Secondary surge capacity: a framework for understanding long-term access to primary care for medically vulnerable populations in disaster recovery

Abstract

Disasters create a secondary surge in casualties because of the sudden increased need for long-term health care. Surging demands for medical care after a disaster place excess strain on an overtaxed health care system operating at maximum or reduced capacity. We have applied a health services use model to identify areas of vulnerability that perpetuate health disparities for at-risk populations seeking care after a disaster. We have proposed a framework to understand the role of the medical system in modifying the health impact of the secondary surge on vulnerable populations. Baseline assessment of existing needs and the anticipation of ballooning chronic health care needs following the acute response for at-risk populations are overlooked vulnerability gaps in national surge capacity plans.

FIGURE 1—

Conceptual model of the relationship among key study variables. Source. Adapted from Cwikel.

FIGURE 2—

Framework for understanding long-term primary care utilization for vulnerable populations in disaster recovery.

FIGURE 3—

Potential timeline scenarios for secondary surge of primary care need and health system capacity in postdisaster recovery, by (a) no change in primary care need during phase II; (b) increased demand for primary care exceeds pre-event capacity in the weeks and months following the disaster but returns to baseline a year after the disaster; (c) increased demand for primary care exceeds system capacity in the weeks, months, and years following the disaster and does not return to pre-event baseline; and (d) baseline health disparities, characterized by excess unmet primary care need exceeding maximum system capacity pre-event, perpetuate unmet primary care in long-term phase II disaster recovery. Source. Adapted from Barbish et al.