Disaster Preparedness at a Department of Veterans Affairs Medical Center

Today, the U.S. Department of Veterans Affairs (VA) operates that nation’s largest health care network, including 170 major medical centers that provide health care services of some type to more than nine million veteran patients each year (VA fast facts, 2019). Given that Iran recently classified all U.S. military personnel as terrorists and the high-profile nature of the VA in many major American cities, disaster preparedness has assumed new importance and relevance for the disaster preparedness administrators at these medical centers. The purpose of this paper is to provide the results of an interview with an emergency preparedness administrator at a Midwestern VA medical center that operates in the state’s capital city. Finally, a summary of the interview results is followed by a recapitulation of the research in the conclusion.
Disaster preparedness interview
The disaster preparedness administrator at the VA medical center in question is also the director of quality assurance (QA) who is a registered nurse with her master’s degree in public health. The quality assurance service oversees the medical center’s risk management function and the QA director is assisted by a full-time risk management program specialist. The results of the two main questions that were asked during this interview are provided below.
1) Question: “What do you consider to be the top three disasters for which you prepare?”
Responses:
a) Inclement weather and earthquakes: We live and work in “Tornado Alley” and we are routinely hit with major wind storms, power outages and thunder storms besides the ongoing threat of actual tornadoes. In fact, I was on the sixth floor a couple of years ago and we were able to see a tornado touch down just a few miles away. Our weather is also harsh in the winter, and ice storms and huge snow drifts are common. We’re also experiencing frequent earthquakes that are blamed on fracking. All of these events can disrupt patient care and surgical procedures so we try to train for these types of events constantly.
b) Fires: Current VA policy prohibits smoking on VA grounds so our patients and their families usually try to stay as close to our premises as possible while they smoke. Last year, there was a fire in our indoor parking garage that was attributed to cigarette smoking and the potential for more fires is always present. In addition, we handle lots of flammable materials here, including oxygen tanks, and an uncontrolled fire would be devastating. Fortunately, because we are located in the city’s health science center district, there is a fire station almost next door, but there is no room for complacency when it comes to this threat.
c) Terrorism: This threat was not even on my list a few years ago, but our veterans and staff are at risk of the same types of shootings that have taken place in other public venues in recent years, so this threat is on my top three list today.
2) Question: “What would you say are your top three lessons learned about managing a disaster?”
a) Every disaster is unique: The first thing I learned in this position was that all disasters are unique in some fashion. Sure, they may be caused by the same thing such as a broken water pipe over a surgical suite in use or a gunman in the lobby (both of these things have happened to us by the way), but the type and level of response that is needed varies greatly. This means that even the most comprehensive disaster preparedness contingency plans are not adequate to prepare for every eventuality, but these types of plans do provide a useful framework in which to proceed.
b) Listen and learn: Even though I’ve studied risk management and have attended courses in disaster preparedness as part of my job, the second thing I learned was that effective planning and responses to disaster in a major medical center requires a team approach and the insights and expertise that are only available from the people who have been doing their jobs for a significant period of time, especially our nursing staff. There are so many different factors and issues to take into account when making contingency plans for different types of disasters that it is vitally important to hear from as many stakeholders, including our veteran patients and their families if appropriate, as possible.
c) Disaster planning is not static, one-time deal: This medical center has more than 1,200 full-time staff and another few hundred part-time support staff and our turnover is about average for our region. This means that every year, about 10 to 20 percent of our staff leave and are replaced with new faces. Our physical structure is also undergoing changes and updates all the time, and new medical equipment is delivered on a daily basis. Our medical center doesn’t resemble the one that was here a decade ago except perhaps the façade. In other words, disaster preparedness is an ongoing enterprise that demands constant attention rather than just an annual hazard vulnerability assessment.
Summary of the findings from the interview
In response to the question, “What do you consider to be the top three disasters for which you prepare?,” the interviewee identified natural disasters such as inclement weather and earthquakes as the most important disaster and anthropogenic disasters such as terrorist attacks as the third most important disaster for which this medical center prepares. This rating is consistent with the guidance provided by the U.S. Centers for Disease Control and Prevention which also identifies tornadoes, earthquakes and other types of severe weather as disasters that hospitals routinely face (Natural disasters and severe weather, 2020). The second most important disaster identified by the interviewee was fire.
In response to the question, “What would you say are your top three lessons learned about managing a disaster?,” the interviewee identified the fact that every disaster is unique in some way and there is no “one-size-fits-all” strategy for responding to even the same types of disasters. In addition, the interviewee emphasized the need to listen and learn from staff members and subject matter experts when developing disaster preparedness plans. These observations are congruent with the guidance provided by Labrague and Yboa (2016) who advise that nurses represent a valuable source of information and feedback for disaster preparedness purposes since they are on the front lines of patient care during any type of emergency. This point is also made by Veenema and Griffin (2014) who note that nurses typically account for the largest group of staff in a tertiary health care facility and emphasize that, “The effectiveness of the healthcare system's response to a public health emergency or disaster is largely dependent on the surge capacity of the nurse workforce” (p. 188).
Finally, the interviewee made the point that disaster planning is an ongoing process that requires diligence in determining what changes have taken place in the medical center that require corresponding changes in disaster preparedness planning. This point is also consistent with the guidance provided by Blake and Wilson (2019) who report that, “Disasters have become a real threat to health care. They can strike at any time and preparedness is vital so healthcare facilities can continue to provide medical services to the community” (p. 24).
Conclusion
Hospitals are already dangerous places that require constant risk management analyses in order to provide the highest quality of health care possible. The research was consistent in showing, though, that hospitals are also highly vulnerable to natural and manmade disasters of all types depending most especially on the geographic location. The results of the interview with a disaster preparedness administrator at a VA medical center reinforced these points as well as highlighting the need for ongoing diligence in order to identify salient changes in the organization that require corresponding changes to disaster preparedness plans.
References
Blake, N. & Wilson, E. (2019, September/October). Disaster preparedness: Mitigation, response, and recovery to ensure staffing excellence in Los Angeles County. Nursing Economics, 37(5), 231-233.
Labrague, L. J. & Yboa, B. C. (2016, January). Disaster preparedness in Philippine nurses. Journal of Nursing Scholarship, 48(1), 98-102.
Natural disasters and severe weather. (2020). Centers for Disease Control and Prevention. Retrieved from https://emergency.cdc.gov/planning/index.asp.
VA fast facts. (2019). U.S. Department of Veterans Affairs. Retrieved from https://www.va. gov/health/aboutvha.asp.
Veenema, T. G. & Griffin, A. (2016, March). Nurses as leaders in disaster preparedness and response - A call to action. Journal of Nursing Scholarship, 48(2), 187-192.