The chief of emergency medicine at a metropolitan hospital stares at the computer screen. She’s looking at statistics on the dozen emergency rooms at hospitals in the area. For each hospital, she can see the number of beds, the number of beds filled, wait time to see a physician and a variety of other statistics on staffing and capacity.
She is staring because, of the dozen ERs, the names of seven are flashing on and off the screen. The flashing means that seven ERs are full and must divert patients to other hospitals.
As she watches the screen, the telephone rings. A hospital near the international airport is reporting six cases of smallpox—almost unheard of in the 21st century. State public health officials have been in conversation with the Centers for Disease Control and Prevention (CDC) in Atlanta and have tentatively determined that the occurrence can only be explained by a terrorist attack. They have also determined that infected passengers have already departed for other cities around the country.
And that tells the doctor two things. First, there is limited time to prepare a facility in which to isolate—or quarantine—patients. And, second, that outside help expected during a disaster will not be coming, because every community will soon be facing the same needs as her own.
She knows the situation is further complicated by the fact that the smallpox vaccine has been subject to increasing skepticism concerning its effectiveness and dangers.
Still, her first question for the public health official who called is when so-called “push packs” of vaccine and antibiotics from the national stockpile maintained by the Department of Homeland Security and the CDC will be on their way.
They soon will be, she is told, but not until the strain of the virus has been identified, which will require examination at one of two Level 4 laboratories in the country. If the terrorists had used an airborne agent, sensors maintained by the same agencies might have alerted the public health system to the attack earlier. But that is not the case here.
If the community’s prognosis isn’t particularly rosy, it is at least better than that of some, because the department of emergency medicine at a local university had worked to create a mobile medical center built on two tractor-trailer rigs and capable of setting up a 200-plus-bed hospital complete with state-of-the-art diagnostic and surgical equipment.
This center will be set up in the parking lot of a shopping mall on the outskirts of the city. Members of the community will go there for examination, diagnosis and quarantine, if they are found to be infected. That might prevent the emergency rooms of local hospitals from being overrun.
The doctor has done what can be done to put into motion, at the local level, a plan developed by hospitals, public health officials and emergency and law enforcement officials to respond to a disaster. She knows her community best, but her experience in medical and public health organizations around the country does not encourage optimism.
She knows that, if she were in the air looking down at a topographical map of the United States, where readiness is represented by height, she would view a wildly undulating terrain with mountains and depressions—sometimes side by side.
At least her city has spent federal grant money on the mobile medical center. Most communities across the country have spent the money on first response equipment—fire trucks or protective gear. Those communities will quickly find their hospital systems overwhelmed with frightened citizens.
But even officials in the doctor’s community will realize within a few hours that their plans had gone awry. Even healthcare workers at metro hospitals are refusing, in large numbers, to be vaccinated against smallpox—and that is true of the general public as well.
The cause is fear that the vaccine is dangerous—more dangerous than it had been decades before, when it had eradicated the disease.
And rather than staying clear of sites where others are known to have been infected, members of the public are unknowingly helping to spread the disease in their attempts to ensure family members and others are safe. Some are simply leaving the city and, if among the infected, spreading the disease to other communities. Chaos will soon reign.
Had government—meaning public health and emergency management officials—done all it could? Was there someplace else medicine could look for help?
Disaster Philanthropy—the Role and the Reality
One answer might be the philanthropic community, where interest in disaster preparedness, particularly in community health, already exists despite some reluctance to tread on ground perceived to be the government’s, and where grantmakers and recipients are beginning to take a growing role.
“We’ve been thinking of the issues of convening and connecting people,” says James S. Marks, M.D., M.P.H., senior vice president and director of the health group at the Robert Wood Johnson Foundation.
“You can’t expect philanthropy to take on the role that government should play. But some roles are very hard for government to take on because of its funding structure, and those are roles that philanthropy can facilitate—and start to build. And philanthropy can often bring to the table some resources that government may be reluctant to bring,” says Marks, who is a former assistant surgeon general and acting head of the Centers for Disease Control and Prevention in Atlanta.
Rebecca W. Rimel, president and chief executive officer of the Pew Charitable Trusts, believes philanthropy can play a crucial role in advocating a stronger public health system in the United States.
“The most important thing we can do,” says Rimel, “is to advocate for strengthening the public health system in this country. In the last 20 years, 30 years, we have starved our public health system, and it’s not nearly as robust as it should be to protect and serve the public interest. And that’s not just for potential terrorist threats or pandemic threats.”
Rimel says philanthropy can also identify and communicate best practices. “If City A has figured it out, then City B and City C can benefit from that. That’s a great role for philanthropy to play,” Rimel says. “So basically, it’s a combination of providing good data, strong advocacy and facilitating best practices.”
Providing good data is critical, according to disaster preparedness experts, to ensure that planning—by whoever does it—is properly informed by the facts.
“Although the public is clearly the object of concern for planners, the public has basically been left out of the development of the plans,” says Roz D. Lasker, M.D., of the New York Academy of Medicine, who is studying disaster readiness under a grant from the W.K. Kellogg Foundation.
“Our Redefining Readiness study was designed to find out if the public’s limited and passive role in developing plans is okay or something we should be concerned about,” says Lasker.
The Kellogg Foundation’s C. Patrick Babcock, interim vice president for health, thinks work such as Lasker’s is critical. “I think the role of philanthropy is to try to test new models,” says Babcock. “The disaster will occur whether it’s bioterrorism or a pandemic or a natural disaster, like the hurricanes.”
“Often there’s a reaction, and it’s not a criticism of the government, but we’re just not well prepared to take corrective action and have models out there. So we have really started to test some approaches to help communities get more engaged,” Babcock says.
The programs supported by the Robert Wood Johnson Foundation, the Pew Charitable Trusts, and the W.K. Kellogg Foundation are national in their scope and application—and might be said to be an attempt to improve the view from 30,000 feet.
Other philanthropists are working closer to the ground. They include individuals such as Gerald Fischer, M.D., founder and a director of the Fischer Family Foundation in Bethesda, Maryland, and managing director of PanFlu LLC. They include groups such as Business Executives for National Security (BENS). They also include foundations that emphasize meeting regional needs, such as the George S. and Dolores Doré Eccles Foundation in Salt Lake City.
In some cases, these philanthropists also are attempting to develop models. And, in every case, they want to see community applications for their work as quickly as possible.
Fischer is promoting the development of mobile medical facilities, such as the one deployed in the opening scenario of this story. The actual MED-1 (see page 26) was conceived, designed and built by the Carolinas Medical Center in Charlotte under the direction of Thomas H. Blackwell, M.D. One additional unit has been completed and may go to New Orleans or Los Angeles County. Discussions have begun about the use of MED-1 in Hawaii.
BENS is involved in programs to staff the distribution of pharmaceuticals in communities after they have been dispatched from the national stockpile run by CDC and Homeland Security and to develop a model for such distribution that can be applied nationwide.
The Eccles Foundation was the largest donor to the George S. and Dolores Doré Eccles Critical Care Pavilion at the University of Utah Hospital in Salt Lake City, a facility which grew in part out of security concerns at the 2002 Salt Lake City Olympics and was built immediately thereafter.
Capacity Money Can’t Buy, Quick Fixes that Can’t Work
If the view from 30,000 feet is an uneven one, the questions become just what the state of planning might be—and how well the plans might work.
“In a normal disaster, local assets may be strained, but state and local governments can usually handle the situation with the resources they have and borrow from other places. And additional federal resources can arrive a couple of days later,” says James Jay Carafano, Ph.D., a senior research fellow and leading homeland security scholar at the Heritage Foundation.
“What the United States lacks is the medical surge capacity for a catastrophic disaster, something on the scale of a Katrina or higher, where you might have tens of thousands of casualties immediately,” Carafano says. “And then add the factor that, in large-scale disasters, for every person you have who is a casualty, there are ten who might come to an emergency room at some point, simply out of concern for their own health.”
“The truth,” says Carafano, “is that you could never buy enough capacity in the traditional medical system to deal with the catastrophic. Whether to hand out grants to keep emergency rooms open or to build extra bed space is a contentious issue, because you wind up buying a lot of excess capacity that’s expensive to maintain and, at the end of the day, may not help in a disaster situation.”
Carafano argues that “you really have to have a national surge capacity and one that you can move around the country pretty flexibly. That’s at the top end. But you build resiliency and sustainability in the community, not by focusing on the traditional medical infrastructure, which is going to fail on a large-scale disaster, but by focusing on how you empower individuals to take care of themselves.”
Philanthropy can play an important role in supporting community-based programs, Carafano says. “And they make a difference. If I walk in as an outsider and say, ‘I’m going to teach you how to treat anthrax,’ that program probably is not very sustainable. On the other hand, if training is conducted with Boy Scouts, Girl Scouts, the church or whatever, the programs are much more likely to be sustainable over time.”
Professor Gerald Ledlow, Ph.D., of Georgia Southern University, sees the same capacity and resource issues and a lack of effective planning as well.
“The biggest problem is that planning has really been a top-down arrangement out of necessity,” says Ledlow. “It hasn’t been a coordinated effort where communities, counties, states, regions, and the federal government all work together on an integrated planning effort and an integrated resourcing effort.”
He adds that even resource needs are not being thoughtfully considered. “We’re creating things such as certain types of expensive foam to decontaminate vehicles when, quite frankly, a bunch of soap with a Clorox compound and water from a large fire truck would be just as good,” he explains.
It is unfortunate, in Ledlow’s view, that “the political climate today requires quick fixes. Everyone wants something done now. And the reality is that to plan and to work through all the issues at the local level and the state level and federal level takes some time; if you want to create a plan that can be executed—where everyone knows what they’re supposed to do—it takes time to evaluate what the needs are. Some are training needs and some are resource needs.”
“So, there are a lot of things that aren’t thought through and aren’t coordinated. And we don’t have a common assessment tool to see where we are and to determine what’s needed,” Ledlow concludes.
Ledlow argues that donors at the community, state and regional levels can play a crucial role in the assessment and planning process. He says donors can act as conveners to foster needed discussion and information exchange and as supporters of programs to apply assessment tools.
As conveners, donors can help solve “the biggest issue,” Ledlow says. “What you’ll find is that among the fire chief, the police chief, the city commissioner, etc., you’re going to find three, four, five very different opinions. In many communities, key people have not talked through the possible scenarios and plans. They don’t even know what resources are available in each other’s departments. And that’s vital.”
“The second issue is money. But that,” according to Ledlow, “is not as much as one might imagine. I was asked to present several years ago to Michigan legislators on the State Preparedness Committee (chaired by Representative Mike Noff). I explained that an assessment would cost $250 per jurisdiction. Michigan, with its 1,776 jurisdictions, could have a community by community assessment of the entire state for $444,000.”
Failed Assumptions and the Tragedy of Katrina
A task as daunting as preparedness for pandemic flu, hurricanes, tornadoes, earthquakes and terrorist attacks of many kinds may seem all but impossible to even the largest private donors. But to philanthropists already involved, important contributions seem possible at both the national and regional or local levels.
One of the contributions at the national level is represented in the work of Dr. Roz D. Lasker, director of the Division of Public Health and the Center for the Advancement of Collaborative Strategies in Health at The New York Academy of Medicine.
Lasker’s work could be described as an attempt to discover and quantify important preconditions for effective planning. Her center’s report, Redefining Readiness: Terrorism Planning Through the Eyes of the Public, has received wide attention, because it concludes that a failure to account for the problems people face trying to protect themselves in disasters has left most of the country without effective preparedness plans.
Lasker describes the report as the result of a very rigorous study that included not only in-depth conversations with planners, but also a survey that enabled over 2,500 Americans to look at emergencies in a way that was meaningful to them.
“Our approach was to put the public into two specific and realistic situations at a place and time they would be likely to hear about the emergency and be told what to do. One scenario was a smallpox outbreak and the other was a dirty bomb explosion. Then we found out how they would react and why.”
“We found that current plans won’t work,” Lasker says, “because people aren’t going to react the way the planners want them to react.”
“For example, only 43 percent of the public said they would follow instructions to go to a public site to be vaccinated in a smallpox outbreak, which is consistent with the small percentage of healthcare professions who agreed to be vaccinated in the prophylactic vaccination strategy that had been attempted earlier. In a dirty bomb explosion, only 59 percent of the population would seek shelter inside the building they were in for as long as officials told them.”
“Contrary to conventional wisdom, we found that the problem wasn’t with the people, the problem was actually with the plans,” Lasker says, adding that the full range of risks that people face must be taken into account to develop plans that have any hope of success.
“In the smallpox situation, going to a public vaccination site can be very dangerous for 50 million people in this country,” she says. “We’re talking here about pregnant women, kids under the age of one, anyone who has ever had a history of a skin disease like eczema, and people who take prednisone or who are on chemotherapy or who are getting radiation treatments or who are infected with HIV.”
Lasker says the results were “really an eye-opener” as were the findings about sheltering in place in a dirty bomb attack. “We found that many people would not be able to follow instructions to shelter in place—again, for very good reasons,” says Lasker. “They realized that if they stayed to protect themselves, other people and pets who depend on them would be left without care. You can imagine parents’ concern for their children. Also, many people said they would be at risk staying in the building because they wouldn’t have critical medications or other needed supplies with them.”
“We came out of this study concluding that it’s essential to understand the barriers people would face trying to protect themselves in emergencies, because if we don’t understand these barriers, we can’t do anything in advance to address them, and a lot of people will suffer and die unnecessarily,” Lasker says.
“Right after we reported the findings of our study, Hurricane Katrina hit,” she continues, “and Katrina proved our prediction to be correct. As Katrina approached New Orleans, everyone was told to evacuate. But many of them couldn’t because they—or their dependents—didn’t have a car; or they didn’t have money for gas or lodging; or they were sick or had impaired mobility. And we know how catastrophic the consequences were.”
Following the Redefining Readiness study, demonstrations projects were launched in four communities around the country to enable the public to contribute their common-sense knowledge to local emergency preparedness efforts. “Some of those communities are very rural, some very urban. Their populations include people who are African-American, Hispanic, Native American, and Caucasian,” Lasker explains.
“Over the last year and a half, the sites have developed new and very effective methods for engaging regular people in emergency preparedness, involving more than 2,000 diverse residents in the process,” Lasker says.
“Their experience shows that the public has critical knowledge that planners need. With the public’s knowledge as a foundation, emergency management professionals can be much more effective, and communities can protect many more people than is currently possible.”
Ready or Not? A State-by-State Survey
A major emergency preparedness effort supported by the Robert Wood Johnson Foundation is Ready or Not? Protecting the Public’s Health from Disease, Disasters, and Bioterrorism. The latest of four annual reports by Trust for America’s Health (TFAH), released in December 2006, found that, five years after the New York, Washington and anthrax attacks, America’s level of preparedness to cope with the health effects of a disaster is still inadequate.
“The nation is nowhere near as prepared as it should be for bioterrorism, bird flu and other health disasters,” says Jeff Levi, Ph.D., executive director of TFAH when the report was released. “We continue to make progress each year, but it is limited. As a whole, Americans face unnecessary and unacceptable levels of risk.”
“September 11, the anthrax attacks and Hurricane Katrina were all wake-up calls to the country, putting us on notice that the nation’s response capabilities were weak and that we needed to improve preparedness,” Levi said. “But, across the board it is clear that we haven’t learned the lessons from these tragedies—we are still too vulnerable to what might come next.”
Ready or Not? contains state-by-state preparedness scores based on ten indicators to assess emergency preparedness capabilities of the health care system. The evaluation included all 50 states and the District of Columbia.
Half of the states scored six or less on the scale of 10 indicators. Oklahoma scored the highest with 10 out of 10; California, Iowa, Maryland, and New Jersey scored the lowest with four out of ten. (See map, page 20.)
The report’s findings included:
- Only 15 states are rated at the highest preparedness level to provide emergency vaccines, antidotes and medical supplies from the Strategic National Stockpile.
- Twenty-five states would run out of hospital beds within two weeks of a moderate flu pandemic.
- Forty states face a shortage of nurses.
- Rates for vaccinating seniors for seasonal flu decreased in 13 states.
- Eleven states and D.C. lack sufficient capabilities to test for biological threats.
- Four states do test year-round for the flu, which is necessary to monitor for a pandemic outbreak.
- Six states cut their public health budgets from fiscal year 2005 to fiscal year 2006; the median rate for state public health spending is $31 per person per year.
The report also offers a series of recommendations to help improve preparedness. One, that the public should be included in emergency planning, echoes Lasker’s conclusions.
Others include better communication of risk and the creation of a set of achievable standards —with results made publicly available—that every state should be accountable for reaching. Integrating health resources and partnering with business community groups in planning and increasing stockpiles of needed equipment and medications are other recommendations.
The Consequences of Failure—Pandemics and Economics
Another project under the direction of the Trust for America’s Health (TFAH) is an attempt to quantify the cost of failure to prevent a flu pandemic that was funded by the Pew Charitable Trusts.
TFAH created a state-by-state model to assess potential losses during a severe pandemic. Twenty different industries, trade, and worker productivity were examined to model the impact of a pandemic. Estimates from financial experts were used to create the impact model and to predict how consumer demand for products and services would change.
According to these estimates, tourism, entertainment, and food services could experience an 80-percent decline, while agriculture, construction, retail trade, finance and insurance could face a ten-percent decrease in demand.
States with high levels of tourism and entertainment would be the hardest hit. Nevada’s economy could face the biggest percent decline with a Gross Domestic Product (GDP) loss of 8.08 percent, followed by Hawaii, which could experience a 6.60 percent loss. Six states could suffer losses over 6 percent (Nevada, Hawaii, Alaska, Wyoming, Nebraska, and Louisiana). The economies in an additional 21 states could drop more than 5.5 percent and every state could lose more than 5 percent in GDP.
The bottom line of the report, released in March 2007 and titled Pandemic Flu and Potential for U.S. Economic Recession, is that a severe pandemic flu outbreak could result in the second-worst recession in the United States since World War II. The U.S. GDP could drop more than 5.5 percent, leading to an estimated $683-billion loss.
Recommendations growing out of the study include modifying family and medical leave policies, expanding telecommuting capabilities and workforce communications, and establishing contingency systems to maintain delivery of goods and services during a pandemic event.
Pew also funded a state-by-state survey, now in progress, of the preparedness of state and local public health systems to deal with a pandemic. This study by the Center for Infectious Disease Research and Policy at the University of Minnesota will look at these systems nationwide to establish a knowledge base and help public health officials examine and adopt best practices.
“We’ve used this process very successfully before,” says Rebecca Rimel of the Pew Charitable Trusts. “We’re using it now on issues of prison reform and K-12 education. We’ve used it before on a range of issues in terms of learning, adoption and having practitioners talking to one another and sharing information. It can also be used to bring some pressure to bear on those who aren’t measuring up.”
The View from Ground Level
Closer to the ground are the efforts philanthropists have been making in cooperation with components of state, regional and local medical systems. Some could be models for national programs. Others have no implications beyond an immediate region. What these efforts have in common is a determination to do something more than talk and plan.
“When I first became involved in the pandemic and disaster preparedness issue,” says Dr. Gerald Fischer of the Fischer Family Foundation, “I sat through many meetings, and the conclusion was always, ‘Let’s have another meeting.’ Good planning is critical, but I came to a point that talking ad infinitum became impossibly frustrating. I wanted to get something done, even if it was just to create an example of what could be accomplished in the area of mobile medical facilities.”
Fischer has taken the practical course. He has allied himself in helping university emergency medical departments create multiple models for mobile medicine—medicine that goes to the victims of disaster, rather than medicine that brings disaster victims to traditional hospital facilities.
The first of these is called Carolinas MED-1 and was built under the leadership of Dr. Thomas H. Blackwell, an attending physician in the Department of Emergency Medicine and medical director for the Center for Prehospital Medicine at Carolinas Medical Center.
“We started putting together a terrorism response team back in 1998,” says Blackwell, “way before the events of 9/11. But as we progressed through time we saw that hospitals today operate at 110 percent of capacity. Most are full, and beds are critical. An Institute of Medicine report released in 2006 on the state of emergency care in the United States showed that we’re running out of emergency beds, that emergency rooms are backed up and there are no beds available in many hospitals.”
Add to that what Blackwell calls the problem of the “worried well”—potentially tens of thousands of uninjured or uninfected persons who want reassurance—and the idea that hospitals can treat the victims of a disaster becomes more tenuous still.
In a quarantine situation, Blackwell asks, “What if one person gets an appendicitis attack, or has a gallbladder flare up, an acute case of pancreatitis or a stroke? We can’t bring them to the hospital to operate on them because they’re quarantined. We can’t let them die because we don’t like to let people die. So we started thinking, okay, we need to build a hospital that has full operating room capabilities.”
The unit, according to Blackwell, grew as planners incorporated facilities that might be needed in a disaster—an intensive care unit, an emergency department and a tent system that creates a 200-plus-bed hospital set up around the two 53-foot trailers that transport the center. MED-1, which cost approximately $1.5 million to build, can be ready to depart in 12 hours and takes only hours to set up, in contrast with a mobile military hospital, which can take four to six days.
MED-1 has not only been built, it was deployed during Hurricane Katrina, sent to New Orleans during a subsequent Mardi Gras and has been demonstrated elsewhere around the country. Blackwell and Fischer are working with a number of states and universities to push for more units that can serve communities and serve to demonstrate the utility of such mobile hospitals.
“I think public-private partnerships are really the way to go with this,” Blackwell says. “Health and Human Services may find some funding for this, but to continue and then sustain these programs will require a private venture or philanthropy group.”
“The beauty of the MED-1 concept is that it’s tangible. It is a solid asset. It’s something that institutions or individuals can sponsor and that can provide health care beyond its use in emergencies.”
“Ideally,” says Blackwell, “we would begin by placing one MED-1 in every Health and Human Services region across the country, then eventually in every Congressional district. This would provide uniform healthcare coverage for the population of the U.S. in the event of a pandemic.”
Other philanthropists are working in local communities to increase medical capacity. In Salt Lake City two donors were the principal financial force behind the George S. and Dolores Doré Eccles Critical Care Pavilion at the University of Utah Hospital.
The $42.5-million project substantially expanded the university’s trauma services. A new emergency center, the William H. and Patricia W. Child Emergency Center can accommodate 34,000 patients annually. The center has six “fast-track” rooms for patients with less severe injuries and 21 rooms designed for acute care, including specialized rooms for burn care and obstetric care. The pavilion also will include 32 surgical intensive-care beds, a pre-admitting area, a post-anesthesia care unit, and 36 same-day surgery recovery suites.
The Eccles pavilion has been named in recognition of a $7-million gift to the project from the George S. and Dolores Doré Eccles Foundation. A $3-million gift from William H. Child, former chief executive officer of R.C. Willey Home Furnishings, and his wife Patricia, has funded the pavilion’s William H. and Patricia W. Child Emergency Center.
Additional funding for the pavilion came from the release of a bond issue and donations by more than 2,000 hospital employees and many community campaigns. No state or federal funds were used.
One motivation for the center was the realization, during planning for the 2002 Winter Olympics in Salt Lake City, that a bioterrorist or similar attack during such an event could present the community with a difficult medical care challenge.
“Yes, we learned a lot from the Olympics,” says Stephen Warner, associate vice president for health science development at the hospital. “Because of the influx of people, the scare of 9/11 and the location of an Army stockpile of old nerve gas agents nearby, one of the things we geared up to handle was a chemical gas emergency in which we would have masses that would come in and need to be showered off and treated very quickly.”
“For that reason,” Warner says, “we designed it so that we could actually set up a portable triage facility directly outside of our emergency room doors. We can put a curtain all the way around the ambulance drop-off facility and shower patients and then move them into a secondary shower facility and capture all of the water and, hopefully, contain all of the bio-waste, and then move patients into the emergency room, where the doctors are ready.”
The pavilion is also equipped, says Warner, to deal with other types of emergencies including epidemics or even radiological attack. An entire floor can be isolated from the remainder of the pavilion and the entire pavilion can be isolated from the hospital to prevent contamination or the spread of disease. “The pavilion can provide effective treatment in any situation,” says Warner.
The hospital serves not just Utah, but a huge geographical area incorporating parts of Idaho, Montana, Wyoming, western Colorado, eastern Nevada and northern Arizona.
Another program that began on the ground in Atlanta and is now being looked on as a potential model for regions, states and communities across the country is an attempt to create a system that can provide the people needed to distribute pharmaceuticals during a terrorist attack or natural disaster.
The program is operated by Georgia Business Force, a subgroup of the Business Executives for National Security (BENS) Georgia chapter.
“The idea is to work with local, state and federal authorities to prevent and react to some type of terrorist attack,” says John Turner, director and program manager of Georgia Business Force. “In light of Katrina, we’ve also extended it to all hazards, either man-made or natural, at the catastrophic level. There needs to be a plan in place to deal with an event that literally could stop societies as we know them and to get business and government to work together in advance to prevent, mitigate and recover.”
The program recruits and trains employees of member companies to assist public health authorities in distributing prophylactic remedies to the victims of biological, chemical or radiological attacks and natural disasters on a major scale.
“Early on in the process,” Turner says, “we sat down with the Georgia division of public health and have been working with them ever since on developing better ways to distribute medications to the greater population of Atlanta and working with the business community to do that. So we’ve looked at using facilities of businesses, and developed exercises that mobilize workforce help at the distribution centers.”
“We would use people with a variety of skills for a variety of tasks. Some have medical training. But we would also use people who can help in distribution. They would need to have some training in advance, but it does not have to be technical. It could include crowd control and record keeping, for example. The idea is to break down all the elements of labor needed and then design the specific training people would need,” says Turner.
“Facilities might be used for other purposes in later plans. For now, they are being looked at simply as distribution centers.”
The next step for BENS and its Business Force organization is to use the results of tests already run in Atlanta to develop a model that can be used in communities nationwide. This development includes further testing in Atlanta and other locations in the next year.
“Actually, our ultimate goal is to develop models that we can share with the rest of the country. And we’ve gotten a lot of enquiries. The CDC is very interested in the development of our plans. FEMA is interested, and the Department of Homeland Security is interested. My view,” Turner concludes, “is that, at the higher levels, officials are still sorting out how to set up to command and control a public health disaster.”
Readiness Forecast: Foggy and Overcast
The idea that our highest officials in public health and homeland security are still sorting out how to deal with a catastrophic event is reflected in the tone and comments of every expert and donor in the field of bringing medical help to the victims of a disaster: We aren’t ready, at least not for the big one, whether it’s a flu pandemic, hurricane or terrorist attack.
“From way up high, it’s definitely foggy and overcast,” says Rimel. “We as a country are not prepared. We in our communities are not prepared. We don’t have the kind of surveillance we need. We don’t have the epidemiologic data based on the past. We still have states in this country that don’t know how many children are born with birth defects. You would think that we would have systems in place to track this sort of thing. But we don’t.”
“The public should demand better,” Rimel says. “I look at the public health system as an insurance policy for the public health. But we haven’t made the investment. I don’t think any of us, in our personal lives, would fail to be prepared. But we have failed to make the investment we need to get the pay-off we want.”
Dr. Lasker of the New York Academy of Medicine wouldn’t disagree, but she would argue that the way out begins with public participation. “Technical and academic expertise is essential, but there is a lot that emergency management professionals need to learn from the public. Community residents are the only ones who know what they would actually face trying to protect themselves in emergency situations. Developing plans without the public’s knowledge is like baking bread without a critical ingredient: yeast.”
“Thanks to the Redefining Readiness demonstrations, we now have public engagement practices that can bring in that missing ingredient,” says Lasker. “And for local donors—no matter whether their focus is emergency response or any other area—these practices can make them much more effective in understanding the problems they care about and what might be done to address those problems in their community,” Lasker says.
The Heritage Foundation’s Carafano also emphasizes local efforts. “There is very interesting data which suggests that when you have disaster plans in which the community participates, the citizens come up with better solutions because they are close to the problem. There is also more of a likelihood that they are going to execute the plans because they participated in them, and they have faith, trust and confidence in them.”
Dr. Fischer, the Maryland donor and executive, uses New Orleans during Hurricane Katrina to illustrate his view: “You’ve read news reports about the field of buses that might have been used to evacuate most of the poor and immobile to safer areas. And you’ve probably read that drivers for those buses couldn’t be found. You probably haven’t read that the school budget was low on money and the buses were low on gas.”
“Every community has problems,” Fischer says. “If it’s not budgetary, it’s something else. Perhaps state and local government should be counted on to assist in solving these problems. But that doesn’t seem to happen very often.”
“This means that every community will be an island in the event of a widespread disaster or pandemic,” says Fischer, “so it’s in the community that philanthropists need to begin.”
Kirk E. Oberfeld is editor-in-chief of Philanthropy.