The Edge of Disaster and Modern Health Care

Stephen Flynn's recent book The Edge of Disaster, featured on national public radio this week, describes a number of large scale vulnerabilities across the United States. His thoughts on pandemic flu, while certainly concerning, pale in comparison to the real numbers.Mr. Flynn describes 80 million infected with as many as 800,000 dying of the disease. However, a review of Avian flu pandemic over the last 300 years shows that one-third of the U.S. population or 100 million people will be infected. If this is not enough one half of these individuals or 50 million will require some level of hospitalization or institutional care from bone health all the way up to intensive care unit services. As Mr. Flynn correctly pointed out there are fewer than 970,000 hospital beds in the United States far less than the 50 million that will be required.Of greater concern is the fact that half of those requiring hospitalization will develop a life threatening lung condition know as Acute Respiratory Distress Syndrome (ARDS). Twenty-five million people requiring advanced lung care will quickly overwhelm not only the capacity of our hospitals but of our respiratory therapists and our nurses. Of those with ARDS half will require ventilator support, unfortunately there are only 105,000 ventilators in the United States and only 16,800 are available at any given moment to treat these 12.5 million ARDS patients. Of those that require ventilators, approximately 6.25 people. This last number is eight times that predicted by Mr. Flynn and has been substantiated in multiple scientific reviews of the major pandemic of the past 300 years.Mr. Flynn also spends a significant amount of time discussing surge capacity and when asked by his NPR host about the economics of increasing surge capacity beyond the pitiful 12 percent currently available nationwide Mr. Flynn simply said it was an investment in the future, an "insurance policy." Those knowledgeable in healthcare surge capacity and healthcare vulnerability analysis differ with Mr. Flynn's otherwise star analysis of the other vulnerabilities of the United States.Immersion Simulation based disaster training for hospitals and healthcare facilities results in a new protocol in the minds of those who are trained. They learn to deal with triage on a moment to moment basis with every patient whether there is an ongoing disaster or not. Those hospitals that adopt this model quickly learn that they can activate their emergency plan even when their hospital is only suffering from the daily surge of patients. Hospitals in New York, Boston and Philadelphia have done this with increasing frequency when emergency room await times have been only two times the norm. As a result the hospital activates its emergency operation center, calls in additional staff and increases the number of patient care areas in the hospital by re-tasking administrative and non-patient care areas to the treatment of non critical individuals. These "green" treatment areas decrease the backlog in the emergency room lobby with surprising results.* Fewer people leave the hospital without medical care because the wait has been reduced.* There is an increase in hospital admissions because greater diagnoses are made by less stressed doctors, nurses.* There is a net increase in hospital revenue despite the cost for staff and re-tasking facility.* Patient satisfaction is improved with patient satisfaction scores on survey rising.* The hospital saves money because a surge capacity emergency plan activation counts as one of the yearly required disaster drills.In addition to Mr. Flynn's "insurance policy" approach to surge capacity there is a real world economic advantage for hospitals and healthcare facilities to participate in large scale disaster planning and preparation. Every hospital in the United States has now accepted money from the federal government under HRSA grants or through various government based insurance payment programs. As a result these facilities are now required to be compliant with the 17 elements of the National Incident Management System implementation plan for hospitals and healthcare facilities. In addition, they are required to maintain a surge capacity equal to 20 percent of licensed hospital beds or 500 bed per million population in the geographic license area of the hospital or whichever is greater, less these facilities be guilty of fraud.The stakes are high for healthcare not only because of the duty and responsibility they take on as part of their role in society but now as a result of the financial assistance they have accepted for the past five years as they were supposed to be preparing for all hazards and all disasters.Mr. Flynn's book and the features on national public radio this week have brought the spotlight to bear on the vulnerabilities in America, the question is will we respond now or lament the next catastrophe? dr seuss cat in hat history