As Texas hos­pi­tals learned in wake of Har­vey, pre­pared­ness key to pro­tect­ing lives

Modern Healthcare - - COMMENT - By Dr. Tom In­glesby

Last week, Hous­ton-area hos­pi­tals dis­played great re­siliency as they faced cat­a­strophic flood­ing from Hur­ri­cane Har­vey’s re­lent­less rains over sev­eral days. How­ever, some vi­tal hos­pi­tal ser­vices—un­der­stand­ably—ex­pe­ri­enced sig­nif­i­cant dis­rup­tions.

Health sys­tems na­tion­wide can learn vi­tal lessons from Texas’ plan­ning and re­sponse to fur­ther strengthen their own pre­pared­ness and “harden” their fa­cil­i­ties to all haz­ards.

So much hap­pened in only 48 hours last week. Memo­rial Her­mann Sugar Land Hos­pi­tal suc­cess­fully evac­u­ated all of its 150 pa­tients and shut down tem­po­rar­ily. Sev­eral hos­pi­tals can­celed out­pa­tient ser­vices. The world-renowned Univer­sity of Texas MD An­der­son Can­cer Cen­ter closed to ap­point­ments for sev­eral days, but in­pa­tient care wasn’t dis­rupted. Ben Taub Hos­pi­tal, the largest in Har­ris Health Sys­tem, main­tained con­ti­nu­ity of care for its pa­tients af­ter halt­ing a planned evac­u­a­tion when wa­ter sur­rounded its fa­cil­i­ties.

Ef­fec­tive plan­ning and emer­gency re­sponse are closely re­lated to this year’s theme for Na­tional Pre­pared­ness Month in Septem­ber: “Dis­as­ters don’t plan ahead. You can.” Har­vey’s ex­treme im­pacts serve as a pow­er­ful re­minder of why it is es­sen­tial to in­vest in pre­pared­ness. Texas providers learned their lessons from pre­vi­ous storms that pounded the state and from the dam­age and large loss of life in­flicted by Hur­ri­cane Ka­t­rina in neigh­bor­ing Louisiana.

Ac­cord­ing to the April 2017 Na­tional Health Se­cu­rity Pre­pared­ness In­dex, many U.S. healthcare sys­tems re­main un­pre­pared to re­spond ad­e­quately to health se­cu­rity threats. Th­ese find­ings are con­cern­ing for many rea­sons. In­fec­tious dis­eases that can mi­grate to the U.S., such as Ebola when it ar­rived here sev­eral years ago, have the po­ten­tial to catch hos­pi­tals off guard, with some­times deadly con­se­quences. Sim­i­larly, an­tibi­otic re­sis­tance con­tin­ues to raise health se­cu­rity con­cerns for hos­pi­tals that are of­ten the front­line de­fense for th­ese in­fec­tions. In ad­di­tion, hos­pi­tals are the epi­cen­ter for treat­ing vic­tims of de­lib­er­ate, large-scale acts of vi­o­lence in their com­mu­ni­ties.

Chal­lenges in healthcare pre­pared­ness are par­tic­u­larly stark in some re­gions of the coun­try. For ex­am­ple, the in­dex found that states in the South and Moun­tain West re­gions ex­pe­ri­enced sig­nif­i­cantly lower marks in health se­cu­rity as­sess­ments than their coun­ter­parts in the North­east and Pa­cific North­west.

With the lat­est emer­gency pre­pared­ness reg­u­la­tions from the fed­eral gov­ern­ment, com­bined with threats of re­duced fund­ing, health sys­tems face se­ri­ous pre­pared­ness chal­lenges that will re­quire close part­ner­ships among fed­eral, state and lo­cal gov­ern­ments, and other health sys­tems in their re­gions.

Hos­pi­tal pre­pared­ness ramped up af­ter the Sept. 11 ter­ror­ist at­tacks, typ­i­cally as an ef­fort for in­sti­tu­tions to pre­pare in­di­vid­u­ally. In the years since, it has be­come in­creas­ingly clear that hos­pi­tals and health sys­tems need to col­lab­o­rate with each other and with pub­lic health agen­cies. The grow­ing em­pha­sis on pop­u­la­tion health and com­mu­nity ben­e­fits un­der the Af­ford­able Care Act have only in­creased the ne­ces­sity of th­ese re­la­tion­ships for out­reach.

Pre­pared­ness also re­quires re­sources. Hard­en­ing fa­cil­i­ties and other dis­as­ter prepa­ra­tions such as re­lo­cat­ing gen­er­a­tors and fuel pumps and in­stalling backup com­mu­ni­ca­tions sys­tems are ex­pen­sive. Mean­while, fund­ing is lim­ited and shrink­ing quickly. For ex­am­ple, Pres­i­dent Don­ald Trump’s fis­cal 2018 bud­get pro­posal re­duces health se­cu­rity fund­ing by $1.25 bil­lion, which is the largest de­crease to th­ese pro­grams in more than a decade. More fund­ing, not less, is needed to pro­tect our healthcare de­liv­ery sys­tem.

Just as fire de­part­ments con­stantly train and mod­ern­ize their equip­ment to be ready for crises, we also can’t af­ford to wait for the next emer­gency. Hos­pi­tals, health sys­tems and other providers must es­tab­lish strong pre­pared­ness plans, in­vest in the right in­fra­struc­ture, and train staff ac­cord­ingly.

Texas providers seem to have taken many cru­cial steps to be pre­pared and avert wide­spread tragedy on their cam­puses as Har­vey came ashore. The rest of the coun­try should be mak­ing plans and in­vest­ments to im­prove the odds for sim­i­lar out­comes.

Dr. Tom In­glesby is di­rec­tor of the Johns Hop­kins Cen­ter for Health Se­cu­rity at the School of Pub­lic Health.

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