Government experts are calling on hospitals and public health agencies to beef up their ability to respond to terrorist attacks, saying they may not have the capacity or expertise to treat large numbers of victims from a conventional or biological strike.
But hospital representatives are opposing a government panel's recommendations that hospital accreditation agencies rate them on their ability to respond to terrorist attacks and that every hospital have at least one decontamination unit. Government officials, meanwhile, said they may not fund such upgrades through Medicare and Medicaid payments or new disaster-preparedness programs.
The discussion about hospitals' disaster capabilities came a week after the terrorist attacks in New York and Washington. While praising hospitals' performance in treating people injured in the attacks, experts said the use of chemical, biological or nuclear weapons, or even more damaging conventional strikes, could increase the number of casualties and strain hospital capacity.
"We believe now that the healthcare system is performing very well, as has been demonstrated in New York and Virginia," said Virginia Gov. James Gilmore III, who heads a congressionally chartered antiterrorism panel. "But in the case of high concentrations (of casualties), such as a weapon of mass destruction or a catastrophic conventional attack such as we have seen, it might be difficult in the future."
Gilmore spoke at a news conference last week to describe his commission's work in the wake of the attacks.
The annual report of Gilmore's panel, released in December 2000, said accreditation agencies should require that hospitals be accredited on the basis of their being able to treat the victims of a terrorist attack. The report recommended that every hospital have at least one decontamination facility.
Hospitals would have considerable work to do to achieve such a goal. A survey of more than 200 hospitals in the Northwest, published in the May 2001 American Journal of Public Health, found that only 45% had decontamination units.
The commission also recommended that when assessing performance, the Joint Commission on Accreditation of Healthcare Organizations include hospitals' ability to respond to terrorist attacks. The commission also recommended stockpiling certain vaccines, such as smallpox vaccine.
The hospital community last week said such rules would restrict their ability to respond to a variety of crises. "I think we have to be careful here that we don't get a set of mandates that are (too) narrow," said James Bentley, senior vice president for strategic policy planning with the American Hospital Association.
In January, the JCAHO began requiring accredited hospitals to use an all-hazards approach to their emergency management planning. Hospitals are expected to develop a plan after surveying all the risks in their environment and responding to those risks.
JCAHO Vice President Robert Wise, M.D., said he was concerned about any blanket standard requiring all hospitals to have a decontamination unit or other specific disaster management resource.
Bentley added that hospitals would be taking on new costs to expand their disaster-preparedness capabilities, which he said would have to be offset by new government funding, either through Medicare or through potential new grant programs.
Gilmore, meanwhile, signaled that the commission wouldn't propose new government funding. "Private money is already spent, which is applicable to the national strategy, and in addition to that there are enormous amounts of public money spent at the state and local level, which also can be . . . dovetailed into the national strategy," he said.