With 9/11 seven years past, hospitals still aren't ready to handle the surge of patients that would come during another mass casualty event, despite billions of dollars spent, according to experts in the field. Since September 2001, the U.S. Department of Health and Human Services (HHS) has distributed nearly $4 billion to state and local hospital preparedness efforts. Nevertheless, officials say hospital emergency departments and emergency medical services (EMS) would be unable to handle a mass casualty event.

Hospital emergency rooms (ERs) nationwide are overcrowded and have trouble coordinating with their inpatient wards to share the emergency patient loads. Emergency managers often overlook EMS, not realizing it's frequently separate from fire departments.

Hospital and EMS officials cite a lack of funding as one of their problems, despite the billions already spent. The paramount struggle, however, appears to be a lack of coordination between the different entities of emergency management operations. Emergency medicine experts are advocating strategies for breaking medical emergency response silos and say reorganization of emergency departments and EMS could better prepare them for mass casualty events. 

Increase Hospital Capacity?

As the number of uninsured Americans climbs, emergency departments are treating more patients who can't afford to pay. As a result, emergency departments are closing because they can't afford to treat those patients for free. Should government emergency managers aim to increase hospital capacity in preparation for a mass casualty event?

Dr. Amy Kaji, director of the Los Angeles County Harbor-UCLA Medical Center's Disaster Resource Center, said emergency patients already clog ERs most days because hospitals don't have enough nurse ward beds. Los Angeles County responded to that challenge by spending federal grant money on a military-style tent to accommodate patients during a mass casualty event.

Dr. Rex Archer, director of health for Kansas City, Mo., thinks hospital capacity shortages during mass casualty events is an overblown concern. Archer insists that hospitals could simply route patients to nearby hospitals and cancel elective surgeries to free up space during an emergency. He argues that newly built "excess hospital capacity" wouldn't be excess for long because physicians would use it for more elective surgeries.

"As it is, probably half of our elective surgeries are unnecessary, inappropriate or just plain dangerous," Archer said.

Cosmetic surgeries, cataract surgeries and some hysterectomies are examples of elective treatments. Archer contends that an increase in elective surgeries would make the United States less healthy.

"During the early '80s when there was a malpractice crisis in California, they stopped elective surgery for 16 weeks," Archer said. "They only did emergency surgeries. The death rate dropped by half for the state. When the crisis was solved, it jumped right back up."

He asserts that increased capacity would also drive up health-care costs nationwide.

Kaji disputes the idea that canceling elective surgeries and rerouting patients would clear sufficient space. More beds are needed, she said.

Dr. Arthur Kellerman, chairman of the Department of Emergency Medicine at Emory University, partially accepts both Archer's and Kaji's arguments.

"When we're diverting at least a half million ambulances a year from private and public hospitals because the ERs are filled with admitted patients who are not being moved upstairs, you can't just say, ‘Oh well, cancel elective admissions and reroute patients to other hospitals,'" Kellerman said. "Other hospitals are on diversion, too. Elective admissions won't get you beds for days, and you need beds in minutes or hours during a mass casualty event.

"On the other hand, we already spend $2.2 trillion on health care per year. We can't afford to build large wings of hospitals and leave them vacant," Kellerman added.

Alternatives to Increased Capacity

Rather than building more hospital capacity, Kellerman advocates changing how hospitals