Emergency management in health: key issues and challenges in the UK

Abstract

BackgroundEmergency planning in the UK has grown considerably in recent years, galvanised by the threat of terrorism. However, deficiencies in NHS emergency planning were identified and the evidence-base that underpins it is questionable. Inconsistencies in terminologies and concepts also exist. Different models of emergency management exist internationally but the optimal system is unknown. This study examines the evidence-base and evidence requirements for emergency planning in the UK health context.MethodsThe study involved semi-structured interviews with key stakeholders and opinion leaders. Purposive sampling was used to obtain a breadth of views from various agencies involved in emergency planning and response. Interviews were then analysed using a grounded approach using standard framework analysis techniques.ResultsWe conducted 17 key informant interviews. Interviewees identified greater gaps in operational than technical aspects of emergency planning. Social and behavioural knowledge gaps were highlighted with regards to how individuals and organisations deal with risk and behave in emergencies. Evidence-based approaches to public engagement and for developing community resilience to disasters are lacking. Other gaps included how knowledge was developed and used. Conflicting views with regards to the optimal configuration and operation of the emergency management system were voiced.ConclusionsFour thematic categories for future research emerged:(i) Knowledge-base for emergency management: Further exploration is needed of how knowledge is acquired, valued, disseminated, adopted and retained.(ii) Social and behavioural issues: Greater understanding of how individuals approach risk and behave in emergencies is required.(iii) Organisational issues in emergencies: Several conflicting organisational issues were identified; value of planning versus plans, flexible versus standardized procedures, top-down versus bottom-up engagement, generic versus specific planning, and reactive versus proactive approaches to emergencies.(iv) Emergency management system: More study is required of system-wide issues relating to system configuration and operation, public engagement, and how emergency planning is assessed.

The evidence base of primary research in public health emergency preparedness: a scoping review and stakeholder consultation

“…This can be problematic in that outcomes and conclusions may not be generalizable to other populations, settings, exposures or interventions [12][13][14]. Public health in general aims to be informed by the best available evidence and there is an appetite to have more rigorous forms of evidence to inform PHEP practice [12,16,17].…”

Public perceptions and attitudes to biological risks: Saudi Arabia and regional perspectives

“…Perry and Lindell (2003) note that 'Emergency management that is not based on accurate knowledge of both the threat and principles of human response is destined to fail' (Perry and Lindell, 2003, p. 59). Several studies covering hazardous events-either natural or man-made-identify risk perception as a factor that may affect the willingness and motivation to implement precautionary behaviours, or to reduce the inherent risks linked to these events (de Zwart et al, 2009;Ho et al, 2008;Lee et al, 2012). Risk perception can also determine the response of individuals and communities to disasters (Howe, 2011).…”

Disaster management in low- and middle-income countries: scoping review of the evidence base

“…The traditional ‘gold standard’ for research methods (ie, randomised controlled trials) as applied to clinical research is inappropriate and impractical in this field,8 except perhaps in very specific areas (eg, brief psychological intervention for survivors). Usual research practice often requires almost an antithesis to an emergency response situation, that is, it typically requires time for planning and resources for carrying it out at a time when both may be in short supply.…”

“…While considerable emphasis has been placed on better planning for disasters, the evidence base for this is questionable particularly within the health sector 8. We have previously reported that the evidence base for health sector emergency planning in high-income countries (HICs), such as the UK, is patchy, not robust and inconsistent 8 9.…”

“…We have previously reported that the evidence base for health sector emergency planning in high-income countries (HICs), such as the UK, is patchy, not robust and inconsistent 8 9. Furthermore, others report a mismatch between disaster plans and what actually happens during disasters, observing that the use of the evidence base in disaster planning in healthcare is not always apparent 10 11.…”