Rachel Moyal-Smith DrPH, MS, PA-C (is Senior Clinical Implementation Specialist, Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston.), Daniel J. Barnett MD, MPH (is Professor, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore.), Eric S. Toner MD (is Senior Scientist, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health.), Jill A. Marsteller PhD, MPP (is Professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health.), Christina T. Yuan PhD, MPH (is Associate Scientist, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Please address correspondence to Rachel Moyal-Smith)
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引用次数: 0
Abstract
Background
Disasters exacerbate health inequities, with historically marginalized populations experiencing unjust differences in health care access and outcomes. Health systems plan and respond to disasters using the Hospital Incident Command System (HICS), an organizational structure that centralizes communication and decision-making. The HICS does not have an equity role or considerations built into its standard structure. The authors conducted a narrative review to identify and summarize approaches to embedding equity into the HICS.
Methods
The peer-reviewed (PubMed, SCOPUS) and gray literature was searched for articles from high-income countries that referenced the HICS or Incident Command System (ICS) and equity, disparities, or populations that experience inequities in disasters. The primary focus of the search strategy was health care, but the research also included governmental and public health system articles. Two authors used inductive thematic analysis to assess commonalities and refined the themes based on feedback from all authors.
Results
The database search identified 479 unique abstracts; 76 articles underwent full-text review, and 11 were included in the final analysis. The authors found 5 articles through cited reference searching and 13 from the gray literature search, which included websites, organizations, and non-indexed journal articles. Three themes from the articles were identified: including equity specialists in the HICS, modifying systems to promote equity, and sensitivity to the local community.
Conclusion
Several efforts to embed equity into the HICS and disaster preparedness and response were discovered. This review provides practical strategies health system leaders can include in their HICS and emergency preparedness plans to promote equity in their disaster response.
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