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1.
Surg Clin North Am ; 102(1): 169-180, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1517479

ABSTRACT

Mass casualty incidents are increasingly common. They are defined by large numbers of patients arriving nearly simultaneously, overwhelming available resources needed for optimal care. They require rapid mobilization of resources to provide optimal outcomes and limit disability and death. Because the mechanism of injury in a mass casualty incident is often traumatic in nature, surgeons should be aware of the critical role they play in planning and response. The coronavirus disease 2019 pandemic is a notable, resulting in a sustained surge of critically ill patients. Initial response requires local mobilization of resources; large-scale events potentially require a national response.


Subject(s)
Civil Defense , Emergency Medical Services , Health Resources , Mass Casualty Incidents , COVID-19/epidemiology , COVID-19/prevention & control , Decision Trees , Humans , Triage
2.
J Emerg Manag ; 19(7): 39-48, 2021.
Article in English | MEDLINE | ID: covidwho-1497651

ABSTRACT

The COVID-19 pandemic exposed numerous challenges in the emergency management (EM) response system. The article contends that had EM deliberately and systematically engaged in systems thinking; it would have been better able to anticipate and respond to many of the challenges. Reasons for EM not fully embracing systems thinking are discussed, including the perception that it is complex and theoretical. This article attempts to dispel these beliefs by first demonstrating how many systems-thinking concepts are already embedded in the EM ethos and then by illustrating the application of system principles in the context of the COVID-19 response. This article concludes by recommending EM invest in training to encourage the systematic application of system principles in emergency preparedness and response.


Subject(s)
COVID-19 , Civil Defense , Humans , Pandemics , SARS-CoV-2 , Systems Analysis
3.
J Emerg Manag ; 19(7): 99-107, 2021.
Article in English | MEDLINE | ID: covidwho-1497644

ABSTRACT

BACKGROUND: There is a paucity of research on college food pantry operations, especially in relation to emergency preparedness and disaster relief. However, there are multiple research studies confirming the efficacy of using social media to communicate with younger adults, especially Generation Z (Gen Z). METHODS: This study examines a college food pantry's social media posts and pantry utilization in a midsize, public university in Texas, prior to and during the COVID-19 pandemic. Collegiate food insecurity was analyzed through the lens of the socioecological model. Social media data during the spring 2019 semester were compared using a two-way ANOVA prior to and following the origination of the COVID-19 pandemic within the state, and pantry utilization over the spring 2019 and fall 2020 semesters was evaluated using a t-test. RESULTS: There were significantly more likes per post on Instagram than other social media outlets, and there were significantly more impressions per post on Twitter as opposed to Facebook, with a trend toward more impressions per posts, after COVID-19. There was no significant difference in food pantry utilization between the fall and spring semester aside from a spike after return following the spring recess, confirmed as Grubb's outlier. Application of the socioecological model emphasized the importance of interdisciplinary collaboration and multitiered interventions during an emergency, including the use of social media. CONCLUSION: This information can help collegiate organizations reach more students through targeted posting on select social media platforms used by their students. Interdisciplinary, inclusive approaches are recommended to reduce food insecurity for Gen Z students.


Subject(s)
COVID-19 , Civil Defense , Social Media , Adult , Communication , Humans , Pandemics , SARS-CoV-2 , Universities
4.
J Emerg Manag ; 18(7): 99-113, 2021.
Article in English | MEDLINE | ID: covidwho-1497634

ABSTRACT

Existing research on individual preparedness in the United States indicates that we are generally unprepared for disasters. While there is an abundance of research on emergency preparedness, there are gaps in our knowledge. For example, the results of extant research are unclear regarding what factors influence individual preparedness. The preparedness literature is also limited in the types of disasters examined and in understanding the timing of preparedness activities. The current COVID-19 global pandemic provides a tragic but albeit unique opportunity to address these limitations of previous research and examine emergency preparedness activities before and immediately following the onset of the COVID-19 outbreak in the United States. This research is further distinctive because it examines preparedness activities related to the global pandemic rather than other types of disasters. Policy and research implications of the findings are presented.


Subject(s)
COVID-19 , Civil Defense , Disasters , Humans , Pandemics/prevention & control , SARS-CoV-2 , United States
6.
Acad Med ; 96(11): 1546-1552, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1493981

ABSTRACT

Racially and ethnically diverse and socioeconomically disadvantaged communities have historically been disproportionately affected by disasters and public health emergencies in the United States. The U.S. Department of Health and Human Services' Office of Minority Health established the National Consensus Panel on Emergency Preparedness and Cultural Diversity to provide guidance to agencies and organizations on developing effective strategies to advance emergency preparedness and eliminate disparities among racially and ethnically diverse communities during these crises. Adopting the National Consensus Panel recommendations, the Johns Hopkins Medicine Office of Diversity, Inclusion, and Health Equity; Language Services; and academic-community partnerships used existing health equity resources and expertise to develop an operational framework to support the organization's COVID-19 response and to provide a framework of health equity initiatives for other academic medical centers. This operational framework addressed policies to support health equity patient care and clinical operations, accessible COVID-19 communication, and staff and community support and engagement, which also supported the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. Johns Hopkins Medicine identified expanded recommendations for addressing institutional policy making and capacity building, including unconscious bias training for resource allocation teams and staff training in accurate race, ethnicity, and language data collection, that should be considered in future updates to the National Consensus Panel's recommendations.


Subject(s)
Academic Medical Centers/organization & administration , COVID-19/ethnology , Disasters/prevention & control , Health Equity/standards , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Civil Defense/organization & administration , Consensus , Cultural Diversity , Government Programs/organization & administration , Government Programs/standards , Healthcare Disparities/ethnology , Humans , Minority Groups/statistics & numerical data , Policy Making , Public Health/standards , SARS-CoV-2/genetics , Social Participation , Socioeconomic Factors , United States/epidemiology
7.
Int J Environ Res Public Health ; 18(20)2021 10 15.
Article in English | MEDLINE | ID: covidwho-1480728

ABSTRACT

Resilience is an important issue in urban development, and community resilience (CR) is the most typical representative in building urban resilience, which has become the forefront of international resilience research. This paper presents a bibliometric and visual analysis of community resilience research collected from the WoS Core Collection database over the past two decades. H-index, citation frequency, centrality and starting year were adopted to analyze the research objects by bibliometric tools including CiteSpace, VOSviewer, and Gephi. The national and institutional characteristics of macro-geographical distribution and the characteristics of disciplines, journals, authors, and author cooperation of micro-knowledge network distribution were revealed. Finally, the potential research directions of community resilience in the future were discussed. The results show that there are three stages in community resilience research. Seven intellectual bases constitute the research background for community resilience, including social capital mechanism, the evolution of resilience knowledge, earthquake resistance and disaster mitigation, substance abuse, resilient development in rural communities, resilience-building in the least-developed countries, and emergency preparedness. Our analysis shows that the hottest community resilience research topics are the concept of resilience, climate resilience, the social capital mechanism, macro-environment and disaster-reduction policies, and an evaluation index system for community resilience.


Subject(s)
Civil Defense , Disasters , Earthquakes , Bibliometrics , Databases, Factual
9.
BMJ Mil Health ; 166(1): 37-41, 2020 Feb.
Article in English | MEDLINE | ID: covidwho-1452951

ABSTRACT

Major disease outbreaks continue to be a significant risk to public health, with pandemic influenza or an emerging infectious disease outbreak at the top of the UK National Risk Register. The risk of deliberate release of a biological agent is lower but remains possible and may only be recognised after casualties seek medical attention. In this context the emergency preparedness, resilience and response (EPRR) process protects the public from high consequence infectious diseases, other infectious disease outbreaks and biological agent release. The core elements of the EPRR response are recognition of an outbreak, isolation of patients, appropriate personal protective equipment for medical staff and actions to minimise further disease spread. The paper discusses how high-threat agents may be recognised by clinicians, the initial actions to be taken on presentation and how the public health system is notified and responds. It draws on the national pandemic influenza plans to describe the wider response to a major disease outbreak and discusses training requirements and the potential role of the military.


Subject(s)
Biohazard Release , Civil Defense , Influenza, Human/prevention & control , Military Personnel , Pandemics/prevention & control , Public Health Practice , Biohazard Release/prevention & control , Civil Defense/education , Communicable Disease Control , Communicable Diseases/diagnosis , Disaster Planning , Disease Notification , Humans , Influenza, Human/therapy , Interinstitutional Relations , Patient Isolation , Personal Protective Equipment , United Kingdom
10.
Health Secur ; 19(5): 508-520, 2021.
Article in English | MEDLINE | ID: covidwho-1447554

ABSTRACT

Federal investment in emergency preparedness has increased notably since the 9/11 attacks, yet it is unclear if and how US hospital readiness has changed in the 20 years since then. In particular, understanding effective aspects of hospital emergency management programs is essential to improve healthcare systems' readiness for future disasters. The authors of this article examined the state of US hospital emergency management, focusing on the following question: During the COVID-19 pandemic, what aspects of hospital emergency management, including program components and organizational characteristics, were most effective in supporting and improving emergency preparedness and response? We conducted semistructured interviews of emergency managers and leaders at 12 urban and rural hospitals across the country. Through qualitative analysis of content derived from examination of transcripts from our interviews, we identified 7 dimensions of effective healthcare emergency management: (1) identify capable leaders; (2) assure robust institutional support; (3) design effective, tiered communications systems; (4) embrace the hospital incident command system to delineate roles and responsibilities; (5) actively promote collaboration and team building; (6) appreciate the necessity of training and exercises; and (7) balance structure and flexibility. These dimensions represent the unique and critical intersection of organizational factors and emergency management program characteristics at the core of hospital emergency preparedness and response. Extending these findings, we provide several recommendations for hospitals to better develop and sustain what we call a response culture in supporting effective emergency management.


Subject(s)
COVID-19 , Civil Defense , Hospitals , Humans , Pandemics , SARS-CoV-2
12.
J Am Geriatr Soc ; 69(10): 2766-2777, 2021 10.
Article in English | MEDLINE | ID: covidwho-1434765

ABSTRACT

BACKGROUND/OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has taken a disproportionate toll on long-term care facility residents and staff. Our objective was to review the empirical evidence on facility characteristics associated with COVID-19 cases and deaths. DESIGN: Systematic review. SETTING: Long-term care facilities (nursing homes and assisted living communities). PARTICIPANTS: Thirty-six empirical studies of factors associated with COVID-19 cases and deaths in long-term care facilities published between January 1, 2020 and June 15, 2021. MEASUREMENTS: Outcomes included the probability of at least one case or death (or other defined threshold); numbers of cases and deaths, measured variably. RESULTS: Larger, more rigorous studies were fairly consistent in their assessment of risk factors for COVID-19 outcomes in long-term care facilities. Larger bed size and location in an area with high COVID-19 prevalence were the strongest and most consistent predictors of facilities having more COVID-19 cases and deaths. Outcomes varied by facility racial composition, differences that were partially explained by facility size and community COVID-19 prevalence. More staff members were associated with a higher probability of any outbreak; however, in facilities with known cases, higher staffing was associated with fewer deaths. Other characteristics, such as Nursing Home Compare 5-star ratings, ownership, and prior infection control citations, did not have consistent associations with COVID-19 outcomes. CONCLUSION: Given the importance of community COVID-19 prevalence and facility size, studies that failed to control for these factors were likely confounded. Better control of community COVID-19 spread would have been critical for mitigating much of the morbidity and mortality long-term care residents and staff experienced during the pandemic. Traditional quality measures such as Nursing Home Compare 5-Star ratings and past deficiencies were not consistent indicators of pandemic preparedness, likely because COVID-19 presented a novel problem requiring extensive adaptation by both long-term care providers and policymakers.


Subject(s)
COVID-19 , Homes for the Aged/organization & administration , Long-Term Care , Nursing Homes/organization & administration , Risk Adjustment , Skilled Nursing Facilities/organization & administration , Aged , COVID-19/mortality , COVID-19/prevention & control , Civil Defense/organization & administration , Humans , Infection Control/methods , Infection Control/standards , Long-Term Care/methods , Long-Term Care/trends , Outcome Assessment, Health Care , SARS-CoV-2
14.
Am J Med ; 134(11): 1380-1388.e3, 2021 11.
Article in English | MEDLINE | ID: covidwho-1397151

ABSTRACT

BACKGROUND: Whether the volume of coronavirus disease 2019 (COVID-19) hospitalizations is associated with outcomes has important implications for the organization of hospital care both during this pandemic and future novel and rapidly evolving high-volume conditions. METHODS: We identified COVID-19 hospitalizations at US hospitals in the American Heart Association COVID-19 Cardiovascular Disease Registry with ≥10 cases between January and August 2020. We evaluated the association of COVID-19 hospitalization volume and weekly case growth indexed to hospital bed capacity, with hospital risk-standardized in-hospital case-fatality rate (rsCFR). RESULTS: There were 85 hospitals with 15,329 COVID-19 hospitalizations, with a median hospital case volume was 118 (interquartile range, 57, 252) and median growth rate of 2 cases per 100 beds per week but varied widely (interquartile range: 0.9 to 4.5). There was no significant association between overall hospital COVID-19 case volume and rsCFR (rho, 0.18, P = .09). However, hospitals with more rapid COVID-19 case-growth had higher rsCFR (rho, 0.22, P = 0.047), increasing across case growth quartiles (P trend = .03). Although there were no differences in medical treatments or intensive care unit therapies (mechanical ventilation, vasopressors), the highest case growth quartile had 4-fold higher odds of above median rsCFR, compared with the lowest quartile (odds ratio, 4.00; 1.15 to 13.8, P = .03). CONCLUSIONS: An accelerated case growth trajectory is a marker of hospitals at risk of poor COVID-19 outcomes, identifying sites that may be targets for influx of additional resources or triage strategies. Early identification of such hospital signatures is essential as our health system prepares for future health challenges.


Subject(s)
Bed Occupancy/statistics & numerical data , COVID-19 , Hospital Bed Capacity/statistics & numerical data , Intensive Care Units/statistics & numerical data , Mortality , Quality Improvement/organization & administration , COVID-19/mortality , COVID-19/therapy , Civil Defense , Health Care Rationing/organization & administration , Health Care Rationing/standards , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Outcome Assessment, Health Care , Registries , Risk Assessment , SARS-CoV-2 , Triage/organization & administration , United States/epidemiology
16.
Int J Environ Res Public Health ; 18(16)2021 08 04.
Article in English | MEDLINE | ID: covidwho-1376801

ABSTRACT

Medical and Health Organization (MHO) staff's emergency preparedness awareness and behaviors are essential variables that affect public health emergency response effectiveness. Based on the theory of psychological capital and the theory of planned behavior (TPB), this study discusses the mechanism of the psychological characteristics of MHO staff on their emergency preparedness behavioral intention (EPBI). To verify the research model, we conducted a web-based questionnaire survey among 243 MHO staff from China and analyzed the data using the structural equation modeling software, AMOS 24.0 (IBM, New York, United States). The empirical results reveal that psychological capital significantly affected cognitive processes theorized by TPB. This study suggests that the positive psychological capital of MHO staff should be developed and managed to improve their EPBI.


Subject(s)
Civil Defense , Humans , Intention , Medical Staff , Psychological Theory , Surveys and Questionnaires
17.
Pharmaceut Med ; 35(4): 203-213, 2021 07.
Article in English | MEDLINE | ID: covidwho-1375861

ABSTRACT

The Emergency Use Authorization (EUA) originated in 2004 because of the need for emergency medical countermeasures (MCMs) against potential bioterrorist attacks. The EUA also proved useful in dealing with subsequent pandemics and has emerged as a critical regulatory pathway for therapeutics and vaccines throughout the Coronavirus Disease 2019 (COVID-19) pandemic. With the EUA process in the USA, we witnessed emergency authorizations, their expansions, as well as withdrawal of previously authorized products, which exemplifies the dynamic nature of scientific review of EUA products. EUAs proved vital for the first group of COVID-19 vaccines, including the temporary pause of one vaccine while emergency safety issues were evaluated. Although this review on the EUA is primarily focused on the USA, distinctions were made with other jurisdictions such as Europe and Canada with respect to the emergency authorizations of the vaccines. Finally, we discuss some important differences following EUA and formal new drug/vaccine application (NDA/BLA) approvals.


Subject(s)
Antiviral Agents/standards , COVID-19 Vaccines/standards , COVID-19/prevention & control , Drug Approval/legislation & jurisprudence , Emergencies/history , Antiviral Agents/administration & dosage , Antiviral Agents/adverse effects , Bioterrorism/history , Bioterrorism/prevention & control , COVID-19/drug therapy , COVID-19/epidemiology , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/adverse effects , Canada/epidemiology , Civil Defense/history , Drug Approval/history , Emergencies/epidemiology , Europe/epidemiology , History, 21st Century , Humans , Pandemics/prevention & control , United States/epidemiology
18.
Transfusion ; 61 Suppl 1: S313-S325, 2021 07.
Article in English | MEDLINE | ID: covidwho-1358635

ABSTRACT

BACKGROUND: The current global pandemic has created unprecedented challenges in the blood supply network. Given the recent shortages, there must be a civilian plan for massively bleeding patients when there are no blood products on the shelf. Recognizing that the time to death in bleeding patients is less than 2 h, timely resupply from unaffected locations is not possible. One solution is to transfuse emergency untested whole blood (EUWB), similar to the extensive military experience fine-tuned over the last 19 years. While this concept is anathema in current civilian transfusion practice, it seems prudent to have a vetted plan in place. METHODS AND MATERIALS: During the early stages of the 2020 global pandemic, a multidisciplinary and international group of clinicians with broad experience in transfusion medicine communicated routinely. The result is a planning document that provides both background information and a high-level guide on how to emergently deliver EUWB for patients who would otherwise die of hemorrhage. RESULTS AND CONCLUSIONS: Similar plans have been utilized in remote locations, both on the battlefield and in civilian practice. The proposed recommendations are designed to provide high-level guidance for experienced blood bankers, transfusion experts, clinicians, and health authorities. Like with all emergency preparedness, it is always better to have a well-thought-out and trained plan in place, rather than trying to develop a hasty plan in the midst of a disaster. We need to prevent the potential for empty shelves and bleeding patients dying for lack of blood.


Subject(s)
Blood Banks , Blood Banks/methods , Blood Preservation/methods , Blood Transfusion/methods , COVID-19/epidemiology , Civil Defense , Emergency Service, Hospital , Humans , Pandemics
19.
Infect Dis Clin North Am ; 35(3): 697-716, 2021 09.
Article in English | MEDLINE | ID: covidwho-1340668

ABSTRACT

The built environment has been integral to response to the global pandemic of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In particular, engineering controls to mitigate risk of exposure to SARS-CoV-2 and other newly emergent respiratory pathogens in the future will be important. Anticipating emergence from this pandemic, or at least adaptation given increasing administration of effective vaccines, and the safety of patients, personnel, and others in health care facilities remain the core goals. This article summarizes known risks and highlights prevention strategies for daily care as well as response to emergent infectious diseases and this parapandemic phase.


Subject(s)
COVID-19 , Civil Defense , Health Facilities/trends , Infection Control , Safety Management/organization & administration , COVID-19/epidemiology , COVID-19/prevention & control , Civil Defense/methods , Civil Defense/organization & administration , Environment, Controlled , Hospital Design and Construction/methods , Humans , Infection Control/methods , Infection Control/organization & administration , SARS-CoV-2
20.
J Cardiovasc Med (Hagerstown) ; 22(9): 701-705, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1339452

ABSTRACT

The Coronavirus disease 2019 (COVID-19) pandemic has thoroughly and deeply affected the provision of healthcare services worldwide. In order to limit the in-hospital infections and to redistribute the healthcare professionals, cardiac percutaneous intervention in Pediatric and Adult Congenital Heart Disease (ACHD) patients were limited to urgent or emergency ones. The aim of this article is to describe the impact of the COVID-19 pandemic on Pediatric and ACHD cath laboratory activity during the so-called 'hard lockdown' in Italy. Eleven out of 12 Italian institutions with a dedicated Invasive Cardiology Unit in Congenital Heart Disease actively participated in the survey. The interventional cardiology activity was reduced by more than 50% in 6 out of 11 centers. Adolescent and ACHD patients suffered the highest rate of reduction. There was an evident discrepancy in the management of the hard lockdown, irrespective of the number of COVID-19 positive cases registered, with a higher reduction in Southern Italy compared with the most affected regions (Lombardy, Piedmont, Veneto and Emilia Romagna). Although the pandemic was brilliantly addressed in most cases, we recognize the necessity for planning new, and hopefully homogeneous, strategies in order to be prepared for an upcoming new outbreak.


Subject(s)
COVID-19 , Cardiac Surgical Procedures , Emergency Medical Services , Heart Defects, Congenital , Infection Control , Risk Management/methods , Adolescent , Adult , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/statistics & numerical data , Civil Defense/methods , Civil Defense/trends , Disease Transmission, Infectious/prevention & control , Emergency Medical Services/methods , Emergency Medical Services/statistics & numerical data , Female , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/surgery , Humans , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Male , Organizational Innovation , SARS-CoV-2
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