Introduction
Substantive research examines individual and household determinants of hurricane preparedness; however, organizational readiness is less understood. Existing studies exploring organizational preparedness have small samples and limited geographic and organizational scope, restricting generalizability.Reference Sadiq and Graham 1
Healthcare and social organizations (HSOs), as first responders, have unique disaster preparedness needs. Noboa-Ramos and colleaguesReference Noboa-Ramos, Almodóvar-Díaz, Fernández-Repollet and Joshipura 2 identified most HSOs had disaster preparedness plans covering emergency plan activation, facility and equipment protection, and inventory checks, but noted deficiencies in consideration of disaster magnitude, financial resources, management systems, and technological capacity.Reference Noboa-Ramos, Almodóvar-Díaz, Fernández-Repollet and Joshipura 2 Communication, staff training, and staff wellbeing remain critical.
Several gaps in the literature remain, particularly regarding organizational procedures during natural disasters. Little is known about how protocols are communicated to new staff or trainees. Marcus and colleaguesReference Marcus, Mai, Brown, Littles and Onge 3 examined the responsibilities of Graduate Medical Education (GME) leadership tasks before, during, and after hurricanes, but their recommendations reflect leadership’s perspective, not trainees’ experiences.
Psychology Trainee Programs and Applicant Considerations
Doctoral internship training represents the capstone clinical experience for PhD or PsyD trainees. Many graduates seek a one-to-two-year postdoctoral fellowship following internship, often relocating for either or both positions to regions where they have never lived.
Applicants weigh many factors when choosing and ranking sites, yet research of the relative importance of these factors in trainee decision-making is limited. In a study of psychology trainees within the Department of Veterans Affairs (VA), Cheng and colleaguesReference Cheng, Fujii and Wong 4 found site location and geographic region only mildly to moderately influenced decisions across racial and ethnic groups. How natural disasters affect trainees’ site choices remains largely unknown.
Setting and Recent Events
In 2024, two major hurricanes (Helene and Milton) struck the county housing the hospital camps within two weeks, landing as Category 4 and 5 storms. Reference Armstrong and Bright 5 , Reference Belles, Dolce, Kaiser and Tonks 6 They caused widespread devastation, damaging 47,896 properties, killing 14 people and triggering 751,000 utility and power outages. The economic toll remains substantial, with ongoing displacement and hardship. These consecutive, intense storms highlighted the critical need for enhanced disaster preparedness across the region.Reference Pushkin 7
Such disasters affect all HSO employees but uniquely impact trainees. Psychology trainees may be particularly vulnerable due to lower salaries (i.e., average intern < $32,000; average fellowship $60,000 8 , Reference Dilly, Sharp and Volkert 9) and variable social support.Reference Calhoun, Stone, Cobb, Patterson, Danielson and Bendezú 10
HSO and Departmental Preparedness Measures
Hurricane preparedness in hospitals is a year-round effort to ensure continuity of patient care and critical operations. At our organization, the multidisciplinary Disaster Assistance Response Team (DART) coordinates pre-storm planning, storm-time care, and post-storm recovery. When the hospital enters the seven-day forecast cone from the National Hurricane Center, structured preparedness measures are activated (See Table 1).
Table 1. Departmental and Organization Action in Preparation and Response of Hurricane Activity
During each phase, HSO leadership completes additional internal communication tactics and support measures. Table 1 summarizes the roles and responsibilities relevant to preparedness for psychology trainees and departmental response. Notably, some disaster preparedness materials (e.g., video presentation) were unique to our department’s initiatives, and to our knowledge, no other residency programs have structured trainee hurricane preparation.
Objective
This paper describes organizational and departmental preparedness, response, and recovery efforts of a nationally-ranked children’s hospital on the west-central coast of Florida during Hurricanes Milton and Helene, focusing on experiences of psychology trainees. It provides insight into strategies for supporting psychology trainees during natural disasters.
Methods
Participants
All psychology trainees (N = 9) completing their doctoral internship (n = 3) and postdoctoral fellowship (n = 6) at a tertiary children’s hospital participated in the survey, which aimed to explore their perceptions and experiences during two hurricanes in the 2024-2025 training year. This convenience sample consisted entirely of female participants. To preserve respondent anonymity, detailed demographic information was not obtained. However, information related to participants’ residence and living arrangement was collected, as these factors may have influenced decision-making during the storms (see Table 2).
Table 2. Residential demographics and evacuation
1 Evacuation zones are based on storm surge risk for the county in which the hospital is located, with Zone A expected to evacuate first and progress alphabetically.
Measures
An anonymous questionnaire developed for the purpose of the survey was distributed via email. The survey included both closed- and open-ended questions, allowing for quantitative assessment as well as descriptive and qualitative feedback. Respondents were first asked to rate their overall levels of distress leading up to each hurricane’s landfall on a scale of 0 to 10 (i.e., rating of 0 indicating no distress; rating of 10 indicating severe distress). Perceived support from the organization and others was then measured via questions evaluating perceived usefulness of departmental preparedness efforts (See Table 1), as well as departmental support (e.g., communication from training directors [TDs]) and organizational response efforts (e.g., communication, financial relief, and access to gasoline supplies), and support from others outside of work. Open-ended responses enabled participants to identify which resources they accessed and to reflect on lessons learned that might influence their future disaster response. The survey was designed with response logic, allowing participants to receive tailored questions based on their specific experiences.
Procedures
The survey was distributed on 11/7/2024, approximately four weeks after the last storm, Hurricane Milton. A reminder email was sent one week later, before the survey closed two weeks after its distribution. The institutional review board at the organization approved this research prior to the initiation of the study.
Results
Hurricane Preparedness
The majority of trainees (89%, n = 8) recalled watching the hurricane preparedness video developed by the department. Of those that watched the video, three trainees “agreed” or “strongly agreed” that it was helpful. In response to the training provided during the orientation video, trainees secured supplies recommended in the event of a storm. Specifically, one purchased portable chargers, one purchased lanterns and medical supplies, and one purchased extra water. As the storms approached, 67% (n = 6) of respondents secured various supplies, including nonperishable food (n = 4), water (n = 3), extra gasoline (n = 3), battery-powered lights/lanterns (n = 2), a generator (n = 1), and sandbags (n = 1). Additionally, one trainee developed a safety plan with a roommate. However, only 22% trainees utilized information provided in the “Hurricane Preparedness” folder.
Response During the Storms
While the 2 trainees that evacuated for Hurricane Helene were in mandatory evacuation zones, the third trainee residing in Zone A was out of the county at the time of the storm. All trainees, regardless of evacuation zone, evacuated during Hurricane Milton (see Table 2). Most evacuations involved temporary relocation within Florida, although one trainee evacuated to a neighboring state. The majority of trainees (88%, n = 8) evacuated with others, and nearly half (n = 4) stayed with friends or family.
Trainees indicated that geographic location of the evacuation site (n = 8) was the most important factor influencing their decision to evacuate, followed by cost (n = 6), pets (n = 5), and ease of return (n = 5).
The majority (n = 6) of trainees lost power in Hurricane Helene, with half of them experiencing power outages lasting 1-3 days. Similarly, all but one trainee lost power during Hurricane Milton, with the majority (n = 6) also losing power for 1-3 days.
Subjective Experience and Support Factors
In the days leading up to Hurricane Helene, respondents reported an average distress rating of 3.8 (on a scale from 0 to 10). As Hurricane Milton was expected to make landfall, all trainees reported moderate (5) or higher levels of distress, leading to an average distress rating of 6.7.
Most trainees (n = 6) reported having a strong support network both at work and outside of work.
During the storms, communication was a critical factor. Trainees received communication from the organization and their immediate leadership at least twice daily. The majority of trainees (n = 6) preferred text messages from their TD, followed by emails from the TD (n = 4). Organization wide emails and texts were less preferred.
Most trainees (n = 8) were able to work remotely after the storm, and only one trainee reported not feeling safe returning to work.
Organizational supports utilized included access to a gas truck (n = 3), financial assistance (n = 3), and the food pantry (n = 1).
Impact of the Storm on Future Decision-Making
Trainees reported that their experiences have led them to prioritize safety, increase future preparedness, engage in early evaluation, and contribute to organizational programs that could sponsor relief efforts for impacted team members. While 33% of trainees indicated that their experiences might influence future professional decision-making based on location, the majority (56%) reported that their job and training decisions would not be impacted.
Limitations
Despite the valuable insights provided by this study, there are several limitations. First, the small and homogeneous sample, of a single hospital setting limit the generalizability of the findings. We relied on self-report data. The study captures a narrow perspective on institutional preparedness and response through an original survey created for this study; therefore, reliability and validity of the survey was not established prior to its use. Another limitation is the timing of data collection, which took place several weeks after the last hurricane, possibly impacting the accuracy of participants’ recall.
Discussion
The findings highlight the critical role of organizational and departmental preparedness in supporting psychology trainees during natural disasters. While most trainees engaged with resources (e.g., orientation videos and preparedness materials), their implementation of concrete measures varied. Some secured essential supplies ahead of storms, but few fully utilized the comprehensive preparedness folder for early planning. Existing literature highlights the need for disaster preparation not only during the onboarding process, but also at regular intervals throughout training.Reference Marcus, Mai, Brown, Littles and Onge 3 Trainees’ evacuation decisions appeared to evolve across the hurricane season, with only a minority of trainees evacuating for Hurricane Helene, but all evacuating for Hurricane Milton. This behavioral shift likely reflects heightened awareness of risk and increased concern about personal safety and property damage as forecast suggested a greater threat from Hurricane Milton.
Psychological distress was higher before the second storm, suggesting repeated exposure to disaster-related stress, especially with two major hurricanes in close succession, may heighten trainee anxiety. This increase may also reflect the greater severity and forecasted path of Hurricane Milton, which posed a more direct threat to the hospital. These findings emphasize the need for stronger psychological and social support systems to promote trainee well-being during crises. Notably, the presence of strong personal and professional support networks among most respondents appeared to serve as a protective factor which is consistent with prior research highlighting the importance of interpersonal relationships with stress recovery.Reference Calhoun, Stone, Cobb, Patterson, Danielson and Bendezú 10 Trainees may also benefit from access to mental health resources post-storm, particularly for those who experienced heightened levels of psychological distress, storm-related property damage or power loss, and/or needing to treat higher acuity of patients admitted in the hospital with storm-related injury or illness.Reference Marcus, Mai, Brown, Littles and Onge 3 Communication from training leadership was a key factor in maintaining engagement and morale. Trainees consistently indicated a preference for direct and personalized communication from TDs, over organization-wide communication that was generalized to all.
Although one-third of trainees reported that their hurricane experiences may influence professional decisions related to geographic location in the future, the majority indicated their long-term training and career plans were not significantly affected. These results are consistent with previous literature that suggests trainees may prioritize other factors in career decision-making (e.g., training experiences, perceived workload, diversity, quality of life) above site location and geographic restriction.Reference Cheng, Fujii and Wong 4 Nevertheless, these experiences highlight the importance of comprehensive disaster preparedness to address personal safety concerns and logistical needs of trainees.
Conclusions
When training in regions likely to impacted by natural disasters, of any type, it is recommended that program orientation include materials and training related to disaster preparedness, with reminders interspersed throughout training.Reference Marcus, Mai, Brown, Littles and Onge 3 Maintaining access to up to date departmental and institution specific resources during training will also be beneficial. Reference Marcus, Mai, Brown, Littles and Onge 3 Further, given the preference for phone calls and text messages directly from training directors, continued communication with trainees during and after natural disasters is of utmost importance. Consistent with prior research,Reference Calhoun, Stone, Cobb, Patterson, Danielson and Bendezú 10 direct communication between training directors and trainees helps to maintain interpersonal connectedness which is an important factor for stress recovery. While financial and wellbeing resources vary greatly by organization, the importance of post-storm resources cannot be overlooked. Reference Marcus, Mai, Brown, Littles and Onge 3
Future research should explore psychology trainees’ experiences across multiple healthcare and training institutions in disaster-prone areas to inform generalized disaster preparedness guidelines, while also examining the impact of institutional wellbeing support and financial assistance. Qualitative methods (e.g., in-depth interviews, focus groups) can offer deeper insight into trainees’ lived experiences and highlight specific challenges and support strategies. These efforts can guide the development of effective, tailored disaster preparedness frameworks for psychology trainees and other healthcare learners.
Data availability statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Author contribution
Conceptualization and design: J.K., M.F. and L.G. Material preparation, data collection and analysis were performed by L.G. and M.F. The first draft of the manuscript was written by A.N, J.K., T.W., M.F., and L.G., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Funding statement
No funding was received for conducting this study.
Competing interests
The authors have no relevant financial or non-financial interests to disclose.
Ethical approval
Ethical approval for this study was obtained from the first author’s Institutional Review Board (IRB00474875).
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