New York City's healthcare transportation during a disaster: a preparedness framework for a wicked problem.

During a disaster, victims with varied morbidities are located at incident sites, while healthcare facilities with varied healthcare resources are distributed elsewhere. Transportation serves an essential equilibrating role: it helps balance the patients' need for care with the supply of care. Studying the special case of New York City, this article sets out the healthcare transportation components as: (1) incident morbidity; (2) transportation assets; and (3) healthcare capacity. The relationship between these three components raises an assignment problem: the management of healthcare transportation within a dynamic and partly unpredictable incident-transportation-healthcare nexus, under urban disruption. While the routine dispatch problem can be tackled through better geographic allocation software and technical algorithms, the disaster assignment problem must be confronted through real-time, mutual adjustment between institutions. This article outlines institutional alternatives for managing the assignment problem and calls for further research on the merits of alternative institutional models.

Faith-placed cardiovascular health promotion: a framework for contextual and organizational factors underlying program success.

The objective of this study was to assess the literature on faith-placed cardiovascular health promotion in order to construct a framework of factors meant to facilitate effective program design. Data source was empirical studies on the contextual and organizational factors underlying faith-placed cardiovascular program performance. Study inclusion criteria were papers reported from 1984 to 2003 that include contextual and organizational variables. Success factors identified in the literature fall under the following clusters: faith support, secular support, partnership (and obstacles to it), faith organization capabilities, secular organization capabilities and caring intervention. Each cluster consists of several factors, whose relative weights cannot be ascertained from the present state of the literature. These clusters of factors can be interrelated through a simple framework that is useful in program design.

Counting crises: US hospital evacuations, 1971-1999.

OBJECTIVES: To investigate the relative distribution of hazards causing hospital evacuations, thereby to provide rudimentary risk information for hospital disaster planning. METHODS: Cases of hospital evacuations were retrieved from newspaper and publication databases and classified according to hazard type, proximate and original cause, duration, and casualties. Both partial and full evacuations were included. The total number of evacuation incidents for all hazards were compared to the total number of hospital incidents for the one hazard, fire, for which national data is available. RESULTS: There were 275 reported evacuation incidents from 1971-1999, with an annual average of 21 in the 1990s, the period for which databases were more reliable. The most, 33, were recorded in 1994, the year of the Northridge Earthquake. Of all incidents, 63 (23%) were attributable primarily to internal fire, followed by internal hazardous materials (HazMat) events (18%), hurricane (14%), human threat (13%), earthquake (9%), external fire (6%), flood (6%), utility failure (5%), and external HazMat (4%). CONCLUSIONS: More than 50% of the hospital evacuations occurred because of hazards originating in the hospital facility itself or from human intruders. While natural disasters were not the preponderant causes of evacuations, they caused severe problems when multiple hospitals in the same urban area were incapacitated simultaneously. Clearly, as hospitals are vulnerable to many hazards, mitigation investments should be assessed not in terms of single-hazard risk-cost-benefit analysis, but in terms of capacity to mitigate multiple hazards. In view of the many qualifications and limitations of the dataset used here, but value of such data for disaster planning, hospitals should be asked to submit standardized incident reports to permit national data gathering on major disruptions.

Planning for resilience in hospital internal disaster.

This article seeks to clarify the terminology and methods of planning to avert hospital internal disaster. It differentiates "crisis" from "disaster" in the in-hospital setting. Preparedness, as contrasted with mitigation, is meant to reduce the likelihood that a crisis will turn into a disaster. Though there are some recurring features of crises, allowing for preparedness through the identification of a few high-likelihood contingencies, crises are subject to numerous, overwhelming uncertainties. These include hazard uncertainty, incident uncertainty, sequential uncertainty, informational uncertainty, consequential uncertainty, cascade uncertainty, organizational uncertainty, and background uncertainty. In view of the uncertainties, the primary aim of planners should not be to try to create plans for ever more contingencies, since contingencies are far too numerous and perhaps approach infinity, but rather to create capabilities (through proper preparedness) for resilience during crisis. Resilience can be cultivated through improvements in information acquisition and dissemination, communication systems, resource management, mobility management, design for resilience, incident command, and staff versatility.