Table 3.
Lessons learned from DHT applications to deliver healthcare in major natural disasters across the globe.
| Study/Study Site | Natural Disaster | DHT Type | Equipment Required | Disaster Stage | DHT Application | DHT Strengths | Implementation Challenges | Lessons Learned |
|---|---|---|---|---|---|---|---|---|
| Vo A.H et al., 2010 [124] USA |
Hurricane Ike | Telemedicine | Broadband computer networks, video monitors, cell phones. | Post-disaster response phase. | Provide a continuum of care and consultation services to those in need. | Telephone-based service with a greater outreach. | Disaster-related impacts. The long sustainability of the technology requires a secure, web-accessible file server system and the development of network hubs. |
Flexibility of data networks is essential for resuming operation. Mobile phones can be used to facilitate healthcare but require ‘how to’ protocols. EMR notes in simple text are transferable between systems. Advance planning to secure critical data ahead of disasters by developing web-accessible file server systems. Develop fault-tolerant networks. |
| Nicogossian et al., 2011 [125] Armenia |
1988 earthquake | Telemedicine | Space Bridge communication infrastructure, video monitors, video recording. | Post-disaster response phase. | Provision of healthcare services to earthquake victims. | Well-established guidelines and protocols. | Safeguarding patient privacy, effective connectivity through telecommunications and internet. | A pre-existing system and connectivity are essential for rapid DHT implementation to meet the needs of disaster victims. The system must be staffed with trained personnel for effective consultation and services. |
| Callaway et al., 2012 [126] Haiti |
2010 earthquake | Mobile Health (iChart mHealth) | Gas-powered generator for electricity, satellite antenna for wireless network, cellular phones. | Post-disaster response phase. | Patient tracking, triage, postoperative care, protection of unaccompanied minors, patient handovers. | Reduced workload, improved patient care, adequate patient triage, and improved patient tracking. | No significant challenges reported. | iChart functioned with or without internet connectivity. Improved service delivery using scalable mobile technology. |
| Kim et al., 2013 [127] USA |
Hurricanes, storms, typhoons and other disasters hitting the US gulf coast | Telehealth | Not reported. | Post-disaster recovery phase. | Provide telehealth services to a disaster-affected population across various health specialties. | Multiple shared challenges and recommendations were identified to support the scalable sustainability of telehealth programs. | Inadequate funding impacted the engagement and implementation. Regulatory challenges (i.e., reimbursement for the uninsured). Lack of guidance on establishment of telehealth policies and procedures. User’s confidentiality. Inadequately trained workforce. |
Lack of IT support impacts DHT implementation. Adequate bandwidth and network architecture are essential to good connection. Strong vendor support and equipment testing essential for effective response. The framework is adaptable to future telehealth programs for high service needs with limited resources. |
| Nagata et al., 2013 [128] Japan (Fukushima) |
2011 earthquake | Cloud-based Electronic Health Record (EHR) | Low-bandwidth computer networks, laptops, and portable internet Wi-Fi devices. | Post-disaster response phase. | Increase coordination and communication to enhance medical response in the aftermath of the earthquake and subsequent nuclear disaster. | Low-bandwidth internet was sufficient for EHR implementation. Low-cost intervention. |
Internet services required for implementation, data security, and privacy. |
Low-bandwidth, low-cost cloud-hosted EHR could perform functions needed to provide safe and quality care. Hospital EHRs need to be connected to a national EHR to permit access to patient data during disasters. Benefits of EHR data accessibility during disasters are likely to outweigh the risks concerning privacy issues. Guidelines to manage privacy concerns regarding a national EHR system need to be developed. |
| Qadir et al., 2016 [129] Pakistan |
2015 flood and earthquake | Telepsychiatry | Not described. | Post-disaster response phase. | Treatment of post-traumatic stress disorder (PTSD). | Active community engagement in the telepsychiatry module. | Not reported | Outcome not assessed. Telepsychiatry could deliver effective services where regular services are interrupted. |
| Taylor et al., 2017 [130] USA |
Hurricane Katrina and Hurricane Harvey | EHR | Laptop | Pre-disaster preparedness and post-disaster response phase. | Safe continuum of care in the face of disasters. | EHR was already set up following Hurricane Katrina, which facilitated service continuation during Hurricane Harvey. | Not reported | High-quality healthcare services were achievable amidst the disaster. Patient portals available to access blood test results and medication prescriptions remotely. |
| Stasiak et al., 2018 [131] New Zealand |
2011 Canterbury earthquake | Computerized cognitive behavioural therapy (BRAVE-ONLINE) | Computer with internet services, telephone. | Post-disaster recovery phase. | Cognitive behavioural therapy for anxiety and PTSD. | The DHT (BRAVE-ONLINE) was a validated tool. | Participants were required to be competent technology (computer and internet) users. | With uninterrupted telecommunication services and electricity supply, DHTs can be successfully implemented to provide remote behavioural therapy services. |
| French et al., 2019 [132] USA |
Hurricane Florence | Telehealth | Devices to support video assessment (video monitors and low-bandwidth connection), and cellular phones. | Pre-disaster preparedness and post-disaster response phase. | Test the applicability of telehealth support to evacuation shelters and emergency medical services. | Could operate in settings with low internet bandwidth. Real-time patient assessment and treatment. |
Cellular towers can be oversubscribed, limiting the connectivity. | Effective implementation and testing of DHTs before the storm were achieved with minimal changes to existing infrastructures. Was not used in response phase. |
| Pasipanodya et al., 2020 [133] USA |
2015 California fire | Telemedicine | Tablet with internet connectivity, home blood pressure machine. | Pre-disaster period and immediate response period following the disaster. | Management of spinal cord injury. | Cheap and effective. | Not described | Uninterrupted quality of care was possible amidst the California wildfire and its aftermath. Changes to reimbursement structure is necessary. |
| Grover et al., 2020 [123] USA |
Hurricane Florence | Telemedicine (RelyMD) | Tablet | Pre-disaster preparedness and post-disaster response phase. | Reduction in unnecessary emergency medical service utilization and emergency department visits. | The DHT in existence before the disaster. | Not described | Telemedicine limitations were not reported. |
| Sago et al., 2020 [134] Croatia |
Earthquake following the COVID pandemic | Telepsychiatry | Telephone, computers with internet connections for Skype consultations, headphones, smartphones. | Post-disaster early response phase during the COVID-19 pandemic. | Psychological counselling and psychotherapy. | Participants’ compliance and active engagement during the telepsychiatry sessions. | Management of social and interpersonal aspects of participants in the group counselling sessions. Use of technology by the service seekers and service providers. Burnout during long sessions of artificial/remote contact. |
DHT limitations were not reported. |
| Paratz et al., 2022 [135] Timor-Leste |
Flood and population dislocation | Cardiac telehealth service | Video monitor, handheld echocardiograms, mobile phones, and landline phones. | Post-disaster response phase during the COVID-19 pandemic. | Management of cardiac care services. | An effective strategy of critical care service delivery amidst the disaster. | Poor internet connection and less coverage. Repeated cycles of disaster during telemedicine services’ reduced efficiency of service delivery. Difficulty in establishing contacts with service seekers. Financial barriers. |
Unreliable internet connection and fixed broadband impacted transmission of echocardiographic images. Zoom link used for clinic appointments. Echocardiographic images shared via email and WhatsApp. Recommend cloud-based system for in-time image optimisation |