Emergency Management: Training and Disaster Preparedness

Introduction

Human societies have become increasingly complex and vastly interconnected. It therefore follows that disasters and emergencies — whether human-induced or natural — can wreak far more widespread havoc today than was the case a few decades ago. This is especially true in relation to disease outbreaks. The relevance of disaster preparedness cannot be overstated. This paper concerns itself with disaster preparedness and, more specifically, focuses on the relevance of a wide range of factors in preparedness efforts.

Disease outbreaks have been selected as an ideal disaster type for examination in contemporary settings. This is particularly pertinent given that we are currently in the aftermath of a pandemic that has affected millions of people worldwide, with fatalities estimated to exceed five million persons. Insights drawn from this discussion could therefore be used to shape strategies related to disaster preparedness in disease outbreak scenarios.

A New Approach to Disaster Preparedness

Disaster preparedness, in the words of Reilly and Markenson (2019), "consists of a set of measures undertaken by governments, organizations, communities or individuals to better respond and cope with the immediate aftermath of a disaster, whether it be human-made or caused by natural hazards" (p. 211). As the authors further point out, the focus on this front is on decreasing the number of casualties if, and when, the disaster actually takes place. Other goals and objectives of disaster preparedness include, but are not limited to, the prevention of wastage in resource deployment during times of disaster and the prevention of loss of livelihood.

Various disaster preparedness models and frameworks have been proposed in the past. Most of these, as Khan, O'Sullivan, Brown, Tracey, Gibson, Henry, and Schwartz (2018) indicate, have been developed in the United States. For this reason, the authors note that such frameworks might not work as effectively in "other settings with substantially different health systems and governance structures" (p. 71). A new approach with universal application should therefore be explored. Having an effective and practical model or framework in place is crucial to minimizing the impact of disaster. An ideal approach, as available literature indicates, ought to incorporate diverse aspects of preparedness and accurately define what preparedness means or entails.

As Desborough, Dykgraaf, Philips, Wright, Maddox, Davis, and Kidd (2021) point out, there are numerous lessons that can be drawn from the COVID-19 pandemic about not only disaster response but also preparedness. Both of these disaster cycle phases were largely suboptimal in some scenarios. There is therefore a need for a new approach to addressing a wide range of aspects related to disaster preparedness in relation to disease outbreaks. The approach should embrace the fact that preparedness efforts are deployed prior to the occurrence of a disaster, and should be grounded in both the identification of likely disasters and an informed assessment of the likelihood of those disasters occurring. The approach outlined below is concise and all-inclusive in the sense that it takes into consideration the relevance of multiple stakeholders in preparedness efforts.

Risk identification can be accomplished through the application of situational awareness concepts — which, in simpler terms, refers to knowledge about potential risks. This is especially important to ensure that resources are directed at only those risks with a high likelihood of occurring. In the realm of disease outbreaks, Lee, Cleare, and Russell (2010) point out that risk awareness relates to the prevailing outlook regarding infectious disease threats that are ongoing or potential. This can be accomplished through diverse surveillance undertakings. The key focus is the identification of if and where outbreaks could occur, as well as why they are likely to occur.

Models can be developed to explore possible pandemics, with data sourced from a wide range of entities including healthcare institutions, government agencies, and relevant NGOs. Situational awareness is instrumental because it would be inappropriate, for example, to prepare for an influenza subtype only to be faced with a viral hemorrhagic fever. It should be noted, however, that this should not serve as a cue to ignore other possible risks. An all-hazards approach would be most ideal on this front (Lee, Cleare, and Russell, 2010). Given that resources are largely finite, however, the importance of focusing on the most likely disaster scenarios cannot be overstated. One approach that can be particularly useful is a risk matrix, which can highlight not only the likelihood of a disease outbreak but also the potential impact of such an outbreak. Both likelihood and impact can be categorized as low, moderate, or high.

Vulnerability assessment relates to the ability of healthcare facilities to effectively manage likely disease outbreak scenarios, with reference to operational, resource, and manpower capacity. It also concerns how well systems are interconnected and the effectiveness of communication mechanisms in place. As Wapling and Sellwood (2016) point out, "poor public health infrastructure is the main limitation and strategic disadvantage against pandemics, as it increases the chances of the risk of exposure to vulnerability" (p. 99). Inadequate infrastructure can effectively derail response to a disease outbreak, which makes vulnerability assessment an essential step in preparedness planning.

To illustrate this point, consider the contrasting experiences of China and India during the COVID-19 pandemic. Whereas China was able to deploy its efficient public health infrastructure to respond to the pandemic, India's inadequate infrastructure served as a significant drawback in its efforts to control the spread of the virus. Had vulnerability assessments been conducted and acted upon in the latter case, the number of fatalities may have been significantly reduced. West Africa has also experienced significant difficulties in epidemic containment as a consequence of failure to identify and address response gaps. Countries in that region have since been called upon by the World Health Organization and other global agencies "to create resilient integrated systems that can be responsive and proactive to any future threat" (Khan et al., 2018, p. 33).

Disaster preparedness efforts should ideally bring on board a wide range of stakeholders — both those who would have significant input in preparedness undertakings and those likely to be affected by them. External stakeholders that could be engaged include, but are not limited to, local communities, disaster management organizations, diverse health authorities, government agencies at all levels (especially state and local governments), and other healthcare institutions. Internal stakeholders may include organizational management, departmental heads, hospital staff, and hospital emergency committees. Disaster response plans would be largely ineffective if formulated in a vacuum. There is therefore a clear need to ensure that all relevant stakeholders are brought on board.

Reilly and Markenson (2019) point out that risk communications are instrumental in the management of disease outbreaks. Risk communication can be two-way: communication to and from the facility, and communication within the facility. Regarding communication to and from the facility, there is a need to ensure seamless exchange of information between healthcare entities, relevant public health authorities, and other external stakeholders. For instance, healthcare facilities could engage in deliberate surveillance efforts to capture relevant data about disease outbreaks and pass it on to the appropriate agencies. This could be accomplished through the close monitoring of the percentage of emergency department visits linked to cases of suspected outbreak.

With regard to internal communication, the focus should be on ensuring clear lines of communication across the facility's various departments, so that coordination and response efforts can be effectively facilitated in the event of a disease outbreak.

Institutions have a responsibility to ensure that their immediate communities are aware of the best courses of action to take in the event of likely disease outbreaks. Awareness campaigns can take diverse formats, including social media, printed posters, public address systems, and mass media engagements. The overall goal is to increase public awareness about the likely outbreak of disease and the measures individuals should take in terms of emergency response and risk reduction. As Lee, Cleare, and Russell (2010) indicate, "risk communications can play a significant role in the control of an emerging epidemic or pandemic by providing information that people can use to take protective and preventive action" (p. 327).

In disaster scenarios, staff members are often required to carry out activities that fall outside their normal responsibilities and roles. It is therefore important to ensure that they are capable of performing effectively in non-routine scenarios. Hospital staff should be equipped with the necessary skills to manage and respond to disease outbreaks. Ideally, training should target all staff. There is also a need to establish a select team of professionals who would coordinate protocols and procedures related to response. This team should be thoroughly familiarized with the institutional emergency response plan and should take an active role in facility-wide drills designed to promote preparedness.

Process Mapping: Inter-Agency Collaboration, Communication, and Logistics

Disaster response plans would be largely ineffective if formulated in isolation. The importance of engaging relevant external partners cannot be overstated. According to Kortepeter, Kwon, Christopher, Hewlett, and Cieslak (2017), disease outbreaks have the potential to be widespread and can breach community or state borders to become a national concern. The authors are therefore categorical that "having ongoing communication and cooperation between agencies, long before an emerging threat surfaces, is paramount for preparedness and effective response" (p. 21). A key benefit of this approach, as the authors further observe, is that it fosters a proactive rather than reactive posture.

Communication in the context of disaster preparedness can take diverse forms. With regard to internal communication, there is a need to ensure that the facility has a robust mechanism to provide facility visitors, patients, and staff with all relevant information when appropriate. All facility employees should also be familiar with the two-way communication protocols in place — for instance, those governing the conveyance of information between staff and hospital administration or management.

When it comes to external communication, there is a need to clearly define and categorize the content, nature, and type of information to be disseminated to the general public. This is especially important in efforts to minimize disease transmission risks. The communication processes and standards adopted should not conflict with the guidelines and policies of relevant government health agencies. Media relations must also be addressed comprehensively, particularly regarding the ideal channels and formats for media engagement. In this regard, Jennings, Aras, and Barrett (2016) offer a useful rule of thumb: engagement should ensure that communication remains "both factual and empathetic, addressing unfolding events and underlying fears through the lens of community experiences, histories, and perceptions" (p. 286).

One of the key objectives of logistics in disaster management is the provision of required resources to ensure that response efforts are not derailed. Logistics should therefore constitute a crucial component of any disaster response plan, and this component should be based on the outcomes of the risk assessment. There is a need to evaluate the facility's existing logistics system in order to identify aspects that require attention — whether in relation to resource deployment mechanisms, or equipment and supplies acquisition.

It may also be necessary to reach out to suppliers and formulate a Memorandum of Understanding committing them to provide the relevant items, equipment, and tools needed for disease spread control and prevention. Furthermore, strategies should be put in place to address potential personnel shortages arising from unexpected surges in the number of persons requiring medical attention. This may include considerations for how to acquire additional skilled staff if and when needed. All such considerations, particularly the latter, should be informed by prior risk and vulnerability assessments.

Conclusion

The relevance of disease outbreak disaster preparedness cannot be overstated. Preparedness efforts are instrumental in reducing fatalities and minimizing disruptions to normal life. Disaster preparedness should therefore be recognized as a crucial phase within the broader disaster management cycle, which also includes the equally important phases of mitigation, response, and recovery.

In addition to highlighting diverse aspects of disaster preparedness — such as training and the need for collaboration — this paper has demonstrated that there exists a clear need for the introduction of a new approach to addressing disease outbreaks. This need is underscored by the many important lessons learned from the COVID-19 pandemic, lessons that must inform and improve future preparedness planning at both the institutional and systemic levels.

References

Desborough, J., Dykgraaf, S. H., Philips, C., Wright, M., Maddox, R., Davis, S., & Kidd, M. (2021). Lessons for the global primary care response to COVID-19: A rapid review of evidence from past epidemics. Family Practice, 38(6), 811–825.

Jennings, B., Aras, J. D., & Barrett, D. H. (2016). Emergency ethics: Public health preparedness and response. Oxford University Press.

Khan, Y., O'Sullivan, T., Brown, A., Tracey, S., Gibson, J., Henry, B., & Schwartz, B. (2018). Public health emergency preparedness: A framework to promote resilience. BMC Public Health, 18(6), 69–75.

Kortepeter, M. G., Kwon, E. H., Christopher, G. W., Hewlett, A. L., & Cieslak, T. J. (2017). Interagency cooperation is the key to an effective pandemic response. The Lancet, 17(1), 20–26.

Lee, J., Cleare, T. W., & Russell, M. (2010). Establishing a healthcare emergency response coalition. Government Institutes.

Reilly, M. J., & Markenson, D. (2019). Health care emergency management: Principles and practice. Jones & Bartlett Learning.

Wapling, A., & Sellwood, C. (2016). Health emergency preparedness and response. CABI.