9. Conclusion

Limitations

Some of the limitations relate to the data that are presented in the profile of the region and measures of preparedness. The HRSA surveys used in profiling regional resources (Chapter 3) provided limited data on hospital equipment and infrastructure capacity. Since the surveys were not standardized instruments, the ability to profile the region and compare States was restricted. As State bioterrorism preparations are ongoing and dynamic, the data from the survey may not reflect current preparedness status. The hospital response rate for the surveys was less than 100 percent, which may have resulted in selection bias. The concern for hospital data confidentiality varied from State to State. This did limit the amount of data that was received from some States.

In Region VIII, the NDMS periodically gathers available bed data from hospitals in two geographic areas of the region. These data have been very helpful is evaluating day-to-day bed availability in these areas, but this type of data collection is not occurring in four of the States in this region.

When developing measures of bioterrorism preparedness (Chapter 5), staffing needs were defined by available health care personnel compared to national averages. The assumption that the national average for medical staffing is adequate to meet current needs may underestimate or overestimate the measures, although this is useful for relative comparisons between States and between regions. This is further complicated by the HRSA recommendation of being able to create and staff 500 surge capacity hospital beds per one million population. This recommendation represents a good starting point, but the justification for the 500 bed number is unclear, untested, and may be overly optimistic depending upon the biological agent and the scenario of exposure of a bioterrorist event.

The caches and site selection matrix (Chapter 4) lack actual demonstration of their validity in the field. While the alternative care site matrix was tested via an orientation exercise, further real time testing at the local level will help to validate this tool. The Level I and Level II caches will still need to be deployed in the field to determine their adequacy. There is a need for supplemental oxygen to be available at alternative care sites, although given the current economic environment it is not feasible for States and providers to purchase and store the necessary components. The engineering logistics for installation at an alternative care site are complicated and labor intensive.

Developing a model/tool for isolation quarantine is challenging. There have not been any large-scale isolation or quarantine events in recent history, so providers lack experience in dealing with these issues. It is also unknown as to whether medical and support staff would be willing to work in an isolation/quarantine environment; this issue can not be assessed through an exercise.

Addressing the special needs of vulnerable populations (disabled, elderly, poor, children, immuno-compromised, chronically ill, homeless) during the event of a bioterrorist incident is challenging with fixed resources and time constraints, particularly since the characteristics of these groups widely vary. The medical needs for these patients may need to be incorporated into current preparedness plans.

In developing a model to address medical resource needs in the event of a bioterrorist incident, monetary resources are a constraint when developing practical potential solutions. Exercises and equipment are expensive and are often not a priority for funding by providers or government.

Return to Contents

Recommendations

The RMBT Working Group recommends the following:

• HRSA and other partners work together to clarify benchmarks for decontamination and isolation infrastructure requirements. The current guidance makes it difficult for States to assess their need.
• Any future hospital preparedness survey should be standardized across States to facilitate regional assessments of preparedness.
• States should investigate the development of an information system to report snapshot or real time hospital bed availability.
• The medical cache and regional assistance concepts should be tested through actual cache deployment across State lines via a real time field exercise.
• State and local bioterrorism planners can use the site selection matrix tool at the local level to identify and rank alternative sites for care and isolation/quarantine facilities in advance of actual need. (Current plans are for this tool to be used in Athens, Greece, to assist in the support for the Summer Olympic Games.)
• The military should continue to work with the civilian population on bioterrorism preparedness since they have the knowledge, experience, and technology to enhance civilian efforts.
• Relationships between neighboring States should be strengthened through joint planning and exercises.
• Other regions of the country may benefit by applying a similar methodology in developing regional measures of preparedness.
• States should do advanced planning to enable and facilitate medical personnel crossing State borders to provide care in the event of a bioterrorist event through State legislation or draft order creation.
• In our region, use of physician assistants and nurse practitioners as physician extenders may assist in dealing with a possible physician shortage during a bioterrorist event.
• Regional advance planning should be encouraged for issues of patient isolation and quarantine.

Participants from all parts of the region benefited from this project by learning through collaboration from those with knowledge and experience in bioterrorism preparedness. The RMBT working group also did not have the solutions to all of the difficult issues that were raised. One issue that was repeated throughout the time frame of this project is that health care providers will need to lower the bar for acceptable care during a bioterrorist event and the public will not be able to expect "care as usual." Much was gained by the civilian sector and the military joining in information sharing and preparedness planning, resulting in a potent partnership. This project allowed for the development of tools that have applicability and usefulness to others involved in preparedness planning. Region VIII, through the implementation of many of the ideas developed by this project, has improved its preparedness to deal with a bioterrorist event.

Return to Contents
Proceed to Next Section