Report identifies policies for making US health sector more resilient to major disasters

The health sector in the United States would be far better positioned to manage medical care needs during emergencies of any scale by empowering existing healthcare coalitions to connect community resilience efforts with a network of hospitals equipped to handle disasters, according to a new report by the Johns Hopkins Center for Health Security.

The report, “A Framework for Healthcare Disaster Resilience: A View to the Future,” was released at a February 22 event at the National Press Club.

"We wondered what an optimal system would look like and how we would get there," said Eric Toner, MD, a senior scholar at the Center and principal investigator on the report. "Change is needed, but the change should be evolutionary, not revolutionary. We need to build on the resources we already have."

Toner’s coauthors on the report are Center colleagues Monica Schoch-Spana, PhD, Richard Waldhorn, MD, Matthew Shearer, MPH, and Tom Inglesby, MD. The team first identified four distinct categories of disasters that could cause significant illness or injury, and for which preparedness gaps likely exist due to differing operational challenges and resource needs. A subsequent gap analysis confirmed their theory: While the US health sector is reasonably well prepared for relatively small mass injury/illness events that happen frequently (e.g., tornadoes, local disease outbreaks), it is less prepared for large-scale disasters (e.g., hurricanes) and complex mass casualty events (e.g., bombings) and poorly prepared for catastrophic health events (e.g., severe pandemics, large-scale bioterrorism).

These gaps, the authors say, exist as a result of the absence of strategies above and beyond the traditional all-hazards approach to improving US health sector preparedness. The authors define the US health sector as all entities and personnel that are involved in people’s health, combined with the community-based organizations that support these entities and represent the patients who receive services from them. This network’s incident-specific response actions and capabilities vary widely across the four categories of disasters.

The authors offer four recommendations for closing preparedness gaps unique to the US health sector:

Build a Culture of Resilience: Launch a new federal program that encourages and incentivizes local grassroots and community-based organizations to become more involved in efforts to enhance the disaster resilience of the local health sector. This Culture of Resilience program would engage organizations traditionally not involved in health sector preparedness.

Create a network of disaster centers of excellence: Connect geographically distributed, large academic medical centers and designate them Disaster Resource Hospitals by setting rigorous standards, providing direct funding, and requiring accountability. These hospitals would be a source of remote, real-time clinical expertise, continuing education and training, and expertise for public health officials, among other benefits.

Increase support for healthcare coalitions (HCCs): Already successful healthcare coalitions comprising well-prepared hospitals, health departments, EMS providers, and emergency management need additional funding to engage other organizations inside the health sector (e.g., nursing homes) and outside the health sector (e.g., faith-based community groups) in preparedness work. HCC-led collaboration would then help integrate disaster resource hospital capabilities into preparedness and response for the overall coalition, and link community resilience efforts back to disaster research hospitals.

Designate a federal coordinator for catastrophic health event preparedness: Within the Office of the Assistant Secretary for Preparedness and Response (ASPR) in the US Department of Health and Human Services, dedicate a group responsible only for preparing the nation for catastrophic health events. This group would coordinate existing decentralized healthcare preparedness initiatives in ASPR and provide a vision for strengthening preparedness in the future, with an increased focus on resilience.

“It is now widely recognized that resilience of communities and systems should be the goal rather than just preparedness,” the authors wrote in the report. “Resilient communities seek to resist the impact of disasters, recover promptly to normal operational capacity, and learn how better to withstand future events.”

The report concludes with policy requirements for each of these recommendations. There is opportunity for some of the requirements to be incorporated into the Pandemic and All-Hazards Preparedness Act reauthorization this year.

"There needs to be more focus at the federal level, particularly on catastrophic health events," Toner said to an audience of more than 40 people in the health security policy community in attendance at the Press Club.

Guest speakers at the event included Luciana Borio, MD, director of global health security and biological threats for the White House National Security Council; Sally Phillips, PhD, deputy assistant secretary for policy in the Office of the Assistant Secretary for Preparedness and Response at the US Department of Health and Human Services; and Linda Langston, director of strategic relations at the National Association of Counties.

To inform their work, the project team reviewed five years of published literature and conducted a series of working group meetings, a focus group, and interviews with more than 40 subject matter experts and thought leaders.

This project was funded by the Robert Wood Johnson Foundation.

About the Johns Hopkins Center for Health Security:
The Johns Hopkins Center for Health Security works to protect people from epidemics and disasters and build resilient communities through innovative scholarship, engagement, and research that strengthens the organizations, systems, policies, and programs essential to preventing and responding to public health crises. The Center is part of the Johns Hopkins Bloomberg School of Public Health and is located in Baltimore, MD.