Last call: The Healthcare Supply Chain Vulnerability

by Jim Rush, contributing Editor

Editor’s Note: This is the first in a series of articles we will feature from our good friend, Jim Rush. It was originally published in Big Medicine, a Healthcare Logistics Website. Jim has deep expertise in Healthcare supply chains and logistics based on years of large scale operational experience. We are looking forward to featuring his content on the site. – Jim

[Salado TX]–With the 8.9 Japan earthquake, America is once again thinking about Disaster Readiness, but I fear this is just a temporary phenomenon. If our past is any indicator, instead of using this tragedy as an opportunity to become truly prepared for disasters, we will once again relapse into a state of complacency. For decades, Japan has invested heavily in earthquake Readiness and has perhaps the world’s most stringent building codes in preparation for the earthquake that has occurred. I can’t help but wonder what an 8.9 earthquake would mean to Los Angeles, Portland or Seattle and to the folks who live in those cities.

Since 2004, the Department of Homeland Security (DHS) has advised state and local leaders to plan for very large disaster scenarios. Some of the DHS’ “Planning Scenarios” include a 10 Kiloton nuclear attack, a major earthquake, and a killer influenza Pandemic. The #1 DHS Planning scenario is a nuclear attack with a 10 Kiloton bomb in large, high risk American city or large metropolitan areas. We can only imagine the loss of life and suffering that would be associated with a major terrorist attack with our current dismal level of Readiness. Even in the face of Federal planning advice, DHS has done little to build the capabilities that would be needed to effectively manage an attack of this size and scope.

For years now, I have been advocating for a calm, resolute culture of Disaster Readiness. Unfortunately, I have been seeing what I refer to as the “PowerGlide” of Public sentiment. For those of you too young to remember, many Chevrolet automobiles in the 1960’s had a “PowerGlide” transmission – low gear and high gear…that’s all there was. Since the terrorist attacks of 9-11, we as a society have had only two collective mental gears….complacency and hysteria.

Prior to 9-11 we were in the complacent gear, and afterward, when we were scared to death we would be attacked again, we transitioned immediately into the hysteria gear. Congress acted as they are wont to do, by enacting laws sending billions of dollars to Federal agencies with urgent instructions to “Get the Money Out Now.” Congress should have first commissioned a group of Operational Readiness experts to outline a common sense National Disaster Readiness Plan which would result in increases in America’s capacities and capabilities to manage the major disaster scenarios promulgated by DHS. At that point, Congress could have appropriated funds to enable actions called for in the National Response Framework. Instead, Congress enacted laws to fund various huge grant programs without the coordination and integration required of any competent National disaster readiness program. When Federal Programs all march in different directions based on the laws enacted by Congress, we have a guarantee of failure. My last blog entry “Unprepared after Tens of Billions of Federal Grant Funding” further explains how we built a fragmented, politically correct National Readiness Program.

Although we all knew we are going to be attacked again, soon after 9-11 we reverted to our complacent gear. As such, we have done little to significantly improve our overall state of Readiness to manage another 3,000 casualty event, let alone a 100,000-300,000 casualty event. As a Nation, we just don’t want to think about unpleasant things and thus, there is little public support for Disaster Readiness. Sadly, many Emergency Managers, the folks whose job it is to plan for major disasters, also refuse to think about or plan for large scale natural disasters, industrial accidents or terrorist attacks.

In 2005, we all saw thousands of people suffering and dying during and immediately following hurricane Katrina. Folks with disabilities were slumped down dead in wheelchairs outside storefronts, nurses crying on hospital rooftops while manually ventilating patients while they waited for a medical evacuation helicopter. We saw the dead floating down streets in New Orleans-an American city, with corpses in the water. If we had mobile hospitals and public health units, we could have deployed them to the high ground near New Orleans to treat those requiring medical care and/or immunizations and other Public Health services. Since we didn’t invest in Mobile health and medical units, we had to fly thousands of hurricane survivors to points around America. One facility located at the decommissioned Kelly Air Force Base in San Antonio received large numbers of Special Needs patients, many without any of critically important medicines like Insulin. Volunteer nurses had no medical supplies on hand and no federal system from which to order. Instead, they resorted to calling pharmaceutical companies to request donations of insulin, lancets and glucometers to care for the evacuees who had been without insulin for days. Imagine that…all those billions of Federal Grant Program dollars, but no medicine for chronic illness care!

Then in 2008, we saw an entire community’s healthcare infrastructure destroyed in Galveston, Texas as a result of hurricane Ike. Once again, instead of deploying cost effective Healthcare and Public Health facilities to Galveston after the hurricane, we embarked on a very costly process of using air evacuation helicopters to airlift patients in Galveston to Houston hospitals for medical care. While this was ongoing, many of the highly skilled physicians, surgeons, nurses, physical and respiratory therapists and other highly skilled medical professionals left Galveston to work elsewhere. If we had deployed mobile hospitals and specialty care facilities to Galveston, many if not all the medical professionals could have continued working in Galveston and serving the Community. Instead, the result was an absence of hospital care for almost a year and untold costs to the taxpayers to airlift folks to Houston for medical care. Even though it will take Galveston years to recover, we pulled the complacency blanket over our heads and went back to sleep.

We have been told by the CDC for years now that it was a matter of “When” and not “If” we would have a killer Pandemic. During the 2009-2010 H1N1 flu season, we experienced far fewer deaths than we experienced in a normal flu season and yet we were all about to dust off our living wills. There were enduring backorders for all manner of respiratory care supplies and other medical supplies. In fact, medical distributors resulted to “allotting” (a nice word for rationing) medical material supply orders from hospitals all across America. As soon as the immediate hysteria subsided, we once again shifted back into our complacency gear, instead of ramping up our Public Health and Healthcare organizations’ ability to manage and logistically support medical care during a future killer pandemic. The opportunity was lost for Federal Response agencies like the Department of Health and Human Services (HHS) to begin building Federal Reserve Inventories (FRI) of medical supplies, equipment, mobile hospitals and public health infrastructure.

I hope we can develop a third gear…an overdrive if you will, that will take us into the future. We need to reinvigorate the National Disaster Medical System (NDMS), including a dedicated medical supply and equipment program to sustain the NDMS during large scale disasters. Let’s develop REAL plans to take care of REAL casualties. Let’s do the hard work to develop supply and equipment lists of all classes of materials, including deployable mobile disaster hospitals, needed to provide professional medical care and competent sheltering for people with disabilities and special medical needs. Let’s ask HHS or DHS to purchase and manage these critical healthcare and public health assets as Federal Reserve Inventories.

Let’s look at the 15 Federal Planning Scenarios and plan for the scenarios which will most likely occur for our high risk jurisdictions. Let’s build mobile disaster hospitals and public health departments which are properly supplied, equipped and sustained during long duration disasters.

Let’s really enhance our Medical Reserve Corps by developing a program similar to our Armed Forces Reserve components; offering paid “Reserve” opportunities to retired Medical Professionals and let’s pay them during summer sessions to update their competencies and integrate with active healthcare and public health professionals. Let’s link-up healthcare and public health with our communities’ Emergency Management Agencies and develop a real disaster-ready community response. Let’s ask the Federal Government to build Federal Reserve Inventories of food, water, medical supplies, equipment and pharmaceuticals to name just a few (FRIs). After all, we already have the model in the Strategic Petroleum Reserve.

Disaster Readiness is never inexpensive, but it is always cost effective. We need to understand that we will either invest in a National Disaster Response System now, or pay much more in future disasters, not just in dollars, but in human life.

If we can muster the will, the good stewardship, and the funding to increase our Readiness posture, we can take the first few steps that lead us to “Full Readiness.” We can begin saving hundreds of thousands of lives during the next man-made or natural disaster.

Lets all insert that extra gear into our two speed culture. Let’s see how it feels to know that we did all that could have been done in preparing our Country for the really big next one. That gear is known as the Readiness gear. Start shifting!

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