Results
The Table describes the 4 primary emerging themes and corresponding quotes: (1) EP barriers, including lack of direction, training, and tools, which would result in negative outcomes; (2) perceived personal and clinic risk for a disaster, including negative outcomes and personal family safety; (3) perceptions of roles and responsibilities in EP, including intent to participate in DM at various staffing levels as well as patient expectations for care; and (4) existing resources that influence EP and the ability to survive a disaster collectively.
Emergency preparedness barriers. Although most respondents realized their potentially critical role in an emergency, they expressed recurrent barrier themes centered on their perceived lack of training, lack of tools to function, and lack of direction to be effective in a disaster response. Lack of knowledge of EP was identified as a great need by multiple participants. One participant stated, “Lack of information is so destructive. If you don’t know how to keep yourself from those things you don’t know…such as in a situation that’s going to be tragic, it is because of a lack of information or a lack of training. And I see that so many times…Mandate that we do our classes, so we know what we’re doing.” Another stated in reference to lack of skills, “I haven’t experienced any drills or anything like that. So I know what is going to happen here.”
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.”