Progress on Health System Disaster Surge Capacity at Risk

Communities Fear Waning Attention Jeopardizes Readiness to Care for Mass Injured or Ill

News Release
June 12, 2008

FURTHER INFORMATION, CONTACT:
Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—Communities fear waning attention to health system surge capacity—the space, supplies, people and command structure to care for many injured or ill people—could jeopardize progress to respond in a terrorist attack, natural disaster or infectious disease pandemic, according to a study released today by the Center for Studying Health System Change (HSC).

Communities rely on federal funding to help coordinate and plan across agencies and health care providers, conduct training and drills, recruit volunteers, and purchase equipment and stockpile supplies for a disaster, according to the study, supported by a grant from a special solicitation for Public Health Systems Research through the Robert Wood Johnson Foundation's Health Care Financing and Organization Initiative, which is administered by AcademyHealth.

"We found that communities have devoted significant time and effort to improve surge capacity, but they're worried about losing ground as times passes since 9/11 and Hurricane Katrina," said HSC Health Researcher Laurie E. Felland, M.S., coauthor of the study with HSC Consulting Researcher Aaron Katz, C.P.H., of the University of Washington; Allison Liebhaber, an HSC health research assistant; and Genna Cohen, an HSC health research assistant.

The study examined community-level surge capacity development and variation across six communities: Boston; Greenville, S.C.; Miami; Phoenix; Orange County, Calif.; and Seattle. To place these communities' perspectives in a broader context with communities that have faced large-scale disasters, interviews also were conducted with officials in New York City, Washington, D.C., and New Orleans, as well as with national leaders. The findings are detailed in a new HSC Research Brief—Developing Health System Surge Capacity: Community Efforts in Jeopardy—available online at www.hschange.org/CONTENT/991/.

While federal funding has raised community awareness of the need for surge capacity and enabled communities to dedicate time to create plans, conduct drills, develop volunteer corps and purchase equipment and supplies, respondents reported that federal funding is fragmented and declining, making it difficult for communities to pursue a comprehensive surge capacity strategy.

Following an initial focus on intentional use of biological agents, federal funding became more flexible to respond to a range of potential emergencies, including manmade and natural disasters. Within this "all-hazards" approach, attention to a potential pandemic influenza has increased over the past year. Although respondents viewed the federal focus on pandemic flu as appropriate overall, in some cases funding restrictions preclude investment in risks and needs seen as important locally, according to the study. Communities are attempting to develop capacity that both supports day-to-day activities and prepares for a disaster.

Other key study findings include:

• Communities are attempting to build broad surge capacity, ranging from communication to transportation to hospital care to handling mass fatalities. To effectively do so, respondents stressed the importance of ongoing planning and coordination among stakeholders to determine who has resources, who has authority and who to request help from.
• In an emergency, hospitals expect to be inundated with additional patients, their families and friends, and others who simply seek a safe haven. Hospitals have worked to determine how to maximize existing space and potentially use other facilities. To reduce pressure on hospitals, communities are attempting to integrate other health care providers into surge planning and to educate the public about alternate sources of care.
• Even if additional space can be made available in an emergency, communities are concerned about having an adequate workforce to care for patients. The day-to-day shortages of key health personnel-such as nurses, physicians, pharmacists, laboratory technicians and respiratory therapists-increase the challenge of having sufficient numbers of health workers in an emergency.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation's changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.