Developing evidence-based practice in emergency planning and management

BACKGROUND Emergency planning is essential to mitigate disasters and ensure appropriate emergency responses. However, it is imperfect and rarely ‘evidence-based’. The extent of the evidence-base and how it is utilised is also unclear. This thesis scopes the evidence-base from a health perspective, and explores the determinants of evidence-based practice in this field. METHODS Three scoping reviews of published literature including British grey literature were conducted to map the evidence-base. Two further studies involving key informant interviews in the UK and Nepal were then conducted to understand how evidence was used and identify determinants of evidence-based practice in this field. A thematic approach was then applied during data analysis for key themes. FINDINGS Many publications originate from high income countries, especially North America. Most were observational and unsystematically reported commentaries and event reports. Whilst many addressed emergency planning and response issues, few covered disaster mitigation or recovery. More disaster research especially from LMIC settings is required. The UK interviews revealed greater practitioner focus on operational aspects. Knowledge gaps included individual and organisational behaviour in emergencies, public engagement and community disaster resilience. There were issues with knowledge acquisition, dissemination and utilisation, and ascertaining the optimal system configuration. Interviews in Nepal uncovered further barriers to evidence-based practice such as contextual factors (e.g. poverty), local custom and culture, weak legislative infrastructure, and limited demand and accessibility of the evidence-base. CONCLUSIONS The validity and generalisability of existing disaster literature is unclear and little evidence synthesis has been performed to inform policy and practice. What constitutes “evidence” is also contested. Various knowledge management issues exist. Current knowledge gaps are diverse, including socio-behavioural aspects, operational processes and organisational configuration issues. Barriers to evidence-based practice include political factors especially in settings where governance, legislation and leadership are weaker. Promoting evidence-based practice will require individual, organisational and system culture change.