Adapting a Federal Disaster Medical Assistance Team to Operate During a Pandemic.

After Hurricane Laura struck the southeast coast of Louisiana in August 2020, the National Disaster Medical System (NDMS), a component of the US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, deployed several 35-person disaster medical assistance teams in response to requests for medical support at 3 hospital locations that had been severely damaged in the storm. This was the first natural disaster medical deployment for NDMS during the coronavirus disease (COVID-19) pandemic. This article describes the modifications to the standard operating procedures that were made at 1 site to reduce the risk of infection to our patients and NDMS responders, including changes to the physical layout of the tenting, and alterations to the triage and treatment process.

Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) Science and the CBRNE Science Medical Operations Science Support Expert (CMOSSE).

A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.

Impact of a Hurricane Shelter Viral Gastroenteritis Outbreak on a Responding Medical Team.

UNLABELLED: Introduction In late October of 2012, Hurricane Sandy struck the northeast United States and shelters were established throughout the impacted region. Numerous cases of infectious viral gastroenteritis occurred in several of these shelters. Such outbreaks are common and have been well described in the past. Early monitoring for, and recognition of, the outbreak allowed for implementation of aggressive infection control measures. However, these measures required intensive medical response team involvement. Little is known about how such outbreaks affect the medical teams responding to the incident. Hypothesis/Problem Describe the impact of an infectious viral gastroenteritis outbreak within a single shelter on a responding medical team. METHODS: The number of individuals staying in the single shelter each night (as determined by shelter staff) and the number of patients treated for symptoms of viral gastroenteritis were recorded each day. On return from deployment, members of a single responding medical team were surveyed to determine how many team members became ill during, or immediately following, their deployment. RESULTS: The shelter population peaked on November 5, 2012 with 811 individuals sleeping in the shelter. The first patients presented to the shelter clinic with symptoms of viral gastroenteritis on November 4, 2012, and the last case was seen on November 21, 2012. A total of 64 patients were treated for nausea, vomiting, or diarrhea over the 17-day period. A post-deployment survey was sent to 66 deployed medical team members and 45 completed the survey. Twelve (26.7%) of the team members who responded to the survey experienced symptoms of probable viral gastroenteritis. Team members reported onset of symptoms during deployment as well as after returning home. Symptoms started on days 4-8, 8-14, on the trip home, and after returning home in four, four, two, and two team members, respectively. CONCLUSION: Medical teams providing shelter care during viral gastroenteritis outbreaks are susceptible to contracting the virus while caring for patients. When responding to similar incidents in the future, teams should not only be ready to implement aggressive infectious control measures but also be prepared to care for team members who become ill.

Public health and medical preparedness for a nuclear detonation: the nuclear incident medical enterprise.

Resilience and the ability to mitigate the consequences of a nuclear incident are enhanced by (1) effective planning, preparation and training; (2) ongoing interaction, formal exercises, and evaluation among the sectors involved; (3) effective and timely response and communication; and (4) continuous improvements based on new science, technology, experience, and ideas. Public health and medical planning require a complex, multi-faceted systematic approach involving federal, state, local, tribal, and territorial governments; private sector organizations; academia; industry; international partners; and individual experts and volunteers. The approach developed by the U.S. Department of Health and Human Services Nuclear Incident Medical Enterprise (NIME) is the result of efforts from government and nongovernment experts. It is a "bottom-up" systematic approach built on the available and emerging science that considers physical infrastructure damage, the spectrum of injuries, a scarce resources setting, the need for decision making in the face of a rapidly evolving situation with limited information early on, timely communication, and the need for tools and just-in-time information for responders who will likely be unfamiliar with radiation medicine and uncertain and overwhelmed in the face of the large number of casualties and the presence of radioactivity. The components of NIME can be used to support planning for, response to, and recovery from the effects of a nuclear incident. Recognizing that it is a continuous work-in-progress, the current status of the public health and medical preparedness and response for a nuclear incident is provided.

Making disaster care count: consensus formulation of measures of effectiveness for natural disaster acute phase medical response.

INTRODUCTION: No standard exists for provision of care following catastrophic natural disasters. Host nations, funders, and overseeing agencies need a method to identify the most effective interventions when allocating finite resources. Measures of effectiveness are real-time indicators that can be used to link early action with downstream impact. HYPOTHESIS: Group consensus methods can be used to develop measures of effectiveness detailing the major functions of post natural disaster acute phase medical response. METHODS: A review of peer-reviewed disaster response publications (2001-2011) identified potential measures describing domestic and international medical response. A steering committee comprised of six persons with publications pertaining to disaster response, and those serving in leadership capacity for a disaster response organization, was assembled. The committee determined which measures identified in the literature review had the best potential to gauge effectiveness during post-disaster acute-phase medical response. Using a modified Delphi technique, a second, larger group (Expert Panel) evaluated these measures and novel measures suggested (or "free-texted") by participants for importance, validity, usability, and feasibility. After three iterations, the highest rated measures were selected. RESULTS: The literature review identified 397 measures. The steering committee approved 116 (29.2%) of these measures for advancement to the Delphi process. In Round 1, 25 (22%) measures attained >75% approval and, accompanied by 77 free-text measures, graduated to Round 2. There, 56 (50%) measures achieved >75% approval. In Round 3, 37 (66%) measures achieved median scores of 4 or higher (on a 5-point ordinal scale). These selected measures describe major aspects of disaster response, including: Evaluation, Treatment, Disposition, Public Health, and Team Logistics. Of participants from the Expert Panel, 24/39 (63%) completed all rounds. Thirty-three percent of these experts represented international agencies; 42% represented US government agencies. CONCLUSION: Experts identified response measures that reflect major functions of an acute medical response. Measures of effectiveness facilitate real-time assessment of performance and can signal where practices should be improved to better aid community preparedness and response. These measures can promote unification of medical assistance, allow for comparison of responses, and bring accountability to post-disaster acute-phase medical care. This is the first consensus-developed reporting tool constructed using objective measures to describe the functions of acute phase disaster medical response. It should be evaluated by agencies providing medical response during the next major natural disaster.

Mitigating absenteeism in hospital workers during a pandemic.

OBJECTIVES: An influenza pandemic, as with any disaster involving contagion or contamination, has the potential to influence the number of health care employees who will report for duty. Our project assessed the uptake of proposed interventions to mitigate absenteeism in hospital workers during a pandemic. METHODS: Focus groups were followed by an Internet-based survey of a convenience sample frame of 17,000 hospital workers across 5 large urban facilities. Employees were asked to select their top barrier to reporting for duty and to score their willingness to work before and after a series of interventions were offered to mitigate it. RESULTS: Overall, 2864 responses were analyzed. Safety concerns were the most frequently cited top barrier to reporting for work, followed by issues of dependent care and transportation. Significant increases in employee willingness to work scores were observed from mitigation strategies that included preferential access to antiviral medication or personal protective equipment for the employee as well as their immediate family. CONCLUSIONS: The knowledge base on workforce absenteeism during disasters is growing, although in general this issue is underrepresented in emergency planning efforts. Our data suggest that a mitigation strategy that includes options for preferential access to either antiviral therapy, protective equipment, or both for the employee as well as his or her immediate family will have the greatest impact. These findings likely have import for other disasters involving contamination or contagion, and in critical infrastructure sectors beyond health care.

Children and megadisasters: lessons learned in the new millennium.

Many specific lessons were learned from recent megadisasters in the United States at the expense of children who suffered from a government and a citizenry that was desperately unprepared to respond to and recover from the disaster's short- and long-term effects. During the 9/11 attacks, the nation learned a new sense of vulnerability as the specter of terrorism was delivered repeatedly to our collective consciousness. As this article has emphasized, children experienced significant and widespread psychological effects from this event, and many did not receive adequate treatment. Hurricane Katrina exploited the weaknesses of an already strained child mental health system and vividly demonstrated the liability of poor preparedness and inadequate communication by both families and governments. The impact of Katrina continues to affect many thousands of children over a year later, as the systems that were intended to care for them have largely moved on. Indeed, there was no mention of Hurricane Katrina, the Gulf Coast, or the storm's survivors in the 2007 State of the Union address by the President. After 9/11 and the unprecedented federal spending that occurred to increase our nation's readiness, it is discouraging that the response to Hurricane Katrina fell so short of what had the potential to be the greatest disaster response and recovery story in the history of our nation. It is unlikely that further uncontained expenditures will solve the problems that were exposed in the Gulf Coast. There is not a solution that money can buy. One need only look a few hundred miles south to the Cuban disaster response system to appreciate where some of our shortfalls lie. Cuba has succeeded where the United States has not in part because its citizens are participants in their own preparedness. They engage their children and their families in preparedness planning and they rely upon other members of their community to strengthen their ability to survive as individuals. The American mentality of "dial 911 in an emergency and wait for help" works only as long as there are enough resources to match the need. In a disaster, this approach has proven to be inadequate over and over again. In America, we are well positioned to be leaders in responding to the needs of children affected by disaster. The resources of our government and the resourcefulness of our people should offer much promise for the future. By analyzing our past shortfalls and taking practical steps to mitigate the existing barriers to preparedness, our children, we hope, will fare much better the next time a megadisaster strikes. Box 7 includes suggestions for national priorities for child disaster care.