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Healthcare systems have a legal and moral duty to provide competent care to all consumers whom seek treatment even when natural disasters, terrorism events, pandemics, widespread chemical/radiologic exposure and other emergency/disaster events stress the system beyond its capabilities. Education, training and exercises are emergency/disaster preparedness activities that are essential to providing quality care to victims. Healthcare providers, including physicians, nurse practitioners, and physician assistants, are a vital resource for an emergency/disaster response; a consensus of research indicates an overall inadequate level of preparedness among healthcare providers. A majority of emergency/disaster planning efforts have been primarily aimed at urban communities with few published disaster planning efforts addressing the needs of rural communities and the unique challenges they face in emergency/disaster preparedness. The purpose of this practice improvement project was to identify the current status of education/training of rural healthcare providers and identify gaps in training/education to better prepare them to care for victims of emergencies/disasters. A needs assessment was administered to the healthcare providers at a rural healthcare facility in southwest North Dakota and analyzed for trends. Based on the analysis of the survey, the healthcare providers felt moderately prepared to care for victims, yet a universal desire to gain access to increased emergency/disaster education and training was reported. A comprehensive educational plan was developed, and corresponding educational resources were identified. The educational plan addressed 12 domains: personal preparedness, hazard recognition/response, terminology/emergency operations frameworks, communication, health/safety, patient logistics management, special needs populations, mental health considerations, legal/ethical principles, and hazard-specific medical management/triage. The needs assessment findings and education plan were provided to key stakeholders within the sponsoring organization to increase healthcare provider emergency/disaster preparedness awareness. Project methods can serve as a framework for ongoing development of assessment of rural healthcare providers’ competency in providing care to victims and rural emergency/disaster educational plans.
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.
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.
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.
In the devastation that follows a major disaster, there is a need for multiple sectors to unite and devote new resources to support the rebuilding of infrastructure, the provision of health and social services, the restoration of care delivery systems, and other critical recovery needs. In some cases, billions of dollars from public, private and charitable sources are invested to help communities recover. National rhetoric often characterizes these efforts as a "return to normal." But for many American communities, pre-disaster conditions are far from optimal. Large segments of the U.S. population suffer from preventable health problems, experience inequitable access to services, and rely on overburdened health systems. A return to pre-event conditions in such cases may be short-sighted given the high costs - both economic and social - of poor health. Instead, it is important to understand that the disaster recovery process offers a series of unique and valuable opportunities to improve on the status quo. Capitalizing on these opportunities can advance the long-term health, resilience, and sustainability of communities - thereby better preparing them for future challenges. Healthy, Resilient, and Sustainable Communities After Disasters identifies and recommends recovery practices and novel programs most likely to impact overall community public health and contribute to resiliency for future incidents. This book makes the case that disaster recovery should be guided by a healthy community vision, where health considerations are integrated into all aspects of recovery planning before and after a disaster, and funding streams are leveraged in a coordinated manner and applied to health improvement priorities in order to meet human recovery needs and create healthy built and natural environments. The conceptual framework presented in Healthy, Resilient, and Sustainable Communities After Disasters lays the groundwork to achieve this goal and provides operational guidance for multiple sectors involved in community planning and disaster recovery. Healthy, Resilient, and Sustainable Communities After Disasters calls for actions at multiple levels to facilitate recovery strategies that optimize community health. With a shared healthy community vision, strategic planning that prioritizes health, and coordinated implementation, disaster recovery can result in a communities that are healthier, more livable places for current and future generations to grow and thrive - communities that are better prepared for future adversities.
Building on the innovative Institute of Medicine reports To Err Is Human and Crossing the Quality Chasm, Quality Through Collaboration: The Future of Rural Health offers a strategy to address the quality challenges in rural communities. Rural America is a vital, diverse component of the American community, representing nearly 20% of the population of the United States. Rural communities are heterogeneous and differ in population density, remoteness from urban areas, and the cultural norms of the regions of which they are a part. As a result, rural communities range in their demographics and environmental, economic, and social characteristics. These differences influence the magnitude and types of health problems these communities face. Quality Through Collaboration: The Future of Rural Health assesses the quality of health care in rural areas and provides a framework for core set of services and essential infrastructure to deliver those services to rural communities. The book recommends: Adopting an integrated approach to addressing both personal and population health needs Establishing a stronger health care quality improvement support structure to assist rural health systems and professionals Enhancing the human resource capacity of health care professionals in rural communities and expanding the preparedness of rural residents to actively engage in improving their health and health care Assuring that rural health care systems are financially stable Investing in an information and communications technology infrastructure It is critical that existing and new resources be deployed strategically, recognizing the need to improve both the quality of individual-level care and the health of rural communities and populations.
Building on the innovative Institute of Medicine reports To Err Is Human and Crossing the Quality Chasm, Quality Through Collaboration: The Future of Rural Health offers a strategy to address the quality challenges in rural communities. Rural America is a vital, diverse component of the American community, representing nearly 20% of the population of the United States. Rural communities are heterogeneous and differ in population density, remoteness from urban areas, and the cultural norms of the regions of which they are a part. As a result, rural communities range in their demographics and environmental, economic, and social characteristics. These differences influence the magnitude and types of health problems these communities face. Quality Through Collaboration: The Future of Rural Health assesses the quality of health care in rural areas and provides a framework for core set of services and essential infrastructure to deliver those services to rural communities. The book recommends: Adopting an integrated approach to addressing both personal and population health needs Establishing a stronger health care quality improvement support structure to assist rural health systems and professionals Enhancing the human resource capacity of health care professionals in rural communities and expanding the preparedness of rural residents to actively engage in improving their health and health care Assuring that rural health care systems are financially stable Investing in an information and communications technology infrastructure It is critical that existing and new resources be deployed strategically, recognizing the need to improve both the quality of individual-level care and the health of rural communities and populations.
During a wide-reaching catastrophic public health emergency or disaster, existing surge capacity plans may not be sufficient to enable health care providers to continue to adhere to normal treatment procedures and follow usual standards of care. This is a particular concern for emergencies that may severely strain resources across a large geographic area, such as a pandemic influenza or the detonation of a nuclear device. Under these circumstances, it may be impossible to provide care according to the standards of care used in non-disaster situations, and, under the most extreme circumstances, it may not even be possible to provide basic life sustaining interventions to all patients who need them. Although recent efforts to address these concerns have accomplished a tremendous amount in just a few years, a great deal remains to be done in even the most advanced plan. This workshop summary highlights the extensive work that is already occurring across the nation. Specifically, the book draws attention to existing federal, state, and local policies and protocols for crisis standards of care; discusses current barriers to increased provider and community engagement; relays examples of existing interstate collaborations; and presents workshop participants' ideas, comments, concerns, and potential solutions to some of the most difficult challenges.
According to the Center for Research and Epidemiology of Disasters, the frequency and severity of disasters has increased over 300% in the last decade. Healthcare systems and individual healthcare practitioners, including nurses, are now fulfilling multiple roles in disaster preparedness in the whole of community: planning, preparedness, risk identification, mitigation, response and recovery. Nurses are considered first responders for biological events or when the disaster occurs where they are working. Nurses act as first receivers when accepting patients/victims for care whose injuries result from non-biological events occurring outside the nurse’s workplace. The vast majority of practicing nurses received no disaster preparedness education in their basic nursing education program. Nurses graduating in the 21st century are exposed to some of the concepts of disaster nursing but have little experience unless there is a disaster or emergency where they work or go to school. Readers will be updated on this topic because articles in this edition demonstrate a vast array of implications for nurses in disaster preparedness around the world: chemical, biological, radiological/nuclear, explosives (CBRNE); natural disasters; new models of training and educating nurses for disasters, military nurse response, mental health issues as well as non-government organizations.
Accompanying CD-Rom has same title as book.