SAN DIEGO—Few hospitals in the world are prepared to respond adequately when the next pandemic strikes, according to a panel of experts.

Based on the timeline of previous pandemics and the progression of avian influenza, the next one should strike soon, said executives with Marsh USA Inc. and affiliate Mercer Health & Benefits L.L.C., subsidiaries of New York-based Marsh & McLennan Cos. Inc.

But a Mercer survey shows that while hospitals worldwide are concerned about how they will function during a pandemic, there is a huge gap "between their concern and the current state of preparedness," said Melissa Updike, a Louisville, Ky.-based Marsh vp.

Hospitals that were affected by severe acute respiratory syndrome in 2003 are best prepared for the next pandemic, Ms. Updike said during an educational session at the American Society for Healthcare Risk Management's 2006 conference and exhibition. ASHRM held its event Oct. 29-Nov. 1 in San Diego.

SARS, a viral respiratory illness that first was reported in Asia in February 2003, killed 774 people and made about 8,000 ill when it spread to more than two dozen countries on four continents over a few months, according to the World Health Organization.

Only eight U.S. citizens were infected during the outbreak, according to the WHO.

The worldwide economic impact of SARS was $60 billion, said Keith Becker, an Atlanta-based senior vp with Marsh.

But that outbreak was extremely tame compared to the picture of a widespread pandemic, noted Dalena Berrett, a vp with Marsh in Nashville, Tenn.

A true pandemic could kill more than 200,000 U.S. citizens and make 35% of the population ill, Ms. Berrett said. The economic impact of such widespread illness would exceed $166 billion, she said.

The WHO's avian flu alert stage is at level three, which means there is limited human-to-human transmission of the illness. Still, at that level, the world is closer to an influenza pandemic than at any time since 1968, the WHO says.

Ms. Berrett said that once the alert reaches level four, health conditions worldwide will deteriorate within months and bring the alert level to its highest stage-level six, when there is sustained human-to-human transmission of the illness.

In preparation for a pandemic, hospitals should consider how they will function with a fraction of their resources, the panelists said.

Otherwise, the combination of huge patient volumes and high staff absenteeism likely will create a toxic climate of medical error, Mr. Becker warned.

Ms. Berrett encouraged hospital risk managers to prepare their facilities to respond to a pandemic by using a guideline prepared by the U.S. Department of Health and Human Services' Centers for Disease Control and Prevention.

The value of preparedness is most evident once the crisis has passed, said Dr. James O. Reynolds, a Denver-based principal with Mercer. Dr. Reynolds noted that a hospital in Singapore that was not prepared to handle SARS-infected patients was forced to close after SARS was contained, because many of the hospital's patients who had been admitted for other reasons contracted SARS during their stay.

Among other things, the CDC recommends:

• Developing a checklist of hospital representatives and their responsibilities during a pandemic. Plans should indicate the conditions that will activate them, and should be coordinated with local, regional and state health departments' pandemic plans as well as with national plans, Ms. Berrett said.

• Develop training and education not only for in-house staff but also for agency staff who will have to fill in for workers who likely will not show up for work during a pandemic.

  Ms. Berrett said the CDC offers a calculator for estimating how resources, such as staffing levels, would be affected during a pandemic.

  But Dr. Reynolds said that hospitals should plan on operating without at least 40% of their staff. While some will be struck with illness, others will stay home to care for sick family members or to supervise their children, who will be home because schools will be closed, Dr. Reynolds said.

  He recommended that risk managers conduct a skill inventory of staff and arrange for cross-training so that facilities will have some staff to perform all necessary functions.

  Risk managers also should arrange for a contingent workforce in other areas, such as housecleaning and food preparation, Dr. Reynolds said.

• Develop triage and admission practices that separate patients with avian flu from those with a non-avian flu.

  During a pandemic, cases will outstrip beds by 400%, so triage will be tremendously important, Dr. Reynolds said.

  If a hospital organization has more than one facility in a geographical area, it should consider designating one as a non-flu hospital to reduce the risk of infecting patients who have been admitted for other reasons, he suggested.

He also recommended that hospitals:

• Develop a plan to ensure the hospital has adequate supplies of all kinds, including medication and surgical gases.

• Conduct drills to discover plan deficiencies.

Dr. Reynolds related that one company prepared for a potential catastrophe by arranging for employees to telecommute. When a disaster did occur, the plan failed because 70% of the telecommuters had not been trained how to get past the company's computer system firewall. If the company had conducted a drill, it would have discovered the problem, he said.

To maintain employee morale and allegiance during a crisis, risk managers should inform them that the facility has a plan to continue operating during a pandemic, Dr. Reynolds advised. That communication should include the assurance that employees will be compensated with "combat pay" for their efforts during the crisis, he said.