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Bioterrorism and Health System Preparedness

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Slide Presentation by Howard Levitin, M.D.


On May 1, 2002, Howard Levitin, M.D., made a presentation in a Web-assisted teleconference at Session 3, which was entitled "Assessing Hospital and Health System Preparedness and Response."

This is the text version of Dr. Levitin's slide presentation. Select to access the slides or to access the streaming video of Bioterrorism and Health System Preparedness.


Assessing Hospital and Health System Preparedness and Response

Howard Levitin, M.D.
Emergency Physician and Consultant
Disaster Planning International

Slide 1

Level of Preparedness in Four Hospitals Surveyed

  • None met minimum level of preparedness.
  • Only one center provided bioweapon (BW) training.
  • Only one facility's plan addressed mass casualties.
  • All four hospitals regularly experience staffing problems.
  • Most had no excess capacity in the ED or ICU.
  • None had sufficient supplies to manage a mass casualty incident.

Slide 2

Obstacles to Preparedness

  • Lack of financial support for BW planning & preparedness (typically volunteer).
  • No generally accepted planning scenario.
  • Shortage of "true" planning/response expertise.
  • Minimal (or no) excess patient care capacity.

Slide 3

Current Health of the Healthcare System

  • Fewer hospitals—Decreased by 1,075 1979-1999.
  • Fewer hospital beds—378,000 decrease 1979-1999.
  • ED overcrowding—ED volume up 14 percent.
  • Personnel shortage—Nurses, Pharmacists, etc.
  • Resource limitations—Just in time purchasing.
  • Financial instability—Decline in government support for hospitals; unfunded mandates; increase demand for charity care.

Slide 4

To Measure Capacity, Hospitals must:

  • Evaluate existing & immediately available services for inpatient & outpatient care.
  • Assess its rapid expansion capacity—physical plant, personnel, supplies & equipment.
  • Consider maintenance of standards for medical care, monitoring & tracking.
  • Consider contingency plans to ensure patient care—alternative care centers, discontinuance of services & patient transfers.

Slide 5

Processes to Increase Capacity

  • Early patient discharge.
  • Cancel elective procedures.
  • Open unused patient care areas.
  • Utilize "non-traditional" patient care areas.
  • Increase nurse/patient ratios.
  • Limiting factors.
    • Personnel.
    • Supplies.
    • Monitors/equipment.
    • Utilities
  • Baseline demand for care doesn't change.
  • What will be the impact of the increased capacity?

Slide 6

Hospital Assessment

  • Biological Emergency Planning & Preparedness Questionnaire For Healthcare Facilities.
  • Clinical Preparedness Maturity Model.
    • Management & Planning.
    • Information Technology.
    • Logistics.
    • Staff Skills.
    • Surveillance/detection.

Slide 7

Public Health

  • Lead agency in a biological attack.
  • Under reporting of infectious outbreaks.
  • Underutilized resource by medical providers.
  • Inadequate daily contact with community emergency resources.
  • Staff shortage—especially Epidemiologists.
  • Not available 24/7.
This slide also shows a picture of individuals walking past a sign that says "medication distribution."

Slide 8

50 Anthrax Patients Bed Requirements

This slide shows a picture of a computerized graph that plots the number of beds that would be needed for 50 anthrax patients by the number of days from exposure. As the number of days from exposure increases, so does the number of beds needed.

Slide 9

Yearly Impact of Influenza

  • Excess hospitalizations 50/100,000.
  • 50 percent hospitalized >65.
  • 20,000 die annually from the flu.
  • Direct costs—$1B (1986).
  • Indirect costs—$2-4B.
  • Seasonal effects:
    • Overcrowding—ED, UCC, PPP, clinics.
    • ED diversion.
    • Prolonged wait times.
    • Bed shortages.
    • Overworked (sick) staff.
    • Scarcity of ventilators.

Current as of June 2002


Internet Citation

Assessing Hospital and Health System Preparedness and Response. Presentation by Howard Levitin at Web-Assisted Teleconference, "Bioterrorism and Health System Preparedness: Emerging Tools, Methods, and Strategies." Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/bioteleconf/session3/levitintxt.htm


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