Some of the quickest emergency assistance to victims of Hurricane Katrina did not come from the American Red Cross or FEMA. It came from Wal-Mart.Millions of people were displaced or otherwise affected by the Gulf Coast calamity. Many waited for days as agencies struggled to provide assistance. Wal-Mart moved faster than traditional emergency aid groups because the retail giant has mastered logistics and supply chain management, according to a study by the University of Arkansas.

Supply chain management involves more than delivering products to a destination. It requires orchestrating the transportation, distribution, storage and timely delivery of inventory, while minimizing costs and serving the maximum number of consumers. It is a desperate balancing act when human life is at stake.

Wal-Mart can be commended for its rapid response to Hurricane Katrina, because consumer goods like food, water and other supplies are important to recovery efforts. But "big box" stores do not carry medical supplies. When it comes to saving lives in a disaster, hospitals and other medical agencies are on the front lines.

Hurricane Katrina exposed the weaknesses of government agencies and relief organizations when it comes to delivering emergency supplies and equipment. The overwhelming number of victims and widespread destruction exacerbated the coordination effort. It is now clear that hospitals and their group purchasing organizations (GPOs) must carefully develop their own supply chain management (SCM) strategies and infrastructure to ensure essential provisions are available during a natural disaster or terrorist attack.

Today, most hospitals are often unable to acquire and deploy the resources needed to respond to a large-scale disaster effectively, according to a 2003 Government Accountability Office report on hospital bioterrorism preparedness1. Senior federal officials from the investigative arm of Congress conducted an exercise that highlighted serious weaknesses in the medical response system. The exercise simulated a bioterrorism attack that infected a community with pneumonic plague, a highly contagious sickness that must be treated with antibiotics within 24 hours. Untreated, the mortality rate is near 100 percent.

Three days after the disease’s simulated release, 500 people had symptoms and there were shortages of antibiotics and ventilators. Two days later, 800 cases were reported, with 100 dead. Medical care was shut down because of insufficient resources. About 3,700 cases of plague were reported after a week, with between 950 and 2,000 deaths. The hospitals did not have the equipment to handle the increased patient load. Half of the hospitals studied in the report had fewer than six ventilators per 100 staffed-beds, three or fewer personal protective equipment suits and fewer than four isolation beds.

Of course, it is impossible to keep on hand enough supplies or equipment to be ready for every disaster and mass casualty event a hospital may face. That is why collective and regional planning is necessary. For example, states can access resources like the CDC’s Strategic National Stockpile of antibiotics, antidotes and other materials. However, according to testimony in 2004 before the House of Representatives, most states have not developed plans to access the Stockpile, and only about a third have outlined how they would distribute the resources.

Fortunately, the lessons learned from Katrina and Rita are being collected in an unprecedented effort to capture and disseminate hard-won know-how. These lessons learned are being incorporated into best practices by a variety of means, including expert systems software. These systems can act as a mentor and guide before, during, and after a crisis and can be configured for a specific facility, customized for a specific incident, and can be accessed as "software on demand." In the case of SCM, these systems can help develop the SCM component of your Disaster Management Plan (DMP), provide supply chain-related job action sheets, and support SCM interaction with your GPOs and local public health and safety agencies (PHSAs). Relevant data can be captured, analyzed and tracked to ensure that important action steps are not overlooked. Due to recent developments, the systems are cheaper and more flexible to build and maintain than ever before. They can help assure that best practices are brought to SCM and, critically, that your hospital can satisfy the disaster program requirements necessary to meet the accreditation standards of the Joint Commission (JCAHO).

So what do best practices for SCM entail? There are three primary components that hospital administrators need to consider before a crisis hits:

• The required supplies and equipment for general and specific threats.

• Whether "disaster response supplies and equipment" – we’ll call them DRSEs – are best kept on site or elsewhere.

• The role of GPOs and PHSAs.

Identify DRSEs

A hospital’s disaster management team must identify the DRSEs necessary for three different aspects of SCM. First, a disaster will interrupt a hospital’s normal supply chain that delivers the range and quantities of resources necessary for regular operations. Thus, a medical facility must determine what it needs to maintain its core clinical and supporting capabilities, in the event the supply chain were severed.

Second, a disaster will result in a patient surge. Hospitals must understand the special supplies and equipment necessary for the injuries or diseases related to possible disaster scenarios faced by the facility.

Third, hospital administrators must determine the specific resources necessary for the maintenance of the hospital’s core capabilities – including the safety and health of hospital personnel. For instance, medical providers may need decontamination equipment or antidotes in case of a bioterrorism attack.

Once administrators determine their needs, they must determine where the DRSEs can be stored. Many factors must be considered to determine the best location to warehouse the supplies:

·The hospital’s physical vulnerability to the effects of an anticipated disaster, such as in an area susceptible to flooding, and the safest areas within the facility.

• The hospital’s vulnerability logistically to the effects of a disaster. For instance, some massive disasters isolate facilities by closing major roads and nearby airports.

• The likely geographic perimeter of areas affected by possible disasters.

• The shelf life of perishable supplies, and the conditions in which they can be safely stored. Items such as antidotes might require refrigeration.

• Special transportation needs, especially when hospitals share DRSEs with other facilities.

• Prioritization of the DRSEs needed. If transportation is limited, it is important to have the most important supplies at hand.

•The needs of hospital personnel. Your own people cannot become victims. Plans must account for supplies like water, protective masks and personal hygiene supplies for staff, as well as for current patients.

It is essential that these and other considerations about SCM be integrated into a hospital’s DMP. This relates to incident-specific assignments of responsibility and job action sheets. Ideally, hospitals should integrate their SCM plan with the strategy of their GPO and PHSAs. It is likely these organizations have a contribution to make to issues like regional supply chain management, warehousing and DRSEs triage among member hospitals. More specifically, your GPO can help mitigate the costs associated with stockpiling critical supplies and equipment. After having learned and imbedded "just in time" SCM, you will not want to sacrifice all of these cost savings in the interest of better disaster planning. By coordinating efforts with your GPO and pooling resources, sound cost management can be combined with higher standards of preparedness.

A hospital’s DMP should include contacts of key GPO/PHSA personnel. Information about any help desk and emergency response capabilities should also be readily available (preferably online for all relevant personnel to access during a disaster). Finally, but crucially, hospitals must have a system in place to record costs and expenses incurred as a consequence of the disaster – in the pre-, during- and post-incident phases. Creating the records required to recover costs will be essential to the hospital’s long-term financial viability.

Hospital administrators must be committed to effective SCM that will be reliable during the rapid tempo of a real crisis. This is a considerable challenge, first to profile the type of disaster you may have to respond to, then to build the SCM response into your DMP, and then to assure coordination with your GPO, PHSAs and neighboring Hospital Incident Response System (HIRS). The complexity of disaster management, combined with the heightened demands for best practices and a robust response capability from JCAHO and our communities, supports an effort to bring a more systematic approach to SCM for disasters in advance. Technology, in the form of online disaster management tools, can provide that extra, essential measure of preparedness. HPN

1 Titled "Hospital Preparedness: Most Urban Hospitals have Emergency Plans but Lack Certain Capacities for Bioterrorism Response"