U.S. Hospital Capacity Breaking Point

In our on-going discussion of prepping and survival topics, we often consider various possible disasters, from small to large, from short-term to long-term, and how we might prudently prepare. Many of these disaster scenarios involve a sharp increase in injuries or illnesses over a large population: a severe flu epidemic, civil unrest with an increase in violent crimes, radioactive fallout, etc. A question then arises as to whether the current hospital system in the U.S. can handle a large influx of new patients.

The population in the U.S. has increased from 215,973,199 persons in 1975 [Census.gov] to 307,006,550 persons in 2009 [Census.gov], for an increase of 91,033,351 persons.

But the number of hospitals and hospital beds has decreased sharply in the same time period.

1975: 7156 hospitals with 1,465,828 beds
2009: 5795 hospitals with 944,277 beds.

We have over 1300 fewer hospitals, which is 19% less, and over 521,000 fewer hospital beds, which is about 35% less. The average occupancy rate for all hospitals (2009) is 67.8%. But for the largest hospitals, which generally offer the most advanced care, the occupancy rate is 74%. [CDC.gov PDF] Based on these figures, there are approximately 304,000 available hospital beds in the U.S. hospital system. Is that enough beds?

The term “hospital bed” refers to the capacity to accept patients and care for them. So it is not merely a question of physical beds, but of all the equipment and personnel needed to treat that patient. Theoretically, the U.S. hospital system could go from 67.8% occupancy to 100% occupancy, while still providing adequate care. But in reality, that increase of 47.5% (32.2/67.8 = 47) would strain hospital resources to the breaking point.

In a typical hospital — almost any unit in any hospital — the staff are already very busy. They cannot increase their work by almost 50%. Interns already work a crazy large number of hours per week. If doctors and nurses were required to work 50% more hours, the quality of their work would suffer, and some would be unable or unwilling to work that much more.

As for medical equipment and supplies, hospitals keep the flow of supplies near to the pace of typical use. Hospitals require money to run, even if it is a non-profit hospital. There is not enough money to store a large excess of medicines and equipment just in case a large increase in patients should occur. Hospitals would run out of supplies. Staffing would not be sufficient. The care of patients would then suffer greatly.

So the estimate of 304,000 available hospital beds is probably too high. There may be that many physical beds, but the hospital system can’t absorb three hundred thousand new patients. How many beds would be needed in the case, let’s say, of a major flu epidemic? “The U.S. death toll during the 1918 pandemic was approximately 675,000″ [flu.gov]. We can presume that those 675 thousand needed hospitalization. And an unknown number of additional persons, perhaps a group as large or larger, would certainly have benefited from hospital care.

Here is what the U.S. government website, Flu.gov, admits about the possible response to a major flu epidemic in the U.S.

Characteristics and Challenges of a Flu Pandemic

Rapid Worldwide Spread
When a pandemic flu virus emerges, expect it to spread around the world.
You should prepare for a pandemic flu as if the entire world population is susceptible.

Overloaded Health Care Systems
Most people have little or no immunity to a pandemic virus. Infection and illness rates soar. A substantial percentage of the world’s population will require some form of medical care.
Nations are unlikely to have the staff, facilities, equipment, and hospital beds needed to cope with the number of people who get the pandemic flu.

Past pandemics spread globally in two or sometimes three waves.

Inadequate Medical Supplies
The need for vaccines is likely to be larger than the supply.
Early in a pandemic, the need for antiviral medications is likely to be larger than the supply.

A pandemic can create a shortage of hospital beds, ventilators, and other supplies. Alternative sites, such as schools, may serve as medical facilities.

Health care providers and hospitals may be overwhelmed [flu.gov]

So, it’s not just me. The U.S. government admits we don’t have the capability to deal with a flu epidemic. The current hospital system simply cannot handle a major influx of patients, even if the epidemic were half or one fourth the size of the 1918 flu pandemic.

As for other possible scenarios, the type of injury or illness is relevant. A hospital might be able to handle a 10% increase in patients, if the types of illness and injury are divided among various types. But suppose all the excess patients have the same type of injury or illness. They all need treatment on the same single hospital unit. They all need the same type of medicine and equipment. The hospital system can be more quickly overwhelmed in such a case.

Suppose that there is a large number of patients affected by radioactive fallout. Most hospitals can only handle a very small number of patients with this particular illness/injury. Most hospital units are designed to treat only a specific range of medical issues. And since radiation sickness is very specialized and generally uncommon, the hospital system would be quickly overwhelmed by a relatively limited number of patients with this illness.

If the hospital system is overwhelmed by a sudden influx of patients with the same injury or illness, expect casualties to be higher. In some disaster scenarios, medical care may not be available. People will be left to their own devices to cope with illness or injury. This is a serious issue for us to consider when making preparations for possible future disasters.

– Thoreau

2 Responses to U.S. Hospital Capacity Breaking Point

  1. A lot of good information there and like anything its worth doing some practical, prudent, probable preps for you and your family. After almost two decades in emergency management let me flesh out the points made.

    1) Remember that government agencies will always paint the worst picture possible in whatever there sphere of responsibility. Two reasons for this: one, their budget depends on it. If you don’t have a problem you don’t get funding. That’s why the government can’t figure out how to spend 2 cents less for every dollar is forks out. And two, do you want to be the agency head that faces a hostile public and political elites because you knew or should have known and just happen to get it wrong or were found to be under prepared. Nope, you don’t build a career in public service by saying your organization is not absolutely essential to some constituent group. Point is, bear these facts in mind, whenever reading government “facts” and remember budgets are at stake including those from the CDC, et.al.

    2) Many jurisdiction have planned for this sort of contingency. My city for example has exercised in real time and table top sessions, mass distribution of medicine to the public in the case of a large scale infectious disease outbreak. Many Offices of Emergency Management have their response plans on the Internet. Check out your city or town’s; if you can’t find one you might want to ask your local politicians why – see point 1.

    3) Triage is a basic concept in the medical community and, again, my city has plans to use schools – mostly elementary schools (because they are the most numerous and closest to “neighborhoods”) for pre-screening points in the event of a large scale incident. Its been done before google the Goiânia accident or how the Russians decontaminated an entire city after Chernobyl accident. Only the most serious cases will be allowed to get anywhere near a hospital, if the local authorities have a good plan – see point 1 and 2.

    4) As mentioned these sorts of events happen in waves and as the crest of the incident wave builds you can expect public health, emergency management personnel, and epidemiologists to see the event coming. Conflicts of turf and questions of “who’s in charge” will arise because most people who should know don’t know anything about the National Emergency Management System (NIMS) and how to implement it. It will be messy and wasteful, nevertheless we’ll muddle through – think Hurricane Katrina’s response. If all goes well, smart politicians will send out warnings and advice to their citizens, sometimes they’ll be wrong, sometimes right – think fog of war concept. Smart citizens will heed the advice and prepare for the event… but don’t count on smart politicians or citizens.

    Given all that what’s a body to do… pay attention, get educated before hand, don’t panic, and get prepared with practical, prudent, and probable preps.

  2. I agree. You’ve got to prepare at home, have resources, have knowledge, yet know your limitations. I see way too many preppers investing in things like sutures and surgical supplies but overlook things for typical ailments such as upper respiratory infections and diarrhea. You need items ranging from guaifenisen to bleach.

    Hospitals have decreased in size because hospitals stays are shorter. Reimbursement necessitates that people be sent home more quickly. I can also assure you that many hospital employees are going to stay home in a disaster situation.