect, identify, and manage incidents involving
large numbers of potentially contaminated casu-
alties. The goal of incorporating first responders
(public safety agencies), public health agencies,
hospitals, and emergency management and linking
local, state, and federal agencies was an innovative
global approach to a healthcare system that is
commonly approached via its components. The
challenges faced by MMRS participants and
administrators in the program's initial incarnation
were less a result of the philosophy than of the
style and method of administration. The MMRS is
now part of the multi-faceted Homeland Security
Grant Program [8A], addressing key issues of
medical surge capacity in the community.
Surge capacity, the ability to handle a large
influx of ill or injured people beyond stan-
dard community resources, is a critical compo-
nent of hospital preparedness. As additional (i.e.,
unused) hospital bed-space has dwindled over the
years, surge capacity in American hospitals has
been allowed to reach an extreme low [9,10].
Even were there significant excess hospital beds,
it would be difficult to staff and equip them.
Realistically, solutions must involve alternative
assessment and treatment centers rather than physi-
cally expanding hospitals—and most do (either via
adapting existing alternate facilities or setting up
temporary ones). Providing adequate staffing for
these alternative centers is the greater challenge.
In addition to preparedness requirements, hospi-
tals fall under regulations of the Occupational
Safety & Health Administration (OSHA) and the
Environmental Protection Agency (EPA). As with
many detailed federal standards, OSHA's require-
ments for hospitals are open to interpretation, with
a great deal riding on sources such as OSHA opin-
ions and interpretations: often the closest to a de
facto standard. The lack of a clear and consis-
tent application of OSHA regulations has been
an obstacle to developing consistency, although
progress appears to be in the making when this
was written.
Plan development, staff training, and equipment
maintenance are non-reimbursable costs in terms
of billing, but some financial support has devel-
oped. In June 2002, the Healthcare Resources and
Services Administration (HRSA) initiated grants
to states and a few cities focusing on preparedness
for bioterrorism in state and local governments
and hospitals [11,12]. The grants were supposed
to assist states in achieving “critical benchmarks
for bioterrorism preparedness planning,” promul-
gated by the Department of Health and Human
Services. Three of the initial benchmarks were
to designate a bioterrorism preparedness coordi-
nator, establish a hospital preparedness planning
committee to advise the state health department,
and develop a plan for managing epidemics,
regardless of origin [13]. States have some discre-
tion on disbursement (provided that funds are
directed toward fulfillment of primary grant goals),
with many aiming for general hospital prepared-
ness as a first step in bioterrorism prepared-
ness. Subsequent and planned grants from HRSA
have allowed expansion of preparedness funding
from hospitals to health systems and encourage
regional and statewide coordination. In combina-
tion with public health preparedness grants from
the CDC and the MMRS component of the
Homeland Security Grant Program, the HRSA
National Bioterrorism Hospital Preparedness
Program [13A] is addressing local, regional, and
state aspects of health-system surge capacity and
capability.
Despite requirements, some standards, and best
intentions, significant obstacles remain, including
the combination of staff and equipment short-
ages, lack of surge capacity, and minimal funding.
Although there have been (and likely will continue
to be) substantial improvements, most hospitals are
still unprepared to effectively manage the results
of a major incident—whether due to mishap,
terrorism, natural disaster, or infectious disease
outbreak—requiring treatment of mass casualties,
staff protection, or facility evacuation [14,15]. An
incident contemporaneous with local or regional
infrastructure disruption will not only magnify
hospital shortcomings, it will further hamper effec-
tive hospital response and hospital and community
recovery.
