Emergency Preparedness Drills for Active and Mass Shootings in Schools.

PURPOSE OF REVIEW: There is widespread use of emergency preparedness drills in public K-12 schools across the US, but considerable variability exists in the types of protocols used and how these practices are conducted. This review examines research into both "lockdown drills" and "active shooter drills" as it relates to their impact on participants across different outcomes and evaluations of their procedural integrity. RECENT FINDINGS: A number of studies on lockdown drills yielded largely consistent findings about their impacts, whereas findings related to the effects of active shooter drills are less uniform. The research also demonstrated that lockdown drills, though not active shooter drills, can help participants build skill mastery to be able to successfully deploy the procedure. Differences in how drills impact participants and whether they cultivate skill mastery are largely attributable to the type of drill being conducted. This review suggests that employing clearly defined drill procedures incorporating best practices, coupled with instructional training, can help schools prepare for emergencies without creating trauma for participants.

H1N1: a Mexican perspective.

In April this year, a new influenza virus of swine origin emerged in Mexico and spread rapidly around the world. As the Northern hemisphere winter flu season kicks off, Laura Vargas-Parada reports on the measures that Mexico is taking to combat the H1N1 pandemic.

A Review of the Increasing Global Impact of Climate Change on Human Health and Approaches to Medical Preparedness.

At the end of 2023, the World Health Organization (WHO) identified climate change as the greatest threat to human health. Global climate change is due to rising atmospheric concentrations of greenhouse gasses, primarily due to the burning of fossil fuels, mainly by populations in developed and developing countries. In 2022, the world experienced the highest temperatures for over 100,000 years. However, in 2022, global investment in fossil fuels increased by 10% and reached more than USD 1 trillion. The 2023 Lancet Commission report concluded that there has been little progress in protecting individuals from the adverse health effects of climate change. It is clear that global action against climate change needs to move more quickly, and the inequalities in the effects of climate change, including the impact on health, are increasing. This article aims to review the ongoing global impact of climate change on human health at individual and population levels, including recent initiatives and medical approaches to prepare for this increasing challenge.

Assessing self-reported public health emergency competencies for civil aviation personnel in China: a pilot study.

INTRODUCTION: COVID-19 has demonstrated the importance of competent staff with expertise in public health emergency preparedness and response in the civil aviation system. The civil aviation system is a critical sentinel and checkpoint to prevent imported cases and slow the spread of communicable diseases. Understanding the current competencies of staff to deal with public health emergencies will help government agencies develop targeted training and evidence-based policies to improve their public health preparedness and response capabilities. METHODS: This cross-sectional pilot study was conducted from November 2022 to October 2023, involving 118 staff members from various positions within China's civil aviation system. A 59-item questionnaire was translated and developed according to a competency profile. Data were collected using the self-report questionnaire to measure the workforce's self-perceptions of knowledge and skills associated with public health emergency proficiency, categorized into (1) general competency, (2) preparedness competency, (3) response competency, and (4) recovery competency. KMO & Bartlett test and Cronbach's α reliability analysis were used to test the reliability and validity of the questionnaire. Descriptive statistics, independent sample T-test, ANOVA, and linear regression models were performed to analyze the competencies. RESULTS: A total of 107 staff members from the aviation system were surveyed in this study. The KMO & Bartlett test, (KMO = 0.919, P < 0.001) and Cronbach's α coefficients (α = 0.985) for this questionnaire were acceptable. The results suggested that respondents scored a mean of 6.48 out of 9 for the single question. However, the staff needed to acquire more knowledge in investigating epidemic information (5.92) and case managing (5.91) in the response stage. Overall, males scored higher (409.05 ± 81.39) than females (367.99 ± 84.97), with scores in the medical department (445.67 ± 72.01) higher than management (387.00 ± 70.87) and general department (362.32 ± 86.93). Additionally, those with completely subjective evaluation (425.79 ± 88.10) scored higher than the general group (374.39 ± 79.91). To predict the total score, female medical workers were more likely to have lower scores (ß = -34.5, P = 0.041). Compared with those in the medical department, the management workers (ß = -65.54, P = 0.008) and general workers (ß = -78.06, P < 0.001) were associated with a lower total score. CONCLUSIONS: There was still a gap between the public health emergency competencies of the civil aviation system and the demand. Staff in China's civil aviation systems demonstrated overall competence in public health emergency preparedness and response. However, there was a need to enhance the accumulation of practical experience. Implementing effective training programs for public health emergencies was recommended to mitigate knowledge gaps. Meanwhile, regular training evaluations were also recommended to give comprehensive feedback on the value of the training programs.

Development of a workforce self-assessment tool for public health emergency preparedness.

BACKGROUND: In collaboration with six European public health agencies as part of the PANDEM-2 consortium, we have developed and validated a self-assessment tool that captures the workforce capacities and capabilities needed at the institutional level within National Public Health Institutes (NPHIs) to deal with public health emergencies. METHODS: The work carried out in this study included (i) a review of existing tools for workforce assessment, (ii) focus group discussions and interviews to map the experiences and needs of NPHI's, (iii) the development of a tool for NPHI's to assess their workforce capacity and capabilities in public health emergency preparedness (PHEP) and (iv) refinement of the assessment tool via a Delphi study. RESULTS: Capacity markers were identified to assess the workforce required for PHEP functions and the availability of surge capacity during a public health emergency. The tool also enables NPHIs to analyze gaps in PHEP staff competencies. The assessment scores can assist NPHI pandemic preparedness by identifying and prioritizing training and recruitment needs. CONCLUSIONS: In line with EU Regulation 2022/2371 on serious cross-border threats to health, article 11 Training of healthcare staff and public health staff, Member States (MS) are tasked with assessing current workforce capacity and capability gaps. The PANDEM-2 workforce self-assessment tool aligns with this requirement and will support effective planning and development to strengthen the public health workforce capacity in EU MS.

Conflict, COVID-19, and crisis response: shifting from 'pivoting' to preparedness.

This paper assesses the extent to which the COVID-19 (Coronavirus disease 2019) pandemic directed the attention and resources of the international community away from peacebuilding, and the potential impact of this on conflict-affected environments. It draws from a global survey, interviews, and conversations with peacebuilding practitioners, publicly available information on peacebuilding funding, and real-time data on conflict events from the Armed Conflict Location & Event Data Project. The paper argues that resources and attention have 'pivoted' away from peacebuilding to tackle the threat presented by COVID-19, and that this can-but does not always-adversely affect conflict dynamics. It contends that this pivoting belies the interconnectedness of crises, leads to 'forgotten crises' and escalating threats, and exposes deficiencies in peacebuilding funding and, more broadly, preparedness and crisis response. Crises do, however, provide opportunities for reflection and change, including how to address these deficiencies and, in so doing, advance more efficient, effective, and ethical practice.

Emergency preparedness in the central sterile supply department: a multicenter cross-sectional survey.

OBJECTIVE: To investigate the current situation of emergency preparation and emergency drill in the CSSD, and analyze its influence on the nurses' emergency attitude and ability. METHODS: This study employed a multicenter stratified sampling method, conducted from January to June 2023 using the online survey, participants completed the general data, emergency preparedness and drill questionnaire, public health emergency response questionnaire and emergency capacity scale. An independent samples t test or Kruskal-Wallis test was used to analyse differences in nurses' emergency capacity and attitudes. RESULTS: The data from 15 provinces 55 hospitals in China. Overall, 77.58% of participants' institutions set up emergency management teams, 85.45% have an emergency plan and revise it regularly. 92.12% store emergency supplies. All survey staff participated in the emergency drill, which predominantly consisted of individual drills (51.52%), with 90.30% being real combat drills, 49.09% of participants engaging in drills every quarter, and 91.52% of the drill's participants exceeding 50%. The respondents' emergency attitude score was (29.346 ± 6.029), their emergency ability score was (63.594 ± 10.413), and those with rescue experience showed a more positive attitude (Z = -2.316, P = 0.021). Different titles, education levels, rescue experience and the frequency of emergency drill affected the emergency rescue ability of the respondents (P < 0.05). CONCLUSIONS: Most medical institutions establish emergency management systems and plans, yet the content lacks geographical specificity.The duration and participation of emergency drills are high, but the effectiveness of the drills needs to be further improved, and the response capacity and attitudes of CSSD nurses are low. It is recommended that agencies develop comprehensive and targeted contingency plans to strengthen the inspection and evaluation of team strength, equipment and safeguards against the contingency plans, so as to ensure that the measures mandated by the contingency plans can be implemented promptly after the emergency response is initiated.

Pandemic Preparedness and Response: Lessons From COVID-19.

The global experience with COVID-19 holds important lessons for preparing for, and responding to, future emergences of pathogens with pandemic potential.

Public Health Emergency Preparedness After COVID-19.

Policy Points The critical task of preparedness is inseparable from the regular work of advancing population health and health equity.

Recommendations for future university pandemic responses: What the first COVID-19 shutdown taught us.

The SARS-CoV-2 epidemic challenged universities and other academic institutions to rapidly adapt to urgent and life-threatening situations. It forced most institutions to shut down nearly every aspect of their research and educational enterprises. In doing so, university leaders were thrust into unchartered waters and forced them to make unprecedented decisions. Successes and failures along the way highlighted how the autonomous nature of the American academic research enterprise and skillsets normally required of university leaders were ill-suited to mounting an emergency response. Here, as faculty from medical centers in the United States, we draw lessons from these experiences and apply them as we plan for the next possible COVID-19-induced shutdown as well as other large-scale pandemics and emergencies at universities in the United States and throughout the world.

Counseling women of reproductive age about emergency preparedness - Provider attitudes and practices.

We report healthcare provider attitudes and practices on emergency preparedness counseling for women of reproductive age (WRA), including pregnant, postpartum, and lactating women (PPLW), for disasters and weather emergencies. DocStyles is a web-based panel survey of primary healthcare providers in the United States. During March 17-May 17, 2021, obstetricians-gynecologists, family practitioners, internists, nurse practitioners, and physician assistants were asked about the importance of emergency preparedness counseling, level of confidence, frequency, barriers to providing counseling, and preferred resources to support counseling among WRA and PPLW. We calculated frequencies of provider attitudes and practices, and prevalence ratios with 95% CIs for questions with binary responses. Among 1503 respondents (family practitioners (33%), internists (34%), obstetrician-gynecologists (17%), nurse practitioners (8%), and physician assistants (8%)), 77% thought emergency preparedness was important, and 88% thought counseling was necessary for patient health and safety. However, 45% of respondents did not feel confident providing emergency preparedness counseling, and most (70%) had never talked to PPLW about this topic. Respondents cited not having time during clinical visits (48%) and lack of knowledge (34%) as barriers to providing counseling. Most respondents (79%) stated they would use emergency preparedness educational materials for WRA, and 60% said they were willing to take an emergency preparedness training. Healthcare providers have opportunities to provide emergency preparedness counseling; however, many have not, noting lack of time and knowledge as barriers. Emergency preparedness resources combined with training may improve healthcare provider confidence and increase delivery of emergency preparedness counseling.

Strategies to strengthen a climate-resilient health system: a scoping review.

BACKGROUND: Climate change is a major global threat to human health and puts tremendous pressure on health systems. Therefore, a resilient health system is crucial to enhance, maintain, and restore the population's health. This study aimed to identify interventions and actions to strengthen a climate-resilient health system to deal with the adverse health effects of climate change. METHOD: This study was a scoping review. Five databases and Google Scholar search engine were searched using relevant keywords. Initially, 4945 documents were identified, and 105 were included in the review. Content thematic analysis method was applied using MAXQDA 10 software. RESULTS: Overall, 87 actions were identified for building a climate-resilient health system and were classified into six themes (i.e., governance and leadership; financing; health workforce; essential medical products and technologies; health information systems; and service delivery). The most commonly reported actions were formulating a national health and climate change adaptation plan, developing plans for essential services (electricity, heating, cooling, ventilation, and water supply), assessing the vulnerabilities and capacities of the health system, and enhancing surveillance systems targeting climate-sensitive diseases and their risk sources. CONCLUSIONS: A holistic and systemic approach is needed to build a climate-resilient health system owing to its complex adaptive nature. Strong governance and leadership, raising public awareness, strategic resource allocation, climate change mitigation, emergency preparedness, robust health services delivery, and supporting research, are essential to building a climate-resilient health system.

The European experience with testing and surveillance during the first phase of the COVID-19 pandemic.

BACKGROUND: COVID-19 pandemic provides a unique opportunity to learn the challenges encountered by public health emergency preparedness systems, both in terms of problems encountered and adaptations during and after the first wave, as well as successful responses to them. RESULTS: This work draws on published literature, interviews with countries and institutional documents as part of a European Centre for Disease Prevention and Control project that aims to identify the implications for preparedness measurement derived from COVID-19 pandemic experience in order to advance future preparedness efforts in European Union member states. The analysis focused on testing and surveillance themes and five countries were considered, namely Italy, Germany, Finland, Spain and Croatia. Our analysis shown that a country's ability to conduct testing at scale was critical, especially early in the pandemic, and the inability to scale up testing operations created critical issues for public health operations such as contact tracing. Countries were required to develop new strategies, approaches, and policies under pressure and to review and revise them as the pandemic evolved, also considering that public health systems operate at the national, regional, and local level with respect to testing, contact tracing, and surveillance, and involve both government agencies as well as private organizations. Therefore, communication among multiple public and private entities at all levels and coordination of the testing and surveillance activities was critical. CONCLUSION: With regard to testing and surveillance, three capabilities that were essential to the COVID-19 response in the first phase, and presumably in other public health emergencies: the ability to scale-up testing, contact tracing, surveillance efforts; flexibility to develop new strategies, approaches, and policies under pressure and to review and revise them as the pandemic evolved; and the ability to coordinate and communicate in complex public health systems that operate at the national, regional, and local level with respect and involve multiple government agencies as well as private organizations.

Bridging the gap, how interprofessional collaboration can support emergency preparedness for children with disabilities and their families: an exploratory qualitative study.

BACKGROUND: Children with disabilities and their families are at higher risk during emergencies and disasters, which is often attributed to the lack of disability inclusion in emergency response as well as disparities in preparedness. This disparity speaks to a need for emergency preparedness that centers children with disabilities and their families. The purpose of this study was to elicit the perspectives of health professionals (nurses, occupational therapists, social workers), disability advocates, and public safety personnel (e.g., fire fighters, police officers, emergency management administrators) on what would enable these types of professionals to support family-centered emergency preparedness for families who care for children with disabilities. One goal of this research is to provide recommendations for practice and policy to improve safety outcomes for children with disabilities and their families in emergency situations. METHODS: This study consisted of 46 qualitative interviews with nurses, occupational therapists, social workers, public safety personnel, and advocacy organization representatives about their role in emergency preparedness for families of children with disabilities. Qualitative content analysis was used to identify themes from participants' responses. RESULTS: Participants expressed interest in family-centered emergency preparedness, and stated that greater awareness, more education and training, increased networking between professions, and institutional support would enable their involvement. CONCLUSIONS: These findings have implications for the importance of interprofessional collaboration in supporting family-centered emergency preparedness for families of children with disabilities. Stronger interprofessional networks would help overcome many of the barriers identified by participants, and advocacy groups appear to be well-positioned to bridge the gap between these professionals and their areas of expertise.

The People's War Against Pandemic: protocol for a randomized control trial based on a virtual interactive training system intervention to improve the emergency preparedness of public for major emerging infectious diseases.

BACKGROUND: The frequent occurrence and increasing severity of major emerging infectious diseases (MEIDs) have posed considerable public health, economic and social issues worldwide. The emergency preparedness of public is inadequate to respond to and recover from MEIDs. Due to the limitation of time, space and resources, it is also difficult to carry out large-scale emergency preparedness training related to MEIDs. Then we developed a virtual interactive training system to improve emergency preparedness of public, including preparation of legal compliance, emergency knowledge, emergency capacity, economic estimation, material reserve and physical and mental health. METHODS: A protocol for conducting a randomized controlled trail to evaluate the People's War against Pandemic, a virtual interactive training system aimed to improve emergency preparedness of public for MEIDs. During the intervention, participants need to complete the storyline task at least once a day, watch at least one article and one video in the knowledge corner, and complete a retest of wrong choices in the intelligent evaluation module. The primary outcome is emergency preparedness of public for MEIDs. The secondary outcome is prevention and control knowledge of MEIDs. DISCUSSION: The People's War Against Pandemic may be an effective approach to provide public with a panoramic understanding of the response to MEIDs, so as to promote their comprehensive preparation and finally achieve effective response. TRIAL REGISTRATION: This study was funded in 2021 and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR2200060919) in June 2022. Recruitment and enrollment of participants began in July 2022.

Constructing an emergency preparedness evaluation index system for public use during major emerging infectious disease outbreaks: a Delphi study.

BACKGROUND: The major emerging infectious diseases (MEIDs) have occurred frequently and become increasingly serious in the world. Sufficient personal emergency preparedness is critical for the general people in efficiently responding to and recovering from MEIDs. Nevertheless, few specific indicators are available for assessing the individual emergency preparedness of the general public during these periods. Therefore, the aim of this study was to construct an index system for comprehensively evaluating the personal emergency preparedness of the public regarding MEIDs. METHODS: Based on the global national-level emergency preparedness index framework and a literature review, a preliminary index system was constructed. From June 2022 to September 2022, a panel of 20 experts from nine provinces and municipalities across multiple research areas participated in this Delphi study. They rated the importance of pre-defined indicators using a five-point Likert scale and provided their qualitative comments. According to the feedback of each round of experts, the indicators of the evaluation index system were revised. RESULTS: After two rounds of expert consultation the evaluation index system reached a consensus, containing five first-level indicators, cooperating with prevention and control work, improving emergency response capacity, securing supplies and equipment, preparing economic resources, maintaining physical and mental health with affiliated 20 s-level indicators and 53 third-level indicators. The expert authority coefficient of consultation was 0.88 and 0.90. The Kendall's coefficient of concordance of expert consultations was 0.294 and 0.322, respectively. The differences were statistically significant (P < 0.05). CONCLUSION: A valid, reliable and scientific evaluation index system was established. This personal emergency preparedness index system, as a precursor form, will further lay the foundation for the formation of an assessment instrument. At the same time, it could provide a reference for future education and training of emergency preparedness for the general public.

Public health emergency preparedness for infectious disease emergencies: a scoping review of recent evidence.

BACKGROUND: The COVID-19 pandemic continues to demonstrate the risks and profound health impacts that result from infectious disease emergencies. Emergency preparedness has been defined as the knowledge, capacity and organizational systems that governments, response and recovery organizations, communities and individuals develop to anticipate, respond to, or recover from emergencies. This scoping review explored recent literature on priority areas and indicators for public health emergency preparedness (PHEP) with a focus on infectious disease emergencies. METHODS: Using scoping review methodology, a comprehensive search was conducted for indexed and grey literature with a focus on records published from 2017 to 2020 onward, respectively. Records were included if they: (a) described PHEP, (b) focused on an infectious emergency, and (c) were published in an Organization for Economic Co-operation and Development country. An evidence-based all-hazards Resilience Framework for PHEP consisting of 11 elements was used as a reference point to identify additional areas of preparedness that have emerged in recent publications. The findings were analyzed deductively and summarized thematically. RESULTS: The included publications largely aligned with the 11 elements of the all-hazards Resilience Framework for PHEP. In particular, the elements related to collaborative networks, community engagement, risk analysis and communication were frequently observed across the publications included in this review. Ten emergent themes were identified that expand on the Resilience Framework for PHEP specific to infectious diseases. Planning to mitigate inequities was a key finding of this review, it was the most frequently identified emergent theme. Additional emergent themes were: research and evidence-informed decision making, building vaccination capacity, building laboratory and diagnostic system capacity, building infection prevention and control capacity, financial investment in infrastructure, health system capacity, climate and environmental health, public health legislation and phases of preparedness. CONCLUSION: The themes from this review contribute to the evolving understanding of critical public health emergency preparedness actions. The themes expand on the 11 elements outlined in the Resilience Framework for PHEP, specifically relevant to pandemics and infectious disease emergencies. Further research will be important to validate these findings, and expand understanding of how refinements to PHEP frameworks and indicators can support public health practice.

Emergency Preparedness in Tennessee Women with a Recent Live Birth.

OBJECTIVES: To assess emergency preparedness (EP) actions in women with a recent live birth. METHODS: Weighted survey procedures were used to evaluate EP actions taken by women with a recent live birth responding to an EP question assessing eight preparedness actions as part of the 2016 Tennessee Pregnancy Risk Assessment and Monitoring System (PRAMS) survey. Factor analysis was used to group preparedness actions. RESULTS: Overall, 82.7% [95% Confidence Interval (CI) 79.3%, 86.1%] of respondents reported any preparedness actions, with 51.8% (95% CI 47.2%, 56.4%) completing 1-4 actions. The most common actions were having supplies at home (63.0%; 95% CI 58.5%, 67.4%), an evacuation plan for children (48.5%; 95% CI 43.9%, 53.2%), supplies in another location (40.2%; 95% CI 35.6%, 44.7%), and a communication plan (39.7%; 95% CI 35.1%, 44.2%). Having personal evacuation plans (31.6%; 95% CI 27.3%, 36.0%) and copies of documents in alternate locations (29.3%; 95% CI 25.0%, 33.5%) were least common. Factor analysis yielded three factors: having plans, having copies of documents, and having supplies. Specific preparedness actions varied by education and income level. CONCLUSIONS FOR PRACTICE: Most Tennessee women (about 8 in 10 women) with a recent live birth reported at least one EP action. A three-part EP question may be sufficient for assessing preparedness in this population. These findings highlight opportunities to improve public health education efforts around EP.

What are the research priorities for strengthening public health emergency preparedness and response in Africa?

BACKGROUND: Research evidence is needed to strengthen capacities in emergency preparedness and response (EPR). However, the absence of a clear research agenda limits the optimal use of research evidence. This paper reports on the prioritization of research questions and topics that could contribute to evidence-informed strengthening of EPR capacities in the African region. METHODS: The priority-setting consisted of desk review and stakeholder consultation workshop. Twenty-nine people participated in the workshop, including representatives from WHO regional office and EPR focal points in Africa, representatives of research institutions, and partners from Science for Africa Foundation, United Nations Children's Fund and Africa Center for Disease Control. Modified Delphi technique was used to systematically arrive at specific and cross-cutting research priorities in the three broad areas of the EPR, which are program Implementation, Clinical and Epidemiology. The research questions/topics were ranked on five-point Likert scale (1 = very low to 5 = very high) based on seven agreed-on criteria. Research priority score was calculated for each question as the mean of the criteria scores. RESULTS: A total of 123 research questions comprising, 29 on Epidemiology, 22 on Clinical, 23 on program Implementation, and 49 on cross-cutting issues were ranked. The top ten research priorities were: knowledge and skills of healthcare workers in detecting and responding effectively to disease outbreaks; quality of data (accuracy, timeliness, completeness) for epidemic prone diseases; determinants of vaccine hesitancy; determinants of infection transmission among health care workers during PHE; effective measures for protecting health workers from highly infectious pathogens in PHE; strategies to improve the effectiveness of contact tracing for epidemic prone diseases; effectiveness of current case definitions as screening tools for epidemic and pandemic prone diseases; measures to strengthen national and sub-national laboratory capacity for timely disease confirmation within the Integrated Diseases Surveillance and Response framework; factors affecting prompt data sharing on epidemic-prone diseases; and effective strategies for appropriate community participation in EPR. CONCLUSIONS: The collaborative multi-stakeholder workshop produced a starting list of priority research questions and topics for strengthening EPR capacities in Africa. Action needs to be taken to continuously update the research agenda and support member States to contextualize the research priorities and commission research for timely generation and uptake of evidence.