The American Preparedness Project: Where the US Public Stands in 2015

The American Preparedness Project was launched by the National Center for Disaster Preparedness (NCDP) in 2002, in the aftermath of the 9/11 attacks in order to survey public perceptions and opinions on disaster preparedness and to acknowledge that a comprehensive understanding of the concerns of individuals and families is critical to emergency planning efforts on …

Children in Disasters: Do Americans Feel Prepared? A National Survey

This study was led by the National Center for Disaster Preparedness (NCDP) at Columbia University’s Earth Institute on behalf of the Resilient Children/Resilient Communities (RCRC) Initiative, in partnership with Save the Children with funding from GSK.The purpose of the study was to learn more about people’s opinions and attitudes toward disaster preparedness with a focus …

System-Level Planning, Coordination, and Communication: Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement

System-level planning involves uniting hospitals and health systems, local/regional government agencies, emergency medical services, and other health-care entities involved in coordinating and enabling care in a major disaster. We reviewed the literature and sought expert opinions concerning system-level planning and engagement for mass critical care due to disasters or pandemics and offer suggestions for system-planning, …

Disaster Planning for Vulnerable Populations: Leveraging Community Human Service Organizations Direct Service Delivery Personnel

Given the variability, complexities, and available resources for local vulnerable populations, it is clear that preparing effectively for catastrophic events cannot be accomplished with a single, simple template. Inclusion of Community Human Service Organizations’ (CHSO’s) direct service delivery personnel ensures that emergency disaster planning efforts for vulnerable populations are effective and responsive to unique needs …

Disaster-Related Environmental Health Hazards: Former Lead Smelting Plants in the United States

Natural disasters exacerbate risks of hazardous environmental exposures and adverse health consequences. The present study determined the proportion of previously identified lead industrial sites in urban locations that are at high risk for dispersal of toxic chemicals by natural disasters. Geographic analysis from publicly available data identified former lead smelting plants that coincide with populated …

Would Triage Predictors Perform Better than First-Come-First-Served in Pandemic Ventilator Allocation?

In a pandemic, needs for ventilators might overwhelm the limited supply. Outcome predictors have been proposed to guide ventilator triage allocation decisions. However, pandemic triage predictors have not been validated. This quantitative simulation study evaluated outcomes resulting from allocation strategies varying in their performance for selecting short stay survivors as favorable candidates for ventilators. A …

Lessons from Sandy — Preparing Health Systems for Future Disasters

Within hours after Hurricane Sandy’s landfall, doctors and staff at one of New York City’s premier medical centers realized that something was going terribly wrong. Lights were flickering, critical devices essential to life support for more than 200 patients, many in intensive care units, were malfunctioning. A decision had to be made by hospital leaders, …

The American Preparedness Project: Executive Summary: Where the US Public Stands in 2011 on Terrorism, Security, and Disaster Preparedness

Ten years after the tragic events of September 11, 2001, America is, in some aspects, a different country. Significant portions of the federal budget over the past decade have been spent on enhancing preparedness and security on the home front, and prosecuting terrorism in Iraq and Afghanistan. As part of its American Preparedness Project, which …

Domestic preparedness cuts in the current federal budget threaten infrastructure gains and public health preparedness

Recent cuts in the federal budget have serious implications for the country’s preparedness and response standing. In mid-May, federal agencies released their final FY11 budgets. Much of the country’s funding for homeland security and public health preparedness resides in the Department of Health and Human Services (DHHS) and Department of Homeland Security (DHS) budgets. Preparedness …

Health care system planning for and response to a nuclear detonation

The hallmark of a successful response to a nuclear detonation will be the resilience of the community, region, and nation. An incident of this magnitude will rapidly become a national incident; however, the initial critical steps to reduce lives lost, save the lives that can be saved with the resources available, and understand and apply …

Planning for Long‐Term Recovery Before Disaster Strikes: Case Studies of 4 US Cities: A Final Project Report

Among the four phases along the hazard continuum — preparedness, response, recovery, and mitigation — the sub‐field of long‐term recovery has long been an outlier, an “orphan” when it comes to concerted policy attention and pre‐disaster planning. It’s not that community residents or municipal and state government officials are unaware of the potential long‐term residual …

Rural and suburban population surge following detonation of an improvised nuclear device: A new model to estimate impact

Background: The objective of the study was to model urban evacuation into surrounding communities after the detonation of an improvised nuclear device (IND) to assist rural and suburban planners in understanding and effectively planning to address the effects of population surges. Methods: Researchers developed parameters for how far evacuees would travel to escape disasters and …

Utilizing paramedics for in-patient critical care surge capacity

INTRODUCTION: While many hospitals have developed preliminary emergency department and in-patient surge plans, the ability to surge is often limited by critical resources. The resource which is often the most limited is usually the human resource and within this category the limiting factor is almost universally nursing. As a result, nursing shortages can result in …

Regional Health and Public Health Preparedness for Nuclear Terrorism: Optimizing Survival in a Low Probability/High Consequence Disaster

The United States remains unprepared to cope with the possibility of an attack on a major city by terrorists capable of acquiring and detonating an improvised nuclear device. Long-held anxieties about the non-survivability of nuclear war promulgated during the intense U.S.—Soviet arms race from the late 1940s through the 1980s, and reluctance to consider low …

Hospital Referral Patterns: How Emergency Medical Care is Accessed in a Disaster

BACKGROUND: A prevalent assumption in hospital emergency preparedness planning is that patient arrival from a disaster scene will occur through a coordinated system of patient distribution based on the number of victims, capabilities of the receiving hospitals, and the nature and severity of illness or injury. In spite of the strength of the emergency medical …

Climate Change and the Public's Health: The Coming Crisis for the U.S. Gulf Coast

This paper reviews the scientific consensus as to how climate change will affect human health on a global scale and describes the limited, emerging research findings concerning climate change health impacts along the U.S. Gulf Coast. Through myriad pathways, climate change is likely to make the Gulf Coast less hospitable and more dangerous for Americans, …

Education and Training of Hospital Workers: Who Are Essential Personnel during a Disaster?

Hospital plans often vary when it comes to the specific functional roles that are included in emergency and incident management positions. Bioterrorism coordinators and emergency managers for 31 hospitals in a seven-county region outside of a major metropolitan area, with urban, suburban, and rural demographics were surveyed to determine which specific functional roles were considered …

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 …

The 2008 American Preparedness Project: Why Parents May Not Heed Evacuation Orders and What Emergency Planners, Families and Schools Need to Know

Since 2002, the National Center for Disaster Preparedness (NCDP) at Columbia University’s Mailman School of Public Health, and The Children’s Health Fund (CHF), have conducted annual surveys of public attitudes and personal preparedness in the aftermath of the terror attacks of September 11, 2001. Produced in collaboration with the Marist College Institute for Public Opinion …

Teaching emergency preparedness to public health workers: use of blended learning in web-based training

This article presents the development of a program and results of a study to evaluate an online distancebased learning (DBL) program for competency-based, basic emergency preparedness training for employees of local health departments nationwide. The program was developed and implemented beginning in May 2003 by Columbia University’s Center for Public Health Preparedness (CU-CPHP), and was …

Of peppers and preparedness

What can a chili pepper teach us about disaster preparedness? In June, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) began issuing advisories about a foodborne salmonella outbreak that was detected in the United States. At the end of August, the agencies announced with little fanfare that the …

The American Preparedness Project: Where the US Public Stands in 2007 on Terrorism, Security, and Disaster Preparedness

Since 2002, the National Center for Disaster Preparedness (NCDP) at Columbia University’s Mailman School of Public Health and The Children’s Health Fund (CHF), have conducted annual surveys of public attitudes and personal preparedness in the aftermath of the terror attacks of September 11, 2001. Produced in collaboration with the Marist College Institute for Public Opinion …

Comparison of Urban Transit Planning Responses to Pandemic Influenza

Pandemic influenza and other large scale communicable disease outbreaks pose a unique public safety concern in respect to transit and emergency planning. While local transit agencies, supported by federal funds, have identified disaster planning and response as critical to maintaining continuity of service and quality of life, most plans contend solely with event-based scenarios such …

The New York City Principals Pandemic Flu Survey: Are Schools Prepared?

It will be only a matter of time before another influenza pandemic occurs. Pandemic flu refers to a novel human influenza virus that causes a global outbreak, or pandemic. Researchers cannot accurately predict the timing, severity, or source of the next pandemic, but are certain it would present a myriad of issues for the public …

Interventions to Mitigate the Reduced Ability and Willingness to Work of Health Care Workers During a Pandemic Influenza Public Health Emergency

Several widely publicized articles were released in the past two years which suggest that health care and public health employees may be unable or unwilling to report to work during a public health emergency involving contagion or contamination such as pandemic influenza, SARS, smallpox, or a terrorist attack using disease or radiation: A 2006 study …

Unanticipated Consequences of Pandemic Flu: School Related Issues: A Preliminary Literature Review

In the event of a pandemic flu outbreak, closing schools would be one of the most likely non pharmaceutical interventions (NPI) considered to contain the outbreak, consistent with social distancing theories (Hodge 2006, Germann 2006). Children in preschool and school-age groups are frequently observed to amplify transmission of many forms of flu (Bell 2006, Germann …

The US pandemic influenza implementation plan at six months

There has been great concern recently about pandemic influenza. The US government developed a National Strategy for Pandemic Influenza in November 2005, followed by an implementation plan in May 2006. A six-month progress report was published in late December. The current strategies are intended to improve preparedness and response for the next influenza pandemic. In …

Emergency Preparedness: Addressing the Needs of Persons with Disabilities

In July 2004, President Bush signed an Executive Order explicitly stating the policy of the United States in the area of emergency preparedness for people with disabilities. The Executive Order built on The Americans with Disabilities Act (ADA), passed in 1990 “to provide a clear and comprehensive national mandate for the elimination of discrimination against …

Safer Schools in an Age of Mass Violence: Back to the Basics of Public Health

Schools in the US are by and large safe environments where millions of our children are secure and thrive. Outbreaks of fatal violence like the recent shootings at Virginia Polytechnic Institute and State University (Virginia Tech) are, fortunately, rare. In fact, the odds of a student losing his or her life to homicide are 50 …

Life under the "new normal": notes on the future of preparedness

Being prepared for emergencies is not a new concept. At every level of government there are contingency plans for natural disasters, accidental catastrophes, local events and personal emergencies of every conceivable manner. Organizations from the Red Cross to the Federal Emergency Management Agency to hospital emergency departments are in a constant state of readiness. Often, …

The Pediatrician and Disaster Preparedness

Recent natural disasters and events of terrorism and war have heightened society’s recognition of the need for emergency preparedness. In addition to the unique pediatric issues involved in general emergency preparedness, several additional issues related to terrorism preparedness must be considered, including the unique vulnerabilities of children to various agents as well as the limited …

National Preparedness Planning: The Historical Context and Current State of the U.S. Public's Readiness, 1940-2005

In the United States, national public preparedness efforts meant to ready individuals and families for disasters have been driven primarily by international threats, actual or anticipated. These include terrorism, war and the potential for global instability such as the millennium Y2K computer error. The national dialogue on public preparedness following Hurricanes Katrina and Rita in …

Ethical and Legal Challenges Posed by mandatory Hurricane Evacuation: Duties and Limits

When Hurricane Katrina made landfall in August 2005, between 70,000 and 100,000 residents of New Orleans either did not or could not comply with the order that had been issued to evacuate. The events surrounding Katrina raised critical legal and ethical questions about the use of mandatory evacuation orders. We discuss four key ethical issues …

Guide to Contracting Public Health Drills and Exercises

In the wake of September 11, the United States Department of Health and Human Services (DHHS) made available hundreds of millions of dollars through the Centers for Disease Control and Prevention (CDC) and the Health Resources Services Administration (HRSA) to assist State, Local, and Territorial Health departments increase their capacity to respond to bioterrorism and …

Homeland Preparedness for Major Terrorism in 2006: Not Yet Ready for Prime Time

This year will represent a turning point for preparedness and homeland security in the United States. With Michael Chertoff firmly in place and making his own mark as the new Secretary of Homeland Security, the anticipated reauthorization of the federal bioterrorism bill and many other new perspectives and strategies on the table, changes are likely …

Critical Concepts for Children in Disasters Identified by Hands-on Professionals: Summary of Issues Demanding Solutions Before the Next One

This supplement contains many hands-on experiences of pediatricians and others who cared for children during the Hurricane Katrina disaster. They have all offered significant insightful suggestions to help planners better prepare for care of children during the next disaster. Pediatricians and other providers need to educate families on many aspects of disaster planning. Families should …

Preparing for disasters: What should you know, and when should you know it?

Three waves of terrorism have ushered in a new era in public health, safety, and health care in the United States: The February 26, 1993 explosions at New York’s World Trade Center, the April 19, 1995 bombing at the Murrah Federal Building in Oklahoma City, and the September 11, 2001 attacks, along with the anthrax …

Terrorism and preparedness: What September 11 and its aftermath mean for physicians

In the aftermath of September 11, the people and government of the United States confronted a new reality–so too did the health care community. The attacks revealed a number of vulnerabilities with respect to the health care system’s infrastructure and ability to respond to terrorism. Although September 11 represents an unprecedented disaster in the United …

Identification and Evaluation of Mental Health and Psychosocial Preparedness Resources From the Centers for Public Health Preparedness

An exemplar group of disaster mental health subject matter experts was formed as part of the CDC Center for Public Health Preparedness program to develop a “toolkit’ of relevant CPHP disaster mental health training and education curricula and resources. The group developed a charter, compiled relevant CPHP training materials, developed an objective review template, and …

Disaster and Terrorism Preparedness: What Pediatricians Need To Know

This chapter is designed to provide an overview of key issues for the pediatrician with respect to terrorism and disaster preparedness. It is not intended to be a complete compendium of didactic content, but it does represent an approach to understanding what needs to be learned by the pediatrician on this difficult topic and how …

Pediatric Preparedness for Disasters and Terrorism: A National Consensus Conference: Executive Summary

In a time of crisis, it is essential to ensure the needs of children are being met in planning and preparing for disasters and terrorist events. The current adult models and guidelines cannot be applied to the care of children. We convened experts from the multiple areas of expertise and disciplines involved in the planning …

The Vigilance Defense: Proven Systems and Well-Prepared People Are Our Best Protection Against Bioterror

Last fall, when physicians diagnosed anthrax in a Florida man named Robert Stevens, they initially suspected that they were seeing a rare, natural case of the disease. The infection of a co-worker of Stevens, however, put the country on alert. Five people eventually died, but the quick recognition that the earliest anthrax infections resulted from …

First Steps: A Pilot Preparedness Program for Public Health Nurses

Public health will face major challenges in the coming decades. The 1999 West Nile outbreak in New York City and other recent incidents demonstrate how important public health is as a frontline defense against emerging infections, bioterrorism, and other unexpected emergencies. A well-prepared public health workforce is more critical than ever. The challenges are particularly …