For Immediate Release: August 29, 2008
On the Third Anniversary of Hurricane Katrina, Trust for America's Health Questions State of National Emergency Preparedness
On the third anniversary of Hurricane Katrina, with Hurricane Gustav building off the Gulf Coast, Trust for America's Health (TFAH) issued the following statement, along with questions to help assess America's ability to respond to major emergencies. TFAH also provides a set of recommendations for how the nation could better prepare for the next potential health emergency based on TFAH's annual Ready or Not? Protecting the Public's Health from Diseases, Disasters, and Bioterrorism report. Read the full report
"On the third anniversary of Hurricane Katrina, we must renew our commitment to preparing for any disaster or emergency that puts Americans at risk," said Jeffrey Levi, PhD, Executive Director of TFAH. "While some progress has been made, we have a long way to go. With the current state of our preparedness, let's hope the next storm does not test our nation's defenses to the extent Katrina did only three years ago."
TFAH asks the following questions about America's current emergency planning:
- Who is in charge of the public health emergency preparedness and response efforts of the federal government? Is there a clear chain of command that is understood within the federal government and by state/local officials? Is there similar clarity at the state and local level?
- Will people from every community know where to go and get the support they need to safely evacuate? Will special arrangements be made for at-risk populations, including the disabled, the elderly and those without cars? Can we be sure that alternative living arrangements - such as trailers - will not pose new threats to the health of evacuees?
- Is there a process in place which would ensure that uninsured victims of a potentially catastrophic hurricane have immediate access to medically necessary healthcare services?
- What type and level of care will be provided to people who may suffer health problems or injuries during an evacuation? What kind of support is being provided to hospital patients who are sick but are being discharged due to the evacuation?
- Does the Strategic National Stockpile (or state/local stockpiles) include sufficient medications for ongoing serious conditions, like diabetes, heart disease, and high blood pressure, to protect people while they are displaced?
- Will all health benefits be portable across state lines in an emergency? Will AIDS Drug Assistance Program (ADAP) benefits be accepted across state lines in an emergency?
- How well will hospitals manage a major influx of potential patients, both in the immediate area of the hurricane and also in areas where evacuees are being sent? How smoothly will hospitalized and institutionalized patients be transported to alternate locations?
- With less than half of hospitals providing incentives for medical workers to come in during emergencies, will enough health workers report to work during emergencies?
- Are systems of pre-registering volunteers working? Will there be problems with permitting out-of-state medical workers providing care? Are volunteers in neighboring states protected from potential liability? Are non-healthcare volunteers also protected?
- While Louisiana has an immunization registry, will a lack of immunization records in other states prevent displaced children from being able to attend school?
- Will mental health support be available for potential victims?
- Are plans in place to provide safe, clean temporary housing for those who need it?
TFAH offers a number of recommendations to address these concerns, including:
Restore Preparedness Funding: For Fiscal Year 2009, the White House once again proposes to cut funding for state and local public health emergency preparedness, by almost $137 million, from $698 million. Funding for hospital preparedness grants would also be cut by $57 million, from $414 million. At a minimum, state and local public health emergency preparedness capabilities should be restored to the Fiscal Year 2005 level of $919 million, and hospital preparedness programs to the Fiscal Year 2004 level of $515 million.
Provide Temporary Health Benefits for the Uninsured During Emergencies: Congress should pass the Public Health Emergency Response Act (PHERA), which would guarantee emergency treatment for victims affected by a major public health disaster, regardless of their health insurance status or ability to pay. PHERA would ensure people with ongoing serious health problems receive the "continuity of care" they need to protect their health and safety. The Act would put into place a framework to ensure hospitals are reimbursed for uncompensated care.
Clearly designate who is in charge: There must be an official in charge of public health preparedness to specify how various departments, state and local officials, and first responders are to collaborate in the event of a public health disaster.
Strengthen Surge Capacity in Hospitals: Surge capacity remains the largest threat to the nation's ability to respond to a major catastrophe. Recommendations for strengthening surge capacity include 1) regional coordination of healthcare facilities, including alternative care sites with public health and emergency management; 2) establish and support alternative care sites; 3) enhance communication systems; 4) designate a disaster coordinator in each hospital; and 5) build a strong surge workforce by recruiting in advance in order to ensure licensing and accreditation issues are resolved before an emergency emerges.
Establish Clear Preparedness Standards for All States: Preparedness varies from state-to-state and community-to-community. HHS has yet to establish clear benchmarks and objective standards for preparedness in states. The objectives should focus on outcome results from real-life drills and exercises. Current benchmarks are often process-oriented and are not clear predictors of how well a state will respond to an emergency.
Ensure Liability Protection for Volunteers: Volunteers and private entities have expressed reluctance to participate in response and recovery efforts for fear that their actions may make them liable. The federal government should issue a clear ruling on what liability protections are offered to volunteers under the Stafford Act; state legislatures should adopt the Uniform Emergency Volunteer Health Practitioners Act, and they should also consider extending the Good Samaritan liability protections to those non-health care volunteers that provide emergency assistance.
Modernize Technology and Equipment: Upgrade surveillance systems so that they meet national standards and are interoperable between jurisdictions and agencies to ensure rapid information sharing. Surveillance systems should be able to detect an infectious disease outbreak and plans should ensure adequate laboratory surveillance of infectious diseases.
Ensure the Strategic National Stockpile has Treatments for Chronic and Infectious Threats: Ensure that medications are available to treat chronic conditions, like diabetes, as well as antiviral drugs to treat possible emerging infectious diseases.
Modernize Risk Communications: Hospitals must develop communication systems that allow health care facilities and public health departments to talk to each other and collectively manage a response.