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US hospitals are unprepared for disaster

BMJ 2007; 335 doi: (Published 22 November 2007) Cite this as: BMJ 2007;335:1071

Many US hospitals are busy stockpiling supplies of equipment and drugs in preparation for a bioterrorism attack. The real problem, however, is that most are already working at full capacity because of closures and other efficiency savings. Where will all the extra patients go?

Three experts have called on the federal government to come up with a national strategy to find the necessary “surge capacity” and to make sure it is properly funded. The private health sector is unlikely to provide the extra beds and personnel on its own, particularly in a perverse system that makes it more financially attractive to close emergency departments than to keep them open.

Local hospitals can help by sharing information about capacity and staffing, and by looking locally for extra space in schools, churches, and other community buildings, say the experts. In the meantime, they urge the federal government to do something urgently about the estimated 116 000 shortfall in available nurses. In 2006, nearly 43 000 qualified applicants were turned away from nursing colleges because of shortages of teachers and classrooms. Being prepared means extra professionals as well as buildings and equipment. Nursing shortages leave a big hole in current disaster plans.


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