The next challenge in healthcare preparedness: catastrophic health events.

Assistant Secretary for Preparedness and Response (ASPR), under contract No. HHSO100200700038C. This report would not have been possible without the more than 100 dedicated and committed hospital and state preparedness planners and other experts who contributed their time to provide the Center for Biosecurity project team with critical insight into the state of U.S. hospital preparedness, or without the efforts of the participants of the June 2008 and February 2009 Issue Analysis Meetings in Baltimore, Maryland. The project team would also like to give special thanks to the leadership and staff of the ASPR Office of Preparedness and Emergency Operations components of the Hospital Preparedness Program and State and Local Evaluation for their guidance and support in the development of this report. (the Center) to conduct a 2-year, comprehensive assessment of the HHS Hospital Preparedness Program (HPP), from the time of its establishment in 2002 through mid-2007, and to develop recommendations for improving and evaluating future hospital preparedness efforts. (delivered March 2009). A key finding of the Evaluation Report was that, while much progress has been made in healthcare preparedness for common medical disasters, the U.S. healthcare system is ill-prepared for catastrophic health events (CHE), and there is as yet no clear strategy that will enable an effective response to such an event. For this report, the definition of " catastrophic health event " is that put forth in Homeland Security Presidential Directive 21 (HSPD-21): an event that could result in tens or hundreds of thousands of sick or injured individuals who would require access to healthcare resources. This Preparedness Report proposes the following key elements of a national strategy for healthcare preparedness and response: • Definition and vision of a U.S. healthcare system prepared to handle the response to a spectrum of mass casualty events that vary in size and severity from common medical disasters (eg, a bus crash or tornado), to catastrophic health events (eg, a nuclear detonation) that would seriously injure or sicken tens of thousands of people or more. • Recommendations and actions that will lead to a healthcare system capable of responding to the full spectrum of mass casualty events, including CHEs. Methodology The methodology used for this Preparedness Report included a thorough review of the published U.S. and international literature on healthcare disaster preparedness, healthcare response to disasters, and complex systems theory literature; a review of HPP program guidance from 2008 and 2009; and …