Emergency Preparedness Planning Research Articles

Differences in Cesarean Rates for Nulliparous, Term, Singleton, Vertex Births Among Racial and Ethnic Groups and States Before and After Stay-at-Home Orders During the COVID-19 Pandemic, United States, 2017-2021.

Evidence is limited on differences in cesarean rates for nulliparous, term, singleton, vertex (NTSV) births across racial and ethnic groups at the national and state level during the COVID-19 pandemic. We assessed changes in levels and trends of NTSV cesarean rates before and after stay-at-home orders (SAHOs) were implemented in the United States (1) overall, (2) by racial and ethnic groups, and (3) by 50 US states from January 2017 through December 2021. We used birth certificate data from 2017 through 2021, restricted to hospital births, to calculate monthly NTSV cesarean rates for the United States and for racial and ethnic groups and to calculate quarterly NTSV cesarean rates for the 50 states. We used interrupted time-series analysis to measure changes in NTSV cesarean rates before and after implementation of SAHOs (March 1 through May 31, 2020). Of 6 022 552 NTSV hospital births, 1 579 645 (26.2%) were cesarean births. Before implementation of SAHOs, NTSV cesarean rates were declining in the United States overall; were declining among births to non-Hispanic Asian, non-Hispanic Black, Hispanic, and non-Hispanic White women; and were declining in 6 states. During the first month of implementation of SAHOs in May 2020, monthly NTSV rates increased in the United States by 0.55%. Monthly NTSV rates increased by 1.20% among non-Hispanic Black women, 0.90% among Hispanic women, and 0.28% among non-Hispanic White women; quarterly NTSV rates increased in 6 states. In addition to emergency preparedness planning, hospital monitoring, and reporting of NTSV cesarean rates to increase provider awareness, reallocation and prioritization of resources may help to identify potential strains on health care systems during public health emergencies such as the COVID-19 pandemic.

Robust Emergency Preparedness Planning for Resilience Enhancement of Energy-Transportation Nexus Against Extreme Rainfalls

This paper proposes a robust emergency preparedness planning (EPP) scheme to optimally pre-position diverse mobile emergency resources (MERs) in staging locations and perform proactive network reconfiguration for resilience enhancement of energy-transportation nexus (ETN) against extreme rainfalls. Based on rainfall-runoff simulation with hydrodynamic partial differential equations, a risk identification approach for flood-prone transportation modeling is developed for vehicle travel time estimation and MER routing optimization. To handle uncertainties in line outages and flooded roads incurred by extreme rainfalls, a tri-level robust EPP model is proposed to determine the optimal emergency preparedness plan immunized against the worst-case realization of uncertainties. Furthermore, a tailored solution method combining nested column-and-constraint generation algorithm with multiple linearization techniques is devised to cope with the proposed nonlinear robust EPP model. Comparative studies have validated the effectiveness of the proposed scheme for resilience enhancement of the ETN confronted with extreme rainfall disasters.

Supporting K-12 Educators’ Professional Development Continuity: A Forecasting Approach for Curating Online Resources for Emergency Preparedness Planning

This study, presented as a research poster for the 2023 AECT conference, identifies critical online professional development (PD) resources to support the PD continuity of about 38,000 K-12 educators as part of an emergency remote teaching (ERT) resource. The 2019, 2020, and 2021 academic year forecasting analyses showed 84 of the 537 online modules for ERT curation. The findings have implications for program evaluation in day-to-day operations and long-term emergency planning.

Building resilience to the expected Marmara earthquake: Preparing for post-disaster population mobility in Istanbul

Along with other causes of migration, earthquakes have displaced millions of people worldwide over the last few decades, forcing them to move to other settlements within the country. As an "earthquake country", Turkey, where approximately 70% of its territory is located in the seismic zone, has faced a variety of environmentally forced migration that refers to a variety of demographic movements like evacuation, flight, displacement, resettlement, as well as forced migration. Disasters and disaster-related forced migrations as an aspect of survival anxiety have severe and irreversible consequences for the existence of physical security, human dignity, health, livelihoods, shelter, and social, economic, and cultural structures and processes of societies or their subunits. Therefore, disasters and disaster-induced migration, which can be defined as a process of significant vulnerability, are considered widespread and severe threats to the enjoyment and realisation of fundamental rights. Earthquake-related forced migration phenomenon is a widespread and high-risk factor, and this risk corresponds to a closer and more destructive possibility for the province of Istanbul. Therefore becomes vital to take preventive measures to mitigate the possible destructive effects as well as to eliminate the risks as much as possible. This study aims to determine whether relevant legislation is adequate to provide an effective and sufficient protection mechanism for environmental displacement that may occur in Istanbul after a significant earthquake for the purpose of “building resilience in crisis” in the view of international standards. Thus, it also emphasises the importance of the human rights approach and legal mechanisms in establishing resilience during crises. This study has been prepared by content analysing the disaster and emergency preparedness plans, policy texts, and relevant legal and regulatory provisions related to understanding and managing the earthquake-induced migration scenario in Istanbul.

Present and Future Infectious Diseases Challenges for the Greek State and Society

The current pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has redefined normality in many social parameters, and has imposed (and continues to) a significant additional burden on health settings, economy, and state resilience worldwide. On the other hand, the SARS-CoV-2 pandemic has highlighted the vulnerabilities that pre-existed in our planning for facing major health-related events. One wonders though whether these lessons are learned, and whether they can be implemented in real life, particularly in a country like Greece, that is still under the shadow of the financial distraught of the previous decade. Based on the Global Health Security Index,1 which measures individual countries’ capability and infrastructure adequacy to deal with epidemics and pandemics, Greece has not exhibited systematic progress in improving aspects of health security that lagged behind the global average. For example, the Greek score for immunization exhibited a significant decline between 2019 and 2021. Other aspects that improved, or remained steady, between the 2019 and 2021 evaluations have not yet reached the global average, as is for example the zoonotic disease, emergency preparedness and response planning, dual-use research and culture of responsible science, real-time surveillance and reporting, case-based investigation, risk communication, medical countermeasures and personnel deployment, healthcare access, communications with health-care workers during a public health emergency, specific funding for correcting gaps identified by Joint External Evaluation or Performance of Veterinary Sciences, financing health, commitment to sharing of genetic and biological data and specimens, infrastructure adequacy, and environmental risks. That’s a lot of work to be done, and it has to be performed in times with significant infectious disease risks, either circulating or anticipated.

Emergency Response Team (ERT) As an Emergency Management for Campus Environment

The emergency preparedness and response plan (EPRP) are a critical system for effectively handling emergencies from various hazards, including the campus of higher education institutions (HEI). The emergencies carry significant risks for employees within their workplace settings and play an integral role in risk management. This paper introduces an Emergency Response Team (ERT) as an emergency management communication for EPRP within the safety management system campus sustainability. It also assesses the ERT's capacity to manage emergencies and involvement in emergencies through the procedure and documentation to optimise emergency preparedness and response. As an organisation, the HEI is encouraged to establish an emergency response team (ERT) and a procedure as essential components of their safety management systems. The paper employs analytical reviews of the related articles to assess the ERT's functions and capacity within the EPRP for the campus sustainability of the HEI. The content analysis is used to analyse the literature review of the article. The findings revealed that an Emergency Response Team (ERT) for campus sustainability plays a crucial role in ensuring the environmental well-being and resilience of a university or college campus. This specialised team addresses and mitigates sustainability-related emergencies, such as natural disasters, environmental hazards, or infrastructure failures. Their primary goal is to safeguard the campus's sustainable infrastructure, promote eco-friendly practices, and coordinate disaster preparedness and response efforts to minimise environmental damage, support the well-being of the campus community, and maintain a commitment to long-term sustainability goals.

IMPROVING NURSING HOME DISASTER READINESS THROUGH IMPLEMENTATION SCIENCE

Abstract The new investigation on the state of emergency preparedness in nursing homes from the Senate Finance and Aging Committee Chairs is a call to action. As large-scale disasters continue to become increasingly common worldwide, nursing homes, whose residents are more vulnerable to disaster-related health and psychosocial shocks, and their staff, are carrying progressively more responsibility for healthcare readiness practices. Implementation science is a research discipline that seeks to improve uptake of evidence-based practices, such as healthcare readiness planning, and thus has potential to improve nursing home care delivery during and after disasters. The purpose of this review was to describe the limited field of existing evidence-based strategies in the peer-reviewed literature that seek to advance healthcare readiness in the nursing home setting and illustrate how implementation science can better support healthcare readiness planning for nursing homes. We discuss three main themes: 1) implementation science frameworks can strengthen nursing home staff engagement around healthcare readiness; 2) implementation science can support tailoring of emergency preparedness plans to individual nursing homes’ unique needs; and 3) implementation science can advance the integration of nursing homes into local, state, and federal healthcare readiness planning initiatives. Finally, research is urgently needed to both generate and disseminate implementation strategies that increase uptake of evidence-based health care readiness practices in the nursing home setting.

"We are still tired": staff and administrators’ experiences during the COVID-19 pandemic within California residential care facilities for older adults

BackgroundExtensive research has been conducted on the impacts of the COVID-19 pandemic on long-term care workers in specialized care facilities. However, little is known about the impacts faced by facilities that provide generalized long-term support and care, such as residential care facilities for older adults (RCFs). This study describes the challenges experienced by staff and administrators of RCFs during the COVID-19 pandemic.MethodsAn electronic questionnaire collecting data using both closed- and open-ended questions on staff experiences was sent to 5,721 unique RCF administrator emails within the state of California between June-December 2021. Email addresses were obtained from the public database of RCFs available through the California Health and Human Services Open Data Portal. Descriptive statistics were calculated on quantitative data regarding staff preparedness training, access to resources, and administrators’ confidence in meeting recommended guidelines during the pandemic. Inductive thematic analysis was conducted on qualitative data regarding the confidence levels in meeting pandemic guidelines and challenges faced related to staff stress and morale.ResultsA total of 150 RCF administrators across California (response rate of 2.6%) completed the survey. Over three-fourths of respondents indicated their facilities had a designated staff member to train other staff members on emergency preparedness plans and the most frequently used resources during the COVID-19 pandemic were the Department of Social Services Community Care Licensing Division (88.7%), the county health department (86.7%), and the Centers for Disease Control and Prevention (80.7%). Administrators felt least confident in their facilities’ ability to maintain adequate staffing (52.0%), communication with nearby hospitals (62.1%) and communication with state and local public health officials (69.8%) during the pandemic. Three central themes emerged from the thematic analysis on staff stress and morale: (1) physical safety, mental and emotional impact of the COVID-19 pandemic; (2) staffing issues; and (3) challenges with guidelines in managing the ongoing pandemic.ConclusionsFindings from this research study can be used to actively target training resources for facility administrators and staff that have been identified as most frequently used and relevant for emergency preparedness in these understudied facilities. Additionally, developing a better understanding of the staffing stress and morale difficulties in RCFs can provide insight on how policymakers can assist these critical facilities in better preparing for future crises.

Planning with a gender lens: A gender analysis of pandemic preparedness plans from eight countries in Africa

BackgroundHealth planning and priority setting with a gender lens can help to anticipate and mitigate vulnerabilities that women and girls may experience in health systems, which is especially relevant during health emergencies. This study examined how gender considerations were accounted for in COVID-19 pandemic response planning in a subset of countries in Africa. MethodsMulti-country document review of national pandemic response plans (published before July 2020 and as of March 2022) from Ethiopia, Ghana, Kenya, Nigeria, Rwanda, South Africa, Uganda, and Zambia, supplemented with secondary data on gender representation on planning committees. A gender analysis framework informed the study design and the Morgan et al. matrix guided data extraction and analysis. ResultsAll plans reflected implicit and explicit considerations of the impacts of the pandemic responses on women and girls. Through a gender lens, the implicit considerations focused on ensuring safety and protections (e.g., training, access to personal protective equipment) for community and facility-based health care workers and broad engagement of the community in risk communication. The explicit gender considerations, reflected in a minority of plans, focused on addressing gender-based violence and providing access to essential services (e.g., sexual and reproductive health care, psychosocial supports), products (e.g., menstrual hygiene products) and social protection measures. Women were underrepresented on the COVID-19 planning committees in all countries. ConclusionsThe plans reflected varying national efforts to develop pandemic responses that anticipated and reflected unique vulnerabilities faced by women, though subsequent plans reflected further consideration of gender-relevant impacts compared to initial plans. Embedding a gender lens in emergency preparedness planning furthers equity and could support anticipation and timely mitigation of negative outcomes for women and girls who are often further marginalized during health emergencies.

Delivering health promotion during school closures in public health emergencies: building consensus among Canadian experts

Abstract School-based health promotion is drastically disrupted by school closures during public health emergencies or natural disasters. Climate change will likely accelerate the frequency of these events and hence school closures. We identified innovative health promotion practices delivered during COVID-19 school closures and sought consensus among education experts on their future utility. Fifteen health promotion practices delivered in 87 schools across Alberta, Canada during COVID-19 school closures in Spring 2020, were grouped into: ‘awareness of healthy lifestyle behaviours and mental wellness’, ‘virtual events’, ‘tangible supports’ and ‘school-student-family connectedness’. Two expert panels (23 school-level practitioners and 20 decision-makers at the school board and provincial levels) rated practices on feasibility, acceptability, reach, effectiveness, cost-effectiveness and other criteria in three rounds of online Delphi surveys. Consensus was reached if 70% or more participants (strongly) agreed with a statement, (strongly) disagreed or neither. Participants agreed all practices require planning, preparation and training before implementation and additional staff time and most require external support or partnerships. Participants rated ‘awareness of healthy lifestyle behaviours and mental wellness’ and ‘virtual events’ as easy and quick to implement, effective and cost-effective, sustainable, easy to integrate into curriculum, well received by students and teachers, benefit school culture and require no additional funding/resources. ‘Tangible supports’ (equipment, food) and ‘school-student-family connectedness’ were rated as most likely to reach vulnerable students and families. Health promotion practices presented herein can inform emergency preparedness plans and are critical to ensuring health remains a priority during public health emergencies and natural disasters.

Abstract A107: The role of social network and provider support on access to care in Puerto Rican and US Virgin Islands gynecologic cancer patients post-Hurricanes Maria and Irma

Abstract Background: Hurricanes Irma and Maria touched down on Puerto Rico (PR) and the US Virgin Islands in 2017 with devastating impacts. Essential infrastructure, services, and the overall environment were impacted, forcing residents to adapt or migrate amid these natural disasters. With Gynecologic cancers representing over 15% of all cancer in Puerto Rican women, these patients were at a high risk of experiencing challenges and barriers detrimental to their health outcomes. This study assessed how social networks (i.e., immediate family, friends, and neighbors) and provider (i.e., oncologists, oncology associations, and hospitals) support played a role in accessing health services by gynecologic cancer patients in the aftermath of the hurricanes. Methods: In-depth interviews were conducted to assess hurricane-related stressors and disaster responses. PR (n=24) and US Virgin Island (n=2) gynecologic cancer patients participated across 4 focus groups (December 2018-April 2019). Key cancer stakeholders were individually interviewed, consisting of oncology care providers and administrators (n=23) providing services in PR. All interviews were recorded, transcribed (verbatim), and coded with emerging themes using inductive methods. Results: The analysis highlighted the impact of stressors and multi-level responses on health outcomes for the patients. The identified emerging themes and subcodes included: 1) Health Access; 2) Stressors; 3) Emergency Response to Communication methods. Participants highlighted how their health needs were satisfied or not during the aftermath of the disasters primarily based on the availability of support from their social network and on recorded responses of available providers and clinics. They also detailed the expression of diverse stressors (i.e., primary, secondary, psychosocial, environmental) experienced while searching for health services. Regarding communications, patients and providers detailed several mechanisms of non-traditional patient-provider communication, such as WhatsApp group messaging, telephone robocalls for texting, leaving written notes at clinics or homes, and traveling outside PR to communicate with outside and local resources. Conclusion: The study demonstrated that social and provider support was critical in patients accessing care. A supportive social network facilitated access to health management, treatments, and primary service (i.e., water and electricity). Conversely, patients with minimal to no social support expressed difficulty improving these areas. Health providers also played an essential role with their patients and in the community by providing innovative alternative resources beyond planned emergency response. Implications for safety data management and sharing are in place when managing adverse outcomes in emergency planning. These results are imperative to include in future emergency preparedness plans for PR to prevent and mitigate the effects of natural disasters among vulnerable populations, such as cancer patients. Citation Format: Celeste M. Charchalac-Zapeta, Edna Acosta-Perez, Sandra I Garcia-Camacho, Mirza Rivera, Ana Patricia Ortiz Martinez. The role of social network and provider support on access to care in Puerto Rican and US Virgin Islands gynecologic cancer patients post-Hurricanes Maria and Irma [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A107.

서울시민의 재난안전 인식 연구

This study aims to diagnose the level of disaster safety awareness among Seoul residents and to strengthen disaster safety awareness as an initial step toward building a disaster-safe community. Due to rapid urbanization and population growth, Seoul has become a central area where people live and economic activities are concentrated. As a result, it creates enormous socio-economic value and is exposed to potentially serious disasters and risks. Natural disasters (earthquakes, floods, etc.) and social disasters (fires, accidents) have a more devastating impact in large cities. Therefore, disaster safety has emerged as one of the key challenges of modern society and is strongly influenced by emergency response capabilities, effective prevention and preparedness plans, and citizens' perceptions of disaster safety. Based on the survey data of 1,000 Seoul residents in 2021 conducted by the Seoul Institute, this study used E-stat 3.0, a statistical program of the Korea Social Science Data Center (KSDC), to study disaster safety awareness using frequency analysis and analysis of variance, and the results of the study are expected to derive measures to improve disaster safety awareness at the local level and serve as a resource for strengthening disaster safety awareness not only in Seoul but also in other large cities.

Assessing US Small Animal Veterinary Clinic Adaptations and Their Impacts on Workforce COVID-19 Preparedness and Response.

Veterinary personnel are an essential yet often underappreciated workforce, critical for zoonotic disease prevention and response efforts that impact human health. During the early COVID-19 pandemic, the veterinary workforce supported emergency responses by promoting zoonotic disease risk communication, sharing animal health expertise, and boosting laboratory surge capacity against SARS-CoV-2 in animals and people. However, small animal veterinary workers (SAVWs), similar to healthcare workers, faced organizational challenges in providing clinical care to family pets, including those susceptible to SARS-CoV-2. We analyzed a cross-sectional survey of 1,204 SAVWs in the United States to assess veterinary clinic adaptations and their associations with SAVWs' self-perceived readiness, willingness, and ability to respond to the COVID-19 pandemic as a workforce. SAVWs who worked fewer hours than before the pandemic (ready, OR 0.59; willing, OR 0.66; able, OR 0.52) or used personal protective equipment less frequently for protection in the clinic (ready, OR 0.69; willing, OR 0.69; able, OR 0.64) felt less ready, willing, and able to respond to COVID-19. SAVWs working remotely felt less ready (OR 0.46) but not less willing or able to respond to COVID-19. Lastly, SAVWs with dependents felt less ready (OR 0.67) and able (OR 0.49) to respond to COVID-19 than SAVWs without dependents. Our findings highlight the importance of proactively managing work schedules, having access to personal protective equipment, and addressing caregiving concerns to enhance SAVW preparedness and response outcomes. SAVWs are knowledgeable, motivated personnel who should be integrated into local public health emergency preparedness and response plans, supporting a One Health framework that unites multidisciplinary teams to respond to future zoonotic disease threats.

“All Hands on Deck”: Administrator Perspectives on Managing COVID-19 Outbreaks in U.S. Nursing Homes

Context: Managing COVID-19 outbreaks at U.S. nursing homes highlight the structural weaknesses of pre-pandemic long-term care emergency preparedness protocols. Objective: To understand how nursing home administrators managed staffing and facility operations during an active COVID-19 outbreak. Methods: This descriptive qualitative study conducted semi-structured interviews with administrators at 40 U.S. nursing homes from July 2020–December 2021. Interview questions focused on the impact of COVID-19 on nursing home operations and staffing, among other topics. Interview transcripts were qualitatively analysed to identify overarching themes using modified grounded theory and thematic analysis. Findings: Four major themes emerged from analysis. (1) Administrators described the rapidity of viral infection of staff and residents as overwhelming and long-lasting; (2) a COVID-19 outbreak had an immediate impact on staffing levels; (3) administrators implemented short-term compensatory strategies to manage staffing shortages during COVID-19 outbreaks; and (4) administrator and staff roles and responsibilities expanded in order to maintain facility operations during, and post-COVID-19 outbreak. Limitations: Findings may not be generalizable to all U.S. nursing homes and may not reflect current COVID-19 mitigation protocols and perspectives as interviews concluded in December 2021. Implications: U.S. nursing home administrators used crisis-management strategies to sustain facility operations during active COVID-19 outbreaks. This approach highlights on-going weaknesses in the long-term care infrastructure at U.S. nursing homes. Learning from administrator experiences during the COVID-19 pandemic is critical for the development of robust emergency preparedness plans and the improvement of state and federal resource coordination efforts to support U.S. nursing homes during future public health emergencies.

Some observations on perceptions of radiation risks in the context of nuclear power plant accidents.

As highlighted by public reactions to accidents at nuclear plants in the past, such as those that occurred in Chernobyl (1986) and Fukushima (2011), and from numerous opinion surveys, there are considerable differences or gaps between how the public and radiation experts perceive the risks from radiation. Even within the community of experts, radiation risk perception differences can be present. The reasons for differences in radiation risk perceptions between the public and experts are complex and involve sociological, ethical and behavioural aspects of society. This presents significant challenges to authorities in trying to improve radiation risk communications targeted at the public within the context of radiation emergency preparedness planning. Of particular importance is to make the communications more citizen-centred than heretofore by having meaningful two-way communications and dialogue with the public. It is emphasised that such strategies should take into account and address the significant mental health and socio-economic impacts of such accidents on affected populations. In particular, the mental health impacts are inadequately addressed by current international radiation protection recommendations reflecting their long established emphasis only on physical health effects. This approach is no longer acceptable or justified.

Effects of Wildfire Events on California Radiation Oncology Clinics and Patients

PurposeThe impact of climate-driven events, such as wildfires, on healthcare delivery and cancer care is a growing concern. Patients with cancer undergoing radiotherapy are particularly vulnerable to treatment interruptions, which have a direct impact on survival. We report the results of a study characterizing the impact of wildfires on radiation oncology clinics and their patients. Methods and MaterialsA survey of California radiation oncologists was used to evaluate emergency preparedness and the impact of wildfires on the delivery of radiotherapy services between 2017-2022. Descriptive statistics and Pearson's chi-squared tests were performed to investigate potential relationships between provider characteristics, practice settings, and perceptions of the impact of wildfire events. California Department of Forestry and Fire Protection (CAL FIRE) data were employed to map the geographic distribution of wildfires to clinic locations. ResultsResponse rate was 12.3% (51/415 radiation oncologists), representing 25% of clinics (43/176) in 41% (24/58) of California counties. 61% (31/51) of respondents reported being impacted by a wildfire, two of which are rural clinics (100%, 2/2) and 29 are (59%, 29/49) metropolitan practices. Of these, 18% (9/51) reported a clinic closure, and 29% (15/51) reported staffing shortages. Respondents reported impacts on patients, including having to evacuate (55%, 28/51), cancel/reschedule treatments (53%, 27/51), and experiencing physical, mental, or financial hardship due to wildfires (45%, 23/51). Respondents described impacts on clinical operations, including being forced to transfer patients (24%, 12/51), transportation interruptions (37%, 19/51), regional/community evacuations (35%, 18/51), and physical/mental health impacts (27%, 14/51) on clinic personnel. Less than half of the respondents (47%, 24/51) reported their workplace had a wildfire emergency preparedness plan. Additionally, geographic analysis revealed that 100% (176/176) of clinics were located within 25 miles of a wildfire. ConclusionsThis study highlights the impact of wildfires on radiation oncology clinics and patients, and underscores the need for emergency preparedness planning to minimize the consequences of such disasters.

The Well-Being of Companion Animal Caregivers and Their Companion Animals during the COVID-19 Pandemic: Scoping Review.

It is important to understand the effects of the COVID-19 pandemic on animal caregivers and their companion animals in order to inform responses to future crises. Prior research is inconsistent, with the benefits of animal companionship believed to be overstated. In this scoping review, we searched four electronic databases and hand-searched reference lists of included studies. Over 4000 citations were found, and 122 were included in the review. Reflecting on the pre-COVID literature, quantitative evidence of the association between psychological well-being and animal companionship during the pandemic was mixed, with numerous positive, negative, and null findings reported. Studies highlighted the benefits of animal companionship during the pandemic, with animals reported to provide their caregivers with a routine, a sense of greater purpose, a positive distraction from COVID-19, companionship, and emotional support. However, participants also reported concerns about meeting animals' needs, fears of animals catching or spreading the virus, and financial worries. Concerns about what would happen to animals if caregivers were hospitalized led some to delay COVID-19 testing or treatment. Animals also experienced benefits (such as increased companionship and calmer mood) and negative impacts (such as increased clinginess and separation anxiety). Companion animals should be a key consideration in emergency preparedness plans.

Impacts of Wildfire Events on California Radiation Oncology Clinics and Patients

The impact of climate-related disasters such as wildfires on healthcare delivery and cancer care is a growing concern. Patients undergoing radiotherapy are particularly vulnerable to treatment interruptions which are known to have a direct impact on survival outcomes. We report results of the first pilot study characterizing the impact of wildfires on radiation oncology clinics and their patients. A survey was sent to 415 California radiation oncologists representing 144 clinics identified using the ASTRO member directory to gather information about clinic and radiation oncologist demographics, wildfires' impacts on the clinic (physical/operational), physicians, staff, and patients between 2017 and 2022, as well as clinics' disaster preparedness efforts. A total of 51 radiation oncologists completed the survey, representing 43 clinics (30% of clinics) in 24 (41%) of California counties. 35 (69%) of respondents self-identified as male, 27 (53%) worked at hospital-affiliated centers, 19 (37%) worked in academic centers, with 49 (96%) practicing in metropolitan areas. A total of 31 clinics were impacted by a wildfire between 2017 and 2020. The two rural clinics (100%) and 29 (59%) of metro practices reported being impacted by wildfires in the last 5 years, with 9 (18%) reporting a clinic closure and 15 (29%) reporting staffing shortages. 28 (55%) of respondents reported impacts on patients including having to evacuate, 27 (53%) having to cancel or reschedule treatments, and 23 (45%) experiencing physical, mental, or financial hardship due to the wildfires. Among the 25 clinics impacted by wildfires, 12 (24%) reported physical/operational impacts including being forced to evacuate patients to another treatment center, transportation interruptions (19, 37%), community and regional evacuations (18, 35%), school closures (18, 35%), and physical/mental health impacts (14, 27%) on staff due to the wildfires. Small clinics (25 staff or less) that experienced a wildfire were twice as likely to experience closures (6 of 16 clinics, 38%) but equally likely to experience staffing shortages (8 of 16, 50 %) as compared to larger practices (7 of 15, 47%). Nearly half of respondents 25 (47%) reported their workplace had a wildfire emergency preparedness plan. The results of this study demonstrate the significant impact wildfires have on patient care in both rural and metropolitan areas. The findings emphasize the importance of emergency preparedness planning to minimize the consequences of such disasters and underscores the need for further research to explore risk factors associated with patient and community vulnerability to climate-related crises. Such research will be essential to informing and developing future emergency preparedness plans.

Prioritization of zoonoses for multisectoral, One Health collaboration in Somalia, 2023

BackgroundThe human population of Somalia is vulnerable to zoonoses due to a high reliance on animal husbandry. This disease risk is exacerbated by relatively low income (poverty) and weak state capacity for health service delivery in the country as well as climate extremes and geopolitical instability in the region. To address this threat to public health efficiently and effectively, it is essential that all sectors have a common understanding of the priority zoonotic diseases of greatest concern to the country. MethodsRepresentatives from human, animal (domestic and wildlife), agriculture, and environmental health sectors undertook a multisectoral prioritization exercise using the One Health Zoonotic Disease Prioritization (OHZDP) tool developed by the United States CDC. The process involved: reviewing available literature and creating a longlist of zoonotic diseases for potential inclusion; developing and weighting criteria for establishing the importance of each zoonoses; formulating categorical questions (indicators) for each criteria; scoring each disease according to the criteria; and finally ranking the diseases based on the final score. Participants then brainstormed and suggested strategic action plans to prevent, and control prioritized zoonotic diseases. ResultsThirty-three zoonoses were initially considered for prioritization. Final criteria for ranking included: 1) socioeconomic impact (including sensitivity) in Somalia; 2) burden of disease in humans in Somalia); 3) availability of intervention in Somalia; 4) environmental factors/determinants; and 5) burden of disease in animals in Somalia. Following scoring of each zoonotic disease against these criteria, and further discussion of the OHZDP tool outputs, seven priority zoonoses were identified for Somalia: Rift Valley fever, Middle East respiratory syndrome, anthrax, trypanosomiasis, brucellosis, zoonotic enteric parasites (including Giardia and Cryptosporidium), and zoonotic influenza viruses. ConclusionsThe final list of seven priority zoonotic diseases will serve as a foundation for strengthening One Health approaches for disease prevention and control in Somalia. It will be used to: shape improved multisectoral linkages for integrated surveillance systems and laboratory networks for improved human, animal, and environmental health; establish multisectoral public health emergency preparedness and response plans using One Health approaches; and enhance workforce capacity to prevent, control and respond to priority zoonotic diseases.

Assessing the pharmacy workforce's preparedness for a workplace violence event.

The purpose of this article is to describe the planning, implementation, and findings of a "person with a weapon" exercise for an inpatient pharmacy department. There has been an increased focus on workplace violence in healthcare within the last few years. The health-system pharmacy workforce should take an active role in planning for workplace violence events by completing a risk assessment analysis and performing tabletop and functional exercises. This study provides an example of how health-system pharmacists collaborated with an emergency management team, security, and communications to carry out a person with a weapon exercise in an inpatient hospital pharmacy. Areas for improvement were identified for pharmacy, communications, and security during education sessions and the tabletop and functional exercises, demonstrating the importance of a multidisciplinary approach when planning for a person with a weapon event. As a result of this exercise, there was increased awareness of the "run, hide, fight" tactic, an increase in workplace violence education and staff awareness, and an enhancement of security measures, including technology improvements. This workplace violence exercise provides an example of how the pharmacy workforce can engage in emergency preparedness planning and risk mitigation for a workplace violence event. Other health systems can use the action plan, findings, and improvements to raise awareness and train about workplace violence events and support the safety of the pharmacy workforce.