NEW YORK -- Those on the front line in a disaster -- hospitals, medical personnel, public health officials and local emergency workers -- will be unprepared to seamlessly handle a surge of patient casualties or to orchestrate a timely, cohesive recovery effort, concludes a report issued today by PricewaterhouseCoopers' Health Research Institute on the state of the nation's health system preparedness for disaster.
According to PricewaterhouseCoopers, despite progress since 9/11 and nearly $8 billion in federal funding for emergency preparedness activities performed by healthcare facilities and agencies, the medical response to a natural or man-made disaster or an act of terror remains sporadic and disconnected. PricewaterhouseCoopers conducted extensive interviews with nearly 50 leading policymakers, a survey of almost 250 health care executives and practitioners and a poll of 1,000 American adults to identify gaps in the system in the event of terrorist attacks, pandemic disease or increasingly extreme weather. Findings include:
* In at least 11 U.S. cities, including Washington, D.C. hospitals lack a sufficient number of beds to handle a surge of patients in a disaster.
* Only four in 10 health professionals believe that local hospitals are very well prepared to deal with casualties from a disaster, and less than 10 percent believe that primary care physicians and community clinics are very well prepared.
* More than 40 percent of health professionals contacted by PricewaterhouseCoopers lack confidence in their ability to transfer patients to non-healthcare facilities such as a stadium or schools, and 25 percent lack confidence in their ability to transfer patients to other health-related facilities such as skilled nursing facilities, community clinics or regional hospitals.
PricewaterhouseCoopers' report, "Closing the Seams: Developing an Integrated Approach to Health System Disaster Preparedness" explores the gaps in preparedness, including a fragmented care system, a lack of planning, breakdowns of command, communications and coordination during disasters, and healthcare workforce shortages that will only be exacerbated in an emergency. Further, the report offers a comprehensive set of recommendations needed to develop an integrated plan that would improve the responsiveness of our health care system and save lives in future catastrophes.
"Recent disasters have revealed the need to make sure the nation's healthcare system is capable of handling the casualties of catastrophes, whether natural or man-made," said R. Carter Pate, global and U.S. managing partner of health industries and government services for PricewaterhouseCoopers. "We tend to think of such large-scale disasters as one-off events, yet a major disaster has occurred every week on average in the United States for the past 10 years. The American public is relying on a fragmented medical system to miraculously mount a swift, well-orchestrated response. Until further planning takes place, we should not be surprised if the system fails next time."
Additional major findings of PricewaterhouseCoopers' research include:
* Since 9/11, Congress has appropriated $7.7 billion for disaster preparedness activities performed by healthcare facilities and public health agencies, but there is little accountability for progress. Annually, federal funding amounts to approximately $4.30 per person per year.Â Eight in 10 (83 percent) industry stakeholders contacted by PricewaterhouseCoopers report that funding is not entirely sufficient and more than one-third report major unmet needs due to limited funding.
* States receive a base amount of federal funding for disaster preparedness, plus an amount indexed to their population.Â Using this methodology, Wyoming, Vermont, North Dakota and Alaska rank in the top five states to receive federal funding for disaster preparedness on a per capita basis.Â Texas and Florida receive the least, and the District of Columbia receives the most.
* The federal government has spent $2.9 billion to build the national stockpile of drugs and supplies.Â Funding for the strategic national stockpile has doubled since 2003, while funding for hospital disaster preparedness has declined by more than 19 percent. Annually, more money is now spent stockpiling drugs and supplies than on hiring and training health providers to distribute them or to treat disaster victims, and there are inadequate systems in place to manage inventory, expirations or access at the local level.
* Fewer than 20 percent of primary care physicians said they were "well prepared" about what to do in a disaster and only one-third (36 percent) have received formal training in terms of what to do in the event of a disaster.
PricewaterhouseCoopers found that peak demand on the healthcare system typically occurs within the first 24 hours of a disaster, when 95 percent of survivors are rescued by emergency responders. It typically takes up to 72 hours for outside resources to arrive or to gain access to the national stockpile of drugs. So localities need to rely on their own resources and their own stockpiles in the first 72 to 96 hours of an emergency.
Until recently, it was not clear which agency at the federal level was responsible for responding to a medical catastrophe. In response, in December 2006, the federal government created an office for the Assistant Secretary for Preparedness and Response (ASPR). Yet the public at large is still uncertain as to where they should turn in the event of a disaster.
"Disaster planning and response must start at the local level," said David Levy, MD, principal of the Health Industries Advisory practice at PricewaterhouseCoopers. "A new integrated, systems-oriented approach is needed, and health providers need to work together within their organizations, in their communities, and across society to be able to treat victims when a disaster occurs."
According to PricewaterhouseCoopers, the chain of command is hampered at the local level because of lack of consensus and breakdowns in communication. Even who makes the decision to order a mandatory evacuation is unclear. While almost every state has authorized the governor to order an evacuation, local governments also are allowed to do so. This twin delegation can be confusing, especially for healthcare facilities who want to avoid the need to evacuate patients.
PricewaterhouseCoopers found that the public turns to the media, first responders and hospitals as a source for information during an emergency. Yet communications among these various groups often break down because of conflicting terminologies used to communicate as well as backup systems and software that are incompatible.
PricewaterhouseCoopers found that interoperability of communications stalls in many localities because of funding issues and turf wars.
PricewaterhouseCoopers' report includes extensive recommendations to close the seams of preparedness as well as nine critical areas of planning that need to be addressed, such as: Health professionals should plan for altered standards of care, identify alternate care sites and make the availability of pharmaceuticals and other supplies a priority; communities should expand emergency staffing and capabilities, develop actionable plans and collaborate regionally; state and national governments should build effective leadership down through the chain of command, develop a public culture of preparedness and provide sustainable funding. PricewaterhouseCoopers calls for collaboration across regions and sectors, and urges the public and private sector to work more closely together to fund disaster preparedness and plan for the long term.
PricewaterhouseCoopers' recommendations and a full copy of the report are available at www.pwc.com/hri.
Source: PricewaterhouseCoopers' Health Research Institute