Innovations in Healthcare Disaster Management for Veterans

Although fewer than 40 percent of U.S. veterans receive care through the U.S. Department of Veterans Affairs (VA), the agency strives to have broad access to reliable medical care during a disaster. The Veterans Emergency Management Evaluation Center and its partners are exploring ways to improve healthcare resilience both inside and outside the VA.

As healthcare providers across the United States enhance their resilience to natural and manmade disasters, a unique research organization embedded in the U.S. Department of Veterans Affairs (VA) is urging them to consider the United States’ 21.5 million veterans in their planning. Given its size – 1,700 points of care stretching from Maine to the Philippines – the VA manages a disaster on some scale nearly every day. To take advantage of this venue to study and test new practices in healthcare disaster management, the VA established the Veterans Emergency Management Evaluation Center (VEMEC) at its Sepulveda Ambulatory Care Center in North Hills, California, in the summer of 2010.

“Our mission basically is to develop an evidence base for emergency management, to essentially try to have the VA serve as a national laboratory,” VEMEC Director Aram Dobalian explained to attendees at the annual Advancing and Redefining Communities for Emergency Management (ARC) conference held 1-3 December 2015 in San Diego, California.

Exchanging Lessons With the Broader Healthcare Community

Now in its sixth year, ARC serves as a platform for researchers, policymakers, and healthcare practitioners to exchangeeas about promoting resilience among veterans. The 2015 conference was held in conjunction with the National Healthcare Coalition Preparedness Conference to encourage the integration of the VA’s and other veteran-focused organizations’ initiatives into community-based healthcare planning efforts across the nation.

Retired Army Colonel Kevin Hanretta, the VA’s assistant secretary for operations, security, and preparedness, told healthcare coalition stakeholders attending the conference that VA facilities welcome the opportunity to be involved in local preparedness planning. “A lot of times because we’re federal we will be forgotten and not invited in, but I will assure you that we are a good partner,” Hanretta said. “We understand what our roles and responsibilities are and it’s to the veterans in your community.” He added that the VA has proven to be an excellent resource to communities in times of need. For example, the VA cared for some 10,000 nonveterans after Hurricane Katrina struck New Orleans in 2005.

Dobalian said the expanded participation at the 2015 ARC provided an opportunity for researchers to learn about innovative research taking place outside of the VA. One initiative showcased was a post-traumatic stress disorder (PTSD) training and treatment protocol developed by the San Diego-based Virtual Reality Medical Center (VRMC). CEO Brenda Wiederhold shared how her organization has adapted a combination of virtual reality exposure therapy and biofeedback designed to help motor vehicle and airline crash victims for use in treating military deployment-related PTSD. Today VRMC’s protocols, which are administered by licensed clinical psychologists using three-dimensional computer simulations, are used in 20 VA facilities. VRMC is also working with the VA to develop a mobile treatment van that can take the therapy to rural patients, and with partners in Europe to adapt the protocols for use in training and treating disaster responders.

Because only 8.3 million of the country’s 21.5 million veterans utilize VA healthcare services, VEMEC also used the ARC as a platform to share some of the agency’s innovations with non-VA facilities in the interest of improving care for veterans everywhere. One such resource is the VA’s new Performance Improvement Management System, said Mary Connelly, an emergency management specialist at the Oak Ridge Associated Universities (ORAU). ORAU modeled the interactive web-based emergency management system for VA’s Office of Emergency Management after one it developed for the U.S. Department of Energy. The system’s prize feature is a tool for designing and managing facility-level disaster exercises. Representatives of several non-VA healthcare systems endorsed its potential value for the broader healthcare community.

Considering Impacts Beyond Hospitals

While many healthcare preparedness initiatives focus on hospitals, VEMEC is also looking at the impacts of disasters on primary care. “When you think of healthcare in disasters, you think of people who go to the emergency room. What about routine care needs?” asked Tiffany Radcliff, a VEMEC research scientist and associate department head of Health Policy And Management at Texas A&M University. Radcliff’s team used appointment data to evaluate the resilience of VA clinics in the Galveston, Texas, area during Hurricane Ike in September 2008. On average, clinics experienced a significant drop in the number of completed appointments following Ike’s landfall, mostly because of road closures and downed power lines. However, most clinics returned to pre-storm appointment completion rates a week after Ike, and the worst affected areas were back on track within two weeks. VEMEC is writing up the results to inform future clinic preparedness.

Other initiatives are exploring the resilience of community-based organizations (CBO) that provide transitional housing and other services to homeless veterans. “A lot of our systems and laws are structured so that we’re trying to return people to how they were before the disaster happened, and if you’re already homeless to start with before the disaster, there’s not that much that’s being done for you,” Dobalian said. VEMEC and partnering federal agencies plan to release a toolkit in February that will provide CBOs technical assistance with disaster planning and encourage local emergency management agencies and healthcare providers to leverage CBO contacts and services to better protect homeless veterans.

As more partners come to the table, Dobalian said the future of healthcare preparedness for veterans should be informed by a comprehensive national survey of veteran resilience. He also encouraged emergency managers to consider how veterans could serve as advocates for preparedness in their communities. “We tend to think of some populations, whether its veterans or other groups, as vulnerable. There may be parts that are, but they’re also potentially significant resources,” Dobalian said. “In the case of the veteran population, you have folks who have a wealth of education, experience, knowledge, training, etc. There’s a lot that they could be doing in their communities.”

For more information about planning for the healthcare needs of veterans during disasters, visit the websites of VEMEC and the VA Office of Emergency Management.

Jessica Wambach Brown

Jessica Wambach Brown, M.A., is a freelance writer with years of experience in healthcare emergency preparedness, including positions at the MESH Coalition, the Northwest Healthcare Response Network, and the Department of Defense’s Center for Excellence in Disaster Management and Humanitarian Assistance. Previously, she was a reporter and editor at newspapers in Washington, Montana, and Virginia. She holds an M.A. in diplomacy and military studies from Hawai’i Pacific University and a B.A. in journalism and history from the University of Montana. She resides in the Seattle, Washington, area.



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