Practice Management

Weathering this storm and the next

Perspectives on disaster preparedness amid COVID-19


The COVID-19 pandemic has tested disaster preparedness in hospitals across the nation. The pandemic brought many unique disaster planning challenges not commonly seen with other emergencies disasters. These included an uncertain and prolonged time frame, the implementation of physical distancing, and the challenges of preserving the health care work force.

Dr. Teena Hadvani, Baylor College of Medicine, Houston

Dr. Teena Hadvani

But how do we prepare for the next disaster when the health care system and staff are already stretched thin? Here, we discuss the concept of maintaining a state of preparedness through and beyond COVID-19, using a disaster preparedness cycle – including continuous assessments of vulnerabilities, dynamic staffing adjustments to support patient and hospital needs, and broadening of the pandemic response to incorporate planning for the next disaster.

Dr. Uremovich is an assistant professor of pediatrics in the Section of Hospital Medicine at Baylor College of Medicine, Texas Children’s Hospital.

Dr. Vicki Uremovich

Disaster preparedness and assessing ongoing needs

Disaster preparedness cycle and Hazard Vulnerability Assessment

The disaster preparedness cycle illustrates that disaster preparedness is continuous. Disaster preparedness is achieved with the non-stop cycle of planning, coordinating, and recognizing vulnerable areas.1-5 Hazard vulnerability analysis (HVA) can play a critical role in recognizing areas in which a hospital system has strengths and weaknesses for different disaster scenarios. There are several tools available, but the overarching goal is to provide an objective and systematic approach to evaluate the potential damage and impact a disaster could have on the health care system and surrounding community.

Dr. Quinonez is an associate professor of pediatrics and chief of pediatric hospital medicine at Baylor College of Medicine, Texas Children’s Hospital

Dr. Ricardo Quinonez

The HVA can also be utilized to reassess system or personnel vulnerabilities that may have been exposed or highlighted during the pandemic.6,7 These vulnerabilities must be addressed during preparations for the next disaster while concurrently “assuming the incident happens at the worst possible time.”7

Disaster preparedness staffing considerations

Management, communication, and staffing issues are critical to disaster response. Key leadership responses during COVID-19 included providing frequent and transparent communication, down-staffing for physical distancing during low census, and prioritizing staff well-being. These measures serve as a strong foundation moving into preparations for the next disaster.8

Dr. Michelle A. Lopez, Baylor College of Medicine, Houston

Dr. Michelle A. Lopez

To ensure adequate staffing during an unexpected natural disaster, we recommend creating “ride-out” and “relief teams” as part of disaster staffing preparedness.9,10 The ride-out team provides the initial care and these providers are expected to stay in the hospital during the primary impact of the event. Once the initial threat of disaster is over and it is deemed safe to travel, the relief team is activated and offers reprieve to the ride-out team. Leaders and backup leaders within these teams should be identified in the event teams are activated. These assignments should be made at the start of the year and updated yearly or more frequently, if needed.

Dr. Brent Mothner, Baylor College of Medicine, Houston

Dr. Brent Mothner

While the COVID-19 pandemic did not significantly affect children, our ride-out and relief teams would have played a significant role in case a surge of pediatric cases had occurred.

Other considerations for disaster staffing include expanding backup coverage and for multisite groups, identifying site leads to help field specific questions or concerns. Lastly, understanding the staffing needs of the hospital during a disaster is vital – bidirectional communication between physicians and hospital leadership optimizes preparedness plans. These measures will help staff feel supported before, during, and after a disaster.


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