Are you ready?

Like the public, health care leaders might feel overwhelmed by the prospect of preparing for a terrorist act, especially one involving biological agents. In our 10-page special report, we look at practical steps you can take today to get ready, drawing lessons from hospitals in New York City, Washington, D.C., and Israel, and from Salt Lake City's efforts to prepare for the possibility of terrorism at the Olympics in February. Please note that our report is based on the latest news about terrorism, reaction to it and readiness efforts as of H&HN's deadline.     

Chemical weapon functional exercise--Cincinnati: observations and lessons learned from a "typical medium-sized" city's response to simulated terrorism utilizing Weapons of Mass Destruction

In the wake of the September 11, 2001, attacks and the subsequent anthrax scare, there is growing concern about the United States' vulnerability to terrorist use of Weapons of Mass Destruction (WMD). As part of ongoing preparation for this terrible reality, many jurisdictions have been conducting simulated terrorist incidents to provide training for the public safety community, hospitals, and public health departments. As an example of this national effort to improve domestic preparedness for such events, a large scale, multi-jurisdictional chemical weapons drill was conducted in Cincinnati, Ohio, on May 20, 2000. This drill depicted the components of the early warning system for hospitals and public health departments, the prehospital medical response to terrorism. Over the course of the exercise, emergency medical services personnel decontaminated, triaged, treated, and transported eighty-five patients. Several important lessons were learned that day that have widespread applicability to health care delivery systems nationwide, especially in the areas of decontamination, triage, on-scene medical care, and victim transportation. As this training exercise helped Cincinnati to prepare for dealing with future large scale WMD incidents, such drills are invaluable preparation for all communities in a world increasingly at risk from terrorist attacks.     

Comparing contemporary medical treatment practices aimed at intersex/DSD bodies in Israel and Germany

Recently, new laws and medical guidelines in many countries have prohibited early genital surgeries and irreversible medical treatment for intersexed babies. Following the passing of the German law that allows parents to register intersexed babies with no sex/gender, and after the establishment of new medical guidelines for intersexed patients in Israel, this study aims to examine the current medical policies regarding intersexed bodies at DSD centres and hospitals in Israel and Germany. How, if at all, have they changed the previous medical guidelines? This is a narrative study that includes 62 in‐depth interviews with medical professionals, parents and intersexed people from Germany and Israel. Three main controversial themes are examined, including the situated diagnostic medical gaze, the surgical practices for normalising intersexed bodies and the concealment of intersexed bodies. I find that in Israeli hospitals, early irreversible surgeries for ‘ambiguous genitals’ and the removal of internal sex organs are taking place frequently, whereas in Germany, the three DSD centres examined offer psychological counselling for parents instead of early surgeries for their babies. While in Israel concealment practices are embodied in the medical policy, the DSD centres in Germany encourage openness and peer group support.     

Toward an understanding of and response to tobacco use among high-risk Israeli and Palestinian youth

Little has been done to bring Israeli and Palestinian people together to address common health problems. Because Jewish and Arab people have been in a declared and/or de facto state of war since the establishment of Israel as a nation in 1948, the possibility of Israelis and Palestinian working together to deal with a mutual problem has been bleak. This article describes efforts to link people together to address tobacco use cessation among Israeli and Palestinian high-risk youth and provides an overview of a current initiative to demonstrate a smoking cessation model, Project EX, which may contribute to the health of those involved and to societal change in the region.     

Preparing for a disaster. Healthcare providers try to ready themselves for biological, chemical attacks without the benefit of government funding

A new era of security alerts and biological terrorism has descended on the nation. Since Sept. 11, 2001, hospitals have been busy preparing for the scenarios of possible terrorist attacks. But providers say federal funding has fallen far short of what is needed to achieve their goals. At left, staff at Beth Israel Medical Center-Kings Highway Division in New York undergo emergency preparedness training.     

Turf battles rock radiology

CEOs tell Hospitals magazine that imaging is a major area of expansion for their hospitals. But radiology is in a state of transition. Technological advances have made it possible to do more radiological procedures in the physician's office. This situation has created competition--and tension--between physicians in the same community, physicians and hospitals, and physicians on the same medical staff. How can you avoid costly turf wars at your hospital? Health care executives and directors of medical affairs say that the answer to this realignment of specialties is to create integrated teams of medical specialists.     

Unexplained symptoms after terrorism and war: an expert consensus statement

Twelve years of concern regarding a possible "Gulf War syndrome" has now given way to societal concerns of a "World Trade Center syndrome" and efforts to prevent unexplained symptoms following the most recent war in Iraq. These events serve to remind us that unexplained symptoms frequently occur after war and are likely after terrorist attacks. An important social priority is to recognize, define, prevent, and care for individuals with unexplained symptoms after war and related events (eg, terrorism, natural or industrial disasters). An international, multidisciplinary, and multiinstitutional consensus project was completed to summarize current knowledge on unexplained symptoms after terrorism and war.     

Private medical services in acute-care hospitals in Israel.

The objective of this study was to assess the proposed introduction of out-of-pocket funded inpatient and outpatient services (abbreviated as PMS) into government acute-care hospitals in Israel. This issue of public-private mix in not-for-profit hospitals is discussed in terms of the experience with PMS gained in selected advanced market economies. Then, the major contours of the Israeli system of health care, and the gradual evolving of patient-financed medical services within government acute-care hospitals in Israel, is described. The experience gained in the few public hospitals in Jerusalem that have been operating PMS is assessed critically. The concluding part reviews the advantages and disadvantages of these developments in public and government acute-care hospitals in Israel. It is concluded that PMS in public hospitals in Israel represents a policy aimed primarily at benefiting a select group of senior physicians in those hospitals.     

Terrorism preparedness training for nonclinical hospital workers: empowering them to take action

While aspects of the national response to the last years' terrorist attacks have included preparedness training for health care institutions, much of the focus has been on clinician recognition of biologic exposures. However, many hospital workers have nonclinical responsibilities (such as housekeepers and mailroom workers) and many more, though active in clinical care, are para-professionals with limited medical training (such as nursing assistants). These workers are critical to the achievement of our institution's mission to provide competent and compassionate medical care, even during an emergency. In recognition of this, and to understand their attitudes and concerns, we conducted focus groups. The process provided a forum to receive immediate feedback from the workers, and will be used to design customized knowledge and skills training sessions that empower them to take proper responsive action should a terrorist attack occur. Our experience may be useful to others who are planning terrorism preparedness training programs.     

COVID-19 Vaccination in Palestine/Israel: Citizenship,Capitalism, and the Logic of Elimination

Despite Israel’s responsibility under international law to combat the spread of contagious diseases and epidemics in its occupied territories, Israeli officials have refused to distribute COVID-19 vaccines to Palestinians in the West Bank and Gaza Strip. Through a critical discourse analysis of Israeli officials’ statements regarding Israel’s COVID-19 vaccination campaign, this paper explores how Israel evades this responsibility while presenting itself as committed to public health and human rights. We find that Israeli officials strategically present Palestinians as an autonomous nation when discussing COVID-19 vaccinations, despite Israel’s ongoing attempts to prevent the creation of a Palestinian state. Relatedly, Israel justifies its refusal to vaccinate Palestinians on the grounds of the Palestinian Authority’s economic independence, thereby obscuring Israel’s control over the Palestinian economy. In this way, Israel relies on citizenship and economic inequality, as internationally sanctioned forms of exclusion, to deny Palestinians their right to health. Drawing on theorists such as Michel Foucault, Achille Mbembe, and Jasbir Puar, we argue that withholding vaccines from Palestinians reveals the ways that Israel furthers its settler-colonial aims under the guise of liberal humanitarianism and economic growth. Instead of directing these conclusions toward Israel as an exceptional case, we contend that these processes reveal how settler-colonial societies use liberal frameworks of citizenship and capitalism to carry out their racialized projects of elimination.     

Electrical safety Q&A. A reference guide for the clinical engineer

This guide, which ECRI developed to answer the electrical safety questions most frequently asked by member hospitals, features practical advice for addressing electrical safety concerns in the healthcare environment. Questions addressed include: STANDARDS AND APPROVALS: What electrical safety standards apply? How do NFPA 99 and IEC 60601-1 differ? What organizations approve medical devices? LEAKAGE CURRENT LIMITS AND TESTING: How are leakage current limits established? What limits apply to equipment used in the hospital? And how should the limits be applied in special cases, such as the use of PCs in the patient care area or equipment used in the clinical laboratory? ISOLATED POWER: What are its advantages and disadvantages, and is isolated power needed in the operating room? Other topics addressed include double insulation, ground-fault circuit interrupters (GFCIs), and requirements for medical devices used in the home. Supplementary articles discuss acceptable alternatives to UL listing, the use of Hospital Grade plugs, the limitations of leakage current testing of devices connected to isolated power systems, and the debate about whether to designate ORs as wet locations. Experienced clinical engineers should find this guide to be a handy reference, while those new to the field should find it to be a helpful educational resource.     

Decisions near the end of life: professional views on life-sustaining treatments.

OBJECTIVES. How do health care professionals assess the care of hospital patients near the end of life? Are physicians and nurses aware of and in agreement with national recommendations regarding patients'' rights to forgo life-sustaining medical treatments and to receive adequate pain control? METHODS. We surveyed 687 physicians and 759 nurses in 5 hospitals. RESULTS. Almost half (47%) of all respondents and fully 70% of the house officers reported that they had acted against their conscience in providing care to the terminally ill. Four times as many respondents were concerned about the provision of overly burdensome treatment than about undertreatment. CONCLUSIONS. In summary, many physicians and nurses were disturbed by the degree to which technological solutions influence care during the final days of a terminal illness and by the undertreatment of pain. However, changes in the care of dying patients may not have kept pace with national recommendations, in part because many physicians and nurses disagreed with and may have been unaware of some key guidelines, such as the permissibility of withdrawing treatments.     

Critical issues for homeland security and health care sector readiness

The “war on terrorism” and the nation's response to associated terrorist threats has created a significant challenge for health care risk management professionals. The Department of Homeland Security and initiation of the National Response Plan have set in motion a series of national requirements and obligations designed to protect and prepare the country to meet terrorist threats. These requirements and obligations have an impact on the health care industry with its ownership of critical infrastructure/key resources requiring protection from all‐hazards events. Health care risk management professionals should be aware that the consequences of not meeting expectations during a future attack are significant.     

System nets economic plusses

How will multi-hospital systems facilitate medical care in the future? How do administrators of such systems integrate the important components and personnel to achieve well-coordinated care for individual patients? In the following article, E. Wynn Presson, president and CEO of Health Midwest, a regional health care system involving 10 counties around metropolitan Kansas City, Kan., discusses the process of building and maintaining a regional care system of 40 health care entities including 11 hospitals and 2,350 licensed acute care beds.     

Updates and reflections about the IJHPR,on the eve of its seventh year

The Israel Journal of Health Policy Research (IJHPR) will soon be completing 6 years of publication. During this period, it has published well over 300 articles and has become a stable and vital part of Israeli health care. The number of IJHPR articles published annually has increased significantly over time, and the number of submissions has increased even more significantly. The journal is regularly drawing submissions from a very broad range of Israeli universities, hospitals, health plans, and other institutions, and from leading institutions abroad. The journal’s articles cover a wide spectrum of subjects related to health policy, as reflected in the diversity of the article collections that the journal has launched to date. True to its mission statement, the IJHPR is promoting “intensive intellectual interactions among scholars and practitioners from Israel and other countries regarding all aspects of health policy”.The journal has been indexed in all of the leading international academic databases and its current impact factor (1.36) puts it in the third quartile in two key Web of Science subject categories. Several IJHPR articles have been accessed over 10,000 times and the IJHPR has become the predominant vehicle in which Israeli scholars are publishing articles with a health policy orientation. IJHPR articles are also figuring prominently in many course syllabi in Israel, and Israeli universities have incorporated IJHPR publications into assessments of faculty members for promotion. The journal’s success and progress are a part of a larger trend of greater reliance on data and analysis in health policymaking in Israel and the increasing prominence of health in the Israeli policy agenda and public discourse.During the journal’s seventh year, its editors will be carrying out a serious assessment of the challenges and opportunities ahead and developing an updated plan for the journal’s development. In doing so, they will draw on data presented in this editorial as well as on in-depth discussions with those who have contributed to the journal’s success to date: it publisher, sponsor, and editorial board members, as well as a sample of authors, reviewers and readers. The expectation is that, by working together, it will be possible to take the journal to new heights.     

Make sure your imaging equipment goes the distance

Today's hospitals have invested a substantial portion of their capital budgets on the purchase of high-tech equipment--diagnostic imaging machinery, clinical laboratory apparatus, biomedical devices--and yet only half have developed strategies for taking care of that equipment as it ages. When do you replace it? When is it obsolete? How do you determine whether it is cost effective? Kenneth Halverson examines the steps to take to develop and implement a successful asset management program that will enable you to keep your high-tech equipment going.     

Point and click. (If only it were that easy.)

Along with tight reimbursement and confounding regulations, any list of big headaches for health care leaders includes information technology. We've been promised so much from IT for so long, and have been disappointed so many times, who can blame us for being skeptical, if not downright cynical? When is the last time an investment in information technology actually improved your bottom line? But we know we can't dismiss IT altogether. At the end of the rainbow there really is efficiency, security and better care for patients. So how close are we? In this issue, H&HN takes a hard look at technology--what it can do for us today and tomorrow. We look at return on investment, examining whether hospitals are measuring what they get back against what they put in; a budding effort to bring a common platform to health care IT; handheld computers; electronic medical records; and computerized physician order entry. The technology is out there, but it's fair to ask: is it really clicking yet?     

Priorities in the Israeli health care system

The Israeli health care system is looked upon by some people as one of the most advanced health care systems in the world in terms of access, quality, costs and coverage. The Israel health care system has four key components: (1) universal coverage; (2) ‘cradle to grave’ coverage; (3) coverage of both basic services and catastrophic care; and (4) coverage of medications. Patients pay a (relatively) small copayment to see specialists and to purchase medication; and, primary care is free. However, during 2011 the Israeli Medical Association (IMA) spent 5 months on a strike, justifying it as trying to ‘save’ the Israeli public health. This paper describes some aspects of the Israeli Health Care System, the criteria for setting priorities for the expenditures on health care and values underlying these criteria. The paper observes that the new agreement between the IMA and the government has given timely priority to problematic areas of specialization (in which there is an acute shortage of physicians) and to hospitals in the periphery of the country. Yet weak points in the health system in Israel remain. Particularly, the extent to which national health care expenditures are being financed privately—which is rising—and the parallel decline in the role of government financing.     

Social and health policy issues in total joint replacement surgery.

Total joint replacement has restored function and provided comfort to many patients who would otherwise have suffered. However, success and widespread diffusion of this procedure pose a number of important questions. The patient's and the doctor's criteria of success may not be the same: Which are to be used? Health resources are becoming limited: Should money be spent to restore function and for pain relief to those late in life or past their work life? Who makes this choice? A medical technology is tested in the best of settings but routinely practiced in many: How should society and health care professionals monitor the results of surgery? Who should do surgery and where should it be done?     

The diversity factor. Is your hospital doing all it can do to address its various patient populations?

What are the barriers to culturally competent health care? How can you collect data to help overcome disparities? How do four hospitals set the standard for meeting this imperative?