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Japan is the only country to have experienced the atomic bombings and still has many nuclear power plants. In 2011, a nuclear power plant accident occurred during a major magnitude 9.0 earthquake, and there was a great deal of concern about radiation exposure medicine for the public. It is necessary to provide appropriate radiation exposure medicine.
Method:
The facility is located within the IAEA's UPZ, and in the event of an emergency, it is necessary to provide medical care for a large number of people exposed to radiation, so an advanced radiation exposure medical facility was built in 2015 (the surrounding population is approximately 300,000).
Results:
The basics of radiation exposure medicine are: 1) medical priority, 2) prevention of the spread of radioactive materials, and 3) protection of our responders from radiation exposure. Everything from whole body assessments, contamination examinations due to exposure, medical procedures (including advanced medical procedures), and decontamination were able to be performed. The facility is also equipped with WBC (whole body counter) that can assess internal exposure. A support system for other medical facilities was being developed in the region by forming a team that can respond to radiation exposure.
Conclusion:
With the current system, not only radiation exposure medicine will be handled, but also CBRNE and other such services in the future. For this reason, repeated training and human resource development are very important.
The United Nations (UN) recognizes Small Island Developing States (SIDS) as a heterogenous group with common geographic and socio-economic challenges. Their vulnerability to disasters was exacerbated during COVID-19 because of emerging nationalism and protectionism towards supply chains and resources. This study aimed to determine if multilateralism engagement improved COVID-19 outcomes and if Foreign Affairs investment improved short term COVID-19 outcomes.
Method:
Metrics were developed to reflect country parameters, clinical impact of COVID-19, engagement in multilateralism, health systems strength and integration in the International Political Economy. Open-source information was used to quantify proxy measures with the calculated percent spent on foreign affairs being the major proxy of multilateralism and disaster impact as lag time to vaccination, case burden and deaths in the first six months of 2020. Data was collected for each of the 38 SIDS. SPSS was used to assess possible correlations with short- and long-term clinical outcomes of the COVID-19 pandemic.
Results:
SIDS were noted to have an average lag of 4.1 months to begin vaccination rollout compared with developed nations and prolonged below global average vaccination rates. Expenditure on Foreign Affairs reduced the vaccination lag (p=0.03), decreased short-term cases (p<0.001) and deaths (p<0.001), Human Development Index improved vaccination rates (p<0.001) and lowered total cases (p=0.03). Foreign Direct Investment (FDI) inflow also decreased vaccination lag (0.02). Dependence on Foreign Aid decreased vaccination rates (p=0.01).
Conclusion:
These relationships suggest that there were multiple factors that determined short- and long-term health outcomes in SIDS. Mitigating the impact of a disaster therefore requires a multiple level investment solution that recognizes the importance of other actors in the global system. The COVID-19 experience suggests that engagement in multilateralism is important in countries that have a high vulnerability to disasters such as SIDS. This is valuable for future disasters in vulnerable states.
Mass gatherings have become more frequent since the beginning of the 21st century. In Canada alone, music festival and sporting event industries will each represent yearly revenues over one billion USD by 2025. Such events require adequate medical planning, as they are associated with a greater prevalence of injuries and incidents than daily life, despite most participants having few comorbidities. Most often, the responsibility of medical planning lies with event producers. This study aims to compare the existing legislative requirements for mass gathering medical response in the ten provinces and three territories of Canada.
Method:
This study is a cross-sectional descriptive study of legislation. Lists of legislative requirements were obtained by contacting via email or phone the emergency medical services (EMS) directors and Health Ministries of all the provinces and territories of Canada, and asking about any legislation or provision within existing laws regarding mass gatherings. Simple statistics were performed to compare legislation across provinces and territories.
Results:
Data collection and analysis are planned to be completed by December 31, 2022. Initial data collection and analysis revealed that none of the seven provinces who answered our emails have provincial legislations. Two referred to specific provisions in the Public Health laws of their province, though nothing specifically refers to mass gatherings. One confirmed that mass gathering medical response was a municipal/local concern to be addressed by the event producers and the locality where the event takes place, and one referred to guidelines published in 2014.
Conclusion:
Although some provinces and territories referred to provisions contained in public health legislation, none of the provinces reached to date could list specific legislation on mass gathering medical response. If this trend continues through full data analysis, it will highlight once more the need to provide more standardized guidance to organizers and municipalities in planning medical response.
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.
Hospitals have had Hospital Disaster Plans (HDP), however, when the COVID-19 pandemic attacked, several hospitals neglected the HDP. They seem to find it difficult to operationalize HDP. The hospital’s problems were also increasingly complex because they must also think about how to break the internal transmission chain and how to deal with the surge in COVID-19 patients besides building a clear incident command system (ICS). This study aimed to carry out documentation and analyze hospital preparedness in dealing with COVID-19 based on the ICS.
Method:
This study was documentation research using a qualitative approach. All hospital preparations in "high case" areas in Jakarta and Yogyakarta from April to June 2020 were documented, followed by interviews and document observations. Furthermore, data were analyzed according to the ICS management functions; commander, secretary, operational, logistics, planning, and financial administration.
Results:
Since the COVID-19 pandemic, hospitals had developed a separate COVID-19 handling system from the existing HDP documents. The analysis showed the division of tasks and functions of each field in the COVID-19 Task Force already existed, but it had not been described in detail. The communication and procedure flow within the internal and external COVID-19 task force were generally only verbal. In conclusion, related to the readiness to face the surge in COVID-19 patients, the hospitals have not made any plans or supervision for handling COVID-19.
Conclusion:
Hospital preparedness in the face of the COVID-19 pandemic based on the Command System has not been maximized. The existing HDP only includes planning for natural disaster management. Furthermore, every health facility established the COVID-19 Task Force. However, the principle of division of tasks, communication, and planning flow in the Task Force still needs to be improved.
After a nuclear or radiological (nuc/rad) incident, there is a need to screen, potentially decontaminate, and monitor the affected population. A Community Reception Center (CRC) is a site that provides these services, plus more, to those displaced by a large-scale incident. By using CRCs, federal agencies and state, tribal, local, and territorial (STLT) health departments can monitor the affected population, help prevent hospitals from becoming overburdened with persons not critically injured, compliment shelter operations, and obtain a basis for a long-term registry. However, public health staff often are not fully trained in their CRC role and the decision-making factors.
Method:
The Centers for Disease Control and Prevention (CDC) developed a unique training board game, “This is a T.E.S.T.” (Tabletop Exercise Simulation Tool), for public health staff about their CRC role and decision-making factors. We play-tested the game with several CDC and STLT staff in 2022 and received informal feedback.
Results:
Players found the game facilitated discussion and identified gaps in CRC plans, safety hazards, population needs, and staffing requirements. They also said the game improved collaboration and communication. Over 90% of players strongly agreed the game accurately simulated both bottlenecks and resource needs, individual needs and anxiety, and allowed a greater understanding of CRC operations.
Conclusion:
Games have been used for emergency response using different platforms such as virtual reality and video games. This is a T.E.S.T. facilitates collaboration by tasking players with managing resources, staff fatigue, public anxiety, and hazards. Players provided valuable feedback on its usability while learning more about CRCs. “This is a T.E.S.T” provides a unique, innovative training experience that incorporates components from typical tabletop and full-scale exercises, CRC capacity estimates through CDC’s CRC SimPLER (Simulation Program for Leveraging and Evaluating Resources), and key principles of adult learning.
During armed conflicts and other situations of violence, EMTs are deployed to respond to the needs of the affected population. It is when fighting breaks out that healthcare services are most needed, but it is also when they are most exposed to violence and insecurity. Current evidence indicates that health personnel, health infrastructure and patients have been the target of different types of attacks.
A new report published on 24 of May 2022 by the Safeguarding Health in Conflict Coalition identified there were 1,335 incidents of violence or obstruction against health care perpetrated in 2021: 161 health workers killed; 320 injured; 170 kidnapped; 713 arrested. Health facilities were destroyed or damaged in 188 incidents, 111 health transports destroyed or damaged and 64 health transports stolen or hijacked.
In a nutshell, health facilities and health workers were subjected to devastating and widespread violence and obstruction of care in 49 conflict-affected countries in 2021.
Method:
This presentation analyzes the current challenges, describes the method used consisting of a scoping review of the available evidence in addition to semi-structured feedback from key stakeholders working in unsecured environments, and supports the identification of skills and competencies that EMT members need before deployment. This presentation will also propose the definition of skills and competencies for EMT members needed before deployment to unsecured environments.
Results:
Recommendations for future action focus on International norms and standards, a competencies framework, evidence and data, and state-of-the-art competencies to address safety and security during deployment needed for a capability-building framework.
Conclusion:
How to optimize EMTs' response in unsecured environments requires designing training and learning pathways that improve skills and knowledge on safety and security for EMT members before their deployment to prevent and mitigate violence against health care during deployment in unsecured environments.
As the number of individuals impacted by disasters rises, an adaptation of Psychological First Aid (PFA) into a group intervention is warranted. Such a model would allow for more people to receive the support they need, while harnessing the power of group interventions. Groups have established effectiveness that is equivalent, if not superior, to individual treatment. Additionally, the five essential elements of early intervention for mass trauma (safety, calm, efficacy, connectedness, and hope) are closely related to the established mechanisms of change in groups. Groups are particularly well-suited to promote connectedness, the element with the strongest empirical link to recovery. Nevertheless, groups are underutilized in disasters and caution is warranted as some models have been shown to cause potential harm by over-exposing those involved to one another’s trauma and attempting to process the trauma when the focus should be on stabilization. This presentation proposes a model for group-based PFA that incorporates the known risks and benefits of disaster response and group interventions.
Method:
Literature on group interventions for disaster was reviewed and compared to established best practices in disaster mental health including PFA, Skills for Recovery, and related interventions. This literature was combined with the clinical and training experience of the presenters to develop an initial model for adapting PFA into a group intervention.
Results:
The model proposed involves dissemination of PFA’s general tenets among large groups and then utilizing small groups to provide the PFA core skills most applicable to each group. The model also incorporates group processes known to promote recovery that are not available in individual interventions, emphasizing the role of group cohesion to create connectedness and social support.
Conclusion:
This proposal is conceptualized as a tabletop presentation to allow for discussion, with a goal of advancing Group PFA and recommending next steps in its development and dissemination.
In Japan, the Disaster Medical Assistance Team (DMAT) is dispatched as an Emergency Medical Team (EMT) in major disasters. DMAT consists of a physician, nurse, and operations coordinators. The operations coordinators include all occupations other than physicians and nurses, and are responsible for activities to facilitate medical treatment, gathering information, establishing communications, and ensuring transportation. Therefore, the operations coordinator must have in-depth knowledge of all aspects. Operations coordinators with this knowledge are qualified as logistics team members in addition to DMAT certification. Paramedics receive pre-graduate training in medical care, transport, and coordination with other organizations, and many of their daily duties are related to these areas. However, there are few opportunities to learn about logistics. If paramedics are effectively trained in logistics, they are likely to play an active role as operational coordinators. However, logistics covers a wide range of topics, and there are few studies on items that require focused education. Therefore, this study examines the level of understanding of each logistics item among paramedics active in the field of disaster medicine to identify items that should be emphasized.
Method:
A questionnaire survey of 36 paramedics was conducted, all of whom hold both DMAT and logistics team certifications, to determine their level of understanding and the importance of each logistics item. The logistics items used in the survey are specified in the Logistics Specialist Certification System of the Japanese Society of Disaster Medicine. The collected questionnaire results were analyzed using SPSS statistical software.
Results:
Characteristic trends were obtained in the logistics items required of paramedics. Trends were also analyzed according to the age and work history of paramedics.
Conclusion:
The logistics education for paramedics needs to be enhanced in accordance with the trends obtained from the study. Specific studies on the means and timing of education will be needed in the future.
The steady increase in the number of natural and man-made disasters causes the need for urgent ambulance aircraft evacuation of seriously injured to the specialized federal medical institutions with appropriate equipment, advanced technologies and highly qualified personnel to provide specialized high-tech assistance to victims. The medical institutions can be located at a considerable distance from the place of emergency.
Method:
EMERCOM of Russia, staffed by highly qualified medical personnel, equipped with resuscitating medical modules in airplanes and helicopters (MMA and MMH), has been successfully carrying out medical evacuation of seriously injured in emergency situations to specialized medical institutions for many years (since 2008).
Results:
Based on the results of the use of the medical modules, it was proved that their use in mass ambulance aircraft evacuation is fully justified. During the flights, sparing transportation of the injured is provided, complete monitoring and compliance with the continuity of the treatment process. With the use of MMA and MMH, the quality of mass ambulance aircraft evacuation of seriously injured has significantly improved and the delivery time from the lesion to specialized hospitals has been reduced, as well as the lethality of victims.
The analysis of the effectiveness of the use of medical modules showed that the use of modules during the ambulance aircraft evacuation of seriously injured reduces mortality at the pre-hospital stage by 3.3 times, at the hospital stage–by two times (p<0.05).
Conclusion:
EMERCOM of Russia introduced into the practice of aviation medical evacuation the medical technology using extracorporeal membrane oxygenation (ECMO) for the rescue of seriously injured.
On the basis of NRCERM, a simulation center has been founded and equipped for the training of aviation medical teams, a training program has been developed for the medical personnel of EMERCOM of Russia participating in ambulance aircraft evacuation of victims in emergency situations.
In Germany, more than 3.3 million people in need of long-term care are receiving home care. Although not all of them use professional home care providers, their services are essential especially to those who need skilled nursing care and medical-technical assistance in addition to everyday support–such as approximately 30,000 people who receive home mechanical ventilation. Little is known about the disaster resilience of home care infrastructures and ways to strengthen them. A research consortium called AUPIK, funded by the German Federal Ministry of Education and Research from 2020-2023, sought to close this gap.
Method:
A participatory process was initiated as part of the AUPIK project based on results of a multi-perspective empirical baseline analysis which resulted in a first draft text about measures to promote disaster resilience in home care. 37 representatives of home nursing care providers and community health-care services, professional boards, scientific and education institutions participated in a web-based survey on the draft text, followed by two digital group discussions. Finally, the gradually revised, condensed and consented starting points were published and distributed.
Results:
Eight starting points were defined. Among others, there is an urgent need to strengthen risk awareness and resource management among home care providers, to promote individual disaster competence and preparedness among all parties involved and, not least, to strengthen community-based networking initiatives between home care providers, emergency and disaster organizations and local authorities. Institutions or persons who should take responsibility for implementation at different levels are addressed directly.
Conclusion:
The final version of the starting points represents a consensus on urgently needed initiatives to promote disaster resilience in home nursing care in Germany. The participatory development process should support commitment on the part of all stakeholders and thus promote effective implementation of disaster resilience initiatives in home nursing care.
Stadiums are an important part of the entertainment and sporting cultures of communities around the world, but the combination of outdated infrastructure with poor safety planning, large numbers of people gathering within a confined space, and the high frequency of such events have led to a number of significant disasters in the past.
This is a descriptive analysis of stadium disasters occurring between 1901-2021 which may provide useful insight for event safety personnel and disaster medicine specialists to better prevent and mitigate the effects of potential future stadium disasters.
Method:
Data was collected using a retrospective database search of the Emergency Events Database (EM-DATS) for all stadium-related accidental disasters occurring between January 1, 1901-July 30, 2022. A disaster is defined by CRED in its glossary as “technological accidents of an industrial nature, or involving industrial buildings”. All categories and definitions are predetermined by the EM-DATS as per their glossary.
Results:
The May 24, 1964 Estadio Nacional disaster in Lima, Peru was the worst (in terms of deaths) to date with 350 deaths. This is followed by the 1982 Luzhniki Stadium disaster in Moscow, Russia (340 deaths), the 2001 Accra Sport Stadium disaster in Ghana (123 deaths), and the 1985 Hillsborough Stadium disaster in Sheffield, England (96 deaths) as well as 14 of the 40 stadium disasters occurred in Africa, 11 in Europe, 10 in the Americas, and five in Asia.
Conclusion:
A total of 40 stadium disasters were included, leading to 2,025 deaths and 6,640 injuries. This equated to an average of 50.6 deaths and 166.0 injuries per disaster. Given the potential risk of mass casualty events, stadiums should incorporate disaster medicine education, training, and expertise in their emergency medical plans.
Global Emergency Care Skills, an Irish-based NGO, provided a five-day intensive training course to 24 local healthcare professionals in Nyabondo, Kenya in November 2022, in advance of the opening of a new major trauma center which will serve the greater Kisumu region. The pre-participation knowledge, experience and skills base was surveyed. Following the completion of didactic, workshop and simulation-based training, the perceived acquired competence and applicability of skills were surveyed. The ability to provide ongoing teaching of skills acquired within local healthcare settings was evident.
Method:
Nine emergency medicine and two anesthesia doctors currently working in the Irish healthcare system traveled to Nyabondo in the Kisumu region in Kenya for one week in November 2022. A five-day course based on providing practical training addressing comprehensive trauma and acute deteriorating patient knowledge and skills was provided. This included extensive focus on the primary survey approach. A quantitative survey of 22 questions with binary answering options was used. 19 participants completed the survey, and qualitative data on the applicability of the training provided to the local healthcare resource environment was gathered.
Results:
Following surveying participants we found that the majority of participants had no previous experience or knowledge of simulation based learning. Further, a vast majority had no formal skills or educational training post completing their medical qualification.
Conclusion:
The overwhelming majority of participants felt that this training improved their confidence and competence in managing trauma and assessment of the critically unwell adult and child. 100% of participants stated they gained new skills and were confident in their ability following this training to deliver local training on an ongoing basis in their own healthcare settings.
Health information technology, especially electronic health records (EHRs) pose difficult design problems due to the data and workflow complexity, high-stakes stressful nature of healthcare work, variability of information and collaboration needs and stakeholders. Emergency response poses further requirements. We propose a different, novel approach in which flexible ‘building block’ platforms composable by nonprogrammers could address rapid implementation and sharing of new functionality as needed at the point of care. In order to truly meet unpredicted emergency needs a philosophy of maximal flexibility and data comprehensiveness is required.
Method:
Existing technologies were used in new ways to permit prototype design of composable health IT platforms, intended to be added to existing health information systems, allowing nonprogrammers (including clinician end users) to assemble any desired data, visualization, and new logic to permit rapid tool deployment in emergencies. An example is the rapid composition of Covid-19 screening and treatment tools (in minutes) for fast implementation of new screening and care guidelines (as happens in a new epidemic), with usable visualization and decision tools.
Results:
Prototype systems were successfully built and configured for rapid tool creation for pandemic-specific needs including setup of automated screening and decision tools using EHR data plus point of care data gathering. These will be demonstrated. A modular, composable approach is usable by nonprogrammer clinicians, permitting those most familiar with rapidly changing clinical needs and guidelines to implement new health IT functionality directly instead of incurring delays typical when IT staff must do ad hoc programming. At this time new initiatives and mandates for health IT interoperability make this more easily doable than previously.
Conclusion:
Disaster response may be facilitated by a different approach to health IT design and use, with advantages for rapid response, streamlining clinician work, and ease of use.
Little is known about Self-Injurious Thoughts & Behaviors and Non-Suicidal Self-Injury in firefighters in two East Coast United States metropolitan fire departments based on fire service tenure.
Method:
• Study comprised of two parts, a survey and a questionnaire, both conducted online. Using the Computer Adaptive Test–Suicide Scale
The only computer-based adaptive mental and behavioral health assessment clinically validated worldwide.
Validated against face-to-face structured clinician-led assessment.
Participants received a unique identifier and hyperlink allowing them access and confidentiality.
Study was completed on participants' personal electronic devices, on their own time, at their own pace.
A single-factor or One-Way ANOVA tested for a significant relationship between the variables and the four tenure groups simultaneously. Time of administration averaged 86 seconds, with a median of eleven questions.
Results:
The C-SSRS identified six participants triggering suicide alerts. One in the early-career category and five in the late-career category. The CAT-SS identified one participant as high-risk and 33 participants for suicidality. One participant in the early-career category.
Conclusion:
Early-career and late-career firefighters have more self-injurious thoughts and behaviors and mid-career firefighters have the least.
919,000 Rohingya refugees live in overcrowded camps in Cox’s Bazar, Bangladesh after fleeing violence in Myanmar. The Médecins Sans Frontières (MSF) Goyalmara Hospital offers the highest level of pediatric and neonatal care serving the Rohingya refugees and palliative care is gradually being integrated due to high mortality and medical complexity of patients. The purpose of this study was to understand the moral experiences of staff involved in providing palliative care to inform program implementation at Goyalmara Hospital and in other humanitarian contexts.
Method:
This focused ethnography was conducted between March-August 2021 at Goyalmara Hospital. Data collection involved participant-observation, individual interviews (22), focus group discussions (5), and analysis of protocols and other documents. Interviews and focus groups were audio-recorded, translated, and transcribed. A coding scheme was developed, and data coded using NVivo 11.
Results:
A key finding of this study was the important yet contested role of clinical guidelines and policies in palliative care related decision-making which was shaped by the authority and impermanent presence of international staff in the project. Staff saw clinical guidelines as a valuable resource that supported a consistent approach to care over time, and some locally hired staff used clinical guidelines as a tool to support their point of view during care planning discussions with international staff. Others felt that palliative care guidelines and other policies were inappropriately or rigidly applied, particularly surrounding decisions to refer (or not refer) patients to a higher level of care, or to discontinue certain medical treatments at end of life.
Conclusion:
MSF staff experienced tension between the need for clarity and consistency, and the need to tailor guidelines to the context, patient, and family. Open discussion of staff concerns may alleviate moral distress and alert teams to areas where advocacy, staff psycho-social support, training, or clinical mentoring are needed.
An effective response to CBRNE requires that frontline staff, such as nurses, are adequately trained in Emergency Preparedness (EP). Understanding the current gaps in nursing knowledge of CBRNE is the first step in creating an effective training program. This study assessed EP training gaps and needs among nursing staff.
Method:
A web-based survey was distributed to all hospital nursing staff. The survey evaluated the CBRNE training that nurses received. Staff listed the types of training they had received and were asked to rate their confidence in performing various disaster-related competencies or capabilities. Competency confidence levels were also surveyed as those who feel; not at all confident or not very confident.
Results:
The survey assessed previous EP training. 572/763 Nursing Staff had completed the survey, for a response rate of 75%. Of the nurses who responded, areas in which they have been trained included: preparedness for radiological and nuclear agents (17.66% trained), preparedness for biological agents (22.20% trained), preparedness for chemical agents (27.45% trained), hazardous materials and patient decontamination (25% trained), and their own role within the hospital's ICS (31.29% trained), Patient evacuation (63.61% trained) and the hospital's EP plan (54.55% trained). The survey also assessed respondents' confidence in performing EP activities. The respondents reported lacking confidence in treating patients exposed to a radioactive material (59.9%), treating patients exposed to a biological agent (57.17%), and performing decontamination procedures (54.71%). The respondents reported having confidence in evacuating patients from units, departments, or hospitals (69.1%). The top incentives for participating in “nonrequired” training were no costs to complete the training (83.1%) and receiving continuing education credits (79.2%).
Conclusion:
A majority of nurses reported inadequate training in CBRNE events with a self-reported lack of confidence in responding to these events. A targeted and educational CBRNE curriculum and materials to enhance EP among nursing professionals are clearly indicated.
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.
In this era of increasingly fragile hospital systems, major emergency preparation is firmly being placed under the spotlight. The response to major emergencies requires the mobiliZation of numerous resources to ensure an effective, coordinated response. Yet, studies confirm a global deficit in the knowledge and skills of staff responding to these events in Ireland. Non-consultant hospital doctors (NCHDs) provide a useful and necessary surge response during these events, but currently there are no training programs specifically focused on their major emergency training requirements. The aim of this research was to define the essential elements of a focused curriculum for non-consultant hospital doctors responding to a major emergency (ME).
Method:
A two-step process was employed. Initially, a comprehensive ME competency set was compiled from relevant literature, consulting field-specific experts and from current ME training programs. A sample of experts was paneled from several acute hospitals in Ireland using purposive and snowball recruitment. A modified Delphi process, using on-line surveys, was utilized to identify the competencies deemed essential for NCHDs responding to an ME event.
Results:
Three Delphi rounds were required to complete this study. Of the 116 initial survey items, 68 competencies were confirmed as essential NCHD competencies, a total reduction of 40%. A 70% consensus rate was applied to 71 survey items in the final round, resulting in an agreement in 68 competencies (96%). A preponderance of the rejected competencies were specific to managerial and administrative tasks, whilst many retained competencies related to direct clinical care.
Conclusion:
This study has defined the essential elements of a curriculum for NCHD doctors responding to a major emergency in Ireland, using the Delphi methodology. This derived competency set should be useful to national bodies, regional organizations, and hospital stakeholders to allow the creation of bespoke NCHD major emergency training programs.
General Practitioners (GPs) manage the majority of usual healthcare needs in a community. These healthcare needs do not cease in disasters; they increase and expand. However, inclusion of GPs in disaster healthcare systems is only just beginning. Systematic review of the health effects of disasters over days, months, and years, shows the major burden of healthcare needs associated with disasters is within the realm of usual general practice. In Australia, Primary Health Networks (PHNs) represent local GPs in each region. They offer the best option for systematic linkage of GPs to the broader DHM system.
Method:
A systematic review of the literature on the health effects of disasters and three qualitative studies reviewing the current experiences, barriers and facilitators to GP involvement in DHM systems were undertaken through a PhD at the Australian National University in 2022. A knowledge to action framework was developed and utilized to provide a systematic strategy to guide efforts to diffuse, disseminate, and implement the research as it emerged, with a focus on sustaining those changes through integration of PHNs into Australian DHM systems.
Results:
Integration of GPs, through PHNs, is evolving, through systematic inclusion in planning and policy in local health districts. Over time, evidence-based knowledge of disaster healthcare needs has been incorporated into GP disaster planning and preparedness, and resource development, and utilized by GPs during the recent 2019 Black Summer Bushfires, and East coast Floods.
Conclusion:
As our knowledge of the healthcare needs of disasters continues to reflect our increasingly challenging and complex world, the proven benefit of active involvement in holistic, comprehensive continuity of healthcare through General Practice in DHM systems through PHN linkage becomes more urgent.