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Canadian Hospitals Not Prepared for Disaster, Say Emergency-Care Doctors

Posted on: Sunday, 14 August 2005, 15:00 CDT

OTTAWA (CP) - Canadian hospitals are not prepared to deal with disasters such as terrorist attacks or epidemics because emergency rooms are already swamped, say crisis-care specialists.

"We don't have the capacity right now to deal with the surges that we could predict with some of these disasters," said Andrew Affleck, president of the Canadian Association of Emergency Physicians, in an interview.

"The system is already under stress."

He was responding to a recent suggestion by Public Health Minister Carolyn Bennett that hospitals be required to have "surge capacity" for a mass-casualty event as a condition of accreditation.

Emergency room physicians have been trying for years to get politicians to recognize the problem of emergency room overcrowding, said Affleck.

Although Ottawa is reinvesting in health, most of the money is going to shorten waiting times for non-emergency procedures, he said.

Last year's health accord between Ottawa and the provinces gave priority to shorter waits for joint replacement, cataract surgery, cancer treatment, diagnostic imaging and cardiovascular care.

"The fact that they're going through and dealing with those kinds of issues. . .will not have one iota of effect on surge capacity when it comes to a disaster," said Affleck.

The hospital emergency department is where Canada's recent preoccupation with security following terrorist attacks around the world collides with familiar distress over the state of health care. Beefed-up security requires sound basic emergency services.

Daniel Kollek, executive director of the Centre for Excellence in Emergency Preparedness, says a hospital operating at full capacity can try to handle a surge in patients by having a plan - but there are limits.

The problem, said Kollek, is that many emergency rooms are already operating well above capacity.

"The places where we would have usually put our surge patients such as hallways, such as perhaps doubling up beds in rooms that were designed for one. . .all that's already being done."

It's a misconception that emergency rooms are overcrowded because people turn up with trivial complaints, he said. The real problem is that there are not enough beds on the regular hospital wards.

"The overall capacity of the system is swamped. There are physicians who will say there's no such thing as emergency department overcrowding; there's hospital overcrowding, you're just seeing it in the emergency room."

The number of hospital beds in Canada was slashed during the budget cuts of the 1990s and numbers have not been restored to pre-cut levels even though Ottawa has put billions of dollars into federal-provincial health accords.

The Canadian Institute for Health Information says the number of hospital beds in Canada declined 30.5 per cent from 1990 to 2002, the most recent year for which data is available.

Jill Oviatt, a spokeswoman for the institute, said the number of beds is not believed to have increased since 2002. That suggests the number of hospital beds is less now than it was 15 years ago.

"Our burden of illness is going up as our population ages and our number of beds is going down," said Kollek.

New techniques and better drugs have shortened the average hospital stay and made it possible to treat many patients outside the hospital setting, but Kollek says those improvements don't justify such deep bed reductions.

"I think there has to be a restoration of appropriate beds, whether they be acute care beds, chronic care, alternate level of care, (or) respite beds."

Kollek strongly agrees with Bennett about the need for disaster planning. He conducted a survey of hospitals in the wake of the Sept. 11, 2001 terrorist attacks on the United States and found that most hospitals were very unprepared.

"Almost every hospital had a paper disaster plan and the vast majority didn't actually ever test that plan," he said.

"When it came to decontamination, the numbers are even worse. Most had no decontamination facilities," he added.

"So there's some big issues there. These are things that are not technically complicated. Most places haven't actually thought it through and I think the planning part is important."

Source: Canadian Press

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