Emergency Operations Center Research Articles

Identification of Anthrax as the Cause of a Cluster of Unexplained Deaths, Uganda, 2023: The Role of Metagenomic Next-Generation Sequencing and Postmortem Specimens.

Between April and November 2023, 27 unexplained human deaths that presented with swelling of the arms, skin sores with black centers, difficulty in breathing, obstructed swallowing, headaches, and other body aches were reported in Kyotera District, Uganda by the Public Health Emergency Operations Center. Subsequently, the death of cattle on farms and the consumption of carcass meat by some residents were also reported. Field response teams collected clinical/epidemiological data and autopsy samples to determine the cause of deaths. Metagenomic next-generation sequencing (mNGS) and target enrichment sequencing conducted on postmortem samples confirmed Bacillus anthracis, the etiological agent of anthrax disease, as the cause of the deaths. Applying mNGS to autopsy specimens is useful as a retrospective tool for identifying high-consequence pathogens during suspected outbreaks of unknown etiology.

Barriers and Solutions in Integrating Technology in Disaster Management: Insights from Saudi Arabia's Emergency Operations Center

Background: Integrating technology into disaster response, particularly in health crisis management, enhances communication, resource management, and patient care. However, critical barriers such as system interoperability, network reliability, and insufficient specialized training hinder its effective adoption. Aim and Objective: This study explores the challenges faced by emergency operations center (EOC) leaders in Saudi Arabia in adopting technology for disaster medicine and identifies practical solutions to improve disaster preparedness and response. Methods: A structured survey was administered to 110 EOC leaders, achieving a response rate of 78.2%. The survey incorporated validated tools to assess technology usage, training adequacy, and implementation challenges. Quantitative data were analyzed using descriptive statistics, while qualitative responses were explored through thematic analysis. Results: Among the 86 respondents, 91.9% reported using telemedicine and digital tools in disaster scenarios. However, 58% found training inadequate, 44% cited staff resistance to new technologies, and 42% highlighted connectivity issues as a significant challenge. Data security concerns were noted by 11%, particularly among older respondents. Correlation analysis revealed that leaders with greater experience perceived technology as more impactful, especially for communication and patient care. Thematic analysis also highlighted the importance of involving staff in decision-making to reduce resistance. Conclusion: Addressing training gaps, building resilient communication networks, and fostering adaptability among staff are critical to advancing technology integration in disaster response. These findings provide actionable insights for Saudi EOCs and offer a roadmap for enhancing global disaster medicine frameworks.

Analysis of Brazilian Emergency Operations Centers in disasters response management

Analysis of Brazilian Emergency Operations Centers in disasters response management

Strengthening Disaster Risk Communication: Insights from Emergency Operation Centers in Saudi Arabia

Effective risk communication is essential for coordinated disaster response, particularly among Emergency Operation Center (EOC) leaders managing crises. This study assesses the perceptions of EOC leaders in Saudi Arabia regarding key risk communication challenges, focusing on clarity, transparency, and consistency. Using a purposive sample of 95 EOC leaders, the study employed a structured survey to gather data on various aspects of disaster communication. Results indicated high ratings for the clarity and accessibility of information, though transparency and consistency scored lower, revealing gaps in cross-agency communication. Notable correlations between trust, reliability, and transparency suggest that strengthening one element may reinforce others, promoting cohesive disaster response. Qualitative responses highlighted the need for standardized protocols, real-time updates, and culturally adaptive messaging suited to the regional context. The findings emphasize practical steps, including centralized communication channels, designated spokespersons, and training programs tailored to EOC leaders’ unique needs. These measures, emphasizing clarity, consistency, and trust, can improve inter-agency coordination and strengthen disaster resilience. This study contributes to the literature on disaster management by providing insights into the Saudi Arabian context, with implications for policy and practice in risk communication.

Public Health Emergency Management (PHEM) for the COVID-19 Pandemic: Lesson learned from Public Health Region 10th Ubon Ratchathani, Thailand

The COVID-19 pandemic affected the health of the Thai people. The PHEM was essential for the surveillance, prevention, and control of COVID-19. This study aimed to present the process of the PHEM for COVID-19 from February 29, 2021, to April 30, 2022, and the factors affecting the successful outcome. The study area covered three provinces. The Target group included 37 public health personnel. The data were collected through in-depth interviews and focus group interviews based on the non-structure interview guideline and were analyzed by content analysis. The components of COVID-19 prevention and control in the process of PHEM included (1) Emergency Operation Center (EOC) with the incidence command system (ICS) from the district to the provincial level to propose the provincial measure, (2) Provincial Communicable Disease Committee (PCDC) to manage the provincial measure, (3) the measure for surveillance, prevention, control, and treatment of COVID-19, and (4) outcomes and best practices for surveillance and control of COVID-19. The success factors of 4S and EC included Space to prepare the quarantine (HQ, LQ), Cohort Ward (CW), field hospitals, community isolation, and home isolation to face the patient and risky group, Staff from various organizations, and groups including the community leader and Health Volunteer (HV), Stuff to manage and share the medical and non-medical equipment, System of Covid-19 response including EOC, ICS, Joint Investigation Team (JIT) and Communicable Disease Control Unit (CDCU) for monitoring the real-time of surveillance and control of COVID-19 output, Environment to conduct management in hospital and the community with Infections Control (IC), and Culture in term of social capital on “the relationship of Isan people” to provide the good care and support for the patients. The structure of PHEM, Isan’s culture, and good preparation were the significant factors in the three provinces.

IT-based health event surveillance in mass gathering - Kumbh Mela 2021, Haridwar, Uttarakhand

The Kumbh Mela is a large religious mass gathering event organised in India. During April 01 to April 30, 2021, Kumbh Mela was organized in Haridwar, Uttarakhand, India in the amid of COVID-19 pandemic. To detect and respond to unusual health events, a special surveillance model was established during Kumbh Mela-2021, Haridwar. The Kumbh module of Integrated Health Information Platform (IHIP) is utilized for real time data capturing. An Emergency Operations Centre (EOC) established to monitor COVID-19 and other disease situations through IHIP. Capacity building of Rapid Response Teams (RRT) was conducted. The special surveillance monitored 24 diseases/ syndromes. Kumbh mela area was divided into 4 zones with total 75 health facilities. A total of 31021 cases were reported on IHIP, including 86% communicable diseases (CDs), 8% non-communicable diseases (NCDs) and 6% unusual syndrome. Among total CDs, 27% acute febrile illness (AFI), 25.3% acute respiratory illness (ARI), 19% water borne diseases (WBDs), 15% COVID-19 and 14% others encountered. Out of total NCDs, 67% trauma, 25% dog bite, 8% others. A total of 36 early warning signals generated and responded, of which 22% WBDs, 22% ARI, 17% COVID-19, 14% AFI, 11% unusual syndrome and 14% others. The special disease surveillance helped monitoring health event alerts and health condition alerts. EOC monitored early warning signals and facilitated early detection and quick response to public health threats. Acute febrile illnesses emerged as a leading cause of morbidity. Future Mass Gathering events like Kumbh Mela should include disease surveillance as part of planning and augment capacity to diagnose and management of acute febrile illness.

Evaluation of response to a cholera outbreak in January 2024 using the 7–1–7 timeliness metrics: a case study of Elegu Point of Entry, Uganda

BackgroundCholera is a major public health threat in Uganda, especially in border districts prone to outbreaks from cross-border movement. We investigated and evaluated the initial response to a January 2024 cholera outbreak in Elegu Town, on the Uganda-South Sudan border, using the 7–1–7 timeliness metrics to assess detection, notification, and response capacities, highlighting Uganda's preparedness and challenges in managing cross-border outbreaks.MethodsWe defined a suspected case as the onset of acute watery diarrhea in an asylum seeker at the Elegu border point from January to February 2024. A confirmed case was a suspected case in which Vibrio cholerae was isolated in the stool by culture or PCR. We actively searched for cases and collected data on person characteristics, symptoms, and outbreak timeliness. We used semi-structured interviews to elicit insights from district health officials on the enabling factors and bottlenecks during the response. We used the 7–1–7 metric to assess detection, notification, and response capacities of the point of entry.ResultsThirteen members of a refugee family from South Sudan were diagnosed with cholera within 6 h of arrival at the Elegu border, with 4 (31%) confirmed cases. No death occurred. The authorities detected, notified, and responded to the outbreak within the 7–1–7 timelines, with no major bottlenecks identified. The outbreak was detected and notified within one day and by the fifth day, a full response was mounted. The prompt response was attributed to the availability of a functional emergency operations center and the presence of trained surveillance frontline health workers.ConclusionResponse to an imported cholera outbreak at Elegu border point demonstrated Uganda's preparedness in managing cross-border disease outbreaks. Achieving the 7–1–7 targets highlighted the country’s-built capacity to detect, notify, and respond to such events. Continued investment in local-level disease detection, communication, and national-level resource mobilization will be crucial to sustaining future effective cross-border outbreak prevention and control strategies.

Integration and use of climate data by the national health system in Mozambique

IntroductionMozambique is increasingly affected by extreme weather events and associated infectious disease outbreaks, highlighting a significant gap in knowledge on use of data to better inform health system preparedness and response. MethodsIn this qualitative study, we collected data from 29 key informants using customized semi-structured questionnaires. Data were then triangulated and analyzed using content and thematic methods. ResultsThe National Institute of Meteorology is primarily responsible for producing and supplying weather data to the national health system (NHS). NHS has access only to weather data, and there is no specific platform or system for integrating weather or climate data and health data. Other notable barriers to sharing and using climate data include poor geographical coverage of the meteorological network and lack of systematic records on the impact of extreme events. Facilitating factors include multiple policies that mention the link between climate change and health, and the existence of health data management platforms and an early warning system piloted by the National Institute of Health. ConclusionOngoing work to develop a health sector climate change adaptation plan and revitalize the Public Health Emergency Operations Center could be key to accelerating efforts to improve climate data use to inform infectious disease outbreak preparedness and response. Results from piloting of the early warning system could be used to advocate for climate data integration into the NHS to help in identifying the impact of climate change on health and designing effective plans to address climate-related infectious disease outbreaks.

Key stakeholders’ perspectives of public health emergency preparedness in Palestine: A qualitative exploratory study

ObjectivesPalestine continues to face emergencies and a series of humanitarian crises. This study aims to comprehend emergency planning and response including the recent COVID-19 pandemic. Comprehending and recording these experiences will facilitate on-going improvement of Palestine's Public Health Emergency Preparedness (PHEP). Study designA qualitative exploratory study. MethodsFifteen semi-structured interviews were conducted with key informant decision-makers representing various sectors of the Palestinian health system. The data collection period took place from April 2022–December 2022. A convenient purposive sample was chosen based on identifying important stakeholders in the West Bank's health sector. Every interview was transcribed. Major themes and subthemes were identified using content thematic analysis. ResultsThe study demonstrates Palestine's inadequate preparation for emergencies, instead there is a focus on response once a crisis has occurred. No national entity or mechanism is leading the collective preparedness efforts, which might ultimately result in a stronger emergency response. Instead, the efforts are dispersed across several entities, and decisions are not made cooperatively. As for resources, the study indicates that an emergency budget has not been allocated. The study showed a good degree of multi-sectoral collaboration with some reservations regarding the creation of various committees and their efficacy in handling crises. ConclusionThe findings made it abundantly evident that significant efforts are needed to improve Palestine's level of preparedness and planning. One of the study's primary conclusions is that the health sector must shift from a reactionary to a preparedness-oriented mindset. Additionally, it is necessary to keep an eye on any changes in the nation's health and analysis must take place to strengthen the health system's response plans. Moreover, the activation of the emergency operation center in Palestine is one of the key advancements of the preparedness system.

Emergency Operations Center structures in public offices of emergency management.

Emergency Operations Centers (EOCs) are locations from where activities are conducted in support of emergency incident response, including management of information flows/communications and coordination of strategic decision-making and activities across diverse communities and organizations. To date, knowledge is limited about practices involved in structuring and operating EOCs at public offices of emergency management (OEMs) and influencing factors. Through surveys and analysis of organizational documents, this study examines the models used by OEMs and the factors that influence the choice of models and organizational perception of the effectiveness of the employed models. Our results indicate that the emergency support function (ESF) model is the most commonly used, followed by a hybrid model, the incident command system model, and finally, the departmental structure and incident support model. We found no single model to be decisively superior; rather, different models are appropriate depending on personnel, resource availability, and the context of the jurisdiction. The ESF model, which is the most commonly utilized, appears to be difficult to employ effectively when organizations have limited access to trained personnel necessary for carrying out the range of functions specified in the model. In comparison, other models appear better suited to handle personnel constraints.

Functional Simulation Exercise on Functionality of National Public Health Emergency Operations Centers in the African Region: Review of Strengths and Gaps.

National public health emergency operations centers (PHEOCs) serve as hubs for coordinating information and resources for effective emergency management. In the International Health Regulations (IHR 2005) Monitoring and Evaluation Framework, a simulation exercise is 1 of 4 components that can be used to test the functionality of a country's emergency response capabilities in a simulated situation. To test the functionality of PHEOCs in World Health Organization African Region member states, a regional functional exercise simulating an Ebola virus disease outbreak was conducted. The public health actions taken in response to the simulated outbreak were evaluated against the exercise objectives. Thematic analysis was conducted to summarize key strengths and areas for improvement. From December 6 to 7, 2022, more than 1,000 representatives from 36 of the 47 African Region member states participated in the exercise from their respective PHEOCs. Approximately 95% of the 461 participants polled agreed with the positive responses to the postexercise survey. More than half of the PHEOC participants were able to test their existing emergency preparedness and response plans and became familiar with the expected roles to be fulfilled during an event. Of the participants who responded to the survey, over 90% reported that the exercise helped them understand their roles during emergency management. The exercise met its objectives and provided an opportunity to test the functionality of PHEOCs using realistic scenarios, and it helped participants understand existing response systems and procedures. However, the exercise also revealed areas for improvement in terms of the timing and preparation of participants. We recommend conducting functional exercises at the regional and national levels at least once a year, early or midyear, to allow many stakeholders to take part in the exercise. Moreover, there is a need to train country-level evaluators and controllers in designing and conducting functional exercises.

Psychological preparedness in disaster management: A survey of leaders in Saudi Arabia's emergency operation centers

This study assesses perceptions of psychological preparedness among leaders in Emergency Operation Centers (EOCs) across Saudi Arabia. Effective disaster management requires managing stress, maintaining emotional stability, and adapting to rapid changes. A descriptive survey was conducted in 2024 with 110 leaders from various Health regions and the National Health EOC, achieving an 86.4 % response rate. Participants completed a structured questionnaire assessing their confidence in managing stress, the effectiveness of stress-relief techniques, and emotional stability. Results indicated high confidence in stress management (mean score 4.19, SD = 0.88) and emotional stability (mean score 4.27, SD = 0.80), along with moderately high ratings for the effectiveness of stress-relief techniques (mean score 3.64, SD = 0.99). Only 30.53 % had received formal training on psychological preparedness, while 96.84 % expressed a need for additional training. The study found significant correlations between confidence, emotional stability, and the regular review of coping strategies. These results highlight the critical need for comprehensive training programs to improve the psychological preparedness of disaster management personnel.

Evaluation of the incident management system of a bigger city during the winter flood 2023/24 in northern Germany: Organized (ir)responsibility in the pre-disaster phase

Incident management systems operate within complex and uncertain conditions during disasters. Therefore, researching their activities is challenging as there is no clear right or wrong. The winter 2023/2024 flood event in the city of Oldenburg, Germany, provided an opportunity to evaluate crisis management under high uncertainty, although no disaster has eventually occurred. Three stakeholder groups of the Incident Management System were examined through After-Action Reviews: The Emergency Operation Center (EOC), specialist advisors, and the Area Command (AC). Data on performance shaping factors (descriptions and judgements) were collected and analyzed using the Countenance Evaluation Model as a general framework in combination with a Systems-Thinking approach. The study aimed to identify variables within and between groups as well as factors in the environment that either hindered or facilitated work transactions. It emerged that the work organization in bodies of public administration is at odds with the uncertain, fast-paced, and problem-oriented structure of Incident Management System operations, causing stress and adding workload to employees. Additionally, the separation of strategic and tactical decision making led to coordination issues due to divergent time structures and task logics of EOC and AC. Furthermore, although specialist advisors played a crucial role in risk assessments and setting the direction of risk mitigation activities, it became clear that this person related resource is scarce and difficult to embed into the Incident Command System. A final finding is the importance of the larger Emergency Operation Center working environment. The spatial constraints and noise levels caused stress.

Preparation to provide healthcare in disasters in public hospitals in the district of Lima, Peru.

To assess the safety and degree of preparation of public hospitals in the district of Lima to provide healthcare in the event of disaster by studying their structural and nonstructural safety and their compliance with the established standards for the organization of the hospital's Emergency Operations Centers (EOCs). A cross-sectional observational study of 20 out of the 38 public hospitals in the district of Lima was conducted. The hospitals were selected based on the criteria of being state-run, having complete information on open access safety indicators, and belonging to Categories II and III according to the Peruvian Ministry of Health classification, equivalent to the usual secondary and tertiary levels of specialization hospitals. A multivariate regression analysis was performed to study the determining elements of vulnerability. Only with the existence of a formally established EOC emergency committee and up-to-date and available telephone directory does the average compliance reach 65 percent among all government hospitals. Only in four of the criteria did the hospitals achieve 50 percent good compliance, indicating that they have a plan, have trained the responsible personnel, and have the necessary resources to implement them. Fifty percent of hospitals in the district of Lima do not have a plan for psychosocial care for patients, family members, and health personnel in the event of a disaster; and that only 55 percent have a plan, trained personnel, and resources available for attention in the case of a disaster. In the multivariant analysis of the vulnerability determinants, the statistically significant (p < 0.05) elements were the year in which the emergency plan was drawn up and the year in which the hospital was built.

Water, water, everywhere and not a drop to drink: Responding to water disruptions in two coastal healthcare facilities

Having a consistent and readily available clean water supply is essential, not only for convenience but also to safeguard public health. While disruptions to the supply of clean water can impact communities of all kinds, some infrastructures and healthcare facilities are more vulnerable than others, such as those located in remote areas or within First Nations communities. This paper presents a case study of water disruption events within Sechelt and the First Nations community of Bella Bella, describing also the associated response efforts and lessons learned. Both events shared similar response activities, requiring the curtailing of normal water usage, the establishment of emergency operations centres, the sourcing of resources via supply chain or transportation partners, implementation of infection prevention and public health considerations, and collaboration with internal and external agencies. The learnings highlight a need for greater focus on building resiliency within healthcare facilities, especially those that serve remote or First Nations communities. The study also presents recommendations for water disruption response planning at the site and community level, and the establishment of non-centralised backup water systems.

Using system dynamics to support a functional exercise for pandemic preparedness and response

AbstractIn pandemic preparedness and response, a Functional Exercise (FX) is used to simulate a situation as close to a real‐life event as possible without the deployment of resources. Participants are drawn from public health emergency operations centres, and work through a scenario script to test possible responses to a novel pathogen outbreak. This paper summarises the role of system dynamics modelling in the design and implementation of a functional exercise, which involved the Dutch and German national public health institutes in March 2023. The findings confirm the value of the system dynamics method in integrating disease and hospital models, and also highlights how well the method aligns with modern software development processes. The paper concludes with a discussion of what worked well, and presents areas for future enhancements of management flight simulators to support functional exercises. © 2024 The Author(s). System Dynamics Review published by John Wiley &amp; Sons Ltd on behalf of System Dynamics Society.

The Lagos State COVID-19 Think-tank, a Potential Framework for Decision-making in a Pandemic Era.

Lagos state remains the epicenter of COVID-19 infection in Nigeria. To facilitate the emergency preparedness and response to COVID-19, the State Governor and Incident Commander constituted a Think Tank comprising 13 experts from various disciplines committed to the health of the public. The Think Tank assisted the government with decision-making strategies and supported the emergency operation centre (EOC) for the COVID-19 response. Their main achievements were developing frameworks for decision-making and strategies for phased easing of the State-wide lockdown. The challenges encountered were that it was often viewed as a parallel structure to the EOC and separated from the traditional civil service structure; causing some reluctance to implement ideas generated by the Think Tank. Nevertheless, the Think Tank played an important role during the COVID-19 pandemic; the lessons learned might help other states and resource-limited countries wishing to adopt this approach to emergency response.

Assessment of dispatch-assisted cardiopulmonary resuscitation performance during out-of- hospital cardiac arrest in a Tuscan emergency operation center: a retrospective study

Background: Time is the most crucial prognostic factor in out-of-hospital cardiac arrest (OHCA) owing to its clinical features. Dispatcher-assisted CPR (DA-CPR) by dispatch centers to a bystander calling for an ambulance, enabling even an inexperienced bystander to start CPR in 50% of cases and reducing the free therapy interval from chest compression to less than three minutes. Objectives: to assess the dispatch-assisted cardiopulmonary resuscitation performance during out-of-hospital cardiac arrest. Methods: a retrospective study was conducted at the Firenze-Prato Emergency Operation Centre to analyse data collected from all dispatch audio recordings of OHCA events that occurred between 1 January 2019 and 31 December 2020. Emergency calls lasting less than 60 s were excluded from the analysis, as this duration does not provide dispatchers with adequate time to accurately identify OHCA and provide pre-arrival instructions to the bystander.Results: A total of 1,267 OHCAs cases were included in this study, with 832 (65.7%) occurring in 2019 and 435 (34.3%) in 2020. Emergency nurses offered pre-arrival instructions in 272 cases (21.5%), with 160 cases in 2019 (19.2%) and 112 cases (25.7%) in 2020 (c2=7.19, p=0.007). These instructions were accepted by the caller in 9% (n=75) and 14% (n=61) of the cases, respectively (c2=7.48, p=0.006). OHCA events that could not be identified by telephone (therefore, DA-CPR was not possible) were 365 cases (43.9%) in 2019 and 175 cases (40.2%) in 2020 (c2=1.55, p=0.213). Conclusions: The adoption of a standardised protocol for delivering pre-arrival instructions, along with training programs focusing on OHCA and interview techniques, is strongly recommended based on the findings of our study. This was reinforced by the analysis of nighttime calls during which DA-CPR was not provided, including cases without clear justification.

Structural and Functional Requirements of Emergency Operations Centers: A Comparative Study

Structural and Functional Requirements of Emergency Operations Centers: A Comparative Study

Tanzania's first Marburg Viral Disease outbreak response: Describing the roles of FELTP graduates and residents.

Viral Haemorrhagic Fever Outbreak presents a significant public health threat, requiring a timely, robust, and well-coordinated response. This paper aims to describe the roles of the Tanzania Field Epidemiology and Laboratory Training Program (TFELTP) graduates and residents in responding to Tanzania's first Marburg Viral Disease (MVD) outbreak. We performed a secondary data analysis using a range of documents, such as rosters of deployed responders and the TFELTP graduate and resident database, to count and describe them. Additionally, we conducted an exploratory textual analysis of field deployment reports and outbreak situational reports to delineate the roles played by the residents and graduates within each response pillar. A total of 70 TFELTP graduates and residents from different regions were involved in supporting the response efforts. TFELTP graduates and residents actively participated in several interventions, including contact tracing and follow up, sensitising clinicians on surveillance tools such as standard case definitions, alert management, supporting the National and Kagera Regional Public Health Emergency Operations Centres, active case search, risk communication, and community engagement, coordination of logistics, passenger screening at points of entry, and conducting Infection Prevention and Control (IPC) assessments and orientations in 144 Health Facilities. The successes achieved and lessons learned from the MVD response lay a foundation for sustained investment in skilled workforce development. FELTP Training is a key strategy for enhancing global health security and strengthening outbreak response capabilities in Tanzania and beyond.