The four key components we identified follow:    Hospital capacity: Following a mass casualty event, hospitals may need the  ability to adequately care for a large number of additional patients. The Federal Government Has Provided States with Funding, Guidance, and Other Assistance to Prepare for Medical Surge

The federal government has provided funding, guidance, and other  assistance to help states prepare their regional and local health care  systems for medical surge in a mass casualty event. From fiscal years 2002  through 2007, the federal government awarded the states about $2.2 billion  through ASPR’s Hospital Preparedness Program to support activities to  meet their preparedness priorities and goals, including medical surge. Further, the federal government developed, or contracted with experts to  develop, guidance that was provided for states to use when preparing for  medical surge. AHRQ also published Reopening Shuttered Hospitals  to Expand Surge Capacity, which contains an action checklist that can be  used by states and local entities to identify organizations that have an  interest or responsibility in preparing for medical surge, and to determine  what resources each could provide. Many States Have Made Efforts to Increase Hospital Capacity, Plan for Alternate Care Sites, and Develop Electronic Medical Volunteer Registries, but Fewer Have Planned for Altered Standards of Care

Many states have made efforts related to three of the key components for  preparing for medical surge, that is, increasing hospital capacity, planning  for alternate care sites, and developing electronic medical volunteer  registries, but fewer have implemented the fourth, planning for altered  standards of care. However, only 7 of the 20 states had adopted or were  drafting altered standards of care for specific medical interventions to be  used in response to a mass casualty event. All States Were Making Efforts to Expand Hospital Capacity

More than half of the states met or were close to meeting the criteria for  the five surge-related sentinel indicators for hospital capacity that we  reviewed from the Hospital Preparedness Program 2006 midyear progress  reports, the most recent available data at the time of our analysis. In our further review of 20 states, all 20 states reported that they had  developed or were developing bed reporting systems to track their  hospital capacity—the first of four key components related to preparing  for medical surge. For example, one state had assigned 2 of 955  volunteers at Level 1. States Reported Concerns Related to All Four Key Components When Preparing for Medical Surge

While the Hospital Preparedness Program has been operating since 2002,  state officials in the 20 states we surveyed reported that they faced  continuing challenges in preparing for medical surge in a mass casualty  event. State officials also reported concerns about reimbursement for medical  services provided at alternate care sites, which are not accredited health  care facilities. According to state officials, some  volunteers do not want to be part of a national database because they are  concerned that they might be required to provide services outside their  own state. Altered Standards of Care Concerns

Some state officials reported that they had not begun work on altered  standards of care guidelines, or had not completed drafting guidelines,  because of the difficulty of addressing the medical, ethical, and legal  issues involved. While some states reported using AHRQ’s Mass Medical Care with Scarce  Resources: A Community Planning Guide to assist them as they  developed altered standards of care guidelines, some states also reported  that they needed additional assistance. Appendix II: Scope and Methodology

To determine what assistance the federal government has provided to help  states prepare their regional and local health care systems for medical  surge in a mass casualty event, particularly related to four key  components—hospital capacity, alternate care sites, electronic medical  volunteer registries, and altered standards of care—we reviewed and  analyzed national strategic planning documents and identified links among  federal policy documents on emergency preparedness. We also reviewed  and analyzed studies and reports related to medical surge capacity issued  by the Congressional Research Service, the Department of Health and  Human Services’ (HHS) Office of Inspector General, the Agency for  Healthcare Research and Quality (AHRQ), the Centers for Disease Control  and Prevention (CDC), the Office of the Assistant Secretary for  Preparedness and Response (ASPR), the Joint Commission, and other  experts.
Why GAO Did This Study

Potential terrorist attacks and the possibility of naturally occurring disease outbreaks have raised concerns about the "surge capacity" of the nation's health care systems to respond to mass casualty events. GAO identified four key components of preparing for medical surge: (1) increasing hospital capacity, (2) identifying alternate care sites, (3) registering medical volunteers, and (4) planning for altering established standards of care. The Department of Health and Human Services (HHS) is the primary agency for hospital preparedness, including medical surge. GAO was asked to examine (1) what assistance the federal government has provided to help states prepare for medical surge, (2) what states have done to prepare for medical surge, and (3) concerns states have identified related to medical surge. GAO reviewed documents from the 50 states and federal agencies. GAO also interviewed officials from a judgmental sample of 20 states and from federal agencies, as well as emergency preparedness experts.

What GAO Found

Following a mass casualty event that could involve thousands, or even tens of thousands, of injured or ill victims, health care systems would need the ability to "surge," that is, to adequately care for a large number of patients or patients with unusual medical needs. The federal government has provided funding, guidance, and other assistance to help states prepare for medical surge in a mass casualty event. From fiscal years 2002 to 2007, the federal government awarded the states about $2.2 billion through the Office of the Assistant Secretary for Preparedness and Response's Hospital Preparedness Program to support activities to meet their preparedness priorities and goals, including medical surge. Further, the federal government provided guidance for states to use when preparing for medical surge, including Reopening Shuttered Hospitals to Expand Surge Capacity, which contains a checklist that states can use to identify entities that could provide more resources during a medical surge. Based on a review of state emergency preparedness documents and interviews with 20 state emergency preparedness officials, GAO found that many states had made efforts related to three of the key components of medical surge, but fewer have implemented the fourth. More than half of the 50 states had met or were close to meeting the criteria for the five medical-surge-related sentinel indicators for hospital capacity reported in the Hospital Preparedness Program's 2006 midyear progress reports. For example, 37 states reported that they could add 500 beds per million population within 24 hours of a mass casualty event. In a 20-state review, GAO found that all 20 were developing bed reporting systems and most were coordinating with military and veterans hospitals to expand hospital capacity, 18 were selecting various facilities for alternate care sites, 15 had begun electronic registering of medical volunteers, and fewer of the states--7 of the 20--were planning for altered standards of medical care to be used in response to a mass casualty event. State officials in GAO's 20-state review reported that they faced challenges relating to all four key components in preparing for medical surge. For example, some states reported concerns related to maintaining adequate staffing levels to increase hospital capacity, and some reported concerns about reimbursement for medical services provided at alternate care sites. According to some state officials, volunteers were concerned that if state registries became part of a national database they might be required to provide services outside their own state. Some states reported that they had not begun work on or completed altered standards of care guidelines due to the difficulty of addressing the medical, ethical, and legal issues involved in making life-or-death decisions about which patients would get access to scarce resources. While most of the states that had adopted or were drafting altered standards of care guidelines reported using federal guidance as they developed these guidelines, some states also reported that they needed additional assistance.