Do Shared Barriers When Reporting to Work During an Influenza Pandemic Influence Hospital Workers’ Willingness to Work? A Multilevel Framework

Objective Characteristics associated with interventions and barriers that influence health care workers’ willingness to report for duty during an influenza pandemic were identified. Additionally, this study examined whether workers who live in proximal geographic regions shared the same barriers and would respond to the same interventions. Methods Hospital employees (n=2965) recorded changes in willingness to …

Surge Capacity Logistics

Successful management of a pandemic or disaster requires implementation of preexisting plans to minimize loss of life and maintain control. Managing the expected surges in intensive care capacity requires strategic planning from a systems perspective and includes focused intensive care abilities and requirements as well as all individuals and organizations involved in hospital and regional …

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 …

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 2011 Tuscaloosa Tornado: Integration of Pediatric Disaster Services into Regional Systems of Care

Objective: To empirically describe the integration of pediatric disaster services into regional systems of care after the April 27, 2011, tornado in Tuscaloosa, Alabama, a community with no pediatric emergency department or pediatric intensive care unit and few pediatric subspecialists. Study design: Data were obtained in interviews with key informants including professional staff and managers …

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 …

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 …

Emergency Response and Public Health in Hurricane Katrina: What Does it Mean to Be a Public Health Emergency Responder?

Since 9/11, federal funds directed toward public health departments for training in disaster preparedness have dramatically increased, resulting in changing expectations of public health workers’ roles in emergency response. This article explores the public health emergency responder role through data collected as part of an oral history conducted with the 3 health departments that responded …

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 …

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 …

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 …

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 …

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 …

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 …

Comfort level of emergency medical service providers in responding to weapons of mass destruction events: impact of training and equipment

Background: Numerous studies have suggested that emergency medical services (EMS) providers are ill-prepared in the areas of training and equipment for response to events due to weapons of mass destruction (WMD) and other public health emergencies (epidemics, etc.). Methods: A nationally representative sample of basic and paramedic EMS providers in the United States was surveyed …

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 …

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 …

Accuracy of a Priority Medical Dispatch System in Dispatching Cardiac Emergencies in a Suburban Community

Introduction: Over-triage of patients by emergency medical services (EMS) dispatch is thought to be an acceptable alternative to under-triage, which may delay how quickly life-saving care reaches a patient. Previous studies have looked at advanced life support (ALS) misutilization in urban- and county-based EMS systems and have attempted to analyze how dispatch methods either contribute …

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 …

The Willingness of U.S. Emergency Medical Technicians to Respond to Terrorist Incidents

A nationally representative sample of basic and paramedic emergency medical service providers in the United States was surveyed to assess their willingness to respond to terrorist incidents. EMTs were appreciably (9-13%) less willing than able to respond to such potential terrorist-related incidents as smallpox outbreaks, chemical attacks, or radioactive dirty bombs (p < 0.0001). EMTs …

Psychosocial Implications of Disaster or Terrorism on Children: A Guide for the Pediatrician

During and after disasters, pediatricians can assist parents and community leaders not only by accommodating the unique needs of children but also by being cognizant of the psychological responses of children to reduce the possibility of long-term psychological morbidity. The effects of disaster on children are mediated by many factors including personal experience, parental reaction, …

Uncommon Sense, Uncommon Courage: How the New York City School System, Its Teachers, Leadership and Students Responded to the Terror of September 11

Eight public schools are situated within a quarter mile of Ground Zero with 9,000 students ranging in ages from three to eighteen years – grammar, middle and high schools. On Tuesday, September 11, 2001 in the midst of chaos and a relentless unfolding of tragedy, professionals of the Board of Education safely evacuated all 9,000 …

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 …

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 …

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 …