Examining Public Health Workers' Perceptions Toward Participating in Disaster Recovery After Hurricane Sandy: A Quantitative Assessment.

OBJECTIVE: We aimed to quantitatively gauge local public health workers' perceptions toward disaster recovery role expectations among jurisdictions in New Jersey and Maryland affected by Hurricane Sandy. METHODS: An online survey was made available in 2014 to all employees in 8 Maryland and New Jersey local health departments whose jurisdictions had been impacted by Hurricane Sandy in October 2012. The survey included perceptions of their actual disaster recovery involvement across 3 phases: days to weeks, weeks to months, and months to years. The survey also queried about their perceptions about future involvement and future available support. RESULTS: Sixty-four percent of the 1047 potential staff responded to the survey (n=669). Across the 3 phases, 72% to 74% of the pre-Hurricane Sandy hires knew their roles in disaster recovery, 73% to 75% indicated confidence in their assigned roles (self-efficacy), and 58% to 63% indicated that their participation made a difference (response efficacy). Of the respondents who did not think it likely that they would be asked to participate in future disaster recovery efforts (n=70), 39% indicated a willingness to participate. CONCLUSION: The marked gaps identified in local public health workers' awareness of, sense of efficacy toward, and willingness to participate in disaster recovery efforts after Hurricane Sandy represent a significant infrastructural concern of policy and programmatic relevance. (Disaster Med Public Health Preparedness. 2016;10:371-377).

Building health care system capacity to respond to disasters: successes and challenges of disaster preparedness health care coalitions.

INTRODUCTION: This research aimed to learn from the experiences of leaders of well-developed, disaster preparedness-focused health care coalitions (HCCs), both the challenges and the successes, for the purposes of identifying common areas for improvement and sharing "promising practices." HYPOTHESIS/PROBLEM: Little data have been collected regarding the successes and challenges of disaster preparedness-focused HCCs in augmenting health care system preparedness for disasters. METHODS: Semi-structured interviews were conducted with a sample of nine HCC leaders. Transcripts were analyzed qualitatively. RESULTS: The commonly noted benefits of HCCs were: community-wide and regional partnership building, providing an impartial forum for capacity building, sharing of education and training opportunities, staff- and resource-sharing, incentivizing the participation of clinical partners in preparedness activities, better communication with the public, and the ability to surge. Frequently noted challenges included: stakeholder engagement, staffing, funding, rural needs, cross-border partnerships, education and training, and grant requirements. Promising practices addressed: stakeholder engagement, communicating value and purpose, simplifying processes, formalizing connections, and incentivizing participation. CONCLUSIONS: Strengthening HCCs and their underlying systems could lead to improved national resilience to disasters. However, despite many successes, coalition leaders are faced with obstacles that may preclude optimal system functioning. Additional research could: provide further insight regarding the benefit of HCCs to local communities, uncover obstacles that prohibit local disaster-response capacity building, and identify opportunities for an improved system capacity to respond to, and recover from, disasters.

Building health care system capacity: training health care professionals in disaster preparedness health care coalitions.

INTRODUCTION: This study aimed to learn from the experiences of well-established, disaster preparedness-focused health care coalition (HCC) leaders for the purpose of identifying opportunities for improved delivery of disaster-health principles to health professionals involved in HCCs. This report describes current HCC education and training needs, challenges, and promising practices. METHODS: A semi-structured interview was conducted with a sample of leaders of nine preparedness-focused HCCs identified through a 3-stage purposive strategy. Transcripts were analyzed qualitatively. RESULTS: Training needs included: stakeholder engagement; economic sustainability; communication; coroner and mortuary services; chemical, biological, radiological, nuclear, and explosives (CBRNE); mass-casualty incidents; and exercise design. Of these identified training needs, stakeholder engagement, economic sustainability, and exercise design were relevant to leaders within HCCs, as opposed to general HCC membership. Challenges to education and training included a lack of time, little-to-no staff devoted to training, and difficulty getting coalition members to prioritize training. Promising practices to these challenges are also presented. CONCLUSIONS: The success of mature coalitions in improving situational awareness, promoting planning, and enabling staff- and resource-sharing suggest the strengths and opportunities that are inherent within these organizations. However, offering effective education and training opportunities is a challenge in the absence of ubiquitous support, incentives, or requirements among health care professions. Notably, an online resource repository would help reduce the burden on individual coalitions by eliminating the need to continually develop learning opportunities.

Proposals for aligning disaster health competency models.

To standardize the key building blocks of disaster health competency models (content, structure, and process), we recommend a reinterpretation of the research, development, test, and evaluation construct (RDT&E) as a novel organizing framework for creating and presenting disaster health competency models. This approach seeks to foster national alignment of disaster health competencies. For scope and completeness, model developers should consider the need and identify appropriate content in at least 4 broad areas: disaster-type domain, systems domain, clinical domain, and public health domain. The whole disaster health competency model should reflect the challenges of the disaster setting to acknowledge the realities of disaster health practice and to shape the education and workforce development flowing from the model. Additional issues for consideration are whether competency models should address response and recovery just-in-time learning and whether the concept of "daily routine doctrine" can contribute to disaster health competency models. The recommendations seek to establish a strategic reference point for disaster competency model alignment within the health workforce.

Core competencies for disaster medicine and public health.

Effective preparedness, response, and recovery from disasters require a well-planned, integrated effort with experienced professionals who can apply specialized knowledge and skills in critical situations. While some professionals are trained for this, others may lack the critical knowledge and experience needed to effectively perform under stressful disaster conditions. A set of clear, concise, and precise training standards that may be used to ensure workforce competency in such situations has been developed. The competency set has been defined by a broad and diverse set of leaders in the field and like-minded professionals through a series of Web-based surveys and expert working group meetings. The results may provide a useful starting point for delineating expected competency levels of health professionals in disaster medicine and public health.

Implementation of evidence-based humanitarian programs in military-led missions: part I. Qualitative gap analysis of current military and international aid programs.

BACKGROUND: A recent Department of Defense instruction mandates country-specific assessments, identification of interventions, and development of guidance for Department of Defense to plan, train, and prepare for the provision of humanitarian assistance in stability operations. It also directs the use of outcome-based measures of effectiveness and the establishment of processes facilitating transparency of information. Whereas this would align military-led projects closer to the standards of the international aid community, how this process will be developed and implemented within the military has not yet been determined. METHODS: To begin developing an evidence-based program for military-led humanitarian aid, we conducted a qualitative gap analysis comparing information from a Web search of Department of Defense medical after-action reports, lessons learned, and expert interviews with the internationally accepted standards in humanitarian assistance impact assessment. RESULTS: There is a major gap in the ability of the Department of Defense to assess the impact of humanitarian assistance in stability operations compared with international development standards. Of the 1000 Department of Defense after-action reports and lessons learned reviewed, only 7 (0.7%) reports refer to, but do not discuss, impact assessment or outcome-based measures of effectiveness. CONCLUSIONS: This investigation shows that the Department of Defense humanitarian assistance operations are, historically, recorded without documentation using quantifiable health data identifying which aid activities contributed directly to desired outcomes or favorable public opinion, and rarely are analyzed for effectiveness. As humanitarian assistance operations assume an ever greater role in US military strategy, it is imperative that we investigate useful impact assessment models to meet mission directives and, more important, to maximize coordination in a necessarily integrated and cooperative development environment. These findings provide baseline knowledge for the implementation of an evidence-based impact assessment process to validate future Department of Defense humanitarian assistance operations.

Implementation of evidence-based humanitarian programs in military-led missions: part II. The impact assessment model.

The Department of Defense does not implement health-sector humanitarian assistance impact assessments to complement those of the international humanitarian aid community. This oversight fails to meet the recent Department of Defense Directive 3000.05 mandate calling for the application of measures of effectiveness. The decision by the Department of Defense to incorporate humanitarian assistance in stability operations should be supported by evidence-based impact assessments. This article proposes implementation of an impact assessment model in Department of Defense humanitarian assistance operations. The use of an impact assessment model will refocus previously identified information gaps from traditional military input-output management toward a greater emphasis on outcomes. This will help answer which humanitarian activities are successful, which are not, and why. Over time, the use of an impact assessment model will ensure that the Department of Defense and its operational units are learning as an organization while applying evidence-based lessons learned to future stability operations. Most important, the use of this model will both provide better understanding of the role that the Department of Defense has in humanitarian activities and help interpret and transfer these activities to the host nation and international aid community in a timely and efficient manner.