Hospital Preparedness Program Research Articles

The Field’s mass shooting: emergency medical services response

BackgroundMajor incidents (MI) happen infrequently in Scandinavia and mass shootings are even less frequently occurring. Case reports and research are called for, as literature is scarce. On 3rd July 2022, a mass shooting took place at the shopping mall Field’s in Copenhagen, Denmark. Three people were killed and seven injured by a gunman, firing a rifle inside the mall. A further 21 people suffered minor injuries during the evacuation of the mall. In this case report, we describe the emergency medical services (EMS) incident response and evaluate the EMS´ adherence to the MI management guidelines to identify possible areas of improvement.Case presentationForty-eight EMS units including five Tactical Emergency Medical Service teams were dispatched to the incident. Four critically injured patients were taken to two trauma hospitals. The deceased patients were declared dead at the scene and remained there for the sake of the investigation. A total of 24 patients with less severe and minor injuries were treated at four different hospitals in connection with the attack. The ambulance resources were inherently limited in the initial phase of the MI, mandating improvisation in medical incident command. Though challenged, Command and Control, Safety, Communication, Assessment, Triage, Treatment, Transport (CSCATTT) principles were followed.ConclusionsThe EMS response generally adhered to national guidelines for MI. The activation of EMS and the hospital preparedness program was relevant. Important findings were communication shortcomings; inherent lack of readily available ambulance resources in the initial critical phase; uncertainty regarding the number of perpetrators; uncertainty regarding number of casualties and social media rumors that unnecessarily hampered and prolonged the response. The incident command had to use non-standard measures to mitigate potential challenges.

The Role of the Louisiana EMS Designated Regional Coordinator in Emergency Response During 2020/2021 COVID Pandemic and Hurricane Season

Introduction:Post Katrina Louisiana’s Health Department (LDH) used some of the Hospital Preparedness Program (HPP) funding to create a regional Emergency Medical Services liaison position entitled EMS Designated Regional Coordinators (EMS DRC). Regional EMS DRCs work with local pre-hospital agencies, hospital coalitions, and local/state/federal counterparts during the preparedness and response phases of a disaster. This presentation explores the EMS DRCs role during the 2020/2021 COVID pandemic and annual hurricane season.Method:The EMS DRCs were activated at the beginning of the COVID-19 pandemic. EMS agencies across the country were struggling to meet the call volume demand while balancing sick employees. The eleven LA Region 1 EMS agencies reached out to the EMS DRC for assistance. The EMS DRC coordinated with the LA State Health Department to provide surge ambulances to any ambulance agency in need. These units were utilized for COVID response, but once hurricane season hit in both 2020 and 2021 Surge ambulances were quickly transitioned to COVID and Hurricane response.Results:During the initial COVID outbreak, 18 state surge ambulances were divided amongst four agencies. In 2020 Louisiana saw six named storms, one of which caused significant damage. After Hurricane Laura hit in 2020 the EMS DRCs managed 80 Federal surge ambulances stationed across 41 non-congruent hotel shelters. The 2021 COVID response brought another 21 Federal Surge ambulances to the region. Once Hurricane Ida hit that year over 60 surge ambulances got reassigned to six regional EMS agencies for COVID and Hurricane response.Conclusion:The COVID-19 pandemic and subsequent hurricane devastation exposed gaps in EMS response capabilities to response. The EMS DRCs play a significant role in providing continuous care through working relationships with local, state and federal partners

The Evolution of the National Special Pathogen System of Care.

Infectious disease outbreaks and pandemics have repeatedly threatened public health and have severely strained healthcare delivery systems throughout the past century. Pathogens causing respiratory illness, such as influenza viruses and coronaviruses, as well as the highly communicable viral hemorrhagic fevers, pose a large threat to the healthcare delivery system in the United States and worldwide. Through the Hospital Preparedness Program, within the US Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response, a nationwide Regional Ebola Treatment Network (RETN) was developed, building upon a state- and jurisdiction-based tiered hospital approach. This network, spearheaded by the National Emerging Special Pathogens Training and Education Center, developed a conceptual framework and plan for the evolution of the RETN into the National Special Pathogen System of Care (NSPS). Building the NSPS strategy involved reviewing the literature and the initial framework used in forming the RETN and conducting an extensive stakeholder engagement process to identify gaps and develop solutions. From this, the NSPS strategy and implementation plan were formed. The resulting NSPS strategy is an ambitious but critical effort that will have impacts on the mitigation efforts of special pathogen threats for years to come.

Innovations in Fatality Management During the COVID-19 Pandemic.

Innovations in Fatality Management During the COVID-19 Pandemic.

Description of the Use of the Incident Command System Among Public Health Agencies Responding to COVID-19

The utilization of Incident Command Systems (ICS) and Emergency Operations Centers (EOCs) in public health emergency and disaster response are cornerstones of the capabilities prescribed for Public Health Emergency Preparedness (PHEP). To assess the use of ICS and EOCs by public health agencies during the COVID-19 response, we conducted a content analysis of online materials available from 62 health departments funded by the Centers for Disease Control and Prevention for PHEP. Bivariate associations between evidence of ICS utilization in COVID response were assessed using relative risk regression. Risk ratios (RR) and 95% confidence intervals (95% CI) were reported. 58% (36 of 62) of PHEP grantees had accessible information regarding the use of ICS in COVID-19 public health response. PHEP grantees with online information about PHEP, Hospital Preparedness Program linkages, public health seats at state or jurisdictional EOCs, exercises, and ICS generally were more likely to have COVID-specific ICS information. COVID-19 has placed significant strain on the operational response capacity of public health agencies. Given that this is the most significant event in which PHEP Capabilities have been tested, both in terms of geographic spread and duration, assessment of both preparedness and response capacities is critical for recognizing strengths and addressing shortcomings to improve PHEP operations in future incidents.

Reexamining Health-Care Coalitions in Light of COVID-19

The national response to the coronavirus disease 2019 (COVID-19) pandemic has highlighted critical weaknesses in domestic health care and public health emergency preparedness, despite nearly 2 decades of federal funding for multiple programs designed to encourage cross-cutting collaboration in emergency response. Health-care coalitions (HCCs), which are funded through the Hospital Preparedness Program, were first piloted in 2007 and have been continuously funded nationwide since 2012 to support broad collaborations across public health, emergency management, emergency medical services, and the emergency response arms of the health-care system within a geographical area. This commentary provides a SWOT (strengths, weaknesses, opportunities, and threats) analysis to summarize the strengths, weaknesses, opportunities, and threats related to the current HCC model against the backdrop of COVID-19. We close with concrete recommendations for better leveraging the HCC model for improved health-care system readiness. These include better evaluating the role of HCCs and their members (including the responsibility of the HCC to better communicate and align with other sectors), reconsidering the existing framework for HCC administration, increasing incentives for meaningful community participation in HCC preparedness, and supporting next-generation development of health-care preparedness systems for future pandemics.

Interdisciplinary Information for Infectious Disease Response: Exercising for Improved Medical/Public Health Communication and Collaboration.

Infectious disease threats like the novel coronavirus that emerged in late 2019 continue to demand an increase in preparedness and response capabilities. One capability that is both essential and consistently challenging is information sharing between responding organizations, particularly between public health agencies and health care providers. This policy analysis reviews the threat that infectious diseases continue to pose to the United States, and the role that the Hospital Preparedness Program can play in countering such threats. Current strategies for preparing for, and responding to, infectious disease outbreaks are also reviewed, noting some gaps that need to be addressed. Particular attention is given to challenges in information sharing that continue to hinder effective surveillance and response, despite advances in technology. The study looks at recommendations from biodefense organizations and experts in the field. It concludes with our recommendation that regulatory requirements and funding opportunities for health care institutions emphasize the importance of communication and training in relation to high consequence pathogens. We further recommend that providers in Ebola treatment hospitals be employed to train and educate providers in frontline hospitals in a 'train-the-trainer' model.

APA, Partner Groups Call for Action on COVID-19

Back to table of contents Previous article Next article Government & LegalFull AccessAPA, Partner Groups Call for Action on COVID-19Katie O'ConnorKatie O'ConnorSearch for more papers by this authorPublished Online:10 Apr 2020https://doi.org/10.1176/appi.pn.2020.4b13AbstractAPA and its coalition partners gave specific recommendations on how state and federal governments can help patients and physicians on the front lines during the COVID-19 outbreak and urged swift action to help mitigate the spread of the disease.Throughout the COVID-19 pandemic, APA has worked with its coalition partners to give specific recommendations on how federal and state governments can help patients and physicians on the front lines during the outbreak, urging swift action to help mitigate the spread of the disease.Earlier in March when Congress was debating phases I, II, and III of COVID-19 legislation, APA and five other medical organizations representing more than 600,000 physicians and medical students sent a joint statement outlining numerous specific actions that state and federal governments should take to address the pandemic.“During this unprecedented national emergency, our organizations are committed to doing everything possible to prevent and slow the spread of the virus while ensuring that patients get the care they need,” the statement reads. “However, they can’t do it alone; there are specific actions that federal and state governments can take now to support access to and coverage for COVID-19 treatment and prevention.”Collectively known as the Group of Six, the organizations in addition to APA are the American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, and American Osteopathic Association.“The repercussions of the COVID-19 pandemic on the physical and mental health of Americans will be long lasting and far reaching,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “With strong, immediate support from federal and state governments using science and medical experts to guide the response, we can slow the spread of this highly contagious virus and ensure patients receive the care they need.”In the statement, the organizations praised some of the steps that Congress and President Donald Trump’s administration have taken so far, including the president’s declaration that COVID-19 is a national emergency under the Stafford Act and the passage of the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (HR 6074) and the Families First Coronavirus Response Act (HR 6201).Yet they urged further action, as well. The organizations outlined several key policy actions that state and federal governments should implement to help ensure widespread coverage of and access to COVID-19 testing and treatment. The recommendations also highlight ways in which governments can support health care system capacity and availability of personal protection equipment (PPE).Recommendations include the following:Congress, the administration, and state governments should continue to assess, fund, and increase the immediate and long-term availability of COVID-19 tests, as well as masks, PPE, and other pharmaceutical and medical supplies. Congress partially addressed this issue in each of the emergency supplemental funding in phases I, II, and III of the COVID-19 legislation, requiring health insurers to cover COVID-19 tests at no cost to patients and increasing funding for PPE and other medical equipment.Congress should appropriate at least $200 million to the Hospital Preparedness Program to bolster health care system emergency readiness. The CARES Act, phase III of COVID-19 legislation, included an additional $100 billion for hospitals and other health care facilities responding to COVID-19 through the Public Health and Social Services Emergency Fund. This funding could be used for hospital readiness, but it is unclear how these funds will be allocated given that this is new funding, not specifically designated for the Hospital Preparedness Program.Congress should additionally authorize funding for community health centers, community mental health centers, and the Teaching Health Center Graduate Medical Education Program. The CARES Act reauthorized and funded these programs through November 30, 2020.The administration should use national disaster relief funding to reimburse physicians at 110% of the Medicare rates for COVID-19–related care for people who are uninsured.“People all over the country are struggling with the stress and anxiety this pandemic is causing,” said APA President Bruce Schwartz, M.D. “Congress, the administration, and the states must act decisively so the physicians on the front lines of the crisis can protect their patients’ and their own physical and mental health.” ■ “Frontline Physicians Recommend Further Actions to Address COVID-19” is posted here. ISSUES NewArchived

From silos to coalitions: The evolution of the US Hospital Preparedness Program.

The objective of this article is to trace the hospital emergency preparedness movement in the United States, strengthen the case for hospital investments in emergency preparedness, and make recommendations to ensure sustainability of the program. Design/Approach: This article is a narrative review. Main themes from the literature about the US Hospital Preparedness Program (HPP) are discussed, beginning with the trends in funding levels of the HPP, the rise of regional healthcare coalitions, preparedness performance measures, and the challenges faced over the past 15 years of HPP activities. Finally, recommendations are made about ways to sustain the program. The HPP was established in 2002 and funding for the program has seen a 56 percent decrease over the last 16 years. Beyond the initial investment in supplies and equipment, hospitals have received very little of the healthcare preparedness funding. Disaster drills and exercises to test emergency plans in hospitals are perceived as a costly distraction from daily work. The biggest challenge is the lack of engagement and support from hospital leadership. To ensure the sustainability of the HPP, the positive impact of preparedness activities on the hospital's day-to-day operations must be demonstrated.

Assessment of community hospital disaster preparedness in New York State.

The intent of this study was to assess disaster preparedness in community hospitals across New York. Descriptive and analytical cross-sectional survey study. The survey instrument consisted of 35 questions that examined six elements of disaster preparedness: disaster plan development, onsite surge capacity, available materials and resources, disaster education and training, disaster preparedness funding levels, and perception of disaster preparedness. Community hospitals in New York. Contact information was obtained for 207 of 208 community hospitals. Email invitations to participate in the survey were sent to hospital CEOs and disaster preparedness coordinators. Completed surveys were received from 80 hospitals. Hospital responses to questions related to the six elements of disaster preparedness. Most (87.5 percent) hospitals had experienced a disaster event during the past 5 years (2012-2016). Eighty percent had disaster plans that addressed all of six major types of disasters. Only 17.5 percent believed their disaster plans were "very sufficient" and did not require any revisions. Nearly three-quarters (73.3 percent) of hospitals could continue operations for less than a week without external resources. Less than half (49.4 percent) reported being satisfied or very satisfied with the level of funding that they received from the Hospital Preparedness Program. Most (88.8 percent) respondents felt that barriers to disaster preparedness exist for their organizations. The results demonstrate the current level of disaster preparedness among New York hospitals. The study's approach is discussed as a model that will enable hospitals to identify focus areas for improvement and opportunities for legislation and advocacy.

Using "Mystery Patient" Drills to Assess Hospital Ebola Preparedness in New York City, 2014-2015.

In response to the Ebola virus disease (EVD) outbreak in West Africa, rapid measures were taken to ensure readiness at frontline New York City (NYC) healthcare facilities, including mandating monthly EVD mystery patient drills to test screening protocols. This study analyzed after-action reports to describe the use of mystery patient drills to test rapid identification and isolation of potential EVD cases in NYC emergency departments. NYC hospitals were required to develop protocols for EVD screening and isolation, and to conduct drills with an actor presenting to the emergency department with symptoms suggestive of EVD. Fifty-five hospitals that participate in NYC's hospital preparedness program were invited to submit after-action reports summarizing at least 1 drill conducted between October 2014 and April 2015. Summary statistics were generated from reported quantitative measures. Report narratives were reviewed, coded, extracted, and analyzed to identify strengths and challenges experienced. Forty-five hospitals submitted after-action reports (82%). The median time from patient entry to isolation was 9 minutes and from isolation to evaluation was 14 minutes. Recurrent strengths included consistent travel history screening and compliance with infection control protocols. Themes for improvement included ensuring timely screening, staff competency with personal protective equipment (PPE), and clarifying notification procedures and staff roles. Mystery patient drills gave hospitals the means to test screening and isolation protocols and identify key gaps, such as competency-based training in PPE, to improve their capacity to respond to highly communicable diseases. Findings from this study will inform the development of a standardized mystery patient drill program.

Public Health Preparedness Funding: Key Programs and Trends From 2001 to 2017.

To evaluate trends in funding over the past 16 years for key federal public health preparedness and response programs at the US Department of Health and Human Services, to improve understanding of federal funding history in this area, and to provide context for future resource allocation decisions for public health preparedness. In this 2017 analysis, we examined the funding history of key federal programs critical to public health preparedness by reviewing program budget data collected for our annual examination of federal funding for biodefense and health security programs since fiscal year (FY) 2001. State and local preparedness at the Centers for Disease Control and Prevention initially received $940 million in FY2002 and resulted in significant preparedness gains, but funding levels have since decreased by 31%. Similarly, the Hospital Preparedness Program within the Office of the Assistant Secretary for Preparedness and Response was funded at a high of $515 million in FY2003, but funding was reduced by 50%. Investments in medical countermeasure development and stockpiling remained relatively stable. The United States has made significant progress in preparing for disasters and advancing public health infrastructure. To enable continued advancement, federal funding commitments must be sustained.

Administrative Preparedness Strategies: Expediting Procurement and Contracting Cycle Times During an Emergency.

We assessed whether administrative preparedness processes that were intended to expedite the acquisition of goods and services during a public health emergency affect estimated procurement and contracting cycle times. We obtained data from 2014-2015 applications to the Hospital Preparedness Program and Public Health Emergency Preparedness (HPP-PHEP) cooperative agreements. We compared the estimated procurement and contracting cycle times of 61 HPP-PHEP awardees that did and did not have certain administrative processes in place. Certain processes, such as statutes allowing for procuring and contracting on the open market, had an effect on reducing the estimated cycle times for obtaining goods and services. Other processes, such as cooperative purchasing agreements, also had an effect on estimated procurement time. For example, awardees with statutes that permitted them to obtain goods and services in the open market had an average procurement cycle time of 6 days; those without such statutes had a cycle time of 17 days ( P = .04). PHEP awardees should consider adopting these or similar processes in an effort to reduce cycle times.

Review of Recent Large-Scale Burn Disasters Worldwide in Comparison to Preparedness Guidelines.

The US National Bioterrorism Hospital Preparedness Program indicates that each care facility must have "a plan to care for at least 50 cases per million people for patients suffering burns or trauma" to receive national funding disaster preparedness. The purpose of this study is to evaluate whether this directive is commensurate with the severity recent burn disasters, both nationally and internationally. We conducted a review of medical journal articles, investigative fire reports, and media news sources for major burn disasters dating from 1990 to present day. We defined a major burn disaster as any incident with ≥50 burn injuries and/or ≥ 30 burn-related deaths. We compared existing preparedness guidelines with the magnitude of recent burn disasters using as reference the 2005 U.S. Health and Human Services directive that each locale must "have a plan to care for at least 50 cases per million people for patients suffering burns or trauma." We reported the number of actual casualties for each incident, and estimated the number of burn beds theoretically available if the "50 [burn-injury] cases per million people" directive were to be applied to metropolitan areas outside the United States. Seven hundred fifty-two burn disaster incidents met our inclusion criteria. The majority of burn disasters occurred in Asia/Middle East. The incidence of major burn disasters from structural fires and industrial blasts remains constant in high-income and resource-restricted countries during this study period. The incidence of terrorist attacks increased 20-fold from 2001 to 2015 compared with 1990 to 2000. Recent incidents demonstrate that if current preparedness guidelines were to be adopted internationally, local resources including burn-bed availability would be insufficient to care for the total number of burn casualties. These findings underscore an urgent need to organize better regional, national, and international collaboration in burn disaster response.

Use of Unannounced “Mystery Patient Drills” to Assess Hospital Emergency Department Preparedness for Communicable Diseases of Public Health Concern in New York City, 2016

Background Recent infectious disease epidemics have highlighted the importance of rapid recognition and isolation of patients with severe infectious diseases. In response, the New York City Department of Health and Mental Hygiene carried out a series of unannounced “Mystery Patient Drills” to assess Emergency Departments (ED) ability to identify and safely respond to patients with communicable diseases of public health concern.Methods All 911-receiving hospitals participating in the NYC Hospital Preparedness Program were recruited to participate. Scenarios utilized an actor presenting to an ED describing symptoms and history consistent with measles or MERS-CoV. An exercise evaluation guide captured performance measures to analyze 1) compliance with key infection control measures; 2) association between screening interventions (e.g., travel history) and implementation of infection control measures; 3) times from patient entry to triage, donning a mask, and placement into isolation. Post-drill report narratives were reviewed to identify additional strengths and challenges.ResultsAmong 50 eligible hospitals, 49 participated in 2 drills (N = 98) during December 2015–May 2016. Three pilot drills were excluded from the analysis. The patient was masked and isolated in 78% of drills; 61% of hospitals completed this process in both drills. Masking and isolation was observed in a higher proportion of drills when travel history was obtained, compared with drills when travel history was not obtained (88% vs. 21%; P < 0.0001). The median time from patient entry to masking was 1 minute and 9 minutes to placement into isolation. Overall, 36% of staff practiced hand hygiene and 77% entered the isolation room wearing Personal Protective Equipment. Identified best practices include the use of triage questionnaires to identify high-risk patients and algorithms to guide masking and isolation procedures.Conclusion ED staff’s ability to identify potentially infectious patients and implement recommended control measures varied. Drill findings were used to inform hospital improvement planning and will guide citywide efforts to improve healthcare system readiness for communicable diseases through addressing identified gaps and supporting implementation of best practice recommendations.Disclosures All authors: No reported disclosures.

Contributions of Health Care Coalitions to Preparedness and Resilience: Perspectives From Hospital Preparedness Program and Health Care Preparedness Coalitions.

The purpose of this article was to describe how the Hospital Preparedness Program (HPP) and other health care coalitions conceptualize and measure progress or success and to identify strategies to improve coalition success and address known barriers to success. We conducted a structured literature review and interviews with key leaders from 22 HPPs and other coalitions. Interview transcripts were analyzed by using constant comparative analysis. Five dimensions of coalition success were identified: strong member participation, diversity of members, positive changes in members' capacity to respond to or recover from disaster, sharing of resources among members, and being perceived as a trendsetter. Common barriers to success were also identified (eg, a lack of funding and staff). To address these barriers, coalitions suggested a range of mitigation strategies (eg, establishing formal memoranda of agreement). Both dimensions of and barriers to coalition success varied by coalition type. Currently, the term health care coalition is a one-size-fits-all term. In reality, this umbrella term describes a variety of different configurations, member bodies, and capabilities. The analysis offered a typology to categorize health care coalitions by primary function during a disaster response. Developing a common typology that could be used to specify capabilities or functions of coalitions may be helpful to advancing their development.

Identifying Indirect Benefits of Federal Health Care Emergency Preparedness Grant Funding to Coalitions: A Content Analysis.

This study aimed to identify the indirect benefits of health care preparedness funding as perceived by current and former recipients of the US Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response's Hospital Preparedness Program. This was a qualitative inductive content analysis of telephone interviews conducted with regional stakeholders from several health care coalitions to identify their perceptions of the indirect benefits of preparedness funding. Content analysis of interviewee responses resulted in 2 main categories of indirect benefits of federal health care preparedness funding: (1) dual-use technology and programs and (2) impact of relationships on day-to-day operations. Within the dual-use technology and programs category, 3 subcategories were identified: (1) information systems, (2) clinical technology, and (3) health care operations. Similarly, 3 subcategories relating to the indirect benefits in the impact of relationships on day-to-day operations category were identified: (1) cooperation, (2) information sharing, and (3) sense of community. This study identified indirect benefits of federal investment in hospital and health care preparedness in day-to-day operations. Major categories of these benefits included dual-use technology and programs and impact of relationships on day-to-day operations. Coalition members placed a high value on these benefits, even though they were not direct outcomes of grant programs. Further research is needed to quantify the economic value of these indirect benefits to more accurately measure the total return on investment from federal grant funding.

Optimizing Health Care Coalitions: Conceptual Frameworks and a Research Agenda.

The US health care system has maintained an objective of preparedness for natural or manmade catastrophic events as part of its larger charge to deliver health services for the American population. In 2002, support for hospital-based preparedness activities was bolstered by the creation of the National Bioterrorism Hospital Preparedness Program, now called the Hospital Preparedness Program, in the US Department of Health and Human Services. Since 2012, this program has promoted linking health care facilities into health care coalitions that build key preparedness and emergency response capabilities. Recognizing that well-functioning health care coalitions can have a positive impact on the health outcomes of the populations they serve, this article informs efforts to optimize health care coalition activity. We first review the landscape of health care coalitions in the United States. Then, using principles from supply chain management and high-reliability organization theory, we present 2 frameworks extending beyond the Office of the Assistant Secretary for Preparedness and Response's current guidance in a way that may help health care coalition leaders gain conceptual insight into how different enterprises achieve similar ends relevant to emergency response. We conclude with a proposed research agenda to advance understanding of how coalitions can contribute to the day-to-day functioning of health care systems and disaster preparedness.

The current state of bioterrorist attack surveillance and preparedness in the US.

The use of biological agents as weapons to disrupt established structures, such as governments and especially larger urban populations, has been prevalent throughout history. Following the anthrax letters sent to various government officials in the fall of 2001, the US has been investing in prevention, surveillance, and preparation for a potential bioterrorism attack. Additional funding authorized since 2002 has assisted the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the Environmental Protection Agency to invest in preventative research measures as well as preparedness programs, such as the Laboratory Response Network, Hospital Preparedness Program, and BioWatch. With both sentinel monitoring systems and epidemiological surveillance programs in place for metropolitan areas, the immediate threat of a large-scale bioterrorist attack may be limited. However, early detection is a crucial factor to initiate immediate response measures to prevent further spread following dissemination of a biological agent. Especially in rural areas, an interagency approach to train health care workers and raise awareness for the general public remain primary tasks, which is an ongoing challenge. Risk-management approaches in responding to dissemination of biological agents, as well as appropriate decontamination measures that reduce the probability of further contamination, have been provided, and suggest further investments in preparedness and surveillance. Ongoing efforts to improve preparedness and response to a bioterrorist attack are crucial to further reduce morbidity, mortality, and economic impact on public health.

Meeting children's needs: a mixed-methods approach to a regionalized pediatric surge plan-the Los Angeles County experience.

Children are one of the most vulnerable populations during mass casualty incidents because of their unique physiological, developmental, and psychological attributes. The objective of this project was to enhance Los Angeles County's (LAC) pediatric surge capabilities. The purpose of this study was threefold: (1) determine gaps in pediatric surge capacity and capabilities; (2) double pediatric inpatient capacity; and (3) document a plan to address gaps and meet pediatric inpatient surge. We hypothesized that LAC would be able to meet the identified pediatric surge target by leveraging resources of hospitals within the region. Deliverables included a pediatric surge plan for LAC, pediatric surge training resources, and pediatric supplies for hospitals participating in LAC's Hospital Preparedness Program (HPP). After Institutional Review Board approval, the authors used a mixed-methods approach to explore gaps in hospital capacity and capabilities in a large urban county. Hospitals were surveyed via Qualtrics® on 38 questions regarding capacity, staffing, availability of pediatric supplies, and existing pediatric surge plans. Publicly available inpatient bed data were collected from the Office of Statewide Health Planning and Development for the year ending June 2010 and supplemented by hospital survey responses. Population data was used from US Census 2010. This combined dataset was analyzed for capacity, pediatric designations, and capabilities. To supplement this data, three focus groups were conducted between April 2011 and May 2012. Focus group topics included: supplies and training needed for pediatric surge, surge targets, and plan development and functionality. Hospitals varied in pediatric capacity and capability. Forty-six percent of facilities provide inpatient pediatric services. Forty-one hospitals are designated as an Emergency Department Approved for Pediatrics. Identified gaps included: limited pediatric bed capacity, geographic variability, limited pediatric intensive care unit capacity, limited pediatric specialty physician resources, varying availability of pediatric trained staff, less availability of pediatric critical care supplies, and limited ability to accept and receive children. Focus group stakeholders requested advance and just-in-time training and reference guides to supplement the plan. LAC was able to create a pediatric surge plan that doubles pediatric acute and pediatric intensive care bed capacity by using participating HPP hospitals. A tiered system was created based on capacity and capability with varying surge targets and guidance on types of patients that could be cared for at each tier. This plan will assist the LAC Emergency Medical Services Agency distribute pediatric patients during a surge event that disproportionately impacts children.