Original Research

Perceived Attitudes and Staff Roles of Disaster Management at CBOCs

Fed Pract. 2015 August;32(8):12-20

References

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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

Health professionals in CBOCs who are trained in disaster management could become active participants in early intervention to initiate the treatment of patients in rescue efforts during a disaster. ¹⁰Given 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. ^11,12The 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?

Methods

In this qualitative study, in-depth semistructured key informant (KI) interviews (N = 3) and focus group discussions (N = 20) guided by risk perception theory and the Andersen Behavioral Model of Health Services Use were conducted and analyzed using grounded theory methods to contextualize the potential of local clinics in disaster response. ^13-15 To optimize breadth of viewpoints on this issue, participants were selected by theoretical sampling methods to explore perceptions of leadership and line staff.