Current Crises and Potential Conflicts in Asia and the Pacific: Challenges Facing Global Health or Global Public Health by a Different Name.

Since 1945, the reasons for major crises and how the world responds to them have changed every 10-15 years or sooner. Whereas these crises vary greatly across global regions, their economic, environmental, ecological, social, and disease aspects are increasingly under the influence of widely integrated global changes and forces arising primarily from: climate extremes; rapid unsustainable urbanization; critical biodiversity losses; and emergencies of scarcity in water, food, and energy. These slow-moving but increasingly severe crises affect larger populations across many borders and lead to the emergence of increasing population-based, preventable public health emergencies related to water, sanitation, food, shelter, energy, and related health illnesses, and ultimately global health security. This report explores the impact of these crises on Asia and the Pacific region, and their potential for regional conflict.

Preparation for the next major incident: are we ready? A 12-year update.

OBJECTIVES: A major incident is any emergency that requires special arrangements by the emergency services and generally involves a large number of people. Recent such events in England have included the Manchester Arena bombing and the Grenfell Tower disaster. Hospitals are required by law to keep a major incident plan (MIP) outlining the response to such an event. In a survey conducted in 2006 we found a substantial knowledge gap among key individuals that would be expected to respond to the enactment of an MIP. We set out to repeat this survey study and assess any improvement since our original report. METHODS: We identified NHS trusts in England that received more than 30 000 patients through the emergency department in the fourth quarter of the 2016/2017 period. We contacted the on-call anaesthetic, emergency, general surgery, and trauma and orthopaedic registrar at each location and asked each individual to answer a short verbal survey assessing their confidence in using their hospital's MIP. RESULTS: Of those eligible for the study, 62% were able to be contacted and consented to the study. In total 50% of respondents had read all or part of their hospital's MIP, 46.8% were confident that they knew where their plan was stored, and 36% knew the role they would play if a plan came into effect. These results show less confidence among middle-grade doctors compared with 2006. CONCLUSIONS: Confidence in using MIPs among specialty registrars in England is still low. In light of this, we make a number of recommendations designed to improve the education of hospital doctors in reacting to major incidents.

[Reflection on rescue and treatment of mass burn casualties in 21st century].

The rescue and treatment of mass burn casualties is a test for both the burn treatment level and the disaster emergency response ability of a country or a region. In recent years, burn disasters happened occasionally around the world despite of the improvement of safety level in production and the awareness of fire prevention. On one hand, mass burn casualty events caused catastrophic damages to human health. On the other hand, they also promoted the development of burn treatment and disaster medicine. This paper may provide some references for further improving the management of mass burn casualties in the future by reviewing several typical cases of burn disaster rescue and treatment in the world since the 21st century.

Project Public Health Ready: History and Evolution of a Best Practice for Public Health Preparedness Planning.

We review the history and evolution of Project Public Health Ready and demonstrate why it is considered a best practice in public health preparedness planning. Previous articles on this program have described its impact on single health departments. We provide background information, review successes and challenges to date, and inform public health practitioners about a vetted tool for local public health planners to develop capacity and capability in all-hazards planning and response.

Progress in Public Health Emergency Preparedness-United States, 2001-2016.

OBJECTIVES: To evaluate the Public Health Emergency Preparedness (PHEP) program's progress toward meeting public health preparedness capability standards in state, local, and territorial health departments. METHODS: All 62 PHEP awardees completed the Centers for Disease Control and Prevention's self-administered PHEP Impact Assessment as part of program review measuring public health preparedness capability before September 11, 2001 (9/11), and in 2014. We collected additional self-reported capability self-assessments from 2016. We analyzed trends in congressional funding for public health preparedness from 2001 to 2016. RESULTS: Before 9/11, most PHEP awardees reported limited preparedness capabilities, but considerable progress was reported by 2016. The number of jurisdictions reporting established capability functions within the countermeasures and mitigation domain had the largest increase, almost 200%, by 2014. However, more than 20% of jurisdictions still reported underdeveloped coordination between the health system and public health agencies in 2016. Challenges and barriers to building PHEP capabilities included lack of trained personnel, plans, and sustained resources. CONCLUSIONS: Considerable progress in public health preparedness capability was observed from before 9/11 to 2016. Support, sustainment, and advancement of public health preparedness capability is critical to ensure a strong public health infrastructure.

A comparative assessment of major international disasters: the need for exposure assessment, systematic emergency preparedness, and lifetime health care.

BACKGROUND: The disasters at Seveso, Three Mile Island, Bhopal, Chernobyl, the World Trade Center (WTC) and Fukushima had historic health and economic sequelae for large populations of workers, responders and community members. METHODS: Comparative data from these events were collected to derive indications for future preparedness. Information from the primary sources and a literature review addressed: i) exposure assessment; ii) exposed populations; iii) health surveillance; iv) follow-up and research outputs; v) observed physical and mental health effects; vi) treatment and benefits; and vii) outreach activities. RESULTS: Exposure assessment was conducted in Seveso, Chernobyl and Fukushima, although none benefited from a timely or systematic strategy, yielding immediate and sequential measurements after the disaster. Identification of exposed subjects was overall underestimated. Health surveillance, treatment and follow-up research were implemented in Seveso, Chernobyl, Fukushima, and at the WTC, mostly focusing on the workers and responders, and to a lesser extent on residents. Exposure-related physical and mental health consequences were identified, indicating the need for a long-term health care of the affected populations. Fukushima has generated the largest scientific output so far, followed by the WTCHP and Chernobyl. Benefits programs and active outreach figured prominently in only the WTC Health Program. The analysis of these programs yielded the following lessons: 1) Know who was there; 2) Have public health input to the disaster response; 3) Collect health and needs data rapidly; 4) Take care of the affected; 5) Emergency preparedness; 6) Data driven, needs assessment, advocacy. CONCLUSIONS: Given the long-lasting health consequences of natural and man-made disasters, health surveillance and treatment programs are critical for management of health conditions, and emergency preparedness plans are needed to prevent or minimize the impact of future threats.

[The evolution of the emergency medical services system - from ancient to modern times]. / Ewolucja systemu ratownictwa medycznego - od starozytnosci do czasów wspólczesnych.

The paper discusses the historical perspective - from ancient to modern times - on the evolution of military medicine and its support during the wars and battles as well as its impact on the development of civilian health care and emergency medical services. Indicated breakthroughs related to conducting military operations and pointed to the visionaries who have developed new paradigms of medical care, including programs designed to assess the health status of patients, treatment in the battlefield, medical transport, anesthesia, surgery and emergency procedures. Highlighted the important role of proper organization and urgent help to victims.

[Experience in health prevention work at the accident at the Chernobyl nuclear power plant].

One of the main conditions for successful completion of liquidation tasks in the consequences of the accident at the Chernobyl nuclearpowerplant is of the swipe-effective sanitary and anti-epidemic (preventive) measures. The main directions of medical services in this area include the prevention of acute radiation injuries of personnel and distant effects of ionizing radiation, prevention of epidemics of acute intestinal, respiratory and other infections in the armedforces, pro-prevention of injuries, poisonings, accidents. Medical preventive measures were performed by the Medical Service, which took part in liquidation of consequences of military units, the specialists of the Operational Group of Civil Defense, the sanitary-epidemiological units and institutions formed the Belarusian, Kiev and Odessa Military District. Sanitary-epidemiological (preventive) activities carried out during the accident at the Chernobyl nuclear power plant, provided the sanitary-epidemiological well-being of the troops, which allowed to perform their tasks.

[Consequences learned from the use of chemical weapons during the First World War for the modern military medicine].

The article describes the way medical service dealed with problems resulted from the use of chemical weapons during the First World War (1914-1918). It was revealed that many of the abovementioned problems remain unsolved up to the present moment. It is stated the existence of the threat of use of chemical weapons in modem military conflicts, which expands the area of responsibility for medical chemical protection. The authors proved necessity and algorithm of the training system, considered as a part of medical protection in case of adverse factors of chemical nature.

Emergency managers as community change agents: an expanded vision of the profession.

Reflecting the historical evolution of attack preparedness, technological failures, and so-called natural disaster events, the profession of emergency management confronts new challenges today. In part, these reflect important cultural differences among stakeholder groups, especially local emergency managers. homeland security personnel, and those focused on public health threats and business continuity. An expanded and more strategic vision of the profession is required wherein fundamental assumption sets are placed into broader contexts. Contrary to the drift experienced in the US during the past decade, a major paradigm shift is required reflecting new orientations and program priorities.

The New Madrid Seismic Zone: not dead yet.

The extent to which ongoing seismicity in intraplate regions represents long-lived aftershock activity is unclear. We examined historical and instrumental seismicity in the New Madrid central U.S. region to determine whether present-day seismicity is composed predominantly of aftershocks of the 1811-1812 earthquake sequence. High aftershock productivity is required both to match the observation of multiple mainshocks and to explain the modern level of activity as aftershocks; synthetic sequences consistent with these observations substantially overpredict the number of events of magnitude ≥ 6 that were observed in the past 200 years. Our results imply that ongoing background seismicity in the New Madrid region is driven by ongoing strain accrual processes and that, despite low deformation rates, seismic activity in the zone is not decaying with time.