The March 9 article on 51˶ by Editor-in-Chief Martin Makary, MD, raises some sobering questions regarding the ability of U.S. healthcare facilities to respond to this public health crisis. Makary notes that "U.S. hospitals ... are on track to soon be overrun with patients..." and predicts that these facilities may be dealing with significant staffing shortages within a matter of weeks. He also points out the potential for shortages of personal protective equipment (PPE) in hospitals, as indicated by a recent nationwide survey of 6,500 nurses.
How prepared are America's hospitals for this and other types of disasters? Makary's writings struck a chord with me, especially since I have done considerable research in this area, including assignment as a U.S. Army physician in Washington, D.C., during the 9/11 terrorist attack, work in private practice and a small hospital afterward, and, finally, performing a study for a 2017 doctoral dissertation on disaster preparedness among New York's community hospitals. I chaired the Committee on Emergency Preparedness and Disaster/Terrorism Response for the Medical Society of the State of New York.
This research was timely in that New York had experienced several disasters, both natural and non-natural, since the beginning of the 21st century. Despite this, there had been no comprehensive studies on disaster preparedness performed in the state and the few that had been published consisted mainly of "lessons learned" following disaster events. In the dissertation study, a 35-item questionnaire was developed and used to examine six elements of disaster preparedness: Disaster plan development, onsite surge capacity, available materials and resources, disaster education and training, and perception of disaster preparedness. Completed surveys were obtained from emergency preparedness coordinators from 80 out of 207 community hospitals in the state.
The general findings, , showed that 87.5% of hospitals had experienced a disaster event within the past five years (2012 through 2016). Eighty percent of hospitals had disaster plans in place to address all six major types of disasters: natural disasters, epidemics/pandemics, biological accidents or attacks, chemical accidents or attacks, nuclear/radiological accidents or attacks, and explosive/incendiary accidents or attacks. In fact, 97.5% of respondents affirmed that they had a plan in place for epidemics/pandemics. Despite this, only 17.5% of hospitals felt that their disaster plans were "very sufficient" and did not require any revisions. Almost three-quarters of the hospitals felt that, in the face of a disaster event and resulting patient surge, they could not continue operations for a full week without external resources. Less than half of respondents reported being satisfied or very satisfied with the level of funding they receive through the federal government's Hospital Preparedness Program. Most hospitals (88.8%) felt that barriers to disaster preparedness exist for their organizations, with many respondents citing the problem of competing priorities for time and resources. As one respondent stated: "We will never be very well prepared."
The survey with respect to disaster plan development, on-site surge capacity, available materials and resources, disaster education and training, and perception of disaster preparedness. No difference was identified between these hospitals in terms of disaster preparedness funding levels. Urban hospitals rated their disaster plans significantly more sufficient than did rural hospitals. They were more likely to have developed a written plan for the conversion of inpatient beds to augment intensive care unit capacity. Urban hospitals also reported participating in more disaster exercises and simulations than rural facilities. Additionally, survey responses showed some in the state.
Other literature on community hospital disaster preparedness as to whether hospitals have become better prepared to handle disasters. Common themes included inability of hospitals to adequately increase surge capacity, larger facilities reporting a higher level of preparedness than smaller organizations, and urban hospitals being better prepared than rural facilities.
The findings from this research are important for several reasons. They suggest that differences in preparedness among hospitals in different settings and different locations within New York state may reflect differing priorities with respect to perceived threats. But the study results can also enable hospitals to identify focus areas for improvement. And they provide information that can assist government agencies and healthcare associations in their legislative and advocacy efforts to obtain additional resources for community hospital disaster preparedness. To this latter point, I shared the findings in late 2018 with representatives of the New York State Department of Health, the Healthcare Association of New York State, and the Iroquois Health Association in New York, all of whom I had been in contact with throughout the study. It is unclear whether any changes have occurred as a result.
The current COVID-19 outbreak is alarming and community hospitals will need to respond swiftly to care for those affected. Given the results of this research, hospitals in the U.S., and New York in particular, may not be able to do so at their current level of preparedness without additional resources. Government agencies need to answer this call for assistance in a timely fashion to ensure that the emergent healthcare needs of the population are met.
is a member of the graduate teaching faculty in the Master of Health Administration Program, School of Health Sciences, in the Herbert H. & Grace A. Dow College of Health Professions at Central Michigan University.