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Barten DG, Klokman VW, Cleef S, Peters NALR, Tan ECTH, Boin A. When disasters strike the emergency department: a case series and narrative review. Int J Emerg Med 2021; 14:49. [PMID: 34503447 PMCID: PMC8427145 DOI: 10.1186/s12245-021-00372-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Emergency departments (EDs) are reasonably well prepared for external disasters, such as natural disasters, mass casualty incidents, and terrorist attacks. However, crises and disasters that emerge and unfold within hospitals appear to be more common than external events. EDs are often affected. Internal hospital crises and disasters (IHCDs) have the potential to endanger patients, staff, and visitors, and to undermine the integrity of the facility as a steward of public health and safety. Furthermore, ED patient safety and logistics may be seriously hampered. METHODS Case series of 3 disasters within EDs. Narrative overview of the current IHCD-related literature retrieved from searches of PubMed databases, hand searches, and authoritative texts. DISCUSSION The causes of IHCDs are multifaceted and an internal disaster is often the result of a cascade of events. They may or may not be associated with a community-wide event. Examples include fires, floods, power outages, structural damage, information and communication technology (ICT) failures, and cyberattacks. EDs are particularly at-risk. While acute-onset disasters have immediate consequences for acute care services, epidemics and pandemics are threats that can have long-term sequelae. CONCLUSIONS Hospitals and their EDs are at-risk for crises and their potential escalation to hospital disasters. Emerging risks due to climate-related emergencies, infectious disease outbreaks, terrorism, and cyberattacks pose particular threats. If a hospital is not prepared for IHCDs, it undermines the capacity of administration and staff to safeguard the safety of patients. Therefore, hospitals and their EDs must check and where necessary enhance their preparedness for these contingencies.
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Affiliation(s)
- Dennis G. Barten
- Department of Emergency Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
| | - Vincent W. Klokman
- Department of Emergency Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
| | - Sigrid Cleef
- Department of Emergency Medicine, Laurentius Hospital, Roermond, The Netherlands
| | - Nathalie A. L. R. Peters
- Department of Emergency Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
| | - Edward C. T. H. Tan
- Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arjen Boin
- Department of Political Science, Leiden University, Leiden, The Netherlands
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Supporting Staff Through a Complete Hospital Evacuation and Extended Displacement Period. J Healthc Manag 2019; 63:195-209. [PMID: 29734281 DOI: 10.1097/jhm-d-16-00009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
EXECUTIVE SUMMARY Complete hospital evacuations due to natural or man-made disasters can have repercussions on all levels of hospital operations. An extended displacement period following an evacuation exacerbates the situation. Retaining a healthy, employed workforce following a disaster is a crucial step in ensuring that a facility is effectively staffed when it returns to normal operations. In this article, the authors address the issue of staff support during evacuation and extended displacement by examining the actions taken by the leadership of the VA New York Harbor Health Care System, a Veterans Health Administration facility, in response to the evacuation and displacement caused by Superstorm Sandy in 2012. As staff began to realize that the displacement would be extensive, frustration, complaints, and a sense of disenfranchisement emerged. The authors' findings suggest that the most valuable tool to allay staffs' fears were monthly forums, whereby staff had the opportunity to meet face-to-face with leadership and ask questions. An important consideration when staff are displaced is the role that cultural differences between host and displaced facility staff plays, even when those facilities are part of the same system. Significant attention must be given to cultural differences, in both acknowledging and resolving them. The study suggests that direct communication with leadership, support from upper and middle management, and an understanding that sharing best practices across facilities strengthens the entire team are key approaches to addressing these challenges.
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Griffin AR, Gable AR, Der-Martirosian C, Dobalian A. Hospitals Providing Temporary Emergency Department Services in Alternative Care Settings After Hurricane Sandy. Crit Care Nurs Clin North Am 2019; 31:249-256. [PMID: 31047097 DOI: 10.1016/j.cnc.2019.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reports findings of a qualitative study describing how the US Department of Veterans Affairs cared for vulnerable veterans after Hurricane Sandy while medical center was closed for an extended period. This experience highlights how vulnerable patients continued to need care. Hospital preparedness planning efforts focus primarily on sheltering in place and evacuation. Research is needed to identify how hospitals provided temporary emergency services in alternative settings to inform practical guidance. Hospital planners should anticipate that their most vulnerable patients will continue to need emergency care. Viable solutions should be considered to meet immediate and long-term patient needs.
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Affiliation(s)
- Anne Reid Griffin
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, 16111 Plummer Street, MS-152, North Hills, CA 91343, USA.
| | - Alicia R Gable
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, 16111 Plummer Street, MS-152, North Hills, CA 91343, USA
| | - Claudia Der-Martirosian
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, 16111 Plummer Street, MS-152, North Hills, CA 91343, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, 16111 Plummer Street, MS-152, North Hills, CA 91343, USA; Division of Health Systems Management and Policy, The University of Memphis School of Public Health, Memphis, TN 38152, USA
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A Crisis Within a Crisis: The Extended Closure of an Opioid Treatment Program After Hurricane Sandy. JOURNAL OF DRUG ISSUES 2018. [DOI: 10.1177/0022042618779541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Disruptions in opioid treatment programs (OTPs) are common after major disasters. Highly regulated OTPs confront challenges when responding to extended closures following disaster. Following Hurricane Sandy in 2012, an OTP located at the Manhattan Veteran Affairs Medical Center (VAMC) closed for 5 months. Semistructured interviews were conducted with clinicians and administrators who participated in the evacuation of the Manhattan VAMC, including the co-located OTP program. The Manhattan OTP preemptively dispensed emergency take-home methadone doses. Following closure, emergency guest-dosing arrangements were made for approximately 100 Veterans with Veterans Affairs (VA) and non-VA OTPs throughout New York City. Fortuitously, a retired VA OTP at another facility was reopened and accredited expeditiously. OTPs must improve contingencies for emergency response. However, disruptions in methadone delivery and threats to patient safety are likely to continue until agencies with oversight authority of OTPs describe specifications for emergency alternate care sites during long-term disaster recovery.
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Igarashi Y, Tagami T, Hagiwara J, Kanaya T, Kido N, Omura M, Tosa R, Yokota H. Long-term outcomes of patients evacuated from hospitals near the Fukushima Daiichi nuclear power plant after the Great East Japan Earthquake. PLoS One 2018; 13:e0195684. [PMID: 29664960 PMCID: PMC5903607 DOI: 10.1371/journal.pone.0195684] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 03/27/2018] [Indexed: 12/05/2022] Open
Abstract
Introduction After the accident of the Fukushima Daiichi nuclear power plant due to the Great East Japan Earthquake in March 2011, the Japanese government issued a mandatory evacuation order for people living within a 20 km radius of the nuclear power plant. The aim of the current study was to investigate long-term outcomes of these patients and identify factors related to mortality. Materials and methods Patients who were evacuated from hospitals near the Fukushima Daiichi nuclear power plant to the Aizu Chuo Hospital from 15 to 26 March, 2011 were included in this study. The following data were collected from medical records: age, sex, activities of daily life, hospital they were admitted in at the time of earthquake, distance between the facility and the nuclear power plant, reasons of evacuation and number of transfers. The patient outcomes were collected from medical records and/or investigated on the telephone in January 2012. Results A total of 97 patients (28 men and 69 women) were transferred from 10 hospitals via ambulances or buses. No patients died or experienced exacerbation during transfer. Median age of the patients was 86 years. Of the total, 36 patients were not able to obey commands, 44 were bed-ridden and 61 were unable to sustain themselves via oral intake of food. Among 86 patients who were followed-up, 41 (48%) died at the end of 2011. Multiple-regression analysis showed that non-oral intake [Hazard Ratio (HR): 6.07, 95% Confidence interval (CI): 1.94–19.0] and male sex [HR: 8.35, 95% CI: 2.14–32.5] had significant impact on mortality. Conclusion This study found that 48% of the evacuated patients died 9 months after the earthquake and they had significantly higher mortality rate than the nursing home residents. Non-oral intake and male sex had significant impact on mortality. These patients should be considered as especially vulnerable in case of hospital evacuation.
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Affiliation(s)
- Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
- * E-mail:
| | - Takashi Tagami
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Jun Hagiwara
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Takahiro Kanaya
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Norihiro Kido
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
| | - Mariko Omura
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Fukushima, Japan
| | - Ryoichi Tosa
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Fukushima, Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
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Hammad KS, Arbon P, Gebbie K, Hutton A. Why a disaster is not just normal business ramped up: Disaster response among ED nurses. Australas Emerg Care 2018; 21:36-41. [DOI: 10.1016/j.aenj.2017.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/17/2017] [Accepted: 10/22/2017] [Indexed: 10/18/2022]
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Der-Martirosian C, Griffin AR, Chu K, Dobalian A. Telehealth at the US Department of Veterans Affairs after Hurricane Sandy. J Telemed Telecare 2018; 25:310-317. [PMID: 29384428 DOI: 10.1177/1357633x17751005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Like other integrated health systems, the US Department of Veterans Affairs has widely implemented telehealth during the past decade to improve access to care for its patient population. During major crises, the US Department of Veterans Affairs has the potential to transition healthcare delivery from traditional care to telecare. This paper identifies the types of Veterans Affairs telehealth services used during Hurricane Sandy (2012), and examines the patient characteristics of those users. METHODS This study conducted both quantitative and qualitative analyses. Veterans Affairs administrative and clinical data files were used to illustrate the use of telehealth services 12 months pre- and 12 months post- Hurricane Sandy. In-person interviews with 31 key informants at the Manhattan Veterans Affairs Medical Center three-months post- Hurricane Sandy were used to identify major themes related to telecare. RESULTS During the seven-month period of hospital closure at the Manhattan Veterans Affairs Medical Center after Hurricane Sandy, in-person patient visits decreased dramatically while telehealth visits increased substantially, suggesting that telecare was used in lieu of in-person care for some vulnerable patients. The most commonly used types of Veterans Affairs telehealth services included primary care, triage, mental health, home health, and ancillary services. Using qualitative analyses, three themes emerged from the interviews regarding the use of Veterans Affairs telecare post- Hurricane Sandy: patient safety, provision of telecare, and patient outreach. CONCLUSION Telehealth offers the potential to improve post-disaster access to and coordination of care. More information is needed to better understand how telehealth can change the processes and outcomes during disasters. Future studies should also evaluate key elements, such as adequate resources, regulatory and technology issues, workflow integration, provider resistance, diagnostic fidelity and confidentiality, all of which are critical to telehealth success during disasters and other crises.
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Affiliation(s)
| | - Anne R Griffin
- 1 Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, USA
| | - Karen Chu
- 1 Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, USA
| | - Aram Dobalian
- 1 Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, USA.,2 Division of Health Systems Management and Policy, University of Memphis, USA
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VanDevanter N, Raveis VH, Kovner CT, McCollum M, Keller R. Challenges and Resources for Nurses Participating in a Hurricane Sandy Hospital Evacuation. J Nurs Scholarsh 2017; 49:635-643. [DOI: 10.1111/jnu.12329] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Nancy VanDevanter
- Professor; New York University; Rory Meyers College of Nursing; New York NY USA
| | | | - Christine T. Kovner
- Professor; New York University; Rory Meyers College of Nursing; New York NY USA
| | - Meriel McCollum
- PhD Candidate; University of North Carolina Chapel Hill; Chapel Hill NC USA
| | - Ronald Keller
- Senior Director of Nursing NYU Hospitals Center; New York University; Langone Medical Center; New York NY USA
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Bish DR, Tarhini H, Amara R, Zoraster R, Bosson N, Gausche-Hill M. Modeling to Optimize Hospital Evacuation Planning in EMS Systems. PREHOSP EMERG CARE 2017; 21:503-510. [DOI: 10.1080/10903127.2017.1302531] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hicks J, Glick R. A meta-analysis of hospital evacuations: overcoming barriers to effective planning. J Healthc Risk Manag 2016; 34:26-36. [PMID: 25630283 DOI: 10.1002/jhrm.21162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A hospital evacuation is a significant disaster scenario facing today's Hospital Emergency Coordinators (HECs) and Risk Managers. In this work we explore the numerous barriers that prevent HECs from being able to effectively plan for and execute hospital evacuations based on a review of the pertinent literature of the last 30 years. We discuss the finding that the reasons for the success or failure generally fall into 1 or more of 8 broad categories: Predisaster Assessment, Logistics, Communications, Community Relationships, Manual Records and Tracking, Resource Management, Special Patient Populations, and Postevacuation Return.
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Personal and professional challenges confronted by hospital staff following hurricane sandy: a qualitative assessment of management perspectives. BMC Emerg Med 2016; 16:18. [PMID: 27151172 PMCID: PMC4857438 DOI: 10.1186/s12873-016-0082-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 04/28/2016] [Indexed: 11/21/2022] Open
Abstract
Background Adequate hospital staffing during and after a disaster is critical to meet increased health care demands and to ensure continuity of care and patient safety. However, when a disaster occurs, staff may become both victim and responder, decreasing their ability and willingness to report for work. This qualitative study assessed the personal and professional challenges that affected staff decisions to report to work following a natural disaster and examined the role of management in addressing staff needs and concerns. Methods Semi-structured interviews were conducted with individuals who filled key management roles in the United States Department of Veterans Affairs New York Harbor Healthcare System’s response to Superstorm Sandy and during the facility’s initial recovery phase. All interviews were audio recorded and transcribed. Three major themes were identified: 1) Barriers to reporting (“Barriers”), 2) Facilitators to reporting (“Facilitators”), and 3) Responses to staff needs and concerns (“Responses”). Atlas.ti 7.1.6 software program was used for the management and analysis of the transcripts. Results Results indicated that staff encountered several barriers that impeded their ability to report to work at mobile vans at the temporarily nonoperational Manhattan campus or at two other VA facilities in Brooklyn and the Bronx in the initial post-Sandy period including transportation problems, personal property damage, and communication issues. In addition, we found evidence of facilitators to reporting as expressed through descriptions of professional duty. Our findings also revealed that management was aware of the challenges that staff was facing and made efforts to reduce barriers and accommodate staff affected by the storm. Conclusions During and after a disaster event, hospital staff is often confronted with challenges that affect decisions to report for work and perform effectively under potentially harsh conditions. This study examined barriers and facilitators that hospital staff encountered following a major natural disaster from the management perspective. Insights gained from this study can be used to inform future disaster planning and preparedness efforts, and help ensure that there is adequate staffing to mount an effective response when a disaster occurs, and to recover from its aftermath.
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Comment organiser les soins pré- et intrahospitaliers en cas d’affluence massive de patients ? MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1100-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Evacuate or Shelter-in-place? The Role of Corporate Memory and Political Environment in Hospital-evacuation Decision Making. Prehosp Disaster Med 2015; 30:233-8. [PMID: 25783663 DOI: 10.1017/s1049023x15000229] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PROBLEM Hospital-evacuation decisions are rarely straightforward in protracted advance-warning events. Previous work provides little insight into the decision-making process around evacuation. This study was conducted to identify factors that most heavily influenced the decisions to evacuate the US Department of Veterans Affairs (VA) New York Harbor Healthcare System's (NYHHS; New York USA) Manhattan Campus before Hurricane Irene in 2011 and before Superstorm Sandy in 2012. METHODS Semi-structured interviews with 11 senior leaders were conducted on the processes and factors that influenced the evacuation decisions prior to each event. RESULTS The most influential factor in the decision to evacuate the Manhattan Campus before Hurricane Irene was New York City's (NYC's) hospital-evacuation mandate. As a federal facility, the Manhattan VA medical center (VAMC) was exempt from the city's order, but decision makers felt compelled to comply. In the case of Superstorm Sandy, corporate memory of a similar 1992 storm that crippled the Manhattan facility drove the decision to evacuate before the storm hit. CONCLUSIONS Results suggest that hospital-evacuation decisions are confounded by political considerations and are influenced by past disaster experience. Greater shared situational awareness among at-risk hospitals, along with a more coordinated approach to evacuation decision making, could reduce pressure on hospitals to make these high-stakes decisions. Systematic mechanisms for collecting, documenting, and sharing lessons learned from past disasters are sorely needed at the institutional, local, and national levels.
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Pre-earthquake burden of illness and postearthquake health and preparedness in veterans. Prehosp Disaster Med 2014; 29:223-9. [PMID: 24721119 DOI: 10.1017/s1049023x14000272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND During an earthquake, vulnerable populations, especially those with chronic conditions, are more susceptible to adverse, event-induced exacerbation of chronic conditions such as limited access to food and water, extreme weather temperatures, and injury. These circumstances merit special attention when health care facilities and organizations prepare for and respond to disasters. METHODS This study explores the relationship between pre-earthquake burden of illness and post earthquake health-related and preparedness factors in the US. Data from a cohort of male veterans who were receiving care at the Sepulveda Veterans Affairs Medical Center (VAMC) in Los Angeles, California USA during the 1994 Northridge earthquake were analyzed. RESULTS Veterans with one or more chronic conditions were more likely to report pain lasting two or more days, severe mental/emotional stress for more than two weeks, broken/lost medical equipment, having difficulty refilling prescriptions, and being unable to get medical help following the quake compared to veterans without chronic conditions. In terms of personal emergency preparedness, however, there was no association between burden of illness and having enough food or water for at least 24 hours after the earthquake. CONCLUSION The relationship that exists between health care providers, including both individual providers and organizations like the US Department of Veterans Affairs (VA), and their vulnerable, chronically-ill patients affords providers the unique opportunity to deliver critical assistance that could make this vulnerable population better prepared to meet their post disaster health-related needs. This can be accomplished through education about preparedness and the provision of easier access to medical supplies. Disaster plans for those who are burdened with chronic conditions should meet their social needs in addition to their psychological and physical needs.
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Rojek A, Little M. Review article: Evacuating hospitals in Australia: What lessons can we learn from the world literature? Emerg Med Australas 2013; 25:496-502. [DOI: 10.1111/1742-6723.12160] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Amanda Rojek
- Royal Brisbane and Women's Hospital; Herston Queensland Australia
| | - Mark Little
- Department of Emergency Medicine; Cairns Base Hospital; Cairns Queensland Australia
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Dobalian A, Stein JA, Heslin KC, Riopelle D, Venkatesh B, Lanto AB, Simon B, Yano EM, Rubenstein LV. Impact of the Northridge Earthquake on the Mental Health of Veterans: Results From a Panel Study. Disaster Med Public Health Prep 2013; 5 Suppl 2:S220-6. [DOI: 10.1001/dmp.2011.60] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
ABSTRACTObjective: The 1994 earthquake that struck Northridge, California, led to the closure of the Veterans Health Administration Medical Center at Sepulveda. This article examines the earthquake's impact on the mental health of an existing cohort of veterans who had previously used the Sepulveda Veterans Health Administration Medical Center.Methods: From 1 to 3 months after the disaster, trained interviewers made repeated attempts to contact participants by telephone to administer a repeated measures follow-up design survey based on a survey that had been done preearthquake. Postearthquake data were obtained on 1144 of 1800 (64%) male veterans for whom there were previous data. We tested a predictive latent variable path model of the relations between sociodemographic characteristics, predisaster physical and emotional health measures, and postdisaster emotional health and perceived earthquake impact.Results: Perceived earthquake impact was predicted by predisaster emotional distress, functional limitations, and number of health conditions. Postdisaster emotional distress was predicted by preexisting emotional distress and earthquake impact. The regression coefficient from earthquake impact to postearthquake emotional distress was larger than that of the stability coefficient from preearthquake emotional distress. Postearthquake emotional distress also was affected indirectly by preearthquake emotional distress, health conditions, younger age, and lower socioeconomic status.Conclusions: The postdisaster emotional health of veterans who experienced greater earthquake impact would have likely benefited from postdisaster intervention, regardless of their predisaster emotional health. Younger veterans and veterans with generally poor physical and emotional health were more vulnerable to greater postearthquake emotional distress. Veterans of lower socioeconomic status were disproportionately likely to experience more effects of the disaster because they had more predisaster emotional distress, more functional limitations, and a greater number of health conditions. Because many veterans use non–Department of Veterans Affairs (VA) health care providers for at least some of their health needs, future disaster planning for both VA and non-VA providers should incorporate interventions targeted at these groups.(Disaster Med Public Health Preparedness. 2011;5:S220-S226)
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Initial management of hospital evacuations caused by Hurricane Rita: a systematic investigation. Prehosp Disaster Med 2013; 28:257-63. [PMID: 23425549 DOI: 10.1017/s1049023x13000150] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Hurricanes remain a major threat to hospitals throughout the world. The authors attempted to identify the planning areas that impact hospital management of evacuations and the challenges faced when sheltering-in-place. METHODS This observational, retrospective cohort study examined acute care institutions from one hospital system impacted by Hurricane Rita in 2005. Investigators used a standardized survey instrument and interview process, previously used in the hospital evacuation context, to examine hospitals' initial internal situational awareness and subsequent decision making that resulted in evacuation due to Hurricane Rita. Participants from each hospital included representatives from senior leadership and clinical and nonclinical staff that comprised the Incident Management Team (IMT). The main measured outcomes were responses to 95 questions contained in the survey. RESULTS Seven of ten eligible hospitals participated in the study. All facilities evacuated the sickest patients first. The most significant factors prompting evacuation were the issuing of mandatory evacuation orders, storm dynamics (category, projected path, storm surge), and loss of regional communications. Hospitals that sheltered-in-place experienced staff shortages, interruptions to electrical power, and loss of water supplies. Three fully-evacuated institutions experienced understaffing of 40%-60%, and four hospitals sustained depressed staffing levels for over four weeks. Five hospitals lost electricity for a mean of 4.8 days (range .5-11 days). All facilities continued to receive patients to their Emergency Departments (EDs) while conducting their own evacuation. CONCLUSION Hospital EDs should plan for continuous patient arrival during evacuation. Emergency Operation Plans (EOPs) that anticipate challenges associated with evacuation will help to maximize initial decision making and management during a crisis situation. Hospitals that shelter-in-place face critical shortages and must provide independent patient care for prolonged periods.
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Abstract
AbstractIntroductionThe evacuation of a health care facility is a complex undertaking, especially if done in an immediate fashion, ie, within minutes. Patient factors, such as continuous medical care needs, mobility, and comprehension, will affect the efficiency of the evacuation and translate into evacuation resource needs. Prior evacuation resource estimates are 30 years old.MethodsUtilizing a cross-sectional survey of charge nurses of the clinical units in an urban, academic, adult trauma health care facility (HCF), the evacuation needs of hospitalized patients were assessed periodically over a two-year period.ResultsSurvey data were collected on 2,050 patients. Units with patients having low continuous medical care needs during an emergency evacuation were the postpartum, psychiatry, rehabilitation medicine, surgical, and preoperative anesthesia care units, the Emergency Department, and Labor and Delivery Department (with the exception of patients in Stage II labor). Units with patients having high continuous medical care needs during an evacuation included the neonatal and adult intensive care units, special procedures unit, and operating and post-anesthesia care units. With the exception of the neonate group, 908 (47%) of the patients would be able to walk out of the facility, 492 (25.5%) would require a wheelchair, and 530 (27.5%) would require a stretcher to exit the HCF. A total of 1,639 patients (84.9%) were deemed able to comprehend the need to evacuate and to follow directions; the remainder were sedated, blind, or deaf. The charge nurses also determined that 17 (6.9%) of the 248 adult intensive care unit patients were too ill to survive an evacuation, and that in 10 (16.4%) of the 61 ongoing surgery cases, stopping the case was not considered to be safe.ConclusionHeath care facilities can utilize the results of this study to model their anticipated resource requirements for an emergency evacuation. This will permit the Incident Management Team to mobilize the necessary resources both within the facility and the community to provide for the safest evacuation of patients.PetinauxB, YadavK. Patient-driven resource planning of a health care facility evacuation. Prehosp Disaster Med. 2013;28(2):1-7.
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Claver M, Friedman D, Dobalian A, Ricci K, Horn Mallers M. The Role of Veterans Affairs in Emergency Management: A Systematic Literature Review. PLOS CURRENTS 2012; 4:e198d344bc40a75f927c9bc5024279815. [PMID: 24678439 PMCID: PMC3957408 DOI: 10.1371/198d344bc40a75f927c9bc5024279815] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Department of Veterans Affairs (VA) is a key player in emergency management for both veterans and civilians. Unfortunately, limited evidence-based research findings exist regarding the role and experience of VA during disasters. The present study is a systematic literature review of 41 published, peer-reviewed articles regarding VA and emergency management. Trained researchers utilized a data abstraction tool and conducted a qualitative content analysis. A description of article characteristics include methodology, phase of emergency management addressed in the research, and study design. Five topic categories emerged from the review including effects of disaster on mental health status and services use, effects of disaster on general health services use, patient tracking, evacuation, and disaster planning/preparation. Findings were used to generate suggestions for future research.
Keywords: Veterans Affairs, veterans, disaster, emergency
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Affiliation(s)
- Maria Claver
- Veterans Health Administration Emergency Management Evaluation Center and VAGLAHS HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, California State University, Sepulveda, California, USA
| | - Darya Friedman
- Veterans Health Administration Emergency Management Evaluation Center and VAGLAHS HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, California State University, Sepulveda, California, USA
| | | | - Karen Ricci
- Veterans Health Administration Emergency Management Evaluation Center and VAGLAHS HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, California State University, Sepulveda, California, USA
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Abstract
AbstractIntroduction:Hospitals the world over have been involved in disasters, both internal and external. These two types of disasters are independent, but not mutually exclusive. Internal disasters are isolated to the hospital and occur more frequently than do external disasters. External disasters affect the community as well as the hospital. This paper first focuses on common problems encountered during acute-onset disasters, with regards to hospital operations and caring for victims. Specific injury patterns commonly seen during natural disasters are reviewed. Second, lessons learned from these common problems and their application to hospital disaster plans are reviewed.Methods:An extensive review of the available literature was conducted using the computerized databases Medline and Healthstar from 1977 through March 1999. Articles were selected if they contained information pertaining to a hospital response to a disaster situation or data on specific disaster injury patterns. Selected articles were read, abstracted, analyzed, and compiled.Results:Hospitals continually have difficulties and failures in several major areas of operation during a disaster. Common problem areas identified include communication and power failures, water shortage and contamination, physical damage, hazardous material exposure, unorganized evacuations, and resource allocation shortages.Conclusions::Lessons learned from past disaster-related operational failures are compiled and reviewed. The importance and types of disaster planning are reviewed.
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Schultz CH, Koenig KL, Auf der Heide E, Olson R. Benchmarking for Hospital Evacuation: A Critical Data Collection Tool. Prehosp Disaster Med 2012; 20:331-42. [PMID: 16295171 DOI: 10.1017/s1049023x00002806] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIn events such as earthquakes or terrorist attacks, hospitals may be victims of disasters. They may need to transfer patients to outside facilities rather than continue to provide on-site care. Following the Northridge earthquake, eight hospitals in the damaged area were the foci of a United States National Science Foundation study that examined the status of the hospitals' pre-event planning, post-event evacuationdecision-making, and internal and external evacuation processes. Building on this experience, this paper offers a standardized data collection tool, which will enable researchers to record hospital evacuation information in a systematic manner so that comparable data can be accumulated, evacuation research methods can be improved, and consensus on methods can be reached. The study's principal subjects include: (1) hospital demographics; (2) description of existing disaster response plans; (3) an event's impacts on hospital operations; (4) decision-making and incident command; (5) movement of patients within the facility; (6) movement of patients to off-site institutions; and (7) hospital recovery.
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Affiliation(s)
- Carl H Schultz
- Department of Emergency Medicine, University of California-Irvine Medical Center, Orange, California 92668, USA.
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22
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Evacuation and Sheltering of Hospitals in Emergencies: A Review of International Experience. Prehosp Disaster Med 2012; 24:461-7. [DOI: 10.1017/s1049023x00007329] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:A scoping exercise to establish how common hospital evacuations are, identify hospital evacuation policies and review case studies to identify trig-gers, processes and challenges involved in the evacuation of hospitals globally.Design:A systematic search of PubMed and disaster agency online resources, search of grey literature and media reports.Results:This study showed that hospitals are vulnerable to both natural and man made disasters and that hospital evacuations do occur globally. It highlighted the paucity of published data and policy on hospital evacuation and emphasised the vital need to collect data on triggers, reasons for evacuation, sheltering facilities and the process of evacuation.Conclusions:This study recommends the collection of case studies and the development of a database to assist with the research and development of well tailored hospital evacuation plans. These recommendations reflect and support the 2008-2009 World Disaster Reduction Campaign on Hospitals Safe from Disasters and the timely 2009 Global Platform priority that, ‘Critical services and infrastructure such as health facilities and schools must be safe from disasters.
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Ardagh MW, Richardson SK, Robinson V, Than M, Gee P, Henderson S, Khodaverdi L, McKie J, Robertson G, Schroeder PP, Deely JM. The initial health-system response to the earthquake in Christchurch, New Zealand, in February, 2011. Lancet 2012; 379:2109-15. [PMID: 22510397 DOI: 10.1016/s0140-6736(12)60313-4] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
At 1251 h on Feb 22, 2011, an earthquake struck Christchurch, New Zealand, causing widespread destruction. The only regional acute hospital was compromised but was able to continue to provide care, supported by other hospitals and primary care facilities in the city. 6659 people were injured and 182 died in the initial 24 h. The massive peak ground accelerations, the time of the day, and the collapse of major buildings contributed to injuries, but the proximity of the hospital to the central business district, which was the most affected, and the provision of good medical care based on careful preparation helped reduce mortality and the burden of injury. Lessons learned from the health response to this earthquake include the need for emergency departments to prepare for: patients arriving by unusual means without prehospital care, manual registration and tracking of patients, patient reluctance to come into hospital buildings, complete loss of electrical power, management of the many willing helpers, alternative communication methods, control of the media, and teamwork with clear leadership. Additionally, atypical providers of acute injury care need to be integrated into response plans.
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Hogan TP, Holmes SA, Rapacki LM, Evans CT, Lindblom L, Hoenig H, Goldstein B, Hahm B, Weaver FM. Disaster preparedness and response practices among providers from the Veterans Health Administration and Veterans with spinal cord injuries and/or disorders. J Spinal Cord Med 2011; 34:353-61. [PMID: 21903009 PMCID: PMC3152807 DOI: 10.1179/2045772311y.0000000011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES Few empirical studies have examined the disaster preparedness and response practices of individuals with spinal cord injuries and/or disorders (SCI/D) and the healthcare providers who serve them. This study was conducted to understand the experiences of Veterans Health Administration (VHA) providers and Veterans with SCI/D in recent natural disasters, and to identify lessons learned for disaster preparedness and response in the context of SCI/D. DESIGN Semi-structured interviews were conducted with providers and Veterans recruited through seven VHA facilities that had sustained a disaster since 2003. Audio recordings of the interviews were transcribed; transcripts were analyzed using constant comparative techniques. RESULTS Forty participants completed an interview, including 21 VHA SCI/D providers and 19 Veterans with SCI/D. Disasters experienced by participants were weather related. While many Veterans were evacuated or admitted to nearby VHA facilities, others chose to stay in their communities. All facilities had formal disaster plans and engaged in related training; however, participants explained that many aspects of a response take shape 'in the moment,' and must address both provider and Veteran needs. Dispersion of resources hindered well-coordinated care, but effective communication, teamwork, advanced warnings, and VHA's electronic medical record facilitated efforts. CONCLUSIONS Even in the case of thorough planning, Veterans with SCI/D and their healthcare providers are faced with pressing needs during disasters, and identifying strategies to coordinate care is critical. The lessons learned are intended to inform the efforts of healthcare providers who may be involved in the care of individuals with SCI/D in future disasters.
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Affiliation(s)
- Timothy P. Hogan
- Center for Management of Complex Chronic Care, and Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA,Program in Health Services Research, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA,Correspondence to: Timothy P. Hogan, Research Service, Department of Veterans Affairs (VA), Center for Management of Complex Chronic Care, 5000 South 5th Avenue, Hines, IL 60141, USA.
| | - Sally A. Holmes
- Spinal Cord Injury Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Lauren M. Rapacki
- Center for Management of Complex Chronic Care, and Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Charlesnika T. Evans
- Center for Management of Complex Chronic Care, and Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA,Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Laurie Lindblom
- Spinal Cord Injury Service, Veterans Affairs Medical Center, Hampton, VA, USA
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service and Spinal Cord Injury, Veterans Affairs Medical Center, Durham, NC, USA
| | - Barry Goldstein
- Spinal Cord Injury and Disorders Strategic Healthcare Group, Veterans Affairs Puget Sound Health Care System Seattle, WA, USA
| | - Bridget Hahm
- HSR&D/RR&D Center of Excellence: Maximizing Rehabilitation Outcomes, James A. Haley Veterans Hospital, Tampa, FL, USA
| | - Frances M. Weaver
- Center for Management of Complex Chronic Care, and Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA,Program in Health Services Research, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
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Analysis of Disaster Response Plans and the Aftermath of Hurricane Katrina: Lessons Learned From a Level I Trauma Center. ACTA ACUST UNITED AC 2008; 65:1126-32. [DOI: 10.1097/ta.0b013e318188d6e5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mcgory M, Cryer HG, Chandler C, Cohen M, Hiatt JR. The Santa Monica Crash: An Urban Multicasualty Event. Am Surg 2004. [DOI: 10.1177/000313480407001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Mass casualty events provide dramatic challenges for trauma centers and trauma systems. We analyzed the management of victims and assessed the response of the UCLA Healthcare System to the Santa Monica multicasualty event of July 16, 2003, when an elderly man drove his car through a crowded outdoor market and injured 73 people, 10 of whom died (eight at the scene). Of the victims, 26 were treated at UCLA (n = 15) and Santa Monica (n = 11) Medical Centers. Fourteen patients (54%) were female; average age was 41.9 years (range 7 months to 88 years). Fifteen patients were treated in the ER only, and 11 patients required admission. Of the latter, 10 (91%) had multisystem injuries, most commonly musculoskeletal, which occurred in nine patients (82%). Seven patients required immediate operations (orthopedic in six and a pericardial window in one). Three patients required delayed operations (orthopedic and plastic surgery). Most surgical and medical specialties were needed in consultation. Average LOH was 11.8 (range 2–23) days. Mean ISS was 21.2 (range 1–75). There were six complications (three early and three late) and one death from head injury. Seven patients (64%) required rehabilitation. We conclude that mass casualty victims have multisystem injuries of variable severity, which underscores the importance of trauma centers and trauma systems. The large trauma scene and particular need for orthopedic services were notable features of this event.
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Affiliation(s)
- Marcia Mcgory
- From the Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - H. Gill Cryer
- From the Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Charles Chandler
- From the Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Marilyn Cohen
- From the Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jonathan R. Hiatt
- From the Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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Schultz CH, Koenig KL, Lewis RJ. Implications of hospital evacuation after the Northridge, California, earthquake. N Engl J Med 2003; 348:1349-55. [PMID: 12672863 DOI: 10.1056/nejmsa021807] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND On January 17, 1994, an earthquake with a moment magnitude (total energy release) of 6.7 occurred in Northridge, California, leading to the evacuation of patients from several hospitals. We examined the reasons for and methods of evacuation and the emergency-management strategies used. The experience in California may have implications for hospital strategies for responding to any major disaster, including an act of terrorism. METHODS From September 1995 to September 1996, we surveyed all acute care hospitals in Los Angeles County that reported having evacuated patients after the Northridge earthquake. Physicians, nurses, hospital administrators, and staff on duty at the hospitals during the evacuation responded to a 58-item structured questionnaire. RESULTS Eight of 91 acute care hospitals (9 percent) were evacuated. Six hospitals evacuated patients within 24 hours (the immediate-evacuation group), four completely and two partially. All six cited nonstructural damage such as water damage and loss of electrical power as a major reason for evacuation. Five hospitals evacuated the most seriously ill patients first, and one hospital evacuated the healthiest patients first. All hospitals used available equipment to transport patients (blankets, backboards, and gurneys) rather than specialized devices. No deaths resulted from evacuation. One hospital evacuated patients after 3 days and another after 14 days because of structural damage, even though initial inspections had shown no damage (the delayed-evacuation group). Both hospitals required demolition. Some hospitals identified destinations for their evacuated patients independently, whereas others sought the assistance of the Los Angeles County Emergency Operations Center; the two strategies were equally effective. CONCLUSIONS After even a moderate earthquake, hospitals are at risk for both immediate nonstructural damage that may force them to evacuate patients and the delayed discovery of structural damage resulting in permanent closure. Evacuation of large numbers of inpatients from multiple hospitals can be accomplished quickly and safely with the use of available resources and personnel.
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Affiliation(s)
- Carl H Schultz
- University of California, Irvine, College of Medicine, Irvine, and the Department of Emergency Medicine, University of California, Irvine, Medical Center, Orange 92668, USA.
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Evidence-Based Tool for Redefining an Approach to Severe Malnutrition in Complex Emergencies. Prehosp Disaster Med 2002. [DOI: 10.1017/s1049023x00010487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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