Not long ago I had the severe displeasure of reading a book called The Edge of Disaster by one Stephen Flynn (Random House, New York, 2007). Mr. Flynn is billed in the author blurb as being “among the world's most widely cited experts in homeland security and trade and transportation security issues.” I say “severe displeasure” not as a reflection on Mr. Flynn's book—it is in fact a well-written and highly educational discussion of America's infrastructure and the country's risk-taking population and ineffective government. My “displeasure” alludes, rather, to the intense nervousness I'm experiencing.

Basically Flynn tells several disturbing stories—for example, of segments of our population who are just asking by their choice of residential locations to be sandbagged by nature; of a federal government so oversold on the virtues of small government that needed leadership is missing; of an aging infrastructure already stretched to the breaking point and in no way ready to accommodate extra stress.

When I turned to the pages addressing our healthcare system, I thought perhaps here we would catch Mr. “Trade and Transportation Expert” in some sort of knowledge shortfall. Sure enough, he discusses how our hospitals, in particular our emergency departments, are sorely unprepared to deal with a surge of population from any disaster, manmade or natural. Aha, I thought, surely such basic services as healthcare and long-term care have done something since Hurricane Katrina to better position themselves for disaster. Flynn was no doubt unaware, for instance, of the highly imaginative work described in an article HEALTHCARE DESIGN published in November 2005.

Called “‘SURGE’ Hospitals: A New Concept in Disaster Medical Care,” and written by George J. Mann, AIA, and Paul K. Carlton, Jr., MD, FACS (Lt. Gen. USAF Ret.), the article discussed a Medical Readiness Conference organized by the Texas A&M University System Health Science Center and College of Architecture in December 2004. The article describes model “SURGE” hospital concepts developed by 17 two-person teams of College of Architecture students. With great creativity and ingenuity, the students presented a set of networks of hospitals, hotels, schools, convention centers, and open-field tent cities serviced by mobile medical units—all organized as a first-response healthcare system for natural or manmade disasters. Re-reading this article gave me heart, and this led to an Editorial Brainstorm: I would follow up with an updated status report on SURGE hospital planning.

Take that, Stephen Flynn!

Long story short: There will be no follow-up article. From what I've been able to determine, nothing much has happened since the conference was held or the article published, and the apparent reason is fairly predictable: Most of the facilities are privately owned, and very few private entities—no matter how well intentioned—want to place themselves at a competitive disadvantage in their daily marketplace by making unique investments in disaster preparedness. Leadership and common rules of the game are required for such an effort and, as Mr. Flynn points out numerous times, these have been sorely lacking from today's federal government.

Oh, well, private organizations have to do what they can. Perhaps the readers of HEALTHCARE DESIGN will take a moment to double-check their facilities' disaster readiness and possibilities for improvement. If nothing else, it would make me feel better. HD