Rachel L. Charney

PUBLIC PERCEPTIONS OF HOSPITAL RESPONSIBILITIES TO THOSE PRESENTING WITHOUT MEDICAL INJURY OR ILLNESS DURING A DISASTER

Abstract Background During natural and manmade disasters, the hospital is perceived as a central rallying and care site for the public, for both those with and without emergency medical needs. The expectations of the public may outstrip hospital plans and abilities to provide nonmedical assistance. Objective Our objective was to determine the public expectations of the hospital during disasters regarding resource provision. Methods A survey was distributed to adult patients or family members at three emergency departments (EDs). Respondents were asked to evaluate hospital responsibility to provide nine resources to those without emergency medical needs, including vaccination, medication refill or replacement, food and water, grief/stress counseling, Federal Emergency Management Agency (FEMA) access assistance, short/long-term shelter, family reunification, and hospital. Additionally, respondents answered questions regarding prior disaster experience and demographics. Results There were 961 respondents (66.9% were female, 47.5% were white, and 44.6% were black). Respondents agreed or strongly agreed that the hospital should provide the following services: event-specific vaccination (84%), medication refill/replacement (76.5%), food and water (61%), grief or stress counseling (53%), FEMA access assistance (52%), short-term shelter (51%), family reunification (50%), long-term shelter (38%), and hospital transportation (29%). Those 36–45 years of age were less likely to expect services (p < 0.05) and non-whites and those with a family member with a medical condition requiring electricity were more likely to expect services (p < 0.001 and p < 0.05, respectively). There were no differences based on frequency of ED use, sex, income, or prior disaster experience. Conclusion There is a high public expectation that hospitals will provide significant nonmedical disaster relief. Understanding these expectations is essential to appropriate community disaster planning.

Public expectations for nonemergency hospital resources and services during disasters

OBJECTIVE The publics expectations of hospital services during disasters may not reflect current hospital disaster plans. The objective of this study was to determine the publics expected hospital service utilization during a pandemic, earthquake, and terrorist bombing. METHODS A survey was distributed to adult patients or family members at 3 emergency departments (EDs). Participants identified resources and services they expect to need during 3 disaster scenarios. Linear regression was used to describe factors associated with higher expected utilization scores for each scenario. RESULTS Of the 961 people who participated in the study, 66.9% were women, 47.5% were white, and 44.6% were black. Determinants of higher pandemic resource utilization included persons who were younger (P < .01); non-white (P < .001); had higher ED visits (P < .01), hospitalization (P = .001), or fewer primary care provider visits (P = .001) in the past year; and did not have a reunification plan (P < .001). Determinants of higher earthquake resource utilization included persons who were non-white (P < .001); who were a patient or spouse (vs parent) participating in the study (P < .05 and P = .001); and had higher ED visits in the past year (P = .001). Determinants of higher bombing resource utilization included persons who were female (P = .001); non-white (P < .001); had higher ED (P = .001) or primary care provider (P < .01) visits in past year; and experienced the loss of home or property during a past disaster (P < .05). CONCLUSIONS Public expectations of hospitals during disasters are high, and some expectations are inappropriate. Better community disaster planning and public risk communication are needed.

Impact of disaster drills on caregiver perception and satisfaction in the pediatric emergency department

Objective: The objective of this study was to assess caregiver perception and satisfaction of a regional disaster drill in a pediatric emergency department (ED). Methods: Caregivers of children receiving care during a 2-hour disaster drill were given a survey regarding perceived importance of the drill, waiting time to see a physician, service timeliness, impact on comfort, and overall recommendation of the ED. As a control, the survey was also given to caregivers a week before and after the drill. Results: Caregivers on the drill date were more likely to consider drill conduction to be highly important (100% vs 82.9%, P < 0.045). Compared with the drill date, there were no significant differences in the perceived duration of waiting, impact on care, or likelihood to recommend the ED to others. Conclusions: In a single regional disaster drill, we found that caregivers feel that disaster drills are important and unlikely to impact care of children negatively. These findings can help support decision making by hospital administrators to commit personnel and resources to conduct necessary disaster drills involving children.

Hospital Employee Willingness to Work during Earthquakes Versus Pandemics.

BACKGROUND Research indicates that licensed health care workers are less willing to work during a pandemic and that the willingness of nonlicensed staff to work has had limited assessment. OBJECTIVE We sought to assess and compare the willingness to work in all hospital workers during pandemics and earthquakes. METHODS An online survey was distributed to Missouri hospital employees. Participants were presented with 2 disaster scenarios (pandemic influenza and earthquake); willingness, ability, and barriers to work were measured. T tests compared willingness to work during a pandemic vs. an earthquake. Multivariate linear regression analyses were conducted to describe factors associated with a higher willingness to work. RESULTS One thousand eight hundred twenty-two employees participated (15% response rate). More willingness to work was reported for an earthquake than a pandemic (93.3% vs. 84.8%; t = 17.1; p < 0.001). Significantly fewer respondents reported the ability to work during a pandemic (83.5%; t = 17.1; p < 0.001) or an earthquake (89.8%; t = 13.3; p < 0.001) compared to their willingness to work. From multivariate linear regression, factors associated with pandemic willingness to work were as follows: 1) no children ≤3 years of age; 2) older children; 3) working full-time; 4) less concern for family; 5) less fear of job loss; and 6) vaccine availability. Earthquake willingness factors included: 1) not having children with special needs and 2) not working a different role. CONCLUSION Improving care for dependent family members, worker protection, cross training, and job importance education may increase willingness to work during disasters.

Speeding up children reunification in disaster scenarios via serverless computing

Children constitute a vulnerable population and special considerations are necessary in order to provide proper care for them during disasters. After disasters such as Hurricane Katrina, the rapid identification and protection of separated children and their reunification with legal guardians is necessary to minimize secondary injuries (i.e., physical and sexual abuse, neglect and abduction). At Camp Gruber, an Oklahoma shelter for Louisianans displaced by Hurricane Katrina, 70% of the children were with their legal guardian after 2 weeks while the last child was reunified after 6 months. In this project, we are using serverless computing to scale and minimize database querie response time as well as to speed up machine learning tasks for rapid reunifying time, in support of a federated set of first-responders. In particular, we are using a Flask-based web system that leverages Apache OpenWhisk to run both (face and text) profile recognition software at the back-end.

Feasibility of a Novel Combination of Influenza Vaccinations and Child Passenger Safety Seat Fittings in a Drive-through Clinic Setting

OBJECTIVE Public health preparedness is an ever-evolving area of medicine with the purpose of helping the masses quickly and efficiently. The drive-through clinic (DTC) model allows the distribution of supplies or services while participants remain in their cars. Influenza vaccination is the most common form of DTC and has been utilized successfully in metropolitan areas. METHODS We hypothesized that combining influenza vaccinations and child passenger seat fittings in a DTC format would be both feasible and desired by the community. Each driver was verbally surveyed at each DTC station. The project was a combination of patient survey and observation. RESULTS In the inaugural 6-hour DTC session, 86 cars were served and contained 161 children, of which 28 also participated in child passenger seat fittings. The median total clinic time regardless of services rendered was 9.0 minutes (interquartile range [IQR]: 6.0, 14.0 minutes). For those who received only an influenza vaccine, the median total time was 7.5 minutes (IQR: 6.0, 10.0 minutes). For those who received both services, the median total time was 27 minutes (IQR: 22.3, 33.5 minutes) with an average of 1.75 child passenger seat fittings per automobile. CONCLUSION This was a pilot study involving 2 different services using the DTC model and the first of its kind in the literature. The DTC was successful in executing both services without sacrificing speed, convenience, or patient satisfaction. Additional studies are needed to further evaluate the efficacy of the multiple-service DTC model. (Disaster Med Public Health Preparedness. 2017;11:647-651).

Family Reunification After Disasters

Opinion statementFamily reunification after disasters remains a priority for all involved in disaster response. The psychological stress for children separated from their families after disasters can be significant and the effects can be prolonged. Unfortunately, planning for family reunification after disasters continues to be fragmented and only exists in silos. This is particularly true in the medical arena where hospital staff must prepare to both care for unidentified children with unknown medical histories and reunite them with their families. Pediatric health care providers have many opportunities to help families and their communities, including schools and daycares, plan for such disasters. The purpose of the article is to present the effects of delayed family reunification on children, the role of the pediatric health care provider in individual family and community reunification planning, available family reunification resources, reunification systems including social media, and use of technology for family reunification. Recommendations for next steps for creating a more coordinated family reunification system will also be provided.