As war approached last week, hospitals throughout the country reacted about as calmly and confidently as could be expected at the prospect of retaliatory attacks, biological, chemical or otherwise.
But amid assurances that facilities would be prepared for such disasters, some hospitals also grumbled that despite guarantees of financial aid from the federal government, they largely have borne the costs of preparing.
At a Senate subcommittee hearing last week, at least one senator, Arlen Specter (R-Pa.), questioned whether the nation's hospitals were ready.
Hospital officials responded that they've been prepared for a while.
"In general, hospitals are already operating at heightened alert levels all the time just because that's their jobs," said Carl Armstrong, vice president and senior medical adviser for the Virginia Hospital and Healthcare Association.
And in Washington, where each police siren and ambulance roaring down the street drew prolonged glances, Jeffrey Elting said, "On a daily basis, hospitals deal with emergencies and disasters." Elting is the medical director for bioterrorism response coordination for the District of Columbia Hospital Association.
The events of the last week, hospital officials said, had more of a psychological effect than a practical one.
Part of the challenge, they said, is that though the threat of an attack has been heightened, it remains vague.
"I think we can overreact," said Greg Rufe, administrator of 650-bed University Hospital in San Antonio. Regardless, the events of last week pushed up the hospital's timeline for implementing a system that allows it to record and analyze patient illness trends and report them to the local health department. The hospital also has started locking some hospital entrances and is increasing the security presence throughout its campus.
For many hospitals, preparations for the war have been subtle. At Suburban Hospital in Bethesda, Md., where emergency drills were being conducted regularly long before last week, the most recent events have meant little more than making sure the hospital has employees' and local government officials' phone numbers readily available and checking that emergency radio systems are working properly, said Cindy Notobartolo, corporate director of emergency, trauma and security services at the 287-bed facility.
The threat of a retaliatory attack was perhaps felt most acutely in the Washington and New York areas, where the memories of Sept. 11, 2001, have not yet dissipated. There, hospital officials acknowledged that staff anxiety had increased but added they are ready for the worst.
"It isn't anything more than what we've lived with on a day-to-day basis for two years," said Rosalia Long, a vice president at 1,055-bed St. Luke's-Roosevelt Hospital Center in Manhattan. A day after President Bush addressed the nation on the impending war, Long had staff check that emergency equipment was functioning. Emergency supplies will be checked daily now instead of monthly, she said.
After Sept. 11, the Greater New York Hospital Association set up the Hospital Emergency Response Data system as a repository of information concerning staffing levels, supplies and bed availability at hospitals.
The association has been compiling a task list for hospitals corresponding to the different terrorist alert levels, said Susan Waltman, senior vice president at the GNYHA. At press time the list had not been finished.
Last week, HHS Secretary Tommy Thompson told Specter and others at the Senate hearing that the terror alert soon could be raised to the highest level-red. A White House spokesman said only, "When we have something to announce, we will announce it."
How hospitals would react to such an event varies widely from facility to facility. The New Jersey Hospital Association has created a guideline for its members to consider in developing their own plans. Among the suggested steps are opening command centers, requiring more identification from employees and visitors and locking some entrances. "They predominantly focus on security, no surprise," said Valerie Sellers, senior vice president of health planning and research at the association.
Preparing for a possible attack is expected to cost hundreds of millions of dollars. Hospitals said that to date, they have received little help from the federal government to defray costs. HHS is paying hospitals $498 million this year to support their preparation efforts.
Waltman said New York City hospitals only recently received federal funds. Each hospital had received $40,000, a fraction of what they have spent on the preparation effort, she said. Last week though, HHS announced states may apply to get 20% of their 2003 funding immediately.
What do you think of the war's impact on healthcare?
Write us with your comments. Via e-mail, it's [email protected]; by fax, 312-280-3183.