Mass Disasters and Burnout in Nephrology Personnel: From Earthquakes and Hurricanes to COVID-19 Pandemic

Abstract

Mass disasters result in extensive health problems and make health care delivery problematic, as has been the case during the COVID-19 pandemic. Although COVID-19 was initially considered a pulmonary problem, it soon became clear that various other organs were involved. Thus, many care providers, including kidney health personnel, were overwhelmed or developed burnout. This review aims to describe the spectrum of burnout in mass disasters and suggests solutions specifically for nephrology personnel by extending previous experience to the COVID-19 pandemic. Burnout (a psychologic response to work-related stress) is already a frequent part of routine nephrology practice and, not surprisingly, is even more common during mass disasters due to increased workload and specific conditions, in addition to individual factors. Avoiding burnout is essential to prevent psychologic and somatic health problems in personnel as well as malpractice, understaffing, and inadequate health care delivery, all of which increase the health care burden of disasters. Burnout may be prevented by predisaster organizational measures, which include developing an overarching plan and optimizing health care infrastructure, and ad hoc disaster-specific measures that encompass both organizational and individual measures. Organizational measures include increasing safety, decreasing workload and fear of malpractice, optimizing medical staffing and material supplies, motivating personnel, providing mental health support, and enabling flexibility in working circumstances. Individual measures include training on coping with stress and problematic conditions, minimizing the stigma of emotional distress, and maintaining physical health. If these measures fall short, asking for external help is mandatory to avoid an inefficient disaster health care response. Minimizing burnout by applying these measures will improve health care provision, thus saving as many lives as possible.

Keywords: COVID-19; burnout; earthquake; hurricane; massive disaster; nephrology; pandemic.

Figure 1.

Role of burnout in health care provision after mass disasters. Overall, there is an increased demand for health care, while there is a decreased supply. Various factors play an important role in ineffective health care provision, which differ depending on the type of disaster (e.g., damaged health care facilities are very frequent after earthquakes, tsunamis, hurricanes, and wars, whereas a shortage of medical material is common after pandemics, and insufficient planning is an almost consistent part of all mass disasters). These factors and safety concerns form the basis of burnout, which further negatively affects health care services, and differ depending on the disaster (e.g., shotgun wounds or bombing injuries during wars, being crushed under collapsed buildings during earthquakes, or being infected during pandemics).

Figure 2.

Variations in mental and physical health status of health care personnel during mass pandemic disasters. Very different, sometimes sequential or even simultaneous conditions may occur and occasionally oblige the personnel to continue working, at the expense of neglecting their own health. Risky working practice may be due to underdiagnoses due to lack of diagnostic or protective resources or simply because of dedication. (1) In ideal conditions, healthy personnel provide health care. (2) Affected family members or colleagues may result in a bereaved health care worker, decreasing efficacy. (3) They may continue to work willingly or unwillingly, even if they are diseased (or affected) by the disaster. (4) The personnel may recover; however, sometimes they may go back to work without adequate rehabilitation. Of note, for nonpandemic disasters such a earthquakes, hurricanes, etc., a similar condition may occur where the terms “healthy” and “diseased” may be replaced by “unaffected” and “affected.”

Figure 3.

Complex interaction between disasters and hemodialysis delivery. (1) Dialysis demand increases after disasters because of new AKI cases. (2) Due to various reasons, there is a shortage of dialysis supply. Thus, number of dialysis sessions decreases, and even daily routine demand may not be met, which in turn exaggerates the increased need for hemodialysis. (3) Health care personnel’s burnout contributes to shortage of personnel, and this factor is a trigger for increasing risk of burnout. (4) Burned-out personnel may not work efficiently, causing deficient dialysis provision. (5) Deficient service supply contributes to increased need for hemodialysis, while dialysis shortage increases the extent of deficiency. Disaster circumstances are the main driving force for each of these components.