Bolstering the Role of Emergency Departments as Part of the Nation’s Critical Infrastructure
Emergency departments need adequate resources and they need to be systematically incorporated into disaster networks.
By Mahshid Abir
New resources should be devoted to the lifesaving work of local emergency departments — especially those in locations at high risk for man-made or natural events — if they are to maintain their role as part of America’s health care critical infrastructure.
Emergency departments are on the front line of the nation’s response to mass-casualty incidents, disasters, and public health emergencies. They respond to unanticipated events, such as terrorist attacks and mass shootings; weather-related events, such as hurricanes, tornadoes, and heat waves, that may occur with some advance notice; and more protracted incidents, such as epidemics and pandemics.
As demonstrated by an ongoing RAND study focused on identifying strategies to sustain emergency care in the United States, emergency department providers often view response to mass-casualty incidents and disasters as something they “just do” — recognizing that this function is often conducted without sustained funding and resources.
Yet, in order to sustain their role as part of America’s critical infrastructure, emergency departments need adequate resources, they need to be systematically incorporated into local, state, and regional disaster networks, and they need to be treated as key partners in disaster planning alongside emergency management, law enforcement, and national security entities at all levels of government.
Emergency departments need to be treated as key partners in disaster planning alongside emergency management, law enforcement, and national security entities at all levels of government.
Hospital and emergency department preparedness activities may be funded by the U.S. government through the Department of Health and Human Services’ Hospital Preparedness Program and Federal Emergency Management Agency (FEMA) grants. FEMA also funds private, nonprofit health care organization disaster recovery through its Public Assistance program.
In addition, health insurance vendors should be considered as a potential source for funding these activities — for example, through a percentage of insurance payment for each emergency visit being designated for disaster preparedness, response, and recovery. Like funding for local law enforcement and fire departments, state and city budgets should routinely include funding for emergency departments to maintain standby surge capacity to respond to events that may require a sudden increase in demand for health care services.
Given the rise in the occurrence of mass shootings and other high-casualty incidents and climate change–related natural disasters, the critical infrastructure role of emergency departments can be expected to grow over time. This makes funding for preparedness, response, and recovery activities even more critical.
In addition to ensuring sufficient funding, emergency departments need to be effectively incorporated into local, state, and regional disaster response networks. For example, routine incorporation of designated leadership and staff in health care coalitions (PDF), regional trauma networks, and networks related to FEMA Regions may help ensure emergency departments play a more effective critical infrastructure role through better integration in the larger emergency response system. Such networks may also be leveraged to facilitate resource sharing among emergency departments in the aftermath of mass-casualty incidents and disasters.
Lastly, in order for emergency departments to optimally function in their critical infrastructure role, the currently siloed health care, emergency management, law enforcement, and national security sectors need to be networked. Building relationships between emergency departments and these key stakeholders before mass-casualty incidents and disasters occur may facilitate more effective emergency department preparedness, response, and recovery processes and ultimately more healthy and safe communities.
Building such cross-sector bridges will entail alignment of priorities in the service of communities and developing the needed policies and platforms for information and resource sharing.
Emergency departments serve many functions in communities across the United States. They provide advanced diagnostics and treatment for acute conditions, they help create additional capacity for addressing unscheduled acute care needs and for managing acute exacerbations of chronic diseases, they serve as a care coordination centers in many instances, and may even assume public health roles.
To continue these vital roles, new focus should be placed on providing emergency departments with adequate resources and including them in regional disaster networks.
Mahshid Abir is an emergency physician and senior physician policy researcher at the nonprofit, nonpartisan RAND and a Professor of Policy Analysis at the Pardee RAND Graduate School.
This originally appeared on rand.org on August 22, 2024.
