Summit convened by:

Center for Biosecurity of UPMC

Canadian Policy Research Network

Center for Science Technology and Security Policy at AAAS

National Consortium for the Study of Terrorism and Responsed to Terror

Roundtable II: What if Hospitals Cannot Take Everyone In?
The Problem of Meeting Immense Medical Needs

Background  |  Issues and participants  |  Purpose and scenario  |  Transcript

Summary
Moderator: Tara O'Toole, CEO and Director, UPMC Center for Biosecurity

In this second roundtable, the moderator led a role playing exercise aimed at elucidating how hospital staff, local officials, and affected residents might react to a sudden and overwhelming surge of flu patients during a severe pandemic. The conversation then shifted from role playing in the hypothetical crisis to generating ideas about real steps that can be taken now to develop sustainable community-wide plans and vibrant volunteer networks to help deliver care for flu victims, maintain other essential medical services in the community, and preserve the viability of local hospitals after the crisis.

At the beginning of the exercise, O'Toole explained the scenari there has been an outbreak of pandemic flu within Washington, DC, and the local hospitals are reaching surge capacity. Concerned citizens, both sick and well, rush to the hospitals hoping for either acute care or vaccination. The 7 roundtable participants assumed the roles of hospital director, federal official, volunteer organization representative, citizen-activist, public health official, mayor, and a leading business executive.

As the participants worked through the crisis exercise, 5 key themes emerged:

1. Hospitals on their own cannot handle the medical demands of a severe pandemic. Running out of hospital beds is only one of many problems hospitals will experience. Some doctors, nurses, and staff may not to come to work for a host of reasons: they may be sick themselves or caring for sick family members at home, or they may be concerned about bringing the infection home with them. Hospitals cannot operate effectively in the face of such labor shortages. Hospitals may also run out of even the most basic supplies, due to patient demand and/or interrupted delivery chains. Hospitals will lose money rapidly when they have to cancel profitable out-patient services and elective surgeries. Routine care will likely suffer, and emergency rooms risk becoming amplifiers of disease as more people crowd the hospitals.
2. Citizen volunteers are invaluable during a major health crisis. As many participants noted, citizen volunteers can make a profound impact during a pandemic. Volunteers can relieve hospitals by establishing phone banks to answer calls from concerned citizens, caring for children of critical staff, and they can also help by delivering food to vulnerable populations. Getting people engaged can also decrease fear and enhance a sense of control in chaotic times.
3. Denial of hospital care can become a reality. Due to the enormous number of sick patients seeking help during a healthcare crisis, denial of medical care is a distinct possibility. Decisions concerning triage need to be debated and laid out publicly, as well as distributed to doctors ahead of time; these decisions are too complex and important to be made during a crisis. This discussion paralleled the prior roundtable's focus on the need for public deliberation of the tough ethical decisions related to scarce medical resources.
4. Local officials will be the primary decision-makers. During this exercise, few requests for aid were made to the role-playing federal official. This highlights the fact that the majority of crisis-related decisions will be left to local leaders. In addition to making necessary decisions regarding hospital care, public health officials and mayors must be prepared to make coordinated announcements regarding information that the public needs, such as school closings, locations of additional acute care facilities, and availability of information hotlines.
5. Community-wide pre-planning is essential. Most participants agreed that communities can handle a pandemic flu crisis more effectively and humanely if government, the health sector, businesses, non-governmental organizations, and grassroots groups actively collaborated in pre-planning and response exercises, and if citizens assumed a larger role in pandemic preparedness. Participants spoke to the logistical and managerial potential of the private sector, the on-the-ground capabilities of neighborhood associations and the federally supported Community Emergency Response Teams (CERTs), and how cross-sector partnerships could enhance pandemic readiness. Lastly, participants noted the important role that the federal government could play in building up local readiness.

Summary by Allison Chamberlain