Pharmaceutical services for public health emergencies, such as the Zika virus (ZIKV) epidemic, are relevant for service effectiveness in the Brazilian health system. Pharmacists can act strategically in risk reduction. However, official guidelines do not consider pharmaceutical services when approaching health emergencies.

To identify and understand primary healthcare pharmacist interventions in risk reduction for the recent ZIKV epidemic in Brazil.

The study took place in Campo Grande, Mato Grosso do Sul, in November 2017. A semi-structured questionnaire was developed, including general issues related to knowledge of Zika, risk communication, and the pharmacist's role in patient care for ZIKV disease. The instrument was pre-tested. Primary healthcare center (PHC) pharmacists were subsequently interviewed. Aspects related to knowledge, risk reduction measures, and role were categorized and analyzed. The project received approval from the Institutional Review Board (IRB) at the Sergio Arouca National School of Public Health.

Forty-two of the 48 PHC pharmacists in Campo Grande were interviewed. Risk reduction measures were cited by most interviewees. Among these strategies, 92% were collective measures, such as making information available for the population (30%) and for the health workers (8%), and vector control strategies (43%). Use of mosquito nets was the most cited individual risk-reduction strategy. Only one pharmacist cited risk for pregnant women and suggested birth control as a strategy. Another pharmacist pointed to ZIKV “treatment.” No interviewee mentioned measures related to preparedness of pharmaceutical services.

PHC pharmacists do not place themselves at the frontline of risk reduction for the ZIKV epidemic. In the face of potential hazards and consequences of this disease, action by pharmacists is deemed critical. This study highlights pharmacist's misconceptions and lack of focused knowledge, pointing to the need for training and capacity-building in order to increase quality of care and positive management of future epidemics.

The pharmacist’s role in disasters is just as important as in everyday practice. Lack of access to health care services and interruptions to continuity of medication care are the major concerns for chronic disease patients during disasters. Pharmacists’ responsibilities during crises is undefined and their skills and knowledge are underutilized.

To convene an expert panel to discuss the role of pharmacists in disasters and the specific roles they could be undertaking in a disaster, prioritizing the roles in order of importance.

There were 15 key opinion leaders identified as experts in their knowledge of pharmacists’ roles and the disaster health management field who agreed to participate in the three rounds of surveys. The first round provided the panelists with a list of 46 roles identified from previous research conducted and the literature. The panelists were asked to rank their opinion of pharmacist’s capability of undertaking each role on a 5-point Likert scale and consensus was set at 80%. There were three rounds of surveys with the final round presenting the results for the panel to provide qualitative comments on the results and roles. The roles were broken up into the four phases of disaster management – prevention, preparedness, response, and recovery (PPRR).

Out of the 46 roles provided to the panelists, consensus was reached on 43 roles with 80% of panelists being in agreement. The experts identified pharmacists had roles across the entire PPRR cycle. The roles included pharmacists being further integrated into disaster teams and managing low-acuity patients requiring chronic disease medications.

This Delphi study begins the process of defining roles for pharmacists in disasters. It can assist policymakers in providing changes to legislative frameworks to allow pharmacists to undertake the roles identified as being beneficial to a community in a disaster.

Every year, 71% of all deaths globally are due to NCDs. Over 85% of these deaths occur in low- and middle-income countries (LMICs), with 36% of all reported deaths in Rwanda attributed to NCDs. Approximately 24 million lives are lost each year in LMICs due to emergency medical conditions. The collaboration between VCU and the EMS Rwanda designed and implemented a pre-hospital medical emergencies training course and train-the-trainers program to address the rise of NCDs.

During the course, pre and post 50 assessment questions were administered. Two cohorts participated 25 prehospital staff identified by EMS to form an instructor core and 19 emergency staff from public hospitals who are likely to respond to local emergencies in the community. A two-day EMCC was developed using established best practices. The Instructor core completed EMCC 1 and a one-day educator course and then taught the second cohort (EMCC2). Student’s t-test and matched paired t-tests were used to evaluate the assessments.

Mean score on EMCC 1 was 43% (SD: 20) compared to 85% (SD: 5) on post-course assessment. Pre-assessment failure rate was 88%. Mean scores for EMCC 2 were 45% (SD: 14) and 81% (SD: 10) on post-assessment. Pre-assessment score was low (50%). A paired t-test comparing pre-course to post-course assessment means demonstrated an increase by 42% (SD 30) for EMCC 1 (p<0.001) and 37% (SD: 14) for EMCC 2 (p<0.001) with 95% confidence. No items had to be removed from analysis based on the discrimination index (di).

NCDs often present as emergencies such as myocardial infarction and stroke. Effective management of these in the prehospital setting is essential to optimal outcomes. This study effectively implemented a training program in Kigali, Rwanda and created an instructor core to allow scale-up of effective pre-hospital services across the country.

Process mining, a branch of data science, aims at deriving an understanding of process behaviors from data collected during executions of the process. In this study, we apply process mining techniques to examine retrieval and transport of road trauma patients in Queensland. Specifically, we use multiple datasets collected from ground and air ambulance, emergency department, and hospital admissions to investigate the various patient pathways and transport modalities from accident to definitive care.

The project aims to answer the question, “Are we providing the right level of care to patients?” We focus on (i) automatically discovering, from historical records, the different care and transport processes, and (ii) identifying and quantifying factors influencing deviance from standard processes, e.g. mechanisms of injury and geospatial (crash and trauma facility) considerations.

We adapted the Cross-Industry Standard Process for Data Mining methodology to Queensland Ambulance Service, Retrieval Services Queensland (aero-medical), and Queensland Health (emergency department and hospital admissions) data. Data linkage and “case” definition emerged as particular challenges. We developed detailed data models, conduct a data quality assessment, and preliminary process mining analyses.

Preliminary results only with full results are presented at the conference. A collection of process models, which revealed multiple transport pathways, were automatically discovered from pilot data. Conformance checking showed some variations from expected processing. Systematic analysis of data quality allowed us to distinguish between systemic and occasional quality issues, and anticipate and explain certain observable features in process mining analyses. Results will be validated with domain experts to ensure insights are accurate and actionable.

Preliminary analysis unearthed challenging data quality issues that impact the use of historical retrieval data for secondary analysis. The automatically discovered process models will facilitate comparison of actual behavior with existing guidelines.

Indonesia’s road traffic fatality rate stands at 15.3 per 100,000 people, compared to 17 in the Southeast Asia region. Traffic fatalities are predicted to increase by 50%, becoming the third leading contributor to the global burden of disease by 2020. Indonesian police reported that 575 people died and 2,742 road accidents occurred during Eid-al-Fitr 2015. The problem is increasing rapidly in Indonesia, particularly during Ramadan. Policy makers need to recognize this growing problem as a public health crisis to prevent mass casualty incidents.

To assess the health system preparedness with regard to road traffic accidents during 2017 Eid-al-Fitr homecoming in West Java, Central Java, East Java, and Lampung.

The project started with an interview and observation followed by stakeholder analysis to assess the level of preparedness. This qualitative and quantitative research was conducted one month prior to Eid-al-Fitr homecoming 2017. The instruments were evaluated for policy, organization, communication, procedure, contingency plan, logistics, facility and human resources, financing, monitoring, evaluation, coordination, and socialization.

The levels of preparedness were moderate (B) for West Java, East Java, and Lampung, but high (A) for Central Java. Levels of preparedness based on district health office indicators were high for coordination, but low for a contingency plan. Levels of preparedness based on hospitals and primary health care were high for logistics and human resources, but low for a contingency plan and financing.

The findings indicated a moderate level (B) of health sector preparedness. Benchmark information from this research will provide information for further training in contingency planning, particularly for the district health office.

Road traffic collisions (RTC) are the leading cause of preventable death among those aged 15–29 years worldwide. More than 1.2 million lives are lost each year on roads. Ninety percent of these deaths take place in low- and middle-income countries. The General Assembly of the United Nations (UN) proclaimed the period from 2011-2020 the “Decade of Action for Road Safety,” with the objective of stabilizing and reducing the number of deaths by 50% worldwide. In this context, the government of Colombia established the National Road Safety Plan (PNSV) for the period 2011–2021 with the objective of reducing the number of fatalities by 26%. However, the effectiveness of road safety policies in Colombia is still unknown.

To evaluate the effect of road safety laws on the incidence of RTC, deaths, and injuries in Colombia.

RTC data and fatality numbers for the time period of January 1, 2010, to December 31, 2017, were collated from official Colombian governmental publications and analyzed for reductions and trends related to the introduction of new road safety legislation.

Data analysis are expected to be completed by January 2019.

RTC remains the leading preventable cause of death in Colombia despite the PNSV. Data is being mined to determine the trends of these rates of crashes and fatalities, and their relation to the introduction of national traffic laws. Overall, while the absolute numbers of RTC and deaths have been increasing, the rate of RTC per 10,000 cars has been decreasing. This suggests that although the goals of the PNSV may not be realized, some of the laws emanating from it may be beneficial, but warrant further detailed analysis.

The swiftwater rescue (SWR) concept of operations (CONOPS) is to access as many victims as quickly as possible using strategies and tactics that maximize safety and minimize risk to all involved. “Reach, throw, row, go” has defined the primary water rescue strategy for 50+ years. However, this paradigm, originally designed for rescue from swimming pools, ponds and lakes, slow-moving rivers, and the ocean, is not conducive to SWR incidents involving submerged vehicles, which is the most common scenario during urban and small stream flash flooding.

To present a new SWR strategy for urban and small stream flood response.

Water rescue strategies and tactics were mapped against the SWR CONOPS to determine which ones are most likely to be successful in the rescue of victims trapped in submerged vehicles.

Rescue should be attempted via high water vehicles (HWVs) whenever possible, followed by watercraft and “go rescues” using advanced line systems techniques and/or tethered rescuers, dependent on incident characteristics. Positioning HWVs at the incident site permits rescuers to access victims quickly from the rear or sides of the vehicle, thereby reducing rescuer time in floodwaters. Multiple sequential rescues can be made since victims are held and medically monitored in the cargo area rather than transporting them to shore individually.

SWR from submerged vehicles is unique among emergency incidents because neither shelter-in-place nor self-evacuation are tenable options until the water recedes. "Reach" and "throw" rescue attempts are only possible if the victim is close to shore. Watercraft operations, whether motorized or manually pulled, can be technically complex, require numerous rescuers, and typically take 30-60 minutes per vehicle. Use of HWVs meets the CONOPS for SWR on flooded roadways since this strategy facilitates the rescue of multiple victims quickly while reducing the time rescuers spend in the water.

When disasters happen, people experience broad environmental, physical, and psychosocial effects that can last for years. Researchers continue to focus on the acute physical injuries and aspects of patient care without considering the person as a whole. People who experience disasters also experience acute injury, exacerbations of chronic disease, mental and physical health effects, effects on social determinants of health, disruption to usual preventative care, and local community ripple effects. Researchers tend to look at these aspects of care separately, yet an individual can experience them all at once. The focus needs to change to address all the healthcare needs of an individual, rather than the likely needs of groups. Mental and physical care should not be separated, nor the determinants of health. The person, not the population, should be at the center of care. Primary care, poorly integrated into disaster management, can provide that focus with a "business as usual" mindset. This requires comprehensive, holistic coordination of care for people and families in the context of their local community.

To examine how Family Doctors (FDs) actually contribute to disaster response.

Thirty-seven disaster-experienced FDs were interviewed about how they contributed to response and recovery when disasters struck their communities.

FDs reported being guided by the usual evidence-based care characteristics of primary practice. The majority provided holistic comprehensive medical care and did not feel they needed many extra clinical training or skills. However, they did wish to understand the systems of disaster management, where they fit in, and their link to the broader disaster response.

The contribution of FDs to healthcare systems brings strengths of preventative care, early intervention, and ongoing local surveillance by a central, coordinating, and trusted health professional. There is no reason to not include disaster management in primary care.

Disasters are part of the Australian landscape. Bushfires, floods, cyclones, and drought reoccurring consistently across the continent. Primary Health Networks (PHNs) and general practitioners (GPs) are scattered across Australia and are inevitably involved when disasters strike their local communities. Limited guidance exists to guide their systematic involvement within the broader disaster response system. In October 2013, large bushfires swept through the NSW Blue Mountains. The response was unusual in its inclusion of NSW general practice networks within the response system, most crucially the local (now) Nepean Blue Mountains Primary Health Network (NBMPHN).

The lessons learned by GPs and NBMPHN during the fires highlighted the need for GP preparedness to improve recovery outcomes. This led to the development of a living discussion document “Emergency management: the role of the GP,” created with input from the various GP groups. More recently, a PHN emergency preparedness guide aimed at strengthening communication and formalizing the role of the PHNs and GPs before, during, and after a natural disaster.

Clarity and implementation of a process for disaster preparedness have enabled a more proactive and coordinated approach to local emergency management with a distinct role for both the PHN and local GPs when responding to a natural disaster.

This presentation discusses lessons learned and the preparedness strategy now in place in the Nepean Blue Mountains PHN region, and launches the emergency preparedness guide that can be used and adapted by GPs and other PHNs across Australia.

The Canterbury Primary Response Group (CPRG) was formed to provide a community-wide approach to manage, coordinate, plan for, and respond to health emergencies in the prehospital setting. Original communications within the CPRG group and to the primary sector were via email and the use of other organizations’ websites. These means were not easy to access and update content, and the group was depending on third parties.

To outline the development of a primary health interactive website, provide up-to-date planning and event information, and provide information and support in relation to emergency planning for major emergency and non-emergency health events.

The advancements of technology and planning practices have given CPRG the ability to develop information, planning, and operational reporting systems.

CPRG has developed a web-based portal that is available to primary health care (including community pharmacy) to provide planning assistance and templates as well as information on current events, such as the influenza season. It includes access to the CPRG suite of emergency plans and is a document repository for the Emergency Operations Centre (EOC). A further development has been a response management system for use in the CPRG EOC to assess any health situation and status of providers to enable a continually up-to-date dashboard and situational awareness reports to be visible to those coordinating the response.

Communication is a major factor, often the most criticized, when managing any response. The development of the CPRG website and system as described can alleviate this and provide accurate and consistent event and planning advice to those in the primary health sector.

Post-disaster psychosocial support (PSS) is an indispensable element of disaster management. A variety of studies contributed to the development of guidelines, information about guideline implementation, and evidence-based practice, as well as the status of local PSS planning and delivery systems in different European regions. However, the multi-disciplinary nature of the organization of post-disaster PSS requires interprofessional and inter-organizational collaboration, but is presently insufficient institutionalized on individual, organizational, and governmental levels, locally, within the region, and nationally.

Objective of this research is to map the existing post-disaster PSS network in the Netherlands in the context of a terrorism scenario, and to identify probable collaboration problems rooted in weak ties and lack of alignment between actors at different levels.

Focus groups were organized in Belgium, France, Norway, and the United Kingdom to learn from the inter-agency response to recent terrorist attacks. Next, social network analysis methods were used to analyze the structure of the collaborative network for post-disaster PSS in the Netherlands. A scenario-based questionnaire was distributed amongst relevant stakeholders through snowballing methods. Respondents were asked to identify organizations they collaborate with on different PSS activities during the preparedness, acute, and recovery phase.

The international focus groups resulted in valuable lessons for the Dutch PSS network. Data collection for social network analysis is currently in progress. Based on previous research we expect limited ties between disciplines during the preparedness phase and during the “registration of affected persons” in the acute phase. Most of the interactions between agencies will be linked to one-stop-shop service delivery, and less to commemorations and health monitoring.

Lessons from the focus groups, verification of whether or not the expectations are supported by the social network data, and reflections on opportunities for improvement will be presented at the conference in Brisbane.

Survivors of mass casualty incidents are vulnerable to both physical and psychological injuries. Hospitals need to triage the walking wounded victims, their loved ones, and witnesses for symptoms of emotional distress to ensure that those who are traumatized benefit from proactive psychological treatment. Hospitals must also manage the influx of searching family and friends, and be able to reunite them with their loved ones, to reduce chaos and prevent hospital skipping.

To analyze previous research on institutional psychosocial disaster response, what has or has not worked, and lessons learned in order to develop evidence-based future planning suggestions.

A literature search was conducted on the following electronic databases: (Medline 2007 to July 2018), (Embase 2007 to July 2018), (PsycInfo 2007 to July 2018). A combination of subject headings and free text keywords were used to perform the searches. After removing duplicates, abstracts were screened independently by two reviewers for the following inclusion criteria: 1) crisis intervention (in a disaster situation), 2) mention of psychosocial response or lack thereof and lessons learned, 3)relevant outcomes, 4) OECD countries, and 5) journal articles published 2007–Present. Review articles were excluded. Primary and secondary reviewers are in the process of discussing discrepancies. Data extraction will be conducted from all articles that meet the inclusion criteria. Key themes to be analyzed include psychological casualties, searching family and friends, and family reunification plans.

The initial search yielded 6,267 results. 5,294 articles remained after duplicates were removed. Of the 4,890 reviewed thus far, 269 articles met inclusion criteria.

Although a wealth of existing literature notes the need for an effective psychosocial response in mass trauma and disaster situations, no prior study has analyzed the efficacy of such interventions or laid out an evidence-based plan. This study will fill this much-needed gap in the literature.

Psychosocial needs related to disaster are increasingly identified as a significant concern for both communities and responders. In response to the needs of travelers suddenly unable to leave Vancouver immediately after 9/11 in the United States, a network for the provision of volunteer mental health response at the time of a disaster was developed through the Provincial government within British Columbia (BC). Starting from less than 20 individuals primarily located within the Vancouver area, Disaster Psychosocial Services (DPS) now encompasses a network of over approximately 200 providers throughout the Province.

To showcase a successfully functioning DPS program modeled after a volunteer-based mental health network, the evolution undergone, its present operational framework, and future goals.

In response to the observed need for trained psychosocial intervention, we developed a framework for recruitment, education, deployment, and support of a volunteer network of mental health professional and paraprofessional providers.

This approach has been found to be effective, significantly increasing our volunteer base and opportunities for deployment.

This presentation will detail the grassroots development of BC’s DPS Program as well as the current model in practice. It will provide an overview of how BC’s DPS network of providers was stimulated and managed; issues related to volunteer management, including the selection of volunteers; methods of specialized training; and deployment. Multiple settings in which DPS is now utilized with increasing regularity will be described, including Emergency Operations Centers, Reception Centers, and Town Hall Meetings. Lastly, there will be a focus on the lessons learned, as well as future goals highlighting a focus on culturally-sensitive support, specifically with respect to British Columbia’s indigenous populations for building community resiliency and knowledge across the province.

Natural disasters confront individuals, communities, and governments with the challenge of rebuilding and addressing psychosocial sequelae. With the increasing number of natural disasters, it is pertinent to evaluate the efficacy of interventions and strategies to address the mental health needs of individuals and the community.

The presentation will highlight the effectiveness of interventions post-disaster, and continued adverse outcomes five years post-event.

An evaluation of literature related to the psychosocial impact of natural disasters, treatment efficacy, and government strategies to confront the social and psychological impact of natural disasters for the period 1983 – 2016 was undertaken.

Epidemiological studies following natural disasters, despite the use of differing psychological measures, demonstrate significant psychological morbidity – anxiety (7-42%), complicated grief (28-41%), depression (6.5-38%), post-traumatic stress disorder (11-89%), and substance misuse (1.3-24%). Intervention studies post-disaster demonstrate efficacy capability.

The increase in the number and impact of meteorological and hydrological events since the 1980s and the psychological, social, and economic consequences of these events have resulted in the development and implementation of government policies to confirm the immediate and long-term adverse outcomes. The focus is typically on resources and infrastructure redevelopment with less focus on social and mental health interventions, with long-term evaluation of interventions uncommon. The consequence of natural disasters emphasizes the importance of developing strategies to ensure effectively evaluated psychosocial interventions are available across at-risk communities.

In July 2013, a train transporting oil derailed and exploded in Lac-Mégantic, causing major human, environmental, and economic impacts. A community-based survey of people aged 10-25, conducted in 2017, revealed that many young people suffer in silence and report feeling isolated. These observations led to the conclusion that we must make room for young people, and that opportunities for engagement and participation must be provided within the community.

The Public Health Direction of Estrie aimed to identify strategies to promote health and wellbeing for young people living in and around Lac-Mégantic.

A collective reflection half-day was hosted with sixty key stakeholders (school board, other education institutions, health and social services, community sector, municipal/political sector, parents, youth). Throughout the event, participants were invited to build on and learn from accomplishments and experiential knowledge, and develop a common vision of the solutions to be pursued or implemented. All qualitative data sources (verbal and written data from large- and sub-group activities) were analyzed through a content analysis.

Several themes (i.e. potential solutions) emerged from the analysis: common venue, diversified activities, communication, collaboration, involvement, support for at-risk youth, intergenerational component, etc. Participants agreed on four priorities for action: 1) creating a gathering place, 2) establishing a Youth Committee, 3) supporting adults working with youth, and 4) fostering a better flow of information.

Several positive outcomes of the collective reflection half-day were observed, including the mobilization of the participants who greatly appreciated the event, and many promising ideas launched by stakeholders. A social worker is now fully dedicated to supporting youth wellbeing and engagement in Lac-Mégantic. A Youth Committee has been established and projects by and for youth are being implemented. Bottom-up approaches to identify solutions to complex situations are not only effective but also respectful of the local culture.

More than half of the world’s youth live in the Asia Pacific region, yet efforts to reduce disaster risk for adolescents are hindered by an absence of age-specific data on protection, health, and engagement.

China and Nepal have faced a recent escalation in the number of climatic and geological hazards affecting urban and rural communities. We aimed to examine disaster-related threats experienced by adolescents and their caregivers in China and Nepal, determine the scope for adolescent participation, and elicit recommendations for improving disaster risk reduction.

Sixty-nine adolescents (51% female, ages 13-19) and 72 adults (47% female, ages 22-66) participated in key informant interviews and focus group discussions in disaster-affected areas of southern China and Nepal. Using inductive content analysis, several themes were identified as key to adolescents’ needs.

Security and protection emerged as a central issue, interlinked with preparedness, timely and equitable disaster response, psychosocial support, and adolescent participation. The mental health risks emerging from trauma exposure were substantial. Adolescents made extensive contributions to disaster response including involvement in rescue efforts and delivering first aid, rebuilding homes and caring for family members. Participants forwarded a number of recommendations, including investing in psychological support, skills training, and stronger systems of protection for those at risk of family separation, trafficking, or removal from school.

The findings informed a multilevel, interconnected model for disaster risk reduction tailored to adolescents’ needs. Supporting adolescents’ recovery and long-term resilience after humanitarian crises will require coordinated efforts in preparedness, security, and mental health care.

The Western Pacific Region, comprised of 37 diverse countries and areas, is one of the world’s areas most prone to be affected by disaster. Seven of the top ten countries most at risk of a natural disaster are in this region. The Regional Agenda for Implementing the Mental Health Action Plan 2013-2020 in the Western Pacific identifies mental health in disasters and emergencies as a priority area and calls for a social movement for action on mental health and well-being. To increase understanding of and need for mental health and psychosocial support in emergency situations, regional guidelines are necessary. It is unclear to what degree international guidelines are applicable in this region.

To synthesize the contents of available evidence-based guidelines and assess their potential to address the mental health and psychosocial needs of people in emergency settings in the Western Pacific Region.

A systematic literature review of existing guidelines for mental health and psychosocial support in disasters and emergencies was conducted. Using the Appraisal of Guidelines for Research and Evaluation II instrument, the quality of each guideline was determined covering the following: (1.) scope and purpose, (2.) stakeholder involvement, (3.) rigor of development, (4.) clarity of presentation, (5.) applicability, and (6.) editorial independence.

The results provide an overview of the quality, number, and specificity of available guidelines. A framework was developed to categorize these guidelines on each stage of the disaster management cycle (prevention, preparedness, response, and recovery) while considering their guidance regarding coordination, monitoring, communication, human resources, and connection with regular health services.

The framework and its implications for further research and development are presented at the conference. We will specifically focus on the question, “What is needed to move from a reactive to a more proactive stance in policy and practice?”

On October 1, 2017, a gunman fired on a festival in Las Vegas, Nevada, killing 58 people and wounding over 500. Multiple casualties were received at two nearby hospitals that sponsor residency programs: Sunrise Hospital and Medical Center and University Medical Center.

To evaluate the impact of the most lethal mass-shooting event in US history on graduate medical education (GME) at the involved hospitals.

Anonymized surveys were sent to 210 physicians at SMC and 110 physicians at UMC. Surveys incorporated 4 validated instruments: The Post Traumatic Growth Inventory (PTGI), The Impact of Events Scale-Revised (IES-R), The Multidimensional Scale of Perceived Social Support (MSPSS), and The Team Cohesion Factor (TCF).

Sixty-six physicians completed the surveys (38 attendings; 17 residents). 10% of physicians scored in the likely posttraumatic stress disorder (PTSD) range and 15% found themselves avoiding or struggling with managing similar patients, though overall survey response rate was low. The majority of physicians did not believe the event impacted their specific GME activities. No attending physician rated the event as negative in terms of global impact on GME, and 34% rated it as positive. However, 12 of 17 residents rated the event as a hurdle in its GME impact. A regression model predicting the IES-R score demonstrated a trend that those with higher pre-event stress and lower social support reported more adverse impact (p<0.06).

We believe our study is the first to examine the impact of mass casualty traumatic events on graduate medical education. Attendings and residents differ in their global perception of the impact, with attendings viewing it as a positive event and residents as a challenge. Pre-event level of stress and perceived social support predicted the impact of the event and may partially explain these results if residents and attendings vary on these parameters.

Invasive mosquito species present significant organizational and health risks of covert disease outbreaks (dengue, Zika, or chikungunya) following an incursion into novel geographies. In Australia, detections at international First Points of Entry will trigger a multi-agency response to prevent escape into nearby urban environments that are largely unmonitored. Brisbane’s mosquito surveillance and response systems were challenged in 2017-2018 by the unprecedented frequency of detections in imported oversized tires that stretched the biosecurity response with escape opportunities.

Describe the unique challenges to Metro South Public Health Unit within a complex stakeholder environment represented by federal, state, and municipal agencies.

We present as a case study of an invasive mosquito detection that escalated to a public health incident of statewide significance through an incident management team structure. We focus on describing the significant governance and logistic challenges to the emergency mobilization of Metro South Health staff.

Since mid-December 2017 biosecurity have reported 12 detections of invasive mosquito species (Aedes aegypti, Ae. albopictus, Ae. japonicus) in infested tires arriving in Brisbane. Each emergency response was successful due to amendments to operational protocols and policy review. The legacy is a permanent enhancement of local mosquito monitoring, improved response systems, and greater operational preparedness.

The organizational impact of invasive mosquitoes is likely to be underestimated and under-resourced in jurisdictions beyond their expected distributions. Our experiences demonstrate the value of a clear and shared understanding of interagency emergency frameworks to effectively integrate each response. Resolution of uncertainties around organizational roles and responsibilities, and interpretations of guidelines, implementation strategies for mosquito surveillance, and control in novel contexts will require organizational agility and robust partnerships. Strategic re-focus is recommended to embed robust preventative measures and review of policy to mitigate the risk and impact of emergency responses to future invasive mosquito detections.

Canada, like many countries, increasingly faces environmental public health (EPH) disasters. Such disasters often require both short- and long-term responses, necessitate evacuation and relocation, cause major environmental impacts, and generate the need for specific knowledge and expertise (chemistry, epidemiology, risk assessment, mental health, etc.).

Given the importance of evidence-based, risk-informed decision making, we aimed to critically assess the integration of EPH expertise and research into each phase of disaster risk management in several Canadian and other jurisdictions.

In-depth interviews were conducted with 23 leaders in disaster risk management from Canada, United States, United Kingdom, and Australia, and were complemented by other methods (i.e. participant observation, information gathered from participation in scientific events, and document review). Three criteria were explored: governance, knowledge creation and translation, and related needs and barriers. An interview guide was developed based on a standardized toolkit from the World Health Organization. Data were analyzed through a four-step content analysis.

Six cross-cutting themes emerged from the analysis. These themes are identified as critical factors in successful disaster knowledge management: 1) blending the best of traditional and modern approaches, 2) fostering community engagement; 3) cultivating relationships, 4) investing in preparedness and recovery, 5) putting knowledge into practice, and 6) ensuring sufficient human and financial resources. A wide range of promising knowledge-to-action strategies was also identified, including mentorship programs, communities of practice, advisory groups, systematized learning, and comprehensive repositories of tools and resources.

There is no single roadmap to incorporate EPH knowledge and expertise into disaster risk management. Our findings suggest that beyond structures and plans, it is necessary to cultivate relationships and share responsibility for ensuring the safety, health, and wellbeing of affected communities while respecting the local culture, capacity, and autonomy. Any such considerations should be incorporated into disaster risk management planning.