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2.
East Mediterr Health J ; 26(8): 870-871, 2020 Aug 25.
Artículo en Inglés | MEDLINE | ID: mdl-32896877

RESUMEN

Emergency preparedness is a critical pillar of the International Health Regulations (IHR), a legally binding instrument underlying the global health security regime that came into effect in 2005. Lebanon, a small country of 10 452 km2 bordering the eastern Mediterranean, ratified the IHR in 2007 after the devasting effects of a sudden military conflict in 2006 that severely impacted the recovering health system. Moreover, the Lebanese health system infrastructure was only just recovering from 15 years of civil war that ended in 1990. Since 2005, the country has also faced a complex refugee crisis potentiating the risk of disease outbreaks since 2011, in addition to a severe financial crisis that has degenerated into social unrest since October 2019, and more recently the COVID-19 pandemic since February 2020.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Planificación en Desastres/organización & administración , Desastres , Sustancias Explosivas , Neumonía Viral/epidemiología , Salud Pública , Betacoronavirus , Brotes de Enfermedades , Humanos , Cooperación Internacional , Líbano/epidemiología , Pandemias
3.
BMJ Glob Health ; 5(9)2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32967981

RESUMEN

INTRODUCTION: There has been little systematic exploration into what affects timeliness of epidemic response, despite the potential for earlier responses to be more effective. Speculations have circulated that previous exposure to major epidemics helped health systems respond more quickly to COVID-19. This study leverages organisational memory theory to test whether health systems with any, more severe, or more recent exposure to major epidemics enacted timelier COVID-19 policy responses. METHODS: A data set was constructed cataloguing 846 policies across 178 health systems in total, 37 of which had major epidemics within the last 20 years. Hypothesis testing used OLS regressions with World Health Organization region fixed effects, controlling for several health system expenditure and political variables. RESULTS: Results show that exposure to any major epidemics was associated with providing earlier response in the following policy categories: all policies, surveillance/response, distancing, and international travel policies. The effect was about 6-10 days earlier response. The significance of this variable was largely nullified with the addition of the other two independent variables. Neither total cases nor years since previous epidemics showed no statistical significance. CONCLUSION: This study suggests that health systems may learn from past major epidemics. Policymakers ought to institutionalise lessons from COVID-19. Future studies can examine specific generalisable lessons and whether timelier responses correlated with lower health and economic impacts.


Asunto(s)
Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/prevención & control , Planificación en Desastres/organización & administración , Brotes de Enfermedades/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Eficiencia Organizacional , Humanos , Innovación Organizacional , Neumonía Viral/epidemiología , Factores de Tiempo
6.
Artículo en Inglés | MEDLINE | ID: mdl-32937946

RESUMEN

The COVID-19 pandemic poses unprecedented challenges for governments and societies around the world and represents a global crisis of hitherto unexperienced proportions. Our research seeks to analyse disaster management systems from a national perspective by examining the Korean management of the COVID-19 crisis according to a four-phase epidemiological disaster management system. Utilising a meta-study, official documents, reports and interviews, we explore the role of the control tower mechanism related to the life-cycle of disaster management, and Korea's sustainable containment strategy. This study begins with a discussion of the crisis and disaster management literature and provides specific information related to the Korean government's response to COVID-19. It continues by detailing specific strategies such as wide-spread testing, tracking, treatment and quarantine that have enabled Korea to prevent wide-spread community transmission. The study concludes emphasising the relevance of systematic national disaster management, providing insight into methods for containment in Korea - a system commended by the WHO. Implications include the extension and the efficient application of disaster management theory by empirical application and integration of concepts.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Planificación en Desastres/organización & administración , Desastres , Neumonía Viral/epidemiología , Betacoronavirus , Control de Enfermedades Transmisibles/métodos , Infecciones por Coronavirus/prevención & control , Gobierno Federal , Humanos , Pandemias/prevención & control , Neumonía Viral/prevención & control , República de Corea
7.
Am J Disaster Med ; 15(1): 7-22, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32804382

RESUMEN

Hospitals, which care for some of the most vulnerable individuals, have been impacted by disasters in the past and are likely to be affected by future disasters. Yet data on hospital evacuations are infrequent and outdated, at best. This goal of this study was to determine the characteristics and frequency of disasters in the United States that have resulted in hospital evacuations by an appraisal of the literature from 2000 to 2017. There were 158 hospital evacuations in the United States over 18 years. The states with the highest number of evacuations were Florida (N = 39), California (N = 30), and. Texas (N = 15). The reason for the evacuation was "natura" in 114 (72.2 percent), made-man "intentional" 14 (8.9 percent), and man-made "unintentional" or technological related to internal hospital infrastructure 30 (19 percent).The most common natural threats were hurricanes (N = 65) (57 percent), wildfires (N = 21) (18.4 percent), floods (N = 10) (8.8 percent), and storms (N = 8) (7 percent). Bombs/bomb threats were the most common reason (N = 8) (57.1 percent) for a hospital evacuation result-ing from a man-made intentional disaster, followed by armed gunman (N = 4) (28.6 percent). The most frequent infrastruc-ture problems included hospital fires/smoke (N = 9) (30 percent), and chemical fumes (N = 7) (23.3 percent). Of those that reported the duration and number of evacuees, 30 percent of evacuations lasted over 24 h and the number of evacuees was >100 in over half (55.2 percent) the evacuations. This information regarding hospital evacuations should allow hospital administrators, disaster planners, and others to better prepare for disasters that result in the need for hospital evacuation.


Asunto(s)
Planificación en Desastres/organización & administración , Desastres/estadística & datos numéricos , Hospitales , Transferencia de Pacientes/estadística & datos numéricos , Transporte de Pacientes/estadística & datos numéricos , Tormentas Ciclónicas , Fuego , Inundaciones , Administración Hospitalaria , Humanos , Estados Unidos
8.
Am J Disaster Med ; 15(1): 25-31, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32804383

RESUMEN

BACKGROUND: Disasters or crises impact humans, pets, and service animals alike. Current preparation at the federal, state, and local level focuses on preserving human life. Hospitals, shelters, and other human care facilities generally make few to no provisions for companion care nor service animal care as part of their disaster management plan. Aban-doned animals have infectious disease, safety and psychologic impact on owners, rescue workers, and those involved in reclamation efforts. Animals working as first responder partners may be injured or exposed to biohazards and require care. DATA SOURCES: English language literature available via PubMed as well as lay press publications on emergency care, veterinary care, disaster management, disasters, biohazards, infection, zoonosis, bond-centered care, prepared-ness, bioethics, and public health. No year restrictions were set. CONCLUSIONS: Human clinician skills share important overlaps with veterinary clinician skills; similar overlaps occur in medical and surgical emergency care. These commonalities offer the potential to craft-specific and disaster or crisis-deployable skills to care for humans, pets (dogs and cats), service animals (dogs and miniature horses) and first-responder partners (dogs) as part of national disaster healthcare preparedness. Such a platform could leverage the skills and resources of the existing US trauma system to underpin such a program.


Asunto(s)
Bienestar del Animal/organización & administración , Planificación en Desastres/organización & administración , Urgencias Médicas , Servicios Médicos de Urgencia , Mascotas , Trabajo de Rescate/métodos , Animales , Gatos , Planificación en Desastres/métodos , Desastres , Perros , Caballos , Humanos
9.
Am J Disaster Med ; 15(1): 33-41, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32804384

RESUMEN

BACKGROUND: Recent mass-casualty events have exposed errors with common assumptions about response proc-esses, notably triage and transport of patients. Response planners generally assume that the majority of patients from a mass-casualty event will have received some level of field triage and transport from the scene to the hospital will have been coordinated through on-scene incident command. When this is not the case, emergency response at the hospital is hampered as staff must be pulled to handle the influx of untriaged patients. OBJECTIVE: Determine whether the use of emergency medical service (EMS) field resources in hospital triage could enhance the overall response to active-shooter and other mass-casualty events. DESIGN: A proof of concept study was planned in conjunction with a regularly scheduled mass-casualty hospital ex-ercise conducted by an urban level II trauma center in Utah. This was a cross-over study with triage initially performed by hospital staff, and at the midpoint of the exercise, triage was transferred to EMS field units. General performance was judged by exercise planners with limited additional data collection. RESULTS: EMS crews at the hospital significantly enhanced the efficiency and efficacy of the triage operation in both qualitative and quantitative assessment. CONCLUSIONS: Hospital planners deemed the proof of concept exercise a success and are now experimenting with implementation of this alternate approach to triage. However, much additional work remains to fully implement this change in processes.


Asunto(s)
Planificación en Desastres/organización & administración , Servicios Médicos de Urgencia/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Incidentes con Víctimas en Masa , Triaje/organización & administración , Estudios Cruzados , Humanos
10.
Am J Disaster Med ; 15(1): 43-48, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32804385

RESUMEN

BACKGROUND: While mass-casualty incidents (MCIs) may have competing absolute definitions, a universally accepted criterion is one that strains locally available resources. In the fall of 2017, a MCI occurred in New York and Bellevue Hospi-tal received multiple injured patients within minutes; lessons learned included the need for a formalized, efficient patient and injury tracking system. Our objective was to create an organized MCI clinical tracking form for civilian trauma centers. METHODS: After the MCI, the notes of the surgeon responsible for directing patient triage were analyzed. A suc-cinct, organized template was created that allows MCI directors to track demographics, injuries, interventions, and other important information for hmultiple patients in a real-time fashion. This tool was piloted during a subsequent MCI. RESULTS: In late 2018, the hospital received six patients following another MCI. They arrived within a 4-minute window, with 5 patients being critically injured. Two emergent surgeries and angioembolizations were performed. The tool was used by the MCI director to prioritize and expedite care. All physicians agreed that the tool assisted in organizing diagnostic and therapeutic triage. CONCLUSIONS: During MCIs, a streamlined patient tracking template assists with information recall and communica-tion between providers and may allow for expedited care.


Asunto(s)
Planificación en Desastres/organización & administración , Servicios Médicos de Urgencia/organización & administración , Incidentes con Víctimas en Masa , Triaje/organización & administración , Hospitales , Humanos , New York , Cirujanos
13.
J Emerg Manag ; 18(4): 341-347, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32804401

RESUMEN

Since the Stafford Act of 1988, the process of obtaining a formal Major Disaster Declaration has been codified for national implementation, with tasks defined at the smallest levels of local government up to the President. The Disas-ter Mitigation Act of 2000 (DMA 2000) placed additional requirements on local government to plan for mitigation ac-tivities within their jurisdictions. The goal of DMA 2000 was to not only implement more mitigative actions at the local level, but also initiate a process by which local governments could set up ongoing conversations and collaborative efforts with neighboring jurisdictions to ensure continuous, proactive measures were taken against the impacts of disasters. Based on the increased attention paid to mitigation and planning activities, a reasonable expectation would be to see a decline in the number of major disaster declarations since DMA 2000. However, simple correlation analy-sis shows that since DMA 2000, the number of major disaster declarations continues to increase. This article is in-tended as a preliminary study to encourage more detailed analysis in the future of the impacts of federal policy on local-level disaster prevention.


Asunto(s)
Planificación en Desastres/organización & administración , Desastres/prevención & control , Sistemas de Socorro/organización & administración , Desastres/economía , Humanos , Gobierno Local , Política Pública
14.
Am J Disaster Med ; 14(4): 247-254, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32803744

RESUMEN

OBJECTIVE: The Pandemic and All-Hazards Preparedness Act calls for establishing a competency-based training program to train public health practitioners. To inform such training, the Centers for Disease Control and Prevention and the Association of Schools of Public Health managed groups of experts to produce a competency model which could function as a national standard of behaviorally based, observable skills for the public health workforce to prevent, protect against, respond to, and recover from all hazards. DESIGN: A systematic review of existing competency models generated a competency model of proposed domains and competencies. PARTICIPANTS: National stakeholders were engaged to obtain consensus through a three-stage Delphi-like process. RESULTS: The Delphi-like process achieved 84 percent, 82 percent, and 79 percent response rates in its three stages. Three hundred sixty six unique individuals responded to the three-round process, with 45 percent (n = 166) responding to all three rounds. The resulting competency model features 18 competencies within four core learning domains targeted at midlevel public health workers. CONCLUSIONS: Practitioners and academics have adopted the Public Health Preparedness and Response Core Competency Model, some of whom have formed workgroups to develop curricula based on the model. Efforts will be needed to develop evaluation materials for training and education programs to refine the model as well as for future training and education initiatives.


Asunto(s)
Planificación en Desastres/organización & administración , Personal de Salud/educación , Competencia Profesional/normas , Salud Pública/normas , Consenso , Curriculum , Técnica Delfos , Humanos
15.
Am J Disaster Med ; 14(4): 255-267, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32803745

RESUMEN

Infectious disease outbreaks, epidemics, and subsequent pandemics are not typical disasters in the sense that they often lack clearly delineated phases. As in any event that is biological in nature, its onset may be gradual with signs and symptoms that are so subtle that they go unrecognized, thus missing opportunities to invoke an early response and implement containment strategies. An infectious disease outbreak-whether caused by a novel virus, a particularly virulent influenza strain, or newly emerging or resistant bacteria with the capability of human-to-human transmission-can quickly degrade a community's healthcare infrastructure in advance of coordinated mitigation, preparation, and response activities. The Transitional Medical Model (TMM) was developed to aid communities with these crucial phases of disaster response as well as to assist with the initial steps within the recovery phase. The TMM is a methodology that provides a crosswalk between the routine operations and activities of a community's public health infrastructure with action steps associated with the mitigation, preparedness, response, and recovery phases of an infectious disease outbreak.


Asunto(s)
Planificación en Desastres/organización & administración , Brotes de Enfermedades/prevención & control , Control de Infecciones/organización & administración , Pandemias/prevención & control , Humanos , Gripe Humana/prevención & control , Salud Pública , Vigilancia de Guardia
16.
Am J Disaster Med ; 14(4): 269-277, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32803746

RESUMEN

OBJECTIVE: To assess the level of pandemic preparedness at emergency departments (EDs) around the country and to better understand current barriers to preparedness in the United States represented by health professionals in the American College of Emergency Physician (ACEP) Disaster Medicine Section (DMS). Methods, design, and setting: A cross-sectional survey of ACEP DMS members was performed. A total of 300 members were surveyed both via e-mail and with paper surveys during the 2009 ACEP Scientific Assembly DMS Meeting. An optional comments section was included for section members' perspectives on barriers to preparedness. A 15-item pandemic preparedness score was calculated for each respondent based on key preparedness indicators as defined by the authors. Results were analyzed with descriptive statistics, χ2 analysis, Cochran-Armitage trend test, and analysis of variance. Free text comments were coded and subjected to frequency-based analysis. RESULTS: A total of 92 DMS members completed the survey with a response rate of 31 percent. Although 85 percent of those surveyed indicated that their hospital had a plan for pandemic influenza response and other infectious disease threats, only 68 percent indicated that their ED had a plan, and 52 percent indicated that their hospital or ED had conducted disaster preparedness drills. Only 57 percent indicated that there was a plan to augment ED staff in the event of a staffing shortage, and 63 percent indicated that there were adequate supplies of personal protective equipment. While 63 percent of respondents indicated that their ED had a plan for distribution of vaccines and antivirals, only 32 percent of EDs had a plan for allocation of ventilators. A total of 42 percent of respondents felt that their ED was prepared in the event of a pandemic influenza or other disease outbreak, and only 35 percent felt that their hospital was prepared. The average pandemic preparedness score among respondents was 8.30 of a total of 15. Larger EDs were more likely to have a higher preparedness score (p = 0.03) and more likely to have a pandemic preparedness plan (p = 0.037). Some major barriers to preparedness cited by section members included lack of local administration support, challenges in funding, need for dedicated disaster preparedness personnel, staffing shortages, and a lack of communication among disaster response agencies, particularly at the federal level. CONCLUSIONS: There appear to be significant gaps in pandemic influenza and other infectious disease outbreak planning among the hospitals where ACEP DMS members work. This may reflect a broader underlying inadequacy of preparedness measures.


Asunto(s)
Planificación en Desastres/organización & administración , Brotes de Enfermedades/prevención & control , Servicio de Urgencia en Hospital/organización & administración , Gripe Humana , Pandemias/prevención & control , Médicos/psicología , Actitud del Personal de Salud , Estudios Transversales , Humanos , Encuestas y Cuestionarios , Estados Unidos
17.
Am J Disaster Med ; 14(4): 287-298, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32803748

RESUMEN

The complexities and challenges for healthcare providers and their efforts to provide fundamental basic items to meet the logistical demands of an influenza pandemic are discussed in this article. The supply chain, planning, and alternatives for inevitable shortages are some of the considerations associated with this emergency mass critical care situation. The planning process and support for such events are discussed in detail with several recommendations obtained from the literature and the experience from recent mass casualty incidents (MCIs). The first step in this planning process is the development of specific triage requirements during an influenza pandemic. The second step is identification of logistical resources required during such a pandemic, which are then analyzed within the proposed logistics science and art model for planning purposes. Resources highlighted within the model include allocation and use of work force, bed space, intensive care unit assets, ventilators, personal protective equipment, and oxygen. The third step is using the model to discuss in detail possible workarounds, suitable substitutes, and resource allocation. An examination is also made of the ethics surrounding palliative care within the construction of an MCI and the factors that will inevitably determine rationing and prioritizing of these critical assets to palliative care patients.


Asunto(s)
Planificación en Desastres/organización & administración , Personal de Salud/psicología , Gripe Humana/prevención & control , Pandemias/prevención & control , Triaje/organización & administración , Cuidados Críticos , Humanos , Gripe Humana/epidemiología , Incidentes con Víctimas en Masa
18.
Am J Disaster Med ; 14(4): 311-326, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32803751

RESUMEN

BACKGROUND: The failure of life-critical systems such as mechanical ventilators in the wake of a pandemic or a disaster may result in death, and therefore, state and federal government agencies must have precautions in place to ensure availability, reliability, and predictability through comprehensive preparedness and response plans. METHODS: All 50 state emergency preparedness response plans were extensively examined for the attention given to the critically injured and ill patient population during a pandemic or mass casualty event. Public health authorities of each state were contacted as well. RESULTS: Nine of 51 state plans (17.6 percent) included a plan or committee for mechanical ventilation triage and management in a pandemic influenza event. All 51 state plans relied on the Centers for Disease Control and Prevention Flu Surge 2.0 spreadsheet to provide estimates for their influenza planning. In the absence of more specific guidance, the authors have developed and provided guidelines recommended for ventilator triage and the implementation of the AGILITIES Score in the event of a pandemic, mass casualty event, or other catastrophic disaster. CONCLUSIONS: The authors present and describe the AGILITIES Score Ventilator Triage System and provide related guidelines to be adopted uniformly by government agencies and hospitals. This scoring system and the set of guidelines are to be used in disaster settings, such as Hurricane Katrina, and are based on three key factors: relative health, duration of time on mechanical ventilation, and patients' use of resources during a disaster. For any event requiring large numbers of ventilators for patients, the United States is woefully unprepared. The deficiencies in this aspect of preparedness include (1) lack of accountability for physical ventilators, (2) lack of understanding with which healthcare professionals can safely operate these ventilators, (3) lack of understanding from where additional ventilator resources exist, and (4) a triage strategy to provide ventilator support to those patients with the greatest chances of survival.


Asunto(s)
Planificación en Desastres/organización & administración , Respiración Artificial , Triaje/organización & administración , Ventiladores Mecánicos , Humanos , Incidentes con Víctimas en Masa , Reproducibilidad de los Resultados , Estados Unidos
20.
Artículo en Inglés | MEDLINE | ID: mdl-32764245

RESUMEN

Humans are living in an uncertain world, with daily risks confronting them from various low to high hazard events, and the COVID-19 pandemic has created its own set of unique risks. Not only has it caused a significant number of fatalities, but in combination with other hazard sources, it may pose a considerably higher multi-risk. In this paper, three hazardous events are studied through the lens of a concurring pandemic. Several low-probability high-risk scenarios are developed by the combination of a pandemic situation with a natural hazard (e.g., earthquakes or floods) or a complex emergency situation (e.g., mass protests or military movements). The hybrid impacts of these multi-hazard situations are then qualitatively studied on the healthcare systems, and their functionality loss. The paper also discusses the impact of pandemic's (long-term) temporal effects on the type and recovery duration from these adverse events. Finally, the concept of escape from a hazard, evacuation, sheltering and their potential conflict during a pandemic and a natural hazard is briefly reviewed. The findings show the cascading effects of these multi-hazard scenarios, which are unseen nearly in all risk legislation. This paper is an attempt to urge funding agencies to provide additional grants for multi-hazard risk research.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Planificación en Desastres/organización & administración , Incidentes con Víctimas en Masa , Desastres Naturales , Neumonía Viral/epidemiología , Betacoronavirus , Planificación en Desastres/economía , Terremotos , Urgencias Médicas , Inundaciones , Humanos , Pandemias , Factores de Tiempo
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