No matter what the Supreme Court decides on the constitutionality of the healthcare reform act, U.S. hospitals must prepare now for major changes in their planning, everyday operations, and both budgetary and personnel resources. Many of those changes may be costly. Most will be time-consuming and/or difficult to implement. But in the long term almost all will benefit - the hospitals themselves, their medical staff, and -most important of all - their patients.
The federal funding streams that improved U.S. preparedness capabilities, at all levels of government, so significantly in the first decade after the 9/11 attacks have already declined, and additional reductions are just over the horizon. But a lack of funds can be overcome, at least in part, by careful planning, increased cooperation, improved training, and a more imaginative and continuing all-hands effort by all of the professional preparedness communities directly involved.
Infected salad bars and the "improved" technological capabilities of modern-day terrorist groups have combined to make U.S. responders, and the American people, much more cautious about what they eat. Fortunately, that heightened awareness has led to a much closer scrutiny of restaurants, super markets, food-processing plants, and the super-rich diet creations to come.
Actions have consequences - not all of which are intended, or desired. Some military actions, for example, are intended to intimidate another nation - but instead lead to an outright war. The same is true in the fields of medicine and biological research that, while expanding the range of knowledge about a lethal and previously unknown disease, might also open the door to a new pandemic.
Growth in the number and capabilities of the nation's healthcare coalitions will undoubtedly continue for the foreseeable future - as will the operational capabilities of those coalitions. Helping that growth, and making the coalitions both more capable and more cost-effective, is a new plan (going into effect this summer) to enhance uniformity if and when needed, while maintaining the diversity required to meet regional concerns and circumstances.
In today's increasingly complex and ever more dangerous world, EMS units in U.S. communities both large and small are learning to cope with a broad spectrum of mass-casualty incidents and events never before encountered by their predecessors. Here are a few common-sense cost, training, political, legal, and operational suggestions that should help.
With the potential to kill thousands in a single attack, chemical warfare agents have been an ongoing threat to nations around the world since World War I. Although efforts have been made to reduce the production and stockpiling of these deadly chemicals, there remains a need not only to stockpile effective antidotes, but also to train and equip the medical community to combat such disasters.
All or almost all suicides are personal tragedies by definition, regardless of the circumstances involved. A rapidly growing number, though, are becoming public dangers as well, with first responders and hospital staff among the most likely to become secondary casualties. All of which translates into a new set of mandatory precautions that must be taken, new lessons to be learned and followed, and additional rules and regulations to be observed.
Major stress and constant pressure are all part of the job for emergency-services personnel and other responders. A less obvious but greater danger is caused by drug and alcohol addictions. Professional help is available, but not always wanted. What is most needed, and in the long term most effective, is an all-hands alert to recognize the addiction earlier, provide the help needed, and avoid being judgmental.
First question: Should "everyday citizens" - however that term is defined - be given access to potentially harmful medications, including antidotes to dangerous narcotics? Well, perhaps. Second question: What if the medication also saves lives? Now the answer is a much more emphatic "perhaps". The Commonwealth of Massachusetts is working hard to come up with a more definitive answer.
