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November 10, 2009

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VIEWS: JIM RUSH

Healthcare Disaster Readiness: "The Cost Effectiveness of Good Stewardship"

[May 7 2009]

From hysteria to complacency

[May 5 2009]

Good Morning: After recently reading and watching the urgent stories about the Swine Flu, I couldn't help but wonder how long it would take before we reverted to complacency. For years now, I have been advocating for a calm, resolute culture of preparedness. Instead, I have been seeing what I refer to as the PowerGlide of Public sentiment. For those of you too young to remember, many Chevrolet automobiles in the 60's had a PowerGlide transmission. Low gear and high gear...that's all there was..... two gears. In the last 8 years, we as a society, have had only two collective mental gears....complacency and hysteria.

Prior to 9-11 we were in the complacent gear, and afterward, we were scared to death we would be attacked again and transitioned immediately into the hysteria gear. Although we all know we are going to be attacked again, soon after 9-11 we reverted to our complacent gear. As such, we have done little to significantly improve our overall state of Readiness to manage another 3,000 casualty event, let alone a 100,000-300,000 casualty event such as a 10 Kiloton detonation on a population center or a Pandemic . We just don't want to think about it.

in 2005, we all saw thousands of people suffering and death during hurricane Katrina. Folks with disabilities were slumped down dead in wheelchairs outside storefronts, nurses crying on hospital rooftops while manually ventilating patients while they waited for a medical evacuation helicopter. We saw the dead floating down streets in New Orleans-an American city, with corpses in the water. We are now trying to recover from hurricane Ike in Galveston and other Texas Coastal towns,,,,and where are we? We are without healthcare for hundreds of thousands of people, that's where we are.

We have been told by the CDC for years now that it was a matter of "When" and not "If" we would have a Pandemic. We have a few thousand ill people around the World who are ill and have experienced far fewer deaths than we experienced in a normal flu season and yet we are about to dust off our living wills.

The fact is, it is too late to worry if the current Influenza strain goes full bloom into a Worldwide Pandemic. I had some really good feedback on my latest article on the 2010 Pandemic (that has yet to happen). 

What I hope we will do is develop a third gear...an overdrive if you will, that will take us into the future. Reinvigorate the National Disaster Medical System...and some big time reinvigorating it will take. Lets develop REAL plans to take care of REAL casualties. Lets do the hard work to develop supply and equipment lists of all classes of materials, including packaged disaster hospitals, needed for real people needing professional medical care and sheltering and lets ask HHS or DHS to purchase and manage these critical assets as Federal reserve Inventories.

Lets look at the 15 Federal Planning Scenarios and plan for the scenarios which will most likely occur for our jurisdictions. Lets build packaged disaster hospitals which are supplied and equipped with 60 days of supply (DOS) without resupply. Lets really enhance our Medical Reserve Corps by contacting every retired nurse and every certified nursing assistant, physician, laboratory and radiology technicians, respiratory and physical therapists and lets not forget the retired support staff. Lets also recruit Psychiatrics, Psychologists and independent practice nurses. Lets link-up to our communities and develop a real disaster-ready community response. Lets ask the Federal Government do build Federal Reserve Inventories of food, water, medical supplies, equipment and pharmaceuticals..to name just a few (FRIs). After all, we already have the model in the Strategic Petroleum Reserve.

If we can muster the "Will," "Good Stewardship" and the funding to increase our Readiness posture, we can take the first few steps that lead us to "Full Readiness." We can begin saving hundreds of thousands of lives during the next man-made or natural disaster.

Lets all insert that extra gear into our two speed culture. Let' see how it feels to know that we did all that could have been done in preparing our Country for the really big next one. That gear is known as the Readiness gear. Start shifting!
 

Interim Lessons Learned - After Action Report on the 2010 Influenza Pandemic

[Jan 27 2009]

This is an interim “After Action” report on a disaster. What separates it from other reports is that this Lessons Learned report can be studied before the event actually takes place. There may be time for Congressional Commissions to not only assign blame for a lack of Readiness after the fact (as they tend to do), but perhaps appoint personnel to the appropriate agencies capable of learning these lessons and putting real systems in place before the Pandemic. It is the hope of this writer that instead of simply assigning blame and writing reports (as most After Action review committees do), the Congress might actually proactively write language into laws that demands operational systems and not just the kind of information papers that currently serve as “readiness.”

Public Health Preparedness was very poor. The Department of Health and Human Services (HHS) underestimated the Pandemic’s impact on the American People in its initial estimate that approximately 92 Million Americans would become ill and that approximately 45 Million Americans would require some level of definitive healthcare, such as in a hospital. While this Lessons Learned report only covers the first wave of the Pandemic, it is clear that even more Americans will be impacted before the last wave of the Pandemic travels across America. HHS was proactive in funding a number of Public Health and Healthcare grant programs targeting syndromic surveillance and Public Health laboratory capabilities. The syndromic surveillance systems, while not perfect, provided advance detection of the novel strain of Influenza almost immediately. However, the American people already knew from news coverage, that the Pandemic was underway before the first cases were detected in the United States. Some lessons learned from a Public Health Preparedness prospective follow. Importantly however, most States did not share Pandemic Preparedness grant funds with hospitals and the “health care” infrastructure, opting to keep the Pandemic funds in the Public Health sector. At the same time, States did not bolster the hands-on care capabilities of the Public Health function, believing hands-on care was the “responsibility” of the Private Sector Healthcare System.

Early detection was not enough. While early detection and timely information to the public was laudable, there were virtually no actions taken to treat the projected 92 million sick Americans. The Public Health position was that public information, primers, and brochures fulfilled their responsibility to alert Americans about a coming Public Health catastrophe. Since no leaders in HHS, CDC or for that matter anywhere in the Public Health Community were alive during the 1918 Pandemic, there was no way for Public Health personnel to know how to care for the sick and dying. There had also been no inclination on the part of Public Health officials to learn how Public Health could expand healthcare services to augment the Healthcare Industry. Thus, there was no “Plan B” in the Public Health system to actually provide healthcare services to persons requiring definitive care if the healthcare industry was unable to care for influenza patients. There was no perceived need to provide additional resources for Private Sector healthcare, since the American Healthcare Industry has the total responsibility for providing actual healthcare services. In other words Pandemic-related healthcare was a Private Sector matter, with Public Health providing guidance only.

The CDC issued a timely Public Health Alert that a novel strain of Bird Flu had mutated to the point of human to human transmission, at about the time where the Pandemic was confirmed in Southeast Asia. Almost immediately, Americans began checking their stocks of prescription medications as well over-the-counter cold and flu products. As a result, before the first case of the new Influenza was diagnosed in America, there was a Nationwide shortage of virtually all prescription medications as well as over-the-counter medications. What was not predicted by HHS or CDC was the societal impact brought on by announcing the pending first wave of the Pandemic. The unintentional consequence of the Public Health alert announcement was an almost immediate failure of the pharmaceutical, medical, food, fuel and retail supply chains. Since raw materials for many American manufactured items are imported from outside the USA, all of these critical supply chains will remain sporadic for approximately 3 years post-Pandemic. In the meantime, those supplies which can be purchased will be in very short supply. Federal officials warn that sporadic violence will continue occurring as limited supplies arrive at retail outlets such as supermarkets, drug stores, gas stations, and retailers everywhere.

The American Healthcare Industry was unprepared. The American Healthcare Industry was totally unprepared to manage even a small percentage of the affected population. The HHS, the American Medical Association, the American Nurses Association, the American Hospital Association and virtually every other known Healthcare Membership Association in America had warned that the American Healthcare Industry was already in a crisis even without any additional stress on the system. However, no Federal agency, organization or association was empowered to do anything about the normal operating crisis, let alone resourcing the Healthcare Industry to effectively manage a major terrorist attack or the Public Health catastrophe which is fully underway now. As a result most of the Healthcare Industry has collapsed under the strain of this first Influenza wave. Since there were no serious plans to drastically expand the Public Health Service to provide “hands-on” health care, most Americans were left to care for themselves and their loved ones. A simultaneous exhaustion of healthcare staff, the healthcare supply chain and overcrowded hospitals, caused a collapse of the entire American Healthcare Infrastructure.

The American Healthcare Industry collapse was due to a lack of elasticity to expand for spikes in demand for a surge in admissions. While numerous studies had confirmed that all study parameters were accurate and that all models were valid, not all external factors were taken into consideration. It seems no Federal agency had predicted a collapse of the American Healthcare Industry under the stress of an Influenza Pandemic. Thus, due to extreme shortages in facilities, healthcare providers, beds, medical equipment, supplies and financial resources, American Healthcare collapsed almost immediately during the early days of the Pandemic. It is anticipated that the American Healthcare Industry will be rebuilt as a National Healthcare System with some Private Healthcare entities providing elective procedures. In any event, it will likely take between 10 to 15 years for American Healthcare to achieve Pre-Pandemic operational capabilities. During this time, religious organizations and charitable non-governmental organizations will provide the bulk of the healthcare available in America.

Factors bearing on the American Healthcare Industry collapse.

1. Lack of Healthcare facilities: During the 1960’s the Federal Government had approximately 1900 Packaged Disaster Hospitals. Each of these hospitals had 250 beds, an X-Ray room and three operating rooms. Thus, as far back as the 1960s, America had a total of 475,000 beds, 1900 radiology suites and 5,700 operating rooms. All of these assets came totally outfitted with equipment and sufficient supplies to remain self sufficient for 30 days. While there were a number of States that used Federal grant dollars to purchase tent hospitals and other smaller care centers on rolling stock, such as 18-wheelers, none of these care solutions were logistically supportable or staffed for continuous operation.

2. Lack of healthcare beds. The Strategic National Stockpile had stockpiled approximately 20,000 cots instead of beds. These cots were unsuited to providing patient care in any facility and thus, were used only for comfort care in patients’ last hours. These cots could not be reused, since there were no decontamination instructions or equipment capable of decontamination. These cots became single-use assets and were used up almost immediately.

3. Lack of caregivers: While there were predictions of an extreme shortage of caregivers, due to the shear numbers of sick Americans, no Federal planning agency placed an actual number on how many skilled and semi-skilled healthcare providers would be needed. As the first wave of the 2010 Pandemic swept across America, the requirement for additional registered nurses (RNs), respiratory therapists, licensed practice nurses (LPN), physicians, medical helpers and support staff rose to 10 million. While the Medical reserve Corps had approximately 200,000 volunteers, many could not respond due to obligations caring for their families or caring for themselves. The end result was that religious congregations, the Red Cross, Salvation Army and other voluntary organizations were and are currently the only entities providing any meaningful care in the United States today.

4. Lack of Healthcare financial assets: Financial pressures on the American Health Industry have been immense since the mid-80s. Government reimbursements for Medicare and Medicaid have been tightening consistently since at least 1985. Simultaneously, “Managed Care”, by way of the healthcare insurance industry, had concentrated on driving healthcare costs out of the system. Thus, both the Federal government and the healthcare insurance industry drove down operational healthcare capabilities to a point where a single, albeit catastrophic insult to the Healthcare Industry was sufficient to cause its collapse.

5. Federal infusion of dollars made little difference. Similar to America’s Financial System near collapse in the fall of 2008, by the time that Congress recognized the American Healthcare Infrastructure was as shallow as it was, it was too late to turn things around. In the Financial System crisis, huge injections of Federal dollars propped up most major financial institutions.

 
Unlike the Financial Crisis, injections of federal dollars made no difference at all, since there was little product available worldwide. Once the Pandemic was recognized, countries like China, America’s largest cotton trading partner for surgical masks, surgical gowns, and patient apparel, had stopped the flow of raw materials outside of their country. Similarly, other countries that previously were our major trading partners for both raw materials or for manufactured medical products, had shut down exports to America in order to sustain their own populations.

While DHS, HHS and private organizations all understood that America was operating in a “Just in Time” supply and equipment environment, Federal agencies took no actions to build National Medical Reserves, as they had with the Strategic National Petroleum Reserve in preparation for interruptions in the oil markets. The global nature of supply chains for food, medical supplies and equipment, and raw materials acquisition, while the ultimate in efficiency, turned out to be useless in any unexpected surge in demand. While Federal agencies well understood the “Just-In-Time” supply paradigm, nothing substantial was done to eliminate or mitigate the impact on America’s multiple critical supply chains, or the catastrophic unemployment consequences the manufacturing, processing and distribution industries faced when raw materials from overseas dried up.

6. Law Enforcement and Societal Norms. During the first several weeks of the crisis, there was widespread looting and vandalizing of supermarkets, drug stores, farmers markets and virtually any marketplace where food, pharmaceuticals, baby formula and other items deemed necessary to provide sustenance or treat the symptoms of Influenza were thought to exist. There were widespread home invasions where gangs in search of food and medicine took whatever goods they found, and then took other items of value in hopes of trading these items for food later. The Law Enforcement and Public Safety communities were themselves degraded in the area of law enforcement, and were essentially out manned and out gunned to protect the population. As expected, persons with disabilities, and the young and old subsets of the population were especially vulnerable to attack (already being more vulnerable to the ravages of the Pandemic and lack of needed food, medicine and shelter).

As larger and larger numbers of Americans were too sick or too weak to defend themselves, society lapsed into a more stoic norm, where religious congregations and other charitable organizations provided the only meaningful comfort for the sick and dying. Federal and State agencies were staffed with employees who either recovered or seemed to have a natural immunity to the novel Influenza strain. The services of these agencies were well intentioned but almost totally ineffective. Sanitation across all affected segments of society was deplorable. Municipal services including waste collection essentially halted. The mortuary affairs departments of State and local governments were overwhelmed with the dead.

Once again, religious congregations and charitable organizations represented the only real remaining societal structure, picking up bodies much the same as they did during the 1918 Pandemic and placing the bodies in communal graves. Grave registries were mainly paper documents, but efforts were taken to achieve a rudimentary accounting for those buried by gravesite.

7. Impact on the financial system. The financial system in the United States has been decimated by the 2010 Influenza Pandemic. Officials are advising Americans to retain all financial instruments, pending a recovery after the third wave of the Influenza Pandemic. It is felt that any idea of retirement based on a 401K or other stock market based instruments are lost for a generation or longer. Still, the United States is expected to make a more rapid recovery at least in comparison to many other countries around the World.

8. Conclusion: It appears that a cascade of failures of America’s critical industries and societal infrastructure began with Healthcare and Public Health functions and have expanded out to municipal services and finally to the fabric of society throughout the United States during this first wave of the 2010 Influenza Pandemic. The results are and will likely continue to remain characterized as “catastrophic” throughout the coming waves. Many of these failings could have been and were anticipated. Better preparedness in advance may have mitigated much suffering now.

9. Lessons Learned.

A. Develop a serious and sober listing of all Federal, State and Local products, services and utilities that will be degraded or destroyed in a Pandemic and fortify those areas immediately.

B. Build Federal Inventories of life sustaining goods such as food, pharmaceuticals, over-the-counter medicines, clothes, shoes, and special needs products for persons with disabilities, the old and the very young.

C. Pay manufacturers and distributors to manage federal inventories in order that the taxpayer’s investments in these commodities can be preserved through stock-rotation and quality control measures.

D. Enhance all critical infrastructure including items not normally associated with Infrastructure:
 

(1) Religious and charitable organizations that will do much to bring America back to normalcy.
 

(2) Bandwidth for the increase in communication requirements for any disaster
 

(3) Healthcare. Private Sector or not, these are the bastions of America’s health in a disaster or Public Health catastrophe. Build a Public-Private enduring relationship with every American hospital, nursing home, medical center, specialty center, community center etc., because in a disaster, they are all we have….and federally fund disaster-related hospital expansion programs.
 

(4) Purchase a minimum 1,000 portable rigid or semi-rigid walled healthcare structures, 200 beds each, with radiology and operating capability for long term use during any disaster that destroys American communities healthcare infrastructure.
 

(5) Build a logistical support system with civilian and military transportation assets sufficient to re-supply every healthcare entity in America during disasters.
 

(6) Assign Public Health Agencies a “hands-on care mission” for relieving the enormous stress hospitals, nursing homes and medical centers will experience during a pandemic. Provide funding not influenced by the “partisan dabbling” we have seen in our past.
(7) Insist on a Good Steward mentality for Government agencies and federal, state and local leaders at all levels of government. Rid ourselves of Government power brokers and castle builders and replace those shallow souls with Americans who seek the good of the People, well above any petty self-interest.

Please let the process begin today!
 

Building and supporting a positive culture of preparedness

[Jan 5 2009]

I have been involved in community preparedness all of my adult life and have had the good fortune to work with some of the best folks in the Emergency Management field. When I read some of the conversations on this IAEM List, I thought I’d comment on the types of personal qualities that promote and foster a “Culture of Preparedness” in jurisdictions and communities. For readers who like the bottom line up front, I’ll provide it here. 

If you are working for an elected official who is not committed, do whatever you can to help this person become a real Community Preparedness leader. It will not be easy to foster this change, but try to exhaust all possible strategies within your scope.

If you can’t help the elected official, it may be time to find a community whose elected official wants to be prepared and elected leaders who will support you.  If you remain in a community and just go with the flow so to speak, you are truly a part of the problem.

Listed below are some traits that are absolutely necessary in Emergency Management leaders at all levels of government.  

It’s a tough job and at times a thankless one. In that 1991Gulf War, I certainly was concerned that there would be casualties and fatalities on both sides. The one thing that I did not worry about was our ability to medically support our troops. I can’t even imagine the horror, shame and sadness I would have felt if I had made decisions based on the safe thing to do for me in the months and years leading up to the war. Emergency Managers will never feel good about a disaster that befalls their community. What can happen though is that each Emergency Manager as a visionary, a leader, a good steward and a teacher can attack future disasters knowing that he or she did the right thing and pulled out all the stops to assist their community achieve a real Culture of Preparedness.   

Leadership and the culture of preparedness

[Jan 3 2009]

Pandemic planning and regulated medical waste

[Oct 24 2008]

It seems everywhere we look today; there is information on how we as a society can prepare for a new strain of avian influenza capable of ravishing our communities.

The fact that it will be a new (novel) strain of influenza means that there is no immunity to the new virus in the general population, or indeed on earth.

Mankind’s lack of immunity to the new virus is at the heart of a Pandemic. Pandemics have occurred in the past and will continue to occur in the future. It is estimated that up to one third of all Americans may be infected during the Pandemic and as many as 45 Million Americans will require some level of definitive medical care.

This is especially bad news for hospitals, medical centers and healthcare systems already
functioning at or near capacity.

In order to manage a Pandemic, many Public Health Officers around the County have dusted off and updated quarantine laws which are designed to cut the Pandemic’s lifeline to new hosts (people) to infect.
 

If Public Health Officers can significantly control access into and out of their jurisdiction, it is hoped that the disease can be encircled, isolated and contained within the quarantined jurisdiction. In that way, the virus cannot perpetuate itself as efficiently and as a result, it dies out.
 

While Quarantine has been recognized for centuries as an effective tool for controlling contagion, it has a number of dire unintended consequences.
 

One of the consequences is the accumulation of normal and pandemic-associated untreated healthcare regulated medical waste (RMW).
 

How are hospitals that use “off-site” transportation and treatment services for medical waste going to rid themselves of their infectious waste?
 

The fact is, “they have a problem.”
 

The last thing Public Health officials need are mountains of untreated medical waste piling up in hospital parking lots throughout their jurisdiction.

Most probably, the Environmental Protection Agency would suspend “clean air regulations” and allow healthcare organizations to resume incineration of RMW.
 

Of course the issue here is that most hospital incinerators were decommissioned and removed after passage of Clean Air Act of 1970 and the Resource Conservation and Recovery Act (RCRA) of 1976. It became clear that there was no come-back likely for onsite incineration. There is a solution to this problem and it is “Back to the Future” in effect.
 

Since the heydays of the incinerator, alternative “on-site RMW treatment technology has advanced to the point where it is the most socially-responsible, environmentally friendly and cost effective method to treat medical waste at the healthcare facility level.
 

Many healthcare professionals believe that once their medical waste is handed off to a transporter, the healthcare organization is “off the liability hook.” Not so according to RCRA.
 

Regulated medical waste is the responsibility of the generator (in this case the healthcare organization) from the “cradle to the grave”, or in other words until the medical waste is rendered safe.
 

Sometimes necessity truly is the mother of invention. As Public Health Officers continue to work on Pandemic Preparedness, many will examine the possibility of using Federal Grant dollars to enhance America’s Pandemic preparedness with on-site medical waste treatment technology.
 

On-site RMW treatment technology reaps immediate benefits by reducing the amount of RMW being transported through American communities and across our roads and Interstate highways. It also protects healthcare workers and conserves valuable landfill resources.

It’s the right thing to do and the right time to do it.

Healthcare disaster preparedness and gap analysis - What it truly entails?

[Sep 8 2008]

With Hurricane Ike in the news, I thought I'd share an article I wrote some time ago on how healthcare organizations can perform a quality “gap analysis” to identify unmet requirements and then to work on narrowing the gap between what is required versus what is on-hand and available through local suppliers to build a robust and resilient healthcare organization. Also, since The Joint Commission (TJC) has significantly broadened and emphasized healthcare Emergency Management standards for 2009, this article may be timely for those preparing for TJC surveys.  

It is imperative that healthcare, public health and jurisdictional emergency managers work extraordinarily closely in identification of all gaps in resources and capabilities and forward the appropriate unmet requirement gaps up the NRF support chain in order to ensure the healthcare and public health needs of communities are met during future man-made and natural disasters. If quality Gap Analyses are conducted and acted upon proactively, we may see healthcare organizations and public health departments performing brilliantly in future disasters, saving and protecting the lives of those in the communities these organizations serve.   

Surge Capacity...and the American healthcare system's [in]ability to respond to the next catastrophe

[June 28 08]

I wish we would stop studying our healthcare industry's inability to respond adequately to a large scale disaster. It's really quite simple....the healthcare industry has been in crisis for over 20 years and many (if not most) ER's are on "Divert Status" during weekends and normal spikes in demand for health care services. The American Healthcare Industry cannot respond effectively and won't be able to respond effectively to any Large-Scale disaster. The reason: The American Healthcare Industry is not funded to surge to manage large-scale disasters. Man, was that a thrifty Readiness Assessment.

I'm even tired of hearing myself say this in article after article. Sure, healthcare entities can surge for short duration, medium intensity events using the integrated healthcare approach outlined in Federal grant guidelines. Healthcare organizations can make the most of integrating healthcare systems locally and even regionally. But still, an integrated approach will still not cope with the numbers of patients associated with a Pandemic or the huge numbers of casualties resulting from a nuclear attack-and never will be capable of this level of healthcare response. Just like we pool our tax money together to form an Armed Force instead of local militias, so too must we fund a National Health and Medical entity to deal with National catastrophes like hurricane Katrina, a nuclear attack or a Pandemic. I know we shudder to think of the Federal Government managing anything, but we must do this and hold the Federal agency fully accountable for Full National Readiness.

We need the Federal Government to respond as they did back when we actually believed we could be attacked by the Soviet Union. The Federal program was called the Civil Defense program. In the '60s America had 1900 "Packaged Disaster Hospitals" and each one of these mobile assets had 250 beds with X-ray and surgical capabilities. These died of old age, expiration of supplies and neglect. This was due to funding cut offs, when somebody probably decided a full-out nuclear war would wipe us all out...so why prepare?

I know this sounds very antiquated, but these disaster hospitals would have served America well if we hadn't abandoned the concept in the '70s. If we had these disaster hospitals and their staffing and logistical support systems in place today we would be in very decent shape for the 15 Federal Scenarios we talk about today. However, even if we had a network of sustainable hospitals, we would still need an air, ground and rail system to move casualties/patients to areas of America where specialty care was available. This is where the National Disaster Medical System transportation element would shine.

I believe our Transportation Industry would work with the Feds IF the federal government bought airframes, ambulance helicopters, ambulance buses, rail cars (there isn't any real excess capacity out there) and built a National ground, rail and air Evacuation system. The Federal leadership is also going to have to bolster other supply chain systems like our food and water supplies, over-the-counter drug inventories etc.

Wouldn't it be great if the National Public Health Information Network (PHIN) was linked to the food supply chain networks? If we had the capability, CDC could link syndromic surveillance peaks from the jurisdiction suffering illness spikes, back through each element of the food supply chain. Jeeze this is great! We might be able to do the same thing for medical products to quickly track down product tampering. Maybe these types of initiatives would be identified by Congressional committees as "Successes in Imagination."

The Medical Reserve Corps and ESAR-VHP programs are working well but need massive expansion. The National Disaster Medical System must be re-invigorated well beyond its current capabilities. Every single retired physician, nurse (all specialties), respiratory therapist, optometrist, psychologist, etc. must be aggressively recruited to join the National Disaster Medical System (NDMS). The NDMS must be returned to its highest state of readiness and then still further bolstered to medically manage a Pandemic and/or a nuclear attack or other large-scale man-made or natural disaster.

The Public Health Service Commissioned Corps and civilian employee ranks must be seriously bolstered with personnel, facilities, a Federal Reserve Inventory (FRI) of Pandemic and Nuclear related supplies, equipment and service contracts to supercharge the NDMS during a Pandemic or a nuclear attack. Federal Reserve Inventories are needed (Just like the National Petroleum Reserve) for very large spikes in demand for medical supplies & equipment, food, water, special needs supplies etc. We all live in a World Economy and a Just-In-Time healthcare and food supply chain. I'd hate to see over-the-counter medicine on sale at eBay during a Pandemic, but we will.

How much will this all cost? About the cost of one Nimitz-Class aircraft carrier $4.2-$5.0 Billion. I am all for a powerful Navy, so I'd be the last to criticize the US Navy's investment in any of the fleet craft. We need to adopt the budgetary processes of the DOD.

There is one very big difference between the Armed Forces and Public Health community. The DOD gets an approved Mission from Congress, then outlines in budgetary documents all Requirements it needs and the costs of each line item to perform the mission. The DOD chops on it, so does the President and Congress; it's their jobs. The job of the DOD is to lay out the items and the costs.

In the case of Healthcare and Public Health Readiness, it seems Congress arbitrarily sends an allocation to HHS and says "Do things with this money." I was an HHS/HRSA employee and I could never understand why we didn't send up to Congress a Requirements Statement along with the line item of each requirement. I know the people are great, but I still don't get it.

For the life of me, I can't figure out why HHS doesn't take the DOD approach. Once again I like HHS very much and I know some extraordinary and devoted people at HHS and CDC...it's not that I have an axe to grind; I don't. However, every time I hear the words (paraphrase) "We are not at full Readiness, but we are more prepared than we were" I get mildly ill and sometimes I kick dirt. Simply put, that's not going to cut it anymore.

The American people deserve to know the line items and the Price Tag of what DHS and HHS needs in order to reach 100% readiness to care for Americans during a Pandemic or a large scale terrorist attack like a nuclear detonation. It's not cheap, but lets give Congress the opportunity to vote on appropriations ...it's their job for crying out loud. And I'm crying out loud that it may be too late for the next big event.

Healthcare and public health disaster readiness made easy

[June 9 2008]

I recently took a breather from Healthcare Readiness and returned to Healthcare Administration to recharge my spirit and to get back to doing real healthcare operations. I was really burned out from reading and writing scholarly articles on Readiness and wondering when, or if indeed if I’d ever get to actually do things again. OK, my articles weren’t scholarly at all, but I tried. Being a high energy person who loves serving people, my healthcare hiatus was just what the doctor ordered. In my case, the doctor was my wife and she also ordered me home…I can’t understand why. One of the things I took away from my recent “on-the ground” healthcare experience was just how demanding Healthcare leadership is in an environment of dwindling resources. Now that I’m back, I thought I’d try to write an article on how Emergency Managers and Healthcare leaders can work together to offer their communities the best chance of surviving future disasters.

1. Share the Community Hazard Vulnerability Assessment. Many healthcare planners are not in sync with their community Emergency Managers regarding the likely disasters the EM is planning for; and the categories and estimated numbers of patients healthcare organizations should plan to receive for each planning scenario.

2. Jointly develop the requirements for staff, materials and service contracts needed for each scenario. It would be counterproductive for the Emergency Manager to plan for a nuclear detonation scenario and keep Healthcare leaders in the dark about the types and numbers of casualties such an event will likely produce. Some questions for consideration:

• How many extra medical staff will be needed to manage the healthcare response?
• How can Emergency Managers help hospitals in communicating with, transporting and providing security for health workers arriving from state networks for Volunteer Health Professionals (ESAR-VHP) and state and local chapters of the Medical Reserve Corps (MRC)?
• How will hospital suppliers re-deploy supplies from one region of the country to the disaster location?
• What supplies and equipment (plus quantities for each item) will be needed to respond effectively to each planning scenario?
• How will hospitals order and receive Federal equipment and supplies and what supplies and equipment are available?
• How can community volunteers help with and augment security, escort and a host of other required hospital functions?
• How will the hospital acquire oxygen, water (potable and washing/chiller water), food and back-up generator fuel throughout a disaster?
• How will medically stabilized patients be transferred (patient regulating and tracking office) and transported to specialty centers outside the disaster location?
• How will loved ones receive healthcare information relating to the status of their affected family members?
• How will hospitals communicate with the EOC/alternate EOC?
• How can the Emergency Manager help Home Health agencies/organizations get power back-up equipment, supplies and food to homebound persons?
• How can healthcare organizations cooperate fully with other healthcare organizations/systems and the Emergency Management community during exercises and gain from past failures and lessons learned?
• How can the Emergency Manager help fortify the hospital/medical center/nursing home so that evacuation becomes the last resort that it must become?


3. Facilitate the cooperation between hospitals and indeed competing healthcare systems. Why? In any widespread disaster it is in the best interest of competitors to work together so that they can both get back up and running after the disaster.

4. Assist healthcare organizations in planning for the care of vulnerable persons during and after a disaster?

5. Help with healthcare recovery efforts, for example temporary & long term shelters, access to care, sanitation, water & waste systems, oxygen, food & special feeding systems and back-up power for all shelters, especially special needs shelters.

6. Help educate Public Health officials that in a pandemic or other public health emergency, the Public Health Officer will be the responsible Public Official for protecting public health and providing care for the community….. It’s called Community Surge. Healthcare organizations aren’t designed or resourced for Public Health catastrophes. As of this writing, many Public Health Officers throughout America are not accepting responsibility for caring for the community during the coming pandemic. Since the Emergency Manager is where the buck stops, it’s only fair that you task the Public Health Officer with Community Surge responsibility….but wear PPE.

7. Finally, I said this was easy didn’t I. Actually I was fibbing, it’s not all that easy but it can be done as long and we care about each other; share resources, information, subject matter expertise, and good old elbow grease.

Emergency Managers realize two important things. First, the communication, transportation, sheltering, provisioning sustaining and caring for the community will all have to be accomplished either before or during a disaster. Second, healthcare leaders don’t work Readiness issues for a living and many Public Health officials haven’t yet accepted that their part goes well beyond syndromic surveillance and education in a public health catastrophe.

The fact is many healthcare executives haven’t faced the reality that the very existence of their organization may very well depend on comprehensive Disaster Readiness planning and coordination with other healthcare organizations as well as their emergency management community. Likewise, the American public health enterprise hasn’t universally accepted the mission of providing care for Americans during a public health catastrophe like a pandemic or a large scale biological weapon attack. It seems to me that as a public official, the Emergency Manager is the best resource we have to get the Healthcare Industry and Public Health Community on the same page. As such, you represent the best chance American jurisdictions have in surviving future disasters. It may not be all that easy, but it’s true.

 

Adapting a Battlefield Medicine System to Civilian Mass Casualty Events

[Jan 7 2008]

As part of the disaster preparedness planning process, many emergency managers, especially in large metropolitan areas, are facing the realities of a possible London or Madrid-style mass casualty scenario.  Even more disturbing, emergency managers in financial and political centers which are likely considered “high-value” targets by terrorists are facing the prospect of thousands or tens of thousands of casualties and evacuees associated with a nuclear attack.  Overwhelming numbers of casualties in a truly catastrophic event can be managed by looking at healthcare models affectively used on the battlefield.

This writer was fortunate enough to be a part of a 1980 US Air Force initiative which adopted many of the lessons learned by the Israeli Defense Forces in battlefield medicine, particularly during the Yom Kippur war in 1973.   This system, called the 4-Echelon Battle Casualty Management System, can now be adopted by emergency planners and managers for managing mass casualty scenarios in civilian settings.   

Introduction to the 4-Echelon Mass Casualty Management System.

Battlefield casualty management experience has resulted in advanced and effective rescue, resuscitation, stabilization, definitive treatment and rehabilitation of soldiers ever since World War II.  The use of the helicopter as an air ambulance greatly improved the survival rates of soldiers wounded in combat in Korea and Vietnam and in all conflicts since.  Many trauma procedures develop in combat medicine have been applied with great success to our civilian trauma systems.  With the ever-present threat of terrorist attacks using biological, chemical, radiological/nuclear and explosive agents or devices, the time may be right for jurisdictions and their civilian healthcare systems to implement a combat proven system for mass casualties called the 4-Echelon Mass Casualty Management System. 

The 1st Echelon of care is provided by first responders and consists of immediate lifesaving procedures and the rapid transport of the living to a 2^nd Echelon facility.  

A 2nd Echelon facility may be a trauma center or an emergency department.  The 2nd Echelon is essential in making the most of the patient’s “Golden Hour.” By providing immediate care and by dramatically increasing the casualty throughput to 3rd and 4th Echelons, the 2nd Echelon care providers prevent or reduce the patient gridlock associated with a disaster and thus, optimize the saving of lives. 2^nd Echelon care is designed only to save lives and stabilize patients and not to provide definitive care.  Employing the latest advances in trauma care, 2nd Echelon care includes procedures for saving life and limb and stabilizing patients. Typically at the 2^nd Echelon, providers ventilate patients if necessary, control bleeding, infuse blood products and expanders and amputate limbs as required.  Once stabilized, patients are quickly transported to the 3rd Echelon of care for definitive treatment.   

The 3rd Echelon of disaster healthcare is typically a hospital or medical center away from the immediate disaster location.  In the early stages of a disaster, a hospital or medical center may provide both 2-E and 3-E care. It is likely that a hospital’s 3-E capacity will almost immediately be reached and the facility will revert to 2-E care only.  3rd Echelon facilities may be within a jurisdiction or may include hospitals in several jurisdictions or even national regions, depending on the number of casualties and the care requirements.  Definitive care is provided at all 3^rd Echelon facilities, but specialized care such as burn centers may also be provided in a 3^rd Echelon facility.  This includes a full complement of surgery specialties, diagnostics and follow-on care for about 7 days.  Patients who cannot be discharged within a week are normally candidates for 4th Echelon care.   

What is the role of Healthcare Organizations as part of a 4-Echelon Mass Casualty Management System? Most medical centers and many hospitals operate as full 4-Echelon capabilities during normal everyday operations.  During a disaster, Healthcare organizations will periodically self-declare their capabilities to the Emergency Operations Center (EOC) in terms of the Echelon of care they can provide in a fluid environment. Depending on the size and scope of a Mass Casualty event, a hospital may eliminate the 4th-Echelon immediately and declare itself as 2nd and 3^rd Echelon capable to the medical representative in the Emergency Operations Center. At that point, the EMA would reach out to adjacent jurisdictions to activate their EOC (s) and to provide a list of healthcare organizations capable of providing 4^th Echelon care.  At some point in disaster operations, an individual healthcare facility may declare itself limited to 2^nd Echelon care only, thus requiring outside healthcare support at both 3^rd and 4^th Echelons.  In fact, in some circumstances, a healthcare organization may reach full capacity and be incapable of accepting any additional patients.  In other cases healthcare organizations may be damaged in the disaster and may need to report to the EOC that all patients must be evacuated and transported to healthcare organizations outside the affected area.  In any case, healthcare organizations must be able to efficiently communicate their capabilities with the jurisdiction’s EOC throughout the disaster.  

How can 4-E work in a competitive Healthcare Marketplace?  A traditional model of disaster healthcare seems to dictate that healthcare organizations provide the full continuum of care to all patients presenting for care.  Competition would seem to dictate that hospitals or medical centers expand (surge) their services until their individual capacity and capabilities are reached. Why then would hospitals want to self-declare themselves as a 2^nd Echelon facility and request rapid transport of stabilized patients to healthcare organizations outside of their service area? The answer lies in continuity of operations.  Hospitals in the affected area need to recover and resume normal healthcare services as soon as possible after a disaster.  By serving as a 2^nd Echelon facility and rapidly transferring patients to 3^rd and 4^th Echelon facilities outside the affected area, hospitals and medical centers in the affected area can conserve staffing and material resources and thus, can more rapidly recover after the disaster event.   

Adopting the 4-Echelon Mass Casualty Management System. The first step is the adoption of the 4-Echelon Mass Casualty Management System by a state or territory EMA and the Healthcare organizations within the jurisdiction.  Once proven in a single state, the 4-Echelon System may be adopted throughout a federal region or multiple regions. In time, the 4-Echelon System can be adopted Nationwide.  The 4-Echelon System will fit seamlessly into the National Disaster Medical System (NDMS), since NDMS healthcare facilities were the planned 4^th Echelon of care for service members returning from either the European or Pacific theaters of operations, had the Cold War turned hot.  Although the 4-Echelon System never needed to be fully implemented on the American battlefield, it may be the right civilian disaster healthcare solution at precisely the right time.

A Happy Thanksgiving Wish for Everyone Out There on the Front Line

[Nov 20 07]

I recently read Hal Newman’s article “Reflections on Life, Death and EMS.”
I am a Healthcare Disaster Preparedness guy and as such, I am a layman in the area of First Response. When I thought about Hal’s EMS colleague who took her life, I wondered if it would have mattered if she had recently read a letter of thanks from a grateful citizen. I also wondered if she knew the extent of the good she did while she was with us and how many lives she touched and enhanced during her life.

You make a real difference in this world. Granted, it may be one patient, one fire, one burglary or one accident at a time, but we would all be in big trouble without you. You resuscitate us, rescue us, protect and defend us when we need you the most. I have always believed that in order to be truly happy, we must make positive contributions to mankind. Hal’s colleague undoubtedly made significant contributions to the human condition and saved many lives during her service. In one regard, I understand some of her depression and sense of hopelessness.

When I served as the only medical supply officer in the Republic of Turkey, I felt isolated, totally alone and most of all I felt an acute sense of responsibility for things I really could not control. I worried constantly about the possibility of losing a patient due to my lack of resourcefulness in getting emergency supplies into Turkey before it was too late. The feeling of having an overbearing weight on one’s shoulders is horrible and it can be too much to bear. I have no any idea why or how I made it through my depression. I do know that many friends saw my isolation and my sadness, and tried to help me. A also know that my self-imposed exile frustrated many of the friends that offered their support.

I discovered that in my good times I was very generous to others, but in my bad times I withdrew from all those I loved most in order to suffer alone. If my story sounds familiar, please try to get help to break out. For some reason still unknown to me, God wanted me to continue my life’s journey. I do my best every day for the people I serve, and for those I’m lucky enough to mentor, hoping that in some measure, I can repay the gift that is my life.

My wish for each of you on the front lines of health, safety and security is that you can give yourselves credit for all the good you do and for the lives you touch and save every day. All too often we hold ourselves responsible for our shortcomings and forget about all the people who are still with us and still need us. Perhaps the most important service you provide to all of us is your mentorship. You will teach, mentor and affect countless others in your career fields and pass on your passion to future generations- be here for them.

Please, when you feel overwhelmed, use the support services available to you. Also, please know that others in your field will be just as ready to give you a hand as you would be to extend your hand to them. Take them up on their offer. Continue to live, love, teach and serve. Pass your passion on to the next generation of selfless contributors. You make such a huge difference to all of us.

Happy Thanksgiving! Be well… and take care of yourselves.

Sincerely,
Jim Rush
 

I want to share an article I wrote for the Association for Healthcare Resource and Materials Management (AHRMM) with the readers of Big Medicine. There is absolutely no question in my mind that emergency managers possesses experience and training that is priceless to both Healthcare and Public Health leaders at all levels of government. The ongoing emergency response to California’s wildfires is a vivid example of the type of integrated response that jurisdictions across America should emulate. While the economic and personal losses are horrible, we can only imagine the losses in human lives if California’s emergency management system was less well refined.

I believe that emergency managers can leverage California’s superb performance and lessons learned to lead the effort in integrating Healthcare and Public Health entities with the Emergency Management Agency in preparing for and responding to a future Influenza Pandemic.

- JR

The Materials Manager's Role in Pandemic Preparedness

[Oct 26 07]

Recently in healthcare, there has been an increased awareness that should a worldwide influenza pandemic break out, American healthcare services would be overwhelmed in the early stages of the public emergency.

A show, recently broadcast on The Science Channel, depicted how a pandemic might begin in Southeast Asia and then spread rapidly across all parts of the world infecting hundreds of millions of humans worldwide and leaving tens of millions dead in its wake. It was striking to see how empty the streets would be and how the normal hustle and bustle associated with everyday life would disappear. It was also alarming to think about the amount of trash that would be left behind as up to 60% of sanitary workers would be either at home with the flu or afraid to report to work because of the risk of becoming exposed to a deadly strain of influenza.

MEDLOG Inc. has been advocating a systems approach for pandemic preparation for a number of years. Using this paradigm, the public health department would provide the majority of the “hands-on” care as part of the “Pandemic Community Surge.” This would ensure valuable hospital resources would be conserved for “the sickest of the sick” (those strong enough to pull through with intensive care equipment). Whether or not this paradigm is adopted by the Department of Health and Human Services (HHS), there is little doubt that materials management professionals will need to take leadership positions in healthcare readiness.

Materials managers know that building huge stockpiles of medical supplies and equipment is unrealistic for a few reasons:

1. “Just-in-time” supply systems function very well only as long as healthcare purchasing patterns reflect actual usage. When large inventories are built, the reorder point may reflect stockpile replenishment instead of actual usage.

2. Financial constraints make investments in inventory untenable.

3. Few healthcare organizations have the space to store massive quantities of food, medical supplies, pharmaceuticals, and ICU equipment even if federal money was available in the hundreds of millions of dollars that would be needed to fund the massive effort.

So what role can the healthcare supply chain professionals play in preparing their organization for a Pandemic? The answer is significant.

What many materials managers may not know is that the HHS already offers modest financial help in the form of Hospital Preparedness Program (HPP) grants. HPP funds are intended to assist healthcare organizations better prepare for “medical surges” in patients associated with man-made and naturally occurring disasters like hurricanes, tornados, and yes, even a pandemic. In the past few years, the Centers for Disease Control and Prevention (CDC) has been funding state, territorial, and even a few major cities’ efforts to become better prepared for a pandemic through one of their major grant programs. Is some of that money available to hospitals as they prepare for surges in the patients and fatalities associated with a pandemic or even an outbreak of SARS? The answer is maybe.

So what can you do to best prepare your organization for operating during and after a disaster? Whether your title is Supply Chain Manager, Director of Purchasing /Procurement, Materials Manager, VP of Medical Logistics Management or any other title, the healthcare organization will look to you for supplies, equipment, and services throughout a pandemic. Here are a few actions you can take to better your organization's preparedness:

1. Establish a close relationship with your organization's disaster preparedness coordinator/emergency management coordinator. It is imperative that materials mangers be brought into the planning process sooner rather than later.

2. Evaluate the assumptions relating to the availability of goods and services that have been built into your organization’s emergency management plan (EMP). Consider whether these assumptions are likely to be valid during peak demands for materials and services during a pandemic. For example, if your organization’s EMP assumes that federal supplies and equipment will be available to sustain hospital operating functions during all phases of a pandemic, your EMP is currently incorrect.

3. Understand the phases/waves associated with a pandemic and evaluate the demand for medical and non-medical supplies, equipment, pharmaceuticals, food, and all contractual services during each pandemic phase.

4. Provide supply, equipment, and services subject matter expertise at emergency management planning committees, exercises, and other hospital and community pandemic preparedness meetings and events.

5. Accompany the Disaster Coordinator to local disaster coordination meetings sponsored by the State Public Health Department's Bioterrorism Coordinator (BT Coordinator), especially pre-proposal federal grant meetings. You can then assist in writing the Hospital Preparedness Program (HPP) grant proposal for submission to the state public health department. Once HPP funds are approved, it is important for the materials management teams to order and obligate HPP funds in the most expeditious manner possible. State health departments as well as federal grant program project officers track the obligation of grant dollars. Rapid obligation of grant dollars may not assure better funding considerations in future years, but tardiness in obligating funds may hurt.

6. Use AHRMM‘s disaster readiness information as a basis to help plan for events depicted in the community HVA and use AHRMM’s Disaster Preparedness Manual for Healthcare Materials Management Professionals to receive greater detail and “how-to” assistance on the 10 functional areas listed in this article.

7. Be the leader in your organization for developing requirements lists for disaster-related goods and services (a sample requirements worksheet is also included in AHRMM’s Disaster Preparedness Manual for Healthcare Materials Management Professionals). The earlier requirements are developed the better. Consider healthcare infrastructure requirements such as back-up generator fuel, water re-supply services, and regulated medical waste challenges associated with a pandemic. During an emergency the jurisdiction’s Public Health Officer in coordination with the Governor’s office may order quarantine. Special convoy arrangements may help ensure vital resources get through to the hospital.

Regulated Medical Waste (RMW) stored in and around the healthcare organization for long periods of time can pose a significant health risk for staff, patients, and the community. Onsite treatment systems backed up with emergency power may be the best option for normal RMW treatment operations and during a pandemic. While federal grant programs will not provide onsite RMW units for normal RMW operations, “add on” units or autoclaves may be funded through the pandemic or HPP grant programs. These will facilitate the treatment of RMW surges associated with a pandemic or other disasters that generate large quantities of RMW.

8. Fortify your organization’s supply chain management program. Work closely with prime vendors and suppliers to plan for surges in demand for medical products. Consider national distribution centers and how suppliers can harmonize their supply chain with the phases/waves of a pandemic as it crosses America. Here, your competence, experience, and resourcefulness as a materials manager will shine through.

9. Become an advocate for healthcare preparedness at local, state, and regional materials management planning work groups and at AHRMM state chapter meetings. Share the strategies you learn with your colleagues and other materials management professionals.

10. Develop memoranda of agreements with DOD active duty and reserve organizations within the state/territory for logistics support during disasters. Local DOD elements may be able to offer helicopter or fixed wing transportation services for supplies and equipment from distributors to hospitals when roads are impassable. The same agreements should be explored with air taxis within the jurisdiction or region and where feasible with law enforcement agencies for supply convoy escorts.

Every materials management professional has the opportunity to make a phenomenal impact on how their organization will effectively function during a possible future pandemic and other disasters and public health emergencies. Those who take an active leadership role in developing requirements and establishing new or broader contractual arrangements with suppliers and community resources will be providing an invaluable service to their patients, and their communities. Today’s healthcare organizations are making decisions now on whether or not to organize for an emergency well in advance. In the event of a disaster, the buck will more than likely stop with the materials manager, so we better be ready.
 

Pandemic Planning Shortfalls - Culture of Scarcity

[Oct 8 07]

I thought I'd add my two cents on shortfalls in America's preparedness to deal with the Pandemic that experts agree is coming sooner or later. I will continue to advocate building Federal Reserve Inventories (FRI) to bolster our food, chronic illness medicines, and medical supplies and equipment supply chains during National catastrophes like a Pandemic or a nuclear attack on a large American population center. FRI will keep the supplies coming during future crises and will keep America from developing a "Culture of Scarcity" which could be devastating to our people and our economy. I though I'd share some experience that leads me to worry about our societal expectations regarding necessities of life in a National crisis. Since product rationing during World War II, we have never had to endure severe and long lasting outages of products or services that we have come to expect in modern day America. That in itself can be a huge National challenge.

In 1977, I volunteered for an Air Force position as the Chief, Medical Logistics Management for our healthcare facilities and medical aid stations in the Republic of Turkey. Because of the tensions between America and Turkey over the Turkish invasion of Cyprus in 1974, the US imposed sanctions on Turkey, and in turn, Turkey closed all commercial shipments of goods into the Republic needed to support our Service Members, their families and Armed Forces healthcare facilities, commissaries and Base Exchange shopping centers.

The closure of commercial transportation channels necessitated that the shipment of all goods including food, consumer items, medical supplies, vaccines and equipment entering Turkey come through military airlift and sea lift channels only. It was a time of hardship for Servicemen and their families. By the time "Yours Truly" arrived, there had existed for some time what I call a "Culture of Scarcity" in the Armed Forces communities throughout Turkey. I experienced logistics management challenges every day, and observed some intriguing insights into how we Americans handle scarcity of food, medical materials and essentially every consumer product group during tough times. That 1977-1979 experience gave me a unique glimpse into what America could become during a Pandemic or other National catastrophe.

You name it, we were out of it. I saw a woman in the Air Base supermarket (the commissary) with a full shopping basket of canned yams. I happen to be both inquisitive and a logistician, and I just had to ask her why she had cleared the shelves of canned yams. She was both open and unabashed in telling me that she and her family hadn't seen a can of yams in their first 6 months in Turkey. So, she was building an 18-month inventory safety level that would provide uninterrupted yams to their table until they rotated back to America.

When regular house fans came into the Base Exchange (BX), the Air Base equivalent of Walmart, there would be a line around the corner a few hours before the BX opened. I asked a medical material team member how folks knew that the fans were arriving that day. He told me there was an informal communication system with high placed BX insiders. I asked "You mean to tell me there's an inside source for 15 inch oscillating fans?"...you bet, he said. Large water containers like the type they use to pour water over the winning coach's head at the end of a football game were also very hard to come by. The same thing was true of space heaters, toys of any kind, all food and above all else, bicycles...they were really hot items. Any kind of bicycle.

Electricity was always a "maybe" - something you couldn't take for granted. The first week there, I lost all of the contents in my side by side freezer-refrigerator due to an 18 hour power outage. Pretty soon I learned that compressors really don't do well with variations in electric current, called brown outs, so the refrigerator-freezer didn't last very long. I know from experience that candles aren't romantic after the first ten power outages...they are just facts of life.

I could have written a book on how to shave in the dark without water. I got pretty good at it and did it several times per week for some time. It seemed that electricity outages also meant no water pressure since pumps use electricity...made sense though. Drinking water had to be personally chlorinated, and we handed out baby medicine droppers to Servicemen and their families which were used to drop a set number of drops of Clorox per gallon of water. You needed two water containers, one for the water where the Clorox was still doing it's job of chlorinating and the other container for the water that had met the required time for full chlorination. The kids were great at pointing out the good water from the bad water containers.

The real horror for me came when I realized that we had a minimum of 13 folks (most of them children) on rabies vaccine at any one time. Getting vaccine released from "customs impoundment" was a real challenge and ultimately my obsession. Everything was impounded until the Turkish customs officials cleared the shipment....and nobody knew when the inspector would arrive, if at all, the day of the shipment. I worried
all the time, because I knew that while I was just an ordinary Air Force medical logistician, I was all they had in Turkey and I was where the buck stopped on medical supplies and equipment. Failure to find ways to get the supplies into Country and released from customs to my customers throughout the Republic could very well result in the death of those who depended on my team. Part of my daily regime like brushing my teeth and shaving was saying a prayer asking that none die due to the lack of medical supplies or equipment.

We lost several shipments of Polio vaccine and Diphtheria, Pertussis and Tetanus (DPT) vaccines due to the impoundment of the vaccines and their spoilage in the impoundment yard. We were living very close to the edge, keeping up with the demand for lifesaving medical products, but we were in a disciplined society. In today's America, what effect would these long term and persistent shortages have on the fabric of our
society?

If we have knock down drag out fights over "Tickle Me Elmo" dolls at Christmastime, and long lines for I-Phones, imagine life during a Pandemic when anxious parents are waiting for infant formula outside supermarkets and drug stores when the supply trucks arrive with far too few supplies. You might ask "Why would we be out of common items during a Pandemic?" There are two main reasons.

1. Breakdown of "Just-In-Time" Supply Chain Management. Our food, gasoline, pharmaceutical, consumer products and medical supply chains work pretty much the same way as our monetary systems....on faith that the materials will always be there for us. The folks have faith and trust in our financial systems, and so we don't see everyone across America withdrawing their money from banks when the stock market or currency markets fall in value. The same thing is true with our other commodity groups. Typically, we only purchase what we need for a few days to a week or so. For pharmaceuticals, we normally have a portion of a month's supply of the drugs that maintain our heath. We are not living in a "Culture of Scarcity," so the supply chains work beautifully based on very long, very accurate product consumption histories.

The Onslaught- When the first report comes out from the CDC that a "Novel Strain" of Influenza has arrived in North America all of us will take inventory of food and water, cold and flu medications, chronic illness supplies and pharmaceuticals and most of the other items we have around the house. We all know what happens when a large segment of the population decides to stock up on the same items at the very same time. We see it in some cities when the weather service predicts a 3 inch snow event....bare shelves.

Imagine the rush to re-supply medicine cabinets all across America during the same week. As store shelves empty out, we become a bit less confident in our supply system, so, by golly, when we see items we need..... or think we might need, we buy them...lots of them. That siege mentality of purchasing drains the supply system dry, since no demand forecasting program can predict a Public Health emergency or the Public's reaction to it. The buying trends are based on fear and not prior week's consumption. As the purchases vacillate wildly, so do the re-supply orders and the supply chain is unable to function as advertised. It is then that we become a "Culture of Scarcity". Instead of having to stick it out for a few days in a snowstorm, we are looking at a long term situation...long after the Pandemic fades - perhaps 3-5 years for accurate consumption trends to emerge and supply chain recovery. Until then, the Just-In-Time supply system will fail over and over again, trying to make sense of erratic demand for products.

2. Culture of Scarcity. It is impossible to predict right now, how American's will behave when there are shortages of everything we take for granted in today's America. We can only hope that we don't become a society of looters and roving gangs of opportunistic thieves. The only thing that I believe that can and will short circuit the Culture of Scarcity is a confidence in our Government's ability to flow life's necessities through established supply chains during National catastrophes. If the Federal Government signals an inability to sure-up the food supply, fuel supply, as well as the Healthcare and Public Health Infrastructure, "Katie bar the door!"

During a Pandemic or other large scale catastrophe, Federal, State and local elected officials can urge calm all they wish. But when the kids are hungry and Uncle John has run out of his pharmaceuticals that manage his mental disease, times will get very bad... and very fast. The answer isn't for each American to build large caches of everything they use in their daily life - in fact that would cause more harm than good. If every American had a three month supply of every product from toilet paper to pharmaceuticals, to meat and canned vegetables, distributors would start to see unforecasted and sporadic large spikes and severe drops in demand for products. What would be going on, would be 300 million Americans replenishing their supply caches - all using different reorder points. What happens in this case is rolling and persistent backorders of everything, because there are no societal shopping trends like the ones most of us use today. These trends are the basis for demand forecasting and are the pillars of a Just-In-Time supply chain. Without solid predictable ordering patterns, our "Just In Time" marketplace begins to disintegrate.

The only real solution is for Government agencies to invest in and oversee the management of sufficient supplies of "life-necessity items" and pre-position the Federal Reserves at the "Wholesale Level" - in other words, at civilian distribution centers. During normal conditions, America's distributors could stock rotate very large quantities of Government-owned products in a way that would result in near-zero losses of the taxpayers' investment in inventory due to expiration in storage. In a crisis, American confidence in it's supply structures would remain high, thus reducing the threat of descending into a Culture of Scarcity.

By maintaining adequate Federal reserves of life's necessities....and releasing some reserves during even the regional disasters like hurricanes and earthquakes, we can demonstrate the dependability our supply structures, further bolstering American's confidence. Is this a tall order? You betcha! Can this be accomplished? You betcha.

Such programs can work very well if they are managed correctly. The Government has been maintaining a Strategic Petroleum Reserve for many years and the oil has been replaced as it was rotated out to refineries.

In a crisis, American life doesn't grind to a halt as soon as we all fill up our gas tanks and oil storage tanks. We can and really must initiate the same types of reserves for food, pharmaceuticals, medical supplies and equipment and other critical life support products.

Can we start now?

Establishing, Provisioning and Managing Special Needs Shelters

While that statement is easy to reduce to writing, the processes needed to determine which items should be stocked, how many of each item to stock and how to conserve the community’s investment in inventory (by avoiding product expiration in storage), are not as easy.  Recruiting sign language specialists, interpreters and medical assistants are also challenging tasks. Below are some suggestions which may be of value when planning special needs shelters: 

1. Select and plan for a shelter for Special Needs populations based on the experience of others.  The best advice one can heed is to communicate with shelter managers and support staff that have first-hand, “on-the-ground” experience from the 2005 hurricane season.  There are hundreds of persons who know the types of facilities and materials and services needs that were not met as well as the work-arounds that had to be employed.  The lessons they learned the hard way can help planners avoid repeating past mistakes.

2. After designating the special needs shelter, get the word out.

Public service announcements are a great way to get information out during community or statewide exercises.  In the PSA, consider specifying the types of services that will be provided in each special needs shelter and the personal items evacuees need to bring with them.  Another way to reach persons with special needs during a disaster is through advocacy groups.  Consider flyers, press releases and newsletters as good ways to publicize which shelters are designated to care for persons with special needs and the particular goods and services offered at each shelter location.  Advocacy groups should be brought into exercise planning as well as designating shelter locations for persons with special needs.  During exercises, your advocacy group partners can be invaluable in getting folks with special needs to the shelters providing the goods and services people require.      

3. Determine who will be the likely populations to show up at the shelter and anticipate what their needs will be.

It may not be necessary to develop “qualifying criteria” for the shelter.  In the end, if a person self-identifies that he or she has special needs during disaster sheltering operations, the shelter manager will have to take those special needs seriously with or without a special qualification.  Some states are developing “registries” where persons with special needs can sign up in advance.  Due to privacy concerns, each State and Territory public health department should have involved specialists in patient confidentiality and the requirements of various Federal regulations regarding privacy. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 has specific requirements regarding the privacy of a persons health records which may pertain to special needs shelters.  

Persons who rely on psychiatric medications did not receive adequate support during hurricanes Katrina and Rita according to the National Council on Disability (NCD). Their findings:  “THE NEEDS OF PEOPLE WITH PSYCHIATRIC DISABILITIES DURING AND AFTER HURRICANES KATRINA AND RITA”: POSITION PAPER AND RECOMMENDATIONS; National Council on Disability, July 7th, 2006.  Now I have read scathing indictments on Inspector General (IG) and the General Accountability Office (GAO) reports in the past, but nothing ever came close to the ones listed at:  http://www.ncd.gov/newsroom/publications/2006/peopleneeds.htm  To make matters worse, the NCD is a federal policy agency, and there is little to suggest that significant progress has been made across America since 2005 in sustaining persons with psychiatric disabilities.  

We know there are literally hundreds of reports, papers, studies and all manner of well intentioned works in the Public Domain regarding the subject of caring for folks with special needs.  I have been unable to find a single report or study that lists the processes that may help Emergency Managers decide what items to include, how to arrive a quantities of medical and non-medical supplies and equipment to manage and how to get the products and services to the right place at the right time.  I thought I’d step out into the discussion and list some concrete steps that my be taken by Emergency Managers who want to make the 2005 Hurricane season a horrible but non-recurring nightmare. 

ü     Recruit a subject matter expert (SME) team consisting of healthcare specialists in Disabilities, Emergency Medicine, Geriatric care, Psychiatric care and long term patient care.  Although nurse specialists will select most of the patient care items, it may be a good idea to recruit a physician as the SME team leader.    Prepare for success by selecting a strong leader for your formulary and special needs development team. A pharmacist will be the SME member who will extremely helpful in the standardization and cross referencing of medications.  The reality of life in a shelter operation will dictate a “lean formulary” and the pharmacist will be invaluable in areas of drug interactions as well as using standardized substitute drugs.   A respiratory therapist and a dietician (for special feeding items) would also be good choices as team members. 

Last but not least, recruit a healthcare purchasing agent or a materials manager as the person who will provide sources for the various products on your formulary listings.  The SME team will need to concentrate on standardizing items in order to meet needs but keep the requirements lists manageable. The purchasing agent or healthcare materials manager can play a supporting role but you need a strong medical person as the formulary development leader, since many formulary choices will be difficult but essential. 

ü     Divide your formularies and services into categories, since this will make vendor selection and advocacy professional group reviewers tasks easier. Food and special feeding items, medical surgical supplies, medical equipment, pharmaceuticals, patient care and apparel and hygiene needs are some of the commodity categories SME teams will need to consider.  Just some categories of needs and products include:

A. Materials

• Respiratory care
• Wound care
• Specialty care-Ostomy products
• Pharmaceuticals-chronic care medications
• Patient shelter hygiene supplies
• Mobility items; wheelchairs (regular and wide), walkers, crutches, etc.
• Special nutritional products, infant formula (including non-dairy), enteral feeding products (for persons who can’t swallow and have a feeding tube).
• Specialty cleaning and care kits (tracheotomy, ostomy,)
• Bariatric care (obese persons), bariatric beds, wheelchairs, special lifting devices (Hoyer lifts and associated equipment)

B. Services

·        Redundant notification systems to notify persons with disabilities that an emergency exists and all pertinent actions that need to be taken

·        Special assistants for the blind.

·        Special assistants for the deaf and hard of hearing including couriers for notification.

·        General services shelter volunteers 

ü     Select distributors for materials.  Most state and territorial Public Health agencies have separate vendors (often called prime vendors) for major product categories such as; vaccines, pharmaceuticals, medical supplies and medical equipment.  When allowable, it’s a good idea to piggy back onto existing state contracts for special needs shelters instead of letting new contracts.  This is because the shelter manager can leverage the jurisdictional purchasing power and often obtain existing jurisdictional contract pricing and terms.  Since the Public Health agency is normally the provider of supplies and equipment for special needs shelters, the additional materials can be added to the existing contract by using a contract amendment.  The public health purchasing agent can work with the state contracting officer on any contractual issues involving special needs shelter acquisitions, delivery and billing information.  The key in this area like all other emergency management functions is advance work.  Those Public Health agencies that wait to develop formularies and arrange contractual details until an actual disaster is underway will most likely be the ones calling FEMA immediately for help.  Also, in large scale disasters, there may be system-wide supply and equipment shortages. 

ü     Recruit and train special services staff.  Advocacy groups for persons with disabilities and other special needs people may be able to help the special needs shelter manager identify companies which provide services to persons with disabilities. Non-governmental organizations including the Red Cross, Salvation Army and Goodwill Inc. as well as faith-based congregations may be able to provide volunteers. Whether the persons who will staff the special needs shelters are paid or unpaid workers, the identification and training components must be accomplished beforehand in order to succeed.  

Throughout my career in healthcare, medical logistics and emergency management, I asked myself if my planning would be sufficient for my mother and sisters should they require sheltering in a disaster situation.  In the end, persons with special needs are indeed our community family.  Good enough doesn’t cut it for family and shouldn’t be “good enough” for our community members, especially the vulnerable.  Planning for and submitting our requirements and the associated budgetary figures to the appropriate funding authority may not result in all requirements being funded.  What it will do is demonstrate that you took the time to determine what is needed, you articulated the needs in writing to the funding authority and as funding was made available, you provided for the needs of our community, including our most vulnerable persons.

Training Citizens for Disasters

[Jul 31 07]

One of the many hats an Emergency Manager must now wear is that of a trainer. Communities need training and familiarity with procedures that work in every day life as well as disasters. For years, we have had pretty much the same scenario of actions following an incident: first response, triage, on-scene stabilization and transportation of casualties to the appropriate level of care. So a question may be: “What additional steps can be taken by Emergency Managers to prepare the community for the real thing?” One answer to that question is “Community Familiarity Training”.

In any disaster, members of the affected community will ask, 'what do I do?' and 'where do I need to go?' The Emergency Manager can make a real impact in both exercises and actual emergencies by putting all the elements of the Community “Emergency Management Plan (EMP)” into effect. The bottom line is, the more familiar the community is with the “Where to?” questions the less ad hoc and “on-the-fly” arrangements need to occur and the smoother the disaster exercise or a real event will go. In the real event, communities which practiced the procedures outlined in the EMP will benefit from the exercises and will have better outcomes. The following is a brief description of some of the questions that can be practiced during exercises.

1. Where do I go in a disaster to give blood? Why not coordinate a blood drive with the American Red Cross for each and every disaster exercise? As a part of each exercise planning meeting, consider including the Red Cross folks to coordinate a number of blood donor drives at well known centers throughout the community. In most cases, the community knows where the every day blood collection centers are located, but haven’t associated these collection centers with actual disasters. It is amazing how many blood collection opportunities are lost because local, state and regional disaster exercises did not include a blood drive. It’s not only the community which will benefit from exercise blood donor centers. The Red Cross may want to exercise their blood processing and transportation plans as a part of the community exercise. We all know that America’s blood supply can be extremely lean at times, resulting in special Red Cross media requests for donors of specific blood types. Ultimately, local, regional, and regional exercises could result in a cross leveling of the American blood supply. The local Red Cross director or the Red Cross Biomedical Services unit may also be able to assist Emergency Managers in the identification and ordering of blood products and tissue from the nearest blood products and tissue banks. These types of products will be in demand during London or Madrid type bombing events or in treating survivors of a nuclear detonation.

2. Where do I go to receive food, water and other emergency supplies? Here is another opportunity to make routine operations the Emergency Manager’s friend. If the Emergency Management Agency intends to set up food and water dispensing locations in the parking lots of large retail stores and or in supermarket parking lots, set up mini-dispensing sites there during exercises to hand out information flyers regarding personal and family preparedness kits and a home emergency provisions cache of food, medical supplies and other emergency essential items. The folks will begin to equate an exercise with the dispensing areas and hopefully, it will become a part of the community’s consciousness.

3. Where do I go to drop off donations of food, clothes, toys etc. Donations are common headaches for Emergency Mangers since all manner of products pour into disaster relief centers making the job of sorting, accounting and distribution more difficult that it needs to be. In this case consider modeling the gift commodities groups to the recycling program. We are all trained to know what products (glass, plastics and paper etc.) to place out during set recycling days. If during exercises, individual commodity donation centers are set up at well known locations, the public will begin to understand where the food centers, clothing centers etc. are set up and will begin associating locations with commodities.

4. Where are evacuation shelters? And which shelter is right for me? Public Service Announcements (PSAs) are a great way to get information out during community or statewide exercises. Local radio and television stations are a great source for recruiting on-air personalities and PSA production folks to help get the word out to the community on a wide variety of emergency-related topics. “PSA spots” can be aired in conjunction with FCC required emergency system tests. In this way, the Emergency Manager’s information will get attention since the Public’s attention is already focused on the emergency test. In the PSA, consider specifying the types of services that will be provided in evacuation shelters, where special needs shelters are located and the personal items evacuees need to bring with them.

“Special Needs” shelters will need to be established along with supplies, equipment and services for persons with disabilities and other segments of each community including the elderly. We all know that information is plentiful regarding personal preparedness steps all citizens should be taking regarding a supply of chronic condition medications and supplies. Still actual experience during the 2005 hurricane season illustrated the need for community special needs sets and assemblages for use during disaster evacuations. Right after this article, we will be submitting a special article to “Big Medicine” with suggestions for developing formularies, Prime vendors as well as service requirements and special equipment sets along with suggestions on how to maintain the items in storage and transport them to the Special Needs Shelters.

Educating the Public on what to do, where to go and what to bring with them in disasters is a never-ending role of the Emergency Manager. By looking for novel ways to deliver the message and inform the Public during exercises, the Emergency Manager will be making deposits into the Community memory bank. During actual events, that bankroll of knowledge will pay huge dividends.

Become a Mission Integrator

[Jun 30 07]

Sometimes I find myself fondly remembering the good old days when Community Emergency Management seemed to be a fairly straightforward function, but today things have definitely changed.  There are now many more players with a role in emergency response which Emergency Managers must help integrate into their jurisdiction’s total disaster response effort.

If you have asked yourself “What can I do to assist Healthcare organizations and Public Health departments integrate into a jurisdiction wide All Hazards response team?” the answer is you can do a great deal. 

I’m afraid what we have today is an old paradigm being applied to a new reality.  First responders rescued casualties, provided emergency medical attention on the way to the hospital and handed off casualty care to the hospital.  Hospitals had decent staffing levels and the medical materials to accept the additional casualties. The good old days are gone. 

1. Include Healthcare and Public Healthcare in all jurisdictional planning.  While the Joint Commission (TJC) for Healthcare Organizations has included standards for disaster preparedness for years, the healthcare organizations got into a bad habit of just going through the motions in planning, training and exercising to meet or exceed the TJC standards in order to be accredited.  You can help healthcare leaders develop a true “Readiness Mindset” in planning for real world disasters based on your community Hazard Vulnerability Assessment (HVA).  The healthcare folks need to know what events are most likely to occur and how many and the likely mix of casualties that will likely be generated under each event scenario.  

Emergency Managers understand resource management and conservation of critical assets in a disaster.   You also know that you can’t expend all of the jurisdiction’s healthcare assets in disaster-care and not be able to treat the heart attack, stroke and trauma patients until after disaster recovery.  You can help healthcare leaders by brainstorming ways to incorporate all community medical personnel including urgent care centers, private physician practices, all medical materials resources, all non-governmental organizations including faith based organizations into a “Community Healthcare Expansion and Sustainment System.”  You understand that in a disaster, the hospital or medical center is the last bastion of defense in caring for the sick and wounded.  You understand multiple levels of response in a disaster battle plan.  Healthcare and Public Health leaders across America need your years of experience in building robust disaster response systems more now than ever before.    

2. Use Healthcare competition to your advantage.  Day in and day out hospitals and medical centers compete with each other for patients, specialists and staffing resources.  All Healthcare leaders understand the value of protecting the healthcare or medical center and its staff in a disaster.  As the word gets out that medical center A, B, and C are attending regular Emergency Planning meetings with the Emergency Manager and elected officials, it won’t be long before medical center D requests a seat at your table.  The fact is the better and more robust a healthcare system is, the better it will respond and the faster it can come back on line with full normal services after a disaster.  That alone is a potent incentive for any healthcare organization to integrate with the Emergency Management Agency and all jurisdictional response agencies. 

In addition, most Public Health agencies will appreciate being involved in the jurisdiction’s planning and your experience in managing disasters.  As you present concepts of Emergency Management including how the Incident Command System works, the Public Health folks will want to do their part and will grow from the experience you offer. Then, Healthcare and Public Health entities may begin to work together while sitting at your table.

3. Understand that Public Health does not see “hands on health care” as their role. But, if there was ever a time for not drawing functional lines in the sand, now would be that time.  Public Health has just recently begun receiving adequate funding after 30 years of mission reductions and funding stagnation.  There are probably few Public Health Officers out there who have personal experience providing “hands-on” care to a community in a Public Health crisis.  Don’t be surprised if your Public Health Officer tells you that during a Pandemic, all healthcare services will be provided by healthcare organizations.  We all know that American Healthcare is in crisis and in some cities it is shutting down.  If we as a People can’t find a way to build an integrated healthcare/public health response to the next pandemic, healthcare as we know it may also be a fond memory. 

4. Integrate Federal Grant Funding Streams.  This may well be the hardest and most contentious issue Emergency Managers will face.  Federal Agencies are working on Crosscutting grant guidance but the concept is not as widely accepted as it needs to be. 

5. And the most important for last:  Only the Emergency Manager can develop competent plans for saving the lives of our most vulnerable citizens.  Persons with disabilities and elder folks need all of the Emergency Manager’s skills, abilities and initiative to survive a catastrophe.  I can’t imagine a caring person watching the scenes on CNN and FOX News where folks were abandoned and died on the streets and in doorways without feeling guilty that this could happen in 2005 America.   We put a man on the moon in 1969 and yet, in 2005 we had to sit helplessly and watch dead bodies floating down streets in New Orleans.  We can do so much better than that and we must do better than that.  The Emergency Manager can lead the National effort to make those scenes just a bad memory never to tolerate that disgrace again in America.  

To get though those days that stripped me of my boyish good looks I would say to myself…  “You may not be all that good, but you are all the folks have and you have to get this done.”   I hope each Emergency Manager reflects on that quote as they plan for communication, evacuation, and sustainment of persons with disabilities and special needs at home, in shelters or in care facilities during disasters. 

The fact is you are that good, persons with disabilities and special needs depend on you and you have to get this done.

[May 11 07]

There is a lack of communication in America regarding Pandemic Influenza planning and resourcing, and it must stop immediately.  The Federal leadership is putting out a loud and clear message that, in a Pandemic, the States and Territories will be pretty much be going it alone.  That sounds great since the CDC grant programs are pouring money into State Public Health Departments so they can do whatever they need to do to pretty much “Stand Alone” during a Pandemic.  So what’s wrong with the plan?  Plenty! 

JIM RUSH

Mr. Rush has over twenty-six years of Healthcare Materials Management and leadership experience with healthcare and public health organizations in both the Public and Private Sectors. He was Middle East Regional Materials Manager with the U.S. Air Force and later served as the Medical War Reserves (stockpile) Manager on the Surgeon General, Europe’s staff in Germany. He later served the Army as a civilian employee and the Chief of Medical Material Requirements for the Readiness division of the U.S Army Medical Material Center, Europe (USAMMCE).

Most recently, Mr. Rush was the Region III Project Officer with the National Bioterrorism Hospital Preparedness Program. As a Health Resources and Services Administration Project Officer, he provided technical assistance to HRSA awardees in developing a truly integrated approach to planning, training and testing their effectiveness for managing the full spectrum of man-made and naturally occurring disasters.

In the Private Healthcare Industry, Mr. Rush has held positions as the Materials Manager at the Children’s Hospital and Center for Reconstructive Surgery in Baltimore, Maryland and at Barrow Medical Center in Winder Georgia and as the Director of Purchasing at Garrett County Memorial Hospital, in Oakland Maryland. He has broad experience with Governmental acquisition systems, as well as major civilian healthcare Group Purchasing Organizations (GPO). He specializes in aggressive Materials Management initiatives and the development of “Corporate Materials Management” standardization programs. He also uses his extensive experience in managing very large wartime and disaster related medical materials management systems to assist customers in developing disaster or bioterrorism materials management programs.

Mr. Rush was the first Logistics Manager for the National Pharmaceutical Stockpile Program at the Centers for Disease Control and Prevention. In that capacity he developed storage and stock rotation plans to effectively and efficiently manage over $300 million in pharmaceuticals, emergency equipment, vaccines, blood products and other lifesaving commodities.

His professional papers have been published in the International Association of Emergency Managers newsletter, with worldwide circulation. Excerpts of his article “Preparing for Bioterrorism” have been published by the Materials Management magazine, a joint publication of the American Hospital Association (AHA) and the Association of Healthcare Resources and Materials Management (AHRMM).

In December, 2005, Mr. Rush served the Federal Emergency Management Agency (FEMA) as a subject matter expert on a focus group for an upcoming FEMA healthcare course. This course will help leaders develop comprehensive healthcare emergency management programs to manage future disasters. This course will also highlight recent lessons learned in disasters where healthcare organizations could no longer sustain patient care and had to evacuate the facility. The course will also present topics designed to help mediate or eliminate healthcare operational vulnerabilities in future disasters.

Previously on Jim Rush:

A Happy Thanksgiving Wish for Everyone Out There on the Front Line [Nov 20 07]
 

The Materials Manager's Role in Pandemic Preparedness
[Oct 26 07]

Pandemic Planning Shortfalls - Culture of Scarcity
[Oct 8 07]

Establishing, Provisioning and Managing Special Needs Shelters

Training Citizens for Disasters [Jul 31 07]

Become a Mission Integrator [Jun 30 07]

Pandemic Planning: Why Healthcare and Public Health Aren't Talking [May 11 07]

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