Onto my emergency management soapbox
I was just looking over this week’s edition of our free e-newsletter, Emergency Management Alert, and was reading the item titled “Hospital ERs unprepared to handle terrorist attacks.” This elicited a number of thoughts, which I will now share.
First off, I recognize that there may have been a wee bit of hyperbole relative to the stance of “medical professionals” as they attempted to dissuade Capitol Hill lawmakers from enacting the Medicaid cuts scheduled to take effect on May 26. Certainly, this is not a time for healthcare organizations to be managing their corporate and civic responsibilities with increasingly limited resources, so I can applaud any efforts to stay the course when it comes to reimbursement.
That said, I can’t help but question playing the “terrorist card” as a means of convincing Congress to refrain from further reductions. In my travels around the country, I have encountered many instances in which reductions have resulted in hospitals facing significant challenges in managing the patients they already have, never mind some hypothetical surge as the result of a terrorist attack.
Anyone who has worked in healthcare for more than a nanosecond recognizes the universal truism: We don’t have enough space, resources, etc., to be able to manage our services without “trying”.
Having said that, what we do have is the practical application of critical thinking skills. I don’t know if I can call the existence of critical thinking skills in healthcare an abundance (cornucopia is certainly more alliterative), but it exists in reasonable supply.
A USA Today article cited a House Committee on Oversight and Government survey of 34 hospitals in seven major cities in which it was found that the hospitals had no space in their EDs to treat a sudden surge of patients. To which my initial response was, “No duh.”
I suppose it’s a valid point to make as it is, after all, accurate. However, authorities unfamiliar with all the work that’s been done relative to alternative care sites, continuity of operations planning, and the like? In order for hospitals to stay in business, they have to treat patients, and, strangely enough, those patients take up space in the ED, in the intensive care units, and on the med-surg units.
Does this mean the feds are going to subsidize hospitals to keep empty beds in the event of a catastrophic failure of homeland security? That hardly seems a useful or productive expenditure of tax dollars.
In discussing similar topics with clients over the past couple of years, my advice has always been that you need to prepare for those circumstances that are the most likely to occur in your community. Any expenditure in preparation for events that are not likely is a disservice to your organization and your community.
The development of real emergency response capacity is much more critical than chasing the “emergency du jour.” Just look at the news about cyclones, tornados, and earthquakes. Those are the real events, and it is most unlikely (at least I hope not) that nature is plotting these occurrences.
My experiences have been that while hospitals may not be completely prepared for every conceivable event (and never shall they be), they have made enormous strides over the last half-decade. I don’t think there is a responsible hospital leadership group in this country that do not understand the critical importance of emergency response.
But, in the absence of a level playing field in terms of reimbursement, expenditures, etc., the management of competing priorities varies from organization to organization, region to region. I’m not necessarily advocating an NFL-style salary cap leveling of the playing field (though maybe…).
It is all well and good to pronounce that hospital EDs are “unprepared,” which is extraordinarily hyperbolic. It is true that we don’t have the beds now, but we can shift things around to make them available because after all. Isn’t that what we do on an everyday basis? But I see no indication of anything in the way of solutions from our august Congress.
One of the most frustrating personalities I run into is that of the delegator, whose response when problems occur is, “I told them to do it, but they wouldn’t listen.” There is no room in this world for delegation. To my mind, it is way too passive. It is an imperative to “do” responsibility, not shift it. There’s a joke in here about shiftiness, but I’ll let you conjure that one up in your spare time, though I suppose one could consider that rather delegatory of me--so be it.
Climbing down from my soapbox, I bid you productive and purposeful disaster response planning and a delightful day in general.
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