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During times of crisis our health-care delivery is still lagging

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When a disaster strikes — whether a hurricane, Ebola, or a mass shooting — health-care providers and the health systems are expected to jump into action to treat the ill and injured.

Unfortunately, much remains to be done to improve our nation’s ability to save lives in the aftermath of large-scale emergencies. After providing more than $5 billion in federal healthcare preparedness grants to states since 2001 our health-care systems and communities are still not sufficiently prepared to respond to mass casualties.

{mosads}A key problem is our current approach. National policy separates health-care delivery during crisis and everyday health-care delivery. The result is a limited scientific foundation, misaligned incentives, inadequate measures and no long-term sustainment plan. Today, hospitals and health-care providers struggle to save lives during mass casualties.


Congress is now considering a bill that could address many of the shortfalls in our disaster preparedness structure, the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAIA). This bill is a chance to use lessons learned to strengthen our ability to respond to disasters.

It should give U.S. Department of Health and Human Services a more robust scientific and economic foundation, enable innovation, appropriate policy development, measure creation, decision making and resource allocation. Unfortunately, as introduced, it doesn’t go far enough.

Disaster readiness simply isn’t a priority for health-care leaders, as demonstrated by a survey recently conducted by the American College of Healthcare Executives. None of the respondents named disaster readiness among their top 10 concerns. This suggests that the people who should be thinking about this issue and working hard to address it, aren’t.

Another example of the lack of interest in disaster issues is the American Medical Association’s decision to cease support of their Disaster Medicine and Public Health journal because it was not viewed as a strategic imperative for the organization.

This is understandable: Often, healthcare executives and providers often have very different priorities and incentives than their disaster planners. Extra capacity, which is crucial to disaster planning, is simply not a financially profitable endeavor. And economic influence is powerful.

Without a clear national aim and sensible approach to influencing healthcare, it is unlikely that any hospital will save all the lives it could during mass casualty events. Provisions in the PAHPAIA could change that.

Heroic acts, expansive rescue efforts under challenging conditions, and trained medical professionals with the best equipment must be supported by systems and protocols that can expand quickly and efficiently from day-to-day operations into mass casualty mode.

If the bill engaged health care providers and systems, insurers and emergency medical services to shape a more rational and impactful approach to national health resilience, our next catastrophe could result in fewer lives lost.

There are some additional, specific actions Congress should consider as it advances and modifies the PAHPAIA. Long overdue, the bill needs to modify the Social Security Act and define emergency medical services (EMS) as a health care asset instead of a transport mechanism. Additionally, as all disasters are local, and to build state resilience, the National Disaster Medical System should mirror a National Guard model.

Thirdly, as mass casualties require rapid responses, the bill should modify the federal regulation requiring a Stafford Act to waive EMTALA (the Emergency Medical Treatment and Active Labor Act) to give hospitals more flexibility to save lives during response to public health emergencies. Finally, PAHPAIA should create an office to strengthen the nation’s emergency care system, the cornerstone of any disaster response.

It is time to change and update our current approach as we simply can’t grant our way to preparedness. The PAHPAIA presents an opportunity to codify a bold step toward an integrated and aligned structure to support improved mass casualty responses. Bridging the gap between daily health-care delivery and the expanded scope of delivery that is needed to respond to disasters will enable us to provide optimal care that will save lives and reinforce our national resilience.

David Marcozzi, MD, is an associate professor at the University of Maryland School of Medicine, and former director of the National Healthcare Preparedness Program in the Department of Health and Human Services. He is also director of population health at the school’s Emergency Medicine Department, and assistant chief medical officer for acute care at the University of Maryland Medical Center.

Tags Global health Natural disaster

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