IMPACT OF VIRTUAL INTERPROFESSIONAL COVID-19 DISASTER SIMULATION TABLETOP EXERCISE (VICTER) WORKSHOP ON DISASTER PREPAREDNESS AMONG INTERPROFESSIONAL TRAINEES IN A TERTIARY CARE TEACHING HOSPITAL IN INDIA

INTRODUCTION: Disaster planning is of significant importance for the healthcare professional and the healthcare setting. Hospital-based disaster protocols form the cornerstone of disaster response. There is a paucity of data on disaster preparedness training using the virtual tabletop exercise (VTTX) module for interprofessional education from in-hospital and prehospital settings. With the coronavirus disease 2019 (COVID-19) pandemic, we have seen a paradigm shift of education strategies to the virtual realm. Here we attempt to study the impact of an online tabletop exercise workshop on the knowledge and confidence of disaster preparedness among Interprofessional trainees. MATERIAL AND METHODS: Interprofessional trainees from medical, dental, nursing, respiratory therapy, and paramedic domains who consented were included in this study. Institutional ethics committee approval was received and the study was registered with the clinical trials registry India (CTRI), before initiation. The VTTX module has been adapted from the World Health Organization (WHO) COVID-19 training resources. Three international experts from the disaster medicine domain validated the module, questionnaire, and feedback. Wilcoxon signed-rank test was used to compare the parameters (Knowledge and confidence level) pre and post-workshop. RESULTS: A total of 76 candidates with a mean age was 21.67 ± 2.5 (range:19-36) were part of the workshop. Comparison of the median scores and interquartile range of confidence level and knowledge respectively before [38 (29.25-45.75), 9 (7-11)] and after [51.50 (45-60), 11 (10-12)] the workshop showed vital significance (p-value < 0.001). All participants gave positive feedback on the workshop meeting the objectives. The majority agreed that the workshop improved their self-preparedness (90%) and felt that the online platform was appropriate (97.5%) CONCLUSIONS: This study sheds light on the positive impact of the online VTTX based workshop on disaster preparedness training among interprofessional trainees. Disaster preparedness training using available online platforms may be effectively executed with the VICTEr workshop even during the COVID-19 pandemic. The VICTEr workshop serves as a primer for developing online modules for effective pandemic preparedness training in interprofessional education. Copyright © 2023 Via Medica.

Preparedness and coping with the COVID-19 pandemic

Health disasters have affected humanity since its dawn. In other epidemics, the casualties caused number in the hundreds of thousands. The preparation for confronting the COVID-19 epidemic at the Military Hospital of Matanzas, "Dr. Mario Muñoz Monroy”, began early. In order to analyze this experience, we reflect on the results of the confrontation in 2020, based on the main aspects, the coordination with other organizations, the decisions made, structural changes and modifications of institutional processes. Consolidating scientific improvement has been a permanent pillar, along with discipline, personal and social responsibility of the members of the collective. © 2023, Editorial Ciencias Medicas. All rights reserved.

Nurses' disaster core competencies and resilience during the COVID-19 pandemic: A cross-sectional study from Turkey.

AIM: The aim of this study is to determine nurses' disaster core competency levels, compare them based on characteristics and examine the relationships with psychological resilience. BACKGROUND: Since nurses constitute a critical part in the health care services, it is important to understand the competencies and effective factors in their disaster preparedness. METHODS: The data were collected from 489 nurses between January and February 2021 with an introductory information form, the Nurses' Perceptions of Disaster Core Competencies Scale and the Connor-Davidson Resilience Scale. RESULTS: The nurses' level of disaster core competencies was above the average, and it was positively correlated with their psychological resilience. The nurses' disaster experiences made higher differences on their disaster core competencies when compared to their personal and professional characteristics. CONCLUSIONS: It is important to provide disaster training and drills to all nurses on a regular basis. However, under disaster conditions, resilience should also be considered and included in the preparation plans for nurses to support their professional competencies and qualifications. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should play a leadership role in planning disaster preparedness training for nurses, and these trainings should be addressed to cover both professional competencies and resilience for nurses to respond effectively to disasters.

Pediatric Behavioral Health during the COVID-19 Pandemic: Expert Advice for Preparedness, Response, and Recovery.

The COVID-19 pandemic exacerbated the child mental health crisis and existing disparities. Child anxiety, depression, suicide attempts and completions, and mental-health-related emergency department visits significantly increased. In response to this crisis, the Administration for Strategic Preparedness and Response (ASPR) developed behavioral health task forces associated with funded pediatric centers of disaster excellence. The Health Resources and Services Administration (HRSA) funded the Pediatric Pandemic Network (PPN) to prepare for future endemics and pandemics, with behavioral health identified as a priority in mitigation, preparedness, response, and recovery. This commentary provides insights from pediatric disaster preparedness and response behavioral health subject matter experts. Our roles have been to identify how to build behavioral health professional competencies across disciplines and various medical settings and to strengthen emergency interdisciplinary behavioral health care capability regionally and at the national level. Specific examples of interdisciplinary training and demonstration projects are included as models for enhancing behavioral health situational awareness and developing curricula to support preparedness and response for the current ongoing pandemic and future natural and biological disasters. This commentary also includes a call to action for workforce development to move beyond a boots-on-the-ground mentality for pediatric behavioral health disaster preparedness and response toward a more inclusive role for behavioral health providers of varied specialties. This means that behavioral health providers should become more informed of federal programs in this area, seek further training, and find innovative ways to collaborate with their medical colleagues and community partners.

Impact of Covid-19 among Small Scale Industry Fishermen - A Mixed Methods Study from Coastal Area of Karnataka

Background: The ongoing COVID-19 pandemic has grave implications worldwide. Workers in small scale industries like fisheries forms a vulnerable group without social security/recognised labour rights Objectives: To assess the physical, mental and socio- economic impact of COVID-19 among fishermen community from coastal area of Karnataka 2. To understand the challenges faced and coping mechanism adopted to mitigate the impact Methodology: This community based mixed methods study was conducted among 138 participants from a fishermen community in coastal Karnataka. Quantitative data included sociodemographics, COVID-19 diagnosis, treatment, related expenses and DASS -21 questionnaire. Qualitative data was collected through 3 Focus Group Discussions and 7 Key informant Interviews till data saturation. Result(s): A total of 138 participants (quantitative 107 and qualitative 31) were included. Majority of the participants were males (70.1%), belonged to age category of 46-60 years (37.4%), nuclear family (71%) and were from low socioeconomic status (79.4%). COVID-19 appropriate behaviour was found to be poor among participants with only 36% using masks, 24.3% washing hands and 10.3% maintaining social distancing. Among 107, 51 (47.7%) participants had probable COVID-19 symptoms. However only 7 (10.9%) had tested for COVID-19 with test positivity rate of 57.1%. Two participants were admitted in hospital with mean hospital stay of 7 days. According to DASS-21, 20.6%, 15.9% and 9.3% screened positive for depression, anxiety and stress respectively. Nealy 90% lost jobs and more than 75% reported to have financial difficulties. Major challenges included loss of livelihood, inaccessibility to health care, repayment of loans, stigma related to Covid-19 and meeting educational expenses of children with one drop out from college. Strategies to cope up with financial difficulty included borrowings, pawning and selling assets at individual level. Activities of local self-help groups in the community and grass root level marketing strategies were highly successful in mitigating the impact as a community. Conclusion(s): COVID-19 has affected fishermen community to a large extent. This understanding will enable to implement need-based intervention strategies and help in disaster preparedness among this population.

Student Perspective of Team Dynamics before and after a Disaster Response Course

Purpose of Study We need to understand the COVID-19 pandemic impact on healthcare students. Loma Linda University requires an annual Critical Incident Response Course for graduating students about the importance of interprofessional teamwork in a disaster response. We surveyed students about the pandemic impact on their lives. Methods Used This is a mixed methods multidisciplinary cohort study of healthcare students (n=442). The 2020 course consisted of asynchronous content (eight hours) and a synchronous virtual meeting (two hours) focusing on triage, disaster simulation, and interprofessional teamwork. Students completed a pre/post survey on the COVID-19 pandemic response. We report both descriptive statistics and qualitative results from two independent coders. Summary of Results Respondents included Medicine (n=149), Nursing Undergraduate (n=169), Nursing Graduate (n=16), Pharmacy (n=45), Dentistry (n=58), Other (n=5). Inter-rater reliability for coded answers exceeded, k=0.827 (Cohen's kappa analysis). Students reported observing examples of efficient teamwork (77%) compared to 42% reporting inefficiencies. The most common efficiency was Mutual Support/ Collaboration (50%) and the least reported was Team Structure (6%). Most common inefficiency was communication (41%) and the least was adaptability (4%). Students believed their profession will be different after COVID-19 (76%). The most reported anticipated change was Disaster Preparedness/ Infection control (59%). Post-coursework survey showed 55% reported a stronger understanding of their profession's impact on disaster management. Individuals reported changing behavior during the pandemic (84%). The biggest change was in sleep: 15% reported a decrease and 41% reported an increase, followed by connecting with people (21% decrease, 39% increase). The biggest unmet need was Money (27%). The most helpful resources were Friends/Family (89%) and Social Media (43%). 34% volunteered or worked at an essential workplace. Conclusions Healthcare students reported that communication, mutual support, and understanding one's interprofessional contribution are the core of fighting a pandemic. Healthcare students have unique challenges and resource requirements during a pandemic.

A framework to assess potential health system resilience using fuzzy logic.

Objectives: To develop and test a framework to assess the potential of public health systems to maintain a resilient performance. Methods: Quantitative data from public databases and qualitative data from technical reports of Brazilian health authorities were used to develop the framework which was assessed and modified by experts. Fuzzy logic was used for the mathematical model to determine scores for four resilient abilities - monitoring, anticipation, learning, and response - and an aggregated coefficient of resilient potential in health care. The coefficient measures used data from before the coronavirus disease 2019 (COVID-19) pandemic. These were compared with measures of the actual performance of health systems in 10 cities in Brazil during the pandemic. Results: The coefficient of resilient potential in health care showed that the cities most affected by COVID-19 had lower potential for resilient performance before the pandemic. Some local health systems had adequate response capabilities, but other abilities were not well developed, which adversely affected the management of the spread of COVID-19. Conclusions: The coefficient of resilient potential in health care is useful to indicate important areas for resilient performance and the different types of resilience capacities that can be considered in different contexts and levels of public health systems. Regular assessment of the potential of health systems for resilient performance would help highlight opportunities for continuous improvement in health system functions during chronic stress situations, which could strengthen their ability to keep functioning in the face of sudden disturbances.

Towards optimal quarantine: A scoping review of quarantine planning in the pandemic preparedness plans and pandemic exercises of Australia and New Zealand

Introduction: Since 2020, the New Zealand and Australian federal, state and territory governments have used quarantine as a strategic infection control measure to contain the SRS-CoV-2 (COVID-19) virus. However, the quarantine programs of both countries were rapidly operationalised without a clear blueprint for infection prevention. This paper identifies gaps in forecasting the need, and planning, for widespread quarantine within New Zealand's and Australia's Pandemic Preparedness Plans and pandemic exercise reports. Method(s): This paper adhered to the Joanna Briggs Institute (JBI) methodology for scoping reviews. Parliamentary websites and databases (Parlinfo, Pandora) were searched for plans and exercise reports, that were publicly available from 2009 to May 2022. Documents were examined using directive content analysis and assessed on their alignment with the core elements of people, resources, governance, systems, and processes, as addressed in the Australian Disaster Preparedness Framework 2018. Result(s): The degree to which the core elements outlined in the Australian Disaster Preparedness Framework were covered in the documents varies significantly across both New Zealand, and the Australian federal, states and territories. Of the 15 identified plans and 8 exercise reports most did not foresee the need for mandatory, large-scale quarantine of people arriving from interstate or overseas and contemplated voluntary quarantine occurring within people's private residences. Conclusion(s): This paper confirms the need to focus on widespread quarantine as an infection control measure to enhance future pandemic operational preparedness. Further development of quarantine capabilities is required in locations aside from private residences, including at Australia's new purpose-built quarantine facilities.Copyright © 2022

Assessing Thai Hospitals' Evacuation Preparedness Using the Flexible Surge Capacity Concept and Its Collaborative Tool

According to the concept of "flexible surge capacity,” hospitals may need to be evacuated on two occasions: (1) when they are exposed to danger, such as in war;and (2) when they are contaminated, such as during the Covid-19 pandemic. In the former, the entire hospital must be evacuated, while in the latter, the hospital becomes a pandemic center necessitating the transfer of its non-contaminated staff, patients, and routine activities to other facilities. Such occasions involve several degrees of evacuation—partial or total—yet all require deliberate surge planning and collaboration with diverse authorities. This study aimed to investigate the extent of hospital evacuation preparedness in Thailand, using the main elements of the flexible surge capacity concept. A mixed method cross-sectional study was conducted using a hospital evacuation questionnaire from a previously published multinational hospital evacuation study. The tool contained questions regarding evacuation preparedness encompassing surge capacity and collaborative elements and an open-ended inquiry to grasp potential perspectives. All 143 secondary care, tertiary care, and university hospitals received the questionnaire;43 hospitals provided responses. The findings indicate glitches in evacuation protocols, particularly triage systems, the inadequacies of surge planning and multiagency collaboration, and knowledge limitations in community capabilities. In conclusion, the applications of the essential components of flexible surge capacity allow the assessment of hospital preparedness and facilitate the evaluation of guidelines and instructions through scenario-based training exercises. © 2023, The Author(s).

Minors Can Have Major Effects: Household Hurricane Preparation Insights from Alabama

While debate about large-scale climate change policy continues, household protective responses to climate-related risk are an increasingly important, potentially less contentious, tool to mitigate some climate impacts. Household actions to prepare for disasters like hurricanes are likely important for personal protection in geographically and socially vulnerable regions with less political appetite for government intervention. To understand social vulnerability in household-level hurricane preparation in this context, residents (n = 915) from the United States Gulf Coast state of Alabama were surveyed about their extreme event experiences, attitudes, and behaviors following the record-breaking 2020 hurricane season. On average, two-thirds of respondents took at least one hurricane preparedness action. Lower levels of preparedness were found for women, and higher levels for households with children, as well as changes in event-related climate change concern, personal harm, and disruption from COVID-19. Race/ethnicity, educational attainment, nor income was related to preparedness. © 2023 Taylor & Francis Group, LLC.

The educational outcomes of an online pilot workshop in CBRNe emergencies

Background: In the past 20 years, humanity, particularly in the Middle East, has experienced three outbreaks of coronavirus disease, restricting our ordinary activities. In addition to the growing risk of chemical, biological, radiological, nuclear, and explosive incidents, discussing an alternative to the usual refresher or first-time face-to-face disaster preparedness education is necessary. This study aimed to evaluate the participants' educational outcomes following their participation in the "HazMat/CBRNe in the context of mass gatherings"online pilot workshop, which used PowerPoint presentations, a remotely facilitated tabletop exercise, and videos. Methods and Analysis: This was a retrospective quantitative analysis study based on the participants' pre- and post-workshop session 1 multiple choice assessment scores and their evaluation results. Result(s): Although it was based on a small number of participants, the implemented workshop helped accomplish the participants' educational outcomes. Conclusion(s): This study demonstrated that this online workshop helped fulfil the participants' educational needs and familiarize them with the concept of readiness and preparedness for CBRNe threats in mass gatherings;hence, it should be conducted again for other participants. The increasing worldwide use of CBRN agents in industries and bioterrorism heightens the need to ensure appropriate healthcare workers' readiness through practical, innovative continuous professional development tools in times of pandemics.Copyright © 2022 Farhat, Laughton, Joseph, Abougalala, Dhiab, Alinier, licensee HBKU Press.

Facing the third COVID-19 wave at the Emergency Department of the Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru, 2021.

Peru has been one of the countries most affected by the COVID-19 pandemic. After having suffered two devastating epidemic waves, the emergency department of the Edgardo Rebagliati Martins National Hospital maintained the challenge of constantly and dynamically preparing to face a third wave that has already hit many countries around the world. For this, the department prepared itself in all areas, to contribute to reducing the impact of the disease, guaranteeing not only the quality of care, but also the safety of health personnel, modulating the work and mental load generated by the pandemic over-demand. In this way, the department was better prepared when the third wave occurred. In conclusion, constant and dynamic preparation is essential to face the increase in cases;as well as to guarantee the safety and well-being of health personnel.Copyright © 2022 Authors. All rights reserved.

European disaster management in response to the COVID-19 pandemic

Top priority of governments in containing the COVID-19 pandemic is "flattening the curve" which implies a slowing down of the virus' spread across the entire population. The situation which European policymakers are facing at the moment is completely new and only few of them have the required experience to handle a disaster of such magnitude. What is important now is to avoid problems that repeatedly occurred in past disaster responses by learning the lessons and acting accordingly. This paper reflects on European disaster management in containing the spread of COVID-19 and uncovers response inefficiencies that are still present. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

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.

Teaching disaster preparedness to pre-licensure students: A collaborative project during the pandemic.

Readiness of nurses to respond to disasters has become paramount with the advent and sequelae of the COVID-19 pandemic. The Future of Nursing 2020-2030 report calls for nurses to be knowledgeable in preparing and responding to disaster management. In New Mexico, five associate degree nursing programs and three university nursing programs collaborated to develop a novel project in teaching disaster preparedness using COVID-19 as the disaster. Tabletop methodology via Zoom was used to simulate incident command centers in Zoom breakout rooms. Students were assigned roles to carry out during the four-hour event using resources from FEMA's Emergency Management Institute. Student and faculty post-surveys were completed with themes identified. Students appreciated collaborating with students from different schools, but also identified challenges with the event posed by remote learning. Students reported their "biggest takeaways" and identified action steps for improving future events; particularly, requesting more information to better understand their roles.

Applying Lessons Learned from the COVID-19 Pandemic to Future Threats to the Perinatal Care System.

INTRODUCTION: Health care systems will continue to face unpredictable challenges related to climate change. The COVID-19 pandemic tested the ability of perinatal care systems to respond to extreme disruption. Many childbearing people in the United States opted out of the mainstream choice of hospital birth during the pandemic, leading to a 19.5% increase in community birth between 2019 and 2020. The aim of the study was to understand the experiences and priorities of childbearing people as they sought to preserve a safe and satisfying birth during the time of extreme health care disruption caused by the pandemic. METHODS: This exploratory qualitative study recruited participants from a sample of respondents to a national-scope web-based survey that explored experiences of pregnancy and birth during the COVID-19 pandemic. Maximal variation sampling was used to invite survey respondents who had considered a variety of birth setting, perinatal care provider, and care model options to participate in individual interviews. A conventional content analysis approach was used with coding categories derived directly from the transcribed interviews. RESULTS: Interviews were conducted with 18 individuals. Results were reported around 4 domains: (1) respect and autonomy in decision-making, (2) high-quality care, (3) safety, and (4) risk assessment and informed choice. Respect and autonomy varied by birth setting and perinatal care provider type. Quality of care and safety were described in relational and physical terms. Childbearing people prioritized alignment with their personal philosophies toward birth as they weighed safety. Although levels of stress and fear were elevated, many felt empowered by the sudden opportunity to consider new options. DISCUSSION: Disaster preparedness and health system strengthening should address the importance childbearing people place on the relational aspects of care, need for options in decision-making, timely and accurate information sharing, and opportunity for a range of safe and supported birth settings. Mechanisms are needed to build system-level changes that respond to the self-expressed needs and priorities of childbearing people.

Disaster preparedness in healthcare professionals amid COVID-19 and beyond: A systematic review of randomized controlled trials.

BACKGROUND: Disasters like COVID-19 are oftentimes inevitable, which makes disaster preparedness indispensable to global health and social stability. However, there is a dearth of understanding of how well healthcare professionals, who often have to work at the epicenter of disasters as they evolve, are trained to be sufficiently prepared for these crises. To this end, this study aims to examine the characteristics and effectiveness of existing interventions that aim to improve healthcare professionals' disaster preparedness. METHODS: We searched RCTs that aim to improve healthcare professionals' disaster preparedness in databases including PubMed, PsycINFO, CINAHL and Scopus. Results were screened against the eligibility criteria. The review was registered with PROSPERO (CRD42020192517) and conducted following the PRISMA guidelines. RESULTS: A total of 7382 articles were screened for eligibility, among which, 27 RCTs, incorporating 35,145, met the inclusion criteria. Review results show that most of the eligible RCTs were conducted in high-income countries. Only two RCTs were developed in disaster contexts that share similarities with COVID-19. Most of the interventions did not address critical disaster coping abilities, such as how can healthcare professionals protect or improve their personal or the general public's mental health amid pandemics. Furthermore, almost half of the disaster preparedness RCTs failed to generate statistically significant outcomes. CONCLUSIONS: Albeit inevitable, disasters are preventable. Our study results underscore the imperative of designing and developing effective and comprehensive interventions that could boost healthcare professionals' disaster preparedness, so that these frontline workers can better protect personal and public health amid global crises like COVID-19.

COVID-19 in the Americas: the role of collaborating centers in understanding lessons and best practices in pandemic preparedness and response.

COVID-19 exposed major gaps in global, regional, state, and local responses to public health emergencies. In preparation for the WHA Special Session to consider the benefits of developing an international instrument on pandemic preparedness, the O'Neill Institute in partnership with Foundation for the National Institutes of Health convened 30 of the world's leading authorities on global health law, financing, biomedical science, implementation, and emergency response along with leaders from prominent international organizations. This meeting was followed by regional consultations convened in Latin America-Caribbean, Africa, and Southeast Asia. These high-level expert consultations generated in-depth discussions on weaknesses and persisting gaps in global pandemic preparedness and what a new international agreement might include to address them. Regional intergovernmental organizations like PAHO can work closely with related multilateral development banks to develop financial instruments that can smooth systemic economic disruption; and regional centers of research and manufacturing excellence can offer a strong front line for producing medicines and vaccines rapidly during a pandemic. With our research focused on the regional response to COVID-19 we are able to look at country responses individually and collectively to see how Latin America - Caribbean countries can capitalize and leverage their regional connections to strengthen their pandemic preparedness and response. By identifying existing gaps and examining the responses and approaches taken by PAHO, we can better understand the role of international and regional organizations and their collaborating centers in preparing and responding to pandemics.

La COVID-19 expuso grandes brechas en las respuestas locales, nacionales, regionales y mundiales a las emergencias de salud pública. En preparación para la reunión extraordinaria de la Asamblea Mundial de la Salud para considerar los beneficios de elaborar un instrumento internacional sobre la preparación frente a las pandemias, el Instituto O'Neill, en colaboración con la Fundación para los Institutos Nacionales de Salud, convocó a 30 de las principales autoridades mundiales en materia de derecho, financiamiento, ciencia biomédica, implementación y respuesta a emergencias de salud, así como a líderes de organizaciones internacionales prominentes. A esta reunión le siguieron consultas regionales convocadas en América Latina y el Caribe, África y el sudeste asiático. Estas consultas con expertos de alto nivel generaron debates en profundidad acerca de las debilidades y brechas persistentes en la preparación frente a las pandemias y qué podría incluirse en un nuevo acuerdo internacional sobre cómo abordarlas. Las organizaciones intergubernamentales regionales como la Organización Panamericana de la Salud pueden trabajar en estrecha colaboración con los bancos multilaterales de desarrollo relacionados para elaborar instrumentos financieros que puedan aliviar las perturbaciones económicas sistémicas; y los centros regionales de excelencia en investigación y producción pueden formar una sólida primera línea de acción para producir medicamentos y vacunas rápidamente durante una pandemia. Con esta investigación centrada en la respuesta regional a la COVID-19, podemos analizar las respuestas de los países de forma individual y colectiva para observar la manera en que América Latina y el Caribe pueden capitalizar y aprovechar sus conexiones regionales para fortalecer su preparación y respuesta frente a una pandemia. Al determinar cuáles son las brechas existentes y examinar las respuestas y los enfoques adoptados por la OPS, podemos comprender mejor el papel de las organizaciones regionales e internacionales y sus centros colaboradores en la preparación y respuesta frente a las pandemias.

A COVID-19 expôs grandes lacunas nas respostas globais, regionais, estaduais e locais a emergências de saúde pública. Nos preparativos para a Sessão Especial da Assembleia Mundial da Saúde para avaliar os benefícios de desenvolver um instrumento internacional de preparação para pandemias, o Instituto O'Neill, em parceria com a Fundação para os Institutos Nacionais de Saúde, reuniu 30 das principais autoridades mundiais em direito sanitário global, financiamento, ciências biomédicas, implementação e resposta a emergências, além de líderes de organizações internacionais proeminentes. Essa reunião foi seguida por consultas regionais convocadas na América Latina/Caribe, na África e no sudeste da Ásia. Essas consultas com especialistas de alto nível geraram discussões minuciosas sobre os pontos fracos e as lacunas persistentes na preparação global para pandemias e o que poderia ser incluído em um novo acordo internacional para resolvê-los. Organizações intergovernamentais regionais, como a OPAS, podem trabalhar em estreita colaboração com os bancos multilaterais de desenvolvimento para desenvolver instrumentos financeiros capazes de atenuar a ruptura econômica sistêmica; por outro lado, centros regionais de excelência em pesquisa e fabricação podem oferecer uma linha de frente expressiva para a rápida produção de medicamentos e vacinas durante uma pandemia. Usando os dados da nossa pesquisa sobre a resposta regional à COVID-19, podemos analisar as respostas dos países de forma individual e coletiva para avaliar como os países da América Latina e do Caribe podem capitalizar e alavancar suas conexões regionais para fortalecer sua preparação e resposta à pandemia. Ao identificar lacunas existentes e analisar as respostas e abordagens adotadas pela OPAS, podemos compreender melhor o papel das organizações internacionais e regionais e de seus centros colaboradores na preparação e resposta a pandemias.

Disaster Evacuation for Home-Based Patients with Special Healthcare Needs: A Cross-Sectional Study.

Recent super-typhoons and torrential rains triggered by global warming have had disproportionately large effects on medically vulnerable people in Japan. This study aimed to identify factors associated with intention to evacuate to the nearest public shelter among family caregivers of pediatric patients receiving home medical care. The study included family caregivers of these patients from the Department of Pediatrics, Fukuoka University Hospital, Japan, including family caregivers of young adults with special healthcare needs. An original questionnaire was prepared drawing on previous studies and used for an interview survey. Overall, 57 individuals provided valid data and were included in the analysis. Factors associated with evacuation intention were non-use of a home ventilator (odds ratio [OR] 3.99, 95% confidence interval [CI]: 1.13-14.03) and not having made arrangements to use a non-public shelter (OR 7.29 95% CI: 1.62-32.88). This means that those who use mechanical ventilation or have secured alternative places to go if they need to evacuate their homes may not use the nearest public shelter in a disaster. We recommend that policy makers consider the use of mechanical ventilation and the availability of non-public shelters as predictors of evacuation behavior when considering disaster preparedness for these patients.