The Current Crisis in Emergency Care and the Impact on Disaster Preparedness

<p>Abstract</p> <p>Background</p> <p>The Homeland Security Act (HSA) of 2002 provided for the designation of a critical infrastructure protection program. This ultimately led to the designation of emergency services as a targeted critical infrastructure. In the context of an evolving crisis in hospital-based emergency care, the extent to which federal funding has addressed disaster preparedness will be examined.</p> <p>Discussion</p> <p>After 9/11, federal plans, procedures and benchmarks were mandated to assure a unified, comprehensive disaster response, ranging from local to federal activation of resources. Nevertheless, insufficient federal funding has contributed to a long-standing counter-trend which has eroded emergency medical care. The causes are complex and multifactorial, but they have converged to present a severely overburdened system that regularly exceeds emergency capacity and capabilities. This constant acute overcrowding, felt in communities all across the country, indicates a nation at risk. Federal funding has not sufficiently prioritized the improvements necessary for an emergency care infrastructure that is critical for an all hazards response to disaster and terrorist emergencies.</p> <p>Summary</p> <p>Currently, the nation is unable to meet presidential preparedness mandates for emergency and disaster care. Federal funding strategies must therefore be re-prioritized and targeted in a way that reasonably and consistently follows need.</p

Public-private partnership and private finance initiatives in the EU and Spanish local governments

This paper analyses the different public-private partnership initiatives carried out by EU and Spanish local governments in the framework of public sector reforms. In the first part we analyse the degree of externalization in the public services delivered by the most important EU cities and the kind of organization chosen to provide them. In the second part we study the different methods of PFI applied in Spain and the accounting, auditing and monitoring of these kinds of contracts. The results of our survey show that almost all EU local governments provide similar services, that there is a high degree of PPP initiatives in the delivery of local government services, and that PPP is concerned with those activities which do not constitute the core of public administration. This means that an important part of the activity controlled by the local governments, which are responsible, are not reflected in their individual annual accounts. Because of this, local governments will have to implement accountability and monitoring tools, such as PPP and PFI accounting standards, consolidation of annual accounts, regulatory bodies and value-for-money audits in order to assess the performance of local services delivered under PPP initiatives, and to prevent monopoly abuses.