Public health management of disasters: the pocket guide

Guide from the American Public Health Association - APHA that provides information about public health interventions in the days immediately preceding and following emergencies. It is divided in six chapters: preparation, strategies, diseases, mental health, food safety and data collection.

Business process improvement: an electronic system to monitor compliance with medical resident work hours.

The limitation of medical intern and resident work hours, known as the Bell 405 regulations, was initiated in New York State in 1989 with a modification to the state hospital code. The Bell 405 regulations were strengthened in 2000, and facilities would now be fined for noncompliance. Monitoring systems in place at that time were insufficient to provide an adequate level of review for the New York City Health and Hospitals Corporation (HHC) with more than 7,000 medical residents whose training is based at or who rotate through these public hospitals. A "simple to use," yet comprehensive, method of monitoring compliance needed to be developed to ensure that residents and interns complied with laws regulating working hours. The subsequent development of national accreditation standards increased the stakes for reliable scrutiny. HHC developed and implemented a Web-based Structured Query Language (SQL) application that facilitated easy access to work hour surveys captured through electronic time sheets. The time sheet data automatically entered a database that provided instant analysis of conformance to state law. The development of an electronic on-line application accessible from anywhere allowed HHC to efficiently identify nonconformance and pinpoint corrective action. Since the inception of the application and its expansion allowing access through the intranet, 26,000 individual time sheets have been submitted for evaluation. With the national movement regulating work hours, other hospitals still at the pencil and manual computation stage would greatly benefit by developing a similar application.

Chapter 12 : Natural disasters

Disasters due to natural causes result in significant losses, physical destruction of dwellings, social and economic disruption, human pain and suffering, injury, and loss of life. This chapter presents the reader with a broad overview of the most frecuently occuring natural/environmental disasters, their impact on communities, and their associated morbidity and mortality. Disaster preparedness, prevention and mitigation activities specific to each type of disasters are discussed. Case studies of naturally ocurring disaster are presented as evidence of the scope of disaster's impact and can be used to evaluate previous disaster response efforts and to predict future needs (AU)

SARA three years later : Emergency physician's knowledge, beliefs, and actions

Objective: Investigate emergency physicians knoledge about the Superfund Amendments and Reauthorization Act (SARA) Title III legislation, passed by the United States Congress in 1986, and to determine the factors contributing to their level of preparedness in dealing with patients exposed to toxic chemicals. Methods: A 115-item questionnaire was mailed to the medical directors of all emergency departments (EDs) in the State of New York. The results of the cross-sectional survey were analysed using standard statistical methods. Rsults: One hundred and eight-seven (72

) of the directors of EDs in New York State responded to the survey. Three years after SARA was enacted, only 33

of the directors had heard about this legislation. Only 18

had been invited to attend the meetings of the Local Emergency Planning Committees (LEPC). Sixty percent of the directors knew whether or not the LEPC had devised plans that defined a role for their EDs in responding to environmental emergencies. This knowledge about community planning mainly had an effect on preparedness of the EDs. Preparedness also was predicted by how recently the EDs had treated patients exposed to toxic chemicals, the perception that emergency physicians had a legitimate role in planning for and responding to chemical emergencies, and how often emergency physicians had attended continuing education courses about hazardous materials. Conclusion: Despite the finding that some emergency physicians are involved in community preparations, two main problems persist in planning a medical response to environmental emergencies. First, the ED directors generally are unaware of the legislation that mandates these preparatins and are not interacting with community planners. Second, there is not full involvement by the local EDs in the LEPC planning efforts. Recommendations: A procedure is needed to disseminate information about legislation which affects emergency physicians, such as SARA, and about regional planning for environmental emegencies. Dissemination should include education about the professions'role in planning for and providing care for patients exposed to toxic chemicals(AU)

Improving medical preparednesss for chemical accidents : An inter-organizational resource review

As accidental chemical releases gain public attention and other sectors of society join to improve the effectiveness of inter-organizational emergency response, the health care system may find itself increasingly called upon to provide services, training and consulation. Hospitals, with their own quantities of stored and used chemicals, are themselves likely sites for toxic substance accidents. Accidents requiring hospital evacuation have already occured. Institutional planning can capitalize on all available resources to prevent in-house accidents and to prepare for participation in necessary community response. Working with emergency agencies in the early planning phase provides links that can prevent organizational mistakes of the kind that occured in the Mississauga incident and can better prepare communities for Bhopal-type chemical releases. This study has not addressed the likelohood that there may be local outcries after information yielded by SARA Title III is publicized. But it seems sensible to adopt a pro-active risk management strategybeforehand. In this way, the tasks of preparedness, most particulary emergency health care preparedness, can be prudently undertaken in advance of public fear and before chemical incidents occur

Improving medical preparedness for chemical accidents : An inter-organizational resource review

As accidental chemical releases gain public attention and other sectors of society join to improve the effectiveness of inter-organizational emergency response, the health care system may find itself increasingly called upon to provide services, training and consultation. Hospitals, with their own quantities of stored and used chemicals, are themselves likely sites for toxic substance accidents. Accidents requiring hospital evacuation have already occurred. Institutional planning can capitalize on all available resources to prevent in-house accidents and to prepare for participation in necessary community response. Working with emergency agencies in the early planning phase provides links that can prevent organizational mistakes of the kind that occurred in the Mississauga incident and can better prepare communities for Bhopal-type chemical releases. This study has not addressed the likelihood that there may be many local outcries after information yielded by SARA Title III is publicized. But it seems sensible to adopt a pro-active risk management strategy beforehand. In this way, the tasks of preparedness, most particularly emergency health care preparedness, can be prudently undertaken in advance of public fear and before chemical incidents occur