I was, for a while, a lecturer/consultant for the “Domestic Preparedness Program.” This was an initiative by the Department of Justice to ensure that first responders around the U.S. were prepared to deal with the medical consequences of nuclear, biological, chemical, and blast injuries. This was before the terrible events of 9/11.
Our job as instructors was to go to cities around the country and educate police, fire, EMS, and medical personnel. We also engaged in table-top exercises, “war-gaming” what mass casualty events might look like.
It was fun and fascinating. But it also caused us to have a uniquely dark way of looking at things. We engaged in a lot of “what if” discussions, mostly about terrorism. We recounted terrorist events that had occurred and discussed lessons from military history. We studied events like the Tokyo subway sarin gas attack by the group, AUM Shinrikyo, and the use of mustard gas in the Iran/Iraq war.
One thing we often discussed was the vulnerability of populations if responders or medical facilities were targeted. This had been a well-known tactic of terrorists: the use of an explosive device, followed by a second once responders arrived.
Without question, we see this today. From Ukraine to Afghanistan to Florida, or anywhere that war or natural disasters occur, healthcare is badly compromised.
Looking back on those discussions, and my time with the incredible experts with whom I worked, I am forced to consider our situation right now. American healthcare, in the semi post-COVID era, is hanging by a thread. I am not trying to spin conspiracies. I am not trying to say that American healthcare has been intentionally attacked. But I do think American healthcare has been criminally neglected.
What I want to do is point out our vulnerability. Because it wouldn’t take much to tip our already fragile balance. Hospital beds are still in short supply and the things I have been writing about are not improving. They will likely get worse as winter approaches. So, what could happen?
America could suffer a dramatic natural disaster. More hurricanes like the one that devastated Florida. Earthquakes are always a possibility, as are meteor strikes or solar flares. (In the case of a solar flare, which has the potential to disrupt communications systems and power grids on Earth, it’s hard to imagine a modern hospital without computers, or the Internet, or perhaps even much of our life-saving equipment.)
Theoretically, there could be the use of an improvised nuclear weapon by terrorist groups or use of a strategic nuclear weapon by a nation. (While the purchase of drugs to treat radiation poisoning may or may not have to do with Putin’s threats, the timing is certainly concerning.)
Another new pathogen could emerge; perhaps one completely unlike SARS-CoV-2, requiring us to learn about it all over again. This could be accidental or intentional. It doesn’t take conspiratorial thinking to recognize that nations have worked with biological weapons for millennia — the U.S. being no exception. This isn’t crazy talk, it’s just history.
So, to put this into focus, right now we’re struggling to find one or two intensive care unit beds for someone with relatively mundane problems (well, not for the patient but in the big picture). A patient who needs a ventilator for pneumonia. A patient who needs surgery for a complicated abdominal infection. A child with ongoing seizures.
Looking for one inpatient bed or looking for two intensive care unit beds can be the labor of hours to days. Much less, as I have pointed out, the difficulty of getting them transported once the beds are available.
Now, imagine looking for 50 ICU beds for patients with severe burns. Imagine trying to find 2,000 hospital beds for patients with an unknown but life-threatening infection that, for example, causes dehydration from vomiting and diarrhea. Consider finding 10,000 beds for victims of an earthquake in an urban area where there were crush injuries and fire.
Those beds wouldn’t be available. Even national guard units would take days to ramp up capacity, and their use of deployed personnel would strip staff from their civilian jobs.
Any of these nightmare events, especially coupled with supply chain issues and diminished energy resources, would be incalculable tragedies with ripples and repercussions for a decade.
And they would result in so many deaths — unnecessary, if only we had planned ahead. If only we had built healthcare to be flexible and part and parcel of national defense. And if our planning, at least in part, had been driven by a concern for the health of the nation rather than the profits of vast corporations (for whom patient care is well down the list from profit, growth, and virtue signaling).
These are perilous times. And we need to start acting like it if we care for the future of our nation.
Our “leaders” need to start acting like real leaders.
Edwin Leap, MD, is an emergency physician who blogs at edwinleap.com, and is the author of The Practice Test and Life in Emergistan. You can read more of his writing on his Substack column, Life and Limb, where a version of this post originally appeared.