Jun 20, 2006 (CIDRAP News) – The US emergency medical care system is woefully inadequate and unprepared for a pandemic, bioterrorist attack, natural disaster, or other national crisis, three recent reports from the Institute of Medicine (IOM) conclude.The nation’s emergency care system, the reports say, is overburdened, underfunded, and too fragmented to communicate and cooperate effectively across levels and geographic areas. It has little surge capacity to deal with a disaster. In addition, emergency care staff members are often not adequately trained to respond to large-scale disasters or to work with pediatric patients.The IOM report preceded by 2 days a Department of Homeland Security report that describes major shortcomings in the nation’s general preparedness for catastrophic events such as category 5 hurricanes.Emergency system needs comprehensive help”Unfortunately, the [emergency care] system’s capacity is not keeping pace with the increasing demands being placed on it,” said Gail L. Warden, MHA, in a Jun 14 news release from the National Academies, the IOM’s parent organization.”We need a comprehensive effort to shore up America’s emergency medical care resources and fix problems that can threaten the health and lives of people in the midst of a crisis,” added Warden, chair of the committee that wrote the reports and president emeritus of Henry Ford Health System in Detroit.To remedy this situation, the committee that wrote the reports recommends that:Congress appropriate at least $325.5 million toward shoring up the emergency care system—plus funding for readying the system for potential disasters.The emergency care system be “regionalized” so that neighboring hospitals, emergency medical services, and other agencies work together to provide care for all the people in their region.The Veterans Health Administration (VHA) be integrated into civilian disaster planning and management.Guidelines on overcrowding and redirecting ambulances away from packed emergency departments (EDs) be enforced, and coordination and communication between facilities improved.Streamlining tools, such as queuing theory, dashboard systems, and 23-hour observation units, be used to optimize patient treatment and flow.The IOM’s 26-member Committee on the Future of Emergency Care in the US Health System convened in September 2003. Its conclusions on problem areas and recommended solutions have just been published as a series of three reports: Hospital-Based Emergency Care: At the Breaking Point, Emergency Medical Services at the Crossroads, and Emergency Care for Children: Growing Pains.Concerning funding, an IOM overall summary of the three documents states, “Perhaps the area in which greater funding is most important is disaster preparedness. To date, despite their importance in any response to disaster, the various parts of the emergency care system have received very little of the funds that Congress has dispensed for disaster preparedness.”In part this is because the money tends to be funneled through public safety agencies that consider medical care to be a low priority. Congress should therefore make significantly more disaster-preparation funds available to the emergency system through dedicated funding,” the summary says.Hospital-Based Emergency Care: At the Breaking Point specifies the following preparedness funding priorities:Strengthening and sustaining trauma care systemsEnhancing ED, trauma center, and inpatient surge capacityImproving EMS response to explosivesDesigning evidence-based training programsIncreasing the availability of decontamination showers, standby intensive care unit capacity, negative-pressure rooms, and appropriate personal protective equipmentConducting international collaborative research on the civilian consequences of conventional-weapons terrorismIn addition to asking for more preparedness funding, the IOM committee says Congress should establish a pool of $50 million to reimburse hospitals for uncompensated emergency and trauma care.Also, in the next 5 years Congress should provide $88 million to foster coordination and “regionalization” of emergency care and $187.5 million to address shortcomings in emergency pediatric care, the reports conclude.Regional coordination urgedRegionalization would involve directing patients not to just the nearest medical center, but to the nearest facility in the region equipped to handle patients’ specific needs. It “can improve health outcomes, mitigate overcrowding, and reduce costs,” according to the IOM news release.Regionalization would also eliminate the need for every hospital to maintain on-call services for every specialty, which would help address staff shortages caused by decreasing numbers of specialists willing to take emergency calls, the news release said.Hospital-Based Emergency Care says the VHA is “well positioned to enhance regional response, particularly since its hospitals are required by law to maintain excess capacity.” Therefore, the report says, federal organizations should work with states to integrate the VHA into regional disaster planning.To remedy overcrowding and ambulance diversions, the committee asked that the Joint Commission on Accreditation of Healthcare Organization (JCAHO) reinstate strong guidelines to reduce crowding, “boarding” patients in halls or exam rooms until beds become available, and diverting ambulances when EDs are overcrowded. It also called on the Centers for Medicare and Medicaid Services to convene a working group to develop standards to address the situation.Further, the reports note, overcrowding and ambulance diversions are caused by lack of coordination and communication between facilities. Patient admission and transport should be better coordinated across municipalities, the reports conclude.In recommending using queuing theory to help improve efficiency, the committee highlighted its ability to smooth the peaks and valleys of patient admissions, which can eliminate bottlenecks, improve care, and lower costs.The 23-hour observation unit, or clinical decision unit, the reports say, can help ED staff with patient triage, which can help reduce ED crowding. And dashboard systems can help coordinate patient flow.DHS reports on preparedness for catastrophesIn another lengthy report, the Department of Homeland Security (DHS) on Jun 16 assessed the nation’s preparedness for catastrophes such as a major terrorist attack or a category 5 hurricane. The assessment included all 56 states and territories, as well as 75 urban areas.The assessment was ordered by President Bush and Congress in the wake of Hurricane Katrina, according to a DHS news release. Last February the agency released a report based on preparedness self-assessments by states and major cities; the new report represents the findings of expert “peer review teams” that visited the states and cities and checked their plans against national standards.Among the key findings in the Nationwide Plan Review for states and urban areas are:Most planning processes are not adequate as defined in the National Response Plan (NRP).A common deficiency in state and urban areas is the absence of a clearly defined command structure.The ability to give the public accurate, timely information should be strengthened.Significant weaknesses in evacuation planning are of profound concern.Resource management is the “Achilles heel” of emergency planning.Among the key findings for the federal government are:Clear guidance needs to be developed on how state and local governments can coordinate operations with federal partners according to the NRP.Collaboration between government and non-governmental organizations should be strengthened at all levels.Federal, state, and local governments should work with the private sector to optimize transportation of people with disabilities before, during, and after an emergency.The federal government should provide leadership, guidance, and resources necessary to build a shared national homeland security planning system.See also:IOM’s “Future of Emergency Care” seriesNational Academies Jun 14 press release
Following the resignation on Monday, October 6, of former Justice Minister Cllr. Christiana P. Tah, rumors are now flying around Monrovia as to who will succeed the former Justice Minister.Liberia’s former Attorney-General and Minister of Justice, resigned her post for what she termed among other things, “collapse of rule of law” within the Ellen Johnson Sirleaf administration.Already, familiar names have been thrown from corner to corner, even within the corridors of power. Among the possible candidates are former Justice Minister under Liberia’s ex-President Charles Taylor, Cllr. Lavela Supuwood, the managing partner for the TIAWA Law and Associate, Cllr. Yarmie-Quiqui Gbeisay, Sr., President Sirleaf’s private lawyer, Cllr. Roland Dahn, as well as Cllr. Michael Jones, among others.But though Cllr. Jones’ name surfaced, his chances are infinitely remote since, regardless of his highly reputed knowledge of the law, the Supreme Court suspended him from practicing law for five consecutive years since 2012.Yet, to even drop his name in the bucket-list suggests that the President’s options may be assumed severely limited. The Justice Ministry’s portfolio requires someone at the helm who is morally strong and knowledgeable enough to manage the nation’s security forces, on the one hand; and who can be the “lynch-pin” in the relationship between the Executive branch of Government and the Judiciary, on the other; and everything in between. Other names being mentioned within the public domain are the present Solicitor-General, Cllr. Betty Larmie Blamo (whose name came first on the list), as well as former Solicitor-General, Cllr. Tiawan Gongloe, and Cllr. Winston Tubman, among others. Cllr. Tubman in 2011, contested for the Liberian Presidency on the ticket of the opposition Congress for Democratic Change (CDC) against the incumbent President Sirleaf, but lost the vote. Tubman, who now runs a law practice in Monrovia, also served as Minister of Justice under the late President Samuel K. Doe in the early 1980s. These names are being especially speculated among top-notch lawyers in the corridors of the Temple of Justice in Monrovia. Meanwhile, it is reliably learnt that following the resignation of Cllr. Tah, official activities at the Ministry of Justice are being paralyzed owing to recent decision by President Sirleaf to dismiss several highly placed officials of the MOJ.Without the prosecuting arm of the government in the face of Minister Tah’s resignation, security apparatuses, including the National Security Agency (NSA), the Liberian National Police (LNP), the Bureau of Immigration for Naturalization (BIN) and other smaller units are doomed to go-slow on operations, pending the appointment of their new boss by the President. The public is, therefore, hoping that President Sirleaf will appoint a candidate with strong moral character and a wealth of experience in the legal profession, particularly dealing with the public in the face of the country’s present day reality. “This is to avoid any incident of regret in the wake of the resignation of Cllr. Tah,” one eminent lawyer hinted the Daily Observer Tuesday during a mobile phone conversation. Also, several other persons who spoke to the Daily Observer late yesterday expressed regret for Cllr. Tah’s resignation, indicating that her decision was a “great setback to the justice system since she was one of such persons with level-headed administrative qualifications.” On Monday, Cllr. Tah resigned her post when noted that “I cannot be the Minister of Justice and not supervise the operations of the security agencies under the Ministry of Justice, for example; or what is ‘the rule of law’ if the President asserts that she does not trust the Ministry of Justice to independently investigate allegations of fraud against the National Security Agency? What is ‘the rule of law’ if a duly appointed Minister of Justice with oversight for security has grave concerns about what her volitional resignation will mean for her own personal security and freedom as a Liberian citizen?”Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)
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