Emergency Management Research Articles

Navigating Diverse Agency Priorities in Emergency Management: A Framework for Hazard Mitigation

Navigating Diverse Agency Priorities in Emergency Management: A Framework for Hazard Mitigation

Policy Note: Special Taxes for Special Times? A Critical Analysis of Fiscal Crisis Responses with an Earmarking Feature in the Context of EU Law

Do special times require special taxes? The answer may not be the same from a legal, political, or economic perspective. One type of answer that legislators in Europe – both on the national and the supranational level – have given to the crises that make our times special are fiscal measures targeting extraordinary profits, revenues, or even assets while reserving the collected revenue for specific purposes. This article discusses the arguments for and against such earmarked crisis response measures in the context of their implications in the framework of EU law. It argues that specific earmarks may be attractive for reasons of political psychology such as health expenditure or inflation relief for households and firms. However, they may have unintended legal consequences by putting the respective measure into the scope of other legal regimes such as social security or banking regulation. The article contributes to the current debate about appropriate fiscal measures in times of crisis by pointing to examples of such direct and indirect interactions with primary or secondary EU law based on earmarking.

Short-term inbound passenger flow prediction at high-speed railway stations considering the departure passenger arrival pattern

Accurate prediction of short-term inbound passenger flow at high-speed railway stations is of great significance for the refined operation of stations, the formulation of emergency plans, and the provision of intelligent services. The arrival of passengers traveling on the same train at the same station shows a similar pattern, which is called the departure passenger arrival pattern (DPAP). The short-term inbound passenger flow at the station is composed of the short-term inbound passenger flow of all waiting trains within the same period. Inspired by this, this paper develops an ensemble prediction model based on the time series decomposition modeling strategy to introduce the DPAP to the short-term inbound passenger flow prediction at stations. Firstly, we propose a new framework for studying the DPAP to calculate the fitted station short-term inbound passenger flow, which is only affected by the DPAP. During this process, we find that 7minutes is the optimal time granularity. Secondly, based on the singular spectrum analysis, we prove that the DPAP is the determining factor affecting the station short-term inbound passenger flow. Finally, we propose an ensemble prediction model that considers the DPAP to achieve short-term inbound passenger flow prediction at stations. The model consists of two parts: the deterministic and stochastic components prediction, where the former is predicted by the fitted station short-term inbound passenger flow, and the latter is achieved by the combination of historical stochastic components and weather type with the help of the Seq2Seq model based on time attention mechanism. Using real inbound passenger flow data, we compare the proposed model with 13 benchmark models and the results show that under different training and prediction steps, our model achieves optimal prediction performance, whether in all-day period and the busiest period of the station. Through further ablation experiments, it has been proven that the introduction of the DPAP effectively improves the prediction accuracy. Our model can provide scientific support for the intelligent operation of stations and the refined management of passenger flow.

Protecting nutrition in a food crisis.

Food insecurity and malnutrition are rising worldwide due to disruptions in food systems related to interconnected health-, climate- and conflict-related crises. Although governments globally are committed to addressing nutritional challenges, policy responses have increasingly focused on food security and, particularly, on food affordability. However, these short-term measures often overlook the necessity of integrating nutritious foods into the food system to ensure improved long-term nutrition. By drawing on the United Nations Committee on World Food Security's Voluntary guidelines on food systems and nutrition, this article outlines opportunities for policy-makers to integrate nutrition into key elements of the crisis response. Key policy areas where nutrition could be further integrated include social protection, agricultural investment, trade policy and urban planning. Strengthening the focus of nutrition in these measures will be essential to establish long-term incentives that support food systems transformation for improved nutrition. Drawing on theories of the policy process, I propose that stronger governance and cross-sectoral dialogue will be critical to achieve sustained nutritional outcomes. Health policy-makers can play a leadership role in supporting cross-sectoral policy change by carefully framing the policy issues, advocating for institutional structures that promote collaboration across sectors to prioritize nutrition, and strengthening the management of conflicts of interest in food system policy-making.

Accident Prevention System for Cars, Buses, Trucks

Driver drowsiness is a significant factor in road accidents, contributing to a large number of crashes annually. To enhance road safety, the development of a Drivers Drowsiness Detection System is essential. This system builds to detect early signs of lazyness in drivers and provide timely alerts to prevent accidents. The proposed system uses to track key indicators of drowsiness, such as eye closure, head position, yawning, and blink rate. By utilizing a camera-based real-time monitoring system, it continuously analyzes the driver’s facial expressions. The system employs cadcade algorithms to distinguish a featurebased object detection algorithm to detect objects from images between alert and drowsy states based on collected data. When drowsiness is detected, the system triggers alerts like audio warnings, seat vibrations, or even vehicle slowing mechanisms, depending on the integration. This technology has the potential to significantly reduce the number of road accidents related to driver fatigue and could be applied in both personal vehicles and commercial fleets. The implementation of such systems represents a critical step toward improving road safety and decreasing driver-related incidents. Nowadays it is very challenging to stay active all the time due to busy schedules. Falling asleep while driving can lead to serious consequences, accidents, and even death. This situation is much more common and therefore it is very important to solve this problem. So, to solve this problem, we developed a sleep alarm system for drivers. This system alerts the user when he falls asleep at the wheel, thus the main concern is preventing accidents and saving lives. This system is useful for long- distance travelers and late-night drivers.

Prioritization of Evaluation Items for Industrial Accident Prevention Factors Using the Fuzzy TOPSIS Technique

With the rapid progress of industrialization, serious accidents have frequently occurred at industrial sites. Despite the existence of several laws and regulations for preventing industrial accidents, including the Occupational Safety and Health Act, social criticism has been raised regarding their inefficiency. To address this issue, the Serious Accident Punishment Act was implemented. The Ministry of Employment and Labor and the Korea Safety and Health Agency have prepared and implemented various industrial accident prevention measures and programs; however, the number of industrial accidents has not decreased. Therefore, new evaluation criteria must be introduced when establishing policies or systems to prevent industrial accidents. This study introduces evaluation items used in Europe and the United States as industrial accident prevention items for assessing industrial accident prevention projects and proposes a plan to select priorities for these items by applying the fuzzy TOPSIS technique. Prioritization was determined by calculating four evaluation criteria and ten industrial accident prevention items using a 7-point linguistic scale. Our results allow for the simultaneous consideration of several industrial accident prevention items. Thus, various aspects of industrial accident prevention activities can be comprehensively evaluated, enhancing the effectiveness and execution of safety and health management, thereby helping to reduce industrial accidents.

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.

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.