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HSPD21: Mass Casualty Care

November 16, 2007

triage careThis post is one in a series examining the recently-released Homeland Security Presidential Directive 21: Public Health and Medical Preparedness. Previous posts can be found here: Initial Reactions, Biosurveillance, Countermeasure Distribution.

Before we start, I have a few points to make. First, this goal deals explicitly with medical care delivery which is something that I have very little experience with. Second, I think that I’ve established that the deadlines given in this Directive are unfeasible and threaten to shortchange the entire effort in the name of delivering the product “on time.” I’ll do my best not to focus on these deadlines, and instead look at the content.

The section on mass casualty care deals with, right, medical surge capacity first. Our just-in-time medical community has provided us with very little extra capacity for unforeseen medical care needs. Hospitals are beginning to look at freeing up beds and equipment in the event the facility experiences a rush on its services. The Pandemic and All-Hazards Preparedness Act (PAHPA) directs that the Secretary of HHS review the National Disaster Medical System and medical surge capacity. This directive says that after that review is complete, he should submit a plan that identifies and uses all availCable resources (read: federal, state, local and private) to address any gaps found. Quite a job – I’m sure Secretary Leavitt is up to it.

But before he does that, he’s been tasked with developing and integrating all federal medical facilities into a coherent system for dealing with medical surge.

But! Before that, he’s supposed to:

[I]dentify any legal, regulatory, or other barriers to public health and medical preparedness and response from Federal, State, or local government or private sector sources that can be eliminated by appropriate regulatory or legislative action and shall, within 120 days after this directive, submit a report on such barriers to the Assistant to the President for Homeland Security and Counterterrorism.

Now, I’m trying to shy very much away from expounding (and pounding, and pounding…) on the deadline thing, but you see how hard it is. Take this last task as an example. I think it’s smart, it’s necessary, it’s appropriate – it’s a great idea. But to ask to get this done – even by one of the largest departments in the federal government – in 120 days is impossible. The folks given this task will take one look at the federal register (all 69,428 pages as of 2006), and the similar-sized documents in each of the 50 states, plus the 75 largest cities and say that none of these problems can be resolved by regulatory or legislative action and we should just make do. So, what was once a noble goal, something that would make tangible progress toward preparedness is only half done (or worse) because of the amazing deadline.

In any case (picture my disgusted face), the final section on mass casualty care is something that has been overlooked in preparedness planning for far too long, so I’m very happy to see it included – and, to boot, the timeline makes sense. Because of that simple thing, I have faith that this will be one of the best outcomes of this Directive. It calls for the establishment of a Federal Advisory Committee for Disaster Mental Health made up entirely of subject matter experts. The Committee is given 180 days to make recommendations for protecting, preserving and restoring individual and community health in catastrophic health event settings. Notice there is no difference made between health care workers (responders) and the community. Both need post-event mental health care, and I hope that both are treated as such in the recommendations.

As before, a great section, no doubt, but completely undoable.

Image borrowed from the Civil Air Patrol

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