Patient Factors

Optimizing patient wellness is an important role for GPs in the prevention stage.^{Reference Burns, Douglas and Hu29} During the preparedness stage, PHCPs can assist in building individual resilience through the maintenance of health and environmentally sustainable lifestyles,^{Reference Ziegler, Morelli and Fawibe30,Reference Purcell and McGirr31} motivating patients to prepare, and conducting disaster assessments.^{Reference Aisbett, Phillips, Sargeant, Gilbert and Nichols32-Reference Killian, Moon, McNeill, Garrison and Moxley34} Discussing preparedness strategies may result in better patient outcomes, particularly for those who are at risk of isolation or adverse health effects during an extreme event, such as the elderly or patients with chronic medical conditions.^{Reference Wyte-Lake, Claver and Dobalian35} General practitioners utilize a “person-focused care” approach across their patient’s visits rather than disease-specific appointments; patient education and health literacy in a disaster context can be integrated as part of the continuity of care model.^{Reference Starfield36} Social workers and occupational therapists in rural and remote areas are in close communication with GPs and can work with clients to individually prepare for unexpected events as well as provide assistance during the disaster itself.^{Reference Wyte-Lake, Claver and Dobalian35} Follow-up on patients after the disaster is the epitome of PHC,^{Reference Burns, Douglas and Hu29,Reference Sartore, Kelly and Stain37} and social workers,^{Reference Kanter, Abramson, Redlener and Gracy38,Reference Howard, Agllias, Bevis and Blakemore39} psychologists,^{Reference Ginexi, Weihs and Simmens40} and other PHCPs play a vital role in assisting patients with accessing support post-disaster, especially as the recovery stage is often prolonged.^{Reference Ziegler, Morelli and Fawibe30,Reference Osofsky, Osofsky, Wells and Weems41}

Organizational Factors

As accepted leaders within their area, PHCPs can coordinate disaster preparedness for both their local community/committee and their PHC organization^{Reference Claver, Wyte-Lake and Dobalian33,Reference Shelton and Foster42} through training other health care staff, participating in disaster planning drills and meetings,^{Reference Claver, Wyte-Lake and Dobalian33} and coordinating leadership roles.^{Reference Rupp43-Reference Anikeeva, Braunack-Mayer and Street48} Family physicians and nurses can provide valuable insights for future disaster planning due to their knowledge of patient factors and medical needs within their community.^{Reference Purcell and McGirr31,Reference Anikeeva, Braunack-Mayer and Street48,Reference Lewis49} Sustaining the on-going delivery of day-to-day services of the PHC organization requires a delicate balance to cater for urgent appointments.^{Reference Ingram, Tinago and Estrada11,Reference Burns, Douglas and Hu29,Reference Hamer46,Reference Mackie and Lu50-Reference Charania and Tsuji52} Clinicians may need to undertake primary surveys in the setting of a disaster and medically manage patients at the clinic,^{Reference Rupp43,Reference Ammons, Moore, Pons, Moore, McCroskey and Cleveland44,Reference Hamer46,Reference Bushfires53-Reference Somers, Drinkwater and Torcello56} as well as coordinate evacuations or transfers to tertiary centers.^{Reference Ammons, Moore, Pons, Moore, McCroskey and Cleveland44,Reference Lewis49,Reference Moralejo, Russell and Porat54,Reference Somers55,57} On the other hand, temporarily providing routine hospital services in the clinic may be required,^{Reference Burns, Douglas and Hu29,Reference Moralejo, Russell and Porat54} as well as sharing clinic supplies with the rural hospital.^{Reference Moralejo, Russell and Porat54}

Specialized roles for a nurse practitioner can involve surge capacity planning, organizing intermediate care beds and home packages,^{Reference Day, Challen and Walter58} as well as alerting other health care staff of the disaster.^{Reference Claver, Wyte-Lake and Dobalian33} Nurses can also train community members to act as auxiliary staff to support the clinic during an event (eg, crowd control or security),^{Reference Charania and Tsuji52} staff temporary walk-in centers treating minor ailments/injuries,^{Reference Day, Challen and Walter58} and assist with essential housekeeping or administrative duties to keep the clinic running.^{Reference Kulig, Penz, Karunanayake, MacLeod, Jahner and Andrews45} The role of securing stocks, bolstering supplies, and use of personal protective equipment during the disaster is also of vital importance for PHCPs to ensure appropriate protection for self and family at home.^{Reference Ziegler, Morelli and Fawibe30,Reference Rupp43,Reference Hamer46,Reference Anikeeva, Braunack-Mayer and Street48-Reference Charania and Tsuji52,Reference Horvath, McKinnon and Roberts59-Reference Chmar, Ranney, Guay, Haden and Valachovic62}

Public Health Factors

Primary health care professionals have a significant role in pandemic surveillance by identifying patients at risk and reporting any potential outbreaks. A strong working relationship between PHCPs and the public health authorities in the preparedness stage can be an important predictor of an effective response,^{Reference Mackie and Lu50} and communication and coordination for this is an important role for doctors.^{Reference Rust, Melbourne, Truman, Daniels, Fry-Johnson and Curtin51,Reference Moore60,Reference Katcher, Bayou, Anderson and Davis61,Reference Hsu, Mas, Jacobson, Papenfuss, Nkhoma and Zoretic63} General practitioners play a crucial role in providing information to public health authorities, and the importance of collecting sentinel data during pandemics such as influenza have been discussed frequently in the literature.^{Reference Anikeeva, Braunack-Mayer and Street48,Reference Mackie and Lu50,Reference Rust, Melbourne, Truman, Daniels, Fry-Johnson and Curtin51,Reference Horvath, McKinnon and Roberts59,Reference Moore60,Reference Hsu, Mas, Jacobson, Papenfuss, Nkhoma and Zoretic63-Reference Morton, Birtwistle, Fumerton and Allison66} Dentists can also be involved in on-going monitoring of the spread of disease and any recurrence within their own patients, and can report to the relevant public health contact, as appropriate.^{Reference Chmar, Ranney, Guay, Haden and Valachovic62,Reference Bhoopathi, Mashabi, Scott and Mascarenhas67} General practitioners, nurses, and nurse practitioners can be tasked with communicating with government and non-governmental agencies as needed during a disaster.^{Reference Purcell and McGirr31,Reference Claver, Wyte-Lake and Dobalian33,Reference Bushfires53,Reference Somers, Drinkwater and Torcello56,57}

Psychological Factors

In the aftermath of disaster, physical wounds heal but emotional sequalae can endure, and it has been well-demonstrated in the literature that PHC doctors, nurses, and psychologists have significant roles in supporting mental health.^{Reference Ziegler, Morelli and Fawibe30,Reference Sartore, Kelly and Stain37,Reference Kanter, Abramson, Redlener and Gracy38,Reference Ginexi, Weihs and Simmens40,Reference Kulig, Penz, Karunanayake, MacLeod, Jahner and Andrews45,Reference Bushfires53} Providing mental health strategies as part of disaster planning helps prepare patients for these psychological impacts,^{Reference Ziegler, Morelli and Fawibe30} and it is valuable for medical and nursing staff, together with psychologists, to collaborate in order to provide a team-based approach for comprehensive patient care.^{Reference Sartore, Kelly and Stain37,Reference Kanter, Abramson, Redlener and Gracy38,Reference Ginexi, Weihs and Simmens40,Reference Osofsky, Osofsky, Wells and Weems41,Reference Kulig, Penz, Karunanayake, MacLeod, Jahner and Andrews45,Reference Bushfires53} Primary care professionals can provide mental health “first-aid”^{Reference Kanter, Abramson, Redlener and Gracy38} as well as conduct mental health evaluations and provide trauma-informed counseling.^{Reference Ziegler, Morelli and Fawibe30} Primary health care professionals are also in an ideal position to initiate mental health interventions at an early stage of concern.^{Reference Sartore, Kelly and Stain37} Due to latency of negative mental health impacts after an acute event, PHCPs can regularly “check in” with their patients by continuing to follow-up their on-going medical and mental health care within the community. This therefore allows patients to integrate into existing services using existing infrastructure as needed.

Specialized Roles

Dentists can assist in the forensic identification of victims, diagnosing possible bioterrorism infection in their own practice, and providing first aid.^{Reference Chmar, Ranney, Guay, Haden and Valachovic62,Reference Bhoopathi, Mashabi, Scott and Mascarenhas67} If online resources are down during the disaster, pharmacists can assist in treating decisions and medical management and can also create medication access points for patients if transport is difficult.^{Reference Moore and Kenworthy68} Specific roles for doctors include managing acute trauma,^{Reference Aisbett, Phillips, Sargeant, Gilbert and Nichols32,Reference Somers, Maxfield and Drinkwater47,Reference Somers, Drinkwater and Torcello56,57,Reference Katcher, Bayou, Anderson and Davis61} carrying emergency equipment as a first responder,^{Reference Somers, Drinkwater and Torcello56,57} being part of the field team,^{Reference Burns, Douglas and Hu29,57,Reference Tsao, Dobalian, Wiens, Gylys and Evans69} assisting the worried-well and being aware of somatic symptoms presenting during a disaster,^{Reference Tsao, Dobalian, Wiens, Gylys and Evans69} quarantining patients,^{Reference Anikeeva, Braunack-Mayer and Street48,Reference Mackie and Lu50,Reference Horvath, McKinnon and Roberts59,Reference Moore60,Reference Morton, Birtwistle, Fumerton and Allison66} home visiting,^{Reference Seale, Ward, Zwar, Van, Leask and Macintyre65} or utilizing telemedicine when necessary.^{Reference Osofsky, Osofsky, Wells and Weems41}

Figure 3 and Figure 4 illustrate that although some of the roles described are not typically fulfilled by certain PHCPs during day-to-day activities, when an unexpected event occurs, these are within their scope of practice. An example of this is in the case of pharmacists and dentists who can both provide assistance in the forms of mass vaccine administration and Basic Life Support.^{Reference Shelton and Foster42,Reference Chmar, Ranney, Guay, Haden and Valachovic62,Reference Bhoopathi, Mashabi, Scott and Mascarenhas67,Reference Moore and Kenworthy68} These non-traditional roles can be immensely useful during the critical phase of a disaster to take pressure off other medical and nursing professionals and is something to consider in health care organizations with extra training of staff members included as part of disaster planning and policy.

Figure 4.

Top Five Roles in Response Stage.

Abbreviations: GPs, general practitioners; PHCPs, primary health care professionals.