Risk Assessment as the Foundation of Healthcare Emergency Management: The Impact of Rural and Urban Differences in Factors Associated with Hazard and Vulnerability Analysis

Abstract

Problem Statement: Rural healthcare systems deliver care to almost twenty percent of Americans that live in rural areas. Rural hospitals and other healthcare partners experience resource-strained communities that inhibit their ability to respond and recover from large-scale emergencies most effectively. Aims: The quantitative aims for this project are to assess the similarities and differences in the overall probability, impact, and preparedness level of potential hazards between 1) rural and urban hospitals and 2) rural and urban healthcare communities. Aim 2 includes a sub-aim: to identify how impact scores and the level of preparedness change when analyzed from the rural perspective. The third, qualitative aim of the research is to explore perceived barriers and facilitators between rural and urban healthcare community hazard identification and interpretation. Aims 1 and 2 Outcome Measures: There are three outcome measures in the quantitative research for this project: self-rated level of impact to healthcare services and the patient population, self-rated level of preparedness, and overall hazard risk. Methods: For the quantitative aims, risk calculations were conducted with aggregated hazard and vulnerability data from the 2022 Arizona Coalition for Healthcare Emergency Response (AzCHER) cross-sectional survey (N=288) to compare rural and urban healthcare settings. Aim 1 Results: Rural hospitals identified communications failure, mass casualty for trauma, and wildfire as presenting the highest overall risk, while urban hospitals identified temperature extremes for heat, supply chain failure, and active threat as presenting the highest overall risk. Both rural and urban hospitals identified staffing shortage, pandemic, and cyberattack as high-risk hazards, however rural hospitals rated them lower than urban hospitals. Aim 2 Results: Both rural and urban healthcare communities identified staffing shortage, communications/telephone failure, pandemic, cyberattack, infectious disease outbreak, and supply chain failure as top hazards. However, rural healthcare communities rated communications/telephone failure and infectious disease outbreak higher than urban healthcare communities. Hazards unique to rural healthcare communities include floods/flash floods and wildfires. Hazards unique to urban healthcare communities include temperature extremes for heat and drought. Aim 3 Methods: For the qualitative aim, I conducted key informant interviews (N=10) to confirm results from Aim 2 and to provide additional insight into social vulnerabilities as applied to hazards. I used a grounded theoretical approach to content analysis and implemented both inductive and deductive coding. Results: The analysis provided additional explanation and areas for improvement among the highest risk hazards for rural and urban healthcare communities. Important thematic categories included social vulnerability themes, emerging themes, and themes based on Aim 2 results. This qualitative aim explores the perspectives of healthcare emergency management stakeholders including their attitudes, knowledge, and beliefs about the most important hazards and vulnerabilities and how healthcare risk assessment operates within a public health framework of preparing the environment to save more lives in the event of an emergency. Conclusion: Systematic healthcare risk assessments effectively summarize the highest risk hazards and vulnerabilities with important differences noted among rural and urban regions that can have greater implications for community-based emergency management. As the first step within the preparedness cycle, hazard risk assessment lays the foundation for policies, training and exercise schedules, and resource allocations. While this research provides detailed methods of a community-based tool for Arizona, there is no standardized format that can be applied nationally. The qualitative findings offer valuable insights to social vulnerabilities as applied to hazards that can benefit public health organizations and health advocacy groups as they undertake future endeavors in disaster preparedness and response in Arizona.