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Managing animal health emergencies through prevention and preparedness in Oceania.

Most countries in Oceania have adequate quarantine legislation, systems and staff to prevent the introduction of new animal diseases. Surveillance and preparedness for dealing with incursions of such diseases are less developed, except in those countries with larger livestock populations. The degree of preparedness for animal health emergencies in the different countries of the region reflects the relative economic importance of exotic diseases to each particular country. For those countries with significant populations of farm animals, appreciable efforts and money are expended. However, in the smaller island countries, it can be assumed that the likelihood of an exotic disease incursion is low and the impact on the economy would be comparatively small. For these reasons, it would be unreasonable to expect these countries to commit significant resources to develop programmes equivalent to those in New Zealand and Australia, for example. Nevertheless, there is a need for increased co-operation between countries in the region. An assessment of each country to determine what resources are available and how they may be used in various aspects of an animal disease emergency, including co-ordinated information sharing, would enable smaller island countries to be fully prepared in the case of an emergency.

Animal Diseases↗

International cooperation and preparedness in responding to accidental or deliberate biological disasters: lessons and future directions.

Preparations for international cooperation in response to disease disasters at the regional or continental levels are poorly coordinated and cooperation is limited, although intergovernmental and international organisations have been advocating for years that emergency responses to infectious disease outbreaks should be planned for and prepared at the national level. National governments are responsible for contingency planning to protect the public; however, this responsibility needs to be broadened to encompass regional and international approaches. Little public domain information is available on international coordinated responses to the deliberate introduction of biological pathogens. Terrorist events in the early 21st Century have increased awareness of the risks, but solid commitment and internationally resourced initiatives are still lacking. The current avian influenza disaster has largely been addressed by the three global agencies: Food and Agriculture Organization (FAO), World Organisation for Animal Health (OIE) and World Health Organization (WHO), using the underlying precepts that shape the Global Framework for the Progressive Control of Transboundary Animal Diseases (GF-TADs). The GF-TADs offers a substantial base to improve regional epidemiological and environmental information, diagnostic networking, trend analysis and intervention against the important epidemic animal diseases. International prevention, preparedness and response require multidisciplinary teams working in an environment of intergovernmental cooperation that encompasses numerous ministries and agencies. This paper focuses on known international aspects of collaboration on emergency preparedness and addresses the FAO/OIE initiative to strengthen veterinary and public health systems involved in controlling and preventing serious health threats.

Animal Welfare↗

Hospital preparedness for victims of chemical or biological terrorism.

OBJECTIVES: This study examined hospital preparedness for incidents involving chemical or biological weapons. METHODS: By using a questionnaire survey of 224 hospital emergency departments in 4 northwestern states, we examined administrative plans, training, physical resources, and representative medication inventories. RESULTS: Responses were received from 186 emergency departments (83%). Fewer than 20% of respondent hospitals had plans for biological or chemical weapons incidents. About half (45%) had an indoor or outdoor decontamination unit with isolated ventilation, shower, and water containment systems, but only 12% had 1 or more self-contained breathing apparatuses or supplied air-line respirators. Only 6% had the minimum recommended physical resources for a hypothetical sarin incident. Of the hospitals providing quantitative answers about medication inventories, 64% reported sufficient ciprofloxacin or doxycycline for 50 hypothetical anthrax victims, and only 29% reported sufficient atropine for 50 hypothetical sarin victims (none had enough pralidoxime). CONCLUSIONS: Hospital emergency departments generally are not prepared in an organized fashion to treat victims of chemical or biological terrorism. The planned federal efforts to improve domestic preparedness will require substantial additional resources at the local level to be truly effective.

Bioterrorism↗

A national assessment of the status of planning for public health preparedness for chemical and radiological contaminating terrorism: CSTE'S findings and recommendations/executive summary.

An association of epidemiologists looks at the state of regional public health preparedness in a time of terrorism in a report that gauges regional readiness. The report examined the status of preparations to deal with chemical and radiological events, and looked at planning gaps, resources, and interagency agreements to coordinate emergency response. The research found inadequate levels of preparedness, planning, and established interagency partnerships and puts forth recommendations to improve the nation's ability to respond.

Journal Article↗

Bioterrorism preparedness and response in European public health institutes.

The terrorist attacks on 11 September 2001 and the deliberate release of anthrax in the United States had consequences for public health not only there, but also in Europe. Europe's public health systems had to manage numerous postal materials possibly contaminated with anthrax. Our survey aimed to document the response of European public health institutes to recent bioterrorist events to identify the gaps that need to be addressed; 18 institutes from 16 countries participated in this Euroroundup. Bioterrorist threats in Europe were hoaxes only, and should be considered as a "preparedness exercise" from which three lessons can be drawn. Firstly, because of inadequate preparedness planning and funding arrangements, Europe was not ready in October 2001 to respond to bioterrorism. Secondly, although European institutes reacted quickly and adapted their priorities to a new type of threat, they need adequate and sustained support from national governments to maintain their overall capacity. Thirdly, the recent crisis demonstrated the need for increased investment in epidemiology training programmes and the establishment of a technical coordination unit for international surveillance and outbreak response in the European Union.

Bioterrorism↗

Preparedness to accept psychiatric referral.

A survey of 312 patients attending 13 Sydney general practices suggested that preparedness to accept psychiatric referral by a general practitioner related most clearly to preparedness to consult the general practitioner in the first instance and the perceived likelihood of the general practitioner suggesting a psychological problem, while the sociodemographic characteristics of the patient did not appear of relevance. Data on actual psychiatric referrals by the contributing general practitioners suggested a higher psychiatric referral by practices in lower social class regions of Sydney and a differential referral pattern, with referral to a community psychiatric facility being rare in other than low social class general practices.

Adult↗

Disaster preparedness: an indictment for action by nursing educators.

America is under constant threat of terrorist attack. The events of September 11, 2001, demonstrate the reality of the threat, as does the magnitude of the impact the attacks had on the healthcare systems of New York City and Washington, DC. Healthcare facilities and continuing education programs should incorporate training in nuclear, biological, and chemical disaster preparedness to provide the essential foundations for safe and effective health care. Advance training in disaster preparedness provides nurses with valuable training to fill the nationwide need for prepared first responders. American nurses have always responded selflessly to help in times of disaster and the country will be looking to nurses to respond to any future disasters.

Attitude of Health Personnel↗

Preparedness for hospital practice among graduates of a problem-based, graduate-entry medical program.

OBJECTIVE: To compare preparedness for hospital practice between graduates from a problem-based, graduate-entry medical program and those from other programs (undergraduate problem-based and traditional). DESIGN: Survey of graduates (by mailed questionnaire) and organisers of clinical training (by semistructured interview); results were compared with published results of surveys of graduates from other programs. SETTING AND PARTICIPANTS: All graduates of the first intake of the University of Sydney graduate-entry medical program were surveyed at the end of their first intern year (2001), along with the director of clinical training or intern manager at each of the New South Wales hospitals that employed the graduates. MAIN OUTCOME MEASURES: Graduates' self-reported level of preparedness in the eight domains of the Preparation for Hospital Practice Questionnaire; and organisers' opinions of their strengths and weaknesses. RESULTS: 76 of 108 graduates from the graduate-entry program (70%) and organisers of clinical training at all 17 hospitals participated. Graduates from the program felt more prepared than did those from other programs in five of the eight domains assessed (interpersonal skills, confidence, collaboration, holistic care, and self-directed learning) and no less prepared in any domain. Organisers rated the graduates highly, especially in clinical competence, confidence, communication and professional skills. Opinions of interns' knowledge of basic sciences conflicted, with strengths and weaknesses mentioned with equal frequency. CONCLUSION: Graduates from the graduate-entry, problem-based program are at least as well prepared for their intern year as graduates from traditional and undergraduate problem-based programs.

Adult↗

Integrating hospitals into community emergency preparedness planning.

BACKGROUND: Strong community linkages are essential to a health care organization's overall preparedness for emergencies. OBJECTIVE: To assess community emergency preparedness linkages among hospitals, public health officials, and first responders and to investigate the influence of community hazards, previous preparation for an event requiring national security oversight, and experience responding to actual disasters. DESIGN: With expert advice from an advisory panel, a mailed questionnaire was used to assess linkage issues related to training and drills, equipment, surveillance, laboratory testing, surge capacity, incident management, and communication. SETTING: A simple random sample of 1750 U.S. medical-surgical hospitals. PARTICIPANTS: Of 678 hospital representatives that agreed to participate, 575 (33%) completed the questionnaire in early 2004. Respondents were hospital personnel responsible for environmental safety, emergency management, infection control, administration, emergency services, and security. MEASUREMENTS: Prevalence and breadth of participation in community-wide planning; examination of 17 basic elements in a weighted analysis. RESULTS: In a weighted analysis, most hospitals (88.2% [95% CI, 84.1% to 92.3%]) engaged in community-wide drills and exercises, and most (82.2% [CI, 77.8% to 86.5%]) conducted a collaborative threat and vulnerability analysis with community responders. Of all respondents, 57.3% (CI, 52.1% to 62.5%) reported that their community plans addressed the hospital's need for additional supplies and equipment, and 73.0% (CI, 68.1% to 77.9%) reported that decontamination capacity needs were addressed. Fewer reported a direct link to the Health Alert Network (54.4% [CI, 49.3% to 59.5%]) and around-the-clock access to a live voice from a public health department (40.0% [CI, 35.0% to 45.0%]). Performance on many of 17 basic elements was better in large and urban hospitals and was associated with a high number of perceived hazards, previous national security event preparation, and experience in actual response. LIMITATIONS: Responses reflect hospitals' self-perception of linkages. The quality of linkages and the extent of possible biases favoring positive responses were not assessed. CONCLUSIONS: In this baseline assessment, most hospitals reported substantial integration. However, results suggest that relationships between hospitals, public health departments, and other critical response entities are not adequately robust. Suggestions for enhancing linkages are discussed.

Community Health Services↗

Disaster preparedness. Ready for earth, air, fire and water (and who knows what else)?

Already the 1990s might be described as a decade of disasters: From the devastation of hurricanes on the East Coast to the havoc of floods in the Midwest to the destruction of earthquakes and civil unrest on the West Coast, the past few years clearly show that disasters can strike anywhere--and at any time. For health facilities caught in the middle of these crises, emergency preparedness means much more than just meeting the basic requirements of the Joint Commission on Accreditation of Healthcare Organizations or complying with state and local regulations. Rather, for most health facilities, preparing for disasters is an integral part of ensuring that they can continue to provide adequate, high-quality patient care under almost any circumstances. This report, the first in a series of articles, examines how health facility managers coped once they found themselves in the midst of major disasters, what lessons they learned about emergency preparedness as a result of their experiences, and what others can learn from these difficult situations.

California↗

CDC recommendations for civilian communities near chemical weapons depots: guidelines for medical preparedness--CDC. Publication of final recommendations.

On July 27, 1994, CDC published in the Federal Register, 59 FR 38191, "CDC Recommendations for Civilian Communities Near Chemical Weapons Depots: Guidelines for Medical Preparedness" and requested public comment. Seven people sent comments; many were responding on behalf of governments or other institutions in affected communities. These comments are available upon request. These recommendations incorporate changes made in response to the comments received and constitutes CDC's final recommendations for minimum standards for prehospital and hospital emergency medical services' readiness in communities near the eight locations where the U.S. stockpile of lethal chemical weapons is stored. The eight locations are: Umatilla Army Depot Activity, Oregon; Tooele Army Depot, Utah; Pueblo Army Depot Activity, Colorado; Pine Bluff Arsenal, Arkansas; Newport Army Ammunition Plant, Indiana; Anniston Army Depot, Alabama; Lexington Bluegrass Depot Activity, Kentucky; and Edgewood Area, Aberdeen Proving Ground, Maryland. These recommendations were prepared to assist emergency planners in determining emergency medical services' readiness in communities near the 8 locations where the U.S. stockpile of lethal chemical weapons is stored. These guidelines should not be used for any purpose other than planning for the Chemical Stockpile Emergency Preparedness Program.

Centers for Disease Control and Prevention, U.S.↗

Survey of emergency preparedness of pediatric dentists from the Southeastern United States.

The fact that 91 percent of respondents to this survey said they could benefit from more emergency training indicates an awareness on the part of clinicians of the importance of emergency preparedness. The average number of hours of continuing education courses in emergency management over the last ten years of the responding dentists was less than six hours. This, coupled with the fact that one third of the responding dentists were not comfortable with their staff's emergency preparedness, should serve as a wake up call to all practicing pediatric dentists, to our institutions who train these dentists, and to the Associations who regulate and govern the practice of dentistry. More continuing education courses on this topic would be very timely and helpful to these respondents.

Education, Dental, Continuing↗

Non-institutional sources of assistance following a disaster: potential triage and treatment capabilities of neighborhood-based preparedness organizations.

The following paper presents an argument for enhancing and encouraging the development of neighborhood-based disaster preparedness organizations, particularly as a potential medical triage and treatment resource following a disaster. First, the research context for the utility of non-institutional sources of post-diaster assistance is outlined, followed by the more specific instance of medical triage and treatment. An emerging model of community disaster preparedness training is described, noting the modules that address disaster medicine. Positive contributions and limitations are addressed looking to disaster and non-disaster experiences. While the potential for non-traditional resources to aid immediate post-disaster response is becoming both more common and more accepted, there are a number of recommendations that would improve the usefulness and value, including: 1) integration with existing emergency care infrastructure; 2) standardization of training; 3) use of coordinated drills between public safety organizations, hospitals, and voluntary sectors; and 4) dedication of more funding to assist in the creation and maintenance of programs. Because of the relative infancy of these community-based programs, and the infrequency of large-scale disasters, there is little, if any, pre-post research that can demonstrate a measured impact on response. More pre-disaster baseline data-gathering efforts are needed, combined with post-disaster evaluative research to understand the utility of these non-traditional resources in terms of overall response, and in particular the ability to assist in areas of disaster medicine practice. One also expects that under these kinds of [disaster] conditions, family members, fellow employees, and neighbors will spontaneously try to help each other. This was the case following the Mexico City earthquake where untrained, spontaneous volunteers saved 800 people. However, 100 people lost their lives while attempting to save others. This is a high price to pay and is preventable through training.

Community Participation↗

[Recommendations for earthquake preparedness in Israel].

Earthquakes have occurred in the past in our region, along the Afro-Syrian fault line and along the eastern border of Israel. Several earthquakes had a magnitude between 6.25 and 6.5 on the Richter scale and caused severe damage to the populated areas in the Galilee, the Judean Hills and along the coastline. The last major earthquake occurred in 1927 in the Jordan Valley and caused more than 300 fatalities and extensive property damage. If we consider the present densely populated regions in the areas at risk, the occurrence of an earthquake with a magnitude of > 6.25 will constitute a major disaster, causing thousands of casualties and extensive property and economic damage. Israel is presently planning a comprehensive response to mitigate the damages by enforcing existing anti-seismic building codes, retrofitting of public buildings, including hospitals and utilizing all available manpower and material resources in case of such an event. The health sector is a vital part of the overall preparedness and response. Hospitals have to plan alternative sites for continued activity and increase the number of beds. Army medical teams will have to operate in the disaster area in conjunction and coordination with the Home Front Command rescue teams and the EMS. Public and primary health services will have to be reinforced to deal with acute and chronic health problems in the wake of the disaster. The burial of the dead and their identification will become a major logistic and emotional problem and must be planned in advance. Preparedness includes establishing contact with NGOs and agencies in countries, which may render medical assistance in such an event.

Disaster Planning↗

Emergency preparedness for hospitals. An overview.

Healthcare facilities have emergency preparedness plans (EPPs) in place to respond to both natural disasters, such as earthquakes and floods, and man-made disasters, such as terrorist acts and transportation accidents. During the terrorist attacks on September 11, 2001, hospitals implemented their EPPs and met the needs of injured people. Is your facility ready to handle large-scale disasters, including such events as terrorist attacks? If not, now's the time to review and update your EPP. This article provides an overview of the hospital's role in handling major disasters and a discussion of how to ensure that you have an effective EPP. It also includes a list of useful Web sites related to emergency preparedness.

Disaster Planning↗

Preparedness of the Israeli health system for a biologic warfare event.

The threat of a disease outbreak resulting from biologic warfare has been of concern for the Israeli health system for many years. In order to be prepared for such an event the health system has formulated doctrines for various biologic agents and defined the logistic elements for the procurement of drugs. During the last 4 years, and especially after the West Nile fever epidemic in 2000, efforts to prepare the healthcare system and the relevant organizations were accelerated. The Director-General of the Ministry of Health nominated a Supreme Steering Committee to fill in the gaps and upgrade the preparedness of the health system for an unusual disease outbreak. This committee and its seven subcommittees established appropriate guidelines, communication routes among different organizations, and training programs for medical personnel. The anthrax outbreak in the United States found the healthcare system in the hub of the preparation process, and all modes of action were intensified. Further work by hospitals, primary care clinics and all other institutes should be increased to maintain a state of proper preparedness.

Biological Warfare↗

Has bioterrorism preparedness improved public health?

In anticipation of future terrorist attacks, the nation has been focused on emergency preparedness, including threats to public health and the ability of communities to respond to them. The Center for Studying Health System Change's (HSC) recent site visits to 12 nationally representative communities found early benefits to public health due to heightened attention to bioterrorism preparedness: more visibility and credibility for public health, stronger public health infrastructure and improved communication and coordination across sectors. Modest negative effects included staff diversions and delays in some program implementation. As the site visits continued from fall 2002 into 2003, concerns grew that the federal smallpox vaccination program was diverting resources from such traditional public health activities as routine immunizations, health promotion and screening.

Bioterrorism↗

Terrorism preparedness in state health departments--United States, 2001-2003.

The anthrax attacks in fall 2001 highlighted the role of infectious disease (ID) epidemiologists in terrorism preparedness and response. Beginning in 2002, state health departments (SHDs) received approximately 1 billion dollars in new federal funding to prepare for and respond to terrorism, infectious disease outbreaks, and other public health threats and emergencies. This funding is being used in part to improve epidemiologic and surveillance capabilities. To determine how states have used a portion of their new funding to increase ID epidemiology capacity, the Iowa Department of Public Health's Center for Acute Disease Epidemiology and the Iowa State University Department of Microbiology conducted two surveys of U.S. state epidemiologists during September 2000-August 2001 and October 2002-June 2003. This report summarizes the results of these surveys, which determined that although the number of SHD epidemiology workers assigned to ID and terrorism preparedness increased by 132%, concerns remained regarding the ability of SHDs to hire qualified personnel. These findings underscore the need to develop additional and more diverse training venues for current and future ID epidemiologists.

Disaster Planning↗