Emergency Management Research Articles

English and Regional Media Coverage of the 2022 Heatwave in India

ABSTRACT The 2022 heatwave in India formed part of a pattern of extreme weather events in the country, which are becoming more intense, frequent, or prolonged. The aim of this study is to explore media coverage of climate change and extreme events in a multilingual media context such as India. Data analysis of a large and diverse sample of Indian media coverage of the 2022 heatwave (n = 309) suggests that only 1 in every 7 news articles (14%) mentioned climate change in their heatwave coverage in the English press, and less than 10% in the Hindi, Telugu, and Marathi language news media. However, many English-language articles reported the links between climate change and the heatwave, although the figure was much lower for the other languages. Two Event Attribution studies analyzing the heatwave were widely quoted, albeit with some inaccuracies. Indian scientists were the most cited, whereas politicians and NGOs were largely absent, in contrast to previous research. Journalists regularly covered three aspects that affect the impact of the heatwave on ordinary people, namely emergency responses, disaster planning, and vulnerabilities. This study concludes by exploring theoretical and practical recommendations for media coverage of heatwaves and climate change.

IoT based smart emergency response system (SERS) for monitoring vehicle, home and health status

This paper presents an innovative Internet of Things (IoT)-based smart emergency response system that aims to improve safety and efficiency across vehicles, homes and healthcare settings. The proposed system combines advanced sensors, communication technologies, and intelligent algorithms to provide a comprehensive solution for real-time data monitoring and emergency management. Here, the vehicle device is equipped with temperature, gas, flame, GPS, piezo, and accelerometer sensor and the system can detect accidents, hazardous conditions, precise location automatically notifying emergency services. The home devices incorporate Flame Sensor, humidity sensor, DHT11, MQ-2 gas sensor, MQ-4 Gas Sensor, MQ-135 gas sensor, and intrusion detection to ensure immediate alerts and response to potential security threats. Lastly the health device is equipped with temperature, humidity, stress levels, heart rate, oxygen saturation, and fetal heart rate sensor which can monitor vital signs and detect anomalies, triggering alerts for medical emergencies and facilitating timely intervention. The novelty of the proposed study is it incorporates the three devices, processes the data and automatically notifies the emergency responders for further emergency assistance. Moreover, the system utilizes a cloud-based platform to collect, analyze, and disseminate data, enabling seamless coordination between emergency responders such as ambulance for health and accident emergency, fire brigade for fire emergency and affected individuals. We have also developed a MySQL-PHP-Laravel based live dashboard and emergency response system where both the user and relevant stakeholder will have the access which could mitigate the emergency situation in the quickest amount of time without human intervention. The findings of our study reveals that incorporation of IoT and smart infrastructure offers significant improvement of server response time 3 ms, accuracy > 99% and overall effectiveness of emergency management. This integrated approach not only enhances individual safety but also contributes to broader public safety goals, showcasing the potential of IoT technologies in creating smarter, safer environments.

Non-locality and spillover effects of residential flood damage on community recovery: Insights from high-resolution flood claim and mobility data

Examining the relationship between vulnerability of the built environment and community recovery is crucial for understanding disaster resilience. Yet, this relationship is rather neglected in the existing literature due to limitations in the availability of empirical datasets needed for such analysis. In this study, we combined fine-resolution flood damage claim data (composed of both insured and uninsured losses) and human mobility data (composed of millions of movement trajectories) during the 2017 Hurricane Harvey in Harris County, Texas, to specify the extent to which vulnerability of the built environment (i.e., residential flood damage) affects community recovery (based on the speed of human mobility recovery) locally and regionally. We examined such relationship using spatial lag, spatial reach, and spatial decay models to measure the extent of spillover effects of residential flood damage on community recovery. The results indicate that: first, the severity of residential flood damage significantly affects the speed of community recovery. A greater extent of residential flood damage suppresses community recovery not only locally but also in the surrounding areas; second, the spillover effects of residential flood damage on community recovery decay with distance from the highly damaged areas with a spatial reach of up to 31.2 miles (49.92 Km); third, areas display heterogeneous spatial decay coefficients, which are associated with urban form and structure features such as the density of facilities and roads. These findings provide a novel data-driven characterization of the spatial spillover effects of residential flood damage on community recovery and move us closer to a better understanding of complex spatial diffusion processes that shape community resilience to hazards. This study also provides valuable insights for emergency managers and public officials seeking to mitigate the non-local effects of flood damage.

The Transformative Impact of the African Cohort Study (AFRICOS) Toward Reaching HIV 95-95-95 Goals in Sub-Saharan Africa.

Over the last 20 years, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has rapidly expanded and made remarkable progress toward the UNAIDS 95-95-95 targets to end the HIV epidemic. Nevertheless, HIV continues to pose a significant health challenge globally, with a particular impact on the African continent. Funded by PEPFAR, the African Cohort Study (AFRICOS) has served as a monitoring and evaluation tool for PEPFAR to help guide HIV policy and PEPFAR programming for the last 10 years since its inception and offers a compelling example of how PEPFAR's investment in science continues to reap dividends. This paper details and critically reviews the transformative research AFRICOS has had on helping to end the HIV epidemic as a public health threat by 2030.

Key Factors Influencing Public Attitudes Toward Charities' Involvement in Emergency Management: A Study Based on Online Public Opinion in China.

Charities play a pivotal role in engaging the public in emergency management efforts. They serve to complement governmental restrictions by leveraging social resources to aid in emergency management. The involvement of charities in emergency management is likely to shape public attitudes, thereby influencing their effectiveness in this sphere. Therefore, understanding the factors that influence public attitudes toward charities in emergency management is crucial. This study sought to identify these key factors and offer recommendations for charities to enhance their participation in emergency management. The data for this study were collected from messages and comments on two prominent instant messaging platforms, WeChat Public and Sina Weibo. Content Analysis was employed to categorize the data, and the Apriori algorithm was utilized to uncover association rules and key factors. Based on the key factors, it is recommended that charities focus on collaborating with celebrities and enterprises, prioritize establishing and upholding a positive reputation, and enhance their expertise in emergency management practices.

Ready or not? The state of emergency preparedness among Italian Public Health medical residents

Abstract Background Italy frequently experiences major events like earthquakes, floods, and migrant shipwrecks, reflecting global concerns that also include climate change, pandemics, and wars. This study aims to assess the role of public health experts and the current state of Italian post-degree Public Health schools in addressing these challenges. Methods In June 2023, a cross-sectional online survey was administered to all Italian Public Health residents enrolled in the Italian Society of Hygiene, Preventive Medicine, and Public Health (SItI). The survey investigated the availability and frequency of training and updates related to emergencies, measured the interest and perceived importance of these topics among residents, examined the impact of the COVID-19 pandemic on their awareness, and identified their primary sources of information in the subject. Results Out of 289 respondents, a significant majority (86.2%) acknowledging the importance of being trained in emergency management and 74.4% expressed interest in topic (p < 0.001). A 90.1% of residents indicated a lack of dedicated courses and 93.1% reported an absence of specialized master’s programs (p < 0.001). There was a strong correlation between recognizing the importance of the topic and the desire to attend specialized conferences (p < 0.001). The COVID-19 pandemic had a noticeable impact: 24.6% recognized the importance of the topic pre-pandemic, while 50.9% raised awareness during (p < 0.001). Conclusions The findings highlight a critical gap in the training of public health professionals in Italy, particularly in the domain of emergency preparedness and management. There is a pressing need to establish enhanced, uniform training programs across different public health training networks in Italy. Implementing such programs would ensure a more robust and effective response to future emergencies, thereby safeguarding public health and improving outcomes during crises. Key messages • Significant gap in specialized training and awareness among health professionals. • Urgent need for emergency preparedness training in public health.

The EU Health Task Force, supporting preparedness and response in the European Union and globally

Abstract The COVID-19 pandemic revealed shortcomings in the European Union (EU) mechanisms for managing public health threats. In 2022, the European Centre for Disease Prevention and Control (ECDC) was mandated to establish the EU Health Task Force (EUHTF) to strengthen preparedness and response at country, EU and global levels. The EUHTF is coordinated by an ECDC Permanent Capacity and relies on pools of experts including ECDC experts, ECDC fellows and European public health experts that can be mobilized for specific assignments or broad public health emergencies. Members from EU/ Economic European Area (EEA) countries, EU agencies, the European Commission, WHO and non-profit organizations advise ECDC on the EUHTF establishment. From May 2023 to April 2024, the EUHTF addressed 13 requests for support from seven EU countries and three non-EU countries. The requests were related to preparedness (e.g. after-action reviews, simulation exercises, mass gathering preparation, capacity building) and emergency response activities (e.g. risk assessment, operational research during crisis, emergency and outbreak response). The EUHTF is operational and able to mobilize expertise from ECDC, the ECDC fellowship and EU/EEA countries. The EUHTF Pool of External Experts, comprised of public health professionals across various levels and institutions of the EU/EEA, is poised to offer comprehensive and robust expertise. Through these resources, the EUHTF is collaborating with and reinforcing the work of EU institutions and other international partners in strengthening preparedness and response. The EUHTF is a new and structured EU-level approach to public health crises, ensuring tailored in-country support to EU and non-EU countries in preparedness strengthening and crisis response.

A system dynamics model based on ISM for risk perception in emergency by employees in chemical industrial parks

Risk perception is one of the factors that guide human behavior in the workplace. In accident prevention and emergency response, the risk perception of employees affects the safety behaviour and efficiency of emergency disposal. Besides, risk perception is a complicated process restricted by many influencing factors. The study aims to identify the most important factors affecting risk perception. This study had three phases. In the first, factors affecting the risk perception were extracted based on the questionnaire survey and the expert scoring. Then, the Interpretive Structure Model (ISM) was used to stratify the 14 influencing factors of risk perception and obtain a hierarchical structure chart. Finally, by analyzing the influence paths in the ISM, the system dynamics feedback loop diagram was constructed. The model took the state variable “risk perception→ risk response→ risk identification→ risk communication→ risk perception” as the main circular loop, and was supplemented and perfected by multiple feeder loop circuits. Research indicates risk experience is the most fundamental factor affecting risk perception. In the aspect of sensitivity analysis, the study shows that the risk perception of employees is related to the distance of the risk source. Its effectiveness in quantifying qualitative data, identifying influential factors, and establishing cause-effect relationships make it a valuable tool for enhancing risk perception in chemical industry park.

Exploring Health Professionals’ Views on Hive: A Digital collaborative space for Health Emergencies

Abstract Background The rapidly changing media landscape has significantly affected how information is consumed, particularly during health emergencies. Conflicting information shared or information lacking in scientific rigour can be exploited nefariously online to undermine the health response and damage trust. Digital platforms have become increasingly vital for facilitating communication, and in response, the WHO developed the Hive digital space to provide a safe environment for public health professionals to convene, share information, ask questions, and learn from each other. This study aims to explore the experiences of public health professionals in health emergencies to assess the added value of the Hive platform to coordinate and connect health expertise globally. Methods This study uses a cross-sectional online survey distributed to Hive users focusing on their experiences of working in health emergencies. The responses will undergo descriptive and thematic analysis, as well as inferential statistics such as one-way ANOVA and post-hoc analysis. The survey will emphasize the practical application, value, satisfaction, perceptions, and strategy for the Hive platform to be utilised for global health emergency coordination. Expected Outcomes Insights from this study will delineate how the Hive platform is used by public health experts at all levels in emergency management. It will also highlight the challenges, needs and demands for digital tools to connect skills, experience and knowledge in one place. These insights will demonstrate how the Hive can streamline these processes and provide a safe space for information exchange for a coordinated response to health emergencies. Conclusions Understanding the needs and perceptions of Hive users involved in health emergency prevention, preparedness, response, and resilience will provide critical insights into optimizing the platform’s usability, connectiveness across emergency teams and sustainability of the platform. Key messages • Connecting communities, fostering collaboration and co-creation for improved health emergency management. • Hive enhances collaboration among health professionals, providing a safe environment for knowledge and information sharing.

Determinants in disaster preparedness of nurses in the Azores

Abstract Background Disasters are situations of complexity and unpredictability, increasingly frequent and more destructive. They require rapid and effective action from different teams from different contexts, with preparation and qualifications for an adequate response to victims, recovering the environment, and restoring living conditions, and nurses play a significant role in these events. Understanding the level of preparedness of nurses for disasters is fundamental for defining the competency framework in the disaster management cycle. Objectives To analyze the preparation of nurses in the Azores for a catastrophe. Methods A cross-sectional study was performed with 160 nurses from the Azores. The questionnaire validated for the Portuguese population “Disaster Preparedness Evaluation Tool (DPET ®): Preparation of nurses in the face of a catastrophe” was applied. It was approved by the Ethics Committee. Results More than half of respondents (n = 137, 71%) indicated that they were not fully prepared to respond to disasters, while 29% (n = 46) acknowledged that they felt adequately prepared. Of the 160 respondents, only 20% (n = 30) participated in the development of emergency plans and only 14% (n = 22) participated in the creation of emergency plans that contribute to improvements at the local level. Training through simulation training was cited as important in disaster preparedness (n = 129, 78%). Discussion The present study identified little involvement of RAA nurses in preparing emergency plans and less than half feel poorly prepared in responding to a catastrophe. This finding is consistent with studies by Baker, Alamri, & Aboshaiqah (2019) and Emaliyawati et al. (2021). Conclusions This study was conducted in a region prone to natural disasters. It is vital to invest in the training of these professionals throughout the disaster cycle so that they can contribute to reducing the impact that the catastrophe will have on the individual/family and community. Key messages • Strengthening capabilities through regular disaster training based on effective information. • Low participation in the development of emergency plans that contribute to improvements at the local level.

Machine learning model using heart rate variability for the prediction of vasovagal syncope

Abstract Background and Aims: Vasovagal syncope (VVS) is a reversible condition that can cause serious events, such as cerebral hemorrhage due to head trauma. Its occurrence is difficult to predict; therefore, this study aimed to develop machine learning (ML) models using heart rate variability (HRV) to predict the occurrence of VVS. Methods and Results We investigated 80 patients with syncope who underwent Holter monitoring during the head-up tilt test. Twenty-six ML models for the prediction of VVS using HRV parameters were examined. We randomly split the subjects into training and testing sets at a 7:3 ratio (training set: 46 positive and 9 negative subjects; testing set: 21 positive and 4 negative subjects). The XGB classifier achieved the highest performance compared with other algorithms (accuracy, 0.72; area under the curve, 0.801; sensitivity, 0.857; specificity, 0.621). When examining the time taken to predict syncope occurrence using the developed prediction model, it was found that the model could forecast approximately 3 min (equivalent to 193.2 beats) prior to the onset of symptoms. Conclusion The ML model utilizing HRV parameters was proficient in preemptively predicting VVS incidents. In practical applications, this approach can effectively enhance VVS prediction by leveraging the HRV, thereby aiding in the prevention of unforeseen accidents.

Effects of deferment of clinic visit on cardiovascular outcomes during COVID-19 outbreak: a prospective cohort study

Abstract Background Current guidelines recommend 3-6 months interval outpatient follow-up for patients with cardiovascular (CV) diseases and risk factors such as hypertension, diabetes mellitus (DM) and dyslipidemia. The impact of longer follow-up intervals is unclear. From 2020 to 2022, due to the infection control measures for COVID-19 pandemic, many patients voluntarily deferred their scheduled clinic visits. This provided us with an opportunity to study the impact of prolonged visit intervals on management CV risk factors. Purpose We aimed to investigate the impact of prolonged clinic visit intervals on CV outcomes and CV risk factor management among patients with CV diseases. Methods Patients with at least 1 CV risk factor (DM, hypertension, dyslipidemia, or a history of CV disease) were recruited from cardiology outpatient clinics from a tertiary teaching hospital from 2020-2022. Patients who opted to defer their appointment (Deferred group) were compared to those who attended their scheduled appointment (Normal group). The primary outcomes were composite major adverse cardiovascular events (MACE) of myocardial infarction, stroke, or CV-related death. The secondary outcomes were any unscheduled hospitalizations, suboptimal DM control (haemoglobin A1C >7%) or hyperlipidemia (LDL > 1.4 mmol/L). Results Out of the 455 patients recruited from outpatient clinics, 162 patients (35.6%) opted to defer their scheduled clinic visit (mean age 64.7 ± 12, 37.7% female), and 293 patients (mean age 64.5 ± 10, 36.2% female) continued to attend their appointments. The mean appointment interval was 226 days for the normal group and 582 days for the deferred group (p< 0.001). There was no significant difference in the primary outcome of MACE between the ‘Normal’ group and the ‘Deferred’ group (2.5% vs 0.6%, p=NS). The number of patients with suboptimal DM control (11.4% vs 21.9%, p = 0.029) was higher in the deferred group, whereas suboptimal hyperlipidemia (73.1% vs 77.1%, p=NS) was not statistically different. There were a total of 27 of unscheduled hospitalizations, among which the majority was for CV-related events (63.0%). Patients in the ‘Deferred’ group had higher rates of unscheduled hospitalization (12.3% vs 2.4%, p < 0.001) and higher rate of CV-related hospitalization compared to the ‘Normal’ group (6.2% vs 2.4%, p=0.041). Conclusion Our prospective data demonstrates that a prolonged clinic visit interval of more than 365 days was not associated with significant increase in adverse CV event or worsening of lipid control. However, prolonged clinic visit interval was associated with worse DM control and more frequent unscheduled hospitalization. More frequent medical contact might allow timely management of medical emergency at the outpatient setting and contribute to the lower rate of hospitalization in the routine follow-up group.

Ethics in social listening in infodemic management in health emergencies

Abstract Issue During the COVID-19 pandemic and subsequent outbreaks, health organizations have increased the use of social listening to inform infodemic management and outbreak response activities. This demonstrated the need to provide ethical guidance to organizations, and individuals engaging in social listening practices before, during and after public health emergencies, whilst protecting human rights. Description of the problem Social listening as a public health activity draws on analysis of conversations in social media, internet platforms, and feedback from geographically localized communities. Infodemic insights are generated rapidly, to support agile action by health organizations that improves outbreak response, health information delivery, community engagement, or reduction of unintended harm experiences by communities. Social listening involves use of social media and internet trace data, which were traditionally not used in public health for understanding community expressions, WHO convened a panel of experts to develop a framework on ethical considerations for social listening in infodemic management to provide recommendations for health authorities and researchers on practical tools that support setting up new data analysis and use of insights hereto not used in routine. Results The guidance framework has been structured into segments that vary from ethical principles and challenges in social listening and generation of infodemic insights, alignment with human rights, substantive principles, procedural principles, and practical guidance for translating these principles into real-world practice. Lessons This guidance aims to illuminate the intricate ethical dimensions of social listening and stress the urgent need for ethical guidance in this realm. The framework is a comprehensive inquiry of the ethical scope in social listening, providing valuable insights, practical guidance, and case studies to enhance understanding of this critical global health issue. Key messages • While essential, social listening and infodemic insights come with ethical risks, including potential harm to populations in vulnerable situations, erosion of trust, and misuse of data. • This ethical framework will govern social listening practices and ensure responsible and ethical social listening.

The 2021-2023 Italian influenza pandemic plan: a critical evaluation of its regional implementation

Abstract Background Influenza pandemic preparedness plans should be adopted, regularly updated in every country, and comply with international guidelines to ensure proper management of public health emergencies. In Italy, each region develops its pandemic plan based on a National Plan. This study, conducted within a project funded by the Italian Ministry of Health, aims to assess the level of compliance of these plans with the national guidelines. Methods The assessment was based on a checklist of 192 items reporting the actions prescribed by the national plan. The items were divided into macro-areas by pandemic phase: general, alert, inter-pandemic, pandemic, and transition. The compliance regarding the presence and contextualization of each item in the regional plans was evaluated. Each macro-area was further assessed for easy identification of actions, congruence with the National Plan, and contextualization in the regional healthcare system. Some analyses grouped the regions into North, Centre, and South/Islands. Results Some macro-areas, such as ‘Communication’ and ‘Prevention and Control measures,’ showed some weaknesses in all phases, especially in the northern regions, which reached levels of full compliance below 50%. Central regions were highly compliant in almost all macro-areas, especially in ‘Strategy/Governance’ (100%), ‘Supplying’ (75-100%), and ‘Surveillance’ (75-100%). Overall, contextualization was the weakest aspect in all phases, while easy identification and congruence were mainly better achieved. Only three regions fully met all the assessed parameters. Conclusions A strict surveillance and monitoring process of planned activities is necessary to strengthen the country’s preparedness. This study identified critical issues and key areas for improvement at the regional level. This might allow us to verify the correct implementation of national guidelines and define the best strategies for improving readiness for public health emergencies in the future. Key messages • Implementation of the Italian influenza pandemic plan was uneven across regions. • Identification of lacking areas of the regional implementation is essential to improving national preparedness.

10.H. Round table: Transforming health systems in Europe to respond to the large-scale displacement from war in Ukraine

Abstract The Russian invasion of Ukraine in 2022 caused one of the largest population displacements in Europe since World War II. More than 6 million persons have sought international protection in other European countries, distributed in ways that take little account of the host countries’ population size, national income, or health system capacity. This workshop provides a platform to present and discuss findings of a health system impact assessment designed to anticipate the range of mid- to long-term impacts of this large-scale displacement on essential health system functions in refugee-receiving countries, identifying the challenges they face and opportunities to develop transformative policies and actions. This task is urgent given the risks of wider conflict in Europe. Objectives The workshop will 1) present the main findings from the health system impact assessment in seven refugee-receiving countries, 2) set out options for effective responses, considering policy and implementation perspectives, and 3) capitalise on the expertise of workshop participants to develop and refine policy options for structural reforms that not only help to sustain an effective response, but enhance the resilience of European health systems for the benefit of displaced populations and national residents alike. Format The workshop will comprise a panel with three speakers, followed by a roundtable discussion. Each panel member will make a short presentation (5 min) on different, but interrelated aspects of a transformative health system response to a protracted crisis scenario. These will highlight country and regional-level challenges arising during the Ukraine crisis, propose concrete policy options for transformation, and identify intersections between the health system response with other societal sectors and crises. The workshop objectives and rationales will be introduced by Kayvan Bozorgmehr, including a short pitch-presentation (3 min) highlighting the unequal distribution of displaced persons from Ukraine and the key-findings of the health system impact assessment. The panel will include follow-up presentations elaborating specific aspects in this context: 1. Healthcare models and needs for transformative response in a protracted crisis (Dr. Nino Berdzuli, WHO Special Envoy for Ukraine Emergency Response in refugee-receiving countries); 2. Supra-national health financing as transformative reform: pros and cons (Eilin Rast, Bielefeld University, Germany); 3. Regional Geopolitical Conflicts and Population Health in Caucasus, CIS and Ukraine (Prof. Akaki Zoidze, Ilia State University, Georgia). The subsequent roundtable discussion will be chaired by Martin McKee. It will focus on the proposed actions and considerations from a policy and implementation perspective, and workshop participants will be invited to contribute to a critical reflection regarding barriers and enablers, as well as required alliances and processes to translate the structural reforms into practice. Key messages • The ongoing conflict-related displacements from Ukraine have created a protracted crisis that will require structural transformations to enhance health system resilience. • Enhancing healthcare delivery, continuity of care, and effective health financing requires national and supra-national collaboration to sustain effective responses and prepare for future crises. Speakers/Panelists Nino Berdzuli Division of Country Health Programmes, WHO/Europe, Denmark Eilin Rast Bielefeld University, Bielefeld, Germany Akaki Zoidze Ilia State University, Tbilisi, Georgia

Language barrier as social determinant of health: unmasking the disparities in the emergency department evaluation for patients with chest pain at a community hospital

Abstract Background/Introduction Patients with limited English proficiency (LEP) constitute 8.6% of the United States population. They may have lower health literacy related to cardiovascular disease, reluctance to seek care, and communication difficulties in reporting symptoms, posing challenges to care provision. Throughout medical literature, these barriers reportedly lead to increased utilisation of diagnostic testing, hospital admission rate, and length of stay. Purpose Language barrier appears to negatively impact individuals' healthcare experience. The goal of this study is to examine whether disparities exist in the emergency department (ED) evaluation and management of chest pain in LEP patients by comparing their wait time and admission rate to that of English-proficient (EP) counterparts. Methods This retrospective cohort study included adults age 18 or older that presented to our hospital ED with a chief complaint of chest pain from 1/9/2022 to 30/9/2023. We identified all LEP patients during this period and matched a random sample of EP patients in a 1:2 ratio. We treated each encounter as an independent subject and eliminated those that left prior to disposition. Our primary outcomes were time from arrival to provider evaluation, and admission rate. Covariates were sex, age, race, acuity level, arrival mode, and insurance status to adjust for characteristic difference between cohorts. Descriptive comparisons between cohorts and bivariate outcomes were conducted using independent samples t-tests for continuous variables and chi-squared tests for categorical ones. Multivariable linear and logistic regression models were used to compute adjusted mean wait time for provider and adjusted odds of admission, respectively. All analyses were done on SAS 9.4. Results Our study sample included 690 encounters, with 239 LEP and 451 EP patients. The two cohorts were similar in sex, age, and acuity level, but there were significant disparities in insurance status, arrival mode, and race. A higher proportion of EP patients were admitted to the hospital or observational unit than LEP patients (45.0% vs. 28.0%, respectively, P<0.001). After multivariable adjustment, LEP patients were half as likely to be admitted compared to EP patients (adjusted odds ratio, 0.51 [95% CI, 0.35-0.74], P<0.001). LEP patients waited longer for provider evaluation from the point of ED arrival, though this was not statistically significant when adjusting for acuity and arrival mode (19.6 minutes, [95% CI, 5.9-45.1], P=0.132). Conclusions Whilst we did not observe a significant difference in wait time for provider between LEP and EP patients, LEP patients were less likely to be admitted when presenting with chest pain at the ED. One possibility is that language barrier may limit a patient’s ability to convey cardiac versus non-cardiac chest pain, adversely influencing downstream management and outcomes. To address this, further large-scale investigation is needed.

Scanning the horizon- environmental health indicator surveillance

Abstract Aim This work aimed to conduct a comprehensive literature review with narrative synthesis of evidence in relation to the surveillance of environmental health indicators by Public Health agencies internationally. This will strengthen the All-Hazards approach to Health Protection in Ireland. Methods The project proposal was registered on PROSPERO. Preferred Reporting Systems for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. A systematic search was conducted across five databases. In addition, relevant websites, reference lists and the grey literature were searched. Data were extracted following TIDieR-PHP guidelines. Risk of bias was considered and quality appraisal was performed using SANRA and AGREE-HS tools. A narrative synthesis of the evidence was completed. Results 12 papers were included in the final review. Four were narrative review articles describing European and worldwide initiatives and the remaining eight described a single health system. Only three papers were deemed high quality. The number of indicators monitored varied widely from one in Italy to over 400 in the USA. The most established programmes described the use of a framework such as Drivers-Pressures-States-Exposures-Effects-Actions (DPSEEA) and indicator selection criteria were applied. The papers described a variety of public health actions arising from the surveillance of environmental health indicators. The knowledge provided by this review can inform the implementation process. Establishment of a project team, and beginning with monitoring one domain is suggested. Air quality is the most frequently monitored domain internationally. The DPSEEA framework is recommended, and Briggs’ indicator selection criteria should be applied to any indicator under consideration. The system should measure both hazard and outcome measures. Finally, meaningful public health action should result from the monitoring. Key messages • Environmental health indicator surveillance is essential to all-hazards health protection. • Few public health agencies internationally are systematically monitoring environmental health outcomes.

A behavioural perspective on pandemic preparedness

Abstract Driven by lessons learned from the COVID-19 pandemic, the RIVM Behavioural Unit is working on the preparedness of social and behavioural sciences. This includes establishing and maintaining a stakeholder network and a knowledge base on pandemic preparedness and behaviour. Using the socio-ecological model and the emergency management cycle, we propose a conceptual framework for a behavioural perspective on pandemic preparedness. The multilevel (individual, community, organisational, national and supra-national), time-dependent (cold, acute, recovery phase) structure of the framework can be helpful in explicating who has to do what, when. In addition, to explain and understand what different actors require for those behaviours prior to or during a pandemic, we propose an adapted version of the COM-B model (Michie et al., 2011), including determinants of behaviour related to motivation, capabilities and opportunities. Based on these frameworks, various monitoring tools are developed. Here we present the Pandemic Preparedness and Behaviour (PPb) survey aimed at cold phase monitoring behaviour on an individual level (i.e. hygiene behaviours, social activity, preparedness behaviours) and their determinants. With this survey we will obtain baseline measurements ahead of a possible future pandemic and will have developed the appropriate tools to be used in a hot phase for as much as possible. In addition, results on cold phase determinants can help to identify where communities, organisations and governments can provide support to improve pandemic preparedness. In this presentation, the proposed conceptual framework and the PPb survey will be discussed, together with their relevance for preparedness of the social and behavioural sciences.

Best Management Practices to Mitigate Contamination of Karstic Aquifers from Emergency Fire-Control Runoff

We propose best management practices to increase karstic aquifer drinking water supplies’ resilience to potential hazardous material impacts where first responders and public safety officials suspect emergency firefighting runoff has entered the subsurface in the aquifer recharge zone. Karstic aquifers are unique because of their direct openings to the land’s surface, which allows contaminants in runoff or other surface waters to rapidly enter the subsurface and impact aquifer water quality. In the United States, 20% of the land surface is karst, and about a third of the groundwater used for drinking comes from karstic aquifers. Proposed best management practices emphasize on-site, real-time evaluation of the transport and fate of HAZMAT that may enter the subsurface and focus on water quality sampling, runoff and groundwater flow modeling, nontoxic dye tracing, and related studies for use in planning before and during an event and after emergency response has ended. We recommend best management practices for evidence-based screening of high-risk sites to facilitate placement of hazardous material sampling devices and emergency responder deployment. The best management practices, tools, curricula, and training described combine with earlier work by the authors to provide a comprehensive menu of actions to (1) help first responders prevent or limit flushing of hazardous material into a karstic aquifer; (2) help emergency management officials understand the consequences of contamination and issue data-driven geographically focused health and safety risk communications; and (3) help provide health and safety officials with relevant science- and data-based information that can help mitigate human and environmental health risks.

ERIMS assessment Tool Enhances Emergency Response in WHO Europe Region

Abstract Issue/problem The implementation of an Emergency Response Information Management System (ERIMS) assessment tool improves health emergency responses within the World Health Organization - European Region. The tool’s deployment aims to refine data management processes and bolster preparedness strategies. Managing health information systems (HIS) effectively during emergencies is a persistent challenge, as technologies keep innovating and potential challenges are constant. The ERIMS assessment tool addresses this by offering a structured approach, ensuring improved emergency responses and system resilience. Description of the problem Adopting a systems approach, the ERIMS tool was designed to be flexible, allowing adaptation to various HIS architectures and emergency coordination mechanisms. Its design and development process included consultations with digital health and emergency management experts and field testing across three WHO member states. Results Field applications of the ERIMS assessment tool demonstrated its capacity to evaluate, including, digital capability and knowledge management with focus on emergency scenarios. The tool identified systemic gaps, offered strategic guidance on enhancing data processes, and fortified decision-making protocols. These outcomes not only highlighted the tool’s utility in assessing HIS readiness but also its impact in improving emergency response mechanisms. Lessons The deployment of the ERIMS assessment tool enhanced HIS by providing an evaluation of emergency preparedness and response capabilities with a focus at the national perspective level. The tool’s application showcased its role in advancing public health emergency preparedness, illustrating how assessments can lead to substantial improvements in health information management and emergency response readiness. Key messages • ERIMS assessment implementation improves emergency data management. • Better preparedness relies on boosting digital capabilities and knowledge management.