A model of the organizational resilience of hospitals in emergencies and disasters.

BACKGROUND: In the health system, hospitals are intricate establishments that offer vital medical services. Their resilience plays a crucial role in mitigating the societal repercussions of disasters. A hospital must possess the capacity to withstand risks, preserve its fundamental structure and operations, and enhance its preparedness by augmenting various capabilities and promptly recovering from the impacts of potential risks. It enables the hospital to attain a heightened level of readiness. Therefore, this study aimed to develop a resilience model tailored for hospitals to navigate crises and disasters effectively. METHODS: This mixed-method study was conducted in 2023 in three phases: (1) Identification of the factors influencing the organizational resilience of the hospital, (2) Evaluation of the influential factors by an expert panel. (3) Following the standardization process, we administered 371 questionnaires to individuals, such as university staff managers and supervisors, nursing managers, and research unit managers. The sample size was determined by multiplying the components by 10, resulting in 360 (10 * 36). Therefore, we selected a sample size of 371 participants. Structural Equation Modeling (SEM) was employed to examine the causal relationships between variables. These steps were performed using SPSS 25.0 and AMOS 22 software. Finally, we identified and presented the final model. We utilized AMOS 22 and applied the SEM to assess the correlation between the variables, with a significance level of 0.05. RESULTS: Findings indicate that the appropriate modeling identified five dimensions comprising 36 components. These dimensions include vulnerability, preparedness, support management, responsiveness and adaptability, and recovery after the disaster. The model demonstrates a good fit, as indicated by the X2/d indices with a value of 2.202, a goodness of fit index (GFI) of 0.832, a root mean square error of estimation (RMSEA) of 0.057, an adjusted comparative fit index (CFI) of 0.931, and a smoothed fit index (NFI) of 0.901. CONCLUSION: Enhancing hospital resilience is crucial for effective preparedness and response to accidents and disasters. Developing a localized tool for measuring resilience can help identify vulnerabilities, ensure service continuity, and inform rehabilitation programs. The proposed model is a suitable framework for assessing hospital resilience. Key factors include human resource scarcity, hospital specialization, and trauma center capacity. Hospitals should prioritize efficient resource allocation, information technology infrastructure, in-service training, waste management, and a proactive organizational framework to build resilience. By adopting this approach, hospitals can better respond to crises and disasters, ultimately reducing casualties and improving overall preparedness.

HAZMAT Technician-level Emergency Response: A Mental Model Framework for Radiological Dispersal Device (RDD) Incidents.

ABSTRACT: This research examines the cognitive frameworks used by HAZMAT technicians when responding to incidents involving Radiological Dispersal Devices (RDDs), which are conventional explosive devices with radioactive materials incorporated. The objective is to introduce the Expected Mental Model State (EMMS) as a comprehensive evaluation tool for assessing and enhancing the expertise and situational awareness of emergency responders dealing with radiation crises. Through a series of expert focus group sessions using the well-established qualitative methodology of grounded theory, an Expected Mental Model State (EMMS) was developed. The methodology used an influence diagram architecture to conceptually capture and codify key areas relevant to effective emergency response. The research identifies fourteen EMMS key conceptual domains, further elaborated into 301 subtopics, providing a multi-dimensional structure for the proposed mental model framework. Three pivotal notions of mental model emerged within the EMMS framework: Knowledge Topology, Envisioning (Belief), and Response and Operability. These notions were found to align with previous theories of mental models and are vital for understanding how HAZMAT technicians conceptualize and respond to RDD incidents. The study emphasizes the critical role of mental models in enhancing preparedness and effective response strategies during radiation emergencies. The EMMS framework offers a versatile methodology that can be adapted across various kinds of emergency responders and high-risk situations, including the broader Chemical, Biological, Radiological, and Nuclear (CBRN) spectrum. Using this EMMS framework to develop an EMMS Diagnostic Matrix can provide a roadmap for identifying areas for the development of specialized training modules that have the potential to significantly elevate both the quality and efficacy of responder training and preparation.

A Community Mental Health Integrated Disaster Preparedness Intervention for Bushfire Recovery in Rural Australian Communities: Protocol for a Multimethods Feasibility and Acceptability Pilot Study.

BACKGROUND: Natural hazards are increasing in frequency and intensity due to climate change. Many of these natural disasters cannot be prevented; what may be reduced is the extent of the risk and negative impact on people and property. Research indicates that the 2019-2020 bushfires in Australia (also known as the "Black Summer Bushfires") resulted in significant psychological distress among Australians both directly and indirectly exposed to the fires. Previous intervention research suggests that communities impacted by natural hazards (eg, earthquakes, hurricanes, and floods) can benefit from interventions that integrate mental health and social support components within disaster preparedness frameworks. Research suggests that disaster-affected communities often prefer the support of community leaders, local services, and preexisting relationships over external supports, highlighting that community-based interventions, where knowledge stays within the local community, are highly beneficial. The Community-Based Disaster Mental Health Intervention (CBDMHI) is an evidence-based approach that aims to increase disaster preparedness, resilience, social cohesion, and social support (disaster-related help-seeking), and decrease mental health symptoms, such as depression and anxiety. OBJECTIVE: This research aims to gain insight into rural Australian's recovery needs post natural hazards, and to enhance community resilience in advance of future fires. Specifically, this research aims to adapt the CBDMHI for the rural Australian context and for bushfires and second, to assess the acceptability and feasibility of the adapted CBDMHI in a rural Australian community. METHODS: Phase 1 consists of qualitative interviews (individual or dyads) with members of the target bushfire-affected rural community. Analysis of these data will include identifying themes related to disaster preparedness, social cohesion, and mental health, which will inform the adaptation. An initial consultation phase is a key component of the adaptation process and, therefore, phase 2 will involve additional discussion with key stakeholders and members of the community to further guide adaptation of the CBDMHI to specific community needs, building on phase 1 inputs. Phase 3 includes identifying and training local community leaders in the adapted intervention. Following this, leaders will co-deliver the intervention. The acceptability and feasibility of the adapted CBDMHI within the community will be evaluated by questionnaires and semistructured interviews. Effectiveness will be evaluated by quantifying psychological distress, resilience, community cohesion, psychological preparedness, and help-seeking intentions. RESULTS: This study has received institutional review board approval and commenced phase 1 recruitment in October 2022. CONCLUSIONS: The study will identify if the adapted CBDMHI is viable and acceptable within a village in the Northern Tablelands of New South Wales, Australia. These findings will inform future scale-up in the broader rural Australian context. If this intervention is well received, the CBDMHI may be valuable for future disaster recovery and preparedness efforts in rural Australia. These findings may inform future scale-up in the broader rural Australian context. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53454.

The disaster liaison for pediatric and perinatal medicine: A new system in Japan.

BACKGROUND: Worldwide, children, newborns, and pregnant or postpartum women are vulnerable to disasters and emergency situations, and providing support to this population is of great concern. Japan is located in a disaster-prone area, so disaster response and risk reduction strategies are important priorities. METHODS: We introduce a system called the Disaster Liaison for Pediatric and Perinatal Medicine (DLPPM). This was created with a specific focus on perinatal children and pregnant women in Japan. We report the details of its activities, discuss its challenges, and draw on lessons learned for the further development of perinatal support systems, particularly for children. RESULTS: The lessons learned from the activities of the DLPPM include the following: (1) establish a support system for emergency specialists beyond those with pediatric and perinatal specialties; (2) mitigate the risk of indirect damage caused by primary disasters; and (3) establish a networking function linked to existing pediatric and perinatal medicine facilities. CONCLUSIONS: By establishing similar systems, we believe that it will be feasible to address pediatric and perinatal care needs in disaster response contexts in other countries and regions around the world.

Exploring disaster preparedness in an obstetric unit in a district hospital in the Western Cape Province.

BACKGROUND: Research on disaster preparedness in public hospitals is limited, and specialised units such as obstetric departments need to be even more prepared when rendering health care to vulnerable populations. Disasters can be natural, such as floods due to human interventions, sinkholes due to mining, or pandemic occurrences, such as the recent COVID-19 pandemic. Research on disaster preparedness is limited, and even more so in specialised units such as obstetrics and evacuating a ward of maternal and neonatal patients present unique challenges. Being prepared for any disaster is the only assurance of effective patient healthcare during a disaster. This study explored and described nurses' knowledge and attitudes regarding preparedness for a disaster in an obstetric unit in a public institution. The study aimed to make recommendations to improve disaster preparedness in an obstetric ward based on the nurses' knowledge and attitudes. METHODS: This study utilised an exploratory, descriptive qualitative design within a contextual approach. The data were acquired through individual interviews that were done using a semi-structured interview schedule. An observational walkabout was performed with the unit manager to validate interviewee responses. The study employed purposive sampling with a sample size of 17 nurses (N = 32, n = 17) and a response rate of 53%. The interviews were transcribed verbatim, and later, the data underwent analysis using theme analysis and a co-coder. RESULTS: The results indicate that the participants demonstrate an awareness of disaster terminology but need more assertiveness in executing the institutional disaster policy. The results illustrate that more frequent training, disaster rehearsals, and simulations should be implemented to improve disaster readiness. Strategies are recommended to enhance preparedness for a disaster in the obstetric unit. CONCLUSION: The study findings recommend more education and training opportunities that should be regularly instilled as a practice within the obstetric ward. More disaster drills and simulation exercises should be performed to ensure confidence in disaster preparedness. Obstetric staff of all levels should be involved with policymaking and disaster plan development.

A higher education approach to active shooter incidents: Evidence from 40 United States university campuses.

In a post-9/11 environment with an increased United States (US) federal government emphasis on active shooter preparedness, this study seeks to understand how higher educational institutions have adapted to this changing policy environment. Furthermore, between 2000 and 2017, there were 15 active shooter incidents at US higher education institutions. This study provides data on how public and private higher education campuses are preparing for this increased active shooter threat. Interviews were conducted with higher education employees familiar with campus security policies from 40 higher education institutions across 18 states in the US. These colleges/universities also represented a range of institution type: community colleges (5), public institutions (9), and private institutions (26). Interviews were conducted with 18 Chief/Director of Campus Safety/Security, 14 members of campus police or security, seven Chiefs of Police, and one staff member familiar with campus security policies.

Factors that support public health infrastructure recovery in Puerto Rico and US Virgin Islands after Hurricanes Irma and Maria.

This paper describes the factors that support recovery of public health infrastructure (PHI), including conditions that facilitated or hindered recovery in United States (US) territories impacted by hurricanes Irma and Maria. A deductive approach was used to categorize data from five organizations that received crisis hurricane recovery (CHR) funds from the Centers for Disease Control and Prevention.* Spending was grouped into five infrastructure gaps: (1) human resources, (2) informatic upgrades, (3) equipment, (4) minor repairs, and (5) preventive maintenance. Unanticipated PHI costs, facilitators, and hinderances to PHI recovery were identified. Most (72 percent) of the $53,529,823 CHR funding was used to address infrastructure gaps in (1) human resources (56 percent), (2) informatics (16 percent), (3) equipment (13 percent), (4) minor repairs (10 percent), and (5) preventive maintenance (5 percent). Most of the requests (56 percent) to redirect funds were associated with unanticipated costs in initial work plans and budgets. The use of administrative partners, planning tools, dedicated staff, streamlined procedures, eg, contracts, and cost sharing facilitated PHI recovery. The most common hindrance to PHI recovery were delays in procurement and shipping. In summary, investments in dedicated funding to upgrade, repair, or replace critical structures and systems for infectious disease surveillance, laboratory capacity, vector control, environmental health inspections, and vaccine storage and administration in Puerto Rico and the US Virgin Islands after Hurricanes Irma and Maria contributed to their recovery capacity. These findings may inform funding and resource allocation considerations for PHI recovery in the US territories.

Building resilience: The role of enterprise security risk management in developing a resilient organisation.

Enterprise security risk management (ESRM) has continued to gain global acceptance as a management philosophy for the development and implementation of an enterprise-wide corporate security programme. As organisations continue to rebuild and recover from COVID-19, the value of assessing the resilience of an organisation through regular testing of its response to events has gained prominence. There are opportunities to link the development and implementation of a risk-based approach for designing a security programme, to assessing an organisation's resilience to future events. Organisations can benefit from the complementary approaches of ESRM and organisational resilience once the commonalities are identified and embraced. This paper expands upon the ESRM management approach, linking the concepts of ESRM to the design of a resilient enterprise.

The need for a whole-of-community, victim-centred approach to mass victimisation incident planning and response.

There have been a large number of masscasualty incidents in recent years, including climate change-related disasters, mass shootings, terrorist attacks, transportation accidents and a global pandemic. Communities, families and friends have suffered grief and loss, while nations continue to bear the scars of trauma. Disasters caused by acts with criminality, although necessarily managed by the police for the investigative aspect, must be planned for, and responded to with victim-centred practices by the police, local government and other relevant community stakeholders for the duration of the response and recovery. Inconsistency and confusion over terminology and language in emergency management can lead to a lack of understanding about which stakeholders or agencies should be engaged in, and responsible for different aspects of the planning, preparedness, mitigation and response to a community disaster - regardless of what type of disaster it is, and irrespective of the disaster being caused by a person or persons with ill-intent. This paper discusses how a wholeof- community and victim-centred approach to criminal act disaster response should be applied to support those persons most adversely affected by the incident. It also promotes the application of victim-centred practices to ensure that the needs of victims are regarded ethically, and with compassion following any disaster caused by an act of criminality. The term 'mass victimisation incident' will be introduced and applied through a case study.

Engagement to collaboration ensures success.

Disruption to our daily business and functional lives is becoming more frequent, complex and costly. As leaders, what do we do with what we know, the support and tools we have, and our knowledge regarding the resources we need to acquire to navigate this disrupted world? One thing is clear: no one can do it alone. This is not a new concept - the ancient Greeks understood the power of the group. This paper argues that collaboration is the key to amplified knowledge, ability, energy, foresight and innovation, as there is obvious synergy when individuals, groups or organisations join together in a shared vision and with a dedicated purpose. This paper describes a process model developed by the Mid-Atlantic Center for Emergency Management & Public Safety to transform operational functions and spark quality engagement, the synergy of ideas and outcomes, and enhanced sustainability of purpose. This model uses a blend of new knowledge and experiences to build on collaboration models of the past, and has proven to be a success.

Operational resilience towards a global alignment.

Operational resilience lies between operational risk and business continuity. This paper provides a view on the implementation of the operational resilience framework, and its relationship with operational risk and business continuity. It analyses the similarities and differences between these exercises and how management information from these exercises can be leveraged and aligned. The paper also provides answers to three important questions: (1) What pushed the international regulators to add additional oversight? (2) What benefits and challenges are brought by operational resilience? (3) Why is it important to harmonise operational resilience within the international regulatory landscape?

Strategic dilemmas when managing cyber attacks.

Cyber attacks have a significant business impact, with the potential to escalate into crises if poorly managed. A recurring pattern is strategic dilemmas that cannot be resolved satisfactorily. Some dilemmas are more pronounced, others less so, and therefore often catch decision-makers unprepared, leaving only bad options for decision-making. Something that all dilemmas have in common is that the associated decisions can have a lasting impact on relationships with stakeholders. This paper introduces four recurring dilemmas; shows the typical considerations; lists options for mitigating these dilemmas; and describes the basic requirements for implementing mitigations. The dilemmas and options, in turn, are rooted in the organisation-specific design of: cyber security incident management and response; IT service continuity and disaster recovery management; business continuity management; and crisis management and communication.

Planning for grey rhino risks : How to prepare for the 'unforeseeable'.

Grey rhino risks are high-impact but seemingly low-probability risks that get shuttled to the sidelines, often due to a misguided hope that the risk will not materialise in the near term, so mitigation planning can be delayed or dismissed. As the author has argued previously in this journal, it is time to change the way we look at risks in order to reassess and re-prioritise our grey rhino risks. We must stop shrugging our shoulders and treating grey rhinos as 'unforeseeable' and therefore absolving ourselves from doing anything about them. The author's previous paper, ''Rhinos and risk assessments: Adjusting risk assessment methodologies to account for "unforeseeable' events"'1 provided a methodology for pulling grey rhinos into the spotlight, so that we can see them more easily and recognise that their high-impact status requires both acknowledging and planning for. The present paper takes the methodology a step further - demonstrating how to plan for grey rhino risks that have been identified. Rather than continuing to tag grey rhinos as 'unforeseeable', we can and must prepare our organisations for them.

Mine the past: How to make better risk-based decisions and improve outcomes with historical threat data.

The impact of every crisis has the potential to cascade throughout an organisation's operations, supply chain and market ecosystem. To properly understand and mitigate this ripple of dynamic risk, business continuity, security and risk management leaders need to know where to focus their attention. Looking at historical threat data provides a clearer picture of the risk landscape, helping leaders better anticipate and plan for the future. To date, however, there have been challenges in this process. As the volume of data about critical events continues to grow at an alarming rate, sifting manually through data puts organisations - and business continuity - in jeopardy. This paper discusses the value of historical threat data and innovations in data-mining technology that can unlock the true power of historical data for informed, strategic decision-making and better outcomes during a crisis.

The Role of Clinic Preparedness to Support Patients and Strengthen the Medical System During and After a Pandemic.

Pediatric clinic preparedness is essential to improve the care and health outcomes for children during a pandemic and to decrease the burden on hospital systems. Clinic preparedness is a process that involves a well thought out plan that includes coordination with staff, open communication between the clinic and patient families, and collaboration with community partners. Planning for disasters can decrease some of the risks for our most vulnerable patients, including children and youth with special health care needs. There are plans, coalitions, and community partners that can help clinics in their preparedness journey.

Pediatric Pandemics and Disasters - A Summary.

Children make up approximately 25% of the population in the United States and are particularly vulnerable to the impact of disasters. The creation of federally-funded programs and advisory committees has had a positive impact on addressing the needs of children and families in disasters by identifying best practices, disseminating information, identifying gaps, and providing information with future investments that will contribute to expanding disaster science for children and their families.