A Preparedness Model for Mother-Baby Linked Longitudinal Surveillance for Emerging Threats.

INTRODUCTION: Public health responses often lack the infrastructure to capture the impact of public health emergencies on pregnant women and infants, with limited mechanisms for linking pregnant women with their infants nationally to monitor long-term effects. In 2019, the Centers for Disease Control and Prevention (CDC), in close collaboration with state, local, and territorial health departments, began a 5-year initiative to establish population-based mother-baby linked longitudinal surveillance, the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). OBJECTIVES: The objective of this report is to describe an expanded surveillance approach that leverages and modernizes existing surveillance systems to address the impact of emerging health threats during pregnancy on pregnant women and their infants. METHODS: Mother-baby pairs are identified through prospective identification during pregnancy and/or identification of an infant with retrospective linking to maternal information. All data are obtained from existing data sources (e.g., electronic medical records, vital statistics, laboratory reports, and health department investigations and case reporting). RESULTS: Variables were selected for inclusion to address key surveillance questions proposed by CDC and health department subject matter experts. General variables include maternal demographics and health history, pregnancy and infant outcomes, maternal and infant laboratory results, and child health outcomes up to the second birthday. Exposure-specific modular variables are included for hepatitis C, syphilis, and Coronavirus Disease 2019 (COVID-19). The system is structured into four relational datasets (maternal, pregnancy outcomes and birth, infant/child follow-up, and laboratory testing). DISCUSSION: SET-NET provides a population-based mother-baby linked longitudinal surveillance approach and has already demonstrated rapid adaptation to COVID-19. This innovative approach leverages existing data sources and rapidly collects data and informs clinical guidance and practice. These data can help to reduce exposure risk and adverse outcomes among pregnant women and their infants, direct public health action, and strengthen public health systems.

Application and Prospect of a Mobile Hospital in Disaster Response.

Disasters such as an earthquake, a flood, and an epidemic usually lead to large numbers of casualties accompanied by disruption of the functioning of local medical institutions. A rapid response of medical assistance and support is required. Mobile hospitals have been deployed by national and international organizations at disaster situations in the past decades, which play an important role in saving casualties and alleviating the shortage of medical resources. In this paper, we briefly introduce the types and characteristics of mobile hospitals used by medical teams in disaster rescue, including the aspects of structural form, organizational form, and mobile transportation. We also review the practices of mobile hospitals in disaster response and summarize the problems and needs of mobile hospitals in disaster rescue. Finally, we propose the development direction of mobile hospitals, especially on the development of intelligence, rapid deployment capabilities, and modularization, which provide suggestions for further research and development of mobile hospitals in the future.

A Public Health Response to a Mudslide in Freetown, Sierra Leone, 2017: Lessons Learnt.

On August 14, 2017, a 6-kilometer mudslide occurred in Regent Area, Western Area District of Sierra Leone following a torrential downpour that lasted 3 days. More than 300 houses along River Juba were submerged; 1141 people were reported dead or missing and 5905 displaced. In response to the mudslide, the World Health Organization (WHO) Country Office in Sierra Leone moved swiftly to verify the emergency and constitute an incident management team to coordinate the response. Early contact was made with the Ministry of Health and Sanitation and health sector partners. A Public Health Emergency Operations Center was set up to coordinate the response. Joint assessments, planning, and response among health sector partners ensured effectiveness and efficiency. Oral cholera vaccination was administered to high-risk populations to prevent a cholera outbreak. Surveillance for 4 waterborne diseases was enhanced through daily reporting from 9 health facilities serving the affected population. Performance standards from the WHO Emergency Response Framework were used to monitor the emergency response. An assessment of the country's performance showed that the country's response was well executed. To improve future response, we recommend enhanced district level preparedness, update of disaster response protocols, and pre-disaster mapping of health sector partners.

The August 24, 2016, Central Italy Earthquake: Validation of the "Modified Utstein Template for Hospital Disaster Response Reporting" As a New Tool for Reporting Hospitals' Response to Disasters.

BACKGROUND: After-action reports analyze events and improve knowledge about how to prevent and react to unexpected situations. Anyway, there is no consensus among the templates developed for disaster events reporting, and there is not a specific model for reporting hospital disaster response. OBJECTIVE: The study was aimed to pilot the use of a new assessment tool for hospital response to natural disasters. METHODS: A data collection tool, focused on hospital disaster response to natural disasters, was created modifying the "Utstein-Style Template for Uniform Data Reporting of Acute Medical Response in Disasters" and tested the reaction of the nearest hospitals to the epicenter after the August 24, 2016, Central Italy earthquake. RESULTS: Four hospitals were included. The completion rate of the tool was 97.10%. A total of 613 patients accessed the 4 emergency departments, most of them in Rieti Hospital (178; 29.04%). Three hundred thirty-six (54.81%) patients were classified as earthquake-related, most with trauma injuries (260; 77.38%). CONCLUSIONS: This template seemed to be a valid instrument for hospital disaster management reporting and could be used for better comprehension of hospital disaster reaction, debriefing activities, and hospital disaster plan revisions.

An Evaluation of the Literacy Demands of Online Natural Disaster Preparedness Materials for Families.

OBJECTIVE: Natural disasters are becoming increasingly common, but it is unclear whether families can comprehend and use available resources to prepare for such emergencies. The objective of this study was to evaluate the literacy demands of risk communication materials on natural disasters for US families with children. METHODS: In January 2018, we assessed 386 online self-directed learning resources related to emergency preparedness for natural disasters using 5 literacy assessment tools. Assessment scores were compared by information source, audience type, and disaster type. RESULTS: One-in-three websites represented government institutions, and 3/4 were written for a general audience. Nearly 1-in-5 websites did not specify a disaster type. Assessment scores suggest a mismatch between the general population's literacy levels and literacy demands of materials in the areas of readability, complexity, suitability, web usability, and overall audience appropriateness. Materials required more years of education beyond the grade level recommended by prominent health organizations. Resources for caregivers of children generally and children with special health care needs possessed lower literacy demands than materials overall, for most assessment tools. CONCLUSIONS: Risk communication and public health agencies could better align the literacy demands of emergency preparedness materials with the literacy capabilities of the general public.

Incorporating Injury Prevention Into Energy Weatherization Programs.

Clients receiving weatherization/energy services with an added injury prevention home assessment with modifications/repairs experienced a decline in falls and thus fall-related costs. Interventions in 35 homes were associated with significant reductions in falls from baseline to 6 months postintervention (from 94% to 9%; P < .001) and falls with calls for assistance (from 23% to 3%; P < .02). The decline in falls with calls for assistance in the intervention group was significant when adjusted for a comparison group effect (P = .07). At a median cost of $2058 per home, the addition of an injury prevention component led by an occupational therapist offers the potential to avoid expensive fall-related medical costs (lift assistance, hospital transport and admission, long-term care). Integration of injury prevention into weatherization work, which targets lower-income seniors with high energy use, offers potential to reduce costly hospitalizations and poor health outcomes.

Examining the Role of Twitter in Response and Recovery During and After Historic Flooding in South Carolina.

CONTEXT: Social media has played an increasing role in the response to emergency situations through information exchange and efforts to promote recovery. Understanding more about how social media users share and re-share information is particularly important to help emergency response entities determine best strategies for expanding reach and impact through social media in disseminating emergency messages. OBJECTIVE: This study examined the role and use of Twitter as a response and recovery strategy before, during, and after historic rainfall and flooding in the Midlands region of the greater Columbia, South Carolina, area in October 2015. DESIGN: A cross-sectional, thematic, and descriptive examination of Twitter data across 4 time periods (before the historic rainfall and flooding, during, immediately after a boil water advisory period, and 6 months later) was conducted. SETTING: Twitter posts containing "#SCFlood" with a focus on the Midlands region were extracted and analyzed. RESULTS: The most common themes of tweets across all 4 time periods were weather conditions, devastation description, resource distribution, volunteerism, actions to reduce threats to health, and appreciation. Tweets mostly originated from individual users, followed by media outlets, governmental agencies, and nonprofit agencies. Tweets from the first 3 time periods were largely focused on built and natural environment devastation and action to reduce threats to health, and tweets from the fourth time period were primarily focused on cleanup and repair. CONCLUSIONS: Twitter was utilized widely as a communication tool to provide time-sensitive and critical information before, during, and after the event. Ensuring that key social media users have developed disaster communication strategies inclusive of Twitter seems important in aiding response to and recovery from natural disasters.

Vaccination Data When the Outbreak Happens: A Qualitative Evaluation of Oregon's Rapid Response Tool.

OBJECTIVE: Immunization data are vital to support responses to vaccine-preventable disease outbreaks. The Oregon Immunization Program developed a unique prototype instrument-the Rapid Response Tool (RRT)-that provides population data to local responders within 2 hours of a request. Data outputs include vaccination coverage by age group and zip code; percentages of students with nonmedical exemptions to vaccination requirements, by school; and current, comprehensive lists of local vaccination providers. METHODS: The RRT was demonstrated to staff at 7 Oregon counties and feedback was solicited via comments and a structured survey. RESULTS: The RRT received strong support. Attendees identified several uses for RRT data, including outbreak response and ongoing intervention efforts, and they pointed to areas for further development. CONCLUSIONS: The success of the RRT demonstrations illustrates that a well-populated immunization information system can contribute to preparedness work well beyond current standards. (Disaster Med Public Health Preparedness. 2019;13:682-685).

The Dark Side of the (Preparedness) Moon: Why Promoting Public Preparedness Remains Challenging.

Despite best intentions and considerable effort, promoting households' preparedness to emergencies remains insufficiently low globally. It seems that, in some cases, particularly those in which populations are frequently exposed to any given threat, a more complex sociopsychological framework emerges - one in which classical motivators, such as threat perception cues, are no longer capable of turning salient belief into action. Recent studies suggest that this phenomenon, called victimization, has considerable implications on the efficacy of risk communication efforts and could jeopardize the success in promoting public readiness. Circumventing the psychological barriers caused by this phenomenon requires innovative approaches, such as using external incentives. The model and its implications are discussed (Disaster Med Public Health Prep. 2019;13:593-595).

Minigrants to Local Health Departments: An Opportunity to Promote Climate Change Preparedness.

CONTEXT: Human health is threatened by climate change. While the public health workforce is concerned about climate change, local health department (LHD) administrators have reported insufficient knowledge and resources to address climate change. Minigrants from state to LHDs have been used to promote a variety of local public health initiatives. OBJECTIVE: To describe the minigrant approach used by state health departments implementing the Centers for Disease Control and Prevention's (CDC's) Building Resilience Against Climate Effects (BRACE) framework, to highlight successes of this approach in promoting climate change preparedness at LHDs, and to describe challenges encountered. DESIGN: Cross-sectional survey and discussion. INTERVENTION: State-level recipients of CDC funding issued minigrants to local public health entities to promote climate change preparedness, adaptation, and resilience. MAIN OUTCOME MEASURES: The amount of funding, number of LHDs funded per state, goals, selection process, evaluation process, outcomes, successes, and challenges of the minigrant programs. RESULTS: Six state-level recipients of CDC funding for BRACE framework implementation awarded minigrants ranging from $7700 to $28 500 per year to 44 unique local jurisdictions. Common goals of the minigrants included capacity building, forging partnerships with entities outside of health departments, incorporating climate change information into existing programs, and developing adaptation plans. Recipients of minigrants reported increases in knowledge, engagement with diverse stakeholders, and the incorporation of climate change content into existing programs. Challenges included addressing climate change in regions where the topic is politically sensitive, as well as the uncertainty about the long-term sustainability of local projects beyond the term of minigrant support. CONCLUSIONS: Minigrants can increase local public health capacity to address climate change. Jurisdictions that wish to utilize minigrant mechanisms to promote climate change adaptation and preparedness at the local level may benefit from the experience of the 6 states and 44 local health programs described.

Enhancing Reporting of After Action Reviews of Public Health Emergencies to Strengthen Preparedness: A Literature Review and Methodology Appraisal.

OBJECTIVE: This literature review aimed to identify the range of methods used in after action reviews (AARs) of public health emergencies and to develop appraisal tools to compare methodological reporting and validity standards. METHODS: A review of biomedical and gray literature identified key approaches from AAR methodological research, real-world AARs, and AAR reporting templates. We developed a 50-item tool to systematically document AAR methodological reporting and a linked 11-item summary tool to document validity. Both tools were used sequentially to appraise the literature included in this study. RESULTS: This review included 24 highly diverse papers, reflecting the lack of a standardized approach. We observed significant divergence between the standards described in AAR and qualitative research literature, and real-world AAR practice. The lack of reporting of basic methods to ensure validity increases doubt about the methodological basis of an individual AAR and the validity of its conclusions. CONCLUSIONS: The main limitations in current AAR methodology and reporting standards may be addressed through our 11 validity-enhancing recommendations. A minimum reporting standard for AARs could help ensure that findings are valid and clear for others to learn from. A registry of AARs, based on a common reporting structure, may further facilitate shared learning. (Disaster Med Public Health Preparedness. 2019;13:618-625).

Disaster preparedness networks in rural Midwest communities: Organizational roles, collaborations, and support for older residents.

This study investigated the roles and interconnections among community organizations belonging to local disaster coalitions in Midwest in supporting older residents. Representatives from 44 organizations participated in one-time survey. Most were non-profit (68%) or federal/state/local government agencies (23%). The analyses of 761 relationships showed stronger collaborations in assessment (average strength=2.88 on a 5-point scale), emergency response (2.72), and planning (2.61); and weaker collaborations in co-sponsoring programs (1.71) and supporting older residents (2.03). The extent of collaboration (network density) to support older adults was also low. Coalitions may enhance network density and centralization by developing sub-committee structure and strengthening existing collaborations.

Keeping Communications Flowing During Large-scale Disasters: Leveraging Amateur Radio Innovations for Disaster Medicine.

Medical facilities may struggle to maintain effective communications during a major disaster. Natural and man-made disasters threaten connectivity by degrading or crippling Internet, cellular/mobile, and landline telephone services across wide areas. Communications among staff, between facilities, and to resources outside the disaster area may be lost for an extended time. A prototype communications system created by the National Library of Medicine (NLM) provides basic communication services that ensure essential connectivity in the face of widespread infrastructure loss. It leverages amateur radio to provide resilient email service to local users, enabling them to reach intact communications networks outside the disaster zone. Because amateur radio is inexpensive, always available, and sufficiently independent of terrestrial telecommunications infrastructure, it has often augmented telecommunications capabilities of medical facilities. NLM's solution is unique in that it provides end-user to end-user direct email communications, without requiring the intervention of a radio operator in the handling of the messages. Medical staff can exchange email among themselves and with others outside the communications blackout zone. The technology is portable, is deployable on short notice, and can be powered in a variety of ways to adapt to the circumstances of each crisis. (Disaster Med Public Health Preparedness. 2018;12:257-264).

How to Choose? Using the Delphi Method to Develop Consensus Triggers and Indicators for Disaster Response.

OBJECTIVE: To identify key decisions along the continuum of care (conventional, contingency, and crisis) and the critical triggers and data elements used to inform those decisions concerning public health and health care response during an emergency. METHODS: A classic Delphi method, a consensus-building survey technique, was used with clinicians around Washington State to identify regional triggers and indicators. Additionally, using a modified Delphi method, we combined a workshop and single-round survey with panelists from public health (state and local) and health care coalitions to identify consensus state-level triggers and indicators. RESULTS: In the clinical survey, 122 of 223 proposed triggers or indicators (43.7%) reached consensus and were deemed important in regional decision-making during a disaster. In the state-level survey, 110 of 140 proposed triggers or indicators (78.6%) reached consensus and were deemed important in state-level decision-making during a disaster. CONCLUSIONS: The identification of consensus triggers and indicators for health care emergency response is crucial in supporting a comprehensive health care situational awareness process. This can inform the creation of standardized questions to ask health care, public health, and other partners to support decision-making during a response. (Disaster Med Public Health Preparedness. 2017;11:467-472).

The general use of outdoor warning sirens: a preliminary survey of emergency managers.

With more direct, personal warning systems becoming popular, the continued maintenance of older warning systems, such as outdoor warning sirens, may be jeopardized as emergency managers (EMs) seek to optimize their limited budgets. However, the extent to which sirens are embedded into the American landscape and culture argues against their removal. To better quantify the distribution and use of outdoor warning sirens, an international survey of EMs was conducted to learn more about where siren systems are deployed and how they are operated. Approximately 593 respondents started the 31 question survey with 383 completing it. Questions were asked regarding siren network size, alternative warning systems, siren use and capabilities, and testing. For those without sirens, a series of questions were asked for why sirens were not used. In general, a lack of perceived threat, high costs, and large geographic area kept some jurisdictions from installing sirens. Of those that operate siren networks, half of networks are small (≤10 sirens), while a small percentage of jurisdictions (6.3 percent) operate very large networks (>100). A large majority of respondents expected to maintain or expand their networks within the next 5 years. Three-quarters of respondents use additional warning systems. Nearly half of respondents use sirens for nonweather applications, and nearly two-thirds have the capability to use multiple sound alerts. Overall, sirens remain a popular tool for warning on a variety of local hazards though how the sirens are operated and tested vary widely by jurisdiction.

ADVICE: a new approach for near-real-time monitoring of surface displacements in landslide hazard scenarios.

We present a new method for near-real-time monitoring of surface displacements due to landslide phenomena, namely ADVanced dIsplaCement monitoring system for Early warning (ADVICE). The procedure includes: (i) data acquisition and transfer protocols; (ii) data collection, filtering, and validation; (iii) data analysis and restitution through a set of dedicated software; (iv) recognition of displacement/velocity threshold, early warning messages via SMS and/or emails; (v) automatic publication of the results on a dedicated webpage. We show how the system evolved and the results obtained by applying ADVICE over three years into a real early warning scenario relevant to a large earthflow located in southern Italy. ADVICE has speed-up and facilitated the understanding of the landslide phenomenon, the communication of the monitoring results to the partners, and consequently the decision-making process in a critical scenario. Our work might have potential applications not only for landslide monitoring but also in other contexts, as monitoring of other geohazards and of complex infrastructures, as open-pit mines, buildings, dams, etc.

Facilitating disaster preparedness through local radio broadcasting.

The 2008 Disaster Mitigation Preparedness (DMP) study took place in Aceh province, Indonesia. It sought to help develop radio programmes and messages to increase resilience to disasters. The role of radio was evaluated during and after the 2004 Asian tsunami disaster. The study team interviewed 984 tsunami survivors from nine sub-districts of Banda Aceh, and local nongovernmental organisations convened eight focus groups around the area of Aceh Besar. Six key informant interviews were held with government disaster management agencies. The DMP survey is the first of its kind to interview a representative random sample of Banda Aceh residents. It reveals the importance of community and social networks, during disaster situations, when essential communications are down. A disaster warning information system based on a multi-media approach needs to be developed. The wider community should be involved in the planning, education and training of Banda Aceh and Aceh Besar residents to facilitate appropriate personal and community survival strategies.

Influenza preparedness in low-resource settings: a look at oxygen delivery in 12 African countries.

BACKGROUND: Pandemic influenza poses a serious threat to populations in low and lower-middle income countries that face delays in access to health care and inadequately equipped facilities. Oxygen is first-line therapy for influenza-related hypoxia and a standard component of emergency respiratory resuscitation, yet remains a scarce resource in many countries. METHODOLOGY: A snapshot survey of oxygen supply and associated infrastructure was performed at 231 health centres and hospitals in twelve African countries using the World Health Organization (WHO) Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. WHO Global Initiative for Emergency and Essential Surgical Care, WHO regional and country offices, and local Ministries of Health facilitated data collection from facilities surveyed. Data was stored in the WHO DataCol SQL database and computerized spreadsheet tools were used to generate descriptive statistics. RESULTS: Ninety-nine (43.8%) of facilities surveyed reported uninterrupted access to an oxygen source and 55 (24.6%) possessed a fully functioning oxygen concentrator. Electricity was fully available at only 81 (35.1%) health facilities. CONCLUSIONS: In addition to efforts to secure vaccines and antivirals, future global influenza preparedness efforts should include investments in oxygen and associated equipment and infrastructure at first referral health facilities, to minimize morbidity and mortality from influenza in regions with limited medical resources. Increasing oxygen delivery capacity in these areas may also provide long-term, post-pandemic benefits in the management of other medical conditions of significance, including trauma, neonatal pulmonary hypofunction, and HIV-related and childhood pneumonia.