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.”
When asked about the expectations of patients for care during a disaster, staff consistently stated that patients and their families would want to get care and direction from clinic staff who knew them instead of going to the hospital for care. Staff anticipated that patients would be calling the clinic first to discuss their medical problems. One stated, “The veterans would head to us…. We can’t turn them away.” Some staff indicated that some patients might have to go to the ED for care instead of coming to the clinic, because the clinic may not be equipped to respond, noting that “we have to remind [the patients] that in our clinic we have minimal abilities.”