The year 2009 will be remembered as a particularly busy one for U.S. healthcare systems, especially hospitals. The spring and fall phases of the H1N1 (Swine Flu) virus challenged the ability of hospitals of all sizes to care for above-average numbers of patients in their emergency departments and inpatient services. Included in that response effort were numerous instances in which hospitals had to deal with serious logistic and financial issues related to, among other things: (a) obtaining and issuing the personal protective equipment (PPE) needed for the hospital staff; (b) having enough vaccinations available for both staff and patients; and (c) finding sources of Tamiflu and/or other medications for their adult and pediatric patients.
Fortunately, the flow of federal funding continued for most if not quite all community hospitals – but in reduced amounts for many of them. As the end of the year approaches it seems likely – with the congressional debate over healthcare reform not yet resolved and the uncertainty continuing about what if any legislation might finally emerge – that 2010 holds the potential for considerable change. Following are some of the more important possibilities.
I: NIMS Compliance Objectives for Healthcare Facilities Will Be Renewed The Departments of Homeland Security (DHS) and Health and Human Services (HHS) will collaborate on the latest round of NIMS-compliance guidance for healthcare facilities. A work group composed of a broad spectrum of individual hospitals, state hospital associations, and AHA (American Hospital Association) representatives already has started to meet on a regular basis and to work with government officials to develop specific recommendations related to current NIMS (National Incident Management System) guidelines.
Preliminary indications suggest that there may be no new objectives added during the coming year to the current fourteen (14) objectives. However, the updated guidelines probably will not only provide greater clarification on how current NIMS objectives can be met but also clarify how they relate to other organizational expectations such as those proposed/recommended by the Joint Commission and the National Fire Protection Association (NFPA). It also seems clear that, with the fiscal challenges hospitals are already facing, any new recommendations that raise costs will not be well received and could be met with stiff resentment if not outright rebellion.
II: The Hospital Incident Command System (HICS) Will Be Modified California Emergency Medical Services, using funds provided by the state’s Department of Veteran Affairs, is planning to hold a stakeholders conference sometime next year to review the current design and use of the Hospital Incident Command System (which was established in 2006). The meeting may well serve as the first step in shaping HICS improvements based on: (a) lessons learned from facilities using the current guidelines during training programs; (b) real-world events that have exposed unforeseen gaps in overall preparedness capabilities; and (c) the recommendations of those who are teaching or managing current training programs. Extensive changes to the current HICS guidelines do not seem likely at this point, but a number of refinements to Job Action Sheets, Incident Planning materials, Response Guides, and a broad spectrum of educational and training materials also are anticipated.
III: Emergency Preparedness Could Become a Lower Priority for Hospitals Whether because of the prolonged and costly response to H1N1, the shrinking of external funding support, and/or the nation’s distressed economic conditions in general, it is entirely possible that hospital emergency preparedness, which is still a high priority for most if not all healthcare facilities, may return to pre-9/11 levels for many of them. Faced with still shrinking operating margins or worse, hospital CEOs may be forced to make more budget cuts and/or staff reductions and, without actually saying so, to move emergency preparedness down a few notches on the overall priority list. The commonly held view that most communities and their hospitals have mounted a successful response to the H1N1 virus may also lead some hospital and healthcare officials to believe that a strong response foundation is already in place – and, therefore, that reductions in the time and effort allocated to emergency preparedness may be justified. That view is reinforced, unfortunately, by the past few years of federal funding emphasizing the development of healthcare coalitions. However, any decision to lower emergency preparedness on the priority list may leave a growing number of hospital emergency preparedness managers either: (a) splitting their time between assigned tasks; and/or (b) paying more attention to other responsibilities that are not preparedness related; and/or (c) even worse – out of jobs altogether.
IV: Healthcare Reform (If Enacted) Will Have a Major Impact Perhaps the greatest potential for change in 2010 will come if (when?) a healthcare reform bill is enacted into law. The current House and Senate bills do not specifically address the need for hospital emergency preparedness. A major related concern is that the bills introduced in both houses have proposed considerable reductions to current Medicare funding for hospitals. In addition, reductions in educational spending that also have been proposed, combined with increased government emphasis on outpatient services and outcome-based care, could have a negative impact on the internal funding support that hospitals can make available for preparedness efforts. One example: HHS’s increased funding support for coalition-related activities may well lead to continued overall system improvements, but there probably would be less direct funding available for individual hospital efforts.
To briefly summarize: The major 2009 healthcare incidents and events – e.g., the H1N1 pandemic, numerous transportation accidents (on land, at sea, and in the air), and various weather-related emergencies – saw hospitals demonstrate the benefits of: (a) keeping emergency preparedness a high priority; and (b) making federal funding available to purchase needed resources and to develop and/or improve current response systems and equipment. The year 2010 may see further advances, many of them building on past successes – or, perhaps, a disturbing recognition that the best efforts to improve preparedness may have already been completed and that there may be additional advances, but at a slower pace.
Craig DeAtley, PA-C, is director of the Institute for Public Health Emergency Readiness at the Washington Hospital Center, the National Capital Region’s largest hospital. He also is the emergency manager for the National Rehabilitation Hospital, and co-executive director of the Center for HICS (Hospital Incident Command System) Education and Training. He previously served, for 28 years, as an associate professor of emergency medicine at The George Washington University. In addition, he has been both a volunteer paramedic with the Fairfax County (Virginia) Fire and Rescue Department and a member of the department’s Urban Search and Rescue Team. An Emergency Department PA at multiple facilities for over 40 years, he also has served, since 1991, as the assistant medical director for the Fairfax County Police Department.