Emergency preparedness: What is the future?

Barriers and potential solutions for effective integration of depression care into non-communicable diseases clinics in Malawi: a qualitative end-point evaluation of the SHARP randomized controlled trial

BACKGROUND

The sub-Saharan African Regional Partnership for mental health and capacity building (SHARP) study was a clinic-randomized trial of two implementation strategies for integrating depression screening and treatment into non-communicable diseases' (NCD) clinics in Malawi between 2019 and 2022. We report on the barriers to implementing depression care integration at SHARP study sites and potential solutions.

METHODS

N = 39 in-depth interviews with participants from all ten sites were conducted, recorded, transcribed, coded in NVivo 12 and analyzed by qualitative experts. We used thematic analysis to identify implementation challenges and potential solutions. The Consolidated Framework for Implementation Research helped to develop guides and organize the results.

RESULTS

Outer setting barriers included high workload (due to high patient volume, increased paperwork, shortage of staff), the effects of coronavirus disease 2019 (COVID-19) pandemic, staff turnover and negative provider attitudes. Limited clinic space arose as an inner setting barrier. Workload can be overcome by increasing the number of NCD personnel, decentralizing the depression/NCD services and integrating mental health and NCD documents (implementation process). The COVID-19 pandemic presented unique challenges including fear of interpersonal contact and changes in scheduling staff that were difficult to overcome in the short term. To deal with the effects of staff turnover, participants identified the need for continuous depression training to new providers. Lobbying for more rooms from leadership can address concerns of limited space. To reduce negative provider attitudes, participants urged facility leadership to make themselves available for consultations and mentorship and to provide continuous learning opportunities such as refresher trainings.

CONCLUSION

The experience in the SHARP study highlights the need for a culture of continuous learning and adaptation in healthcare settings, enabling the development of strategies to overcome evolving challenges. Planning for the integration of mental health and NCD care should extend beyond immediate challenges and consider long-term goals and sustainability.

TRIAL REGISTRATION

This study reports part of the findings from the endpoint evaluation of the SHARP clinical trial that is registered at ClinicalTrials.gov, NCT03711786 first posted 20,181,018.

Perennial disaster patterns in Central Europe since 2000 and implications for hospital preparedness planning - a cross-sectional analysis

The goal of this analysis is to describe seasonal disaster patterns in Central Europe in order to raise awareness and improve hospital disaster planning and resilience, particularly during peak events. Hospitals are essential pillars of a country's critical infrastructure, vital for sustaining healthcare services and supporting public well-being-a key issue of national security. Disaster planning for hospitals is crucial to ensure their functionality under special circumstances. But the impact of climate change and seasonal variations in the utilization of hospital services are raising challenges. Therefore, the knowledge of perennial disaster patterns could help strengthen the resilience of hospitals. We conducted a cross-sectional analysis of the Emergency Events Database EM-DAT for disasters in Central Europe (Germany, France, Denmark, The Netherlands, Belgium, Luxembourg, Switzerland, Austria, Czech Republic, and Poland) between January 2000 and December 2023. Time distribution of disasters, patterns and longitudinal trends, were analyzed to discuss impact on disaster preparedness in hospitals. Out of 474 events, 83% were associated with a natural hazard and only 80 events (17%) were of technological cause. While technological disasters were spread equally over the whole year, the vast majority of disasters related to natural hazards (n = 394), i.e. storms (n = 178, 45%), floods (n = 101, 26%), and extreme temperatures (n = 93, 24%) peaked during summer and winter months. Fewer disasters were registered during autumn and especially spring seasons. More than 50% of the technological disasters were categorized in the transport accident subgroup. Technological disasters were spread equally over the whole year. Looking at the three most common disaster types, extreme temperatures, floods, and storms are clearly dominating and cause over 90% of the disasters due to natural hazards in central Europe. Overall, the number of events per year fluctuates without a clear trend, only the technological events appear to become less frequent with 70% (n = 56) of the registered disasters occurring in the first half of the study period (2000-2011). An overlap of hospital admissions due to seasonal effects and catastrophic events, mainly triggered by disasters of natural cause in vulnerable periods may lead to a partial collapse of the health care system. To close knowledge gaps, future comprehensive data collection is vital for informed decision-making. Awareness and preparedness are key: an "all-hazards" approach to manage diverse, potentially simultaneous seasonal threats is often the most versatile strategy for hospital emergency planning.

Exploring Volunteer Pharmacists' Experiences in Responding to 2023 Türkiye Earthquakes: A Qualitative Phenomenological Study

OBJECTIVE

Pharmacists are vital in disaster response efforts, dispensing essential medications, managing pharmacy services, consulting, and educating survivors regarding their medications. Their contributions, however, are often underrepresented in scientific literature. This study aimed to explore the experiences of pharmacists who provided pharmacy services to meet the pharmaceutical needs of the survivors after 2 major earthquakes in Türkiye in 2023.

METHODS

This study adopted a phenomenological approach. Data were collected using semi-structured interviews. Purposive sampling was used to invite pharmacists who provided pharmacy services to survivors. Interview transcripts were analyzed following an inductive, reflexive thematic analysis.

RESULTS

In total, 15 pharmacists were interviewed. Four main overarching themes "response to the earthquake," "preparedness for the earthquake," "experiences during service delivery," and "mental and physical experiences" were developed.

CONCLUSIONS

From participants' experiences, it is essential to expand the clinical responsibilities of pharmacists and train them in providing wound care, administering immunization, and prescribing. Pharmacists should be integrated as essential members of disaster health teams. International health organizations, nongovernmental organizations, and governments are encouraged to work collaboratively and develop disaster management plans including pharmacists in early responders. This might help mitigate the deficiencies and overcome challenges in health-care systems to provide effective patient-centered care by health professionals and respond effectively to disasters.

Sustaining Preparedness in Hospitals

PURPOSE

The years following the 9/11/2001 terrorists attacks saw a marked increase in community and hospital emergency preparedness, from communications across community networks, development of policies and procedures, to attainment and training in the use of biological warfare resources. Regular drills ensured emergency and health care personnel were trained and prepared to address the next large-scale crisis, especially from terrorist and bioterrorist attacks. This chapter looks at some of the more familiar global health issues over the past two decades and the lessons learned from hospital responses to inform hospital management in preparation for future incidents.

SEARCH METHODS

This study is a narrative review of the literature related to lessons learned from four major events in the time period from 2002 to 2023 - SARS, MERS, Ebola, and COVID-19.

SEARCH RESULTS

The initial search yielded 25,913 articles; 57 articles were selected for inclusion in the study.

DISCUSSION AND CONCLUSIONS

Comparison of key issues and lessons learned among the four major events described in this article - SARS, MERS, Ebola, and COVID-19 - highlight that several lessons are "relearned" with each event. Other key issues, such as supply shortages, staffing availability, and hospital capacity to simultaneously provide care to noninfectious patients came to the forefront during the COVID-19 pandemic. A primary, ongoing concern for hospitals is how to maintain their preparedness given competing priorities, resources, and staff time. This concern remains post-COVID-19.

Identifying a competency improvement strategy for infection prevention and control professionals: A rapid systematic review and cluster analysis

Remarkable progress has been made in infection prevention and control (IPC) in many countries, but some gaps emerged in the context of the coronavirus disease 2019 (COVID-19) pandemic. Core capabilities such as standard clinical precautions and tracing the source of infection were the focus of IPC in medical institutions during the pandemic. Therefore, the core competences of IPC professionals during the pandemic, and how these contributed to successful prevention and control of the epidemic, should be studied. To investigate, using a systematic review and cluster analysis, fundamental improvements in the competences of infection control and prevention professionals that may be emphasized in light of the COVID-19 pandemic. We searched the PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Data, and CBM databases for original articles exploring core competencies of IPC professionals during the COVID-19 pandemic (from January 1, 2020 to February 7, 2023). Weiciyun software was used for data extraction and the Donohue formula was followed to distinguish high-frequency technical terms. Cluster analysis was performed using the within-group linkage method and squared Euclidean distance as the metric to determine the priority competencies for development. We identified 46 studies with 29 high-frequency technical terms. The most common term was "infection prevention and control training" (184 times, 17.3%), followed by "hand hygiene" (172 times, 16.2%). "Infection prevention and control in clinical practice" was the most-reported core competency (367 times, 34.5%), followed by "microbiology and surveillance" (292 times, 27.5%). Cluster analysis showed two key areas of competence: Category 1 (program management and leadership, patient safety and occupational health, education and microbiology and surveillance) and Category 2 (IPC in clinical practice). During the COVID-19 pandemic, IPC program management and leadership, microbiology and surveillance, education, patient safety, and occupational health were the most important focus of development and should be given due consideration by IPC professionals.

[Qualitative analysis of health preparedness policies in ChileUma análise qualitativa das políticas de preparação na área de saúde no Chile]

Objective

Analyze health preparedness policies in Chile and identify their strengths and weaknesses. No other studies to date provide an analysis of the country's preparedness policies.

Methods

A desk review and semi-structured interviews with experts in emergency preparedness and response were conducted to identify the regulatory framework, key actors, and the strengths and weaknesses of health preparedness policies.

Results

The researchers identified 103 standards and interviewed seven preparedness experts. The reviewed standards and interviews show that Chile is in a transitional phase between the old National Civil Protection System and the new National Disaster Prevention and Response System. Only three standards were directly related to health, but the preparedness regulations provide for a multidisciplinary set of actors to address any threat. The experts gave a positive assessment of the Chilean system, although they agreed that certain weaknesses must be corrected. The country's main strength is its disaster response experience, along with its coordination mechanisms. The main shortcomings include risk communication, mitigation, preparedness and assessment, and human resources.

Conclusions

Chile has a solid regulatory framework with an all-hazards approach and a set of multisectoral institutions. The new National Disaster Prevention and Response System must build on its strengths to correct the weaknesses that limit its emergency preparedness and response capacity.

A Qualitative Study on the Use of the Hospital Safety Index and the Formulation of Recommendations for Future Adaptations

The Hospital Safety Index is a tool developed by the World Health Organization and the Pan American Health Organization in 2008 and updated in 2015. Although it is the most widely used instrument of its kind to assess the level of hospital preparedness, scientific literature on its application in real life is scarce. This study aimed to investigate the use of the Hospital Safety Index to assess disaster preparedness in healthcare facilities. A retrospective, qualitative study employing semi-structured online interviews was conducted to gather the opinions and perspectives of professionals who have experience in applying the Hospital Safety Index. Authors of scientific publications using the Hospital Safety Index were recruited. A semi-structured interview guide was developed. It addressed different phases of data collection with the Hospital Safety Index, the challenges and facilitators of using it, and recommendations for future adaptations. Data were analysed using inductive thematic analysis. Nine participants who were from three countries (Serbia, Sri Lanka, and Indonesia) and had different professional backgrounds (medical doctors, engineers, spatial planners, etc.) participated in this study. A total of 5 themes and 15 subthemes emerged during data analysis. Most of the participants reported their reasons for choosing the Hospital Safety Index as being its comprehensiveness and the fact that it was issued by the World Health Organization. The tool appears to be very specific and allows investigators to spot details in hospitals; however, it is not easy to use, and training is highly encouraged to learn how to navigate the different components of the tool. Governmental support is a crucial facilitator for investigators to be able to enter hospitals and conduct their evaluations. Overall, the tool has a lot of potential, and it should be used to reach a broader audience, such as community members, and assess the preparedness of other facilities that can take part in the response to disasters (hotels, stadiums, schools, etc.). Nevertheless, it still needs more adaptations to be tailored to different contexts and settings.

COVID-19 data reporting systems in Africa reveal insights for future pandemics

Globally, countries have used diverse methods to report data during the COVID-19 pandemic. Using international guidelines and principles of emergency management, we compare national data reporting systems in African countries in order to determine lessons for future pandemics. We analyse COVID-19 reporting practices across 54 African countries through 2020. Reporting systems were diverse and included summaries, press releases, situation reports and online dashboards. These systems were communicated via social media accounts and websites belonging to ministries of health and public health. Data variables from the reports included event detection (cases/deaths/recoveries), risk assessment (demographics/co-morbidities) and response (total tests/hospitalisations). Of countries with reporting systems, 36/53 (67.9%) had recurrent situation reports and/or online dashboards which provided more extensive data. All of these systems reported cases, deaths and recoveries. However, few systems contained risk assessment and response data, with only 5/36 (13.9%) reporting patient co-morbidities and 9/36 (25%) including total hospitalisations. Further evaluation of reporting practices in Cameroon, Egypt, Kenya, Senegal and South Africa as examples from different sub-regions revealed differences in reporting healthcare capacity and preparedness data. Improving the standardisation and accessibility of national data reporting systems could augment research and decision-making, as well as increase public awareness and transparency for national governments.

How Personality and Communication Patterns Affect Online ad-hoc Teams Under Pressure

Critical, time-bounded, and high-stress tasks, like incident response, have often been solved by teams that are cohesive, adaptable, and prepared. Although a fair share of the literature has explored the effect of personality on various other types of teams and tasks, little is known about how it contributes to teamwork when teams of strangers have to cooperate ad-hoc, fast, and efficiently. This study explores the dynamics between 120 crowd participants paired into 60 virtual dyads and their collaboration outcome during the execution of a high-pressure, time-bound task. Results show that the personality trait of Openness to experience may impact team performance with teams with higher minimum levels of Openness more likely to defuse the bomb on time. An analysis of communication patterns suggests that winners made more use of action and response statements. The team role was linked to the individual's preference of certain communication patterns and related to their perception of the collaboration quality. Highly agreeable individuals seemed to cope better with losing, and individuals in teams heterogeneous in Conscientiousness seemed to feel better about collaboration quality. Our results also suggest there may be some impact of gender on performance. As this study was exploratory in nature, follow-on studies are needed to confirm these results. We discuss how these findings can help the development of AI systems to aid the formation and support of crowdsourced remote emergency teams.