Disasters create a secondary surge in casualties due to the sudden increase in need for long-term healthcare within the disaster population. Surging demands for medical care in the months after a disaster place excess strain on an overtaxed health care system operating at maximum or reduced capacity. Amplified demand met by diminishing supply likely disrupts the provision of and access to routine health services in the months post-disaster. Health disparities within vulnerable disaster populations present before the disaster are often exacerbated by systematic differences in access to primary care after the disaster. The following article applies a leading health services use model to identify areas of vulnerability that perpetuate health disparities for at-risk populations seeking entry into a frayed health system recovering from a disaster. We propose a framework to understand the role of the medical system in modifying the health impact of the secondary surge on vulnerable populations. Baseline assessment of existing needs and the anticipation of ballooning chronic health care needs following the acute response for at-risk populations are vulnerability gaps currently overlooked in national surge capacity plans.

Context A disaster is indiscriminate in whom it affects. Limited research has shown that the poor and medically underserved, especially in rural areas, bear an inequitable amount of the burden. Objective To review the literature on the combined effects of a disaster and living in an area with existing health or health care disparities on a community’s health, access to health resources, and quality of life. Methods We performed a systematic literature review using the following search terms: disaster, health disparities, health care disparities, medically underserved, and rural. Our inclusion criteria were peer-reviewed, US studies that discussed the delayed or persistent health effects of disasters in medically underserved areas. Results There has been extensive research published on disasters, health disparities, health care disparities, and medically underserved populations individually, but not collectively. Conclusions The current literature does not capture the strain of health and health care disparities before and after a disaster in medically underserved communities. Future disaster studies and policies should account for differences in health profiles and access to care before and after a disaster.

Disasters serve as shocks and precipitate unanticipated disturbances to the health care system. Public health surveillance is generally focused on monitoring latent health and environmental exposure effects, rather than health system performance in response to these local shocks. The following intervention study sought to determine the long-term effects of the 2005 chlorine spill in Graniteville, South Carolina on primary care access for vulnerable populations. We used an interrupted time-series approach to model monthly visits for Ambulatory Care Sensitive Conditions, an indicator of unmet primary care need, to quantify the impact of the disaster on unmet primary care need in Medicaid beneficiaries. The results showed Medicaid beneficiaries in the directly impacted service area experienced improved access to primary care in the 24 months post-disaster. We provide evidence that a health system serving the medically underserved can prove resilient and display improved adaptive capacity under adverse circumstances (i.e., technological disasters) to ensure access to primary care for vulnerable sub-groups. The results suggests a new application for ambulatory care sensitive conditions as a population-based metric to advance anecdotal evidence of secondary surge and evaluate pre- and post-health system surge capacity following a disaster.

Objective In the aftermath of an Environmental Public Health Disaster (EPHD) a healthcare system may be the least equipped to respond. Preventable visits for ambulatory care sensitive conditions (ACSCs) may be used as a population-based indicator to monitor health system access post-disaster. The objective of this study was to examine whether ACSCs rates among vulnerable sub-populations are sensitive to the impact of a disaster. Methods We conducted a retrospective analysis using Poisson regression with generalized estimating equations to calculate change in monthly ACSC visits at the disaster site in the post-disaster period compared to the pre-disaster period after adjusting for parallel changes in two control groups. Results The adjusted rate of an ACSC hospital visit pre-disaster for the direct group was 1.68 times the rate for the primary control group (95% CI: 1.47, 1.93), while the adjusted ACSC hospital rate post-disaster for the direct group was 3.10 times the rate for the primary control group (95% CI: 1.97, 5.18). For emergency department ACSC visits, the adjusted rate among those directly affected pre-disaster were 1.82 times the rate for the primary control group (95% CI: 1.61, 2.08), while the adjusted ACSC rate post-disaster was 2.81 times the rate for the primary control group (95% CI: 1.92, 5.17). Conclusions Results revealed increased demand on the health system altered health services delivery for vulnerable populations directly impacted by the disaster. Preventable visits for ACSCs may advance meaningful use practice and public health surveillance by identifying and characterizing healthcare disparities during disaster recovery.