Objective: Natural and manmade disasters have claimed the lives of thousands of individuals in the US and caused billions of dollars in property damage. First responders carry the responsibility of disaster management, leaving other health care professionals such as medical clinic staff underutilized to support the clinic staff. We explored how medical and support staff in Community-based Outpatient VHA Clinics (CBOC) perceive their roles in disaster response, their attitudes about clinic readiness and continuity of care during disasters, and their ability to function in a post disaster environment.

Methods: A mixed method study was conducted to answer questions related to clinic readiness. In the qualitative phase of the study we conducted key informant interviews and validation focus groups (N= 23); participants were selected by theoretical sampling. Interviews were transcribed, coded, and analyzed using grounded-theory methods for emerging themes. Results and existing scales were used to develop an on-line survey that was completed by a convenience sample of 146 individuals from 35 of the 53 CBOC clinics in California. Descriptive, bivariate, and multivariate logistic regression analysis was conducted to explore variables associated with perceived readiness for a severe vs. a minor/moderate (aka moderate) disaster.

Results: Emerging themes indicated that staff felt they were more vulnerable to natural disasters, were more confident in handling minor disasters, that they needed additional training and that their effectiveness depended on the support they received from leadership. Quantitative findings supported the qualitative results: Only 65% of respondents felt some preparedness for either minor (24.7%), moderate (7.5%), or severe (32.2%) disasters, while 35.6% were unsure if they were prepared. While bi-variable results identified many variables that distinguished respondents who felt prepared for a moderate vs. a severe disaster, multivariate results indicate that professionals were more likely than support staff to feel prepared for a severe disaster, felt less prepared for a severe vs. a moderate disaster based on a disaster plan, and felt less prepared to lead during a severe than a moderate disaster.

Conclusions: VHA CBOCs are an untapped resource for disaster management that could be a critical stakeholder to help communities be better prepared and more responsive to a disaster. However, while clinic staff was willing to help, many felt unsure about their readiness to help, citing lack of training and resources. If we wish to draw upon the resources of this underutilized group we need to increase their readiness by establishing better response plans and encouraging their leadership to support such efforts.


School of Public Health

First Advisor

Susanne Montgomery

Second Advisor

Thelma Gamboa-Maldonado

Third Advisor

Patti Herring

Degree Name

Doctor of Public Health (DrPH)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Disaster Medicine -- organization & administration; Disaster Medicine -- standards; Disaster Planning -- methods; Disaster Planning -- organization & administration; Community Health Centers -- organization & administration; Public Health Administration -- standards; Health Personnel -- organization & administration; Emergency Responders -- standards; Health Promotion -- utilization.



Page Count

xii; 203

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives