As the earthquake in Haiti reminds us, large-scale disasters often occur without warning and, absent adequate planning, medical supplies and staffing, can tax global medical resources and logistics capabilities to the brink.
Other potential disasters, like the recent slowly evolving swine flu pandemic, provide an unmistakable warning. The last six-months' labored and expensive efforts to deploy public health staff at all levels to deal with vaccine production and distribution should be a wake-up call for everyone.
Unless we repair our capacity to cope with major medical crises on our own homeland, large populations will be vulnerable during the serious challenges that are sure to come.
To be fair, authorities have not completely ignored these challenges, despite the fact that some 90 years have passed since Spanish flu, our last true homeland medical catastrophic disaster, struck the world. It killed as many as 675,000 Americans in three waves over 18 months. Just as in the recent swine flu pandemic, some victims were healthy and in the prime of life.
When the system utterly failed after Hurricane Katrina, the federal government put a great deal of energy into standardizing the National Incident Management System (NIMS), which gives us a unified approach at all levels to handling emergencies. We have also enhanced the National Medical Disaster System (NDMS), which sends relief teams to areas hard hit by disaster. But are these initiatives enough?
Local measures can also go a long way. In Los Angeles, there is the Sheriff's Homeland Security Advisory Council, which has helped establish public-private partnerships to provide emergency supplies during a disaster. The LA Department of Public Health and FBI have in place the first of its kind, a joint "Technical Advisory Group" to link public health assessment with F.B.I. investigation of possible bioterrorism and other events. The Strategic National Stockpiles and many local caches are good examples of prepositioning of supplies.
However, even such collaborations do not promise to mitigate the impacts of a high magnitude earthquake. Even with 74 emergency-receiving hospitals, LA County remains woefully unprepared for the tens of thousands of injured that surely will follow any major disaster.
Moreover, there remains terrorism. The recent aircraft incident in Detroit reminds us that catastrophic acts remain plausible and inevitable, and like natural disasters, our capacity to deal with the medical consequences from a serious terrorist strike, especially using WMDs, remains questionable.
Much remains to be done. We need to enhance our emergency responder surge and coordination capacity. Anticipating the worst, we must prepare for a brief breakdown of services such as water, food, electricity, oxygen, phone, electricity or fuel. We will need to be self-reliant until public authorities can quickly restore these goods and services. We need to better prepare for a shortage of the workforce as many essential workers are incapacitated, need to deal with their families, or merely leave the stricken area.
But this is only a small start. Health care providers need better guidelines on how to share limited resources among a large population. We need a central, non-classified, easily accessible repository databank of all relevant local, regional and national resources. We need to do a much better job breaking down competitive barriers among agencies to ensure that information is shared in the most effective way possible, as we tried to do with the Department of Homeland Security and the National Counter-Terrorism Center. We need to educate the public -- and the media -- as to what to do and say as well as what not to do and what not to say. We need to develop good metrics to see how we're doing.
When disaster strikes, trust and faith in government can easily fail. We can mitigate the challenge with strong contingency planning.
We are reaching a critical point in new health care legislation. Among the matters that failed to get on to the agenda is the country's ability to respond to catastrophic emergencies that truly tax the medical system. And we should take little comfort that the recent swine flu pandemic generated a mild illness. We may not be as fortunate next time.
As the perfect storm is destined to approach, we must recognize that maturing medical crisis preparedness and management must be on a par with national defense. Indeed it is national defense itself.
Dr Katona is Associate Professor of Clinical Medicine at the David Geffen School of Medicine at UCLA and a Physician Specialist at the LA County EMS Agency. He has edited two books: Countering Terrorism and WMD: Creating a Global Counter-Terrorism Network and Global Biosecurity: Threats and Responses.