Discussion Paper - Harvard Kennedy School

Ambulances to Nowhere: America's Critical Shortfall in Medical Preparedness for Catastrophic Terrorism

Sep. 30, 2001


While the public assumes the medical community and hospitals are adequately prepared for terrorist attacks, in reality hospitals are having problems keeping up with everyday capacity. Regulations reflect the public assumption that hospitals are prepared. For example, Title III of the Superfund Amendment and Reauthorization Act of 1986 led to guidelines that recommend that individual hospitals be ready to receive contaminated chemical casualties. However, the law does not specify how that capacity will be financed. The public, emergency responders and policymakers have limited knowledge of mass casualty care issues. Financial constraints have been placed on hospitals. The 1997 Balanced Budget Amendment curtailed longstanding Federal financial support for medical training programs. At the same time, expenses for new equipment, medications, construction, and maintenance have gone up. Other factors include unfounded mandates, charity cases, and a national shortfall of nurses. Hospitals keep a minimum supply of sterile supplies, equipment, and drugs, have a restricted workforce, and have difficulty maintaining immediately available medical specialists, all of which results in little surge capacity. Adequate preparation for mass casualty events is expensive and time-consuming. Millions of dollars have been spent on supporting weapons of mass destruction training for first responders, but not as much has been spent on hospital preparedness even though hospital health care capacity is more expensive and just as important as first-responder capacity. To improve capacity at hospitals, financial responsibility for the costs of preparation should be given either to the public as a whole or to the activities and organizations associated with increased risk of casualties.

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For Academic Citation: Barbera, Joseph A., MD, Anthony G. Macintyre, MD, and Craig A. DeAtley, PA-C. “Ambulances to Nowhere: America's Critical Shortfall in Medical Preparedness for Catastrophic Terrorism.” Discussion Paper, 2001-15, Harvard Kennedy School, September 30, 2001.