Managing Hospital Emergency Preparedness without Federal Funding

It has been fourteen years since the September 11 attacks and the subsequent anthrax letters in the fall of 2001. Those tragic events highlighted the vital role of hospitals in our emergency care system. It is the place where victims and first responders are treated during a disaster and where support is provided to them and their families during their recovery. As noted by Dr. Dan Hanfling in the Healthy Affairs Blog (12/31/2013), our emergency care system is both the “safety net and the foundation upon which emergency preparedness and response is built.”

After these events, disaster preparedness became the driving force in the United States and around the world. Congress started funding hospital readiness efforts in 2003 for $515 million per year. Current HPP (Hospital Preparedness Program) funding has dropped significantly to $228.5 million in fiscal year 2015. This level of hospital funding is insufficient to sustain the multitude of capabilities needed for a comprehensive emergency management program and ongoing readiness.  

Without adequate, consistent and ongoing funding, hospitals are being forced out of necessity to wean down the list of ASPR capabilities expected of them to the few they can afford to sustain. These capabilities include healthcare system preparedness, healthcare system recovery, emergency operations coordination, fatality management, information sharing, medical surge, responder health and safety, and volunteer management. Failure of our state of readiness became all too apparent during the Ebola outbreak in Africa when hospitals in the US were scrambling to master (once again) the use of personal protective equipment and how to perform patient decontamination.

Improving Hospital Emergency Preparedness Capabilities

To sustain a reasonable and practical level of readiness, hospitals need to invest their own funds in emergency preparedness in a cost-effective manner based on realistic scenarios. They will need to explore new public-private partnerships to offset costs, and when internal resources are lacking, seek out seasoned professionals to guide their efforts. Each phase of emergency management (mitigation, preparedness, response and recovery) will need to be explored to determine, for example, if each initiative is focused with measurable outcomes, is realistic and within their capability, and is earmarked for sustainability. 

Cost Effective Steps to Maintain Preparedness

Together, these cost-effective steps will help keep staff more familiar with their role and responsibilities during an emergency event and will help ensure that institutionally, a reasonable level of preparedness is maintained; an investment that will hopefully reap valuable rewards in the future.

1) Equipment caches will need to be inspected to assess functionality and to maximize investment by reducing costly duplicity (a problem commonly seen with protective clothing, respirators, and communication equipment).

2) Alternative training formats will need to be explored (e.g., internet-based training) with greater emphasis placed on performance-based drills and exercises that can be conducted internally.

3) Processes for incorporating readiness actions (triage, incident management, EOP activation parameters, communication, patient evacuation, tracking, infrastructure, etc.) into normal daily routines will need to be sought out to enhance a hospital’s response capability at minimal expense. 

The change in funding for disaster response has ushered in a new era of preparedness where the development and maintenance of valuable skills sets, equipment supplies, and capabilities are funded and sustained internally. Although funding may have been reduced, recognition of the critical role hospitals play during a disaster has not diminished.  

Partnering with DQE can be the first step hospitals take to help maintain their pivotal role in community disaster preparedness. The prior investment your hospital made should not be allowed to wither; rather, it should be considered a foundation that is built upon in a cost effective and functional manner for future emergency events. With over twenty years of experience, DQE brings a realistic and practical approach to emergency readiness that is both measurable and sustainable.