bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of a Logistics System for Disaster Medical Container Operations Using Drones and GIS
Authors: Maebayashi Asuka , Nakata Keiji , Showa Naoki , Takada Takamitsu
Published: June 2023

Introduction:

To quickly operate a temporary hospital using disaster medical containers in the event of a large-scale disaster, dozens of large trailers must be quickly brought to the disaster site. This study aims to establish a logistic system for transporting and installing containers using drones and GIS.

Method:

By linking drones and GIS, a theoretical model was created to quickly determine routes and installation sites for large trailers transporting medical containers from candidate routes simulated in advance by taking into account hazard maps and road conditions.

Results:

Using this system, it is possible to

(1) Establish whether the roads planned to be passed through are passable.

By narrowing down candidate routes through preliminary simulations that overlay hazard maps and roads that are passable for large trailers, it is possible to narrow down the routes that need to be confirmed. Immediately after a disaster, a drone can be used to confirm road damage, flooding, landslides, etc., and map them on the GIS to determine the extent to which they are passable.

(2) Identify locations that take into account demand and safety.

Locations that are close to the disaster area, safe, and in demand for medical care can be determined and identified based on the population mesh and the damage situation.

Conclusion:

GIS and drones have a high affinity and are used in various ways. However, there is still no linkage between GIS and drones adapted to medical care and logistics at disaster sites in Japan. This system is indispensable to comprehensively determine the safety and demand of roads and installation sites.
An Innovative Mobile Hospital for the Management of a Massive Flow of Victims.
Authors: Houze-Cerfon Vanessa , VIAULT Benoit , Marcou Eric , Pardon Thomas , Ribera-Cano Anna , Nouzières Cédric , Bounes Vincent
Published: June 2023

Introduction:

In order to deal with disastrous situations needing massive healthcare support, a new tool, financed by FEDER European funds (Interreg POCTEFA program) has been designed: the multipurpose mobile hospital Europe Occitanie (UMPEO). It is a projectable, foldable, versatile and autonomous truck with an interchangeable function from advanced medical post to operational command center, for acute events involving mass gathering or during multiple victims disasters. This study aims to show the usefulness of this structure during the COVID-19 health crisis.

Method:

The UMPEO is a shelter deployable in an emergency ward or intensive care unit, mobilizable in one hour, projectable by truck and autonomous for the first two hours. A descriptive, transversal, European study was carried out to describe its use in the cross-border countries of the Pyrenees (France, Spain and Andorra). When applicable, demographic data were gathered and/or a satisfaction questionnaire was given to the caregivers involved.

Results:

Between September 8, 2020 andFebruary 25, 2021, UMPEO was mobilized as a COVID-19 testing center, emergency department, vaccination center or as a command center at a political summit. Thus, 1322 screening tests were carried out over the screening three weeks deployment and 91% of the volunteers considered the screening operation useful. Used as a hospitalization ward, UMPEO was able to accommodate 266 patients over a period of four weeks. Eight hundred people were able to benefit from two doses of vaccines during the six weeks of the mobile vaccination campaign.

Conclusion:

This tool, initially designed to be used in the event of a catastrophic event of an accidental or terrorist type or as a help station during mass gathering, has been diverted without any modification of its structure to meet the challenges of the global health crisis and provide a solution adapted to the population of countries bordering the Pyrenees.
Nurses' Perception of Humanitarian Training Post-deployment on Plans to Redeploy
Authors: Mount Monica
Published: June 2023

Introduction:

Pre-deployment training for nurses ensures readiness.

Method:

A quantitative descriptive research methodology was used to conduct an anonymous survey distributed to all registered nurses deployed in 2017 to Hurricane Maria with a hospital-supported team and a federal team. The project sought to improve the pre-deployment preparation experience of nurses to positively impact nurses' willingness to redeploy. The survey was administered for ten days in January 2021.

Results:

This quantitative descriptive study sought to understand nurses’ perceptions of their readiness for deployment during a disaster response. Thirty-nine surveys were distributed with a 46% response rate (n = 18).

Gender was not related to agreement with the role variable (p = 0.070). Marital status was significantly related to role (p = 0.015), as was age (p = 0.022). Single individuals and individuals >50 yo were more likely to agree that they understood their role during the disaster.

Gender was not related to agreement with the preparedness variable (p = 0.465), nor was marital status (p = 0.067). Age was significantly related to perceptions of preparedness (p = 0.004). Individuals >50 yo were more likely to respond that they were prepared for their deployment.

Gender was not related to perceptions of knowledge of providing clinical care during a disaster (p = 0.235), nor was marital status (p = 0.627) or age (p = 0.674).

Conclusion:

The results suggest that single nurses > 50 yo with more years of nursing experience who have previously deployed may understand the role better and feel more prepared to deploy.

However, their responses do not indicate that they feel more knowledgeable about the type of nursing care they are expected to provide in a disaster response.
Exploring Advanced Nursing Practice in Australian Disasters: A Scoping Review
Authors: Hutton Alison , Conlon Lisa , Kako Mayumi , Wilson Rhonda , Ranse Jamie
Published: June 2023

Introduction:

As the largest body of health professionals, nurses are looked upon during a disaster for leadership, clinical assistance, and support during these events. Nurses are at the forefront of managing disasters in their communities, yet their complex role as advanced nurse practitioners, clinicians, managers, and leaders is not always fully understood and/or recognized. The aim of this paper is to explore the level of Advanced Nursing Practice (ANP) in Australia that takes place in a disaster

Method:

This scoping review was guided by Arksey and O’Malley’s framework. The review searched five relevant databases. A scoping review design was chosen as the authors expected that evidence in the field would be produced using a wide variety of methodologies.

Results:

Nurses work long hours during a disaster with hospitals and nurses becoming the center of events and the "go to" place during a disaster. During disasters nurses often have little sleep, have limited time to meet their individual/personal needs, and frequently put others needs before themselves. Nurses mentioned in these studies were reported to have worked while they were worried for themselves and their families. These nurses reported feeling capable and reported that all their experience and skills came to the fore during these challenging situations.

Conclusion:

During disasters, most nurses are found to be flexible and adaptable, with many taking on a variety of roles. Nurses are quick to find solutions with problem-solving keys and their ability to respond to disasters "just what you do." The nurses in these studies demonstrated fundamental expertise and had the agility to pivot when the occasion demanded. As a result of this study, it is evident, and not surprising, that these Australian nurses work beyond conventional limits during a disaster.
Designing a Robust Methodology to Evaluate Emergency Health and Medical Responses to Disasters
Authors: Finnigan Gerard
Published: June 2023

Introduction:

Health and medical disciplines have traditionally preferred experimental and quasi-experimental methods to evaluate interventions. More recently, mathematical modeling was used to test intervention efficacy in the SARS-CoV-2 pandemic. The challenge for disaster researchers is neither approach suits examining phenomena about emergency health responses in disasters. This study applied an alternative methodology to examine questions of how and why emergency health and medical responses reduced mortality during six different natural hazard disaster events.

Method:

The case study methodology is orientated by the researcher’s perspective and ‘not assigned a fixed ontological, epistemological or methodological position’. This flexibility allows alignment of the researcher’s worldview with the methodology best fitting the research problem and its context, such as post-positivism. Qualitative case study design carefully links five key design elements and sequences, including research questions, propositions, a unit of analysis, data collection, and data analysis.

Results:

Six holistic single case studies described how and why the emergency health response reduced mortality risk of people affected by different disasters. An evidenced-based theoretical emergency health program logic model compared and contrasted inputs, activities, outputs, and outcomes between theoretical and actual responses. Rival explanations were tested before data collection for each single case and applied to challenge the logic model. Each case applied four strategies to increase the validity and reliability of the holistic single case study findings.

Conclusion:

Qualitative case study methodology provides a robust and flexible framework to examine complex questions about emergency health and medical responses, including questions about events, processes, activities, performance, and outcomes. The methodology is equally suited to real-time or retrospective studies. The strength of the approach is the high compatibility for examining phenomena within the context they occur, and linking program logic, data collection, and data analysis methods to the specific question being investigated.
A National Survey of Hospital Cyber Attack Emergency Operation Preparedness
Authors: Sullivan Natalie , Selzer Jordan , Tully Jeffery , Dameff Christian , Opara Chibuzo , Snead Mackenzie
Published: June 2023

Introduction:

Cyberattacks on healthcare systems are increasing in frequency and severity. Hospitals need to integrate cybersecurity preparedness into their emergency operations planning and response in order to mitigate adverse outcomes during increasingly likely cyber events. No data currently exists regarding the level of preparedness of US hospital systems for cybersecurity attacks. We surveyed hospital emergency managers to assess cybersecurity preparedness for these events.

Method:

Fifty-seven emergency managers representing hospitals across the US participated in an online Qualtrics survey regarding current preparedness and response procedures for cybersecurity hazards.

Results:

Survey responses between April 2019 and May 2021 demonstrated that a majority of hospital systems surveyed included cybersecurity disasters in their HVA (82.4%, 47/57), and most ranked it as one of their top five priorities (57.4%, 27/47). However, over half denied specifically mentioning cybersecurity in their EOPs (52.6%, 30/57). Fourteen of the 57 hospital systems (24.5%) endorsed previously activating an Emergency Response for a cybersecurity incident unrelated to Information Technology (IT) failure.

Conclusion:

The survey results suggest that American hospitals are currently underprepared for cybersecurity disasters. We emphasize the importance of prioritizing cybersecurity in HVAs and implementing specific EOP annexes for cybersecurity emergencies.
The Isolation System for Treatment and Agile Response for High-Risk Infections (ISTARI) Unit, a Carecubes Design: Moving PPE Around the Patient, An Assessment of Provider Safety and Infection Control with Emergency Medicine Residents During Simulation
Authors: Willet Katie , Huff Brad , Wadman Tori , Broadhurst Jana , Lawler James , Brett-Major David , Prudhomme Rachel
Published: June 2023

Introduction:

The ISTARI unit is designed to be assembled in buildings or field hospitals to provide negative-pressure rooms in low-resource areas and decrease PPE use in the setting of highly-infectious diseases. Each unit is designed to perform ~20 air exchanges/hour with HEPA filters with multiple access points for providers to perform patient care without entering the unit while decreasing overall PPE usage. The goals of the design include patient safety, ease of use for, decreased infectious spread, and unit affordability.

Method:

A survey was obtained following a medical simulation within the ISTARI unit with Emergency Medicine resident physicians. The case involved an Ebola patient with Ventricular Tachycardia which progressed to cardiac arrest. Teams were given written and video instructions for the ISTARI unit and Ebola-level PPE. They were limited to one set of high-level PPE for the case. The survey scoring was a 0-5 scale, five being the highest.

Results:

Medical history-taking provider safety (PS)- 2.87, infection control (IC)-3.09, physical examination PS-3.52, IC-3.78, ultrasound usage PS-3.35, IC-3.43, intubation PS-2.35, IC-2.57, CPR PS-3.43, IC-3.65, cardioversion PS-3.35, IC-3.78, and overall average PS-3.145, IC-3.383.

Limitations were noted compared with traditional care, but 100% of teams met critical actions for patient management, including intubation, cardioversion, and CPR. GloGerm showed no contamination to those providing care outside the unit, but a small amount of contamination after doffing for those who entered the unit.

Conclusion:

The ISTARI unit is a cost-effective isolation unit maximizing provider safety in management of patients with highly-infectious diseases, particularly in low-resource settings. It allows for easy mobilization of units and decreased medical supplies waste. The preliminary study shows satisfactory data about provider safety and infection control when using ISTARI for a highly-infectious patient, especially in providers unfamiliar with typical high-level PPE. Providers were able to provide all necessary critical actions for highly-infectious, critically-ill patients.
The Impact of Previous Disasters on Hospital Disaster Surge Capacity Preparedness in Finland
Authors: Kerola Anna , Hirvensalo Eero , Franc Jeffrey
Published: June 2023

Introduction:

In a disaster, the number of victims and severity of injuries may overwhelm the treatment capacity of the local hospital. Surge capacity is the hospital’s ability to receive and treat an increased number of patients. This study aimed to explore if a past disaster or mass casualty incident (MCI) affects local hospital surge capacity preparedness.

Method:

The current hospital preparedness plans (HPPs) of University and central hospitals receiving surgical emergency patients in Finland were collected (n=28). The HPPs were read and analyzed using the World Health Organization (WHO) hospital emergency checklist tool with eight key components and 67 action items. The scores of key components were compared by percentage of the maximum score. The surge capacity score was compared between the hospitals that had been exposed to a disaster or MCI with those who had not. The effective level was considered as 70% of total points.

Results:

The overall median score of all key components was 76% (range 24%). The highest score was in command and control (median 93%, range 29%) and the lowest in post-disaster preparedness (median 50%, range 90%). The median surge capacity score was 65% (range 39%). There has been 12 disasters or MCIs during the past 25 years in Finland, all anthropogenic. There was no statistical difference between the surge capacity score of the hospitals with a history of a disaster or MCI compared to those without (65% for both, p=0.735).

Conclusion:

In Finland, the overall hospital preparedness level is effective with command and control being the best covered area. Surge capacity preparedness was below the effective level and it was not affected by a past disaster or MCI. Present-day challenges with the lack of resources in the health care system, more attention should be drawn to the surge capacity aspect in hospital preparedness plans.
Healthcare and Media Interaction in Major Incidents and Disasters: Experiences Based on Swedish KAMEDO Reports in 20 years
Authors: Englund Liselotte
Published: June 2023

Introduction:

Major Incidents and Disasters are often associated with early, extensive and prolonged media reporting. It is important to understand the interaction between first responders/rescue services and the media to create better conditions for providing and making available correct and objective information to as many people as possible.

Method:

A systematic literature review and content analysis was made on all Swedish KAMEDO reports (emergency medicine observations published by the National Board of Health and Welfare) from the last twenty years, in total 39 reports. KAMEDO’s primary task is to feedback experience data (lessons learned) from disasters worldwide, through expert observers at the site of an emergency event. The aim of this study was to evaluate and analyze the experiences made regarding the interaction between media and healthcare in connection with major incidents and disasters, both on site and in hospitals.

Results:

The analysis resulted in the following main themes:

(1) Communication problems and other challenges in Major Incidents and Disasters

No protection and restrictions

Information craving and news hunt

Interviews as intervention

(2) Recommendations for efficient interaction between healthcare and the media:

Strategies from alert to action

Satisfying information needs

Clarity measures on site

Key actors of importance

Proactive media alertness

Conclusion:

Some conclusions regarding lessons learned about interaction between healthcare and the media, as well as about communication with the afflicted and citizens, in brief: The hospital management should take control of the communication through efficient communication strategies. An accommodating approach to the media's presence can facilitate the dissemination of the necessary early, correct and balanced information. Joint authority press conferences are a model tested and positively evaluated. Healthcare communicators are key actors in hospital crisis communication and media management. Healthcare and media both benefit from developing routines and reciprocal respect for proactive and efficient interaction in emergencies.
The Dark Side of the (Preparedness) Moon: Why Promoting Public Preparedness Remains Illusive
Authors: Bodas Moran
Published: June 2023

Introduction:

Despite advancements in health behavior theories, understanding the human motivation to engage in disaster preparedness remains elusive. Most attempts at engaging the public in protective behavior rely on risk communication that assumes an information deficit among the people; ergo, risk communicators operate under the assumption that by increasing awareness of risks, sufficient motivation can be generated for preparedness behavior. Yet, this is far from being true.

A growing body of literature indicates the prevalence of fear-directed preparedness behavior, which is suboptimal in motivating behavioral change. This should come as no surprise, as using fear appeal tactics in risk communication designed to promote health behaviors have been proven to be primarily a failure.

Arguably, the phenomenon of failed risk communication campaigns could be linked to unconscious concerns about death, as proposed in the context of the Terror-Management Theory (TMT). According to TMT, since the experience of death-related thoughts triggers the potential for anxiety, the human psyche responds with motivated avoidance. In other words, the mind utilizes mechanisms that prevent death from becoming salient and remove death-related thoughts from focal attention when they arise. In turn, these defense mechanisms may yield procrastination in adopting protective behavior generated by denial as an adaptive coping mechanism.

Preliminary data suggest that procrastination in preparedness behavior until the threat becomes actual and imminent might be explained by TMT; however, explicit evidence for this association is yet to be provided. Should this understanding of the phenomenon be substantiated, it could significantly contribute to expanding our knowledge of the theoretical model behind public preparedness behavior.

The presentation will discuss the state-of-the-art research currently being done by the author to support the above claims. It will provide preliminary findings and will call the community to reconsider the current paradigm of disaster risk reduction and risk communication.

Method:

n/a

Results:

n/a

Conclusion:

n/a
Improving Hospital Incident Command Organizational Structures
Authors: Little Charles , Noll Samantha
Published: June 2023

Introduction:

The current Incident Command System (ICS) was developed to manage wildland fires, then was adopted by general firefighting. It has since been adapted to multiple other sectors and widely used. The Hospital Emergency Incident Command (HICS) was introduced in 1991. An ICS currently is required to be used for hospital incident management in the US.

The overarching structure of traditional HICS consists of Command Staff (Incident Commander, Public Information Officer, Safety Officer, Liaison Officer and Medical/Technical Specialist) and General Staff. The General Staff has Sections consisting of Operations, Planning, Logistics and Finance/Administration. Multiple and flexible subgroups carry out the processes in these areas.

This HICS structure does not adapt easily to hospital daily functions and alternatives have been proposed. This includes structuring around essential functions and mixed models. Over time hospital systems have become larger, and incidents more complex and sustained. New more expansive and flexible ICS structures are needed for complex responses.

Method:

We reviewed both the published and grey literature for examples of different incident management structures and evidence of their effectiveness.

Results:

There is very little scientific literature on this topic. Several different descriptive reports exist. Multiple examples of hospital incident command organization structures from the hospital level progressing to hospital (and healthcare) system level and then multistate regional models will be reviewed. This includes the standard HICS model, emergency support function models and modifications following advanced ICS principles such as area command.

Conclusion:

Different ICS models exist that may offer individual healthcare systems improved ways to manage disasters.
NO FEAR–Better Integrating Healthcare Into Crisis Management Structures
Authors: Rafalowski Chaim
Published: June 2023

Introduction:

Since the beginning of the COVID 19 pandemic, the EU-funded project, NO FEAR collected lessons observed from the response. One of the issues raised in the retrospective “lessons observed” exercise, was the need to better integrate health care into “crisis management structures” (e.g. Civil Protection).

Method:

Lessons observed from the COVID-19 response were collected and analyzed by the NO FEAR project, through a questionnaire, discussion with consortium partners, and a large conference in Madrid, with a high-level briefing for policymakers.

Results:

During the Madrid conference, different speakers pointed out the lack of training for healthcare professionals in crisis management (processes and procedures)–except those with military training or EMS officers who are part of Fire and Rescue Services. In a same manner, crisis managers have very little (if any) training in health. This was identified as a gap in future preparedness.

Conclusion:

Looking into the future, healthcare professionals who will be called to take part in crisis management systems have to be trained in this task, as well as basic awareness of crisis managers to health issues in emergencies.
PEM Pandemic Pivot: A Hybrid Approach to Pediatric Emergency Medicine Training in Thailand Allows for COVID-era Flexibility.
Authors: Bailey Jessica , Burns Beech , Sullivan Danielle , Hartenstein Melinda , Husen Pakorn , Chaiprapa Hathaitip , Pandee Uthen , Plainkum Parit , Burns Erin , Techapaitoon Surangkana
Published: June 2023

Introduction:

The COVID-19 pandemic poses challenges in maintaining global medical education partnerships, with travel restrictions and infection control concerns forcing program adaptation. The Pediatric Emergency Medicine Specialty Training and Accelerated Review (PEM-STAR) program is one such international collaboration which addresses education and training gaps in emergency care for children within Thailand. As an assessment of PEM-STAR’s ability to deliver consistent outcomes despite COVID-19 constraints, we compared program results for Cohort #1 (2018-2019, pre-pandemic) and Cohort #2 (2019-2021, spanning pandemic).

Method:

Oregon Health & Science University and Bangkok Dusit Medical Services implemented the PEM-STAR tandem physician-nurse curriculum in 2018. The cornerstone of the year-long course is a set of 22 PEM-specific topic modules, incorporating remote-accessible voiceover slide lectures, quizzes, and scholarly references to teach pediatric emergency medicine essentials. Content is reviewed via monthly teleconferences. Baseline and final assessments include written knowledge tests and high-fidelity simulation cases led by physician-nurse teams. Cohort #1 simulations were performed with evaluators in-situ using critical action checklists and validated teamwork assessment tools. Due to COVID-19 restrictions, Cohort #2 final assessments were hybrid; students completed Thailand-based simulations while Oregon leaders assessed and debriefed teams via videoconference.

Results:

Written exam scores for pre-pandemic Cohort#1 improved from 48.6% (95%CI 40.30-56.9) to 92.0% (95%CI 88.1-95.9) (p< 0.001). Cohort #2, during the pandemic, had scores improve similarly from 48.5% (95%CI 40.1-56.9) to 96.4% (95%CI 94.8-98.0) (p< 0.001). One-hundred percent of physician-nurse teams from both Cohort #1 and Cohort #2 achieved the program’s established passing score on final simulation testing: performing >85% of critical action items and scoring > 85% on the teamwork tool.

Conclusion:

The PEM-STAR design, with its emphasis on videoconferencing, web-based content, and asynchronous learning, required minimal modifications to maintain satisfactory knowledge and skill acquisition during the pandemic. Educational partnerships emphasizing these features have distinct sustainability advantages in times of global disorder.
Pediatric Long-Term Care Disaster and Pandemic Planning
Authors: Frogel Michael , Jermyn John , Foltin George , Cooper Arthur
Published: June 2023

Introduction:

Children are frequently victims of disasters. However, significant gaps remain in pediatric disaster preparedness planning. This includes a lack of planning for pediatric residents in long-term care facilities. The New York City (NYC) Pediatric Disaster Coalition (PDC) is funded by the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) to improve NYC’s pediatric disaster preparedness and response. The NYC PDC partnered with experts in pediatric disaster management and the care of pediatric residents in long-term care facilities to create the Pediatric Long-Term Care Planning Committee (PLTCPC).

Method:

The PLTCPC included physicians, nurses, administrators, and emergency planning experts. The PLTCPC’s goal was to create guidelines and templates for use in disaster planning for pediatric residents at long-term care facilities. The committee met bi-weekly over three months and shared facility resources to create tools that meet the specific challenges presented by this population.

Results:

Utilizing an iterative process that included a literature review, participant presentations, review and improvement of the working documents, the final guidelines and templates for surge and evacuation of pediatric residents in long-term care facilities were created. Due to the onset of the COVID-19 pandemic, the NYC PDC reconvened the PLTCPC to focus on surge planning for pandemics at pediatric long-term care facilities. Two pediatric infectious disease clinicians were added to the committee. Utilizing the same process delineated above, a detailed pandemic specific annex was created based on clinical pediatric experience gained throughout the pandemic.

Conclusion:

To the authors' knowledge, these are the first pediatric-specific resources for long-term care disaster planning. They address the importance of matching resources to the unique needs of PLTC facilities, in regard to space, equipment, staffing, and training. Pediatric long-term care facilities present special needs during pandemics and this approach can be utilized as a model for other facilities.
Lessons Learned from 28 Hospitals and City Agencies: Pediatric Disaster Exercise
Authors: Frogel Michael , Jermyn John , Foltin George , Cooper Arthur
Published: June 2023

Introduction:

Children are frequently victims of disasters. However, gaps remain in pediatric disaster preparedness. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to prepare NYC for mass casualty events that involve large numbers of children. The NYC PDC conducted a functional exercise testing surge, communications, and secondary transport. Participants included 28 NYC hospitals, the NYC Fire Department-Emergency Medical Services (FDNY-EMS), NYC Emergency Management (NYCEM), NYC DOHMH and the NYC Medical Reserve Corps (MRC).

Method:

The hospitals and agencies participated in group and individual planning meetings. Scenario-driven, operations-based activities challenged participants to employ their facility's existing pediatric surge and secondary transport plans during an event. The exercise assessed: Communications, Emergency Operation Plans, Surge, Patient Tracking, Patient Transfer, Supplies, and Staffing. Internal and external evaluators assessed the exercise performance.

Results:

An After-Action Report was written based on information from evaluation data, site-specific and group hot-washes, and an after-action conference. Strengths included meaningful improvement of plans before/after the exercise and doubling pediatric critical care capacity through the implementation of the exercise objectives. Challenges included: gaps in communication/patient tracking, lack of sufficient sub-specialty support, the need for "babysitters” and inadequate supplies of blood products and ventilators.

Conclusion:

Conducting a multi-hospital and agency pediatric specific exercise demonstrated current planning and produced lessons learned to address planning and training gaps that can improve citywide planning and capabilities during future full-scale exercise and real-time events.
Pediatric Outpatient, Urgent-care Emergency and Disaster Planning
Authors: Frogel Michael , Jermyn John , Foltin George , Cooper Arthur
Published: June 2023

Introduction:

Children are frequently victims of disasters; however important gaps remain in pediatric disaster planning. This includes a lack of resources for pediatric preparedness planning for patients in outpatient/urgent-care facilities. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to improve NYC’s pediatric disaster preparedness and response.

After creating planning resources in Pediatric Long-Term Care Facilities, Hospital Pediatric Departments, Pediatric and Neonatal Intensive Care Units, and Obstetric/Newborn Services within NYC hospitals, the NYCPDC partnered with leaders and experts from outpatient/urgent-care facilities caring for pediatric patients and created the Pediatric Outpatient Disaster Planning Committee (PODPC). PODPC’s goal was to create guidelines and templates for use in disaster planning for pediatric patients at outpatient/urgent-care facilities.

Method:

The PODPC includes physicians, nurses, administrators and emergency planning experts who have experience working with outpatient facilities. There were 21 committee members from eight organizations (the NYCPDC, DOHMH, Community Healthcare Association of NY State, NY State DOH, NYC Health and Hospitals, Maimonides Medical Center and Presbyterian/Columbia University Medical Center). The committee met six times over a four-month period and shared information to create disaster planning tools that meet the specific pediatric challenges in the outpatient setting.

Results:

Utilizing an iterative process including literature review, participant presentations, discussions review and improvement of working documents, the final guidelines and templates for surge and evacuation of pediatric patients in outpatient/urgent care facilities were created in 2018. Subsequently model plans were completed and implemented at five NYC Outpatient/Urgent-care facilities.

Conclusion:

An expert committee utilizing an iterative process successfully created disaster guidelines and templates for pediatric outpatient/urgent care facilities. They addressed the importance of matching the special needs of children to available space, staff and equipment needs and created model plans for site-specific use.
Systems of Care Approach to Improve Care for Children During Public Health Emergencies
Authors: Godfred-Cato Shana , Fitzpatrick Heather , Smiley Stephanie , Polen Kara
Published: June 2023

Introduction:

During public health emergencies, like COVID-19 or natural disasters, care for the pediatric population can become fragmented. Communication between systems may be challenged due to lack of relationships or infrastructure barriers such as incompatible electronic health record (EHR) systems. This can create critical, life-threatening situations for pregnant patients, infants, and children with exposures to threats. A systems-level approach was developed to guide planning efforts to improve and enhance communication and data sharing along the spectrum of care for children during public health emergencies.

Method:

The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) gathered subject matter experts to discuss how healthcare systems and community partners could strengthen the communication within the pediatric system of care. Three primary challenges emerged: Communication, Screening and Data, and Preparedness and Planning. Action steps were identified to address these challenge areas and meet the goals of reaching diverse populations, addressing health disparities, improving collaboration between health systems and public health, implementing effective screening practices that are guided by data, and strengthening infrastructure.

Results:

As a result of the in-depth discussions a graphic was developed to help guide those working to improve the system of care in their communities by implementing the activities described above. Selected multidisciplinary state teams will test strategies to address these goals.

Conclusion:

Improving communication and data sharing in the pediatric system of care will improve care and better inform the response during public health emergencies. Building successful partnerships, such as those between health care and public health, will be critical to success. The example of the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET) program, which collects and analyzes data related to public health threats, demonstrates the strength of this approach.
Disaster Preparedness at the Primary Health Care Level: The Proposal of a New Framework
Authors: Lamberti-Castronuovo Alessandro , Valente Martina , Barone-Adesi Francesco , Hubloue Ives , Ragazzoni Luca
Published: June 2023

Introduction:

With the publication of the Health Emergency and Disaster Risk Management (H-EDRM) Framework in 2019, the World Health Organization (WHO) emphasized the need for disaster preparedness in all sectors of the health system, including primary health care (PHC). PHC disaster preparedness plays a crucial role in guaranteeing continuity of care and responding to the health needs of vulnerable populations during disasters. While this is universally acknowledged as an important component of disaster management (DM), there is still a severe paucity of scholarship addressing how to practically ensure that a PHC system is prepared for disasters. The objective of this study is to propose a new framework that describes key characteristics for PHC disaster preparedness and lays the groundwork to deliver operational recommendations to assess and improve PHC disaster preparedness.

Method:

A systematic literature review including the following online scientific databases was performed: Cochrane Library, Embase, Medline, National Library of Medicine, PubMed, Scopus, and Web of Science. Gray literature was also found by searching in: Trove, Mednar, and OpenGray. A total of 145 records were analyzed.

Results:

Twenty-five characteristics that contribute to a well-prepared PHC system were identified and categorized according to the WHO Health System Building Blocks to form a new PHC disaster preparedness framework.

Conclusion:

The findings will contribute to the elaboration of a set of guidelines for PHC systems to follow in order to assess and boost their disaster preparedness. This will hopefully help to raise awareness among international policymakers and health practitioners on the importance to design interventions that integrate PHC into overall DM strategies, as well as to assess the preparedness of PHC systems in different political, developmental, and cultural contexts. The proposed framework is currently being used by our research group as groundwork for the creation of an assessment tool for evaluating all-hazards preparedness at the PHC level.
Scoping Review of Exploring Primary Health Care Providers Services to Increase Vulnerable Population Disaster Preparedness
Authors: Simsek Perihan , Harada Nahoko , Kako Mayumi
Published: June 2023

Introduction:

Primary healthcare providers (PHCPs) are uniquely positioned to evaluate and increase vulnerable patients' disaster preparedness, in that they have detailed information about their medical needs, resources, and limitations. Nevertheless, it is still unclear what their roles and services are in this field. This study aimed to review the literature on PHCPs services to prepare the vulnerable population for disasters.

Method:

MEDLINE, Scopus, and PubMed databases were searched. Inclusion criteria include peer-reviewed articles published in English with no restriction on publication date. In order to obtain a broad perspective on the subject, the study type was not limited. The retrieved articles were imported into EndNote Reference Manager to manage duplications. Then, the reference lists of retrieved articles were checked for the relevance of the title and abstract. Lastly, fulltext articles identified were inspected against the inclusion criteria. Thematic analysis was performed to consolidate the commonalities in PHCPs roles and services for disater preparedness.

Results:

From the database search, 2193 articles were retrieved and 844 duplications were eliminated. Afterwards, 1349 articles were screened based on title and abstract, 49 full-text articles were assessed for eligibility, and 22 full-text articles were included. The six themes associated with services provided by PHCPs were emerged as follows: identifying vulnerable groups and assisting them in disaster planning, providing written materials and/or recommendations; protecting vulnerable population’ records; educating staff, vulnerable clients, and their caregivers; coordinating disaster planning and response across agencies; routine assessment of disaster preparedness, and planning for evacuation.

Conclusion:

This scoping review reveals that the literature on PHCPs services to improve vulnerable populations’ disaster preparedness is limited. Consequently, there is a need for scientific research to increase the existing capabilities of PHCPs for vulnerable population disaster preparedness and identify barriers and facilitators affecting their coordination with disaster management agencies.
Description of Patients with Out-of-Hospital Cardiac Arrest within 24 Hours of EMS Transport Refusal.
Authors: Klausner Howard , Curtin Andrea , Dunne Robert , Brennan Erin , Rosenthal Marc , Reece Ryan , Gorelick Damon
Published: June 2023

Introduction:

Patients refusing transportation is common EMS practice with potentially fatal outcomes. Determining which patients are at high risk for poor outcomes is poorly defined. This study described patients who experienced an out-of-hospital cardiac arrest (OHCA) within 24 hours of refusing transportation.

Method:

This is a retrospective, descriptive study of patients who had an OHCA within 24 hours of refusing EMS transportation between 2019 to 2021. Data was obtained from a large, urban medical control authority seeing 175,000 EMS calls annually. We reviewed patient demographics, EMS events when transportation was refused, and cardiac arrest outcome.

Results:

There were 6, 30, and 28 EMS refusals resulting in OHCA in 2019, 2020, and 2021. Patients who had OHCA were 65.7 (range 28-103) years old, and African American (54/64). Patients had HTN (36/64), diabetes (19/64), COPD (11/64), and CHF (7/64). Common complaints included breathing problems (17/64), near syncope (8/64) however chest pain was uncommon (4/64). One (28/64) or two (13/64) abnormal vital signs were present and missing vital signs (28/64) were common. Tachycardia (32.8%, 21/64), HTN (29.7%, 19/64), and hypotension (17.2%, 11/64) were more prevalent in the OHCA population compared to all refusal patients (Tachycardia 0.33% [1,978/598,416], HTN 2.27% [13,601/598,416], and hypotension 0.04% [218/598,416]). Patients were seen by both ALS (29/64) and BLS (35/64) providers. Most providers documented risk including death (38/64) though few contacted medical control (14/64). Return encounter for OHCA resulted in obvious deaths (23/64) or field termination (20/64). Few patients achieved ROSC (7/64).

Conclusion:

Patients who had an OHCA within 24 hours of refusing transport had underlying comorbidities and abnormal or missing vital signs. The patients experienced tachycardia, hypertension, and hypotension at a higher rate than the overall refusal population. Few patients obtained ROSC. Further research is needed to determine methods to mitigate poor outcomes and decrease refusals.
Creating a Disaster Ready Pharmacy Workforce: Evaluation of a Disaster Tabletop Exercise
Authors: McCourt Elizabeth , Watson Kaitlyn
Published: June 2023

Introduction:

While the importance of pharmacists' involvement in disaster management is becoming increasingly recognized in the literature, there are few mechanisms by which pharmacists can prepare themselves for emergencies. This project aimed to determine the effectiveness of a disaster tabletop exercise (TTX) in preparing pharmacy staff for disasters.

Method:

A TTX was held at the American Society of Health-System Pharmacists Summer Meeting which was held in Phoenix, Arizona in June 2022. The workshop incorporated an evolving emergency scenario in which participants worked through activities pertaining to the mitigation, preparedness, response, and recovery cycle. The scenario involved a hypothetical storm and landside scenario across fictional towns in Arizona, US. Workshop attendees worked in small groups on one of two provided hospital profiles. The attendees were invited to complete a pre-post survey assessing their perceptions of disaster management including perceived preparedness. This survey was previously developed, piloted, and published. The paper surveys were collected at the end of the workshop and inputted into RedCap. Data were descriptively summarized using SPSS, and pre-post survey results were compared using appropriate statistical tests.

Results:

The workshop was attended by 40 pharmacy personnel and 31 completed the survey. All participants agreed that the exercise was well structured, realistic, allowed them to test their response plans and systems, and helped improve their understanding of their role and function in disaster response. After the workshop, participants' perceptions of their ability to prevent, respond, and recover from a disaster all significantly improved (p=0.004, 0.013, and 0.013 respectively). However, perceptions of their preparedness for a disaster did not significantly change (p=0.197).

Conclusion:

This study adds to the evidence of the effectiveness in training and preparing the pharmacy workforce. The TTX improved the understanding and perceived capabilities of pharmacy personnel in responding and recovering from emergencies.
Integration and Disjuncture within the Israeli Health System During COVID 19 Pandemic
Authors: Arama Daniel Elbo , Cohen Odeya , Davidovitch Nadav
Published: June 2023

Introduction:

The Israeli health system had a critical role in leading the response to the COVID-19 pandemic facing a wide-range of challenges following the length and the unique characteristics of this health emergency. This study evaluated the weaknesses and strengths of the different parts of the system, relying on WHO building blocks to promote better coping with large-scale health emergencies.

Method:

The experiences of 13 high-level senior experts in the Israeli health system who directly managed COVID-19 were examined, using in-depth semi-structured interviews conducted during 2021. Critical and snowball sampling were used to select participants. Interviews were recorded and transcribed. Data analysis was conducted using ATLS.TI 22 software and reviewed by peers. The interviews were analyzed using the thematic analysis method. A theme expresses a broad central idea that tends to appear and reoccur in the analytical material in different forms of expression. Specifications and ideas were discussed among the researchers while engaging in repeated rereading of the transcriptions until saturation was achieved with the final themes.

Results:

The role of the Ministry of Health in integrating the health response and importance of spokespersons providing professional information increase trust as a crucial role of community health services in emergencies having political tensions reflected in the medical response. The Israeli Health system differ from hospital systems abroad by the relationships between preparedness during routine and emergency response. The importance of trust was highlighted.

Conclusion:

The study demonstrates a deep understanding of the way the Israeli health system dealt with the pandemic, revealing needs, resources, weaknesses and strengths. The results offer a rare opportunity to learn how integration of service-delivery can be improved within the health system in all levels. These lessons should be translated to advance better handling of future emergencies.