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A 20-year-old woman was referred to the emergency department with rapid acceleration of complaints of palpitations, fever, diarrhea, and agitation that had been present for several weeks. During physical examination, the patient was uncomfortable and restless with a tachycardia of 170/minute, and a fever of 38.5 °C. Palpation of the neck revealed a small ventral, painless, solid elastic mass, more prominent on the right side, clinically suspicious for goiter. An electrocardiograph showed an atrial flutter of 150/min. Initial laboratory results showed an erythrocyte sedimentation rate of 35 mm/hour (0–20 mm/hour) and urine analysis tested positive for ketones.
Outcome and Treatment
The patient was presumed to be suffering from a thyroid storm. She was treated promptly with Propranolol 160 mg and Thiamazole 30 mg twice daily at the emergency department. She was admitted to the Cardiac Care Unit for observation of the heart rhythm, which slowed down to 110/minute the same day and her condition improved clinically. The following day her laboratory result confirmed the diagnosis with a thyroid-stimulating hormone of < 0.01 mIU/L (0.4–4.0 mIU/L) and a free thyroxine (T4) of > 75 pmol/l (10–22 pmol/l). Eventually, she was diagnosed with Graves Disease.
Discussion
Thyroid storm is an acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones. The adult mortality rate is high (90%) if early diagnosis is not made and the patient is left untreated. Therefore, in case of clinical suspicion for thyroid storm, it is critical to start prompt treatment with Beta blockade and Thiamazole before the diagnosis can be confirmed biochemically.
Crisis, disasters, terror attacks or any other traumatic event may cause among the survivors acute stress reaction (ASR). The main goal of the first responder in terms of mental health in the acute phase is to provide the victim the basic support that will stabilized the needed coping resources and re-establish the sense of control and safety (Kutz & Bleich, 2005). This process encourages the shift of the victim's perspective from a helpless victim to a coping survivor. The emergency mental health interventions are differentiated by the location: Location 1: The event's location: Pacing & Leading using varied communications channels. Re-establishing sequences of contingency. Regaining sense of control. Using the cognitive communication channel. Yes-set sequences. Location 2: Emergency rooms or Traumatic Stress First Aid Centers (TSFAC) Stress symptoms reduction using suggestive techniques Memory Structure Intervention (MSI). Psychological Inoculation (PI). Group interventions. Basic deferential diagnosis: ASR-PTSD Patent release decision making. The higher the number of casualties, the more likely is the need for early interventions by non-professionals. This may be particularly true for a mega-terror attack, when the numbers of survivors with ASR can flood the hospital gates. The general principles for intervention by non-professionals, adopted by the Israel Ministry of Health (2002), are: a. Establish personal contact with the survivors and provide words of comfort or supportive touch. b. Encourage survivors to verbalize their experiences. c. Provide orienting information about what happened and what is about to happen in the hospital. d. Ensure physical needs such as hydration, food, and rest when appropriate. e. Enable contact with any significant other as soon as possible through phone or personal contact. During the presentation the above subjects will be elaborated and demonstrated by case studies and short videos.
Disaster reports are common in the literature. Accurate and complete reporting assists readers and researchers in developing best practices. There have been notable efforts, such as the Utstein Template, to standardize the language of disasters and promote consistent use of definitions. However, case reports are complicated by the presence of four dominant types recognized in the literature. Moreover, the disciplines of medicine, public health, and disaster management differ in origins, definitions, research paradigms, and tools of evidence-based decision-making. Finally, biomedical journal guidelines for authors writing disaster case reports have lacked the rigor of standards associated with observational studies (2007 STROBE statement, 2010 MOOSE statement), or with randomized controlled trials (1996 CONSORT statement, 1999 QUORUM statement). This paper examines current efforts to intensify the rigor of future disaster case reports through uniform reporting requirements for authors. The initial workgroup comprised editorial board members of two biomedical journals indexed in the US National Library of Medicine—Prehospital and Disaster Medicine, and Emergency Medicine Australasia. The workgroup members self-selected based on extensive disaster field experience as technical advisor with governmental, non-governmental, Red Cross and UN agencies. The workgroup identified key information needed to understand the context, structure, process, and outcome/impact of disaster field interventions. Then, the workgroup organized this information in thematic domains. Consensus guidelines emerged for Reports of Field Interventions in Disasters and Emergencies (CONFIDE). The CONFIDE Statement addresses 16 keys areas within seven domains, including: field authorization for access, field logistics, initial assessment, clinical epidemiology, and funding. The Statement was first published in December 2010, at which time, the authors began integrating the guidelines with biomedical journal instructions for authors. The paper details current efforts to broaden editorial acceptance of the guidelines, implications for future authors, and potential benefits to the disaster medicine community.
In July 2010, the government of Honduras requested VCOM assistance with a widespread Dengue Outbreak. At the time of the mission trip, over 33,000 Hondurans had been hospitalized for Dengue Fever and a National State of Emergency declared. VCOM sent a team of medical students, faculty and volunteers to answer the call for help. The Honduran government selected five villages where the need for medical attention was greatest. The team provided medical exams, treatment or referral when necessary to approximately 200 patients in each of the five villages. General medical exams were provided in addition to screenings for Dengue Fever and subsequent supportive treatment including oral rehydration salts, Tylenol, vitamins and treatment of complications. National and local strategic partnerships to provide emergency medical response services included the Minister of Health, Minister of Defense, Minister of Transportation and Housing and office of the President of Honduras; Deans of the National and Catholic Medical Schools; President of the Board of Medicine and other governmental and non-governmental offices; Mayors and local officials, and often local media. At Marcala, the Minister of Public Transportation and Housing arrived by Helicopter from Tegucigalpa to greet the VCOM team and patients at the clinic; and at Santa Maria del Real, the Honduran President's son met the team personally. The Honduran support for VCOM's ongoing continuity of health and improved medical care efforts in the country was evident. The trip enhanced the skills and knowledge of participating students and faculty. Student Jenie Sales writes, “I not only enhanced my own clinical experience and knowledge, but I obtained a greater understanding for the people and culture of Honduras.” Student opportunities for reflective learning included case study writing, surveys and evaluations. The successful experience will lead to increased knowledge in the care of patients during a Dengue outbreak.
Western Australia (WA) currently is undergoing a major rebuild of its key metropolitan and regional hospitals, with the planned construction of a major tertiary hospital, pediatric hospital, and several large general hospitals in the metropolitan area, and a range of small and medium size hospitals in WA over the next five years. Protecting these hospitals from major internal failure and external assault, while preparing them to cope with mass casualties, has been a major focus of the WA Department of Health over the last five years. This program has involved capital investment in current infrastructure, including critical asset protection, and detailed planning to ensure that the new health infrastructure will have both the redundant systems, to allow for continued operations in a range of infrastructure failure and disaster scenarios, and the facilities to deal with a mass-casualty incident. This presentation will review the implementation of this critical infrastructure program, the evolving issues facing hospitals working to ensure their continued operations in a range of scenarios, the security and infrastructure threats facing major hospitals, and the planning required to ensure that these threats are addressed at an early stage of hospital development. Issues as diverse as the placement of underground garages to minimize bomb threats, the location of helicopter landing pads, and the consideration of how to lock down hospitals to prevent the uncontrolled access of contaminated patients, are some of the challenges that need measured consideration and a planned response. The preparations and planning for such contingencies, and the infrastructure to facilitate continued operations and an appropriate disaster response, are key elements in protecting critical health infrastructure.
The pyramid of pain management involves sequential drug escalation but its role is limited in an emergency department (ED). The efficacy of parental opioid analgesics versus non-opioid analgesic in acute pain management of trauma victims in the ED was evaluated to formulate protocol.
Methods
All alert patients with a baseline visual analogue scale score (≥ 7) was randomly assigned either parental non-opioid (Group A) or opioid analgesics (Group B). The emergency care providers noted the VAS in either group at 15 minutes, 30 minutes, and 60 minutes, and at the time of discharge from the ED. If the patient's VAS score did not reduce by 50% at 30 minutes, repeat parental analgesics was given. The oral analgesics prescribed at the time of discharge were documented. Ethical clearance was taken. Data was compiled and analyzed.
Results
Of 106 patients, 99 were analyzed. The mean age in Group A was 33.2 ± 13.2 years and 32.5 ± 18 years in Group B. The male:female ratio in Group A was 1.5:1 and 7:1 in Group B. The average baseline VAS score in Group A was 7.5, and that of Group B was 8.96. The average VAS at 15, 30, and 60 minutes and at discharge in Group A was 5.4, 5.34, 4.3, and 3.5 and it was 6.1, 6, 5.1, and 4.4. Repeat parental dose of analgesics were required in 95/99 (95%) patients in Group A and 5% that of Group B. The most common prescription at discharge from ED was non-opioid analgesics.
Conclusions
Acute pain relief was comparable in both groups. Non-opioid analgesics may be preferred over opioid in VAS score ± 7 in a busy emergency department for early disposition.
1. To hear the types of ethical challenges foreign health care workers (HCWs) experience while providing health care in conditions of disaster and deprivation. 2. To hear how they responded 3. To understand the kinds of resources that may have been helpful to support HCWs in these ethical dilemmas.
Methods
Qualitative study, loosely grounded theory. Canadian trained HCWs (n = 20, mean age 39) who have worked in disaster response, conflict, post disaster.
Results
Ethical dilemmas emerged from 4 main sources: resource scarcity, historical/political/social structures, aid agency policies/agendas, HCWs norms roles/interactions. Participants described little preparation to deal with ethical dilemmas, and the value in pre-departure training. Clinicians are nurtured in western ethics- mostly formed on autonomy, beneficence, non-maleficence and justice. New realities for many were related to community oriented Public Health Ethics. Early discussion has emerged about the possibility of developing a simple, practical, hand held decision-making model (toolkit) to be used in the field to help guide reflection about ethical dilemmas for HCWs in disaster settings.
Unusual biological events (UBEs) pose a distinct challenge for emergency preparedness. Not only are these events rare and difficult to detect, but they also pose clear hazards for both medical personnel and their families. Distinct skills include identifying UBEs and activating institutional and national response. Staff attendance and confidence in the health system play a vital role in effective management of UBEs. The Israeli Ministry of health conducts yearly drills on the personal, institutional, and national response to UBEs.
Aim
The aim of this study was to evaluate the effect of various educational tools and personnel characteristics on personnel skills, views, and compliance to participate in the management of UBEs.
Methods
As part of the preparations for an institutional drill in the Tel Aviv Medical Center, several educational methods were employed. These included e-mail notifications, computer-based self learning, publication of an institutional protocol, tabletop drills, personal briefings, and finally, a large scale exercise. Questionnaires regarding personnel characteristics, participation in pre-drill education, personal views, compliance, and familiarity of institutional protocols and selected diseases were distributed.
Results
Age, family status, and years of experience had no significant influence on personal views. Confidence in the health system increased with experience. Intensity of training had significant positive effect on personal confidence and compliance to attend work during a UBE, however it did not appear to significantly influence personal views or medical knowledge.
Conclusions
Comprehensive education and exercise of personnel is beneficial effect in terms of personal confidence and work attendance during UBEs. Specific educational tools, such as self-learning software, increase proficiency.
One of the most prevalent issues identified by Emergency Response Program Organizations (ERPOs), is the inability to care for an overwhelming number of contaminated patients within a civilian community. Even when emergency responders successfully decontaminate and triage large numbers of patients at the scene, it is unlikely that neighboring hospitals are prepared and equipped to receive such a large amount of patients and treat them within the boundaries of the existing healthcare system. Thus, planners must avoid any collapse of the healthcare system and may need to redistribute existing resources to enhance and facilitate patient outcome. As a response to this issue, ERPOs should develop an alternative healthcare facility: the Off-Site Triage, Treatment and Transportation Center (Off-Site Center). This Center is a temporary patient clearinghouse to be disassembled once the flow of new patients has diminished to the point that they can be handled by the existing healthcare systems.
Methods
The Off-Site Center is intended to care for patients who have been triaged as “Minimal” at the scene, those patients who are worried that they might have been exposed to contamination, and those who self-refer to the Center.
Results
Planners, administrators, first responders, medical professionals, and public health and emergency management personnel must evaluate the Concept of Operation for the Off-Site Center in order to increase their level of preparedness and provide effective mass-casualty care.
Conclusions
In this report, some general guidelines will be provided for the efficient planning and management of an Off-Site Center. A practical example will be also illustrated: a case study in Bergamo during a May 2010 National Meeting of the Italian Association of Alps Infantry Troops.
Comparative analysis of under considered psychological implications in earning members of family who happen to be victims of trauma and end up in early or delayed amputations to those in whom salvage to acceptable or useful function was possible.
Material
Working and ably earning members who sustained traumatic wounds in industry, domestic, traffic, calamity, war, homicide, suicide, etc. Age groups from 1 to 75 years studied. Grade I,II,III A and III B compound wounds included. Psychological evaluation in early and delayed amputations compared with those salvaged to partial / useful function.
Methods
Periodic and frequent counseling as integral part of treatment regime to victims of trauma and their peers, family members, employers, police and lawyers.
Discussion
Classification, incidence and outcome of post traumatic psychosis. Need of effective counseling to reduce post traumatic psychological imbalance and improve quality of life.
Observations
Behavioral changes and suicidal tendency are profound and pronounced in traumatic and early amputees compared to subjects of delayed and revision amputations. Acceptance and adaptability with limb / extremity salvage is encouraging with minimal post traumatic psychosis.
Conclusion
Frequent and repetitive counseling aids reduce post traumatic psychosis. Depressive psychosis is much less prevalent even in partially functionally acceptable traumatic limb salvage than in early or delayed amputations, though salvage takes a long course in management, rehabilitation and changed occupation by relocation.
A Flood disaster struck the Islamic Republic of Pakistan in July 2010. It affected 3 million people and caused 1,400 deaths. Humanitarian Medical Assistance (HuMA) is a non-profit organization in Japan. The organization dispatched three personnel to Islamabad on 20 August in order to conduct an initial needs assessment. They discovered that medical assistance and supplies could not reach all of the victims, especially in the North. Their visits to the surrounding regions highlighted the Nowshera district of KPK province, which had not received enough assistance from the government or aid organizations despite the fact that there were thousands of Internally Displaced Persons (IDPs) with health issues such as diarrhea, eye and skin disease, and upper respiratory tract infection (URTI). On 03 September, the HuMA Disaster Relief Mission began with the purpose of providing medical treatment and promoting public health for the flood victims in the Nowshera District. Eleven medical providers and coordinators from HuMA operated field mobile clinics in the district in collaboration with a local counterpart non-governmental organization, Nippa Welfare Association (NWA). This project was supported financially by the grant funding from Japan Platform. Humanitarian Medical Assistance served seven sites in Nowshera Districts as mobile field clinics, and consulted 2,216 patients. Total distribution of disease was: (1) URTI = 18.1%; (2) skin disease = 17.9%; (3) musculoskeletal = 15.2%; and (4) others = 19.7%. The team considered continuous medical consultation in the Nowshera District after 2010. The HuMa medical activities ended at the end of September, and the organization donated multi-vitamin tablets, syrups, FE tablets, and anti-biotic cream in order to assist NWA's continuing assistance for the affected communities. The medical providers also left lists of medicines for local doctors and medical staff. Humanitarian Medical Assistance also provided basic supplies needed to prevent victims from experiencing further sanitation problems.
On 12 January 2010, the fate of Haiti and its people shifted with the ground beneath them as the strongest earthquake in 200 years, and a series of powerful aftershocks demolished the capital and multiple areas throughout the southern coast in thirty seconds, leaving some 220,000 people dead, and 300,000 persons injured. On 27 February 2010, at 03:35 hours local time, an earthquake of magnitude 8.8 struck Chile. As a consequence, the tsunami generated affected a coastal strip of more than 500 kilometers. Approximately 1.5 million people were affected and thousands lost their homes and livelihoods. The emergency health response of the International Red Cross Movement to both disasters was immediate, powerful and dynamic. The IFRC deployed seven emergency response units (ERU) to Haiti: one 150-bed referral hospital, one Rapid Deployment Emergency Hospital, and five basic health care units. One surgical hospital and two Basic Health Care Units were deployed to Chile. The ERU system of the IFRC is a flexible and dynamic tool for emergency health response in shifting and challenging environments. Evaluations show that the system performs well during urban and rural disasters. Despite a very different baseline in the two contexts, the ERU system of IFRC can adapt to the local needs. As panorama of pathology in the aftermath of an earthquake changes, the ERU system adapts and continues supporting the local health care system in its recovery.
Emergency Response Units (ERUs) were pioneered over a decade ago by the International Federation of Red Cross and Red Crescent Societies (IFRC), with the intention of providing a standardized, rapid global tool for response in disasters. Health ERUs are one example of several types of ERUs on stand-by in various countries around the world. Their tented infrastructure, basic medical equipment, and pre-trained personnel allow for the provision of surge medical capacity where it is needed. Commonly used set-ups include a Basic Health Care Unit and a Referral Hospital. The recently-introduced Rapid Deployment Emergency Hospital allows for a lighter, highly mobile infrastructure, with surgical and emergency medical capacity. The modular design of these ERUs allows for deployment with materials “tailored” to the disaster. Their flexibility has been demonstrated in public health emergencies such as the nation-wide cholera epidemic that occurred in Zimbabwe (2008) and more recently in earthquake-damaged Haiti (2010) and flood-affected Pakistan (2010). Health ERUs already on the ground in post-earthquake Haiti were able to re-organize equipment for use in cholera treatment units and centers, and additional ERUs were deployed specifically to set-up treatment centers. In Pakistan, a mobile clinic set-up was used to deliver primary health services to displaced populations, including psychosocial support initiatives and community health messages to minimize the emergence of communicable diseases. The Community Health module (CHM) is a new module in development since 2009. Experience has shown that disrupted health systems, combined with displaced populations can create a fertile environment for communicable disease outbreaks. The CHM addresses primary, secondary and tertiary prevention early in emergencies by engaging communities and more specifically National Society volunteers in epidemic control. The modular design of Health ERUs allow for a rapid and comprehensive approach to delivery of health care in a disaster, with a longitudinal perspective of population needs.
Long term Effects of a Flood on the Psychosocial Health of Victims D. Maltais1 et L. Lachance2, Université du Québec à Chicoutimi, Québec, Canada, 1Département des sciences humaines, 2Département des sciences de la santé In July 1996, floods disrupted the lives of thousands of people living in rural and urban communities in the Saguenay area of Quebec. Data collected three years after the events showed that flood victims experienced more precarious psychological health, with various factors being controlled including sex, age, and life events. Flood victims demonstrated more post-traumatic symptoms, somatic symptoms, social dysfunctions, and depressive symptoms than non-victims. Victims also showed significantly lower levels of psychological well-being than non-victims. In order to identify the long-term impacts of flood exposure, a second study was conducted eight years after the event (2004) with the same groups of victims (N = 129) and non-victims (N = 89). Variance analyses show that urban survivors obtained improved scores on scales measuring PTSD, and depression yet remained significantly more affected than non-victims. Over time, victims also obtained improved scores on the GHQ-28 and the Affect Balance Scale yet also remained significantly different from non-victims on the GHQ-28. Rural victims improved their GHQ scores over time as well, yet maintained significant differences with rural non-victims for the PTSD score. No significant differences were observed over time (time 1 and time 2) or between groups (victims and non-victims) regarding psychological well-being and depressive symptoms in rural area.
Emergency Services in catastrophic flooding in Poland (2010 experience) Przemyslaw Gula MD PhD, Edyta Szafran Institute for Emergency Medicine Flooding, Natural Disasters, Rescue Operations Between 17th May and 22nd June Poland faced one of the most catastrophic natural disasters in past 100 years history. The overall area of 779300 sq km. has been flooded. The flood affected several large municipalities. Nearly 270.000 people suffered the direct effects of the flood and 31000 were evacuated from their homes, 22 people were killed. Total number of 19000 buildings were destroyed or seriously damaged. Responding services were mainly the Fire and Rescue Service, Police, EMS, Military Units as well as supporting NGO's. The rescue and relief operation focused on evacuation, providing temporary shelter, water supply, establishing medical treatment and vaccination, providing public security. One of the challenges was the threat of evacuation of the hospitals in the affected areas. The total number of 80000 of rescue personnel and 15000 of military was involved in the rescue operation. The medical emergency operation included helicopter and boat evacuation, organization of field medical posts and secondary medical transfers. 43 helicopters and 1.000 vehicles were used. One of the problem was the collapse of the telephone network that affected the 112 Emergency Dispatch System. The out coming conclusions presented the high vulnerability of local medical systems on the effects of flooding. However the logistic support of Fire and Rescue and Military recourses can give quick compensation. The role of HEMS and SAR helicopters in providing evacuation and medical assistance is essential. Special emphasis should be made on providing the coordination of multiservice response and replacing the affected local communication systems. The main conclusion after flooding was the need of stronger integration of civil and military services, procedures, communication systems and compatibility of the equipment.
The impact of natural disasters on individuals is substantial. Among the affected population in any disaster, children are identified as the most vulnerable group along with women, aged and disabled people. An estimated 77 million children under 15, on average, had their lives severely disrupted by a natural disaster or an armed conflict, each year, between 1991 and 2000 (Plan UK, 2003). Children are most affected since they loose the familiar environment, loss of parents, witness death of their loved ones, fear of reoccurrence of the disaster event. The impact of disaster on children of different age group is multiple times greater than that of the adults. This leads to various psychological problems in children (Dave et al., 2003). Disaster preparedness, through care givers, is one among the ways to reduce the distress of individuals followed by any disaster because it reduces the vulnerability factor that minimizes the impact of any disaster on the individual. A disaster preparedness program with special reference to psychosocial aspects was developed and implemented among the school children through teachers in Kanniyakumari District, Tamil Nadu, India, one of the severely affected areas in Tsunami. The current attempt was to standardize a disaster preparedness module focusing on preparing children to deal with their psychosocial issues before and after disaster in an effective manner. The outcome of disaster preparedness input through teachers and its reach out to the students was determined through an experimental research. The results reveal that the teachers and students from the experimental group gained significantly more knowledge on psychosocial disaster preparedness after implementation of the program in comparison to control group where the program was not implemented. The implications of the study points out the need to integrate psychosocial component of disaster preparedness in to the broader Community Based Disaster Preparedness (CBDP) programs.
The derailment accident occurred on 25 April 2005. 562 passengers were injured and 107 people died. Based on our periodic training in mass disaster triage, we accepted 113 wounded victims regardless of the severity of their condition. Initially, Simple Triage and Rapid Treatment was supposed to be performed by an emergency physician as a triage officer but START is not the most effective method for this case because patients of different severity levels were admitted to our hospital. Therefore, we performed triage by inspection and palpation based on our experience and intuition. Patient's facial color, breathing patterns, and trauma were processed for inspection. Furthermore, palpation was carried on without counting pulse and we diagnosed victims based upon strength of pulse and sensation of cold. From inspirational and sensuous diagnosis, the severity was determined. Comparing START with experiential and intuitive triage, differences between level of consciousness, the severity of trauma, and vital sign were examined. In addition, which components were necessary for primary survey was also reviewed.
Method
Severe or moderate, which were evaluated from ISS, vital sign, and Revised Trauma Score: RTS, Probability of survival: PS, were classified and then agreement rate, sensitivity, and specificity between START (S model) and triage (D model) were assessed. For START, data was extracted from clinical records.
Result
Agreement rate between the S model and the D model was 76.9%. Moreover, at the percentage of questions answered, the S model showed 84.2% and the D model showed 68.4%. Thus the experiment showed significant difference. 5 over triage cases appeared when the D model was operated. RTS, vital sign, and PS did not show great differences.
Conclusion
It could be difficult and insufficient to use START when a mass disaster occurs, however experiential and intuitive triage is also effective as START.
China is one of the countries most affected by natural disasters, it is an important restricting factor for economic and social development. However, Disaster Medicine training is not included in medical education curriculum in China, continual training is separated among public health professionals and clinical personals.
Methods
WHO provides technical and financial support for public health emergency preparedness through intensive training and workshop. We intended to develop a new working mechanism under the support of WHO and MOH, China for capacity building of disaster preparedness in China with the combination of public health professionals and clinical personals though TOT training.
Results
Through the new mechanism, public health professionals from CDC system and clinical personals from hospitals could benefice mutually fro each side and strengthen the effectiveness for the disaster preparedness.
Conclusion
The new mechanism increases the effectiveness of capacity building for disaster preparedness, TOT training should transit from national level to local level.
Agriculture emergency responders always will require equipment and supplies. A rapid and effective logistical response depends upon having the right item in the right quantity at the right time at the right place for the right price in the right condition to the right responder. Established in 2004 by U.S. Homeland Security Presidential Directive 9, the National Veterinary Stockpile (NVS) within the U.S. Department of Agriculture (USDA), Animal and Plant Health Inspection Service, Veterinary Services is the nation's repository of critical veterinary supplies, equipment, vaccines, and services appropriate to respond to the most damaging animal diseases affecting human health and the economy. An overview of the NVS program, its capabilities, training and exercise strategy, and outreach to stakeholders will be presented.
The NVS Program
The goals of the NVS program are to deploy countermeasures against the 17 most damaging animal disease threats within 24 hours, and to help states/tribes/territories plan, train, and exercise the receipt, processing, and distribution of NVS countermeasures. To meet these goals, the NVS program heavily relies upon science-based logistics to identify animal vaccines and other countermeasures to respond, and sound business processes to purchase, hold, maintain, and deploy the countermeasures. Significant resources also are dedicated to the NVS outreach activities, which interface directly with federal/state/tribe/territory animal health stakeholders. NVS team members work hand-in-hand with these leaders to help develop written NVS-specific plans for their jurisdictions, provide logistics training, and sponsor discussion-based and operations-based exercises in accordance with the Homeland Security Exercise and Evaluation Program.
Conclusion
The USDA NVS exists to provide states/tribes/territories the countermeasures they need to respond to catastrophic animal disease outbreaks created by either terrorists or nature. As logistical experts, the NVS team develops plans for logistical emergency response, manages their supply chain of countermeasures, and helps stakeholders improve logistical response capabilities.
Social media and social networks are integral components of our daily personal, professional, and community lives with Facebook, Friendster, and Twitter alone having > 750,000,000 registered users worldwide. All types of communication modalities are utilized in disasters for a variety of purposes. Experience with Exercise 24 and the Haiti Earthquake and public health response amplify both the power of social media and social networks and the need to research, understand, refine, and train in their utilization in disaster management. A Haiti Epidemic Advisory System was established to provide a mechanism for care providers to report health status in camps and treatment centers, exchange technical and logistical information, provide reach-back services such as GIS mapping and data shepherding, and provide a platform for emotional support. This information was incorporated into additional platforms including Haiti User Defined Operational Picture (UDOP) and Haiti Medical/Public Health Information Sharing Enterprise (MPHISE). Successes in the systems were seen in the early warning provided for cholera and social stress, the ability to link on-the-ground resources with local, national, and international assets, and the ability to inform policy makers through real-time reporting and advanced visualization. Many challenges were highlighted that deserve future study. These include: (1) how to manage the extreme volume of data flow including rating, ranking, filtering, and archiving; (2) how to effectively use social media and networks for response; (3) how to provide visualization in temporal and geospatial terms; and (4) how integrate social media with traditional media and official communications in an effective risk communication matrix.