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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In general, clinic staff who reported feeling inadequately prepared for disasters (ie, felt more vulnerable) and staff with firsthand disaster experience were more inclined to prepare than were those without experience. Without clearly spelled-out expectations, staff tend to depend and wait on others to lead in a disaster. They noted a desire for better preparation and thus, clarity of roles, need for a reliable method of communication with the outside world during a disaster, and the required equipment and supplies for self-care or care of the patients for ≥ 3 days post disaster. Some indicated that they did not have the resources to provide medical care on the scale that may be required.

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.