RESUMO
STUDY OBJECTIVE: Hospital evacuations have myriad effects on all elements of the health care system. We seek to (1) examine the effect of patient surge on hospitals that received patients from evacuating hospitals in New York City during Hurricane Sandy; (2) describe operational challenges those hospitals faced pre- and poststorm; and (3) examine the coordination efforts to distribute patients to receiving hospitals. METHODS: We used a qualitative, interview-based method to identify medical surge strategies used at hospitals receiving patients from evacuated health care facilities during and after Hurricane Sandy. We identified 4 hospital systems that received the majority of evacuated patients and those departments most involved in managing patient surge. We invited key staff at those hospitals to participate in on-site group interviews. RESULTS: We interviewed 71 key individuals. Although all hospitals had emergency preparedness plans in place before Hurricane Sandy, we identified gaps. Insights gleaned included improvement opportunities in these areas: prolonged increased patient volume, an increase in the number of methadone and dialysis patients, ability to absorb displaced staff, the challenges associated with nursing homes that have evacuated and shelters that have already reached capacity, and reimbursements for transferred patients. CONCLUSION: Our qualitative, event-based research identified key opportunities to improve disaster preparedness. The specific opportunities and this structured postevent approach can serve to guide future disaster planning and analyses.
Assuntos
Tempestades Ciclônicas , Planejamento em Desastres/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Transferência de Pacientes/organização & administração , Capacidade de Resposta ante Emergências , Prática Clínica Baseada em Evidências , Fechamento de Instituições de Saúde , Humanos , Cidade de Nova Iorque , Pesquisa QualitativaRESUMO
Since 2001, three autochthonous dengue fever outbreaks have occurred in the United States: in Hawaii (2001); Brownsville, Texas (2005); and southern Florida (2009-2011). We sought to characterize and describe the response to these outbreaks from the perspectives of public health and vector control officials. By conducting a medical literature review through PubMed and news media searches through Google, we identified persons involved in managing each outbreak; 26 persons then participated in qualitative, semistructured interviews. After analyzing the 3 outbreaks, we found the following prominent themes in the response efforts: timely detection of illness; communication of up-to-date, correct information; and development of a rapid response that engages the community. We therefore recommend that public health authorities involve the clinical and laboratory community promptly, provide accurate information, and engage the local community in vector control and case identification and reporting.
Assuntos
Dengue/epidemiologia , Surtos de Doenças/prevenção & controle , Controle de Doenças Transmissíveis , Dengue/prevenção & controle , Humanos , Disseminação de Informação , Entrevistas como Assunto , Estudos Retrospectivos , Estados Unidos/epidemiologiaAssuntos
Planejamento em Desastres/organização & administração , Aplicações da Informática Médica , Administração em Saúde Pública/métodos , Mídias Sociais/estatística & dados numéricos , Telemedicina/organização & administração , Planejamento em Desastres/métodos , Planejamento em Desastres/tendências , Humanos , Disseminação de Informação/métodos , Entrevistas como Assunto , Governo Local , Aplicativos Móveis/estatística & dados numéricos , Aplicativos Móveis/tendências , Administração em Saúde Pública/tendências , Mídias Sociais/tendências , Telemedicina/métodos , Telemedicina/tendências , Estados UnidosRESUMO
Personal health records (PHRs), in contrast to electronic health records (EHRs) or electronic medical records (EMRs), are health records in which data are accessible to patients and not just providers. In recent years, many systems have enabled PHRs to be available in a mobile format. Mobile PHRs (mPHRs) allow patients to access health information via the Internet or telecommunication devices, such as mobile phones, personal digital assistants, and tablet computers. mPHRs have the potential to help patients and providers identify medical conditions and prescriptions from numerous locations, which may minimize medical errors and identify improvements to health behaviors during emergencies, when patients present to a new provider, or EHRs are not accessible. Despite their benefits, numerous challenges inhibit the adoption and further development of mPHRs, including integration into overall health technology infrastructure and legal and security concerns. This paper identifies the benefits of mPHRs during emergencies and the remaining challenges impeding full adoption and use, and provides recommendations to federal agencies to enhance support and use of mPHRs.
RESUMO
Hurricane Katrina demonstrated that a catastrophic event in the continental United States (US) can overwhelm domestic medical response capabilities. The recent focus on response planning for a catastrophic earthquake in the New Madrid Seismic Zone and the detonation of an improvised nuclear device also underscore the need for improved plans. The purpose of this analysis is to identify the potential role of foreign medical teams (FMTs) in providing medical response to a catastrophic event in the US. We reviewed existing policies and frameworks that address medical response to catastrophic events and humanitarian emergencies and assess current response capabilities by a variety of FMTs. While several policies and plans outline the role of the US in providing medical assistance during foreign disasters, further planning is necessary to identify how the US will integrate foreign medical assistance during a domestic catastrophic event. We provide an overview of considerations related to federal roles and responsibilities for managing and integrating FMTs into the overarching domestic medical response to a catastrophic disaster occurring in the continental US.
Assuntos
Planejamento em Desastres/organização & administração , Serviços Médicos de Emergência/organização & administração , Socorristas , Cooperação Internacional , Capacidade de Resposta ante Emergências/organização & administração , Planejamento em Desastres/normas , Desastres , Humanos , Agências Internacionais/organização & administração , Agências Internacionais/normas , Avaliação das Necessidades , Capacidade de Resposta ante Emergências/normas , Estados Unidos , Recursos HumanosRESUMO
Conditions that facilitate sustained dengue transmission exist in the United States, and outbreaks have occurred during the past decade in Texas, Hawaii, and Florida. More outbreaks can also be expected in years to come. To combat dengue, medical and public health practitioners in areas with mosquito vectors that are competent to transmit the virus must be aware of the threat of reemergent dengue, and the need for early reporting and control to reduce the impact of dengue outbreaks. Comprehensive dengue control includes human and vector surveillance, vector management programs, and community engagement efforts. Public health, medical, and vector-control communities must collaborate to prevent and control disease spread. Policy makers should understand the role of mosquito abatement and community engagement in the prevention and control of the disease.
Assuntos
Dengue/epidemiologia , Surtos de Doenças/prevenção & controle , Insetos Vetores , Aedes/virologia , Animais , Dengue/história , Dengue/transmissão , Vírus da Dengue/patogenicidade , Pessoal de Saúde , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Controle de Mosquitos , Vigilância da População , Estados Unidos/epidemiologiaRESUMO
The process of environmental decontamination is a key step in a successful response to a large-scale attack involving a biological agent. Costs for the decontamination response following the 2001 anthrax attacks were estimated in the hundreds of millions of dollars, and some facilities could not be reopened for more than 2 years. However, a large-scale biological attack would likely result in an even greater amount of contamination, more areas that need to be cleaned and made safe, and a much greater cost to the American public. This article identifies gaps in decontamination policy and technical practice at the federal level and provides practical recommendations that will better enable the U.S. to undertake a biological decontamination response.
Assuntos
Bioterrorismo/prevenção & controle , Descontaminação , Planejamento em Desastres/tendências , Governo Federal , Armas Biológicas , Descontaminação/métodos , Recuperação e Remediação Ambiental/métodos , Humanos , Estados UnidosRESUMO
In a public health emergency involving significant surges in patients and shortages of medical staff, supplies, and space, temporarily expanding scopes of practice of certain healthcare practitioners may help to address heightened population health needs. Scopes of practice, which are defined by state practice acts, set forth the range of services that licensed practitioners are authorized to perform. The U.S. has had limited experience with temporarily expanding scopes of practice during emergencies. However, during the 2009 H1N1 pandemic response, many states took some form of action to expand the practice scopes of certain categories of practitioners in order to authorize them to administer the pandemic vaccine. No standard legal approach for expanding scopes of practice during emergencies exists across states, and scope of practice expansions during routine, nonemergency times have been the subject of professional society debate and legal action. These issues raise the question of how states could effectively implement expansions for health services beyond administering vaccine and ensure consistency in expansions across states during catastrophic events that require a shift to crisis standards of care. This article provides an overview of scopes of practice, a summary of the range of legal and regulatory approaches used in the U.S. to expand practice scopes for vaccination during the 2009 H1N1 response, and recommendations for future research.
Assuntos
Programas de Imunização , Vírus da Influenza A Subtipo H1N1/imunologia , Influenza Humana/prevenção & controle , Pandemias/prevenção & controle , Padrões de Prática Médica/legislação & jurisprudência , Humanos , Prática de Saúde Pública , Estados UnidosRESUMO
Over the past 3 decades, dengue has spread rapidly and has emerged as one of the world's most common mosquitoborne viral diseases. Although often found in tropical and semitropical areas, dengue is capable of being transmitted in temperate climates as well. Dengue is currently endemic to Mexico, most other Latin American countries, and parts of the Caribbean, and it has the potential to become reestablished as an endemic disease in the United States. In fact, sustained transmission of dengue has occurred in Florida within the past year. Conditions exist in the U.S. that could facilitate sustained dengue transmission, including environmental factors, competent mosquito vectors, limited vector and dengue surveillance, increased domestic outdoor daytime activities in warmer months, and low public awareness of the disease. If dengue were to be reestablished in the U.S., it could have significant medical, public health, and economic consequences for the country. The impact of dengue as a public health threat could be lessened through enhanced awareness and reporting of cases, increased support for vector surveillance and control programs, and a greater focus on vaccine development.
Assuntos
Dengue , Animais , Culicidae , Dengue/etiologia , Dengue/transmissão , Vigilância da População , Saúde Pública , Fatores de Risco , Estados UnidosRESUMO
At the outset of the 2009 H1N1 influenza ("swine flu") pandemic, Mexican nationals and Mexican commodities were shunned globally, and, in the United States, some media personalities characterized Mexican immigrants as disease vectors who were a danger to the country. We investigated instances in the U.S. of stigmatization of Latino migrant and seasonal farmworkers (MSFWs) and developed guidance for officials in curtailing its effects. At the same time, we explored social factors that make farmworkers more vulnerable to influenza infection and its complications, including high rates of underlying medical conditions, limited access to health care, and certain circumstances that interfere with the ability to implement community mitigation measures. This article reviews study findings and concludes with advice to policymakers and practitioners on the need to mitigate stigmatization in future outbreaks, to create public health preparedness systems that better protect migrant and seasonal farmworkers, and to undertake larger reforms to reduce institutional conditions that render farmworkers at greater risk for morbidity and mortality during health emergencies.