All-hazards Preparedness Research Articles

Considering the human-animal bond in developing One Health guidelines and standards for companion animals in humanitarian crises

Abstract Establishing international One Health guidelines and standards for the evacuation and care of small companion animals in humanitarian crises is essential to protect the overall well-being of people and pets impacted, improve efficacy and safety of response operations, safeguard public health and biosecurity, and mitigate the impacts of free-roaming pets on the environment and biodiversity. Given predictably larger scale and more frequent crises due to climate change and human conflict or violence, it is increasingly important to consider and plan for the impacts that invariably result when both people and pets are displaced. One Health impact statement Currently, there is a prominent focus on One Health approaches to plan for and respond to emerging infectious disease threats as they impact human physical and public health. Much less attention has been paid to all-hazards disaster preparedness and planning (DPP) that comprehensively addresses the myriad additional ways humans, other animals, and the environment are impacted by co-displacement of pets and people. If applied, One Health approaches to DPP for humanitarian crises would address a broader range of risks and harms and build the cross-disciplinary collaborations and platforms necessary to truly plan and prepare for “all hazards.” This approach also provides an exceptional opportunity to elevate One Health understanding among both professionals and the public when disaster planning initiatives are developed with, and shared among, communities around the world.

Assessing primary healthcare disaster preparedness: a study in Northern Italy.

The aim of this paper is to outline the steps taken to develop an operational checklist to assess primary healthcare (PHC) all-hazards disaster preparedness. It then describes a study testing the applicability of the checklist. A PHC approach is an essential foundation for health emergency and disaster risk management (H-EDRM) because it can prevent and mitigate risks prior to disasters and support an effective response and recovery, thereby contributing to communities' and countries' resilience across the continuum of the disaster cycle. This approach is in line with the H-EDRM framework, published by the World Health Organization (WHO) in 2019, which emphasizes a whole-of-health system approach in disaster management and highlights the importance of integrating PHC into countries' H-EDRM. Nevertheless, literature focusing on how to practically integrate PHC into disaster management, both at the facility and at the policy level, is in its infancy. As of yet, there is no standardized, validated way to assess the specific characteristics that render PHC prepared for disasters nor a method to evaluate its role in H-EDRM. The checklist was developed through an iterative process that leveraged academic literature and expert consultations at different stages of the elaboration process. It was then used to assess primary care facilities in a province in Italy. The checklist offers a practical instrument for assessing and enhancing PHC disaster preparedness and for improving planning, coordination, and funding allocation. The study identified three critical areas for improvement in the province's PHC disaster preparedness. First, primary care teams should be more interdisciplinary. Second, primary care services should be more thoroughly integrated into the broader health system. Third, there is a notable lack of awareness of H-EDRM principles among PHC professionals. In the future, the checklist can be elaborated into a weighted tool to be more broadly applicable.

INSIDE PAHPA: A GSA POLICY INTERN’S JOURNEY TO THE INTERSECTION OF POLICY AND PREPAREDNESS

Abstract Public health and safety are facing increasingly severe threats from natural disasters, infectious diseases, and emergencies caused by human actions, both intentional and unintentional. These incidents now impact a larger number of people and cover broader geographical areas compared to the past. Chief among those most affected are older people, as highlighted during the COVID-19 pandemic and other crises. Addressing these disparities is crucial, and the federal government plays a pivotal role in tackling this issue. Much of my research up to this point has focused on preparedness among older people for emergencies that threaten public health. My experience as a GSA Summer Policy Intern has significantly influenced my understanding of the relationship between public health emergencies and aging policy. Through witnessing the legislative process at the national level, monitoring resource allocation in the federal budget, and attending Congressional hearings, I gained valuable insights into the complexities of this field. My perspective was further shaped by closely monitoring, synthesizing, and disseminating information about the 2023 Reauthorization of the Pandemic and All-Hazards Preparedness Act (PAHPA). Additionally, I provided valuable feedback on the relevance of this bill to the interests of GSA and contributed to comments on a bipartisan discussion draft related to this legislation. Equipped with this newfound insight and understanding, I am confident that I will be a more effective advocate and scholar in the field of aging policy.

Disaster Preparedness at the Primary Health Care Level: The Proposal of a New Framework

Introduction:With the publication of the Health Emergency and Disaster Risk Management (H-EDRM) Framework in 2019, the World Health Organization (WHO) emphasized the need for disaster preparedness in all sectors of the health system, including primary health care (PHC). PHC disaster preparedness plays a crucial role in guaranteeing continuity of care and responding to the health needs of vulnerable populations during disasters. While this is universally acknowledged as an important component of disaster management (DM), there is still a severe paucity of scholarship addressing how to practically ensure that a PHC system is prepared for disasters. The objective of this study is to propose a new framework that describes key characteristics for PHC disaster preparedness and lays the groundwork to deliver operational recommendations to assess and improve PHC disaster preparedness.Method:A systematic literature review including the following online scientific databases was performed: Cochrane Library, Embase, Medline, National Library of Medicine, PubMed, Scopus, and Web of Science. Gray literature was also found by searching in: Trove, Mednar, and OpenGray. A total of 145 records were analyzed.Results:Twenty-five characteristics that contribute to a well-prepared PHC system were identified and categorized according to the WHO Health System Building Blocks to form a new PHC disaster preparedness framework.Conclusion:The findings will contribute to the elaboration of a set of guidelines for PHC systems to follow in order to assess and boost their disaster preparedness. This will hopefully help to raise awareness among international policymakers and health practitioners on the importance to design interventions that integrate PHC into overall DM strategies, as well as to assess the preparedness of PHC systems in different political, developmental, and cultural contexts. The proposed framework is currently being used by our research group as groundwork for the creation of an assessment tool for evaluating all-hazards preparedness at the PHC level.

Haddon matrix analysis of medical preparedness for mass gathering music festivals.

Beginning in the 1960s as a tool to disaggregate complicated auto injuries, the Haddon matrix has evolved into a modern method of analyzing complex public health challenges. Throughout the United States and internationally, music festivals have become a rapidly growing and increasingly complex area of mass gathering medicine. Given the austere environment and inherent challenges of providing medical care during a music festival, we utilized a modified Haddon matrix. The objective is to assess the relevant human, physical, and sociocultural factors that impact these festivals throughout the pre-event, event, and post-event time periods. This will ensure an all-hazards preparedness approach to the historically high incidence of traumatic injuries and polysubstance abuse, coupled with modern challenges such as infectious diseases and acts of intentional violence.

Comparative study on Vietnam’s and Philippines' COVID-19 response using historical institutionalism

PurposeThis paper analyzed the healthcare systems of the Philippines and Vietnam prior to the coronavirus disease 2019 (COVID-19) and their strategies on mass testing, contact tracing, quarantine procedures and information dissemination about the pandemic.Design/methodology/approachSteinmo's (2008) historical institutionalism approach was used in this paper. Secondary data gathering, document analysis and comparative process tracing were employed.FindingsThe findings revealed that Vietnam's implementation of its Law on Prevention and Control of Infectious Diseases in 2007, its relatively low-cost healthcare system, its efficient mass testing and contact tracing strategies and its science-based decisions are contributory to its success in handling the pandemic. Meanwhile, the Philippines failure to enact its Pandemic and All-Hazards Preparedness Act in 2013, its costly and dominantly private healthcare system, its heavy focus on strict, long lockdowns and its militarist methods to control the spread of the pandemic were found to be insufficient.Research limitations/implicationsDetailed study on the delivery of healthcare services in marginal areas, healthcare spending for COVID-19 positive individuals and information dissemination strategies about the pandemic were not explored.Practical implicationsHealth institutions can redesign their governance mechanisms by ensuring a cost-effective healthcare system and maximizing resource utilization to ensure efficient management of future pandemics. Moreover, national governments should not compromise their country's healthcare system over the economy during a pandemic.Originality/valueThis paper analyzed the countries' history of healthcare governance and its influence in handling COVID-19 compared to previous studies which only focused on the countries' strategies during the pandemic.

Comparative Analysis of Emergency Provisions During A Pandemic

The novel Corona virus is a pandemic that has affected every human being on this planet, either directlyby the virus itself, or by the social and economic consequences of the same. Needless to say, this pandemichas also had an effect on the administrations of most, if not all, the nations. This research paper seeks todraw a comparative analysis between the powers of the Executive in India and the United States of Americaduring this pandemic. As we know, India follows a Parliamentary form of governance where the PrimeMinister is the Head of the Government and a system of collective leadership is followed, whereas the USAfollows a Presidential form of governance where the President is the Head of the State and the principle ofindividual leadership is followed. A comparative analysis of the two States’ powers of the Executive willenable an enhanced comprehension by highlighting important details about pandemic related legislationslike the Pandemic and All-Hazards Preparedness Act, 2006 (USA) and the Epidemic Act of India, 1897; andhelp making abstract ideas more concrete. In this research paper, using the doctrinal method of research, wewill analyse the background of the pandemic via medical papers and WHO mandates, and further delve intothe executive powers of both, India and the USA during a pandemic by analysing constitutional provisionslike that of the 10th Amendment of the Constitution of the USA and the Emergency Provisions under Articles352 to 360 of the Indian Constitution and different legislations. In conclusion, we shall see that in India,including pandemics as a valid ground to give power to the President to impose a nationwide lockdown,under the National Emergency clause in Article 352 of the Indian Constitution, shall prove to be beneficial.

Amend Pandemic Preparedness Legislation to Prioritize Diagnostic Test Development and Deployment

As the world becomes increasingly globalized, the propensity of pandemics, such as COVID-19, increases. The United States Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 (PAHPAI) details the federal response to a health crisis including pandemics. The PAHPAI has hindered the nation’s response to COVID-19 due to its lack of emphasis on diagnostic testing (Burr 2019). Rapid testing is critical to slowing the spread of this disease. Ample testing will identify infected populations and will allow communities to take necessary precautions such as staying home and avoiding contact with others. Widespread shelter in place would not be necessary to control the spread of the virus, therefore reducing the economic impact of the pandemic. We propose Congress amends the PAHPAI to institute an improved testing response for future pandemics.

Best practices for after-action review: turning lessons observed into lessons learned for preparedness policy.

All-hazards preparedness and response planning requires ongoing individual, organisational and multi-jurisdictional learning. Disaster after-action reviews are an established emergency management practice to acquire knowledge through a process of analysing what happened and why, to improve the emergency response before the next crisis. After-action reviews help individuals and organisations learn, and are an essential step in the preparedness cycle. Human and animal health authorities have begun to employ after-action reviews for disaster preparedness and response among public health and Veterinary Services. The World Organisation for Animal Health (OIE) encourages Members to establish after-action reviews and share best practice. The adoption of afteraction review is an essential step for all provincial, national and multinational emergency management authorities to mitigate the impact of disasters on human and animal health. Emerging and re-emerging infectious diseases with pandemic potential pose unique preparedness challenges, requiring high-level policy attention to close long-standing gaps. A review of after-action reports from the 2001 anthrax bioterror attacks and of naturally occurring infectious disease crises, from the 2003 outbreak of severe acute respiratory syndrome (SARS) to the 2014 Ebola epidemic, reveal a similar pattern of repeated weakness and failures. These phenomena are described as 'lessons observed but not lessons learned'. Most infectious disease outbreaks with pandemic potential are zoonotic and require a One Health approach to prevent, prepare for and respond to global health security crises. After-action reviews in a One Health security context are essential to improve the pandemic preparedness of public health and Veterinary Services. After-action reviews can also provide the evidence-based 'feedback loop' needed to galvanise public policy and political will to translate lessons observed into sustained and applied lessons learned.

Environmental Health Workforce - Essential for Interdisciplinary Solutions to the COVID-19 Pandemic.

Interdisciplinary public health solutions are vital for an effective coronavirus disease 2019 (COVID-19) response and recovery. However, there is often a lack of awareness and understanding of the environmental health workforce connections and capabilities. In the United States, this is a foundational function of health departments and is the second largest public health workforce. The primary role is to protect the public from exposures to environmental hazards, disasters, and disease outbreaks. More specifically, this includes addressing risks relating to sanitation, drinking water, food safety, vector control, and mass gatherings. This profession is also recognized in the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019. Despite this, the profession is often not considered an essential service. Rapid integration into COVID-19 activities can easily occur as most are government employees and experienced working in complex and stressful situations. This role, for example, could include working with leaders, businesses, workplaces, and churches to safely reopen, and inspections to inform, educate, and empower employers, employees, and the public on safe actions. There is now the legislative support, evidence and a window of opportunity to truly enable interdisciplinary public health solutions by mobilizing the environmental health workforce to support COVID-19 response, recovery, and resilience activities.

Healthcare Challenges in the Era of Cybersecurity.

As a result of the extensive integration of technology into the healthcare system, cybersecurity incidents have become an increasing challenge for the healthcare industry. Recent examples include WannaCry, a nontargeted ransomware attack on more than 150 countries worldwide that temporarily crippled parts of the National Health Service in the United Kingdom, and the 2016 ransomware attack on Los Angeles's Hollywood Presbyterian Medical Center. The attacks cost millions of dollars in lost revenue and fines, as well as significant reputational damage. Efforts are needed to devise tools that allow experts to more accurately quantify the actual impact of such events on both individual patients and healthcare systems as a whole. While the United States has robust disaster preparedness and response systems integrated throughout the healthcare and government sectors, the rapidly evolving cybersecurity threat against healthcare entities is outpacing existing countermeasures and challenges in the "all-hazards" disaster preparedness paradigm. Further epidemiologic research of clinical cybersecurity attacks and their effects on patient care and clinical outcomes is necessary to prevent and mitigate future attacks.

Public health preparedness and response competency model methodology.

The Pandemic and All-Hazards Preparedness Act calls for establishing a competency-based training program to train public health practitioners. To inform such training, the Centers for Disease Control and Prevention and the Association of Schools of Public Health managed groups of experts to produce a competency model which could function as a national standard of behaviorally based, observable skills for the public health workforce to prevent, protect against, respond to, and recover from all hazards. A systematic review of existing competency models generated a competency model of proposed domains and competencies. National stakeholders were engaged to obtain consensus through a three-stage Delphi-like process. The Delphi-like process achieved 84 percent, 82 percent, and 79 percent response rates in its three stages. Three hundred sixty six unique individuals responded to the three-round process, with 45 percent (n = 166) responding to all three rounds. The resulting competency model features 18 competencies within four core learning domains targeted at midlevel public health workers. Practitioners and academics have adopted the Public Health Preparedness and Response Core Competency Model, some of whom have formed workgroups to develop curricula based on the model. Efforts will be needed to develop evaluation materials for training and education programs to refine the model as well as for future training and education initiatives.

Preparation and response to a targeted automobile ramming mass casualty (TARMAC) attack: An analysis of the 2017 Charlottesville, Virginia TARMAC attack.

Targeted automobile ramming mass casualty (TARMAC) attacks have recently become a common modality for those wishing to inflict mass harm. Intentional vehicular ramming is a unique wounding mechanism and deserves special consideration. An emergency response case analysis of the 2017 TARMAC attack in Charlottesville was conducted to review preparedness and identify shortcomings at the University of Virginia Health System University Hospital. Intentional mass blunt trauma is unique to TARMAC events, and current all-hazards approach preparedness may not suffice. TARMAC attacks warrant further attention by disaster medicine specialists; with adequate data, researchers may identify injury patterns and "lessons learned" that may improve mitigation strategies, provider preparation, and overall emergency care.

The Role of the Nurse Disaster Preparedness Coordinator at a Large Suburban Teaching Hospital

Introduction:Mass casualty incidents, whether man-made or natural, are occurring with increasing frequency and severity. Hospitals and health systems across the United States are striving to be more rigorously prepared more such incidents. Following a mass shooting in 2012 and significant growth and expansion of our hospital and health system in the following years, a need was identified for more staff to support preparedness efforts.Aim:To discuss the roles and responsibilities of Nurse Disaster Preparedness Coordinator (NDPC), a dedicated position in the Emergency Department (ED).Methods:The role of Nurse Disaster Preparedness Coordinator was implemented in 2016, is a part-time position in the Emergency Department and reports to the ED Manager while working closely with the ED Director of Emergency Preparedness and the hospital Emergency Manager. The role addresses all areas of the emergency management continuum, from planning and mitigation to response and recovery.Results:The NDPC’s responsibilities fall into the categories of all-hazards preparedness, chemical, biological, radioactive, nuclear and explosive (CBRNE) response, and general nursing practice. All-hazards preparedness includes ED staff training, policy and procedure development, and liaising with hospital emergency manager to coordinate hospital-wide efforts. CBRNE response includes the training and maintenance of a patient decontamination team, a high-risk infectious disease team, and their equipment. General nursing practice addresses research, nursing indicators as they apply to disasters, promoting evidence-based practice, and community outreach.Discussion:A dedicated Nurse Disaster Preparedness Coordinator has allowed transition from intermittent larger exercises to a regular and frequent exercise schedule and better application of full-scale exercises. Overall, the creation of the role has strengthened hospital readiness for mass casualty incidents while alleviating the vast scope of emergency management responsibilities for a large suburban hospital.

Exploring the Ethical Dimensions of All-Hazards Public Health Emergency Preparedness in Canada

Introduction:With increasing disaster risks from extreme weather, climate change, and emerging infectious diseases, the public health system plays a crucial role in community health protection. The disproportionate impacts of disaster risks demonstrate the need to consider ethics and values in public health emergency preparedness (PHEP) activities. Established PHEP frameworks from many countries do not integrate ethics into operational approaches.Aim:To explore the ethical dimensions of all-hazards public health emergency preparedness in Canada.Methods:A qualitative study design was employed to explore key questions relating to PHEP. Six focus groups, using the Structured Interview Matrix (SIM) format, were held across Canada with 130 experts from local, provincial, or federal levels, with an emphasis on local/regional public health. An inductive approach to content analysis was used to develop emergent themes, and iteratively examined based on the literature. This paper presents analyses examining the dimensions of ethics and values that emerged from the focus group discussions.Results:Thematic analysis resulted in the identification of four themes. The themes highlight the importance of proactive consideration of values in PHEP planning: challenges in balancing competing priorities, the need for transparency around decision-making, and consideration for how emergencies impact both individuals and communities.Discussion:Lack of consideration for the ethical dimensions of PHEP in operational frameworks can have important implications for communities. If decisions are made ad-hoc during an evolving emergency situation, the ethical implications may increase the risk for some populations, and lead to compromised trust in the PHEP system. The key findings from this study may be useful in influencing PHEP practice and policy to incorporate fairness and values at the core of PHEP to ensure readiness for emergencies with community health impacts.

CRITICAL EVENT PREPAREDNESS AND RESPONSE: KEYNOTE ADDRESS TO THE 2006 SLOAN RESEARCH WORKSHOP BY JON LINKS

At the intersection of online education and preparedness, Johns Hopkins University’s (JHU) Center for Public Health Preparedness provides all-hazards preparedness and response training for public health and public safety professionals. This report comes from Jonathan Links’ keynote address to the Sloan Summer Research Workshop in Baltimore, Maryland in August 2006.

Securitisation across borders: the case of ‘health security’ cooperation in the European Union

Global health governance has increasingly become articulated and acted upon in ways that emphasise ‘health security’. This article applies a collective securitisation approach to understand how a particular governance regime has evolved at the European level, one concerned with large-scale ‘threats’ to public health and societies at large. The analysis shows that alongside elite-level securitisation moves, transnational professional networks and bureaucratic actors have also taken part both as securitising agents and audience, with outcomes reflected not only in policy change but also new EU-specific surveillance technologies, institutional structures, and information-sharing platforms. While these developments are partially interlinked with global trends, we show that the EU has gradually institutionalised its own approach to health security. This new status quo is enshrined in a legal framework and set of practices with an all-hazards approach targeting preparedness, early detection and containment of ‘serious cross-border threats to health’ of any origin – beyond infectious disease.

The role of unarmed security in active killer defence

Active shooter-type attacks are low-probability/ high-consequence incidents that must be a part of every organisation’s all-hazards emergency preparedness programme. All too often, law enforcement is viewed as the only viable response, and while law enforcement’s role is imperative, on-site security can do a great deal to prevent and mitigate this ever-growing threat. This paper argues that security officers should be trained and empowered with tools to help them identify Pre-Attack INdicators (PAINs) and those elements of first timer’s syndrome that are exhibited prior to an attack. An understanding of PAINs combined with courteous, proactive and engaging interactions, will improve overall security value and provide early recognition and faster response in the unlikely event of an active-shooter type attack. Current active shooter response best practices embrace the runhide- fight survival options. The run and hide options are lower risk, and typically far more effective. Early recognition, and a thorough understanding of their environment, empowers security officers to provide clear and immediate run or hide instructions to others before the emergency occurs.

Fourteenth Annual Warren K. Sinclair Keynote Address: Aren't We Ready Yet? Closing the Planning, Response, and Recovery Gaps for Radiological Terrorism.

Following the tragic events of 11 September 2001, the nation has made significant strides in preparing for disasters and emergencies of all types. Federal funding to state, local, territorial, and tribal public health and healthcare systems has required an all-hazards preparedness approach with special focus on those incidents that rise to the top of a jurisdiction's Threat and Hazard Identification and Risk Assessment. While disaster planners in many areas of the country have recognized the potential for nuclear accidents and radiological terrorism, these presumably rare events fall further down on their list to plan for when funding and human resources are limited.

After-action review of the 2009-10 H1N1 Influenza Outbreak Response: Ohio's Public Health System's performance.

In early 2009, H1N1 influenza was identified within the human population. Centers for Disease Control and Prevention (CDC) officials responded with focused assessment, policy development, and assurances. The response was mobilized through efforts including procurement of adequate vaccine supply, local area span of control, materials acquisition, and facilities and resource identification. Qualitative evaluation of the assurance functions specific to the system's ability to assure safe and healthy conditions are reported. The methodology mirrors the Homeland Security Exercise and Evaluation Program used to assess system capability. Findings demonstrate the effectiveness of community responsive disease prevention efforts in partnership with the public health systems mission to unify traditional public sector systems, for-profit systems, and local area systems was accomplished. As a result of this response pharmaceutical industries, healthcare providers, healthcare agencies, police/safety, colleges, and health and human service agencies were united. Findings demonstrate the effectiveness of community response strategies utilizing feedback from system stakeholders. After-action review processes are critical in all-hazards preparedness. This analysis of local health district response to the H1N1 influenza outbreak informs future public health service delivery. Results provide a synthesis of local health department's emergency response strategies, challenges encountered, and future-focused emergency response strategy implementation. A synthesis is provided as to policy and practice developments which have emerged over the past seven years with regard to lessons learned from the 2009-10 H1N1 influenza outbreak and response.