Is your rural hospital or healthcare facility ready for a major disaster? When we think about disasters, we often think about 9/11, Hurricane Katrina, Superstorm Sandy and the Boston Marathon Bombings. All of these disasters happened in larger cities where an abundance of emergency response resources and healthcare preparedness planning has taken place. But what about rural and remote regions of the nation? These big disasters may not happen a lot in rural areas but our regions are not immune from experiencing them, though. We need to look at the facts about rural communities. Most nuclear plants are in rural communities. Rural communities are often situated around the Southern Border of the country. Rural communities has less in terms of resources for emergency management and systems in place for homeland security. Rural communities are vulnerable to major disasters – that about sums it up.
When a rural community experiences a major disaster, there is one particular type of sector that first responders and the community as a whole is going to be relying on. This sector is the healthcare sector which includes hospitals, clinics and other healthcare facilities. People are going to need medical assistance as soon as possible and they are going to be rushed to the hospital to get such attention. But as stated above, big city healthcare systems are usually quite ready for major incidents and their budgets and resources have helped them accomplish that goal. But when disaster strikes in a rural area, do you think the rural hospital is going to be able to handle it like a hospital in a large city? Large or small, the people of the community will always expect the local healthcare system to be on their toes in regards to disaster response.
The Disaster Management Challenges of Rural Healthcare Facilities
It is important to understand the various types of disasters that rural healthcare facilities are often faced with. As stated above, many nuclear facilities are situated in rural community thus causing concern for nuclear and other harmful chemical incidents that impact a large area of residents and communities within the region. Border communities dealing with illegal immigration have to worry about undocumented persons sneaking in with infectious diseases that could threaten a population. And agro-terrorism is always going to be a threat to the farmers and livestock ranchers throughout the nation’s rural regions. Rural areas are susceptible to various types of disasters whether natural, human-made or technological and this causes concern for local hospitals and healthcare facilities. The following challenges have been identified when addressing these concerns.
Evacuations and Sheltering in Place – Imagine having to evacuate 300-500 patients from your local hospital to another hospital that is about 70 miles away from your community. There wouldn’t likely be enough ambulance services in the area and the hospital that you would need to take the patients to might also be ready to close their doors due to too many patients as well. Imagine not being able to move patients out of the hospital due to some sort of hazard outside that could harm them. Whether it is evacuating or sheltering in place, each of these poses significant challenges to rural healthcare facilities especially when other facilities are often many miles away.
Infrastructure Failures – Electricity, water, sewage, and communications – all of these forms of infrastructure are common to fail during a major disaster. For a rural community, these utilities are often vital, especially for hospitals and healthcare clinics within the community. A hospital must have these utilities in working order in able to perform their duties to the health and safety of the public. Without these utilities, a hospital or healthcare clinic lacking them might be forced to halt operations and cease taking in new patients until a solution is resolved. Time is everything in terms of a disaster and victims don’t often have time to wait for hospitals to get their systems in working condition after some sort of failure.
Surge Capacity – Many rural hospitals and healthcare facilities are often understaffed and not as big as facilities located in larger communities and big cities. This leads to the issue of surge capacity for the local healthcare facility. After some kind of disaster strikes, patient in-take is going to dramatically increase and hospital staff and resources will simply become overwhelmed very quickly. Besides the local, it is also important to remember to tourists and travelers in the area that might be stuck in the area and need immediate medical assistance. Surge capacity defines the number of patients that could enter a healthcare facility during some kind of disaster.
Decontamination Capabilities – In regards to accidents and emergencies at local nuclear and/or chemical facilities or even acts of terrorism that involve CBRNE events (Chemical, Biological, Radiological, Nuclear and Explosive) whether accidental or intended by acts of terrorism – can we be assured that a local rural healthcare facility is capable to decontamination functions and being able to handle such types of victims? These victims would need immediate assistance otherwise death or major injury would be a given diagnoses.
Planning and Coordination Efforts – Being prepared for the worst type of disasters is only accomplished through proper planning, coordination with local partners and of course, exercising plans to gain experience before an incident actually occurs. Is the local hospital or healthcare clinic making these efforts possible? Is there an emergency management official ensuring the preparedness needs of the healthcare facility? Is a plan in place for the various types of disaster management functions that will likely occur within a hospital? Are staff experience in these disciplines through real-life events and exercises?
The challenges listed above are often the challenges of larger city healthcare facilities as well. However, as mentioned previously, larger cities have the budget, staff and resources available to curb and even eliminate these challenges quickly whereas rural capacities and capabilities are very limited in terms of funding, personnel and resources. But waiting around for the disaster to strike without being prepared beforehand isn’t the answer. People can die. Injuries could increase and the legal liability of the healthcare clinic sworn to provide medical assistance to the community could be threatened. It is critical that rural communities prepare their healthcare facilities for times of disaster so that the challenges above do not overwhelm staff as well as the community as a whole.
Recommendations for Improving Rural Healthcare Facilities
The following are recommendations for the challenges above. It is important that rural healthcare providers, the community and the citizens of the community assist in helping to make these recommendations happen. The Whole Community approach to emergency preparedness takes the whole community – everyone needs to be involved and sometimes officials will need to ask people to be involved before the people ask the officials. In a rural area, due to all the constraints and limits, Whole Community is even more important than ever. Let’s take a look at some of the ways we can counter the challenges listed above.
Planning, Coordination and Exercising – First and foremost, the one thing that has always ended with successful and favorable results concerning emergency management and preparedness is proper planning. Planning is needed in order to ready a rural healthcare facility for disaster and make it resilient to hazards. However, planning isn’t really a simple task to do and be done with. Planning is a continuous effort that should be updated each year and especially when some type of change management occurs within the facility or the overall hazard-prone environment.
Coordination with partners and resource sources should be made during the planning process and these partners should be invited to take part within the actual planning stages to strengthen the healthcare emergency management framework being developed to be put into place. Partnerships should be made with federal, state, tribal and local government, private sector entities and Non-Governmental Organizations (NGOs) within the area, businesses, social organizations and even citizens of the community.
Exercising is also critical and often required in order to improve emergency preparedness. Full-scale exercises involving multiple personnel, actors, agencies and so on is going to be the best bet. Exercising allows a rural healthcare facilities and coordinated partners involved to gain experience in disaster management without a disaster actually occurring. Exercising also helps the facility to identify gaps in the overall emergency plan and consider what resource capabilities are present to respond to a variety of different types of hazardous situations that may threaten the local healthcare system during a disaster.
Routine PM on Infrastructure – It is important to conduct Preventative Maintenance (PM) on equipment and resources that the hospital or healthcare facility will depend on before, during and after a disaster has occurred. Consider the fact that rural areas will likely receive assistance last – bigger cities tend to have more impact on the global economy of the nation so they will get more attention at first than rural areas with less infrastructure and critical resources that the nation needs to continue to thrive. With that being said, rural healthcare providers will need their equipment to work at all times which is why PM activities are so important. If something needs to be fixed, then it should be a priority before it turns into a situation where fixing it will be impossible.
Cross-training staff for events such as a disaster in the case of repairing equipment might be considered a reasonable idea. Sure, we don’t want medical doctors and nurses repairing a generator but this task could be done by officials other than maintenance such as custodial and even facility security and EHS personnel. Some repair and maintenance tasks will require certification though such as with HVAC so it is important to take note of that before cross-training employees to take on other tasks during an emergency situation.
It is also important to have backup systems and establish partnerships with other organizations, communities and businesses to aid and assist when critical equipment is needed. For example, a local coal mining company could provide the local hospital with generators and fuels if the event of a major power outage happens post-disaster. The partnership and agreements need to be made long before a disaster actually strikes the community and the healthcare system. Spontaneous partnerships during a disaster are not always successful especially due to the chaos and confusion that the partners may be experiencing at the moment.
Surge Planning – Imagine a normal day at your healthcare facility; a normal but busy day. The hospital or clinic is packed and capacity is reaching its end. Now imagine that busy days increases three fold due to a sudden disaster happening with warning. More local residents are spilling into the doors while nearby travelers and visitors from the local interstate area are also starting to show up. The facility quickly becomes overwhelmed with people needing critical and immediate assistance and everyone is demanding the same service and care as the next person. Staff and security personnel are very few to the massive amounts of confused and panicked patients starting to flood the facility. A scenario like this would be chaotic but for a rural community, it can be a reality at any moment.
Planning for surge capacity is an important process of instilling preparedness and resilience of a disaster into a local healthcare provider and/or facility. The day may come when the facility is overwhelmed with people needing help. If the facility plans for this now before a disaster strikes, the chaotic situation that occur at any time could be more easily managed than if planning never occurred in the first place. Depending on the situation, during this planning stage, ideas can be generated for outdoor triage centers and even ‘tent city’ type camps that can be used to help with the surge capacity of victims after a disaster has occurred.
Like with any planning, exercising the plan should take place. A full-scale exercise testing the surge capabilities of the healthcare facility can answer a lot of different questions concerning the challenges of the healthcare provider. Gaps in the plan can be identified and capabilities can be checked to see if more work and planning is needed to ensure that the facility can take on more people than it normally takes on during an emergency situation. When exercising, it is good to involve local public safety since they will be playing a key role in the protection and transportation of victims and healthcare service assets during the disaster. The more people who do participate in the exercise will make the exercise more realistic and thus allow everyone to gain more experience in the process.
Decon Exercising and Resource Stockpiling – Many rural communities are situated near nuclear and hazardous chemical facilities, roads and bridges, rail road systems and even marine areas. Because of this, there is often a hazard of the potential for chemical and related threats. When people become victim to chemical and other related threats, they can threaten the safety of others if exposing the masses to the chemicals they have on them. It is important for all healthcare providers, whether in a big city or a rural village, to have some kind of decontamination plan in place.
Creating a plan and setting up a decontamination area isn’t enough. The plan and specific type of scenario needs to be exercised by the healthcare provider and the community. This is an area where if mistakes happen, they will most certainly result in a mass casualty incident (MCI) type situation. Basically, the slightest mistake can result in mass fatalities or other serious injuries among those who have come to the facility for safety and medical support. As always, exercising decontamination protocols will help gain experience and fill the gaps and resource needs of the healthcare facility as well as the community long before an actual incident ever takes place.
Before a disaster occurs, resource stockpiling should also take place. This is the time to meet with partners and sources that will provide resources, plan for the storage and logistical operations of such resources and maintain the resources by throwing out expired ones and replacing resources that need to be replaced. Sadly, most types of resources do have a shelf life and while it is often expensive to replace resources, it is important to do so as well especially if a time ever comes with the resource is a critical need.
Public Health & Preparedness Coalitions – No one should have to face a disaster alone. If a hospital or healthcare facility were to do all their preparedness tasks on their own without involving anyone else – they would likely fail in the end after the results of a disaster had taken place. Emergency management cannot be done alone. It is and will always be a Whole Community effort. Even the US Military understands this and has taken steps to involve the Whole Community for their own emergency management needs. Healthcare facilities should be looking for outside assistance to share the responsibility of disaster preparedness and resiliency.
One particular avenue to consider participating in is a public healthcare or preparedness coalition within the local region. This type of coalition often has many members from other healthcare facilities, emergency management agencies, public safety departments, businesses, organizations and even individual members. Coalitions often share experiences, resources and provide assistance as well as educational and training opportunities to members that need the help. These types of organizations really infuse the success behind the effort of Whole Community preparedness.
If no coalition exists, then this allows you the perfect opportunity to start and form your own. In my professional opinion, every region throughout the United States should have some kind of healthcare or preparedness type coalition. The only way we are going to truly accomplish success in preparing this nation for all types of natural, human-made and technological hazards is to work together as an entire community which is what a coalition like this would be meant for. To form the coalition, you need members – start with the local governments of surrounding communities, other healthcare providers, emergency management offices, businesses and even citizens who are always willing to help. Together, we can make a difference – that has been proven time and time again.
Thank you for taking the time to read my article about major challenges and potential recommendations concerning disaster preparedness for rural hospital and healthcare providers. Please help support my efforts of writing this article by sharing it with others and especially on your favorite social media profiles. Subscribe to my free monthly newsletter for article updates and exclusive content by visiting the bottom area of the homepage. Be sure to visit again for more articles that will be published in the near future.
About the Author
Shawn J. Gossman is an article and publication contributor of rural and remote-based emergency management, continuity and public health topics. Shawn holds a Master of Science concentrating in Emergency Management and a MBA in Hazardous Environment Logistics and Supply Chain Management. Shawn is dedicated to helping rural communities and organizations be a part of the Whole Community approach of National Preparedness.
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