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This dissertation examines disaster preparedness in the U.S. and explores the relationships between risk perception, funding from U.S. Health Resources and Services Administration (HRSA), and preparedness. Secondary data analysis was conducted using the National Study of Rural Hospitals from Johns Hopkins University. The study, based on a random sample of rural hospitals, consisted of a mail questionnaire and a follow-up phone interview with the hospital's Chief Executive Officer (n=134). A model of disaster preparedness was utilized to examine seven elements of preparedness and one overall preparedness measure. Risk perception was examined by seven risk threats and one all-hazards measure, and HRSA funding was examined as a continuous and categorical variable. The results indicated that rural hospitals were moderately prepared overall (78% prepared on average), with high preparedness in education/ training (89%) and isolation/ decontamination (91%); moderate preparedness in administration/ planning (80%), communication/ notification (83%), staffing/ support (66%), and supplies/ pharmaceuticals/ laboratory support (70%); and low preparedness in surge capacity (64%). The respondents reported greater risk perception from natural disasters (79% of hospitals reported moderate to high risk) and vehicular accidents (77%) than from manmade disasters (23%). Overall, 59% of the hospitals reported moderate to high risk perception. Eighty-nine percent of the hospitals had received HRSA funding, ranging from $1000 to $526,555. Results obtained from logistic regression models indicated that there was no statistically significant difference in the odds of a hospital being prepared overall when comparing high vs. low risk perception (OR=.61; 95% CI, .26-1.44) or high vs. low HRSA funding (OR=1.09; 95% CI, .50-2.39), and no interaction was found between HRSA funding and risk perception on preparedness. Positive associations were identified between risk perception and the subcategory of education/training (OR=1.24; 95% CI, 1.05-1.27) and between HRSA funding and isolation/decontamination (OR=1.26; 95% CI, 1.08-1.83). Additionally, positive associations were found between system affiliation and staffing/ support, and supplies/ pharmaceuticals/ laboratory support; and between Joint Commission accreditation and administration/ planning, education/ training, and supplies/ pharmaceuticals/ laboratory support. Rural U.S. hospitals reported being moderately prepared overall in the event of a disaster. Further research should be conducted to identify predictors of preparedness in rural hospitals in order to optimize readiness for potential disaster events.
"The goal of this research is to evaluate the hospital's role in a regional disaster response. It focuses on identifying the level of the hospital's preparedness and its response to disasters and include a comparison study between an urban and a rural hospital in New York state. The findings of this work show some difference between the urban and rural hospitals in terms of their capabilities and available resources and the effect of the community infrastructures on their preparedness. Both hospitals have similarities in the way participants view the hospital's role during a regional disaster response. It is noted that the urban hospital has more resources, a better geographical location, staff, medical centers, equipment, and supply management."--Abstract.
Today our emergency care system faces an epidemic of crowded emergency departments, patients boarding in hallways waiting to be admitted, and daily ambulance diversions. Hospital-Based Emergency Care addresses the difficulty of balancing the roles of hospital-based emergency and trauma care, not simply urgent and lifesaving care, but also safety net care for uninsured patients, public health surveillance, disaster preparation, and adjunct care in the face of increasing patient volume and limited resources. This new book considers the multiple aspects to the emergency care system in the United States by exploring its strengths, limitations, and future challenges. The wide range of issues covered includes: • The role and impact of the emergency department within the larger hospital and health care system. • Patient flow and information technology. • Workforce issues across multiple disciplines. • Patient safety and the quality and efficiency of emergency care services. • Basic, clinical, and health services research relevant to emergency care. • Special challenges of emergency care in rural settings. Hospital-Based Emergency Care is one of three books in the Future of Emergency Care series. This book will be of particular interest to emergency care providers, professional organizations, and policy makers looking to address the deficiencies in emergency care systems.
Problems contacting emergency services and delayed assistance are not unusual when incidents occur in rural areas, and the consequences can be devastating, particularly with mass casualty incidents. The IOM's Forum on Medical and Public Health Preparedness for Catastrophic Events held a workshop to examine the current capabilities of emergency response systems and the future opportunities to improve mass casualty response in rural communities.
The purpose of this project was to identify the current status of education/training of rural health care providers and identify gaps in training/education to better prepare rural providers to care for victims of disasters. A survey was conducted and distributed to 21 physicians, nurse practitioners, and physician assistants employed at rural clinic/critical access hospital. The survey consisted of quantitative and fill in the blank questions. The survey was distributed through the electronic survey engine “Qualtrics.” Participation in the survey was voluntary and responses were anonymous. The survey addressed/identified: basic demographic information, knowledge of disaster/emergency preparedness and care of victims as a first receiver, experience and education related to disasters/emergencies, perceptions of emergencies/disaster types most likely to impact their facility, future education/training preferences, and barriers to participation in disaster/emergency education/training. The survey also assessed the providers’ comfort level with suggested disaster/emergency core competencies put forth from professional emergency/trauma organizations.
Preparedness, Response and Recovery Considerations for Children and Families is the summary of a workshop convened in June, 2013 by the Institute of Medicine Forum on Medical and Public Health Preparedness for Catastrophic Events to discuss disaster preparedness, response, and resilience relative to the needs of children and families, including children with special health care needs. Traditional and non-traditional medical and public health stakeholders from across federal, state, and local government health care coalitions, community organizations, school districts, child care providers, hospitals, private health care providers, insurers, academia, and other partners in municipal planning met to review existing tools and frameworks that can be modified to include children's needs; identify child-serving partners and organizations that can be leveraged in planning to improve outcomes for children; highlight best practices in resilience and recovery strategies for children; and raise awareness of the need to integrate children's considerations throughout local and state emergency plans. Communities across the United States face the threat of emergencies and disasters almost every day, natural and man-made, urban and rural, large and small. Although children represent nearly 25 percent of the U.S. population, current state and local disaster preparedness plans often do not include specific considerations for children and families. The preparedness and resilience of communities related to children will require a systems framework for disaster preparedness across traditional and non-traditional medical and public health stakeholders, including community organizations, schools, and other partners in municipal planning. This report examines resilience strategies that lead to successful recovery in children after a disaster and discusses current approaches and interventions to improve recovery in children.