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The coronavirus disease 2019 (COVID-19) pandemic dramatically accelerated a growing trend toward online and asynchronous education and professional training, including in the disaster medicine and public health sector. This study analyzed the impact of the COVID-19 pandemic on the growth of the TRAIN Learning Network (TRAIN) for the year 2020 and evaluated pandemic-related changes in use patterns by disaster and public health professionals.
The TRAIN database was queried to determine the change in the number of registered users, total courses completed, and courses completed related to COVID-19 during 2020.
In 2020, a total of 755,222 new users joined the platform – nearly 3 times the average added annually over the preceding 5 y (2015-2019). TRAIN users completed 3,259,074 training courses in 2020, more than double the average number of training courses that were completed annually from 2015-2019. In addition, 17.8% of all newly added disaster and public health training courses in 2020 were specifically related to COVID-19.
Online education provided by TRAIN is a critical tool for just-in-time disaster health training following a disaster event or public health emergency, including in a global health crisis such as a pandemic.
The aim of this study was to investigate the performance of key hospital units associated with emergency care of both routine emergency and pandemic (COVID-19) patients under capacity enhancing strategies.
This investigation was conducted using whole-hospital, resource-constrained, patient-based, stochastic, discrete-event, simulation models of a generic 200-bed urban U.S. tertiary hospital serving routine emergency and COVID-19 patients. Systematically designed numerical experiments were conducted to provide generalizable insights into how hospital functionality may be affected by the care of COVID-19 pandemic patients along specially designated care paths, under changing pandemic situations, from getting ready to turning all of its resources to pandemic care.
Several insights are presented. For example, each day of reduction in average ICU length of stay increases intensive care unit patient throughput by up to 24% for high COVID-19 daily patient arrival levels. The potential of 5 specific interventions and 2 critical shifts in care strategies to significantly increase hospital capacity is also described.
These estimates enable hospitals to repurpose space, modify operations, implement crisis standards of care, collaborate with other health care facilities, or request external support, thereby increasing the likelihood that arriving patients will find an open staffed bed when 1 is needed.
The national response to the coronavirus disease 2019 (COVID-19) pandemic has highlighted critical weaknesses in domestic health care and public health emergency preparedness, despite nearly 2 decades of federal funding for multiple programs designed to encourage cross-cutting collaboration in emergency response. Health-care coalitions (HCCs), which are funded through the Hospital Preparedness Program, were first piloted in 2007 and have been continuously funded nationwide since 2012 to support broad collaborations across public health, emergency management, emergency medical services, and the emergency response arms of the health-care system within a geographical area. This commentary provides a SWOT (strengths, weaknesses, opportunities, and threats) analysis to summarize the strengths, weaknesses, opportunities, and threats related to the current HCC model against the backdrop of COVID-19. We close with concrete recommendations for better leveraging the HCC model for improved health-care system readiness. These include better evaluating the role of HCCs and their members (including the responsibility of the HCC to better communicate and align with other sectors), reconsidering the existing framework for HCC administration, increasing incentives for meaningful community participation in HCC preparedness, and supporting next-generation development of health-care preparedness systems for future pandemics.
The Centers for Disease Control and Prevention developed 15 National Public Health Emergency and Preparedness Response Capabilities (NPHPRCs) to serve as national standards for health-related core capabilities. The objective of this study is to determine the level of federal funding allocated for research related to NPHPRCs during 2008–2017.
An online search of http://www.USAspending.gov was performed to identify federal awards, grants, contracts from 2008–2017 related to research associated with NPHPRCs. Inclusion criteria were identifiable as research and disaster-related; US-based; and specific reference to any of the NPHPRCs. A panel of 3 experts reviewed each entry for inclusion.
The search identified 15 278 transactions representing US $29.2 billion in awards. After exclusions, 93 entries were found to be related to NPHPRCs, averaging US $2 783 136 annually. Funding notably dropped to US $168 684 in 2010 and ceased entirely in 2016. Ten (67%) of NPHPRCs received funding. Eighty-percent of funding focused on 4 capabilities. Three federal agencies funded 80% of research. Sixteen (24%) of the 47 recipients received 80% of all funding.
US federal investments in research and development related to NPHPRCs have been highly variable over the past decade. One-third of NPHPRCs receive no funding. There are notable gaps in funding, content, continuity, and scope of participation.
Disaster-related research funding in the United States has not been described. This study characterizes Federal funding for disaster-related research for 5 professional disciplines: medicine, public health, social science, engineering, emergency management.
An online key word search was performed using the website, www.USAspending.gov, to identify federal awards, grants, and contracts during 2011–2016. A panel of experts then reviewed each entry for inclusion.
The search identified 9145 entries, of which 262 (3%) met inclusion criteria. Over 6 years, the Federal Government awarded US $69 325 130 for all disaster-related research. Total funding levels quadrupled in the first 3 years and then halved in the last 3 years. Half of the funding was for engineering, 3 times higher than social sciences and emergency management and 5 times higher than public health and medicine. Ten (11%) institutions received 52% of all funding. The search returned entries for only 12 of the 35 pre-identified disaster-related capabilities; 6 of 12 capabilities appear to have received no funding for at least 2 years.
US federal funding for disaster-related research is limited and highly variable during 2011–2016. There are no clear reasons for apportionment. There appears to be an absence of prioritization. There does not appear to be a strategy for alignment of research with national disaster policies.
Interventions to reduce disability from acute orthopedic injuries require a primary assessment of knowledge and need. There are no previous studies to assess this need in the remote provincial islands of the Philippines, an area recurrently affected by natural disaster.
A preliminary assessment of orthopedic knowledge and need was performed to be expanded for regional or national implementation.
Two independent surveys were conducted of households and mid-level providers who represent the first contact of care. The goal of the survey was to describe the local health care system, to identify barriers to care, and to assess gaps in knowledge for acute traumatic orthopedic injuries. Both surveys were conducted in June of 2015.
Population proportional sampling assessed a total of 100 households from 25 local Barangay communities. Questions focused on existing knowledge of acute traumatic orthopedic injuries and barriers to care.
The mid-level provider survey focused on knowledge and barriers to care regarding acute traumatic orthopedic injuries. A total of 10 school nurses and Barangay midwives representing 25 local Barangay were surveyed.
In the household population survey, 84% of respondents reported cost was either always or sometimes a barrier to care; 73% cited transportation as a barrier to care. A total of 68% of respondents reported that they would seek care at the provincial hospital for a suspected broken bone; 28% percent of respondents did not believe broken bones making an arm or leg crooked could be corrected without surgery. Only 55% percent believed care should be sought within six hours of injury, and 37% stated that more than three days after an injury was an appropriate timeframe to seek care.
Of the mid-level providers surveyed, 90% reported that they would refer possible broken bones to a higher level of care. Aggregate ranking of barriers to care from greatest to least were: cost, transportation, knowledge of time sensitive nature of treatment, religious beliefs, and other (not specified). In all, 100% reported that an education initiative regarding acute orthopedic injuries would increase the number of patients seeking care within 12 hours.
The survey describes perceived barriers to care and gaps in knowledge for acute orthopedic injuries. With some modification, this survey tool could be expanded and utilized on a regional or national level to assess gaps in knowledge and barriers to acute orthopedic care.
CourtneyCS, KirschTD. Orthopedic Knowledge and Need in the Provincial Philippines: Pilot Study of a Population-Based Survey. Prehosp Disaster Med. 2018;33(3):293–298.
Health care coalitions play an increasingly important role in both preparedness for, response to, and recovery from large scale disaster events occurring across the United States. The actions taken by the South East Texas Regional Advisory Council (SETRAC) in response to the landfall of Hurricane Harvey, and the consequential flooding that ensued, serve as an excellent example of how health care coalitions are increasingly needed to play a unifying role in response. This paper highlights a number of the strategic planning, operational planning and response, information sharing, and resource coordination and management activities that were undertaken for the response to Hurricane Harvey. The successful response to this devastating storm in the Houston, Texas area serves as an example to other regions across the country as they work to implement the 2017-2022 health care capabilities articulated by the Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response. (Disaster Med Public Health Preparedness. 2017;11:637–639)
In an effort to enhance education, training, and learning in the disaster health community, the National Center for Disaster Medicine and Public Health (NCDMPH) gathered experts from around the nation in Bethesda, Maryland, on September 8, 2016, for the 2016 Disaster Health Education Symposium: Innovations for Tomorrow. This article summarizes key themes presented during the disaster health symposium including innovations in the following areas: training and education that saves lives, practice, teaching, sharing knowledge, and our communities. This summary article provides thematic content for those unable to attend. Please visit http://ncdmph.usuhs.edu/ for more information. (Disaster Med Public Health Preparedness. 2017;11:160–162)
Personal preparedness is a core activity but has been found to be frequently inadequate. Smart phone applications have many uses for the public, including preparedness. In 2012 the American Red Cross began releasing “disaster” apps for family preparedness and recovery. The Hurricane App was widely used during Hurricane Sandy in 2012.
Patterns of download of the application were analyzed by using a download tracking tool by the American Red Cross and Google Analytics. Specific variables included date, time, and location of individual downloads; number of page visits and views; and average time spent on pages.
As Hurricane Sandy approached in late October, daily downloads peaked at 152,258 on the day of landfall and by mid-November reached 697,585. Total page views began increasing on October 25 with over 4,000,000 page views during landfall compared to 3.7 million the first 3 weeks of October with a 43,980% increase in views of the “Right Before” page and a 76,275% increase in views of the “During” page.
The Hurricane App offered a new type of “just-in-time” training that reached tens of thousands of families in areas affected by Hurricane Sandy. The app allowed these families to access real-time information before and after the storm to help them prepare and recover. (Disaster Med Public Health Preparedness. 2016;page 1 of 6)
On November 8, 2013, Typhoon Haiyan (Yolanda) made landfall in the Philippines. The literature characterizing the medical, surgical, and obstetrics burden following typhoons is lacking. This study aimed to improve disaster preparedness by analyzing medical diagnoses presenting to a city district hospital before, during, and after Typhoon Haiyan.
The assessment of disease burden and trends was based on logbooks from a local hospital and a nongovernmental organization field hospital for the medicine, surgical, and obstetrics wards before, during, and after the typhoon.
The hospital provided no services several days after typhoon impact, but there was an overall increase in patient admissions once the hospital reopened. An increase in gastroenteritis, pneumonia, tuberculosis, and motor vehicle collision-related injuries was seen during the impact phase. A dengue fever outbreak occurred during the post-impact phase. There was a noticeable shift in a greater percentage of emergent surgical cases performed versus elective cases during the impact and post-impact phases.
Overall, several public health measures can prevent the increase in illnesses seen after a disaster. To prepare for the nonfatal burden of disease after a typhoon, health care facilities should increase their resources to accommodate the surge in patient volume. (Disaster Med Public Health Preparedness. 2016;10:240–247)
Determining how clinicians should meet their professional obligations to treat patients with Ebola virus disease in nonepidemic settings necessitates considering measures to minimize risks to clinicians, the context of care, and fairness. Minimizing risks includes providing appropriate equipment and training, implementing strategies for reducing exposure to infectious material, identifying a small number of centers to provide care, and determining which risky procedures should be used when they pose minimal likelihood of appreciable clinical benefit. Factors associated with the clinical environment, such as the local prevalence of the disease, the nature of the setting, and the availability of effective treatment, are also relevant to obligations to treat. Fairness demands that the best possible medical care be provided for health care professionals who become infected and that the rights and interests of relevant stakeholders be addressed through policy-making processes. Going forward it will be essential to learn from current approaches and to modify them based on data. (Disaster Med Public Health Preparedness. 2015;9:527–530)
The 2010 Haiti earthquake and Pakistan floods were similar in their massive human impact. Although the specific events were very different, the humanitarian response to disasters is supposed to achieve the same ends. This paper contrasts the disaster effects and aims to contrast the medium-term response.
In January 2011, similarly structured population-based surveys were carried out in the most affected areas using stratified cluster designs (80×20 in Pakistan and 60×20 in Haiti) with probability proportional to size sampling.
Displacement persisted in Haiti and Pakistan at 53% and 39% of households, respectively. In Pakistan, 95% of households reported damage to their homes and loss of income or livelihoods, and in Haiti, the rates were 93% and 85%, respectively. Frequency of displacement, and income or livelihood loss, were significantly higher in Pakistan, whereas disaster-related deaths or injuries were significantly more prevalent in Haiti.
Given the rise in disaster frequency and costs, and the volatility of humanitarian funding streams as a result of the recent global financial crisis, it is increasingly important to measure the impact of humanitarian response against the goal of a return to normalcy.
WeissWM, KirschTD, DoocyS, PerrinP. A Comparison of the Medium-term Impact and Recovery of the Pakistan Floods and the Haiti Earthquake: Objective and Subjective Measures. Prehosp Disaster Med. 2014;29(3):1-8.
The use of spontaneous volunteers (SV) is common after a disaster, but their limited training and experience can create a danger for the SVs and nongovernmental voluntary organizations (NVOs). We assessed the experience of NVOs with SVs during disasters, how they were integrated into the agency's infrastructure, their perceived value to previous responses, and liability issues associated with their use.
Of the 51 National Voluntary Organizations Active in Disasters organizations that were contacted for surveys, 24 (47%) agreed to participate.
Of the 24 participating organizations, 19 (72%) had encountered SVs during a response, most (79%) used them regularly, and 68% believed that SVs were usually useful. SVs were always credentialed by 2 organizations, and sometimes by 6 (31%). One organization always performed background checks; 53% provided just-in-time training for SVs; 26% conducted evaluations of SV performance; and 21% provided health or workers compensation benefits. Two organizations reported an SV death; 42% reported injuries; 32% accepted legal liability for the actions of SVs; and 16% were sued because of actions by SVs.
The use of SVs is widespread, but NVOs are not necessarily structured to incorporate them effectively. More structured efforts to integrate SVs are critical to safe and effective disaster response. (Disaster Med Public Health Preparedness. 2014;8:65-69)
Objective: The objective of this study was to assess the impact of the 2010 Chilean earthquake on hospital functions and services. Hospitals functioning in a post-disaster environment must provide emergency medical care related to the event, in addition to providing standard community health services. This study focused on damage to both structural and nonstructural components, as well as to utility services.
Methods: Site visits were made to every hospital in a single province (Bio-Bio). Engineers conducted damage assessments while interviews of hospital administrators were conducted. The survey was requested by the Chilean Ministry of Health (MOH) to assess the impact of the earthquake on hospital operations and facility responses to those effects. Other important regional and hospital data were gathered from hospital administrators and the MOH.
Results: Seven government hospitals were surveyed. All hospitals in the region lost communications, municipal electrical power and water for several days. All reported some physical damage although only one suffered significant structural damage. All lost some functional capacity as a result of the earthquake. The loss of telephones and cellular service was identified as the most difficult problem by administrators. An average of 3 physical areas per hospital lost some degree of functional capacity following the earthquake.
Conclusion: Even in an earthquake-prone and very well-prepared country such as Chile hospital functions were widely disrupted by the event. The loss of hospital functions can occur even with minimal damage to the physical structure. The loss of communications can impede or halt response efforts at all levels. Hospitals should be prepared to self-sustain following a disaster for 2-3 days regardless of the level of structural damage. Understanding the details of these impacts is essential to hospital preparedness and plans for continuing services after a disaster.
(Disaster Med Public Health Preparedness. 2010;4:122-128)
Background: Although the training of future physicians in disaster preparedness and public health issues has been recognized as an important component of graduate medical education, medical students receive relatively limited exposure to these topics. Recommendations have been made to incorporate disaster medicine and public health preparedness into medical school curricula. To date, the perspectives of future physicians on disaster medicine and public health preparedness issues have not been described.
Methods: A Web-based survey was disseminated to US medical students. Frequencies, proportions, and odds ratios were calculated to assess perceptions and self-described likelihood to respond to disaster and public health scenarios.
Results: Of the 523 medical students who completed the survey, 17.2% believed that they were receiving adequate education and training for natural disasters, 26.2% for pandemic influenza, and 13.4% for radiological events, respectively; 51.6% felt they were sufficiently skilled to respond to a natural disaster, 53.2% for pandemic influenza, and 30.8% for radiological events. Although 96.0% reported willingness to respond to a natural disaster, 93.7% for pandemic influenza, and 83.8% for a radiological event, the majority of respondents did not know to whom they would report in such an event.
Conclusions: Despite future physicians' willingness to respond, education and training in disaster medicine and public health preparedness offered in US medical schools is inadequate. Equipping medical students with knowledge, skills, direction, and linkages with volunteer organizations may help build a capable and sustainable auxiliary workforce. (Disaster Med Public Health Preparedness. 2009;3:210–216)
Effective emergency response among hospitals and other health care providers stems from multiple factors depending on the nature of the emergency. While local emergencies can test hospital acute care facilities, prolonged national emergencies, such as the 2009 H1N1 outbreak, raise significant challenges. These events involve sustained surges of patients over longer periods and spanning entire regions. They require significant and sustained coordination of personnel, services, and supplies among hospitals and other providers to ensure adequate patient care across regions. Some hospitals, however, may lack structural principles to help coordinate care and guide critical allocation decisions. This article discusses a model Memorandum of Understanding (MOU) that sets forth essential principles on how to allocate scarce resources among providers across regions. The model seeks to align regional hospitals through advance agreements on procedures of mutual aid that reflect modern principles of emergency preparedness and changing legal norms in declared emergencies.
(Disaster Med Public Health Preparedness. 2011;5:54-61)
Objectives: The southern California wildfires in autumn 2007 resulted in widespread disruption and one of the largest evacuations in the state’s history. This study aims to identify unmet medical needs and health care–seeking patterns as well as prevalence of acute and chronic disease among displaced people following the southern California wildfires. These data can be used to increase the accuracy, and therefore capacity, of the medical response.
Methods: A team of emergency physicians, nurses, and epidemiologists conducted surveys of heads of households at shelters and local assistance centers in San Diego and Riverside counties for 3 days beginning 10 days postdisaster. All households present in shelters on the day of the survey were interviewed, and at the local assistance centers, a 2-stage sampling method was used that included selecting a sample size proportionate to the number of registered visits to that site compared with all sites followed by a convenience sampling of people who were not actively being aided by local assistance center personnel. The survey covered demographics; needs following the wildfires (shelter, food, water, and health care); acute health symptoms; chronic health conditions; access to health care; and access to prescription medications.
Results: Among the 175 households eligible, 161 (92.0%) households participated. Within the 47 households that reported a health care need since evacuation, 13 (27.7%) did not receive care that met their perceived need. Need for prescription medication was reported by 47 (29.2%) households, and 20 (42.6%) of those households did not feel that their need for prescription medication had been met. Mental health needs were reported by 14 (8.7%) households with 7 of these (50.0%) reporting unmet needs. At least 1 family member per household left prescription medication behind during evacuation in 46 households (28.6%), and 1 family member in 48 households (29.8%) saw a health care provider since their evacuation. Most people sought care at a clinic (24, 50.0%) or private doctor (11, 22.9%) as opposed to an emergency department (6, 12.5%).
Conclusions: A significant portion of the households reported unmet health care needs during the evacuations of the southern California wildfires. The provision of prescription medication and mental health services were the most common unmet need. In addition, postdisaster disease surveillance should include outpatient and community clinics, given that these were the most common treatment centers for the displaced population. (Disaster Med Public Health Preparedness. 2009;3(Suppl 1):S24–S28)