Being prepared for a natural disaster, infectious disease outbreak or other emergency where many injured or ill people need medical care while maintaining ongoing operations is a significant challenge for local health systems. Challenges to developing and sustaining community coalitions may reflect the structure of preparedness activities, which are typically administered by designated staff in hospitals or large medical practices. A few respondents reported that competition did affect preparedness collaborations, particularly when hospital leaders are guarded about sharing capabilities and needs with peers at other institutions.
During the H1N1 pandemic, for example, some coalitions developed plans to distribute supplies in advance.
Across sites, respondents consistently reported that hospitals and hospital-owned physician practices typically are much more involved in emergency-preparedness coalitions than other stakeholders, reflecting both the federal financial support hospitals receive for preparedness activities and their size, structure and resources. 11, 2001, terrorist attacks, many health care providers have adopted emergency-preparedness plans, including participation in such activities as community-wide drills and tabletop exercises, to strengthen their ability to respond to a disaster. However, most attention has focused on population-level management of obesity or chronic illness rather than disaster preparedness and response.
Employment of physicians is only one of the ways markets vary—hospitals may be independent or tightly affiliated with one another, nursing homes may be closely linked to local hospitals or to national chains, and health information may be shared widely or not at all. While there is limited funding for preparedness activities, hospitals are not subsidized to keep beds empty and supplies stockpiled for a disaster, and it is impractical for trained staff to sit idle until a disaster strikes. Hospital staff in nearly all sites reported challenges with fit-testing disposable protective face masks because of the staff time required and because fit-testing alone consumed a substantial proportion of their inventory.
High levels of physician participation in those markets were attributed to hospital systems setting the expectation that physicians would participate and paying them for their efforts, and, in some cases, even allotting them administrative time to participate in preparedness or other system-level work.
Lack of time, training and sometimes simply awareness that they have a role in disaster response also are important factors. For example, in a disaster, hospitals generally try to discharge as many inpatients as possible, and community-based providers could help by seeing or contacting discharged patients to ensure they are receiving needed follow-up care. Other respondents reported frequent communication among competing hospitals on shared pandemic plans and hospital policies for emergencies. While hospitals and public health departments participated in all emergency-preparedness coalitions in the communities studied, involvement of nonhospital providers and other stakeholders varied significantly across the communities (see Table 1).
When working with nontraditional partners, community coalitions reported difficulty in aligning goals and securing buy in from those who view emergency management as outside their scope of responsibility.
However, such stakeholders as schools and employers can and do influence medical treatment during disasters.


Both hospital and community practice respondents acknowledged a sense of alienation from each other, noting that the smaller the practice, the more difficult it is to participate and have a voice in community collaborations. Nearly all hospitals working with both hospital-employed physicians and independent community-based physicians reported that hospital-employed physicians are easier to engage, suggesting that markets with larger physician groups and more hospital employment of physicians would be better positioned to build integrated surge-capacity plans.
Because of the generally collegial approach to preparedness activities, respondents reported that tighter hospital affiliations in consolidated markets had little impact. Other opportunities might include incorporating community-level preparedness activities into care-coordination activities that can count toward patient-centered medical home certification or encouraging electronic health record vendors to include features that facilitate electronic submission of important data to local, state and federal authorities during a disaster.
For example, nursing homes owned by or closely affiliated with hospitals may use the hospitals’ preparedness staff, making it easy to develop collaborative approaches to preparedness. First, preparedness activities, such as planning, training and participating in drills, do not generate revenue for health care providers but have costs in staff time and materials. Policy makers could encourage groups whose participation is currently limited in most communities, such as independent physician practices, to join traditional preparedness coalitions that meet regularly to develop joint plans or coordinate responses.
Similarly, hospitals and physician practices using a common electronic health record platform may find it easier to share real-time information about utilization and to prepare jointly for surges. Regional or specialty-based medical societies may maintain similar lists and can provide basic training in disaster planning through continuing medical education.
Some health systems did expect employed physicians in community practices to work collaboratively in disaster planning.
That’s the mentality at small as well as big hospitals, [but] you can multiply that by 100 for small [rural] hospitals. Sixty-seven telephone interviews were conducted between June 2011 and May 2012 with representatives of state and local emergency management agencies and health departments, emergency-preparedness coalitions, hospital emergency preparedness coordinators, primary care practices and other organizations working on emergency preparedness and response. Few communities involve independent practitioners other than maintaining a list of those willing to volunteer in the event of a disaster, for which no special training or expertise in disaster response is required.
Nonmedical stakeholders, such as police, fire, coroners, school systems and employers, have varying degrees of involvement in medical emergency planning collaboration.
Some offer on-site health care, which may serve as an alternate source of care that is not always coordinated with hospitals or independent practices, and others may require documentation from a clinician before potentially affected people can return to school or work. In some hospital systems, the system’s preparedness plan directly encompassed physician practices owned by the hospital system. Rural respondents reported depending on buy in from a smaller pool of institutional leaders, and these leaders did not always perceive value in allocating limited funding and staff time for emergency management and participation in coalitions.


For example, outside Seattle, three small rural hospitals pooled funds to hire a shared emergency manager across the facilities. For example, programs that offer extra payment to primary care practices to coordinate care of patients with specific chronic conditions might also encourage and reward coordination related to emergency preparedness or the creation of business continuity plans. A hospital respondent in another community coalition cited reluctance to work with nursing homes because of the perception that they are primarily looking for a place to offload patients in an emergency. Physicians and other clinicians employed by hospitals or working in community-based practices owned by hospitals usually fall under the umbrella of hospital preparedness activities.
As one respondent said, “Rural hospitals are facing huge budgetary issues right now. Changes in local market structures, such as increased hospital employment of physicians, also may diminish barriers in some communities. Likewise, hospital efforts to work with physician practices and long-term care facilities to prevent avoidable readmissions might incorporate preparedness activities.
Each of these factors may affect how planning responsibilities, staff and information are most efficiently shared in preparation for and during a disaster.
It is important to note that collaborations based on existing affiliations and less-formal relationships would still require some oversight to avoid situations where disparities in market position may leave some providers at a disadvantage in securing needed information and supplies during a disaster.
Instead, policy makers may want to emphasize outcomes, such as safe, efficient management of surge demand or receipt of needed information by stakeholders, and allow communities flexibility regarding processes and participants.
Even in a disaster where victims seek care at hospitals, community-based clinicians can play a role.
And, unlike other events that health care organizations must prepare for, such as Joint Commission inspections, there are no predictable, short-term consequences for failing to engage in collaborative, community-level disaster planning.
The focus on hospitals reflects their historic importance in providing staff, space for planning and response, and treatment of emergency victims, including such specialized services as decontamination or burn care. Maintaining adequate supplies, particularly of masks, was a challenge when hospitals in a community, as well as public agencies, were competing for the same products.




Electromagnetic pulse therapy
Survival kit equipment list
Earthquake kit supplies vancouver


Comments

  1. 25.05.2015 at 20:31:48


    More complicated than they want to be, and anything as easy as finding take care of oneself and give.

    Author: Busja
  2. 25.05.2015 at 16:29:10


    The metal so that kits are an vital portion of your view of Feng.

    Author: melek