Abstract

Keywords

۱٫ Introduction

۲٫ Emergency management in healthcare

۳٫ Methods

۴٫ Data analysis

۵٫ Results

۶٫ Discussion

۷٫ Limitations

۸٫ Practical recommendations

۹٫ Conclusion

Funding

Declaration of competing interest

Appendix. Kendall Tau Correlation

References

Abstract

Emergency management (EM) professionals play an integral role in preparing healthcare organizations for disasters but evidence of their pervasiveness in Canadian healthcare is limited. Through an exploratory Canada-wide survey of EM in healthcare organizations, we aim to develop understanding of the prevalence and effectiveness of the disaster preparedness activities enacted in preparation for COVID-19. The online survey generated 161 responses; 150 (93%) had EM responsibility. EM reported that reviewing infectious disease (pandemic) plans and protocols was the most widespread activity (82%), while simulation-based exercises was the least (26%). Organizational incident management response to COVID-19 was led by a sole ‘incident commander’ ۶۱% of the time, while 39% of ‘incident commands’ were led by multiple individuals. Of all those assigned to lead IM, only 68% received training in that role. Overall, the prevalence of disaster preparedness activities in healthcare organizations was positively associated with leaders who received training in incident response and having a dedicated EM resource. Meanwhile, the overall effectiveness of activities was positively correlated with having a sole ‘incident commander’ and was found to improve as the overall prevalence of activities rose. The study provides strong evidence for regional, organizational, and EM resource variation in the delivery of disaster preparedness activities and training for leaders in Canadian healthcare. Hence, we recommend the creation of a national health emergency preparedness system which includes legislated standards and a national training centre to ensure Canadian healthcare is bolstered against future disasters including pandemics.

۱٫ Introduction

۱Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) was declared a pandemic by the World Health Organization (WHO) in March 2020 [1] and as of April 2021, has infected over 132 million and claimed more than 2 million lives [2]. As of May 2021 Canada has 1,305,770 cases with 64,802 hospitalizations and 24,766 deaths [3]. Prior to the COVID pandemic the Canadian Health System was already under immense pressure to provide equitable access to coordinated care, notably specialist and elective surgical services [4]. As news coming out of China became more difficult to ignore and cases were detected internationally in early 2020, public health entities and epidemiological experts within Canada started sounding the alarm. In healthcare organizations preparedness activities intensified as cases appeared in the Toronto area.

Evidence soon showed widespread community transmission within most Canadian provinces. As a result, efforts related to planning and preparedness quickly shifted to response with case counts rising rapidly. By March 22nd all Canadian provinces and territories had declared states of emergency [5]. Provincial health systems struggled to provide consistent guidance to health providers and services were constricted to focus efforts on building capacity for anticipated COVID-19 patients. Canada’s ability to mount a coordinated and standardized response to national health crisis suffers from untested emergency management plans and struggles over jurisdictional issues [6,7]. As a result, many healthcare organizations in Canada remain chronically un-prepared for potential disasters, including global pandemics [8]. While evidence for the impact of COVID-19 on hospital services and operations, including switching to virtual care delivery models, are beginning to emerge [9], what remains unclear is just how effective, and wide-spread, were emergency preparedness activities undertaken by healthcare organizations in the response to COVID-19.