Frontiers: When Disaster Strikes: Healthcare's Response

Lead article by David J. Campbell and Pietro D. Marghella

Softbound, 46 pp, Fall 2002, ISSN 0748-8157
Order code: WWW1-J472,
Price: $29.00

(Taken from Leonard Friedman's Editorial)

...The words "nine-eleven" will forever be etched in the consciousness of the United States and much of the world. The numbers are stark: 4 aircraft, 19 hijackers, 3 buildings, and 3,214 persons dead or missing, and 8,800 persons injured.

In the days, weeks, and months immediately following the September 11 attacks, a number of unexpected jolts hit healthcare organizations across the nation. Some of the unanticipated aftereffects include the following:

• A health system CEO anticipates that insurance premiums overall will continue to climb given a combination of payouts associated with the 9/11 attacks and the slump in the stock market, which has seriously eroded the portfolio values of insurance companies.
• An executive of a large integrated delivery network notes that many staff are members of Army and Air Force reserve units. As a result of the ramp-up of military operations post-September 11, a hospital's staffing level can be significantly affected, particularly when the reserve members are physicians who have to leave at a moment's notice
• The same executive has noticed the effects on hospital construction as new and improved security measures are put into place, including limiting the number of building entrances and implementing lockdown procedures.

No doubt hospitals and healthcare providers will be central to the survival of a community immediately after a devastating manmade, or natural, disaster. The question is, how should healthcare organizations prepare for these types of calamitous events?

In this issue of Frontiers, we are privileged to have two uniquely qualified individuals write from different yet connected perspectives. In "9/11: A healthcare Provider's Response," David J. Campbell, FACHE, president and CEO of St. Vincent Catholic Medical Centers (SVCMC) in New York, writes about the experience he and his staff encountered as the closest Level I trauma center to the site of the World Trade Center. As a member of the Greater New York Hospital Association, which encourages the effective management of healthcare resources, and building from its experience following the 1993 World Trade Center bombing and several "routine" weather-related problems, SVCMC was already well-positioned to deal with a significant crisis. However, despite its experience and preparation, the staff at SVCMC was taught eight important lessons in the hours, days, and weeks following the 9/11 attacks. Campbell enumerates these lessons in compelling fashion in his article and repeatedly stresses the importance of regional healthcare providers working collaboratively to develop a coordinated response to disasters.

Commander Pietro Marghella (USN) is the author of the second article, titled "Medical Planning Considerations in Consequence Management." Marghella is chief of the Medical Plans and Operations branch on the staff of the Chairman, Joint Chiefs of Staff. While civilian healthcare organizations have formal disaster plans to cover virtually every common eventuality, the job of the military health sector is to plan for the unthinkable and have a response in place that allows that system of care to continue to function. In the aftermath of the 9/11 attacks, Marghella reminds us of three things: threats to the United States that might have previously been considered absurd are now possible; another attack can come at virtually any time; and "we are not even close to being collectively prepared to effectively counter or mitigate the effects of another such 'event.'" According to Marghella, effective consequence management is vital if we are to withstand an asymmetrical attack by one or more groups that seek to do our nation harm.

A common thread is found in the two articles: no substitute can take the place of effective and ongoing planning. However, planning by itself is not enough. We must move beyond our history of competition and isolation with the understanding that in the event of any widespread, disabling business interruption, our first obligation is to our patients, staff, and community. Only by pooling resources and sharing information will we be able to withstand the next 9/11, whenever that day arrives.

—Len Friedman