Less than 10 years ago the lending of needed supplies to the healthcare organization down the street, in the middle of the night, was perhaps the best example of coordination, as it was then practiced, involving two or more hospitals or other medical facilities. Hospitals were at that time – and still are, of course – motivated primarily by competition; almost all of them are private-sector businesses and must therefore be economically viable in order to survive. If a community hospital becomes a stroke center it might well motivate other hospitals in the same general geographic area to improve their own ability to handle stroke victims so that they, too, would be accorded that same prestigious designation. In the mid-1980s, hospitals in certain states competed to be designated as trauma centers. Their motivation was simply that, if they were not certified as being able to handle trauma victims, the public might opt to go to another hospital.
In more recent years – i.e., since managed-care systems have spread throughout the United States – the competition between hospitals has escalated to the point that hospitals that are unable to compete may either have to close or be purchased by a bigger and more solvent healthcare system.
Most of the nation’s hospitals were required in the 1990s to include emergency preparedness in their disaster plans. If the hospital had been accredited by JCAHO (the Joint Commission on Accreditation of Healthcare Organizations), a hospital administrator probably would be required to produce not only the hospital’s emergency-preparedness plan but also two examples of disaster drills that had been carried out during the previous year.
Actual Disasters and Unfunded Mandates
A hospital disaster plan was based on just that: an actual disaster resulting in numerous casualties. The scenario postulated usually was a plane crash, a train crash, a 10-car pileup on the interstate, or an internal fire. Hospitals typically carried out a drill once a year with their community EMS agency in preparation for just such an incident. If a community was fortunate enough to be served by several hospitals in the same general area, they might all participate by getting enough victims to put their plans in place – but it was the very rare community that actually coordinated the response between two or more hospitals.
In 1986, after thousands of deaths had been caused by a toxic release from a chemical plant in Bhopal, India, one of the first attempts was made to require communities throughout the United States to work with hospitals in their home areas to plan for similar emergencies.
This planning initiative by the federal government was required by the Emergency Planning & Community Right-to-Know Act (EPCRA – also known as the Title III Superfund Amendments and Reauthorization Act, or SARA). Under the Act, communities were required to set up Local Emergency Planning Committees (LEPCs). Unfortunately, this well-intended requirement amounted in fact to an unfunded mandate and, at least partly for that reason, received little attention from the nation’s hospitals.
9/11: A Cataclysmic Turning Point
The terrorist attacks of 11 September 2001 changed hospital emergency planning forever. No longer was it acceptable simply to plan for hospital emergencies in a vacuum. The potential loss of life during major disasters such as hurricanes, a pandemic flu or a smallpox outbreak, an anthrax attack and/or terrorist use of various weapons of mass destruction all made it clear that one hospital, or even a community-wide hospital system, would not be adequate for potential emergencies that really do happen. If nothing else, this dawning realization gave those hospitals that already were fearful about business competition something else, and much more important, to fear.
In 2002, though, the allocation of federal grant dollars to community hospitals throughout the country created an important incentive for hospitals to work and cooperate with other hospitals. At the national level, states were given hospital funding for emergency preparedness through the Department of Health and Human Services (HHS). The delivery of such funding was based on demonstrable coordination and cooperation between and among hospitals. States and hospitals had no choice but to demonstrate community, regional, and statewide hospital coordination.
Today, hospital planners sit next to one another on community emergency planning committees. They also share emergency-response equipment, develop “best practices” for various emergency-response situations, and work on ways to communicate with one another during a mass-casualty incident. Most U.S. hospitals still have a long way to go to set up truly integrated emergency-response systems to manage trauma, burns, the outbreak of a pandemic flu, chemical exposures, and other potentially lethal events. However, although they still compete with one another financially, an increasing number of hospitals now also cooperate with one another more closely than ever before in the development and implementation of their emergency planning and response policies and procedures.