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Perceived Attitudes and Staff Roles of Disaster Management at CBOCs

Community-based outpatient clinics can play an important role in disaster response, but significant barriers exist, which must be addressed.
Federal Practitioner. 2015 August;32(8):12-20
August 18, 2015|Federal Practitioner
Tony Hilton, DrPH, MSN, FNP, CRRN;Susanne Montgomery, Mph, PhD;Patti Herring, PhD;Thelma Gamboa-Maldonado, CHES;Ryan Sinclair, PhD, MPH;Bret McLaughlin, MA
Author and Disclosure Information

Dr. Hilton is a safe patient handling coordinator and Mr. McLaughlin is a VHA regional manager in emergency management, both at the Loma Linda VA Health Care System in California. Dr. Montgomery is a professor and director of research at the Behavioral Health Institute; Dr. Herring is an associate professor at the Center for Health Promotion, School of Public Health; Dr. Gamboa-Maldonado is an assistant professor at the Department of Global Health, School of Public Health, and at the Center for Health Disparities and Molecular Medicine School of Medicine, and co-investigator for the University of California, Los Angeles Preparedness and Emergency Response Research Center (2011-2013) in collaboration with Loma Linda University School of Public Health and Center for Public Health Preparedness; and Dr. Sinclair is a consultant at the Department of Environmental Health and Geoinformatic Sciences, School of Public Health; all at the Loma Linda University in California.

Many did not have a clear understanding of an all-hazard approach plan and had not been involved in hazard assessments. Already tightly staffed for personal health care delivery, staff spent minimal time and energy thinking about the risk of a disaster or preparing for one. However, there seemed to be a direct relationship between the attitude of the supervisor and the attitudes of clinic staff to EP. Although these qualitative results are encouraging and point to these clinics as an important undertapped resource for EP, further quantitative studies should expand this inquiry.

Lessons learned from this study include the need to expand qualitative data collection to include a larger sample size to retrieve information that would contribute to a better understanding of how staff view their roles in DM. There are 152 VAMCs and hundreds of associated CBOCs that should be queried as to their EM readiness. Also, replicating this study in non-VHA clinics, such as private CBOCs and PPPs, might bring greater insight into what is needed to involve them in DM plans. Finally, future studies should determine clearer criteria when care can be provided at a clinic and when it would be appropriate for the patient to report at their local ED.

Conclusions and Recommendations

Given the VHA EP mandate, the authors recommend the following steps to address barriers identified in this study: (1) Develop a more structured approach to DM in a CBOC setting to provide staff with a clear understanding of their roles and responsibilities; (2) Conduct a comprehensive assessment of each clinic to determine staff knowledge, skills, and resources required to provide EP and institute a DM training curriculum; (3) Provide clinic leadership with direction on developing a disaster plan as well as how to partner with their primary and local VA health care system, especially onsite physicians, to provide effective DM leadership; (4) Recruit staff into routine drills for natural disasters and expand to an all-hazard approach to manmade disasters to identify gaps in delivering DM in a disaster; (5) Facilitate partnerships and a standardized approach to DM between CBOCs within the VISN by scheduling routine video and teleconferencing, live meetings, and webinars so that procedures and language are clearly understood and communicated between facilities; and (6) Identify key barriers to clinic preparedness by assessing EP elements through mock disaster drills and offer solutions to fill DM gaps.

The authors also recommend that CBOCs should be included in community DM and EP plans in order to understand how to integrate resources in a disaster. Networking, planning, and interdisciplinary staff training between agencies to include CBOCs will bring a wealth of information of what CBOCs require to participate effectively in DM. Lessons learned from these partnerships can provide valuable information to facilitate resource allocation for acute care hospitals, which may be burdened with treating patients with minor medical issues when they should be focusing on providing care to those with catastrophic medical conditions.

Acknowledgments
This study and this material is the result of work supported with resources and the use of facilities at the VA Loma Linda Health Care System. Research in this publication was in part supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under award number P20MD006988.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.

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