Perceived Attitudes and Staff Roles of Disaster Management at CBOCs
Role of First Responders
Individuals who respond immediately are referred to as first responders. First responders come in 2 archetypes: those who are there purely based on unexpected circumstances and take action and those who are trained first responders, such as firefighters, police officers, and emergency medical technicians (EMTs). These first responders are trained to partner with one another. Firefighters primarily handle fire rescue as well as assessing the extent of potential damage to the area. Law enforcement’s responsibility is to restore order after an emergency, whether it is a natural disaster, community disturbance, or outbreak of hazardous chemicals. An EMT’s role is to attend to the immediate medical care of patients who have been injured or become ill during the emergency.5
Related: Disaster Preparedness for Veterans With Dementia and Their Caregivers
There are occasions where other potential incident responders, such as health care professionals, can play a key role and yet are not integrated into the emergency response. The VHA needs to focus on this facet in order to more effectively respond to events that threaten lives, property, and current infrastructure of the veterans it serves.
Role of CBOCs and Private Physician Practices
Community-based outpatient clinics (CBOCs), including outpatient community health centers and private physician practices (PPPs), maintain and improve routine community health but are rarely involved in routine planning for disasters. They are, therefore, typically not open for business or may have limited hours as they recover from the event. This results in patients who do not have access to their primary care providers (PCPs) turning to EDs, which are already at capacity. As a result, in a disaster the costly and overburdened ED functions as the PCP site for even larger populations affected by a disaster, including those who are uninsured.6,7
Kahan and colleagues reported that two-thirds of patients preferred their family doctor or health care authorities as their first choice for care instead of receiving care in the ED.8 Researchers found that 89% of physicians in private practice felt it was their responsibility to treat, for example, patients infected with anthrax.8 Some argue that if PCPs are included in planning and appropriately trained in disaster preparedness, their attitudes and willingness to participate in emergency services would follow.9
Given the many challenges to disaster preparedness, CBOCs could be a critical partner in EM, and interest continues to grow to explore that role. Health professionals in CBOCs who are trained in disaster management (DM) could become active participants in early intervention to initiate the treatment of patients in rescue efforts during a disaster.10 For instance, a CBOC could triage patients in a postdisaster situation, thus limiting the burden on hospital EDs by evaluating populations at risk and providing them with important information when communication is difficult.
This already existing network of community-based triage stations would offer natural locations to assess the health needs of the population and determine their level of appropriate medical care. Additionally, these clinics can ensure continuation of basic services after initial medical care has been completed in the hospital setting.10 Because clinics have not been included in coordinated DM, there is scant literature that addresses their potential role in disaster response. Community-based outpatient clinics and PPPs are untapped resources; however, it is unknown whether medical staff in these medical clinics have the interest, training, knowledge, skills, and resources in DM or whether barriers to providing safe care can be overcome.10
Case Study
The VHA is the largest integrated health care system in the U.S. It is mandated to serve as a backup to the DoD during disasters, and VHA CBOCs can play an important role.11,12 The CBOCs are staffed with a medical director, nurse manager, and other clinical and support staff. As a study population, CBOCs are well suited to examine and explore staff attitudes and roles in DM. To date, no research reports have been found studying EP in CBOCs.
The purpose of this study was to learn how to best integrate the CBOCs into disaster response. This qualitative study aimed to answer 3 questions: (1) How do VA clinic personnel perceive their personal and their clinic’s risk, level of preparedness, role, and knowledge for an active response in a disaster; (2) What do VA clinic personnel perceive they need in order to function in a disaster; and (3) What resources are necessary for clinic staff to function competently in a disaster?
