Adapting to a Public Health Crisis

From patient outcomes to personal health and safety, learn how healthcare professionals can prepare for a public health crisis, what they can do to adapt, and where they can find support.

MEET THE EXPERTS

Terri Bogue
Terri Bogue

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Terri Bogue began her career in nursing more than 30 years ago and has practiced in both bedside and leadership positions. Terri’s expertise centers around the prevention and reduction of healthcare-associated infections (HAIs). Her experience as a Clinical Nurse Specialist implementing quality improvement projects has provided a unique systems approach to her work. Terri is an accomplished speaker and author on topics related to the impact, prevention, and reduction of HAIs and inter-professional practices, and shares her knowledge in an engaging and encouraging manner. A consultant to hospitals and healthcare systems, Terri provides support related to practice standards and the development of solutions to HAI prevention challenges. She is the co-author of the SHRM published book, Extinguish Burnout, A Practical Guide to Prevention and Recovery.

Bob Schmidt
Bob Schmidt

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Robert W. Schmidt, LPC, is a licensed professional counselor who lives and practices in Sandy Hook, Connecticut. He taught in the Counselor Education Department at Fairfield University for ten years and served as president of the Connecticut Counseling Association, as well as the Connecticut Association for Counselor Education and Supervision. Bob is currently the chair of the Newtown Sandy Hook Community Foundation’s Distribution Committee. Bob and co-author, Sharon Cohen, work to inform the public and healthcare workers about the importance of mental health during crises in their book, Disaster Mental Health and Community Planning.

On This Page

In the face of natural disasters, pandemics, and other devastating emergencies, the public turns to our healthcare professionals for help and support. These healthcare workers selflessly do all they can ensure our health and safety, even during the most disastrous events. However, public health emergencies can overwhelm outpatient facilities, emergency departments, hospitals, and ICUs, leading to critical shortages of staff, space, and supplies. This can seriously impact patient care, and can put healthcare workers at risk, as well.

While patient care may be a top priority for healthcare workers, it’s just as important that these professionals care for themselves during these times of increased stress. The physical and emotional toll of long hours with few breaks can be immense, and when a healthcare worker experiences fatigue, it can jeopardize the health and safety of themselves and their patients.

This guide doesn’t replace the medical advice of a doctor, but it does offer tips healthcare workers can use to prepare for public health emergencies, and ways to cope both during and after a public health crisis. From expert advice and resources to coping strategies and personal health pointers, keep reading to learn how you can prepare for and adapt to a public health crisis as a healthcare worker.

help

If you’re a healthcare worker or anyone in crisis, you can get help and support now. Call the Lifeline at any time to speak to someone. For confidential support available 24/7 for everyone in the U.S., call 1-800-273-8255. You can also visit the Lifeline website for immediate help.

What Is a Public Health Crisis?

Declaring a public health emergency (PHE) allows state governments more flexibility to address crises that threaten public wellbeing. According to the World Health Organization, a public health emergency may be declared when a pandemic or epidemic disease; illness or health condition caused by bioterrorism; or novel and fatal infection or toxin occurs or poses an imminent threat to a large number of people.

Public health emergencies fall into different categories, some of which can be foreseen and others which happen unexpectedly. In either case, early preparation can go a long way in curbing worker stress and providing effective care to patients. Below are some events that would constitute a public health crisis.

Disease Outbreak

Pandemics and epidemics

Outbreaks such as Ebola or coronavirus are considered public health emergencies because of their wide-reaching effect on populations and their ability to spread easily from person-to-person.

Foodborne outbreaks

Foodborne diseases are considered to be outbreaks when two or more people experience similar illness symptoms from the ingestion of a common food.  Outbreaks like E. coli or botulism may  be cause for a public health emergency declaration depending on the number of people effected.

Common damaging conditions

Conditions like dementia can also be considered public health emergencies. Even though dementia doesn’t spread, it’s a common condition without a cure and its effects are permanent.

Human Caused Disaster

Bioterrorism

Bioterrorism events, for example, when people purposely spread deadly diseases like anthrax, is an unpredictable public health emergency. Officials can look to past examples of bioterrorism threats to prepare for possible threats in the future.

Chemical emergencies

A chemical emergency occurs when a hazardous chemical is released, and the release has the potential for harming the public’s health. These events can be unintentional, as in the case of an industrial accident, or intentional, as in the case of a terrorist attack.

Radiation emergencies

Similar to chemical emergencies, radiation emergencies may be intentional (e.g., caused by a terrorist) or unintentional, as in the case of a nuclear explosion and require immediate response.

Fires

Whether intentional or accidental, fires can start small but quickly get out of control, creating a public health crisis where people lose their housing and experience injury and respiratory issues.

Natural Disaster

Hurricanes, earthquakes, & wildfires

These devastating natural events aren’t usually public health emergencies on their own. However, they can and often do lead to public health emergencies, like mass injury or increased health risk from infrastructure damage.

How Can Facilities Plan for a Public Health Crisis?

Facilities need to prepare as best they can for PHEs (public health emergencies) in order to protect patients and healthcare workers. Considering their surge capacities is an impactful step healthcare facilities can take to increase emergency preparedness. Surge capacity refers to a health care system’s ability to “quickly expand beyond normal services to meet the increased demand for medical care in the event of bioterrorism or other large-scale PHE,” according to the Agency for Healthcare Research and Quality (AHRQ).

Surge capacity is comprised of four elements, known as The Four S’s

  • 1 Staff
  • 2 Stuff
  • 3 Structure
  • 4 Systems

Staff and systems are typically the weak points of healthcare facility emergency preparedness. By using the Centers for Disease Control (CDC) surge capacity projections, regions and individual hospitals can see where they stand and make preparations accordingly.

In localized PHEs, facilities can borrow healthcare staff and supplies from other states or regions. In national emergencies, however, demand for resources is widespread and sharing is often not an option. In these situations, facilities and governments should collaborate with each other to find the best way to ethically allocate resources in order to do the greatest good for the greatest number of people. Considering and writing up frameworks for emergency systems before a national PHE can help facilities move quickly and distribute resources in an organized, streamlined way in the face of a crisis.

Healthcare leaders can do additional worst-case projections and preparation, which can include creating protocols and procedures, sourcing emergency supplies and developing specific, actionable plans to reduce mortality among patients and provide support to staff. Although it’s sometimes hard to foresee and plan for resource shortages, getting familiar with ways to conserve and reuse supplies, make appropriate substitutions or adapt to providing care without them can help facilities and workers feel more prepared for worst-case situations.

5 Principles to Caring for Patients During a Health Crisis

1

Fairness

When it comes to fairness in a health crisis, equity must be taken into account. Groups that are vulnerable before a crisis are likely to be extra vulnerable during one. Fairness entails creating care protocols that alleviate the “burden of disaster” for vulnerable groups. Stemming disparities in care access should tend to the vulnerable while benefiting a community as a whole.

2

Transparency

Including communities in the development of emergency health care policies and communicating plans clearly to communities during an event are key components of PHE transparency. Candor about treatment options and resource limitations during an emergency are also important.

3

Consistency

Treating different groups alike is at the core of consistency. Allocating resources and providing care fairly between facilities in the same region is relatively straightforward, but in national emergencies, consistency is more difficult. Success requires flexibility and careful, purposeful early planning, since maintaining consistency between state and local governments can clash with communities’ capacity for care and the values behind their emergency policies.

4

Proportionality

Health emergencies often come with stressful and challenging lifestyle changes for everyone, so it’s important that disaster policies and procedures are appropriate in scale for a given emergency. The burdens placed on people’s personal and professional lives should be essential to public safety and appropriate for the crisis.

5

Accountability

Accountability factors into all aspects of health crisis planning and response and includes knowing and following through with your responsibilities, maintaining situational awareness and helping other people and groups know who is responsible for different aspects of planning and response. Healthcare professionals, facilities and government entities must be accountable to their respective communities and the public in establishing policy, providing care, communicating candidly and disseminating information on resources and the disaster itself.

Staying Safe as a Healthcare Worker

Taking care of yourself is essential if you hope to take care of others. Especially in moments of crisis, healthcare professionals need to make sure to keep their physical and mental health in good standing.

Below are some of the ways healthcare professionals can prepare both their minds and bodies for sudden crisis.

How Healthcare Workers Can Prepare in Advance

While healthcare workers can’t always foresee public health emergencies, they can take proactive steps before a crisis to help them take care when the unexpected occurs. Getting into healthy routines and putting safeguards in place beforehand can keep healthcare workers from having to scramble for support while dealing with the stress and uncertainty crisis can bring. Here are some tips for preparing in advance.

Mental preparation:

  • Get familiar with emergency response protocol.
  • Establish a relationship with a counselor or therapist.
  • Make a self-care toolkit.
  • Engage in a hobby.
  • Ask your employer to establish or promote mental health workshops and incentives, like resilience training.

Physical preparation:

  • Have an exercise routine. Making a backup routine that you can do at home, on the road, between shifts, or in quarantine may be a good idea as well. You don’t want your physical health to decline because you only know how to work out in a gym.
  • Maintain a healthy diet. Plan for days that are high in stress and short on time by getting familiar with healthy, portable meal prep options.
  • Establish and keep a regular sleep schedule. This benefits mental health, too.
  • See a physician regularly and make sure you will be able to access any medication you need during a PHE.

Tips on Dealing with Stress During an Emergency  

Identifying signs of stress is an important part of being able to effectively cope with it. In times of crisis, healthcare workers may experience physical stress symptoms, like heart palpitations, gastrointestinal upset and dizziness.

The mental impacts of stress can be just as varied and significant. Anger outbursts, guilt, hypervigilance, debilitating or irrational fear, grief, panic or anxiety attacks, insomnia, poor concentration, and depression symptoms like hopelessness, sadness, and crying are all signs of stress healthcare workers should look out for in themselves and their coworkers.

While they won’t get rid of the stressful and emotionally taxing situations healthcare workers face in times of crisis, these coping techniques can help alleviate stress and its symptoms.

  • Work in teams 
    Keeping alone-time to a minimum while working in stressful conditions can help stave off depression and other overwhelming emotions. It’s important to be around people who can empathize, share coping techniques, and monitor your health and workload.
  • Talk to others
    Share your experiences and feelings. If you’re quarantined, call or video chat with people to reduce feelings of isolation.
  • Journal, write, or vlog 
    These are excellent, and often therapeutic, ways to process feelings, document experiences and share insights with others while keeping safe by staying physically isolated.
  • Practice breathing and relaxation 
    Having some meditation and breathing techniques on hand can help you stabilize when emotions are high.
  • Seek counseling 
    If you’re having a hard time managing stress, talk to a counselor. Telemedicine may be a good option during PHEs.
  • Take breaks 
    During emergencies, healthcare workers sometimes feel that taking breaks is selfish or just not possible. However, they’re incredibly important for good mental and physical health, and effective patient care as a result.
  • Take care of physical needs 
    Eat and rest well, and squeeze in some gratifying exercise. Scale back your workload if you’re getting sick.
  • Stay informed
    Keeping on top of what’s going on can reduce stress and provide a nugget of empowerment and agency in chaotic situations.
  • Use your care toolkit 
    Utilize pre-planned coping and self-care tools, like books, baths, your favorite snack and phone calls with a good friend or a therapist.
Identifying Burnout

Identifying Burnout

In January 2019, four leading healthcare organizations declared physician burnout a public health crisis in its own right. While burnout, a condition characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment, develops over time, PHEs may exacerbate or spur burnout symptoms in healthcare workers.

Burnout is caused by working with people who are troubled, putting frontline healthcare providers at high risk of experiencing it. As many as half the country’s doctors and nurses experience burnout, according to a 2019 report from the National Academy of Medicine.

Identifying Burnout

During PHEs in particular, healthcare providers should also be aware of the risk of developing secondary traumatic stress (STS). Unlike burnout, STS can develop suddenly. STS stems from exposure to other people’s trauma rather than experiencing trauma firsthand. For instance, healthcare professionals who work with large numbers of hurricane victims or people affected by infectious disease, like COVID-19, would be at risk of developing STS.

Those with STS may experience stress symptoms, nightmares, and excessive worry. They may feel on high alert and may take on other people’s traumas as their own.

If you’re experiencing STS or burnout, talk to a counselor or therapist for advice. These conditions can be helped, and it’s important to address them, for the sake of your health and your patients’ health alike.

FAQ: Coping in the Aftermath

How do I know if I have PTSD?

Public health emergencies can be traumatic and lead to PTSD. As many as one in four nurses experience PTSD at some point in their careers, so it’s a definite possibility. PTSD can come from experiencing trauma firsthand or witnessing others’ trauma. Signs of PTSD include flashbacks, nightmares, high stress, anxiety and intrusive or uncontrollable thoughts about the event.

What is moral injury? Can healthcare professionals experience it?

Moral injury–when people have to commit acts that go against their ethics–is typically associated with veterans, but healthcare workers can and do experience moral injury, too. For instance, healthcare workers who have to decide who gets treatment and who does not in times of limited resources could experience moral injury. Moral injury can be mistaken for PTSD or burnout, but the treatment is different and unique to the condition.

Should I seek professional help?

If you’re questioning whether or not to seek help, it couldn’t hurt. If you think you may be experiencing burnout, secondary traumatic stress, PTSD, moral injury, or you need help processing the events and emotions of a public health crisis, talk to a therapist or counselor. They can provide you with more guidance.

Where can I find help?

How do I adjust back to normal life after a public health emergency?

Expert Q&A

Terri Bogue

Terri Bogue

Bob Schmidt

Bob Schmidt

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Q: What can facilities or workers do to address preparedness weaknesses when they don’t have resources or funding necessary to accommodate their surge capacities or address other points of concern?

Terri Bogue: In the face of a public health emergency, it’s almost impossible to make up for weaknesses in preparedness. We have to work with other facilities and departments of health to find ways to provide the care we need to provide. This is not the time to try to manage it all alone. Work with your community and partners to be able to do what needs done now. Take notes along the way so that you can learn from the difficulties and improve your preparedness plans for the future.

Q: What is the biggest challenge healthcare professionals face in terms of maintaining their own wellness during a public health emergency?

Terri Bogue: During a public health emergency, one of the biggest challenges healthcare professionals face is balancing their desire to support their teams and their need for rest and self-care. The need for them to be at work is immense and they realize that their presence makes a big impact. Saying no to the extra shift when there are so few people to care for the patients never feels comfortable. Setting boundaries to help keep you healthy both physically and mentally is necessary. We talk about not being able to give what you don’t have, but somehow this doesn’t feel like it should apply to us in a public health emergency. Setting a boundary to change the belief that self-care is essential and not indulgent is difficult and frequently not comfortable.

Bob Schmidt: Healthcare workers are facing several challenges right now in light of the epidemic. The most significant one is that every day they are in danger of contracting the [COVID-19] virus at work. Next is the concern that they could unknowingly pass it on to family members they live with.  Facing that threat daily and the physical exhaustion they deal with is like a soldier fighting on the front lines of a war. Over time, like the soldiers, the healthcare workers are at risk for developing anxiety disorders and PTSD.

Q: If you could suggest one prep, coping, or adapting tool that healthcare workers should keep in their crisis response toolkit, what would it be?

Terri Bogue: In Extinguish Burnout, we talk about maintaining your personal agency, or your ability to get things done. We know that support, results, and self-care fill our personal agency, and demands drain our personal agency. The demands during a crisis are going to be excessive, so we need to recognize we have to take the extra moments to first look at our results. We are seeing more and more patients with less supplies and staff, so taking a moment to recognize you are doing a good job and having positive impact, even if it doesn’t look like the care we typically provide.  Support during a crisis is frequently seen, but it is harder to recognize when you are working so hard. Make a conscious effort to look at the support you are receiving from your family, friends, colleagues and the community. Finally, self-care: self-care actually increases the capacity or volume of personal agency you can draw from. Take every moment you can to give back to yourself, even if it is a few deep and cleansing breaths in the bathroom. Prioritize caring for yourself.

Bob Schmidt: It’s essential that healthcare workers make time to rest their body and mind when they get home. Take long relaxing baths, have soft music playing in the home and don’t watch the news. There is one thing they can do at work on a short break and at home to relax the mind and all one needs is a cell phone and ear buds. Go to youtube.com and search for BioLateral Sound Healing by David Grand, PhD. David’s arrangements use music or nature sounds and mix them in a way that the sound gently sweeps from left to right (using the ear buds) and it calms the brain down. It has been shown to lower the stress level and can be used without earbuds to help someone get to sleep.

Q: How do response and adaptation techniques differ between different types of public health emergencies? For instance, what are some different considerations healthcare workers might take when dealing with a foreseeable crisis, like COVID-19, versus an unforeseeable one, like a mass shooting?

Bob Schmidt: After a mass shooting or a natural disaster there is a great deal of stress on the survivors and the people who lost loved ones, but the threat is gone. However, with the COVID-19 crisis, healthcare workers are still in eminent danger. It would be helpful if the healthcare workers were working on a schedule where they had four days on and three days off each week. They need the three days off to rest and recuperate. Right now, that is impossible to do, but when healthcare workers feel stressed, they should talk to a mental health professional who is trauma-informed. Most therapists now are set up to do Telebehavioral Health Sessions online. Therapists must use HIPAA approved sites, so the sessions are safe and confidential. Talking to someone who understands trauma will be helpful in keeping emotional balance.

Q: Signs that a healthcare worker needs help adapting to a crisis may be easier to recognize in others than in oneself. What can healthcare professionals do if they see that a coworker needs help, or what can friends and family of healthcare workers do to support their loved ones?

Terri Bogue: In healthcare we frequently do not want anyone to know we are struggling, even when everyone is struggling. We have the belief that we have to “hold it all together” and if we don’t, we are not good enough. We have to be willing to speak up and ask what we can do to help, and if that doesn’t work, a more direct approach may be necessary. There are times we do not know what we need, it may be we need someone to notice that we are working hard, or it may be we need someone to help us complete our work or watch our patient so we can eat or even go to the bathroom. Consider what you can give to someone and be willing to say, “Let me do this for you.” When we care for one another, we can grow and survive any experience.

Additional Resources

These resources can help healthcare workers and those who support them prepare for and cope with public health emergencies.

The American National Red Cross Ready Rating

This tool from the Red Cross grades facilities on their emergency preparedness, allowing them to see holes in their planning and adjust accordingly.

Centers for Disease Control and Prevention Mental Health Tools and Resources

Visitors can find a range of resources and tips on mental health, including advice aimed at healthcare professionals.

Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations 

This framework gives an in-depth look at ethical best practices in times of emergency.

Managing Healthcare Workers’ Stress Associated with the COVID-19 Virus Outbreak

This guide from the U.S. Department of Veterans Affairs gives detailed advice to healthcare workers on managing stress before, during and after the COVID-19 outbreak, but the advice can be applied to a wide range of PHEs.

Resilience Resources for Emergency Response

The U.S. Department of Labor offers a list of useful care and resilience tips for emergency responders.

SAMHSA Resources

The Substance Abuse and Mental Health Services Administration (SAMHSA) has a variety of resources to help healthcare and disaster response workers return to everyday life after a disaster.

Surge Toolkit and Facility Checklist

The Agency for Health Research and Quality offers a comprehensive toolkit and series of checklists to help facilities and healthcare workers prepare for emergencies.

Sustaining Yourself During the Coronavirus Crisis (PDF)

This tip sheet from the Harvard T.H. Chan School of Public Health is made up of self-care “microsteps” for PHE responders. It’s aimed at those responding to the COVID-19 outbreak but has advice that can be applied to a range of public health crises.