Wednesday, October 31, 2007

Disaster Preparedness for Healthcare Workers

According to the Department of Labor, about 545,000 establishments make-up the healthcare industry (source, Bureau of Labor Statistics website). These establishments vary greatly in terms of size, staffing patterns and organizational structures. They exist in every population center, from major metropolitan areas to the smallest rural communities. The common denominator for all of these establishment is they employ a wide variety of workers with unique skill-sets which are invaluable during a response to a homeland security crisis.

Most healthcare workers in this day and age have to have at least an associate’s degree in order to be certified and hired. The training they receive is rigorous and subject to various state and national certifications. As healthcare worker’s technical proficiency increases in complexity, the one critical element that may be missing is an understanding of emergency response procedures during a large scale event (such as a terrorist attack).

Healthcare workers, as opposed to first-responders, often do not receive training in the Incident Command System (ICS) or the National Incident Management System (NIMS). Many would be at a loss if suddenly assigned to a medical strike team or may even wonder why their skills would be needed. The healthcare workers of today have dynamic technical skills that are applied at the individual level. What is needed to enhance their abilities is a basic understanding of how those skills are applied on a large-scale to a whole community facing a crisis.

Healthcare workers tend to focus on their primary skills without realizing the value of their ancillary skills. For example, during an emergency response the processing of hundreds or even thousands of casualties still requires the basics; taking patient histories, identifying allergies, identifying medication, or simply providing comfort and support to the injured. These are common skills shared across a wide spectrum of disciplines.

The healthcare worker who has had some initial training in ICS or NIMS is able to immediately function in a multi-agency response involving not only other healthcare providers but other responders as well. Healthcare workers unfamiliar with these incident response systems are not as immediately effective and may cause unnecessary delays. The training need not be overly arduous, the majority of those working towards a degree in healthcare already have full course loads. The intent here is encourage all healthcare workers to obtain at least a basic familiarization with ICS or NIMS, not to become subject matter experts.

A simple familiarization course of 1-3 credit hours for students enrolled in healthcare curriculums would be a good start. The course should cover the basics of the National Response Plan (NRP) and the 15 Emergency Support Functions (ESF) with emphasis on ESF #8 (Public Health and Medical Services). Healthcare workers need an early exposure to the concept of multi-agency response to a crisis situation. The individual needs to understand that they may have to respond as part of a larger effort versus their more individual centric responses. Their hospital or clinic may be only one of many dealing with mass casualties.

In order to better prepare these professionals, it is necessary to help them understand how they may have to help augment other healthcare professionals with whom they have not worked before. The healthcare worker responding during a major emergency may have to perform their duties at a different location than they are used to. The responding healthcare worker may have to pack up a kit and re-locate to another city or state and be able to still perform their jobs immediately upon arrival. This is a skill not taught in most healthcare curriculums. It may be an unnecessary skill for most making it too costly to add to all curriculums. However, the basic concept should be introduced to the student healthcare worker with follow-on training once they begin working in the field.

A healthcare worker leaving his or her home base should plan on being gone from anywhere from a week to 30 days. For major crisis response, these are not unusual timeframes. The responding healthcare worker needs to have already in advanced planned out their kit. While the basic equipment may seem obvious for their respective field, many other questions still need answering. Will there be additional equipment at their destination or will they have to pack everything before leaving? Will there be sufficient power or do they need to bring portable equipment and batteries? Will they need to pack their own food and water? If they do leave their home, what family care plans have they arranged? The time to start answering these questions is BEFORE the healthcare worker finds himself or herself heading out the door.

Why haven’t we seen more emphasis on emergency response training for healthcare workers? Large scale responses to emergencies involving large numbers of healthcare workers operating outside of their normal establishment aren’t the norm. In large metropolitan areas, healthcare workers tend to remain centered around their normal work locations. Responses to events with mass casualties can often be handled within existing healthcare systems negating the need to re-locate healthcare workers. Smaller communities normally don’t experience emergencies of large enough scale to require importing large numbers of healthcare workers from outside their region. Patients requiring specialized care can be flown to the nearest trauma center.

A pandemic illness, such as avian flu, could introduce the very set of circumstances that would cause the need for healthcare workers from one area being deployed to another area. Models of the effect of a pandemic illness on the workforce show something on the order of 40 percent of the workforce being out due to illness. Imagine the crisis that could happen should pandemic illness take out a large number of healthcare workers in a major city that simultaneously experiences a natural disaster (flood, hurricane, or earthquake). The need for large numbers of healthcare workers would be incredible. These workers won’t have much time to get ready to deploy and will need to focus on getting their gear together, not taking initial courses on incident management.

Healthcare workers that have been trained in the basics of incident management will more quickly grasp their role in a multi-agency response. Those who may have to work from a different location will be able to more quickly identify they equipment and supplies to take with them. The workers who have such preparation and training are able to quickly leave and report to their new work location. Fresh workers who are able to quickly start working in a multi-agency response environment are incredibly valuable. They can assist in treating casualties as well as providing much needed relief for healthcare workers already working crisis response.

Two years after Hurricane Katrina stuck land, we are still evaluating the response efforts and trying to determine how to improve responses to future events. Successful coordination of a wide range of resources is the key to achieve an effective response. Healthcare workers who have basic familiarization with incident management are just one more step to achieving that goal.

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