Biomedical Engineering Reference
In-Depth Information
much as possible. External evaluators will
enhance objectivity and help keep employees
out of difficult situations (such as evaluating
their supervisors). Focused exercise design and
competent controllers can prevent or minimize
distractions arising from obstacles encoun-
tered during play. Local and state emergency
management and public safety agencies are
excellent resources.
of dedicated (and internally immutable) funding
stream to cover not just equipment but planning,
initial training, refresher training, and exercises.
Preparedness is an ongoing process and must
have ongoing support. The current multi-year
cycle of HRSA preparedness grants is an impor-
tant step in the right direction (albeit already
reduced from in its initial funding levels),
but it needs to evolve into a secure funding
stream and be tied to measurable, sustainable
improvements in broad-spectrum (as opposed
to bioterrorism-dominant) preparedness. For
now and the foreseeable future, NIMS compli-
ance is a necessary price to pay for maintaining
access to federal preparedness grants.
Use realistic staffing patterns for exercises
:
In addition to the need for covering all shifts
on training and exercises, it is essential to
employ staffing patterns that are likely to be
in effect when a real incident happens. Task-
based drills may not need scenarios, but larger-
scale exercises do. Exercises for off-peak shifts
should use off-peak staffing; incidents that
would require callbacks to provide additional
staffing or specialized skills should not assume
that
those assets are present at the outset
.
•
Realistic consensus standards
: Hospitals and
public safety agencies still rely on unproven
tenets, many incorporating military models that
have little application in the civilian world.
In the absence of national standards, states
and even localities have been developing their
own. In many areas and individual facilities,
equipment and training are determined in the
absence of standards or even an identified
strategy. Such standards are most important
with respect to PPE, mass decontamination
(including “no decontamination”), and dealing
with mass illness. The EMSA and AHRQ best
practices and models are substantial resources,
but they are not yet standards.
•
•
Recognize that success has multiple definitions
:
An exercise that evaluates its intended objec-
tives and yields action items is a success, but
only if there is action. “Lessons” are not neces-
sarily “learned.” It is appropriate to determine
whether a plan or procedure was successful,
particularly regarding specific tasks or func-
tions. Failure requires corrective action, but the
objective determination of success or failure
has value as well—not everything is relative.
Successes should be publicized, internally and
externally. An effective preparedness program
can use successes and failures as motivators for
continued improvement.
Ethics and liability
: As discussed by Pesik
et al. [52], triage following use of a weapon of
mass destruction on the U.S. civilian popula-
tion will not fit familiar models. In particular,
mass illness related to bioterrorism could create
a paradox in which the sickest patients receive
palliative care only. Effective, ethical planning
is as essential as the legal protection to conduct
it. Currently such indemnity from liability does
not exist in most states.
•
1.18 Critical Steps
To facilitate hospital and community preparedness,
there are some essential needs that require action
on the federal level (and in some cases require not
just a federal but a national approach):
References
1.
•
Financial incentives and support for hospital
preparedness
: As long as preparedness is
competing with everyday essential needs, it will
fail to thrive. Whether by grant, reimbursement,
or other means, hospitals must have some type
Joseph A. Barbera, Anthony G. Macintyre, and
Craig A. DeAtley. Ambulances to nowhere:
America's critical shortfall in medical preparedness
for catastrophic terrorism.
Journal of Homeland
