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Disasters, armed conflicts, and disease outbreaks often overwhelm normal corpse-handling capacities, highlighting the importance of mass fatality management in emergency preparedness and response. This paper examines principles, practices, and challenges of ensuring dignified corpse management after catastrophic events leading to sudden mass fatalities. It draws insights from Nepal’s experience with the 2015 earthquakes, as well as other recent disasters worldwide. The discussion reveals planning and policy gaps that undermine the dignity of the deceased and prolong trauma for survivors. Recommendations are provided for improving global preparedness to accord proper respect to the dead amid immense tragedy. As climate change escalates disasters, all vulnerable nations must enhance their capacities for systematic and empathetic mass fatality management. Even when protocols exist, overwhelmed systems lead to a breakdown in practical implementations, violating cultural norms. By building robust preparedness through strategic plans, training, infrastructure, and international cooperation, we can preserve humanity even amidst utter inhumanity.
Drawing on pedagogical tools utilized in clinical scenario simulation and emergency preparedness training, the authors describe an innovative method for teaching clinical ethics consultation skills, which they call a “tabletop” exercise. Implemented at the end of a clinical ethics intensive course, the tabletop enables learners to implement the knowledge and practice the skills they gained during the course. The authors highlight the pedagogical tools on which the tabletop exercise draws, describe the tabletop exercise itself, offer how to best operationalize such an exercise, reflect on the method’s strengths and weaknesses, and provide insights for others who may want to implement their own tabletop for ethics consultation education.
Italy often experiences major events, such as earthquakes, floods, and migrant shipwrecks. Current and future global challenges for health workers are made up by climate change, pandemics, and wars. In this work, we will assess the state-of-art of training and interest towards these challenges among Italian post-degree public health schools.
Methods
A cross-sectional survey was conducted in Italy in June 2023 among Italian public health residents. The study investigated training levels and updates regarding emergencies in Italian residencies. It also analyzed interest and importance of topic, impact of the COVID-19 pandemic, and sources of information.
Results
Of 289 respondents, 86.2% deemed the topic important and 74.4% expressed interest. 90.1% pointed out the lack of dedicated courses and 93.1% of specialized master’s programs. Perceived importance in the topic was associated with the desire to attend dedicated conferences. As for COVID-19, 24.6% recognized the importance of this topic pre-pandemic, while 50.9% raised awareness during the pandemic.
Conclusions
This survey shows the need for the offer of emergency training programs in Italian public health schools. Professionals in public health can make a great contribution to emergencies, not only in preparedness, but also in response and recovery phases.
Continuing laboratory research into zoonotic diseases is necessary for public health preparedness. However, the COVID-19 pandemic has elevated existing concerns about the risks BSL-4 research facilities can pose to the surrounding community. This study places such concerns in the context of previous research regarding the construction of biosafety labs, as well as policy discussions related to other scientific controversies like gain of function research. Building on this prior knowledge as well as established theories in the field of communication, we propose using a Culture-Centered Approach paired with a Communication Complex approach to facilitate more meaningful and effective communication between researchers and community members, particularly those who tend to be marginalized in such conversations. The commentary concludes by outlining a risk assessment process using the CCA-Communication Complex Approach.
Surge capacity—the ability to acquire additional workers and resources during unexpected increases in service demand—is often perceived as a luxury. However, the COVID-19 pandemic necessitated an urgent expansion of surge capacity within health systems globally. Health systems in Bangladesh, Nepal, and Sri Lanka managed to scale up their capacities despite severely limited budgets. This study employs a mixed-methods approach, integrating qualitative interviews with quantitative data analysis, to propose a comprehensive framework for understanding Human Resources for Health (HRH) surge capacity from 2018 to 2021, termed ARRAS: Anticipate, Recruit, Retain, Adapt, Sustain. We present national-level data to demonstrate how each country was able to maintain their per capita health care workforce during the crisis. Interviews with key informants from each country reinforce the ARRAS framework. Quantitative data revealed ongoing increases in doctors and nurses pre- and post-pandemic, but no country could rapidly expand its health workforce during the crisis. Qualitative findings highlighted critical strategies such as pre-crisis planning, financial incentives, telemedicine, and re-skilling the workforce. Despite adaptive measures, challenges included inadequate funding, poor data systems, and coordination issues. This study underscores the necessity for robust, long-term strategies to enhance surge capacity and better prepare health systems for future crises.
Response to the coronavirus disease (COVID-19) pandemic revealed gaps in medical supply quality and personnel training and familiarity in San Francisco County, prompting the reexamination of county disaster supply caches and emergency medical services (EMS) system decompression protocols. Project RESPOND (Rapid Emergency Supplies for Prehospital Operations in Disaster) was developed to bridge the gap in patient care infrastructure during short- or no-warning disasters and enhance EMS system offloading by introducing a novel capacity for the safe treatment and discharge of patients with minor injuries from the scene of an event. This design, while scaled to the needs of a unique metropolitan population, can be used as a template for the reimagining of disaster response policy and development of disaster supply caches.
There is significant public health interest towards providing medical care at mass-gathering events. Furthermore, mass gatherings have the potential to have a detrimental impact on the availability of already-limited municipal Emergency Medical Services (EMS) resources. This study presents a cross-sectional descriptive analysis to report broad trends regarding patients who were transported from National Collegiate Athletic Association (NCAA) Division 1 collegiate football games at a major public university in order to better inform emergency preparedness and resource planning for mass gatherings.
Methods:
Patient care reports (PCRs) from ambulance transports originating from varsity collegiate football games at the University of Minnesota across six years were examined. Pertinent information was abstracted from each PCR.
Results:
Across the six years of data, there were a total of 73 patient transports originating from NCAA collegiate football games: 45.2% (n = 33) were male, and the median age was 22 years. Alcohol-related chief complaints were involved in 50.7% (n = 37) of transports. In total, 31.5% of patients had an initial Glasgow Coma Scale (GCS) of less than 15. The majority (65.8%; n = 48; 0.11 per 10,000 attendees) were transported by Basic Life Support (BLS) ambulances. The remaining patients (34.2%; n = 25; 0.06 per 10,000 attendees) were transported by Advanced Life Support (ALS) ambulances and were more likely to be older, have abnormal vital signs, and have a lower GCS.
Conclusions:
This analysis of ambulance transports from NCAA Division 1 collegiate football games emphasizes the prevalence of alcohol-related chief complaints, but also underscores the likelihood of more life-threatening conditions at mass gatherings. These results and additional research will help inform emergency preparedness at mass-gathering events.
To determine factors predicting emergency preparedness (EP) behaviors among Hawaii parents.
Methods:
A cross-sectional online survey of parents of children (age 0-12 y) living in Honolulu, Hawaii, in March 2023 examined associations with (1) having an EP kit (supplies for use during emergencies) and (2) having a family emergency plan (what to do, where to go, how to communicate during emergencies) with demographics/household characteristics and theoretical constructs of the Health Belief Model. A multivariable regression model obtained odds ratios and 95% confidence intervals.
Results:
Participants (N = 278) were mainly female (84%), college-educated (68%), and were similar in diverse racial/ethnic composure (White; 13.3%) to the overall Honolulu County. Logistic regression determined participants with lower perceived susceptibility to disasters, greater time barriers, and those who needed help to prepare for emergencies were less likely to have an EP kit. Among participants without an EP kit, a website able to create personalized instructions for household EP would be useful. Participants who needed help to prepare for emergencies were less likely to have a family emergency plan.
Conclusions:
Future interventions should focus on evidence-based strategies that improve self-efficacy associated with developing EP kits and family emergency plans.
This study was conducted to reveal the relationship between nursing students’ disaster response self-efficacy and their disaster preparedness perceptions.
Methods:
This cross-sectional study was conducted on nursing students after a major earthquake that occurred in Turkey on February 6, 2023 (n = 302). Data collection took place from June 2023 to October 2023, using the Disaster Response Self-Efficacy Scale (DRSES) and Disaster Preparedness Perception Scale (DPPS). Descriptive statistics, independent samples t-test, correlation, and multiple linear regression analysis were used to analyze the data.
Results:
Nursing students’ DRSES mean score was 63.35 ± 10.83 (moderate level) and DPPS mean score was 3.41 ± 0.50 (high level). A positive and moderate correlation was found between nursing students’ DRSES and DPPS scores (r = 0.515; P = 0.000). Predictors affecting nursing students’ disaster preparedness are disaster response self-efficacy score, being male, and making a family disaster plan.
Conclusions:
The results of this study highlight the importance of increasing the disaster response self-efficacy needed by nursing students to successfully assist patients in disaster situations.
Current escalation of natural disasters, pandemics, and humanitarian crises underscores the pressing need for inclusion of disaster medicine in medical education frameworks. Conventional medical training often lacks adequate focus on the complexities and unique challenges inherent in such emergencies. This discourse advocates for the integration of disaster medicine into medical curricula, highlighting the imperative to prepare health-care professionals for an effective response in challenging environments. These competencies encompass understanding mass casualty management, ethical decision-making amidst resource constraints, and adapting health-care practices to varied emergency contexts. Therefore, we posit that equipping medical students with these specialized skills and knowledge is vital for health-care delivery in the face of global health emergencies.
Edited by
William J. Brady, University of Virginia,Mark R. Sochor, University of Virginia,Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida,John C. Maino II, Michigan International Speedway, Brooklyn,K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
The mass casualty incident marks the ultimate challenge for emergency services at a mass gathering event. This chapter provides a thorough review of the unique challenges associated with the occurrence of a mass casualty incident in a mass gathering setting and summarizes a comprehensive, flexible framework to manage this specific scenario. In particular, we provide a detailed summary of the evidence and recommendations associated with the prevention, preparedness, response, and recovery efforts related to mass casualty incident management at a mass gathering event. Our discussion of prevention focuses on proper risk assessment practices and a recommended set of effective measures that can be used to promote crowd management within the mass gathering setting. Our section on disaster preparedness highlights the critical initial step to identify and engage all stakeholders associated with the mass gathering event and the particular disaster scenarios identified in the event’s risk assessment profile, as well as key measures to establish clear disaster plans and promote organized command and communication. Finally, specific recommendations are provided for efficient disaster response through the initial and longer-term phases, as well as for the recovery process that includes effective community support and psychological first aid for affected parties.
Edited by
William J. Brady, University of Virginia,Mark R. Sochor, University of Virginia,Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida,John C. Maino II, Michigan International Speedway, Brooklyn,K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
Providing medical care during a mass event requires important situational awareness and preparation. Significant planning and relationship building provides a foundation for creating an operational outline, and establishing crowd dynamics and expectations for related medical activities. Collaboration with stakeholders will provide insight into the operations of various other event management entities, and allows for more seamless operations during the event. Once an operational plan has been established and circulated, the event medical team can be prepared for the expected external and crowd conditions and respond appropriately, while maintaining vigilance for any emergency that may arise. Contingency planning is key for the medical team to have appropriate emergency response defaults. Special attention is also needed on communications strategies for real-time intel, information dissemination, and crowd management. Once the event reaches its end, it is important to establish stand-down procedures to be followed as the crowd disperses to ensure an orderly event closure. After action reports can provide valuable insights for future crowd management.
Escalating global challenges (such as disasters, conflict, and climate change) underline the importance of addressing Chemical, Biological, Radiological, and Nuclear (CBRN) terrorism for sustainable public health strategies. This study aims to provide a comprehensive epidemiological analysis of CBRN incidents in the Middle East and North Africa (MENA) region, emphasizing the necessity of sustainable responses to safeguard healthcare infrastructures.
Method:
Utilizing a retrospective approach, this research analyzes data from the Global Terrorism Database (GTD) covering the period from 2003 to 2020. The study focuses on examining the frequency, characteristics, and consequences of CBRN incidents in the MENA region to identify patterns and trends that pose significant challenges to public health systems.
Results:
The analysis revealed a significant clustering of CBRN incidents in Iraq and Syria, with a predominant involvement of chemical agents. These findings indicate the extensive impact of CBRN terrorism on healthcare infrastructures, highlighting the challenges in providing immediate health responses and the necessity for long-term recovery strategies.
Conclusions:
The study underscores the need for improved healthcare preparedness, robust emergency response systems, and the development of sustainable public health policies. Advocating for international collaboration, the research contributes to the strategic adaptation of healthcare systems to mitigate the impacts of CBRN terrorism, ensuring preparedness for future incidents in the MENA region and beyond.
Future pandemics may cause more severe respiratory illness in younger age groups than COVID-19, requiring many more mechanical ventilators. This publication synthesizes the experiences of diverse contributors to Medtronic’s mechanical ventilator supply chain during the pandemic, serving as a record of what worked and what didn’t, while identifying key factors affecting production ramp-up in this healthcare crisis.
Method:
In-depth, one-on-one interviews (n = 17) were held with key Medtronic personnel and suppliers. Template analysis was used, and interview content was analyzed for signals, initiatives, actions, and outcomes, as well as influencing forces.
Results:
Key findings revealed many factors limiting ventilator production ramp-up. Supply chain strengths and weaknesses were identified. Political factors played a role in allocating ventilators and also supported production. Commercial considerations were not priority, but economic awareness was essential to support suppliers. Workers were motivated and flexible. Component shortages, space, production processes, and logistics were challenges. Legally based pressures were reported e.g., import and export restrictions.
Conclusion:
Crisis response alone is not enough; preparation is essential. Coordinated international strategies are more effective than individual country responses. Supply chain resilience based on visibility and flexibility is key. This research can help public health planners and the medical device industry prepare for future healthcare crises.
This work aimed to demonstrate that a website, www.epidemic-em.org, encompassing “static” resources, and videos, as well as other tools, can be used to strengthen public health emergency management capacity during epidemic response.
Methods:
Existing resources were updated and developed for self-directed Emergency Operations Centers’ capacity strengthening, in order to encompass current best practices, and to emphasize how public health emergency management concepts can support epidemic response activities. These materials formed the core of the website, launched in June 2020, to which country case studies were added. In 2021, a pilot virtual training program was designed using recorded video lectures and interviews with global experts in addition to the website material, which was delivered to South African responders.
Results:
The website has been accessed in more than 135 countries, demonstrating widespread reach and interest in online and freely accessible materials to support public health emergency operations. Over 30 people participated in the pilot virtual training, and the evaluation showed improvement in knowledge, confidence in using emergency management concepts for epidemic response, and positive feedback on the virtual modality.
Conclusions:
Online tools can expand access to materials and resources for public health emergency management capacity strengthening. Virtual modalities can further serve as a powerful complement, and perhaps replacement, for traditional in-person technical assistance, despite some limitations.
Community-based medication therapy management advanced pharmacy practice experiences (MTM APPE) can engage pharmacy students in public health initiatives, including emergency response preparedness, to successfully impact patient care. This study aimed to evaluate pharmacy students’ perceptions of their experience on an MTM APPE during disasters in Puerto Rico.
Methods:
After completing the MTM APPE during times of hurricanes, earthquake or pandemic, pharmacy students were asked to voluntarily participate in a questionnaire about their perception of assisting during a disaster. The survey consisted of 5 questions. Four questions were based on a Likert scale with answers choices ranging from Agree, Not Sure, Disagree, or Not Applicable. One question requested free text comments from participants.
Results:
Sixteen students completed the survey. Pharmacy students agreed that the MTM APPE taught them the clinical skills needed to assist and educate individual patients and the community that suffered from a disaster, and that the role of the pharmacist is vital when a disaster disrupts a community’s health-care system.
Conclusions:
Training in emergency response to disasters should be a considered component of MTM APPE.
Edited by
Richard Williams, University of South Wales,Verity Kemp, Independent Health Emergency Planning Consultant,Keith Porter, University of Birmingham,Tim Healing, Worshipful Society of Apothecaries of London,John Drury, University of Sussex
This chapter considers the components and organisation of civil protection. The first part of the chapter includes key definitions of terms. The second part defines and examines civil protection. The third part provides a critical review of the basis of emergency planning, and the fourth part looks at various aspects of emergency preparedness. Emergency planning is based on reference events from the past and, in the fifth part of the chapter, the key question of whether the past really is still an adequate guide to the future is addressed. The final part of the chapter looks at the growing field of risk and disaster science.