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When Disaster Strikes

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Efforts to add science and systems to disaster medicine could be undermined in the United States by federal budget cuts. The Hospital Preparedness Program, for example, has seen its funding decline from $515 million a year in 2003 to $331 million today, a reduction that could endanger the sustainability of efforts to improve hospital responses to disaster, says Dan Hanfling, an emergency physician and professor at George Washington University. He worries that full-scale drills for emergency incidents, which may cost up to $200,000 to stage—and that depend on HPP for funding—may be replaced with inadequate “tabletop” exercises. “Our emergency response programs are only going to be as good as the people who are expected to make them work,” says Hanfling, who also serves as a special advisor for emergency preparedness and response for Inova Health System in northern Virginia. “We can’t simply rely upon equipment, supplies and pharmaceuticals. Without trained and experienced staff, those materials won’t be put to effective use.”

A baby being born in a field hospital

Xinhua/eyevine/Redux Pictures

A baby boy was delivered in Sichuan Province, China, four days after an earthquake in 2013.

“Haiti highlighted what most of us who have been in the disaster field have known for years: There’s a need for people who know what they’re doing in these environments and who aren’t putting themselves or others at additional risk,” says Aschkenasy, who served there with the Harvard Humanitarian Initiative. “Before we allowed any medical responder in our field hospital, we sat them down at the security tent and checked their credentials.”

In contrast, Aschkenasy saw a small sign of progress in the Philippines. When she and her team arrived at Cebu City last year, she says, they were asked to register immediately as a foreign medical team in a book right at the airport. “That’s the first time I’ve been asked that in 15 years of disaster work,” she says.

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1. Advanced Disaster Medical Response Manual for Providers, Second Edition, edited by Susan Miller Briggs, Ciné-Med, Inc., January 2014. Briggs, a trauma surgeon at Massachusetts General Hospital and global expert in disaster medicine, enlisted more than three dozen contributing authors to create a comprehensive handbook that reviews medical and public health response to disasters.

2. “Disaster Medical Sciences: Towards Defining a New Discipline,” by Kristi L. Koenig, Health Affairs Blog, Dec. 19, 2013. Koenig, a leading scholar in disaster medicine, provides a succinct review of the challenges under way as the field evolves as a science.

3. “Health Care Preparedness Funding: Are We Inviting Disaster?” by Dan Hanfling, Health Affairs Blog, Dec. 31, 2013. Emergency preparedness expert Hanfling addresses the potential domino effect of federal funding cuts for hospitals and other stakeholders in the emergency response system and the risks, such as potential lives lost and loss of public confidence, should a catastrophe take place.

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