Hospital closures, cyberattacks and care delays reflect that the American healthcare system is already strained. In the case of a large-scale emergency, like a terrorist attack, it could crumble, three physicians argued in an op-ed published to Forbes Dec. 20.
The article was co-authored by Robert Glatter, MD, an emergency medicine physician at Lenox Hill Hospital in New York City; Peter Papadakos, MD, an anesthesiologist at the University of Rochester (N.Y.) Medical Center; and Paul Pepe, MD, an emergency medicine physician affiliated with Children's Medical Center Dallas.
As illustrated by Hamas' Oct. 7 attack on Israel, "a robust modern healthcare can still be so easily stressed by a mass terrorist attack," the authors wrote. In the wake of these events, FBI Director Chris Wray has twice warned of elevated terrorism threats, emphasizing concerns about copycat violence.
In the coming months, U.S. EMS systems and trauma centers should "quickly update and fine tune their protocols for imminent terrorist events in the coming weeks and months," according to the authors. Health systems should prioritize preparations for injuries caused by high-powered firearms, but should conduct drills for a wide spectrum of potential events, like bombings or chemical, biological or radiological attacks.
The authors recommend that hospitals create additional secure triage areas outside in case emergency departments and operating suites become full; stockpile supplies; and establish protocols to call in additional staff if an emergency occurs.
Particularly, the authors are concerned about the 1 in 3 Americans who live in "trauma deserts": regions without a complete or formal trauma system designation, and with limited access to trained first responders. There are multiple ways to bolster support for these regions, the article says, beginning with the expansion of helicopter transport services to low-resource areas — especially those where hospitals have closed. The healthcare system should also bolster its pre-hospital structure, ensuring EMS agencies are trained to transport patients to the correct level of trauma center for their injuries and can conduct pre-hospital whole blood transfusions where possible.
Well-trained bystanders can also improve victims' chance of survival, according to the authors. They recommend that health systems prioritize training for civilians that teach direct pressure and proper tourniquet application, as uncontrolled bleeding in the first few minutes after injury is the leading cause of preventable trauma death. "Stop the Bleed" programs, often offered by hospitals and the local Red Cross, can teach these skills in 90 minutes and are even available online; they should become a "top-tier" priority, according to the authors (read here about a Washington health system that recently donated emergency backpacks containing tourniquets, medical equipment and medical gauze to every teacher in a local school district).
"In summary, we can all play a part in saving lives and better prepare for the next terrorist attack if our nation can adopt a renewed mindset and focus on preparedness among all citizens, first responders, trauma center leaders and our public health and elected officials," the authors wrote.
Read the full op-ed here.