title: Vulnerable Populations in Hospital and Health Care Emergency Preparedness Planning: A Comprehensive Framework for Inclusion.
abstract: BACKGROUND
  As attention to emergency preparedness becomes a critical element of health care facility operations planning, efforts to recognize and integrate the needs of vulnerable populations in a comprehensive manner have lagged. This not only results in decreased levels of equitable service, but also affects the functioning of the health care system in disasters. While this report emphasizes the United States context, the concepts and approaches apply beyond this setting.
  
  
  OBJECTIVE
  This report: (1) describes a conceptual framework that provides a model for the inclusion of vulnerable populations into integrated health care and public health preparedness; and (2) applies this model to a pilot study.
  
  
  METHODS
  The framework is derived from literature, hospital regulatory policy, and health care standards, laying out the communication and relational interfaces that must occur at the systems, organizational, and community levels for a successful multi-level health care systems response that is inclusive of diverse populations explicitly. The pilot study illustrates the application of key elements of the framework, using a four-pronged approach that incorporates both quantitative and qualitative methods for deriving information that can inform hospital and health facility preparedness planning.
  
  
  CONCLUSIONS
  The conceptual framework and model, applied to a pilot project, guide expanded work that ultimately can result in methodologically robust approaches to comprehensively incorporating vulnerable populations into the fabric of hospital disaster preparedness at levels from local to national, thus supporting best practices for a community resilience approach to disaster preparedness.
authors.affiliation: 1Department of Environmental and Occupational Health,Colorado School of Public Health;University of Colorado Anschutz Medical Campus,Aurora,ColoradoUSA.
authors.forename: Debra
authors.initials: D
authors.lastname: Kreisberg
authors.affiliation: 3Department of Geography and Environmental Sciences,University of Colorado Denver,Denver,ColoradoUSA.
authors.forename: Deborah S K
authors.initials: DS
authors.lastname: Thomas
authors.affiliation: 4Department of Psychology,Colorado State University,Fort Collins,ColoradoUSA.
authors.forename: Morgan
authors.initials: M
authors.lastname: Valley
authors.affiliation: 5Department of Surgery,VA Eastern Colorado Health Care System,Denver,ColoradoUSA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Newell
authors.affiliation: 6Michael Baker International,Lakewood,ColoradoUSA.
authors.forename: Enessa
authors.initials: E
authors.lastname: Janes
authors.affiliation: 2Department of Emergency Medicine,University of Colorado Anschutz Medical Campus,Aurora,ColoradoUSA.
authors.forename: Charles
authors.initials: C
authors.lastname: Little
mesh_terms: D002959:Civil Defense; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D004189:Disaster Planning / Q000379:methods*; D004190:Disasters; D006301:Health Services Needs and Demand; D006761:Hospitals; D006801:Humans; D008962:Models, Theoretical; D011634:Public Health; D014481:United States; D035862:Vulnerable Populations
keywords: CLAS culturally and linguistically appropriate services; ESF Emergency Support Function; NHSS National Health Security Strategy (United States); TJC The Joint Commission on Accreditation of Healthcare Organizations (United States); delivery of health care; disasters; health facility planning; public health; vulnerable populations