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

HOSPITAL CLINICAL 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 these deaths, considering the conditions during the two weeks following landfall. We know that it has been almost five years, and it may be difficult to remember, 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 hurricanes landfall, 2) the conditions of the hospital on the day of landfall, and 3) the conditions of the hospital during the two weeks after landfall the impact of the hurricane.

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, clinical work unit and the primary responsibilities you had at [NAME OF HOSPITAL] the days prior to Hurricane María.

1a. Position

1b. Clinical work unit

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 your clinical work unit 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. Were there any operational problems in your clinical work unit that affected direct patient care in August 2017? IF THE ANSWER IS YES, please briefly explain. IF ANSWER IS NO, GO TO QUESTION 7.

3. How would you describe the impact that the problem had on direct patient care in your clinical work unit in August of 2017?

4. Was there a plan designed for your clinical work unit to improve direct patient care? IF ANSWER IS NO, GO TO QUESTION 7.

5. Was this plan implemented? IF ANSWER IS NO, GO TO QUESTION 7.

6. Did the implementation of the plan have a positive impact on improving direct patient care in your clinical work unit ? Please elaborate.

7. Please briefly explain any impact that Hurricane Irma had on the operations or infrastructure of the hospital and your clinical work unit that 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 the conditions of direct patient care in the hospital and in your clinical work unit during Hurricane Maria’s landfall, that is on September 20, 2017.

8. Briefly tell us what happened in the hospital during the day of Hurricane Maria’s landfall.

9. Briefly tell us what happened in your clinical work unit during the day of Hurricane Maria’s landfall.

10. What were some of the challenges faced by clinical staff in your area of work during Hurricane Maria’s landfall (for example, lack of electricity, environmental factors, lack of personnel, lack of supplies, lack of oxygen and other gases, availability of beds, emotional impact, etc.)?

11. How did these challenges impact your capability to provide direct patient care in your clinical work unit?

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

PART IV: AFTER HURRICANE 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 direct patient care in your clinical work unit during the two weeks after 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.

13. Please tell us of any situation that might have affected direct patient care in your clinical work unit during the two weeks after Hurricane Maria’s landfall (for example, difficulty with support services, such as, laboratory, X-ray’s, pharmacy, and also, lack of electricity, environmental factors, bed availability, emotional impact, oxygen supply, patient conditions or complications, etc.)? IF THE ANSWER IS NONE, GO TO QUESTION 18.

14. How much did these situations affect direct patient care during the first week after landfall, that is, from September 21 to September 27, 2017?

15. How did you and other clinical staff work through these challenges to direct patient care during the first week after landfall?

16. How much did these situations affect direct patient care during the second week after landfall, that is, from September 28 to October 4, 2017?

17. How did you and other clinical staff work through these challenges to direct patient care during the second week after landfall?

18. What actions were implemented to maintain direct patient care during these two weeks? IF ANSWER IS NONE, GO TO QUESTION 20.

19. Were these actions effective? Why or why not?

20. Did any patient die in your clinical work unit during the first week after landfall? IF ANSWER IS NO, GO TO QUESTION 22.

21. How do you think that the situations caused by the hurricane may have contributed directly or indirectly to that death during the first week after landfall?

22. Did any patient die in your clinical work unit during the second week after landfall? IF ANSWER IS NO, GO TO QUESTION 24.

23. How do you think that the situations caused by the hurricane may have contributed directly or indirectly to that death during the second week after landfall?

PART V: ADDITIONAL INFORMATION

Now for the final questions.

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

25. Do you have additional information that you would like to share with us regarding anything that impacted direct patient care before, during and up to two weeks after Hurricane Maria? IF YES, please elaborate. IF ANSWER IS NO, GO TO CLOSING.

26. Please clarify if you believe that any of these issues impacted direct patient care contributing directly or indirectly to any death, and why.

27. 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.