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PubMed2005

Preparedness and response to terrorism: a framework for public health action.

UNLABELLED: Political group violence in the form of terrorist actions has become a reality worldwide, affecting the health and economies of populations. As a consequence, preparedness and response are becoming an integral part of public health action. Risk appraisal, preservation of human and civil rights and communications within and between countries are all issues to be considered in the process. The combination of the natural history of terrorist actions and the epidemiological triangle model has been adapted in this paper and suggested as a comprehensive approach for preparedness and action. It covers preparedness (pre-event), response (event) and the consequences (post-event) of a terrorist attack. It takes into account the human factor, vectors and environment involved in each one of the phases. KEY POINTS: Terrorism is a global reality with varying underlying causes, manifestations and impact on the health of the public. Preparedness, response and rehabilitation are an integral part of public health action. Consideration of the pre-event, event and post-event phases in terrorist actions, together with the human factor, vector/agent and environment in each of these phases, offers a framework for public health preparedness, response and rehabilitation. Planning should consider risk assessment, risk communication, inter-sectorial cooperation, enactment of laws and regulations which consider protection of the public's health and civil liberties. Allocation of resources would need to make allowance for maintenance and development of ongoing public health activities.

Civil Rights↗

PubMed2005

Assessing bioterrorism and disaster preparedness training needs for school nurses.

Meeting the complex needs of a school system and all its members in the event of a bioterrorism (BT) disaster demands a competent workforce. School nurses are in position to be key contributors to planning for and responding to potential BT and disaster events. As part of a state preparedness leadership institute, the BT and disaster preparedness needs of school nurses in a three-county area were assessed and the nurses' preferred method to meet those needs was determined. Using competencies derived from publications by the Centers for Disease Control and Prevention and National Association of School Nurses, a survey was created and mailed to school nurses (N = 125) in public and private k-12 schools. Eighty surveys were returned (64% response rate). Responses were analyzed according to BT and emergency preparedness competencies and skills required for the phases of emergency management: mitigation, preparedness, response, and recovery. Low confidence in preparedness capabilities across almost all categories was reported. High training need was identified across almost all competencies, with 63 percent to 70 percent requesting additional education related to emergency response, infectious disease, hazardous materials, and diagnostic criteria. Although two-thirds report having Internet access in their school office, traditional classroom instruction was overwhelmingly preferred (74%) for training.

Attitude of Health Personnel↗

PubMed2005

Train-the-trainer as an educational model in public health preparedness.

Train-the-trainer (TTT) is a widely acknowledged educational model across a number of disciplines, including public health preparedness. However, many questions arise about its proper use, its efficacy, and its optimal role in preparedness education. After careful consideration of the literature and past anecdotal experiences with this educational model, TTT was selected as the preferred and sustainable method for public health preparedness in Maine. Upon completion of Year 1 of the Maine TTT program, our evaluation results revealed that TTT was successful and well received by participants. It is evident that TTT is potentially a valuable tool in public health preparedness, but it should be noted that there is no clear prescription for implementing TTT. Institutions and communities adopting TTT as an educational model must be flexible and willing to revise the training plan as challenges are encountered. Future research is required to help clarify optimal ways of using TTT to promote public health preparedness in the 21st century.

Disaster Planning↗

PubMed2005

Perceived preparedness to provide preventive counseling: reports of graduating primary care residents at academic health centers.

OBJECTIVE: To assess the perceived preparedness of residents in adult primary care specialties to counsel patients about preventive care and psychosocial issues. DESIGN: Cross-sectional national mail survey of residents (63% response rate). PARTICIPANTS: Nine hundred twenty-eight final-year primary care residents in Internal Medicine (IM), family practice (FP), and Obstetrics/Gynecology (OB/GYN) at 162 U.S. academic health centers. MEASUREMENTS: Residents self-rated preparedness to counsel patients about smoking, diet and exercise, substance abuse, domestic violence, and depression. RESULTS: Residents felt better prepared to counsel about smoking (62%) and diet and exercise (53%) than about depression (37%), substance abuse (36%), or domestic violence (21%). In most areas, females felt better prepared than males. Rates of counseling preparedness varied significantly by specialty after adjustment for gender, race, medical school location, and percent of training spent in ambulatory settings. FP residents felt better prepared than OB/GYN residents to counsel about smoking, diet and exercise, and depression, while OB/GYN residents felt better prepared to address domestic violence than IM or FP residents. IM residents' perceptions of preparedness were between the other 2 specialties. Proportion of training spent in ambulatory settings was not associated with residents' perceived preparedness. CONCLUSIONS: Physicians completing residencies in adult primary care did not feel very well prepared to counsel patients about preventive and psychosocial issues. Significant differences exist among specialties, even after adjusting for differences in time spent in ambulatory settings. Increasing residency time in ambulatory settings may not alone be sufficient to ensure that residents emerge with adequate counseling skills.

Academic Medical Centers↗

PubMedDate not supplied

Variables that may enhance medical students' perceived preparedness for computer-based testing.

OBJECTIVE: To identify variables that may enhance medical student's preparedness for computer-based administration of the United States Medical Licensing Examination (USMLE). DESIGN: A cross-sectional survey of 301 medical students who completed a self-administered questionnaire. MEASUREMENTS: The questionnaire was designed to obtain information about students' computer resources, personal experience with computers, computer expertise, opinions about computers, experience with computer-based testing, perceived preparedness for the computer-based USMLE, and demographic variables. Variables related to students' perceived preparedness for the computer-based USMLE were identified by ordinal logistic regression. RESULTS: A significant regression model yielded four significant predictors: perceived preparedness for USMLE content (P: < 0.0001), opinions about computers (P: < 0.0012), gender (P: < 0.0001), and a gender by computer-based testing experience interaction (P: < 0. 0004). Computer resources, personal experience with computers, computer expertise, age, race, and year of medical school were not significant predictors. CONCLUSION: Students' perceived preparedness for computer-based administration of high-stakes examinations may be facilitated by preparing them for examination content, by enhancing their opinions about computers, and by increasing their computer-based testing experiences.

Attitude to Computers↗

PubMed2007

Assessing public health emergency preparedness: concepts, tools, and challenges.

Policymakers are increasingly seeking to determine whether the federal government's recent investments in public health preparedness have left the public health system better prepared to respond to large-scale public health emergencies. Yet, there remain questions about how to define "public health emergency preparedness," how much preparedness is enough, and how preparedness can be measured and assessed. This chapter identifies the key challenges associated with measuring public health preparedness and reviews approaches currently in use. We also identify some emerging measurement techniques that might help address some of these challenges.

Disaster Planning↗

PubMed2006

Public health preparedness in Alberta: a systems-level study.

BACKGROUND: Recent international and national events have brought critical attention to the Canadian public health system and how prepared the system is to respond to various types of contemporary public health threats. This article describes the study design and methods being used to conduct a systems-level analysis of public health preparedness in the province of Alberta, Canada. The project is being funded under the Health Research Fund, Alberta Heritage Foundation for Medical Research. METHODS/DESIGN: We use an embedded, multiple-case study design, integrating qualitative and quantitative methods to measure empirically the degree of inter-organizational coordination existing among public health agencies in Alberta, Canada. We situate our measures of inter-organizational network ties within a systems-level framework to assess the relative influence of inter-organizational ties, individual organizational attributes, and institutional environmental features on public health preparedness. The relative contribution of each component is examined for two potential public health threats: pandemic influenza and West Nile virus. DISCUSSION: The organizational dimensions of public health preparedness depend on a complex mix of individual organizational characteristics, inter-agency relationships, and institutional environmental factors. Our study is designed to discriminate among these different system components and assess the independent influence of each on the other, as well as the overall level of public health preparedness in Alberta. While all agree that competent organizations and functioning networks are important components of public health preparedness, this study is one of the first to use formal network analysis to study the role of inter-agency networks in the development of prepared public health systems.

Alberta↗

PubMed2006

Physicians' preparedness for bioterrorism and other public health priorities.

OBJECTIVES: Potential bioterrorism challenges policy makers to balance competing public health priorities. Earlier surveys showed low physician bioterrorism preparedness but did not assess physicians' general public health preparedness, compare the preparedness of emergency and primary care physicians, or assess temporal trends. METHODS: This was a national, cross-sectional, random-sample survey conducted in 2003. RESULTS: Overall, 744 of 1,200 eligible physicians responded (response rate, 62%). Of these, 58% of emergency physician respondents and 48% of primary care physician respondents reported having learned a lot about responding to bioterror since September 11, 2001 (p < 0.01). However, only 43% of emergency physicians and 21% of primary care physicians agreed they are generally "well prepared to play a role in responding to a bioterror attack" (p < 0.001). Beliefs about balancing public health priorities were similar among emergency and primary care respondents. Seventy-eight percent of respondents believed that local health care systems need to be prepared for bioterrorism, and 92% believed that local health care systems need to be prepared for natural epidemics. By contrast, only 23% and 46% of respondents reported that their local health care systems are well prepared for bioterrorism and natural epidemics, respectively. Meanwhile, 77% agreed that "influenza is a greater threat to public health than bioterrorism," and 21% reported that bioterrorism preparedness efforts are diverting resources from more important public health problems. CONCLUSIONS: In 2003, most emergency and primary care physicians reported that they and their local health care systems were not yet well prepared to respond to a bioterror attack, and many believed that more resources should go toward preparing for natural epidemics. These findings highlight the importance of expanding bioterrorism preparedness efforts to improve the public health system more broadly.

Attitude of Health Personnel↗

PubMed2005

The Public Health Information Network (PHIN) Preparedness initiative.

The Public Health Information Network (PHIN) Preparedness initiative strives to implement, on an accelerated pace, a consistent national network of information systems that will support public health in being prepared for public health emergencies. Using the principles and practices of the broader PHIN initiative, PHIN Preparedness concentrates in the short term on ensuring that all public health jurisdictions have, or have access to, systems to accomplish known preparedness functions. The PHIN Preparedness initiative defines functional requirements, technical standards and specifications, and a process to achieve consistency and interconnectedness of preparedness systems across public health.

Bioterrorism↗

PubMed1997

The World Health Organization Network for Radiation Emergency Medical Preparedness and Assistance (REMPAN).

The World Health Organization (WHO) has established a system of collaborating centers known as the Radiation Emergency Medical Preparedness and Assistance Network (REMPAN) to promote radiation emergency medical preparedness, assistance, and advice to countries in cases of overexposure of populations from any source of radiation. This network consists of 13 specialized institutions located in 10 countries. Within the REMPAN there are three separate but linked activities. The first is aimed at strengthening radiation emergency medical preparedness and assistance to treat and monitor acutely exposed individuals. The second activity is directed toward improving public health advice to mitigate long-term effects of exposure to low and protracted doses that might accrue in populations living in the affected territories. This involves giving advice on protecting public health, e.g., iodine prophylaxis, psychosocial risks associated with countermeasures, and public information strategies. In addition, the REMPAN develops activities aimed at improving long-term follow-up studies and preparedness for epidemiologic investigations in territories contaminated by radionuclides from a nuclear accident. The WHO's response in a radiation emergency depends on the type of accident and its time phase. This includes a wide range of actions from studying the situation to providing medical and public health assistance through the network of collaborating centers and relevant institutions within the REMPAN. The process of creating a reliable international system for radiation emergency medical preparedness and assistance has not yet been completed. Deficiencies in this system are outlined in this paper to attract the attention of specialists in the field of radiation protection and potential donors of the WHO program.

Disaster Planning↗

PubMed2006

The pediatrician and disaster preparedness.

Recent natural disasters and events of terrorism and war have heightened society's recognition of the need for emergency preparedness. In addition to the unique pediatric issues involved in general emergency preparedness, several additional issues related to terrorism preparedness must be considered, including the unique vulnerabilities of children to various agents as well as the limited availability of age- and weight-appropriate antidotes and treatments. Although children may respond more rapidly to therapeutic intervention, they are at the same time more susceptible to various agents and conditions and more likely to deteriorate if not monitored carefully. The challenge of dealing with the threat of terrorism, natural disasters, and public health emergencies in the United States is daunting not only for disaster planners but also for our medical system and health professionals of all types, including pediatricians. As part of the network of health responders, pediatricians need to be able to answer concerns of patients and families, recognize signs of possible exposure to a weapon of terror, understand first-line response to such attacks, and sufficiently participate in disaster planning to ensure that the unique needs of children are addressed satisfactorily in the overall process. Pediatricians play a central role in disaster and terrorism preparedness with families, children, and their communities. This applies not only to the general pediatrician but also to the pediatric medical subspecialist and pediatric surgical specialist. Families view pediatricians as their expert resource, and most of them expect the pediatrician to be knowledgeable in areas of concern. Providing expert guidance entails educating families in anticipation of events and responding to questions during and after actual events. It is essential that pediatricians educate themselves regarding these issues of emergency preparedness. For pediatricians, some information is currently available on virtually all of these issues in recently produced printed materials, at special conferences, in broadcasts of various types, and on the Internet. However, selecting appropriate, accurate sources of information and determining how much information is sufficient remain difficult challenges. Similarly, guidance is needed with respect to developing relevant curricula for medical students and postdoctoral clinical trainees.

Child↗

PubMed2005

Improvement in local public health preparedness and response capacity--Kansas, 2002-2003.

After the terrorist attacks of September 11, 2001, increased funding was provided to federal, state, and local health departments to improve their capacities for terrorism preparedness and emergency response. To evaluate the effect of this funding and to identify priority program areas in Kansas, the Kansas Association of Local Health Departments (KALHD) contracted with the Kansas Health Institute (KHI) to perform an independent assessment of local health department (LHD) preparedness capacity using a CDC assessment tool. This report summarizes the results of two surveys of LHDs and changes in preparedness capacity from 2002 to 2003. The findings indicated a substantial increase in local preparedness capacity, although increases among counties varied widely. Repeated assessments of preparedness using standardized tools can provide useful information to help guide federal, state, and local public health policies and investments.

Disaster Planning↗

PubMed2002

Preparedness of internal medicine and family practice residents for treating common conditions.

CONTEXT: Although both internal medicine (IM) and family practice (FP) physicians frequently provide care for the same common adult conditions, IM and FP residency programs differ in their training emphases. OBJECTIVE: To assess differences in IM and FP residents' self-perceived preparedness to diagnose and treat common adult medical conditions. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of a national survey administered in the spring of 1998 to residents in their final year of residency at US academic health centers. A total of 279 IM residents in 25 programs and 326 FP residents in 75 programs responded to the survey. MAIN OUTCOME MEASURES: Residents' self-rated preparedness to diagnose and treat 4 inpatient conditions (acute myocardial infarction, diabetic ketoacidosis, acute asthma, and acute renal failure) and 8 outpatient conditions (diabetes, hypertension, low back pain, vaginitis, headache, depression, upper respiratory tract infection, and hyperlipidemia), controlling for resident sex, race/ethnicity, US medical school graduate status, intent to subspecialize, and estimates of exposure to patients in inpatient and outpatient settings. RESULTS: Internal medicine residents were more likely to report being very prepared for all 4 inpatient conditions (P< or =.001), while FP residents were more likely to report being very prepared for 5 of 8 outpatient conditions (P< or =.05). Differences between IM and FP residents persisted in multivariate analyses for all inpatient conditions and some outpatient conditions. Exposure to patients in inpatient and outpatient settings varied by specialty and was significantly associated with resident self-report of preparedness for a majority of conditions investigated. CONCLUSIONS: Internal medicine and FP residents report differences in preparedness to manage common adult conditions. These differences were consistent with the emphasis on an inpatient setting for IM residents and on office-based care for FP residents.

Adult↗

PubMed1989

Preparedness and electrodermal fear-conditioning: ontogenetic vs phylogenetic explanations.

In a review of existing theories of learning, Seligman (Psychol. Rev. 77, 406-418, 1970) suggested that humans should have an evolutionary derived preparedness to associate fear-relevant (e.g. snakes) events with aversive reinforcers. The preparedness hypothesis has been extensively tested by Ohman and his colleagues. One argument against a non-preparedness explanation for the Ohman findings has been that culturally aversive stimuli, like pictures of guns have not shown the same resistance towards extinction as pictures of snakes. However, the effect of pointing a gun directly towards the S vs pointing it to the side has not been tested. Therefore both slides of guns and snakes, directed both towards and aside from the subject, were used as conditioned stimuli (CSs) in the present study. A second question that has been discussed in the preparedness-literature is the quality of the unconditioned stimulus (UCS), i.e. if only shock can act as UCS for prepared CSs. Thus, both shock and noise UCSs were used in the present study. Skin conductance responses (SCRs) were recorded as dependent measures. The results showed conditioned acquisition, i.e. larger SCRs to CS+ than to CS-, in all groups except for the shock and noise UCS groups with the gun pointing aside as CS+ (where actually larger responses were observed to the CS-, i.e. the gun pointing towards). The extinction data showed significantly larger SCRs to CS+ than to CS- for both snakes and guns directed towards the S. Strongest resistance to extinction was observed for the group with the gun pointed towards as CS+ and with noise as UCS. The gun with noise as UCS pointed towards the S was not different from the snake with shock as UCS. Taken together, the results have shown three things; (a) directing a fear-relevant CS towards the S was a potent manipulation, and especially directing a gun with noise as UCS; (b) shock was overall not superior to noise as UCS, and especially not for snake CSs; (c) a weak form of unique belongingness was demonstrated.

Adult↗

PubMed2006

Differences in individual-level terrorism preparedness in Los Angeles County.

BACKGROUND: Increasing individual preparedness for disasters, including large-scale terrorist attacks, is a significant concern of public health planners. As with natural disasters, individuals can help protect their health and safety by preparing for the emergency situation that may follow a terrorist event. Our study describes variations in preparedness among the population of Los Angeles County after the September 11, 2001 and subsequent anthrax attacks. METHODS: In 2004, the data were analyzed from the Los Angeles County Health Survey, a random-digit-dialed telephone survey of the non-institutionalized population in Los Angeles County fielded October 2002 through February 2003. RESULTS: Overall, 28.0% of respondents had emergency supplies, and 17.1% developed an emergency plan in the past year in response to the possibility of terrorism. Factors associated with having emergency supplies included African American (adjusted odds ratio [AOR] 1.8, 95% confidence interval [CI]=1.1-3.1) and Latino (AOR=1.5, 95% CI=1.0-2.4) race/ethnicity; having a household dependent aged<or=18 years (AOR=1.4, 95% CI=1.0-2.0); being born outside the United States (AOR=1.9, 95% CI=1.3-2.9); some college or trade school education (AOR=1.9, 95% CI=1.3-2.9); and higher perceived likelihood of a bioterrorist attack (AOR=2.2, 95% CI=1.6-3.0). Factors associated with having an emergency plan included African American (AOR=2.6, 95% CI=1.5-4.6) race/ethnicity; having a household dependent aged<or=18 years (AOR=2.4, 95% CI=1.6-3.5); and physical disability (AOR=1.7, 95% CI=1.1-2.7). CONCLUSIONS: Some groups were more likely to adopt some, but not all, recommended preparedness activities. Identifying subpopulation differences in preparedness is important since different public health messages, programs, and distribution channels are required for different subgroups.

Adult↗

PubMed2005

Emergency preparedness: concept development for nursing practice.

Emergency preparedness is a concept frequently referred to within medical and psychological literature and in local, state, and federal documents, yet it is not well defined. There is no published theoretical or operational definition of the term, and no conceptual analysis of the phenomena of emergency preparedness exists within the literature.Because nursing is the single largest health professional resource for response, work toward further refinement of the concept of emergency preparedness has relevance for nursing practice. This article examines and attempts to clarify the concept of emergency preparedness,especially as it applies to nursing.

Disaster Planning↗

PubMedDate not supplied

Better prepared but spread too thin: the impact of emergency preparedness funding on local public health.

Local public health authorities (LPHAs) are recognized as playing critical roles in response to biological, chemical, and other health emergencies. An influx of emergency preparedness funding has created new and expanding responsibilities for LPHAs. Concern that funding for emergency response is diverting attention and resources away from other core public health responsibilities is increasing. In order to determine the impact of emergency preparedness funding on public health infrastructure, qualitative interviews with 27 LPHAs in the metro-Boston area were conducted as part of an on-going evaluation of preparedness planning in Massachusetts. Feedback on the benefits and challenges of recent emergency preparedness planning mandates was obtained. Benefits include opportunities to develop relationships within and across public health departments and increases in communication between local and state authorities. Challenges include budget constraints, staffing shortages, and competing public responsibilities. Policy recommendations for improving planning for emergency response at the local level are provided.

Bioterrorism↗

PubMedDate not supplied

What a disaster?! Assessing utility of simulated disaster exercise and educational process for improving hospital preparedness.

INTRODUCTION: Recent events have brought disaster medicine into the public focus. Both the government and communities expect hospitals to be prepared to cope with all types of emergencies. Disaster simulations are the traditional method of testing hospital disaster plans, but a recent, comprehensive, literature review failed to find any substantial scientific data proving the benefit of these resource- and time-consuming exercises. OBJECTIVES: The objective of this study was to test the hypothesis that an audiovisual presentation of the hospital disaster plans followed by a simulated disaster exercise and debriefing improved staff knowledge, confidence, and hospital preparedness for disasters. METHODS: A survey of 50 members of the medical, nursing, and administrative staff were chosen from a pool of approximately 170 people likely to be in a position of responsibility in the event of a disaster. The pre-intervention survey tested factual knowledge as well as perceptions about individual and departmental preparedness. Post-intervention, the same 50 staff members were asked to repeat the survey, which included additional questions establishing their involvement in the exercise. RESULTS: There were 50 pre-intervention tests and 42 post-intervention tests. The intervention resulted in a significant improvement in test pass rate: pre-intervention pass rate 9/50 (18%, 95% confidence interval ((CI) = 16.1-19.9%) versus post-intervention pass rate 21/42 (50%, 95% CI = 42.4-57.6%; chi-square test, p = 0.002). Emergency department (ED) staff had a stronger baseline knowledge than non-ED staff: ED pre-test mean value for scores = 12.1 versus non-ED scores of 6.2 (difference 5.9, 95% CI = 3.3-8.4); t-test, p <0.001. Those that attended > or = 1 component had a greater increase in mean scores: increase in mean attendees was 5.6, versus the scores of non-attendees of 2.7 (difference 2.9, 95% CI = 1.0-4.9); t-test, p = 0.004. There was no significant increase in the general perception of preparedness. However, the majority of those surveyed described the exercise of benefit to themselves (53.7%, 95% CI = 45.5-61.8%) and their department (63.2%, 95% CI = 53.5-72.8%). CONCLUSIONS: The disaster exercise and educational process had the greatest benefit for individuals and departments involved directly. The intervention also prompted enterprise-wide review, and an upgrade of disaster plans at departmental levels. Pre-intervention knowledge scores were poor. Post-intervention knowledge base remained suboptimal, despite a statistically significant improvement. This study supports the widely held belief that disaster simulation is a worthwhile exercise, but more must be done. More time and resources must be dedicated to the increasingly important field of hospital disaster preparedness.

Audiovisual Aids↗