Three keys to supply chain management in times of disaster

Healthcare Purchasing News, Dec, 2005 by Paul A. Dimitruk

Some of the quickest emergency assistance to victims of Hurricane Katrina did not come from the American Red Cross or FEMA. It came from Wal-Mart.

Millions of people were displaced or otherwise affected by the Gulf Coast calamity. Many waited for days as agencies struggled to provide assistance. Wal-Mart moved faster than traditional emergency aid groups because the retail giant has mastered logistics and supply chain management, according to a study by the University of Arkansas.

Supply chain management involves more than delivering products to a destination. It requires orchestrating the transportation, distribution, storage and timely delivery of inventory, while minimizing costs and serving the maximum number of consumers. It is a desperate balancing act when human life is at stake.

Wal-Mart can be commended for its rapid response to Hurricane Katrina, because consumer goods like food, water and other supplies are important to recovery efforts. But "big box" stores do not carry medical supplies. When it comes to saving lives in a disaster, hospitals and other medical agencies are on the front lines.

Hurricane Katrina exposed the weaknesses of government agencies and relief organizations when it comes to delivering emergency supplies and equipment. The overwhelming number of victims and widespread destruction exacerbated the coordination effort. It is now clear that hospitals and their group purchasing organizations (GPOs) must carefully develop their own supply chain management (SCM) strategies and infrastructure to ensure essential provisions are available during a natural disaster or terrorist attack.

Today, most hospitals are often unable to acquire and deploy the resources needed to respond to a large-scale disaster effectively, according to a 2003 Government Accountability Office report on hospital bioterrorism preparedness (1). Senior federal officials from the investigative arm of Congress conducted an exercise that highlighted serious weaknesses in the medical response system. The exercise simulated a bioterrorism attack that infected a community with pneumonic plague, a highly contagious sickness that must be treated with antibiotics within 24 hours. Untreated, the mortality rate is near 100 percent.

Three days after the disease's simulated release, 500 people had symptoms and there were shortages of antibiotics and ventilators. Two days later, 800 cases were reported, with 100 dead. Medical care was shut down because of insufficient resources. About 3,700 cases of plague were reported after a week, with between 950 and 2,000 deaths. The hospitals did not have the equipment to handle the increased patient load. Half of the hospitals studied in the report had fewer than six ventilators per 100 staffed beds, three or fewer personal protective equipment suits and fewer than four isolation beds.

Of course, it is impossible to keep on hand enough supplies or equipment to be ready for every disaster and mass casualty event a hospital may face. That is why collective and regional planning is necessary. For example, states can access resources like the CDC's Strategic National Stockpile of antibiotics, antidotes and other materials. However, according to testimony in 2004 before the House of Representatives, most states have not developed plans to access the Stockpile, and only about a third have outlined how they would distribute the resources.

Fortunately, the lessons learned from Katrina and Rita are being collected in an unprecedented effort to capture and disseminate hard-won know-how. These lessons learned are being incorporated into best practices by a variety of means, including expert systems software. These systems can act as a mentor and guide before, during, and after a crisis and can be configured for a specific facility, customized for a specific incident, and can be accessed as "soft ware on demand." In the case of SCM, these systems can help develop the SCM component of your Disaster Management Plan (DMP), provide supply chain related job action sheets, and support SCM interaction with your GPOs and local public health and safety agencies (PHSAs). Relevant data can be captured, analyzed and tracked to ensure that important action steps are not over looked. Due to recent developments, the systems are cheaper and more flexible to build and maintain than ever before. They can help assure that best practices are brought to SCM and, critically, that your hospital can satisfy the disaster program requirements necessary to meet the accreditation standards of the Joint Commission (JCAHO).

So what do best practices for SCM entail? There are three primary components that hospital administrators need to consider before a crisis hits:

* The required supplies and equipment for general and specific threats.

* Whether "disaster response supplies and equipment"--we'll call them DRSEs--are best kept on site or elsewhere.

* The role of GPOs and PHSAs.

Identify DRSEs

A hospital's disaster management team must identify the DRSEs necessary for three different aspects of SCM. First, a disaster will interrupt a hospital's normal supply chain that delivers the range and quantities of resources necessary for regular operations. Thus, a medical facility must determine what it needs to maintain its core clinical and supporting capabilities, in the event the supply chain were severed.