Realities of Disaster Preparedness in Rural Hospitals

Comparison of the Level of Disaster Preparedness Between Private and Government Hospitals in Saudi Arabia: A Cross-Sectional Study

OBJECTIVE

The objective of this study was to describe and compare almost all the components of disaster preparedness between private and government hospitals in the Eastern Province of the Kingdom of Saudi Arabia, using the World Health Organization's (WHO) checklist.

METHODS

We assessed and compared the disaster preparedness between government and private hospitals in Province, using the 10-key component WHO checklist in a descriptive cross-sectional study. Of 72 hospitals in the region, 63 responded to the survey.

RESULTS

All 63 hospitals had an HDP plan and reported having a multidisciplinary HDP committee. In all responding hospitals, HDP was acceptable in most indicators of preparedness; however, some hospitals to some extent fell short of preparedness in surge capacity, equipment and logistic services, and post-disaster recovery. Government and private hospitals were generally comparable in disaster preparedness. However, government hospitals were more likely to have HDP plans that cover WHO's "all-hazard" approach, both internal and external disasters, compared to private hospitals.

CONCLUSION

HDP was acceptable, however, preparedness in surge capacity, equipment and logistic services, and post-disaster recovery fell short. Government and private hospitals were comparable in preparedness with regards to all indicators except surge capacity, post-disaster recovery, and availability of some equipment.

Factors Influencing Hospitals' Disaster Preparedness in the Eastern Province of Saudi Arabia

OBJECTIVE

The study aimed to identify the factors that influence the disaster preparedness of hospitals and validate an evaluation framework to assess hospital disaster preparedness (HDP) capability in the Eastern Province of Saudi Arabia.

METHODS

A cross-sectional survey of all hospitals (n = 72) in the Eastern Region of Saudi Arabia was conducted. A factor analysis method was used to identify common factors and validate the evaluation framework to assess HDP capacity.

RESULTS

Sixty-three (63) hospitals responded to the survey. A 3-factor structure was identified as key predicators of HDP capacity. The first factor was the most highly weighted factor, which included education and training (0.849), monitoring and assessing HDP (0.723), disaster planning (0.721), and command and control (0.713). The second factor included surge capacity (0.708), triage system (0.844), post-disaster recovery (0.809), and communication (0.678). The third factor represented safety and security (0.638) as well as logistics, equipment, and supplies (0.766).

CONCLUSION

The identified 3-factor structure provides an innovative approach to assist the operationalization of the concept of HDP capacity building and service improvement, as well as serve as a groundwork to further develop instrument for assessing HDP in future studies.

Metrics and indicators used to assess health system resilience in response to shocks to health systems in high income countries-A systematic review

Health system resilience has never been more important than with the COVID-19 pandemic. There is need to identify feasible measures of resilience, potential strategies to build resilience and weaknesses of health systems experiencing shocks. The purpose of this systematic review is to examine how the resilience of health systems has been measured across various health system shocks. Following PRISMA guidelines, with double screening at each stage, the review identified 3175 studies of which 68 studies were finally included for analysis. Almost half (46%) were focused on COVID-19, followed by the economic crises, disasters and previous pandemics. Over 80% of studies included quantitative metrics. The most common WHO health system functions studied were resources and service delivery. In relation to the shock cycle, most studies reported metrics related to the management stage (79%) with the fewest addressing recovery and learning (22%). Common metrics related to staff headcount, staff wellbeing, bed number and type, impact on utilisation and quality, public and private health spending, access and coverage, and information systems. Limited progress has been made with developing standardised qualitative metrics particularly around governance. Quantitative metrics need to be analysed in relation to change and the impact of the shock. The review notes problems with measuring preparedness and the fact that few studies have really assessed the legacy or enduring impact of shocks.

[Hospital disaster planning in south-western Germany. A survey of 214 clinics]

Background

Due to legal regulations in Germany, public acute and emergency (A&E) hospitals-along with responsible authorities, emergency medical services, and other institutions such as the state medical associations-are committed to participate in civil protection. This participation includes the need to create and update emergency plans for external and internal crises and to take part in disaster drills. In fact, so far there is only little literature to prove whether and to what extent hospitals fulfill their obligations on this topic.

Objectives

Using a standardized survey, the state of emergency planning in hospitals in Baden-Wuerttemberg was evaluated.

Materials and methods

Based on a listing provided by the Hospital Society of Baden-Wuerttemberg (BWKG), all 214 hospitals in Baden-Wuerttemberg were identified. The standardized questionnaire inquired about specific characteristics of the emergency plan, the availability and knowledge of this plan by the hospital workforce and other local institutions that take part in civil protection and, finally, participation in disaster drills were queried.

Results

Of the 214 hospitals in Baden-Wuerttemberg, 135 (63%) provided information using the questionnaire. Except for one hospital, all other clinics indicated having a special emergency plan ready. In most cases (79.3%), both external (e.g., mass casualty incidents) and internal (e.g., fire, failure of technical equipment) crises are covered. In the vast majority of cases (94%), the hospitals also indicated that they regularly update their emergency plan, whereby the frequency of updates varied markedly. Three quarters of the hospitals said that they also regularly simulate the use of the emergency plan in disaster drills. In two thirds of the cases, external forces such as emergency medical services or the fire department also take part in these drills along with the hospitals themselves. In some cases, knowledge gained from the drills was incorporated into the emergency plan or led to improvements in staff training.

Conclusions

The willingness of public hospitals to establish comprehensive disaster planning and to take part in related drills seems to have improved noticeably in recent years. However, there is still the need for improvement in keeping the concepts up to date at some hospitals. Especially smaller hospitals showed deficits in emergency planning, particularly concerning preparedness for internal crises, resulting from failure of technical equipment. More regular drills should be used to test existing concepts and to familiarize employees with the processes on a routine basis.

Hospitals Disaster Preparedness and Management in the Eastern Province of the Kingdom of Saudi Arabia: A Cross-sectional study

OBJECTIVE

The current study was conducted to assess disaster preparedness of hospitals in the Eastern region of Saudi Arabia.

METHODS

A descriptive cross-sectional study of all hospitals in the Eastern Region of KSA was conducted between July 2017 and July 2018. The included hospitals were selected using convenience sampling. The questionnaire was distributed together with an official letter providing information about the aim and objectives of the study as well as ethical issues guiding their participation in the exercise.

RESULTS

All the included hospitals had a disaster plan that was completely accessible by all staff members. About 70% of the included hospitals established an educational program on disaster preparedness once per year. Assessment of hospital disaster preparedness was conducted using disaster drills in 62 (n= 98%) of the hospitals. However, only 9.5% of the hospitals had post-disaster recovery assistance programs like counseling and support services.

CONCLUSION

Most hospitals involved in this study had sufficient resources for disaster management; however, the overall effectiveness of hospitals' disaster preparedness was slight to moderate. Some recommendations to improve hospitals' disaster preparedness should be proposed, including improved staff training and testing, better communications and safety procedures, and adoption of a holistic approach for disaster management.

Perception and Attitude of Medical Staff in the Saudi Red Crescent Authority Toward their Preparedness for Disaster Management and Response

OBJECTIVE

The Saudi Red Crescent Authority (SRCA) plays a major role in the event of disasters and crisis, as it is the main pre-hospital health-care provider. This study reports on the attitude and perceptions of SRCA medical staff concerning their knowledge of disaster management and response.

METHOD

This is a descriptive cross-sectional study performed in Riyadh, Saudi Arabia. An Arabic version of the Disaster Preparedness Evaluation Tool (DPET), a self-administered Likert-scale survey, was used to obtain data from SRCA medical staff to evaluate the current status of disaster preparedness.

RESULTS

The population surveyed consisted of 302 participants; 20.9% had participated in a drill exercise or practical application of a regular disaster or emergency plan in their workplaces. Most of participants (85.3%) had incentives to extend their education regarding their role, scope of practice, and skills as medical staff in disaster situations.

CONCLUSION

Results indicate a lack of regular disaster drills available to prehospital care providers, although most of them are willing to participate in more training and education programs regarding preparedness for disaster management, especially concerning their role in a disaster situation.

Improving rural disaster response preparedness

BACKGROUND

Disasters happen in all communities and negatively impact the health and safety of populations if not well managed. Rural health organizations face greater challenges when implementing emergency preparedness policies and need unique resources to help ensure the health of their communities. The purpose of this article is to describe the development and evaluation of an agricultural simulation scenario designed for rural health organizations.

METHODS

The agricultural disaster scenario was developed after determining the desired content domains. Forty students from nursing, medicine, public health, and social work participated in a functional simulation using the scenario. Outcomes were measured using a pre-post measurement with one cohort design. Data were analyzed using paired-samples t-tests.

RESULTS

Students reported a 30% increase in self-confidence, 38% increase in disaster competence, and 19% increase in interprofessional collaboration competence after the simulation. Statistically significant increases in student scores were noted on all surveys across professions.

CONCLUSION

The agricultural disaster simulation is a valid scenario to use for disaster preparation using emergency operations plans.

How are healthcare provider systems preparing for health emergency situations?

Natural disasters, disease outbreaks, famine, and human conflict have strained communities everywhere over the course of human existence. However, modern changes in climate, human mobility, and other factors have increased the global community's vulnerability to widespread emergencies. We are in the midst of a disruptive health event, with the COVID-19 pandemic testing our health provider systems globally. This study presents a qualitative analysis of published literature, obtained systematically, to examine approaches health providers are taking to prepare for and respond to mass casualty incidents around the globe. The research reveals emerging trends in the weaknesses of systems' disaster responses while highlighting proposed solutions, so that others may better prepare for future disasters. Additionally, the research examines gaps in the literature, to foster more targeted and actionable contributions to the literature.

Understanding and Strengthening the Emergency Management and Comprehensive Disaster Reduction in China’s Rural Areas: Lessons from Coping with the COVID-19 Epidemic

Community based bottom-up design is the foundation of national emergency management system. The outbreak of COVID-19 epidemic in early 2020 is a major test of emergency management capability in rural China. This paper first describes the necessity of strengthening the emergency management design in rural areas of China. Then this paper introduces the fundamental role of emergency management design based on bottom-up for the security of rural areas in China, especially in improving the level of comprehensive disaster reduction at the grassroots level, which plays an important role in improving the emergency management ability of China’s rural areas. Based on the above analysis, this paper takes the COVID-19 epidemic prevention and control of epidemic in rural areas of China as an example, and find out many problems in China’s rural emergency management system, such as the grass-roots government’s emergency needs cannot be met, the existing mode of systematic lack, the lack of psychological intervention and so on. Finally, this paper proposes to strengthen the emergency management design in China’s rural areas from expanding the scope of emergency management subjects, strengthening the systematic design of rural emergency management system and strengthening the psychological intervention in rural areas.

Challenges in Pandemic Disaster Preparedness: Experience of a Saudi Academic Medical Center

In December 2019, a pneumonia of unknown etiology was detected in Wuhan, China. This outbreak was then declared an international public emergency in January 2020 by the World Health Organization (WHO), and the announcement activated disaster management plans worldwide. This global crisis created several challenges for the health-care sector. This study reviews the challenges faced by a middle-sized urban academic hospital that are likely present to some extent in all health-care sectors, regardless of their existing disaster plans and policies. While preparing this Saudi academic hospital with a capacity of 192 beds for the emerging pandemic, obstacles arose despite its extensive prior disaster planning and training. Specifically, these challenges were related to health-care workers, supplies, and patient care. We review the actions taken to overcome and resolve these difficulties and provide future planning suggestions for each area to potentially assist other hospitals in their disaster planning and preparedness.

Disaster Preparedness in Hospitals in the Middle East: An Integrative Literature Review

Disasters occur rarely but have significant adverse consequences when they do. Recent statistics suggest that millions of lives and billions of US dollars have been lost in the last decade due to disaster events globally. It is crucial that hospitals are well prepared for disasters to minimize their effects. This integrative review study evaluates the preparedness level of hospitals in the Middle East for disasters using the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) guidelines. The key terms include disaster preparedness OR disaster management OR emergency response AND Middle East AND hospitals. The study reviews articles published between January 2005 and December 2015, which focused on the hospitals’ preparedness for disasters in the Middle East nations. Based on their meeting 5 eligibility criteria, 19 articles were included in the review. Twelve of the articles focused on both natural and man-made disasters, whereas 6 of them were based on mass casualty events and 1 on earthquake. Thirteen of the reviewed articles ranked the level of preparedness of hospitals for disasters to be generally “very poor,” “poor,” or “moderate,” whereas 6 reported that hospitals were “well” or “very well prepared” for disasters. Factors affecting preparedness level were identified as a lack of contingency plans and insufficient availability of resources, among others. (Disaster Med Public Health Preparedness. 2019;13:806–816).

Disappearing everyday materials: The displacement of medical resources following disaster in Fukushima, Japan

This study draws upon interviews of medical staff working in the city of Minamisoma, Japan, following the 2011 Triple Disaster. It investigates staff responses to the disruption of material resources as a consequence of the disaster and its management. The disruption of spaces, and the loss of oxygen supplies, food, and medications impacted upon staff experience and the ability of institutions to care for patients. This resulted in a restructuring of spaces and materials as workers made efforts to reconfigure and reestablish healthcare functions. This is one of the few qualitative studies which draws upon the experience and perspectives of health workers in understanding material disruption following disaster. This is particularly important since this case did not involve the breakdown of lifeline infrastructure, but rather, brought to attention the way everyday material objects shape social experience. In highlighting these effects, the paper makes the case for the social scientific investigation of the impact of disasters on healthcare, shedding light on an area of research currently dominated by disaster medicine.

Local emergency medical response after a terrorist attack in Norway: a qualitative study

INTRODUCTION

On 22 July 2011, Norway suffered a devastating terrorist attack targeting a political youth camp on a remote island. Within a few hours, 35 injured terrorist victims were admitted to the local Ringerike community hospital. All victims survived. The local emergency medical service (EMS), despite limited resources, was evaluated by three external bodies as successful in handling this crisis. This study investigates the determinants for the success of that EMS as a model for quality improvement in healthcare.

METHODS

We performed focus group interviews using the critical incident technique with 30 healthcare professionals involved in the care of the attack victims to establish determinants of the EMS' success. Two independent teams of professional experts classified and validated the identified determinants.

RESULTS

Our findings suggest a combination of four elements essential for the success of the EMS: (1) major emergency preparedness and competence based on continuous planning, training and learning; (2) crisis management based on knowledge, trust and data collection; (3) empowerment through multiprofessional networks; and (4) the ability to improvise based on acquired structure and competence. The informants reported the successful response was specifically based on multiprofessional trauma education, team training, and prehospital and in-hospital networking including mental healthcare. The powerful combination of preparedness, competence and crisis management built on empowerment enabled the healthcare workers to trust themselves and each other to make professional decisions and creative improvisations in an unpredictable situation.

CONCLUSION

The determinants for success derived from this qualitative study (preparedness, management, networking, ability to improvise) may be universally applicable to understanding the conditions for resilient and safe healthcare services, and of general interest for quality improvement in healthcare.

[Impact assessment of inadequate hospital disaster management : Reflection based on a risk model]

BACKGROUND

According to legal regulations alarm and emergency plans have to be developed and kept current in hospitals. However, often neither the hospital administration, nor the medical employees and nursing staff pay the necessary attention to these alarm and evacuation plans. In particular, risks and consequences - including financial ones - due to insufficient planning, are not adequately considered.

OBJECTIVES

Risks in hospitals are assessed based on a risk analysis. The risk assessment evaluates, whether the risk is acceptable, critical or unacceptable. Parameters for the risk analysis are the magnitude of damage and number of affected people. The intention of this paper is to evaluate whether there is a connection between estimated risk, quality of risk planning, and financial damage.

MATERIALS AND METHODS

We visualized the risk analysis as a two-dimensional matrix. In addition, we introduced disaster planning quality as a third dimension and calculated the dependency between risk and planning quality and also between the resulting damage level and the planning quality.

RESULTS

We showed that a poor disaster planning quality increases the unacceptable risk exponentially. Risk assessment can also draw conclusions about the extent of financial damage caused, for example fires, terrorist attacks or infrastructure failure. The amount of damage can be described as a function depending on the planning deficit of emergency planning. The worse the planning quality, the higher the amount of damages for non-tolerable risks can be.

CONCLUSIONS

Risk management means recognizing risks, assessing risks and managing risks. In hospitals, this mostly means using a critical incident reporting system (CIRS), however risk management in the sense of disaster planning is largely unknown. With a three-dimensional risk matrix, we showed a clear correlation between the quality of disaster planning and relative risk or financial damage. To substantiate the presented theoretical considerations, however, further research must be designed and implemented.

Tools and Checklists Used for the Evaluation of Hospital Disaster Preparedness: A Systematic Review

Hospitals need to be fully operative during disasters. It is therefore essential to be able to evaluate hospital preparedness. However, there is no consensus of a standardized, comprehensive and reliable tool with which to measure hospital preparedness. The aim of the current study was to perform a systematic review of evaluation tools for hospital disaster preparedness. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words "crisis," "disaster," "disaster medicine," "emergency," "mass casualty," "hospital preparedness," "hospital readiness," "hospital assessment," "hospital evaluation," "hospital appraisal," "planning," "checklist," and "medical facility" were used in combination with the Boolean operators "OR" and "AND." PubMed (National Library of Medicine, Bethesda, MD), ISI Web of Science (Thomson Reuters, New York, NY), and Scopus (Elsevier, New York, NY) were searched. A total of 51,809 publications were screened. The following themes were required for relevance: logistics, planning, human resources, triage, communication, command and control, structural and nonstructural preparedness, training, evacuation, recovery after disaster, coordination, transportation, surge capacity, and safety. The results from 15 publications are presented. Fifteen articles fulfilled the criteria of relevance and considered at least 1 of the 14 predetermined themes. None of the evaluated checklists and tools included all dimensions required for an appropriate hospital preparedness evaluation. The results of the current systematic review could be used as a basis for designing an evaluation tool for hospital disaster preparedness. (Disaster Med Public Health Preparedness. 2016;page 1 of 8).

Cross-sectional survey of the disaster preparedness of nurses across the Asia-Pacific region

Healthcare workers who have received disaster preparedness education are more likely to report a greater understanding of disaster preparedness. However, research indicates that current nursing curricula do not adequately prepare nurses to respond to disasters. This is the first study to assess Asia-Pacific nurses' perceptions about their level of disaster knowledge, skills, and preparedness. A cross-sectional survey was conducted with 757 hospital and community nurses in seven Asia-Pacific countries. Data were collected using the modified Disaster Preparedness Evaluation Tool. Participants were found to have overall low-to-moderate levels of disaster knowledge, skills and preparedness, wherein important gaps were identified. A majority of the variance in disaster preparedness scores was located at the level of the individual respondent, not linked to countries or institutions. Multilevel random effects modelling identified disaster experience and education as significant factors of positive perceptions of disaster knowledge, skills, and management. The first step toward disaster preparedness is to ensure frontline health workers are able to respond effectively to disaster events. The outcomes of this study have important policy and education implications.

Human resource crises in German hospitals--an explorative study

BACKGROUND

The complexity of providing medical care in a high-tech environment with a highly specialized, limited labour force makes hospitals more crisis-prone than other industries. An effective defence against crises is only possible if the organizational resilience and the capacity to handle crises become part of the hospitals' organizational culture. To become more resilient to crises, a raised awareness--especially in the area of human resource (HR)--is necessary. The aim of this paper is to contribute to the process robustness against crises through the identification and evaluation of relevant HR crises and their causations in hospitals.

METHODS

Qualitative and quantitative methods were combined to identify and evaluate crises in hospitals in the HR sector. A structured workshop with experts was conducted to identify HR crises and their descriptions, as well as causes and consequences for patients and hospitals. To evaluate the findings, an online survey was carried out to rate the occurrence (past, future) and dangerousness of each crisis.

RESULTS

Six HR crises were identified in this study: staff shortages, acute loss of personnel following a pandemic, damage to reputation, insufficient communication during restructuring, bullying, and misuse of drugs. The highest occurrence probability in the future was seen in staff shortages, followed by acute loss of personnel following a pandemic. Staff shortages, damage to reputation, and acute loss of personnel following a pandemic were seen as the most dangerous crises.

CONCLUSIONS

The study concludes that coping with HR crises in hospitals is existential for hospitals and requires increased awareness. The six HR crises identified occurred regularly in German hospitals in the past, and their occurrence probability for the future was rated as high.

Self-care Decontamination within a Chemical Exposure Mass-casualty Incident

Growing awareness and concern for the increasing frequency of incidents involving hazardous materials (HazMat) across a broad spectrum of contaminants from chemical, biological, radiological, and nuclear (CBRN) sources indicates a clear need to refine the capability to respond successfully to mass-casualty contamination incidents. Best results for decontamination from a chemical agent will be achieved if done within minutes following exposure, and delays in decontamination will increase the length of time a casualty is in contact with the contaminate. The findings presented in this report indicate that casualties involved in a HazMat/CBRN mass-casualty incident (MCI) in a typical community would not receive sufficient on-scene care because of operational delays that are integral to a standard HazMat/CBRN first response. This delay in response will mean that casualty care will shift away from the incident scene into already over-tasked health care facilities as casualties seek aid on their own. The self-care decontamination protocols recommended here present a viable option to ensure decontamination is completed in the field, at the incident scene, and that casualties are cared for more quickly and less traumatically than they would be otherwise. Introducing self-care decontamination procedures as a standard first response within the response community will improve the level of care significantly and provide essential, self-care decontamination to casualties. The process involves three distinct stages which should not be delayed; these are summarized by the acronym MADE: Move/Assist, Disrobe/Decontaminate, Evaluate/Evacuate.

MonteithRG, PearceLDR. Self-care decontamination within a chemical exposure mass-casualty incident. Prehosp Disaster Med. 2015;30(3):1–9.

Rural Mass Casualty Preparedness and Response: The Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events

The Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events hosted a workshop at the request of the Federal Interagency Committee on Emergency Medical Services (FICEMS) that brought together a range of stakeholders to broadly identify and confront gaps in rural infrastructure that challenge mass casualty incident (MCI) response and potential mechanisms to fill them. This report summarizes the presentations and discussions around 6 major issues specific to rural MCI preparedness and response: (1) improving rural response to MCI through improving daily capacity and capability, (2) leveraging current and emerging technology to overcome infrastructure deficits, (3) sustaining and strengthening relationships, (4) developing and sharing best practices across jurisdictions and sectors, (5) establishing metrics research and development, and (6) fostering the need for federal leadership to expand and integrate EMS into a broader rural response framework.

(Disaster Med Public Health Preparedness. 2012;6:297–302)

Health systems' "surge capacity": state of the art and priorities for future research

CONTEXT

Over the past decade, a number of high-impact natural hazard events, together with the increased recognition of pandemic risks, have intensified interest in health systems' ability to prepare for, and cope with, "surges" (sudden large-scale escalations) in treatment needs. In this article, we identify key concepts and components associated with this emerging research theme. We consider the requirements for a standardized conceptual framework for future research capable of informing policy to reduce the morbidity and mortality impacts of such incidents. Here our objective is to appraise the consistency and utility of existing conceptualizations of health systems' surge capacity and their components, with a view to standardizing concepts and measurements to enable future research to generate a cumulative knowledge base for policy and practice.

METHODS

A systematic review of the literature on concepts of health systems' surge capacity, with a narrative summary of key concepts relevant to public health.

FINDINGS

The academic literature on surge capacity demonstrates considerable variation in its conceptualization, terms, definitions, and applications. This, together with an absence of detailed and comparable data, has hampered efforts to develop standardized conceptual models, measurements, and metrics. Some degree of consensus is evident for the components of surge capacity, but more work is needed to integrate them. The overwhelming concentration in the United States complicates the generalizability of existing approaches and findings.

CONCLUSIONS

The concept of surge capacity is a useful addition to the study of health systems' disaster and/or pandemic planning, mitigation, and response, and it has far-reaching policy implications. Even though research in this area has grown quickly, it has yet to fulfill its potential to generate knowledge to inform policy. Work is needed to generate robust conceptual and analytical frameworks, along with innovations in data collection and methodological approaches that enhance health systems' readiness for, and response to, unpredictable high-consequence surges in demand.

Long-term impact of environmental public health disaster on health system performance: experiences from the Graniteville, South Carolina chlorine spill

OBJECTIVES

In the aftermath of an environmental public health disaster (EPHD) a healthcare system may be the least equipped entity to respond. Preventable visits for ambulatory care-sensitive conditions (ACSCs) may be used as a population-based indicator to monitor health system access postdisaster. The objective of this study was to examine whether ACSC rates among vulnerable subpopulations are sensitive to the impact of a disaster.

METHODS

We conducted a retrospective analysis on the 2005 chlorine spill in Graniteville, South Carolina using a Medicaid claims database. Poisson regression was used to calculate change in monthly ACSC visits at the disaster site in the postdisaster period compared with the predisaster period after adjusting for parallel changes in a control group.

RESULTS

The adjusted rate of a predisaster ACSC hospital visit for the direct group was 1.68 times the rate for the control group (95% confidence interval [CI] 1.47-1.93), whereas the adjusted ACSC hospital rate postdisaster for the direct group was 3.10 times the rate for the control group (95% CI 1.97-5.18). For ED ACSC visits, the adjusted rate among those directly affected predisaster were 1.82 times the rate for the control group (95% CI 1.61-2.08), whereas the adjusted ACSC rate postdisaster was 2.81 times the rate for the control group (95% CI 1.92-5.17).

CONCLUSIONS

Results revealed that an increased demand on the health system altered health services delivery for vulnerable populations directly affected by a disaster. Preventable visits for ACSCs may advance public health practice by identifying healthcare disparities during disaster recovery.

Secondary surge capacity: a framework for understanding long-term access to primary care for medically vulnerable populations in disaster recovery

Disasters create a secondary surge in casualties because of the sudden increased need for long-term health care. Surging demands for medical care after a disaster place excess strain on an overtaxed health care system operating at maximum or reduced capacity. We have applied a health services use model to identify areas of vulnerability that perpetuate health disparities for at-risk populations seeking care after a disaster. We have proposed a framework to understand the role of the medical system in modifying the health impact of the secondary surge on vulnerable populations. Baseline assessment of existing needs and the anticipation of ballooning chronic health care needs following the acute response for at-risk populations are overlooked vulnerability gaps in national surge capacity plans.

Prediction of unmet primary care needs for the medically vulnerable post-disaster: an interrupted time-series analysis of health system responses

Disasters serve as shocks and precipitate unanticipated disturbances to the health care system. Public health surveillance is generally focused on monitoring latent health and environmental exposure effects, rather than health system performance in response to these local shocks. The following intervention study sought to determine the long-term effects of the 2005 chlorine spill in Graniteville, South Carolina on primary care access for vulnerable populations. We used an interrupted time-series approach to model monthly visits for Ambulatory Care Sensitive Conditions, an indicator of unmet primary care need, to quantify the impact of the disaster on unmet primary care need in Medicaid beneficiaries. The results showed Medicaid beneficiaries in the directly impacted service area experienced improved access to primary care in the 24 months post-disaster. We provide evidence that a health system serving the medically underserved can prove resilient and display improved adaptive capacity under adverse circumstances (i.e., technological disasters) to ensure access to primary care for vulnerable sub-groups. The results suggests a new application for ambulatory care sensitive conditions as a population-based metric to advance anecdotal evidence of secondary surge and evaluate pre- and post-health system surge capacity following a disaster.

Availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in emergency departments in Malaysia

Acute poisoning is a common medical emergency in Malaysia. Life can be saved if the patient is diagnosed properly and receives the appropriate treatment such as gastrointestinal decontamination techniques and resources to increase poison elimination according to clinical guidelines at a reasonable time. The aims of this study were to determine the availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in accident and emergency departments in Malaysia, and to compare the availability of such facilities among various types of hospitals. A comparative, descriptive cross-sectional study was conducted using a structured questionnaire. Seventy-four (58.3%) out of the targeted 127 hospitals replied and completed the questionnaire. The availabilities of most items related to stabilization resources were far better in general hospitals compared to district hospitals with specialists and district hospitals without specialists. These items were mechanical ventilators (p = 0.011), non-invasive positive pressure ventilators (0.024), pacemakers (p = 0.019), and transcutaneous cardiac pacing (p < 0.001). The availability of decontamination resources varied substantially with hospital type. Nevertheless, these differences did not reach statistical significance in any of the cases, whereas sodium sulphate, sorbitol, and polyethylene glycol were almost never available. The availabilities of most items related to elimination enhancement resources were far better in general hospitals and district hospitals with specialists compared to district hospitals without specialists. These items were haemodialysis (p = 0.046), haemoperfusion (p = 0.002), haemofiltration (p = 0.002), acid diuresis (p = 0.04), peritoneal dialysis (p < 0.001), and exchange transfusion (p < 0.001). Most Malaysian hospitals have certain important immediate interventions such as gastrointestinal decontamination techniques and resources to increase poison elimination. The availabilities of most facilities were far better in the general hospitals. Coordination between the National Poison Centre in Malaysia and hospitals should be established regarding the emergency facilities for effective management of poisoning cases in each hospital in order to direct the poisoned patients to the hospital where the appropriate management resources is available.

Disaster health-related challenges and requirements: a grounded theory study in Iran

BACKGROUND

Despite frequent disasters caused by natural hazards, concern has been raised regarding the effectiveness of disaster health services in disaster-prone countries such as Iran. The purpose of this study was to explore, in relation to health disaster management, the experiences and perceptions of individuals who responded or were affected by a recent Iranian earthquake disaster.

METHODS

This study was conducted using grounded theory. Study participants included members of a multidisciplinary disaster response team as well as residents of the community affected by the earthquake (n = 29). Data collection included semi-structured interviews, field notes, and reviews of narratives.

RESULTS

The findings of this study indicate that the lack of planning, inadequate organizational management of resources, insufficient coordination in the provision of health services during the disaster, and the manner of participation of international relief efforts were the most important barriers to adequate disaster healthcare services delivery during the 2003 Bam Iranian earthquake.

CONCLUSIONS

This study supports the value of health service managers coordinating the appropriate use of international aid in advance. It is suggested that this can be done by better communication with local and foreign constituents. Further, this study indicates that public education and proper pre-event planning help to bring about an effective response to providing healthcare services during a disaster.

Jordanian nurses' perceptions of their preparedness for disaster management

AIM

To assess Jordanian RNs' perceptions regarding their knowledge, skills, and preparedness for disaster management.

BACKGROUND

Current disaster knowledge, skills, and preparedness levels need to be evaluated to guide plans for effective educational programs. There is also a need to know where RNs received their knowledge, skills, and preparation, to enhance or improve future educational opportunities.

METHODS

Cross-sectional survey where the Disaster Preparedness Evaluation Tool (DPET(®)) was distributed to Jordanian RNs who work in three randomly selected Ministry of Health hospitals and two university hospitals.

RESULTS

Four hundred and seventy-four participants completed the survey. Sixty-five per cent of respondents described their current disaster preparedness as weak: 18% medium: 12% good; and 5% felt their preparation was very good. Thirty-one per cent received disaster education in undergraduate programs; 8% in graduate nursing programs; 31% in facility drills, and 22% in continuing education courses. Eleven per cent had participated in a real disaster. Four hundred and thirty RNs wanted to learn more about RNs role in disasters, including knowledge and skills.

CONCLUSION

Knowledge,skills, and disaster preparedness need continual reinforcement to improve self efficacy for disaster management.

RECOMMENDATIONS

There is a need for a consistent national nursing curriculum for disaster preparedness and nationwide drills to increase disaster knowledge, skills, preparedness, and confidence.