Health Care: Money Needed To Bolster ERs, Provide Education in Bio-Warfare
With San Diego County maintaining a heightened state of alert over a potential terrorist attack, the Board of Supervisors will vote this week on allocating $15 million toward enhancing a variety of emergency health needs.
The county’s health care leaders, however, want to see that figure boosted to $25 million to fund an improved computer system for coordinating the county’s Emergency Medical Services System and protective gear and equipment to detect biological warfare agents, including anthrax and smallpox.
They also want funds to train health professionals on how to spot biological warfare infections, quarantine infected people and deliver treatments and educate the public on non-emergency use of hospital emergency rooms
The county is using $15 million from settlement money it received as a result of lawsuits against tobacco firms. Supervisors will vote Oct. 16 on how to allocate the money for emergency care.
County officials also expect an additional $10 million in federal and state funds.
The vote was preempted by a news conference Oct. 4 during which local health officials sought to reassure residents that they have joined forces to counter any potential threat. The conference followed the discovery of anthrax cases in Florida that officials say may have been caused by criminal activity.
San Diego County public health officer Dr. George Flores urged residents not to rush out and stockpile medicines or buy gas masks.
“If needed, large federal supplies of vaccine and antibiotics and other materials will be made rapidly available to our community,” Flores said.
Dr. James Hay, president of the San Diego County Medical Society, said local physicians will be given material to educate them on how to spot biological or chemical agents and treat associated illnesses.
Emergency Rooms Overwhelmed
Yet, some people contend the county’s emergency system would be hard pressed to deal with a germ attack given its own problems.
Dr. Roneet Lev, an emergency room doctor at Scripps Mercy Hospital and former president of the California chapter of the American College of Emergency Physicians, stated in a recent report that local emergency rooms are chronically overcrowded, understaffed and underfunded.
According to Lev, hospitals frequently turn ambulances away because their emergency rooms are full.
Because there aren’t enough nurses and support staff to take care of patients as well as a shortage of beds, including intensive care unit beds, patients are left waiting in emergency rooms and line the hallways.
County Supervisor Bill Horn said the emergency care problem in East County is especially severe.
Ambulances are turned away while too many patients use the county’s emergency rooms for non-emergency services.
Horn recommends a $500,000 injection from the tobacco funds to educate people on using community clinics for non-emergency care.
Additionally, Horn wants to put $5 million into a reserve account for “whatever we might need in public health and $3 million to upgrade the computer network.”
System Prepared For Crises
Lev said sweeping legislative and system reform is needed to clean up emergency care.
She agreed with local experts that the county emergency system has trained extensively to prepare for disasters, including shootings, bomb attacks, fires and evacuations.
Dr. James Dunford, director of medical services for the city of San Diego, said the county has long had a plan in place to deal with mass casualties and drills regularly.
Yet, he admitted the threat of germ warfare offers a whole set of new problems.
“We discovered in New York and with the (1978) PSA crash that often times there are few casualties, but many more fatalities,” he said.
The challenges in dealing with a biological attack are far greater. It starts with identifying the particular agent. Distributing large amounts of medicines to potentially hundreds or thousands of people quickly will also be difficult.
The national pharmacy stockpile has been in existence for years, but that is no guarantee that transporting, unpacking and distributing large amounts of medicines will go smoothly.
Dunford speculated that a majority of infected people would need to be cared for at their homes by a friend or family member.
At the same time, Dunford thinks a potential act of terrorism should not cause people to panic.
“Everybody is using everything in their power and using every resource to mitigate the problem,” he said referring to the county’s emergency network.
Lev said local hospitals are “dusting off their disaster manuals” and updating them.
Two major health care providers, Kaiser Permanente and Sharp Healthcare, said they have faith in the county’s existing emergency plan and will not implement major changes.
“We don’t have to reinvent the wheels the bones of our plans are solid,” said Sylvia Wallace, spokeswoman for Kaiser Permanente in San Diego. She added, “If you look at the overall picture, San Diego’s response team has been a model in the country.”
Janie Taylor, director of emergency, trauma and ambulatory services for Sharp Memorial Hospital, said medical staff members are prepared to deal with any type of a threat.
“There is one person in charge and everyone has a role,” Taylor said.
Yet, everyone agrees, the $15 million injection will help mitigate problems in emergency care, but is far from being a cure.
