GAO: City hospitals lack equipment to handle bioterror attack

Most of the country's urban hospitals do not have sufficient resources to handle a sudden surge in patients seeking medical attention because of a bioterrorist attack, according to a new report.

Although 81 percent of the hospitals included in a new study by the General Accounting Office (03-924) have developed emergency response plans for bioterrorism, most also reported that they lacked enough medical equipment to treat large numbers of victims of a sudden terrorist attack. GAO surveyed 2,041 urban hospitals from May to September 2002.

The availability of medical equipment, including ventilators, isolation beds and protective suits, varied among the hospitals GAO studied. "If a large number of patients with severe respiratory problems associated with anthrax or botulism were to arrive at a hospital, a comparable number of ventilators would be required to treat them. Yet half of the hospitals reported having fewer than six ventilators per 100 staffed beds," the report said. In addition, fewer than half of the hospitals surveyed have conducted drills simulating their response to a bioterror attack, GAO found.

The GAO report acknowledged the continuing efforts of the federal government and the American Hospital Association-both before and after its survey-to help hospitals with bioterrorism preparedness, but also said "efforts to improve hospitals' bioterrorism response capacities must be mindful that hospitals face multiple challenges, including having to prepare for other types of disasters and continuing to meet the everyday needs of cities for emergency care."

Marcia Crosse, GAO's acting director of health care in public health and science issues and author of the report, said that hospitals have to balance many different demands when allocating resources. Crosse said some equipment shortages "relate to funding, but some of it relates to them [hospitals] having to balance their priorities and where to spend or not spend on resources that they may or may not need."

But the report noted that some types of equipment could be used to respond to various public health hazards, not only bioterrorist attacks. "For example, a large-scale outbreak of Severe Acute Respiratory Syndrome would require many of the same capabilities that would be needed to respond to an intentionally caused epidemic."

The Health and Human Services Department plans to purchase 2,700 ventilators by September to add to the national stockpile of drugs, vaccines and medical supplies, according to the report. The Bioterrorism Hospital Preparedness Program, administered by HHS, provided approximately $125 million in funds last year to eligible states and cities to improve the capacity of hospitals to respond to a bioterrorist attack. Eligible states and cities are slated to receive $498 million for fiscal 2003 through the same program. Since GAO completed its study, "the expenditures of 2002 may have led to some improvements," Crosse said. She said the government is slated to send out the fiscal 2003 funding to eligible states and cities at the end of August.

Almost all the hospitals surveyed are working with other state and local agencies on coordinated responses to a bioterrorist attack and most reported providing some training to their medical personnel on identifying and diagnosing biological agents involved in a possible attack. Coordinated regional plans can help address equipment shortfalls by encouraging hospitals and other state and local agencies to share resources with one another, the report said.

Representatives of the American Hospital Association generally agreed with GAO's findings.