Enhancing emergency preparedness and response systems: correlates of collaboration between local health departments and school districts.

OBJECTIVE: Collaboration between existing components of the public health system is important for protecting public health and promoting community resilience. We describe the factors that promote collaborative emergency preparedness and response activities between local health departments (LHDs) and school systems. METHODS: We gathered data from a multistage, stratified random sample of 750 LHDs nationwide. Utilizing a mailed invitation, we recruited respondents to participate in an online questionnaire. We calculated descriptive and inferential statistics. RESULTS: The majority of LHDs collaborated with school systems for emergency preparedness and response activities and most indicated they were likely to collaborate in the future. Characteristics of the jurisdiction, general experience and perceptions of collaboration, and characteristics of the preparedness collaboration itself predicted future collaboration. CONCLUSION: Our results help us understand the nature of collaborations between LHDs and school systems on emergency preparedness and response activities, which can be used to identify priority areas for developing successful and sustainable joint efforts in the future. By focusing on the perceived value of collaboration and building on existing non-preparedness partnering, communities can increase the likelihood of ongoing successful LHD-school system emergency preparedness collaborations.

Local health department epidemiologic capacity: a stratified cross-sectional assessment describing the quantity, education, training, and perceived competencies of epidemiologic staff.

INTRODUCTION: Local health departments (LHDs) must have sufficient numbers of staff functioning in an epidemiologic role with proper education, training, and skills to protect the health of communities they serve. This pilot study was designed to describe the composition, training, and competency level of LHD staff and examine the hypothesis that potential disparities exist between LHDs serving different sized populations. MATERIALS AND METHODS: Cross-sectional surveys were conducted with directors and epidemiologic staff from a sample of 100 LHDs serving jurisdictions of varied sizes. Questionnaires included inquiries regarding staff composition, education, training, and measures of competency modeled on previously conducted studies by the Council of State and Territorial Epidemiologists. Number of epidemiologic staff, academic degree distribution, epidemiologic training, and both director and staff confidence in task competencies were calculated for each LHD size strata. RESULTS: Disparities in measurements were observed in LHDs serving different sized populations. LHDs serving small populations reported a smaller average number of epidemiologic staff than those serving larger jurisdictions. As size of population served increased, percentages of staff and directors holding bachelors' and masters' degrees increased, while those holding RN degrees decreased. A higher degree of perceived competency of staff in most task categories was reported in LHDs serving larger populations. DISCUSSION: LHDs serving smaller populations reported fewer epidemiologic staff, therefore might benefit from additional resources. Differences observed in staff education, training, and competencies suggest that enhanced epidemiologic training might be particularly needed in LHDs serving smaller populations. RESULTS can be used as a baseline for future research aimed at identifying areas where training and personnel resources might be particularly needed to increase the capabilities of LHDs.

Evaluation of the seroprevalence of influenza A(H1N1) 2009 on a university campus: a cross-sectional study.

BACKGROUND: Human infection with influenza A(H1N1) 2009 was first identified in the United States on 15 April 2009 and on 11 June 2009, WHO declared that the rapidly spreading swine-origin influenza virus constituted a global pandemic. We evaluated the seroprevalence of influenza A(H1N1) 2009 virus on a large public University campus, as well as disparities in demographic, symptomatic and vaccination characteristics of participants. METHODS: Using a cross-sectional study design, sera was collected from volunteers and then tested for the presence of antibodies to the virus using a ≥ 1:40 dilution cut-off by hemagglutination inhibition assay. In conjunction, participants were asked to complete a questionnaire allowing us to estimate risk factors for infection in this population, as well as distinguish artificially derived antibodies from naturally derived antibodies. RESULTS: 300 total participants were recruited and tested. 158 (52.6%) tested positive for influenza A(H1N1) 2009 via hemagglutination inhibition assay using a ≥ 1:40 dilution cut-off. 86 people (54.4%) tested positive for H1N1 but did not report experiencing symptoms during the pandemic meeting the May 2010 CDC definition of influenza-like illness. Furthermore, of those individuals who reported that they had received the H1N1 vaccine, 16% did not test positive. CONCLUSIONS: Overall, 52.7% of the total study population tested positive for influenza A(H1N1) 2009. 54.4% of those who tested positive for influenza A(H1N1) 2009 using the ≥ 1:40 dilution cut-off on the hemagglutination inhibition assay in this study population did not report experiencing symptoms during the pandemic meeting the May 2010 CDC definition of influenza-like illness. 16% of those who reported receiving the H1N1 vaccine did not test positive by HAI. We also found that vaccination coverage for H1N1 vaccine was poor among Blacks and Latinos, despite the fact that vaccine was readily available at no cost.

A graduate curriculum in emergency public health.

The increase in adverse health impacts of disasters has raised awareness of the need for education in the field of emergency public health. In the past, most traditional models of graduate education in schools of public health have not incorporated the theory and practice of disaster public health into their curricula. This paper describes the development of a curriculum in emergency public health within a US masters program in public health, and provides a description of the courses that comprise an area of specialization in the field. The interdisciplinary nature of the faculty, close ties with public health practitioners, and practical applications of the nine courses in this program are highlighted. The curriculum is presented as one model that can be used to meet the educational needs of professionals who will assume the responsibility for planning for and responding to the public health impacts of mass-populations disasters.

Pandemic influenza triage in the clinical setting.

INTRODUCTION: There has been much federal and local health planning for an influenza pandemic in the United States, but little is known about the ability of the clinical community to deal quickly and effectively with a potentially overwhelming surge of pandemic influenza patients. PROBLEM: The attitudes and expectations of emergency physicians, emergency nurses, hospital nursing supervisors, hospital administrators, and infection control personnel concerning clinical care in a pandemic were assessed. METHODS: Key informant structured interviews of 46 respondents from 34 randomly selected emergency receiving hospitals in Los Angeles County were conducted using an Institutional Review Board-approved protocol. The interview asked about supplies/resources, triage, quality of care, and decision-making. At the conclusion of each interview, the informant was asked to provide the contact information for at least two others within their respective professional group. Interviews were transcribed and coded for key themes using qualitative analytical software. RESULTS: There was little salience that an influx of variably ill patients with influenza would force stratified healthcare decision-making. There also was a general lack of preparation to address the ethics and practices of triaging patients in the clinical setting of a pandemic. CONCLUSIONS: Guidelines must be developed in concert with public health, medical society, and legislative authorities to help clinicians define, adopt, and communicate to the public those practice standards that will be followed in a mass population, infectious disease emergency.

Development of a training curriculum for public health preparedness.

We describe the development of a 2-day training curriculum in emergency public health to improve the competency of public health personnel to prepare for, and respond to, both natural and human-caused disaster hazards. The training is conducted in a face-to-face setting and content is mapped to recognized emergency preparedness competencies for public health workers. The training materials are uniquely structured to the specific hazards, demographics, resources, and local emergency response agencies for each jurisdiction. This training program incorporates a series of challenging interactive scenarios that reinforce decision making in a public health emergency. Pretesting and posttesting are used to evaluate knowledge gained by participants. This interactive approach aligns with the principles of adult learning, and training evaluations indicate that this method is an effective integration of process and content.

Psychological distress following urban earthquakes in California.

During and following a disaster caused by a natural event, human populations are thought to be at greater risk of psychological morbidity and mortality directly attributable to increased, disaster-induced stress. Drawing both on the research of others and that conducted at the Center for Public Health and Disaster Relief of the University of California-Los Angeles (UCLA) following California earthquakes, this paper examines the extent to which research evidence supports these assumptions. Following a brief history of disaster research in the United States, the response of persons at the time of an earthquake was examined with particular attention to psychological morbidity; the number of deaths that can be attributed to cardiovascular events and suicides; and the extent to which and by whom, health services are used following an earthquake. The implications of research findings for practitioners in the field are discussed.

Victimization after a natural disaster : Social disorganization or community cohesion?

The data were collected from three independent community samples, beginning seven months after the 1994 Northridge, California earthquake and following in one year intervals for the two subsequent samples. Exposure to traumatic stress (Norris 1990)-including criminal victimization-in the 12 months prior to the interview was assessed in each sample. For all traumatic stress/victimization and for each of seven individual events, rates remain flat over time (3 data points), suggesting that neither social disorganization nor social cohesion occurred after the earthquake. In the first sample respondents only reporton pre-disaster events, for them post-earthquake rates of traumatic stress and victimization were compared with pre-earthquake rates. In contrast to the trend data, reduction in rates of robbery and, to a lesser extent, major life changes suggest that an altruistic community (social cohesion) may have risen. A third set of analyses show that the severity of exposure to the earthquake does not make a contribution to traumatic stress or victimization beyond that explained by the demographic variables repeatedly found to predict vulnerability to victimization. There is no indication that social disorganization follows a natural disaster, and there is minor support for the emergence of an altruistic community (AU)