US Governmental Spending for Disaster-Related Research, 2011-2016: Characterizing the State of Science Funding Across 5 Professional Disciplines.

OBJECTIVE: Disaster-related research funding in the United States has not been described. This study characterizes Federal funding for disaster-related research for 5 professional disciplines: medicine, public health, social science, engineering, emergency management. METHODS: An online key word search was performed using the website, www.USAspending.gov, to identify federal awards, grants, and contracts during 2011-2016. A panel of experts then reviewed each entry for inclusion. RESULTS: The search identified 9145 entries, of which 262 (3%) met inclusion criteria. Over 6 years, the Federal Government awarded US $69 325 130 for all disaster-related research. Total funding levels quadrupled in the first 3 years and then halved in the last 3 years. Half of the funding was for engineering, 3 times higher than social sciences and emergency management and 5 times higher than public health and medicine. Ten (11%) institutions received 52% of all funding. The search returned entries for only 12 of the 35 pre-identified disaster-related capabilities; 6 of 12 capabilities appear to have received no funding for at least 2 years. CONCLUSION: US federal funding for disaster-related research is limited and highly variable during 2011-2016. There are no clear reasons for apportionment. There appears to be an absence of prioritization. There does not appear to be a strategy for alignment of research with national disaster policies.

Teaching emergency management students about money: "Without money you ain't doin bupkis".

The objective of this article is to address the glaring deficiency in educating emergency managers with regard to the financial aspects of Emergency Management (EM) and suggest curriculum changes. This article reviews 313 Higher Education Programs in EM located in 189 institutions of higher education in the United States to determine which include courses in the financial aspects of EM. The programs reviewed range from undergraduate certificates to PhD Degrees in EM. Of the 313 EM programs, only 78 [24.8 percent] have any courses discussing accounting, budgeting, economics, or finance either as a required or restricted elective course. Only nine [2.9 percent] courses focus on the financial issues of EM. Based upon the data reported, the author suggests changes in EM education as a starting point in the necessary discussion of what an EM educational program should cover.

Epidemiological Effectiveness and Cost of a Fungal Meningitis Outbreak Response in New River Valley, Virginia: Local Health Department and Clinical Perspectives.

OBJECTIVE: We evaluated the effectiveness and cost of a fungal meningitis outbreak response in the New River Valley of Virginia during 2012-2013 from the perspective of the local public health department and clinical facilities. The fungal meningitis outbreak affected 23 states in the United States with 751 cases and 64 deaths in 20 states; there were 56 cases and 5 deaths in Virginia. METHODS: We conducted a partial economic evaluation of the fungal meningitis outbreak response in New River Valley. We collected costs associated with the local health department and clinical facilities in the outbreak response and estimated the epidemiological effectiveness by using disability-adjusted life years (DALYs) averted. RESULTS: We estimated the epidemiological effectiveness of this outbreak response to be 153 DALYs averted among the patients, and the costs incurred by the local health department and clinical facilities to be $30,413 and $39,580, respectively. CONCLUSIONS: We estimated the incremental cost-effectiveness ratio of $198 per DALY averted and $258 per DALY averted from the local health department and clinical perspectives, respectively, thereby assisting in impact evaluation of the outbreak response by the local health department and clinical facilities. (Disaster Med Public Health Preparedness. 2018;12:38-46).

[A million football fans in a city of 120,000 inhabitants--a nightmare for emergency medicine and disaster management? Euro 2008 and the "Orange wonder of Berne"]. / 1.000.000 Fussballfans in einer Stadt mit 120.000 Einwohnern--ein notfallmedizinischer Albtraum? Die Euro 2008 und das "Oranje-Wunder von Bern"

The 2008 European Football Championship 2008 (Euro 08) is the largest sporting event ever organized in Switzerland. One million visitors came to the city of Berne during the event and the local airport in Bern/Belp registered 261 extra flights. For each football game there were 33,000 fans in the stadium and 100,000 fans in the public viewing zones.The ambulance corps and the Department of Emergency Medicine (ED) at Inselspital, University Hospital Berne, were responsible for basic medical care and emergency medical management. Injuries and illnesses were analyzed by a standardized score (NACA score). The preparation strategy as well as costs and patient numbers are presented in detail.A total of 30 additional ambulance vehicles were used, 4,723 additional working days (one-third medical professionals) were accumulated, 662 ambulance calls were registered and 240 persons needed medical care (62% Swiss, 28% Dutch and 10% other nationalities). Among those needing treatment 51 were treated in 1 of the 4 city hospitals. No injuries with NACA grades VI and VII occurred (NACA I: 4, NACA II: 17, NACA III: 16, NACA IV: 10 and NACA V: 4 patients). The city of Berne compensated the Inselspital Bern with a total of 112,603 Euros for extra medical care costs. The largest amount was spent on security measures (50,300 Euros) and medical staff (medical doctors 22,600 Euros, nurses 29,000 Euros). Because of the poor weather and the exemplary behavior of the fans, the course of events was rather peaceful.

Economía y equidad en urgencias y emergencias / Economics and equity in urgency and emergency care

públicos (SSP) está amenazada por el crecimientopoblacional, la mayor prevalencia de procesos crónicosy discapacidades, la inequidad residual en el acceso yutilización de los recursos, el coste nulo en la prestacióny la crisis económica mundial.Los servicios de Urgencias y Emergencias (SUE)son uno de los más demandados –sin relación con elmodelo de salud– porque la enfermedad asienta enáreas sociodemográficas menos favorecidas, se mantieneninequidad, hiperconsumo y capacidad de decisiónmás ligada al usuario. El producto sanitario de los SUEes múltiple y con líneas de producción diversas quedificultan su medición. En esta revisión se analiza lanecesidad de implantar herramientas de medida en losSUE, donde existen altos costes directos –fundamentalmenteestructurales– y otros variables relacionadoscon la actividad, donde el coste marginal es superior almedio y sin economía de escala en estas intervenciones.Se estudian, asimismo, los posibles mecanismos decoparticipación privada en la financiación de la ofertade los SUE, se muestran sus ventajas e inconvenientesy se concluye que no son recomendables –por su escasacapacidad recaudadora y disuasoria– por lo queson necesarios cambios estratégicos fundamentales enla gestión de estos recursos(AU)

The financial sustainability of public health systems(PHS) is currently threatened by populationgrowth, increased prevalence of chronic conditions anddisabilities, inequality in access and use of resources,zero cost delivery and global economic crisis.The emergency department (ED) is one for whichdemand is highest – without relation to the health model– because disease becomes established in disadvantagedsocio-demographic areas and inequalities, hyperconsumptionand decision making more closely linkedto the user are maintained. The medical device of EDis a multiple one and its diverse product lines make itdifficult to measure.This review discusses the need to deploy measurementtools in ED, where there are high direct costs– primarily structural – and other variables related tothe activity, where the marginal cost is higher than theaverage and there is no economy of scale in such interventions.The possible mechanisms of private copaymentin financing the supply of EDs are also studied,showing their advantages and disadvantages, with theconclusion that they are not recommendable – due totheir scarce fund raising and deterrent capacity, whichis why fundamental strategic changes in the managementof these resources are needed(AU)

Cuban medical cooperation in Haiti: one of the world's best-kept secrets.

This article analyzes Cuba's medical role in Haiti since Hurricane Georges in 1998, with particular emphasis on the Cuban government's response to the 2010 earthquake. The article examines two central themes. First, it assesses the enormous impact on public health that Cuba has made since 1998, and second, it provides a comparative analysis of Cuba's medical role since the earthquake.

Recommendations for modeling disaster responses in public health and medicine: a position paper of the society for medical decision making.

PURPOSE: Mathematical and simulation models are increasingly used to plan for and evaluate health sector responses to disasters, yet no clear consensus exists regarding best practices for the design, conduct, and reporting of such models. The authors examined a large selection of published health sector disaster response models to generate a set of best practice guidelines for such models. METHODS: . The authors reviewed a spectrum of published disaster response models addressing public health or health care delivery, focusing in particular on the type of disaster and response decisions considered, decision makers targeted, choice of outcomes evaluated, modeling methodology, and reporting format. They developed initial recommendations for best practices for creating and reporting such models and refined these guidelines after soliciting feedback from response modeling experts and from members of the Society for Medical Decision Making. RESULTS: . The authors propose 6 recommendations for model construction and reporting, inspired by the most exemplary models: health sector disaster response models should address real-world problems, be designed for maximum usability by response planners, strike the appropriate balance between simplicity and complexity, include appropriate outcomes that extend beyond those considered in traditional cost-effectiveness analyses, and be designed to evaluate the many uncertainties inherent in disaster response. Finally, good model reporting is particularly critical for disaster response models. CONCLUSIONS: . Quantitative models are critical tools for planning effective health sector responses to disasters. The proposed recommendations can increase the applicability and interpretability of future models, thereby improving strategic, tactical, and operational aspects of preparedness planning and response.

Through hell and high water: New Orleans, August 29 - September 15, 2005.

In October of 2005 the Historic New Orleans Collection initiated an oral history project entitled "Through Hell and High Water: New Orleans, August 29 - September 15, 2005." The intent of the project was to capture the stories of first responders who worked in the New Orleans metropolitan area during the storm and the weeks that followed. The interview process has been linked with the after-action studies done by some of the local first-responding agencies and has provided a much-needed outlet for first responders. To date over three hundred subjects have been interviewed, and our work thus far has shown us that top-down methods of documentation do not work with an event like Katrina. The almost total loss of communications made it impossible for high-ranking members of the different agencies to control or even know what lower-ranking members were doing. As a result it will be necessary to cast a wide net in our documentation effort.

Measuring health program effectiveness in the field: an assessment tool.

To assist field workers in program evaluation and to explicitly discuss program strengths and weaknesses, a practical method to estimate the effectiveness of public health interventions within the existing program capacity was developed. The method and materials were tested in seven countries (Afghanistan, Zimbabwe, Tanzania, Uganda, Guatemala, the Philippines, and Ghana). In this method, four core components are assessed using a questionnaire: (1) the efficacy of the intervention; (2) the level of existing human resources (i.e., quality of recruitment, training, and continuing education); (3) the infrastructure (i.e., supplies, salary, transportation, and supervision); and (4) the level of community support (i.e., access and demand). Using the assessment tool provided, program staff can determine if all necessary elements are in place for a successful program that can deliver the specific intervention. Based on the results of the assessment program, weaknesses can be identified, explicitly discussed, and addressed. The usefulness of this tool in humanitarian relief may be twofold: (1) to assess the design and implementation of effective programs; and (2) to highlight the inevitable need for capacity building as the disaster situation evolves.