Evaluation of CBRN Preparedness of German Hospitals with Higher Level of Care: A Cross- Sectional Survey.

OBJECTIVE: Chemical, biological, radiological, and nuclear (CBRN) events with multiple casualties are rare events, but preparedness is crucial for hospitals to respond properly. This study evaluated the preparedness and disaster planning of German hospitals for CBRN incidents. METHODS: In a cross-sectional study, German hospitals with level III (highest level) emergency departments were surveyed using an online questionnaire focusing on risk assessment, infrastructure, hospital disaster planning, and preparedness for CBRN events. RESULTS: Between June and July 2023, 50 hospitals were surveyed. 62.5% of the hospitals had a section on chemical incidents in their disaster plan. A decontamination facility was available in 29.8% of the hospitals and chemical protective suits in 46.8%. The minority of the hospitals trained the correct handling of personal protective equipment (PPE) (39.1%) regularly or had frequent CBRN drills (21.3%). Most hospitals had the infrastructure for medical isolation (93.6%). CONCLUSIONS: The level of CBRN preparedness is heterogeneous for German hospitals. Most were well prepared for infectious patients, but only half of all hospitals had sufficient PPE for chemical incidents and only 30% had a decontamination facility available. Overall, the level of CBRN preparedness is still insufficient and needs further improvement.

Understanding Barriers and Facilitators to Disaster Preparedness in Federally Qualified Health Centers in the United States: A Mixed Methods Study.

OBJECTIVE: Severe weather events exacerbate existing health disparities due to poorly managed non-communicable diseases (NCDs). Our objective is to understand the experiences of staff, providers, and administrators (employees) of Federally Qualified Health Centers (FQHCs) in Puerto Rico and the US Virgin Islands (USVI) in providing care to patients living with NCDs in the setting of recent climate-related extreme events. METHODS: We used a convergent mixed-methods study design. A quantitative survey was distributed to employees at 2 FQHCs in Puerto Rico and the USVI, assessing experience with disasters, knowledge of disaster preparedness, the relevance of NCDs, and perceived gaps. Qualitative in-depth interviews explored their experience providing care for NCDs during recent disasters. Quantitative and qualitative data were merged using a narrative approach. RESULTS: Through the integration of quantitative and qualitative data, we recognize: (1) significant gaps in confidence and preparedness of employees with a need for more training; (2) challenges faced by persons with multiple NCDs, especially cardiovascular and mental health disorders; and (3) most clinicians do not discuss disaster preparedness with patients but recognize their important role in community resilience. CONCLUSION: With these results, we recommend strengthening the capacity of FQHCs to address the needs of their patients with NCDs in disasters.

Review of National Health Service England's Emergency Preparedness, Resilience and Response Annual Assurance for 2021-2022.

OBJECTIVE: National Health Service (NHS) England conducts annual assurance of NHS bodies in England's readiness to respond to emergencies using its Core Standards for emergency preparedness, resilience, and response (EPRR). This review assessed whether the first complete EPRR assurance after England's coronavirus disease (COVID-19) pandemic national response was performed successfully. METHODS: The primary outcome of interest was the quantity of information regarding applicable Core Standards held by NHS England at the end of that assurance. Secondary outcomes were variations between the number of applicable Core Standards and information held by NHS bodies about the number of applicable Core Standards. RESULTS: NHS England recorded the correct number of applicable Core Standards for 88 of the 124 NHS trusts in England which provided general hospital accommodation and services in relation to accidents or emergencies. It recorded an incorrect number of standards for 13 trusts and did not record the number of standards for 23 trusts. CONCLUSION: NHS England's EPRR assurance resulted in correct data not being recorded for over a quarter of the above NHS trusts. This review may also be of interest to other state-level bodies that rely on the high-level assurance of their ability to provide health care during emergencies.

Does Disaster Severity Have a Long-Term Effect on Survivors' Disaster Preparedness? A Survey a Decade after the 2008 Wenchuan Earthquake in China.

OBJECTIVES: Disaster experiences have long-term effects on disaster preparedness. This study examined the long-term (10-y) effect of disaster severity of the 2008 Wenchuan earthquake on survivors' disaster preparedness and the moderating effects of household vulnerability. METHODS: The data were collected in January 2018 covering 30 counties in Wenchuan earthquake-stricken areas. The dependent variable was survivors' disaster preparedness (including overall, material, knowledge and awareness, and action preparedness) in 2018. Disaster severity included survivors' housing damage and county death rate caused by the earthquake in 2008. Household vulnerability is a set of conditions that negatively affects the ability of people to prepare for and withstand disaster, proxied by households' per-capita income and the highest years of schooling of household members. We performed multivariable linear regression models to answer the research questions. RESULTS: A higher county death rate was associated with better overall preparedness (ß = 0.043; P < 0.05) and knowledge and awareness preparedness (ß = 0.018; P < 0.05), but housing damage was not significantly associated with disaster preparedness. The positive association of county death rate with overall preparedness (ß = -0.065; P < 0.05) becomes weaker when a household has a higher per-capita income. Also, with the household per-capita income increasing, the associations of county death rate with material preparedness (ß = -0.037; P < 0.05) and action preparedness (ß = -0.034; P < 0.01) become weaker. CONCLUSIONS: Disaster severity has positive and long-term effects on survivors' disaster preparedness. Also, the positive and long-term effects are affected by household vulnerability. Specifically, the positive and long-term effects of disaster severity on disaster preparedness are more substantial when a household is more vulnerable.

Factors Affecting Nurses' Disaster Preparedness in Türkiye: A Cross-Sectional Study.

OBJECTIVE: It is of critical importance to determine the factors that contribute to nurses' disaster preparedness. This study aimed to examine nurses' perceptions of disaster preparedness and the factors affecting it. METHODS: This descriptive study was conducted with 464 nurses working in the East Marmara region of Türkiye. The data were collected online using the "Personal Information Form," "The Scale of Perception of Disaster Preparedness on Nurses," and the "Adult Motivation Scale." Linear regression analysis was used to analyze the influencing factors. RESULTS: It was found that nurses possessed a high level of perceived disaster preparedness, influenced by individual disaster preparedness, status of receiving disaster-related training, willingness to respond in the case of a disaster, disaster plan awareness, experience with caring for disaster victims, extrinsic motivation, and general motivation. CONCLUSIONS: The results of the study offer evidence that can be implemented by managers and educators to better prepare nurses for disasters. Hospital administrators and policy makers should consider the factors affecting nurses' perception of disaster preparedness to develop solutions for such disasters.

Diabetes mellitus service preparedness and availability: a systematic review and meta-analysis.

Background: In areas with limited resources, the lack of preparedness and limited availability of diabetes mellitus services in healthcare facilities contribute to high rates of illness and death related to diabetes mellitus. As a result, this study focused on analyzing the combined prevalence of preparedness and availability of diabetic services in countries with limited resources. Methods: A comprehensive search was conducted across various databases, such as PubMed/MEDLINE, Web of Science, Google Scholar, and African Journal Online. The search aimed to identify primary research articles that assessed the availability and preparedness of services for individuals with type 2 diabetes mellitus specifically. The articles included in the search spanned from January 2000 to 23 February 2024. To analyze the data, a meta-analysis of proportions was performed using the random-effects model. Additionally, the researchers assessed publication bias by examining a funnel plot and conducting Egger's test. Heterogeneity and sensitivity analyses were also conducted to evaluate the data. The findings of the study regarding the pooled prevalence of diabetes service preparedness and availability, along with their corresponding 95% confidence intervals, were presented using a forest plot. Results: A comprehensive analysis was conducted on 16 research articles that focused on service preparedness and 11 articles that examined service availability. The sample sizes for these studies were 3,422 for service preparedness and 1,062 for service availability. The findings showed that the pooled prevalence of diabetes service preparedness was 53.0% (95% CI: 47.0-60.0). Furthermore, in this systematic synthesis, the overall pooled prevalence of service availability for diabetes mellitus was 48% (95% CI: 36.0-67.0), with the highest pooled prevalence observed in Asia, with a pooled prevalence of 58% (95% CI: 38.0-89.0). Conclusion: Our study reveals a significant disparity in the preparedness and availability of services for diabetes mellitus, which falls below the minimum threshold set by the WHO. These findings should capture the attention of policymakers and potentially serve as a foundation for reevaluating the current approach to diabetes service preparedness and availability. To enhance the availability and preparedness of diabetes services, a tailored, multifaceted, and action-oriented approach to strengthening the health system is required. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024554911.

Predictors of Emergency Preparedness Among Parents in Hawaii: A Cross-Sectional Survey.

OBJECTIVE: To determine factors predicting emergency preparedness (EP) behaviors among Hawaii parents. METHODS: A cross-sectional online survey of parents of children (age 0-12 y) living in Honolulu, Hawaii, in March 2023 examined associations with (1) having an EP kit (supplies for use during emergencies) and (2) having a family emergency plan (what to do, where to go, how to communicate during emergencies) with demographics/household characteristics and theoretical constructs of the Health Belief Model. A multivariable regression model obtained odds ratios and 95% confidence intervals. RESULTS: Participants (N = 278) were mainly female (84%), college-educated (68%), and were similar in diverse racial/ethnic composure (White; 13.3%) to the overall Honolulu County. Logistic regression determined participants with lower perceived susceptibility to disasters, greater time barriers, and those who needed help to prepare for emergencies were less likely to have an EP kit. Among participants without an EP kit, a website able to create personalized instructions for household EP would be useful. Participants who needed help to prepare for emergencies were less likely to have a family emergency plan. CONCLUSIONS: Future interventions should focus on evidence-based strategies that improve self-efficacy associated with developing EP kits and family emergency plans.

Tailoring Household Disaster Preparedness Interventions to Reduce Health Disparities: Nursing Implications from Machine Learning Importance Features from the 2018-2020 FEMA National Household Survey.

Tailored disaster preparedness interventions may be more effective and equitable, yet little is known about specific factors associated with disaster household preparedness for older adults and/or those with African American/Black identities. This study aims to ascertain differences in the importance features of machine learning models of household disaster preparedness for four groups to inform culturally tailored intervention recommendations for nursing practice. A machine learning model was developed and tested by combining data from the 2018, 2019, and 2020 Federal Emergency Management Agency National Household Survey. The primary outcome variable was a composite readiness score. A total of 252 variables from 15,048 participants were included. Over 10% of the sample self-identified as African American/Black and 30.3% reported being 65 years of age or older. Importance features varied regarding financial and insurance preparedness, information seeking and transportation between groups. These results reiterate the need for targeted interventions to support financial resilience and equitable resource access. Notably, older adults with Black racial identities were the only group where TV, TV news, and the Weather Channel was a priority feature for household disaster preparedness. Additionally, reliance on public transportation was most important among older adults with Black racial identities, highlighting priority needs for equity in disaster preparedness and policy.

Relationship Between Disaster Response Self-Efficacy and Disaster Preparedness in Nursing Students: After-Earthquake Study.

OBJECTIVE: This study was conducted to reveal the relationship between nursing students' disaster response self-efficacy and their disaster preparedness perceptions. METHODS: This cross-sectional study was conducted on nursing students after a major earthquake that occurred in Turkey on February 6, 2023 (n = 302). Data collection took place from June 2023 to October 2023, using the Disaster Response Self-Efficacy Scale (DRSES) and Disaster Preparedness Perception Scale (DPPS). Descriptive statistics, independent samples t-test, correlation, and multiple linear regression analysis were used to analyze the data. RESULTS: Nursing students' DRSES mean score was 63.35 ± 10.83 (moderate level) and DPPS mean score was 3.41 ± 0.50 (high level). A positive and moderate correlation was found between nursing students' DRSES and DPPS scores (r = 0.515; P = 0.000). Predictors affecting nursing students' disaster preparedness are disaster response self-efficacy score, being male, and making a family disaster plan. CONCLUSIONS: The results of this study highlight the importance of increasing the disaster response self-efficacy needed by nursing students to successfully assist patients in disaster situations.

Knowledge, attitude, and practice of health professionals working in emergency units towards disaster and emergency preparedness in South Gondar Zone hospitals, Ethiopia, 2020.

Introduction: catastrophe is a thoughtful community's well-being problem nowadays. Tragedies of any kind can strike at any time and have claimed many lives. Because, the emergency unit is at the frontline of disaster/emergency response system and helps as initial point to the most proper care of causalities, health professionals who are working in this area are the first caregivers, main players, and upfront role in calamity responses after pre-hospital medical services to disaster victims. The aim of this study was to assess emergency unit health professionals´ knowledge, attitude, practice, and related factors towards disasters and emergency preparedness at hospitals in the South Gondar Zone, Ethiopia, 2020. Methods: institution-based cross-sectional study with the census method was conducted at South Gondar Zone hospitals. All health professionals working in emergency units of South Gondar Zone hospitals were taken as a sample. A structured self-administered questionnaire was used to collect data. EPI-data version 4.2 and SPSS version 25 were used to enter and analyze data, respectively. The result was presented by narration, tables, and charts. Binary logistic regression was employed to determine the relations between dependent and independent variables. Results: the majority of the respondents (58.3%) were male. Regarding their profession, 52.2% were nurses, followed by physicians, 18.5%, while the rest were others. The mean age of the respondents was 29.48 ± 6.34 years. A substantial proportion (58.9%) of the study participants didn´t know whether their hospitals had a disaster management plan or not. In general, fifty-one-point seven percent´s (51.7%) of the study participants had poor knowledge toward disaster/emergency preparedness. Concerning their attitude, 55.0% had a negative attitude toward disaster preparedness. Regarding their levels of practice, 67.5% had inadequate practice disaster/emergency preparedness. Age category and profession of the respondents had a significant effect on the knowledge and attitude of respondents at P-value 0.05. Conclusion: more than half of the study participants had poor knowledge, negative attitudes, and inadequate practice about disaster/emergency preparedness.

Disaster Preparedness Training Needs of Healthcare Workers at the US Department of Veterans Affairs.

OBJECTIVES: Training healthcare workers in disaster preparedness has been shown to increase their willingness and ability to report to work during disasters. Little is known, however, about the relation between sociodemographic, household, and workforce characteristics and the desire for such training. Accordingly, this study aimed to assess healthcare workers' desire for additional workforce preparedness training, and the determinants that influence the need for such training, for three types of disasters (natural, pandemic, manmade). METHODS: The US Department of Veterans Affairs (VA) Preparedness Survey was a random, anonymous, Web-based questionnaire fielded nationwide (October-December 2018). Multivariate, logistic regression analyses were conducted. RESULTS: In total, 4026 VA employees, clinical and nonclinical, responded. A total of 61% of respondents wanted additional training for natural, 63% for pandemic, and 68% for manmade disasters. VA supervisors (natural: odds ratio [OR] 1.28, pandemic: OR 1.33, manmade: OR 1.25, P < 0.05) and clinicians (natural: OR 1.24, pandemic: OR 1.24, manmade: OR 1.24, P < 0.05) were more likely to report the need for additional training. Those who reported that they understood their role in disaster response were less likely to report the need for training (natural: OR 0.25, pandemic: OR 0.27, manmade: OR 0.28, P < 0.001), whereas those who perceived their role to be important during response (natural: OR 2.20, pandemic: OR 2.78, manmade: OR 3.13, P < 0.001), and those who reported not being prepared at home for major disasters (natural: OR 1.85, pandemic: OR 1.92, manmade: OR 1.94, P < 0.001), were more likely to indicate a need for training. CONCLUSIONS: Identifying which factors encourage participation in disaster preparedness training can help hospitals and other healthcare providers create targeted training and educational materials to better prepare all hospital staff for future disasters.

An Emergency Preparedness Response to Opioid-Prescribing Enforcement Actions in Maryland, 2018-2019.

Federal and state enforcement authorities have increasingly intervened on the criminal overprescribing of opioids. However, little is known about the health effects these enforcement actions have on patients experiencing disrupted access to prescription opioids or medication-assisted treatment/medication for opioid use disorder. Simultaneously, opioid death rates have increased. In response, the Maryland Department of Health (MDH) has worked to coordinate mitigation strategies with enforcement partners (defined as any federal, state, or local enforcement authority or other governmental investigative authority). One strategy is a standardized protocol to implement emergency response functions, including rapidly identifying health hazards with real-time data access, deploying resources locally, and providing credible messages to partners and the public. From January 2018 through October 2019, MDH used the protocol in response to 12 enforcement actions targeting 34 medical professionals. A total of 9624 patients received Schedule II-V controlled substance prescriptions from affected prescribers under investigation in the 6 months before the respective enforcement action; 9270 (96%) patients were residents of Maryland. Preliminary data indicate fatal overdose events and potential loss of follow-up care among the patient population experiencing disrupted health care as a result of an enforcement action. The success of the strategy hinged on endorsement by leadership; the establishment of federal, state, and local roles and responsibilities; and data sharing. MDH's approach, data sources, and lessons learned may support health departments across the country that are interested in conducting similar activities on the front lines of the opioid crisis.

Using Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses in Real Time : Development, Validation, and Use of a Case Definition, Rhode Island, 2018.

OBJECTIVE: No case definition exists that allows public health authorities to accurately identify opioid overdoses using emergency medical services (EMS) data. We developed and evaluated a case definition for suspected nonfatal opioid overdoses in EMS data. METHODS: To identify suspected opioid overdose-related EMS runs, in 2019 the Rhode Island Department of Health (RIDOH) developed a case definition using the primary impression, secondary impression, selection of naloxone in the dropdown field for medication given, indication of medication response in a dropdown field, and keyword search of the report narrative. We developed the case definition with input from EMS personnel and validated it using an iterative process of random medical record review. We used naloxone administration in consideration with other factors to avoid misclassification of opioid overdoses. RESULTS: In 2018, naloxone was administered during 2513 EMS runs in Rhode Island, of which 1501 met our case definition of a nonfatal opioid overdose. Based on a review of 400 randomly selected EMS runs in which naloxone was administered, the RIDOH case definition accurately identified 90.0% of opioid overdoses and accurately excluded 83.3% of non-opioid overdose-related EMS runs. Use of the case definition enabled analyses that identified key patterns in overdose locations, people who experienced repeat overdoses, and the creation of hotspot maps to inform outbreak detection and response. PRACTICE IMPLICATIONS: EMS data can be an effective tool for monitoring overdoses in real time and informing public health practice. To accurately identify opioid overdose-related EMS runs, the use of a comprehensive case definition is essential.

Evaluation of Emergency Department Pediatric Readiness and Outcomes Among US Trauma Centers.

Importance: The National Pediatric Readiness Project is a US initiative to improve emergency department (ED) readiness to care for acutely ill and injured children. However, it is unclear whether high ED pediatric readiness is associated with improved survival in US trauma centers. Objective: To evaluate the association between ED pediatric readiness, in-hospital mortality, and in-hospital complications among injured children presenting to US trauma centers. Design, Setting, and Participants: A retrospective cohort study of 832 EDs in US trauma centers in 50 states and the District of Columbia was conducted using data from January 1, 2012, through December 31, 2017. Injured children younger than 18 years who were admitted, transferred, or with injury-related death in a participating trauma center were included in the analysis. Subgroups included children with an Injury Severity Score (ISS) of 16 or above, indicating overall seriously injured (accounting for all injuries); any Abbreviated Injury Scale (AIS) score of 3 or above, indicating at least 1 serious injury; a head AIS score of 3 or above, indicating serious brain injury; and need for early use of critical resources. Exposures: Emergency department pediatric readiness for the initial ED visit, measured through the weighted Pediatric Readiness Score (range, 0-100) from the 2013 National Pediatric Readiness Project ED pediatric readiness assessment. Main Outcomes and Measures: In-hospital mortality, with a secondary composite outcome of in-hospital mortality or complication. For the primary measurement tools used, the possible range of the AIS is 0 to 6, with 3 or higher indicating a serious injury; the possible range of the ISS is 0 to 75, with 16 or higher indicating serious overall injury. The weighted Pediatric Readiness Score examines and scores 6 domains; in this study, the lowest quartile included scores of 29 to 62 and the highest quartile included scores of 93 to 100. Results: There were 372 004 injured children (239 273 [64.3%] boys; median age, 10 years [interquartile range, 4-15 years]), including 5700 (1.5%) who died in-hospital and 5018 (1.3%) who developed in-hospital complications. Subgroups included 50 440 children (13.6%) with an ISS of 16 or higher, 124 507 (33.5%) with any AIS score of 3 or higher, 57 368 (15.4%) with a head AIS score of 3 or higher, and 32 671 (8.8%) requiring early use of critical resources. Compared with EDs in the lowest weighted Pediatric Readiness Score quartile, children cared for in the highest ED quartile had lower in-hospital mortality (adjusted odds ratio [aOR], 0.58; 95% CI, 0.45-0.75), but not fewer complications (aOR for the composite outcome 0.88; 95% CI, 0.74-1.04). These findings were consistent across subgroups, strata, and multiple sensitivity analyses. If all children cared for in the lowest-readiness quartiles (1-3) were treated in an ED in the highest quartile of readiness, an additional 126 lives (95% CI, 97-154 lives) might be saved each year in these trauma centers. Conclusions and Relevance: In this cohort study, injured children treated in high-readiness EDs had lower mortality compared with similar children in low-readiness EDs, but not fewer complications. These findings support national efforts to increase ED pediatric readiness in US trauma centers that care for children.

Rethinking hiker preparedness: Association of carrying "10 essentials" with adverse events and satisfaction among day-hikers.

INTRODUCTION: Many trusted organizations recommend a particular set of gear for hikers. Termed the "10 essentials," the importance of these items to wilderness preparedness has not been critically evaluated. We sought to better understand the value of these items in day hiker preparedness by assessing the association between carried items, the occurrence of adverse events, and satisfaction. METHODS: A cross-sectional survey study was conducted at Mount Monadnock (NH) over 4 non-consecutive days. Adults finishing a day hike were invited to participate. The survey assessed items carried, adverse events, satisfaction, and whether hikers felt prepared for the adverse events that occurred. The primary outcome was the occurrence of an adverse event. RESULTS: A total sample of 961 hikers reported 1686 adverse events. Hikers felt prepared for 89% of the events experienced. The most common adverse events reported were thirst (62%), hunger (50%), feeling cold (18%), and needing rain gear (11%). Medical events such as sprains and lacerations made up 18% of all adverse events. Carrying more items was associated with an increased likelihood of reporting an adverse event and a decreased likelihood of adverse events that the hiker was not prepared for, without a change in satisfaction rates. CONCLUSIONS: Carrying more items did not translate into improved satisfaction for day hikers, but was associated with fewer events for which the hiker was unprepared. Other than adverse events related to hunger, thirst, weather, and minor medical events, adverse events were unlikely during this day hike. Nutrition, hydration, and insulation were the items reported as most often needed, followed by a kit to treat minor medical events, while the remaining 6 items were infrequently used.

Critical preparedness and operational response actions directed for the acute and post-acute COVID-19 pandemic in Brazil: the experience of a nationwide outpatient healthcare group.

ABSTRACT: While the new Coronavirus Disease 2019 (COVID-19) pandemic rapidly spread across the world, South America was reached later in relation to Asia, Europe and the United States of America (USA). Brazil concentrates now the largest number of cases in the continent and, as the disease speedily progressed throughout the country, prompt and challenging operational strategies had to be taken by institutions caring for COVID-19 and non-COVID-19 patients in order to assure optimal workflows, triage, and management. Although hospitals in the USA, Europe and Asia have shared their experience on this subject, little has been discussed about such strategies in South America or by the perspective of outpatient centers, which are paramount in the radiology field. This article shares the guidelines adopted early in the pandemic by a nationwide outpatient healthcare center composed by a network of more than 200 patient service centers and nearly 2,000 radiologists in Brazil, discussing operational and patient management strategies, staff protection, changes adopted in the fellowship program, and the effectiveness of such measures.

Impact of the COVID-19 pandemic on emergency and elective hip surgeries in Norway.

Background and purpose - Many countries implemented strict lockdown policies to control the COVID-19 pandemic during March 2020. The impacts of lockdown policies on joint surgeries are unknown. Therefore, we assessed the effects of COVID-19 pandemic lockdown restrictions on the number of emergency and elective hip joint surgeries, and explored whether these procedures are more/less affected by lockdown restrictions than other hospital care.Patients and methods - In 1,344,355 persons aged ≥ 35 years in the Norwegian emergency preparedness (BEREDT C19) register, we studied the daily number of persons having (1) emergency surgeries due to hip fractures, and (2) electively planned surgeries due to hip osteoarthritis before and after COVID-19 lockdown restrictions were implemented nationally on March 13, 2020, for different age and sex groups. Incidence rate ratios (IRR) reflect the after-lockdown number of surgeries divided by the before-lockdown number of surgeries.Results - After-lockdown elective hip surgeries comprised one-third the number of before-lockdown (IRR ∼0.3), which is a greater drop than that seen in all-cause elective hospital care (IRR ∼0.6). Men aged 35-69 had half the number of emergency hip fracture surgeries (IRR ∼0.6), whereas women aged ≥ 70 had the same number of emergency hip fracture surgeries after lockdown (IRR ∼1). Only women aged 35-69 and men aged ≥ 70 had emergency hip fracture surgery rates after lockdown comparable to what may be expected based on analyses of all-cause acute care (IRR ∼0.80)Interpretation - It is important to note for future pandemics management that lockdown restrictions may impact more on scheduled joint surgery than other scheduled hospital care. Lockdown may also impact the number of emergency joint surgeries for men aged ≥ 35 but not those for women aged ≥ 70.

How Many SARS-CoV-2-Infected People Require Hospitalization? Using Random Sample Testing to Better Inform Preparedness Efforts.

CONTEXT: Existing hospitalization ratios for COVID-19 typically use case counts in the denominator, which problematically underestimates total infections because asymptomatic and mildly infected persons rarely get tested. As a result, surge models that rely on case counts to forecast hospital demand may be inaccurately influencing policy and decision-maker action. OBJECTIVE: Based on SARS-CoV-2 prevalence data derived from a statewide random sample (as opposed to relying on reported case counts), we determine the infection-hospitalization ratio (IHR), defined as the percentage of infected individuals who are hospitalized, for various demographic groups in Indiana. Furthermore, for comparison, we show the extent to which case-based hospitalization ratios, compared with the IHR, overestimate the probability of hospitalization by demographic group. DESIGN: Secondary analysis of statewide prevalence data from Indiana, COVID-19 hospitalization data extracted from a statewide health information exchange, and all reported COVID-19 cases to the state health department. SETTING: State of Indiana as of April 30, 2020. MAIN OUTCOME MEASURES: Demographic-stratified IHRs and case-hospitalization ratios. RESULTS: The overall IHR was 2.1% and varied more by age than by race or sex. Infection-hospitalization ratio estimates ranged from 0.4% for those younger than 40 years to 9.2% for those older than 60 years. Hospitalization rates based on case counts overestimated the IHR by a factor of 10, but this overestimation differed by demographic groups, especially age. CONCLUSIONS: In this first study of the IHR based on population prevalence, our results can improve forecasting models of hospital demand-especially in preparation for the upcoming winter period when an increase in SARS CoV-2 infections is expected.

New York State Local Health Department Preparedness for and Response to the COVID-19 Pandemic: An In-Progress Review.

A mixed-methods approach was taken to describe lessons learned by local health department leaders during the early stages of the COVID-19 pandemic in New York State and to document leaders' assessments of their departments' emergency preparedness capabilities and capacities. Leaders participating in a survey rated the effectiveness of their department's capabilities and capacities in administrative and public health preparedness, epidemiology, and communications on a scale from 1 to 5; those partaking in focus groups answered open-ended questions about the same 4 topics. Subjects rated intragovernmental activities most effective ( = 4.41, SD = 0.83) and reported receiving assistance from other county agencies. They rated level of supplies least effective ( = 3.03, SD = 1.01), describing low supply levels and inequitable distribution of testing materials and personal protective equipment among regions. Local health departments in New York require more state and federal aid to maintain the public health workforce in preparation for future emergencies.