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This report describes the response, action plan, and after-action changes adopted by the Louisiana State University New Orleans (LSU-NO)–Emergency Medicine (EM) Residency Program in response to Hurricane Ida, which occurred in New Orleans, Louisiana in late August through early September 2021. Summarized are the redistribution of emergency department (ED) residents within the primary clinical site, University Medical Center New Orleans (UMCNO); the daily communication flow from chief residents and program leadership; and discussions pertaining to procedural revisions instituted following investigation of pre- and post-hurricane operations.
Method:
Small-group debrief sessions and after-action reports were conducted post-storm to discuss perceived deficiencies from a resident stand-point. Debriefing occurred between chief residents and individual classes through standardized residency forums. Additionally, an after-action committee, comprised of senior residents, academic faculty, and ancillary personnel, convened a separate counsel with hospital administration-level leadership to analyze retrospective limitations that occurred both during, and immediately following, Code Grey activation.
Results:
Following data collection and analysis from the various feedback channels, several changes were made to the residency’s Code Grey activation plan going into the 2022-2023 academic residency year. The information obtained was used to develop a more formalized Code Grey process, and to create more robust orientation and education materials for residents.
Conclusion:
Throughout the events of Hurricane Ida, the LSU-NO Emergency Medicine Department at University Medical Center New Orleans managed a substantial intensification in daily emergency medical activity, while contending with a near-immediate reduction in available resources. Consequently, our program has formalized a more durable residency response to future disasters, including real-time, evolving evacuation correspondence and modernized protocols for rapid re-distribution of resident-power. These procedures are now distributed and practiced throughout each residency year and reinforced on an ad hoc basis in advance of any major weather-related events predicted to impact the greater New Orleans metropolitan area.
The 'all hazards' approach that the Sendai Framework on Disaster Risk Reduction calls for ‘to strengthen technical and scientific capacity to capitalize on and consolidate existing knowledge and to develop and apply methodologies and models to assess disaster risks, vulnerabilities and exposure to all hazards;’ (paragraph 24 j)’ needed clarification.
Method:
Following extensive scientific consultation, the United Nations Office for Disaster Risk Reduction (UNDRR) and the International Science Council (ISC) published in 2020 the UNDRR/ISC Hazard definition and classification review. This was followed by the UNDRR/ISC Hazard Information Profiles: Supplement to UNDRR-ISC Hazard Definition & Classification Review–Technical Report (2021). This Supplement consists of a description of each of the 302 hazard information profiles (HIPs), which was developed using a consultative process by scientists and experts across the globe.
Results:
The UNDRR/ISC Hazard Information Profiles (HIPs) provide a common set of hazard definitions and other information relevant to informing the strategies and actions of governments and stakeholders, and for managing the risks associated with hazards. They can be used whenever and wherever for assessment, planning, and action related to hazards. As such, they relate to the design, implementation, and monitoring of disaster risk reduction and risk-informed investments at all levels.
Conclusion:
The science-based structure of the HIPs serves to avoid confusion and duplication in the classification of hazards. It also promotes up-to-date information derived from the ‘data revolution, rigorous accountability mechanisms and renewed global partnerships’. The HIPs support the implementation of not only the Sendai Framework for Disaster Risk Reduction 2015-2030, but also the Sustainable Development Goals of Agenda 2030, the Paris Agreement and International Health Regulations (2005). In 2022 an International Science Council Policy Brief was published describing the use of UNDRR/ISC HIPs to manage risk and implement the Sendai framework for disaster risk reduction.
Major Incidents and Disasters are often associated with early, extensive and prolonged media reporting. It is important to understand the interaction between first responders/rescue services and the media to create better conditions for providing and making available correct and objective information to as many people as possible.
Method:
A systematic literature review and content analysis was made on all Swedish KAMEDO reports (emergency medicine observations published by the National Board of Health and Welfare) from the last twenty years, in total 39 reports. KAMEDO’s primary task is to feedback experience data (lessons learned) from disasters worldwide, through expert observers at the site of an emergency event. The aim of this study was to evaluate and analyze the experiences made regarding the interaction between media and healthcare in connection with major incidents and disasters, both on site and in hospitals.
Results:
The analysis resulted in the following main themes:
(1) Communication problems and other challenges in Major Incidents and Disasters
No protection and restrictions
Information craving and news hunt
Interviews as intervention
(2) Recommendations for efficient interaction between healthcare and the media:
Strategies from alert to action
Satisfying information needs
Clarity measures on site
Key actors of importance
Proactive media alertness
Conclusion:
Some conclusions regarding lessons learned about interaction between healthcare and the media, as well as about communication with the afflicted and citizens, in brief: The hospital management should take control of the communication through efficient communication strategies. An accommodating approach to the media's presence can facilitate the dissemination of the necessary early, correct and balanced information. Joint authority press conferences are a model tested and positively evaluated. Healthcare communicators are key actors in hospital crisis communication and media management. Healthcare and media both benefit from developing routines and reciprocal respect for proactive and efficient interaction in emergencies.
Weather significantly affects the distribution of fallout radiation resulting from a nuclear detonation. Prior nuclear detonation models have either utilized a “typical” day for the city of interest or have chosen conditions that optimize fallout radiation. However, models that aid emergency planners should utilize representative weather conditions to capture the most likely distribution of fallout radiation for the region of interest.
Method:
Fallout radiation resulting from an improvised nuclear device detonation in Atlanta, Georgia, USA was simulated for each day in 2019 using the Hazard Prediction and Assessment Capability (HPAC) software and weather from Modern-Era Retrospective analysis for Research and Applications, Version 2 (MERRA-2). A partition around medoids cluster analysis was conducted, based on the characteristics of the plumes, population at risk, and estimated proportion of fatalities. A multinomial logistic regression, a decision tree, and a random forest model were then used to predict the cluster from surface-level weather data.
Results:
On average, the fallout plume was 160.25km long, had an area of 3,174.44 km2, and was angled 83.5° from due north. The plume on average contained 3,668,173 individuals at risk for exposure and caused 416,8908 casualties. Four clusters were identified to represent the distribution of fallout radiation. The random forest model was best able to predict the cluster using surface-level weather data, with an average accuracy of 57.24% (kappa = 0.385). The variable importance plot suggests north-westerly winds, cloud coverage at detonation, whether it is summer, and average temperature are among the most important variables for classification.
Conclusion:
Meaningful representation of the variation in the distribution of fallout radiation is imperative while creating nuclear detonation models. While an analysis of the fallout distribution throughout a calendar year provides important insight, future research may examine longer study periods to better understand the climatological impacts on fallout radiation.
The constraints of performing prehospital decontamination in mass casualty incidents involving the release of chemical agents at disaster sites in modern cities are notable. Compounding this are highly built-up urban areas with significantly high population density and traffic congestion. This places the burden of performing such decontamination on nearby healthcare facilities. Based on this need, public hospitals in Singapore have been equipped with decontamination facilities. We present a review of the utilization of this facility at our institution.
Method:
A retrospective review of the utilization of the hospital decontamination station (HDS) was carried out, noting its frequency, purpose, and outcomes.
Results:
Since its construction, the HDS has been deployed successfully many times a year for both routine training and disaster preparedness exercises. Despite the lockdown measures due to Covid-19, with concomitant reduction in social and economic activity, the HDS was activated five times for decontamination of chemical contaminated casualties. It is fortunate that, although HDS training activities were curtailed during this period, emergency department (ED) staff were still able to function effectively using prior experience, donning chemical protective suits, and performing decontamination. The semi-automated HDS facilitated rapid deployment which contributed to ease of use of this resource for timely decontamination of casualties with good outcomes.
Conclusion:
Chemical incidents resulting in contaminated casualties are uncommon events. Nonetheless hospitals must be prepared to deal with this situation in a timely manner. The rapidly deployable HDS has become an important resource and an operationally ready solution for dealing with chemical contaminated casualties presenting at short notice to the ED. Regular training and deployment exercises utilizing the HDS provide staff familiarity critical to overall readiness for chemical incidents. This strategy provides a reliable countermeasure in an all-hazards approach to disaster preparedness at the hospital.
Heatwaves are the leading weather-related causes of deaths globally. Since the mid 20th century, the frequency and intensity of heatwaves has increased with recent reports projecting a substantial warming in temperature extremes by the end of the 21st century.
Method:
In this cross-sectional study, we attempted to assess public perception and knowledge on heatwaves. Data was collected across Pakistan among a sample of people aged 18 years and above using an online survey questionnaire. Health Belief Model (HBM) constructs were used to assess risk perception using a total of 14 statements while knowledge was measured using 12 statements. The Unadjusted Odd Ratio (UOR) and Adjusted Odd Ratio (AOR) of 95% Confidence Intervals (CI) were employed through binary logistic regression. A total of twelve variables were included in the model (11 categorical and 1 continuous).
Results:
Out of the 686 participants, the majority of the people (57.73) showed high heatwaves risk perception and a high level of heatwave knowledge (59.91). The results of the multivariate regression model (AOR) showed that participants within the Secondary and/or higher Secondary (Grade 9th to Grade 12th) were less likely (OR=0.304) perceiving heatwaves risk compared to the reference group (Basic/Elementary Level i.e., (Grade 1st to Grade 8th)). As the number of participants who lives with others and who heard about heatwaves increases, the participants are more likely to perceive high heatwaves risk. For instance, participants who lives with others and have heard about heatwaves perceived heatwaves risk 1.982 and 1.816 times higher respectively than those who live alone and those who have not heard about heatwaves before.
Conclusion:
HBM can be useful in designing interventions aimed at increasing people’s adaptive behaviors during heat waves. This study provides useful insights to the policymakers across Pakistan in understanding the public’s perception that can lead to informed decision-making.
The COVID-19 pandemic hit Kentucky in March of 2020. While around the world the pandemic had already reared its head and strained international hospital systems at their core, Kentucky hospitals remained wholly underprepared. University of Kentucky Hospital is a relatively resource rich hospital. However, utilization of these resources was severely misplaced and inefficiently distributed. This led to unnecessarily large upfront costs in an attempt to prepare for large volumes of patients that never actually came, as well as risk stratifying patients in a costly and unproductive way.
Method:
We reviewed the initial response to the COVID-19 pandemic from the University of Kentucky as well as specifically within the emergency department. This included all system-wide preparations as well as emergency medicine-specific COVID-19 protocols regarding risk stratification of patients, testing, and delivering results.
Results:
Initially the number of patients that would need to be hospitalized with COVID-19 as well as how to risk stratify or treat them was completely unknown. This led to multiple large issues within University of Kentucky's response to the pandemic. A 400-bed field hospital was constructed out of University of Kentucky’s football field and subsequently deconstructed two months later before ever being used, costing the hospital $6.7 million dollars. Lack of tests and knowledge about the disease in combination with over ordering labs and CT scans in an attempt to risk stratify. There was no reliable way to obtain COVID-19 testing or deliver the results and this led to increased non-sick patients presenting to the ED just for information.
Conclusion:
The COVID-19 pandemic highlighted many shortcomings of our hospital system and its preparedness for a pandemic or mass disaster. The silver lining of these failures was the implementation of system wide improvements in throughput and preparation within our emergency department.
Post Katrina Louisiana’s Health Department (LDH) used some of the Hospital Preparedness Program (HPP) funding to create a regional Emergency Medical Services liaison position entitled EMS Designated Regional Coordinators (EMS DRC). Regional EMS DRCs work with local pre-hospital agencies, hospital coalitions, and local/state/federal counterparts during the preparedness and response phases of a disaster. This presentation explores the EMS DRCs role during the 2020/2021 COVID pandemic and annual hurricane season.
Method:
The EMS DRCs were activated at the beginning of the COVID-19 pandemic. EMS agencies across the country were struggling to meet the call volume demand while balancing sick employees. The eleven LA Region 1 EMS agencies reached out to the EMS DRC for assistance. The EMS DRC coordinated with the LA State Health Department to provide surge ambulances to any ambulance agency in need. These units were utilized for COVID response, but once hurricane season hit in both 2020 and 2021 Surge ambulances were quickly transitioned to COVID and Hurricane response.
Results:
During the initial COVID outbreak, 18 state surge ambulances were divided amongst four agencies. In 2020 Louisiana saw six named storms, one of which caused significant damage. After Hurricane Laura hit in 2020 the EMS DRCs managed 80 Federal surge ambulances stationed across 41 non-congruent hotel shelters. The 2021 COVID response brought another 21 Federal Surge ambulances to the region. Once Hurricane Ida hit that year over 60 surge ambulances got reassigned to six regional EMS agencies for COVID and Hurricane response.
Conclusion:
The COVID-19 pandemic and subsequent hurricane devastation exposed gaps in EMS response capabilities to response. The EMS DRCs play a significant role in providing continuous care through working relationships with local, state and federal partners
The SARS-CoV-2 virus 2019 (COVID-19) has consumed many available resources within contingency plans, necessitating new capacity surges and novel approaches. This study aimed to explore the possibility of implementing the Flexible Surge Capacity concept in relieving hospitals by focusing on the community resources to develop “Home Isolation Centers” in Bangkok, Thailand.
Method:
This is a qualitative study consisting of observational and semi-structured interview data. The development and activities of Home Isolation Centers were observed, and interviews were conducted with leaders and operational workforces. Data were deductively analyzed and categorized based on the practical elements necessary in disaster and emergency management.
Results:
The obtained data could be categorized into the seven collaborative elements of the major incident medical management and support model. The command-and-control category demonstrated four subcategories: 1) coordination and collaboration, 2) staff engagement, 3) responsibility clarification, and 4) sustainability. Safety presented two subcategories: 1) patients’ information privacy and treatment, and 2) personnel safety and privacy. Communication showed internal and external communications subcategories. Assessment, triage, treatment, and transport followed the processes of the COVID-19 treatment protocols according to the World Health Organization guidelines and hospital operations. Several supplies and patient-related challenges were identified and managed during center development.
Conclusion:
The use of community resources, based on the flexible surge capacity concept, was feasible under restricted circumstances and enabled the relief of hospitals during the pandemic. Continuous education among multidisciplinary volunteer teams facilitated their full participation and engagement. The concept of flexible surge capacity may promote an alternative community-based care opportunity, irrespective of the emergencies’ etiology.
As disasters increase globally in both frequency and intensity, the vulnerability of children during disasters has become obvious. Pediatricians are often left to manage the resulting physical and mental repercussions. With minimal to no disaster medicine training offered at most U.S. pediatric residencies, the need for an easily accessible pediatric disaster medicine curriculum has been exacerbated. While this need has been highlighted in the literature, material to include or methods to sustainably incorporate disaster medicine into training programs has not been established.
Method:
From a thorough literature review, 19 topics were selected as potentially necessary to include in a disaster medicine curriculum for pediatric residents. Utilizing the Delphi method, subject matter experts were asked to rank these topics with an option to add others. Two independent surveys separated by time were administered with the goal of identifying ten critical core concepts for pediatric resident disaster medicine education. A virtual roundtable discussion then took place to finalize the ten core concepts, discuss objectives, and consider realistic methods of incorporating the curriculum into the residency timeline.
Results:
The ten core concepts identified were 1) introduction to disaster medicine, 2) patient triage, 3) surge capability, 4) mental health effects of a disaster, 5) preparedness for children with special healthcare needs, 6) communicating personal/family disaster preparedness, 7) hospital disaster mitigation, 8) reunification, 9) drills and training, and 10) disaster ethics and crisis standards of care.
Experts agreed upon a longitudinal multi-modal approach with inclusion of short didactics, case scenarios, questions/answers, games, and links to further educational activities and opportunities focused on individualized needs.
Conclusion:
The Delphi method was a successful approach to gathering expert consensus to establish core concepts for a pediatric resident disaster medicine curriculum.
There is a clear need for research evidence to drive policymaking and emergency responses so lives are saved and resources are not wasted. The need for evidence support for health and humanitarian crisis is pertinent because of the time and practical constraints that decision makers in these settings face. To improve the use of research evidence in policy and practice, it is important to provide evidence resources tailored to the target audience. This study aims to gain real-world insights from decision makers about how they use evidence summaries to inform real-time decision making in crisis settings, and to use the findings to improve the format of evidence summaries.
Method:
This study used an explanatory sequential mixed method study design. First, a survey was used to identify the views and experiences of those who were directly involved in crisis response in different contexts, and who may or may not have used evidence summaries. Second, the insights generated from the survey helped inform qualitative interviews with decision makers in crisis-settings to derive an in-depth understanding of how they use evidence summaries and their desired format for evidence summaries.
Results:
Twenty-six decision-makers working in health and humanitarian emergencies were interviewed. The study identified challenges decision makers face when trying to find and use research evidence in crises, including insufficient time and increased burden of responsibilities during crises. Decision makers preferred the following components in evidence summaries: title, target audience, presentation of key findings in an actionable checklist, implementation considerations, and assessment of the quality of evidence presented. The study developed an evidence summary template with accompanying training material to inform real-time decision making in crisis settings.
Conclusion:
The study provided a deeper understanding of the preferences of decision-makers working in health and humanitarian emergencies regarding the format of evidence summaries to enable real-time evidence-informed decision-making.
Japan is geographically prone to natural disasters such as earthquakes, volcanoes, and tsunamis, economically advanced, and socially characterized as a super-aged society. The SDGs are a concrete strategy to achieve a society where no one is left behind. So what exactly can we do to protect the vulnerable populace? This presentation will introduce the system of cooperation and implementation of medical, health, and welfare disaster relief in Japan.
Method:
Government documents were received on developing national policies regarding the strategy for the unification of medical, health, and welfare. For implementation, the status of support teams specializing in disaster welfare and training status was reviewed.
Results:
National policy level achievements: The Ministry of Health, Labor and Welfare (MHLW) issued a "Notification on Enhancing and Strengthening the Medical System in Times of Disaster" in 2012 and conducted a critical review of the initial response to the Kumamoto earthquake in 2016 in the "Initial Response Verification Report." This process reaffirmed the need to support vulnerable populations such as the disabled, children, and the elderly. In 2021, the Disaster Welfare Assistance Team was added to the Basic Plan for Disaster Management and the MHLW Disaster Management Work Plan.
Implementation level Achievement: As of 2022, 24 of the 47 prefectures have a DWAT in place. Gunma, Kyoto, and Miyazaki prefectures were the most advanced, with 1) ongoing meetings to strengthen cooperation with medical and health care teams, 2) participation in joint drills, and 3) DWAT awareness-raising activities through training for municipal administrative staff.
Conclusion:
While this review revealed that the national government had made progress in developing policies, the implementation revealed that some prefectures have not yet established DWATs.
In March 2022, Team Rubicon deployed an EMT Type 1 mobile team to provide medical care for internally displaced people in Ukraine. Regional medical facilities and universities identified a need for training programs to prepare for the expected increase in wartime casualties.
Method:
Deployed medical teams researched and compiled initial course content. Presentations were prepared and conducted with the assistance of Ukrainian translators. The curriculum was expanded to include whole blood transfusion and point of care ultrasound. After the prioritization of needs by the MOH, Team Rubicon deployed a seven-member team to conduct training in 16 cities over two months. They provided instruction in whole blood transfusion, hemorrhage control, blast injuries, prehospital triage, shock management, point of care ultrasound, and treatment of chemical exposures. Surveys were conducted pre- and post-training to assess the usefulness of the training provided.
Results:
In two months, a total of 1549 unique individuals were trained. The participants included 769 physicians, 244 nurses, 299 paramedics, 83 hospital administrators, and 154 additional professionals. They included 614 males and 935 females. The number of participants in each course included: 477 for hemorrhage control, 564 for treatment of chemical exposures, 483 for blast injury and field trauma, 412 for pre-hospital and triage training, 135 for point-of-care ultrasound, and 154 for whole blood transfusion.
Conclusion:
With the assistance of the Ukrainian Ministry of Health, an NGO was able to conduct 64 sessions training 1549 individuals. This experience demonstrates the ability to create a robust educational platform to fulfill the medical needs of a community affected by warfare.
Sub-Saharan Africa (SSA) has become a hotspot for global terrorism, with nearly 50% of global terror-related deaths occurring in SSA in 2021. To address growing terrorism-related health implications the field of counter-terrorism medicine (CTM) seeks to study the impacts of terrorism and implement healthcare initiatives. This study is a semi-quantitative analysis of terrorist-related activity in SSA from 1970-2020.
Method:
A retrospective analysis of the Global Terrorism Database (GTD) was performed for the region of SSA between 1970-2020. The number of attacks, deaths, and injuries, as well as primary weapons types, country where attacks occurred, and primary target types, were collated into a Microsoft Excel™ spreadsheet (Microsoft, Redmond Washington, USA) and analyzed.
Results:
A total of 19,320 attacks were recorded, resulting in 77,565 deaths and 52,986 injuries. Nigeria had the greatest number of attacks. Firearms were the most frequent weapons used, followed by explosives, unknown, and incendiary, with all others making up the remainder. Private citizens and property were the most frequently targeted entities, followed by general government facilities, police, business, military, diplomatic government facilities, and religious figures/institutions, with all other targets making up the remainder.
Conclusion:
The majority of deaths from terrorism in SSA are the result of firearm attacks. Nigeria had the largest number of attacks and the highest number of killed and wounded. Private citizens and property are the most frequently targeted. Terrorism poses unique challenges to governments, populations, healthcare systems, and aid organizations. By understanding the impact and scope of terrorist activity in SSA, Counter-Terrorism Medicine (CTM) initiatives can be employed to improve healthcare outcomes.
Coastal area cities Jakarta and Semarang in Indonesia portray higher hazard that links to an annual sinking rate of up to 20cm. Four main factors have been determined to contribute: groundwater extraction, sea-level rise (SLR), land subsidence, and coastal floods. It accounts for people living in those high-risk regions to prevent the exacerbating situation.
Method:
This study’s main objective is to generate risk mapping in Jakarta and Semarang using Geographic Information System (GIS) from three open-source websites: Surging Seas, OpenStreetMap (OSM), and Healthsites.io. Through GIS analysis, prediction can be analyzed more accurately with precision when the sinking hits slowly to identify the risks involved.
Results:
Satellite data geographical analysis risk mapping done via Surging Seas, OpenStreetMap (OSM), and Healthsites.io showed that by 2050, North, West, part of Central Jakarta and Semarang will sink 5.6 meters below sea level with an annual sinking rate up to 20cm. Critical infrastructure will be affected in Jakarta, including Soekarno-Hatta International Airport and Tanjung Priok Port. Similarly, in Semarang, the Jenderal Ahmad Yani International Airport, Tanjung Mas Port, and Terboyo Bus Station are affected as well. Consequently, it will situate 13 million at both coastal cities as the worst impacted, categorized by the World Bank data, updated Sept 2022 as Urban Poverty, the population living at 2.15 US Dollar a day poverty line. Those living below the poverty line are also deprived of education and access to infrastructure, mainly electricity, water and sanitation hygiene indicators measured by the World Bank 2021 and 2022, Multidimensional Poverty Measure.
Conclusion:
As a conclusion, GIS mapping of Jakarta and Semarang by 2050 using Surging Seas, OpenStreetMap, and Healthsites.io showed a high risk of sinking, especially in the northern areas of both cities, with the mapping done as of April 2022.
The US Federal Emergency Management Agency (FEMA) has created a publicly available National Risk Index (NRI) using natural disaster and community risk factor data to provide numeric and visual representations of communities’ disaster risk. Of particular interest is the index’s use of the social vulnerability and community resilience variables. This study’s purpose was to identify and explore differences in vulnerability and resilience based on racial demographic data at the census tract level. By identifying communities at the highest risk, we can address modifiable risk factors to improve natural disaster outcomes for vulnerable populations.
Method:
This project used merged data from the US Census Bureau’s 2019 American Community Survey and source data for the FEMA NRI. Using Microsoft Excel, we created scatter plots of the social vulnerability and community resilience variables by census tract and predominant racial group, and calculated the mean, standard deviation, and statistical difference between those variables by race.
Results:
In census tracts where Native Americans made up ≥50% of the population:
1) There was a positive linear association between percent of Native Americans and increased social vulnerability.
2) The average social vulnerability score (ASV) was significantly higher (ASV = 55.74) than for predominantly White tracts (ASV = 31.43) (p < 0.001).
3) The average risk score (ARS) was significantly higher (ARS = 30.18) compared to predominantly White tracts (ARS = 16.98) (p < 0.001).
4) The average resilience index score (ARIS) was significantly lower (ARIS = 51.83) than predominantly White tracts (ARIS = 55.08) (p < 0.001).
Conclusion:
Results show that census tracts with predominantly Native American populations face significantly higher natural disaster risk and social vulnerability, and have significantly lower resilience scores compared to predominantly White tracts. Using modifiable factors to improve community resilience and decrease social vulnerability, the US can better protect communities at high natural disaster risk.
Considering the need for hospital disaster preparedness post-Nepal earthquake 2015, the Ministry of Health and Population of Nepal developed a Hospital Disaster Preparedness and Response Plan (HDPRP) for mass casualty management. However, until now, there is no scientific literature on how the district hospitals, which are the major health service providers in Nepal, implemented their HDPRP during mass casualty incidents (MCIs). So, this study aims to understand how the HDPRP was implemented during MCIs in three district public hospitals of Nepal.
Method:
A mixed sequential QUANT-QUAL study was designed. Out of seven districts under the severely hit category by Nepal Earthquake 2015, three districts were selected randomly. For the quantitative component, the WHO hospital emergency response checklist was adapted which was self-administered in each hospital. Based on a scoring system, each hospital was placed in one of three categories (effective, insufficient, unacceptable), to assess the level of HDPRP implementation. For the qualitative component, semi-structured interviews were conducted to understand how the HDPRP was implemented in each hospital. An inductive thematic analysis was carried out. All information was collected for the most recent management of MCI reported in the hospital.
Results:
Out of three hospitals, two hospitals have effectively implemented their HDPRP, whereas one has insufficient implementation. Three themes emerged during the data analysis: enablers in implementation of HDPRP, barriers in implementation of HDPRP, and recommendations for the future. Multiple enablers and barriers were identified for the implementation of HDPRP, and the recommendations were identified for the hospital, hospital staff, and external stakeholders.
Conclusion:
Implementation of HDPRP as per the protocol is difficult due to many external and internal factors that arise while managing the MCIs. The findings of this study provide the basis for the Ministry of Health and Population and district hospitals for the future update of HDPRP and planning of MCIs.
In 2022, the Harvard/Beth Israel Deaconess Disaster Medicine Fellowship conducted a full-scale exercise (FSX) with the dual mission of 1) training Disaster Medicine Fellows (DMFs) in exercise design, planning, and execution, and 2) expanding local first responder experience with pediatric casualties in a mixed-method terrorist attack.
Method:
Project PUNCH (Preparedness for Uncertain and Novel Chemical Hazards) was planned in two stages. A tabletop exercise in the form of a facilitated discussion was conducted in March 2022 with stakeholders from Fire, Emergency Medical Services (EMS), and the Massachusetts HazMat Team. A FSX simulating a combined blast and chemical attack on a family gathering was held in June 2022 at Anna Maria College in Paxton, MA.
Results:
Fire, EMS, HazMat, LifeFlight, local Police, MA State Police, a local Medical Reserve Corps, and over 40 volunteer victims including 16 pediatric volunteers participated in the FSX. The FSX was a two-hour exercise with a simulated explosion and a secondary drone-deployed dummy-opioid aerosol release. This was the first FSX for the Paxton Region since the coronavirus pandemic began. Planning was conducted by the DMFs between January and June 2022 with the aid of Fellowship faculty and local stakeholders following Homeland Security Exercise and Evaluation Program guidelines. Local and Fellowship leadership with Pediatric expertise were engaged to plan pediatric specific considerations, precautions and safety measures. COVID precaution guidelines were followed. These efforts are detailed in the forthcoming field report. Educational guides for toxidromes and triage and resuscitation of pediatric victims were distributed to first responders.
Conclusion:
The end outcome was a FSX that trained DMFs in exercise design, planning, and execution, and increased experience of local first responders with the concepts of asymmetric terrorist attacks and comfort with pediatric disaster victims. Multi-agency disaster drills remain an important training tool for preparedness and response to mass casualty events.
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.
In a disaster, the number of victims and severity of injuries may overwhelm the treatment capacity of the local hospital. Surge capacity is the hospital’s ability to receive and treat an increased number of patients. This study aimed to explore if a past disaster or mass casualty incident (MCI) affects local hospital surge capacity preparedness.
Method:
The current hospital preparedness plans (HPPs) of University and central hospitals receiving surgical emergency patients in Finland were collected (n=28). The HPPs were read and analyzed using the World Health Organization (WHO) hospital emergency checklist tool with eight key components and 67 action items. The scores of key components were compared by percentage of the maximum score. The surge capacity score was compared between the hospitals that had been exposed to a disaster or MCI with those who had not. The effective level was considered as 70% of total points.
Results:
The overall median score of all key components was 76% (range 24%). The highest score was in command and control (median 93%, range 29%) and the lowest in post-disaster preparedness (median 50%, range 90%). The median surge capacity score was 65% (range 39%). There has been 12 disasters or MCIs during the past 25 years in Finland, all anthropogenic. There was no statistical difference between the surge capacity score of the hospitals with a history of a disaster or MCI compared to those without (65% for both, p=0.735).
Conclusion:
In Finland, the overall hospital preparedness level is effective with command and control being the best covered area. Surge capacity preparedness was below the effective level and it was not affected by a past disaster or MCI. Present-day challenges with the lack of resources in the health care system, more attention should be drawn to the surge capacity aspect in hospital preparedness plans.