Abstract
Providing healthcare services during the disaster response stage may be associated with many challenges. The process of triage, transportation of the victims, the timeliness of the response, the interagency collaboration and online communication may cause barriers to the high quality of care and result in the increased mortality rates. This paper presents an analysis of the problems associated with the availability of healthcare facilities and treatment during the emergency incidents and suggests the new approach to their management.
Introduction
Disaster management may present serious challenges to the emergency departments and state authorities involved in it. The actions taken during the response stage are crucial as they affect the number of losses and shape future disaster planning policies. This paper discusses the challenges of providing healthcare services during this phase that are associated with triage, transportation, response delays, and interagency and online communication. It also suggests the approach to addressing these aspects and ensuring the positive outcomes of emergency measures. The paper concludes that prompt and effective response to emergencies is associated with the high level of disaster preparedness.
The Significance of the Disaster Response Stage
The process of emergency management may be divided into four phases, each of which addresses different challenges of providing healthcare services and suggests the tools and strategies that eliminate adverse outcomes of disasters. The stages include mitigation, preparedness, response, and recovery; each of them has specific factors defining its effectiveness. The focus of this paper is the response stage as its role in disaster management is significant.
The actions taken during the emergency response stage should be well rehearsed and planned because they affect the number of lives saved and reduce economic losses. This phase of disaster management implies the mobilization of emergency services, such as police, ambulance crews, and firefighters. Besides the execution of an emergency and preparedness plans, possible interventions and activities may include the analysis of potential risks of natural disasters, pandemics, terrorism, and other emergencies, as well as law enforcement aimed to disrupt illegal activities, and public health surveillance.
The challenges in providing healthcare services associated with this phase are transportation issues, triage, delays in response to emergencies, and the lack of interagency collaboration and communication.
Triage Challenges
The aspects of triage management during emergencies and challenges associated with them depend on the scale and nature of disasters. The problems related to providing healthcare services occur when there are no supplies for the patients, the resupply is not available, and it is impossible to transport affected individuals to hospitals immediately. Triage is a necessary measure because the mentioned problems may result in poor sanitation conditions and create an unsafe environment for the injured. As the sizes of the world populations increase along with individuals’ longevity, the number of elderly people and those having chronic and acute medical conditions expands as well. Possible triage challenges may be discussed in the example of Hurricane Katrina.
Triage Challenges Following Hurricane Katrina
Hurricanes pose a serious threat to public health and often impose triage. The case of Hurricane Katrina showed the inability of the states’ authorities to organize immediate mass evacuation and provide healthcare services to the injured. Guidelines for triage decisions were not available, and the triage assessment tools were not developed during the disaster preparedness stage. Consequently, more than 1100 people were confirmed dead as a result of the catastrophe (Labib & Read, 2015).
The case of Katrina proves that patients with non-traumatic illnesses and special medical care needs should be considered in triage-management protocols along with the individuals that sustain severe injuries due to the disaster. The incident shows that although some catastrophes may be expected and followed by preparedness measures, it may not be possible to provide high-quality healthcare services even to the valuable groups of individuals.
Triage Success during the Boston Marathon Bombing
The incident that happened in Boston in 2013 is exemplary as it shows how rapid triage may ensure positive patient outcomes. Gates et al. (2014) report that during the event, the emergency departments of hospitals mobilized their efforts to respond to the incident. All inpatient facilities were informed about the necessity of the prompt triage, and trauma surgeons collaborated with leaders responsible for emergency cases to perform it. Moreover, the care teams were assigned to each group of individuals. Consequently, the life-saving procedures, including blood transfusions, for the patients with the most acute conditions were provided timely. This case illustrates the significance of rapid triage efforts and their role in ensuring the access to high-quality healthcare services for the injured.
Logistical Issues
Providing healthcare services during the response stage can be challenging as it may imply the transfer of victims. Triage principles should be implemented to ensure that people affected by the disaster receive timely help. If the accident does not involve many victims, they should be transferred to hospitals according to the type of injuries, which may not be possible during the majority of incidents.
Moreover, the information about the number of available hospitals should be received and updated regularly, and the overland routes should be available, which may not be possible during floods, hurricanes, or earthquakes. The problems of providing healthcare services may occur due to the lack of emergency departments’ staff and the uncertainty of their tasks, as well as conflicting information about the number of transferred people.
Transportation Challenges and Success Following the Indian Ocean Tsunami
The Indian Ocean tsunami in 2004 was one of the deadliest incidents in the world. It resulted in over 280,000 fatal injuries; more than a million individuals had to leave their homes (Li & Zheng, 2014). During this catastrophe, poor weather conditions and unique geographical location presented serious challenges for medical rescue efforts. The majority of roads and bridges were damaged, which made land transportation impossible; the majority of other means of transportation was unavailable. The air forces of Indonesia, America, Australia, and Singapore had to join their efforts to transport the victims to medical facilities (Li & Zheng, 2014). It is necessary to mention that the joint patient transfer center was established at the airport, where people received medical treatment and underwent triage.
This case is the example of the successful response to the emergency situation, which allowed for individuals’ access to healthcare services. Although the situation presented many challenges, the rescue departments were able to perform triage and rapid transportation, collaborating with international colleagues and military forces. Moreover, helicopters were used along with other aircraft, which eliminated delays in the transportation of the injured. The case shows that possible logistical problems should be considered and managed timely to reduce the number of preventable deaths. Mobilization of all of the available sources and means of transportation is crucial during the response stage.
Response-Related Delays
Disasters are usually associated with chaos and the lack of communication and collaboration between emergency agencies, which may result in delays in response to the incidents and, consequently, reduce individuals’ access to health care. The objective of the disaster response stage is to perform timely actions to eliminate the adverse consequences of the event, save lives and prevent property damage (Whybark, 2015).
Nevertheless, delays at some levels of the disaster response frequently occur due to the lack of preparedness, underestimation of the possible risks, and insufficient mitigation measures. The significance of the timeliness of the response can be illustrated on the example of the Boston Marathon Bombing.
The Success of the Response Measures Following the Boston Marathon Bombing
The results of the Boston Marathon Bombing in 2013 showed that a rapid response to emergency incidents may decrease the number of deaths significantly. Gates et al. (2014) report that during the event, 281 people were affected by the bomb blast, three of which died at the scene. The authors note that almost 80% of severely injured individuals were admitted to trauma centers within 90 minutes of the event (Gates et al., 2014). 10% of them required an immediate blood transfusion, which was performed timely and allowed for saving their lives. The success of the response measures is determined by the adequate preparation for the possible incidents following a public event, short transportation times, and availability of operating rooms. The low mortality rate of the bombing proves that the response to the emergency was timely.
Response Delay during Hurricane Katrina
Hurricane Katrina caused a great number of human and property losses, which was partially a result of late emergency management action. According to Labib and Read (2015), the catastrophe was followed by an inadequate response associated with the lack of mandatory evacuation order, unpreparedness of the local and state agencies, and poor risk management. As the disaster was predictable, the states should have developed a plan for rapid response to save people’s lives and decrease the level of property and infrastructural damage.
Interagency Collaboration
Interagency collaboration is one of the determinant factors of the successful response to the emergency. According to Ward, Varda, Epstein, and Lane (2018), the interagency collaborative efforts during disasters are primarily designed to improve the effectiveness of implementation of preparedness plans and policies as well as reduce their costs. Pourhosseini, Ardalan, and Mehrolhassani (2015) state that the lack of interagency collaboration may result in chaos and inconsistency of emergency services. The challenges associated with cooperation between the departments may include the unpredictability of the events, such as terrorist attacks, and their large scale.
Interagency Collaboration in Fire Disaster Management in Kenya
The impact of poor collaborative efforts in the management of emergencies, fire disasters, in particular, can be illustrated on the example of Nairobi City, Kenya. Menya and K’Akumu (2016) note that the city’s fire brigade cannot perform its duties as there is the lack of necessary equipment and the workforce. Consequently, other departments and agencies are usually involved in the disaster management as well, including police, ambulance, defense forces, and Kenya Red Cross representatives.
During fire events, the fire brigade plays a primary role in the elimination of adverse consequences, while other departments perform the tasks of monitoring the similar future accidents, the collection of data, first aid services, and provision of financial, equipment, and human services (Menya & K’Akumu, 2016). However, although the practice of interagency collaboration is established in Nairobi City, its implementation may be challenging as there are no guidelines for operating procedures.
The Role of Online Communication
The use of social media and other online communication tools can be significant during the disaster response stage. Currently, emergency service workers adopt these methods to engage with the individuals that may be affected by disasters (Hughes, St-Denis, Palen, & Anderson, 2014). The challenges associated with the use of online and media communication tools are the inability to integrate the innovative approach into the existing formal procedures and identify the extent of public awareness, as well as the lack of staff’s training. Poor online communication and the lack of information may present challenges for individuals’ access to healthcare services.
Online Communication during Hurricane Sandy
The role of online communication can be discussed based on the case of Hurricane Sandy. According to Hughes et al. (2014), 70% of fire and police departments engaged in emergency activities had a social media account or a website, but only 20% of them used these to convey the data about the storm. This information included warnings, facts related to response efforts such as a number of rescues, as well as the data about the future recovery process (Hughes et al., 2014).
Online communication during the response stage is also crucial because it allows for the feedback of those affected by the disaster. In the case of Sandy, individuals were able to ask questions and discuss their concerns with incident response teams and each other. The departments, on the other side, used social media and their websites to provide emotional support and reassurance to the population. It is crucial to mention that online communication tools increase individuals’ awareness about the disaster and have a potential to decrease the future demand in healthcare services.
Although the utilization of online and media tools can be critical during the response phase, it is necessary to point out that it may present several challenges to the emergency management departments. For example, they can be used only as alternative communication methods, as they may not be available for several large groups of the population including elderly people and those being unable to utilize online and media sources due to their health conditions. Moreover, currently, many departments lack capacities to implement technology during the response stage.
New Approach
The approach to interventions related to the disaster response stage depends on the nature of the disaster. The challenges associated with providing healthcare services should be implemented on all levels of emergency management. For example, to improve the process of triage and eliminate the number of deaths, the development of multilevel and system-based approach may be vital. Triage may be divided into several phases. A first-order triage should be organized at the community and pre-hospital level. A second-order triage can be performed at the hospital or other care facility level. Such an approach to triage allows for a more time-efficient response to a disaster and is designed to identify valuable groups that need immediate care and treatment quickly.
Logistical issues can present serious challenges during the emergency response stage due to the lack of transportation means, low capacity of the hospitals, and the characteristics of the geographical location. The effective approach to transportation may include several steps that vary depending on the nature of the catastrophe.
For example, local authorities and emergency departments should assess the capacity of hospitals and other medical facilities, and consider establishing emergency care centers that will provide support in case of a possible disaster. It is also necessary to evaluate the risks of logistical problems associated with the geographical location to select the means of transportation that will be primarily used during emergencies. Finally, state government should allocate funds on the equipment used by rescue teams.
Timely response measures are crucial as they eliminate the number of the injured and ensure their access to healthcare services. To allow for prompt emergency actions, the incident response teams should develop of clear preparedness plans. For example, all staff that may be involved in disaster management should receive proper training on triage and health assessment. The risks associated with individuals’ health should be eliminated during the disaster mitigation stage, including those related to low hospitals’ capacities and supplies, as well as the lack of public awareness about possible emergency incidents. Finally, it is necessary to provide the population with information about self-preparedness methods, which may include the protection of houses from water damage.
As seen on the example of fire disaster management in Kenya, the plan for interagency collaboration should be clearly defined to ensure the effectiveness of this measure during the response stage. For example, the state authorities can develop disaster management instructions and indicate the roles of each department. The steps that the organizations and institutions should take during emergencies should be clearly outlined, and their significance should be explained. Effective interagency collaboration may result in the increased access to healthcare services or the decreased demand in them.
The role of online communication as a tool used to enhance individuals’ preparedness for disaster should not be underestimated. Several steps may be taken to increase the emergency departments’ capacity to convey the information about the incidents and reduce the health risks of the population. First, it is necessary to promote the utilization of the departments’ websites or social media accounts as it may help many people to have timely updates on emergency situations. Second, it may be effective to provide training for the staff. Personnel can learn how to engage in conversations with individuals and what information should be presented. These measures may increase people’s awareness of disasters and eliminate the risks of injuries associated with them.
Conclusion
Providing healthcare services during the disaster response stage may be difficult as it involves many aspects that should be considered. The process of triage may present complications due to the lack of staff’s training and unavailability of related protocols or guidelines. Transportation may be challenging as well because of geographical factors and the lack of equipment or logistical means. Healthcare services may not be available due to the response-related delays and the lack of interagency and online communication. To eliminate these barriers to high-quality and timely care for individuals, it is necessary to develop preparedness plans, implement educational programs for incident response teams, and estimate the risks during the disaster mitigation stage.
References
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