Battlefield casualty management experience has resulted in advanced and effective rescue, resuscitation, stabilization, definitive treatment and rehabilitation of soldiers ever since World War II. The use of the helicopter as an air ambulance greatly improved the survival rates of soldiers wounded in combat in Korea and Vietnam and in all conflicts since. Many trauma procedures develop in combat medicine have been applied with great success to our civilian trauma systems. With the ever-present threat of terrorist attacks using biological, chemical, radiological/nuclear and explosive agents or devices, the time may be right for jurisdictions and their civilian healthcare systems to implement a combat proven system for mass casualties called the 4-Echelon Mass Casualty Management System.
For more than 10 years, Public Health agencies at all levels of government have been ramping up capabilities for early detection and responses to biological warfare agents and disease outbreaks. HHS through the Hospital Preparedness (HPP) grant program has advocated a 6-Tiered approach to managing expanding disasters from local communities (Tier 1) all the way outward to a National (Tier 6) fully integrated response to catastrophic events. The overarching idea is to build a scaled response to disasters by forging strong relationships between the Emergency Management community, public health agencies and Private Sector healthcare organizations in order to effectively manage casualties resulting from any disaster event. The system should maximize the number of casualties stabilized during the “Golden Hour” and then rapidly transport stabilized patients to hospitals and medical centers away from the affected community for definitive care and long term rehabilitation.
What is the 4-Echelon Disaster Patient Management System? The 4-Echelon Disaster Patient Management System is a highly effective and efficient system of managing very large numbers of casualties throughout a disaster and until local healthcare organizations recover and can resume normal operations.
The 1st Echelon of care is provided by first responders and consists of immediate lifesaving procedures and the rapid transport of the living to a 2nd Echelon facility. All living casualties are transported to 2nd Echelon facilities with the dead left for the mortuary affairs team.
A 2nd Echelon facility may be a trauma center or an emergency department. The 2nd Echelon is essential in making the most of the patient’s “Golden Hour.” By providing immediate care and by dramatically increasing the casualty throughput to 3rd and 4th Echelons, the 2nd Echelon care providers prevent or reduce the patient gridlock associated with a disaster and thus, optimize the saving of lives. 2nd Echelon care is designed only to save lives and stabilize patients and not to provide definitive care. Typically at the 2nd Echelon, providers ventilate patients if necessary, control bleeding, infuse blood products and expanders and amputate limbs as required. Once stabilized, patients are quickly transported to the 3rd Echelon of care for definitive treatment.
The 3rd Echelon disaster healthcare facility is typically a hospital or medical center away from the immediate disaster location. In the early stages of a disaster, a hospital or medical center may provide both 2-E and 3-E care. It is likely that a hospital’s 3-E capacity will almost immediately be reached and the facility will revert to 2-E care only. 3rd Echelon facilities may be within a jurisdiction or may include hospitals in several jurisdictions or even national regions, depending on the number of casualties and the care requirements. Definitive care is provided at all 3rd Echelon facilities, but specialized care such as burn centers may also be provided in a 3rd Echelon facility. This includes a full complement of surgery specialties, diagnostics and follow-on care for about 7 days. Patients who cannot be discharged within a week are normally candidates for 4th Echelon care.
The 4th Echelon may include specialty centers or rehabilitation hospitals capable of providing long term ventilation care, psychiatric care, burn or wound care and rehabilitation or specialization in physical therapy or orthopedic care including providing prosthetic devices and associated therapies.
Depending on the location and scope of the disaster, a particular hospital may function as a 2nd, 3rd or a 4th Echelon facility. When close to the disaster location, a hospital may have to function only as a 2nd Echelon facility, transporting all stabilized patients to 3rd and 4th Echelon facilities further away from the disaster location. By so doing, the hospital serving as a 2nd Echelon hospital may be able to treat more patients in need of stabilization than it could as a multiple-Echelon facility. In another disaster scenario further away, this same hospital could be functioning as a 3rd or 4th Echelon facility, providing definitive and/or specialty care to stabilized patients.
What is the role of Healthcare Organizations as part of a 4-Echelon Disaster Patient Management System? Most medical centers and many hospitals operate as a de-facto full 4-Echelon self-contained system during normal everyday operations. During a disaster, Healthcare organizations will periodically self-declare their capabilities to the Emergency Operations Center (EOC) in terms of the Echelon of care they can provide in a fluid environment. Depending on the size and scope of a Mass Casualty event, a hospital may eliminate the 4th-Echelon immediately and declare itself as 2nd and 3rd Echelon capable to the medical representative in the Emergency Operations Center. At that point, the EMA would reach out to adjacent jurisdictions to activate their EOC (s) and to provide a list of healthcare organizations capable of providing 4th Echelon care. In any case, healthcare organizations must be able to efficiently communicate their capabilities with the jurisdiction’s EOC throughout the disaster.
How can 4-E work in a competitive Healthcare Marketplace?
A traditional model of disaster healthcare seems to dictate that healthcare organizations provide the full continuum of care to all patients presenting for care. Competition would seem to dictate that hospitals or medical centers expand (surge) their services until their individual capacity and capabilities are reached. Why then would hospitals want to self-declare themselves as a 2nd Echelon facility and request rapid transport of stabilized patients to healthcare organizations outside of their service area? The answer lies in continuity of operations. Hospitals in the affected area need to recover and resume normal healthcare services as soon as possible after a disaster. 2nd Echelon healthcare facilities performing thousands of life saving procedures over the course of a disaster, (if properly documented) may generate significantly more revenue than 3rd Echelon facilities away from the disaster location. Also, by serving as a 2nd Echelon facility and rapidly transferring patients to 3rd and 4th Echelon facilities outside the affected area, hospitals and medical centers in the affected area can conserve staffing and specialty care material resources and thus, can more rapidly recover after the disaster event.
This definitely requires a paradigm shift, but experience shows that after a disaster, healthcare providers need decompression time. If the staff is exhausted, who will provide healthcare services immediately following a disaster? Likewise, medical supplies are consumed at an enormous rate during a disaster. Equipment used during a disaster needs to be disinfected and inspected prior to being returned to normal service. If the support services personnel are exhausted, who is going to disinfect hospital areas and the equipment and how long will the hospital be closed after a disaster? Heart attacks and strokes will still occur, babies will be born and the population in general will need care immediately after a disaster.
Finally but importantly, disaster operations can and do strain healthcare financial resources to the breaking point. The last thing that any community needs after a disaster is a number of bankrupt hospitals or medical centers. Civilian healthcare organizations cannot issue continuing resolutions in order to make payroll or pay suppliers during and after a disaster. Federal and State payers as well as private insurance companies must develop and publish simplified health care claim procedures for use during declared emergencies. These simplified claim procedures will sustain healthcare organizations and their services during and after a disaster and can help ensure that healthcare services are available after the disaster. Perhaps, simplified financial procedures can be tied to services rendered at each Echelon of care.
Adopting the 4-Echelon Disaster Patient Management System. The first step is the adoption of the 4-Echelon Disaster Patient Management System by a state or territory EMA, EMS organizations and the Healthcare organizations within the jurisdiction. Once proven in a single state, the 4-Echelon System may be adopted throughout a federal region or multiple regions. In time, the 4-Echelon System can be adopted Nationwide. The 4-Echelon System will fit seamlessly into the National Disaster Medical System (NDMS), since had the Cold War turned hot, the NDMS healthcare facilities were the planned 4th Echelon of care for service members returning from either the European or Pacific theaters of operations. The 4-Echelon System is in effect today for returning injured service members. Thus, while jurisdictions and health systems struggle to develop an effective “Medical Surge” system, this may be the right time to integrate this efficient and effective patient management system into our civilian disaster healthcare system. ©2011 JVR Health Readiness Inc.
Wednesday, March 30, 2011
Sunday, March 13, 2011
Disasters Only Happen To Others
(Jim Rush Salado, Texas) With the 8.9 Japan earthquake, America is once again thinking about Disaster Readiness, but I fear this is just a temporary phenomenon. If our past is any indicator, instead of using this tragedy as an opportunity to become truly prepared for disasters, we will once again relapse into a state of complacency. For decades, Japan has invested heavily in earthquake Readiness and has perhaps the world’s most stringent building codes in preparation for the earthquake that has occurred. I can’t help but wonder what an 8.9 earthquake would mean to Los Angeles, Portland or Seattle and to the folks who live in those cities.
Since 2004, the Department of Homeland Security (DHS) has advised state and local leaders to plan for very large disaster scenarios. Some of the DHS’ “Planning Scenarios” http://tiny.cc/czgr4 include a 10 Kiloton nuclear attack, a major earthquake, and a killer influenza Pandemic. The #1 DHS Planning scenario is a nuclear attack with a 10 Kiloton bomb in large, high risk American city or large metropolitan areas. We can only imagine the loss of life and suffering that would be associated with a major terrorist attack with our current dismal level of Readiness. Even in the face of Federal planning advice, DHS has done little to build the capabilities that would be needed to effectively manage an attack of this size and scope.
For years now, I have been advocating for a calm, resolute culture of Disaster Readiness. Unfortunately, I have been seeing what I refer to as the “PowerGlide” of Public sentiment. For those of you too young to remember, many Chevrolet automobiles in the 1960's had a “PowerGlide” transmission - low gear and high gear...that's all there was. Since the terrorist attacks of 9-11, we as a society have had only two collective mental gears....complacency and hysteria.
Prior to 9-11 we were in the complacent gear, and afterward, when we were scared to death we would be attacked again, we transitioned immediately into the hysteria gear. Congress acted as they are wont to do, by enacting laws sending billions of dollars to Federal agencies with urgent instructions to “Get the Money Out Now.” Congress should have first commissioned a group of Operational Readiness experts to outline a common sense National Disaster Readiness Plan which would result in increases in America’s capacities and capabilities to manage the major disaster scenarios promulgated by DHS. At that point, Congress could have appropriated funds to enable actions called for in the National Response Framework. Instead, Congress enacted laws to fund various huge grant programs without the coordination and integration required of any competent National disaster readiness program. When Federal Programs all march in different directions based on the laws enacted by Congress, we have a guarantee of failure. My last blog entry “Unprepared after Tens of Billions of Federal Grant Funding” further explains how we built a fragmented, politically correct National Readiness Program.
Although we all knew we are going to be attacked again, soon after 9-11 we reverted to our complacent gear. As such, we have done little to significantly improve our overall state of Readiness to manage another 3,000 casualty event, let alone a 100,000-300,000 casualty event. As a Nation, we just don't want to think about unpleasant things and thus, there is little public support for Disaster Readiness. Sadly, many Emergency Managers, the folks whose job it is to plan for major disasters, also refuse to think about or plan for large scale natural disasters, industrial accidents or terrorist attacks.
In 2005, we all saw thousands of people suffering and dying during and immediately following hurricane Katrina. Folks with disabilities were slumped down dead in wheelchairs outside storefronts, nurses crying on hospital rooftops while manually ventilating patients while they waited for a medical evacuation helicopter. We saw the dead floating down streets in New Orleans-an American city, with corpses in the water. If we had mobile hospitals and public health units, we could have deployed them to the high ground near New Orleans to treat those requiring medical care and/or immunizations and other Public Health services. Since we didn’t invest in Mobile health and medical units, we had to fly thousands of hurricane survivors to points around America. One facility located at the decommissioned Kelly Air Force Base in San Antonio received large numbers of Special Needs patients, many without any of critically important medicines like Insulin. Volunteer nurses had no medical supplies on hand and no federal system from which to order. Instead, they resorted to calling pharmaceutical companies to request donations of insulin, lancets and glucometers to care for the evacuees who had been without insulin for days. Imagine that…all those billions of Federal Grant Program dollars, but no medicine for chronic illness care!
Then in 2008, we saw an entire community’s healthcare infrastructure destroyed in Galveston, Texas as a result of hurricane Ike. Once again, instead of deploying cost effective Healthcare and Public Health facilities to Galveston after the hurricane, we embarked on a very costly process of using air evacuation helicopters to airlift patients in Galveston to Houston hospitals for medical care. While this was ongoing, many of the highly skilled physicians, surgeons, nurses, physical and respiratory therapists and other highly skilled medical professionals left Galveston to work elsewhere. If we had deployed mobile hospitals and specialty care facilities to Galveston, many if not all the medical professionals could have continued working in Galveston and serving the Community. Instead, the result was an absence of hospital care for almost a year and untold costs to the taxpayers to airlift folks to Houston for medical care. Even though it will take Galveston years to recover, we pulled the complacency blanket over our heads and went back to sleep.
We have been told by the CDC for years now that it was a matter of "When" and not "If" we would have a killer Pandemic. During the 2009-2010 H1N1 flu season, we experienced far fewer deaths than we experienced in a normal flu season and yet we were all about to dust off our living wills. There were enduring backorders for all manner of respiratory care supplies and other medical supplies. In fact, medical distributors resulted to “allotting” (a nice word for rationing) medical material supply orders from hospitals all across America. As soon as the immediate hysteria subsided, we once again shifted back into our complacency gear, instead of ramping up our Public Health and Healthcare organizations’ ability to manage and logistically support medical care during a future killer pandemic. The opportunity was lost for Federal Response agencies like the Department of Health and Human Services (HHS) to begin building Federal Reserve Inventories (FRI) of medical supplies, equipment, mobile hospitals and public health infrastructure.
I hope we can develop a third gear...an overdrive if you will, that will take us into the future. We need to reinvigorate the National Disaster Medical System (NDMS), including a dedicated medical supply and equipment program to sustain the NDMS during large scale disasters. Let’s develop REAL plans to take care of REAL casualties. Let’s do the hard work to develop supply and equipment lists of all classes of materials, including deployable mobile disaster hospitals, needed to provide professional medical care and competent sheltering for people with disabilities and special medical needs. Let’s ask HHS or DHS to purchase and manage these critical healthcare and public health assets as Federal Reserve Inventories.
Let’s look at the 15 Federal Planning Scenarios and plan for the scenarios which will most likely occur for our high risk jurisdictions. Let’s build mobile disaster hospitals and public health departments which are properly supplied, equipped and sustained during long duration disasters.
Let’s really enhance our Medical Reserve Corps by developing a program similar to our Armed Forces Reserve components; offering paid “Reserve” opportunities to retired Medical Professionals and let’s pay them during summer sessions to update their competencies and integrate with active healthcare and public health professionals. Let’s link-up healthcare and public health with our communities’ Emergency Management Agencies and develop a real disaster-ready community response. Let’s ask the Federal Government to build Federal Reserve Inventories of food, water, medical supplies, equipment and pharmaceuticals to name just a few (FRIs). After all, we already have the model in the Strategic Petroleum Reserve.
Disaster Readiness is never inexpensive, but it is always cost effective. We need to understand that we will either invest in a National Disaster Response System now, or pay much more in future disasters, not just in dollars, but in human life.
If we can muster the will, the good stewardship, and the funding to increase our Readiness posture, we can take the first few steps that lead us to "Full Readiness." We can begin saving hundreds of thousands of lives during the next man-made or natural disaster.
Lets all insert that extra gear into our two speed culture. Let's see how it feels to know that we did all that could have been done in preparing our Country for the really big next one. That gear is known as the Readiness gear. Start shifting!
Since 2004, the Department of Homeland Security (DHS) has advised state and local leaders to plan for very large disaster scenarios. Some of the DHS’ “Planning Scenarios” http://tiny.cc/czgr4 include a 10 Kiloton nuclear attack, a major earthquake, and a killer influenza Pandemic. The #1 DHS Planning scenario is a nuclear attack with a 10 Kiloton bomb in large, high risk American city or large metropolitan areas. We can only imagine the loss of life and suffering that would be associated with a major terrorist attack with our current dismal level of Readiness. Even in the face of Federal planning advice, DHS has done little to build the capabilities that would be needed to effectively manage an attack of this size and scope.
For years now, I have been advocating for a calm, resolute culture of Disaster Readiness. Unfortunately, I have been seeing what I refer to as the “PowerGlide” of Public sentiment. For those of you too young to remember, many Chevrolet automobiles in the 1960's had a “PowerGlide” transmission - low gear and high gear...that's all there was. Since the terrorist attacks of 9-11, we as a society have had only two collective mental gears....complacency and hysteria.
Prior to 9-11 we were in the complacent gear, and afterward, when we were scared to death we would be attacked again, we transitioned immediately into the hysteria gear. Congress acted as they are wont to do, by enacting laws sending billions of dollars to Federal agencies with urgent instructions to “Get the Money Out Now.” Congress should have first commissioned a group of Operational Readiness experts to outline a common sense National Disaster Readiness Plan which would result in increases in America’s capacities and capabilities to manage the major disaster scenarios promulgated by DHS. At that point, Congress could have appropriated funds to enable actions called for in the National Response Framework. Instead, Congress enacted laws to fund various huge grant programs without the coordination and integration required of any competent National disaster readiness program. When Federal Programs all march in different directions based on the laws enacted by Congress, we have a guarantee of failure. My last blog entry “Unprepared after Tens of Billions of Federal Grant Funding” further explains how we built a fragmented, politically correct National Readiness Program.
Although we all knew we are going to be attacked again, soon after 9-11 we reverted to our complacent gear. As such, we have done little to significantly improve our overall state of Readiness to manage another 3,000 casualty event, let alone a 100,000-300,000 casualty event. As a Nation, we just don't want to think about unpleasant things and thus, there is little public support for Disaster Readiness. Sadly, many Emergency Managers, the folks whose job it is to plan for major disasters, also refuse to think about or plan for large scale natural disasters, industrial accidents or terrorist attacks.
In 2005, we all saw thousands of people suffering and dying during and immediately following hurricane Katrina. Folks with disabilities were slumped down dead in wheelchairs outside storefronts, nurses crying on hospital rooftops while manually ventilating patients while they waited for a medical evacuation helicopter. We saw the dead floating down streets in New Orleans-an American city, with corpses in the water. If we had mobile hospitals and public health units, we could have deployed them to the high ground near New Orleans to treat those requiring medical care and/or immunizations and other Public Health services. Since we didn’t invest in Mobile health and medical units, we had to fly thousands of hurricane survivors to points around America. One facility located at the decommissioned Kelly Air Force Base in San Antonio received large numbers of Special Needs patients, many without any of critically important medicines like Insulin. Volunteer nurses had no medical supplies on hand and no federal system from which to order. Instead, they resorted to calling pharmaceutical companies to request donations of insulin, lancets and glucometers to care for the evacuees who had been without insulin for days. Imagine that…all those billions of Federal Grant Program dollars, but no medicine for chronic illness care!
Then in 2008, we saw an entire community’s healthcare infrastructure destroyed in Galveston, Texas as a result of hurricane Ike. Once again, instead of deploying cost effective Healthcare and Public Health facilities to Galveston after the hurricane, we embarked on a very costly process of using air evacuation helicopters to airlift patients in Galveston to Houston hospitals for medical care. While this was ongoing, many of the highly skilled physicians, surgeons, nurses, physical and respiratory therapists and other highly skilled medical professionals left Galveston to work elsewhere. If we had deployed mobile hospitals and specialty care facilities to Galveston, many if not all the medical professionals could have continued working in Galveston and serving the Community. Instead, the result was an absence of hospital care for almost a year and untold costs to the taxpayers to airlift folks to Houston for medical care. Even though it will take Galveston years to recover, we pulled the complacency blanket over our heads and went back to sleep.
We have been told by the CDC for years now that it was a matter of "When" and not "If" we would have a killer Pandemic. During the 2009-2010 H1N1 flu season, we experienced far fewer deaths than we experienced in a normal flu season and yet we were all about to dust off our living wills. There were enduring backorders for all manner of respiratory care supplies and other medical supplies. In fact, medical distributors resulted to “allotting” (a nice word for rationing) medical material supply orders from hospitals all across America. As soon as the immediate hysteria subsided, we once again shifted back into our complacency gear, instead of ramping up our Public Health and Healthcare organizations’ ability to manage and logistically support medical care during a future killer pandemic. The opportunity was lost for Federal Response agencies like the Department of Health and Human Services (HHS) to begin building Federal Reserve Inventories (FRI) of medical supplies, equipment, mobile hospitals and public health infrastructure.
I hope we can develop a third gear...an overdrive if you will, that will take us into the future. We need to reinvigorate the National Disaster Medical System (NDMS), including a dedicated medical supply and equipment program to sustain the NDMS during large scale disasters. Let’s develop REAL plans to take care of REAL casualties. Let’s do the hard work to develop supply and equipment lists of all classes of materials, including deployable mobile disaster hospitals, needed to provide professional medical care and competent sheltering for people with disabilities and special medical needs. Let’s ask HHS or DHS to purchase and manage these critical healthcare and public health assets as Federal Reserve Inventories.
Let’s look at the 15 Federal Planning Scenarios and plan for the scenarios which will most likely occur for our high risk jurisdictions. Let’s build mobile disaster hospitals and public health departments which are properly supplied, equipped and sustained during long duration disasters.
Let’s really enhance our Medical Reserve Corps by developing a program similar to our Armed Forces Reserve components; offering paid “Reserve” opportunities to retired Medical Professionals and let’s pay them during summer sessions to update their competencies and integrate with active healthcare and public health professionals. Let’s link-up healthcare and public health with our communities’ Emergency Management Agencies and develop a real disaster-ready community response. Let’s ask the Federal Government to build Federal Reserve Inventories of food, water, medical supplies, equipment and pharmaceuticals to name just a few (FRIs). After all, we already have the model in the Strategic Petroleum Reserve.
Disaster Readiness is never inexpensive, but it is always cost effective. We need to understand that we will either invest in a National Disaster Response System now, or pay much more in future disasters, not just in dollars, but in human life.
If we can muster the will, the good stewardship, and the funding to increase our Readiness posture, we can take the first few steps that lead us to "Full Readiness." We can begin saving hundreds of thousands of lives during the next man-made or natural disaster.
Lets all insert that extra gear into our two speed culture. Let's see how it feels to know that we did all that could have been done in preparing our Country for the really big next one. That gear is known as the Readiness gear. Start shifting!
Monday, March 7, 2011
Unprepared After Tens of Billions of Federal Grant Funding
We are “Unprepared” for any large-scale disaster, despite tens of Billions of dollars spent by the Department of Homeland Security (DHS) and other Federal agencies that have been tasked with preparing America for major disasters. DHS itself has advised states and local Governments to prepare for 15 Federal Planning Scenarios. http://tiny.cc/cekws
While tens of Billions have been expended,the manner in which Congress has mandated that the disaster preparedness dollars be distributed, have diluted the value of this huge investment. Instead of a funding stream that mirrors the capabilities needed by cities, states and the federal response agencies, the money was pushed down to states for future distribution to cities. Also, instead of financing Readiness on the basis of risk, the money went to states and cities based on population.
By diluting Readiness grant dollars to states and a few large urban centers, Congress and Federal Agencies can assert that “We have spent Billions of dollars in Preparedness and Readiness for future disasters. The fact is states and local governments will undoubtedly require a robust Federal response to large-scale disaster,but since the money is spent, there are very few Federal assets that can be usefully deployed to future disaster areas. Below are just a few illustrations of just how “Unprepared” we truly are.
1.If there is a nuclear detonation of a 10Kiloton nuclear device in a major US City (DHS Planning Scenario #1.): There will be no large scale evacuation of the living away from high-radiological zones to safe areas. Result: People who could easily survive if given antidote and quickly removed from high levels of radiation will absorb ever larger levels of radiation until hundreds of thousands if not millions of Americans will die where they lie from acute radiation sickness.
Solution: FEMA must develop mass evacuation and resettlement plans and Health and Human Services must purchase and manage mobile disaster hospitals and specialty treatment centers.
2. If we have a widespread well coordinated biological attack on our food supply (DHS scenario #13) America has no Strategic Food Inventory to provide food to Americans while scientists and food inspectors can ascertain which portions of our food supply is safe to eat. We have a strategic petroleum reserve to bridge a disruption of oil from major oil producers, but if an attack by well trained terror cells infiltrates major food processing centers, Americans will be no longer be confident of what we eat.
Solution: USDA must purchase a 30 day supply of meals ready to eat or similar long-shelf life food products AND develop food purchase programs with our allies to keep Americans fed until the American food supply is certified as safe.
3. If we have a worldwide killer Pandemic (DHS planning scenario #3):The Department of Health and Human Services (HHS) will have no mobile hospitals and no meaningful medical supplies and equipment inventories to bolster our already overloaded and heavily stressed healthcare system.
In the 1960s the Federal Government had 2,000 packaged disaster hospitals to bolster the private healthcare system during large scale disasters and catastrophes. Each hospital had 200 beds, three operating rooms and an X-Ray machine. Each hospital also had a high-output power generator. In addition each hospital had enough equipment and supplies to function without resupply for 30 days. By day 30, sustainment supplies would come from Defense Supply Agency depots-those closed in 1992 as a part of the Peace Dividend of the Clinton Administration. Today the Federal government has some mobile beds and cot and blanket sets called Federal Medical Stations which contain no meaningful inventories except first aid supplies.
Solution: Build and manage mobile disaster hospitals and build inventories of lifesaving supplies and equipment which can be stored in secure facilities and rapidly deployed to the disaster location.
4. If we experience a well coordinated series of terrorist suicide attacks on subways, train stations etc in DC, New York, Philadelphia and other large cities’ transportation systems Federal planning Scenario #12 (I have no idea why this scenario is #12): Healthcare Systems, Hospitals and Medical Centers will collapse under the pressure of enormous spikes in demand for trauma care, wound and burn care, blood and tissue supplies, orthopedic surgery and all other specialty care supplies and equipment.
Solution: The solution outlined in 3 above will also fulfill this requirement.
These are just a few Federal Planning Scenarios that the Department of Homeland Security has forecasted since 2004, yet as a Nation, we are almost as unprepared now as we were on 9-11. Worse, we have not learned lessons from hurricane Katrina and hurricane Ike in managing the healthcare needs of large numbers of persons, especially those with disabilities and chronic illnesses. When the next large-scale disaster occurs, we will have tons of receipts, but little ability to save lives and communities.
While tens of Billions have been expended,the manner in which Congress has mandated that the disaster preparedness dollars be distributed, have diluted the value of this huge investment. Instead of a funding stream that mirrors the capabilities needed by cities, states and the federal response agencies, the money was pushed down to states for future distribution to cities. Also, instead of financing Readiness on the basis of risk, the money went to states and cities based on population.
By diluting Readiness grant dollars to states and a few large urban centers, Congress and Federal Agencies can assert that “We have spent Billions of dollars in Preparedness and Readiness for future disasters. The fact is states and local governments will undoubtedly require a robust Federal response to large-scale disaster,but since the money is spent, there are very few Federal assets that can be usefully deployed to future disaster areas. Below are just a few illustrations of just how “Unprepared” we truly are.
1.If there is a nuclear detonation of a 10Kiloton nuclear device in a major US City (DHS Planning Scenario #1.): There will be no large scale evacuation of the living away from high-radiological zones to safe areas. Result: People who could easily survive if given antidote and quickly removed from high levels of radiation will absorb ever larger levels of radiation until hundreds of thousands if not millions of Americans will die where they lie from acute radiation sickness.
Solution: FEMA must develop mass evacuation and resettlement plans and Health and Human Services must purchase and manage mobile disaster hospitals and specialty treatment centers.
2. If we have a widespread well coordinated biological attack on our food supply (DHS scenario #13) America has no Strategic Food Inventory to provide food to Americans while scientists and food inspectors can ascertain which portions of our food supply is safe to eat. We have a strategic petroleum reserve to bridge a disruption of oil from major oil producers, but if an attack by well trained terror cells infiltrates major food processing centers, Americans will be no longer be confident of what we eat.
Solution: USDA must purchase a 30 day supply of meals ready to eat or similar long-shelf life food products AND develop food purchase programs with our allies to keep Americans fed until the American food supply is certified as safe.
3. If we have a worldwide killer Pandemic (DHS planning scenario #3):The Department of Health and Human Services (HHS) will have no mobile hospitals and no meaningful medical supplies and equipment inventories to bolster our already overloaded and heavily stressed healthcare system.
In the 1960s the Federal Government had 2,000 packaged disaster hospitals to bolster the private healthcare system during large scale disasters and catastrophes. Each hospital had 200 beds, three operating rooms and an X-Ray machine. Each hospital also had a high-output power generator. In addition each hospital had enough equipment and supplies to function without resupply for 30 days. By day 30, sustainment supplies would come from Defense Supply Agency depots-those closed in 1992 as a part of the Peace Dividend of the Clinton Administration. Today the Federal government has some mobile beds and cot and blanket sets called Federal Medical Stations which contain no meaningful inventories except first aid supplies.
Solution: Build and manage mobile disaster hospitals and build inventories of lifesaving supplies and equipment which can be stored in secure facilities and rapidly deployed to the disaster location.
4. If we experience a well coordinated series of terrorist suicide attacks on subways, train stations etc in DC, New York, Philadelphia and other large cities’ transportation systems Federal planning Scenario #12 (I have no idea why this scenario is #12): Healthcare Systems, Hospitals and Medical Centers will collapse under the pressure of enormous spikes in demand for trauma care, wound and burn care, blood and tissue supplies, orthopedic surgery and all other specialty care supplies and equipment.
Solution: The solution outlined in 3 above will also fulfill this requirement.
These are just a few Federal Planning Scenarios that the Department of Homeland Security has forecasted since 2004, yet as a Nation, we are almost as unprepared now as we were on 9-11. Worse, we have not learned lessons from hurricane Katrina and hurricane Ike in managing the healthcare needs of large numbers of persons, especially those with disabilities and chronic illnesses. When the next large-scale disaster occurs, we will have tons of receipts, but little ability to save lives and communities.
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