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A health care system that has seen economic forces steadily beat down its ability to meet peak demand situations now finds itself facing a real threat of bioterrorism, Dennis O’Leary, MD, president of the Joint Commission on Accreditation of Healthcare Organizations told members of Congress. Mixing a call for more government funding with the "stark realities" of the current health care system, O’Leary set out a series recommendations Oct. 10, 2001, at a special hearing on bioterrorism by the Subcommittee on Oversight and Investigations of the House Committee on Energy and Commerce.
"For more than two decades, public policy-makers have taken clear steps to reduce excess delivery system capacity [and] hospital beds," he said. "During this time many emergency departments and satellite clinics have closed. But we are entering a new era that requires a re-examination of fiscal public policy on emergency preparedness."
"Resource commitments" at the federal, state, and local levels are essential to any effective bioterrorism response capacity, he said. "Some people believe that the health care delivery system — if faced with a bioterrorism event — will somehow be able to accommodate the thousands of ill, injured, and worried who will seek health care in that situation," he said. "The unfortunate truth is that we have much to do before such a belief can be fulfilled. This is not intended as an alarmist statement, but there are some stark realities that must be faced about the current [readiness]."
For example, victims of a virulent pathogen could pose risk to physicians, nurses, and other staff, and thus limit the availability of critical medical personnel, he said. "Under such circumstances, it may be prudent to keep the hospital free from contamination by setting up off-campus isolation units and treatment modalities outside of the hospital that are overseen by properly protected staff," he said. "This would permit the hospital itself to remain a safe haven for management of other injuries and illnesses."
Medical personnel must also become knowledgeable about routes of transmission, the vectors for various biologic agents, and the effective therapeutic approaches to these agents, he added.
"The reality is that most physicians would not recognize a case of anthrax, tularemia, or smallpox that presented to them in the emergency department or in their office," O’Leary said. "Nor would they know what kinds of specimens to collect for testing, how to handle such specimens, or which clinical laboratories possess the expertise to detect some of the rare agents that could be used by terrorists. Such education is essential to a prompt response to any bioterrorism attack."
While the Joint Commission has always required some level of disaster planning, it has recently moved to broaden the ability of individual health care organizations to deal with rare events, he said. This was in response to the threat of bioterrorism as well as the growing threat of emerging infections across the globe. "Regardless of the source of the threat, readiness for managing biological events has certain common elements."
New standards, effective January 2001, require accredited organizations to take an "all hazards approach" to planning: Organizations must develop emergency management plans with a chain-of-command approach that is common to all hazards deemed to be credible threats — an approach that also can be easily integrated into their community’s emergency response structure, he said. "Hospitals must start this aspect of planning by considering a wide variety of threats that could befall their community, including terrorism," O’Leary said. "While this vulnerability analysis is obviously important, the abilities of the individual organizations, and indeed of communities, to prepare for and respond to the full array of potential threats are seriously constrained by the major cost restraints in most health care organizations."