Disasters often disrupt critical services and operations of healthcare facilities and other public and private businesses. Without adequate preparation, many organizations may not be able to resume their services after these disruptions, and many even have to close their doors. Organizations that are better prepared are more likely to survive and perform amid adversity. Preparedness and continuity of operations planning are essential to ensuring that businesses are able to continue their vital services during and after disasters. VEMEC has built a wealth of experience improving business continuity for VA, its community partners, and with other businesses.
Modeling Vaccine Resource Allocation and Coverage Among Veterans
VEMEC is partnering with Sandia National Laboratories to investigate the impact of different vaccine resource allocation and service partnership strategies on vaccination levels of Veterans. This project uses system dynamics modeling to explore hypotheses related to delivery of vaccine services through community partnerships and coordination. Preliminary analysis of data has identified that community partnership and coordination are strategic policy actions the VHA could take to improve vaccination uptake among Veterans. Ultimately, we hope to foster community partnerships in VHA disaster preparedness efforts and examine the effect of coordination on best practice adoption of vaccinations and other preventive efforts, including disaster preparedness kits.
Disaster Preparedness of Non-Profit Organizations Serving Homeless Veterans
The Disaster Preparedness in Non-Profit Organizations Serving Homeless Veterans project seeks to understand what community-based organizations in a major metropolitan area need to become better prepared for a disaster and what barriers they currently face. Non-profit homeless service organizations constitute a “safety net” for homeless populations, both daily and in times of crisis. Homeless individuals may be particularly vulnerable to the adverse effects of a disaster due to extreme poverty, lack of access to housing and other resources, and chronic health conditions, particularly if disaster shelters are not prepared to address their needs. We conducted semi-structured interviews with 12 key staff members from 6 community-based non-profit providers of housing and shelter services to individuals experiencing homelessness. Topics discussed included: 1) expected disaster impacts; 2) current plans; and 3) needs and barriers for disaster preparedness. Interviews were audio-recorded, transcribed, and analyzed using qualitative analysis software. Preliminary findings suggest that providing technical assistance and training, and improving non-profit organizations’ collaboration with government emergency management agencies would strengthen the disaster readiness of this vital safety net for homeless Veterans. These findings have been translated into policy recommendations through the 2013 Workshop on Integrating Homeless Populations into Disaster Preparedness, Planning, and Response, and a Toolkit is currently in development to identify best practices, policies, and further research to improve organizational preparedness.
Emergency Management Capabilities Assessment Program (EMCAP)
VEMEC is working with VA emergency managers on the development of the VA’s Emergency Management Capabilities Assessment Program (EMCAP), a tool to assess the preparedness of VA Medical Centers (VAMCs). The study identifies the most critical missions of an emergency management program, and the capabilities associated with those missions. From 2008-2010 (Phase I), 140 VAMCs were evaluated using an initial tool assessing 69 emergency preparedness capabilities organized in six domains. In 2011-2013 (Phase II), the measurement tool was modified and expanded to include 71 capabilities, which were then used to evaluate the preparedness of the same 140 VAMCs. Both phases of capability data have been analyzed using various analytical approaches. We compared EMCAP Phase I and Phase II capability-level descriptive data to identify trends in scores between the two phases.
Impact of Disasters on Health Services Use, Costs, and Resource Allocation among Veterans
The VA’s large electronic medical records data systems provide a unique opportunity to study the impact of natural disasters on the health of VA’s Veteran patients and on the delivery of healthcare services, including disruptions to the service delivery chain. The CDW project includes a series of studies. One study examines the impact of Hurricane Ike on missed opportunities for outpatient clinic care. Scheduled encounters 60 days prior to and following Hurricane Ike were tracked for the service areas primarily impacted by the storm and compared to others in the same region. Completed and missed opportunities were identified and compared according to key clinical, patient, and timeframe characteristics. Three other studies focus on Superstorm Sandy: 1) Patient dispersion across neighboring VA medical facilities following the temporary closure of the Manhattan VA Medical Center (VAMC); 2) Re-admission rates of patients who were discharged prior to the evacuation of the Manhattan VAMC before Superstorm Sandy struck the facility; and 3) Types of health services used by veterans who were diagnosed with PTSD one year prior to Superstorm Sandy.
Hospital Preparedness Planning for Evacuation: The VA NY Harbor Healthcare System Experience
The increasing frequency of weather disasters has been accompanied by an increase in the number of hospitals that are forced to evacuate in the midst of disaster. Yet there is little data on hospital evacuation. The Manhattan Evacuation project studies VA staff who has participated in New York Harbor Healthcare System’s (NYHHS) preemptive evacuations of the Manhattan Campus for Hurricane Irene and Superstorm Sandy. The study aims to expand our understanding of hospital evacuation, a critical disaster response capability for all hospitals. We conducted 31 key informant interviews as part of an in-depth case study. We found that the Irene evacuation experience was the most important factor in the successful evacuation for Sandy.
Understanding and Promoting Collaboration to Strengthen Hospital Resilience and Community Preparedness
Effective disaster preparedness and response needs to be a community effort. The Collaboration project works with VA Medical Centers (VAMCs) to: 1) describe VAMCs’ emergency management collaborations with non-VA partners; 2) describe the role VA facility and regional leadership, and VA headquarters staff have in these collaborations; and 3) identify facilitators and barriers to collaboration. We used purposive sampling to select 12 diverse VAMCs from across the nation, and conducted semi-structured telephone interviews with the facility’s emergency manager. Findings will guide the development of tools and processes to help strengthen VA emergency management collaborations, thereby contributing to a more resilient VA healthcare system.