Striving towards an effective emergency preparedness and disaster management response: Lessons learned and future directions

Emergency preparedness and disaster management (EPDM) were brought to the forefront with the COVID-19 pandemic. The five major phases of EPDM are 1) preparedness, 2) mitigation/prevention, 3) response, 4) recovery, and 5) resilience [1,2]. Preparedness comprises multi-step collaboration to optimize intelligence sharing [3,4]. Next is mitigation, the process of addressing the ongoing situation and its risks through the allocation of resources [2]. The response phase requires efficient mobilization of needed resources, timely actions to contain the situation and limit its spread and effects, and utilizing effective communication [2]. Afterward, recovery processes (immediate, short-term, and long-term) require repairing the infrastructure, re-employment, making resources available, economic support, mental health support, and ongoing research [2,5]. Lastly, the resilience phase includes rebuilding communities at both the personal and structural levels [6].

Successful EPDM depends heavily on the level of planning, education and training, and research done in anticipation of disasters and emergencies [7]. However, over the past few decades the United States (US) has spent less than 3% of its health expenditures on public health prevention programs, mostly through the Centers for Disease Control and Prevention (CDC), and the Prevention and Public Health Fund (PPHF) [8]. From 2010 to 2020, the CDC funding for prevention and emergency preparedness programs had an almost $3 billion reduction [8]. The lack of adequate preparedness was evident during the COVID-19 pandemic. For example, personal protective equipment PPE) and testing supplies were in shortage [9]. Despite attempts to rectify these missteps, there have been 506,834 deaths as of February 26, 2021 [[9], [10], [11], [12], [13]]. The PPE shortage especially impacted nursing home residents, who represent over 50% of the US pandemic fatalities [14,15].

To save lives and reduce the burden on our healthcare system, strategies implemented include targeted testing, non-pharmaceutical interventions (hand washing/social distancing), optimization and augmentation of existing resources, implementation of crisis standards of care, and reduction of demand for healthcare services through medical countermeasures like mass vaccination [1,16,17]. Of particular importance in these efforts is the ongoing surveillance and contact tracing with targeted distribution of tests for viral transmission suppression and efficient reallocation of appropriate resources [[18], [19], [20], [21]]. These efforts are crucial as the US attempts to return to normalcy and already overwhelmed resources (medications, blood products, ventilators, etc.) could worsen as the incidence of trauma injuries return to baseline and elective operations increase [22,23]. These deficiencies and burdens on the healthcare system will severely impact vulnerable populations (low socioeconomic status, minorities, elderly) and those with comorbidities, warranting strategies that will efficiently protect these populations [[24], [25], [26], [27]].

Leadership in crises such as pandemics is an ongoing re-evaluation process as more knowledge and information becomes available. Until the science is clear, healthcare leaders and policymakers should take proactive measures and then refine policy as more data becomes available. For example, during the beginning of the COVID-19 pandemic, there was controversy surrounding the effectiveness of facemasks to prevent infections and through scientific inquiries, facemasks proved to be an effective tool [28]. Once this information became available, many leaders showed humility and did not hesitate to change their position and advocate for facemasks based on scientific evidence. However, with daily fluctuations in circumstances and knowledge during crisis management and preparedness, outcomes cannot be guaranteed, especially under uncommon situations. Many examples of this can be seen throughout the COVID-19 pandemic as healthcare facilities struggled with hospital bed capacity due to insufficiencies to effectively prevent or treat the disease [29,30] through effective protocols and management guidelines [29,31]. Leadership should ensure the resilience of their team. The lack of proactive measures in healthcare operations and leadership affected its preparedness to lead their team and keep them resilient. The nursing workforce reported significant psychological distress including post-traumatic stress and burnout [32]. It is an analytical, ethical, diverse leadership with reliable and high-quality information streams that can effectively utilize EPDM plans to decrease the impact of public health disasters both in the health sector and beyond [[3], [4], [5]].

As seen with COVID-19, the impacts of emergencies/disasters may be severe with effects ranging from unemployment, property and infrastructure damages, business closures, healthcare facility closures or reduced services, and decreased gross domestic product [[33], [34], [35], [36], [37]]. Public health emergencies such as pandemics are a threat to human livelihood thus requiring the creation of a national pandemic strategy, expansion of budgets for hospitals and research both in times of crises and as part of EPDM. The preparation to tackle a disaster occurs before the disaster strikes [3,4,9]. This preparation is key to developing comprehensive action plans for damage control and developing credible responses. This expedites a healthy cost-effective recovery process and builds resilience in communities [3,4]. EPDM relies on advanced, resilient, well-equipped, and accessible healthcare systems [38]. Appropriate EPDM program budgets and multisystem/multidisciplinary collaboration on the national and international level can help mitigate the severe impacts and loss of life that occurred during the COVID-19 pandemic and prevent it from reoccurring.

Author contribution

Study design and conception: AE.

Data collection and interpretation: AE, MH, MA, CE.

Manuscript preparation and critical revisions: AE, MH, MA, CE.

All authors read and approved the final manuscript.

Funding

None.

Declaration of Competing Interest

Authors disclose no competing interest.