ABSTRACT
BACKGROUND: Hurricane Maria, which hit Puerto Rico in 2017, catastrophically impacted infrastructure and severely disrupted medical services. The US Department of Veterans Affairs Caribbean Healthcare System (VA CHCS), which serves approximately 67,000 patients and has most of its facilities on the island of Puerto Rico, was able to successfully maintain operations after the hurricane. As a part of the larger VA system, VA CHCS also has a mission to support "national, state, and local emergency management, public health, safety and homeland security efforts." The objective of this study is to better understand the ways VA and its facilities meet this mission by exploring how VA CHCS acted as a community resource following Hurricane Maria. METHODS: This study investigated experiences of five employees in critical emergency response positions for VA CHCS, Veterans Integrated Service Networks (VISN) 8, and the Office of Emergency Management. All respondents were interviewed from March to July 2019. Data were collected via semistructured interviews exploring participants' experiences and knowledge about VA's activities provided to the community of Puerto Rico following Hurricane Maria. Data were analyzed using thematic and in vivo coding methods. RESULTS: All respondents underscored VA's primary mission after a disaster was to maintain continuity of care to Veterans, while concomitantly describing the role of VA in supporting community recovery. Three major themes emerged: continuity of operations for the San Juan VA Medical Center (VAMC) and its affiliated outpatient clinics, provision of services as a federal partner, and services provided directly to the Puerto Rican community. DISCUSSION: Recent disasters have revealed that coordinated efforts between multidisciplinary agencies can strengthen communities' capacity to respond. This case example demonstrates how a VA hospital not only continued serving its patients but, with the support from the greater VA system, also filled a wide variety of requests and resource gaps in the community. Building relationships with local VAMCs can help determine how VA could be incorporated into emergency management strategies. In considering the strengths community partners can bring to bear, a coordinated regional response would benefit from involving VA as a partner during planning.
