bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.