IDIS480 MidtermReport

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Intro In 2005, the catastrophic event of Hurricane Katrina devastated the community of New Orleans. The damage Katrina caused reflected the severity of the storm itself, as it struck land with up to 140mph winds, stretched 400 miles across the US gulf coast, and displaced approximately 2 million people (USDC, 2022). The level of destruction and chaos following Katrina created a glaring example of the critical importance of interprofessional collaboration in disaster response efforts (Robinson, et al., 2006). The American Red Cross (ARC) played a significant role in disaster response, providing critical assistance to the community of New Orleans. Within the organization, ARC implemented interprofessional teams composed of volunteers and staff from various disciplines to address the multifaceted needs of hurricane survivors. Natural disasters of Katrina’s magnitude provide an opportunity for reflection and analysis of interprofessional collaboration processes for the purpose of improving future projects and scenarios of a similar nature. In this critical analysis report, the interprofessional efforts of ARC’s response to Hurricane Katrina will be analyzed on a local level, within the context of the National Interprofessional Competency Framework (NICF) (2010) and the World Health Organization’s (WHO) (2010) Framework for Action on Interprofessional Education & Collaborative Practice. Contextualization of case study and IP teams ARC is a non-profit humanitarian organization that provides emergency relief, disaster response, and disaster preparedness education in the United States (ANRC, 2023). When incidents of national significance occur, the ARC serves as a direct service provider to disaster victims, providing services including feeding, sheltering, financial assistance, and emergency

first aid (GAO, 2006). Within New Orleans, many interprofessional teams were mobilized by the ARC, some of which included shelter teams, medical, mental health, finance, and communications teams. These teams each had their own targets yet shared the common goal of providing effective disaster relief to displaced victims. Succeeding in this common goal required multiple interprofessional teams to work collaboratively on attending to the needs of individuals and families; a complex task made increasingly difficult by external factors. Working together to address the diverse needs of hurricane survivors, the interprofessional teams interacted with one another on a regular basis through various means, depending on the state of infrastructure, as response efforts progressed. Shelter teams, primarily responsible for managing temporary accommodation for affected individuals and families, worked closely with the finance team to govern and distribute resources and expenses related to refuge (Mattox, 2006). Medical teams partnered with shelter teams to identify individuals with healthcare needs, and worked collaboratively with mental health teams to ensure the psychological and emotional needs of survivors were met (Mattox, 2006). Logistics teams, striving to procure, stockpile, and allocate supplies communicated with medical and shelter teams to confirm that adequate equipment and resources were provided (Mattox, 2006). Financial teams bore the responsibility of managing and allocating funds throughout relief efforts, and their interaction with all teams was required to guarantee efficient use of resources (Mattox, 2006). Alongside these collaborative efforts, communication teams played a vital role in information flow between interprofessional teams and with external agencies and media to maintain clarity on the evolving situation, and to help ARC’s efforts to reunite families. Regular stakeholder meetings, updates, and briefings helped to facilitate the exchange of information between teams as the situation unfolded. These efforts empowered interprofessional teams to adjust their efforts as required.

Application of IP frameworks The NICF highlights specific domains of competency which empower successful interprofessional collaboration, including patient/family-centered care, role clarification, and interprofessional communication (CIHC, 2010). Unsurprisingly, ARC’s response excelled in some of these domains and fell short in others due to the chaotic nature of the natural disaster. For example, while response teams excelled in patient-centered care, listening respectfully to the expressed needs of individuals and families to help shape the care and services provided, teams struggled with role clarification (CIHC, 2010). Dr. Hilarie H. Cranmer spoke on this aspect saying that many self-deployed volunteers found themselves “sitting on their hands, doing nothing for which they had been trained” due to a “lack of clearly assigned roles within a properly planned framework (Cranmer, 2005). Additionally, “many volunteers were employed in unusual roles”, or “were asked to work with populations they were not accustomed to”, creating opportunities for role confusion (Slepski, 2007). The NICF competency of interprofessional communication is imperative to the success of relief efforts, and though ARC’s interprofessional teams worked to communicate with each other in a collaborative, responsive and responsible manner (CIHC, 2010), post-relief, the resounding narrative is that the interprofessional teams within ARC failed to adequately meet this competency. An example of this in action comes from the organization’s own initiative debrief which outlines that interprofessional teams’ “communication failures, [specifically] with minority populations” lead to complaints against the organization (ARC, 2006). These failures kept teams from actively listening to team members, including patients/clients/families, ensuring common understanding of care decisions and, ultimately, developing trusting relationships with patients/clients/families and other team members (CIHC, 2010).

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The Framework for Action on Interprofessional Education and Collaborative Practice (FAIECP) is a framework tool created by the World Health Organization (WHO) which aims to move health systems from states of fragmentation to positions of strength, where health workers are well equipped to participate in a collaborative, practice-ready work force (WHO, 2010). The WHO (2010) explains that “Interprofessional education (IE) occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes”. IE is also discussed by the WHO as “a necessary step in preparing a ‘collaborative, practice-ready' health workforce that is better prepared to respond to local health needs” (WHO, 2010). In the context of this framework, ARC’s Katrina response in New Orleans is found to be significantly lacking in adequate IE, with no information available outlining IE efforts within the organization prior to, during, or after this natural disaster. While the organization is esteemed for emergency response education of professionals, volunteers, and the public, there appears to have been no education between the interprofessional teams operating in New Orleans in 2005 (ARC, 2006). While this is understandable, given the extending circumstances of a natural disaster of this magnitude, this reality actively shaped the collaborative practice of interprofessional teams within ARC’s disaster response in that it disempowered the team’s ability to show up as a practice-ready workforce (WHO, 2010). Gaps in collaborative efforts due to lack of IE often result in significant loss of life and property during natural disasters (Mackintosh & Mcclure, 2011). Ultimately, while ARC’s losses are not the focus of this analysis, their existence (Delisi, 2006) exemplifies that the New Orleans Katrina response could have significantly benefitted from implementing IE values defined in the FAIECP (WHO, 2010).

Evaluation and explanation of interprofessional teamwork Throughout the community of New Orleans, interprofessional teams of ARC experienced success in terms of ultimately achieving their common goal, providing food, shelter, and medical care to thousands of people. Some of the processes which helped to move interprofessional teams forward during this time included standard operating procedures (SOPs), the Incident Command System (ICS), and situational awareness. ARC has established SOPs that outline the roles and responsibilities of various team members. The CIHC explains that role clarification is essential to interprofessional collaborative practice (ICP) as the determination of who has the knowledge and skills needed to address patient needs is essential to individuals working to their full scope of practice (CIHC, 2010). Examples of ARC SOPs include the procedures for evacuating to a safe haven, and flood safety rules (IFRC, 2021). These SOPs provide a clear framework for how teams should operate during disaster responses and were well employed in this situation in helping ARC reunite families and uphold best safety practices (CPSI, 2009). Similarly, ARC often uses the ICS, which is a standardized system for emergency response management. The system aids in coordination by establishing clear roles, and a hierarchal decision-making structure, which is essential for managing safety risks in ICP (CPSI, 2009). Finally, maintaining situational awareness was crucial to interprofessional teams in their response efforts. Using situational awareness, ARC monitored evacuee numbers, needs, and shelter conditions to help make accurate resource allocation and volunteer deployment decisions. Keeping the “big picture” in mind while working collaboratively helped to ensure that stakeholders were “prepared to think ahead, discuss contingencies, and plan for readiness to act safely” in their efforts (Brander, 2023).

The successes and failures of ARC’s 2005 disaster response in New Orleans were a recipe made up by the ingredients of contextual factors, organizational structures, communication protocols, and resources constraints. Leading up to Katrina, systemic factors in New Orleans such as infrastructure vulnerabilities, which led to the levee collapse that flooded the community; population growth, which taxed damaged communication lines, shelter and aid distribution systems; and poor local disaster response policies, set the stage for the catastrophe that locals experienced. The magnitude of hurricane damage to key shelter, transportation, and communications infrastructure deeply impacted the availability of vital resources and the effectiveness of response initiatives, hindering the ability of ARC interprofessional teams to effectively accomplish disaster relief goals. Interprofessional teams within ARC faced significant challenges that threatened their organizational structures and communication protocols. Shortages in communication equipment such as satellite phones, cell phones, and radios all but prohibited communication between teams (ARC, 2006). Additionally, resource shortages extended to volunteer pools, leaving the organization with fewer trained volunteers than usual. In a post-Katrina survey of shelter staff preparedness, it was found that “less than one-third of shelter health staff had public health training, and only 55% had received public health training specific to managing the health needs of evacuees”(Brahmbhatt, et al., 2009). Future IP teamwork While one can only hope that a tragedy of Hurricane Katrina’s magnitude never occurs again, it is important to analyze, plan, and improve for future hurricane scenarios. Key aspects which could have improved ARC’s Katrina response in New Orleans include the implementation of interprofessional education programs for professional staff and volunteers, as well as the institution of IE training protocols for emergent volunteers. As outlined in the FAIECP , “IE

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provides health workers with the kind of skills needed to coordinate the delivery of care when emergency situations arise”, such as gaps in food, water, and medical supplies (WHO, 2010). Providing interprofessional teams, such as the shelter and mental health teams, with the opportunity to learn about, from, and with each other would enable effective collaboration and improve emergency response outcomes (WHO, 2010). Additionally, the institution of interprofessional communication and role clarification protocols, established through a framework like the NICF, would significantly improve ARC’s ability to provide patient or client-centered care and preform their roles in a culturally respectful way (CIHC, 2010). Educating interprofessional teams on communication techniques for active listening of team members, clarifying for common understanding and working to develop trusting relationships with individuals they are providing care to, as well as other team members, could help to close this gap in care (CIHC, 2010). Conclusion The disaster response effort of ARC in New Orleans was one of great success and significant failure, as interprofessional teams within the community struggled to work collaboratively in unprecedented circumstances. While teams mobilized to provide thousands with necessary care, interprofessional competencies of role clarification and communication fell short, largely due to a lack of adequate interprofessional education. The implications of these shortcomings, not just on interprofessional teams within ARC, but also within other organizations which operate on a local level, are significant. The value of preparing for disaster through IE, as well as the structures which enabled ARC’s quality patient-centered care can be carried forward to inform future disaster response strategies. This analysis reveals the importance of interprofessional teamwork in disaster response and serves as a reminder to invest in preparation of protocols and

trainings. In conclusion, policy makers and disaster response organizations should be encouraged to implement recommended changes and empower stakeholders to embrace best practices for interprofessional collaboration in disaster relief. References American Red Cross. (n.d.). About Us. Retrieved from https://www.redcross.org/about-us.html American Red Cross. (2006). From challenge to action: - American Red Cross. Retrieved from https://www.redcross.org/content/dam/redcross/atg/PDF_s/Publications/Annual_Reports/ ChallengeToAction.pdf Brahmbhatt, D., Chan, J. L., Hsu, E. B., Mowafi, H., Kirsch, T. D., Quereshi, A., & Greenough, P. G. (2009). Public health preparedness of post-Katrina and Rita shelter health staff. Prehospital and Disaster Medicine, 24(6), 500–505. https://doi.org/10.1017/s1049023x00007408

Brander, R. (2023). Communication Strategies for Safe Work. I n Interprofessional approaches to healthcare (IDIS 480) , Module 5. Canada: Queen’s University Canadian Interprofessional Health Collaborative (CIHC). (2010). A National Interprofessional Competency Framework. Vancouver, British Columbia: CIHC. Canadian Patient Safety Institute (CPSI). (2009). The safety competencies: Enhancing patient safety across the health professions. Ottawa, Ontario: CPSI. Cranmer, H. H. (2005). Hurricane Katrina. Volunteer work--logistics first. The New England Journal of Medicine, 353(15), 1541–1544. https://doi.org/10.1056/NEJMp058234 Delisi, L. E. (2006). The Katrina disaster and its lessons. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 5(1), 3–4. IFRC. (2021). Standard Operating Procedures for disasters and emergencies in schools: IFRC. International Federation of Red Cross and Red Crescent Societies. Retrieved from https://www.ifrc.org/document/standard-operating-procedures-disasters-and- emergencies-schools Mackintosh, S., & McClure, D. (2011). (A157) Interprofessional Education as a Vehicle to Instill Teamwork Mentality for Disaster Preparedness and Response in Healthcare Professional Students. Prehospital and Disaster Medicine, 26(S1), S45-S45. doi:10.1017/S1049023X11001555 Mattox, K. L. (2006). Hurricanes Katrina and Rita: role of individuals and collaborative networks in mobilizing/coordinating societal and professional resources for major

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disasters. Critical Care (London, England), 10(1), 205. https://doi.org/10.1186/cc3942 Robinson, S. E., Berrett, B., & Stone, K. (2006). The Development of Collaboration of Response to Hurricane Katrina in the Dallas Area. Public Works Management & Policy, 10(4), 315- 327. https://doi.org/10.1177/1087724X06289053 Slepski, L. (2007). Emergency preparedness and professional competency among health care providers during Hurricanes Katrina and Rita: Pilot study results. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1540248707001009 U.S. Department of Commerce. (2022). Hurricane Katrina - August 2005. National Weather Service. Retrieved from https://www.weather.gov/mob/katrina#:~:text=In %20addition%2C%20Katrina%20is%20one,un%2Dadjusted%202005%20dollars). U.S. Government Accountability Office (U.S. GAO). (2006). Hurricanes Katrina and Rita: Coordination between FEMA and the Red Cross should be improved for the 2006 hurricane season. Retrieved from https://www.gao.gov/products/gao-06-712 World Health Organization (WHO). (2010). Framework for Action on Interprofessional Education & Collaborative Practice. Geneva, Switzerland; WHO.

IDIS480 MidtermReport

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