In times of uncertainty, such as during an unfolding global pandemic, it’s easy to blame health care for being underprepared. Nationwide, health care staff are gaining well-deserved daily kudos for working on the front lines, often leaving families at home and taking social distancing terms and conditions to new levels, ensuring the safety of their loved ones. Our health care system as a whole, however, has not been the recipient of such appreciation. But it is both simplistic and unfair to believe that health care has never worked to prepare for catastrophes like COVID-19.
Like an elephant on a high wire, hospitals across the country face a continuous balancing act, in their case the balance between risk and consequence. Recent reimbursement and billing laws for hospitals have assigned back-burner status to expenditures that do not contribute to daily revenue and survivability. And investing in supplies strictly dedicated to something that may never happen is a tough sell. Things like elective capital improvements and expensive disaster supplies are often the first to be marginalized, and justifying these ongoing purchases has become harder and harder for those responsible to plead their case. At the end of the day, however, questions like “Why don’t they have enough?” or “Why didn’t they plan for this?” facilitate headlines but often fail to address the systemic answers.
The costs of being fully prepared (to the extent that it’s even a rational prospect) are enormous. Disaster preparedness professionals consider a million dollars to be the typical starting point to be prepared for anything. Serious funding is invariably necessary just for purchasing supplies, establishing systems and ensuring that collaborators are on the same page. It’s difficult for critics to understand that supply preparation is not just a one-time exercise of ordering “stuff” prior to an incident. Without constant attention, deterioration and obsolescence are virtually guaranteed. Most supplies cannot simply be hoarded in a warehouse waiting for the next disaster to strike. It takes meticulous planning and conscientious people to assure that stock is rotated, technical equipment is properly and routinely maintained, and expiration dates are not exceeded. Not only is the use of expired equipment dangerous to patients and medical providers, it is also illegal.
Here in Maine, we should celebrate and be proud of our preparedness efforts. For over 15 years, we have had a robust statewide emergency health care preparedness network. It is dedicated to planning for all types of disasters, including global pandemics and emerging infectious diseases (think SARS, EBOLA and the like). You’ve likely never heard about the technical experts and dedicated professionals who staff this network unless you have been involved in disaster preparedness or have been on the receiving end of the network’s response. Unfortunately, the infectious-disease experts, epidemiologists, emergency managers, equipment specialists and first responders responsible for this hard work are often overlooked and unrecognized for their what-if-related work.
The hundreds and hundreds of Mainers who have worked hard to eliminate silos and improve collaboration for disaster preparedness are largely unseen by media critiques of preparedness. Hospitals and health care systems have strengthened critical relationships with one another and formed robust planning and working groups across county and even state lines. They have invested in additional equipment to fill obvious deficits in response capabilities, created dedicated programs to address disaster preparedness – and, perhaps most importantly, their leaders have committed to methodical investments related to disaster preparedness of all types. So, in our state, and nationwide as well, it is just uninformed to scapegoat health care organizations for underpreparedness. Hospitals in our state have worked assiduously to prepare for catastrophic events; and they have achieved effective results while balancing tight budgets.
The experts behind the scenes continue to advocate for necessary purchases, draft endless plans, create evidence-based protocols, develop essential communication channels and provide necessary interagency coordination. They fight relentlessly for optimal disaster preparedness because it’s the right thing to do. It’s definitely not for any personal rewards. They deserve our recognition and high praise for their work, which ultimately benefits us all during some of our hardest times.
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