The words “disaster preparedness” have been used so many times in the past several years that their mere mention now makes some people’s eyes glaze over. But as much as the drums have been beaten for preparing for natural and manmade calamities, the far more common health care disasters that affect people on a daily basis still go largely unaddressed. Among them is the cycle of over-crowding, ambulance diversions, and admission delays that compromise care in the majority of emergency departments in this country.
Since the fall of 2001, every talk I’ve given about disasters has included a picture of the September 10, 2001, cover of U.S. News & World Report that proclaimed: “Crisis in the ER—Turnaways and Huge Delays Are a Sure-fire Recipe for Disaster.” This striking background for 9/11 was also noted by the Institute of Medicine in its 2006 report, “Hospital-Based Emergency Care: At the Breaking Point.”
If the goal of preparing for an un-anticipated major disaster is to save as many people as possible and minimize the harm to those who survive, why aren’t we willing to devote the same degree of attention and re-sources to our daily disasters? When added together, over the course of a year, these disasters affect more lives and result in more harm to more people than most single mass-casualty events. Is it rational to devote so many resources that hopefully will never be needed while at the same time ignoring what actually happens day after day?
For at least 10 months prior to 9/11, there was a nationwide shortage of tetanus diphtheria (Td) toxoid. Then, late in the afternoon of September 11, our hospital’s apothecary-in-chief called to ask me how many doses of the Td vaccine we would like delivered to the ED. The federal disaster “push packs” had arrived in the New York City area and the supplies they contained (including 50,000 doses of Td) were being distributed to hospitals dealing with the aftermath of the terrorist attack.
Were they important and necessary for a mass-casualty disaster? Absolutely. But no less important for treating the tens of thousands of contaminated wound exposures that people sustained in the months leading up to 9/11.
During disaster drills at our hospital, I make it a practice to “disappear” in order to let the lead attending physician gain the experience of running the ED portion of the exercise. If I were in the ED, participants from every department would inevitably come up to me to ask what was needed, and it would be delivered immediately. This is what happens during actual disasters—what needs to happen happens. Patients in the ED are instantly transferred upstairs to beds that seemingly didn’t exist moments before. House officers, attending physicians, and consultants from all other departments appear in the ED, ready to assist for as long as necessary, often before their presence is even requested.
But why are there no state and federal officials asking during our daily disasters what else is needed in order to quickly care for everyone waiting to be seen? And where are the resources needed to expand the nation’s EDs to accommodate all who seek care there? Why is one type of disaster less important than the other? This seeming oversight is perhaps best expressed in the words of the late comedian George Carlin: “I’m not concerned about all hell breaking loose, but that a part of hell will break loose. It will be much harder to detect.”
Our article on Ebola this month was expanded in response to the diagnosis of the first case in the United States. “Update: Current Management of HIV/AIDs in the Emergency Department” by Sarah Battistich, MD, originally scheduled for this issue will appear instead in the November issue.