Hurricane Maria National Construction Safety Team Investigation: Characterization Of Deaths And Injuries (di) In Puerto Rico After Hurricane Maria Hospital Interviews

HOSPITAL ADMINISTRATION PERSONNEL INTERVIEW GUIDE

OMB Control # 0693-0078

Expiration Date 07/31/2022

A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995 unless the information collection has a currently valid OMB Control Number. The approved OMB Control Number for this information collection is 0693-0078. Without this approval, we could not conduct this survey/information collection. Public reporting for this information collection is estimated to be approximately 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. All responses to this information collection are voluntary. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the National Institute of Standards and Technology at: 100 Bureau Drive, Gaithersburg, MD 20899, Attn: Dr. Judith Mitrani-Reiser, Senior Research Scientist, Materials and Structural Systems Division, NIST Engineering Laboratory; or contact at [email protected].

First, we would like to confirm that you worked at NAME OF HOSPITAL on the day of Hurricane Maria’s landfall, as well as the two weeks after, that is, from September 20 to October 4, 2017. IF THE ANSWER IS NO, DO NOT COMPLETE THE INTERVIEW.

This project aims to identify the deaths associated, directly and indirectly, with Hurricane María, and the factors associated with attribution, considering the conditions during the two weeks immediately following landfall. We know that it has been almost five years, and it may be difficult to remember, so please answer the questions to the best of your ability to recall, based on your experience and knowledge. The information provided will assist in strengthening Puerto Rico’s hospital infrastructure.

The interview is divided into three main parts: 1) the conditions of the hospital before the impact of the hurricane, 2) the conditions of the hospital on the day of the landfall, and 3) the conditions of the hospital during the two weeks after landfall.

Thank you for signing the informed consent form. Do you have any questions or doubts before we begin?

We will now start the recording, as mentioned in the informed consent form.

PART I: INTRODUCTION

1. Please tell us your position, length of time you held the position and primary responsibilities at NAME OF HOSPITAL in the days prior to Hurricane Maria.

1a. Position

1b. Length of time at position

1c. Briefly explain your primary responsibilities

PART II: BEFORE HURRICANE MARIA LANDFALL

Remembering that Hurricane Maria’s landfall was September 20, 2017, we would like to start by understanding the hospital’s conditions approximately one month before that day. This is important given that, as you may remember, Hurricane Irma impacted Puerto Rico on September 7, 2017. Therefore, please consider this time frame in your answers.

2. In August of 2017, did your hospital have emergency plans for hazard events, such as, hurricanes? IF ANSWER IS NO, GO TO QUESTION 7.

3. Which plans did the hospital have in August of 2017 and who was responsible for their implementation? PROBE IF NECESARRY: all hazards emergency plan, continuity of operations plan, recovery operational plan, other?

4. When did you last participate in a formal training of the hospital’s emergency plans before September of 2017?

5. Please briefly explain any operational or infrastructure problems in the hospital that impacted direct patient care in August of 2017. IF ANSWER IS NONE, GO TO QUESTION 7.

6. How would you describe the impact these operational or infrastructure problems had on direct patient care?

7. Please briefly explain any impact that Hurricane Irma had on the operations or infrastructure of the hospital that could have compromised direct patient care.

PART III: DURING THE DAY OF HURRICANE MARIA LANDFALL

We understand that there might have been some physical and infrastructure damage to the hospital on the day of Hurricane Maria’s landfall. Therefore, we would like to understand how these conditions impacted direct patient care in the hospital during the day of Hurricane Maria’s landfall, that is on September 20, 2017.

8. Briefly tell us what happened in your hospital during the day of Hurricane Maria’s landfall focusing on its impact on direct patient care.

9. Did you have any concerns regarding the hospital's capability to continue to provide direct patient care? Please elaborate.

10. Briefly describe a specific difficult situation you encountered regarding direct patient care during that day.

PART IV: AFTER HURRRICANE MARIA LANDFALL

Again, we know that it has been almost five years, and it may be difficult to remember, however, we would like to better understand the conditions of patient care in the hospital during the two weeks after the Hurricane Maria’s landfall, meaning September 21 to October 4, 2017. Some of the questions will be asked by each week, that is week 1 meaning from September 21 to 27, 2017, while the second week is from September 28 to October 4, 2017.

11. Which of the following best describes the overall operational status of the facility during the first week after Hurricane Maria’s landfall, that is, September 21 to September 27, 2017?

11a. Fully operational

11b. Partially operational

11c. Forced to close

12. Please describe details for your answer, including changes in hospital functionality, if there were any during the first week after landfall.

13. Which of the following best describes the overall operational status of the facility during the second week after Hurricane Maria’s landfall, i.e., September 28 to October 4, 2017?

13a. Fully operational

13b. Partially operational

13c. Forced to close

14. Please describe details for your answer, including changes in hospital functionality, if there were any during the second week after landfall.

15. What were the overall consequences of Hurricane Maria on direct patient care during the two weeks after landfall, i.e., September 21 to October 4, 2017?

16. Please tell us of any situation you recall that might have disrupted patient care during these two weeks, for example, lack of electricity, lack of personnel, environmental factors, difficulty in obtaining supplies, bed availability, emotional impact, oxygen supply, patient conditions or complications, etc. IF ANSWER IS NONE, GO TO QUESTION 19.

17. By your criteria, how might those situations have contributed, directly or indirectly, to any patient death?

18. Can you provide a specific example of a situation with a patient?

19. During the two weeks after Hurricane Maria made landfall, did any of the hospital’s CLINICAL UNITS have any problems functioning in any way that could have compromised direct patient care? IF ANSWER IS NO, GO TO QUESTION 22.

20. Are you aware if any of those problems contributed directly or indirectly to any patients’ death? IF ANSWER IS NO, GO TO QUESTION 22.

21. Can you provide a specific example of a difficult situation in providing care which led directly or indirectly to a patient’s death?

22. During the two weeks after Hurricane Maria made landfall, did any of the hospital’s OPERATIONAL UNITS have any problems functioning in any way that could have compromised direct patient care? IF ANSWER IS NO, GO TO QUESTION 25.

23. Are you aware if any of those problems contributed directly or indirectly to any patients’ death? IF ANSWER IS NO, GO TO QUESTION 25.

24. Can you provide a specific example of a difficult situation in providing care which led directly or indirectly to a patient’s death?

25. During the two weeks after Hurricane Maria made landfall, were there patients you wanted to transfer to other hospitals because of the impact of Hurricane Maria on your hospital? IF ANSWER IS NO, GO TO QUESTION 29.

26. What were the reasons for wanting to transfer these patients? PROBE: LOSS OF UTILITY, LACK OF PERSONNEL, SUPPLIES, ETC.

27. Was your hospital able to transfer those patients to other hospitals? IF ANSWER IS YES, GO TO QUESTION 29.

28. What were the reasons for a transfer not happening?

29. During the two weeks after landfall, did your hospital accept any patient transfers from other hospitals or institutions because of the impact of Hurricane Maria? IF ANSWER IS NO, GO TO QUESTION 31.

30. Was your hospital able to provide the needed care for these patients?

PART V: ADDITIONAL INFORMATION

Now for the final questions.

31. What factors increased your hospital’s resiliency enabling direct patient care during the two weeks after Hurricane María’s landfall?

32. Do you have additional information that you would like to share with us regarding the physical and functional status of the overall hospital or of specific units before, during and up to two weeks after Hurricane Maria that compromised patient care? IF YES, please elaborate. IF ANSWER IS NO, GO TO CLOSING.

33. Please clarify if you believe that any of these contributed to any death directly or indirectly, and why.

34. After all the above questions, and with the experience you later gained, what recommendations do you have on how to protect hospital operations during natural disasters that may affect its infrastructure while minimizing the impact on patient care.

THANK YOU VERY MUCH FOR YOUR TIME AND SUPPORT.

If you have any questions about this interview or if you remember important information later that may be helpful for us to know, please see contact information on the informed consent form you were provided.