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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.
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.
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.
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.
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.
Disasters and Public Health: Planning and Response, Second Edition, examines the critical intersection between emergency management and public health. It provides a succinct overview of the actions that may be taken before, during, and after a major public health emergency or disaster to reduce morbidity and mortality. Five all-new chapters at the beginning of the book describe how policy and law drive program structures and strategies leading to the establishment and maintenance of preparedness capabilities. New topics covered in this edition include disaster behavioral health, which is often the most expensive and longest-term recovery challenge in a public health emergency, and community resilience, a valuable resource upon which most emergency programs and responses depend. The balance of the book provides an in-depth review of preparedness, response, and recovery challenges for 15 public health threats. These chapters also provide lessons learned from responses to each threat, giving users a well-rounded introduction to public health preparedness and response that is rooted in experience and practice. Contains seven new chapters that cover law, vulnerable populations, behavioral health, community resilience, preparedness capabilities, emerging and re-emerging infectious diseases, and foodborne threats Provides clinical updates by new MD co-author Includes innovative preparedness approaches and lessons learned from current and historic public health and medical responses that enhance clarity and provide valuable examples to readers Presents increased international content and case studies for a global perspective on public health
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.
In June 2006, the Institute of Medicine (IOM) Committee on the Future of Emergency Care in the U.S. Health System released a series of reports on the state of emergency care. The reports, Emergency Medical Services at the Crossroads; Hospital-Based Emergency Care: At the Breaking Point; and Emergency Care for Children: Growing Pains, identified a number of disturbing problems including overcrowded emergency departments, a lack of coordination among emergency providers, variability in the quality of care provided to patients, workforce shortages, lack of disaster preparedness, a limited research base, and shortcomings in the systems' ability to care for pediatric patients. These problems, while apparent to those who work in the field, are largely hidden from public view, in part because popular fictional television programs frequently depict the emergency care system in fine shape. Despite the lifesaving feats performed every day by emergency departments and ambulance services, the nation's emergency medical system as a whole is overburdened, underfunded, and highly fragmented. The IOM received funding from 14 organizations to conduct a series of dissemination workshops associated with the release of the 2006 reports on the future of emergency care. Three one-day regional dissemination workshops were conducted in Salt Lake City, Utah (September 7, 2006), Chicago, Ilinois (October 27, 2006), and New Orleans, Louisiana (November 2, 2006). Each of the workshops featured focused discussions in two issue areas. The meeting in Salt Lake City focused on pediatric emergency care and care in rural areas; in Chicago it was workforce issues and hospital efficiency; and in New Orleans it was EMS issues and disaster preparedness. A fourth capstone workshop, held in Washington, D.C., provided an opportunity to engage congressional and other federal policy leaders in a discussion of emergency care issue. Future of Emergency Care summarizes the proceedings of the workshops. Each regional workshop began with an overview of the findings and recommendations from the three reports on the future of emergency care. Findings and recommendations from those three reports are also summarized in this report.