Ecology of emergency care in lower-tier healthcare providers in Ghana: an empirical data-driven Bayesian network analytical approach

The healthcare landscape in Ghana is primarily composed of lower-tier providers, which serve as the initial  point of contact for most medical emergencies. This study aimed to assess the emergency care preparedness and readiness of primary healthcare providers using a robust evaluation approach. A multicentre retrospective cross-sectional study was conducted on  460 healthcare facilities  using the standardised Health Facilities Emergency Preparedness Assessment Tool (HeFEPAT). Data were analysed via Bayesian Belief network. Emergency preparedness was associated with facility location, type, ownership, and in-charge personnel. Over 70% of facilities lacked specialised emergency/critical care personnel. Although 65% of in-charges reported protocol knowledge, only 7.8% could execute cardiopulmonary resuscitation. 90% of facilities lacked onsite defibrillators, and over 80% had no cerebrovascular accident medications. Road traffic accident protocols were largely unavailable, with an  estimated 53% probability of  lacking such protocols. Private-owned facilities were more likely to lack protocols for road traffic accidents (76% vs 20% probability) and general acute care (62% vs 32%) compared to government-owned facilities. Significant gaps in emergency preparedness were identified across the studied health facilities, indicating limited capacity to manage critical situations effectively. Urgent investments in emergency medicine training, essential resources, and evidence-based protocols are needed. Standardised emergency preparedness assessments should be implemented for accreditation and quality improvement. Further research can inform the development of national guidelines and targeted interventions to strengthen emergency response capacities.

Emergency Preparedness Drills for Active and Mass Shootings in Schools

PURPOSE OF REVIEW

There is widespread use of emergency preparedness drills in public K-12 schools across the US, but considerable variability exists in the types of protocols used and how these practices are conducted. This review examines research into both "lockdown drills" and "active shooter drills" as it relates to their impact on participants across different outcomes and evaluations of their procedural integrity.

RECENT FINDINGS

A number of studies on lockdown drills yielded largely consistent findings about their impacts, whereas findings related to the effects of active shooter drills are less uniform. The research also demonstrated that lockdown drills, though not active shooter drills, can help participants build skill mastery to be able to successfully deploy the procedure. Differences in how drills impact participants and whether they cultivate skill mastery are largely attributable to the type of drill being conducted. This review suggests that employing clearly defined drill procedures incorporating best practices, coupled with instructional training, can help schools prepare for emergencies without creating trauma for participants.

"Saving Students' Lives": Instructor Sharing of Run-Hide-Fight® Emergency Preparedness Materials

When emergency situations occur, it is essential that individuals can effectively respond to keep themselves and others safe. One attempt at increasing individuals' readiness for an emergency is the Run-Hide-Fight® campaign, which has been adopted by several higher education institutions in the United States. This study explores the dissemination of this campaign by instructors at a large Midwestern university in the United States. We generally find support for the reasoned action perspective, with attitudes, norms, and perceived behavioral control influencing intentions to share the emergency preparedness video with students. Through open-ended responses provided by the instructors, we identify four main themes surrounding video dissemination. First, most instructors felt comfortable sharing the video, believing it would be useful in preparing students for an emergency. Second, some instructors voiced concerns about the negative emotional effects the video may have on students. Third, instructors generally appreciated the brief and effective delivery of the message, though some were concerned about dramatizing emergencies. Finally, instructors suggested ways of improving the video, such as including more specific guidance on how to behave in an emergency situation. Practically, these findings suggest that universities should consider their emergency preparedness information dissemination strategy to maximize credibility, minimize message fatigue, and reach more students. Theoretically, this study affirms the tenets of reasoned action and suggests alternative theoretical approaches for future scholarship.

Unleashing excellence: using a project management approach to effectively implement a simulation curriculum to improve residents' preparedness

BACKGROUND

Integrating innovative, simulation-based training programs into medical curricula frequently encounters familiar challenges, including scepticism, limited faculty time, and financial constraints. Recognized for its success in business projects, the Harvard Project Management Theory emerges as a promising approach to optimizing the implementation process and achieving sustainable success. This study endeavours to elucidate the application of project management theory in our implementation process and assess its impact on the clinical preparedness of novice residents.

METHODS

The research utilized a structured four-phase implementation strategy-Planning, Build-up, Execution, and Closing-to develop a simulation-based education curriculum. Incorporating project management tools like project charters and risk management tools played a crucial role in facilitating the effective implementation of standardized processes and improved clinical outcomes. Essential components of this innovative management approach encompass stakeholder engagement, milestone definition, and the alignment of institutional policies and processes.

RESULTS

A collective of 395 residents actively engaged in eight monthly simulation-based events, reflecting an average participation rate of 39 residents per lecture (± 19). A noteworthy enhancement was observed in the average rating for knowledge gain, with a significant improvement from 5.9/10 to 8.8/10 (p = 0.0001). Participants highlighted the program's considerable impact on future clinical practice (4.7/5) and teamwork (4.8/5) as particularly valuable aspects. The introduction of a novel organizational structure received favourable feedback from faculty members, with a notable rating of 4.8/5 for predictive time planning. Qualitative insights from the evaluation highlighted the significance of targeted incentive schemes in optimizing the implementation process.

CONCLUSION

This project underscores the constructive influence of project management principles in designing simulation-based curricula, explicitly focusing on stakeholder engagement, faculty motivation, and data utilization. Adopting the Harvard Project Management Approach emerges as a catalyst for heightened success in curriculum design, contributing to enhanced emergency preparedness among novice residents. The positive outcomes observed in this study provide valuable insights for future implementations, offering a foundation for refining and optimizing medical education programs to meet the evolving needs of learners and stakeholders alike.

Dementia Caregivers' Perspectives on Disaster Preparedness: Barriers, Resources, and Recommendations

BACKGROUND AND OBJECTIVES

Disaster preparedness is an urgent concern, particularly for caregivers of persons with dementia. Developing and executing plans for oneself and another person who needs care can be difficult when the care recipient is cognitively impaired. We sought to better understand caregivers' disaster preparedness for the purpose of generating guidance for future interventions to increase caregiver resilience.

RESEARCH DESIGN AND METHODS

We conducted a qualitative descriptive study of caregiver disaster experiences and perceptions of their preparedness. Fifty-two participants from diverse backgrounds participated in a focus group or interview. Deductive thematic data analysis was utilized to identify themes. Stress process models guided the interpretation of our findings.

RESULTS

Analyses of caregivers' experiences and observations revealed that disaster preparedness was challenging for caregivers, though also perceived to be an important responsibility. We identified 3 main themes: (a) barriers to preparing for a disaster as a caregiver for a person living with dementia, (b) why it is important for a caregiver to develop a disaster plan, and (c) how to facilitate preparedness for caregivers of persons living with dementia.

DISCUSSION AND IMPLICATIONS

This study highlighted the difficulties of preparing for a disaster while caring for a person with dementia. Applying stress process models to our results provided strong evidence that interventions could be developed to bolster caregivers' resources to cope with stressors associated with disaster preparedness. A key issue for public officials is the question of whether disaster shelters are appropriate for persons with dementia.

Perceptions of the Zika Virus, Contraceptive Access, and Motivation to Participate in the Zika Contraception Access Network Program: Qualitative Analysis of Focusgroup Discussions with Puerto Rican Women

OBJECTIVE

During the 2016-2017 Zika virus outbreak in Puerto Rico, the Zika Contraception Access Network (Z-CAN) provided client-centered contraceptive counseling and access to the full range of reversible contraceptive methods at no cost to prevent unintended pregnancies and thereby to reduce Zika-related birth outcomes.

METHODS

To understand how Puerto Rican women's perceptions of the Zika virus affected contraceptive decisions and assess how they heard about the Z-CAN program and what influenced their participation, or lack thereof, 24 focus-group discussions were conducted among women of reproductive age who did and did not participate in Z-CAN.

RESULTS

Women who participated in the discussions often had heard about Z-CAN from their physician or friends; non-participants had heard about Z-CAN from Facebook or friends. Women expressed satisfaction on finding a Z-CAN clinic and valued the same-day provision of contraceptives. When a preferred contraceptive method or a first appointment was not readily available, women reconsidered accessing the program. Women's perceptions and trust of reproductive healthcare providers, their engagement in social networks, and their ability to choose a contraceptive method that best meets their needs can influence participation in contraception-access programs.

CONCLUSION

Focus groups can be used to understand women's knowledge of the Zika virus, barriers and facilitators to contraception access, and motivations for participation in the Z-CAN program.

Do Experienced Nurses Benefit From Training on Bleeding Control in the Community Setting?

INTRODUCTION

Nurses' preparedness to provide hemorrhage control aid outside of the patient care setting has not been thoroughly evaluated. We evaluated nurses' preparedness to provide hemorrhage control in the prehospital setting after a proof-of-concept training event.

METHODS

We performed a secondary analysis of evaluations from a voluntary hemorrhage control training offered to a group of experienced nurses. Education was provided by a nurse certified in Stop the Bleed training and using the Basic Bleeding Control 2.0 materials. The training lasted approximately 1 hour and included a didactic portion followed by hands-on practice with task trainer legs. Participants were surveyed after training to assess their preparedness to provide hemorrhage control aid using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree); comments and feedback were also requested. Mean (SD) was used to analyze Likert scale data. Content analysis was performed to identify common themes in qualitative data.

RESULTS

Forty-five experienced nurses participated in the voluntary training. Nursing experience included obstetrics, pediatrics, critical care, acute care, community health, and psychiatric/mental health. Only 39% of participants reported having previously completed a similar course. After training completion, participants reported an increase in their preparedness to provide hemorrhage control aid (mean 3.47 [SD = 1.40] vs mean 4.8 SD [.04], P < .01). Major themes identified included wanting to feel prepared to help others, refreshing skills, and knowing how to respond in an emergency.

DISCUSSION

Regardless of background and experience, nurses may benefit from more advanced hemorrhage control education to prepare them to provide aid in prehospital emergency settings.

Mass fatality and disaster response preparedness across medical examiner and coroner offices in the United States

With the rise of mass fatalities and disasters, access to mass fatality and disaster planning trainings and resources available to medical examiners and coroners (MECs) in the United States should be reviewed. This paper provides a necessary update on the extent of access to these resources by analyzing data from the 2018 Census for Medical Examiner and Coroner Offices (CMEC). Results show that a high percentage of respondents have access to mass fatality and disaster planning trainings/resources; however, the access is disproportionate. Respondents in the Midwest and South-and those with smaller populations-have less access to resources, while agencies with larger budgets and more full-time staff have more access to resources. This paper discusses potential contributing factors for these disparities, but the data only begin to elucidate gaps in access to mass fatality and disaster planning trainings/resources for MECs and where further research should be conducted.

U.S. COVID-19 vaccine distribution strategies, systems, performance, and lessons learned, December 2020 - May 2023

During December 2020 through May 2023, the Centers for Disease Control and Prevention's (CDC) Immunization Services Division supported and executed the largest vaccine distribution effort in U.S. history, delivering nearly one billion doses of COVID-19 vaccine to vaccine providers in all 50 states, District of Columbia, Puerto Rico, Virgin Islands, Guam, Federated States of Micronesia, American Samoa, Marshall Islands, Northern Mariana Islands, and Palau. While existing infrastructure, ordering, and distribution mechanisms were in place from the Vaccines for Children Program (VFC) and experience had been gained during the 2009 H1N1 pandemic and incorporated into influenza vaccination pandemic planning, the scale and complexity of the national mobilization against a novel coronavirus resulted in many previously unforeseen challenges, particularly related to transporting and storing the majority of the U.S. COVID-19 vaccine at frozen and ultra-cold temperatures. This article describes the infrastructure supporting the distribution of U.S. government-purchased COVID-19 vaccines that was in place pre-pandemic, and the infrastructure, processes, and communications efforts developed to support the heightened demands of the COVID-19 vaccination program, and describes lessons learned.

Navigating Through Disaster: Application of Oncology Nurse Navigator Competencies to Climate Disaster Preparation and Response

OBJECTIVES

The role of the oncology nurse navigator (ONN) before, during, and after a climate disaster is critical to ensuring that individuals with cancer continue to receive the necessary care and support. The objective of this article is to provide an overview of the essential role of the ONN by highlighting the application of core competencies to climate disasters.

METHODS

Competencies available for ONNs from the Oncology Nursing Society include coordination of care, communication, education, professional role, and expertise. International Council of Nurses (ICN) core competencies for disaster nursing include eight domains: preparation and planning, communication, incident management systems, safety and security, assessment, intervention, recovery, and law and ethics. These competencies are explored for application to climate disaster preparation, mitigation, and response.

RESULTS

The ONN competencies and the domains of the ICN disaster nursing competencies were integrated to outline the role of the ONN in disaster preparedness and response.

CONCLUSION

The ONN is pivotal in maintaining the continuity of cancer care. The ONN's expertise is critical for navigating the difficulties presented by hurricanes, floods, wildfires, and other extreme climate events as well as existing barriers to cancer care. The ONN's adeptness at coordinating care, communicating effectively, and tapping into community resources will transfer to a climate disaster, ensuring minimal treatment interruptions and access to necessary care.

IMPLICATIONS FOR NURSING PRACTICE

The ONN is integral to the cancer care team in preparing and responding to climate disasters. The ONN ensures ongoing access to cancer care and advocates for the specialized care that people with cancer need. The ONS ONN Core Competencies and the ICN Disaster Competencies are applicable for developing processes and procedures to address climate disasters in clinical practice.

Preparing for another Ebola Outbreak: The impact of viral inactivation methods on commonly measured biochemistry analytes in plasma and urine

INTRODUCTION

Infectious specimens containing viruses like Ebola require sample manipulation to ensure the safety of laboratory staff, which may negatively impact biochemistry test results. We evaluated the impact of viral inactivation methods on 25 biochemistry analytes in plasma, and seven biochemistry analytes in urine.

METHODS

Fifteen lithium heparinized plasma specimens with and without gel underwent the following viral inactivation methods: 1) untreated, 2) Triton X-100 treatment, 2) heated for 60 min then Triton X-100 treatment, 3) heated for 60 min, 4) heated for 75 min, and 5) heated for 90 min. Electrolytes, protein, enzymes, glucose, as well as hepatic and renal markers were measured on the Roche Cobas e601, c502 or c702. Urinalysis analytes were measured on the Siemens CLINITEK. Acceptable recovery was based on Institute for Quality Management in Healthcare 2021 guidelines or ± 1 for urinalysis.

RESULTS

Potassium and lactate dehydrogenase were impacted by the presence of gel. Viral inactivation with Triton X-100 had minimal impact on the biochemistry results. Heat inactivation resulted in significant negative bias in alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, creatinine, total protein, amylase, lactate dehydrogenase and creatine kinase. Positive bias in phosphate, aspartate transaminase, total bilirubin, and uric acid were observed after heat inactivation.

CONCLUSION

Reliable results for commonly measured electrolytes, enzymes and proteins can be obtained after viral inactivation by Triton X-100 treatment at room temperature. However, heat inactivation has significant negative impact on routine biochemistry enzymes and alternative testing processes should be explored.

The Impact of Climate Change on Global Oncology

Climate change is the greatest threat to human health of our time, with significant implications for global cancer control efforts. The changing frequency and behavior of climate-driven extreme weather events results in more frequent and increasingly unanticipated disruptions in access to cancer care. Given the significant threat that climate change poses to cancer control efforts, oncology professionals should champion initiatives that help protect the health and safety of patients with cancer, such as enhancing emergency preparedness and response efforts and reducing emissions from our own professional activities, which has health cobenefits for the entire population.

Data-Driven Interventions for an Emergency Preparedness System: A National Experience in Australia

Natural disasters and health emergencies disproportionally affect vulnerable populations causing disruptions to usual care and increasing chronic disease burden. Data and digital technologies are important tools to identify and mitigate indirect effects of emergencies. In this paper, we describe the methods used in the development of a series of digital emergency preparedness interventions to mitigate the direct and indirect consequences of the COVID-19 pandemic in the veteran community in Australia. The case studies demonstrate the use of data for surveillance, patient phenotyping, data-driven decision support and stakeholder communication in primary care. The intervention successfully increased appropriate healthcare use by vulnerable individuals and could be expanded to other populations.

"We are still tired": staff and administrators' experiences during the COVID-19 pandemic within California residential care facilities for older adults

BACKGROUND

Extensive research has been conducted on the impacts of the COVID-19 pandemic on long-term care workers in specialized care facilities. However, little is known about the impacts faced by facilities that provide generalized long-term support and care, such as residential care facilities for older adults (RCFs). This study describes the challenges experienced by staff and administrators of RCFs during the COVID-19 pandemic.

METHODS

An electronic questionnaire collecting data using both closed- and open-ended questions on staff experiences was sent to 5,721 unique RCF administrator emails within the state of California between June-December 2021. Email addresses were obtained from the public database of RCFs available through the California Health and Human Services Open Data Portal. Descriptive statistics were calculated on quantitative data regarding staff preparedness training, access to resources, and administrators' confidence in meeting recommended guidelines during the pandemic. Inductive thematic analysis was conducted on qualitative data regarding the confidence levels in meeting pandemic guidelines and challenges faced related to staff stress and morale.

RESULTS

A total of 150 RCF administrators across California (response rate of 2.6%) completed the survey. Over three-fourths of respondents indicated their facilities had a designated staff member to train other staff members on emergency preparedness plans and the most frequently used resources during the COVID-19 pandemic were the Department of Social Services Community Care Licensing Division (88.7%), the county health department (86.7%), and the Centers for Disease Control and Prevention (80.7%). Administrators felt least confident in their facilities' ability to maintain adequate staffing (52.0%), communication with nearby hospitals (62.1%) and communication with state and local public health officials (69.8%) during the pandemic. Three central themes emerged from the thematic analysis on staff stress and morale: (1) physical safety, mental and emotional impact of the COVID-19 pandemic; (2) staffing issues; and (3) challenges with guidelines in managing the ongoing pandemic.

CONCLUSIONS

Findings from this research study can be used to actively target training resources for facility administrators and staff that have been identified as most frequently used and relevant for emergency preparedness in these understudied facilities. Additionally, developing a better understanding of the staffing stress and morale difficulties in RCFs can provide insight on how policymakers can assist these critical facilities in better preparing for future crises.

Validation of secondary triage algorithms for mass casualty incidents : A simulation-based study-English version

BACKGROUND

In the event of a mass casualty incident (MCI), the situation-related shortage of medical resources does not end when the patients are transported from the scene of the incident. Consequently, an initial triage is required in the receiving hospitals. In the first step, the aim of this study was to create a reference patient vignette set with defined triage categories. This allowed a computer-aided evaluation of the diagnostic quality of triage algorithms for MCI situations in the second step.

METHODS

A total of 250 case vignettes validated in practice were entered into a multistage evaluation process by initially 6 and later 36 triage experts. This algorithm-independent expert evaluation of all vignettes-served as the gold standard for analyzing the diagnostic quality of the following triage algorithms: Manchester triage system (MTS module MCI), emergency severity index (ESI), Berlin triage algorithm (BER), the prehospital algorithms PRIOR and mSTaRT, and two project algorithms from a cooperation between the Federal Office of Civil Protection and Disaster Assistance (BBK) and the Hashemite Kingdom of Jordan-intrahospital Jordanian-German project algorithm (JorD) and prehospital triage algorithm (PETRA). Each patient vignette underwent computerized triage through all specified algorithms to obtain comparative test quality outcomes.

RESULTS

Of the original 250 vignettes, a triage reference database of 210 patient vignettes was validated independently of the algorithms. These formed the gold standard for comparison of the triage algorithms analyzed. Sensitivities for intrahospital detection of patients in triage category T1 ranged from 1.0 (BER, JorD, PRIOR) to 0.57 (MCI module MTS). Specificities ranged from 0.99 (MTS and PETRA) to 0.67 (PRIOR). Considering Youden's index, BER (0.89) and JorD (0.88) had the best overall performance for detecting patients in triage category T1. Overtriage was most likely with PRIOR, and undertriage with the MCI module of MTS. Up to a decision for category T1, the algorithms require the following numbers of steps given as the median and interquartile range (IQR): ESI 1 (1-2), JorD 1 (1-4), PRIOR 3 (2-4), BER 3 (2-6), mSTaRT 3 (3-5), MTS 4 (4-5) and PETRA 6 (6-8). For the T2 and T3 categories the number of steps until a decision and the test quality of the algorithms are positively interrelated.

CONCLUSION

In the present study, transferability of preclinical algorithm-based primary triage results to clinical algorithm-based secondary triage results was demonstrated. The highest diagnostic quality for secondary triage was provided by the Berlin triage algorithm, followed by the Jordanian-German project algorithm for hospitals, which, however, also require the most algorithm steps until a decision.

Experiences from the ARGOS user group nuclear emergency exercise

The Accident Reporting and Guiding Operational System (ARGOS) is a decision support system used to assist in the Emergency Preparedness and Response (EPR) to nuclear and radiological incidents. The ARGOS user group has been formed that is made up of government agencies across many countries that have a role in EPR to nuclear and radiological incidents. In 2020, a desktop exercise was organised for the members of the ARGOS user group. The exercise involved two hypothetical accidents at different times on the same date, namely a radiological release from a floating nuclear power plant (NPP) off the Norwegian coast and from the Loviisa NPP in Finland. The objectives of the exercise were to train and increase knowledge of the ARGOS system, to perform a comparison of model outputs, and to compare the recommendations of protective actions. In the case of the floating NPP the source term was provided, while in the Loviisa NPP scenario the participants were required to provide their own source term based on a description of the accident. The results on radiological consequences based on dispersion modelling, protective actions, source terms and dispersion modelling settings were collected from participants. A comparison was made between each of these reported aspects. In general, it was found that there was general agreement between the results for the floating nuclear power plant scenario in the sense of plume direction and extent, while in the case of the Loviisa NPP scenario, there was much greater variation, with the difference in source term estimates between the participants being an influencing factor. The participants acknowledged that taking part in an exercise of this nature increased their knowledge and understanding about using decision support tools such as ARGOS in planning and responding to nuclear and radiological emergencies.

[Special emergency situations and hazard control in German hospitals-A survey on the current state]

BACKGROUND AND RESEARCH QUESTION

In case of events such as a cyber attack or a mass casualty incident, ad hoc measures have to be taken in hospitals. As part of the critical infrastructure, hospitals are required by law to prepare, update and exercise alarm and emergency plans for various special situations. The processes and instruments involved for emergency response are defined in the hospital alert and emergency planning. The present study aims to explain with which resources and for which special situations hospitals are prepared.

METHODS

A prospective, exploratory, anonymous survey of hospitals in Germany was conducted. Hospitals with both internal medicine and surgery departments were included. Out of 2497 hospitals listed in the German Hospital Directory ( www.deutsches-krankenhaus-verzeichnis.de ), 1049 met the inclusion criteria. After correcting for hospital groups with shared administrations, 850 employees were identified and contacted by e‑mail. Quality and risk management managers were asked about resources, risks, and content of their own hospital alert and emergency planning using a standardized questionnaire. The survey was conducted using the online platform EFS Survey (Tivian XI GmbH, Cologne) via www.unipark.de . Access to the survey was via a nonpersonalized hyperlink. Apart from the size and type of hospital surveyed, no data were collected that would allow identification of an individual person.

RESULTS

Of the participating hospitals 45% (n = 43) were primary care hospitals, 24% (n = 23) were specialty care hospitals, 10% (n = 9) were nonuniversity maximum care hospitals, and 21% (n = 20) were university maximum care hospitals. In total 95 hospitals participated in the survey, of which 98% (n = 93) reported having a hospital alert and emergency plan. Preparation for individual scenarios varied widely. Of the participating hospitals 45% (n = 43) reported having been the target of cyber attacks with an emphasis on maximum care hospitals (55%, n = 11 of 20). Technical redundancy for computer systems is available in 67% (n = 63) of participating hospitals, while independent means of communication exist in 50% (n = 47) of hospitals. A physician-staffed crisis and disaster management unit existed in 60% (n = 56) of the surveyed hospitals. At least a part time position for planning issues was installed in 12 hospitals.

CONCLUSION

Most participating hospitals are aware of the need for a hospital alert and emergency plan and have various scenario-specific plans in place. Especially mass casualty events, fire and hospital evacuation scenarios are uniformly covered among participating hospitals; however, gaps appear to exist not only for chemical, biological or radionuclear situations but also especially in the area of extreme weather events and infrastructure failures. Only about two thirds of all participating hospitals have contingency plans for water supply and/or heating failures. An important limitation of the study is the comparatively low response rate of 12.9% (n = 95 of 850). While primary care hospitals were underrepresented in the study, 32% of Germany's larger hospitals (> 800 beds) participated. In the future, there is a particular need to engage enough medical staff in the area of hospital alert and emergency planning and refunding of these measures by hospitals.

A cross-sectional survey of Australian service providers' emergency preparedness capabilities

PURPOSE

Emergency and disaster management planning is an emerging role with limited practical guidance on how it should be implemented by community, disability, health and rehabilitation service providers. This study examined the emergency preparedness of service providers and how they viewed their role and contributions to disaster risk reduction, including their capacity and willingness to facilitate preparedness planning with their clients.

MATERIALS AND METHODS

A questionnaire was developed and administered nationally. Descriptive statistics, multivariate regression analyses, and thematic analysis of open-ended questions provide insight on the knowledge, tools and training needs of service providers to contribute to preparedness of themselves and the people they support.

RESULTS

Facilitating emergency preparedness with people with disability was strongly associated with a high level of mental preparedness, household preparedness scores, and completion of Person-Centred Emergency Preparedness (P-CEP) training. Perceived lack of funding, insufficient tools, and exclusion of emergency planning from job descriptions were negatively associated with facilitating emergency preparedness with clients.

CONCLUSIONS

Study findings lay the groundwork for development of the role and capabilities of individual service providers including the need to equip disability, health and rehabilitation service providers with training and tools to prepare themselves and the people they support for emergencies.

A Multisite Investigation of Areas for Improvement in COVID-19 Surge Capacity Management

The congressionally authorized National Disaster Medical System Pilot Program was created in December 2019 to strengthen the medical surge capability, capacity, and interoperability of affiliated healthcare facilities in 5 regions across the United States. The COVID-19 pandemic provided an unprecedented opportunity to learn how participating healthcare facilities handled medical surge events during an active public health emergency. We applied a modified version of the Barbisch and Koenig 4-S framework (staff, stuff, space, systems) to analyze COVID-19 surge management practices implemented by healthcare stakeholders at 5 pilot sites. In total, 32 notable practices were identified to increase surge capacity during the COVID-19 pandemic that have potential applications for other healthcare facilities. We found that systems was the most prevalent domain of surge capacity among the identified practices. Systems and staff were discussed across all 5 pilot sites and were the 2 domains co-occurring most often within each surge management practice. These results can inform strategies for scaling up and optimizing medical surge capability, capacity, and interoperability of healthcare facilities nationwide. This study also specifies areas of surge capacity worthy of strategic focus in the pilot's planning and implementation efforts while more broadly informing the US healthcare system's response to future large-scale, medical surge events.

Provider Perceptions of Facilitators of and Barriers to Implementation of the Zika Contraception Access Network: A Qualitative Evaluation

OBJECTIVE

From May 2016 through September 2017, the Zika Contraception Access Network (Z-CAN) program increased access to contraception during the Zika virus outbreak in Puerto Rico by providing no-cost client-centered contraceptive counseling and (same-day) access to the full range of US Food and Drug Administration-approved reversible contraceptives to women desirous of not becoming pregnant. The purpose of this study was to identify areas for programmatic improvement and enhance the sustainability of services from the perspectives of participating Z-CAN physicians and other staff.

METHODS

From April through July 2017, 49 in-depth key-informant interviews were conducted with Z-CAN physicians and clinic staff. Twenty-five clinics participating in the Z-CAN program were selected through a cluster randomization process. A semi-structured interview guide was developed to explore the participants' perceptions of the Z-CAN program and examine facilitators of and barriers to said implementation. A thematic analysis of the emerging topics was conducted.

RESULTS

Our analysis encountered 4 common overarching themes: facilitators of the Z-CAN program; barriers to Z-CAN implementation; the perceived impact of Z-CAN on providers and communities; and the sustainability of contraception access after the Z-CAN program ended. The key findings were that provider training, mentor support, and communication campaigns facilitated program implementation and that delays in the acquisition and distribution of contraceptives were obstacles.

CONCLUSION

Lessons learned from the implementation of Z-CAN from the perspective of physicians and other staff can be used to work towards sustainable contraceptive services in Puerto Rico and inform other contraception-access programs' design and implementation strategies.

Use of simulation models when developing and testing hospital evacuation plans: a tool for improving emergency preparedness

BACKGROUND

In recent decades, analyses of hospitals evacuations have generated valuable knowledge. Unfortunately, these evacuation case studies often lack crucial details and policies that would be helpful in evacuation preparedness. The aim of this study was to use a simulation model to illustrate how it can aid emergency planners in the development, testing, and revising of hospitals evacuation plans. This study includes evacuation exercises at two emergency hospitals in Region Stockholm, Sweden.

METHODS

A scientifically validated simulation system for "table top" exercises was used for interactive training of hospital medical staff, prehospital staff and collaborating agencies. All participants acted in their usual professionals' roles. The exercises were run in real-time and mirrored actual hospital resources with the aid of moveable magnetic symbols illustrating patients, staff and transport, presented on whiteboards. During the exercises, observers and independent instructors documented actions taken and post-exercise surveys were conducted to obtain reactions and compare results.

RESULTS

The simulation system allowed the emergency planner to test the whole evacuation process, making it possible to train and evaluate the important functions of management, coordination, and communication. Post-exercise surveys explored participants perception of the exercises. Analysis of open-ended questions included areas for improvement and resulted in five main categories: (1) management and liaison; (2) communication; (3) logistics; (4) medical care and patient prioritisation; and (5) resource utilisation.

CONCLUSIONS

This study has shown that "table top" exercises using a validated simulation system can serve to guide emergency planners when developing evacuation plans, procedures, and protocols as well in training of all medical staff. The system also served to train adaptive thinking, leadership, communication, and clarification of critical functions.

Development of the Spinal Cord Injury COVID-19 Pandemic Experience Survey (SCI-CPES)

CONTEXT

Early during the COVID-19 pandemic, rehabilitation providers received reports from people with spinal cord injury (SCI) of considerable disruptions in caregiver services, medical and nursing care, and access to equipment and supplies; concomitantly, the medical community raised concerns related to the elevated risk of acquiring the infection due to SCI-specific medical conditions. Due to the novel nature of the pandemic, few tools existed to systematically investigate the outcomes and needs of people with SCI during this emergency.

OBJECTIVE

To develop a multidimensional assessment tool for surveying the experience of the COVID-19 pandemic on physical and psychological health, employment, caregiving services, medical supplies and equipment, and the delivery of medical care for people with SCI.

METHODS

The Spinal Cord Injury COVID-19 Pandemic Experience Survey (SCI-CPES) study, conducted between July 2020 through August 2021, surveyed people with SCI about their experiences during the early COVID-19 pandemic. The SCI-CPES was developed by a SCI care and research consortium using an iterative process.

RESULTS

Two hundred and twenty-three people completed the survey. Most respondents resided in the consortium catchment area. As the survey progressed, online informed consent became available allowing dissemination of the SCI-CPES nationally.

CONCLUSIONS

The consortium rapidly implemented the capture of experiences with COVID-19 pandemic directly from people with SCI, including survey creation, institutional approvals, distribution, online e-consenting, and data collection. In the future, the SCI-CPES is adaptable for use in other types of emergencies and disasters.

Emergency Preparedness in Tennessee Women with a Recent Live Birth

OBJECTIVES

To assess emergency preparedness (EP) actions in women with a recent live birth.

METHODS

Weighted survey procedures were used to evaluate EP actions taken by women with a recent live birth responding to an EP question assessing eight preparedness actions as part of the 2016 Tennessee Pregnancy Risk Assessment and Monitoring System (PRAMS) survey. Factor analysis was used to group preparedness actions.

RESULTS

Overall, 82.7% [95% Confidence Interval (CI) 79.3%, 86.1%] of respondents reported any preparedness actions, with 51.8% (95% CI 47.2%, 56.4%) completing 1-4 actions. The most common actions were having supplies at home (63.0%; 95% CI 58.5%, 67.4%), an evacuation plan for children (48.5%; 95% CI 43.9%, 53.2%), supplies in another location (40.2%; 95% CI 35.6%, 44.7%), and a communication plan (39.7%; 95% CI 35.1%, 44.2%). Having personal evacuation plans (31.6%; 95% CI 27.3%, 36.0%) and copies of documents in alternate locations (29.3%; 95% CI 25.0%, 33.5%) were least common. Factor analysis yielded three factors: having plans, having copies of documents, and having supplies. Specific preparedness actions varied by education and income level.

CONCLUSIONS FOR PRACTICE

Most Tennessee women (about 8 in 10 women) with a recent live birth reported at least one EP action. A three-part EP question may be sufficient for assessing preparedness in this population. These findings highlight opportunities to improve public health education efforts around EP.

Climate disasters and oncology care: a systematic review of effects on patients, healthcare professionals, and health systems

PURPOSE

Climate disasters have devastating effects on communities and society that encompass all aspects of daily life, including healthcare. Patients with cancer are particularly vulnerable when disaster strikes. As the number and intensity of disasters increases, it is important to understand the effects across the cancer care continuum. This systematic review investigates the effect of climate disasters on patients, the oncology healthcare workforce, and healthcare systems.

METHODS

A medical librarian conducted a literature search in PubMed, Embase, CINAHL, and Web of Science from January 1, 2016, through May 11, 2022. Eligible studies included any published report on a climate disaster globally reporting on patient-, oncology healthcare workforce-, or healthcare systems-level outcomes. Study quality was assessed, and findings were narratively synthesized, given the diversity of reported evidence.

RESULTS

The literature search identified 3618 records, of which 46 publications were eligible for inclusion. The most frequent climate disaster was hurricanes (N = 27) followed by tsunami (N = 10). Eighteen publications were from disasters that occurred in the mainland USA with 13 from Japan and 12 from Puerto Rico. Patient-level outcomes included treatment interruptions and inability to communicate with the healthcare team. At the workforce level, findings included distressed clinicians caring for others when their own lives have been affected by a disaster along with lack of disaster preparedness training. Health systems reported closures or shifting services post-disaster and a need to have improved emergency response plans.

CONCLUSION

Response to climate disasters necessitates a holistic approach at the patient, workforce, and health systems levels. Specifically, interventions should focus on mitigating interruptions in care for patients, advanced coordination and planning for workforce and health systems, and contingency planning for allocation of resources by health systems.

[Validation of secondary triage algorithms for mass casualty incidents-A simulation-based study-German version]

BACKGROUND

In the event of a mass casualty incident (MCI), the situation-related shortage of medical resources does not end when the patients are transported from the scene of the incident. Consequently, an initial triage is required in the receiving hospitals. In the first step, the aim of this study was to create a reference patient vignette set with defined triage categories. This allowed a computer-aided evaluation of the diagnostic quality of triage algorithms for MCI situations in the second step.

METHODS

A total of 250 case vignettes validated in practice were entered into a multistage evaluation process by initially 6 and later 36 triage experts. This algorithm-independent expert evaluation of all vignettes-served as the gold standard for analyzing the diagnostic quality of the following triage algorithms: Manchester triage system (MTS module MCI), emergency severity index (ESI), Berlin triage algorithm (BER), the prehospital algorithms PRIOR and mSTaRT, and two project algorithms from a cooperation between the Federal Office of Civil Protection and Disaster Assistance (BBK) and the Hashemite Kingdom of Jordan-intrahospital Jordanian-German project algorithm (JorD) and prehospital triage algorithm (PETRA). Each patient vignette underwent computerized triage through all specified algorithms to obtain comparative test quality outcomes.

RESULTS

Of the original 250 vignettes, a triage reference database of 210 patient vignettes was validated independently of the algorithms. These formed the gold standard for comparison of the triage algorithms analyzed. Sensitivities for intrahospital detection of patients in triage category T1 ranged from 1.0 (BER, JorD, PRIOR) to 0.57 (MCI module MTS). Specificities ranged from 0.99 (MTS and PETRA) to 0.67 (PRIOR). Considering Youden's index, BER (0.89) and JorD (0.88) had the best overall performance for detecting patients in triage category T1. Overtriage was most likely with PRIOR, and undertriage with the MCI module of MTS. Up to a decision for category T1, the algorithms require the following numbers of steps given as the median and interquartile range (IQR): ESI 1 (1-2), JorD 1 (1-4), PRIOR 3 (2-4), BER 3 (2-6), mSTaRT 3 (3-5), MTS 4 (4-5) and PETRA 6 (6-8). For the T2 and T3 categories the number of steps until a decision and the test quality of the algorithms are positively interrelated.

CONCLUSION

In the present study, transferability of preclinical algorithm-based primary triage results to clinical algorithm-based secondary triage results was demonstrated. The highest diagnostic quality for secondary triage was provided by the Berlin triage algorithm, followed by the Jordanian-German project algorithm for hospitals, which, however, also require the most algorithm steps until a decision.

Constructing an emergency preparedness evaluation index system for public use during major emerging infectious disease outbreaks: a Delphi study

BACKGROUND

The major emerging infectious diseases (MEIDs) have occurred frequently and become increasingly serious in the world. Sufficient personal emergency preparedness is critical for the general people in efficiently responding to and recovering from MEIDs. Nevertheless, few specific indicators are available for assessing the individual emergency preparedness of the general public during these periods. Therefore, the aim of this study was to construct an index system for comprehensively evaluating the personal emergency preparedness of the public regarding MEIDs.

METHODS

Based on the global national-level emergency preparedness index framework and a literature review, a preliminary index system was constructed. From June 2022 to September 2022, a panel of 20 experts from nine provinces and municipalities across multiple research areas participated in this Delphi study. They rated the importance of pre-defined indicators using a five-point Likert scale and provided their qualitative comments. According to the feedback of each round of experts, the indicators of the evaluation index system were revised.

RESULTS

After two rounds of expert consultation the evaluation index system reached a consensus, containing five first-level indicators, cooperating with prevention and control work, improving emergency response capacity, securing supplies and equipment, preparing economic resources, maintaining physical and mental health with affiliated 20 s-level indicators and 53 third-level indicators. The expert authority coefficient of consultation was 0.88 and 0.90. The Kendall's coefficient of concordance of expert consultations was 0.294 and 0.322, respectively. The differences were statistically significant (P < 0.05).

CONCLUSION

A valid, reliable and scientific evaluation index system was established. This personal emergency preparedness index system, as a precursor form, will further lay the foundation for the formation of an assessment instrument. At the same time, it could provide a reference for future education and training of emergency preparedness for the general public.

The People's War Against Pandemic: protocol for a randomized control trial based on a virtual interactive training system intervention to improve the emergency preparedness of public for major emerging infectious diseases

BACKGROUND

The frequent occurrence and increasing severity of major emerging infectious diseases (MEIDs) have posed considerable public health, economic and social issues worldwide. The emergency preparedness of public is inadequate to respond to and recover from MEIDs. Due to the limitation of time, space and resources, it is also difficult to carry out large-scale emergency preparedness training related to MEIDs. Then we developed a virtual interactive training system to improve emergency preparedness of public, including preparation of legal compliance, emergency knowledge, emergency capacity, economic estimation, material reserve and physical and mental health.

METHODS

A protocol for conducting a randomized controlled trail to evaluate the People's War against Pandemic, a virtual interactive training system aimed to improve emergency preparedness of public for MEIDs. During the intervention, participants need to complete the storyline task at least once a day, watch at least one article and one video in the knowledge corner, and complete a retest of wrong choices in the intelligent evaluation module. The primary outcome is emergency preparedness of public for MEIDs. The secondary outcome is prevention and control knowledge of MEIDs.

DISCUSSION

The People's War Against Pandemic may be an effective approach to provide public with a panoramic understanding of the response to MEIDs, so as to promote their comprehensive preparation and finally achieve effective response.

TRIAL REGISTRATION

This study was funded in 2021 and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR2200060919) in June 2022. Recruitment and enrollment of participants began in July 2022.

Challenges and opportunities for improved contact tracing in Ghana: experiences from Coronavirus disease-2019-related contact tracing in the Bono region

BACKGROUND

In Ghana, contact tracing received heightened attention in the fight against the COVID-19 pandemic during its peak period. Despite the successes achieved, numerous challenges continue to limit the efforts of contact tracing in completely curtailing the effect of the pandemic. Despite these challenges, there are still opportunities that could be harnessed from the COVID-19 contact tracing experience for future eventualities. This study thus identified the challenges and opportunities associated with COVID-19 contact tracing in the Bono Region of Ghana.

METHODS

Using a focus group discussion (FGD) approach, an exploratory qualitative design was conducted in six selected districts of the Bono region of Ghana in this study. The purposeful sampling technique was employed to recruit 39 contact tracers who were grouped into six focus groups. A thematic content analysis approach via ATLAS ti version 9.0 software was used to analyse the data and presented under two broad themes.

RESULTS

The discussants reported twelve (12) challenges that hindered effective contact tracing in the Bono region. These include inadequate personal protective equipment, harassment by contacts, politicisation of the discourse around the disease, stigmatization, delays in processing test results, poor remuneration and lack of insurance package, inadequate staffing, difficulty in locating contacts, poor quarantine practices, poor education on COVID-19, language barrier and transportation challenges. Opportunities for improving contact tracing include cooperation, awareness creation, leveraging on knowledge gained in contact tracing, and effective emergency plans for future pandemics.

CONCLUSION

There is a need for health authorities, particularly in the region, and the state as a whole to address contact tracing-related challenges while simultaneously harnessing the recommended opportunities for improved contact tracing in the future for effective pandemic control.

Home-Based Emergency Preparedness for Families of Children and Youth With Special Healthcare Needs: A Scoping Review

Children and youth with special healthcare needs (CYSHCN) are at disproportionate risk of harm from widespread disasters and from life-safety emergencies. These risks may be mitigated by providing preparedness training and support to family caregivers. We conducted a scoping review to identify and map the scholarly literature on home-focused preparedness of families with CYSHCN. Our search strategy yielded 22 relevant articles; 13 pertained to life-safety emergencies, 5 centered on widespread disasters, and 4 addressed preparedness on multiple scales. Approaches to measure or attempt to improve emergency preparedness levels in CYSHCN and their families were diverse and included interviews and focus groups; didactic, video-based, or side-by-side instruction; simulated medical crises; and provisioning of emergency kits. For the studies that involved an intervention (n=15, 68%), several proxy indicators of preparedness were used, including caregiver knowledge, skill, or comfort level with managing emergencies that could affect their CYSHCN; completion of preparedness tasks; and reduction in adverse clinical outcomes. Despite the varied methodologies, prevailing themes in the studies were that family caregivers of CYSHCN felt underprepared for emergencies and disasters, desired training to improve their preparedness at home, and benefited from such trainings, at least in the short term, across domains of self-efficacy, skill, and health outcomes of their CYSHCN. Although more research is needed to compare preparedness interventions and evaluate the durability of these interventions in larger, more diverse samples of CYSHCN and their families, our findings support incorporating preparedness training into preventive care encounters and the hospital-to-home transition.

The FLURESP European commission project: cost-effectiveness assessment of ten public health measures against influenza in Italy: is there an interest in COVID-19 pandemic?

BACKGROUND

The FLURESP project is a public health research funded by the European Commission, with the objective to design a methodological framework to assess the cost-effectiveness of existing public health measures against human influenza pandemics. A dataset has been specifically collected in the frame of the Italian health system. As most of interventions against human influenza are relavant against other respiratory diseases pandemics, potential interests in COVID-19 are discussed.

METHODS

Ten public health measures against human influenza pandemics pandemic were selected to be also relevant to other respiratory virus pandemics such as COVID 19: individual (hand washing, using masks), border control (quarantine, fever screening, border closure), community infection (school closure, class dismissal, social distancing, limitation of public transport), reduction of secondary infections (implementation of antibiotic therapy guidelines), pneumococcal vaccination for at-risk people, development of Intensive Care Unit (ICU) capacity, implementation of life support equipments in ICU, screening interventions, vaccination programs targeting health professional and targeting general population.

RESULTS

Using mortality reduction as effectiveness criteria, the most cost-effective strategies are "reduction of secondary infections" and "implementation of life support equipment in ICU". The least cost-effective option whatever the level of pandemic events are screening interventions and mass vaccination.

CONCLUSIONS

A number of intervention strategies against human influenza pandemics appears relevant against every respiratory virus, including the COVID-19 event. Measures against pandemics should be considered according to their expected effectiveness but also their costs for the society because they impose substantial burden to the population, confirming the interest of considering cost-effectiveness of public health measures to enlighten decision making.

Counseling women of reproductive age about emergency preparedness - Provider attitudes and practices

We report healthcare provider attitudes and practices on emergency preparedness counseling for women of reproductive age (WRA), including pregnant, postpartum, and lactating women (PPLW), for disasters and weather emergencies. DocStyles is a web-based panel survey of primary healthcare providers in the United States. During March 17-May 17, 2021, obstetricians-gynecologists, family practitioners, internists, nurse practitioners, and physician assistants were asked about the importance of emergency preparedness counseling, level of confidence, frequency, barriers to providing counseling, and preferred resources to support counseling among WRA and PPLW. We calculated frequencies of provider attitudes and practices, and prevalence ratios with 95% CIs for questions with binary responses. Among 1503 respondents (family practitioners (33%), internists (34%), obstetrician-gynecologists (17%), nurse practitioners (8%), and physician assistants (8%)), 77% thought emergency preparedness was important, and 88% thought counseling was necessary for patient health and safety. However, 45% of respondents did not feel confident providing emergency preparedness counseling, and most (70%) had never talked to PPLW about this topic. Respondents cited not having time during clinical visits (48%) and lack of knowledge (34%) as barriers to providing counseling. Most respondents (79%) stated they would use emergency preparedness educational materials for WRA, and 60% said they were willing to take an emergency preparedness training. Healthcare providers have opportunities to provide emergency preparedness counseling; however, many have not, noting lack of time and knowledge as barriers. Emergency preparedness resources combined with training may improve healthcare provider confidence and increase delivery of emergency preparedness counseling.

Bridging the gap, how interprofessional collaboration can support emergency preparedness for children with disabilities and their families: an exploratory qualitative study

BACKGROUND

Children with disabilities and their families are at higher risk during emergencies and disasters, which is often attributed to the lack of disability inclusion in emergency response as well as disparities in preparedness. This disparity speaks to a need for emergency preparedness that centers children with disabilities and their families. The purpose of this study was to elicit the perspectives of health professionals (nurses, occupational therapists, social workers), disability advocates, and public safety personnel (e.g., fire fighters, police officers, emergency management administrators) on what would enable these types of professionals to support family-centered emergency preparedness for families who care for children with disabilities. One goal of this research is to provide recommendations for practice and policy to improve safety outcomes for children with disabilities and their families in emergency situations.

METHODS

This study consisted of 46 qualitative interviews with nurses, occupational therapists, social workers, public safety personnel, and advocacy organization representatives about their role in emergency preparedness for families of children with disabilities. Qualitative content analysis was used to identify themes from participants' responses.

RESULTS

Participants expressed interest in family-centered emergency preparedness, and stated that greater awareness, more education and training, increased networking between professions, and institutional support would enable their involvement.

CONCLUSIONS

These findings have implications for the importance of interprofessional collaboration in supporting family-centered emergency preparedness for families of children with disabilities. Stronger interprofessional networks would help overcome many of the barriers identified by participants, and advocacy groups appear to be well-positioned to bridge the gap between these professionals and their areas of expertise.

The role of Medical Officers of Health in Civil Defence and how they influenced modern emergency medical practice

OBJECTIVES

The article will examine the role of the Medical Officer of Health within United Kingdom Local Authorities in the period preceding the Second World War, the war itself, the residual impact of their work on emergency medical and public health practice and lessons that can be learned to improve.

STUDY DESIGN

The article uses archival and secondary source analysis of documents related to the work of the Medical Officer of Health, their staff, and associated organisations.

METHODS AND RESULTS

The Medical Officer of Health performed a key role in the Civil Defence of the United Kingdom, ensuring that the victims of aerial bombardment were treated quickly. They also worked to ensure the public health of the population was maintained, especially those covering areas receiving evacuees, and worked to improve conditions within deep shelters and other areas with displaced individuals.

CONCLUSIONS

The work of the Medical Officer of Health created the forerunner of modern emergency medical practice in the United Kingdom, often through local innovation, and embedded the work on health promotion and protection fulfilled by Directors of Public Health.

Emergency preparedness is a healthcare issue: COVID-19 pandemic's influence on attitudes and behaviors among a national sample of parents

BACKGROUND

Improving household emergency preparedness (EP) is a public health priority, yet little is known about what influence the COVID-19 pandemic had on families' EP. This study aimed to explore current EP attitudes and behaviors.

METHODS

We conducted online focus groups in Winter 2022 with a nationwide sample of parents of adolescents. We held six 90-min focus groups of 9-15 participants using a semi-structured interview script that elicited parental knowledge and attitudes related to household EP. Two researchers conducted qualitative content analysis on focus group transcripts. First-level coding within and across scripts was used to identify broad categories or themes regarding EP. The process was reviewed continuously to verify data and coding procedures. Three investigators independently verified the final themes that emerged.

RESULTS

Participants (N = 64) were mostly female (n = 54, 84.3%), white (n = 46, 71.9%), and college-educated (n = 49, 76.6%). Major themes included: 1) Expanded awareness and behavioral change related to EP due to the COVID-19 pandemic, 2) Reconceptualization of planning for family health as part of EP, 3) Changing perspectives related to vaccination as a component of EP, and 4) Perspectives related to discussing EP with their health care provider.

CONCLUSIONS

EP was described as a healthcare issue and healthcare providers were identified as trusted sources of EP information. Interventions to support providers' ability to assist with individual EP health action plans, including discussing vaccination as part of preparedness are needed.

Mathematical modelling and simulation of leak detection system in crude oil pipeline

A first-order differential leak detection model that accurately detects leaks in a crude oil pipeline is presented. This model incorporates a leak factor K_L in the axial direction, which is simulated by applying the finite element method of numerical solution using COMSOL multi-physics software. Additionally, the model includes the transport equation for turbulent kinetic energy and the rate of kinetic energy model. Eigenvalues for velocities and pressures were determined and plotted against time for various pipe segments. The system is stable when the Eigenvalue is zero, but a leak is declared when the Eigenvalue for pressure or velocity is less than one. The study shows that pressure measurements are more sensitive parameters for detecting leaks than velocity measurements, and the sinusoidal waveform characterizes leak behaviours for velocity.

COVID-19 and human resources for health: analysis of planning, policy responses and actions in Latin American and Caribbean countries

BACKGROUND

The COVID-19 pandemic led to worldwide health service disruptions, due mainly to insufficient staff availability. To gain insight into policy responses and engage with policy-makers, the World Health Organization (WHO) developed a global approach to assess and measure the impact of COVID-19 on the health workforce. As part of this, WHO, together with the Pan American Health Organization (PAHO), supported an impact analysis of COVID-19 on health workers and policy responses, through country case studies in Latin America and the Caribbean (LAC).

METHODS

We sought to identify lessons learned from policies on human resources for health (HRH) during health emergencies, to improve HRH readiness. First, we performed a rapid literature review for information-gathering. Second, we used the WHO interim guidance and impact measurement framework for COVID-19 and HRH to systematically organize that information. Finally, we used the Health Labour Market Framework to guide the content analysis on COVID-19 response in eight LAC countries and identify lessons learned to improve HRH readiness.

RESULTS

Planning and implementing the COVID-19 response required strengthening HRH governance and HRH data and information systems. The results suggest two main aspects for HRH governance crucial to enabling an agile response: (1) aligning objectives among ministries to define and produce regulation and policy actions; and (2) agreeing on the strategy for HRH management between the public and private sectors, and between central and local governments. We identified three areas for improvement: (a) HRH information systems; (b) methodologies to estimate HRH needs; and (c) teams to analyse information for decision-making. Three key actions were identified during countries monitored, reviewed, and updated their response stages: (i) strengthening response through primary health care; (ii); planning HRH needs to implement the vaccination plan; and (iii) securing long-term HRH availability.

CONCLUSION

Countries coordinated and articulated with different stakeholders to align objectives, allocate resources, and agree on policy actions to implement the COVID-19 response. Data and information for HRH preparedness and implementation were key in enabling an agile COVID-19 response and are key areas to explore for improved pandemic preparedness.

Public health emergency preparedness for infectious disease emergencies: a scoping review of recent evidence

BACKGROUND

The COVID-19 pandemic continues to demonstrate the risks and profound health impacts that result from infectious disease emergencies. Emergency preparedness has been defined as the knowledge, capacity and organizational systems that governments, response and recovery organizations, communities and individuals develop to anticipate, respond to, or recover from emergencies. This scoping review explored recent literature on priority areas and indicators for public health emergency preparedness (PHEP) with a focus on infectious disease emergencies.

METHODS

Using scoping review methodology, a comprehensive search was conducted for indexed and grey literature with a focus on records published from 2017 to 2020 onward, respectively. Records were included if they: (a) described PHEP, (b) focused on an infectious emergency, and (c) were published in an Organization for Economic Co-operation and Development country. An evidence-based all-hazards Resilience Framework for PHEP consisting of 11 elements was used as a reference point to identify additional areas of preparedness that have emerged in recent publications. The findings were analyzed deductively and summarized thematically.

RESULTS

The included publications largely aligned with the 11 elements of the all-hazards Resilience Framework for PHEP. In particular, the elements related to collaborative networks, community engagement, risk analysis and communication were frequently observed across the publications included in this review. Ten emergent themes were identified that expand on the Resilience Framework for PHEP specific to infectious diseases. Planning to mitigate inequities was a key finding of this review, it was the most frequently identified emergent theme. Additional emergent themes were: research and evidence-informed decision making, building vaccination capacity, building laboratory and diagnostic system capacity, building infection prevention and control capacity, financial investment in infrastructure, health system capacity, climate and environmental health, public health legislation and phases of preparedness.

CONCLUSION

The themes from this review contribute to the evolving understanding of critical public health emergency preparedness actions. The themes expand on the 11 elements outlined in the Resilience Framework for PHEP, specifically relevant to pandemics and infectious disease emergencies. Further research will be important to validate these findings, and expand understanding of how refinements to PHEP frameworks and indicators can support public health practice.

Perceptions of preparedness, timing of cancer diagnosis, and objective emergency preparedness among gynecological cancer patients in Puerto Rico before and after Hurricane Maria

OBJECTIVES

This study investigated the impact of cancer diagnosis status, individual feelings of preparedness, and other covariates on objective emergency preparedness among women diagnosed with gynecological cancers before or after the 2017 Hurricanes Irma and Maria in Puerto Rico.

METHODS

This study included 240 women who were interviewed by telephone from 9/2019-11/2020. Objective emergency preparedness was assessed using a list of six items. Subjective emergency preparedness was assessed by asking the women how prepared they felt (well, somewhat, or not at all) to face an emergency. Crude and multivariable logistic regression analyses were conducted to assess the associations (odds ratios [ORs] and 95% confidence intervals [CIs]) between variables of interest and objective preparedness.

RESULTS

Before and after the hurricanes, 60% and 66% of women, respectively, were objectively prepared. Before the hurricanes, women reporting feeling well-prepared (vs. not prepared) (OR=9.31, 95%CI:3.96-21.91) and those who were diagnosed before (vs. after) the hurricanes (OR=1.71, 95%CI:0.95-3.09) were more likely to be objectively prepared. After the hurricanes, self-perceived well-preparedness (OR=2.46, 95% CI: 1.10-5.51) was positively associated with emergency preparedness when compared to feeling unprepared.

CONCLUSIONS

Perceptions of emergency preparedness and having a cancer diagnosis increased the likelihood of being objectively prepared for an emergency.

POLICY SUMMARY

This study demonstrates the need for state, territorial, and federal governments to include emergency preparedness plans for cancer patients in the Comprehensive Cancer Control plans. The study also indicates a need for cancer specific emergency preparedness information to be readily available for patients.

Importance of continuing health care before emergency hospital evacuation: a fatal case of a hospitalized patient in a hospital within 5 km radius of Fukushima Daiichi Nuclear Power Plant: a case report

BACKGROUND

After a disaster, it is essential to maintain the health care supply levels to minimize the health impact on vulnerable populations. During the 2011 Fukushima Daiichi Nuclear Power Plant accident, hospitals within a 20 km radius were forced to make an immediate evacuation, causing a wide range of short- and long-term health problems. However, there is limited information on how the disaster disrupted the continuity of health care for hospitalized patients in the acute phase of the disaster.

CASE PRESENTATION

An 86-year-old Japanese man who needed central venous nutrition, oxygen administration, care to prevent pressure ulcers, skin and suctioning care of the trachea, and full assistance in the basic activities of daily living had been admitted to a hospital within 5 km radius of Fukushima Daiichi Nuclear Power Plant and experienced Fukushima Daiichi Nuclear Power Plant accident. After the accident, the hospital faced a manpower shortage associated with hospital evacuation, environmental changes caused by infrastructure and medical supply disruptions, and the difficulty of evacuating seriously ill patients. As a result, antibiotics and suction care for aspiration pneumonia could not be appropriately provided to the patient due to lack of caregivers and infrastructure shortages. The patient died before his evacuation was initiated, in the process of hospital evacuation.

CONCLUSIONS

This case illustrates that decline in health care supply levels to hospitalized patients before evacuation during the acute phase of a radiation-released disaster may lead to patient fatalities. It is important to maintain the health care supply level even in such situations as the radiation-released disaster; otherwise, patients may experience negative health effects.

Optimization of a Patient Distribution Framework: Second Wave COVID-19 Preparedness and Challenges in the Amsterdam Region

To meet surge capacity and to prevent hospitals from being overwhelmed with COVID-19 patients, a regional crisis task force was established during the first pandemic wave to coordinate the even distribution of COVID-19 patients in the Amsterdam region. Based on a preexisting regional management framework for acute care, this task force was led by physicians experienced in managing mass casualty incidents. A collaborative framework consisting of the regional task force, the national task force, and the region's hospital crisis coordinators facilitated intraregional and interregional patient transfers. After hospital admission rates declined following the first COVID-19 wave, a window of opportunity enabled the task forces to create, standardize, and optimize their patient transfer processes before a potential second wave commenced. Improvement was prioritized according to 3 crucial pillars: process standardization, implementation of new strategies, and continuous evaluation of the decision tree. Implementing the novel "fair share" model as a straightforward patient distribution directive supported the regional task force's decisionmaking. Standardization of the digital patient transfer registration process contributed to a uniform, structured system in which every patient transfer was verifiable on intraregional and interregional levels. Furthermore, the regional task force team was optimized and evaluation meetings were standardized. Lines of communication were enhanced, resulting in increased situational awareness among all stakeholders that indirectly provided a safety net and an improved integral framework for managing COVID-19 care capacities. In this article, we describe enhancements to a patient transfer framework that can serve as an exemplary system to meet surge capacity demands during current and future pandemics.

Development and validation of a lockdown preparedness scale: Understanding lockdown preparedness through a social vulnerability perspective

Millions of people around the world were subjected into nationwide or community wide lockdowns in response to the COVID-19 pandemic. Scientists also predict that as we enter into a new normal, another pandemic is not impossible, and that lockdowns may be implemented again. Therefore, examining factors affecting lockdown preparedness (LDP) is important. Through a survey of 800 adult residents in Singapore during the pandemic, this study proposed and tested an LDP scale and found that quality of social interactions, news consumption, as well as education and income affect the extent of psychological and emotional preparedness for lockdowns.

Emergency preparedness during the COVID-19 pandemic: Modelling the roles of social media with fuzzy DEMATEL and analytic network process

While the utility of social media has been widely recognized in the current literature, minimal effort has been made to further the analysis of their roles on disruptive events, such as the COVID-19 pandemic. To address this gap, this work comprehensively identifies the 16 prevalent social media roles in disaster preparedness during the COVID-19 pandemic. Furthermore, an integrated fuzzy decision-making trial and evaluation laboratory (FDEMATEL) and analytic network process (ANP), hereby termed the FDANP methodology, is used to perform the causal analysis of social media roles and to systemically measure the priority of these roles in emergency preparedness. Among the identified roles, those considered top priority are social media roles concerned with the facilitation of public health policy development, prevention of misinformation, and management of public behavior and response. These results were found to be robust, as evidenced by the sensitivity analysis. The implications of these findings were also detailed in this work in the context of a developing country.

Implementation of a unique mass casualty and emergency preparedness longitudinal learning experience for postgraduate year 2 pharmacy residents

BACKGROUND AND PURPOSE

The American Society of Health-System Pharmacists (ASHP) postgraduate year 2 (PGY2) critical care pharmacy residency program offers an elective competency area, E3: Mass Casualty. Similar elective competencies are also available for PGY2 emergency medicine and postgraduate year 1/2 pharmacotherapy programs. Because of the COVID-19 pandemic, pharmacist proficiency in the management of disasters is even more urgent. However, few residency programs require or include a specific learning experience to achieve this competency. This article provides examples of opportunities that residency programs can implement to offer an Emergency Preparedness/Mass Casualty (EP/MC) learning experience.

EDUCATIONAL ACTIVITY AND SETTING

A longitudinal EP/MC learning experience was integrated into a PGY2 critical care program.

FINDINGS

A longitudinal EP/MC learning experience within the PGY2 critical care, emergency medicine, and pharmacotherapy residency program curricula is achievable and promotes resident development. Learning experience components included topic discussions, participation on local and state-level emergency preparedness (EP) committees, completion of certification programs, projects, and participation on statewide emergency response teams.

SUMMARY

Implementation of a longitudinal EP/MC learning experience formalizes topics and activities that support achievement of the ASHP elective competency area of Mass Casualty for PGY2 residency programs. EP/MC goals and objectives should be a requirement for critical care, emergency medicine, pharmacotherapy, and health-system pharmacy administration and leadership PGY2 programs. By formalizing training, pharmacists can be better prepared for EP and more integrated into multidisciplinary disaster response teams.

Leveraging WHO's Global Benchmarking Tool to strengthen capacity in clinical trials oversight for public health emergencies: the GHPP VaccTrain model

Background

A stable, well-functioning and integrated national medicines regulatory system is a core component of health systems resilient against infectious disease outbreaks. In many low- and middle-income countries, however, sizable gaps exist in the emergency preparedness framework of national regulatory authorities (NRAs). RegTrain-VaccTrain is a project of Germany Ministry of Health’s Global Health Protection Programme that contributes to global efforts aimed at strengthening such regulatory systems by providing technical support and advice to partner NRAs. In this study, we probed the outputs of our capacity-strengthening activities for clinical trials oversight (CTO) to take stock of progress made and examine remaining priorities in order to provide specialized technical assistance in addressing them to improve operational readiness for emergencies.

Method

Data validated from NRA self-benchmarking results in 2017 and worksheet records of November 2021 were utilized to assess the emergency preparedness capacity for CTO in three VaccTrain partner NRAs (Liberia, Sierra Leone, The Gambia) before and after interventional capacity-strengthening partnership, using specific public health emergency-related (sub-)indicators of the WHO Global Benchmarking Tool.

Results

A generally weak and vulnerable structural framework for CTO characterized the emergency preparedness capacity in all three partner NRAs at baseline, thus putting their operational readiness for public health emergencies at risk. VaccTrain’s collaborative work was successful at supporting individual NRAs to develop the full spectrum of operational structures (including (draft) regulations, guidelines, and standard operating procedures) required to improve regulatory preparedness. A gap in the formal approval and implementation of developed legal documents in two of three NRAs still remains. Notwithstanding, a robust emergency framework now exists and the NRAs stand better prepared to respond to (future) locally-concerning health emergencies, during which time clinical trials activity was observed to heighten.

Conclusions

These results exemplify a north-south capacity-strengthening partnership model that effectively contributes in developing structures to enhance regulatory oversight and support expeditious product development in response to crises. They further underscore the equally critical role local/national processes play in facilitating the full implementation of developed structures.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12992-022-00854-0.

Breastfeeding and humanitarian emergencies: the experiences of pregnant and lactating women during the earthquake in Abruzzo, Italy

Background

Emergencies have a great impact on infant and young child feeding. Despite the evidence, the recommended feeding practices are often not implemented in the emergency response, undermining infant and maternal health. The aim of this study was to explore the experiences of pregnant and lactating women during the earthquake emergency that occurred in L’Aquila on 6 April 2009.

Methods

The study design was qualitative descriptive. Data were collected by individual semi-structured interviews, investigating the mother’s experiences of pregnancy, childbirth, breastfeeding, infant formula or complementary feeding during the emergency and the post emergency phase. Data analysis was categorical and was performed by using N-Vivo software.

Results

Six women who were pregnant at the time of the earthquake were interviewed in January 2010. In addition to the essential needs of pregnant and lactating women, such as those related to the emergency shelters conditions, the main findings emerged from this study were: the reconfiguration of relationships and the central role of partners and family support; the need of spaces for sharing experiences and practices with other mothers; the lack of breastfeeding support after the hospital discharge; the inappropriate donations and distribution of Breast Milk Substitutes.

Conclusions

During and after L’Aquila earthquake, several aspects of infant and young child feeding did not comply with standard practices and recommendations. The response system appeared not always able to address the specific needs of pregnant and lactating women. It is urgent to develop management plans, policies and procedures and provide communication, sensitization, and training on infant and young child feeding at all levels and sectors of the emergency response.

The critical need for WASH in emergency preparedness in health settings, the case of COVID-19 pandemic in Kisumu Kenya

The devastating effects of inadequate basic utilities such as water, sanitation, hygiene, waste management and environmental cleaning (WASH) is underscored by the current global pandemic declared on March 11, 2020. This paper explores the experiences of key informants (n = 15) ie government and non-government organization officials on the impacts of the COVID-19 pandemic in health care facilities (HCFs) and the role of WASH in emergency preparedness in health settings and the communities they serve using Kisumu, Kenya as a case study. The results from interviews with the key informants indicate socioecological challenges shaping access to hygiene services in HCFs and related disparities in social determinants of health such as WASH that serve as barriers to the pandemic response. All participants indicated the healthcare system was ill-prepared for the pandemic. Health care workers experienced such severe psychosocial impacts due to the lack of preparedness that they subsequently embarked on strikes in protest. These situations influenced citizens' perceptions of the COVID-19 pandemic as a hoax and resulted in a surge in other population health indicators (e.g., increased maternal mortality; decreased vaccination rates for other illnesses such as measles). We recommend authentic partnerships among all stakeholders to develop and implement context-driven sustainable solutions that integrate WASH and emergency preparedness in HCFs and the communities they serve across all spatial scales, from the global to the local.

The COVID-19 risk perceptions, health precautions, and emergency preparedness in older CALD adults in South Australia: A cross-sectional study

Background

In Australia, the relationships of cultural contexts with health challenges in older culturally and linguistically diverse (CALD) adults during the COVID-19 remain under-investigated. This study explored the older CALD adults’ risk perceptions of COVID-19, and identified demographics and risk perceptions associated with their health precautions and emergency preparation in South Australia.

Methods

A cross-sectional online survey was conducted. 155 older adults aged 60 years and over from 28 CALD communities completed the surveys. We described demographics, risk perceptions, seven items of health precautions, and five items of emergency preparedness. Data were analyzed in Stata/MP version 13.0.

Results

Mean sum-score of fear was 7.3 [SD 1.9], signifying that the participants were afraid of being infected with COVID-19. Health precaution items presented a mean sum-score of 24.8, with a compliance in washing and disinfecting hands [M: 4.4], avoiding public places and events [M: 3.9] and transports [M: 3.8], but they did not present high-alignment with staying at home and avoiding meeting at risk population groups. Overall health precautions were positively influenced by ethnicity [Asian β 3.40; 95% CI 1.21, 5.59; African β 5.46; 95% CI 0.76, 10.16]; perceptions of long-term effects [β 1.82; 95% CI 0.65, 2.99]; and fear [β 0.55; 95% CI 0.08, 1.01]. Mean sum-score of emergency preparedness was 14.9, which indicated the participants’ responses, on average, did not prevent them from buying large quantities and storing essential goods.

Conclusion

A pandemic-related response plan is needed to ensure all older CALD adults receive and follow advice and care appropriately.

Comparison of Household Perceptions and Practices of Food and Water Emergency Preparedness Between Latter-Day Saints and Non-Latter-Day Saints in the USA

This study evaluated whether Latter-day Saints have more favorable perceptions and practices of food and water emergency preparedness than other households. Individuals across 46 states in the USA completed an online survey in 2014 (n = 572). Results indicated that Latter-day Saints, compared to Non-Latter-day Saints, were more likely to have a disaster supplies kit, to have long-term food storage, to have preserved food by canning/bottling, and to perceive neighborhood/community connectedness. Latter-day Saints had significantly lower odds of having less than one month of food storage available compared to Non-Latter-day Saints. Our findings suggest Latter-day Saints may be better prepared to handle a disaster than Non-Latter-day Saints.

Emergency Preparedness and Modish Practices among Primary Healthcare Delivery Systems Facilitated through Public-private Partnership Models in a South Indian Metropolitan City: A Descriptive Cross-sectional Study

Background and aim

Access to health care is supposed to be a basic human right but the present scenario of the healthcare sector in India displays a large disparity in the healthcare services provided by the public and private sectors with wide variations in the infrastructure and services delivered by both sectors. Hence, public-private partnership (PPP) in healthcare delivery is an urgent and essential component that needs attention to ameliorate this gap. The aim of this study was to assess the current practices in healthcare services provided through PPPs in Bengaluru city.

Materials and methods

A cross-sectional questionnaire survey was conducted among primary healthcare centers (PHC) run under PPP in Bengaluru city, Karnataka, India. The pretested self-designed structured questionnaire consisted of 18 items regarding the current practices of PPP at the primary healthcare level. Descriptive statistics were used to describe the data.

Results

A total of 15 PPPs at the primary healthcare level were identified and included in the study. All of the participants provided basic healthcare services, some participants (33%) provided specialized services, and some (27%) mobile healthcare services. The overall impression of the medical officers in charge interviewed was that PPPs are better than individual endeavors by both public and private sectors. They also believed that it was important to have policies and guidelines in place to monitors aspects like the functioning of the setup, risk sharing, etc.

Conclusion

The results indicated that all the participants were at the primary healthcare level and mostly involved in preventive practices. It is also important to look at venturing into services that provide curative services as well. Oral health, however, did not prominently feature at any point and is another area that requires attention.

How to cite this article

Mukherji I, Eshwar S, Srivastava BK, et al. Emergency Preparedness and Modish Practices among Primary Healthcare Delivery Systems Facilitated through Public-private Partnership Models in a South Indian Metropolitan City: A Descriptive Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(2):153-158.

Nearly all thirty most frequently used emergency department drugs experienced shortages from 2006-2019

BACKGROUND

Drug shortages contribute to avoidable medication error and patient harm; these shortages are exacerbated in the Emergency Department due to the time-sensitive nature of acute care.

METHODS

We performed a cross-sectional study to describe the frequency and duration of drug shortages associated with the most frequent medications administered in the ED. We identified the most frequently used ED medications and calculated number of visits associated with these medications using the 2006-2019 National Hospital Ambulatory Medical Care Survey. We obtained the frequency and duration of shortages associated with these medications from the University of Utah Drug Information System. We calculated duration and total ED visits associated with shortages of the most frequently used ED medications.

RESULTS

From 2006 through 2019, the most frequently used drugs were ondansetron (255.1 million ED visits), 0.9% normal saline (251.3 million ED visits), and ibuprofen (188.5 million ED visits). All but two of the top thirty most frequently used medications experienced a shortage. The median shortage duration was 425 days, while the longest were for injectable morphine (3,202 days). The number of ED visits associated with drugs experiencing shortages increased from 2,564,425 (2.2% of U.S. ED visits) in 2006 to 67,221,968 (60.4%) in 2019. The most common reasons for shortage include manufacturing delays and increased demand.

CONCLUSIONS AND RELEVANCE

Drug shortages were more frequent and persistent from 2006 through 2019. Further studies on the clinical impact of these shortages are needed, in addition to policy interventions to mitigate shortages.