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Special report: Planning for the unlikely

by Carol Ko, Staff Writer | August 28, 2013
From the August 2013 issue of HealthCare Business News magazine

During the Boston Marathon bombing on April 15th, hospitals in the area had already been preparing for an emergency situation — they just didn’t know what form that emergency would take.

Because of the size of the marathon crowd, hospitals had already staffed up and developed an emergency plan in case they saw an influx of patients who were dehydrated, exhausted or suffering from race-related injuries.

When the bombing occurred, area facilities were faced with a bigger emergency than they had imagined. But their preparations for a patient surge enabled them to respond quickly and more efficiently to the situation.

Boston’s experience is a prime example of why experts say it’s generally more helpful to plan for capabilities rather than trying to develop emergency exercises around very specific threat scenarios. “There’s a natural tendency to focus on threat scenarios because people are always drawn to the last thing that happens, so they focus on snowstorms or earthquakes because that’s what gets your attention,” says Dr. Paul Biddinger, director of disaster medicine at Massachusetts General Hospital Department of Emergency Medicine. “But there’s no question hospitals have been encouraged to engage in capability-based planning. And the vast majority has tended to move in that direction.”

In fact, medical surge is listed as one of the National Healthcare Preparedness Programs’ eight primary capabilities, which provide the base for all forms of hospital preparedness. “You can’t adjust to every different type of event. What you need to have is foundational processes that apply to all hazards,” says David Marcozzi, director of National Healthcare Preparedness Programs, U.S. Department of Health and Human Services.

Speak easy
Thanks to recent investments in an interoperable communication system, Boston’s emergency medical services agency was able to leverage aid from outside agencies from the greater metro area to save lives during the bombing — of the 250 patients who were admitted to the hospital alive, all survived.

But what’s disturbing about the success of Boston’s response is that it may be a notable exception rather than the norm. In fact, the biggest obstacle to hospital preparedness consistently cited by experts is surprisingly simple: communication.

In the past, EMS response to mass casualty events has commonly been hampered by a lack of communication. For instance, if the community sends all its ambulances to one hospital that’s limited in capacity, that hospital may be overloaded while another nearby hospital that’s available may not be part of the response.

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