Friday, November 6, 2009

The sadness that surrounds the events of Fort Hood and Orlando in the past days is a reminder that the aura of safety that we believe surrounds us can be shattered in a moment. That so many people can be killed and injured at once strains our ability to understand. Yet as the news crew rushed to the scene, emergency personnel were mobilized to deal with multiple victims and disaster plans went live.

Predicting when the next disaster will occur is an impossible task. The just-in-time supply and production methods that other industries can employ to decrease expenses don’t work in medicine. The cost of medical care includes hospitals, equipment and personnel readiness for a potential situation that might never happen.

The ability to care for 31 gunshot victims at Fort hood just doesn’t happen. Disaster preparation and training drills happen routinely and are mandated by many hospital accreditation organizations and governmental bodies. But when the call to action comes, real people need to be there to respond and there are a lot of people needed for each patient.

Imagine one victim with a gunshot wound. An ambulance will be needed with two paramedics to deliver the patient to a hospital where a trauma team is available in the ER for resuscitation and stabilization. The team might include an emergency physician, a surgeon, two nurses, a respiratory therapist, radiology and laboratory technicians and a pharmacist. If the patient goes to the operating room, there needs to be a minimum of an anesthesiologist or nurse anesthetist and a couple of surgical nurses. If the patient survives to recovery room, another nurse is needed for care, and then to a hospital bed where more nurses and technicians. Behind the scenes, there needs to be people to clean the used rooms, stock the supplies, wash the laundry, sterilize equipment and the list goes on. Now imagine multiplying this team by 31 and appreciate the resources needed to train the doctors, nurses and technicians and the amount of effort to have the equipment available not just-in-time but ready and waiting.

To be fair, many patients involved in disasters do not need emergent care and the ability to triage the sickest from the walking wounded is an important first step at the scene. Disaster planning begins with getting medical care to the scene to make difficult decisions with triage. Not everybody gets to go first. Those patients who are significantly injured and who are savable get transferred first for care. The walking wounded can wait and those who are deemed unable to survive their injuries are made comfortable only.

As the health care reform debate continues, concerns should be raised as to the ability of hospitals to rise to the challenge of disaster response. Each year increased numbers of hospitals are closing around the country causing access to emergency care to decrease even as the number patients seeking emergency care rises.

How much should a community be asked to spend to be ready for the next disaster? And disasters aren’t just trauma. This fall, hospitals and medical offices were overwhelmed by patients seeking care for influenza infections and potential existed that all the intensive care beds in a community could be occupied by flu victims with respiratory failure.

The ability to respond to disaster is difficult to measure or predict. Ultimately, it isn’t the number of beds, operating rooms or ventilators. People are the key to good care. The ability to see the next patient depends upon having a doctor or nurse available and that requires enough qualified people being trained to fill the needs of the next month, next year and next generation. Hospitals don’t take care of patients, people do.

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