Integrating Weather, GIS and Inventory Management Systems For Disaster Operations

Salado, Texas.  Today’s meteorological forecast models and Geographical Information Systems (GIS) can play an enormous role in helping emergency managers inform the public of available sheltering and healthcare services in advance of natural disasters. These systems can also facilitate supply efforts during and immediately after disasters. GIS maps can highlight in real time, hospitals, medical centers and Mass Care shelters with various capacities and capabilities for persons evacuating their homes. The GIS mapping in conjunction with Inventory Management Systems (IMS) can also identify facilities requiring initial and resupply of food, water, medicines, medical supplies and specialty life support equipment. Television stations and other media outlets can use GIS to inform first responders and residents in projected affected areas of where general and specialized services are available.

Using advanced meteorological models and GIS, healthcare and other supply chain leaders can redeploy stock from distribution centers in unaffected areas of the region or Nation to distribution centers near the disaster area which will support healthcare and shelter operations. These systems can offer lifesaving information in advance of landfall of future hurricanes and tsunamis.  Integrating meteorological models, GIS and Supply Chains into NIMS will also help the National Disaster Medical System (NDMS) identify where evacuees are physically located and based on their medical requirements, which hospitals in unaffected areas have the appropriate services to receive evacuees.  

Concept of Operations

Hurricanes: Advanced meteorological models already offer the most accurate predictions in history, regarding where a hurricane will have the greatest likely impact and over time, these models are more and more accurate. Jurisdictional emergency managers have pre-designated Mass Care and general population shelter locations as well as listings of local hospitals, medical centers and other healthcare organizations. Integrating weather modeling, GIS and inventory management systems can enhance the NIMS by depicting the capabilities, capacities and needs (orders) of healthcare organizations, general population shelters and Mass Care shelters in real time throughout a disaster and through the recovery stage. As meteorological models’ cones of uncertainty are narrowed and more accurately predict landfall, healthcare distributors as part of the ESF-6 and ESF-8 support structures can redeploy pharmaceuticals, medical supplies and durable medical equipment (DME) directly into the distribution centers supporting the disaster location (s). GIS information can be incorporated into inventory management systems to provide real-time, facility-specific information on facilities with open orders and their location for use by transporters. Color coded facility depictions can also highlight the criticality of supply requirements by facility type.

Tsunamis:  Based on the number of hours of notice available and the affected area, people and hospital patients in the impact area can be evacuated to receiving location shelters, Mass Care Shelters and healthcare organizations away from the affected area (s). Time permitting, healthcare distribution centers in the impact area can rapidly transport their medical materiel to company distribution centers outside the impact area. Distribution centers away from the impact area can surge operations to meet the increases in demand for medical and non-medical materials, food, water and other commodities. GIS information will provide distributors with active shelters and healthcare organizations and GIS may be integrated into inventory management systems (IMS) to assist suppliers and transporters in delivering supplies to the ordering shelters and healthcare organizations.

Note: General Population shelter managers should adopt similar processes and procedures for providing fuel, waste treatment services, water, food, clothing, personal hygiene and other day to day living supplies to general shelter populations. It is imperative that emergency planners develop systems which can “Stand Alone” and sustain large numbers of people for weeks; not just days.

Earthquakes, Industrial accidents and terrorist attacks. There are currently no (or limited) advanced notification or prediction systems for these events. However, weather can certainly become a confounder in any disaster and may provide another level of complexity to response and recovery operations. By integrating modern weather forecasting, GIS and supply chain systems into the NIMS, we will be able to optimize our emergency management planning, response and recovery operations for virtually any future emergency or disaster.

Summary: Today’s highly accurate meteorological modeling systems have provided vital advance warning to jurisdiction leaders for years. GIS mapping can provide graphic depictions on available services and urgency of needs at each facility. It is time to synchronize weather prediction models and GIS information with America’s various supply chains for disaster support operations. The technology is available, so hopefully, jurisdictions can employ these advanced systems in a manner which saves lives and reduces suffering in future disasters. 

An Emerging Healthcare Leader- The Vice President, Medical Logistics Management

Some 40 years after my first assignment as the Base Medical Supply Officer in the US Air Force, with subsequent experience in Private Sector Healthcare Materials Management, it is time for me to wind down my career....but not just yet.

I thought I’d share some thoughts on the future of the career field as one who saw the Materials Management career field evolve in a very positive way in the US Air Force. In the mid 1970s, the Air Force began replacing physician commanders with Medical Service Corps (MSC) administrators in Air Force clinics and select hospitals. One of the Air Force’s happy surprises was that former Materials Managers did especially well as clinic and hospital commanders. It was discovered that our dedication to customer service, operational experience and understanding of the challenges faced by unit and department leaders, prepared us well for future leadership roles. The bottom line was Materials Managers had for years, assisted hospital leaders improve processes, save money and improve patient care. As significant changes in American Healthcare Industry continue, there is an opportunity for Private Sector health systems to recognize the full potential of Materials Managers. By expanding Materials Managers’ job responsibilities to include leading some or all of the hospital departments or offices listed below, the new title` of Vice President, Medical Logistics Management will be fully earned and very appropriate.

For the past couple decades, some of the larger healthcare systems have centralized much of the Materials Management functions at the corporate level. As a result, their Materials Managers’ everyday functions center on contract compliance and cost management. Without a significant expansion of a Materials Managers’ responsibilities, healthcare organizations may replace outgoing Materials Managers with “lead purchasers” to reduce costs. In reality, healthcare organizations would be better advised if they fully utilized the corporate knowledge and operational experience of today’s Materials Managers. By expanding the scope of today’s Materials Managers job, healthcare systems will tap into their deep operational experience, problem solving and process improvement skills. This will not only result in significant savings, but also better, safer or more efficient work processes throughout the healthcare organization or health system.

As long as the Materials Manager/Supply Chain Manager reports to the Chief Financial Officer, the major emphasis will be on contract adherence and cost containment, rather than problem solving and outstanding customer service. Once innovative Chief Executive Officers recognize the experience and operational expertise of Materials Managers , I believe the position of Vice President, Medical Logistics Management will be created and fully justified.

Below is just a sample list of the departments, offices and functions that could be managed by the VP Medical Logistics Management.

Materials Management- Director Level

a. Purchasing
b. Receiving
c. Inventory Management
d. Quality Control-product recalls and suspend from issue advisories
e. Strong interface with the Director of Emergency Management
f. Emergency Logistics Support Planning
g. Ensure all suppliers have emergency stock redeployment and sustainment plans
h. Entire Supply Chain must sustain the healthcare organization throughout a disaster and until recovery.
i. Mailroom Services
j. Graphics & Copy Center

Environmental Services (EVS)-Manager level

a. Maintains a clean and aseptic workplace and patient care environment.
b. Deep interface with Infection Control Officer
c. Understands the dramatic surge of EVS staff and product requirements in a disaster environment.
d. Understanding of FEMA recovery grants (Public Assistance) documentation requirements

Laundry / Linen Services- Supervisor level

a. In house laundry
b. Contract for outsourcing laundry activities
c. Inventory of all hospital-owned linen, smocks, uniforms etc.
d. Quality Control

Biomedical Equipment Maintenance-Supervisor level

a. Periodic maintenance (PM) of all in-service medical equipment
b. Performs calibrations on medical equipment as required
c. Serves as SME on “Equipment Lifecycle Management.”
d. Updates the master electronic equipment management records system to reflect operational status and a historical record of all preventive maintenance checks and repair of all hospital in-service and in-storage biomedical equipment
e. (Non-Profits) Understands damaged/destroyed equipment documentation requirements for FEMA post disaster grants.
f. Inspects and approves all incoming/new medical equipment prior to payment
g. Signs off on any equipment item leaving the hospital for any reason

Medical Equipment Management Officer- Manager Level

a. Equipment Review and Purchasing Prioritization
b. GPO interface for future purchases
c. Strong interface with Biomedical Equipment Maintenance Manager
d. Non-Medical Equipment
e. Maintains in-use medical and non-medical equipment electronic data records for post disaster documentation for FEMA grants (Private Non-Profit-PNP) organizations.
f. Lifecycle Equipment Management tracking
g. Excess equipment sale, donation or disposal

Vehicle Fleet Management-Manager level
Automated Accountable Records for:

a. Ambulances
b. Hospital owned Trucks, Autos, Vans etc.
c. Leased Vehicles
d. Electronic records for vehicle maintenance history and fuel usage records for entire vehicle fleet.

Healthcare Emergency Management. Director level

a. Hospital Representative in Public Health Healthcare Preparedness Committees, healthcare coalitions, jurisdiction’s committees
b. Writes Emergency Operations Plan (EOP)
c. Conducts hospital Hazard Vulnerability Assessment
d. Conducts briefings for teams new employees on the EOP
e. Expert in HICS and Whole Community Emergency Management
f. (Non-Profits) Understands FEMA administration policies on post disaster Public Assistance Grants.
g. Strong interface with Materials Manager to ensure all hospital suppliers have emergency product redeployment plans.
h. Strong interface with Human Resources Officer
i. Document ESAR-VHP and Medical Reserve Corps volunteers Badge control for all volunteers team assignments for volunteers

Summary: Whether future changes in the American Healthcare Industry are mandated by the Affordable Care Act or by some other major catalyst, change is here to stay. Instead of establishing hospital cost reduction goals to align with future Government or Insurer reimbursements, a total top to bottom review of all hospital functions, processes, costs and opportunities to change/streamline or eliminate is required.

As Healthcare Industry executives begin matching required competencies for future leaders with the skills, knowledge and abilities of today’s Materials Managers, they will see they had a previously underutilized expert within the healthcare organization all along in their Materials Manager. Like the Air Force Medical Service in the 70’s Healthcare Corporations will realize the benefits of using their current Materials Managers as their Vice Presidents, Medical Logistics Management.

Healthcare Disaster Readiness-And 10 Steps to Get There

In addition to the latest Marathon bombings in Boston, Massachusetts and the Industrial explosion in West, Texas, America has experienced many other terrorist attacks, major hurricanes, tornados and floods over the past decade. Many healthcare organizations have suffered catastrophic consequences in association with these events. One would think with the variety and scale of disasters America has faced, we would be getting very good at Emergency Management. The reality points to the fact that instead of learning lessons from past disasters, we are stuck in the past practice of writing plans for accreditation purposes instead of taking an “Operational Readiness Approach” to Healthcare Emergency Management. A suggested paradigm shift described in this paper will build support systems strong enough and deep enough to sustain healthcare functions during and after major disasters. There is a silver lining to the future of Healthcare Disaster Readiness if we grasp it.

There is a real opportunity for Healthcare organizational leaders to encourage a new generation of Healthcare Disaster Readiness professionals to become pioneers in building a “Whole Community” organic response and recovery system to bolster Healthcare Disaster Readiness for future disasters. The new framework will concentrate on building strong, resilient systems, capable of standing up to long-term, large-scale disasters. Those leaders who encourage and champion the new breed of Disaster Readiness leader will reap much more than Medical Readiness. As Healthcare systems, and even stand alone hospitals increase their Disaster Readiness profile, they will discover ways to save money, save time, improve procedures and systems, enhance the quality and safety of healthcare and increase community trust and commitment to its healthcare organization.

These ten steps will go a very long way to ensuring healthcare organizations have the systems depth and resiliency in place to successfully manage a major disaster and more quickly return to normal operations.

1. Emergency Operations Plan. Over the years, all manner of Emergency Management Plans /Disaster Preparedness Plans and now the Emergency Operations Plans (EOP) have been meticulously developed and distributed in health care organizations. A major problem with the plans is that many have been so complex and laborious that often healthcare workers didn’t read them. The key to a readable EOP is to open with the CEO statement of the importance of Emergency Management in maintaining hospital operations during and after any future disaster. There should be an overview of how the healthcare response will work, using the Hospital Incident Command System (HICS) and how the Hospital Command Center (HCC) will be ramped up in a graduated way as well as the positions represented in the HCC. Finally the CEO should direct operational leaders to the annexes pertaining to their departments, teams and responsibilities. Each director, unit manager and supervisor is responsible for training their respective teams on specific duties and how the team interfaces/supports ongoing disaster functionality of the healthcare organization during disasters. Each annex leader should brief their individual annex at Directors’ meetings and explain how their annex builds resiliency and how it supports the overall EOP.

2. Facility services. A good facility support annex bolsters the facility against the 3-5 disaster planning scenarios outlined in the jurisdiction’s Hazard Vulnerability Assessment (HVA). Simply put, the jurisdiction Emergency Management Agency needs to advise the healthcare organization on the disasters most likely to occur in that region. The healthcare organization then develops an in-house HVA and develops mitigation efforts to address the top 3-5 jurisdictional planning scenarios. The in-house HVA can add other facility-specific disaster planning scenarios such as active shooter, bomb threat or other relevant scenarios.

The following discussion outlines the goods, services and systems needed to maintain and bolster healthcare facility disaster operations. The facility engineer should work closely with the Materials Manager (Supply Chain Manager) to establish solid contracts with emergency support clauses with providers of facility supplies, equipment and services (for example, Grainger, Home Depot. Lowes, Environmental Services companies, fuel, food and medicinal gas providers), All vendors should be required to provide the Materials Manager with their rapid resupply plans for redeploying stock and staff from unaffected regional centers into local outlets during and after disasters. There should also be concrete plans for the corporate organization’s assets in unaffected areas to redeploy to the corporation’s affected healthcare organization (s) in the disaster area. The facility engineer should work closely with the Chief Financial Officer to ensure hospital insurance policies are appropriate for the potential losses associated with the top 3-5 planning scenarios and that cash reserves are adequate to support disaster activities. If there is no formal Medical & Non-Medical Equipment Management Office, the CFO should be able to provide a list of in-use equipment from financial amortization files. The organization needs a current in-use equipment inventory and pictures to make post disaster claims to insurers and to FEMA for Public Assistance (PA) grants much easier, more accurate and less stressful.

3. Staffing. The Human Resources (HR) Officer should develop a list of employees in the Corporation designated as “Mission Essential” and those who agree to deploy during disasters to assist affected healthcare organizations within the corporation. Part of the change in mindset for the organization must include enhanced staffing. The HR officer should think outside the four walls and look to the community for reinforcements in the form of either volunteers or “Extra Hires.” In addition, each State (or Territory) has an “Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) Program” which allows for advanced registration and credentialing of Health Professionals. HR will also need to develop procedures to badge volunteers and extra hires, add language to HR regulations on their pay and insurance coverage, privileging, team assignments and ensure these folks receive training with their assigned team. For Private, Non-Profit (PNP) healthcare organizations, the Emergency Manager should request an Emergency Management Agency (EMA) or FEMA representative brief C-Suite and HR on how to establish “Extra Hire” procedures in order to understand which costs associated with disaster related activities may be reimbursed via FEMA’s Public Assistance (PA) post disaster grants. FEMA administrative policies can change. Thus, periodic reviews and regularly scheduled EMA/FEMA representative briefings are wise.

In any long-term disaster, the staff must be certain that their family members are safe, cared for and close by, or they may not report for duty as planned. It is wise to establish brainstorming sessions with all “Mission Essential” employees and augmentees to explore the types of services for family members that will enable staff to remain in service to the healthcare organization during and after disasters. Healthcare Systems can contract with community child care centers to relocate near hospitals to care for the family members of hospital staff. To keep the staff nearby, healthcare procurement officials can negotiate room rates and emergency availability processes with local hotels. Insurance providers and EMA/FEMA representatives can offer guidance on eligibility for reimbursing the costs associated with sheltering and caring for families of mission essential medical staff during emergencies for PNP Healthcare organizations. “For Profit” healthcare organizations will need to address disaster related costs and potential damage / replacement costs and activities with their insurance providers. The differentiation between Private-Non-Profit and For Profit healthcare organizations is prescribed by law in The Stafford Act.

4. Medical Materials. The current “Just-In-Time” model of managing pharmaceuticals, medical supplies and equipment is inadequate to provide the required quantities of medical materials during large-scale or long-duration disasters. We have recommended a solution to the Federal Drug Administration (FDA) that would mitigate current persistent shortages of pharmaceuticals and other medical items as well as suggesting the FDA establish Federal Reserve Inventories (FRI) for use in disasters. Currently the Strategic National Stockpile (SNS) contains some medical items for use during disasters, but these inventories were never designed to sustain Healthcare organizations during disasters. Short of building reserve inventories at the federal level, Materials Managers need to develop very robust and very deep supplier contracts (Prime Vendor and ancillary suppliers). These plans should include contract stipulations that suppliers provide plans to redeploy supplies and equipment from the unaffected regions of America into distribution centers supporting hospitals in the affected community (or communities). Besides pharmaceuticals and treatment supplies these contracts should also address medicinal gases, food, durable medical equipment (DME), ventilators and associated supplies and special needs items. Materials Managers must own the materials sustainment mission and must ensure the continuous flow of goods and services throughout the response and recovery phases of a disaster or public health emergency.

5. Management of Medical Surges of casualties and fatalities. The jurisdiction’s HVA may point to disaster planning scenarios capable of generating thousands of casualties and even more fatalities. Your Emergency Management Agency should provide both planning scenarios and the estimated numbers of casualties and fatalities for each planning scenario. Most healthcare planners understand that hospitals may be overwhelmed and patient gridlock may result in many patients dying of treatable injuries or exposures. An innovative, combat proven system that hospitals and Emergency Medical Services (EMS) organizations should be adopted to optimize patients’ “Golden Hour” and thus, save many more lives than current mass casualty management systems. The 4-Echelon Mass Casualty Management System optimizes the saving of lives through stabilization of injuries or exposures in health care facilities close to the disaster, followed by rapid transportation to hospitals and specialty centers with the appropriate capabilities in outlying, less affected jurisdictions.

Please see http://www.jvrhr.com/Adapting-a-Battlefield-Medicine-System.php for a discussion on how the 4-Echelon Mass Casualty Management System works in managing casualties and fatalities. This system also mitigates staff burnout and resource depletion in the disaster location and enables a more timely healthcare recovery. The 4-Echelon concept requires a robust Electronic Medical Record (EMR) and patient tracking system as well as redundant medical communications systems for all participating hospitals and specialty centers.

6. Non-Governmental Organizations (NGOs). Thinking outside the healthcare campus into the community is an excellent staff-multiplier approach to adding depth and resilience to the healthcare organization. This requires serious coordination and staff work, but is well worth the time and effort. Future disasters or public health emergencies will truly require a “Whole Community” approach to supporting the healthcare organizations. Emergency Managers should coordinate with the American Red Cross for sheltering, food as well as blood & tissue products. Religious congregations are excellent resources for social services, caring for the homebound and dying, last rites etc. Community Service Groups (LIONS Clubs, Rotary Clubs; Moose Lodges etc.) can be a great resource as security augmentees, for extra security, staffing day care centers for hospital staff’s, family and they may also be able to provide guest housing for medical staff deploying to support your hospital. The American Red Cross should be a part of all community-wide disaster drills. A blood drive during each jurisdiction-wide exercise will help the community to get accustomed to donating blood during disasters and knowing where donation centers are located. The American Red Cross can also use planned blood drives to help level America’s blood supply. The Red Cross can also be instrumental in planning scenarios involving large numbers of burn patients, in order to coordinate the supply of blood products and skin grafting tissue.

7. Communications. Healthcare organizations have done a good job in developing redundant communications, much of which was supported by grants from HHS’ Hospital Preparedness Program (HPP). Still, Emergency Management Agencies need to provide mobile communications systems, including portable cell towers and satellite systems to communities as an extra layer of support to Healthcare Organizations and EMS providers for adding communications infrastructure during disasters. Social Media has benefits, but “bad guys” can use Social Media to set traps for responders and to confound response and recovery operations through misinformation. Reliable, redundant and secure jurisdiction-wide communications systems are a must.

8. Contract Services. Healthcare organizations should establish contingency contracts for supplemental security and Environmental Services support along with pharmaceutical and medical surgical suppliers along with suppliers of medicinal gasses and water for drinking, washing/bathing, toilets and chillers. This will help keep the facility operational and aseptic during the response phase of a disaster and until normalcy returns. Update contracts with emergency clauses for generator fuel deliveries, per diem staffing agencies, food and nutritional products, DME and medical equipment rental companies, etc. Consider contingency contracts with commercial generator vendors to further back-up the facility’s auxiliary power supply. If the healthcare organization does not treat its regulated medical waste (RMW) on site, service for the transportation of RMW may not be available until the recovery phase of the disaster due to traffic disruptions. In these cases, Emergency Managers and Facility Engineers will need to establish a RMW storage area approved by the appropriate jurisdictional regulatory agencies.

9. Jurisdiction Services. This is where the new mindset change is most difficult. Jurisdiction leaders usually think about healthcare representation in the jurisdiction’s Emergency Operations Center (EOC). However, when the Emergency Management Agency is asked if they can provide the mobile communications systems (like mobile cell towers or satellite linkups) or the rapid response /mobile high output generator systems that a health care organization may need for disaster response, the answer may surprise you. Likewise, inquiring about funeral services and a grave registry for mass fatalities, emergency medical waste treatment systems, mobile water purification and sanitation services for Public Health etc., the responses may be very mixed and in some cases, incredulous. Similarly, when the jurisdiction’s Public Health Officer is asked what public health services will be available to the Public, the poor and special needs persons or persons requiring lifesaving chronic medications such as insulin during and after emergencies or disasters, the responses may be mixed as well. This is why a “Whole Community” approach to emergency management is necessary and will entail the Whole Community coming together to form an “Organic Emergency Response and Recovery System.” There is much work and tireless coordination required to bring this notional concept to full fruition. While individual communities’ needs vary, we recommend a “Whole Community Disaster Resiliency Prototype” be supported by the Federal Government to help all jurisdictions benefit from a fully developed “Whole Community” emergency response model.

10. Exercises. For many years, exercises have been confined to patient decontamination (as needed), patient triage and receiving and the “Immediate,” “Delayed,” “Minimal” and “Expectant” treatment stations or areas. During accreditation surveys, we rolled out the Emergency Operations Plan, exercise documentation, an “after action report” and a “lessons learned” paper along with documentation that a retest of the problem areas had resolved noted problems.

Future exercises must include a brutally honest evaluation of the steps outlined above to offer a true “Operational Readiness Assessment” of a healthcare organization’s Emergency Operations Plan. By so doing, healthcare organizations will achieve accreditation but will also remain fully functional and sustainable during the types of “Large Scale/Long Term” disasters that America is facing in the 21st Century.

Healthcare leaders will notice that the 10-steps to Healthcare Disaster Readiness outlined above do not involve large outlays of funds. They do require hard work and an unshakable determination to remain in service to their communities during the worst of times.

It is definitely worth the effort.

Achieving Operational Excellence and Disaster Readiness

A “Total System-Dual Track” approach to Healthcare Operational Excellence and Disaster Readiness.

As many American healthcare organizations recover from the disruptions caused by hurricane Sandy, there is an opportunity for real innovation in both healthcare operations and disaster readiness. By taking a “total system-dual track” approach to measuring everyday healthcare operations as well as for disaster readiness, we can realize multiple benefits from one process. Just some benefits of taking a “total system-dual track approach” to measuring organizational effectiveness and Disaster Readiness are:

·         Improving everyday healthcare operations

·         Achieving a high correlation between operational effectiveness and Disaster Readiness

·         Deepening Medical Surge capacities and capabilities

·         Discovering countless opportunities to save time and money such as

o   Reducing wasteful practices

o   Eliminating redundancies

·         Improving safety for patients and staff

·         Improving the patient experience / patient satisfaction

·         Reducing administrative burdens of patient care providers

·         Invigorating an organizational sense of purpose, sense of community and dedication to mission

Organizational Change. Changes in American Healthcare are here to stay. Health outcome measurements will become increasingly tied to reimbursements, and healthcare organizations will be increasingly accountable for the overall health of their total patient mix. Eventually, those organizations which can adapt to meeting the needs of their entire community will be those who survive and thrive.

Measure Everything. If it isn’t measured, it’s not being done. Healthcare organizations need to understand all business processes and consistently look for better, safer, less expensive ways to accomplish their mission. Every department and patient care unit’s processes and policies must be examined with an eye to improvement and resilience during disasters.

The future will belong to healthcare organizations that are totally committed to remain in service to their communities by managing on purpose, rather than by habit. At the same time, healthcare organizations must plan and prepare for disaster contingencies in order to remain functioning for the communities they serve, both during the disaster and until normalcy returns.  They must do this to remain a viable organization that survives the disaster to continue as a resource that serves their communities.

Healthcare organizations’ longtime approach to Emergency Management has been focused on passing Accreditation inspections instead of building true disaster resiliency. Consequently, Healthcare executives have paid little attention to the changing skill sets required for Emergency Management Coordinators (The word Coordinator in the job title often means 30K-45K in salary). Healthcare leaders must revise the EM job requirements (and salaries) to reflect the many skill sets needed to:

1.    Ensure all hospital systems are:

Hardened: Facility mitigation against likely disaster scenarios, HVAC zoning, facility lockdown, generator capabilities (and what equipment is on the Generator power grid for long term operations), etc.

Enhanced: Staff (augmentees), Communications systems (redundancy), Materials Management (emergency provisions in all supplier contracts to deepen supply chains through stock redeployments).

Resourced: Contracts for Per Diem nurses and CNAs, security personnel, patient transport, food service vendors need to include emergency provision clauses. Likewise, medical materials and pharmaceutical contracts must include emergency clauses for redeploying materials into distribution centers supporting future disasters. Healthcare organizations should consider automated resupply contracts for medicinal gases, water (drinking, washing and chillers), food, generator fuel, laundry/linen and Environmental Services supplies and equipment. The Infection Control Officer should take a major role on the hospital post-disaster recovery team.

Coordinated: Coalitions of healthcare organizations, Emergency Medical Services, (EMS), Non Governmental Organizations (NGO), Medical Reserve Corps units and rescue services must train together in order to mount an effective disaster response. Protocols for Health Information Exchange (HIE), patient transfers and admissions must be consistent in both normal and emergency conditions. Federal Hospital Preparedness Program (HPP) grant dollars may be available from states to fund these activities.

Recovered: Private-Non-Profit healthcare organizations should develop a FEMA disaster grant package for post-disaster documentation. This package should include a list of in-use equipment inventory (linked to purchase orders for proof of ownership) and procurement policies such as Group Purchasing, procedures for off contract purchases, credit card policies and open bid processes. The package should also include a copy of Human Resources policies on extra hires, overtime and timekeeping etc.

2. Build strong alliances in the Community, including the Emergency Management Agency (EMA) staff, Police, Fire and Rescue, EMS companies, Nongovernmental Organizations (NGOs), Religious Congregations, Utility companies, Waste Management companies, etc. in order to enhance resiliency and surge support services from within the Community (Whole Community Organic Response System).

3. Build real coalitions with all Healthcare Organizations operating within the community. This means other hospitals operating in the community, but should also include surgical centers, physician and dental professionals and practices, physical and occupational therapists & practitioners and Medical Reserve Corps Units. It’s important to make sure all volunteers and extra hires are registered in the state’s ESAR-VHP system as well as privileged and assigned to an individual care team. Ensure ongoing competency training for all augmentees.

4. Develop a full pre-disaster documentation package of hospital assets (consider pictures) which complies with what FEMA will need to review as part of the Public Assistance grant program. Lots of work here, but it is well worth the effort should assets be damaged or destroyed in a disaster. 

 FEMA’s Immediate Needs Funding (INF):  Private-Non-Profit Healthcare organizations that have developed a pre-disaster FEMA documentation package will be far ahead in quantifying and supporting FEMA’s Preliminary Damage Assessment (PDA) and in justifying accelerated funding through FEMA’s Immediate Needs Funding (INF) program. This package will also streamline and accelerate the FEMA Project Worksheet process and optimize Public Assistance grants.

Conclusion.  By taking a “total system-dual track approach” to measuring Organizational Effectiveness and Disaster Readiness, healthcare leaders will be ready for future disasters and for whatever challenges lie ahead for American Healthcare.

A Lack of Imagination………Again?

Salado, Texas.  Do our Biosafety (BSL) Levels 3 & 4 Laboratories provide terror groups with a more horrible and more lethal weapons delivery platform than the aircraft they used on September 11^th, 2001?

I’ll never forget the Public Statement Release of 9/11 Commission Report from the Hon. Thomas H. Kean and the Hon. Lee H. Hamilton on July 22, 2004….. “But on that September day we were unprepared. We did not grasp the magnitude of a threat that had been gathering over time. As we detail in our report, this was a failure of policy, management, capability, and – above all – a failure of imagination.”

The General Accountability Office (GAO) released reports and recommendations regarding “High Containment Laboratories” in 2007, 2008 and 2009, but as of this writing, I can find no single Federal agency responsible for developing and measuring the standards to ensure the security of all agents used in our BSL-3 and BSL-4 laboratories. Is it HHS/CDC? Is it the DOJ/FBI? Is it DHS…or is it all of the above?  My motto is: “If everyone is responsible, no one is accountable.”

Is this a “Back to the Future” moment? Could the proliferation of Biosafety Laboratories across America and the World present an irresistible opportunity for terrorists?  Can we “Imagine”:

·         A terrorist group notifying the Federal Government that they have acquired killer biological agents from our BSL labs and prepositioned the agents with their terror cells in cities across America?

·         A threat from a terrorist organization warning the United States to take (or not take) actions against Iran, lest they unleash the killer agents on our population centers?

·         A directive to release terrorists from US custody or face a retaliatory attack for every terrorist held by American officials?

I can surely imagine these scenarios since there are a lot of folks in the world that would love to do us great harm.

Is it too late to put stringent measures in place?  If not, here are a few recommendations for limiting the unauthorized removal of dangerous biological agents from BSL 3 & 4 laboratories.

1.      Implement strict initial and periodic FBI background checks on every person who has access to a BSL 3 or BSL-4 laboratory.

2.      Require every BSL-3 and BSL-4 to implement a Personnel Reliability Program (PRP) and the Human Reliability Program (HRP).  I have heard academics claim that PRP/HRP programs haven’t proven effective deterrents. They are wrong. Contact the US Air Force PRP/HRP offices and (if cleared) they will present researchers with all the proof they need.

3.      Prevent unlawful agent transport by requiring all vials, or any other container be easily detected as anomalies on whole body scanners (or require industry to manufacture these vials.

4.      Install whole body scanners at exit points (and strictly restrict exit points) in BSL3 and BSL-4 laboratories. I have found no exit security measures in place to prevent agents exiting BSL 3 or 4 laboratories to prevent smuggling agents out through body orifices.

5.      Prohibit the resale of any equipment declared excess from BSL-3 and BSL-4 laboratories.

6.      Tightly control the resale of any excess equipment from public health laboratories, hospital labs and pharmaceutical manufacturing equipment which can be used to unlawfully manufacture and transport biological agents. (Centrifuges, mixer/investors, warming units etc.).

7.      Scrutinize all procedures for BSL-3 and BSL-4 laboratories in jurisdictions vulnerable to alternative points of entry into America. Suspect international deep sea ports (crews on liberty), cruise terminals (crew disembarking) etc., where biological agents can be handed off from a terrorist scientist to a terror cell member for transport out of area to other areas of America.

Every time I take my shoes off at a TSA screening point, I think of the shoe bomber and every time I pack shampoo, mouthwash and other toiletries, I think of the liquid bomb mixing terrorists. Every time I go through a body scanner, I think about the underwear bomber and wonder what the next after-the-fact screening measure might be in store for us.

The fact is, each of the above measures was a reactionary measure. With the lethality of agents used in our BSL 3 and BSL 4 laboratories, reactionary steps will be too late. The number of fatalities caused in a biological attack with an agent that may not be treatable, will be so horrific, these labs may be closed down and moved offshore. Any reactionary action will be too late to save the countless lives lost because of……A failure of imagination-Again.

Linking Weather Models, GIS and Inventory Systems For Disaster Operations

Salado, Texas.  Today’s meteorological forecast models and Geographical Information Systems (GIS) can play an enormous role in helping emergency managers inform the public of available sheltering and healthcare services in advance of natural disasters. These systems can also facilitate supply efforts during and immediately after disasters. GIS maps can highlight in real time, hospitals, medical centers and Mass Care shelters with various capacities and capabilities for persons evacuating their homes. The GIS mapping in conjunction with Inventory Management Systems (IMS) can also identify facilities requiring initial and resupply of food, water, medicines, medical supplies and specialty life support equipment. Television stations and other media outlets can use GIS to inform first responders and residents in projected affected areas of where general and specialized services are available.

Using advanced meteorological models and GIS, healthcare and other supply chain leaders can redeploy stock from distribution centers in unaffected areas of the region or Nation to distribution centers near the disaster area which will support healthcare and shelter operations. These systems can offer lifesaving information in advance of landfall of future hurricanes and tsunamis.  Integrating meteorological models, GIS and Supply Chains into NIMS will also help the National Disaster Medical System (NDMS) identify where evacuees are physically located and based on their medical requirements, which hospitals in unaffected areas have the appropriate services to receive evacuees.  

Concept of Operations

Hurricanes: Advanced meteorological models already offer the most accurate predictions in history, regarding where a hurricane will have the greatest likely impact and over time, these models are more and more accurate. Jurisdictional emergency managers have pre-designated Mass Care and general population shelter locations as well as listings of local hospitals, medical centers and other healthcare organizations. Integrating weather modeling, GIS and inventory management systems can enhance the NIMS by depicting the capabilities, capacities and needs (orders) of healthcare organizations, general population shelters and Mass Care shelters in real time throughout a disaster and through the recovery stage. As meteorological models’ cones of uncertainty are narrowed and more accurately predict landfall, healthcare distributors as part of the ESF-6 and ESF-8 support structures can redeploy pharmaceuticals, medical supplies and durable medical equipment (DME) directly into the distribution centers supporting the disaster location (s). GIS information can be incorporated into inventory management systems to provide real-time, facility-specific information on facilities with open orders and their location for use by transporters. Color coded facility depictions can also highlight the criticality of supply requirements by facility type.

Tsunamis: Based on the number of hours of notice and the affected area

people and hospital patients in the impact area can be evacuated to receiving location shelters, Mass Care Shelters and healthcare organizations away from the affected area (s). Time permitting, healthcare distribution centers in the impact area can rapidly transport their medical materiel to company distribution centers outside the impact area. Distribution centers away from the impact area can surge operations to meet the increases in demand for medical and non-medical materials, food, water and other commodities. GIS information will provide distributors with active shelters and healthcare organizations and GIS may be integrated into inventory management systems (IMS) to assist suppliers and transporters in delivering supplies to the ordering shelters and healthcare organizations.

Note: General Population shelter managers should adopt similar processes and procedures for providing fuel, waste treatment services, water, food, clothing, personal hygiene and other day to day living supplies to general shelter populations. It is imperative that emergency planners develop systems which can “Stand Alone” and sustain large numbers of people for weeks; not just days.

Earthquakes, Industrial accidents and terrorist attacks. There are currently no (or limited) advanced notification or prediction systems for these events. However, weather can certainly become a confounder in any disaster and may provide another level of complexity to response and recovery operations. By integrating modern weather forecasting, GIS and supply chain systems into the NIMS, we will be able to optimize our emergency management planning, response and recovery operations for virtually any future emergency or disaster.

Summary: Today’s highly accurate meterological modeling systems have provided vital advance warning to jurisdiction leaders for years. GIS mapping can provide graphic depictions on available services and urgency of needs at each facility. It is time to synchronize weather prediction models and GIS information with America’s various supply chains for disaster support operations. The technology is available, so hopefully, jurisdictions can employ these advanced systems in a manner which saves lives and reduces suffering in future disasters. 

Last Call- The Healthcare Supply Chain Vulnerability

Salado, Texas. During the financial crisis of 2008, the federal government printed money to stabilize our economy. In a future large-scale disaster or catastrophic event, no amount of money will purchase critical medical supplies and pharmaceuticals that do not exist. When a sudden very large spike in demand for medical materials occurs, we will either have the lifesaving medicines and support therapies or we will not.

A recent survey from the American Hospital Association reveals very disturbing details on the number of drug shortages at hospitals all across America. Folks, these are the best of times and yet this is the reality. Imagine our plight in a large scale disaster when the demand for lifesaving medicines will be huge.  I applaud the AHA for this report and I hope most earnestly that American healthcare leaders take this wake up call. 

 http://www.aha.org/aha/content/2011/pdf/drugshortagesurvey.pdf

Any large-scale public health emergency, natural disaster or terrorist attack will cause a sudden and profound spike in demand for both pharmaceuticals and medical surgical products. A very lean supply chain is remarkably easy to deplete if the demand is both sudden and very large. This could result in massive curtailments in healthcare operations across America and could threaten America’s entire healthcare industry.

The relatively modest surges in medical product demand during the 2009-2010 H1N1 flu season put many if not most healthcare organizations on “Allocation.” Just imagine what would occur if we face a large-scale, material intensive disaster.

HHS and CDC have not used plain language on what categories and quantities of federal supplies would and would not be available to healthcare organizations during disasters. http://www.cdc.gov/phpr/stockpile.htm#sns7  

I’m sad to say that the language outlining the Strategic National Stockpile lends itself to a totally unwarranted sense that the federal government will back up hospitals, medical centers, surgical centers and outpatient clinics during disasters. This vague and carefully crafted language is unwise at best and may be catastrophic in the worst cases. The young, old and those with chronic illnesses will suffer the most. We should do the right thing and we should do it right now! The Federal Government should clearly state which categories of supplies, equipment and pharmaceuticals will and not be available to healthcare organizations and when and for how long healthcare organizations can count on Federal support.

The Defense Logistics Agency (DLA) medical materiel depots have been effectively closed since 1992 and that safety net is gone.  

I am profoundly concerned about the plight of all Americans during disasters, but especially those whose lives depend most on medication and support therapies.  Many Americans can live through a persistent lack of medicines, but many lives depend on it.

Since 1999 I have advocated Federal planners purchase large quantities of critical pharmaceuticals and medical supplies and pay national distributors to manage the Federal Reserve Inventories and stock rotate the material in storage. During times of crisis, federal stocks could be quickly released and immediately flow seamlessly into the Health Care Industry’s supply chain.

This simple preparatory step can sustain medical operations, save lives and prevent untold human suffering.  A modest national investment in Federal Reserve Inventories in advance of a catastrophic event may also obviate the need to rebuild the Healthcare Industry requiring appalling sums of money and time many Americans simply won’t have.

It is very late morning in America and I hope healthcare leaders will answer this very sincere wake up call. There is no snooze button.

Let's Give Wounded Warriors Job Opportunities in Healthcare Disaster Readiness

The recent outbreaks of tornados and floods led me to think of how we could better respond to future disasters.  Giving returning Service Members employment opportunities in Healthcare Emergency Management would make excellent use of their skills and is the right thing to do.  Read my article

Jobs for Wounded Warriors

Writing Measurable Target Capabilities

My most recent article on Disaster Readiness discusses how to write measurable Target Capabilities. I think as a result of the latest Presidential Policy Directive (PPD-8), we will see a Presidential mandate to measure Disaster Readiness in quantifiable terms.

As the term “Whole Community” approach to Disaster Readiness becomes more common in future DHS/FEMA discussions and guidance documents, I hope the Jurisdictional Emergency Manager will be recognized as the overall leader, facilitator and community mentor for Disaster Readiness. I believe that if “Everyone is Responsible, No one is Accountable.” The buck has to stop with the community expert in Emergency Management. That person is the jurisdiction’s Emergency Manager. Read the article at: http://tiny.cc/dn1eu

Catastrophic Event Patient Care: An EMS and Disaster Healthcare Paradigm Shift

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.

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!

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.