Homeland Defense Journal - January 2009 - 16

FEATURE ARTICLE end of 2013.” Terrorist attacks, natural disasters, and pandemics offer sober examples of how swiftly local health care professionals and medical infrastructure can be severely damaged, leaving tens of thousands of people without emergency medical support. The attacks of September 11, 2001 did just that, causing thousands of casualties and subjecting many more to health risks, because the scale of the disaster “…overwhelmed the response capacity of most of the local jurisdictions where the hijacked airliners crashed.” The loss of a large number of municipal emergency ﬁrst responders, attempting to rescue and evacuate people from the World Trade Center towers, illustrates the fragility of local support. Natural disasters can impact large regional areas and damage local emergency medical support. According to FEMA, the 1994 California Northridge earthquake killed 72 people, injured more than 9,000 people, hospitalized 1,600 people and rendered 11 hospitals unusable due to damage. In 2005, Hurricane Katrina killed at least 1,500 people, injured more than 5,000 people, and caused major damage to transportation, medical, and support infrastructure. Some catastrophes, however, leave physical infrastructure intact while decimating the human population— medical personnel included. With the increased speed of travel, infectious diseases can spread rapidly across large populations, crippling medical and support infrastructures. “[T]he formerly extinct 1918 strain of the inﬂuenza virus…was responsible for the global pandemic that killed between 2040 million people.” Former Sen. Bob Graham testiﬁed to the WMDPT Commission that: “Today [the 1918 ﬂu virus] is still in the laboratory, but if it should get out and into the hands of scientists who knew how to use it for a violent purpose, we could have multiple times the 40 million people who were killed 100 years ago.” While the above tragedies highlight some limitations of existing emergency medical capacity, they are not worst cases scenarios. A Category 5 hurricane, a magnitude 8 or greater earthquake, a nuclear or biological terrorist attack in a large metropolitan area, or an emergent pandemic would overwhelm local emergency medical support and expand to engulf regional or even national medical response structures. The surge requirement for a national pandemic affecting 300 million people is 75,000 health care professionals. Building National Emergency Medical Surge Local emergency medical surge is dependable in a disaster, attack, or pandemic only if infrastructure remains intact and health care professionals are not signiﬁcantly affected. Unfortunately, the aforementioned events show that the local impact is often signiﬁcant. The lack of existing local emergency medical surge, the likelihood of unusable local infrastructure, and the threat of more extreme disasters, attacks, and diseases, exposes an urgent need for national emergency medical surge of full-time responders and reserve health care professionals. National emergency medical surge, which includes pre-staged and mobile medical response equipment, would be more efﬁcient than maintaining surge capacity at every local level. Distributing responders and equipment throughout the U.S. would solve the problem of local medical failure, and modular systems would provide mobility across degraded or unusable transportation infrastructure. The Agency for Healthcare Research and Quality under HHS estimates the optimum medical surge capacity is 250 health care professionals per million people. Large metropolitan areas like New York, Chicago, or Los Angeles have populations of 5-10 million people. Using this formula then, a terrorist attack or regional natural disaster affecting 10 million people would require 2,500 health care professionals. Teams of 2,500 health care professionals in the 10 largest metropolitan areas results in a surge requirement of 25,000 health care professionals. The nation’s population is approximately 300 million people. The surge requirement for a national pandemic affecting 300 million people is 75,000 health care professionals. We propose to balance the risks of a major disaster or attack against the high cost of developing a nationwide surge capacity as follows. First, continue the expansion of the U.S Public Health Service (PHS) Commissioned Corps to 25,000 fulltime public health ofﬁcers organized into Disaster Medical Assistance Teams (DMATs) and Health and Medical Response (HAMR) teams, which could be tasked to provide immediate support to speciﬁc regions, such as the Gulf Coast or major metropolitan areas. Since 2006, PHS has been enlarging its Commissioned Corps of full-time public health ofﬁcers towards a target of 6,600 medical personnel, roughly 30 percent of whom could be deployable in emergency reaction teams by 2012. The 2009 PHS Commissioned Corps budget is $30 million. A fourfold increase in DMAT and HAMR teams to 25,000 would cost on the order of $120 million. This would not include the cost for modular hospitals or transportation capabilities. Our second recommendation is to establish a National Medical Guard, or else to expand the Army National Guard Medical Units to 50,000 health care professionals that can be mobilized and deployed in a federal or state status following the National Guard model. The nation’s Governors call upon their state National Guard units to respond to ﬁres, ﬂoods, hurricanes, and other disasters, and the President may authorize the use of the National Guard in a Title 32 status (federally-funded but State-controlled). This model can be based upon our response to Hurricanes Rita and Katrina, in which over 50,000 medical and non-medical National Guard members from every state, territory, and the District of Columbia gave assistance to Gulf Coast states. When not responding to emergencies, full-time and reserve personnel could help local communities by training and providing medical care in areas where needed. The Air and Army National Guard each have just over 100,000 personnel, and each 14 | Homeland Defense Journal Visit www.homelanddefensejournal.com

Homeland Defense Journal - January 2009

Table of Contents for the Digital Edition of Homeland Defense Journal - January 2009