A Novel Digital Twin Architecture with Similarity-Based Hybrid Modeling for Supporting Dependable Disaster Management Systems.

Disaster management systems require accurate disaster monitoring and prediction services to reduce damages caused by natural disasters. Digital twins of natural environments can provide the services for the systems with physics-based and data-driven disaster models. However, the digital twins might generate erroneous disaster prediction due to the impracticability of defining high-fidelity physics-based models for complex natural disaster behavior and the dependency of data-driven models on the training dataset. This causes disaster management systems to inappropriately use disaster response resources, including medical personnel, rescue equipment and relief supplies, to ensure that it may increase the damages from the natural disasters. This study proposes a digital twin architecture to provide accurate disaster prediction services with a similarity-based hybrid modeling scheme. The hybrid modeling scheme creates a hybrid disaster model that compensates for the errors of physics-based prediction results with a data-driven error correction model to enhance the prediction accuracy. The similarity-based hybrid modeling scheme reduces errors from the data dependency of the hybrid model by constructing a training dataset using similarity assessments between the target disaster and the historical disasters. Evaluations in wildfire scenarios show that the digital twin decreases prediction errors by approximately 50% compared with those of the existing schemes.

Training Community Health Workers to Enhance Disaster Resilience.

Community health workers (CHWs) have significant potential to contribute to public health in the United States by promoting disaster preparedness, speeding postdisaster recovery, and building disaster resilience in their communities. To maximize this potential, however, they must undergo rigorous and relevant training. As part of the Gulf Region Health Outreach Program, an appropriate curriculum was developed and delivered in several training sessions conducted from 2013 to 2016. This article provides insights into the primary issues associated with such training and offers a detailed elaboration of the basic and specialized curricula as presented and adapted over the course of the program. We present lessons learned from these training experiences, as reflected in participants' initial ratings and comments, training staff debriefings, and feedback from CHWs working in the field. Informed by this feedback, as well as additional research and conceptual development, we offer recommendations aimed at expanding and refining CHW training curricula in the areas of chronic disease, psychosocial symptoms, community resilience, and environmental health. In addition to curriculum changes, we review policy implications aimed at promoting and facilitating the inclusion of CHWs in disaster response and recovery teams.

Nursing education for disaster preparedness and response.

Catastrophic mass casualty events (MCEs), such as pandemic influenza outbreaks, earthquakes, or large-scale terrorism-related events, quickly and suddenly yield thousands of victims whose needs overwhelm local and regional health care systems, personnel, and resources. Such conditions require deploying scarce resources in a manner that is different from the more common multiple casualty event. This article presents issues associated with providing nursing care under MCE circumstances of scarce resources and the educational needs of nurses to prepare them to effectively respond in these emergencies.

Evaluation of a Disaster Preparedness Curriculum and Medical Students' Views on Preparedness Education Requirements for Health Professionals.

OBJECTIVE: In general, medical students perceive themselves as inadequately prepared to assist in disasters. This study evaluated the impact of a disaster preparedness curriculum and medical students' views toward required preparedness education for health care professionals. METHODS: A comprehensive disaster preparedness curriculum was evaluated on its effect on medical students' views on preparedness education requirements, preparedness, and prior disaster training using self-report survey methodology. RESULTS: Results provide evidence to support curricular effectiveness in significantly increasing initial participant views of health professionals' education requirements, perceived preparedness for integrating professional roles into the emergency response system, and confidence in exposure risk assessment and triage skills. Most participants possessed limited recent prior disaster training and drill experience. Most interestingly, the majority consistently believed throughout the study that disaster preparedness training should be a medical license mandate. CONCLUSIONS: For those instructing current medical students in disaster preparedness, it is suggested that a curriculum be chosen that can create participant initial anticipation, awareness, and belief in the importance of and need for disaster preparedness training. Further investigation is recommended into the relationship between students' perceived training importance and any future curriculum delivery efforts on behalf of required or mandatory preparedness offerings in continuing professional development.

Providing culturally competent care during disasters: strategies for nurses.

Planning for and responding to disasters involves more than traditional emergency management; members of vulnerable populations should be included in the disaster response cycle. Nurses are key to employing culturally competent strategies with vulnerable populations during disasters, enhancing the access of these populations to care and reducing their health disparities.

The earthquake and tsunami--observations by Japanese physicians since the 11 March catastrophe.

Japan was struck by a magnitude 9.0 earthquake and a tsunami on 11 March 2011. Although this catastrophe has caused the most devastating damage to Japan since World War II, we believe that our systematic preparation for disasters somewhat alleviated the damage. Learning lessons from the magnitude 7.3 Great Hanshin earthquake in 1995, the government organized approximately 700 medical teams specialized in disaster management. In this earthquake of 2011, hundreds of medical teams were successfully deployed and started operations within the first 72 hours. Furthermore, the internet, which was not commonly used in 1995, made significant contributions in communication among clinicians and enabled them to promptly identify the needs of the affected hospitals. In addition, medical professional societies took leadership in the logistics of transferring victims away from the disaster zone. We also observed that the spectrum of causes of death is distinct between the earthquakes of 1995 and 2011. In 1995, many victims died from trauma, including crash injury, and delays in providing hemodialysis contributed to additional deaths. In 2011, in contrast, many victims died from drowning in the tsunami, and most survivors did not have life-threatening injuries.

Disaster preparedness for nurses: a teaching guide.

As one of the largest groups of health care providers in the United States, nurses are trained to attend to the physical, psychological, and spiritual needs of their patients, making them highly qualified to influence the outcomes of victims of an emergency situation. Unfortunately, nursing programs offer limited content on delivering care under extreme conditions, and few continuing education programs are available to practicing nurses. This article provides a brief educational presentation that can be used without an extensive time commitment or in-depth instructor knowledge of the subject. The course content has been presented to nurses at the American Red Cross, at local chapter meetings of professional nursing organizations, and to both graduate and undergraduate nursing students. This presentation is not designed to be a comprehensive study of disaster nursing, but serves as a starting point that might lead to further study and encourage active participation in preparedness education and planning.

Improving emergency preparedness capability of rural public health personnel in China.

OBJECTIVES: Since the outbreaks of severe acute respiratory syndrome and avian influenza, improving the emergency preparedness capability of rural public health personnel has become a new priority in building the infrastructure needed to address public health emergencies. The Chinese Government has carried out a series of emergency preparedness education and training programmes to improve the emergency preparedness capability of rural public health personnel nationwide. The purpose of this study was to evaluate and develop a participatory emergency preparedness training programme for rural public health personnel. STUDY DESIGN: The research emphasizes the major components of instructional design, including assessing, designing, delivering and evaluating training. The approach is an integrated system with results from one phase influencing the next, so that a series of steps are followed when developing, implementing and evaluating emergency preparedness training. METHODS: The 226 participants were rural public health personnel from 84 different rural centres for disease control and prevention in China. The programme was evaluated by anonymous questionnaires and semi-structured interviews held prior to training, immediately post-training and 12-months after training (follow-up). RESULTS: The emergency preparedness training resulted in positive shifts in knowledge and skills for rural public health personnel. At follow-up, the knowledge and skill scores of participants declined slightly compared with the post-test levels (P>0.05). However, there was a significant increase compared with the pre-test levels (P<0.01). Moreover, more than 90% of participants reported that this training provided a valuable learning experience and reinforced the importance of emergency preparedness. CONCLUSIONS: The emergency preparedness training programme was effective and feasible in improving the performance of rural public health personnel on emergency response. Further studies are needed to test the efficacy of the training approach for competency improvement.

On the front lines of disaster recovery: Nurse practitioners fill the health care void.

Hurricane Michael made landfall in Florida's northwest Gulf Coast on October 10, 2018, causing massive destruction. It was the first Category 5 storm in recorded history to make landfall in the northeast Gulf Coast and the third most destructive hurricane to hit the continental United States. The health care infrastructure collapsed due to the severe damage to two main acute care hospitals, several heath care facilities, and clinics, resulting in large staff layoffs with many physicians relocating out of the area due to lack or support. With many schools and business destroyed, nearly 3,000 children left the school system along with their families. Ultimately, there were not enough living spaces for first responders and recovery crews, so posthurricane recovery efforts were gravely affected. Here are the stories of four nurse practitioners (NPs) who stepped up and recreated themselves to provide needed health care to several communities ravaged by Hurricane Michael. NPs, as skilled and trusted health care providers, are well-prepared to address the pressing life-threatening needs often associated with disasters such as hurricanes, thus ultimately making a difference in health outcomes in affected communities. It is a testimony for NPs across the state of Florida to be able to practice to their full extent of their education and preparation.

The National Training Strategy for emergency preparedness: collective lessons learned.

Seven distinct National Training Strategy programs were developed to meet the needs of the nation's community healthcare providers. Data on barriers and challenges, lessons learned, and best practices of the seven programs were collected from unpublished grant reports written by National Training Strategy awardees. Commonly reported themes were reviewed and compiled into these collective lessons learned.

Understanding Liability Risks and Protections for Pediatric Providers During Disasters.

Although most health care providers will go through their careers without experiencing a major disaster in their local communities, if one does occur, it can be life and career altering. The American Academy of Pediatrics has been at the forefront of providing education and advocacy on the critical importance of disaster preparedness. From experiences over the past decade, new evidence and analysis have broadened our understanding that the concept of preparedness is also applicable to addressing the unique professional liability risks that can occur when caring for patients and families during a disaster. In our recommendations in this policy statement, we target pediatric health care providers, advocates, and policy makers and address how individuals, institutions, and government can work together to strengthen the system of liability protections during disasters so that appropriate and timely care can be delivered with minimal fear of legal reprisal or confusion.

Emergency Preparedness for Health Professionals in a Statewide AHEC Program: the first two years.

In 2003 through 2005, the California Statewide Area Health Education Centers (AHEC) Program developed an educational delivery system, through partnerships with six AHECs and state organizations concerned with emergency preparedness, to train for public health emergency preparedness the health professionals who practice primarily in the state's medically underserved areas. Four educational modules--General Emergency Preparedness, Bioterrorism, Chemical and Radiologic Agents, and Emerging Infections--were developed and delivered by a trained, multidisciplinary, community-based faculty. The authors discuss the organization, partnerships, curriculum, faculty, characteristics of trainees, outcomes of the program, effects for AHECs, and the evaluation used to commit the organization and program process to the intended program objectives during the two-year period. Over 9,000 health professionals attended one or more of the 462 educational presentations. Approximately one third of attendees were physicians, and 82% of the learners were from sites that typically care for the underserved. Important to the success of the program (which still continues in a revised form) were the types of partnerships, an orientation of the curriculum to all-hazards disaster preparedness, the delivery of educational sessions at clinical sites, and the increased capacities of community AHECs to facilitate continuing professional education. The challenges were the diminished role of a key partner organization, uncertainties within the funding agency, and the widespread geographic area to address.