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PubMed2001

Sideline preparedness for the team physician: consensus statement.

The objective of the Sideline Preparedness Statement is to provide physicians who are responsible for making decisions regarding the medical care of athletes with guidelines for identifying and planning for medical care and services at the site of practice or competition. It is not intended as a standard of care and should not be interpreted as such. The Sideline Preparedness Statement is only a guide, and as such, is of a general nature, consistent with the reasonable, objective practice of the health care professional. Individual treatment will turn on the specific facts and circumstances presented to the physician at the event. Adequate insurance should be in place to help protect the physician, the athlete, and the sponsoring organization. The Sideline Preparedness Statement was developed by a collaboration of six major professional associations concerned about clinical sports medicine issues; they have committed to forming an ongoing project-based alliance to bring together sports medicine organizations to best serve active people and athletes. The organizations are: American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine.

Athletic Injuries↗

PubMedDate not supplied

Developing the academic institution's role in response to bioterrorism: the Iowa Center for Public Health Preparedness.

The terrorist acts during the fall of 2001 triggered renewed concern about the capacity of the nation's public health system to deal with crisis. A critical element of the response ability of the public health system is a prepared workforce. Based on a pre-existing concern about emerging infectious disease, the Centers for Disease Control (CDC), working with the Association of Schools of Public Health, had established a network of university-based Centers for Public Health Preparedness. The events of September 11 accelerated, expanded, and focused this effort. This article discusses this national program, details the activities of the based Center for Public Health Preparedness located at the University of Iowa, and suggests preparedness issues deserving future development.

Bioterrorism↗

PubMedDate not supplied

Building academic-practice partnerships: the Center for Public Health Preparedness at the Columbia University Mailman School of Public Health, before and after 9/11.

The Center for Public Health Preparedness at the Columbia University Mailman School of Public Health is part of a national network of academic centers established by the Centers for Disease Control and Prevention to strengthen links between public health practice and academe, especially for public health workforce development. Since its inception in Fall 2000, the Center has been working in partnership with the New York City Department of Health & Mental Hygiene (DOHMH) on planning and competency-based training in emergency preparedness (including bioterrorism and infectious diseases) and evaluation. Initial programs with DOHMH included development of a 3-hour orientation to basic emergency preparedness for their workforce. In the wake of 9/11 and the anthrax events, Center members gave over two dozen presentations at community forums, seminars, and clinical rounds, and over 100 press interviews, provided lay language information through community forum presentations and the School's Web site, and developed a database of volunteers for surge capacity. Subsequent programs include bioterrorism response training for clinicians and emergency medical services personnel, incident command for public health, and a study of evacuation from the World Trade Center on 9/11.

Bioterrorism↗

PubMed2005

Emergency preparedness academy adds public health to readiness equation.

From November 2003 to May 2004, the University of South Carolina Center for Public Health Preparedness and the South Carolina Department of Health and Environmental Control co-sponsored a 6-month-long Academy for Public Health Emergency Preparedness. Six-member teams made up of public health staff and community partner representatives (N = 78) attended from their respective health districts. The Academy consisted of three 6-day training sessions designed to prepare the teams to complete a team-based covert biological bioterrorism tabletop exercise. Program evaluation results revealed increases in (1) public health emergency preparedness core competencies; (2) capacity to plan, implement, and evaluate a tabletop exercise; and (3) successful collaboration and partnership formation between participating Public Health District teams and their local partner agencies. Lessons learned are also described.

Academic Medical Centers↗

PubMed2005

User patterns and satisfaction with on-line trainings completed on the North Carolina Center for Public Health Preparedness Training Web Site.

Short online training modules have been developed by the North Carolina Center for Public Health Preparedness (NCCPHP) and provided to registered users for free on its Training Web Site. Use of these modules can improve the knowledge, skills, and awareness of public health professionals in topics related to public health preparedness. According to the results of a survey implemented in October 2004, the NCCPHP Training Web Site is effectively reaching its target audience of local and state public health workers. The utilization of distance learning technology allows for broad distribution of training materials, with registered users in all 50 US states and 122 foreign countries. In addition, the NCCPHP Training Web Site is providing training materials in topics most requested by the public health workforce. According to the findings of this survey, online training in public health preparedness and response is an efficient way to improve the knowledge and skills of our public health workforce to increase competency.

Consumer Behavior↗

PubMed2005

Competency-based preparedness training for public health practitioners.

The bioterrorism preparedness training needs of the public health workforce have been described in several studies, assessments, and surveys. To meet these needs, the North Carolina Center for Public Health Preparedness (NCCPHP) and the Public Health Leadership Program (PHLP) at the University of North Carolina School of Public Health developed a new distance learning course, Introduction to Public Health Preparedness for Disasters and Emergencies. After a review of assessment data to identify training needs, we conducted a literature review of methodology and concluded that a distance learning course would be the best approach. The course curriculum is based on the Bioterrorism and Emergency Readiness Competencies for All Public Health Workers. This paper describes the course development process and methods used to make this course an effective training tool.

Bioterrorism↗

PubMedDate not supplied

Fear of terrorism and preparedness in New York City 2 years after the attacks: implications for disaster planning and research.

OBJECTIVES: To help improve disaster planning and research, we studied psychosocial predictors of terrorism fear and preparedness among New York City residents after the World Trade Center disaster (WTCD). METHOD: We conducted a random cross-sectional survey of 1,681 adults interviewed 2 years after the WTCD. Participants were living in New York City at the time of the attack and exposed to ongoing terrorist threats. RESULTS: We found 44.9 percent (95% confidence interval [CI] = 41.9-47.9) of residents were concerned about future attacks and 16.9 percent (95% CI = 14.7-19.3) reported a fear level of "10" on a 10-point analog scale. Furthermore, 14.8 percent (95% CI = 12.8-17.0) reported they had made some plans for a future attack, a significant increase from the previous year. In addition, although 42.6 percent (95% CI = 39.6-45.7) indicated that they would likely wait for evacuation instructions following a chemical, biological, or nuclear attack, 34.4 percent (95% CI = 31.5-37.3) reported they would evacuate immediately against official advice. Predictors of high terrorism fear in a multivariate model included Hispanic ethnicity (odds ratio [OR] = 2.0, P = .006), lower education (OR = 4.4, P < .001, and OR = 3.7, P < .001, respectively, for nonhigh school and high school graduates, compared with college graduates), being exposed to stressful life events (OR = 1.6, P = .048), having current posttraumatic stress disorder (3.1, P < .001), having a fear of death (OR = 2.5, P = .002), and reporting a likelihood of fleeing an attack against advice (OR = 1.5, P = .034). The best predictors of preparedness in a multivariate model was being between 30 to 64 years old (30-44 years old, OR = 2.6, P = .001; 45-64 years old, OR = 1.8, P = .03, respectively, compared with 18-29 years old), having higher exposure to the WTCD (moderate exposure, OR = 1.7, P = .05; high exposure, OR = 2.4, P = .002; very high exposure, OR = 4.1, P < .001), respectively, compared with no little WTCD exposure), and having greater exposure to other lifetime traumatic events (high traumatic event exposure, OR = 2.1, P = .005, compared with no exposure). CONCLUSION: Our study suggests that among those exposed to ongoing terrorism threats, terrorism fear and preparedness were related to socioeconomic factors, mental health status, terrorism exposure levels, and exposure to stressful life events.

Adolescent↗

PubMed2001

Disaster mitigation and preparedness: the case of NGOs in the Philippines.

The Philippines is very vulnerable to natural disasters because of its natural setting, as well as its socio-economic, political and environmental context--especially its widespread poverty. The Philippines has a well-established institutional and legal framework for disaster management, including built-in mechanisms for participation of the people and NGOs in decision-making and programme implementation. The nature and extent of collaboration with government in disaster preparedness and mitigation issues varies greatly according to their roots, either in past confrontation and political struggles or traditional charity activities. The growing NGO involvement in disaster management has been influenced by this history. Some agencies work well with local government and there is an increasing trend for collaborative work in disaster mitigation and preparedness. Some NGOs, however, retain critical positions. These organisations tend to engage more in advocacy and legal support for communities facing increased risk because of development projects and environmental destruction. Entry points into disaster mitigation and preparedness vary as well. Development-oriented agencies are drawn into these issues when the community members with whom they work face disaster. Relief organisations, too, realise the need for community mobilisation, and are thus drawn towards development roles.

Community Participation↗

PubMed2003

Preparedness for emergency response: guidelines for the emergency planning process.

Especially since the terrorist attacks of 11 September 2001, governments worldwide have invested considerable resources in the writing of terrorism emergency response plans. Particularly in the United States, the federal government has created new homeland security organisations and urged state and local governments to draw up plans. This emphasis on the written plan tends to draw attention away from the process of planning itself and the original objective of achieving community emergency preparedness. This paper reviews the concepts of community preparedness and emergency planning, and their relationships with training, exercises and the written plan. A series of 10 planning process guidelines are presented that draw upon the preparedness literature for natural and technological disasters, and can be applied to any environmental threat.

Disaster Planning↗

PubMed2006

Preparedness for influenza pandemic in Hong Kong nursing units.

BACKGROUND: To present preparedness planning for an influenza pandemic for two nursing subunits: nursing services in hospitals and schools of nursing in universities. DISCUSSION: The preparedness plan is modeled on a modified Haddon matrix, a logical approach to identify measures appropriate for the pre-event, event, and postevent phases of an influenza pandemic. For the pre-event phase, the objective is to ensure preparedness for the potential pandemic outbreak through training, communication, surveillance, infection control, and vaccination. Once the pandemic outbreak is declared, the aim is to implement effective measures to ensure a rapid and appropriate response. For the postevent phase, the plan is focused on the restoration of core functions, vigilance for a second or possibly more waves of the pandemic, and psychosocial support to staff and students. CONCLUSION: Measures required to prepare for, respond to, and manage the consequences of influenza pandemic are identified. This planning indicates the need to balance a logical approach with contextual perspectives and the importance for nursing leaders to develop plans for subunits of larger entities.

Communication↗

PubMedDate not supplied

The Road Map to Preparedness: a competency-based approach to all-hazards emergency readiness training for the public health workforce.

Facing limited time and budgetary resources, state and local health departments need a practical, competency-based training approach to meet the all-hazards readiness requirements of their employees. The Road Map to Preparedness is a training tool designed to assist health departments in providing comprehensive, agency-tailored readiness instruction to their employees. This tool uses an incentive-based, game-like, experiential learning approach to meet the Centers for Disease Control and Prevention's nine core competencies for all public health workers while facilitating public health employees' understanding and acceptance of their emergency response roles. A corresponding evaluation tool, the Road Map to Preparedness Evaluation, yields metrically-driven assessments of public health employee readiness competencies. Since its pilot in 2003, the Road Map to Preparedness has met with enthusiastic response from participating health departments in the mid-Atlantic region. In addition to its public health impact, the Road Map offers future promise as a tool to assist organizational emergency response training in private sector and non-public health first-responder agency settings.

Competency-Based Education↗

PubMedDate not supplied

A review of instruments assessing public health preparedness.

OBJECTIVES: The purpose of this study was to review instruments that assess the level of preparedness of state and local public health departments to respond to health threats such as bioterrorism. METHODS: The authors examined 27 published population-based instruments for planning or evaluating preparedness that were mostly unavailable in the peer-reviewed literature. Using the Essential Public Health Services framework, the instruments were evaluated for (1) clarity of measurement parameters, (2) balance between structural and process measures, (3) evidence of effectiveness, and (4) specification of an accountable entity. RESULTS: There was a great deal of overlap but little consistency in what constitutes "preparedness" or how it should be measured. Most instruments relied excessively on subjective or structural measures, lacked scientific evidence for measures assessed, and failed to clearly define what entity was accountable for accomplishing the task or function. CONCLUSION: Strategies for improvement include measure standardization, better interagency communication, and investment in public health practice research to develop the underlying evidence base required for developing quality measures and assessments.

Bioterrorism↗

PubMed2005

Public health and terrorism preparedness: cross-border issues.

On December 15, 2003, the Centers for Public Health Preparedness at the University of Minnesota and the University of Iowa convened the "Public Health and Terrorism Preparedness: Cross-Border Issues Roundtable." The purpose of the roundtable was to gather public health professionals and government agency representatives at the state, provincial, and local levels to identify unmet cross-border emergency preparedness and response needs and develop strategies for addressing these needs. Representatives from six state and local public health departments and three provincial governments were invited to identify cross-border needs and issues using a nominal group process. The result of the roundtable was identification of the needs considered most important and most doable across all the focus groups. The need to collaborate on and exchange plans and protocols among agencies was identified as most important and most doable across all groups. Development of contact protocols and creation and maintenance of a contact database was also considered important and doable for a majority of groups. Other needs ranked important across the majority of groups included specific isolation and quarantine protocols for multi-state responses; a system for rapid and secure exchange of information; specific protocols for sharing human resources across borders, including emergency credentials for physicians and health care workers; and a specific protocol to coordinate Strategic National Stockpile mechanisms across border communities.

Bioterrorism↗

PubMed2006

Hospital disaster preparedness in Los Angeles County.

BACKGROUND: There are no standardized measures of hospital disaster preparedness or hospital "surge capacity." OBJECTIVES: To characterize disaster preparedness among a cohort of hospitals in Los Angeles County, focusing on practice variation, plan characteristics, and surge capacity. METHODS: This was a descriptive, cross-sectional survey study, followed by on-site verification. Forty-five 9-1-1 receiving hospitals in Los Angeles County, CA, participated. Evaluations of hospital disaster plan structure, vendor agreements, modes of communication, medical and surgical supplies, involvement of law enforcement, mutual aid agreements with other facilities, drills and training, surge capacity (assessed by monthly emergency department diversion status, available beds, ventilators, and isolation rooms), decontamination capability, and pharmaceutical stockpiles were assessed by survey. RESULTS: Forty-three of 45 hospital plans (96%) were based on the Hospital Emergency Incident Command System, and the majority had protocols for hospital lockdown (100%), canceling elective surgeries (93%), early discharge (98%), day care for children of staff (88%), designating victim overflow areas (96%), and predisaster "preferred" vendor agreements (96%). All had emergency medical services-compatible radios and more than three days' worth of supplies. Fewer hospitals involved law enforcement (56%) or had mutual aid agreements with other hospitals (20%) or long-term care facilities (7%). Although the vast majority (96%) conducted multiagency drills, only 16% actually involved other agencies in their disaster training. Only 13 of 45 hospitals (29%) had a surge capacity of greater than 20 beds. Less than half (42%) had ten or more isolation rooms, and 27 hospitals (60%) were on diversion greater than 20% of the time. Thirteen hospitals (29%) had immediate access to six or more ventilators. Less than half had warm-water decontamination (42%), while approximately one half (51%) had a chemical antidote stockpile and 42% had an antibiotic stockpile. CONCLUSIONS: Among hospitals in Los Angeles County, disaster preparedness and surge capacity appear to be limited by a failure to fully integrate interagency training and planning and a severely limited surge capacity, although there is a generally high level of availability of equipment and supplies.

Cross-Sectional Studies↗

PubMed2005

Agroterrorism workshop: engaging community preparedness.

INTRODUCTION: Agroterrorism is the deliberate tampering with and/or contamination of the food supply with the intent of adversely affecting the social, economic, physical, and psychological well-being of society. Testimony before the Government Affairs Committee of the U.S. Senate has suggested that agriculture is an area that has received comparatively little attention with regard to terrorism. METHODS: In February of 2004, the NIOSH Southwest Center for Agricultural Health, Injury Prevention, and Education developed a workshop on agroterrorism designed to engage local community leaders in a process to prepare for and respond to a terrorist event involving the food supply. The workshop was an effective collaboration between NIOSH Ag Centers, the state department of health (Texas), a school of public health, and the Texas Agricultural Research and Extension Centers in five urban and rural locations with substantial agricultural production. In order to reach a diverse and geographically widespread audience, the workshop was conducted by synchronous two-way interactive televideo (9 geographic sites). The audience of 155 participants was comprised of numerous stakeholders. The workshop format involved separate modules addressing food and fiber, livestock and poultry, food distribution, and emergency preparedness, with participants developing priorities for future consideration within their communities to address all phases of an event from preparedness to follow-up debriefing. There were 13 additional individuals (for a total of 168) who participated in the workshop subsequently through use of a video. RESULTS: Workshop evaluation components included pre- and post-workshop objective assessment of factual information presented (tests), and follow-up for implementation of priorities developed by conference participants. Statistically significant improvement was noted in knowledge acquisition. The six-month follow-up demonstrated implementation of preparedness planning priorities. CONCLUSIONS: This is an effective method of reaching a geographically widespread and diverse audience of community members who will be on the front lines of an agroterrorism event. An attempt was made to enhance communication and collaboration among involved groups for effectively detecting and addressing such an event. This workshop can serve as a model for use in other communities.

Animals↗

PubMed2006

Dentists' preparedness for responding to bioterrorism: A survey of Hawaii dentists.

BACKGROUND: The authors conducted a survey of dentists in Hawaii to assess their knowledge of, perceived readiness for and willingness to respond to bioterrorist (BT) events. METHODS: Using a cross-sectional study design to access a random sample (n = 240) of all licensed dentists residing in the state of Hawaii (N = 1,016), the authors mailed study participants an anonymous survey up to three times during June and July 2004. Knowledge-based questions were taken from accredited Internet-based free continuing medical education offerings. RESULTS: Of 234 deliverable surveys, 133 were returned (response rate of 56.8 percent). Only 2.3 percent of respondents reported having received prior BT preparedness training. A total of 14.5 percent felt able to identify and recognize a BT event, and 9.2 percent indicated they were able to respond effectively to a BT attack. A total of 73.8 percent expressed willingness to provide assistance to the state in the event of a BT attack. Dentists scored a mean of 62 percent correct (5.6 of nine questions) on the objective knowledge-based questions. CONCLUSIONS: A low prevalence of prior training coupled with a high degree of willingness to provide assistance indicates the need for additional BT preparedness training. This should be provided as continuing education offerings to practicing dentists and incorporated into the dental school curriculum. CLINICAL IMPLICATIONS: Dentists have the basic knowledge and experience to perform a number of key roles in a BT event; however, additional training must be provided to develop BT preparedness competencies.

Adult↗

PubMed2000

Pediatric office emergencies and emergency preparedness in a small rural state.

OBJECTIVE: Although the frequency of pediatric office medical emergencies has been investigated in a retrospective manner, there have been no prospective studies. We examined how often pediatricians in a small rural state encountered medical emergencies in the office setting. This study included an in-office educational program and the donation of resuscitation equipment to study participants. DESIGN AND INTERVENTION: Thirty-eight of the 40 active primary care pediatric practices in the state of Vermont participated in this study. Thirty-seven sites were surveyed retrospectively regarding office preparedness for emergencies and frequency of office emergencies. At each practice site, an educational session was provided and an office resuscitation kit was donated. Thirty-seven sites were followed prospectively for a 12-month period evaluating the incidence of office medical emergencies and the adequacy of the donated resuscitation kit. RESULTS: Three hundred twenty-seven individuals from 38 Vermont pediatric practice sites participated. Forty-nine percent had basic life support training and 26% had pediatric advanced life support training. Sixty-seven percent of practices had a plan for office medical emergencies. Forty-six percent of practices had called local emergency medical services providers to their offices in the past year. Emergency preparedness ranged from a high of 95% of sites with oxygen to a low of 27% of sites with intraosseous needles. The estimate of the frequency of medical emergencies was.9 (standard deviation =.8) per office in the previous 12 months. In the 12-month study, there were 28 medical emergencies reported, averaging.8 (standard deviation = 1.5) emergencies per office per year. Sixty-five percent of participating sites had no emergencies in the study. Of the emergencies reported, 75% were respiratory in origin. The donated resuscitation kits proved sufficient for all of the emergencies reported. CONCLUSIONS: Serious medical emergencies are rare events in the primary care pediatric office, occurring less than once per office per year. The most common emergency situations encountered are respiratory. All of the emergencies in this study were managed effectively using a simple and relatively inexpensive resuscitation kit. We provided an emergency preparedness program for pediatric practices in a small rural state.

Certification↗

PubMed2006

Mass-casualty events at schools: a national preparedness survey.

OBJECTIVE: Recent school shootings and terrorist events have demonstrated the need for well-coordinated planning for school-based mass-casualty events. The objective of this study was to document the preparedness of public schools in the United States for the prevention of and the response to a mass-casualty event. METHODS: A survey was mailed to 3670 school superintendents of public school districts that were chosen at random from a list of school districts from the National Center for Education Statistics of the US Department of Education in January 2004. A second mailing was sent to nonresponders in May 2004. Descriptive statistics were used for survey variables, and the chi2 test was used to compare urban versus rural preparedness. RESULTS: The response rate was 58.2% (2137 usable surveys returned). Most (86.3%) school superintendents reported having a response plan, but fewer (57.2%) have a plan for prevention. Most (95.6%) have an evacuation plan, but almost one third (30%) had never conducted a drill. Almost one quarter (22.1%) have no disaster plan provisions for children with special health care needs, and one quarter reported having no plans for postdisaster counseling. Almost half (42.8%) had never met with local ambulance officials to discuss emergency planning. Urban school districts were better prepared than rural districts on almost all measures in the survey. CONCLUSIONS: There are important deficiencies in school emergency/disaster planning. Rural districts are less well prepared than urban districts. Disaster/mass-casualty preparedness of schools should be improved through coordination of school officials and local medical and emergency officials.

Child↗