Dental Students' Perceptions Regarding Bioterrorism, a Cross-Sectional Study

Introduction: During the COVID-19 outbreak, dental professionals have demonstrated their importance in combating mass casualty incidents. This study aimed to understand dental students' perceptions of their potential roles in a bioterrorism attack. Methods: This cross-sectional study used a self-administered anonymous questionnaire, which was sent to all dental students and interns at King Abdulaziz University, Saudi Arabia. Bivariate and multiple linear regression analyses were conducted to assess dental students' willingness to provide care during a bioterrorism attack, knowledge regarding bioterrorism and total number of roles a dentist should play during an attack. Results: This study included 472 dental students and interns. The mean knowledge score regarding bioterrorism was 3.3 +/- 1.9 out of 5. A large majority of the respondents (83.8%) were willing to provide care during a bioterrorism attack. Students with a cumulative grade point average (GPA) of 4.5-5 were more likely to indicate that a dental professional should take on more roles during a bioterrorism attack than those with a GPA of 2.5-2.99. Fourth- and fifth-year dental students had lower knowledge scores regarding bioterrorism than dental interns (B: -0.71;SE: 0.30;95% CI: -1.3-0.1 and B: -0.68;SE: 0.30;95% CI: -1.3- -0.1, respectively). Conclusion: Despite the fact that dental curricula do not cover topics related to bioterrorism, most students would be willing to provide care under bioterrorism conditions. There is wide agreement among the students regarding the need to add bioterrorism-related educations to dental curricula.

Collective Efficacy and Perceived COVID-19 Severity Predict Preparedness and Response Behaviors: A Longitudinal Study of Intersectionally Vulnerable University Students.

OBJECTIVE: To promote equity for intersectionally disaster-vulnerable individuals and address three literature gaps: (1) incremental effects of collective and self-efficacy as preparedness predictors, (2) differentiation of fear and perceived severity of a disaster, and (3) clarification of the relationship between fear and preparedness. METHODS: Due to infection risks associated with communal housing, early in the coronavirus disease (COVID-19) pandemic, many universities permitted students to remain in campus housing only if they were housing insecure, including many international students. We surveyed intersectionally-vulnerable students and their partners at a southeast US university, N = 54, who were international (77.8%), Asian (55.6%), and/or housing insecure at baseline (79.6%). In 14 waves from May-October 2020, we assessed pandemic preparedness/response behaviors (PPRBs) and potential PPRB predictors. RESULTS: We examined within- and between-person effects of fear, perceived severity, collective efficacy, and self-efficacy on PPRBs. Within-person perceived severity and collective efficacy both significantly, positively predicted greater PPRBs. All effects of fear and self-efficacy were not significant. CONCLUSIONS: Perceived severity and confidence that one's actions positively impact one's community fluctuated throughout the pandemic and are linked to greater PPRB engagement. Public health messages and interventions to improve PPRB may benefit from emphasizing collective efficacy and accuracy over fear.

Systematic review of medical student willingness to volunteer and preparedness for pandemics and disasters.

OBJECTIVE: This systematic review aimed to estimate the willingness of students to volunteer during a disaster, and how well-prepared medical students are for volunteering by assessing their knowledge and medical school curriculum of disaster and pandemic medicine. RESULTS: A total of 37 studies met inclusion criteria including 11 168 medical students and 91 medical schools. 24 studies evaluated knowledge (64.9%), 16 evaluated volunteering (43.2%) and 5 evaluated medical school curricula (13.5%). Weighted mean willingness to volunteer during a disaster was 68.4% (SD=21.7%, range=26.7%-87.8%, n=2911), and there was a significant difference between those planning to volunteer and those who actually volunteered (p<0.0001). We identified a number of modifiable barriers which may contribute to this heterogeneity. Overall, knowledge of disasters was poor with a weighted mean of 48.9% (SD=15.1%, range=37.1%-87.0%, n=2985). 36.8% of 76 medical schools curricula included teaching on disasters. However, students only received minimal teaching (2-6 hours). CONCLUSIONS: This study demonstrates that there is a large number of students who are willing to volunteer during pandemics. However, they are unlikely to be prepared for these roles as overall knowledge is poor, and this is likely due to minimal teaching on disasters at medical school. During the current COVID-19 pandemic and in future disasters, medical students may be required to volunteer as auxiliary staff. There is a need to develop infrastructure to facilitate this process as well as providing education and training to ensure students are adequately prepared to perform these roles safely.

Managing blood supplies during natural disasters, humanitarian emergencies, and pandemics: lessons learned from COVID-19.

INTRODUCTION: The COVID-19 pandemic has resulted in a historic public health crisis with widespread social and economic ramifications. The pandemic has also affected the blood supply, resulting in unprecedented and sustained blood shortages. AREAS COVERED: This review describes the challenges of maintaining a safe and sufficient blood supply in the wake of natural disasters, humanitarian emergencies, and pandemics. The challenges, which are accentuated in low- and high-income countries, span the impact on human capacity (affecting blood donors and blood collections personnel alike), disruption to supply chains, and economic sustainability. COVID-19 imparted lessons on how to offset these challenges, which may be applied to future pandemics and public health crises. EXPERT OPINION: Pandemic emergency preparedness plans should be implemented or revised by blood centers and hospitals to lessen the impact to the blood supply. Comprehensive planning should address the timely assessment of risk to the blood supply, rapid donor recruitment, and communication of need, measures to preserve safety for donors and operational staff, careful blood management, and resource sharing.

Planning for the next pandemic: Reflections on lessons from the uncontained transmission phases of the COVID-19 pandemic and their impacts on emergency departments in Australia.

Australia was a world leader in managing the earlier waves of the COVID-19 pandemic. Subsequently, three major turning points changed the trajectory of the pandemic: mass vaccinations, emergence of more transmissible variants and re-opening of Australia's borders. However, there were also concomitant missteps and premature shifts in pandemic response policy that led to mixed messaging, slow initial vaccination uptake and minimal mitigation measures in response to the Omicron variant. The latter marked Australia's entry into a new phase of (or approach to) the pandemic: widespread transmission. This led to an exponential increase in cases and significant impacts on the health system, particularly, EDs. This paper reflects on this phase of the pandemic to urge for system-level changes that instal better safeguards for ED capacity, safety and staff well-being for future pandemics. This is essential to strengthening our health system's resilience and to better protecting our communities against such emergencies.

Facilitating Real-Time, Multidirectional Learning for Clinicians in a Low-Evidence Pandemic Response.

As COVID-19 was declared a health emergency in March 2020, there was immense demand for information about the novel pathogen. This paper examines the clinician-reported impact of Project ECHO COVID-19 Clinical Rounds on clinician learning. Primary sources of study data were Continuing Medical Education (CME) Surveys for each session from the dates of March 24, 2020 to July 30, 2020 and impact surveys conducted in November 2020, which sought to understand participants' overall assessment of sessions. Quantitative analyses included descriptive statistics and Mann-Whitney testing. Qualitative data were analyzed through inductive thematic analysis. Clinicians rated their knowledge after each session as significantly higher than before that session. 75.8% of clinicians reported they would 'definitely' or 'probably' use content gleaned from each attended session and clinicians reported specific clinical and operational changes made as a direct result of sessions. 94.6% of respondents reported that COVID-19 Clinical Rounds helped them provide better care to patients. 89% of respondents indicated they 'strongly agree' that they would join ECHO calls again.COVID-19 Clinical Rounds offers a promising model for the establishment of dynamic peer-to-peer tele-mentoring communities for low or no-notice response where scientifically tested or clinically verified practice evidence is limited.

The COVID-19 Pandemic, Fukushima Nuclear Disaster, and Commonalities and Public Health Threat Complexities: A Public Health, Healthcare, and Emergency Management Command and Support Supersystem Model

This article is a 12-year retrospective of the Fukushima nuclear disaster with a 7-year revisitation of our publication, "Implications of the Fukushima Nuclear Disaster: Man-Made Hazards, Vulnerability Factors, and Risk to Environmental Health" (Eddy & Sase, 2015). We shed light on early and erroneous assumptions made about the global environmental health impact, as well as follow up on prolonged site remediation difficulties and controversial scheduled discharges of containerized wastewater. As we developed a refreshed vision of the triple nuclear reactor meltdown, we incorporated lessons learned from the COVID-19 pandemic that resulted in a novel and universally applicable Public Health, Healthcare, and Emergency Management Command and Support Supersystem Model. The model addresses all-hazards readiness needs, which is a core component of U.S. Department of Health and Human Services/Administration for Strategic Preparedness and Response, U.S. Department of Homeland Security/Federal Emergency Management Agency, and U.S. Centers for Medicare & Medicaid Services (CMS) guidelines and law. The model and associated narrative is intended to guide future global and international public health threat planning and response and provide a decision support tool for state and local public health, emergency management, and homeland security practitioners. The model integrates core aspects of U.S. emergency preparedness and response federal doctrine and CMS regulations--representing multiple agencies, professions, and healthcare facility guidelines--with an integrated foundation of practical concepts from One Health, public health, and all-hazards approaches. Although internationally coordinated public health threat prevention and containment is the primary point of emphasis, our model can be applied at all jurisdictional levels.

Long COVID and chronic pain: overlapping racial inequalities

The American Public Health Association (APHA) and prominent U.S. health organizations have acknowledged racism as a central cause of health inequality. In the midst of the COVID-19 pandemic, the U.S. confronts an additional public health crisis: mass impairment from Long COVID. Occupational segregation and institutionalized racism have made working-class Black, Indigenous, and people of color (BIPOC) more likely to experience Long COVID. Medical gatekeepers also prevent equal access to health: BIPOC face more obstacles in their search for disability accommodations and social support. To provide health equity to the Long COVID community, Disability Studies must confront racialized understandings of chronic pain and the consequences of these meanings by centering the lived experiences of BIPOC living with chronic pain.

Disasters and the blood community (including COVID-19)

This chapter is an attempt to explain and link the reader to the resources available to guide the development of an organization wide disaster preparedness process. Issues presented by the COVID-19 pandemic are also discussed. National governmental authorities generally have agencies responsible for the coordination of disaster planning and response in their respective countries. Important exemplars of international sources of information and training on disaster planning and emergency operations are provided. The blood community is highly regulated worldwide and even slight changes to processes and procedures can have far-reaching effects for facilities and patients, especially during an emergency. Blood collection and transfusion facilities must address regulatory impacts as part of their disaster planning. Vital records must be secured and maintained. These documents include records of donors, donations, manufacturing, testing, quality assurance, product disposition, as well as transfusion records. © 2022 John Wiley & Sons Ltd.

Rapid Emergency Department Physical Space Modifications for COVID-19: Keeping Patients and Health Care Workers Safe.

The COVID-19 pandemic has placed significant strain on emergency departments (EDs) that were not designed to care for many patients who may be highly contagious. This report outlines how a busy urban ED was adapted to prepare for COVID-19 via 3 primary interventions: (1) creating an open-air care space in the ambulance bay to cohort, triage, and rapidly test patients with suspected COVID-19, (2) quickly constructing temporary doors on all open treatment rooms, and (3) adapting and expanding the waiting room. This description serves as a model by which other EDs can repurpose their own care spaces to help ensure safety of their patients and health care workers.

Your Call Is Important to Us: COVID-19 and Trends in Public Health Unit Call Service Utilization.

OBJECTIVE: The aim of this study was to analyze coronavirus disease 2019 (COVID-19) -related call data at Metro North Public Health Unit, Brisbane Australia, over the 2020 calendar year to assist surge preparedness. METHODS: Call data were retrieved by call category or reference to "COVID" in summaries from the call management system at a large metropolitan public health service. Under a mixed-methods approach, qualitative data (caller, call purpose, and call outcome) were categorized with categories arising de novo. Resulting variables were numerically analyzed to identify trends by categories and time. RESULTS: Of the 3468 calls retrieved, 160 duplicates and 26 irrelevant calls were excluded. Of 3282 included calls, general practitioners, followed by the public, contributed the greatest call volumes. Health-care-related callers and the public made 84.2% of calls. Calls most frequently related to patient testing (40.7%) and isolation/quarantine (23.2%). Education provision accounted for 29.4% of all outcomes. A total of 11.8% of all call outcomes involved applying relevant case definitions, and 49.1% of calls were identified as potentially preventable through effective emergency risk communication and targeted call-handling. CONCLUSIONS: This study identified key drivers of public health unit phone service use related to the COVID-19 pandemic throughout 2020. The results highlighted where risk perception influenced call volume and provided important insights for future public health preparedness.

COVID-19: A Comprehensive Analysis of the Pandemic's Effect on an Emergency Department.

OBJECTIVE: Coronavirus disease 2019 (COVID-19, caused by severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) is a historic pandemic severely impacting health care. This study examines its early effect on a busy academic emergency department. METHODS: A retrospective analysis of patients from an academic tertiary care Level I trauma, cardiac and stroke center's emergency department seeing an average of 54,000 adults and 21,000 pediatric patients per year. Total visits, reasons for patient visits, demographics, disposition, and length of stay were analyzed from January through July 2020 and compared with the same time period in the previous 2 y. RESULTS: From March through July 2020 there were statistically significant decreases in the total number of patient visits (-47%) especially among pediatric (-73%) and elderly (-43%) patients and those with cardiovascular (-39%), neurological (-63%) complaints, headaches (-60%), back pain (-64%), abdominal pain (-51%), and minor trauma (-71%). There was, however, a significant increase in pulmonary complaints (+54%), as well as admissions (+32%), and length of stay (+40%). CONCLUSIONS: There was a significant drop in overall patients and select groups early in the pandemic, while admissions and emergency department length of stay both increased. This has implications for future pandemic planning.

Factors Impacting Readiness to Perform Secondary Population-Based Triage During the Second Wave of COVID-19 in Victoria, Australia: Pilot Study.

OBJECTIVE: Pandemics generate such a significant demand for care that traditional triage methods can become saturated. Secondary population-based triage (S-PBT) overcomes this limitation. Although the coronavirus disease (COVID-19) pandemic forced S-PBT into operation internationally during the first year of the pandemic, Australian doctors were spared this responsibility. However, the second wave of COVID-19 provides an opportunity to explore the lived experience of preparing for S-PBT within the Australian context.The aim of this study is to explore the lived experience of preparing to operationalize S-PBT to allocate critical care resources during Australia's second wave of COVID-19 in 2020. METHODS: Intensivists and emergency physicians working during the second Victorian COVID-19 surge were recruited by purposive non-random sampling. Semi-structured interviews were hosted remotely, recorded, transcribed, and coded to facilitate a qualitative phenomenological analysis. RESULTS: Six interviews were conducted with an equal mix of intensivists and emergency doctors. Preliminary findings from a thematic analysis revealed 4 themes: (1) threat of resources running; (2) informed decision requiring information; (3) making decisions as we always do; and (4) a great burden to carry. CONCLUSION: This is the first description of this novel phenomenon within Australia and, in doing so, it identified a lack of preparedness to operationalize S-PBT during the second wave of COVID-19 in Australia.

Experience of frontline nurses who managed the COVID-19 crisis: A qualitative study.

Background: The health system was challenged during the COVID-19 pandemic. Nurses, as part of the health system, were expected to manage themselves in a situation where everyone was in crisis and to be able to do their work quietly and calmly. This study was conducted to show how Iranian nurses faced the COVID-19 crisis. Methods: In a qualitative content analysis study, 16 participants, including eight nurses, five supervisors, and three head nurses of a university hospital in Tehran, Iran, were interviewed between February and December 2020. Using purposive sampling, nurses who were working with patients with COVID-19 were selected to be involved. Data were analyzed using MAXQDA 10 software, and codes were categorized based on similarities and differences. Finding: Data analysis revealed 212 codes. These codes were classified based on similarities and differences in 16 categories, and four main themes emerged: unpreparedness, positive adaptation, negative coping, and reorganization. Conclusion: Since nurses are on the frontline in times of biological disaster, the COVID-19 pandemic provided an opportunity to demonstrate the role of nurses in reducing the burden of disease, identifying problems and opportunities, and planning appropriate interventions.

Training of Medical Responders to Nuclear Disaster: Hybrid Program in the COVID-19 Pandemic.

OBJECTIVE: The spread of COVID-19 has made it difficult to provide training in medical treatment in a radiation disaster. In this study, we will examine the effects and challenges of using a hybrid approach that combines online and face-to-face components. METHODS: Five face-to face and 25 online medical staff participated in the training program. This program was conducted by using multiple cameras with live coverage, and protective clothing and decontamination kits to the participants in advance were sent so they could experience face-to-face and online learning at the same time. RESULTS: Participants reported a high level of satisfaction and achievement with the style of delivery, as well as problems such as fatigue due to long hours and dissatisfaction with the debriefing. CONCLUSIONS: In designing new online training, it is necessary to consider the quantity and content of the program, and take participant fatigue into consideration.