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RENEE MONTAGNE, host:

This is MORNING EDITION from NPR News. With Steve Inskeep, I'm Renee Montagne.

And this week we've been hearing from a security expert who is warning that we should do more to prepare for disasters.

Mr. STEPHEN FLYNN (Author, "The Edge of Disaster"): You know, we're focused on what's myopically on preventing every act of terror, which is a bit of a - which, frankly, is an impossibility. But what we can do and what we can control is how we respond when terrorist incidents happen or when accidents happen.

MONTAGNE: Stephen Flynn showed us a port here in Southern California that he says could be better prepared for attack, and he's been telling Steve Inskeep about a series of vulnerable points.

STEVE INSKEEP: And that includes a California levee system that is not ready for an earthquake.

Mr. FLYNN: What will happen is the ground will shake, and the peat soil in the sand foundations of these levees will essentially shake and liquefy, as its called. And you will have massive breaches of this levee system.

INSKEEP: Stephen Flynn is the author of a book called "The Edge of Disaster," and to finish our conversations, we asked him to stop by a hospital in the nation's capital.

Mr. FLYNN: Well I'm here in a emergency room in a Washington-area hospital, and a few people are straggling in looking to get their appointments for coping with what ailments they have today.

INSKEEP: When you as a professional in security issues look at emergency room like this, what are you looking for?

Mr. FLYNN: Well I'm looking for, really, is surge capacity. Is this a place that could really manage a catastrophic event? Look around and say, Jesus, this kind of place that couldn't handle potentially hundreds or thousands of casualties, all requiring triage and other kinds of life-and-death care.

INSKEEP: When you say does it have that capacity, are you asking does it have hundreds of vacant beds? Does it have hundreds of idle doctors?

Mr. FLYNN: Everything from just is there enough real estate to get people in? Is there a place to put folks? Are there doctors that are available? And almost certainly, the answer to all of those is no, not enough.

INSKEEP: Why is that?

Mr. FLYNN: It is in part because the medical community has been moving in the direction of much of our economy, which is ringing out the extra capacity in order to essentially focus on the bottom line.

INSKEEP: I suppose there are a lot of different problems where you might need extra hospital capacity. Let's talk about one that you've written about. What happens in the case of a major flu outbreak somewhere in the United States?

Mr. FLYNN: Each year we have with flu about over 300,000 people end up in hospitals that have to basically receive medical treatment in a hospital environment, and about 32,000 of those people won't go home. The fact is flues are very dangerous in the normal season.

But we're really wary, of course, is an avian pandemic flu or some variation of that, what we had back in 1918, the last major flu outbreak where one percent of the people who were infected died from the flu. And estimates right now is about 80 million people would be infected if we had a pandemic flu outbreak.

So we're talking about 800,000 people dying and a lot of other people being very sick. But the total number of hospital beds in the entire country is only 970,000. So clearly we'd have to find a much different way to provide emergency care for people outside of our hospital settings. This requires an enormous amount of effort at the local state level and simply won't happen without real federal leadership, which has been pretty much missing today.

INSKEEP: Just wanted to check that number, when you said 80 million people could be infected, do you mean in the United States?

Mr. FLYNN: Yes, that's just in the United States. And our medical care system would be called upon to try to cope with that surge. But it's barely staying afloat managing the day-to-day demands being placed on it. I think anybody who's have to go to the hospital recently knows they're in a long wait.

INSKEEP: If you did a cost-benefit analysis of this, you would want in any given city, any city in America that could be struck with some kind of disaster, you'd want extra hospital capacity, extra supplies, extra doctors. When you do the brutal analysis, is it going to be found to be worth it?

Mr. FLYNN: I think what is clear is that we're going to have incidents, whether by acts of God or acts of man, that are going to place a lot of people in desperate need for emergency care. And it will be life and death whether or not they receive it. And so investments like insurance for that rainy day by making sure our medical care system can handle that surge I think is something that we can't afford not to do.

But there's ways to do this that are not all about having the kind of big hospitals and lots of people standing by idly. Some of this are involving our citizenry in preparing them to assist the medical community when needed. We need to do a lot more of reaching out to our retired ranks of nurses and doctors.

INSKEEP: And sort of like an army - the Army uses its reserve, its former officers.

Mr. FLYNN: Exactly so. And citizens themselves can be trained to something called a CERT Program. It's Citizen Emergency Response Training where they can get 20 hours of training and basically be able to assist on some of the basic care needs. So there's a lot that we could do that would not be enormously expensive, that would be quite prudent to do. But we really have to recognize that we're essentially moving in the wrong direction. That the efforts to essentially try to keep costs down and to ultimately make our medical care system as efficient as possible stands in opposition to the need to have surge capacity when things go very wrong.

INSKEEP: Stephen Flynn is author of "The Edge of Disaster", and tomorrow on MORNING EDITION, we'll listen to a top official from the Department of Homeland Security answer some of the concerns that Flynn has raised this week.

MONTAGNE: All of Steve's conversations with Stephen Flynn are at npr.org.

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