Case study of VA Caribbean Healthcare System’s community response to Hurricane Maria




Hurricane Maria, Puerto Rico, US Department of Veterans Affairs, collaboration


Background: Hurricane Maria, which hit Puerto Rico in 2017, catastrophically impacted infrastructure and severely disrupted medical services. The US Department of Veterans Affairs Caribbean Healthcare System (VA CHCS), which serves approximately 67,000 patients and has most of its facilities on the island of Puerto Rico, was able to successfully maintain operations after the hurricane. As a part of the larger VA system, VA CHCS also has a mission to support “national, state, and local emergency management, public health, safety and homeland security efforts.” The objective of this study is to better understand the ways VA and its facilities meet this mission by exploring how VA CHCS acted as a community resource following Hurricane Maria.

Methods: This study investigated experiences of five employees in critical emergency response positions for VA CHCS, Veterans Integrated Service Networks (VISN) 8, and the Office of Emergency Management. All respondents were interviewed from March to July 2019. Data were collected via semistructured interviews exploring participants’ experiences and knowledge about VA’s activities provided to the community of Puerto Rico following Hurricane Maria. Data were analyzed using thematic and in vivo coding methods.

Results: All respondents underscored VA’s primary mission after a disaster was to maintain continuity of care to Veterans, while concomitantly describing the role of VA in supporting community recovery. Three major themes emerged: continuity of operations for the San Juan VA Medical Center (VAMC) and its affiliated outpatient clinics, provision of services as a federal partner, and services provided directly to the Puerto Rican community.

Discussion: Recent disasters have revealed that coordinated efforts between multidisciplinary agencies can strengthen communities’ capacity to respond. This case example demonstrates how a VA hospital not only continued serving its patients but, with the support from the greater VA system, also filled a wide variety of requests and resource gaps in the community. Building relationships with local VAMCs can help determine how VA could be incorporated into emergency management strategies. In considering the strengths community partners can bring to bear, a coordinated regional response would benefit from involving VA as a partner during planning.

Author Biographies

Tamar Wyte-Lake, DPT, MPH

Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, California

Susan Schmitz, MAIDP

Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, California

Cosme Torres-Sabater, RN, MEP, CHCM

VHA Office of Emergency Management, US Department of Veterans Affairs, San Juan, Puerto Rico

Aram Dobalian, PhD, JD

Veterans Emergency Management Evaluation Center (VEMEC), US Department of Veterans Affairs, North Hills, California; Division of Health Systems Management and Policy, University of Memphis School of Public Health, Memphis, Tennessee


Dobalian A, Callis R, Davey VJ: Evolution of the veterans health administration’s role in emergency management since September 11, 2001. Disaster Med Public Health Prep. 2011; 5: S182-S184.

Adalja AA, Watson M, Bouri N, et al.: Absorbing citywide patient surge during Hurricane Sandy: A case study in accommodating multiple hospital evacuations. Ann Emerg Med. 2014; 64(1): 66-73e1.

Courtney B, Toner E, Waldhorn R, et al.: Healthcare coalitions: The new foundation for national healthcare preparedness and response for catastrophic health emergencies. Biosecur Bioterror. 2009; 7(2): 153-163.

Toner ES, Ravi S, Adalja A, et al.: Doing good by playing well with others: Exploring local collaboration for emergency preparedness and response. Health Secur. 2015; 13(4): 281-289.

Walsh J, Swan AG: Utilization of health care coalitions and resiliency forums in the United States and United Kingdom: Different approaches to strengthen emergency preparedness. Disaster Med Public Health Prep. 2016; 10(1): 161-164.

Schmitz S, Wyte-Lake T, Dobalian A: Facilitators and barriers to preparedness partnerships: A veterans affairs medical center perspective. Disaster Med Public Health Prep. 2018; 12(4): 431-436.

National Oceanic and Atmospheric Administration: Hurricane Maria’s devastation of Puerto Rico. 2018. Available at Accessed February 8, 2021.

Irvin-Barnwell EA, Cruz M, Maniglier-Poulet C, et al.: Evaluating disaster damages and operational status of health-care facilities during the emergency response phase of Hurricane Maria in Puerto Rico. Disaster Med Public Health Prep. 2019; 8(1): 1-9.

de Arzola OR: Emergency preparedness and Hurricane Maria: The experience of a regional academic medical center in southwest Puerto Rico. J Grad Med Educ. 2018; 10(4): 477-480.

Kishore N, Marques D, Mahmud A, et al.: Mortality in Puerto Rico after Hurricane Maria. N Engl J Med. 2018; 379(2): 162-170.

Affairs UDoV: VA Caribbean Healthcare System. Available at Accessed February 8, 2021.

US Department of Veterarans Affairs: Veterans health administration. Available at Accessed February 8, 2021.

Federal Emergency Management Agency: Robert T. Stafford Disaster Relief and Emergency Assistance Act, as amended, and related authorities as of June 2019. 2020. Available at Accessed February 8, 2021.

Saldana J: The Coding Manual for Qualitative Researchers. London: Sage, 2009.

VHA Office of Emergency Management: Disaster emergency medical personnel system (DEMPS). 2020. Available at Accessed February 8, 2021.

Michaud J, Kates J: Public Health in Puerto Rico after Hurricane Maria: Kaiser family foundation. 2017. Available at Accessed February 8, 2021.

Reidmiller D, Avery C, Easterling D, et al.: Fourth National Climate Assessment, Volume II: Impacts, Risks, and Adaptation in the United States. Washington, DC: US Global Change Research Program, 2017.

Wulff K, Donato D, Lurie N: What is health resilience and how can we build it? Annu Rev Public Health. 2015; 36: 361-374.

Chandra A, Acosta J, Howard S, et al.: Building community resilience to disasters: A way forward to enhance National Health Security. Rand Health Q. 2011; 1(1): 6.

Carrier E, Yee T, Cross D, et al.: Emergency preparedness and community coalitions: Opportunities and challenges. Res Brief. 2012; 24: 1-9.

Dobalian A: The US Department of Veterans Affairs and Sustainable Health Care Coalitions. Disaster Med Public Health Prep. 2015; 9(6): 726-727.

US Department of Veterarans Affairs: VA announces ‘Fourth Mission,’ actions to help America respond to COVID-19. 2020. Available at Accessed February 8, 2021.

Wyte-Lake T, Griffin AR, Dobalian A: Supporting staff through a complete hospital evacuation and extended displacement period. J Healthc Manag. 2018; 63(3): 195-209.

Lichtveld M: Disasters through the lens of disparities: Elevate community resilience as an essential public health service. Am J Public Health. 2018; 108(1): 28-30.

Kim H, Marcouiller DW: Natural disaster response, community resilience, and economic capacity: A case study of coastal Florida. Soc Nat Resour. 2016; 29(8): 981-997.

de Ville de Goyet C, Sarmiento J, Grünewald F: Health Response to the Earthquake in Haiti. Geneva: World Health Organization, 2010.



How to Cite

Wyte-Lake, DPT, MPH, T., S. Schmitz, MAIDP, C. Torres-Sabater, RN, MEP, CHCM, and A. Dobalian, PhD, JD. “Case Study of VA Caribbean Healthcare System’s Community Response to Hurricane Maria”. Journal of Emergency Management, vol. 19, no. 8, Sept. 2021, pp. 189-9, doi:10.5055/jem.0536.