[Management of COVID-19 mass casualty incidents in nursing and retirement homes]. / Managementstrategie für den Massenanfall von Erkrankten/Infizierten in Alten- und Pflegeheimen im Kontext der COVID-19-Pandemie.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, outbreaks in inpatient care facilities, which grow into a large-scale emergency scenario, are frequently observed. A standardized procedure analogous to algorithms for mass casualty incidents (MCI) is lacking. METHODS: Based on a case report and the literature, the authors present a management strategy for infectious MCI during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and distinguish it from traumatic MCI deployment tactics. RESULTS: This management strategy can be divided into three phases, beginning with the acute emergency response including triage, stabilization of critical patients, and transport of patients requiring hospitalization. Phase 2 involves securing the facility's operational readiness, or housing residents elsewhere in case staff are infected or quarantined to a relevant degree. Phase 3 marks the return to regular operations. DISCUSSION: Phase 1 is based on usual MCI principles, phase 2 on hospital crisis management. Avoiding evacuation of residents to relieve hospitals is an important operational objective. The lack of mission and training experience with such situations, the limited applicability of established triage algorithms, and the need to coordinate a large number of participants pose challenges. CONCLUSION: This strategic model offers a practical, holistic approach to the management of infectious mass casualty scenarios in nursing facilities.

Perceptions of Resilience and Physical Health Symptom Improvement Following Post Disaster Integrated Health Services.

OBJECTIVE: Theorists and researchers have linked resilience with a host of positive psychological and physical health outcomes. This paper examines perceptions of resilience and physical health symptoms in a sample of individuals exposed to multiple community disasters following involvement in integrated mental health services. METHODS: A multiwave naturalistic design was used to follow 762 adult clinic patients (72% female; 28% minority status), ages 18-92 years (mean age=40 years), who were evaluated for resilience and physical health symptoms prior to receiving services and at 1, 3, and 6 months' follow-up. RESULTS: Data indicated increases in perceptions of resilience and decreased physical health symptoms reported over time. Results also indicated that resilience predicted physical health symptoms, such that resilience and physical health symptoms were negatively associated (ie, improved resilience was associated with decreases in physical health symptoms). These effects were primarily observed for those individuals with previous exposure to natural disasters. CONCLUSIONS: Findings provide correlational evidence for behavioral health treatment provided as part of a stepped-care, collaborative model in reducing physical health symptoms and increasing resilience post-disaster. Controlled trials are warranted. (Disaster Med Public Health Preparedness. 2019;13:223-229).

Integrating Health System Preparedness and Community Resilience: Using the CMS Preparedness Rule as a Focusing Event.

This commentary discusses the prospect and value of using the preparedness rule developed and implemented by the Centers for Medicare and Medicaid Services as a focal point for better integrating health system preparedness into broader community resilience efforts, whether at the local or international level. Much attention has been given to the idea that community resilience requires extensive collaboration and coordination between actors across sectors, elements that are vital to effective emergency preparedness in health care as well. To facilitate improved fiscal sustainability, the federal government has since 2012 been encouraging healthcare coalitions to pursue nonprofit status. Building such organizations for the long term will require coalitions to become more proactive in involving organizations outside of the health sector. The preparedness rule has done much to encourage more dialogue between health system actors, and we argue that this momentum should be carried forward to generate a broader discussion of the importance of health preparedness to community resilience. The value of embedding preparedness planning into larger community resilience initiatives is discussed.

Evaluation of Regional Vulnerability to Disasters by People of Ishikawa, Japan: A Cross Sectional Study Using National Health Insurance Data.

The 2013 Partial Amendment of the Disaster Countermeasures Basic Law mandated that a roster of vulnerable persons during disasters be created, and further development of evacuation support is expected. In this study, the number of vulnerable people living in target analytical areas are identified in terms of neighborhood units by using the National Health Insurance Database to create a realistic and efficient evacuation support plan. Later, after considering the "vulnerability" of an area to earthquake disaster damage, a quantitative evaluation of the state of the disaster is performed using a principle component analysis that further divided the analytical target areas into neighborhood units to make a detailed determination of the number of disaster-vulnerable persons, the severity of the disaster, etc. The results of the disaster evaluation performed after considering the vulnerability of an area are that 628 disaster-vulnerable persons live in areas with a relatively higher disaster evaluation value.

Midwives' Professional Competencies for Preventing Maternal Mortality in Disasters: A Cross-Sectional Study in Iran.

OBJECTIVE: Maternal mortality may increase after a disaster. Because midwives are at the frontline of offering reproductive health care services in disasters, they should be competent. METHODS: This was a cross-sectional, descriptive study carried out in 2015 in Tehran. The sample consisted of 361 midwives selected by use of a cluster random sampling method. Data were collected by using a questionnaire on professional competency for preventing maternal mortality in disasters. RESULTS: The midwives' mean professional competency score was 177.74±31, which was an average level of professional competency. The level of knowledge and skills of the midwives was reported as inadequate for most items, particularly for the items of "managing mothers affected by chronic diseases," "physical trauma," "recognizing patients who needed to be referred," and "stabilizing mothers when referring them." Statistically significant relationships were observed between the midwives' competencies and age (P=0.001), work experience (P=0.054), educational level (P= 0.043), previous experience in a disaster (P=0.014), and workplace (P=0.006). These data were drawn by using Spearman's correlation, t-test, and ANOVA, respectively. CONCLUSIONS: Given the average scores for midwives' professional competency in disasters and the inadequacy of prior training courses, extra educational programs for midwives are recommended. (Disaster Med Public Health Preparedness. 2018; 12: 305-311).

Are Commercial Complementary Food Distributions to Refugees and Migrants in Europe Conforming to International Policies and Guidelines on Infant and Young Child Feeding in Emergencies?

In 2015, more than one million migrants and refugees arrived in Europe. Commercial complementary foods, processed foods marketed for infants and young children 6-23 months of age, were distributed by various humanitarian actors along migrant routes and in European refugee camps. Unsolicited donations and distributions of commercial complementary food products were problematic and divergent from international policies on infant and young child feeding during humanitarian emergencies. Interim guidance regarding commercial complementary foods was published during the peak of the emergency but implemented differently by various humanitarian actors. Clearer and more technical specifications on commercial complementary foods are needed in order to objectively determine their suitability for operational contexts in Europe and emergency nutrition assistance in the future.

What are the most common domains of the core competencies of disaster nursing? A scoping review.

AIM: Scoping review was conducted to identify the most common domains of the core competencies of disaster nursing. BACKGROUND: Nurses play an essential role in all phases of disaster management. For nurses to respond competently, they must be equipped with the skills to provide comprehensive and holistic care to the populations affected by or at risk of disasters. METHODS: A scoping review was conducted using the Joanna Briggs Institute methodology. The review used information from six databases: the Cumulative Index to Nursing and Allied Health Literature, Ovid MEDLINE, ScienceDirect, ProQuest, Scopus and the Education Resources Information Center. Keywords and inclusion and exclusion criteria were identified as strategies to use in this review. RESULTS: Twelve studies were eligible for result extraction, as they listed domains of the core competencies. These domains varied among studies. However, the most common domains were related to communication, planning, decontamination and safety, the Incident Command System and ethics. CONCLUSION: Knowledge of the domains of the core competencies, such as understanding the content and location of the disaster plan, communication during disaster and ethical issues is fundamental for nurses. Including these domains in the planning and provision of training for nurses, such as disaster drills, will strengthen their preparedness to respond competently to disaster cases. Nurses must be involved in future research in this area to explore and describe their fundamental competencies in each domain.

Vulnerable Populations in Hospital and Health Care Emergency Preparedness Planning: A Comprehensive Framework for Inclusion.

INTRODUCTION: As attention to emergency preparedness becomes a critical element of health care facility operations planning, efforts to recognize and integrate the needs of vulnerable populations in a comprehensive manner have lagged. This not only results in decreased levels of equitable service, but also affects the functioning of the health care system in disasters. While this report emphasizes the United States context, the concepts and approaches apply beyond this setting. OBJECTIVE: This report: (1) describes a conceptual framework that provides a model for the inclusion of vulnerable populations into integrated health care and public health preparedness; and (2) applies this model to a pilot study. METHODS: The framework is derived from literature, hospital regulatory policy, and health care standards, laying out the communication and relational interfaces that must occur at the systems, organizational, and community levels for a successful multi-level health care systems response that is inclusive of diverse populations explicitly. The pilot study illustrates the application of key elements of the framework, using a four-pronged approach that incorporates both quantitative and qualitative methods for deriving information that can inform hospital and health facility preparedness planning. CONCLUSIONS: The conceptual framework and model, applied to a pilot project, guide expanded work that ultimately can result in methodologically robust approaches to comprehensively incorporating vulnerable populations into the fabric of hospital disaster preparedness at levels from local to national, thus supporting best practices for a community resilience approach to disaster preparedness.

The future of exposure assessment: perspectives from the X2012 Conference.

The British Occupational Hygiene Society, in collaboration with the Institute of Occupational Medicine, the University of Manchester, the UK Health and Safety Executive, and the University of Aberdeen hosted the 7th International Conference on the Science of Exposure Assessment (X2012) on 2 July-5 July 2012 in Edinburgh, UK. The conference ended with a special session at which invited speakers from government, industry, independent research institutes, and academia were asked to reflect on the conference and discuss what may now constitute the important highlights or drivers of future exposure assessment research. This article summarizes these discussions with respect to current and future technical and methodological developments. For the exposure science community to continue to have an impact in protecting public health, additional efforts need to be made to improve partnerships and cross-disciplinary collaborations, although it is equally important to ensure that the traditional occupational exposure themes are still covered as these issues are becoming increasingly important in the developing world. To facilitate this the 'X' conferences should continue to retain a holistic approach to occupational and non-occupational exposures and should actively pursue collaborations with other disciplines and professional organizations to increase the presence of consumer and environmental exposure scientists.

The integration of mental and behavioral health into disaster preparedness, response, and recovery.

The close interplay between mental health and physical health makes it critical to integrate mental and behavioral health considerations into all aspects of public health and medical disaster management. Therefore, the National Biodefense Science Board (NBSB) convened the Disaster Mental Health Subcommittee to assess the progress of the US Department of Health and Human Services (HHS) in integrating mental and behavioral health into disaster and emergency preparedness and response activities. One vital opportunity to improve integration is the development of clear and directive national policy to firmly establish the role of mental and behavioral health as part of a unified public health and medical response to disasters. Integration of mental and behavioral health into disaster preparedness, response, and recovery requires it to be incorporated in assessments and services, addressed in education and training, and founded on and advanced through research. Integration must be supported in underlying policies and administration with clear lines of responsibility for formulating and implementing policy and practice.

The H1N1 crisis: a case study of the integration of mental and behavioral health in public health crises.

In substantial numbers of affected populations, disasters adversely affect well-being and influence the development of emotional problems and dysfunctional behaviors. Nowhere is the integration of mental and behavioral health into broader public health and medical preparedness and response activities more crucial than in disasters such as the 2009-2010 H1N1 influenza pandemic. The National Biodefense Science Board, recognizing that the mental and behavioral health responses to H1N1 were vital to preserving safety and health for the country, requested that the Disaster Mental Health Subcommittee recommend actions for public health officials to prevent and mitigate adverse behavioral health outcomes during the H1N1 pandemic. The subcommittee's recommendations emphasized vulnerable populations and concentrated on interventions, education and training, and communication and messaging. The subcommittee's H1N1 activities and recommendations provide an approach and template for identifying and addressing future efforts related to newly emerging public health and medical emergencies. The many emotional and behavioral health implications of the crisis and the importance of psychological factors in determining the behavior of members of the public argue for a programmatic integration of behavioral health and science expertise in a comprehensive public health response.

Federal disaster mental health response and compliance with best practices.

This study investigated the comprehensiveness of disaster mental health state plans and their adherence to published best practices in three states that experienced post-9/11 federally-declared disasters. There were 59 disaster mental health best practices used in this study to assess each state disaster mental plan's compliance with best practices; the states demonstrated a range of adherence to the best practices. This research may serve as a guide for those developing disaster mental health plans and encourage further considerations in disaster mental health response.

Use of the reciprocal calculation procedure for setting workplace emergency action levels for hydrocarbon mixtures and their relationship to lower explosive limits.

This paper proposes a novel use of the reciprocal calculation procedure (RCP) to calculate workplace emergency action levels (WEALs) for accidental releases of hydrocarbon mixtures. WEALs are defined here as the concentration in air that area monitors should alarm at to provide adequate warning and be sufficiently protective of health to allow at least enough time to don respiratory protective equipment (RPE) and escape. The rationale for the approach is analysed, and ways of defining suitable substance group guidance values (GVs) for input into the RCP are considered and compared. WEAL GVs could be based on: 3× RCP GVs (i.e. using the 3× rule), the 5× RCP GVs (i.e. using the 5× rule for calculating ceiling values), emergency exposure limits, or immediately dangerous to life or health values (IDLHs). Of these, the method of choice is to base WEAL GVs on health-based IDLH values, which were developed for emergency situations in the workplace. However, IDLHs have only been set for 11 hydrocarbons, so the choice of GVs is also informed by comparison with possible GVs based on the other approaches. Using the proposed GVs, WEALs were calculated for various hydrocarbon mixtures, and the way they vary with the composition of the mixture was examined. Also, the level of health protection given by the current practice of setting emergency area alarms in the oil and gas industry at 10% of the lower explosive limit (LEL) was tested by comparing this with the WEAL. In the event of an accidental release, this comparison suggests that, provided that aromatics constitute <50% of the mixture, an alarm set at 10% LEL should provide adequate warning and be sufficiently protective of health to at allow at least enough time to don RPE and escape. In the absence of better information or specific acute toxicity concerns (such as the presence of hydrogen sulphide), it is proposed that the WEALs be used as a guide for assessing the adequacy of area alarm levels in respect of warning of an acute health risk. This work is exploratory (e.g. other rationales for setting GVs are possible) and the approach needs testing on further real-life samples. Although not explored here, the RCP approach may also lend itself to the calculation of in-house short-term exposure limits for hydrocarbon mixtures and other mixtures where the acute toxic end points of the components are similar.

Remodelling reparation: changes in the compensation of victims of natural catastrophes in Belgium and the Netherlands.

The paper presents a comparative analysis of the development and present state of compensation for victims of catastrophes in Belgium and the Netherlands. These two neighbouring countries have both seen legislative changes in this field in recent years, albeit with different outcomes. The paper thus analyses to what extent the two compensation scheme structures allow for conclusions as to the comparative benefits of a comprehensive insurance scheme for natural disasters. From the perspective of law and economics, the evolution of private insurance and public intervention through compensation funds, the preference for private or public solutions and the actual financing of these are examined. Drawing on practical experience, such as the case of flood risks, the solutions are tested in view of incentive-based financing. The paper concludes that the private insurance market is more developed in Belgium than it is in the Netherlands, where the reform process has not yet ended.

Identification of environmentally vulnerable areas with priority for prevention and management of pipeline crude oil spills.

The oil industry is one of the main productive activities in Mexico and has a huge infrastructure, including a wide pipeline network that crosses urban, industrial, agricultural and natural areas. The threat of crude oil spills is greatest in those regions with a high concentration of oil extraction and refining activities, as in the case of the Coatzacoalcos and Tonalá Rivers Low Basin. This study ranked the geosystems of the basin in terms of vulnerability to pipeline crude oil spills. Very high vulnerability (level I) was assigned to the water bodies (lakes and rivers) and their margins of influence, including surfaces that flood during normal hydraulic load. High vulnerability areas (level II) comprised surfaces that can flood during extraordinary hydraulic load related with extreme hydrometeorological events. The remaining three vulnerability levels were defined for areas with low or negligible flooding potential, these were ranked according to physical (slope, relief and permeability), biological (richness, singularity and integrity) and socio-economic (social marginalization index and economic activities index) conditions. These results are presented on a map for better visualization and interpretation. This study will be useful to establish preventive and effective emergency management actions in order to reduce remediation costs and adverse effects on wild species. It also can help local and national authorities, oil industry and civil protection corps to better protect ecosystems, natural resources and human activities and goods.

Emergency surgical care delivery in post-earthquake Haiti: Partners in Health and Zanmi Lasante experience.

BACKGROUND: The earthquake that struck Haiti on 12 January 2010 caused significant devastation to both the country and the existing healthcare infrastructure in both urban and rural areas. Most hospital and health care facilities in Port-au-Prince and the surrounding areas were significantly damaged or destroyed. Consequently, large groups of Haitians fled Port-au-Prince for rural areas to seek emergency medical and surgical care. In partnership with the Haitian Ministry of Health, Partners in Health (PIH) and Zanmi Lasante (ZL) have developed and maintained a network of regional and district hospitals in rural Haiti for over twenty-five years. This PIH/ZL system was ideally situated to accommodate the increased need for emergent surgical care in the immediate quake aftermath. The goal of the present study was to provide a cross-sectional assessment of surgical need and care delivery across PIH/ZL facilities after the earthquake in Haiti. METHODS: We conducted a retrospective review of hospital case logs and operative records over the course of three weeks immediately following the earthquake. RESULTS: Roughly 3,000 patients were seen at PIH/ZL sites by a combination of Haitian and international surgical teams. During that period 513 emergency surgical cases were logged. Other than wound debridement, the most commonly performed procedure was fixation of long bone fractures, which constituted approximately one third of all surgical procedures. CONCLUSIONS: There was a significant demand for emergent surgical care after the earthquake in Haiti. The PIH/ZL hospital system played a critical role in addressing this acutely increased burden of surgical disease, and it allowed for large numbers of Haitians to receive needed surgical services. Our experiences reinforce that access to essential surgery is an essential pillar in public health.

Accidental spills at sea--risk, impact, mitigation and the need for co-ordinated post-incident monitoring.

A fully integrated and effective response to an oil or chemical spill at sea must include a well planned and executed post-incident assessment of environmental contamination and damage. While salvage, rescue and clean-up operations are generally well considered, including reviews and exercises, the expertise, resources, networks and logistical planning required to achieve prompt and effective post-spill impact assessment and monitoring are not generally well established. The arrangement and co-ordination of post-incident monitoring and impact assessment need to consider sampling design, biological effects, chemical analysis and collection/interpretation of expert local knowledge. This paper discusses the risks, impacts and mitigation options associated with accidental spills and considers the importance of pre-considered impact assessment and monitoring programmes in the wider response cycle. The PREMIAM (Pollution Response in Emergencies: Marine Impact Assessment and Monitoring; www.premiam.org) project is considered as an example of an improved approach to the planning, co-ordination and conduct of post-incident monitoring.