Personal and professional challenges confronted by hospital staff following hurricane sandy: a qualitative assessment of management perspectives

Emergency Medicine Residents' Perceptions of Working and Training in a Pandemic Epicenter: A Qualitative Analysis

INTRODUCTION

We sought to describe the range of emergency medicine (EM) resident physicians' perceptions and experiences of working and training during the initial coronavirus 2019 (COVID-19) pandemic surge at two, large-volume, urban training hospitals in Brooklyn, New York.

METHODS

A total of 25 EM resident physicians who worked at either of two large emergency departments (ED) from March 15-April 11, 2020 participated in semi-structured interviews conducted in July and August 2020. Interviews were conducted by the authors who were also emergency medicine resident physicians working in the ED during this time. We asked open-ended questions to residents about their experiences and emotions at work and outside of work, including their relationship with co-workers, patients, and their community. The interviews were audio-recorded and transcribed. We then conducted a thematic analysis to identify, classify, and define themes from interview transcripts. Iterative commonalities and differences between interview response themes were grouped to create a broadly applicable narrative of the residents' perceptions and experiences of working and training during this initial wave of a novel pandemic. Interviewees also responded to a demographics survey.

RESULTS

Study participants described four major aspects of their perceptions and experiences of working and training during the stated time, including emotional challenges such as anxiety and feeling underappreciated; protective thoughts, including camaraderie, and sense of duty; workplace challenges such as limited knowledge surrounding COVID-19 and a higher volume of acute patients; and adaptive strategies including increased communication with ED administrators.

CONCLUSION

Emergency medicine residents have a unique perspective and were key frontline hospital responders during a prolonged disaster and mass triage event within a local health system. Considering the chronic case and mortality fluctuations and new variants of COVID-19, as well as the anticipation of future infectious disease pandemics, we believe it is important for key decision-makers in resident education, hospital administration, and all levels of public health management to inform themselves about residents' emotional and workplace challenges when establishing hospital and residency program disaster protocols.

Willingness to Work during Public Health Emergencies: A Systematic Literature Review

The identification of the factors underlying the willingness or lack thereof to respond to public health emergencies is paramount to informing more capable health services. The interest in this topic appears renewed with each surge of threat, either referring to natural disasters, man-made violence, or epidemic and pandemics. However, there is no systematic approach to the research patterns and related main findings concerning individual and contextual determinants. The present article contributes to this theme through a systematic literature review of a sample of 150 articles published in the last 30 years on the subject of willingness and preparedness of health professionals to deal with public health threats. Our findings show that the research is mainly phenomena and contextual driven, responding to whichever emergency threat is more salient in a given period. Geographically, research on this topic is led by USA and China, mostly solely, while European countries invest in collaborations that are more international. Universities, including health institutes and schools, and researchers at hospitals conduct most of the research on the topic. The main research areas are medicine, psychology, and psychiatry. Pandemics, including COVID-19, influenza, and natural disasters, are the phenomena gauging more attention as opposed to terrorism events and biological accidents. The specific role of health professionals within the institution, their belief in ethical duties, preparation training, and concerns regarding infection of self and family are the main variables influencing the willingness and ability to report to work in public health emergencies.

Chemical, Biological, Radiological, or Nuclear Response in Queensland Emergency Services: A Multisite Study

A disaster overwhelms the normal operating capacity of a health service. Minimal research exists regarding Australian hospitals' capacity to respond to chemical, biological, radiological, or nuclear (CBRN) disasters. This article, and the research supporting it, begins to fill that research gap. We conducted a descriptive quantitative study with 5 tertiary hospitals and 1 rural hospital in Queensland, Australia. The study population was the hospitals' clinical leaders for disaster preparedness. The 25-item survey consisted of questions relating to each hospital's current response capacity, physical surge capacity, and human surge capacity in response to a CBRN disaster. Data were analyzed using descriptive statistics. The survey data indicated that over the previous 12 months, each site reached operational capacity on average 66 times and that capacity to respond and create additional emergency, intensive care, or surgical beds varied greatly across the sites. In the previous 12 months, only 2 sites reported undertaking specific hospital-wide training to manage a CBRN disaster, and 3 sites reported having suitable personal protective equipment required for hazardous materials. There was a noted shortfall in all the hospitals' capacity to respond to a radiological disaster in particular. Queensland hospitals are crucial to CBRN disaster response, and they have areas for improvement in their response and capacity to surge when compared with international preparedness benchmarks. CBRN-focused education and training must be prioritized using evidence-based training approaches to better prepare hospitals to respond following a disaster event.

Hospitals as disaster victims: Lessons not learned?

OBJECTIVE

Hospitals are a key component to disaster response but are susceptible to the effects of disasters as well, including infrastructure damage that disrupts patient care. These events offer an opportunity for evaluation and improvement of preparedness and response efforts when hospitals are affected directly by a disaster. The objective of this structured review was to evaluate the existing literature on hospitals as disaster victims.

METHODS

A structured and scoping review of peer-reviewed literature, gray literature, and news reports related to hospitals as disaster victims was completed to identify and analyze themes and lessons observed from disasters in which hospitals are victims, to aid in future emergency operations planning and disaster response.

RESULTS

The literature search and secondary search of referenes identified 366 records in English. A variety of common barriers to successful disaster response include loss of power, water, heating and ventilation, communications, health information technology, staffing, supplies, safety and security, and structural and non-structural damage.

CONCLUSIONS

There are common weaknesses in disaster preparedness that we can learn from and account for in future planning with the aim of improving resilience in the face of future disasters.

Registered nurses: can our supply meet the demand during a disaster?

BACKGROUND

Death and destructions are often reported during natural disasters; yet little is known about how hospitals operate during disasters and if there are sufficient resources available for hospitals to provide ongoing care during these catastrophic events. The purpose of this study was to determine if the State of New Jersey had a supply of registered nurses (RNs) that was sufficient to meet the needs of hospitalized patients during a natural disaster - Hurricane Sandy.

METHODS

Secondary data were used to forecast the demand and supply of New Jersey RNs during Hurricane Sandy. Data sources from November 2011 and 2012 included the State Inpatient Databases (SID), American Hospital Association (AHA) Annual Survey on hospital characteristics and staffing data from New Jersey Department of Health. Three models were used to estimate the RN shortage for each hospital, which was the difference between the demand and supply of RN full-time equivalents.

RESULTS

Data were available on 66 New Jersey hospitals, more than half of which experienced a shortage of RNs during Hurricane Sandy. For hospitals with a RN shortage in ICUs, a 20% increase in observed RN supply was needed to meet the demand; and a 10% increase in observed RN supply was necessary to meet the demand for hospitals with a RN shortage in non-ICUs.

CONCLUSION

Findings from this study suggest that many hospitals in New Jersey had a shortage of RNs during Hurricane Sandy. Efforts are needed to improve the availability of nurse resources during a natural disaster.

Health Systems Responsiveness in Addressing Indigenous Residents' Health and Mental Health Needs Following the 2016 Horse River Wildfire in Northern Alberta, Canada: Perspectives From Health Service Providers

Following the 2016 Horse River Wildfire in northern Alberta, the provincial health authority, the ministry of health, non-profit and charitable organizations, and regional community-based service agencies mobilized to address the growing health and mental health concerns among Indigenous residents and communities through the provision of services and supports. Among the communities and residents that experienced significant devastation and loss were First Nation and Métis residents in the region. Provincial and local funding was allocated to new recovery positions and to support pre-existing health and social programs. The objective of this research was to qualitatively describe the health systems response to the health impacts following the wildfire from the perspective of service providers who were directly responsible for delivering or organizing health and mental wellness services and supports to Indigenous residents. Semi-structured qualitative interviews were conducted with 15 Indigenous and 10 non-Indigenous service providers from the Regional Municipality of Wood Buffalo (RMWB). Interviews were transcribed verbatim and a constant comparative analysis method was used to identify themes. Following service provider interviews, a supplemental document review was completed to provide background and context for the qualitative findings from interviews. The document review allowed for a better understanding of the health systems response at a systems level following the wildfire. Triangulation of semi-structured interviews and organization report documents confirmed our findings. The conceptual framework by Mirzoev and Kane for understanding health systems responsiveness guided our data interpretation. Our findings were divided into three themes (1) service provision in response to Indigenous mental health concerns (2) gaps in Indigenous health-related services post-wildfire and (3) adopting a health equity lens in post-disaster recovery. The knowledge gained from this research can help inform future emergency management and assist policy and decision makers with culturally safe and responsive recovery planning. Future recovery and response efforts should consider identifying and addressing underlying health, mental health, and emotional concerns in order to be more effective in assisting with healing for Indigenous communities following a public health emergency such as a wildfire disaster.

How Prepared Are the Health Care Professionals for Disaster Medicine Management? An Insight from Pakistan

Countries need healthcare professionals who are competent first responders with a positive attitude and prepared to deal with catastrophes. The study evaluated the knowledge, attitude, and readiness of the practice of healthcare professionals towards disaster management. A survey was carried out among hospital healthcare professionals using a self-administered validated questionnaire. The questionnaire comprised knowledge, attitude, and readiness to practice items. Descriptive and inferential statistics (Mann-Whitney, Kruskal-Wallis, correlation and regression tests) at alpha = 0.05 were used in the analysis. The mean (SD) score of knowledge was 12.25 (4.27) (range: 3.00 to 20.00), attitude (39.32 ± 9.55; range: 18.00 to 61.00), readiness to practice (32.41 ± 6.69; range: 21.00 to 61.00), and KArP (83.99 ± 12.21; range: 60.00 to 124.00). The average knowledge score was moderate, low attitude score, moderate readiness to practice score, and an average score of overall KArP. Attitude is a significant predictor of readiness to practice (p = 0.000). The levels of knowledge, attitude, and readiness of the practice of healthcare professionals were not satisfactory. The educators and health policymakers should build a robust curriculum in disaster medicine management and preparedness to prepare for the future of competent healthcare professionals for the nation.

Improving flood disaster preparedness of hospitals in Central Thailand: Hospital personnel perspectives

AIM

To improve hospitals disaster preparedness during floods.

BACKGROUND

The Thai flood disaster in 2011 struck several sectors, including hospitals. It is necessary to build a disaster preparedness system that ensures that hospitals have the capacity to respond effectively to any kind of disaster.

METHODS

This qualitative study was conducted using content analysis. Purposive sampling was used to select 15 participants, including doctors, nurses and other staff involved in disaster preparedness, and semi-structured interviews were conducted with them. The study was reported according to COREQ guidelines.

RESULTS

Healthcare personnel identified several ways in which flood disaster preparedness of hospitals may be enhanced. Three themes and eight subthemes were identified during the data analysis. The three themes were as follows: 1) ongoing efforts for flood prevention and mitigation at a national level; 2) developing operational guidelines to effectively prevent and resolve flood problems at provincial levels; and 3) increasing the levels of flood readiness at the hospital level.

CONCLUSIONS

The results of this study indicate strategies to help policymakers and health personnel enhance flood disaster preparedness measures at hospitals based on the experiences of hospital personnel involved in one of the worst flood disasters worldwide.

RELEVANCE TO CLINICAL PRACTICE

Hospitals alone cannot deal with unpredictable events; they need additional assistance in disaster preparedness. There are three levels at which improving hospital flood disaster preparedness can take place: national, provincial and hospital levels. Nursing professionals participate in hospital disaster preparedness and work with multidisciplinary teams to provide services. Nurses should be prepared for such participation, as their involvement, through tailored services for hospital disaster preparedness, can expand the literature on nursing knowledge to improve clinical outcomes.

Emergency and Disaster Handling Preparedness Among Front Line Health Service Providing Nurses and Associated Factors at Emergency Department, at Amhara Regional State Referral Hospitals, Ethiopia

Introduction

Globally around 1.6 million individuals have died as a result of disasters per year. These disruptive events that happen in the world each day result in damage to individuals, families, and communities.

Methods

An institution-based cross-sectional study was conducted. All frontline health-care providers at the emergency departments of Amhara Regional State Referral Hospitals during the study period were considered as studied subjects. Data were collected through a self-administered technique. Once all essential data were collected, data were coded and entered into epidata manager (v4.6.0.2) statistical software. SPSS version 26 was used to analyze the findings of this paper.

Results

The result of this research study showed that 66.7% were males and 33.3% were females with mean age of respondents being 31.2 ± 5.8. Among respondents, 54% (52.9) % did not have an understanding of disaster preparedness. As a result, the majority of participants, 52 (51%), have inadequate knowledge. Most respondents have adequate attitude (57.8%) and only a few, 12 (11.8%), of respondents were very familiar with regard to disaster and disaster handling preparedness. In multivariate logistic regression, receiving training on the subject (P = 0.000, AOR: 15.109. 95% CI: 3.525–64.769), respondents receiving simulation in the subject of disaster (P = 0.015, AOR: 4.855, 95% CI: 1.366–17.260) and having a direct personal/professional experience of disaster (P = 0.003, AOR: 5.703, 95% CI: 1.825–17.823) were significantly associated.

Conclusion and Recommendation

Disaster handling preparedness, knowledge and familiarity levels were below those expected for emergency department nurses. Capacity building through training, education and simulation is essential.

Workforce preparedness for disasters: perceptions of clinical and non-clinical staff at the U.S. Department of Veterans Affairs

Background

Most U.S. studies on workforce preparedness have a narrow scope, focusing primarily on perceptions of clinical staff in a single hospital and for one type of disaster. In contrast, this study compares the perceptions of workplace disaster preparedness among both clinical and non-clinical staff at all U.S. Department of Veterans Affairs (VA) medical facilities nationwide for three types of disasters (natural, epidemic/pandemic, and manmade).

Methods

The VA Preparedness Survey used a stratified simple random, web-based survey (fielded from October through December 2018) of all employees at VA medical facilities. We conducted bivariate and multivariate logistic regression analyses to compare the sociodemographic characteristics and perceptions of disaster preparedness between clinical and non-clinical VA staff.

Results

The study population included 4026 VA employees (2488 clinicians and 1538 non-clinicians). Overall, VA staff were less confident in their medical facility’s ability to respond to epidemic/pandemics and manmade disasters. Depending on the type of disaster, clinical staff, compared to non-clinical staff, were less likely to be confident in their VA medical facility’s ability to respond to natural disasters (OR:0.78, 95% CI:0.67–0.93, p < 0.01), pandemics (OR:0.82, 95% CI:0.70–0.96, p < 0.05), and manmade disasters (OR: 0.74, 95% CI: 0.63–0.86, p < 0.001). On the other hand, clinicians, compared to non-clinicians, were 1.45 to 1.78 more likely to perceive their role in disaster response to be important (natural OR:1.57, 95% CI:1.32–1.87; pandemic OR:1.78, 95% CI:1.51–2.10; manmade: OR:1.45; 95% CI: 1.23–1.71; p’s < 0.001), and 1.27 to 1.29 more likely to want additional trainings to prepare for all three types of disasters (natural OR:1.29, 95% CI:1.10–1.51; pandemic OR:1.27, 95% CI:1.08–1.49; manmade OR:1.29; 95% CI:1.09–1.52; p’s < 0.01). Clinicians were more likely to be women, younger, and more educated (p’s < 0.001) than non-clinicians. Compared to clinicians, non-clinical staff had been employed longer with the VA (p < 0.025) and were more likely to have served in the U.S. Armed Forces (p < 0.001).

Conclusions

These findings suggest both a desire and a need for additional training, particularly for clinicians, and with a focus on epidemics/pandemics and manmade disasters. Training programs should underscore the importance of non-clinical roles when responding to disasters.

Impact of Hurricane Harvey on Healthcare Utilization and Emergency Department Operations

INTRODUCTION

Hurricanes have increased in severity over the past 35 years, and climate change has led to an increased frequency of catastrophic flooding. The impact of floods on emergency department (ED) operations and patient health has not been well studied. We sought to detail challenges and lessons learned from the severe weather event caused by Hurricane Harvey in Houston, Texas, in August 2017.

METHODS

This report combines narrative data from interviews with retrospective data on patient volumes, mode of arrival, and ED lengths of stay (LOS). We compared the five-week peri-storm period for the 2017 hurricane to similar periods in 2015 and 2016.

RESULTS

For five days, flooding limited access to the hospital, with a consequent negative impact on provider staffing availability, disposition and transfer processes, and resource consumption. Interruption of patient transfer capabilities threatened patient safety, but flexibility of operations prevented poor outcomes. The total ED patient census for the study period decreased in 2017 (7062 patients) compared to 2015 (7665 patients) and 2016 (7770) patients). Over the five-week study period, the arrival-by-ambulance rate was 12.45% in 2017 compared to 10.1% in 2016 (p < 0.0001) and 13.7% in 2015 (p < 0.0001). The median ED length of stay (LOS) in minutes for admitted patients was 976 minutes in 2015 (p < 0.0001) compared to 723 minutes in 2016 and 591 in 2017 (p < 0.0001). For discharged patients, median ED LOS was 336 minutes in 2016 compared to 356 in 2015 (p < 0.0001) and 261 in 2017 (p < 0.0001). Median boarding time for admitted ED patients was 284 minutes in 2016 compared to 470 in 2015 (p < 0.0001) and 234.5 in 2017 (p < 0.001). Water damage resulted in a loss of 133 of 179 inpatient beds (74%). Rapid and dynamic ED process changes were made to share ED beds with admitted patients and to maximize transfers post-flooding to decrease ED boarding times.

CONCLUSION

A number of pre-storm preparations could have allowed for smoother and safer ride-out functioning for both hospital personnel and patients. These measures include surplus provisioning of staff and supplies to account for limited facility access. During a disaster, innovative flexibility of both ED and hospital operations may be critical when disposition and transfer capibilities or bedding capacity are compromised.

The Development of a Veterans Health Administration Emergency Management Research Agenda

INTRODUCTION

The Veterans Health Administration (VHA), the largest integrated healthcare delivery system in the United States, is charged with ensuring timely access to high-quality care for veterans during disasters, and supporting national, state, local, and tribal emergency management and homeland security efforts. In 2008, the VHA Office of Public Health (OPH) sponsored the first VHA Emergency Management Research Agenda-setting conference to develop research priorities that address the needs of veterans and to position VHA as a national leader in emergency management by having VHA serve as a "laboratory" for the development of evidence-based emergency management practices.

METHODS

We focused on four steps: #1: Appraising the emergency management research portfolio of VHA-based researchers; #2: Obtaining systematic information on VHA's role in emergency management and the healthcare needs of veterans during disasters; #3: Based upon gaps between the current research portfolio and the existing evidence base, identifying strategic priorities using a research agenda-setting conference; and #4: Laying the groundwork to foster the conduct of emergency management research within VHA.

RESULTS

Identified research priorities included how to prevent and treat behavioral health problems related to a disaster, the efficacy of training programs, crisis communication strategies, workforce resilience, and evacuating veterans from health care facilities. Conclusion: VHA is uniquely situated to answer research questions that cannot be readily addressed in other settings. VHA should partner with other governmental and private entities to build on existing work and establish shared research priorities.