Feb 9, 2010: I began this post a while ago, but it’s already longer and less focused than I had originally intended. It’s not complete, but I think the point gets across.
http://www.cnn.com/2010/OPINION/01/25/doctors.haiti.hardships/index.html?eref=rss_health&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+rss/cnn_health+(RSS:+Health)
This opinion piece submitted by doctors from New York City’s Hospital for Special Surgery really got me thinking. There’s no logical reason for America’s total inability to respond quickly to a natural disaster, especially after Katrina. Why does it seem like there is no emergency response plan or infrastructure?
It’s clear that any kind of response to a natural disaster necessarily relies upon a coordination of both public and private resources; the military has the transportation equipment, security personnel, and to some extent, supplies and expertise in logistics. However, the supplies held by the military cannot possibly support the entire population of any disaster-stricken region. Therefore, private resources are necessary, but while supplies and personnel support in this sector are usually widely available, they are often dispersed, and worse yet, not organized in a single cohesive system that lends itself well to emergency response. Therefore, it should be necessary and prudent to establish such a organizational system.
The benefits of coordinating both public and private sector resources for emergency response should be obvious. Rapid response and medical treatment for survivors increases the rate of survival, and minimizes the catastrophic impact of the disaster at many levels: social, economic, and political. The pitfalls, however, are equally glaring. From an economic standpoint, it is unsustainable to maintain excess stock indefinitely, waiting for a natural disaster. Such inventory incurs maintenance costs, and all equipment and supplies have finite useful lifetimes, whether related to natural spoilage, or technological obsolescence. These kinds of programs tend to enjoy huge initial support, which results in a large initial expense put toward the acquisition of supplies. However, little funding is allocated for ongoing maintenance of those supplies, and often, without regular disasters, and consequently, use of the inventory, funding may even be curtailed to the point where the inventory is allowed to deteriorate. Clearly, such a model would be ineffective, purely from an economic standpoint.
Perhaps instead, a federal program could be established that would ask suppliers of basic goods and equipment that would be useful in emergency situations to maintain a 1-3month supply or reserve a 10% inventory of their products that could be called upon by the military or government, in exchange for tax credits, low-interest loans, and other economic incentives, to defray the cost of maintaining the inventory. This would keep the supplies fresh, as the stock would be constantly rotated with new material, limit the size of the investment needed from the federal government, and provide for perpetual upkeep of emergency supplies. Part of the system would also be a national database for tracking this inventory, complete with transportation plans and coordination centers already designated. Maybe FEMA was set up to do exactly this, but it failed during Katrina.
The logistics of transporting the supplies from the reserve inventories would be perhaps the post critical aspect of the program, at least from a political perspective; having the supplies but no way of moving them, or worse, moving them inefficiently, would be the biggest political blunder of all time. Domestically, distribution centers should be no more than 12 hours apart by the most reasonable means of heavy transport, for a maximum transport time time of 6 hours from regional suppliers to any central distribution location. Supplies could be allocated and transported to local distribution and aid centers beginning no longer than 9 hours after the initial disaster, which would provide for at least 3 hours to check inventories and coordinate the response, tailoring general response plans to the specific incident. Existing infrastructure, like convention centers, fairgrounds, sports stadiums, and schools could be designated distribution centers; they do not need to maintain inventories, but they must have the facilities to accept deliveries and access to multiple modes of transportation, and ideally, multiple paths for each of those modes.
The key point relevant to the piece regarding the medical response in Haiti is that private citizens who volunteer need to be able to enter the system and help.
A new, shorter piece about a couple doctors from Boston has less impact, but I think shows more pragmatism from the medical professionals who went to Haiti to help: http://www.cnn.com/2010/HEALTH/01/26/haiti.doctors.lessons/index.html?eref=rss_health&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+rss/cnn_health+(RSS:+Health)
It seems obvious now that a region hit by a natural disaster would be completely without modern advances in medical technology we likely take for granted.
Three weeks ago, I finally bought a bike after talking about it for about two years.