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Genetic and paleontological evidence are combining to provide a new and surprising picture of mammalian biogeography in southeastern Alaska. Prior to our study, the brown and black bears of the Alexander Archipelago were considered postglacial immigrants that never had overlapping ranges. Vertebrate fossils from caves on Prince of Wales Island now demonstrate that brown and black bears coexisted there (and even inhabited the same caves) both before and after the last glaciation. Differences in mtDNA sequences suggest that living brown bears of the Alexander Archipelago comprise a distinct clade and are more closely related to polar bears than to their mainland conspecifics. We conclude that brown bears, and perhaps other large mammals, have continuously inhabited the archipelago for at least 40,000 yr and that habitable refugia were therefore available throughout the last glaciation.
While information for the medical aspects of disaster surge is increasingly available, there is little guidance for health care facilities on how to manage the psychological aspects of large-scale disasters that might involve a surge of psychological casualties. In addition, no models are available to guide the development of training curricula to address these needs. This article describes 2 conceptual frameworks to guide hospitals and clinics in managing such consequences. One framework was developed to understand the antecedents of psychological effects or “psychological triggers” (restricted movement, limited resources, limited information, trauma exposure, and perceived personal or family risk) that cause the emotional, behavioral, and cognitive reactions following large-scale disasters. Another framework, adapted from the Donabedian quality of care model, was developed to guide appropriate disaster response by health care facilities in addressing the consequences of reactions to psychological triggers. This framework specifies structural components (internal organizational structure and chain of command, resources and infrastructure, and knowledge and skills) that should be in place before an event to minimize consequences. The framework also specifies process components (coordination with external organizations, risk assessment and monitoring, psychological support, and communication and information sharing) to support evidence-informed interventions.
(Disaster Med Public Health Preparedness. 2011;5:73-80)
Although information is available to guide hospitals and clinics on the medical aspects of disaster surge, there is little guidance on how to manage the expected surge of persons needing psychological assessment and response after a catastrophic event. This neglected area of disaster medicine is addressed by presenting a novel and practical quality improvement tool for hospitals and clinics to use in planning for and responding to the psychological consequences of catastrophic events that create a surge of psychological casualties presenting for health care. Industrial quality improvement processes, already widely adopted in the healthcare sector, translate well when applied to disaster medicine and public health preparedness. This paper describes the development of the tool, presents data on facility preparedness from 31 hospitals and clinics in Los Angeles County, and discusses how the tool can be used as a benchmark for targeting improvement. The tool can serve to increase facility awareness of which components of disaster preparedness and response must be addressed through hospitals' and clinics' existing quality improvement programs. It also can provide information for periodic assessment and evaluation of progress over time.
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