Rush, CPHM, is passionate about what he does – and that passion scares him. More accurately, he’s frightened by what he finds, or really doesn’t find, among hospitals and other healthcare facilities three years after the terrorist attacks on Sept. 1, 2001. These facilities either are not preparing to handle the aftershocks of man-made or natural disasters or they’re ill-prepared based on unrealistic scenarios and suspect data.

As with most operational directives it boils down to money. And despite rest-assuring reports to the contrary vendors are equally as perplexed about the magnitude of a realistic disaster planning process using 9/11 as a backdrop and a benchmark.

Despite an ongoing undercurrent of dirty bomb, suicide bomber, contagion spreading threats, as well as four violent hurricanes in six weeks in Florida, tornadoes in the Great Plains and Midwest, and flooding, mudslides and wildfires out West, Rush sometimes feels like Chicken Little.

"Unfortunately, when it comes to disaster planning we have short memories," he noted, "especially for appropriate stock levels and developing supply requirement lists for hospitals. They are woefully behind the eight ball in getting the resources they need." That includes the appropriate number of respirators, ventilators and other necessary medical devices and equipment.

"What we’re seeing the most in the industry is that hospitals want to be prepared but there’s no money available for them to accomplish it effectively," said Rush, president of Medlog Inc., a consulting firm specializing in disaster planning assistance, training and outsourcing. "Everybody knows we’re going to get hit again but we can’t figure out when and where. And federal funds are just not getting down to the hospitals in sufficient quantities for them to be ready."

Ironically, 30 years ago when the United States was embroiled in the Cold War, the Vietnam War, the Middle East crisis and domestic gas shortages hospitals weren’t equipped with the computer forecasting capabilities they have today, Rush noted. And hospitals, for the most part, operated warehouses stocked with enough supplies to last at least a month without reordering. At the same time, distributors had to support those demand habits in their own depots.

Today, however, distributors such as Owens & Minor have developed software that can do it down to the case level based on purchasing history, and most hospitals have exited the warehouse-management business in favor of shifting that responsibility to distributors in terms of just-in-time, stockless and vendor-managed inventory programs.

Taking stock of lacking stock
But the bottom line complicating any disaster planning efforts is simple economics. "Nobody can afford to hold enough inventory for an event that may happen," Rush said.

Even the shoring up of regional supply stockpiles tends to fall short of anticipated demand. For a recent real-life example recall what happened with the availability of gas during the clean-up efforts following the Florida hurricanes. "Every time there’s a surge in demand it sucks the system dry," Rush said. "When everybody draws on a commodity line at the same time it shuts down the system. When there is a surge in demand it’s going to take a region down very quickly. It’s like a cascade." Last month’s flu vaccine shortage is a case in point.

"People think there’s this big warehouse behind every hospital that contains tons of supplies so we won’t ever run out," he said. These days, however, many hospitals maintain very little inventory – maybe enough for a day or two (not accounting for any secret stashes), according to Rush. As a result, distributors have lowered their inventory holds in order to reduce their carrying costs. Both inventory momentum and turnover are phenomenal, according to Rush. "That’s good for finance but trouble for disaster planning," he said.

"Distributors don’t fight wars," he continued. "You’ll get excellent service on a daily basis but we’ve not yet been tested during a real crisis."

Healthcare facilities shouldn’t use the war in Iraq as a baseline for disaster planning strategies in the area of medical supplies, according to Rush. "The consumption of medical supplies in Iraq doesn’t look like a [traditional] war," he said. "It resembles something along the lines of an inner city – like New York – during a violent crime wave. What we’re seeing overseas is not the demand we see during a full-blown war but more of elevated consumption."

Realistic demand forecasting for disaster planning comes down to simple math, Rush indicated. It’s the difference between treating 10 to 15 injured people per day versus treating 35,000 to 40,000 people per day suffering from burns, infections and wounds. Even the terrorist-instigated hostage crisis that produced hundreds of casualties and injuries at that Russian school in September doesn’t come close. A distributor may stock enough supplies in a safety net to get facilities started but not enough for a long-term blitz, he said. "They can’t cost-justify stocking for what may happen," he said, such logic is understandable.

In fact, one distributor told Rush that it kept a rotating 100 days worth of supplies in stock, which should suffice. But Rush questioned whether that 100 days worth of supplies was geared for normal consumption days or crisis-inspired surges? It’s like comparing water flowing through a drinking straw versus water gushing out of a fire hydrant, he noted. "We have millions of dollars worth of supplies being distributed freely throughout the country," he said, "but in times of crisis we may not be able to get them to places within a few hours."

Hospitals to Uncle Sam: We want you
That’s why he believes it’s the bailiwick of government to maintain adequate stockpiles by supporting a regional warehousing network to back up hospitals and distributors, even though federal agencies have been operating under the private sector’s prime vendor distribution strategies for the last decade or so.

Still, Rush expressed confidence in the government’s national stockpile for dealing with outbreaks, including anthrax, plague and other potentially lethal infections. In fact, the government’s stockpile of post-exposure prophylactic meds is on target, he said with assurance. "Even with pain meds, which are so necessary in a mass casualty event, you can’t come up short," he added.

But with medical supplies needed to treat mass victims of a dirty bomb detonation with burns and wounds to the appendages, chest and head he’s uncertain. Prior to 9/11, disaster planners couldn’t fathom the idea of terrorists hijacking occupied commercial jets to fly them into buildings for their cause. Such chutzpah was the realm of Hollywood. Now disaster planners expanded their thinking to include crop dusters, food and water supply and attacks on concentrated populous areas, such as airports and amusement parks like Walt Disney World, and stadia during sporting events.

"It’s amazing how many tons of burn creams, gauzes, sponges and other medical supplies are needed to treat thousands of casualties at once," he said. "Distributors can’t keep 25 times what they normally need with the perception that something may happen.

"You’re either economically efficient and unprepared for disaster or you are prepared for disaster and economically inefficient," he deadpanned. "There really is no middle ground."

Because distributors and healthcare facilities must keep their operations as lean and mean as possible, Rush said, the Centers for Disease Control and Prevention must further expand its strategic national stockpile. "They’re in good shape with antibiotics but the big question remains about who handles medical/surgical devices and equipment?"

Profile the bad guys
Healthcare facilities have to understand the motivation, strategies and tactics of terrorists. "The bad guys don’t want to kill people," Rush said. "They want to sever limbs and injure people to the point that it stresses resources to the max." For example, thousands of screaming burn victims, as well as the prostrate and walking wounded stretches the limits of what a healthcare facility can do that’s not properly prepared to handle it, according to Rush.

Healthcare facilities must assemble a realistic requirement list of supplies to handle victims of chemical, biological, radioactive, nuclear and environmental incidents, a k a CBRNE events, Rush urged. While such predictive modeling is essentially a crystal ball exercise, healthcare facilities don’t have to shoot in the dark or extrapolate complicated analyses of data gleaned from high-tech computer simulation software, he noted.

"If hospitals need a baseline or a benchmark to work with they can contact the military," Rush advised. "The Army has requirement lists based on the number of CBRNE event victims that it is willing to share with the private sector if asked." Rush should know. He spent the early part of his nearly 30-year career overseeing war-time and disaster-related medical logistics and readiness requirements for the Air Force before he moved to the private sector as a hospital materials manager for a succession of facilities.

Another useful source is the Federal Bureau of Investigation, which can be recruited to develop and evaluate threat scenarios that will influence needed supply capacity.

But perhaps the ultimate disaster-planning mentor should be healthcare materials management counterparts in terrorist hotbeds, such as Tel Aviv, Israel, whose facilities have to be prepared 24/7 for a suicide bomber to hop on a bus or enter a diner. In fact, Rush helped develop a "4-Echelon Healthcare System" plan with assistance from the Israelis in Tel Aviv. (See graphic.)

"This is not easy stuff but it’s better to have a usable ballpark estimate than to be caught unprepared," he said.

Even with natural disasters – be they utility- or weather-related – the planning measures should be similar as contingency projects. "If you’re in the Midwest or Great Plains, you and your distributors should be talking," he said. "If you’re on the Gulf Coast, you and your distributors should be talking. This year, in particular, is bad and it may be a fluke but that’s no excuse.

"Hospitals are having a hard enough time keeping their doors open with reimbursement levels the way they are so they certainly can’t overlook planning for what might happen even if they don’t have the time or resources," he continued.

"I was sure after 9/11 there would be a demand for disaster planning assistance, but it’s now three years later and we’re still not prepared," he lamented. "I

 would never have imagined we would not be appreciably more prepared three years after being hit.

"I’m so glad we haven’t had any attacks since 9/11 but I’m so scared that we’ve become complacent," he added. "Everybody wants to be ready but nobody wants to pick up the check."

MMs on the hot seat
Rush urges materials managers to work with disaster planning experts on the state and municipal levels so that all the necessary stakeholders can understand the problem and prepare accordingly. "Everybody needs to be working with the same sheet of music."

Economics should play a role only after requirements are established and plans are developed, Rush advised. "Hospitals should figure out what they need and then look at what they can afford," he said. "Any shortfall would have to be assumed by the government stockpile. But people aren’t doing that. It’s silly to say that because you only have 10 people or X amount of dollars you can only plan for this or that event. You can’t think like that." Instead, he recommends hospitals to establish casualty estimates (including injuries) and work backward from there.

"When something bad happens, materials managers will be up to their ears," he warned. "It’s something they have to deal with. [Materials managers] are all facilities have in a disaster to make sure supplies arrive. If they’re not on top of what’s available, then shame on them."HPN