Lessons Learned from the Launch and Implementation of the COVID-19 Contact Tracing Program in New York City: a Qualitative Study.

On June 1, 2020, NYC Health + Hospitals, in partnership with the NYC Department of Health and Mental Hygiene, other city agencies, and a large network of community partners, launched the New York City Test & Trace (T2) COVID-19 response program to identify and isolate cases, reduce transmission through contact tracing, and provide support to residents during isolation or quarantine periods. In this paper, we describe lessons learned with respect to planning and implementation of case notification and contact tracing. Our findings are based on extensive document review and analysis of 74 key informant interviews with T2 leadership and frontline staff, cases, and contacts conducted between January and September 2022. Interviews elicited respondent background, history of program development, program leadership and structure, goals of the program, program evolution, staffing, data systems, elements of community engagement, trust with community, program reach, timeliness, equity, general barriers and challenges, general facilitators and best practices, and recommendations/improvement for the program. Facilitators and barriers revealed in the interviews primarily revolved around hiring and managing staff, data and technology, and quality of interactions with the public. Based on these facilitators and barriers, we identify suggestions to support effective planning and response for future case notification and contact tracing programs, including recommendations for planning during latent periods, case management and data systems, and processes for outreach to cases and contacts.

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.

Cracking the code of health security: unveiling the balanced indices through rank-ordered effect analysis.

BACKGROUND: Health security is a critical issue which involves multiple dimensions. It has received increasing attention in recent years, especially in China. In order to improve the national health level, China has made many efforts, such as the "Healthy China 2030" plan proposed several years ago. However, due to the complexity of its national conditions and the difficulty of index design, the results of these efforts are not significant. Therefore, it is necessary to construct a new measurement index system. METHODS: Based on the questionnaire of "Health China 2030", we have collected a total of 3,000 participants from all 31 provinces, autonomous regions, and municipalities in China. We used statistical methods such as multiple correspondence analysis and rank-ordered effect analysis to process the data. The balance index is constructed by a series of actions such as weight division, order calculation and ranking. RESULTS: Through multiple correspondence analysis, we can find that there was a close relation in the correspondence space between the satisfaction degrees 1, 2, and 3, while a far distance from satisfaction degrees 4 and 5. There were four positive and four negative indices separately based on the average expected level and four clusters after ordinal rank cluster analysis. Generally speaking, there are no prominent discrepancies across gender and residential areas. CONCLUSIONS: We created and examined balanced indicators for health security in China based on the "Health China 2030" questionnaire. The findings of this study give insight into the overall situation of health security in China and indicate opportunities for improvement.

Key stakeholders' perspectives of public health emergency preparedness in Palestine: A qualitative exploratory study.

OBJECTIVES: Palestine continues to face emergencies and a series of humanitarian crises. This study aims to comprehend emergency planning and response including the recent COVID-19 pandemic. Comprehending and recording these experiences will facilitate on-going improvement of Palestine's Public Health Emergency Preparedness (PHEP). STUDY DESIGN: A qualitative exploratory study. METHODS: Fifteen semi-structured interviews were conducted with key informant decision-makers representing various sectors of the Palestinian health system. The data collection period took place from April 2022-December 2022. A convenient purposive sample was chosen based on identifying important stakeholders in the West Bank's health sector. Every interview was transcribed. Major themes and subthemes were identified using content thematic analysis. RESULTS: The study demonstrates Palestine's inadequate preparation for emergencies, instead there is a focus on response once a crisis has occurred. No national entity or mechanism is leading the collective preparedness efforts, which might ultimately result in a stronger emergency response. Instead, the efforts are dispersed across several entities, and decisions are not made cooperatively. As for resources, the study indicates that an emergency budget has not been allocated. The study showed a good degree of multi-sectoral collaboration with some reservations regarding the creation of various committees and their efficacy in handling crises. CONCLUSION: The findings made it abundantly evident that significant efforts are needed to improve Palestine's level of preparedness and planning. One of the study's primary conclusions is that the health sector must shift from a reactionary to a preparedness-oriented mindset. Additionally, it is necessary to keep an eye on any changes in the nation's health and analysis must take place to strengthen the health system's response plans. Moreover, the activation of the emergency operation center in Palestine is one of the key advancements of the preparedness system.

Unleashing excellence: using a project management approach to effectively implement a simulation curriculum to improve residents' preparedness.

BACKGROUND: Integrating innovative, simulation-based training programs into medical curricula frequently encounters familiar challenges, including scepticism, limited faculty time, and financial constraints. Recognized for its success in business projects, the Harvard Project Management Theory emerges as a promising approach to optimizing the implementation process and achieving sustainable success. This study endeavours to elucidate the application of project management theory in our implementation process and assess its impact on the clinical preparedness of novice residents. METHODS: The research utilized a structured four-phase implementation strategy-Planning, Build-up, Execution, and Closing-to develop a simulation-based education curriculum. Incorporating project management tools like project charters and risk management tools played a crucial role in facilitating the effective implementation of standardized processes and improved clinical outcomes. Essential components of this innovative management approach encompass stakeholder engagement, milestone definition, and the alignment of institutional policies and processes. RESULTS: A collective of 395 residents actively engaged in eight monthly simulation-based events, reflecting an average participation rate of 39 residents per lecture (± 19). A noteworthy enhancement was observed in the average rating for knowledge gain, with a significant improvement from 5.9/10 to 8.8/10 (p = 0.0001). Participants highlighted the program's considerable impact on future clinical practice (4.7/5) and teamwork (4.8/5) as particularly valuable aspects. The introduction of a novel organizational structure received favourable feedback from faculty members, with a notable rating of 4.8/5 for predictive time planning. Qualitative insights from the evaluation highlighted the significance of targeted incentive schemes in optimizing the implementation process. CONCLUSION: This project underscores the constructive influence of project management principles in designing simulation-based curricula, explicitly focusing on stakeholder engagement, faculty motivation, and data utilization. Adopting the Harvard Project Management Approach emerges as a catalyst for heightened success in curriculum design, contributing to enhanced emergency preparedness among novice residents. The positive outcomes observed in this study provide valuable insights for future implementations, offering a foundation for refining and optimizing medical education programs to meet the evolving needs of learners and stakeholders alike.

"The genie is out of the bottle": a qualitative study on the impact of COVID-19 on continuing professional development.

BACKGROUND: The onset of the COVID-19 pandemic catalysed a monumental shift in the field of continuing professional development (CPD). Prior to this, the majority of CPD group-learning activities were offered in-person. However, the pandemic forced the field to quickly pivot towards more novel methods of learning and teaching in view of social distancing regulations. The purpose of this study was to obtain the perspectives of CPD leaders on the impact of the pandemic to elucidate trends, innovations, and potential future directions in the field. METHODS: Semi-structured interviews were conducted between April-September 2022 with 23 CPD leaders from Canada and the USA. Interviews were audio-recorded, transcribed, and de-identified. A thematic analysis approach was used to analyse the data and generate themes. RESULTS: Participants characterised COVID-19 as compelling widespread change in the field of CPD. From the interviews, researchers generated six themes pertaining to the impact of the pandemic on CPD: (1) necessity is the mother of innovation, (2) the paradox of flexibility and accessibility, (3) we're not going to unring the bell, (4) reimagining design and delivery, (5) creating an evaluative culture, and (6) a lifeline in times of turmoil. CONCLUSION: This qualitative study discusses the impact of the pandemic on the field of CPD and leaders' vision for the future. Despite innumerable challenges, the pandemic created opportunities to reform design and delivery. Our findings indicate a necessity to maintain an innovative culture to best support learners, to improve the healthcare system, and to prepare for future emergencies.

Mapping and analysing community health worker programmes in the Eastern Mediterranean region.

BACKGROUND: Community health worker (CHW) programmes are increasingly being recognized as an important strategy that can help to strengthen comprehensive primary health care (PHC), as the foundation of work towards achieving universal health care (UHC) and meeting the Sustainable Development Goals (SDGs). The WHO Regional Office for the Eastern Mediterranean undertook a situational analysis of CHW programmes in the Region to better understand the current situation and the issues involved. METHODS: A two-step process was employed: a review of available literature on CHWs in the Region was conducted, followed by a survey of CHW programmes in the region, focussing on programmes that were country-led and country-wide. RESULTS: Thirteen countries were found to have community health worker programmes with varying governance and programmatic structures. Broadly, two categories can be distinguished: (a) several countries have well established and mature national CHW programmes that are in most cases supported by external donors but driven and coordinated by national governments; (b) a greater number of countries that have smaller, emerging government or partner led projects and programmes. A few countries have deliberately opted for other models to strengthen primary care and community outreach, for example, through community nursing. CONCLUSION: CHW programmes play an increasingly important role in primary health care in the Eastern Mediterranean Region, providing promotive, preventive, and emergency services. This bodes well for efforts to strengthen and embed comprehensive primary health care as the foundation of national health systems, to improve health emergency preparedness, achieve UHC and meet the SDGs. Nonetheless, all but a few programmes face challenges of weak governance, fragmentation and unreliable support, similar to those in other countries. However, the main finding of the analysis was that the role of CHWs in countries' health service delivery is woefully under-researched in almost all countries in the region, and more research to better understand and support programmes in the context of local health system contexts is urgently needed.

A comprehensive review of dose limits, triage systems and measurement tools for consequence management of nuclear and radiological emergencies.

During a radiological or nuclear emergency, occupational workers, members of the public, and emergency responders may be exposed to radionuclides, whether external or internal, through inhalation, ingestion, or wounds. In the case of internalized radiation exposure, prompt assessment of contamination is necessary to inform subsequent medical interventions. This review assembles the constituent considerations for managing nuclear and radiological incidents, focused on a parallel analysis of the evolution of radiation dose limits - notably in the emergency preparedness and response realm - alongside a discussion of triage systems and in vivo radionuclide detection tools. The review maps the development of international and national standards and regulations concerning radiation dose limits, illuminating how past incidents and accumulated knowledge have informed present emergency preparedness and response practices, specifically for internalized radiation. Additionally, the objectives and levels of radiation triage systems are explored in-depth, along with a global survey of practices and protocols. Finally, this review also focuses on in vivo detection systems and their capacities for radionuclide identification, prioritizing internalized gamma-emitting isotopes due to their broader relevance. Collectively, this study comprehensively addresses the intricacies of triage management following radiation emergencies, emphasizing the imperative for enhanced standardization and continued research in this critical domain.

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.

Emergency Department and Health Care System Factors Associated with Telehealth Innovation During the COVID-19 Pandemic.

Objective: Telehealth capacity may be an important component of pandemic response infrastructure. We aimed to examine changes in the telehealth use by the US emergency departments (EDs) during COVID-19, and to determine whether existing telehealth infrastructure or increased system integration were associated with increased likelihood of use. Methods: We analyzed 2016-2020 National ED Inventory (NEDI)-USA data, including ED characteristics and nature of telehealth use for all US EDs. American Hospital Association data characterized EDs' system integration. An ordinary least-squares regression model obtained one-step-ahead forecast of the expected proportion of EDs using telehealth in 2020 based on growth observed from 2016 to 2019. Among EDs without telehealth in 2019, we used logistic regression models to examine whether system membership or existing telehealth infrastructure were associated with odds of innovation in telehealth use in 2020, accounting for ED characteristics. Results: Of 4,038 EDs responding to telehealth questions in 2019 and 2020 (73% response rate), 3,015 used telehealth in 2020. Telehealth use by US EDs increased more than expected in 2020 (2016: 58%, 2017: 61%, 2018: 65%, 2019: 67%, 2020: 74%, greater than predicted 71%, p = 0.004). Existing telehealth infrastructure was associated with increased telehealth innovation (OR = 1.88, 95% CI: 1.49-2.36), whereas hospital system membership was not (odds ratio [OR] = 1.00, 95% confidence interval [CI]: 0.80-1.25). Conclusions: Telehealth use by US EDs in 2020 grew more than expected and preexisting telehealth infrastructure was associated with increased innovation in its use. Preparation for future pandemic responses may benefit from considering strategies to invest in local infrastructure to facilitate technology adoption and innovation.

Understanding Physical Distancing and Face Mask Use Across High-Risk African American Subgroups During the COVID-19 Pandemic: Application of Health Belief Model.

Physical distancing and face masks remain frontline prevention strategies due to suboptimal vaccine uptake and the highly infectious COVID-19 variants. Communities of color are disproportionately impacted by a chronic disease burden that places them at higher risk of severe COVID-19 disease. Therefore, they can greatly benefit from face mask use and physical distancing, especially if the individual(s) have not received the vaccine. We applied the Health Belief Model to explore barriers and motivators influencing physical distancing and face mask use among high-risk, Black American subgroups during the early COVID-19 pandemic stages. We conducted 62 semi-structured interviews among four Black American subgroups: young adults, individuals with underlying medical conditions, essential workers, and parents. Thematic analysis, guided by the Health Belief Model, yielded six themes: (1) Knowledge on Face Mask Use and Physical Distancing, (2) Perceived Susceptibility and Severity Varies by Subgroup, (3) Experience with and Perceived Self-Efficacy to Engage in Preventive Behavior, (4) Perceived Benefits to engaging in preventive behaviors, (5) Perceived Barriers to engage in preventive behaviors, and (6) Cues to action to increase participation. Each subgroup's unique experience informed multilevel, tailored approaches that can be used by health promotion practitioners to improve face mask use and physical distancing among uniquely vulnerable Black American subgroups in the current and future pandemic.

Calibration of medical gamma cameras for estimation of internal contamination from137Cs.

Calibration of 22 gamma camera units was performed at 15 hospitals in southern and western Sweden to estimate137Cs contamination in humans in a supine static geometry, with a new developed calibration protocol and phantom. The minimum detectable activities (MDAs) and the estimated committed effective doses (CEDs) were calculated for each calibration. Generic calibration factors were calculated for five predetermined groups based on the detector type and manufacturer. Group 1 and 2 included NaI-based gamma cameras from General Electrics (GEs) with a crystal thickness of 5/8'' and 3/8'' respectively. Group 3 and 4 included NaI-based gamma cameras from Siemens Healthineers with a crystal thickness of 3/8'', with a similar energy window as the GE NaI-based cameras and a dual window respectively. Group 5 included semiconductor-based gamma cameras from GE with a CdZnTe (CZT) detector. The generic calibration factors were 60.0 cps kBq-1, 52.3 cps kBq-1, 50.3 cps kBq-1, 53.2 cps kBq-1and 48.4 cps kBq-1for group 1, 2, 3, 4, and 5 respectively. The MDAs ranged between 169 and 1130 Bq for all groups, with measurement times of 1-10 min, corresponding to a CED of 4.77-77.6µSv. A dead time analysis was performed for group 1 and suggested a dead time of 3.17µs for137Cs measurements. The dead time analysis showed that a maximum count rate of 232 kcps could be measured in the calibration geometry, corresponding to a CED of 108-263 mSv. It has been shown that semiconductor-based gamma cameras with CZT detectors are feasible for estimating137Cs contamination. The generic calibration factors derived in this study can be used for gamma cameras of the same models in other hospitals, for measurements in the same measurement geometry. This will increase the measurement capability for estimating internal137Cs contamination in the recovery phase following radiological or nuclear events.

Usefulness and limitations of various detector systems for estimation of131I thyroid activity following an RN event.

Following a radiological or nuclear (RN) event, rapid measurement of131I in members of the public is of utmost importance, and much equipment is needed for a high throughput. In this study, three gamma cameras (GCs), two thyroid uptake meters (TUMs) and one whole-body counter (WBC) were calibrated for activity measurements of131I in the thyroid. Minimum detectable activity was derived for the GCs, the TUMs and the WBC giving that a committed effective dose (CED) in the interval 2.0-85µSv, 13-700µSv and 0.52-6.4µSv, and thyroid absorbed doses in the interval 0.075-2.1 mGy, 0.48-17 mGy, and 0.020-0.15 mGy, respectively, can be assessed for children, adolescents, and adults. These numbers are based on 10 min measurement, performed at 1, 3 and 7 d after intake, and the CED includes intake by ingestion and inhalation of aerosols Type F, with an activity median aerodynamic diameter of 1µm. For a fractional signal loss of 63% due to dead time, a CED up to 2.0, 84 and 3.6 Sv and thyroid absorbed dose up to 47 Gy, 2000 Gy and 88 Gy for the three systems, respectively, can be assessed for children and intake by ingestion as a worst-case scenario in terms of CED, measured 7 d after intake. This study demonstrates the potential and limitations of using equipment readily available at larger hospitals for estimation of131I content in thyroid, which could increase the measurement capability following an RN event.

Rebuilding Caribbean Environmental Health Post-Crisis Programs: A Preliminary Study for Virtual Mentorship.

After the hurricanes in 2017 in the U.S. Caribbean, it was essential to rebuild, strengthen, and sustain essential environmental health (EH) services and systems. The National Environmental Health Association, in partnership with the Centers for Disease Control and Prevention, developed an online mentorship program for newly hired and existing EH staff and health department leadership in Caribbean health departments. Participants were provided with both practical and didactic learning and were allowed to evaluate the program. Both mentors and mentees were highly satisfied with the knowledge and skills acquired, and mentees expressed it was relevant to their daily work. Based on the findings, we recommend both an online and a hybrid mentorship program for leadership- and inspector-level workforces in EH and potentially in other fields.

Do Experienced Nurses Benefit From Training on Bleeding Control in the Community Setting?

INTRODUCTION: Nurses' preparedness to provide hemorrhage control aid outside of the patient care setting has not been thoroughly evaluated. We evaluated nurses' preparedness to provide hemorrhage control in the prehospital setting after a proof-of-concept training event. METHODS: We performed a secondary analysis of evaluations from a voluntary hemorrhage control training offered to a group of experienced nurses. Education was provided by a nurse certified in Stop the Bleed training and using the Basic Bleeding Control 2.0 materials. The training lasted approximately 1 hour and included a didactic portion followed by hands-on practice with task trainer legs. Participants were surveyed after training to assess their preparedness to provide hemorrhage control aid using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree); comments and feedback were also requested. Mean (SD) was used to analyze Likert scale data. Content analysis was performed to identify common themes in qualitative data. RESULTS: Forty-five experienced nurses participated in the voluntary training. Nursing experience included obstetrics, pediatrics, critical care, acute care, community health, and psychiatric/mental health. Only 39% of participants reported having previously completed a similar course. After training completion, participants reported an increase in their preparedness to provide hemorrhage control aid (mean 3.47 [SD = 1.40] vs mean 4.8 SD [.04], P < .01). Major themes identified included wanting to feel prepared to help others, refreshing skills, and knowing how to respond in an emergency. DISCUSSION: Regardless of background and experience, nurses may benefit from more advanced hemorrhage control education to prepare them to provide aid in prehospital emergency settings.

[Impact of border control measures on public health center operations and staffing at international airports during the emergence of the SARS-CoV-2 B.1.1.529 (Omicron) variant of concern].

Objective　Ota City, located in southeastern Tokyo, including Haneda Tokyo International Airport, has numerous scattered lodging facilities. Shortly after the first case of SARS-CoV-2 B.1.1.529 (Omicron) variant was reported abroad, the Japanese government strengthened border control measures, including quarantine procedures and public health official involvement, for incoming travelers. This study aims to propose effective and efficient border control measures to prevent future outbreaks of emerging and re-emerging infectious diseases.Methods　Border control measures implemented between November 2021 and mid-January 2022 were analyzed from three perspectives: chronological changes in government notifications, the situation of in-flight contacts and Omicron cases, and the support system for coronavirus-disease 2019 control department of the Ota City Public Health Center. Additionally, a questionnaire survey was conducted among public health centers with jurisdiction over the top four international airports. This survey aimed to assess the effectiveness of the support system, evaluate cooperation with related organizations, identify common issues faced by public health concerns, and gather suggestions for improvements in future border control measures.Results　The definition and treatment of in-flight contacts of Omicron-positive individuals were initially outlined on November 30, 2021, and underwent frequent revisions until January 14, 2022. Between December 1, 2021, and January 12, 2022, only one Omicron case was identified among the 470 tests conducted on in-flight contacts. However, out of 136 additional domestic specimens collected (including 57 positives for genetic analysis), 40 were confirmed Omicron positive. The results of the questionnaire survey across the four public health centers largely mirrored the issues and suggestions identified by Ota City officials. A significant portion of these issues arose from managing temporary non-Japanese residents staying near international airports.Conclusion　Border control measures should be implemented to delay the domestic spread of the virus. In this reason, it is crucial to avoid placing an undue burden on public health officials responsible for handling domestic infections. Since response policies and target definitions may need to adapt to unknown pathogens, they may be changed frequently, baffling the officials; however, a system for collecting real-time data from frontline sites and making evidence-based decisions is essential. Additionally, deploying liaisons from national and prefectural governments to focal points of emergency response would strengthen the support system by promoting unified instructions and information sharing.

Kidney health for all: preparedness for the unexpected in supporting the vulnerable.

As the rate of natural disasters and other devastating events caused by human activities increases, the burden on the health and well-being of those affected by kidney disease has been immeasurable. Health system preparedness, which involves creating a resilient system that is able to deal with the health needs of the entire community during times of unexpected disruptions to usual care, has become globally important. In the wake of the COVID-19 pandemic, there is a heightened awareness of the amplification of negative effects on the renal community. Paradoxically, the complex medical needs of those who have kidney diseases are not met by systems handling crises, often compounded by an acute increase in burden via new patients as a result of the crisis itself. Disruptions in kidney care as a result of unexpected events are becoming more prevalent and likely to increase in the years to come. It is therefore only appropriate that the theme for this year's World Kidney Day will focus on Kidney Health for All: preparedness for the unexpected in supporting the vulnerable.

Sustainable and Resilient Health Care in the Face of a Changing Climate.

Climate change is a threat multiplier, exacerbating underlying vulnerabilities, worsening human health, and disrupting health systems' abilities to deliver high-quality continuous care. This review synthesizes the evidence of what the health care sector can do to adapt to a changing climate while reducing its own climate impact, identifies barriers to change, and makes recommendations to achieve sustainable, resilient health care systems.

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.

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.