Coordinated Communications and Decision Making to Support a Regional Severe Infectious Disease Response.

Infectious disease response, particularly high-consequence acute infectious disease and special pathogen response, requires the coordination of numerous public and private entities to ensure the safety and appropriate care for patients, healthcare and EMS staff, and the public. The Northwest Healthcare Response Network, an independent 501(c)(3) healthcare coalition, has partnered with the local health departments in the Puget Sound area of Washington State to develop a communication and decision-making structure to support coordinated information sharing, patient care, patient transportation, laboratory testing, contact monitoring, and healthcare and EMS staff safety in events involving suspected or diagnosed acute infectious disease patients. The network has developed a comprehensive regional plan and associated tools outlining standard communication practices that include defining who will lead coordinated communications and decision making concerning patient care needs and how all partners will connect during an acute infectious disease response. Over the past 2 years, the network has tested and refined these communication and coordination processes through a facilitated tabletop exercise and a webinar-based functional exercise. These processes can serve as a model to inform the creation of coordinated communications structures for infectious disease response in communities around the country.

How to Choose? Using the Delphi Method to Develop Consensus Triggers and Indicators for Disaster Response.

OBJECTIVE: To identify key decisions along the continuum of care (conventional, contingency, and crisis) and the critical triggers and data elements used to inform those decisions concerning public health and health care response during an emergency. METHODS: A classic Delphi method, a consensus-building survey technique, was used with clinicians around Washington State to identify regional triggers and indicators. Additionally, using a modified Delphi method, we combined a workshop and single-round survey with panelists from public health (state and local) and health care coalitions to identify consensus state-level triggers and indicators. RESULTS: In the clinical survey, 122 of 223 proposed triggers or indicators (43.7%) reached consensus and were deemed important in regional decision-making during a disaster. In the state-level survey, 110 of 140 proposed triggers or indicators (78.6%) reached consensus and were deemed important in state-level decision-making during a disaster. CONCLUSIONS: The identification of consensus triggers and indicators for health care emergency response is crucial in supporting a comprehensive health care situational awareness process. This can inform the creation of standardized questions to ask health care, public health, and other partners to support decision-making during a response. (Disaster Med Public Health Preparedness. 2017;11:467-472).

Predicting outcome of drowning at the scene: A systematic review and meta-analyses.

OBJECTIVE: To identify factors available to rescuers at the scene of a drowning that predict favourable outcomes. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Embase and Cochrane Library were searched (1979-2015) without restrictions on age, language or location and references lists of included articles. STUDY SELECTION: Cohort and case-control studies reporting submersion duration, age, water temperature, salinity, emergency services response time and survival and/or neurological outcomes were eligible. Two reviewers independently screened articles for inclusion, extracted data, and assessed quality using GRADE. Variables for all factors, including time and temperature intervals, were categorized using those used in the articles. Random effects meta-analyses, study heterogeneity and publication bias were evaluated. RESULTS: Twenty-four cohort studies met the inclusion criteria. The strongest predictor was submersion duration. Meta-analysis showed that favourable outcome was associated with shorter compared to longer submersion durations in all time cutoffs evaluated: ≤5-6min: risk ratio [RR]=2.90; (95% confidence interval [CI]: 1.73, 4.86); ≤10-11min: RR=5.11 (95% CI: 2.03, 12.82); ≤15-25min: RR=26.92 (95% CI: 5.06, 143.3). Favourable outcomes were seen with shorter EMS response times (RR=2.84 (95% CI: 1.08, 7.47)) and salt water versus fresh water 1.16 (95% CI: 1.08, 1.24). No difference in outcome was seen with victim's age, water temperatures, or witnessed versus unwitnessed drownings. CONCLUSIONS: Increasing submersion duration was associated with worse outcomes. Submersion durations <5min were associated with favourable outcomes, while those >25min were invariably fatal. This information may be useful to rescuers and EMS systems deciding when to perform a rescue versus a body recovery.

Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis.

To determine the association between Mycoplasma genitalium infection and female reproductive tract syndromes through meta-analysis, English-language, peer-reviewed studies were identified via PubMed, Embase, Biosis, Cochrane Library, and reference review. Two reviewers independently extracted data. Random-effects models were employed to calculate summary estimates, between-study heterogeneity was evaluated using I(2) statistics, publication bias was assessed via funnel plots and the Begg and Egger tests, and methodologic quality was rated. Mycoplasma genitalium infection was significantly associated with increased risk of cervicitis (pooled odds ratio [OR], 1.66 [95% confidence interval {CI}, 1.35-2.04]), pelvic inflammatory disease (pooled OR, 2.14 [95% CI, 1.31-3.49]), preterm birth (pooled OR, 1.89 [95% CI, 1.25-2.85]), and spontaneous abortion (pooled OR, 1.82 [95% CI, 1.10-3.03]). Risk of infertility was similarly elevated (pooled OR, 2.43 [95% CI, .93-6.34]). In subanalyses accounting for coinfections, all associations were stronger and statistically significant. Testing of high-risk symptomatic women for M. genitalium may be warranted.