Risk and Risk Assessment in Health Emergency Management

What's the Plan? Exploring the Bounds of a Health-Care Standard of Preparedness for Florida Hospitals: A Policy Analysis

Hurricane Katrina uncovered a potential new theory of liability for the health-care industry-failure to plan. Today, the issue remains unresolved: how does a hospital define its duty of preparedness? Research shows there are over 13 definitions for hospital preparedness, multiple types of risk, and arbitrary hospital assessment tools that are not based on empirical data. In the absence of a clear definition for health-care preparedness, this article proposes a "reasonable under the circumstances" test to evaluate alleged liability for failure to plan and similar claims of negligence. In addition, translational science is proposed to aid in the development of a health-care standard of preparedness through a 5-phase evidenced-based, multi-disciplinary process.

Validation of a Belgian Prediction Model for Patient Encounters at Football Mass Gatherings

BACKGROUND

To validate the Belgian Plan Risk Manifestations (PRIMA) model, actual patient presentation rates (PPRs) from Belgium's largest football stadium were compared with predictions provided by existing models and the Belgian PRIMA model.

METHODS

Actual patient presentations gathered from 41 football games (2010-2019) played at the King Baudouin Stadium (Brussels, Belgium) were compared with predictions by existing models and the PRIMA model. All attendees who sought medical help from in-event health services (IEHS) in the stadium or called 1-1-2 within the closed perimeter around the stadium were included. Data were analyzed by ANOVA, Pearson correlation tests, and Wilcoxon singed-rank test.

RESULTS

A total of 1,630,549 people attended the matches, with 626 people needing first aid. Both the PRIMA and the Hartman model over-estimated the number of patient encounters for each occasion. The Arbon model under-estimated patient encounters for 9.75% (95% CI, 0.49-19.01) of the events. When comparing deviations in predictions between the PRIMA model to the other models, there was a significant difference in the mean deviation (Arbon: Z = -5.566, P <.001, r = -.61; Hartman: Z = -4.245, P <.001, r = .47).

CONCLUSION

When comparing the predicted patient encounters, only the Arbon model under-predicted patient presentations, but the Hartman and the PRIMA models consistently over-predicted. Because of continuous over-prediction, the PRIMA model showed significant differences in mean deviation of predicted PPR. The results of this study suggest that the PRIMA model can be used during planning for domestic and international football matches played at the King Baudouin Stadium, but more data and further research are needed.

Validation of a Belgian Prediction Model for Patient Encounters at Belgium's Largest Public Cultural Mass Gathering

OBJECTIVE

To compare actual patient presentation rates from Belgium's largest public open-air cultural festival with predictions provided by existing models and the Belgian Plan Risk Manifestations model.

METHODS

Retrospectively, actual patient presentation rates gathered from the Ghent Festivities (Belgium) during 2013-2019 were compared to predicted patient presentation rates by the Arbon, Hartman, and PRIMA models.

RESULTS

During 7 editions, 8673000 people visited the Ghent Festivities; 9146 sought medical assistance resulting in a mean patient presentation rate (PPR) of 1.05. The PRIMA model overestimated the number of patient encounters for each occasion. The other models had a high rate of underprediction. When comparing deviations in predictions between the PRIMA model to the other models, there is a significant difference in the mean deviation (Arbon: T = 0.000, P < 0.0001, r = -0.8701; Hartman: T = 0.000, P < 0.0001, r = -0.869).

CONCLUSION

Despite the differences between the predictions of all 3 models, our results suggest that the PRIMA model is a valid tool to predict patient presentations to IEHS during public cultural MG. However, to substantiate the PRIMA model even further, more research is needed to further validate the model for a broad range of MG.

Validation of a Belgian Prediction Model for Patient Encounters at Music Mass Gatherings

Introduction:

A Belgian predictive medical resource tool, Plan Risk Manifestations (PRIMA), for the prediction of the number of patient encounters at mass gatherings (MGs) has recently been developed, in addition to the existing models of Arbon and Hartman. This study presents the results of the validation process for the PRIMA model for music MGs.

Methods:

A retrospective study was conducted using data gathered from music MGs in the province of Antwerp (Belgium) during the period of 2012-2016. Data from 87 music MGs were used for the study. The forecast of medical resources for these events was determined by entering the characteristics of individual events into the Arbon, Hartman, and PRIMA models. In order to determine if the PRIMA model is under- or over-predictive, the data gathered were retrospectively compared to the predicted number of resources needed using the aforementioned models. Statistical analysis included means, medians, and interquartile ranges (IQRs). Nonparametric related samples test (Wilcoxon Samples Signed Rank Test) for comparison of the median in deviations in predictions of patient presentation rates (PPRs) was performed using SPSS version 23 (IBM Corp.; Armonk, New York USA). Confidence interval levels were set at 95% and results were deemed statistically significant at P <.05. This triple comparison was used to determine the overall performance of all three models.

Results:

All three models had an acceptable rate of over-prediction of number of patient encounters ([Arbon 25.29%; 95% CI, 30.91-43.74]; [Hartman 29.89%; 95% CI, 57.10-68.90]; and [PRIMA 19.54%; 95% CI, 57.80-76.20]). But all models also had a high rate of under-prediction of number of patient encounters ([Arbon 74.71%; 95% CI, 453.31-752.52]; [Hartman 70.11%; 95% CI, 546.90-873.77]; and [PRIMA 78.16%; 95% CI, 288.91-464.89]). Only the PRIMA model succeeded in the correct prediction of the number of patient encounters on two occasions (2.3%).

Conclusion:

Results of this study are in-line with existing literature. When comparing the predicted patient encounters, all three models had high rates of under-prediction and moderate rates of over-prediction. When comparing mean deviations, the PRIMA model had the lowest mean deviation of all predicted PPRs. Belgian events of the types included in the presented data may use the PRIMA model with confidence to predict PPRs and estimate the in-event health services (IEHS) requirements.

Rapid Emergence and Increasing Risks of Hailstorms: A Potential Threat to Sustainable Agriculture in Northern Bangladesh

This study investigates the recent changes in natural hazard prioritizations in northern Bangladesh and presents community-based risk analyses of the various natural hazards that present threats to sustainable agriculture. The study area in northern Bangladesh included two union council areas under the Panchagarh sub-district. Climatological data analysis, a detailed questionnaire survey, and focus group discussions were conducted to assess farmers’ perceptions regarding the shifting and identification of hazards, their seasonal variation, and hazard prioritizations. The SMUG (seriousness, manageability, urgency, and growth) and FEMA (Federal Emergency Management Agency) models were applied for hazard prioritization. Hailstorms were found to be the most prioritized hazard over droughts and flash floods as perceived by the community. The farmers’ perceptions as evaluated through a questionnaire survey also support the findings of the SMUG and FEMA models. This was the first attempt to analyze the potential of hailstorms as a significant hazard in Bangladesh, and GIS maps showed their spatial distribution and temporal frequency across Bangladesh. This newly identified hazard is significantly diminishing farmers’ motivation to continue farming and has the potential to affect sustainable agriculture. The farmers’ perceptions, historical data analysis, use of the two models, institutional approach, hazard risk assessment, and vulnerability to the major sectors show that hailstorms should be considered as an important hazard in northern Bangladesh, and policymakers should pay urgent attention to minimize the threat to sustainable agriculture in northern Bangladesh.

Towards Improved Linkage of Disaster Risk Reduction and Climate Change Adaptation in Health: A Review

Climate change and climate-sensitive disasters significantly impact health. Linking Disaster Risk Reduction (DRR) and Climate Change Adaptation (CCA) is essential for addressing these ever present, complex and increasing risks. Recent calls have been made to build these links in health. However, there is a need to clearly articulate why linking DRR and CCA is important in health. Furthermore, little is known about how DRR and CCA should be linked in health. By extensively examining relevant literature, this review presents the current state of knowledge of linking DRR and CCA in health. This includes the potential for maximising conceptual synergies such as building resilience, and reducing vulnerability and risk. Additionally, technical and operational synergies are identified to link DRR and CCA in health, including: policy, Early Warning Systems, vulnerability and risk assessment, health systems strengthening, infrastructure resilience, disaster preparedness and response, and health impact pathways. Public health actors have a central role in building these links due to their expertise, work functions, and experience in addressing complex health risks. The review concludes with recommendations for future research, including how to better link DRR and CCA in health; and the opportunities, challenges and enablers to build and sustain these links.

Assessment of hospital emergency management in the Beijing area

INTRODUCTION

In recent years, the number of public health emergencies has increased. Improving hospital emergency management is an important challenge.

OBJECTIVE

This is a pilot study intended to assess hospital emergency management in the Beijing area, make recommendations to government health authorities and hospital managers, and offer references for similar studies.

METHODS

This was an observational, cross-sectional survey. Forty-five hospitals in the Beijing area were selected randomly. A self-administered questionnaire was used as a data collection tool. It comprised of three sections: (1) Section A was the introduction; (2) Section B asked for the respondent's personal information; and (3) Section C comprised the major part of the questionnaire and was intended to gather information regarding the hospital's general emergency management situation.

RESULTS

The survey response rate was 44%, accounting for 29% of total hospitals that the study targeted. No hospital had an established emergency management department or full-time staff for emergency management. A total of 15-45% of the hospitals had established a hospital emergency management committee, performed a vulnerability analysis, or evaluated emergency management regularly. Twenty-five percent of respondents thought that the local government health authority had established an integrated hospital incident command system. A total of 40%-55% of hospitals contracted with outside institutions for supplements, backup of key functional systems and professional support.

CONCLUSIONS

After the occurrence of the 2003 severe acute respiratory syndrome (SARS) epidemic, Chinese hospital managers took many measures to improve hospital resilience. However, most of these efforts lacked the guidance of theories, concepts, principles, and methods. An integrated, standardized, operational hospital emergency management model has not been established. Although the survey response rate was relatively low, some clues for further study were discovered, and suggestions to the health authority for hospital emergency management improvement were revealed.

International guidelines and standards for education and training to reduce the consequences of events that may threaten the health status of a community. A report of an Open International WADEM Meeting, Brussels, Belgium, 29-31 October, 2004

The continued professionalization of the humanitarian workforce requires sound underpinning by appropriate educational programs. The international disaster medicine and emergency health community requested the World Association for Disaster and Emergency Medicine (WADEM) develop international standards and guidelines for the education and training for disaster medicine. The Working Group of the WADEM Education Committee prepared and circulated an Issues Paper to structure input on this significant international task. Subsequently, the Working Group facilitated an Open International Meeting convened in Brussels, Belgium, 2004. The "Issues Paper" also was used as a framework to structure this International Meeting, which utilized case studies selected to represent the scope of disaster medicine, and prepared a meeting consensus on a framework for disaster health and for related educational programs. The two-day Brussels meeting attracted 51 participants from 19 countries, representing 21 disciplines. Participants reinforced the need to address the development of international standards and guidelines on education and training in this emerging discipline. Participants supported the view that the term "Disaster Health" suggested a multidisciplinary approach that is a more inclusive contemporary and appropriate term to describe this field, although there were dissenting views. The meeting formulated a consensus view in support of a framework for "Disaster Health", which included: (1) primary disciplines; (2) support disciplines; (3) community response, resilience, and communication; and (4) socio-political context. The participants considered that this model lends itself to facilitating the development of educational programs in this field and believed that standards and guidelines initially should be developed in the "Core of Disaster Health" for undergraduates in relevant professions, for practicing professionals wishing to expand their practice in this field, and in the "Breadth of Disaster Health" for those wishing to be recognized as "Disaster Health Specialists" as academics, professionals, or policy leaders in this field at a University multidisciplinary Masters Degree level. A community-level and higher-specialist doctoral level would follow. Although the view of the participants was that the establishment of international approval/endorsement processes for education programs may have some benefits, there was less comfort in identifying which body/agency should be charged with this responsibility. The WADEM, the United Nations Office for the Coordination of Humanitarian Affairs, and the World Health Organization were identified as potential lead agents. The outcome of this international meeting is an important step toward meeting the challenge given the WADEM and will be developed further in consultation with the international disaster and emergency health community in order to improve education and training standards and professional practice.