bluuebunny/crossref_metadata_2025_split huggingface dataset:
Linking Public Health and the Emergency Care Community: 7 Model Communities
Authors: Lerner E. Brooke , Cronin Michael , Schwartz Richard B. , Sanddal Teri L. , Sasser Scott M. , Czapranski Tim , Piazza Gina M. , Sheahan William D. 
Published: October 2008

ABSTRACTPublic health and the emergency care community must work together to effectively achieve a state of community-wide disaster preparedness. The identification of model communities with good working relationships between their emergency care community and public health agencies may provide useful information on establishing and strengthening relationships in other communities. Seven model communities were identified: Boston, Massachusetts; Clark County, Nevada; Eau Claire, Wisconsin; Erie County, New York; Louisville, Kentucky; Livingston County, New York; and Monroe County, New York. This article describes these communities and provides a summary of common findings. Specifically, we recommend that communities foster respectful working relationships between agency leaders, hold regular face-to-face meetings, educate each other on their expertise and roles during a disaster, develop response plans together, work together on a day-to-day basis, identify and encourage a leader to facilitate these relationships, and share resources. (Disaster Med Public Health Preparedness. 2007;1:142–145)
Definition and Functions of Health Unified Command and Emergency Operations Centers for Large-scale Bioevent Disasters Within the Existing ICS
Authors: Burkle Frederick M. , Hsu Edbert B. , Loehr Michael , Christian Michael D. , Markenson David , Rubinson Lewis , Archer Frank L. 
Published: October 2008

ABSTRACTThe incident command system provides an organizational structure at the agency, discipline, or jurisdiction level for effectively coordinating response and recovery efforts during most conventional disasters. This structure does not have the capacity or capability to manage the complexities of a large-scale health-related disaster, especially a pandemic, in which unprecedented decisions at every level (eg, surveillance, triage protocols, surge capacity, isolation, quarantine, health care staffing, deployment) are necessary to investigate, control, and prevent transmission of disease. Emerging concepts supporting a unified decision-making, coordination, and resource management system through a health-specific emergency operations center are addressed and the potential structure, function, roles, and responsibilities are described, including comparisons across countries with similar incident command systems. (Disaster Med Public Health Preparedness. 2007;1:135–141)
Addressing Gaps in Health Care Sector Legal Preparedness for Public Health Emergencies
Authors: Ransom Montrece McNeill , Goodman Richard A. , Moulton Anthony D. 
Published: October 2008

ABSTRACTHealth care providers and their legal counsel play pivotal roles in preparing for and responding to public health emergencies. Lawyers representing hospitals, health systems, and other health care provider components are being called upon to answer complex legal questions regarding public health preparedness issues that most providers have not previously faced. Many of these issues are legal issues with which public health officials should be familiar, and that can serve as a starting point for cross-sector legal preparedness planning involving both the public health and health care communities. This article examines legal issues that health care providers face in preparing for public health emergencies, and steps that providers, their legal counsel, and others can take to address those issues and to strengthen community preparedness. (Disaster Med Public Health Preparedness. 2008;2:50–56)
Measuring Humanitarian Emergencies
Authors: Garfield Richard 
Published: October 2008

ABSTRACTThe ability to monitor assistance, define humanitarian needs, and approach equity in the distribution of assistance has lagged behind the world’s growing commitment to responding to humanitarian emergencies. This article highlights relevant data sources to elucidate elements of an operational definition of humanitarian need. New and refined measures are proposed to assist in assessing the level of need among affected populations. An original measure that combines data on conflict and disasters to summarize the cumulative magnitude of 4 types of humanitarian threats is presented. (Disaster Med Public Health Preparedness. 2007;1:110–116)
Botulism: Cause, Effects, Diagnosis, Clinical and Laboratory Identification, and Treatment Modalities
Authors: Dembek Zygmunt F. , Smith Leonard A. , Rusnak Janice M. 
Published: October 2008

ABSTRACTBotulism is a neuroparalytic disease caused by neurotoxins produced by the bacteriaClostridium botulinum. Botulinum neurotoxins (BoNTs) are among the most potent naturally occurring toxins and are a category A biological threat agent. The 7 toxin serotypes of BoNTs (serotypes A–G) have different toxicities, act through 3 different intracellular protein targets, and exhibit different durations of effect. Botulism may follow ingestion of food contaminated with BoNT, from toxin production ofC botulinumpresent in the intestine or wounds, or from inhalation of aerosolized toxin. Intoxication classically presents as an acute, symmetrical, descending flaccid paralysis. Early diagnosis is important because antitoxin therapy is most effective when administered early. Confirmatory testing of botulism with BoNT assays orC botulinumcultures is time-consuming, and may be insensitive in the diagnosis of inhalational botulism and in as many as 32% of food-borne botulism cases. Therefore, the decision to initiate botulinum antitoxin therapy is primarily based on symptoms and physical examination findings that are consistent with botulism, with support of epidemiological history and electrophysiological testing. Modern clinical practice and antitoxin treatment has reduced botulism mortality rates from ∼60% to ≤10%. The pentavalent botulinum toxoid is an investigational product and has been used for more than 45 years in at-risk laboratory workers to protect against toxin serotypes A to E. Due to declining immunogenicity and potency of the pentavalent botulinum toxoid, novel vaccine candidates are being developed. (Disaster Med Public Health Preparedness. 2007;1:122–134)
Regional Health System Response to the 2007 Greensburg, Kansas, EF5 Tornado
Authors: Ablah Elizabeth , Tinius Annie M. , Konda Kurt , Synovitz Carolyn , Subbarao Italo 
Published: October 2008

ABSTRACTBackground:On May 4, 2007 an EF5 tornado hit the rural community of Greensburg, KS, destroying 95% of the town and resulting in 12 fatalities.Methods:Data was requested from the emergency medical services units that initially responded and the regional hospitals that received people injured in the tornado within 24 hours following the tornado. Requested data included patient age and sex, and injury severity score orICD-9codes. Critical mortality, or the number of deaths of critically injured patients, was also calculated.Results:The extensive damage caused by the tornado effectively destroyed the infrastructure of the community and created enormous challenges for emergency medical services responders, who were unable to record any triage data. Area hospitals treated 90 patients, who had an average injury severity score of 6.4. Age was found to be related to injury severity, but no relationship between sex and injury severity was found. Critical mortality was found to be 18% for this event.Conclusions:Injury severity score has seldom been used to analyze natural disasters, especially tornadoes, although such analysis is helpful for understanding the magnitude of the disaster, comparing to other disasters, and preparing for future incidents. Advanced warning and personal preparedness are important factors in reducing tornado-related injuries and deaths. (Disaster Med Public Health Preparedness. 2007;1:90–95)
Prediction Modeling to Determine the Adequacy of Medical Response to Urban Nuclear Attack
Authors: Dallas Cham E. , Bell William C. 
Published: October 2008

ABSTRACTBackground: Government reports have persistently indicated the intent of terrorists and hostile nations to acquire and “weaponize” nuclear materials for deliberate attack on a major US metropolitan city.Methods: A modeling analysis of the effects of 20- and 550-kiloton nuclear detonations on the 2 major metropolitan centers of Los Angeles and Houston is presented with a focus on thermal casualties. Brode’s work as modified by Binninger was used to calculate thermal fluence, using thermal fractions. The EM-1 and WE programs were used to calculate blast effects. Fallout radiation was calculated using the Defense Threat Reduction Agency’s Hazard Prediction and Assessment Capability V404SP4 with “urban effects” turned on. The ESRI ArcView program calculated affected populations from 2000 US Census block-level data for areas affected by thermal effects.Results: The population affected by a 550-kiloton nuclear weapon detonated in Los Angeles and Houston is staggering: surviving thermal casualties are estimated at 185,000 and 59,000, respectively. Even the 20-kiloton detonations in Los Angeles and Houston are significant: the numbers of surviving thermal casualties requiring care exceed 28,000 and 10,000, respectively.Conclusions: The surviving health care community postdetonation would be faced with an unprecedented burden of care for thermal casualties. A great expansion of personnel involved in emergency burn care response is critical. Bold, new approaches such as regionalization and predetermined medical air transport need to be considered. (Disaster Med Public Health Preparedness. 2007;1:80–89)
The New International Health Regulations: Considerations for Global Public Health Surveillance
Authors: Sturtevant Jessica L. , Anema Aranka , Brownstein John S. 
Published: October 2008

ABSTRACTGlobal public health surveillance is critical for the identification and prevention of emerging and reemerging infectious diseases. The World Health Organization recently released revised International Health Regulations (IHR) that serve as global legislation and provide guidelines for surveillance systems. The IHR aim to identify and prevent spread of these infectious diseases; however, there are some practical challenges that limit the usability of these regulations. IHR requires Member States to build necessary infrastructure for global surveillance, which may not be possible in underdeveloped countries. A large degree of freedom is given to each individual government and therefore different levels of reporting are common, with substantial emphasis on passive reporting. The IHR need to be enforceable and enforced without impinging on government autonomy or human rights. Unstable governments and developing countries require increased assistance in setting up and maintaining surveillance systems. This article addresses some challenges and potential solutions to the ability of national governments to adhere to the global health surveillance requirements detailed in the IHR. The authors review some practical challenges such as inadequate surveillance and reporting infrastructure, and legal enforcement and maintenance of individual human rights. (Disaster Med Public Health Preparedness. 2007;1:117–121)
Unexplained Deaths in Connecticut, 2002–2003:Failure to Consider Category A Bioterrorism Agents in Differential Diagnoses
Authors: Palumbo John P. , Meek James I. , Fazio Darcy M. , Turner Susan B. , Hadler James L. , Sofair André N. 
Published: October 2008

ABSTRACTBackground: Recognition of bioterrorism-related infections by hospital and emergency department clinicians may be the first line of defense in a bioterrorist attack.Methods: We identified unexplained infectious deaths consistent with the clinical presentation of anthrax, tularemia, smallpox, and botulism using Connecticut death certificates and hospital chart information. Minimum work-up criteria were established to assess the completeness of diagnostic testing.Results: Of 4558 unexplained infectious deaths, 133 were consistent with anthrax (2.9%) and 6 (0.13%) with tularemia. None were consistent with smallpox or botulism. No deaths had anthrax or tularemia listed in the differential diagnosis or had disease-specific serology performed. Minimum work-up criteria were met for only 53% of cases.Conclusions: Except for anthrax, few unexplained deaths in Connecticut could possibly be the result of the bioterrorism agents studied. In 47% of deaths from illnesses that could be anthrax, the diagnosis would likely have been missed. As of 2004, Connecticut physicians were not well prepared to intentionally or incidentally diagnose initial cases of anthrax or tularemia. More effective clinician education and surveillance strategies are needed to minimize the potential to miss initial cases in a bioterrorism attack. (Disaster Med Public Health Preparedness. 2008;2:87–94)
Chronic Disease and Related Conditions at Emergency Treatment Facilities in the New Orleans Area After Hurricane Katrina
Authors: Sharma Andrea J. , Weiss Edward C. , Young Stacy L. , Stephens Kevin , Ratard Raoult , Straif-Bourgeois Susanne , Sokol Theresa M. , Vranken Peter , Rubin Carol H. 
Published: October 2008

ABSTRACTBackground:Disaster preparations usually focus on preventing injury and infectious disease. However, people with chronic disease and related conditions (CDRCs), including obstetric/gynecological conditions, may be vulnerable to disruptions caused by disasters.Methods:We used surveillance data collected after Hurricane Katrina to characterize the burden of visits for CDRCs at emergency treatment facilities (eg, hospitals, disaster medical assistance teams, military aid stations). In 6 parishes in and around New Orleans, health care providers at 29 emergency treatment facilities completed a standardized questionnaire for injury and illness surveillance from September 8 through October 22, 2005.Results:Of 21,673 health care visits, 58.0% were for illness (24.3% CDRCs, 75.7% non-CDRCs), 29.1% for injury, 7.2% for medication refills, and 5.7% for routine or follow-up care. The proportion of visits for CDRCs increased with age. Among men presenting with CDRCs, the most common illnesses were cardiovascular disease (36.8%), chronic lower-respiratory disease (12.3%), and diabetes/glucose abnormalities (7.7%). Among women presenting with CDRCs, the most common were cardiovascular disease (29.2%), obstetric/gynecological conditions (18.2%), and chronic lower-respiratory disease (12.0%). Subsequent hospitalization occurred among 28.7% of people presenting with CDRCs versus 10.9% of those with non-CDRCs and 3.8% of those with injury.Conclusions:Our data illustrate the importance of including CDRCs as a part of emergency response planning. (Disaster Med Public Health Preparedness. 2008;2:27–32)
SWiFT: A Rapid Triage Tool for Vulnerable Older Adults in Disaster Situations
Authors: Dyer Carmel B. , Regev Mor , Burnett Jason , Festa Nicolo , Cloyd Beth 
Published: October 2008

ABSTRACTBackground: In 2005, Hurricane Katrina caused extensive damage to parts of Mississippi, Louisiana, and Alabama, causing many people, including vulnerable older adults, to evacuate to safe surroundings. Approximately 23,000 evacuees—many of them 65 years old or older, frail, and lacking family to advocate for their care—arrived at the Reliant Astrodome Complex in Houston, Texas. There was no method for assessing the immediate and long-term needs of this vulnerable population.Methods: A 13-item rapid needs assessment tool was piloted on 228 evacuees 65 years old and older by the Seniors Without Families Team (SWiFT), to test the feasibility of triaging vulnerable older adults with medical and mental health needs, financial needs, and/or social needs.Results: The average age of the individuals triaged was 66.1 ± 12.72 (mean ± standard deviation [SD]) years. Of these, 68% were triaged for medical and or mental health needs, 18% were triaged for financial assistance, and 4% were triaged for social assistance. More than half of the SWiFT-triaged older adults reported having hypertension.Conclusions: The SWiFT tool is a feasible approach for triaging vulnerable older adults and provides a rapid determination of the level of need or assistance necessary for vulnerable older people during disasters. The tool was only piloted, thus further testing to determine reliability and validity is necessary. Potentially important implications for using such a tool and suggestions for preparing for and responding to disaster situations in which vulnerable older adults are involved are provided. (Disaster Med Public Health Preparedness. 2008;2(Suppl 1):S45–S50)
Trial of Prophylactic Inhaled Steroids to Prevent or Reduce Pulmonary Function Decline, Pulmonary Symptoms, and Airway Hyperreactivity in Firefighters at the World Trade Center Site
Authors: Banauch Gisela I. , Izbicki Gabriel , Christodoulou Vasilios , Weiden Michael D. , Webber Mayris P. , Cohen Hillel , Gustave Jackson , Chavko Robert , Aldrich Thomas K. , Kelly Kerry J. , Prezant David J. 
Published: October 2008

ABSTRACTBackground: Inhaled corticosteroids (ICS) are the most effective anti-inflammatory treatment for asthmatics. This trial evaluated the effects of prophylactic ICS in firefighters exposed to the World Trade Center disaster.Methods: Inhaled budesonide via a dry powder inhaler (Pulmicort Turbuhaler, AstraZeneca, Wilmington, DE) was offered on-site to New York City firefighters between September 18 and 25, 2001. One to 2 years later, firefighters (n = 64) who completed 4 weeks of daily ICS treatment were evaluated and compared with an age- and exposure-matched comparison group (n = 72) who did not use ICS.Results: When spirometry results at the final visit were compared with those from the weeks following the 9/11 disaster, the treatment group had a greater increase in forced vital capacity (P = .009) and possibly a slower decline in forced expiratory volume at 1 second (P = .11), as well as a greater improvement in perceived well-being as assessed by the St George's Respiratory Questionnaire (P < .01). There was no difference in airway hyperreactivity and no evidence of adverse effects from ICS.Conclusions: Because the potential for hazardous exposures is great at many disasters, disease prevention programs based on environmental controls and respiratory protection are warranted immediately. Our results suggest that, pending further study with a larger sample, prophylactic ICS should be considered, along with respiratory protection, to minimize possible lung insult. (Disaster Med Public Health Preparedness. 2008;2:33–39)
Implementing the Cities Readiness Initiative: Lessons Learned From Boston
Authors: Koh Howard K. , Elqura Loris J. , Judge Christine M. , Jacob John P. , Williams Amy E. , Crowther M. Suzanne , Serino Richard A. , Auerbach John M. 
Published: October 2008

ABSTRACTThe federally funded Cities Readiness Initiative (CRI) requires seamless federal, state, and local public health coordination to provide antibiotics to an entire city population within 48 hours of an aerosolized release of anthrax. We document practical lessons learned from the development and implementation of the Boston CRI plan. Key themes center on heightened emphasis on security, a new mass protection model of dispensing, neighborhood-centric clinic site selection, online training of Medical Reserve Corps volunteers, and the testing of operations through drills and exercises. Sharing such lessons can build national preparedness. (Disaster Med Public Health Preparedness. 2008;2:40–49)
Analyzing Postdisaster Surveillance Data: The Effect of the Statistical Method
Authors: DiMaggio Charles , Galea Sandro , Abramson David 
Published: October 2008

ABSTRACTData from existing administrative databases and ongoing surveys or surveillance methods may prove indispensable after mass traumas as a way of providing information that may be useful to emergency planners and practitioners. The analytic approach, however, may affect exposure prevalence estimates and measures of association. We compare Bayesian hierarchical modeling methods to standard survey analytic techniques for survey data collected in the aftermath of a terrorist attack. Estimates for the prevalence of exposure to the terrorist attacks of September 11, 2001, varied by the method chosen. Bayesian hierarchical modeling returned the lowest estimate for exposure prevalence with a credible interval spanning nearly 3 times the range of the confidence intervals (CIs) associated with both unadjusted and survey procedures. Bayesian hierarchical modeling also returned a smaller point estimate for measures of association, although in this instance the credible interval was tighter than that obtained through survey procedures. Bayesian approaches allow a consideration of preexisting assumptions about survey data, and may offer potential advantages, particularly in the uncertain environment of postterrorism and disaster settings. Additional comparative analyses of existing data are necessary to guide our ability to use these techniques in future incidents. (Disaster Med Public Health Preparedness. 2008;2:119–126)
Cash Grants in Humanitarian Assistance: A Nongovernmental Organization Experience in Aceh, Indonesia, Following the 2004 Indian Ocean Tsunami
Authors: Doocy Shannon , Johnson Diane , Robinson Courtland 
Published: October 2008

ABSTRACTBackground: Historically, cash interventions, as opposed to material or in-kind aid, have been relatively uncommon in the humanitarian response to emergencies. The widespread implementation of cash-based programs following the 2004 Indian Ocean tsunami provided an opportunity to examine cash distributions following disasters. The Mercy Corps cash grant program in Aceh, Indonesia, was a short-term intervention intended to assist in recompensing losses from the December 2004 tsunami.Methods: An evaluation of the Mercy Corps cash grant program was conducted for the 12-month period following the tsunami using program monitoring data and a systematic survey of cash grant beneficiaries.Results: in 2005, the cash grant program disbursed more than US$3.3 million to more than 53,000 beneficiaries; the average cash grant award was US$6390, which was shared by an average of 108 beneficiaries. In a beneficiary survey, more than 95% of respondents reported the grant allocation processes were fair and transparent and that grant funds were received.Conclusions: The Mercy Corps experience with cash programs suggests that cash interventions in the emergency context, when properly administered, can have an immediate impact and serve as an efficient mechanism for providing assistance. Organizations involved in humanitarian relief, particularly donors and nongovernmental organizations, should consider incorporating cash-based interventions as an element of their response in future emergencies. (Disaster Med Public Health Preparedness. 2008;2:95–103)
Emergency Medical Services Response to a Major Freeway Bridge Collapse
Authors: Hick John L. , Ho Jeffrey D. , Heegaard William G. , Brunette Douglas D. , Lapine Anne , Ward Tom , Clinton Joseph E. 
Published: October 2008

ABSTRACTBackground: The Interstate 35W Bridge in Minneapolis collapsed into the Mississippi River on August 1, 2007, killing 13 people and injuring 127.Methods: This article describes the emergency medical services response to this incident.Results/Discussion: Complexities of the event included difficult patient access, multiple sectors of operation, and multiple mutual-aid agencies. Patient evacuation and transportation was rapid, with the collapse zone cleared of victims 95 minutes after the initial 9-1-1 call. A common regional emergency medical service incident management plan that was exercised was critical to the success of the response.Conclusions: Communication and patient tracking difficulties could be improved in future responses. (Disaster Med Public Health Preparedness. 2008;2(Suppl 1):S17–S24)