CHICAGO — If the H1N1 virus had reached levels of severity predicted by the World Health Organization last winter, the flu pandemic would have overwhelmed the Cook County public health system, choking medical facilities here and in urban areas throughout the nation, public health officials said.
“We’re not ready for a major pandemic,” said Linda Murray, chief medical officer for the Cook County Department of Health. “We don’t have that level of preparation. We don’t have that infrastructure in place. We were lucky with the last pandemic.”
Hospitals take a multi-pronged approach to prepare for pandemics and other national security threats. Because hospitals must be able to accommodate dramatic patient increases during an emergency, their preparation depends in part on their ability to track available beds and coordinate beds with other hospitals throughout the state.
The U.S. Department of Health and Human Services oversees the Hospital Available Beds for Emergencies and Disasters (HAvBED) System, a program that requires hospitals to report available bed counts to state authorities every morning by 10 a.m. In an emergency, state authorities would use HAvBED to redirect patients to the closest hospitals with available beds, staff and equipment, said Matthew Roberts with the division of disaster planning and readiness at the Illinois Department of Public Health.
HAvBED was tested last December, when the state was preparing to evacuate Rush University Medical Center in Chicago due to a problem with the steam plant. Although evacuation never became necessary, authorities used HAvBED to coordinate patient transfers, Roberts said.
“The plan worked pretty well,” Roberts said.
Hospitals should be prepared to accommodate a patient increase of 10 to 15 percent during an emergency, said Jack Fleeharty, division chief of emergency medical systems with the state Department of Public Health. For Cook County’s Stroger Hospital, which treats an average of 334 patients daily, a 15 percent increase would bring another 50 patients, according to state data. With 464 beds, Stroger should be able to easily accommodate the additional patients.
But there is often a discrepancy between preparation plans and what actually plays out in an emergency, Murray said. The county’s public health system doesn’t have the resources to move patients to other facilities, Murray said. Complicating the matter are questions of which hospital will cover the cost of the patient and the type of care the patient needs. A hospital bed isn’t just a bed – it’s tied to the medical and personnel resources the patient requires, and some hospitals are better equipped than others, Murray said.
Hospitals in urban areas that are understaffed and operating close to capacity will have a harder time in a disaster, Fleeharty said. But in emergency preparation, communication may be as critical as resources. Although HAvBED was used nationally last year to prepare for H1N1, Murray and several other Cook County public health professionals interviewed had never heard of the program and said local hospitals did not use a bed tracking system.
Northwestern Memorial Hospital tracks bed availability in real time daily and compares it with nearby hospitals, according to hospital resource bed coordinator Donald Threets. During H1N1, Northwestern used HAvBED in addition to the university’s own data processing center to track beds.
Northwestern and Stroger operate at close to the same patient occupancy, according to state data. About 75 percent of Northwestern’s beds are occupied daily, and Threets said the hospital could easily accommodate a patient surge without straining its resources. At Stroger, 72 percent of hospital beds are occupied daily. Yet for the county health system, another pandemic could prove disastrous, Murray said. Despite any emergency plans in place, without the resources to execute it, the hospital won’t be prepared for anything more than the minor patient surge H1N1 delivered, she said.
“We have not put the resources in to the infrastructure to deal with these emergencies,” Murray said. “Our public health infrastructure is completely underfunded.”
