Leveraging natural history biorepositories as a global, decentralized, pathogen surveillance network.

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic reveals a major gap in global biosecurity infrastructure: a lack of publicly available biological samples representative across space, time, and taxonomic diversity. The shortfall, in this case for vertebrates, prevents accurate and rapid identification and monitoring of emerging pathogens and their reservoir host(s) and precludes extended investigation of ecological, evolutionary, and environmental associations that lead to human infection or spillover. Natural history museum biorepositories form the backbone of a critically needed, decentralized, global network for zoonotic pathogen surveillance, yet this infrastructure remains marginally developed, underutilized, underfunded, and disconnected from public health initiatives. Proactive detection and mitigation for emerging infectious diseases (EIDs) requires expanded biodiversity infrastructure and training (particularly in biodiverse and lower income countries) and new communication pipelines that connect biorepositories and biomedical communities. To this end, we highlight a novel adaptation of Project ECHO's virtual community of practice model: Museums and Emerging Pathogens in the Americas (MEPA). MEPA is a virtual network aimed at fostering communication, coordination, and collaborative problem-solving among pathogen researchers, public health officials, and biorepositories in the Americas. MEPA now acts as a model of effective international, interdisciplinary collaboration that can and should be replicated in other biodiversity hotspots. We encourage deposition of wildlife specimens and associated data with public biorepositories, regardless of original collection purpose, and urge biorepositories to embrace new specimen sources, types, and uses to maximize strategic growth and utility for EID research. Taxonomically, geographically, and temporally deep biorepository archives serve as the foundation of a proactive and increasingly predictive approach to zoonotic spillover, risk assessment, and threat mitigation.

Improving mass casualty planning in low resource settings: Médecins Sans Frontières and International Committee of the Red Cross perspective.

Mass casualty events occur on a regular although unpredictable basis within the contexts of both Mèdecins Sans Frontières (MSF) and the International Committee of the Red Cross (ICRC) activities. The frequency of both natural disasters and other mass casualty incidents is increasing with urbanisation and industrialisation, compounded by climate change and conflict. Both organisations have recognised that the historical training focus on full-scale mass casualty simulations has not always been followed through to the resolution of action points and dissemination of learning. Staff training for mass casualty management has been variable. This led MSF and ICRC to develop a multimodal approach to assist development of mass casualty plans and preparedness. Capitalising on our presence in these contexts we are incorporating our experience of quality improvement and change management to complement simulation to 'stress and test' systems. We examine the challenges and share our efforts to improve training of staff in field projects across both MSF and ICRC and discussing future innovations.

Health technology assessment applied to emergency preparedness: a new perspective.

Emergency preparedness is a continuous quality improvement process through which roles and responsibilities are defined to effectively anticipate, respond to, and recover from the impact of emergencies. This process results in documented plans that provide a backbone structure for developing the core capacities to address health threats. Nevertheless, several barriers can impair an effective preparedness planning, as it needs a 360° perspective to address each component according to the best evidence and practice. Preparedness planning shares common principles with health technology assessment (HTA) as both encompass a multidisciplinary and multistakeholder approach, follow an iterative cycle, adopt a 360° perspective on the impact of intervention measures, and conclude with decision-making support. Our "Perspective" illustrates how each HTA domain can address different component(s) of a preparedness plan that can indeed be seen as a container of multiple HTAs, which can then be used to populate the entire plan itself. This approach can allow one to overcome preparedness barriers, providing an independent, systematic, and robust tool to address the components and ensuring a comprehensive evaluation of their value in the mitigation of the impact of emergencies.

'I can see clearly now': clarifying the role of psychiatry in global disaster.

OBJECTIVE: First, to review the principles and practice of disaster psychiatry, in light of recent global events. Second, to identify opportunities for research. METHOD: A literature review of the MEDLINE database, UpToDate and the Cochrane Library was conducted. Reference lists were also reviewed. RESULTS: Psychiatrists are well-positioned to contribute to positive outcomes at all stages of the disaster response. These contributions derive from their roles as doctors, mental illness specialists and clinical leaders. CONCLUSION: A novel framework for the psychiatrist's contributions was proposed. Specific knowledge of disaster psychiatry may be worthwhile, and establishment of a public disaster psychiatry centre is reasonable. Research should further examine the role of tele-psychiatry and pursue a best practice for community and front-line employee psychological preparedness.

The need for a coordinated international pandemic response.

The COVID-19 pandemic has drawn attention to the international agreement governing responses to public health emergencies, with some experts calling for its revision. Lynn Eaton and Gary Humphreys report.

A Commons for a Supply Chain in the Post-COVID-19 Era: The Case for a Reformed Strategic National Stockpile.

Policy Points Reflecting on current response deficiencies, we offer a model for a national contingency supply chain cell (NCSCC) construct to manage the medical materials supply chain in support of emergencies, such as COVID-19. We develop the following: a framework for governance and response to enable a globally independent supply chain; a flexible structure to accommodate the requirements of state and county health systems for receiving and distributing materials; and a national material "control tower" to improve transparency and real-time access to material status and location. CONTEXT: Much of the discussion about the failure of the COVID-19 supply chain has centered on personal protective equipment (PPE) and the degree of vulnerability of care. Prior research on supply chain risks have focused on mitigating the risk of disruptions of specific purchased materials within a bounded region or on the shifting status of cross-border export restrictions. But COVID-19 has impacted every purchase category, region, and border. This paper is responsive to the National Academies of Sciences, Engineering and Medicine recommendation to study and monitor disasters and to provide governments with course of action to satisfy legislative mandates. METHODS: Our analysis draws on our observations of the responses to COVID-19 in regard to acquisition and contracting problem-solving, our review of field discussions and interactions with experts, a critique of existing proposals for managing the strategic national stockpile in the United States a mapping of the responses to national contingency planning phases, and the identification of gaps in current national healthcare response policy frameworks and proposals. FINDINGS: Current proposals call for augmenting a system that has failed to deliver the needed response to COVID-19. These proposals do not address the key attributes for pandemic plan renewal: flexibility, traceability and transparency, persistence and responsiveness, global independence, and equitable access. We offer a commons-based framework for achieving the opportunities and risks which are responsive to a constellation of intelligence assets working in and across focal targets of global supply chain risk. CONCLUSIONS: The United States needs a "commons-based strategy" that is not simply a stockpile repository but instead is a network of repositories, fluid inventories, and analytic monitoring governed by the experts. We need a coordinated effort, a "commons" that will direct both conventional and new suppliers to meet demands and to eliminate hoarding and other behaviors.

Nurses: Call to Action to Run for an Elected Office, Lessons From a State Senate Candidate.

Nurses are experienced leaders, understand how to improve quality and access to care, and have the essential skills to be an elected official. Knowing the key tasks to running a campaign is critical to achieving an elected office role. This article presents a call to action for nurse leaders, advice on running for office, and lessons learned from a nurse running for State Senate.

[ATLS® and TDSC®: how it fits together : A treatment concept for mass casualty and terrorist-related mass casualty situations, life-threatening and special scenarios]. / ATLS® und TDSC®: How it fits together : Ein Behandlungskonzept für MANV und TerrorMANV, lebensbedrohliche oder besondere Lagen.

Terrorist-related mass casualty incidents represent a medical and organizational challenge for all hospitals. The main reasons are the special patterns of injuries, the onset and development of the scenario, the lack of information at the beginning, the overall number of casualties and the number of uninjured but involved patients presenting at the hospital.Due to these circumstances and the high percentage of penetrating injuries with a permanent risk of uncontrollable bleeding and other life-threatening complications, a strategic and tactical initial surgical care is necessary.For these special terrorist-related mass casualty (MasCal) situations, the Terror and Disaster Surgical Care (TDSC®) course was developed and imparts special medical and surgical knowledge as well as a scenario-based training in surgical decision-making. The TDSC® course focusses on the scenario-related provision of surgical care and distribution of the limited resources to enable survival for as many patients as possible.To improve individualized trauma care course formats, such as the Advanced Trauma Life Support (ATLS®) were established and are nowadays widespread in Germany. It could be shown that standardized approaches and algorithm-based treatment could improve the outcome of trauma victims. Faced with the present day permanent risk of a possible terrorist-related MasCal situation, the question arises how and to what extent elements and principles of both course formats (TDSC® and ATLS®) could be used to improve and organize the initial care in a terrorist-linked MasCal incident.For the first time it is shown that the key elements of both courses (primary survey of the ATLS® and the TDSC® principles: categorization, prioritization, disposition and realization) could be established and integratively used to structure the initial intrahospital medical and surgical care.

Operational intervention levels for enabling the transition from an emergency exposure situation to an existing exposure situation following a radiological emergency involving release of radioactive material in the environment.

Experience has demonstrated lack of preparedness at national levels to manage the consequences of a nuclear or radiological emergency in its later phase which, on occasions, resulted in unjustified actions. To assist Member States preparing for this phase, the International Atomic Energy Agency (IAEA) published guidance (IAEA Safety Standards Series No. GSG-11) recommending, inter alia, for operational intervention levels (OILT) to be developed for enabling the transition from an emergency exposure situation to an existing exposure situation. OILT are intended to also support decisions be made on lifting or adapting public protective actions imposed early in the emergency response and on actions to be taken to further reduce exposures. Using the methodology provided therein, OILT have been calculated for radiological emergencies involving release of the most commonly used alpha, beta and gamma emitting radionuclides in the environment. In addition, an approach for deriving a default OILT value has been presented and a default OILT value for the ambient dose equivalent rate at 1 m above ground level has been derived. The derived OILT values support the application of relevant IAEA safety standards (i.e. No. GSR Part 7 and No. GSG-11) as well as relevant recommendations of the Council Directive 2013/59 in relation to the transition from the emergency exposure situation to an existing exposure situation at national levels. However, they need to be integrated within the national protection strategies to guide the implementation of activities and actions that support the resumption of normal social and economic activity after the emergency which include those concerning return of members of the public, who were resettled during the implementation of evacuation or relocation, to their homes.

Individual emergency-preparedness efforts: A social justice perspective.

BACKGROUND: Since 2010, the United States has experienced 228 disasters, affecting over 86 million people. Because of population shifts, the growing number of people living with chronic conditions or disabilities, and the growing number of older citizens living independently, access and service gaps often exist for those without money or other transferable resources. There is a lack of evidence regarding individual community members' capacity to prepare for emergencies. RESEARCH OBJECTIVE: The purpose of this study is to highlight participant experiences in becoming better prepared for emergencies and provide insight from a social justice perspective. RESEARCH DESIGN: This is a descriptive qualitative study, staying very close to the data as an end product rather than a beginning for interpretation. PARTICIPANTS AND RESEARCH CONTEXT: A total of 13 low-income, uninsured, or under-insured attendees at a medical outreach clinic were interviewed. ETHICAL CONSIDERATIONS: Institutional Review Board approval was obtained from the University of Texas at Tyler. FINDINGS: Four themes emerged from the interview data: (a) evaluation of the emergency-preparedness education, (b) making emergency plans, (c) challenges in preparing for emergencies, and (d) facilitators of emergency preparedness. DISCUSSION: Identifying the potential challenges to individual emergency preparedness among vulnerable populations is the first step in overcoming them. The capacity to comply with such measures, especially the ability of those with limited incomes and other vulnerable populations, must be considered. CONCLUSION: Synchronized, well-ordered assistance will close gaps in recovery and enhance efficiency in pre- and post-event aid. Theoretically, doing so will promote engaged and resilient members of society who are better able to withstand adverse events. The importance of the relationship between individual preparedness levels and the resiliency of nations supports the social justice imperative to address the needs of vulnerable populations in the mitigation and planning phase of the emergency management cycle.

Assessing Disaster Preparedness and Educational Needs of Private Veterinary Practitioners in Mississippi.

The veterinary medical education system faces increasing challenges in educating students in the most current technologies while responding to changing community needs and expectations. Communities expect veterinarians to be involved in disaster management at some level. The purpose of this study was to describe the level of disaster preparedness and educational needs of veterinary practitioners in Mississippi. A survey was mailed to 706 practitioners to assess disaster plans, disaster training, and familiarity with disaster-related organizations. Forty-three percent of veterinarians had a clinic disaster plan. Veterinary practitioners who had experienced a disaster were more likely to have a personal plan (odds ratio [OR] = 4.55, 95% confidence interval [CI] = 2.47-8.37) and a clinic plan (OR = 4.11, 95% CI = 2.28-7.44) than those who had not. Veterinarians residing in Mississippi Gulf Coast counties were more likely to have a personal plan (OR = 3.62, 95% CI = 1.54-8.72) and a clinic plan (OR = 3.09, 95% CI = 1.35-7.21) than were those residing in other areas. Only 17% of veterinarians had assistance agreements with other practices, and few veterinarians indicated having disaster education materials available for their clients. Twenty percent of respondents indicated having obtained formal disaster training, and more than two-thirds of respondents were interested in receiving disaster training, mostly in the form of online delivery. Results suggest that private veterinary practitioners have the desire and need to obtain disaster education. Providing opportunities for both veterinarians and veterinary students to obtain education in disaster management will result in better overall community disaster preparedness.

Improving Hurricane Harvey Disaster Research Response Through Academic-Practice Partnerships.

After Hurricane Harvey, researchers, media, and public health agencies collected data in Houston, Texas, to assess potential health effects and inform the public. To limit redundancy and ensure sampling coverage of impacted areas, research and practice partners used disaster research response (DR2) resources and relied on partnerships formed during a 2015 DR2 workshop in Houston. Improved coordination after the disaster can improve the effectiveness and efficiency of DR2 and enable the use of data to improve recovery and preparedness for future disasters.

Blood bank preparedness for mass casualty incidents and disasters: a pilot study in the Piedmont region, Italy.

BACKGROUND AND OBJECTIVES: Blood is a critical resource for responding to mass casualty incidents (MCI). The main framework for transfusion preparedness is the American Association of Blood Bank (AABB) Disaster Operation Handbook. A disaster preparedness plan for co-ordinated blood supply was issued in Italy in 2016. AIM: To assess the level of preparedness of the Transfusion Centers (TS) in the Piedmont region, to evaluate the applicability of AABB checklist and to evaluate the application of the Italian plan. MATERIALS AND METHODS: We surveyed all the Regional Transfusion Centers (TS) using the AABB checklist, addressing 74 priority action items grouped according to 16 preparedness domains. The Italian 2016 plan has been considered the regulatory cut-off and hospitals were stratified based on the type and the TS workload. A principal component analysis (PCA) was conducted to summarize the variance among centres. RESULTS: Twenty-one out of 25 TS agreed to participate. Eighty-one % were at high and 18% were at medium level of preparedness. All but two centres were above the cut-off determined by the Italian law. A significant better preparedness was found in medium size hospitals compared to bigger and smaller hospitals. Other than that, the different TS showed a quite homogeneous distribution of preparedness variance. CONCLUSIONS: This study demonstrated a good level of preparedness in the Piemonte TS, above the Italian law requirements in the majority of TS. The AABB checklist could be used to highlight gaps and needs in the regional TS networks in case of emergency crisis.

Disaster Management in a Nephrology Service: Lessons Learned from Hurricane Maria.

BACKGROUND: Puerto Rico suffered a major humanitarian -crisis after Hurricane Maria. We describe our experience with patients with renal disease in an academic medical center. SUMMARY: A comprehensive emergency response plan should be developed, shared and discussed with the team and the patients prior to the hurricane. The needs of the staff should not be ignored to ensure their ability to participate as responders. Physical damage to facilities, lack of basic services, shortage of disposable products, and the inability to get to treatment centers are the most common threats. Preemptive dialysis can avoid serious complications. A contingency plan to move patients to another center should be prearranged in case the unit is rendered nonfunctional after the storm. Patients must receive preventive education about fluid and dietary restrictions and the possible use of potassium binding drugs if they cannot reach a dialysis unit. A list of alternative drugs that could be used if patients are not able to fill their medications is required. The Internet and social media proved to be an invaluable communication tool. A registry of patients with updated contact information, as well as contact information for relatives and a physical address where an emergency rescue team can be dispatched is essential. Water safety should be reinforced. Key Message: Our experience showed us that preparing for the worst is not enough. Advanced planning of a streamlined response is the best tactic to decrease harm.

Hurricane Harvey: One Hospital's Journey Toward Organizational Resilience.

One hospital's experiences during the Hurricane Harvey disaster are reviewed and detailed using the strategic technique of strengths, weaknesses, opportunities, and threats analysis. Three leadership behaviors, adaptability, empowerment, and social justice, are discussed relative to organizational resiliency. This hospital's journey during Hurricane Harvey is analyzed using these leadership behaviors in a detailed strengths, weaknesses, opportunities, and threats analysis format. Key lessons learned from this exercise are presented and are applicable to other disaster situations facing hospital performance.

Difficulties faced by Korean disaster relief workers while providing humanitarian aid: A descriptive study.

The aim of the present study was to identify difficulties experienced by Korean disaster relief workers during humanitarian aid deployment. A convenience sample of disaster relief workers aged >18 years, who had been dispatched to an overseas disaster site, were recruited; 107 relief workers completed the Humanitarian Aid Difficulty Scale that consists of 23 items comprising five factors. The average difficulty rating was 2.64 on a five point scale. By item, participants gave the highest scores for bathroom use and the lowest scores for cooperation among team members. By factor, infrastructure was rated as the greatest difficulty, followed by health conditions, goods and equipment, culture and customs, and cooperation. Considering sociodemographic characteristics, there were significant age differences in the culture and customs factor, as well as significant occupation differences in the cooperation, culture and customs, and goods and equipment factors. These findings highlight the need to improve the welfare of workers. It is recommended that further research be conducted according to occupation and with repeated measurement prior to, in the middle of, and after deployment of relief workers.