Perceived Attitudes and Staff Roles of Disaster Management at CBOCs
Lack of abilities to communicate with key DM players also were identified. For example, “Downed power lines may result in no telephone connection to communicate next steps for critical issues, such as if evacuation of the clinic is required.” Another respondent indicated, “We need backup communication...devices, wind-up radios, or whatever.”
Lack of a clear disaster plan was also identified. Questions arose centered on details—how to actually implement a clinic response plan, including concerns that there were none, as the respondents “had not seen the plan in a couple of years” and were not sure who really was in charge of giving directions. Lack of community/organizational support voiced included aspects such as interdepartmental, facility, and community resource connectedness. There was acknowledgement that department assets should be clearly identified so that resource sharing might be used as part of the plan.
Last, regarding lack of resources, one participant said, “We don’t have the resources. We don’t have gurneys. We don’t have enough wheel chairs….We don’t have a crash cart. We don’t have the triage tarps or whatever for the triage of people; we don’t have any supplies to supply the energy room for diabetics, like what they have in the ER.”
Perceived personal and clinic risk for a disaster. Participants stated they felt at risk for natural disasters, including fire, floods, and earthquakes, but expressed concerns and even more fears about how they would handle a response to bombings, spills of hazardous materials, airplane accidents, and gunfire, which also qualify as disasters but are much harder to prepare for, because they could be so varied. One participated stated, “They are so unpredictable whether it is an earthquake or a fire…they are unpredictable….We see planes that fly close to our window and we wonder about the possibility of a crash—you never know.”
Many staff members expressed fear of what these disasters would mean to them in the clinic and to their patients. Another comment shared was, “I don’t think anybody really thinks about this kind of stuff until it happens and then it is too late…If we had just done this or that or knew how to do this or that then…” The biggest fear expressed was that of a massive earthquake in which there would be power outages and resulting fires, blocked building exits, and no way to get to evacuation areas. Fears expressed included working with people who are dying and trying to get the patients down the stairs and out of the disaster area.
Personal safety in a disaster was also a concern; a nurse stated, “Your personal safety is a priority. Yourself, that is first, if you are not safe, you can’t do any good to anyone else.” Another shared concern was the safety of family members during a disaster and conflicting obligations between duties at work and protecting family members. Participants felt they would want to be at home with their families.
Perceptions of roles and responsibilities in EP. Supervisors of the clinics shared that their primary responsibility is to the staff and their current patients; ensuring their safety was a top priority. Their knowledge, skills, and available resources were crucial to their duties, including establishing methods of communication outside the clinic for advice and direction, such as notifying the power company and other outside agencies of the condition of the clinic. They felt that their duties included making sure generators were working, ensuring telephones and lighting were available, and advising staff when to leave the building. One manager stated that more EP discussions need to happen in order to determine how to react: “...in event of a disaster it is important to control patient flow, staffing the clinic appropriately and managing the employees.” They felt a need to help empower their staff by making sure staff were trained in EP tasks and that they could complete the tasks they were required to perform.
Staff consistently reported that the doctors were in charge of providing direction concerning activities and care of the patients. However, most were able to identify their own role in helping preserve lives and keeping the patients and other staff safe. One nurse stated, “My job would be to evacuate the physicians’ offices, to make sure they are aware of the disaster, get them out safely, put an X on their door, keep the patients calm and guide them out to the designated area, then look out for medics or other help so that they would be directed to the correct locations.” Another staff nurse stated, “My role is to check the bathrooms and then under the direction of the physician assist in the care of patient injuries.”
