Emergency Preparedness, Resilience and Response

BACKGROUND: Hazardous areas are places emitting hazardous materials, terrorist- or war-related, which lead to public health risks in developed and developing countries globally. Hence, prehospital emergency medical personnel who work as frontliners should be trained. PATIENTS AND METHODS: Data via pretest, posttest, and questionnaire surveys regarding the HART's knowledge of and confidence in operational skills were collected using the 5-point Likert scale. The cohort included prehospital emergency medical personnel aged >18 years...

INTRODUCTION: Intentional mass-casualty incidents (IMCIs) involving motor vehicles (MVs) as weapons represent a growing trend in Western countries. This method has resulted in the highest casualty rates per incident within the field of IMCIs. Consequently, there is an urgent requirement for a timely and accurate casualty estimation in MV-induced IMCIs to scale and adjust the necessary health care resources. STUDY OBJECTIVE: The objective of this study is to identify the factors associated with the number of casualties during the initial phase of MV-IMCIs...

BACKGROUND: In the event of a mass casualty incident (MCI), the situation-related shortage of medical resources does not end when the patients are transported from the scene of the incident. Consequently, an initial triage is required in the receiving hospitals. In the first step, the aim of this study was to create a reference patient vignette set with defined triage categories. This allowed a computer-aided evaluation of the diagnostic quality of triage algorithms for MCI situations in the second step...

INTRODUCTION: Effective response to a mass-casualty incident (MCI) entails the activation of hospital MCI plans. Unfortunately, there are no tools available in the literature to support hospital responders in predicting the proper level of MCI plan activation. This manuscript describes the scientific-based approach used to develop, test, and validate the PEMAAF score (Proximity, Event, Multitude, Overcrowding, Temporary Ward Reduction Capacity, Time Shift Slot [Prossimità, Evento, Moltitudine, Affollamento, Accorpamento, Fascia Oraria], a tool able to predict the required level of hospital MCI plan activation and to facilitate a coordinated activation of a multi-hospital network...

PURPOSE: To investigate prehospital preparedness work for Mass Casualty Incidents (MCI) and Major Incidents (MI) in Norway. METHOD: A national cross-sectional descriptive study of Norway's prehospital MI preparedness through a web-based survey. A representative selection of Rescue and Emergency Services were included, excluding Non-Governmental Organisations and military. The survey consisted of 59 questions focused on organisation, planning, education/training, exercises and evaluation...

INTRODUCTION: Stadiums are an important part of the entertainment and sporting cultures of communities around the world, but the combination of outdated infrastructure with poor safety planning, large numbers of people gathering within a confined space, and the high frequency of such events have led to a number of significant disasters in the past. This is a descriptive analysis of stadium disasters occurring between 1901 and 2021 which may provide useful insight for event safety personnel and disaster medicine specialists to better prevent and mitigate the effects of potential future stadium disasters...

This article presents a reflective analysis of the role of public leadership within the context of crises, advocating for increased involvement of public health experts in crisis management. The study delves into the intricate dynamics that executives and board members exhibit when faced with crises. A primary focus of this research is the essential aspects that illuminate the engagement of public officials in the ongoing crisis, notably rapid decision-making and innovative thinking. The article underscores the paramount importance of leaders emphasizing values and mission while employing clear, meaningful, and empathetic communication...

OBJECTIVE: To provide standardized recommendations for the emergency department (ED) response to chemical, biological, radiological, and nuclear (CBRN) events by combining the human factors/ergonomics method of hierarchical task analysis with the theoretical framework for Work as Imagined versus Work as Done. METHODS: Document analyses were used to represent CBRN response operational procedures. Semi-structured interviews using scenario cards were carried out with 57 first receivers (ED staff) to represent CBRN practice at 2 acute hospitals in England...

The application and provision of prehospital care in disasters and mass-casualty incident response in Europe is currently being explored for opportunities to improve practice. The objective of this translational science study was to align common principles of approach and action and to identify how technology can assist and enhance response. To achieve this objective, the application of a modified Delphi methodology study based on statements derived from key findings of a scoping review was undertaken. This resulted in 18 triage, eight life support and damage control interventions, and 23 process consensus statements...

Ethical decision making in disaster and emergency management requires more than good intentions; it also asks for careful consideration and an explicit, systematic approach. The decisions made by leaders and the effects they have in a disaster must carry the confidence of the community to which they serve. Such decisions are critical in settings where resources are scarce; when decisions are perceived as unjust, the consequences may erode public trust, result in moral injury to staff, and cause community division...

INTRODUCTION: The leadership of Vista Forge 2022 requested evaluation of the handoff process between military assets and civilian emergency medical services (EMS) providers by the Beth Israel Deaconess Fellowship in Disaster Medicine (BIDMF). Vista Forge was a multi-agency military-civilian full-scale disaster exercise coordinated by the U.S. Military. The exercise, held in Atlanta, Georgia, simulated response to a nuclear bomb in an urban setting by military and civilian disaster teams...

Mass shootings are horrific events that annually take scores of innocent lives in the United States. Federal, state, and local governments as well as educational, religious, and private-sector organizations propose and enact polices and strategies to protect people from and during active shooter situations. A probabilistic risk assessment of a mass shooting for a specific organization, jurisdiction, or location can be the first step toward evaluating the effectiveness of risk mitigation strategies and determining which strategies might be most appropriate for a location...

This paper describes how toxicological considerations are an essential component of acute chemical incident response, and how the UK Health Security Agency (UKHSA), as Category 1 responders under the Civil Contingencies Act (2004), provide that expert, authoritative, and timely advice to protect people from exposure to harmful substances. Background information about the general response to emergencies is provided, which gives context to how scientific advice has a positive impact. The importance of chemical identification and speciation, local, and systemic effects, and exposure characteristics are described...

INTRODUCTION: In 2019, the World Health Organization (WHO) published the Health Emergency and Disaster Risk Management (H-EDRM) framework detailing how effective management of disasters, including mass-casualty incidents (MCIs), can be achieved through a whole-of-health system approach where each level of the health care system is involved in all phases of the disaster cycle. In light of this, a primary health care (PHC) approach can contribute to reducing negative health outcomes of disasters, since it encompasses the critical roles that primary care services can play during crises...

The onset of the COVID-19 pandemic revealed significant gaps in the United States' pandemic and public health emergency response system. At the federal level, government responses were undercut by a lack of centralized coordination, inadequately defined responsibilities, and an under-resourced national stockpile. Contradictory and unclear guidance throughout the early months of the pandemic, along with inconsistent funding to public health agencies, also created notable variance in state and local responses...

OBJECTIVES: In a mass casualty incident (MCI) exercise, live-actor patients (LAPs) simulated different scenarios in the exercise. This study compared the benefit to LAPs with that to exercise players (EPs) and nonparticipants (NPs). METHODS: An MCI exercise was conducted in 2018. Emergency department (ED) nurses were assigned as EPs, LAPs, or NPs and asked to attend a pre-exercise lecture. A pre-exercise survey evaluated all ED nurses' background, confidence level, and knowledge of MCI management...

INTRODUCTION: As the COVID-19 pandemic has demonstrated, the complexity of factors involved in the emergence of health threats requires a holistic One Health (OH) approach to enhance the effectiveness of prevention, preparedness, and response (PPR) strategies. Therefore, we conducted a scoping review to explore how the OH approach has been adopted in the context of PPR strategies to health threats, and the challenges and benefits deriving from its integration. METHODS: We defined the research questions and a strategy to guide the peer-reviewed and grey literature search to identify relevant articles and documents (identification)...

A programme of asymptomatic swabbing was piloted in 2021/2022 in England to further understand the risk of human infection with avian influenza in exposed individuals and to evaluate this surveillance approach as a public health measure. There were challenges in deploying this pilot that will need to be addressed for future seasons. However, there was one detection of avian influenza A(H5N1) in a human despite low uptake in eligible exposed persons. Future use of asymptomatic swabbing could help provide an evidence base to quantify asymptomatic infection, quickly identify signals of increased animal to human transmission and improve public health preparedness...

The risk of internal and external exposure to ionizing radiation (IR) has increased alongside the development and implementation of nuclear technology. Therefore, serious security issues have emerged globally, and there has been an increase in the number of studies focusing on radiological prevention and medical countermeasures. Radioprotective drugs are particularly important components of emergency medical preparedness strategies for the clinical management of IR-induced injuries. However, a few drugs have been approved to date to treat such injuries, and the related mechanisms are not entirely understood...

Background : Prioritisation of research activities for infectious disease pathogens is usually undertaken through the identification of important research and knowledge gaps. Research prioritisation is an essential element of both effective responses to disease outbreaks and adequate preparedness. There is however currently no published mapping of activities on and evidence from research prioritisation for high consequence pathogens. The objectives of this review are to map all published research prioritisation exercises on high-consequence pathogens; provide an overview of methodologies employed for prioritising research for these pathogens; describe monitoring and evaluation processes for research areas prioritised; and identify any standards and guidance for effectively undertaking research prioritisation activities for high consequence pathogens...