The Either/Or Dilemma: Hard Choices Ahead in Materials Management

The management of materials – food, water, medicines, etc. – in times of disaster depends on citizens at every level of society not only being self-sufficient, insofar as possible, but also willing to help one another. That principle is equally true of households and governments; unfortunately, the problems facing both entities also are the same.There are some realities that all Americans must understand. The first is that no one, and no agency or organization, including the government, can protect everyone from all elements of risk, nor can the government (or any family) stockpile enough materials of all types that every possible emergency can be met both immediately and effectively every time. It is also important to understand that this fact does not excuse the community, or the individual, from trying. The website suggests that a three-day supply of food and other essentials should be set aside to meet the reasonable and foreseeable needs of a family preparing for an emergency. That principle, taken to a higher level, suggests that communities, including local and state governments, must lay in some rather large stockpiles of those same supplies (and many others) for use during a wide spectrum of disasters, with a focus on survival always being the first priority. The estimated 5.9 million Americans now living below the poverty line and making “heat or eat” decisions every week obviously would be unable to build up enough of an emergency stockpile to sustain themselves for even a few days – which means that special provision must be made, in the planning stage, for the homeless and the helpless. Major Stockpiles and Major Problems On a larger scale – e.g., for a pandemic influenza, or any other emergency during which hospitals throughout the nation would have to expand their capacities tenfold or more – the management of materials becomes an immensely greater task. The same is true, on only a slightly reduced scale, for a localized disaster, such as an earthquake or hurricane – that would make the movement of food supplies and other materials into the affected region impossible for perhaps an extended period of time.   Materials management is a particularly challenging problem for hospitals and other medical facilities. A localized disaster such as an earthquake or hurricane would make the movement of food supplies and other materials impossible for an extended period of time Although much good work and thought has been put into preparing for a pandemic, much of that effort has focused on the purchase of materials such as ventilators, which would be useful only in events that cause respiratory failure. It probably would save many lives to be able to place as many sick flu patients on ventilators as possible. However, if a hospital is not able at the same time to maintain its basic “housekeeping” and other functions, this higher-level treatment would not have the infrastructure foundation it needs to be effective in treating a greater number of patients for a longer period of time. Many hospitals have taken a number of forward steps to maintain their cost-effectiveness, but some of those steps actually hinder the emergency-preparedness goals that have been established. It is easy to point to the shrinking number of beds as a loss of the expanded capacity needed in an emergency, but there are other more subtle issues that also should be examined. Business Costs and Higher Prices The modern “just-in-time” business model of ordering and storing medicines and other supplies may prove to be the principal difference between the way the nation’s medical community as a whole coped with the great flu pandemic of 1918 and the way it will cope, or be unable to cope, with the next pandemic. To avoid keeping large amounts of inventory, many hospitals and other critical-infrastructure facilities have moved in recent years to a model where little inventory is kept in house, and replenishment deliveries are made on an almost daily basis. A large number of hospitals also have outsourced many of their support functions – e.g., linen cleaning. In the past, most if not all hospitals had their own laundries and linen supplies on site, but in recent years many of them have outsourced the storage and cleaning of linens, almost always as a cost-saving measure. The result, however, is that, even though the supply is replenished periodically, the extra or surge supplies likely to be needed in an emergency are stored off-site. Unfortunately, during an emergency both the hospital and the roads to and from the linen service may be affected, which means that the theoretically simple but vitally important task of changing the linen on patients’ beds would be outside the hospital’s control. What has developed, therefore, amounts to a “pay today or pay twice tomorrow” situation. But even that easy summation understates the real problem, which is that it is either “pay today” (in increased taxes and/or other costs) or “pay tomorrow” – in lives lost that might otherwise have been saved.


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Joseph Cahill
Joseph Cahill

Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.



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