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Public health emergency management involves the timely translation of relevant evidence and effective coordination of diverse actors. In practice, this can be challenging in the absence of a common framework for action among diverse actors.
To apply an Integrated Knowledge Translation (iKT) approach throughout the development of a conceptual framework and performance measurement indicators for public health emergency preparedness (PHEP), to ensure knowledge generated is relevant and useful to the field.
The iKT approach was initiated by identifying a research question based on priorities from the field. The two phases of the study used participatory research methods as well as active engagement with potential end users at key study milestones. The Structured Interview Matrix (SIM) facilitation technique for focus groups and an expert panel using Delphi methodology were used to define the PHEP framework and performance measurement indicators, respectively. An advisory committee was assembled consisting of potential end-users of the research, in senior positions in applied and decision-making roles.
iKT was an essential component for this applied public health project, contributing to and enhancing the relevance of the knowledge generated. iKT contributed to the following: broad national engagement and interest in the study, successful recruitment in both phases, and engagement with decision-makers. This multi-dimensional participatory approach successfully generated knowledge that was important to the field demonstrated by relevance to practice and policy in jurisdictions across Canada. Furthermore, the approach fostered building resilience in local and national communities through collaboration.
The iKT approach was essential to generating knowledge that is relevant and useful to the field, mainly to promote health system preparedness and resilience. Future research to study the implementation of knowledge will be important to continue addressing the knowledge-to-action gap in health emergency management research.
Policy-makers and practitioners have a need to assess community resilience in disasters. Prior efforts conflated resilience with community functioning, combined resistance and recovery (the components of resilience), and relied on a static model for what is inherently a dynamic process. We sought to develop linked conceptual and computational models of community functioning and resilience after a disaster.
We developed a system dynamics computational model that predicts community functioning after a disaster. The computational model outputted the time course of community functioning before, during, and after a disaster, which was used to calculate resistance, recovery, and resilience for all US counties.
The conceptual model explicitly separated resilience from community functioning and identified all key components for each, which were translated into a system dynamics computational model with connections and feedbacks. The components were represented by publicly available measures at the county level. Baseline community functioning, resistance, recovery, and resilience evidenced a range of values and geographic clustering, consistent with hypotheses based on the disaster literature.
The work is transparent, motivates ongoing refinements, and identifies areas for improved measurements. After validation, such a model can be used to identify effective investments to enhance community resilience. (Disaster Med Public Health Preparedness. 2018;12:127–137)
We outline a conceptual framework developed to meet the needs of public health professionals in the province of Ontario for incident management system-related education and training. By using visual models, this framework applies a public health lens to emergency management, introducing concepts relevant to public health and thereby shifting the focus of emergency preparedness from a strict “doctrine” to a more dynamic and flexible approach grounded in the traditional principles of incident management systems. These models provide a foundation for further exploration of the theoretical foundations for public health emergency preparedness in practice. (Disaster Med Public Health Preparedness. 2015;9:415–422)
The disciplines of paramedicine and emergency medicine have evolved synchronously over the past four decades, linked by emergency physicians with expertise in prehospital care. Ambulance offload delay (OD) is an inevitable consequence of emergency department overcrowding (EDOC) and compromises the care of the patient on the ambulance stretcher in the emergency department (ED), as well as paramedic emergency medical service response in the community. Efforts to define transfer of care from paramedics to ED staff with a view to reducing offload time have met with resistance from both sides with different agendas. These include the need to return paramedics to serve the community versus the lack of ED capacity to manage the patient. Innovative solutions to other system issues, such as rapid access to trauma teams, reducing door-to-needle time, and improving throughput in the ED to reduce EDOC, have been achieved by involving all stakeholders in an integrative thinking process. Only by addressing this issue in a similar integrative process will solutions to OD be realized.
Recent research indicates that cognitive reserve mitigates the clinical expression of neuropsychological impairment in multiple sclerosis (MS). This literature primarily uses premorbid intelligence and lifetime experiences as indicators. However, changes in current recreational activities may also contribute to the maintenance of neural function despite brain atrophy. We examined the moderation effects of current changes in recreational activity on the relationship between brain atrophy and information processing speed in 57 relapsing-remitting MS patients. Current enrichment was assessed using the Recreation and Pastimes subscale from the Sickness Impact Profile. In patients reporting current declines in recreational activities, brain atrophy was negatively associated with cognition, but there was no such association in participants reporting stable participation. The MRI metric-by-recreational activity interaction was significant in separate hierarchical regression analyses conducted using third ventricle width, neocortical volume, T2 lesion volume, and thalamic volume as brain measures. Results suggest that recreational activities protect against brain atrophy's detrimental influence on cognition. (JINS, 2013, 19, 1–6)
To define and delineate the nontechnical core competencies required for disaster response, Disaster Medical Assistance Team (DMAT) members were interviewed regarding their perspectives and experiences in disaster management. Also explored was the relationship between nontechnical competencies and interprofessional collaboration.
In-depth interviews were conducted with 10 Canadian DMAT members to explore how they viewed nontechnical core competencies and how their experiences influenced their perceptions toward interprofessonalism in disaster response. Data were examined using thematic analysis.
Nontechnical core competencies were categorized under austere skills, interpersonal skills, and cognitive skills. Research participants defined interprofessionalism and discussed the importance of specific nontechnical core competencies to interprofessional collaboration.
The findings of this study established a connection between nontechnical core competencies and interprofessional collaboration in DMAT activities. It also provided preliminary insights into the importance of context in developing an evidence base for competency training in disaster response and management. (Disaster Med Public Health Preparedness. 2013;0:1–8)
The presence of weeds during bermudagrass putting green establishment can reduce growth and turf quality. Three field experiments were conducted in Georgia to investigate efficacy of dimethenamid, S-metolachlor, and oxadiazon on the establishment of ‘TifEagle’ bermudagrass from sprigs. Dimethenamid at 0.85 and 1.7 kg ai ha−1, S-metolachlor at 1.1 and 2.2 kg ai ha−1, and oxadiazon at 1.1, 2.2, and 4.4 kg ai ha−1 did not reduce bermudagrass cover from the untreated after 8 wk. S-metolachlor at 4.4 kg ha−1 was the only treatment that reduced sprig cover from the untreated after 12 wk. All S-metolachlor and oxadiazon treatments provided excellent (≥ 90%) green kyllinga control by 8 wk after treatment (WAT) while dimethenamid at 0.85, 1.7, and 3.4 kg ha−1 provided 78, 85, and 92% control, respectively. Dimethenamid treatments provided poor control (< 70%) of spotted spurge but fair control (70 to 79%) was achieved from S-metolachlor at 4.4 kg ha−1 and oxadiazon at 2.2 and 4.4 kg ha−1 by 8 WAT. Overall, low to middle rates of the herbicides tested appear to temporarily inhibit TifEagle bermudagrass sprig establishment but high rates of dimethenamid and S-metolachlor may reduce cover from the untreated.
We sought to assess the knowledge of, use of and barriers to the use of personal protective equipment for airway management among emergency medical technicians (EMTs) during and since the 2003 Canadian outbreak of Severe Acute Respiratory Syndrome (SARS).
Using a cross-sectional survey, EMTs in Toronto, Ont., were surveyed 1 year after the SARS outbreak during mandatory training on the use of personal protective equipment in airway management during the outbreak and just before taking the survey. Practices that were addressed reflected government directives on the use of this equipment. Main outcome measures included the frequency of personal protective equipment use and, as applicable, why particular items were not always used.
The response rate was 67.3% (n = 230). During the SARS outbreak, an N95-type particulate respirator was reported to be always used by 91.5% of respondents. Conversely, 72.9% of the respondents reported that they never used the open face hood. Equipment availability and vision impairment were often cited as impediments to personal protective equipment use. In nonoutbreak conditions, only the antimicrobial airway filter was most often reported to be always used (52.0%), while other items were used at an intermediate frequency. The most common reason for not always donning equipment was that paramedics deemed it unnecessary for the situation.
Personal protective equipment is not consistently employed as per medical directives. Reasons given for nonuse included nonavailability, judgment of nonnecessity or technical difficulties. There are important public health implications of noncompliance.
Canada is moving forward quickly with plans to ensure that it is prepared to deal with emergencies. The National Framework for Health Emergency Management, released Nov. 26, 2004, recommends that a National Health Incident Management System (IMS) be developed. However, although most communities have successfully implemented IMS in the emergency services sector, many are still struggling with the integration of IMS into their health care systems. It is essential that all health care workers, regardless of profession or position, understand at least the basic concepts of emergency preparedness because of the wide variety of roles they may be asked to fulfill in an emergency situation. This article will review the basic concepts in emergency preparedness and management with a specific focus on IMS in health care.
Batch adsorption/dissolution experiments were conducted to examine the interactions between 233U(VI) and a synthetic aluminum oxyhydroxide (boehmite, γ-AlOOH) in 1.0M NaCl suspensions containing 1-hydroxyethane-1,1-diphosphonic acid (HEDPA). In the pH range 4 to 9, complexation of Al(III) by HEDPA significantly enhanced dissolution of boehmite. This phenomenon was especially pronounced in the neutral pH region where the solubility of aluminum, in the absence of complexants, is limited by the formation of sparsely soluble aluminum hydroxides. At high pH levels, dissolution of synthetic boehmite was inhibited by HEDPA, likely due to sorption of Al(III)/HEDPA complexes. Addition of HEDPA to equilibrated U(VI)-synthetic boehmite suspensions yielded an increase in the aqueous phase uranium concentration. The concentration of uranium continually increased over 59 days. Partitioning of uranium between the solid and aqueous phase was found to correlate well with HEDPA partitioning.
Emergency medical services (EMS) responses to
mass gatherings have been described frequently,
but there are few reports describing the response
to a single-day gathering of large magnitude.
This report describes the EMS response to the
largest single-day, ticketed concert held in North
America: the 2003 “Toronto Rocks!” Rolling Stones
Medical care was provided by paramedics,
physicians, and nurses. Care sites included
ambulances, medically equipped, all-terrain
vehicles, bicycle paramedic units, first-aid
tents, and a 124-bed medical facility that
included a field hospital and a rehydration unit.
Records from the first-aid tents, ambulances,
paramedic teams, and rehydration unit were
obtained. Data abstracted included patient
demographics, chief complaint, time of incident,
treatment, and disposition.
More than 450,000 people attended the concert and
1,870 sought medical care (42/10,000 attendees).
No record was kept for the 665 attendees simply
requesting water, sunscreen, or bandages. Of the
remaining 1,205 patients, the average of the ages
was 28 ±11 years, and 61% were female.
Seven-hundred, ninety-five patients (66%) were
cared for at one of the first-aid tents.
Physicians at the tents assisted in patient
management and disposition when crowds restricted
ambulance movement. Common complaints included
headache (321 patients; 27%), heat-related
complaints (148; 12%), nausea or vomiting (91;
7.6%), musculoskeletal complaints (83; 6.9%), and
breathing problems (79; 6.6%). Peak activity
occurred between 14:00 and 19:00 hours, when 102
patients per hour sought medical attention.
Twenty-four patients (0.5/10,000) were transferred
to off-site hospitals.
This report on the EMS response, outcomes, and
role of the physicians at a large single-day mass
gathering may assist EMS planners at future