The U.S. government understands that economic growth and development is dependent on the health of the citizens. Therefore, the government has invested over $2.3 trillion in enhancing the healthcare provision and quality for all its citizens. The massive investment makes U.S. health sector the largest in the world. The Obama Care comes to mind when analyzing the progress of the sector in enhancing the accessibility of the public. However, one of the primary concern has been on dealing with emergencies such as terrorist attacks, natural disasters and other forms of disasters that result in mass casualties. Since the 1993 New York terrorist attack, the federal government has instilled more emphasis on disaster preparedness. The September 11, 2001 attacks demonstrated that hospitals in the country were lacking in their ability to handle the mass victims during such disasters thus resulting reforms that led to the Patient Protection and Affordable Care Act. The act gave the Joint Commission the mandate to set the requirements of disaster pre3paredness by developing a written Emergency Operation Plan (Myers & Bearss, 2018). The plan enables the Joint Commission to set accreditation on the emergency preparedness of the hospital.
The purpose of this paper is to demonstrate the emergency preparedness of a full-service 600-bed government health organization following the claim that there is an impending terrorist threat against the U.S. As the Vice President of Quality and Safety in the hospital, this study will demonstrate the emergency preparedness of the hospital to handle the impending terrorist attack.
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Understanding Disasters
The disaster both natural or human-made disasters in the 1990s and the beginning of 21st century led to the formation of the Hospital Preparedness Program (HPP). HPP is under the office of the Assistant Secretary for Preparedness and Response (ASPR) at the Department of Health and Human Services (HHS) and the Public Health Emergency Preparedness (PHEP) program (The Walker Company, 2011). These programs have instilled the doctrines to be used in enabling better healthcare provision in the country, but the lack of integration into other programs such as the National Disaster Medical System (NDMS) and that of local volunteers such as the Medical Reserve Corps (MRC) has failed in enabling improved disaster management (The Walker Company, 2011). The federal and state governments have also have focused on using programs such as the Emergency Medical Assistance Compact (EMAC) to ensure that emergency patients are treated first before the hospital needs payments (Taschner, Nannini, Laccetti & Greene, 2016). These regulations helped in the formulation of this paper because they are the cornerstone of the strategies and activities needed to deal with a terrorist attack.
Past Terrorist Attacks and Responses
Based on previous experiences, for instance, the Boston Marathon bombing and the shooting in Las Vegas, the hospital has employed some of the successful strategies in developing a suitable and robust emergency plan of the organization. Disaster under the CDC guideline is classified into four types namely, small-mass injuries, large-scale natural disasters, multiple mass casualty and catastrophic health events but this paper is determined to demonstrate its preparedness on the complex mass casualty similar to those named earlier (The Walker Company, 2011). In this mass casualty events, several characteristics to understand the scope and impacts of such events to ensure that this research provides the best possible emergency preparedness plan for the organization. Complex mass casualty events are characterized by having little or no infrastructure damage since even in the case of the September 11, 2001 incident only the targeted buildings were destroyed. The average healthcare capacity is not affected, but due to the number of victims, there is a need for specialist care to help treat the large number of patients suffering from burns, trauma and other illness that can be grouped under bleeding and concussion which require intensive care units (The Walker Company, 2011). The past disasters of this magnitude have demonstrated that the high burden of specialty, trauma treatment, a transient surge that overwhelm the individual facility and need the coordination of the local or regional facilities. These burdens make it difficult for facilities that are not prepared to handle such emergencies.
Past strategies such as the Boston Marathon bombing and the Las Vegas shooting during a concert provided the following lessons. The success in dealing with the Boston Marathon bombing was due to the first respondent who were the civilians who did not wait for the national and Homeland Securities and Emergency agencies to arrive. The bystanders did not panic following the blast but used their first-aid knowledge to help the victims (Myers & Bearss, 2018). The emergency agencies received help from these civilians who were assisted in paving the roads to provide ambulances paths to get the victims. These are some of the great depictions of the value of the bystanders when faced with an accident.
The Boston Marathon was quite smooth and demonstrated that the hospitals involved were prepared to handle such a disaster. However, different scholars claim that the efficacy of dealing with the Boston Marathon incident was because the event did not present a significant or complicated scenario that a bigger terror-attack may present (TariVerdi, Miller-Hooks & Kirsch, 2018). The Las Vegas incident presented a more prominent casualty and victims that proved that U.S. hospitals are still lacking in preparedness in dealing with such a mass casualty event. The biggest challenge was that the nearest hospitals could not accommodate the overwhelming number of patients just as in the 9/11 incident where the hospitals around New York were overwhelmed by the crowds of victims requiring emergency treatment. In the 9/11 terrorist attack, most of the victims walked to the hospital or were brought to the hospital by civilians. The panic and dust from the collapsing buildings made more people crowd the hospitals to seek refuge or trying to find their families or loved ones.
The overwhelming number of patients led to nearby hospitals migrating some of the patients to other hospitals, but it was evident that in both the 9/11 and Las Vegas moving patients be a failure as victims were transported to other facilities without the knowledge of the receiving facilities that they were to expect these emergency patients. These situations demonstrated that communication failures and coordination within the rescue teams, the hospitals, and community and ambulance agencies influenced the number of victims’ deaths and complicating the conditions of the patients (Gomez, 2015). These failures and success helped in writing the organization’s emergency preparedness plan.
Hospital’s Preparedness
According to the Joint Commission requirements as cited by TariVerdi, Miller-Hooks & Kirsch (2018) hospital boards must be notified and oversee the emergency preparedness of the hospital to ensure that they provide the needed financial support for implementing the plans. The full-service 600-bed government hospital will gain the needed emergency preparedness organization from the federal, state, local government with the community involvement also sponsoring the different projects. These projects are expensive. Therefore, the hospitals must ensure that they can access support from sponsors and other government sources. The hospital must ensure that it provides an emergency unit within the organization that will be called upon whenever an emergency occurs. Setting a specialty care unit is paramount, but in most situations hospitals of this size, it is impossible for the organization to set have all specialty units (TariVerdi, Miller-Hooks & Kirsch, 2018). Therefore, the organization focused on enhancing the department that deals with burns and bleeding patients. These units have paid specialists who work regularly in the facility since no other hospital provides these services in the area.
The hospital is aware that having a functional specialty unit for burns and bleeding cases is not enough to cater for victims of the impending terrorist attack, but it understands that trying to cater for all forms of injuries would reduce its efficiency. Therefore the hospital has built a local relationship with a hospital five miles away that has trauma specialty unit to ensure that patients that require treatment of mental or trauma treatment are referred in that hospital. The relationship has been growing with sharing of data and communication through the EMS dispatching systems and networks to ensure that during the attack, it will be easier to coordinate and migrate victims to the other hospitals.
The past incidents have demonstrated that the number of patients is mostly higher than what a single facility can accommodate, therefore, using the state’s ASPR, the regional, states, city and local hospitals can communicate and participate together to provide emergency services without overwhelming a single facility. By integrating the local MRC and the NDMS, it is easy to engage in accepting victims and moving them to other hospitals without the fear of failures documented in past incidents. It was also clear that family members and friends of the victims tend to devastate the running of the hospital with requests to move the victims or see that they are being provided with the best care possible (Myers & Bearss, 2018). Therefore, through the dispatching systems and departments, the hospital has agreed to let families move their family members to other facilities only if they are conditions that moving them would not be risky or detrimental to their conditions (Gomez, 2015). The concession is based on the opportunity to allow empty beds in the medium-sized hospital to receive and cater for other victims.
The Boston Marathon incident illustrated that the community is instrumental in enabling primary healthcare provision of the victims which increases the chances of saving the victims’ lives. Hence the move by the hospital to engage the community in seminars and provide them with the necessary first-aid lessons. The seminar also included the education on ways to empower the community to work and coordinate with the different emergency teams in the site and use of different communication platform to communicate with the specialty units and ambulance agencies. The strategy of including and empowering the community in times of crisis and terrorist attacks was borrowed from Israel’s emergency management which has empowered the civilians to help in saving lives.
Israel’s emergency management is one of the best in the world mainly because of the mandatory military training of all adult citizens which makes the civilians knowledgeable to provide help and first-aid. However, even with the different knowledge in the U.S., our rigid policies tend to exclude the civilians from participating in saving lives. The hospital through its strong community-based foundation has moved towards engaging the community, therefore, borrowed Israel’s strategy (Adini & Peleg, 2013). The strategy has also empowered volunteers by encouraging veteran doctors and other people with healthcare knowledge to participate in different activities in the hospitals and through the MRC to have contacts of these volunteers in the event of the attacks.
Lastly, medical records and failure of victims being enrolled in health insurance have hindered effective emergency preparedness. The EMS and the EHRs enable the hospital to acquire medical records of the patients and reduce the errors of complications and misdiagnosis. Guided by the EMAC, the hospital has calculated the expected budget for providing free emergency treatment in the absence of health insurance for reducing the legal charges that may follow if the facility denies treating any of the victims because of an absence of insurance coverage (Myers & Bearss, 2018). The tort reforms and healthcare quality may have eased the fear of facing legal charges in case of an error, but the hospital is guided by the Emergency Medical Treatment, and Active Labor Act (EMTALA) (TariVerdi, Miller-Hooks & Kirsch, 2018). The law requires post-attack healthcare services, but the hospital will request health insurance from the victims which will be instrumental in maintaining the medical records and financial support needed for those without any medical coverage.
References
Adini, B., & Peleg, K. (2013). On Constant Alert: Lessons To Be Learned From Israel’s Emergency Response To Mass-Casualty Terrorism Incidents. Health Affairs , 32 (12), 2179-2185.
Gomez, C. (2015). Mass casualty events present special communications challenges. Campus Security Report , 11 (10), 1-5.
Myers, N., & Bearss, A. (2018). Mandating Public Health Emergency Preparedness: Analysis of the CMS Rule. Risk, Hazards & Crisis In Public Policy .
TariVerdi, M., Miller-Hooks, E., & Kirsch, T. (2018). Strategies for Improved Hospital Response to Mass Casualty Incidents. Disaster Medicine And Public Health Preparedness , 1-13.
Taschner, M., Nannini, A., Laccetti, M., & Greene, M. (2016). Emergency Preparedness Policy and Practice in Massachusetts Hospitals. Workplace Health & Safety , 65 (3), 129-136.
The Walker Company. (2011). Preparing for the Worst, Leading with the Best The Hospital Board’s Role in Disaster Readiness. Retrieved June 5, 2018, from http://www.calhospitalprepare.org/sites/main/files/file-attachments/board_brief_may_2011.pdf
