U.S. to urge hospitals to form emergency plan

Terrorism or disaster could swamp emergency facilities, experts say


WASHINGTON - The emergency room at Mount Sinai Medical Center in Miami Beach was so crowded recently that Dr. Lisa DeWitt found herself treating patients in the halls, worrying how she would cope if disaster struck right then.

"All I could do was go out in the parking lot to treat patients," said DeWitt, a disaster-response specialist with worldwide experience.

Lots of disaster planners are worrying about the problem: how to treat a sudden influx of hundreds or thousands of casualties of terrorism or natural disaster. Belt-tightening over the past 20 years has made the pressure more acute by forcing many hospitals to shrink or close.

Today, Homeland Security Director Tom Ridge is expected to urge members of the American Hospital Association to quickly come up with contingency plans for use in mass emergencies.

If state and local authorities fail to enhance their "surge capacity," the Bush administration is threatening to withhold their share of $1.6 billion in federal bioterrorism grants.

Also today, the AHA plans to release a report showing how bad emergency room overcrowding has become. According to industry figures, the number of U.S. hospitals dropped by 14 percent from 1985 to 2000 while the number of patients admitted remained the same.

Massachusetts, a hard-hit state, lost half the hospital beds it had in 1980. In California, the number of emergency departments dropped by 12 percent in the 1990s while the number of emergency room visits rose 27 percent.

"There is very little excess capacity in hospitals, and surge capacity is one of the core issues we're dealing with," said Jerry Hauer, a former New York City disaster chief who now is national security adviser to Health and Human Services Secretary Tommy G. Thompson.

"Overwhelming a hospital these days is a piece of cake," said David Ozonoff, a professor at the Boston University School of Public Health. "The reason New York made it [without flooding hospitals Sept. 11] is because everybody was dead. They didn't need any hospital beds. If there had been 1,000 [life-threatening] burns, it would probably have overwhelmed the burn treatment capacity in this country."

For now, communities are improvising solutions for emergency surges. New York City plans to use armories and convention centers as makeshift hospitals. Syracuse, N.Y., has talked about making the state fairgrounds into a hospital if needed, officials said.

Hotels and motels could be turned into instant hospitals, said Ozonoff, a leading proponent of the idea. They have individual rooms that are helpful in containing infectious diseases.

"You don't want [victims] next to each other in a huge open area," Ozonoff said.

The District of Columbia and the Department of Defense are picking up on the idea. They plan to spend up to $8 million to prepare and convert a major hotel into an emergency hospital if needed, said District Health Director Dr. Ivan C.A. Walks.

"Hotels are ideal facilities, because they come equipped with their own beds," Hauer said.

Kevin Maher, vice president for governmental affairs at the American Hotel and Lodging Association in Washington, said the idea will take some study, but might work.

"We've helped the government house people who lost their homes in floods and hurricanes," Maher said. "There is precedent for this."

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