Public Health Preparedness

Since the September 9/11 attack, the US has continued to experience the threat of terrorist attacks. Terrorist attacks are associated with casualties that necessitate the involvement of the healthcare system. Emergency rooms are supposed to treat those injured in the conventional terrorist attacks. In large attacks such as the 9/11 attack, hospitals are tasked with handling a large number of casualties beyond their capability. Terrorist attacks also presented the challenge of hospitals having to handle terrorists. Given the challenges presented by a terrorist attack, there is a need for hospitals to create a policy on the levels of preparedness to handle such incidences. This paper presents a public health preparedness in case of a terrorist incident.

Examining Information Management and Health Care Records And How the Legal Reporting Requirements Impact Health Care

Among the ten essential public health services, the hospital emergency preparedness will focus on diagnosing and investigating, assuring a competent workforce, developing policies and plans, and accessibility to care.

To create a competent workforce, the preparedness plan will conduct specialized training in the clinical management of disaster victims. Given that disaster training is not a core component of medical and nursing curriculums, the hospital will introduce on-the-job training (Centers for Disease Control and Prevention, 2017). The training will delve into handling victims of a terrorist attack as well as a terrorist attack on the hospital (Centers for Disease Control and Prevention, 2017). The training will help them detect bioterrorist attack victims as well as an indoor attack and how they can respond. 

Given that the hospital is located in an urban area and operates in a near full capacity, the hospital will prepare on ways it can do a number of things to free up capacity and extend its resources. In the recent terrorist attacks, the most number of people that were injured in the 2019 Texas shooting is 24, while the 2013 Boston marathon shootout injured 280. The bed capacity figure that seems appropriate to handle a terrorist attack is 50. The preparedness will emphasize on physical space. Hospital capacity on short notice will be increased by halting elective admissions and discharging non-critical patients (Boyce, 2016).

In planning, the hospital will prepare for coordination with other hospitals in the region. The coordination plan will include how resources can be shared with other hospitals. These include human resources and equipment. Ensuring communication in case of an attack will be essential. 

The hospital will focus on diagnosing and treating patients. In the events of a terrorist attack, the hospital will conduct casualty decontamination as well as primary and secondary and Medicare care to stabilize patients. The patients will be sorted depending on the severity of the injury. Those in critical condition will be taken to the ICU. The hospital will discharge those with less critical injuries and organize follow-ups. Follow-ups are important to ensure victims are assessed for trauma or depression (Miller, 2004).

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The Importance of Continuing to Evaluate Patients, As Stipulated by the Emergency Medical Treatment and Active Labor Act (EMTALA), During the Emergency

EMTALA is a state law that was enacted in 1986 requiring that any person, irrespective of the ability to pay or insurance status, coming to the emergency department be stabilized and treated (Boyce, 2016). The law aims at preventing healthcare organizations from relocating uninsured or Medicaid patients to public hospitals without treating or at least stabilizing them (Boyce, 2016). Moreover, given that terrorist attacks are associated with explosions, the victims are subjected to life-threatening injuries such as burns, closed and open brain injury, fractures, and concussions, among others. Such injuries fall under the EMTALA definition of an emergency.

It is important for hospitals to uphold EMTALA since they have a moral obligation to save a life. The sacredness of life, coupled with the moral obligation of saving the life of every person, should not be defied by financial interests. Nurses and physicians should be guided basic values to decide ethical dilemma to decide. The beneficence principle requires care providers do good to the patient, while non-maleficence requires that they do not harm the patient (Deboutte, 2016).  Mixing business and care may lead to neglect and unintended abuses that violate patient dignity (Merin, Goldberg, & Steinberg, 2015). Generally, it is morally recognized from a philosophical and ethical standpoint that all humans, regardless of financial position, deserve medical care.

Failure to evaluate patients as required by EMTALA may attract penalties. The CMS and OIG, which have been mandated by law to enforce EMTALA, note that a hospital or physician’s Medicare provider agreement can be terminated if the Act is violated. According to the American College of Emergency Physicians (ACEP) (2020), hospitals can attract fines of up to $50,000 per violation. Physicians, as well as on-call physicians, can also attract fines of up to $50,000. Victims of the terrorist attack may take legal action against the healthcare facility for personal injury in a civil court under a “private cause of action” (ACEP, 2020). If a hospital decides to “dump” un-stabilized patient in another hospital, the receiving facility, if it suffers a financial loss from this action, can bring a suit to claim damages. It thus follows that financial penalties involved necessitate upholding of EMTALA.

The hospital should see the opportunity of handling patients during emergency situations. Terror attack victims present challenges that stretch hospitals’ expertise beyond their current position. Physicians have their innovativeness, and clinical decision making put to the test. The ICU capabilities, as well as the doctor’s ability to perform restorative surgeries, can be evaluated and improved after emergency situations (Deboutte, 2016).  Upholding EMTALA thus offers an opportunity to learn.

Three Measures That Can Be Used In Order To Maintain the Electronic Medical Record System during the Emergency

Electronic health records have come to define care in the healthcare system by offering timely information about a patient. However, disasters and emergency situations can severely disrupt the EHR if hospitals are not well prepared. HIPAA requires covered entities to develop contingency plans for responding to emergencies and safeguarding EHR (Horahan et al., 2014). In this regard, hospitals should ensure they have a data backup plan, interoperability, and training. 

During a terrorist attack, nearby hospitals may be forced to handle a large number of patients. This is in addition to handling normal emergencies outside the attack. This may overwhelm the HER hence a need to ensure its efficiency (Deboutte, 2016).  Data can be temporarily stored in a remote data warehouse or with a cloud-based service to allow the accommodation of new patients. The hospital should ensure temporary withholding and retrieve of data is applicable in their EHR system. 

Hospitals should ensure their system has interoperability. Interoperability is defined as “the ability of two are more systems or components to exchange information and subsequently use it” (Horahan et al., 2014). However, the hospital must be part of a larger healthcare organization to achieve this feature. Hospitals should make sure their EHR system is compatible with other local and regional systems. This assertion is informed by the fact that terrorist victims may not necessarily belong to the hospital, but their medical history is needed. During an emergency, the care that is administered should incorporate a patient’s history, taking into consideration a patient’s illnesses, allergies, and medication history (Deboutte, 2016).  For example, given that stabilizing a patient requires several medications to be administered, a patient’s allergies and a history of hypertension are crucial. Failure to utilize patient information may amplify their prior conditions. Horahan et al. (2014) argue that hospitals EHR must be able to request information from the patient’s care providers on time and act on it. The EHR system should facilitate the smooth transfer of data without violating HIPAA regulations.

The hospital practitioners will be trained on operating and navigating the EHR during an emergency. Given that a huge number of patients will be admitted, they will be trained on how the system can quickly help them make decisions. The training will also delve into how they can utilize care information from various departments ranging from diagnosis, treatment, to medication. They will also be trained on using timely using the EHR as it can lead to slow administration of care.

Why Health Insurance Should Be accepted During the Emergency as a Potential Source of Income for the Facility

In the event of a terror attack, the hospital will continue to accept insurance for various reasons. The loss due to EMTALA is very significant hence a need to accept insurance. ACEP (2020) cited a 2003 report of the America Medical Association, which noted that emergency physicians provided $138, 300 of EMTALA services every year. The report also noted that 30 percent of emergency physicians offered in excess of 30 hours of EMTALA services every week. 

Accepting insurance means that the responsibility of determining whether the emergency was genuine is transferred to the insurance provider. Kliff (2018) narrates the story of a patient who visited an emergency room with abdominal pain and fever only for the final diagnosis to reveal she had ovarian cysts that required non-emergency care. She was sent a bill of $12,000 after the insurer refused to pay, the hospital recovered the fees (Kliff, 2018).

The number of insured people in the US stands at 91.2 percent of the population. Those privately insured are 67.2 percent (Kliff, 2018). The high number of insured people means that there is no problem accepting or requesting insurance even during an attack.

Analyzing the Extent to Which This Emergency Might Affect the Quality of Care Provided To the Patients and the Unimpeded Operation of the Organization

A terrorist attack may affect the quality of care in several ways. In the event of a terror attack, most people with minor injuries or those who have been briefly discharged from hospitals are likely to self-prescribe medications (Deboutte, 2016). During the anthrax scare following 9/11, people hoarded the drug Ciproflaxin, used to treat anthrax (Deboutte, 2016). Some took pro-prophylactic doses while others demanded the drug from their doctors who simply caved in to the pressure. During bombings, those with minor injuries might self-prescribe painkillers (Deboutte, 2016). To avoid self-treatment of patients in the event of a terrorist attack, care providers must talk to them about the role of medical treatment. This will help curb panic behavior that leads to self-treatment.

During terror attacks involving a large number of casualties. Hospitals might find themselves disadvantaged in terms of supply of resources such as medical personnel with training on multiple casualty incidents (MCI) (Deboutte, 2016).   Doctors might neglect those with less significant injuries or might withhold critical treatment because of the volume of MCI (Al-Shimemeri, 2012). This might also cause burnout among practitioners, further amplifying neglect. Neglect can raise the severity of an injury or lead to death. The hospital can concentrate on stabilizing and referring patients to other hospitals.

References

Al-Shimemeri, A. (2012). Challenges Faced by the Intensive Care Unit during a Terrorist Attack: The Riyadh Experience. ISRN Emergency Medicine, 2012, 1-5. https://doi.org/10.5402/2012/859783

American College of Emergency Physicians (ACEP). (2020). EMTALA Fact Sheet. ACEP // Home Page. https://www.acep.org/life-as-a-physician/ethics–legal/emtala/emtala-fact-sheet/

Boyce, R. J. (2016). Measuring the Correlation Between the Integration of Community Engagement-Related Essential Public Health Services and Health Outcomes in Rural Local Public Health Agencies.

Centers for Disease Control and Prevention. (2017). Ten Essential Public Health Services and How They Can Include Addressing Social Determinants of Health Inequities. Atlanta, GA: Centers for Disease Control and Prevention.

Deboutte, D. (2016). Terrorism and health. Journal of Intelligence and Terrorism Studies, 1, YKKRQ6.

Horahan, K., Morchel, H., Raheem, M., Stevens, L., & Pawlak, S. (2014). Electronic Health Records Access During a Disaster. Online Journal of Public Health Informatics, 5(3). https://doi.org/10.5210/ojphi.v5i3.4826

Kliff, S. (2018, January 29). An ER visit, a $12,000 bill — and a health insurer that wouldn’t pay. Vox. https://www.vox.com/policy-and-politics/2018/1/29/16906558/anthem-emergency-room-coverage-denials-inappropriate

Merin, O., Goldberg, S., & Steinberg, A. (2015). Treating terrorists and victims: a moral dilemma. The Lancet, 385(9975), 1289. https://doi.org/10.1016/s0140-6736(15)60674-2

Miller, L. (2004). Psychotherapeutic Interventions for Survivors of Terrorism. American Journal of Psychotherapy, 58(1), 1-16. https://doi.org/10.1176/appi.psychotherapy.2004.58.1.1